Ear, Nose and Throat Flashcards
(266 cards)
1
Q
What is Conductive Hearing Loss?
A
the dysfunction of the External air Middle Ear
2
Q
What is the etiology of conductive hearing loss?
A
1 Obstruction : cerumen, otitis externa
2 Middle rare effusion, scarring
3 Otosclerosis: abnl bone formation
3
Q
What is the Tx for conductive hearing loss?
A
it is generally correctable with medical or surgical therapy
4
Q
What is Neural Hearing Loss?
A
- lesions to the 8th CN or central pathway
- it is the least common type of hearing loss
5
Q
What is the etiology of neural hearing loss?
A
- Acoustic nuron : F > M, unilateral
- Multiple Sclerosis
- Cerebrovasular disease
6
Q
Describe the typical history with Sensorineural hearing loss?
A
- it is the typical progressive, predominantly high-frequency loss with advanced age
7
Q
Where is the tuning fork placed with the Weber test?
A
placed on the forehead
8
Q
What are the Weber test findings in unilateral conductive losses?
A
the sound appears loader in the affected ear (poorer hearing)
9
Q
What are the Weber test findings in unilateral sensorineural losses?
A
sound radiates louder to the unaffected ear (normal hearing)
10
Q
Where is the tuning fork placed with the Renne Test?
A
it is placed on the mastoid bone and then front of the ear canal
11
Q
What are the Rinne findings with conductive hearing loss?
A
in bone conduction losses, bone conduction exceeds air conduction
12
Q
What are the Rinne test findings with Senosrineural hearing loss?
A
both air conduction and bone conduction are equally depreciated
13
Q
What are the S/Sx of External Otitis? (swimmers ear)
A
- Otalgia
- pruritis
- purulent discharge
14
Q
What is the etiology of External Otitis?
A
-Pseudomonas (gram neg rods) or fungi
15
Q
What are the risk factors for External Otitis?
A
- water exposure
- mechanical trauma
16
Q
What is the Tx for external otitis?
A
- antibiotic ear drops, +/- ear wick
- (neoomycin sulfate, polymyxin B sulfate)
17
Q
What causes Viral Otitis Externa?
A
usually caused by Varicella Zoster
18
Q
What is Ransey-Hunt Syndrome?
A
otitis extern with CN 7 palsy
19
Q
What are the S/Sx of viral otitis external?
A
- severe ear pain
- visicles in the external auditory canal or around the ear
20
Q
What is the Tx for viral otitis externs?
A
- antivirals
- acyclovir, valcyclovir, famcyclovir
- +/- steroids
21
Q
What is Malignant External Otitis?
A
persistent external otitis causing a necrotizing and osteomylitis of the skull base
22
Q
What are the risk factors for Malignant External Otitis?
A
diabetics and immunocompromised patients
23
Q
What is the Tx for Malignant External Otitis?
A
- prolonged antipseudomonal antibiotics (usually IV)
- +/- surgical debridement
24
Q
What is Acute Otitis Media?
A
it is a bacterial infection of the mucosally lined air contained spaces of the temporal bone
25
What is the etiology of acute otitis media?
-Poor drainage from the eusachian tubes
26
What are bacteria etiology of acute otitis media?
- streptococcus pneumoniae or pyogenes
- haemophilus influezae
- Morazella catarrhalis
- staphylococcus
27
What are the S/Sx of acute otitis media?
- otalgia
- aural pressure
- decreasing pressure
- +/- fever
28
If bullae (blisters) are seen with Acute Oitis Medial, what is the organism causing this?
-Mycoplasma pneumoniae
29
What are the physical exam findings for acute otitis media?
- immobile eardrum
| - red, bulging tympanic membrane
30
What are the Tx for acute otitis media?
```
Antibiotics
amoxicillin or augmentin
cephalosporins
erythromycin + sulfonamide
Tympanic membrane perforation
```
tympanic membrane rupture : relieves pain immed.
Tubes (surgery)
31
What are the organisms that cause Chronic Otitis Media?
- pseudomonas aeruginosa
- proteus species
- staphylococcus aureus
32
What is the hallmark characteristic of chronic otitis media?
purulant aural discharge
33
What is the Tx for chronic otitis media?
topical antibiotic ear drops
34
What is Serous Otitis Media?
inability to aerate the middle ear
35
What characteristics of serous otitis media?
pain and fever are absent
36
What are the physical exam findings of serous otitis media?
- fluid is present
| - Tm is retracted with bony landmarks preserved
37
What is the Tx for serous otitis media?
Surgery, tubes are recommended for chronic cases
38
What is a Cholesteatoma?
a growth of skin cells behind the eardrum that cause damage to the tympanic membrane itself, the bones of the ear, and sometimes to the nerve
39
What causes a Cholesteatoma?
- is due to a prolonged auditory tube dysfunction, with resultant chronic negative middle ear pressure that draws inward the tympanic membrane
- this area becomes filled with desquamated keratin and becomes chronically infected
40
What may eventually occur with a cholesteatoma?
may erode bone
41
What are the complications of Otitis Media?
- masoiditis
- osteomyelitis
- facial paralysis
- central nervous system infection
42
What are the S/Sx of masoiditis?
post auricular pain and erythema with spiking fever
43
What is the Tx for mastoiditis?
IV antibiotics or surgery if no improvement
44
What is the organism responsible for Osteomyelitis in otitis media?
pseudomonas
45
What is the Tx for Facial Paralysis seen in Otitis media?
IV antibiotics and myringotomy
46
What organisms are responsible for central nervous infection of otitis media?
Meningitis : H. influenzae and Strep pneumo
47
What is Vertigo?
a feel in that you or your environment is moving or spinning
48
Vertigo is a cardinal symptom of abnormality of what system?
the vestibular system
49
Describe vertigo.
an illusion of movement (usually rotational)
50
Where is the problem of vertigo located?
anywhere from the vestibular end organs to the temporal bone
51
Which lesions cause the most systemic upset?
the peripheral lesions
52
What are the vertigo systemic symptoms that the peripheral lesions cause?
- pallor
- sweating
- nausea
- vomiting
also:
-sudden onset of hearing loss and tinnitus
53
How long does benign positional vertigo last?
30 min to 12 hours
54
How long does vestibular neuritis vertigo last?
days to weeks
55
How long does labryinthitis last?
days to weeks
56
How long does acoustic neuroma vertigo last?
months
57
How long does Ototoxicity vertigo last?
months
58
How long does Multiple Sclerosis vertigo last?
months
59
How long does Psychogenic vertigo last?
several years
60
What is the classic syndrome of Meniere's disease?
- episodic vertigo
- hearing loss
- tinnitis and sensation of aural pressure
61
What is the etiology of Meniere's Disease?
- distention of the membranous labrinyh (endolymph pressure)
- syphillis
- head trauma
62
What are the S/Sx of Meniere's disease?
- symptoms wax and wane +/- N/V
| - low frequency fluctuation hearing loss
63
What is the Tx for Meniere's Disease?
-Low-salt diet
-Diuretic
+/- surgery
64
What is labyrinthitis?
- inflammation
| - irritation and swelling of the inner ear (the labyrinth)
65
Describe the clinical picture of Labyrinthitis?
-acute onset of continuous, usually severe vertigo lasting several days to a week, accompanied by HEARING LOSS AND TINNITIS
66
What may bring on the transient vertigo of Labyrinthitis?
-unknown but often follows an upper respiratory infection
67
What is the Tx for Labyrinthitis?
- meclizine
- promethazine
- dimenhydrinate
68
What is Vestibular Neuronitis?
- a paroxysmal, usually single attack of vertigo occurs without accompanying impairment of auditory function
- no loss of hearing
69
What is the etiology Vestibular Neuronitits?
probably a viral infection
70
What are the S/Sx of Vestbular Neuronitis?
- vertigo
- N/V
- lasts days to weeks
71
What is the Tx for Vestibular Neuronitis?
Tx the symptoms
72
Describe Benign Paroxysmal Positional Vertigo (BPPV)?
- vertigo symptoms that occur a few seconds after head movements
- this vertigo lasts 10-60 seconds
73
What is the etiology of Benign Paroxysmal Positional Vertigo (BPPV)?
-free floating debris within a semicircular canal
74
What are the symptoms of Benign Paroxysmal Postional Vertigo?
-vertigo with torsional nystagmus
75
How is BPPV diagnosed?
Epely maneuver
76
How is BPPV treated?
-Repositional techniques
Hallpike maneuver
Epley maneuver
Nylen-Barany maneuver
77
What are the Tx for Vertigo?
- antihistamines
- Meclizine (antivert)
- Promethazine
- Scopolamine patch
- Phenothiazine (compazine)
78
What are the side effects of a Scopolamine patch?
- dry mouth
- blurred vision
- urinary obstruction
79
What are the 3 types of Nystagmus?
- Downbeat Vertical Nystagmus
- Peripheral Nystagmus
- Central Nystagmus
80
Is Downbeat Vertical Nystagmus pathologic?
yes, it is pathologic
81
Describe the eye movement with Peripheral Nystagmus?
move slowly in one direction and then rapidly to midline
82
What does Multidirectional or vertical nystagmus indicate?
it indicates a brainstem injury
83
What does nystagmus without vertigo indicate?
it indicates a central lesion
84
What are the characteristics of Peripheral Nystagmus?
- sudden onset
- fatigue symptoms
- horizontal movement with rotary component
- vertigo is common
- enhanced by loss of visual fixation
- usually temporary
- Also: N/V, tinnitis, and decreased hearing
85
What are the characteristics of Central Nystagmus?
- slower onset
- no fatique
- Vertical > Horizontal nystagmus
- may not have vertigo
- no change with loss of visual fixation
- may be permanent
86
What is Barotrauma?
the inability to equalize barometric stress on the middle ear, resulting in pain
87
What is the etiology of Barotrauma?
auditory tube disfunction
88
What are the S/Sx of Barotrauma?
most likely to occur during an airplane descent, rapid altitude descent, or underwater diving
89
What is the Tx for barotrauma?
- frequent swallowing or yawning to auto inflate the tube
| - +/-decongestants
90
What are the complications for barotrauma?
middle ear infection
91
What is another term for Acoustic Neuroma?
Vestiblular Schwannoma
92
What is an Acoustic Neuroma or Vestibular Schwannoma?
tumor of the Eighth Cranial Nerve
93
What type of hearing loss does and Acoustic Neuroma cause?
sensorineural hearing loss
94
Does an Acoustic Neuroma cause dizziness?
it takes the form of continuous dysequilibrium than episodic vertigo
95
How does an acoustic neuroma Dx?
MRI
96
What is the Tx for an acoustic neuroma/Vestibular Schwannoma?
surgery
97
What are the S/Sx of a Viral Rhinitis?
- watery rhinorrhea, sneezing
- Nasal congestion, headache
- Scratchy throat, general malaise
98
What are the etiology of Viral Rhinitis?
- rhinoviruses
- adenoviruses
- RSV
99
What are the PE findings for a Viral Rhinitis?
- reddened, edematous mucosa
| - watery discharge
100
What are the Tx for Viral Rhinitis?
- decongestants
- nasal sprays
- hydration
101
What is a another name for Allergic Rhinitis?
Hey fever
102
What is the etiology of allergic rhinitis?
IgE hypersensitivity
103
Allergic Rhinitis is often associated with what other medical conditions?
- asthma
- eczema
- atopic dermatitis
104
What are the etiology for allergic rhinitis?
- pollens
- grasses
- ragweed
- dust
105
What are the S/Sx of allergic rhinitis?
- eye irritation
- erythema
- excessive tearing
- rhinorrhea
- sneezing
- dry cough
106
What are the PE findings for allergic rhinitis?
-pale and boggy nasal mucosa
| +/- polyps
107
What is the Tx for allergic rhinitis?
-Nasal corticosteroid sprays
- oral decongestants (pseudoephedrine)
- antihistamines,
- mast cell stabilizers (Nasacrom)
108
What is Vasomotor Rhinitis?
is a syndrome of nasal blockage and rhinorrhea without evidence of immunologic or infectious nasa disease
it involvers increased parasympathetic activity of the nasal mucosa
109
What are the factors that exacerbate Vasomotor Rhinitis symptoms?
- environmental temperature
- humidity
- stress
- smoke
- odors
- weather
- exercise
- alcohol
110
What is the Tx for vasomotor rhinitis?
-avoid the irritant
| +/- atrovent nasal spray
111
What is Rhinitis Medicatmentosa?
rhinitis caused by overzealous use of decongestant drops or sprays
112
How does overuse of decongestant drops or sprays cause rhinitis?
cause a rebound congestion
113
What are the S/Sx of Rhinitis Medicamentosa?
bogginess of the nasal mucosa associated with complaints of stuffiness and rhinorrhea
114
What is the Tx for Rhinitis Medicamentosa?
discontinue the irritant (the spray or drops)
115
What are the PE findings for a Viral Rhinitis?
- reddened, edematous mucosa
| - watery discharge
116
What are the Tx for Viral Rhinitis?
- decongetants
- nasal sprays
- hydration
117
What is a another name for Allergic Rhinitis?
Hey fever
118
What is the etiology of allergic rhinitis?
IgE hypersensitivity
119
Allergic Rhinitis is often associated with what other medical conditions?
- asthma
- eczema
- atopic dermatitis
120
What are the etiology for allergic rhinitis?
- pollens
- grasses
- ragweed
- dust
121
What are the S/Sx of allergic rhinitis?
- eye irritation
- erythema
- excessive tearing
- rhinorrhea
- sneezing
- dry cough
122
What are the PE findings for allergic rhinitis?
-pale and boggy nasal mucosa
| +/- polyps
123
What is the Tx for allergic rhinitis?
-Nasal corticosteroid sprays
- oral decongestants (pseudoephedrine)
- antihistamines,
- mast cell stabilizers (Nasacrom)
124
What is Vasomotor Rhinitis?
is a syndrome of nasal blockage and rhinorrhea without evidence of immunologic or infectious nasa disease
it involvers increased parasympathetic activity of the nasal mucosa
125
What are the factors that exacerbate Vasomotor Rhinitis symptoms?
- environmental temperature
- humidity
- stress
- smoke
- odors
- weather
- exercise
- alcohol
126
What is the Tx for vasomotor rhinitis?
-avoid the irritant
| +/- atrovent nasal spray
127
What is Rhinitis Medicatmentosa?
rhinitis caused by overzealous use of decongestant drops or sprays
128
How does overuse of decongestant drops or sprays cause rhinitis?
cause a rebound congestion
129
What are the S/Sx of Rhinitis Medicamentosa?
bogginess of the nasal mucosa associated with complaints of stuffiness and rhinorrhea
130
What is the Tx for Rhinitis Medicamentosa?
discontinue the irritant (the spray or drops)
131
What is Epistaxis?
nose bleed most commonly due to bleeding from Kiesselbach's plexus (anterior nasal septum)
132
What is the etiology of epistaxis?
- nasal trauma
- rhinitus
- drying
- alcohol use
- anticoagulants
133
What is the Tx for Epistaxis?
- direct pressure while sitting and leaning forward
- vasoconstricting nasal sprays
- nitrate stick
- nasal packing
134
What are Nasal Polyps?
pale, edematous, mucosally covered masses
135
What other medical conditions are nasal polyps associated with?
- commonly linked with allergic rhinitis
| - in children think cystic fibrosis
136
What is the Tx for nasal polyps?
- topical steroids
- surgery
- avoid aspirin if the patient has nasal polyps and a history of asthma, aspirin may precipitate bronchospasm
137
What are the pathogens that cause Actue Sinusitis?
- Strep pneumoiae & pyogenes
- H. influenzae
- Staph aureus
138
What are the risk factors for an Acute Sinus Infection?
- recent URI
- smoking
- foreign body
- rhinitis
139
What are the signs and symptoms of an Acute Sinus Infection?
-facial pain
-pressure over the sinuses
-referred pain to the upper teeth
-purulent nasal drainage with congestion
+/- fever, malaise
140
What are the PE exam findings for an acute sinus infection?
- tenderness to palpation
| - opacification with transillumination
141
What tests can confirm a Dx of an acute sinus infection?
- Sinus X-ray (water's view)
| - CT scan
142
What is the Tx for an Acute Sinus Infection?
- oral decongestants : pseudoephedrine
- nasal decongestant sprays
- topical heat, hydration, humidified vapor
-Oral Antibiotics : for 10 days
Amoxicilliin / Augmentin
Bactirm
Cephalosporin
143
What are the possible complications of an Acute Sinus infection?
- osteomylelitis
- orbital cellutitis
- covernous sinus thrombosis
144
Describe Glossitis.
red, smooth-surfaced tongue with loss of filform papliiae
145
What is the etiology of Glossitis?
```
1 drug reactions
2 autoimmune reactions
3 nutritional deficiencies
Niacin
riboflavin
vitamin E
```
146
What is Gossodynia?
burning and pain of the tongue
147
What is the etiology of Glossodynia?
- diabetes
- tobacco
- candidiasis
- drugs (diuretics)
148
Describe Thrush (Candidiasis)?
-creamy-white curd-like patches overlying erythematous mucosa
149
What is the etiology for Thrush?
Candida Albicans
150
What are the risk factors for Candidiasis (Thrush)?
- denture wearers
- dibilitation
- diabetes
- anemia
- chemotherapy
- antibiotics
- steroids
151
What are the signs and symptoms of Thrush (Candidiasis)?
painful, sore throat
152
What is the lab test to Dx Thrush?
wet prep with potassium hydroxide
153
What is the Tx for Thrush?
-Fluconazole
"swish and swallow"
-Ketoconazole
"swish and swallow"
154
What is an Apthous Ulcer?
AKA : canker sore
155
Describe the Apthous Ulcer appearance?
2mm-2 cm painful round ulcerations with yellow-grey fibrinoid centers surrounded by red halos
they are painful and last around 7 days, healing completely in 1-3 weeks
156
What is the Tx for an Aphthous Ulcer/ canker sore?
- symptomatic relief (orabase gel)
| - topical prednisone
157
What medication is associated with numerous ulcers?
Behchet's disesae
158
What is another name for oral herpes?
AKA : herpetic gingivostomatitis
159
What is the etiology for oral herpes?
herpes simplex virus type 1
160
What are the risk factors for Herpetic Gingivostomatitis?
- immunocompromised
- trauma
- emotional stress
- sunlight exposure
161
What are the S/Sx of oral herpes?
burning erythematous papules with vesicles that rupture
162
What lab test is used to Dx oral herpes?
+ Tzank smear & culture
163
What is the Tx for Oral Herpes?
antivirals
164
What is a Leukoplakia lesion?
- a white oral lesion that cannot be removed by simply rubbing the mucosal surface
165
What is a Leukoplakia lesion due to?
they are a response to chronic irritation : dentures, smokers, chew tobacco, ETOH, AIDS
166
What percentage of Leukoplakia lesions are precancerous?
10% of Leukoplakia are precancerous
167
Describe Erythroplakia?
- 90 % are precancerous
| - similar to leukoplakia with a definite erythematous component
168
What is oral cancer
Squamous cell carcinoma (90%)
169
What are the RF for oral cancer?
-alcohol and tobacco use
170
What is pharyngitis?
a sore throat caused by a virus or bacteria
171
What are the etiology for pharyngitis?
-GABHS (Group a B-Hemolytic Streptococcal)
-Viruses: coryza, often lack exudate, low grade fever,
+/- lymphadenopathy
- Neisseria gonarrhoea, mycoplasma, chlamydia, trachomatis
- Diphtheria (grey tonsillar pseudomembrane)
172
What are the S/Sx of pharyngitis?
- sever throat pain
- odynophagia
- lympthadenopathy
173
What are the S/Sx of GABHS?
- most common age 5-12
- Fever > 38 degrees
- tender anterior cervical adenopathy
- lack of cough
- pharyngotonsillar exudate
174
What are the Lab findings for GABHS?
-leukocytosis with left shift
| + rapid strep screen
175
What is the Tx for GABHS?
-penicillin (oral) for 10 days or erythromycin
176
What ae the complications for GABHS?
- scarlet fever/rheumatic fever
- glomerulonephritis
- rheumatic myocardits
- local abscess formations
177
What is the etiology for Mononucleosis?
-Ebstein-Barr virus (EBV)
178
What are the S/Sx for Mononucleosis?
- malaise
- sore throat
- odnophyagia
- marked lymphadenopathy
- hepatosplenomegaly
179
What are the physical exam findings for Mononucleosis?
-shaggy white-purple exudate
180
What Lab is used to Dx Mononucleosis?
+ Herophil agglutination test (Monospot)
| -elevated anti-EBV titer
181
What is the Tx for Mononucleosis?
-symptomatic
182
What antibiotic should be avoid with mononucleosis?
-ampicillin
183
What are the S/Sx for a Peritonsillar Abscess?
- trismus, fever, drooling, muffled voice
- sever sore throat, odynophagia, dysphagia
- deviation of the soft palate and "hot potato voice"
184
What is the Tx for a peritonsillar abscess?
-aspiration or incision and drainage
-parental antibiotics
+/- tonsillectomy
185
What is Sialadenitis?
acute swelling of the parotid or submandibular gland due to ductal obstruction
186
What is the etiology of Sialadenitis?
usually bacterial (staph aureus)
187
What are the S/Sx of Sialadenitis?
- increased pain and swelling with meals
| - pus may be massaged from the duct
188
What medical conditions are associated with Sialadentitis?
- dehydration
| - Sjogren's syndrome
189
What is the Tx for Sailadenitis?
- warm compresses
- lemon drops
- hydration
- gland massage
- antibiotics
190
What is Sialolithiasis?
- stone formation in the salivary gland duct
- WHARTON'S DUCT : submandibular gland
- Stenson's Duct : parotid gland
191
What are the S/Sx of Sialoithiasis?
- postprandial pain
| - local swelling
192
What diseases cause bilateral parotid gland enlargement?
- Sjogren's disease
- sarcoidosis
- DM
- Alcoholism
193
How frequent is Acute Epiglotitis?
now rare due to H. influenze vaccine
194
What is the etiology for acute epiglottis?
- bacterial is H. flu
| - viral
195
What are the S/Sx for acute epiglottis?
- rapidly developing sore throat
* ***Dysphagia****
* ***Drooling****
* ***High fever****
* ***Systemic toxicity****
- swollen, cherry-red epiglotitis
196
How is acute epiglottis Dx?
-x-ray shows "thumb print sign"
197
What is the Tx for acute epiglottis?
-IV antibiotics (cepaloporins) + dexamethasone
198
Describe Croup.
- laryngitis
| - tracheobronchitis with sub glottal edema and airway obstruction
199
What is the etiology of croup?
viruses
200
What are the S/Sx of croup?
- hoarseness
- inspiratory stridor
- brassy cough
- worse at night
201
What is the Tx for croup?
- systemic and inhaled steroids
- cold humidification
- aerosolized racemic epinephrine may help
202
What is the most common cause of hoarseness?
acute laryngitis
203
What are the etiology for acute laryngitis?
- usually viral
| - follows an upper respiratory infection
204
What is the Tx for Acute Laryngitis?
Tx is symptomatic
205
What are the causes of vocal cord paralysis?
- injury to recurrent laryngeal nerve : from surgery
- Unilateral : breathy hoarseness
- Bilateral : inspiratory & expiratory stidor
206
What are the neck masses?
- Brachial Cleft Cysts
| - Thyroglossal Duct Cyst
207
Describe a Brachial Cleft Cyst?
soft cystic mass along the anterior border of the sternomastoid muscle
208
What is the Tx for a Brachial Cleft Cyst?
surgical removal to prevent recurrence or carcinoma
209
Describe a Thyroglossal Duct Cyst?
remnant of the thyroid tissue causing a midline mass just below the hyoid bone
210
What is the Tx for a Thyroglossal Duct Cyst?
surgical excision
211
Acute sinusitis is most commonly caused by which 2 pathogens?
- Strep pneumoniae
| - haemophilus influenzae
212
Oral herpes is best treated with systemic or topical antiviral?
-topical is first line. Systemic antivirals will help but are only indicated for severe cases
213
A patient presents with several episodes of vertigo over the past several weeks. He has had intermittent unilateral hearing loss and a "blowing" in his ears. What is the most likely Dx?
Meniere's disease
214
White oral lesions which cannot be scraped off should make you thing of what Dx?
Oral leukoplakia
215
What type of hearing loss is associated with aging?
Sensory
216
Which is the most commonly affected sinus in acute sinusitis?
Maxillary
217
A patient presents with a hot potato or muffled voice. What is the most likely Dx?
peritonsilar abscess
218
What time frame are we talking about for chronic sinusitis?
> 3 months
219
List the time of year when each of the following allergens is most prominent : pollen, grass, mold, ragweed
- pollen tree and flower : spring
- grasses : summer
- mold and ragweed : fall
220
How long should pressure be applied to Tx epistaxis?
15 minutes
221
List four things that suggest group A beta hemolytic strep in a patient with pharyngitis?
- fever
- tender anterior cervical lymph nodes
- exudate in the throat
- no cough
222
A child presents with an erythematous sandpaper rash should make you think of what Dx?
Scarlet fever
223
In a patient with sensorineural hearing loss what will be the results of the Weber test?
patient will hear the sound louder in the unaffected ear
224
List 4 complications of untreated strep throat?
- Scarlet fever
- glomerulonephritis
- rheumatic fever
- local abscess
225
A patient presents with a round yellow ulcer in her mouth that is yellow-grey with a red halo. It is on the buccal mucosa and it is painful. What is the most likely Dx?
amphthous ulcers
226
A patient presents with drooling, with stridor and in tripod position. What's the Dx and how do you Tx it?
you Tx the epiglottis with a second or third generation cephalosporin like cefuroxime or ceftriaxone
227
White oral lesions which can be scrapped off leaving punctate bleeding should make you think of what Dx?
oral candida
228
What are the three possible Tx for peritonsillar abcess?
- needle aspiration
- I & D
- tonsillectomy
229
What virus causes mumps?
Paramyxovirus
230
How do you Tx allergic rhinitis?
intranasal corticosteroid and antihistamines
231
What is the Tx of choice for strep throat?
- penicillin
- amoxicillin
- erythromycin
232
A patient presents with unilateral hearing loss and a decrease in speech discrimination. She has also had difficulty with balance over the past week. What is the most likely Dx?
Acoustic neuroma
233
Acute swelling and pain in the cheek that increases at meals. What is the most likely Dx?
Sailadenitis (salivary gland infection)
| staph aureus
234
When is watchful wanting with a Dx of acoustic neuroma an appropriate plan?
the tumor is very slow growing. watching a small tumor in an elderly patient is appropriate Tx.
235
How do you administer the Weber hearing test?
tuning fork placed in the middle of the forehead
236
A 14 year old field hockey player presents with a prominent adenopathy, white purple exudates in the throat and palpable spleen. What is the most likely Dx?
Mononucleosis
237
How do you administer the Rinne hearing test?
place the tuning fork on the mastoid and then move it next to the ear
238
Describe the result of a Weber hearing test in a patient with conductive hearing loss.
patient will report the sound louder in the affected ear
239
An x-ray of the skull reveals coalescence of mastoid air cells. What is the most likely Dx?
Mastoiditis
240
After 7 days of sinusitis what antibiotic would you start?
Amoxicillin or bactrim
241
A 45 year old female complains of feeling the ground is rolling under feet at times. What is the most likely Dx?
vertigo
242
A patient with a history of smoking presents with a new onset of hoarseness. This has been persistent for the past two weeks. What is the most likely Dx?
Laryngeal squamous cell carcinoma
243
A patient presents with acute onset of continuous severe vertigo for the past five days. He does have a history of a URI 2 weeks ago. What is the most likely Dx?
Labrynthitis
244
What does Kiesselach's plexus refer to?
a group of vein's in the anterior nose which bleed a lot
245
Small grouped vesicles on the vermillion border should make you think of what Dx?
Herpes
246
What is the treatment for Mastoiditis?
-Mastoiditis is an infection of the mastoid bone secondary to otitis media
- Tx with IV cefazolin (Ancef)
- Myringotomy (whole to drain the middle ear)
- Excision of the mastoid bone if necessary
247
What is the most common intracranial tumor?
-Acoustic Neuroma (Vestibular Schwannoma)
248
Who gets an Acoustic Neuroma (Vestibular Schwannoma) ?
-occurs in males and females equally most often between the ages of 50 and 60
249
A 52 y.o. female presents with sudden unilateral hearing loss, and vertigo, and tinnitus. What test do order and what is the likely Dx?
- Dx is Acoustic Neuroma (Vestibular Neuroma)
| - order an MRI with contrast
250
What are the Tx options for an Acoustic Neuroma (Vestibular Neuroma)
- if older than 70 observe and get an annual MRI/Contrast
- surgical excision
- radiotherapy
251
Patient presents with intense ear pain, vesicle on the pinna, and left facial paralysis. What is the Dx and TX?
- Dx is Ramsay-Hunt syndrome, which is acute peripheral facial palsy, associated otalgia and vermicelli-like cutaneous lesions (caused by the herpes zoster virus)
- Tx is steroids, antiviral meds, and pain meds
252
50 y.o. presents with progressive hearing loss in her right ear. Tympanic membrane is normal. Weber's test lateralizes to the affected right ear. AC > BC of the left ear, on the right BC > AC. What is the Dx?
-conductive hearing loss, such as otosclerosiss
253
14 y.o. presents with severe nosebleeds from left nostril for 2 weeks. Exam shows a large reddish-brown mass within the posterior nasal cavity. What is the mass and Dx?
-Dx is Juvenile angiofibraoma, a benign vascular tumor that tend to occur in postpubescent males (13-21). Patients usually present with brisk unilateral epistaxis and biopsy is done if necessary in OR due to risk of hemorrhage.
254
What nasal condition if found in young kids is suggestive of cystic fibrosis?
- nasal polyps
| - get a sweat chloride test to confirm Dx of cystic fibrosis
255
Which is the most common site of epistaxis in adults?
- anterior septum from Kiesselbach plexus
- Tx: pinching the nose firmly, sitting upright, leaning slightly forward is helpful. Site of bleeding should be sought with a nasal speculum, topical nasal decongestant, and effective light source. Once bleeding site is located it should be cauterized with a silver nitrate stick.
256
In order, what are the three most common causes of chronic cough in adults?
- Post nasal drip syndrome (PNDS)
- asthma
- gastroeosphageal reflux
257
Elderly lady presents with slurred speech. When she sticks her tongue out it deviates to the right. Which cranial nerve is involved?
- Cranial nerve XII, Hypoglossal
| - increase in muscle tone of the innervated portion of the tongue pushes it to the weaker (contralateral side)
258
14 y.o. boy presents with unilateral tonsilitis. The tonsil has much increased in size since his visit 5 wks ago when he was tx for tonsillitis with amoxicillin. Exam shows enlarged right tonsil and ipislateral cervical adenopathy. What do you not want to miss and what do you do with him.
- dont miss Lymphoma or squamous cell carcinoma
| - send to ENT for tonsilectomy and biopsy
259
What ear drop antibiotic should you avoid if there is a chance of perforated tympanic membrane?
-do not give Neomycin preparations with a perforated typmpanic membrane as it can be neuro-ototoxic.
260
Otitis in a child with swelling behind the ear and a protruding ear, along with fever needs what tx?
- emergent referal to ENT
- extension of the infection from the middle ear to the mastoid air cells can lead to acute mastoiditis. Facial nerve can become inflamed and cause facial paresis.
261
24 y.o. presents with acute right facial paralysis. She awoke with this along with discomfort behind her right ear and weakness of her face. Exam in Normal. What is the Dx and tx?
- Dx is Bell's Palsy (CN VII, the facial nerve)
| - Tx is 10 day course of tapering dose steroids and antiviral meds as Bell's Palsy usually caused by a virus
262
Complaints of the bed spinning when turning in bed. Patient also has complaints of spinning occasionally when he turns his head to the right. What is the likely Dx?
- paroxysamal positional vertigo
| - (use the Dix-Hallpike maneuver to check for positonal vertigo)
263
Acute vestibular neuronitis and labyrinthitis are caused by what?
-Caused by viruses
- they cause temporary vertigo
- movement does not cause this vertigo
264
Central vertigo with associated unilateral hearing loss?
-acoustic neuroma on the VII cranial nerve
265
18 y.o. boy with hot potato voice, 4 days of sore throat and getting worse, pain with swelling and difficulty opening mouth. Dx?
-retropharyngeal abscess
266
The four Sx/sx of Acute Bacterial Sinusitis (ABS) ?
- purulent nasal discharge
- maxillary tooth or facial pain (especially unilateral)
- unilateral maxillary sinus tendernes
- sudden worsening of symptoms after initial improvement
