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NPLEX II TIA > ENT > Flashcards

ENT Flashcards

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1
Q

Causes of tympanosclerosis

A

Secondary to repeat trauma, infxn, perforations, and age

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2
Q

How does serous effusion present?

A

Bubbles/fluid line
Often associated with poor drainage of auditory tubes and middle ear and can allow bacteria to grow

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3
Q

What is an infectious process with bacterial overgrowth in middle ear?

A

Otitis media with prurulent effusion (OME)

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4
Q

What is bullous myringitis?

A

Vesicular infxn ON the TM
Viral in most cases, can be mycoplasma
Generally an indication to NOT rx abx

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5
Q

What do serous effusions, OME, and bullous myringitis have in common?

A

All have sequele of TM rupture

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6
Q

Conductive vs sensorineural hearing loss

A

conductive - can’t transmit sound waves;
kids/younger adults may seem better in noisy places, own voice is soft, visible abnormality (except in otosclerosis)

Weber - lateralizes to bad ear, Rinne BC > AC, AC=BC

SN - can’t neurologically process sound waves;

middle/later years, upper tones often lost, hearing worse in loud environment, own voice may be loud (they can’t hear it), problem not visible

Weber - Lateralizes to good ear, Rinne- AC > BC

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7
Q

Three tonsillar tissues

A

Lingual
Palatine
Pharyngeal (adenoid)

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8
Q

Ddx sore throat

A

Tonsillitis - inflammation of lymphatic tissue; usually self limited, rarely can cause airway issues

Pharyngitis - inflammation of pharynx and sometimes tonsillar tissues

Abscess - dangerous infxn in deeper tissues; can be deadly

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9
Q

Tonsillar swelling grades

A

Based on 25% each of oropharyngeal opening to midline

0 - none
4- tonsils touch in center

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10
Q

What are the major dangers of abscesses in the throat?

A

Sepsis
Airway obstruction

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11
Q

Different types of pharyngitis ***

A
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12
Q

Tx abscesses in throat

A

Abx
Dexamethasone

If not better > ENT drains

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13
Q

Centor criteria

A

Group A BH strep; should you test for strep

Exudates, tender ant cervical LA, fever, absence of cough, <15 (extra), 15-25

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14
Q

What is a thyroglossal duct cyst? How is it treated?

A

Midline swelling; goes all the way back to pre-vertebral area needs surgery

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15
Q

What is the most common congenital cyst formation in the neck?

A

Branchial cleft cysts (benign)

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16
Q

How do brachial cleft cysts present?

A

Large swellings on side of neck, pops out between scalenes when turns head

Benign, need to be removed

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17
Q

Etiologies of facial paralysis

A

Idiopathic (Bell’s palsy) - acute onset, viral prodrome
Trauma - sudden/acute
Herpes zoster - Ramsay hunt
Tumor - slow progression
Infxn/inflammation - mastoiditis, OM, Lyme, CN
Birth
Brain/CNS lesion

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18
Q

How is Bell’s palsy dx?

A

Only CN 7 involvement, hemiplegic paralysis

Otherwise, get imaging

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19
Q

Etiologies of epistaxis

A

HTN
Anticoags
Tumors (bleeding wont stop)

Trauma/surgery, barometric changes, structural deformities, inflammatory, tumor, HTN, hepatic/renal failure, coagulation disorders, drugs, valvular disorders

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20
Q

Epiglottitis presentation, dx, tx

A

H flu, BH strep
Sudden onset fever, drooling, toxic appearing

DONT OPEN THEIR MOUTH

Lateral cervical radiograph (thumbprint sign)

IMMEDIATE ER REFERRAL

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21
Q

Retropharyngeal abscess presentation, dx, and tx

A

Child/adult (trauma); fever, sore throat, stiff neck, no trismus (jaw spasm)

Lateral cervical radiograph or CT

Stabilize airway, surgical drainage, abx

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22
Q

Ludwig angina presentation, dx, and tx

A

Submaxillary, sublingual, or submental mass with elevation of tongue, jaw, swelling, fever, chills, trismus

Lateral cervical radiograph or CT

Stabilize airway, drain abscess, abx (penicillin, metronidazole)

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23
Q

Peritonsillar abscess presentation, dx, and tx

A

Swelling in peritonsillar region with uvula pushed aside, fever, sore throat, dysphagia, trismus

Cervical radiograph or CT
Aspiration of region with pus

Abscess drainage, abx

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24
Q

Presentation + etiology of laryngeal cancer

A

Tobacco smoke
30-50% has Mets at sx

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25
Presentation + etiology of upper respiratory polyps
Reactive nodes that rarely become cancerous Vocal cords of heavy smokers or singers, men
26
Presentation + etiology of Leukoplakia of larynx
Any hyperkeratotic lesion Benign or malignant, depends how much atypia present Strongly correlated with tobacco and alcohol
27
What is ear retraction?
TM retraction = pressure in external versus internal ear is imbalanced > dizziness, esp if uneven R to L
28
Abx generally used for ear complaints
Penicillins, macrolides Sometimes fluouroquinolones Macrolides and tetracyclines for mycoplasma
29
What are important things to consider in a pt with tinnitus?
Ototoxic drugs - salicylates (aspirin), cinchona alkaloids (quinine, quinidine), lots others Thyroid, adrenal issues Trauma
30
work up for dizziness/vertigo
BP/vitals, neuro exam, HEENT, chest and abdomen screening MRI in all recurrent cases, and all acute cases with no peripheral explanation CT sinuses CMP, CBC, RBC element profile
31
In terms of “red eye” - what findings should you key in on?
- pattern of injection (conjunctival, ciliary, or hemorrhagic) - level of (or presence of) pain (constant, with blinking, with movement) - visual disturbance - presence or level of photophobia
32
In terms of “red eye” - What are your common ddx?
Conjunctivitis (v, bac, all, toxic) Conjunctival hemorrhage Keratitis (corneal irritation) Corneal injury Iritis/uveitis Scleritis Acute glaucoma attack
33
Ciliary vs peripheral/conjunctival flush/injection
Ciliary - deeper Peripheral/conjunctival - peripheral vasculature Tells you if its “bad” or “good” red eye
34
Which types of red eye have ciliary vs conjunctival hemorrhage?
Conjunctival - conjunctivitis, sub conjunctival hemorrhage Ciliary - corneal injury or infxn, acute iritis, acute glaucoma
35
Name the pathology: Red eye with ciliary flush, cloudy cornea, plasmoid aqueous
Acute ant uveitis/iris in a pt with UC/IBD EMERGENCY > can cause blindness
36
Etiologies of acute uveitis
Trauma, inflammation in adjacent tissue, acute episode of a chronic condition (chrohns)
37
Etiologies of chronic uveitis
Systemic disease such as Bechets, IBD, juvenile RA, reiters, sarcoidosis, syphilis, TB, Lyme
38
Name the pathology: Red eye with diffuse ciliary injection and corneal clouding
Acute angle closure glaucoma Painful EMERGENCY to save eye and sight
39
Presentation of acute angle closure glaucoma
Fluid drain becomes blocked; ant chamber is shallow, filtration angle narrowed, iris may obstruct entrance of schlemm or pupil may become blocked Unilateral severe pain and rapid loss of vision Possible N/V Prodrome sx (transitory episodes of diminished visual acuity, colored halos around lights, pain in eye and head) Hazy cornea (hypopion), fixed mid dilated pupil, eye firm to palpation
40
Hallmark signs/sx of orbital cellulitis
Systemic signs/sx of infection and lid/EOM dysfunction EMERGENCY > CLOSE TO BRAIN
41
keratitis tx
Cornea involvement (MUST REFER TO EYE DR/ER) > can scar and blind
42
What is Hutchison sign?
Zoster coming down to nose > affecting CN to eye > can lead to blindness
43
Conjunctivitis presentation
No pain Clear cornea
44
Presentation, tx of retrobulbar (optic) neuritis
Pain on eye rotation Inflammatory disorder Typically self limited (NSAIDS) May indicate systemic dz (orbital cellulitis, recurrent neuritis > MS)
45
Presentation, tx of Ocular/atypical migraine
Pain with eye movement Photophobia Ddx by doing EOM in dark room
46
Normal fundus
Normal cup/disc, lateral to disc is macula
47
Eroded/large cup/disc ratio is indicative of what
Chronic Glaucoma
48
All forms of age related macular degeneration have initial common destructive changes in the _______-
Macular retinal pigment epithelium
49
Dry vs wet macular degeneration
Dry: RPE degeneration, vascular failure, loss of photoreceptors Wet: all of above plus neurovascular component (leakage of plasma, lipid, glucose into choroid and retina > fibrous disciform scar formation)
50
Vision loss patterns macular degeneration vs glaucoma
MD: central vision loss (dec in eye chart acuity and central on perimetry) Glaucoma: peripheral vision loss/“tunnel vision” (dec in peripheral vision on perimetry)
51
Nutrients/supp for macular degeneration
Taurine Zinc Selenium Antioxidants Carotenoids Vit C, E Vaccinum myrtilus, ginkgo biloba and crataegus
52
Arteriosclerosis vs atherosclerosis
ARTERIO - trouble with artery wall, “hardening of arteries” (small artery, big vein) ATHERO - atheroma or lesion inside vascular lumen
53
Changes seen in HTN retinopathy? Where else might you see these changes?
Hard leaking exudates, flame hemorrhage (blow out end of arterioles), cotton wool spots (scarred flame hemorrhages), papilledema, copper wire, silver wire HIV retinopathy, renal disease retinopathy
54
What is the pathophysiology behind diabetic retinopathy?
Excess sorbitol destroys pericyte cells that support vascular epithelium > inc leakage of blood, protein, lipids > vascular insufficiency > retinal hypoxia Release of angiogenic factors > neovascularization (poor quality, leak) > cont cycle
55
Retinal detachment presentation, dx, tx
Signs/sx: sudden onset single/multiple floating spots, flashes of light. Recent hx trauma to head/eye. Vitreous hemorrhage > multiple floaters. Vision loss Binocular indirect ophthalmoscopy EMERGENCY - lie supine and wait for transport to ER
56
Presentation, dx, tx posterior vitreous detachment
Due to aging and dec hyaluronic acid > lack of collagen integrity > vitreous collapses forward 50+, acute onset floaters with one large floating spot. If dec in vision > vitreous hemorrhage Direct referral for evaluation
57
Lipemia retinalis vs atherosclerosis
Atherosclerosis - only Arteries change color/lighten Lipemia - fat in all of the tree from high blood lipids
58
Presentation, dx, tx
Hereditary degenerative process of rod cells Slow progressive BL loss of night vision > dec central vision. Ring scotoma on perimetry, “bone spicule” pigment changes No tx, some use Vit A - AVOID Vit E
59
Common bugs blepharitis
Staph or strep
60
What is a hordeolum?
Stye; painful tender red infection around hair follicle on eyelid margin of eyelashes External: glands of zeis or moll Internal: meibomian glands
61
What is parotitis?
Infection of parotid gland; viral/mumps most common
62
What is herpangina?
Acute febrile illness associated with small vesicles on post oropharyngeal structures (soft palate, uvula) Occur during summer, typically mild and self limiting
63
Etiologies of glossitis
Iron def Pellagra B12/folate def Scurvy Scarlet fever EBV associated hairy leukoplakia
64
What is stomatitis?
Canker sore
65
Work up and tx for oral thrush
KOH wet punt with hyphae, pseudo hyphae, budding yeast cells Tx: nystatin, fluconazole if severe
66
What are the forms of oral cancer?
Gingival, tongue, tonsillar
67
Presentation, tx of Meniere dz
Progressive condition affecting labyrinth > vertigo, tinnitus, hearing loss episodes No sure, sx management only
68
What is a Cholesteatoma?
Desctructive and expanding growth of keratinizing squamous epithelium in the middle ear and/or mastoid process
69
Causes and sx of retinal hemorrhage
Diabetic retinopathy Retinal vein occlusions Ocular ischemic syndrome Sickle cell retinopathy Sx: floaters
70
What is CMV retinitis? What is the presentation and workup?
Retinitis most common manifestation in pts who are HIV+ Blurred vision, floaters, progressive blinding, necrotizing retinitis with retinal hemorrhage, esophagitis, ulcers, colitis, fever Culture, PCR, exam shows “cottage cheese and ketchup”
71
retinoblastoma
white pupillary reflex (leukocoria) vision problems

NPLEX II TIA (21 decks)

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