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7mo sem > Otorrino Parcial 1 > Flashcards

Otorrino Parcial 1 Flashcards

1
Q

Inflammation that affects naso-mucose 

A

RHINITIS

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2
Q

functions nose

A

warming, humidifying, and cleansing

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3
Q

Type of nasal ephitelium

A

ciliated, pseudostratified, columnar

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4
Q

Structures thta drain into inferior meatus

A

Nasolacrimal duct

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5
Q

Structures thta drain into middle meatus

A
  • Frontal
  • maxillary
  • anterior ethmoid sinuses
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6
Q

Structures thta drain into superior meatus

A

Posterior ethmoid sinuses

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7
Q

Most important artery for irrigation of the nose

A

sphenopalatine artery 

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8
Q

The venous drainage of the nose is primarily through the

A

pterygoid and ophthalmic plexuses

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9
Q

Rhinitis classification

A
  • Allergic: seasonal, perennial  
  • Infectious: viral, bacterial 
  • Non-allergic: metabolic, medication, vasomotor (abrupt temperature changes), pregnancy, polyposis, chemical exposure  
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10
Q
  • Clear mucous 
  • Nasal obstruction 
  • Incidence related to aging
    Are symptoms of:
A

Non-Allergic rhinitis

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11
Q

Common cause of Rhinitis medicamentosa  

A

Afrin = Oximetazolina

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12
Q

Non allergic rhinitis Caused by indoor and outdoor pollutants producing dryness, reduced airflow, rhinorrhea, and sneezing.
Also decreased ciliary movement can be seen.

A

Occupational

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13
Q

Non allergic rhinitis in which patients frequently experience more severe exacerbations, including the development of sinusitis and polyposis.

A

With eosinophilia

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14
Q

allergic rhinitis phases

A

early - alelrgen exposure cause mast c release histamine and symptoms
late - influx of inflamatory cell in the area

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15
Q

concentration of which substance rises throughout pregnancy causing rhinitis

A

Estrogens –> Hialuronic acid –> edema

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16
Q

Rhinitis classification related to incidence and intensity:

A

Incidence
* Intermitent (< 4 days a week or < 4 weeks)
* Persistent (> 4 days a week and for >4 weeks)

Intensity
* Mild (normal life, no interference) 
* Moderate/Severe (abnormal sleep, impairment of activities, abnormal work/school, troublesome symptoms)

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17
Q

Tx for rhinitis <4 days a week or < 4 weeks without troublesome symptoms

Mild&Intermitent

A

First line: Intranasal antihistaminic
Second line: Intranasal corticosteroid

NOT ORAL

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18
Q

Tx for rhinitis <4 days a week or < 4 weeks with abnormal sleep

Moderate&Intermitent

A

First line: intranasal antihistaminic (Acelanine)
Second line: Intranasal corticosteroid (Mometasone)
Third line: Both of above

add third line

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19
Q

Tx for Mild rhinitis which lasts >4 days or >4 weeks

Persistent

A

Same as intermittent one but you can add pseudo ephedrine (AFRIN) if needed 

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20
Q

Tx for Moderate/severe & Persistent  rhinitis

A

First line: intranasal antihistamine + intranasal corticosteroid
Second line: Intranasal antihistaminic + pseudo ephedrine 
Third line: Intranasal corticosteroid + pseudo ephedrine 

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21
Q

Type of rhinitis that is Ig mediated inflammation resulting from an allergen induction. It may have its onset at any age, but the incidence of onset is greatest in adolescence

A

Allergic rhinitis

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22
Q
  • sneezing 
  • Itching 
  • Rhinorrhea 
  • congestion  

Are symptoms of:

A

Allergic rhinitis

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23
Q

Classification of allergic rhinits (other tan incidence and intensity)

A

Seasonal (outdoor)
Perennial (indoor)

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24
Q

Hypersensibility reaction related to allergic rhinitis

A

Hypersensibility type 1 - IgE mediated

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25
Q

Cells related to response of allergic rhinitis

A

Mast cells

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26
Q

Seasonal (outdoor) clinic

4

A
  • usually related to pollination
  • sneezing
  • watery rhinorrhea
  • itching of the nose, eyes, ears, and throat
  • red and watering eyes
  • Worsen during morning
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27
Q

Perennial (indoor) clinic

2

A
  • commonly nasal congestion
  • blockage
  • postnasal drip
    Food allergens are also known for causing this, as well as infections.
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28
Q

Gold Standard for diagnosis of allergic rhinitis

A

Skin allergy testing

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29
Q

common manifestations of allergic rhinitis in children

A
  • Asthmatic wheezing
  • Nasal salute
  • mouth breathing
  • shiners (dark circles under eyes)   
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30
Q

Antihistamines (first generation cause sleepiness bc they cross hematoencephalic barrier) 

A

True

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31
Q

Tx for mild&intermitent allergic rhinitis

A

First line: Oral antihistamine (60min onset) OR Intranasal antihistamine (<10-15min onset)

Second line: Oral Antihistamine + Pseudoephedrine

  

INAH: fenofenadina 2da generación

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32
Q

Tx for moderate&intermitent allergic rhinitis

A

First line: Oral antihistamine (60min onset) OR Intranasal antihistamine (<10-15min onset)

Second line: Intranasal Corticosteroids  (1-3hrs onset)

  

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33
Q

Tx for mild&persistent allergic rhinitis

A

First line: Intranasal Corticosteroids 

Second line: Oral antihistamine or Intranasal antihistamine  

  

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34
Q

Tx for moderate&persistent allergic rhinitis

A

Intranasal antihistamines + Intranasal Corticosteroids (in one drug or separated)

  

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35
Q

Symptomatic inflammation of the paranasal sinuses and nasal cavity. It’s almost always accompanied by inflammation of the contiguous nasal mucosa.

A

Sinusitis

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36
Q

Classification of sinusitis acording to time

A

Acute: <4 weeks
Sub acute: 4-12 weeks
Chronic: >12 weeks
Recurrent: >4 episodes in a year

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37
Q

Acute or chronic sinusitis should be acompanied by 2+ symptoms, 1 of which should be either:

A

1) nasal blockage/obstruction/congestion
2) nasal discharge (anterior/posterior nasal drip)
± facial pain/pressure
± reduction or loss of smell

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38
Q

Acute viral and bacterial etiologies:

A

Viral: Rhinovirus, respiratory syncytial
Bacterial: Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

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39
Q

Chronic bacterial etiologies:

A

Staph aureus, Pseudomona aeru, Haemophilus influenzae

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40
Q

4 pair sinuses

A
  1. frontal
  2. maxillary
  3. ethmoidal (anterior and posterior divided by lamella of the middle turbinate)
  4. sphenoidal
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41
Q

Sinuses that form osteomeatal complex

A
  • maxillary ostium
  • infundibulum
  • ethmoid bulla
  • uncinate process
  • hiatus semilunaris
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42
Q

sinus that can communicate if complication with sella turca creating neurologic pathologies

A

Sphenoidal

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43
Q

Clinic triade for bacterial acute sinusitis

A
  • Purulent nasal drainage
  • Nasal obstruction
  • Facial pain or feeling of pressure
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44
Q

Difference between viral and bacterial clinic in sinusitis (time related)

A

VIRAL: Symptoms don’t worsen and are present <10 days

Bacterial: Symptoms worsen within 10 days after an initial improvement and are present 10+ day

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45
Q

In chronic sinusitis ther isnt fever

A

True

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46
Q

samter triad

A
  • asthma
  • nasal polyps
  • aspirin intolerance
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47
Q

Gold standar image study for sinusitis and scale to evaluate it

A

CT scan with Lund Mackey Score

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48
Q

Sinus visible in Caldwell , Waters and Lateral X-ray projections

A

Caldwell: Ethmoid and frontal
Waters: Maxillary
Lateral: Sphenoid, Frontal, ethmoids and maxillary

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49
Q

system classification for complications common to use in acute rhinosinusitis

A

Chandler System

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50
Q

Chandler System grades

A
  1. Inflamatory edema (preseptall cellulitis, only in skin)
  2. Orbital cellulitis (postseptal)
  3. Subperiosteal abscess (infection in the ethmoid cells) –meye movement affected
  4. Orbital access (neuroinfection)
  5. Cavernous sinus thrombosis (3, 4, 6 nerve affected) – hemiplejia, ptosis, diplopia
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51
Q

Sinusitis complication: Fungal infection which causes necrosis in immunosuppressed patients

A

Mucormicosis

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52
Q

Lund Mackay Score findings

A

Examinate 5 pairs of sinuses and ostiomeatal complex
1. Evaluate R&L side
2. Each side must be punctuated 0= normal// 1: partially occupated // 2: occupation
3. Except for ostiomeatal complex 0: no occupation // 2: ocuppated

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53
Q

Lund Mackay Score according to results:

A

Normal: 0
Leve: 1-3
Moderada: 4-10
Severa: >10

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54
Q

Chronic RS dx

A
  1. > 12 weeks
  2. 2+ of the following symptoms: Mucopurulent drainage (anterior, posterior, or both), Nasal obstruction (congestion), Facial pain-pressure-fullness or Decreased sense of smell
  3. 1+ signs of image inflamation: Purulent mucus or edema in the middle meatus or ethmoid region, Polyps in the nasal cavity or the middle meatus or X-Ray positive
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55
Q

Tx for Mucormicosis

A

Amphotericin B and srugery for necrosed areas

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56
Q

development of a noninvasive conglomeration of fungal hyphae into a mass. Patients are usually immunoCOMPETENT with no other risk factors.

A

Fungal ball

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57
Q
  • poorly controlled diabetes, HIV/AIDS, hematologic malignancies, and pharmacologic immunosuppression

rapid development of progressive angioinvasive fungal infection that may extend to the orbit, pterygopalatine fossa, cavernous sinus, or intracranial cavity

A

Acute invasive fungal sinusiti

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58
Q

osteomyelitis of the frontal bone with the development of a subperiosteal abscess manifesting as a puffy swelling on the forehead or scalp. It usually occurs as a complication of frontal sinusitis. Treatment is prompt surgical drainage and initiation of broad-spectrum antibiotics.

A

Pott’s Puffy Tumor

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59
Q

sinusitis

MRI scanning should be the imaging method of choice in

A

the evaluation of soft-tissue masses, complicated sinus inflammatory diseases, and intracranial or intraorbital extension of sinus pathology.

potts, chandler, murcormic, meninigitis, fungall

60
Q

Tx for acute non bacterial sinusitis

A
  • Antihistaminics
  • Decongestants <10 days
  • Paracetamol
  • AVOID antibiotics
61
Q

Tx for acute bacterial sinusitis
(>10 days or worsen in 5 days)

FEVER >38°C, unilateral, severe pain

A
  • Inhaled corticosteroids
  • Decongestants >10 days
  • Saline rinses
  • Antibiotics: amoxiciline/calvulanate
62
Q

Tx chronic sinusitis

A
  • Inhaled corticosteroids
  • Saline rinses
63
Q

Definitive tx for chronic sinusistis

A

Functional endoscopic sinus surgery (except for frontal sinus)

64
Q

Monoclonal antibodies (additional therapy but expensive) and where they work

A

Omalizumab (IgE)
Mepolizumab (IL-5)
Dupilumab (IL-4r) best option for nasal polyps

65
Q

patient with bleeding from the nostril, nasal cavity, or nasopharynx that is sufficient to warrant medical advice or care.

66
Q

Principal cause of posterior epistaxis in children

67
Q

3 principal causes of epistaxis

A
  1. Idiopathic/spontaneous
  2. Trauma [fracture], picking
  3. Postop/iatrogenic
68
Q

The reference point to calssify epistaxis in anterior or posterior

A

maxillary sinus ostium

69
Q

Blood flows forward through the nose. Epistaxis in this area can result in blood flowing into the orbit

A

Anterior epostaxis

70
Q

Major blood loss and it goes through the oral cavity with aspiration risk into the lungs; therefore is more dangerous

A

Posterior epistaxis

71
Q

he majority of posterior idiopathic bleeds are from the septum, usually from the septal branch of the

A

sphenopalatine

72
Q

Located on the cartilage is the most common site of anterior nosebleed because various arteries conflux

A

Kieselbach’s plexus/Little’s area

73
Q

Initial management on non complicated epistaxis patients

A
  1. Nasal compression for 20min with head inclined forward
  2. Children: petroleum jelly
74
Q

If patient still bleeding after 20min of compression:

A
  1. Examination to identify bleeding site
  2. Topical tx: cautery or nasal packing
75
Q

If patient still bleeding after topical treatment

A
  1. posterior nasal packing with a foley catheter (ONLY otorrinos)
  2. surgical ligation
  3. embolization
76
Q

GS tx for posterior epistaxis

A

endoscopic sphenopalatine artery cautery

77
Q

most common benign SINUS neoplasm

A

inverted papilloma

78
Q

most common malignant sinus tumor

A

squamous cell carcinoma (SCC)

79
Q

The nasal cavity and paranasal sinuses are lined by

A

Schneiderian mucosa

80
Q

Tumors located superior and posterior to Ohngren’s line re more likely to involve the skull base and carry a worse prognosis

A

(plane from the medial canthus to angle of mandible)

81
Q

clinical symptoms can suggest a neoplastic process

A
  • unilateral swelling
  • Pain
  • Epistaxis

IF big enough can cause orbital and hearing manifestations

82
Q

Image study helpful in defining the tumor relationship to arteries and veins , and in evaluating cervical lymph node metastatic

A

Contrast CT scan

83
Q

Image study good for evaluating soft tissue extension of tumor, perineural invasion (PNI), cranial nerve involvement,

84
Q

Contraindication of tumor biopsy

A

highly vascular tumors or encephaloceles which shouldn’t be biopsied.

85
Q

Highly vascular benign tumors seen almost exclusively in adolescent/children males.
Hollman Miller sign

A

JUVENIL NASOPHARYNGEAL ANGIOFIBROMA

86
Q

Percentaje of inverted papilloma that can become malignant

87
Q

Benign tumors

3

A
  • Osteoma
  • Inverted papilloma
  • Juvenile angiosarcoma
88
Q

Malignant tumors

4

A
  • SCC
  • Olfatory neuroblastoma
  • Rabdomyosarcoma
  • Lymphoma
89
Q

Tx for lymphoma

A

ONLY QT and RT

90
Q

sinus tumor in which histoiology presents eosinophils

91
Q

sinus tumor related to EBV

92
Q

General treatment for sinus tumors

A

Surgery to remove most of tumor + adjuvant RT

*Except for JAF which needs previous embolization and lymphoma

93
Q

loss of active movement of the “true” VC, or vocal fold (VF), secondary to disruption of the motor innervation of the larynx.

A

Vocal cord paralysis

94
Q

muscle that open the vocal cords

A

Posterior cricoarythenoiod

95
Q

ALL the intrinsic laryngeal muscles are supplied by the recurrent laryngeal nerve.

ADDUCTORS AND POSTERIOR CRYCOARYTENOID

A

FALSE, the cricothyroid muscle is inervated by external superior laringeal nerve

96
Q

Nerve that gives sensibility to the larynx

A

Internal superior larynx nerve

97
Q

Vocal cords epithelium

A

Stratified squamous

98
Q

Three types of vocal chord positions

A

Speaking: true vocal cords must reach midline

Paramedia: movement between 10°-30°

Intermediate/Cadaveric: too separated almost 45°

99
Q

Types of vocal chord paralysis

A

Vagal nerve
* unilateral
* bilateral
Recurrent laryngeal nerve
* unilateral
* bilateral

100
Q

Vocal cord position in vagal paralysis

A

Vocal chords position: Intermediate

101
Q

Vocal cord position in recurrent laryngeal nerve paralysis

A

Vocal chord position: Paramedium

102
Q
  • Dysphonia.
  • “Bovine” cough (como si tuviera hollín)
  • Voice may tire with use

VC paramedium

Clinic of

NO DISNEA

A

Recurrent larygeal nerve unilateral paralisis

103
Q
  • Weak, breathy hoarseness.
  • Possible history of aspiration.
  • Site of injury above the origin of the superior laryngeal nerve

VC intermediate

Clinic of

NO DISNEA

A

Vagal nerve unilateral paralisis

104
Q

Most common type of laryngeal paralisis

A

Recurrent laryngeal nerve paralysis

105
Q
  • Often presents with stridor. –> Disnea
  • Voice may be normal.
  • Usually a history of thyroid surgery.

VC paramedian position

EMERGENCYYYYYYYY

NO DYSPHONIA

A

Recurrent laryngeal nerve BILATERAL paralysis

106
Q
  • Weak voice or NO VOICE
  • History of aspiration and choking.
  • Satisfactory glottic aperture at rest. –> VC intermediate
A

Vagal nerve BILATERAL paralysis

107
Q

Tx unilateral VN paralysis

A

Thyroplasty

108
Q

Tx unilateral RLN paralysis

A

Speech therapy
+/OR
Injection of hyaluronic acid or fat
OR
Thyroplasty

109
Q

Tx bilateral RLN paralysis

A

Lateralization of vocal cord (will breathe but wont speak)
OR
Cordectomy (cut the vocal cord to create more space for breathing)
OR
Tracheotomy as last resource

110
Q

Larynx cartilages

A

3 unpaired cartilages: epiglottis, thyroid and cricoid cartilages.
3 paired: arytenoid, corniculate and cuneiform

111
Q

Cartilage that protects vocal chords

112
Q

divides the larynx and the hypopharynx

A

Aryepiglottic fold

113
Q

Differential diagnosis in children who are hoarse

A

vocal cord nodules and juvenile papillomatosis.

114
Q
  • Most common pathology
  • 1 cause of dysphonia in adults and children
  • Common in singers
  • bilateral
A

Vocal cord nodules

115
Q

Tx for vocal nodules

A

Speech therapy 3 moths
NO srugery

116
Q
  • unilateral unique lession of the vocal cords
  • Pedunculated lesion red colored
  • Inflammation of the mucosa
  • AP reflux or excessive voice use
A

Vocal cords polyps

117
Q

Tx polyps vocal cord

A

Microsurgery + Speech therapy
IF reflux: Add IBP

118
Q

Benign tumor related to patients that have been intubated; located near to the arytenoid cartilage
Can present dysphonia

A

Intubation granuloma

119
Q

Tx Intubation granuloma

A

Corticosteroids or botox to avoid touching and infamation

120
Q
  • Bilateral in the lamina propia
  • Diffuse polyposis of the vocal cord (like they have water inside)
  • Risk factor: smoking
  • Clinic: raspy voice (like alejandra guzman)
A

Reinke edema

121
Q

Tx Reinke edema

A

Speech therapy + avoid irritants
IF doesnt work: surgery

122
Q

it’s inside of the vocal cord and can contain mucus or epithelial cells
Clinic: dysphonia

A

Laryngeal cyst

DONT KNOW DIFFERENCE BETWEEN THIS AND SACULAR

123
Q

Full of air because of the herniation of the mucosa
Common in wind instrument musicians
Clinic: valsalva
Diagnosis: CT Scan

A

Laringocele

124
Q

Tx for larinogcele, larynx cyst and papillomatosis

125
Q
  • Common in children (through the birth-canal)
  • Wardy lesions located in the larynx and they can block the airway
  • HPV 6&11 virus
  • Clinic: dysphonia and if big enough they can cause disnea
A

Papillomatosis

126
Q

3 areas of the larynx

A

Supraglottic
Glotis
Subglottic

127
Q

Most common site of larynx SCC

A

Glotis = vocal cords

128
Q

**T3 and T4 **- Advanced stage is common that SCC has spreaded to

VOCAL CORD FIXATION

A

supraglottis metastasis

129
Q

Masculine 50 years with History of smoking, alcohol comes to the doctor for bleeding when coughing (it has lasted >3 months) presenting dysphonia , dyspnea. At PE neck lymph nodes, leucoplaquia

You decide to:

A
  1. Laringoscopy and if something found
  2. Biposy partially
130
Q

Tx larynx SCC

A

Early stage (single modal therapy: RT or cordectomy)

Advanced stage (surgery + RT/QT)

131
Q

Two pillars that delimitate the tonsillar fossa

A

Anterior: palatoglossal muscle

Posterior: palatopharyngeal muscle

132
Q

Coxsackie virus
* Adults: Inmnuosupression & Children: Hand-feet-mouth sindrome
* EF: Hafts (ulcers) on the cavity: anterior pilar, soft palate, conjunctival involvement
* Clinic: High fever, very painful sore through, anorexia
* Tx: symptomatic

A

Herpangina

133
Q
  • AHF: **chicken pox **
  • EF: vesicles in soft palate (gums and oral mucus), tonsils, lesions follow dermatomes
  • Clinic: very painful
  • Tx: NAIDs, frozen foods, antivirals: Acyclovir
A

Herpes zoster

134
Q
  • Epstein-Barr
  • EF: lymphadenopathy with tonsil growth that doesn’t allow food to pass through, and exudate (white-gay membrane that appear over the tonsils)
  • Clinic: high fever
  • Complications: hepatosplenomegaly
  • Dx: heterophil antibodies
  • Tx: steroids, pain relievers, mouth washes with Vantall
A

Mononucleosis

135
Q

Most common baterial patogen for adenotonsillar disease

A

Streptococo b-hemilytic group A

136
Q
  • EF: purulent exudate generalized, hyperemia
  • Clinic: sore through, fever, painfull
  • Dx: Blood agar (+)
A

Acute Streptococcus

137
Q

Non suppurative complications

S.B-Hem

A

rheumatic fever (Jones criteria), scarlet fever (exantema), post streptococcal glomerulonephritis, PANDAS

138
Q

suppurative complications

A

peritonsilar abscess, pharyngeal abscess

139
Q

Criteria for tonsillectomy caused by an infection

A

Paradise criteria

140
Q

Tonsillectomy criteria for infectious causes from the book

A
  • 7+ ep a year // 5+ ep e/y for 2years // 3+ ep e/y for 3 years
  • Febrile seizure or cardiac dissease
  • chronic unresponsive tonsillitis
  • peritonsillar abscess with recurrency
141
Q

Centro criteria points and when to give antibiotic

A

Each one = 1 point
* Fever
* Exudate
* NO cough
* Anterior cervical lymphadenopaty
* Age <14

> 44 years (-1 point)

3+ = ANTIBIOTICS

142
Q

Eradication treatment Reumathic fever

A

Benzathine penicillin 1200UI every 21 days for 3 dosis)

143
Q

Chronic tonsillitis is an indication of tonsilectomy

144
Q

BIOPSY is contraindicated on suspected adenotonsilar tumors because irrigation, it needs to be fully removed (excisional) with Tonsillectomy (both) and then sent to the pathologist

145
Q

Paradise criteria

A
  1. Sore throats: 7+ a year OR 5+ each year last 2 years OR 3+ each year last 3 years
  2. 1+ of the following:
    Fever >38.3
    Exudate
    Lymphadenopathy
    Culture (+) SBH
  3. Previous antibiotic medication with no result

7mo sem (11 decks)

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