ENT Flashcards
(101 cards)
1
Q
he health status of the oral cavity is linked to
A
cardiovascular disease
diabete
other systemic illnesses.
2
Q
Assume any head and neck infection or swelling to be _______ in origin until proven otherwise.
A
odontogenic
3
Q
Caries is what type of infection
A
bacterial
- causes demineralization and destruction of the hard tissues of the teeth (enamel, dentin and cementum).
- Caries are the result of the production of acid by bacterial fermentation of food debris accumulated on the tooth surface.
4
Q
Caries are formed If ______ exceeds saliva and other_______ factors
A
demineralization
remineralizing
5
Q
caries are likely a result of the acidic secretions of what bacteria
A
strep mutans
6
Q
name some other bacterial agents implicated w/ caries
A
7
Q
populations at risk for periodonatal dz
A
diabetics
elderly
pregnant women - preg gingivitis due to hormonal changes promoting increase in alterations in types and amounts of pathogens
•Pyogenic Granuloma- Occur in 1% of women, Exaggerated response to irritation
8
Q
Jaw pain can be [an] ______ equivalent
A
anginal
postmenopausal women / long-term diabetic patients
and especially lower-left portion of the jaw
9
Q
Si/ Sx of dental caries
A
- Sensitivity to hot or cold stimuli
- Pain on biting (trigeminal nerve)
10
Q
children < 4 y.o. with stiff neck, sore throat and dysphagia should be worked up for ______ ______
A
retropharyngeal abscess secondary to molar infection
11
Q
fils mordered for suspected infection
A
•Panoramic film of the teeth and jaw for evaluation of the extent of the infection
CT w/o contrast determine the extent and density of the swelling, locating the abscess within the soft tissue and bone (aids in determining tx)
12
Q
first line tx for dental infection
A
Pen VK
Amox
If PCN allergic:
clinda or erythro
13
Q
second line dental inf tx
A
•If long-standing infection or previously treated infection that does not respond to first line treatment:
oral clinda
IF SEVERE consider clinda + double coverage with metronidazole (B. fragilis and C. diff)
14
Q
admission criteria for pts w/ dental infections
A
- swelling involving deep spaces (pre fascial planes) of the neck
- unstable vital signs, fever, chills, confusion or delirium
- evidence of invasive infection
15
Q
complications of dental infections
A
- Ludwig’s angina (sublingual cellulitis, +/- tracking abscess inferiorly; potential for airway issue)
- Vincent’s angina, aka ANUG (acute necrotizing ulcerative gingivitis), aka ‘trench mouth’
- Smells HORRIBLE, “worst breath you have ever smelt
- Retropharyngeal infection (possibility of retropharyngeal abscess) and mediastinal infection
- Child w/ fever, dysphagia, neck stiffness think retropharyngeal abscess
16
Q
acute vs chronic rhinosinusitis timeframe
A
17
Q
sublingual cellulitis is
A
Ludwig Angina
•Note the diffuse submandibular swelling and fullness.
airway compromise is a major concern
18
Q
most common pathpgens responsible for viral sinustitis
A
19
Q
most common bacterial pathogens responsible for rhinosinusitis
A
- S. pneumoniae
- H. flu
- M. catarrhalis
- S. aureus
- S. pyogenes
20
Q
dx criterial for acute viral vs bacterial sinusitis
A
<•10 days nonworsening sx - viral
>10 days or biphasicor worsening ® bacterial
21
Q
tx for bacterial sinusitis
A
- Amoxicillin
- Augmentin
- Doxycycline
- Levofloxacin
- Moxifloxacin
•
•Macrolides no longer recommended due to resistant so S. pnuemoniae
22
Q
•Nasal mucopurulent drainage (“post-nasal drip”) is seen with?
A
chronic sinusitis
23
Q
cough in children is a sx of
A
chronic sinusitis
24
Q
3 types of chronic sinusitis
A
- Chronic w/ nasal polyposis (20%)
- Allergic fungal rhinosinusitis (8-10%)
- Chronic w/o nasal polyps (60%)
25
dx criteria symptom wise for chronic sinusitis
imaging dx?
– 2 of 4
1. Anterior/posterior mucopurulent drainage
2. nasal obstruction/blockage/congestion
3. Facial pain, pressure, fullness
4. Reduction or loss of sense of smell
Objective evidence w/ one or more using nasal endoscopy or CT
1. Purulent (not clear) mucus or edema in middle meatus or ethmoid
2. Polyps in nasal cavity or middle meatus
3. Imaging showing mucosal thickening, partial or complete opacification of paranasal sinuses
26
tx chronic sinusitis w/ Nasal polyps present
* Oral glucocorticoids
* Dupilumab (Dupixent)
* Abx if infection
* Allergy/immune eval
* Endoscopic surgery
27
tx chronic sinusitis w/o nasal polyps
* Intranasal saline irrigation
* Intranasal glucocorticoids
* Oral abx/GCs – if no improvement in 2-4 wks
28
preferred imaging for chronic sinusitis
•CT – preferred imaging modality - sinus mucosal thickening, polyps, sinus opacification
29
•Palatal click – when scratching palate w/ tongue is assoc w/
allergic rhinitis
30
si/sx of allergic rhinitis
* Infraorbital edema & darkening (“allergic shiners”)
* Accentuated lines below eyes (Dennie-Morgan lines)
* Transverse nasal crease (“nasal salute”)
* Hyperplastic lymphoid tissue lining post. Pharynx (“cobblestoning”)
* Retracted TM
* Nasal mucosa pallor
31
* Prick skin test
* IgE immunoassays (RAST)
used to dx?
allergies
patch better
RAST better w/ severe allergies
32
common source of bleeding in anterior vs posterior nose bleeed
* Anterior ® Keisselbachs plexus (most common) involves branches of anterior ethmoid artery, sphenoplantine and facial a.
* Posterior ® sphenopalatine a. or branches of carotid a. (significant)
33
tx minor epistaxis
* Tamponade
* Silver nitrate
* Electrocautery w/ anesthetization
34
tx of major epistaxis
* Nasal packing – contralateral nare if bleeding persists for tamponade
* ENT consultation
35
what risk is assoc w/ packing a nose bleed
TSS - prophylaxis is augemntin or cephalexin
36
positive pressure techniques such as a mothers kiss can help tx
FB impaction
37
common FB impactions
* Button batteries – at neg poly electrolysis generates hydroxide ions that cause alkaline tissue necrosis or septal perf
* Paired disc magnets – perf from chronic compression
38
complciations fo FB
* Septal perforation w/ saddle nose deformity
* Nasal meatal stenosis
* Inferior turbinate necrosis
* Cartilage collapse
* Epistaxis
39
fucntions of ET (3)
* Equalizing pressure across TM
* Protecting middle ear from infection and reflux of nasopharyngeal contents
* Clearance of middle ear secretions
40
ET tube dysfucntion can be caused by (3)
1. Pressure dysregulation
2. Impaired protective function – reflux into ET
3. Diminished clearance
41
ET dysfucntion assoc w/
* Any cause of inflammation (ex. allergies, exposure to smoking)
* Hypertrophied adenoids
* Laryngopharyngeal reflux
42
pt presents w/
## Footnote
* Ear pain
* Sensation of ear fullness or pressure
* Hearing loss
* “Popping” or “snapping” noise
autophony
dx?
ET tube dysfunction
43
Tx Et tube (meds and surgical
Medical management
* Decongestants –phenylephrine pseudoephrine
* Intranasal glucocorticoids
* Nasal saline drops
Surgical management
* Tympanostomy Tubes – first line surgical tx
* Eustachian tuboplasty
* Balloon dilation of the eustachian tube (BDET)
44
Cholesteatoma is a complicaiton of
ET
45
peripheral vs central vertigo
peripheral •Disorders affecting labyrinth or vestibular nerves (ex. vestibular neuritis)
Central
•Disruption of central vestibular pathway
46
when to use HINTS test
•acute onset persistent vertigo to diff b/w vestibular neuritis (benign) from central cause (life threatening)
47
si/sx vertigo
48
positive Head impulse test indicated
perip vertigo (diff b/w central and peripheral)
49
Vestibular Nystagmus is
horizontal nystagmus w/ fast going away from affected side
50
Torsional (rotary) nystagmus –
can be any direction and may reverse direction,
central sign
Not suppressed by visual fixation –
life thretaning
51
tx vertigo
* Symptom management
* Vestibular rehab – balance activities
* Antihistamines
* Benzos
* Anti-emetics
52
Acute onset sustained vertigo – assess ____ \_\_\_\_\_
Episodic vertigo asses for ___ using \_\_\_\_\_
vestibular neritis
BBPV – dix-haplike
53
Menieres dz is caused by
and lasts
Excess endolymph in the inner ear ® distortion & distension of the membranous labyrinth (excess fluid)
minutes to hours
54
Meniere’s disease is hearing loss that first affects \_\_-pitched sounds and is assoc w/ intense ipselateral aural ____ and head \_\_\_\_\_\_
low
aural fullness and head pressure
55
tx for menieres dz
* Dietary modification
* Vestibular rehab
* Vasodilators or diuretic
* HCTZ / triamterene PO daily
* Benzos – acute vertigo attack
* Systemic glucocorticoids –dexmethaosne
* Intratympanic steroid injection or gentamycin
* Surgery (ex. labyrinthectomy, vestibular neurectomy)
56
diagnostic test of choice for menieres
Audiometry - •documented low to mid frequency sensorineural hearing loss in affected ear)
57
Labyrinthitis is defined as an acute onset of severe vertigo w/ N/V and gait instability with \_\_\_\_\_\_\_\_
Vestibular neuritis an acute onset of severe vertigo w/ N/V and gait instability with \_\_\_\_\_\_.
unilateral hearing loss
preserved autiory function
58
Vestibular neuritis acute onset vertigo without hearing loss that persistens when head is \_\_\_\_, unlike \_\_\_\_
Persists when head is still unlike BPPV
59
labrynth and vestibular nueritiis both present w/
severe vertigo
N/V
gait disturbances
60
when evaluating labrynthitis and vest. nueritis the head impulse test will be (+/-) meaning ...
+ head impulse test – pt unable to maintain visual fixation w/ rapid head turns
61
when evaluating labrynthitis and vest. nueritis Nystagmus is
suppressed w/ visual fixation, beats away from affected side
62
Loose otoconia in the vestibule or the utricle
that presents w/ recurrent episodes of vertigo lasting one minute or less that are provoked by specific head movements
Benign paroxysmal positional vertigo (BPPV)
63
when evaluating BPPV the Dix Hallpike maneuver will
64
what would we tx w/ the Particle repositioning maneuver (ex. Epley maneuver) ?
goal of tx?
BPPV - NO MEDS
## Footnote
– goal is to have debris migrate toward common crus of anterior and posterior canals and exit utricular cavity
65
how to tx labryn and vestib neuritis
Prednisone taper dose pack
Antihistamines
Anticholinergics
Benzos
Vestibular rehab
66
recurrent vertigo lasting under a minute
67
acute onset of vertigo that persist for a few days
vestoibular neuritis
68
Peripheral vertigo lasting minutes to hours
Meniere’s disease
69
dz characterized by disruption of normal neural firing patterns along the entire auditory pathway
tinnitus
70
si/sx of tinnitus
* Ringing or buzzing in one or both ears
* +/- hearing loss
* High-pitched tinnitus ® sensorineural
* Low-pitched tinnitus ® Meniere’s
* Rushing, flowing or humming à vascular in origin
* Clicking tinnitus ® MSK
71
high-pitch tone loss =
low pitch tone loss =
Rushing, flowing or humming =
Clicking tinnitus =
sensorinueral
menieres
vascualr origin
physiological / MSK
72
•MRA/CT in tinnitus if we suspect
vasc origin
73
* Cochlear implants
* Hearing aids
* Discontinue ototoxic meds
* Angiographic embolization or surgical resection
tx for?
tinnitus
74
sensorinueral hearing impairment
75
conductive hearing loss:
76
mixed hearing loss
combo so conductive and sensorineural
77
Barotrauma
78
Traumav
79
most common inner ear tumor
80
most common external ear tumor
SCC-occlusion cholestoma growth of squamous epithelium in middle ear erodes ossicular chain
81
Conductive loss Weber and Rene
Good ear AC\>BC
Bad ear to bad ear BC\>AC
82
Sensorineural Weber and Rene
83
Speech audiometry
Impedance audiometry
* softest level someone can repeat 50% of words said
* ex. tympanometry, stapedial reflex)
84
Vestibulocochlear n. responsible for sense
hearing,
body position,
pertinent to balance,
transmits sounds and equilibrium info to brain from the inner ear
85
•Schwann cell derived tumors arise from vestibular portion of _____ CN resulting in an _______ of Schwann cells
8th CN
overproduction of schwann cells
86
pt presents w/ unilateral (asymmetric) sensorineural hearing loss.
ON physical exam:
* Rinne not affected (AC \> BC)
* Weber is louder in good ear
dx
Vestibular schwannomas
87
best initial screening test showing asymmetrical sensorineural hearing loss at high-frequencies
Audiometry - vest. schwanommas
88
* MRI w/ gadolinium
* CT w/ contrast
are used to dz
Vestibular schwannomas
89
Surgery options of Vestibular schwannomas (3)
* Retromastoid suboccipital - any size tumor w/ or w/o attempted hearing preservation
* Translabyrinthine – larger then 3cm and for smaller tumors when hearing preservation not an issue
* Middle fossa – small \<1.5cm tumors where hearing preservation is the goal
90
Radiation options w/ vest. schwannomas
* Stereotactic radiosurgery - single beam dose radiation
* Proton bean therapy – deliver of high-dose radiation to target volume while decreading ”scatter” to surrounding tissue
91
when can we observe scwannomas
C/I in pts w/ large tumors or brainstem compression) schwann slo growing follow up MRI in 6-12 mo
92
* Unilateral (asymmetric) sensorineural hearing loss
* Tinnitus
* Unsteadiness
Rinne not effected
dx
Vestibular schwannomas
93
Mutation of the NF2 gene - inactivates TSG merlin
age of onset 20
NFT 2
94
NFT presents similarly to Vestibular schwannomas they both:
## Footnote
* Tinnitus
* Unsteadiness
what differentiates them?
Vestibular schwannomas - unilateral hearing loss , normal rene, wber louder in affected ear
NFT 2bilateral hearing loss
95
NFT2 predisposes the pt to multiple nervous system tumors – most common\_\_\_\_ \_\_\_\_\_\_
bilvestibular schwannomas
96
Injury to TM or other parts of the ear from failure to equalize pressure
ear barotrauma
97
most common cause of ear barotruama
flyinf - shorter flights
98
most common dz in divers
Ear barotrauma
99
si/sx of ear barotruama
* Ear pressure(most common)
* Pain w/ stretching of the TM
* Hearing loss
* Tinnitus
* Vertigo
100
tx for ear barotruma
* Self-limiting
* Supportive care
* Surgical tympanoplasty
101
dx ear barotrauma
* History and physical exam
* Otoscopy for ruptured TM
