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Block 3 > HEENT 2 > Flashcards

HEENT 2 Flashcards

1
Q

tonsil sinus lymphatic drainage? 4 cmpts? membrane cells/APC?

A

deep cervical lvl2/jugular digastric. reticular crypt epithelium, extrafollicular area, mantle zone, germinal center. transport ag to epith layer to T cells -> B cells in germinal zone make ab

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2
Q

B lactamase against?

A

s pneu, H flu, Morax; provides PCN resistance to group A strep

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3
Q

types of tonsillar dz (5). know sxs, dx, tx of ea

A

tonisillitis, obstructive tonsillar hypertophy, peritonsillar abscess, congen teratoma/hemangioma/lymphangioma/cystic hygroma; neoplasm (nonhodgkins, sCC)

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4
Q

indic vs modern techniques vs complications of tonsillectomy

A

3+ infxns/yr, halitosis vs bipolar scissor, thermal weld, coblation, monopolar cautery, harmonic scalpel, laser vs 1/2ndary hem 5-8d postop; AA sublux (Down’s = AA lax; Grisel’s = ant long lig lax, vert body decalcified)

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5
Q

what are the 5 spaces spanning the neck? know details of ea

A

superficial, true retropharyngeal, danger, prevertebral, visceral vascular

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6
Q

superficial vs deep cervical fascia. know details of ea layer in deep cervical

A

divided by platysma; from zygoma & facial express muscles to chest/shoulders vs superficial/investing layer -> surround neck, parotid, submandib gland, scm/trap, masseter; middle/visceral layer -> surround aerodigestive tract & thyroid, 2 divisions (muscular around infrahyoid strap & visceral); deep/prevertebral layer -> true retropharyngeal space

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7
Q

retropharyngeal abscess etio/bacteria vs sx vs dx vs tx

A

from URTI/oral infxn to node of Henle; B hemolytic strep, staph vs <6yo, sore throat, dysphagia, fever vs uni retropharyngeal bulge (DON’T palpate), XR for size, CT for carotid/abcsess, MRI, Us; inc WBC, blood cx vs monitor airway, avoid trauma, intub, trach/cricothyrotomy, I&D if you know carotid location

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8
Q

danger space infxn etio vs dx vs tx

A

infxn from deep neck space -> descending necrotizing mediastinitis vs img: midline lesion T1/T2 vs CT surg or similar to retropharyngeal tx

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9
Q

prevertebral space infxn etio vs sx vs dx vs tx

A

vertebral osteomyelitis by staph, TB via hematogenous spread (IVDU) -> neck/back pain, radicular pain vs midline lesion on img vs abx, drain, neurosurg

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10
Q

visceral vascular space infxn etio vs sx vs complications

A

IVDU vs induration, tender sCM; torticollis opposite side, spike fever vs sepsis mediastinitis, carotid rupture -> sentinel ENT bleed

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11
Q

Lemierre’s syndrome & tx

A

Fusobacterium necrophorum = embolized into internal jugular vein –> occluded –> septic thrombus; jugular thrombophlebitis assoc w/ posterior pharyngitis. I&D if abscess, 4-6wks abx

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12
Q

Ludwig’s angina & tx

A

dental -> sublingual space infxn, retro tongue displace -> airway obstruction, submental swell. airway, IV abx, I&D, dental extraction

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13
Q

sx of thyroglossal duct cyst vs branchial cleft/Cervical lymphoepithelial cyst vs dermoid cyst vs cystic hygroma/lymphangioma vs hemangioma vs laryngocele

A

good vs watery/mucous lat mass on scm d/t incomplete involution of branchial cleft vs midline/orbit cheesy desquam cyst <3yo vs benign uni/multilocular post triangle straw mass -> airway obstruct, assoc w/ Down/XXY/Noonan vs dome lobulated red/blue mass slowly involuting at 18-24mo vs dil/hern laryngeal saccule -> mass in neck/supraglottic region -> hoarse, airway obstruct

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14
Q

lipoma. Dx vs tx

A
  • Most common soft tissue tumor
  • rubbery, circumscribed, encapsulated mature adipose. PE; US, CT, MRI to r/o liposarcoma. bx if sx or >3cm, excised if bothersome
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15
Q

reactive viral vs bacterial vs persistent generalized lymphadenopathy

A

most common cervical lymphadenopathy in children; underlying URI from adeno, rhino, enterovirus; persists or >1cm -> w/u vs s aureus, group A strep; submandib or jugulodigastric tx w/ empiric abx, FNA + I&D vs neck, HIV/low CD4 -> tx underlying HIV

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16
Q

infectious mono vs cat scratch dz sx; dx; tx

A

EBV, saliva from infected person; spleno/hepatomegaly, Burkitt’s lymphoma, nasopharyngeal ca. incubation 4-6wks. supportive vs Bartonella from kittens infecting immunocompetent/promised; submandib, periauricular papules. clinical, indirect fluorescent ab. resolve on own, azith

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17
Q

non-TB mycobacterium sxs; dx; tx vs cutaneous TB sxs; dx; tx

A

Mycobacterium intracellulare in soil, water, animals; uni subacute/chronic violaceous in ant triangle or parotid in immunocompetent; weakly pos TsT. isolation of the organism via FNA. Complete surgical excision, abx for children -> clarith or azith + ethambutol and/or rifampin/rifabutin vs scrofuloderma from extrapulm TB in submandib, parotid, supraclavicular. Histopath for AFB by FNA or lymph node biopsy. tx systemic TB

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18
Q

sarcoidosis sxs vs dx vs tx

A

multisystem noncaseating granulomas, fatigue, fever, cough; hilar LAD in lung; skin w/ erythema nodosum, maculopapular lesions vs clinical vs NSAIDs for arthralgia. Observation. Steroids if involving mult organs

19
Q

allergen immunotherapy? mechanism? mech of allergies? know advantages

A

scit -> wkly/monthly injections 3-5y of allergen -> isotype switch from E to G; or slit. ag taken up by dendrites in mouth (fewer mast cells) -> Th2 -> igG; ag reaching si -> Th2 in Peyer’s patch -> igA -> periph tol. allergen -> Tfh -> IgE -> mast cells -> cytok. think pharm

20
Q

Nasopharyngeal angiofibroma vs Sinonasal papillomas vs Plasmacytoma vs Nasopharyngeal carcinoma

A

Benign, vascular, male vs Squamous, resp epithelium; HPV 6 or 11; Benign but aggressive vs Malignant plasma cell tumor vs Malignant epith cell tumor

21
Q
  • How children hear influences their?
  • Children before 6 m/o have what than children identified after 6 m/o?
  • Hearing screening recommended for all?
  • In children who have unremediated hearing handicaps, the ability to discriminate what?
A

language, behavioral, social, and eventually academic development. higher language levels. newborn. background noise from speech = impaired -> severely hinder child’s develop normal speech and language -> Learning disabilities and emotional difficulties

22
Q

outer vs mid vs inner ear poor hearing causes

A

congen microtia/atresia, infxn, trauma, tumor vs congen atresia ossicles, Etube dysfxn, Tumors: Langerhans cell histiocytosis, squamous cell carcinoma, cholesteatoma, otosclerosis vs congen, Viral cochleitis – sudden loss, Meniere’s disease – episodic vertigo, noise exposure, inner ear traum/barotrauma, acoustic neuroma, stroke/TIA, thyroid, DM, syphilis, MS, Chiari

23
Q

nml hearing vs mild vs mod vs severe hearing loss threshold

A

0-20dB vs 25-39dBHL vs 40-68dBHL vs 70-94dBHL -> can’t hear quieter than 95dB

24
Q

how to eval hearing loss? unexplained vs sudden SHL cause? how to tx?

A

whisper test, Weber and Rinne, pneumoscopy, audio assess. blood sugar, CBC, TSH, syphillis vs syndrome not dx rapid loss in morning or <12h -> referral to ENT; infectious cause. high-dose steroid taper or injection, abx if infectious

25
Q

Presbycusis def vs cause vs sx vs tx

A

bil hearing loss w/ advancing age, conductive and/or central dysfxn but always affect sensory cells vs loss hair cells, dec fxn of TM or ossicles, vasc dz (HTN, HLD, DM, aterosclerosis) vs sound less clear & low vol, hear men voices better, background noise inc difficulty, tinnitus vs tx vasc dz

26
Q

socioacusis vs nosoacusis

A

d/t environ like occupation & recreational noise, nml wear/tear vs intrinisic bio factors like comorb, diet, smoke/alc

27
Q

Meniere’s/idio endolymphatic hydrops def w/ cause vs sx vs tx

A

2ndary to interfering nml prod or resorption of endolymph like inc hydraulic pressure in inner ear, endo abnlities, electrolyte imbal, trauma, autoimmune, infxn -> accum in mem labyrinth vs fluctuating hearing loss, occasional vertigo, tinnitus, aural fullness vs IV diazepam/valium, IV fluid for nausea/dehydration, Steroids, Meclizine PRN, avoid triggers, diuretics 3mo trial Rowan tree; surg if diuretics trial fail, endolymph sac decompress/shunt, Transtympanic medication perfusion, Vestibular nerve sectioning, Labyrinthectomy – fully lose hearing

28
Q

acoustic neuroma def vs cause vs sx vs tx

A

intracran, extraaxial tumor of schwann on coch or vestib n vs direct injury to coch n -> progressive SHL, or interrupted blood supply -> sudden hearing loss vs unilat hearing loss + tinnitus, disequil from lg tumors, facial numb, hypoesthesia of teeth vs depends on age, size/location tumor but: old pt + sm tumor -> MRI; everything else -> radiosurg

29
Q

acute otitis media def vs bact & viral cause vs sx vs tx

A

mid ear purulent perfusion w/ inflam in febrile children vs s pneu/H flu/Morax, group A strep/staph; RSV/flu/corona enhance bact adherence to nasopharynx, para, adeno, entero; allergy, congested Etube vs TM bulging, opac, dec mobility; otalgia, fever, dec hearing; vertigo, tinnitus, chronic allergies, sinusitis vs pain meds, antihist, decongest, abx if recurrent or severe otalgia/fever

30
Q

Waldeyer’s ring

A
  • Adenoids
  • Palatine tonsils
  • Lingual tonsils
  • Lateral bands
  • Extratonsilar lymphatics
    o Posterior pharynx
    o Laryngeal ventricles
31
Q

ex of ototoxic drugs (4 types)

A

o Analgesics: ASA, NSAIDs
o Abx: aminoglycosides, erythromycin, tetracycline
o Chemotherapeutics: bleomycin, cisplatin
o Loop diuretics: ethacrynic acid, furosemide, torsemide

32
Q

vibratory vs nonvibratory tinnitus. periph vs central causes of tinnitus?

A

transmission to cochlea of vibrations from adjacent tissues or organs –> assess bp vs biochemical changes in nerve ending. BPV, vestib neuritis, labyrinthitis, HZV, Meniere, otosclerosis, perilymphatic fistula vs cerebellar hem, cerepontine angle tumor, cerebrovasc dz, MS, vert a dissect, migraine

33
Q

disequil def vs indic for imging

A

abnlity of brain, spinal cord, cerebellum, periph n from B12 defic or other CNS dz -> at least 2: visual loss, proprioceptive loss, chronic vestibular damage, and orthopedic disorder vs cerebellar sxs/atax, cranial neuropathies, h/o CVD/A

34
Q

CVD vs vertebrobasilar insufficiency vs lacunar infarct in pons/cerebellum

A

no blood Supply to CNS from emb, hem, thrombus vs vertigo, visual sxs from emb/thrombus vs rapid hemiparesis, atax, apraxia, aphasia from basal ganglia, thal, internal capsule, pons

35
Q

how to tx Bell’s palsy?

A

short term glucocorticoids, artificial tears, PT, surg decompression for hearing loss/facial n dysfxn, brow ptosis correction, long term botox for synkinesis/face spasm, insert wts to upper lid & suspend lower lid for lid closure

36
Q

allergic vs nonallergic rhinitis

A

asthma or atopic eczema, <20yo, szn>per; antihist, LT antag, decongest, steroid nasal spray vs chronic, >20yo, per>szn; steroid nasal spray, nasal irrig, ipra

37
Q

NAREs

A

perennial sneeze, rhinorrhea, pruritus, anosmia. nasal smear = pos for eos, allergy screen neg. tx w/ steroids +/- antihist

38
Q

rhinitis medicamentosa. other sxs? tx?

A

rebound congest from overusing decongestants. punctate bleed, erythematous mucosa, vasoconstrict. stop meds 1 nostril at a time, topical/oral steroids bil and taper off 1 wk

39
Q

mono = what type of tonsillitis; tx? peritonsillar abscess sx vs tx

A

exudative; steroids, don’t give amox -> rash. hot potato voice, uvula dev opposite side vs abx, I&D, Quinsy tonsillectomy

40
Q

airway foreign body def vs sx vs dx vs tx

A

<3yo, small/food stuck in R bronchus vs cough/choke, wheeze vs inspiratory stridor -> supraglottic, biphasic stridor -> glottic, expiratory stridor -> subglottic; CXR, fluoroscopy, CT, bronchoscopy; coin/disk in esop/hypopharynx -> lat, larynx/airway -> A/P vs Heimlich if can’t speak/cry & TOTAL airway obstruct, brochoscopy

41
Q

warthin tumor vs pleomorphic adenoma

A

parotid gland; smoke. Us, MRI, FNA. superficial parotidectomy vs parotid gland; head/neck rad. CT, MRI, FNA, core needle bx. superficial or total parotidectomy

42
Q

sup vs mid vs inf turbinates do? all contain what?

A

heat, humidify, filter air; direct airflow vs direct air to max, eth sinus vs condition air; direct airflow. pseudostrat mucociliary escalator, goblet cells, vasc plexus delivering immune cells

43
Q

acute vs chronic suppurative OM

A

otalgia, fever in peds; vertigo, tinnitus in adults. dx: immobile TM, bulging TM, yellow, purulent/exudate. tx: abx vs >3mo, TM perforation, purulent, mucous threads, Pseudo/staph/strep. dx: otoscopy, cx. tx: abx, myringotomy, tympanoplasty, mastoidectomy

Block 3 (23 decks)

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