ENT Flashcards
1
Q
Cerumen impaction 3 recommended therapeutic options
A
Cerumenolytics, Irrigation, and Manual removal by clinician
2
Q
How are cerumenolytics used
A
- Avoid if TM damage
- Do not exceed 3-5 days
- can cause Allergic rx, Otitis externa, earache, Transient HL Dizziness
3
Q
How is irrigation used
A
Warm water/saline 1:10 hydrogen peroxide
Tip of syringe should not pass lateral 1/3
Post and upward, follow w/ water and 2% acetic acid or boric acid
4
Q
Foreign bodies
A
No irrigation for organic material
Immobilize insects w 2% Lidocaine
(kills insect and anesthetizes skin
5
Q
Otitis Externa Main organisms that cause infx
A
P Aeruginosa and Staphylococcus Aureus MC
6
Q
Mild AOE Tx
A
Drying Agent 50/50 mixture Isopropyl Alcohol/ Vinegar
2% acetic acid (Vosol) 5 gtts in canal TID-QID
7
Q
P Aeruginosa and Staphylococcus Aureus readily grow in what pH
A
6.5-7.5
8
Q
Moderate AOE Tx
A
Polymixin B/Hydrocortisone
(Potent sensitizer: Neomycin) for Pruritis erythema edema
Amynoglycosides: (Gentamycin)Ototoxic
Quinolones: Ofloxacin 10 gtts X1 daily X 7 days
9
Q
Cellulitis, diabetes Immunodeficiency, Severe AOE, significant edema inhibiting application TX
A
Combo Ototopical and Systemic PO (No water sports X 10 days)
Cipro 500mg PO BID X 7 days P. aero and S. Aureus
10
Q
Severe bacterial infection of External Auditory Canal EAC; MC Diabetics and Immunocompromised
A
Necrotizing Otitis Externa (Malignant Otitis externa)
11
Q
MC cause of Necrotizing Otitis Externa?
A
Pseudomonas Aeruginosa
12
Q
MC cause of Necrotizing Otitis Externa MC S/S?
A
Deep otalgia, EAC Granulation, Foul otorrhea, CN Palsies
13
Q
What cranial nerve palsies does Necrotizing Otitis Externa affect?
A
VI, VII, IX, X, XI, XII
14
Q
Necrotizing Otitis Externa TX?
A
I.V Cipro X several months
15
Q
Pedunculated bony EAC lesion, benign osseus neoplasms attached to Tympanosquamous/mastoid suture line
A
Osteoma
16
Q
Multiple EAC lesion, firm , bony, broad-based lesion
composed of lamellar bone reactive bone formation
A
Exostoses (Surfer’s ear)
17
Q
MC neoplasm of ear canal
A
SCC TX resection 5 year mortality
18
Q
MC cause of this is Viral URIs and allergies.
Acid reflux, Pregnancy 3rd Trimester, Down’s, Turners Adenoids and Cleft palate
A
Dilatory ETD
19
Q
MC Cause of this is Neuro muscular disorders, High estrogen, OCPs prostate cancer, Scarring weight loss > 6lbs
A
Patulous ETD
20
Q
Dilatory ETD Tx
A
URI, Allergic rhinitis- Decongestant/Antihistamine
GERD- PPI 2nd smoke cessation
21
Q
Patulous ETD TX
A
Reassure, hydrate and NS spray, Sx, TM tubes
22
Q
Prolonged ETD with Neg. middle pressure causes this
A
Serous Otitis Media
23
Q
Serous Otitis Media s/s
A
Middle ear fluid presence without Acute S/S of illness or inflammation
CHL, Aural fullness reduce TM mobility, bubbles
Tympanometry Best dx
24
Q
Suspect nasopharyngeal carcinoma when
A
Adult persistent unilateral Serous Otitis Media
25
Serous Otitis Media Tx?
Observation X 3 months if HL is mild; frequent Valsalva may be effective meds if indicated
PET if measures fail
26
Indications for PE Tubes
Severe or recurrent AOM
- HL> 30 db -Chronic retraction ETD
- Autophony (Patulous) (Stay 6-18 mths)
27
AOM Risk Factors
Pacifiers, bottle feeding, Day care, 2nd hand smoke
28
AOM Dx?
Erythema, decreased TM mobility, bulging, TM w/o landmarks, Bullae
29
Most common organisms cause AOM
Catarrhalis, H. Influenza, Pyogenes, "#1 S. Pneumoniae"
30
AOM Tx patient
<2 yo
>102.2 fever
No improvement in 48-72 hrs
31
AOM Tx 1st line?
1st Line Amoxicillin 80-90 mg/kg/day xx10 days
32
AOM Tx 2nd Line
Amox-clavunate 20-40 mg/kg/day X 10 days
33
AOM PCN Allergy
Cefdinir 300mg BID, Ceftriaxone 2G IM
| Erythromycin + sulfanomide X 10 days
34
Amoxicillin, Ampiccillin or PCN rash =
MONO
35
AOM at 2 weeks ______ Pts will have fluid in their ears
50%
36
AOM at 10 weeks ______ Pts will have fluid in their ears
10%
37
Recurrent otitis media = TX PE Tubes
>= 3 distinct episodes in 6 months
>=4 distinct episodes in 12 months
38
Chronic Otitis Media essential dx
Chronic Otorrhea w/ Otalgia (Hallmark; Purulent DC)
TM perforation w/ CHL
Amenable Sx correction
39
AOM becomes COM in
2 weeks- 3 months
40
COM organisms
P. Aeruginosa, S. Aureus, Proteus
41
COM Tx?
Topical Ofloxacin/ Cipro w Dexamethasone
Cipro PO 500 mg BID X 1-6 weeks
SX repair / Mastoidectomy
42
COM complications
Cholesteatoma -TM perforation
Mastoiditis - Facial Paralysis
CNS infx
43
Most TM heal spontaneously when
< 25% surface
Persist > 6 weeks= ENT
44
3 layers of the TM
Squamous
Collagen Fibrous- Stops growing = Chronic TM perf.
Cuboidal Layer
45
D/O due to Prolonged ETD w negative middle ear pressure draws the upper flaccid portion inwards of TM
Erosion of inner ear can occur involves CN VIII
Cholesteatoma (Pars Flaccida)
46
Mastoiditis TX
IV ABX Cefazolin (0.5-1.5 G ever 6-8 hrs
MC S. Pneumoniae, H Influenza S. Pyogenes
47
Petrositis Triad (Gradenigo Syndrome)
Retro orbital pain
AOM
Abducens Paresis (CN-VI)
48
Ear Barotrauma prevention meds
Pseudoephedrine 60-120 mg several hrs prior to descent
Oxymetazoline (Afrin) 1 hrs prior to descent
Chew gum, Valsalva, swallow
49
Barotrauma referral to ENT when
Severe otalgia, HL, VErtigo, persistent > 4-5 days or blast injury
50
TM Perf TX if
(+) Infx Signs
(+) HL
Otherwise f/u in 2-3 mths
51
Pulsatile Tinnitus + CHL =
Middle ear neoplasia + MRI
52
Peripheral Vertigo Cause
80% , typically not serious, S/S severe
X3 MC BPPV, Meniere's , Vestibular neuritis
53
Central Vertigo cause
20% case, Mild and discrete, brainstem cerebellar
MC Vestibular migraine and Vascular etiologies or Multiple Sclerosis
54
Uses electrodes to record eye movements
Electronystagmography
55
Uses video cameras to record eye movements
Videostagmography
56
Vestibular ocular reflex or nonvestibular
Caloric Stimulation
| COWS Cold-Opposite Warm same
57
Sudden onset lasting less than 1 minute triggered by change in head position NO HL
Benign Paroxysmal Positioning Vertigo
58
BPPV DX
Dix-Hallpike Maneuver- Nystagmus and vertigo w/in seconds and last 30 seconds
59
BPPV TX
Epley's Maneuver
60
Episodic Vertigo Lasting from 20 min. to several hours
| SNHL w Lower frequencies- Blowing tinnitus, Unilateral aural fullness
Endolymphatic Hydrops (Meniere's)
61
Endolymphatic Hydrops Dx
Caloric Testing and SHL Audiometry
2ndary distention of the endolymphatic space
62
Endolymphatic Hydrops TX
Oral meclizine Diuretics (Acetazolomide)
Vestibular rehab Exercises
Low salt diet, caffeine, nicotine Alcohol
refractory: Intratympanic corticosteroids inj.
Vestibular ablation, labyrynthectomy
63
Endolymphatic Hydrops two known causes
Syphilis and Head trauma
64
Acute onset of persistent and severe vertigo days-weeks Nausea / Vomiting
Follows Viral Infx, awakens w room spinning
Vestibular Neuritis (Hearing preserved)
Labyrinthitis (Transient Unilateral SHL)
65
Vestibular Neuritis (Hearing preserved) Dx
Labyrinthitis (Transient Unilatera
Positive head trust, suppressed w visual fixation
66
Vestibular Neuritis (Hearing preserved)
Labyrinthitis (Transient Unilateral SHL) TX
Vestibular therapy rehab exercises
Benzos and Meclizine
67
Progressive or sudden unilateral SNHL
Continuous disequilibrium
Acoustic neuroma (Vestibular schwannoma)
| Involves cerebellopontine Angle (MRI)*
Nerve Sheath CN VIII tumor
68
Presents w/ s/s identical to Meniere's inflammatory and degenerative for CNS episodic vertigo and chronic imbalance]
SHL rapid onset and unilateral, facial numbness, Diplopia
Multiple Sclerosis
69
Typically elderly w arteriosclerosis, triggered by posture changes or extension of neck
Vertigo w brainstem deficits
Vertebrobasilar insufficiency
Tx Vasodilator and aspirin
70
SNHL MC Cause
Presbycusis age related
Noise trauma > 85 DB injury cochlea
71
Ototoxicity
Aminoglycosides neomycin gentamycin, loop diuretics, antineoplastic agents
72
Hereditary Loss FMHX
Connexin-26 mutation MCC genetic deafness
73
Staccato tinnitus means
Clicking tinnitus
74
Acute Viral rhinorrhea
clear rhinorrhea, hyposmia, congestion, erythematous mucosa S/S < 4weeks typically <10 days
75
Acute viral rhinorrhea Tx
Zinc 75 mg, sudafed 30-60 mg q 4-6 hrs,
| Oxymetazoline no > 3 days
76
Acute Bacterial rhinosinusitis
Purulent yellow- green DC or expectoration 3-4 days
Nasal congestion Facial pain over sinuses 3-4 days
Tooth pain: persistent> 10 days, fever 102, worsening s/s
77
Subacute Bacterial sinusitis
4-12 weeks
78
Acute bacterial Sinusitis
<4 weeks
79
Chronic sinusitis
> 12 weeks
80
Recurrent sinusitis
X4 in 1 year
81
Bacterial Sinusitis TX
< 10 days NSAID, decongestant, ICS
ABX: 102 fever> 10 days worsening Augmentin 875
PCN Allergy Doxy 7-10 days
82
Nasal Vestibulitis S Aureus
Dicloxacillin 7-10 days Mupirocin/Chlorhexidine BID 5 days
83
Rhinocerebral Mucormycosis
Aspergillus in DM, Aids, Corticosteroid use prolonged
Black Eschar middle turbinate, silver stains
Tx: Amphotericin B (Kidney dz= Mortality >50%)
84
Allergic rhinitis
Clear rhinorrhea, Sneezing teary eye, pruritus pale violaceous turbinates, cobblestoning post pharynx
TX: ICS 2 week delay tx
85
Septal hematoma check
Infraorbital rim step-off, Infraorbital numbness, and Septal hematoma (Clot between perichondrium and septum)
--> septal necrosis --> Saddle -nose deformity
86
Nasal trauma reduction w/in
Closed reduction w/in 1 week
Anti Staph ABX cephalexin QID, Clindamycin QID
87
Malignant Nasopharyngeal Paranasal Sinus Tumors
Unilateral =SCC *MRI*
88
Blood stained crust and friable mucosa: Bx= Necrotizing granulomas and vasculitis
Multisystem granulomatous D.O involves sinuses
Granulomatosis w/ Plyangiitis (Wegener's) Sarcoidosis
(Wegener's rare blood disease90% nose involvement
89
Chronic waxing and waning inflammatory condition
White lacy striations (Wickham's Striae) or papules on mucosa (No pain)
Oral Lichen Planus
Tx: = Manage pain and discomfort
90
Oral candidiasis X 2 forms
Pseudomembranous (MC)
Atrophic form AKA denture stomatitis
91
Oral candidiasis Infants
Clean bottles nipples and pacifiers boiled
Nystatin Suspension Applied w/ swab X2weeks: continued until 2-3 days after resolution
Refractory: Gentian violet oral fluconazole
92
Children Tx Mild candidiasis
< 50% mucosa involved: Topical Nystatin or clotrimazole X7-14 days
Nystatin suspension swished in mouth long as possible QID Lozenges 10 mg 5-6 times daily
93
Children Candidiasis Tx severe
>50% mucosa
Fluconazole 6 mg/kg X1 1st day: 3 mg/kg q day X 7-14 days
94
Tx Adults candidiasis
Fluconazole 100 mg PO X 7days
Ketoconazole 200-400 mg 7-14 days
Nystati rinses 5ml long as possible swallow
Chlorhexadine or H2O2 rinses (Nystatin powder dentures)
95
Recurrent Aphthous Ulcer Tx
Triamcinolone of Fluocinonide or Diclofinac
Oral prednisone 60 mg X 1 week taper
96
Inflammatory D/O that leads to atrophy of the papillae
Atrophic Glossitis
Smooth glossy tongue: B12, iron folate deficiency
Sjogren disease Protein calorie malnutrition
Burn sensation with salty and citrus foods
97
Tongue lesion associated with Downs Syndrome
Fissured Tongue
98
Black tongue is cause by what medications
Bysmuth Subsalycilate, Tetracyclines, PPIs, Antidepressants
99
Affects epithelium of tongue--> ulcer like lesions: Lesions can change location and pattern in minutes
Associated wit?
Geographic Tongue : Candidiasis, psoriasis, Reiter's , Lichen planus
100
Centor criteria if present Pharyngitis/Tonsilitis
Fever > 100.4
Anterior cervical LAD
Cough Absent
Exudate present on tonsils 3/4 present = 90%
101
Heterophile Auto Ab
Mononucleosis (Palatal petechiae and shaggy white purple tonsillar exudate
102
Group A Beta Hemolytic Strep TX
PCN VK 500 mg BID X 10days (250 mg Children<27kg)
| PCN Allergy= Azythromycin 500 mg X 3days
(12mg/kg Qd X 5 days Children
103
Peritonsillar abscess Tx
Cellulitis w/o Airway compromise, septicemia, Trismus
= IV ABX cover GABHS
No Airway S/S- W fever, trismus voice change, uvula deviation= Aspiration + Admit + Abx, hydrate analgesia
Tonsillectomy I and D no response in 24 hrs
104
Recurrent tonsillitis for tonsillectomy?
Watchful waiting if < 7 episodes in 12 months
<5 episodes in 2 years
<3 episodes a year in past 3 year
105
Tx of Parotitis
Hydration and IV ABX Nafcillin + metronidazole or Clinda
106
Sialolithiasis MC
Wharton Duct
2< cm from duct opening= Sialogogues, warm fluids, massage, the dialate or incise
>2 cm from duct opening= Sialoendoscopy
107
Salivary gland tumor
80% in parotid gland (adenoid cystic carcinoma)
Malignancy concern if CN VII affected
108
Most common neck space infection. BL infection of the submandibular space.
Tongue pushed back, may obstruct airway
Ludwig's Angina
109
Ludwig's Angina MC Cause
Dental infection
110
Thrombophlebitis of the internal jugular vein secondary to oropharyngeal inflammation
Typically ICU pts prolonged Internal Jug vein
Lemierre Syndrome
111
Ludwig's Angina MC bugs
Streptococci and staphylococci
112
Ludwig's Angina Tx
Penicillin + Metronidazole
Ampicillin sulbactam
(Deep neck + InD IV Abx Intubate tracheotomy
113
Lemierre syndrome Abx cover organisms
Fusibacterium Necrophorum
114
Painful enlargement of lymph nodes: Infection
MC cause of neck mass of all age groups
Reactive cervical LAD
Tx FNA >1.5 cm >40 R/O cancer
115
Cat scratch disease
Bartonella Henselae Single node enlarged
116
Toxoplasmosis Gondii
OOcytes in cat feces Single enlarged node posterior triangle
117
Lyme disease
Borrelia Burgdorferi Ticks
75% head involved Facial Paralysis, Distorted taste,
118
Scores > 10 considered abnormal excessive daytime sleepiness. Range 0-24
Epworth Sleepiness Scale
119
Foreign Body in children Tx
Bronchoscopy
50% non sharp will pass in stool
120
MC congenital masses of lateral neck. Typically soft slow growing and painless. Anywhere along SCM m.
Not midline does not move with swallowing
Branchial Cleft Cyst
TX excise w fistoulous tract
121
MC Congenital mass of the central neck. Remnant occurring along the embryologic thyroid descent
Contains thyroid tissue Carcinoma reported
Midline below hyoid moves w swallowing
Thyroglossal Duct Cyst
TSH if abnormal: US confirm position of thyroid
Tx Removal with tract
122
Head an neck cancer get
triple endoscopy Laryngo/Broncho/Esophago- scopy
MRI or PET
123
Multiple rubbery nodes =
Lymphoma (Hodgkin's non Hodgkin's)
124
Thyroid cancers
Papillary-Slow 80%
Follicular- More aggressive 10%
Medullary- FNA dx, Iodine poor uptake men2A 5%
Anaplastic-Most aggressive <2 %
125
Leakage of peri lymphatic fluid from the inner ear to the tympanic cavity via the round/oval window due to..
Extreme barotrauma, hand-slap to ear trauma, vigorous Valsalva extreme weight lifting
Peri lymphatic Fistula
126
frequently assoc. w migraine headache w/o associated hearing loss or tinnitus.
head pressure- visual, motion or auditory sensitivity.
Migrainous Vertigo
127
Amongst the MC intracranial tumors. Most unilateral w unilateral HL
Any individual w/ Unilateral HL should be evaluated for Intracranial mass lesion DX MRI
Vestibular schwannoma (Acoustic Neuroma)
128
Common cause of vertigo in the elderly triggered by changes in posture or extension of the neck
Vertebrobasilar insufficiency
