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PANRE 2016 > ENT > Flashcards

ENT Flashcards

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1
Q

in CHL Weber test lateralizes to what ear? What is the Rinne finding?

A

Affected ear for Weber. BC>AC for Rinne

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2
Q

In SNHL what are the Weber and Rinne findings?

A

Weber - lateralizes to unaffected ear, Rinne AC>BC

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3
Q

Retraction of TM or a perforation with visible keratin coming out or granulomatous tisse. What is is caused by? Tx?

A

Cholesteatoma. Chronic OM with effusion. Refer for surgical repair

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4
Q

Abnl growth of bone on stapes causing CHL first then SNHL - often hereditary

A

Otosclerosis

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5
Q

Anatomic cause of SNHL

A

Detioration of cholear hair cells or lesions in CN8 pathway

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6
Q

What meds are ototoxic?

A

Aminogylcosides, Vancomycin, Lasix, Cisplatin, ASA

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7
Q

Unilateral hearing loss (gradual or sudden), tinnitis and continuous disequilibrium

A

Acoustic Neuroma

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8
Q

Presents with TM perforation, vertigo, hemotympanum or SNHL. Pt was just on a flight or scuba diver

A

Barotrauma

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9
Q

How to prevent barotrauma

A

yawning, autoinflation, swallowing

or topical/systemic decongestants

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10
Q

Pt presents with popping/crackling, aural fullness, mild-moderat hearing loss and suffers from allergies or just had a cold. How does TM look on exam? Tx?

A

Eustachian tube dysfunction. Retracted TM, tx with antihistamines and anti-inflammatoy meds

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11
Q

Tx of foregn body in ear canal?

A

Animate - mineral oil or lidocaine and extract

Inanimate - attempt removal or refer to ENT for removal

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12
Q

Tx of auricular hematoma?

A

I&D and compression

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13
Q

Complication of repeat trauma to ear cartilidge

A

Cauliflower ear

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14
Q

Pathogens for mastoiditis

A

Typically S. pneumoniae / H. influenza (related to AOM) or S. pyogenes
(related to pharyngitis)

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15
Q

Infection of mastoid air cells that typically occurs after

untreated AOM

A

Mastoiditis

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16
Q

presents with fever, postauricular erythema, and pain. What test to order?

A

Mastoiditis - CT scan reveals coalescence of mastoid air cells due to destruction of
their bony septa

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17
Q

Presents with otalgia, hearing loss, discharge, bleeding, dizziness or nystagmus (depending on extent of injury) Tx?

A

TM perforation - Usually heal spontaneously, monitor for secondary infection

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18
Q

How do you evaluate and tx tinnitis?

A

Audiometry, MRI +/- venography,

Tx - avoid noise or ototoxic agents, hearing aid may help

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19
Q

What med can be used for tinnitis?

A

Oral antidepressants (nortriptyline)

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20
Q

Acute onset of continuous, severe vertigo lasting days to

weeks with hearing loss and tinnitus - usually following a URI

A

Labyrinthitis

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21
Q

Tx of Labyrinthitis

A

Symptoms typically resolve over weeks, however hearing loss may be permanent.
Tx - supportive measures – meclizine or promethazine

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22
Q

Distention of endolymph compartment of inner ear

A

Meriere Syndrome

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23
Q

Episodic vertigo (20 min to several hours), low
frequency SNHL, tinnitus and sensation of unilateral
aural pressure

A

Meniere Syndrome

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24
Q

Tx of Meriere Syndrome

A

Treatment:
– Decrease dietary sodium
– HCTZ and meclizine
– Referral to ENT

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25
Recurrent episodes of vertigo; associated with changes in position of head and possibly nausea/vomiting; gait instability
BPPV
26
Tx of BPPV
Meclizine and diazepam
27
Pathogens for acute Sinusitis
• Bacteria pathogens – S. pneumoniae, H. influenza, M. catarrhalis and S. aureus • Viral: rhinoviruses, adenoviruses, influenza/parainfluena
28
Most commonly caused by viral infections associated with viral URI, but may follow an allergy exacerbation
Acute sinusitis
29
URI symptoms: purulent rhinorrhea, maxillary tooth pain, nasal obstruction, facial pain,(pressure or fullness) Nasal cavity/turbinate edema
Acute Sinusitis
30
Test for sinusitis
– Plain films have poor sensitivity and specificity | – CT helpful in severe cases
31
Tx of acute sinusitis
Symptomatic – Pain management (NSAIDS, APAP, or opioid) – Nasal saline (Neti pot) – Intranasal steroids in the first 5 days – Short course nasal or systemic decongestants May use anitbiotics: May be considered in patients with: • Acute sinusitis that does not improve within 7 days or that worsens at any time • Moderate to severe pain or T ≥ 101° F • Immunocompromised patients
32
First line tx for acute sinusitis
1st line (7-10 days) • Amoxicillin • TMP-SMZ or Doxycycline (PCN allergic)
33
Second line tx for acute sinusitis
2nd line (10 days) – if no improvement • Amoxicillin-clavulanate (after 3 days of 1st line) • Moxifloxacin (after 3 days of 1st line)
34
Complications of Acute Sinusitis
``` • Bony complications – Osteomyelitis (frontal sinus osteomyelitis – Pott Puffy Tumor) • Orbital complications – Preseptal/periorbital/orbital cellulitis – Cavernous sinus thrombosis • Intracranial complications – Meningitis – Epidural/subdural/cerebral abscesses ```
35
Presents with H/A, nasal congestion, sneezing or pruritis, clear rhinorrhea and increased lacrimation in the spring
allergic rhinitis
36
Tx of allergic rhinitis
1st line: Intranasal steroids – (ex. Fluticasone (Flonase), mometasone (Nasonex) 2nd line options - combination therapy may be indicated for severe/persistent symptoms • Oral antihistamines (1st generation – diphenhydramine, 2nd generation – loratidine, desloratidine, fexofenadine) • Intranasal antihistamines – Azelastine (Astelin) and olopatidine (Patanase) currently available • Sympathomimetics (decongestants) – Topical not recommended due to possibility of rhinitis medicamentosa (tachyphylaxis & rebound nasal congestion) • Intranasal cromolyn • Montelukast (Singulair) • Immunotherapy
37
Epistaxis occurs from trauma to what?
Kesselbach’s plexus in anterior septum | – Also think about cocaine use, sinusitis, leukemia, coagulation disorders
38
Yellowish, boggy masses of hypertrophic mucosa, nasal | congestion and decreased sense of smell
nasal polyps - often in pt's will atopy or allergies - think CF in kids
39
Acute pharyngitis - viral vs bacterial causes
``` 80% are viral in etiology viral: Rhinovirus, adenovirus, enterovirus, EBV and HSV bacterial: GABHS, mycoplasma, gonococcal ```
40
pt presents with fever, acute sore throat, adenopathy, tonsillar edema, erythema and exudate, scarlatina rash – Absence of conjunctivitis and cough
strep pharyngitis
41
Centor criteria for strep pharyngitis
``` Centor criteria – Fever over 38°C – Tender anterior cervical lymphadenopathy – Tonsillar exudate – Lack of a cough tx if 3-4 criteria rapid strep if 1-2 criteria ```
42
Tx of strep pharyngitis
PenVK or cefuroxime | • Azithromycin/Clarithromycin or erythromycin in penicillin allergic patients
43
``` Presents with severe sore throat, pain on swallowing or opening mouth (trismus), deviation of soft palate and uvula and a muffled voice Dx and tx? ```
Peritonsillar abscess Tx: Aspiration and drainage, and antibiotics – amoxicillin, amoxicillin-sulbactam, and clindamycin
44
presents with fever, throat pain and pain with swallowing - sitting in sniffing position
Epiglottitis
45
“thumbprint sign” on Lateral ST neck film
Epiglottitis
46
Tx of epiglottitis
IV antibiotics, IV steroids,admit and possible intubation
47
Single or multiple small shallow ulcers with yellow grey fibrinoid centers with red halos found on labial and buccal mucosa
apthous ulcers
48
what causes apthous ulcers?
unknown but HSV 6
49
Tx of apthous ulcers
viscous lidocaine, topical or oral steroids
50
what med can be used for maintenance tx of apthous ulcers
cimetadine
51
white patches in mouth that can be scraped off
oral candidiasis
52
tx of oral candidiasis
oral antifungal
53
tx or oral HSV
oral antiviral
54
fixed white lesions that can't be scraped off
oral leukoplakia
55
causes of oral leukoplakia
chronic irritation in tobacco users and denture wearers
56
leudkoplakia or erythroplakia think
oral squamous cell CA
57
pt's at risk for oral squamous cell CA
tobacco users and use of alcohol
58
tx of benign migratory glossitis
goes away on it's own
59
red smooth surfaced tongue
glossitis
60
causes of glossitis
``` nutritional deficiency (niacin, riboflavin, vit E), chemo, dehydration -if unsure of cause tx for nutritional deficiency ```
61
redness and swelling of gumline
gingivitis
62
tx of gingivitis
brush, floss, cleaning q 6 mths
63
dental abscess - cause, dx, tx
from a cavity, exam and Xray, refer to dentist - PCN or clindamycin
64
most common cause of hoarseness
acute laryngitis
65
cause of acute laryngitis
almost always viral - following an URI - like 1 week after
66
tx of acute laryngitis
rest vocal cords and symptomatic treatment
67
new and persistent hoarseness > 2 weeks (in a smoker), hemoptysis, persistent throat or ear pain with swallowing
laryngeal squamous cell CA
68
risk factors for laryngeal CA - dx, tx
smoking and HPV (non-smokers), bx and CT/MRI, radiation and surgery and possibly chemo
69
acute swelling, increased pain and swelling with eating
sialadentis
70
what glands most often affected with sialadentis
parotid
71
causes of sialadentis
dehydration and chronic illness
72
cause of sialadentis
s. aureus
73
tx of sialadentis
rehydration, warm compresses, massage, and antibiotics (nafcillin, clindamycin or augmentin
74
calculus in salivary gland
sialolithiasis
75
most common duct for sialolithiasis
Wharton's duct (drains submandibular gland)
76
two ducts affected by sialolithiasis
Wharton's and Stenson's
77
what drains submandibular gland
Wharton's duct
78
what drains parotid gland
Stenson's duct
79
postprandial pain and localized swelling
sialolithiasis
80
tx of sialolithiasis
refer to ENT
81
most common location of salivary gland tumors
parotid gland (80%)
82
symptom of salivary gland tumor
asymptomatic swelling
83
tx of salivary gland tumor
refer to ENT
84
young person with gingival inflammation & necrosis, bleeding, pain, halitosis, fever, cervical lymphadenopathy
necrotizing ulerative gingivitis aka trench mouth
85
cause of necrotizing gingivitis and tx
caused by stress tx: salt water +/- peroxide rinses, oral hygiene, oral penicillin

PANRE 2016 (2 decks)

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