EENT (PEARLS and BOARD REVIEW)

Question 1

Recurrent painful inflammation of the cartilage of the external auricle.

Answer 1

Polychondritis

Question 2

How do you tell whether it’s polychondritis or cellulitis?

Answer 2

The lobule is NOT involved in polychondritis.

Question 3

How do you treat polychondritis?

Answer 3

Prednisone (steroid)

Question 4

Bacteria that causes otitis externa are likely what?

Answer 4

GRAM negative rods (pseudomonas, proteus)

Question 5

How do you treat OE?

Answer 5

abx/steroid drops (be careful with neomycin because it can cause ototoxicity if the eardrum is ruptured).

Question 6

What do you treat resistant OE with?

Answer 6

Fleuroquinolones (Cipro)

Question 7

A pt has retracted TM with decreased mobility of the TM. They feel aural fullness, hearing issues, popping/clicking noises, and discomfort with pressure changes. What is this? How might you treat it?

Answer 7

Auditory tube dysfunction. Treat for rhinitis (decongestant)

Question 8

Treatment for serous otitis media?

Answer 8

Short course of oral steroids

Question 9

What is your biggest concern if you find hemotympanum?

Answer 9

Basilar skull fracture

Question 10

Traumatic TM perforations treatment?

Answer 10

Usually resolve. Can consider ABX (water caused, etc). and referral.

Question 11

Top causes of acute OM

Answer 11

Strep pneumo/pyogenes, h. flu, mycoplasma

Question 12

Main complication of untreated/unresolving acute OM

Answer 12

Mastoiditis or osteomyelitis

Question 13

Treatment for acute OM

Answer 13

Amoxicillin or erythromycin. Consider decongestant.

Question 14

Treatment for acute OM if unresolved with abx or if recent abx

Answer 14

Augmentin.

Question 15

A pt presents with post auricular pain, swelling, erythema, and fever. Had recent OM

Answer 15

Acute mastoiditis

Question 16

What is the classic physical feature of acute mastoiditis?

Answer 16

Displacement of pinna anteriorly.

Question 17

Tx for acute mastoiditis?

Answer 17

IV abx, myringotomy for culture and drainage, possible complete mastoidectomy.

Question 18

What if a pt you suspect has had a recent bout of acute mastoiditis presents with signs of increased ICP?

Answer 18

Possible septic thrombophlebitis due to trapped infection within the mastoid air cells.

Question 19

Green drainage from ruptured TM.

Answer 19

Pseudomonas

Question 20

Complication of chronic OM

Answer 20

Cholesteatoma.

Question 21

Tx for chronic OM

Answer 21

Topical abx, oral floxin, keep ears dry, may need surgical reconstruction.

Question 22

What is it when a person has auditory tube dysfunction which causes a negative pressure drawing the upper portion of the TM inward creating a sac lined with epithelium?

Answer 22

Cholesteatoma

Question 23

Should you refer a cholesteatoma?

Answer 23

Yes

Question 24

Weber test lateralization to one ear means what?

Answer 24

Either conductive loss in LOUD ear or sensorineural loss in OTHER ear. (Can’t hear same ear or Sucky Senses other ear)

Question 25

Rinne Test explanation.

Answer 25

Should hear (conductive) sound 2 x longer than hear (sensorineural) sound. AC > BC is normal UNLESS there is > 2:1 ratio. If it is MORE than 2:1, there may be sensorineural loss. If BC > AC then loss may be conductive.

Question 26

T/F. Sensorineural hearing loss is usually symmetric.

Answer 26

TRUE

Question 27

What is the most common type of sensorineural hearing loss?

Answer 27

Presbycusis (age related hearing loss)

Question 28

What CN is affected by a acoustic neuroma?

Answer 28

8th cranial nerve

Question 29

Another name for an acoustic neuroma?

Answer 29

Vestibular schwannoma

Question 30

A pt has unilateral hearing loss, loss of speech discrimination, tinnitus, and chronic disequilibrium.

Answer 30

Acoustic neuroma

Question 31

Meniere syndrome. Another name? Lasts? Sx? Test? Tx?

Answer 31

Endolymphatic hydrops, lasts 1-8 hours, fluctuating low frequency hearing loss, cold water calorics testing shows alteration of nystagmus on AFFECTED side, treat with low sodium diet, thiazide diuretics, antiemedics (for nausea)

Question 32

Acute labyrinthitis. Lasts? Sx? Situation? Tx?

Answer 32

Acute onset of continuous severe vertigo lasting days to a week. Accompanied by hearing loss and tinnitus. Often follows a URI. Treat with antihistamines, anticholinergics, sedative-hypnotics.

Question 33

Free floating otoconia in the semicircular canal.

Answer 33

BPPV

Question 34

T/F. Acute vertigo with BPPV usually only lasts a few seconds to a minute but pts can feel unbalanced or hours.

Answer 34

TRUE

Question 35

Maneuvers for treating BPPV

Answer 35

Epley maneuvers

Question 36

Where does anterior epistaxis usually originate from?

Answer 36

Kiesselbach's plexus

Question 37

What causes nasal vestibulitis?

Answer 37

This is cellulitis or folliculitis of the hairs within the nasal vestibule. Usually staph a.

Question 38

A black necrotic eschar found in the nose.

Answer 38

Rhinocerebral mucormycosis

Question 39

What is it when a deadly fungus invades through the vascular channels?

Answer 39

Rhinocerebral mucormycosis

Question 40

You see "cobblestoning" down the throat and have a patient with allergic shiners, and pale/violaceous mucosa

Answer 40

Allergic rhinitis

Question 41

A pt has pale, boggy masses of hypotrophic tissue that looks a lot like "peeled grapes"

Answer 41

Nasal polyposis

Question 42

When do you commonly see nasal polyposis

Answer 42

With allergic rhinitis

Question 43

A pt with a history of asthma AND nasal polyposis. What are you thinking with regard to allergies? What triad is this?

Answer 43

Allergy to ASA! Samter triad.

Question 44

What is the treatment for nasal polyposis?

Answer 44

Intranasal steroids for 1-3 months

Question 45

Most common causes of viral rhinitis/rhinosinusitis

Answer 45

Adenovirus, rhinovirus.

Question 46

What can overuse of decongestions cause?

Answer 46

Rhinitis medicamentosa

Question 47

How often can parents expect to have their child get a URI per year?

Answer 47

6 episodes.

Question 48

How often do adults get URI's each year?

Answer 48

1-3 episodes.

Question 49

URI symptoms that persist >7-10 days.

Answer 49

Sinusitis

Question 50

Sx of sinusitis

Answer 50

UNILATERAL pain over the maxillary sinus, toothache, fever, swelling, watery/purulent discharge .

Question 51

What type of image should you perform for a dx of sinusitis?

Answer 51

Coronal CT. NOT sinus XR

Question 52

Guidelines for treatment of sinusitis?

Answer 52

Sx persistent or unimproved > 10 days, severe for > 3-4 days, or double sick > 3-4 days

Question 53

Tx for sinusitis

Answer 53

Augmentin, amox, or 1st gen ceph.

Question 54

Parameters of subacute chronic sinusitis

Answer 54

Persist 4-12 weeks LESS than 4 x yearly

Question 55

Parameters of subacute chronic sinusitis

Answer 55

Persist more than 4 weeks more than 4 x yearly

Question 56

A pt named YOUNG PERSON name VINCENT comes in with halitosis, bleeding, gum pain, and fever.

Answer 56

Acute necrotizing gingivitis aka VINCENT gingivostomatitis

Question 57

Acute necrotizing gingivitis aka VINCENT gingivostomatitis is caused by what bacteria?

Answer 57

Borrelia or fusobacterium

Question 58

Treatment for acute necrotizing gingivitis aka VINCENT gingivostomatitis

Answer 58

Oral PCN, peroxide rince, gingival curettage.

Question 59

A pt has hoarseness for > 2 weeks, persistent throat/ear pain, neck mass, hemoptysis, stridor. What do you want to do?

Answer 59

CT or MRI asap. Biopsy at laryngoscopy. Concern for squamous cell carcinoma of the pharynx.

Question 60

What STI is associated with oral cancers?

Answer 60

HPV

Question 61

What is the most common malignancy of the pharynx?

Answer 61

Squamous cell carcinoma

Question 62

What is the most common cause of sore throat?

Answer 62

Viral pharyngitis

Question 63

A pt with fever, tender cervical lymph nodes, NO cough, tonsilar exudates.

Answer 63

Group A beta h. strep pharyngitis

Question 64

A pt has a odynophagia, trismus (tight jaw), severe soar throat, "hot potato" voice.

Answer 64

Peritonsilar abscess. May also have medial deviation of soft palate.

Question 65

Treatment for peritonsilar abscess.

Answer 65

Aspirate, I&D, abx (IV or oral), tonsillectomy

Question 66

What will you see with mono?

Answer 66

Marked lymphadenopathy, occipital nodes, "shaggy" tonsilar exudate, severe fatigue, splenomegaly.

Question 67

How should you test for mono?

Answer 67

Monospot or elevation in anti EBV.

Question 68

What other pathology do 1/3 people with mono have?

Answer 68

Strep

Question 69

What medication should be avoided in treating somebody with mono and strep?

Answer 69

Ampicillin

Question 70

What activities should be avoided if a pt has mono?

Answer 70

Contact sports

Question 71

Pt presents with sore throat, nasal discharge, and malaise. You notice tenacious gray membranes on his pharynx.

Answer 71

Diphtheria

Question 72

What is the concern with diphtheria?

Answer 72

Exotoxin production that can cause myocarditis/neuropathy.

Question 73

Sialothiasis are what?

Answer 73

Calculus formations in the Wharton and Stensen ducts.

Question 74

Sialadenitis is what?

Answer 74

Bacterial infection of a salivary gland.

Question 75

Most common etiology of sialadenitis?

Answer 75

Staph aureus.

Question 76

Parotitis is commonly seen in what other diseases?

Answer 76

Metabolic disorders, sjogrens, etOH, sarcoidosis, DM

Question 77

Grayish/white, irregular hyperkeratotic plaques.

Answer 77

Leukoplakia

Question 78

Velvety-red hyperkeratotic plaques.

Answer 78

Erythroplakia

Question 79

Which can progress to squamous cell cancer? Leukoplakia or Erythroplakia?

Answer 79

Erythroplakia.

Question 80

Most common oral cancer?

Answer 80

Squamous cell

Question 81

Most lip cancers occur on the top/bottom lip?

Answer 81

Bottom.

Question 82

Half all intraoral cancers occur on the...?

Answer 82

Tongue

Question 83

What is the deep neck infection/cellulitis of the sublingual and/or submandibular spaces?

Answer 83

Ludwig Angina

Question 84

Most common offending organisms in Ludwig angina

Answer 84

Strep, staph

Question 85

Most important intervention with Ludwig angina.

Answer 85

Emergency!!! These patients with have fever, edema of the upper neck, possible airway obstruction by displacement of tongue.

Question 86

A pt has a soft cystic mass on the ANTERIOR BORDER of the sternocleidomastoid (lateral neck).

Answer 86

Brachial cleft cyst

Question 87

A pt has a soft cystic mass on the MIDLINE of the neck that MOVES with swallowing.

Answer 87

Thyroglossal duct cyst

Question 88

Tx for brachial cleft cysts and thyroglossal duct cysts?

Answer 88

ABX and surgical removal of cyst.

Question 89

Painful swollen red lump on eyelid. What? Etiology? Treatment?

Answer 89

Hordeolum caused by STAPH A. Treat with warm compress. May add erythromycin or bacitracin ointment if actively draining. I&D if it doesn't drain within 48 hours.

Question 90

Inflammation of BOTH eyelids with crusting, scaling, RED RIMMING and eyelash flaking.

Answer 90

Blepharitis. If it's ANTERIOR it will involved the eyelashes. If it's POSTERIOR it will involved the meibomian gland.

Question 91

How would you treat blepharitis?

Answer 91

Anterior = warm compresses, eye hygiene, scrubbing with baby shampoo and/or applying abx ointment. Posterior = Eyelid massage. Express the meibomian gland regularly.

Question 92

Hard NON TENDER eyelid swelling with large firm granuloma. What is it? What will you do?

Answer 92

Eyelid hygiene, warm compresses. May inject steroids in large ones

Question 93

Tender, redness, swelling to nasal side of lower eyelid. What is it? Cause? Treatment?

Answer 93

Dacrocystitis. Caused by Staph A, GABHS. Treat with systemic abx (clindamicin or 3rd gen ceph)