Rhinitis, Hearing Loss, Epistaxis, Pharyngitis Flashcards
ENT
2 types hearing loss
conductive:failure of one or more of the components of the external or middle ear
sensorineural
defect in inner ear or CN VIII; injury to the hair cells in the cochlea and/or the nerves innervating the hair cells (usually bilateral and symmetrical)
ENT
weber rinne
Weber = Widows peak Conductive = Crap
Rinne
A>B normal
ENT
screening for hearing loss
whisper test
ENT
risk for hearing loss
- Noise exposure
- Frequent/recent infections
- Trauma
- Ototoxic meds (NSAIDS, aminoglycosides, furosemide, fluoroquinolones)
- Barotrauma
- Cerumen impaction
- Foreign body
- eustachian tube dysfunction with middle ear effusion
ENT
hearing loss red flags
- sudden
- pain (not responsive to medication)
- mastoiditis/osteomyelitis
ENT
Hearing loss Ddx
so many… broad strokes
Conductive (hearing canal/drum) trauma infection impaction congenital (cholesteatoma) otosclerosis tumor
SNHL (hairs w/ sensory receptors & nerves): metabolic (hypothryroidism) infectious toxins tumor neurodegenerative autoimmune
Common causes: presbycusis medication-induced barotrauma impaction infection
ENT
complications of age-related hearing loss?
- depression
- dementia/MCI
- social isolation
ENT
allergic rhinitis vs non-allergic
allergic: boggy, purplish, oedematous. turbinates
associated allergic symptoms (conjunctivitis, etc)
non-allergic: may be boggy, or may be inflamed looking (erythema, oedematous, or normal)
both: shiners transverse crease nose post-nasal drip & cough dennie-morgan skin folds under eyelids?
ENT
classifications of non-allergic rhinitis
- Idiopathic
- Vasomotor
- Atrophic
- Geriatric
- Drug induced
- Gustatory: runny nose when eating spicy food
- Occupation
- Pregnancy
ENT
non-pharm & pharm management rhinitis
avoid allergens, saline rinse, etc
Pharm: fluticasone nasal spray
If allergic: can try nasal antihistamine (2nd line), or oral antihistamines
ENT
epistaxis red flags
posterior bleed (sphenopalatine artery)
systemically unwell 24-48 hours post packing posterior bleed (sepsis)
ENT
risks for epistaxis
- Anticoagulation
- foreign body
- chronic use of nasal steroids
- systemic causes: bleeding disorders, HTN
- Trauma
- Tumors
- pregnancy
- cocaine use
ENT
s/s epistaxis
Anterior: bleeding from one nare, may be able to visualize source at the septum
Posterior: “brisk” arterial hemorrhage, patient reports swallowing blood
ENT
epistaxis tx
- Direct pressure
- Nasal packing
- Nasal balloons
- Cautery
- TXA soaked packing
- oxymetazoline
ENT
GAS most common age
5-15
ENT
risk for pharyngitis
- Cigarette smoking
- allergies
- URI
- ORal sex
- Drugs (Abx and Immunosuppressants)
ENT
pathogens for pharyngitis
- Viral: Coxsackievirus, ECHO, Epstein-Barr
- Bacterial: Group A Beta-hemolytic Streptococcus, Neisseria gonorrhoeae, Corynebacterium diphtheriae
- Fungal: Candida albicans
- Atypical agents: Mycoplasma pneumoniae
ENT
Oral lesions (herpangina, HSV, trench mouth, thrush, mono)
Herpangina – oral coxsackie A virus - ulcers palate & pharynx
Herpes – vesicles on buccal mucosa, tongue and pharynx
Trench mouth (gingivitis)
Oral candidiasis – first Sx of HIV?
MONOnucleosis: 50% have tonsillar exudate; 33% develop petechia at junction of the hard and soft palate.
ENT
complications GAS
Suppurative adenitis Scarlet fever Peritonsillar abscess Glomerulonephritis Rheumatic fever
ENT
centor score
Age Exudate Lymphadenopathy Temp Cough (absent)
ENT
Tx GAS
PenVK 600 mg PO BID X 10 days
