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Surgery Semester 3 > Otolaryngology, Otitis, Rhinosinutitis > Flashcards

Otolaryngology, Otitis, Rhinosinutitis Flashcards

1
Q

Phase of swallowing: Voluntary, chewing

A

Prepatory oral phase

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2
Q

Phase of swallowing: reflexive phase

A

Pharyngeal phase

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3
Q

Phase of swallowing: fluid passive, solid is active

A

Esophageal phase

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4
Q

Problems with prepatory and oral phase: cause and effect

A

Cause: Tongue thrust and teeth. Effect: choking and aspiration are common

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5
Q

Problems with pharyngeal phase: Cause and effect

A

Cause: upper pharyngeal sphincter (crisopharyngeus muscle relaxes with swallowing). Effect: choking and aspiration common

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6
Q

Problems with esophageal phase: cause and effect

A

Solid and/or liquid problems swallowing

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7
Q

Test used to vizualize oral and pharyngeal phases

A

Barium Swallow

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8
Q

Risk factors for GERD

A

tobacco, caffeine, EtOH

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9
Q

Common sleep symptom found with GERD

A

Snoring

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10
Q

Gold standard for Dx hiatal hernia

A

24Hr probe (not very practical)

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11
Q

Medical management of hiatal hernia

A

GERD: 1x day PPI; EER: 2x/day PPI

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12
Q

Radiography finding of achalasia

A

Bird beak on esophagram

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13
Q

Autoimmune disorder with atrophy of smooth muscle and collagen deopsition

A

Scleroderma

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14
Q

Face is calcified and cannot exhibit expressions

A

Fixed face (sign of scleroderma)

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15
Q

CREST syndrome

A

Calcinosis, Raynauds, Esophageal dysfunction, Sclerodactyly, Telangiectasias

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16
Q

Idiopathic inflammatory myopathy of striated muscle

A

Polymyositis

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17
Q

S&S of polymyositis

A

Proximal muscle wasting, dysmotility of proximal 1/3 of esophagus, increased CPK

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18
Q

Tx of scleroderma

A

Reflux control, NSAIDS, steriods, Ca CB

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19
Q

Tx of polymyositis

A

Reflux control, immunosuppressive and steriods

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20
Q

Diverticulum of esophagus at Killian’s triangle

A

Zenker’s Diverticulum

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21
Q

Most common cause of esophageal rupture

A

Instruments during testing

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22
Q

Incomplete esophageal tear from increased pressure (i.e. vomiting)

A

Mallory-Weis syndrome

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23
Q

Rupturing od all 3 layes of the esophagus

A

Boerhaave syndrome

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24
Q

What sign is “crunching” over the heart?

A

Hammers sign

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25
Q

Intermittent dysphagia cuased by the right subclavian artery being behind the esophagus

A

Dysphagia Lusoria (Bayford syndrome)

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26
Q

Elongated styloid process or ossified stylohyoid ligament, can cause odynophagis and unilateral throat pain

A

Eagle syndrome

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27
Q

Dysphagia from esophageal webs, iron deficeincy anemia, glossitis, and has an increased rish of squamous cell carcinoma

A

Plummer-Vinson Syndrome

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28
Q

Tx of Plummer-Vinson Syndrome

A

Iron supplementation and esophageal dilation

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29
Q

Immediate gagging or cyanosis after birth

A

Tracheoesophageal fistula

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30
Q

Most common esophageal malignancy and location

A

Squamous cell carcinoma, middle 1/3 of esophagus

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31
Q

Assoc. w/ Barretts metaplasia from reflux

A

Adenocarcinoma

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32
Q

Most common cause of acute pharyngitis

A

Viral

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33
Q

Most common cause of acute bacterial pharyngitis

A

Group A pyogenes

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34
Q

Causes of chronic pharyngitis

A

GERD, EER, smoking, allergy, rhinocinusitis

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35
Q

Commonly called hand, foot, mouth disease

A

Herpangina, from coxsackie A virus

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36
Q

Grading system on tonsil size

A

0-4 (gone to 100% to mid line)

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37
Q

S&S of peritonsilar abcess

A

Anterior pillar fullness, uvula shifted from tonsils, no exudate on tonsils

38
Q

Paradise Criteria

A

Tonsillectomy guidelines: 7 infx/year for 1 yr, 5infx/year for 2 yrs, 3 infx/yr for 3 years

39
Q

Non infx reasons for tonsillectomy

A

sleep disorder breathing, cor pulmonale (from SDB), recurrent or chrontic otitis media

40
Q

Contraindications for tonsillectomy

A

Leukemia, hemophilia, systemic disease, cleft palate, acute infx, bifid uvula

41
Q

Why is snoring important?

A

All snoring is pathologic

42
Q

Complications of snoring

A

Cardiopulmonary disease (RHF), HTN, Failure to thrive)

43
Q

Dx of obstructive sleep apnea

A

Polysomnogram shows >5 episodes per an hour

44
Q

Most common cause of acute otitis externa

A

Pseudomonas (followed by proteus, staph, strep)

45
Q

Tx of acute otitis externa

A

1:cleaning! Ear drops w/ steriod, Cipro+dexamethasone

46
Q

Difference b/t acute and necrotizing otitis externa

A

Necro has involvement of osteomyelitis of temporal bone, abnormally high pain for externa appearance, cranial nerve involvement (BAD prognosis)

47
Q

Tx of necrotizing otitis externa

A

Control of immunodeficienies and DM

48
Q

Most common causes of otomycosis

A

Aspergillus, then candida

49
Q

Tx of otomycosis

A

Meticulous debridement, clean with vinegar, antifungal drops

50
Q

Causes of acute otitis media

A

Strep pneumo, H Inf, Moraxella Catarrhalis

51
Q

Risks for acute otitis media

A

Smoke exposure, day care, nasal intubation, breast fed <2 years

52
Q

S&S for acute otitis media

A

HEARING LOSS

53
Q

When to use myrongotomy with pressure equalization tubes?

A

Recurrent otitis media, poor response to Abx, persistent effusion >3months

54
Q

S&S of serous otitis media

A

Hearing loss W/O pain

55
Q

Plan for adult with unilateral persistent middle ear fluid

A

Must undergo inspection of nasopharynx

56
Q

S&S of chronic otitis media

A

Tympanic membrane perforation, conductive hearing loss, >6 weeks of otitis media

57
Q

Common cause of CHRONIC otitis media

A

Pseudomonas

58
Q

Complications of chronic otitis media

A

Facial nerve paralysis, sinus thrombophlebitis, mastoiditis, Meningitis

59
Q

Slow progressive hearing loss and ringing in ears cuased by abnormal reabsorption/deposition of bone in all 3 layers of otic capsule and ossicles

A

Otosclerosis

60
Q

Cause of labryinthitis

A

Bacterial infx that progresses into labyrinth from otitis media or meningitis

61
Q

Complications of labrynthitis

A

Permanent hearing loss and vestibular dysfunction

62
Q

Viral infection of vestibular nerve

A

Vestibular neuronitis

63
Q

S&S of vestibular neuronitis

A

Vertigo lasting days-weeks, no hearing loss, NYSTAGMUS

64
Q

Cold water associated, smooth protusions of medial osseau canal

A

Exostoses (surfers ear)

65
Q

White “pearly” mass in middle ear, caused by squamous epithelium in the middle ear with accumulation of keraton debri

A

Cholesteatoma

66
Q

Inflammation of the nose and sinuses

A

Rhinosinusitis

67
Q

Dx of rhinosinusitis

A

2 or more major criteria, 1 major criteria +2 minor criteria

68
Q

Major criteria of rhinosinusitis

A

Facial pain, nasal obstruction, hyposmia, purulence on examination, fever

69
Q

Minor criteria of rhinosinusitis

A

headache, fatigue, dental pain, cough

70
Q

Acute rhinosinusitis: definition and cause

A

lasts up to 4 weeks. Rhinovirus, strep, H flu, Moraxella Cattarrahlis

71
Q

Chronic rhinosinusitis: definition and causes

A

6 weels or more. (usually polymicrobial) S. aureus, anaerobes, gram negatives and pseudomonas

72
Q

Recurrent acute rhinosinusitis: definition

A

4 or more times a year with resolution b/t attacks

73
Q

Imaging for rhinosinusitis

A

NO XRAY, Non-contrast coronal CT is gold standard, MRI for complicated cases

74
Q

Tx of acute rhinosinusitis

A

Empirically: amox+clavulanate (augmentin), bactrim, doxycycline, clarithromycin, cipro for 7-10 days

75
Q

Tx of chronic rhinosinusitis

A

Culture based is preferable: 1st) amox+clavulanate OR 2nd/3rd gen cephalosporin, 2nd)quinolones (cipro, levo, moxi) OR clarithromycin

76
Q

Use what in chronic rhinosinusitis for culture documented resistant S. Pneumonia

A

Clindamycin

77
Q

Chronic rhinosinusitis in children

A

can be treated with PPI due to GERD/EER

78
Q

How to thicknes/Thin mucus

A

acidic mucus in thick, alkaline (baking soda) mucus is thinned

79
Q

Decongestants

A

Phenylephrine, pseudoephedrine (stronger)

80
Q

Why are leukotrienes important to nasal allergic inflammation?

A

More potent than histamine trigger

81
Q

Tx of leukotrienes

A

Antagonist (Singulair)

82
Q

MOA of corticosteriods

A

Stabilizes mast cells so do not degranulate, inhibits chemotaxis of inflammatory cells

83
Q

Use of corticosteriods in allergies

A

Short use is good for severe mucosal congestion

84
Q

Contraindications for corticosteriods

A

DM, PUD, glaucoma, severe hypertension

85
Q

Why is informed consent needed for high dose steriods?

A

Avascular necrosis and other side effects

86
Q

rhinosinusitis associated diseases

A

GERD, EER, cystic fibrosis, cilia dysfunction, fungal rhinosinusitis

87
Q

Associated with cilia dysfunction

A

Kartageners syndrome: situs invertus, bronchiectasis, sinusitis, male infertility

88
Q

What is produced in fungal rhinosinusitis and no other rhinosinusitis?

A

IL-5 and IL-13

89
Q

S&S of chronic rhinosinusitis

A

Eosinophil inflammation, epithelial damage, basal membrane thickening (SAME AS ASTHMA)

90
Q

Tx of fungal rhinosinusitis

A

Amphotericin B

91
Q

Complications of rhinosinusitis

A

Cavernous sinus thrombophlebitis, abcess, meningitis, sinocutaneous fistula

Surgery Semester 3 (3 decks)

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