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Flashcards in ENT Deck (45):
1

Weber test

fork on center of head and see if sound laterizes

Conductive Hl--> lateralizes to affected ear
Sensory neural--> lateralizes to to unaffected ear

2

Rinne test

fork on mastoid until vibrations no longer felt and up to ear ( should continue to hear)

bone-> air= CHL
Air > bone = SNHL

3

conductive hearing loss
etiologies

dz of external ear canal, TM, or ossicles
causes: cerumen impaction, eustachian tube dysfunction with URI, AOM/middle ear effusion, TM perforation,

4

cholesteatoma

upper flaccid portion of TM is drawn inward from chronic pressure d/t eustachian tube dysfunction --> keratinization of middle ear and chronic infection
PE: retractions in the TM, perforation with keratin
complication with chronic OM
TX: refer to ENT for surgical repar

5

otoscleoris

abn growth of bone on stapes
females > males
hereditary
tx; refer to ENT

6

SNHL
why its happens

deterioration of cochlear hair cells or lesions CN 8 pathway

causes: hight frequency age-related hearing loss
trauma, ototoxic ( van com, cisplatin), Menier syndrome, auto immune ( lupus)

7

acoustic neuroma

CN 8 - bening intracranial tumor
causes hearing loss
unilateral , gradual
do mRI
tx: refer to ENT for observation , excision, radiotherapy

8

barotrauma

injury to ear
scuuba diver, pilots
prevent with yawning, auto inflation, swelling, decongestant
tx: via myringotomy

9

dysfunction of eustachian tubes

frequent with URI/ allergic
popping/ cracking, aural fullness
PE: retracted RM with decreased mobility
tx: anti-histamin/ anti-inflammatory

10

foreign body

h/o : otalgia, CHL
tx: animate: mineral oral or lidocaine and extract object
inanimate object: attempt to removal or may refer to ENT for microscopic removal

11

auricular hematoma

blunt trauma
erythema, swelling at pinna
tx; I and D followed by compression dressing
f/u to ensure complex hematoma
anti-staph abx
complication: destruction of cartilage

12

mastoiditis

infection of mastoid cells after untreated AOM
- s. pneumo, h/ flu
s/s: fever, post auricular erythema, pain
testing: myringotomy for culture of middle ear fluid
CT
tx; IV cefazolin +/- surgery for drainage

13

TM perforation

trauma, impact
s/sx: otalgia, hearing loss, d/c bleeding, dizziness
spontaneous, monitor for infection
refer to eNT if continued dizziness, delayed TM healing

14

tinnitus

abn persistent ear or head noises
check for hearing loss
evolution; audiometry r/o HL
pulsatile- check for aneurysm
MRI
tx: avoid excessive noise
avoid ototoxic med
music
nortripyline

15

vertigo

sensation of movement without movement or exaggerated response to body movement
evaluation; full neuro exam 9 Rhomber, gai, nystagmus, Dix-Halpike)
if cause from peripheral source--> ENT
don't miss cerebella ischemia
tx: base on underlying etiology
acute sxs: meclizine, diazepam, scopolamine

16

central vertigo

causes: brainstem vascular issues, AV malformation, MS, vertebrobasiliar migraine

sxs; more gradual onset and vertical nystagmus
no auditory sxs
commonly with motor/sensory /cerelbellar deficit

17

peripheral vertigo

causes: labyrinthitis, BPPV, endolymphatic hypos, vestibular neuritis

sxs; sudden onset, n/v, hearing loss, and nystagmus ( horizontal with rotary component)

18

labyrinthitis- type of peripheral vertigo

acute, continuous, severe vertigo associated with HL and tinnitus
sxs resolve over weeks
tx: mezclizine

19

Menieresyndrome

endolymph compartment of inner ear

sxs: episodis vertigo, low frequency HL, unilateral aural pressure

tx: decrease sodium, HCTZ, meclizine

20

BPPV

recurrent episodes associated with changes in position, n/v
tx; meclizine/ diazepam

21

acute sinusitis

pathophys and common bacteria

viral URI, allergic
inflammation from URI causes obstruction and infected

bacterial: strep pneuma. . H. flu, M catarrhalis, s. aura

22

acute bacterial sinusitis

sx: URI sxs, purulent rhinorrhea, tooth pain
signs: nasal cavity, turinate team
testing: plain films, CT in sever cases

tx; analgesics, neti pot, intranasal steroids X 5 days, abx tx> 7 days, worsen
immunoscomprimised status

1st line; amor, bacterium, doxycycline
levaquin/ augmentin
2n line: augmentin

complication: osteomyelitis, meningitis, epidural/ subdural abscesses

23

allergic rhinitis

IGE mediated--> histamine

perenial- dust, dander, molds
seasonal: pollens, grasses, ragweed
sx: h/a nasal congestion, clear rhinorrhea, eye testing
signs; pale violaceous boggy turbinates

tx; avoid allergens, pt education, evaluate for asthma,

tx: fluticasone, mometasone daily

2ndline: oral anti histamines, decongestants, singular immunotherapy

24

epistaxis

trauma
think cocaine, sinusitis, leukemia, coag disorders
recurrent: consider abc, pt/ put, bleeding time

anterior: unlit, continuous, can be visualized by exam
tx; remove clot, blow nose
apply vasconstrictor- lidocaine
direct pressure
silver nitrate, packing

posterior: brisk flow into pharynx
tx; packing
consult ENT
must admit and observe

25

nasal foreign body

kids 2-5
presentation: history by parent
halitosis, sinusitis, stridor, wheezing

tx; mechanical removal and caution to not displace or other offices

26

nasal polyps

yellowish, boggy masses of hypertrophic mucosa, nasal congestion and decrease send of smell

in kids- consider CF
tx: intranasal steroids
refer to ENT

27

viral pharyngitis

adenovirus, EBC, HSV, rhinovirus, enterovirus
bacterial GABSH, myopiasma, gonoccocal

28

strep pharyngitis

5-15 yrs
s/sxs: fever, acute sore throat, adenopathy

Centor criteria:
fever > 38F
tender anterior CA
tonsilar exudate
lack of cough

3 or 5 criteria--> tx
0- d/c without abx
in between--> rapid sure
tx: Pen V K or cefuroxime
augmentin or erythromycin

29

peritonsilar abscess

s/sx: severe ST, muffled voice, truisms

tx; Aspiration and drainage an abx- amox, clindamycin
tonsillectomy

30

epiglottitis

decrease due to Hib vaccine
seen in adults with DM
s/s: fever, throat pain with swelling
kids; appear toxic, tripod position
diagnostic; cherry red swollen epiglottis on laryngoscope
kids: keep kids calm, OR,
BC, IV ( ceftriazoxon)
adults: scope at bedside,
IV abx, iV steroids, admit

31

apthlous ulcers

single or multiple shallow lesions with yellow/ gray center seen in mouth

tx; viscus lidocaine, coricosteroids
cimetidine

32

orla thrush

seen in pt with dentures, DM,, cancer pt

sxs: burning pain on tongue/ buccal mucose
lesions can be scarped off and underlying tissue is friable
tx: anti fungal meds- troche, swish , etc

33

oral herpes simplex

hsv 1-acquired by childhood
hsv 2- sexually acquired

presentation: grouped vesicular lesions on erythematous base, erosion into shallow ulcer
burning , shining
tx; immunocompetent; none
immunocompromised; systemic agents - valtrex 7-10 days

34

oral leukoplakia

small white lesions on mucosal surface
does not scape off

seen in denture wearer

all need to get a bx to r/o oral cancer

35

oral squamous cell carcinoma

early lesions look like leukoplakia

RF: tobacco/ ETOH
Tx:

36

geographic tongue

erythema in manlike distribution caused by filiform papillae of the tongue


removes on own

37

glossitis

red smooth surface tongue
lack of niacin, riboflavin, chemo, adverse med rxn.

tx: tx underlying cause

38

gingivitis

inflame of gingiva causing redness/ swelling of gum line
RF: poor oral hygiene, dry mouth, tobacco

tx: dental hygiene
6 month cleaning

39

necrotizing ulcerative gingitivits

young adults, stress

s/s: gingiva inflammation, bleeding, fever, halitosis, CVA

tx: salt water/ peroxide rinses, oral hygiene, ora PCN

40

dental access

starts from cavity

s/s: pain over are of tooth, localized swelling.
tooth sensitive

tx: referral to dentist with I and D, extraction

41

acute laryngitis

causes hoarseness
almost always viral
sxs last > 1 week after URI sxs subsided

tx: vocal cord rest mandatory
sx tx

42

laryngeal squamous cell carcinoma

> 2 week hoarseness with smoking hx

ear/ throat pain, neck pass

RF: tobacco, HPV

dx: laryngoscope and bx
CT/ MRI
tx: rad and tx
advanced: chemo, rad , tx

43

siladenitis

salivary gland affected, parotid is common
- associated with dehydration and chronic illness causing ductal obstruction

s/s: acute swelling, increased pain an, d swelling with eating

bug: s. aureus

tx: rehydration, wam compressie, sialogogue, massage and abx ( clinda, augmentin)

44

sialolithiasis

calculus formation in salivary glans: Wharton's duct most common

postprandial pain with localized swelling

tx: refer to ENT for stone extraction

45

salivary gland tumors

80% occur in parodic glad
Ct/ MRI
refer to ENT