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Adult Primary Care > T2- ENT > Flashcards

T2- ENT Flashcards

1
Q

Nasal airway obstruction (NAO) can be due to 2 main things:

A

Anatomical abnormality/obstruction (septum, turbinate, hypertrophy, valve collapse, nasal mass)
Chronic sinusitis, allergic rhinitis.

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2
Q

What questions can you ask if a patient complains of “not being able to breathe through their nose”

A

One side or both? Fixed or alternating? Seasonal or all year? Night or day? Vision changes, HA? Epistaxis? CN deficits? Pain or pressure in sinuses?

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3
Q

If it’s an ALLERGIC NAO, then what 5 main therapies would you consider?

A

Sinus rinse (netipot)
Nasal steroid (Flonase)x2 weeks
Nasal Antihistamine (Astapro OTC)
Anti-leukotrines (singulair)
Oral antihistamine.

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4
Q

Therapy for NAO that is at night or sinus related

A

Medicated sinus rinse with steroid budesonide capsule in it
Nasal decongestant (Ipartropium)

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5
Q

When should you refer NAO (with no red flags) to ENT?

A

Med failure after 2 months of using above therapy.

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6
Q

How to properly use Flonase?

A

Use the opposite hand for the opposite nostril.
Point to the back of the head (or point straight up if your head is looking down at your feet)
Spray outwards towards the eyes.

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7
Q

What should you do if you see a septal hematoma after trauma to the nose?

A

Emergency. Refer to ENT. If you let it go, it could cause necrosis in the septum and eventually an ulcer that goes right through the septum!

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8
Q

MAJOR s/s of sinonasal disease vs a minor s/s

A

MAJOR: face pain/pressure/fullness, nasal obstruction and blockage, nasal/post nasal drainage (purulent) hyponosmia/anosmia. Dental pain.
MINOR: HA (cluster type) and fever, halitosis, fatigue, dental px, cough, ear px/pressure

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9
Q

Why might someone feel like they have a sinus infection with a URI?

A

The swelling causes the drainage of the sinuses to be closed off and the negative “sucking” pressure builds causing that sinus pain. It’s not necessarily an infection.

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10
Q

Chronic sinusitis is > _____

A

12 weeks

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11
Q

Tx for sinonasal disease

A

Early sinus rinse!!. Budesonide, and salt packet rinse.
Oral antihistamine (Zyrtec, Allegra, claritan)

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12
Q

What is sinus pain?

A

When sinus airspace gets closed off, the cavity starts to pull in nitrogen and fluids and has a negative “SUCKING” pressure which the patient feels as sinus pressure/pain.

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13
Q

When should you start being concerned about acute rinosinusitis (ARS)?

A

Around day 7 if you are not improving or had an initial improvement but now worsening again (double worsening), then you should start considering abx, and definitely by day 10 if no improvement.

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14
Q

What abx are given for ARS? Acute rinosinusitis.

A

Augmentin or amoxicillin. Be careful if they just had tx with the same recently for other things such as pharyngitis/strep, etc.

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15
Q

in addition to abx, what should be given for acute rhinosinusitis?

A

Oral steroids

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16
Q

What is a contraindication for oral steroids in ARS?

A

Glaucoma - confirm with ophthalmologist first. QD budesonide (topical) is usually ok, but educate about worsening s/s of glaucoma and to get checked out right away if that occurs.

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17
Q

What is considered “recurrent” ARS?

A

> or = 4 sinus infections/year. Refer to ENT.

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18
Q

Someone with chronic rhinosinusitis - treatment?

A

21 days of doxy (w/probiotic)
Oral steroid course
Sinus rinse
Antihistamine

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19
Q

Why is the course of abx longer for chronic RS?

A

It kills off the biofilm that has developed and is resistant to rinsing.

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20
Q

If you order a CT of anything in the head (sinuses etc), then order_____

A

CT Landmark/Image guidance

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21
Q

T/F: a mucus seal in the sinus needs to be addressed immediately.

A

False. Only if it’s symptomatic or infectious. Up to 30-50% of the population has one and are asymptomatic.

22
Q

Reasons to refer to ENT with rhinosinusitis.

A

Fungal sinusitis on CT (snakes of hyper density throublocked sinus) - “peanut butter” nasal discharge
Unilateral polyps (concern for malignancy)
HA only if sinus dz present too
Nasal polyps in a child (CF until proven otherwise)
Anatomic obstructions.

23
Q

Epistaxis - treat?

A

Spray afrin, pinch SOFT bits together and lean forward for at least 10 mins. NOTHING IN THE NOSE.

24
Q

What is JNA and how does the patient present?

A

Juvenile nasopharyngeal angiofibroma -unilateral nose bleeds in pubescent boys.

25
Q

Why do we only cauterize one side of the nose at a time?

A

If you cauterize both sides, then the septum will get perforated. Cauterize 1 side then wait 6 weeks and then cauterize the other side.

26
Q

Interpreting the Weber hearing test.

A

Weber tells you “whether” you have hearing loss in R or L ear.

27
Q

In sensorineural hearing loss, the Weber test directs the sounds/vibration _______ the affected ear.
In conductive hearing loss, the Rinne test directs the sounds/vibration ______ the affected ear.

A

Sensorineural -> away from the affected ear (hear louder in the ear that is NOT affected)
Conductive -> towards the affected ear (hear louder in the ear that has a conductive loss) “sticky wax sticks the sound to the affected side”

28
Q

In sensorineural hearing loss with Rinne test, air conduction (AC) is ______ bone conduction (BC)
In conductive hearing loss, with Rinne test, air conduction (AC) is ______ than BC

A

SN hearing loss AC > BC - (Positive Rinne’s Test)
Conductive loss AC < BC - you can hear/feel the BC sound/vibration because it is bypassing the ear canal/middle ear (bypassing the blockage)and going straight to the nerves. (Negative Rinne’s test)

29
Q

If your patient has a pulsatile ringing in their ear (tinnitus) what should you do?

A

CT w/ contrast and consider neck CT too for carotid.

30
Q

What is the best test to order for concern of hearing loss?

A

Audio gram.

31
Q

What are some history questions to ask about dizziness?

A

Explain to me what you’re feeling without using the word dizzy
Triggers?
Frequency?
Duration (seconds? Weeks)
Associated with other symptoms (HA, aura, vision changes, sweating, palpitations?)

32
Q

What exactly is vertigo?

A

Incorrect movement of the eyes. The inner ear is telling the eyes to move based on the position of the head. If this communication is messed up, then your eyes don’t move the way they are supposed to when the head moves, and the patient experiences this as dizziness.

33
Q

What is the Dix-Hallpike maneuver and what is it used for?

A

Used to diagnose BPPV.
Patient starts sitting up. Their head is guided to a 45* angle, and then they are lowered down quickly to laying with head slightly lower back than the table. If there is any nystagmus, then it is considered a positive Dix-Hallpike and you should progress to the Eply maneuver.

34
Q

What is the Eply maneuver used for?

A

To treat BPPV.

35
Q

How long does the vertigo of Meniere’s last?

A

Hours

36
Q

Meniere’s - endolymphatic hydrops (swelling). May be accompanied by low frequency sensorineural hearing loss, rumbling tinnitus, unilateral.

A
37
Q

The vertigo with Vestibular neuronitis ________ accompanied with hearing loss.
The vertigo with labrynthitis ________ accompanied with hearing loss.

A

Vestibular neuronitis IS NOT accompanied with hearing loss
Labrynthitis IS accompanied with hearing loss

38
Q

Vertigo in vestibular neuronitis and labrynthitis lasts for ______. Treatment?

A

Days.
Steroids plus antivirals if dx w/in 72hours.

39
Q

What are some causes of constant vertigo (>days)?

A

TBI, white matter dz, low B12, MS.

40
Q

Is meclizine good or bad for vertigo tx?

A

Good in small amounts in the very beginning but long term use can blunt cerebellar adaptation.

41
Q

Home remedy for otitis externa (and for prevention)

A

Vinegar drops.

42
Q

If you have ear pain with a normal er exam, consider _______

A

TMJ, sinus infx.

43
Q

If the auricular cartilage becomes involved (VERY painful!) in OE, then how should you treat?

A

FQs.

44
Q

Recurrent AOM defined as ________ /6 mo or ________/year

A

> 3/6mo
4/year

45
Q

What is trismus and what causes it?

A

Inability to open the jaw wider than gravity.
Abcess (PTA) that affects pterygoid muscle.

46
Q

“Pant like a puppy” or deep Ahhhhh

A

Can help lower the back of the tongue.

47
Q

Grading tonsils:

A

0 - absent or not visible
4 - almost touching.

48
Q

What is the best way to image thyroid nodules?

A

US

49
Q

Best time to reset the nose?

A

Kids <7 days
Adults 10-14 days

50
Q

What is a cholesteatoma?

A

An abnormal collection of epithelial cells in the middle ear or mastoid process.

Adult Primary Care (18 decks)

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