Otolaryngology

Question 1

Describe the Weber test and what the results mean

Answer 1

Use a 512 Hz tuning fork and place on the bridge of forehead

Ask the paient where they hear the sound? Both sides or does it lateralize to one side?

Results
Lateralization to affected side = conductive loss
Lateralization to normal side = sensorineural loss

Question 2

Describe the Rinne test and what the results mean

Answer 2

Testing air vs bone conduction

Hold tuning fork to mastoid process and ask pt to tell you when they no longer hear the sound

Immediately move tuning fork near external auditory meatus and ask pt to tell you when they no longer hear the sound. Note how long pt hears sound through air conduction.

Results
A>B = normal
A>B for much shorter time = Sensorineural hearing loss
B>A = Condunction hearing loss

Question 3

Patient presents with recurrent vertigo, lower range hearing loss, tinnitus, and one-sided aural pressure. What do you suspect?

Answer 3

Ménière disease

Question 4

A dx of Meniere disease requires what?

Answer 4

2 episodes of vertigo (>20 min <12 hours)

Hearing loss verified by hearing test

Tinnitus or feeling of fullness in ear

Question 5

Meniere disease tx

Answer 5

Low-Na diet and diuretics (acetazolamide)

Question 6

What’s the mose common etiology of sensorineural hearing loss?

Answer 6

Presbycusis (age-related hearing loss)

Question 7

What are some common examples of ototxic agents?

Answer 7

aminoglycosides

loop diuretics

anticancer drugs

Question 8

A kid presents complaining of ear pain. Mom states the child has a fever and has had a cold for the last couple days. Otoscope exam shows tympanic membrane erythema. What do you suspect?

Answer 8

Acute otitis media

Question 9

What are the most common organisms that cause acute otitis media?

Answer 9

S. pneumoniae

H. influenzae

M. catarrhalis

S. pyogens

Question 10

Acute otitis media tx

Answer 10

Amoxicillin

TMP-SMX, azithromycin

Question 11

medical term for ear pain

Answer 11

otalgia

Question 12

Patient presents with ear pain, fever, postauricular pain and eythema. What do you suspect?

Answer 12

Mastoiditis

Question 13

Most common organisms that cause chronic otitis media?

Answer 13

P. aeruginosa

S. aureus

Proteus

anarobes

Question 14

Etiology of Otitis externa

Answer 14

Pseudomonas

Proteus

fungi

Question 15

Patient presents with ear pain that worsens with movement of the tragus/auricle. Exam shows redness and swelling of the ear canal. What do you suspect?

Answer 15

Otitis externa

Question 16

Otitis externa tx

Answer 16

• Check TM- is it perforated?
• Antibiotic otic drops
  
  • aminoglycoside or fluoroquinolone +/- corticosteroids)
  • Ciprofloxacin /dexamethasone
• If TM perforated
  
  • Ofloxacin 0.3% otic 4 ggt BID x 5 days
• Keep dry

Question 17

How do you test for benign paroxysmal positional vertigo (BPPV)?

Answer 17

dix hallpike maneuver

Question 18

Benign paroxysmal positional vertigo (BPPV) tx

Answer 18

Epley maneuver

Some cases may require interventional/surgical therapies

Question 19

Patient presents with purulent nasal discharge, facial pain, and congestion. PE shows tnderness to palpation over the affected sinus. What do you suspect?

Answer 19

Acute sinusitis

Question 20

Acute sinusitis tx

Answer 20

• NSAIDs for pain
• saline washes
• decongestants
• antibiotics for severe sx or sx >10-14 days
  
  • Amoxicillin 7-10 days
  • TMP-SMX, doxycycline (PNC allergy)

Question 21

3 types of rhinitis

Answer 21

Allergic

Vasomotor

Medicamentosa

Question 22

What is rhinitis medicamentosa?

Answer 22

Rhinitis caused by overuse of decongestants. This causes rebound congestion which prompts increased use of the agent, creating a vicious cycle.

Question 23

etiology for acute sinusitis

Answer 23

• S. pneumonia
• H. influenzae
• S. aureus
• M. catarrhalis

Question 24

Acute pharyngitis etiology

Answer 24

1. Viral
2. Bacterial
   
   • Group A Beta-hemolytic streptococci (GABHS)

Question 25

Patient presents with a sore throat, fever, and tender anterior cervical adenopathy. Patient denies cough. Exam showed pharyngotonsillar exudate. What do you suspect?

Answer 25

Acute pharngitis- Group A strep

Question 26

Group A Strep (GABHS) tx

Answer 26

* Children * **Amoxicillin** (better taste) * Adults * **Penicillin V** 10 days * **IM penicillin G** (single dose) * Macrolides * Clindamycin

Question 27

"Hot Potato" voice is associated with what

Answer 27

Peritonsillar abscess

Question 28

Patient presents with a sore throat, pain with swallowing, trismus, **deviation of soft palate**/uvula, and muffled **"hot potato" voice**. What do you suspect?

Answer 28

Peritonsillar abscess

Question 29

peritonsillar abcess tx

Answer 29

* **Aspiration, incision and drainage** * **Antibiotics** * amoxicillin * augmentin * clindamycin * Tonsillectomy may be considered

Question 30

Oral candidiasis vs leukoplakia

Answer 30

* Oral candidiasis * can be scraped off * throat/mouth pain * Leukoplakia * cannot be rubbed or scraped off * painless

Question 31

What is pictured and what increases a patients risk for this?

Answer 31

Oral candidiasis from ***candida albicans*** MC in patients: * dentures * diabetes * immunocompromised states (chemo/rad) * corticosteroids or broad spectrum abx

Question 32

Oral candidiasis (thrush) tx

Answer 32

* Antifungals * ketoconazole * fluconazole * clotrimazole * nystatin liquid rinses

Question 33

What is pictured and what do you need to be concerned about?

Answer 33

Leukoplakia Linked with tobacco, alcohol, and denture use About 5% are dysplastic or squamous cell carcinomas If erythroplakia is also present, risk of dysplasia or cancer is 90%

Question 34

etiology of epiglottitis

Answer 34

**H. influenzae** Group A Strep (GABSH) viral

Question 35

"thumb sign" on x-ray

Answer 35

epiglottitis

Question 36

Epiglottitis tx

Answer 36

* Manage airway (intubation) * IV antibiotics * Ceftizoxime * Cefuroxime * IV corticosteroids * dexamthasone