ENT Flashcards
(99 cards)
1
Q
Triad of Presbycusis
A
B/L progressive sensorineural deafness With loss of high frequency pitch initially
Need quiet environment to hear
Observation and education as a t/m
2
Q
How otosclerosis occurs?
A
Due to abnormal bone deposition resulting in stiffening of ossicular chains
3
Q
How otosclerosis presents?
A
Seen in young adults with conductive hearing loss
Hearing improve in noisy environment (paracusis of willis)
4
Q
Triad of Aspirin exacerbated Respiratory distress
A
Asthma
Chronic rhinosinusitis with nasal polyposis
Bronchospasm or nasal congestion with following the ingestion of Aspirin or NASIDS
5
Q
Important point of Aspirin exacerbated Respiratory distress
A
Non IgE mediated diseases
6
Q
Triad of Perforated Nasal septum
A
Noisy breathing on inspiration
Nasal congestion with crusting and bleeding
Seen in cocaine abuse or nasal surgery
7
Q
How Vestibular neuritis present?
A
Self limiting condition occur after viral infection
Vertigo that can last days with abnormal thrust test
Sometimes U/L hearing loss
8
Q
How to manage Vestibular neuritis?
A
Vestibular suppressant like meclizine
Steroids
Vestibular rehabilitation
9
Q
How BPPV presents?
A
Recurrent vertigo with head movement
Last for less than 1 minute
Dix hallpike maneuver causes nystagmus
10
Q
Name the complications which leads to Perilymphatic (Labyrinthine) fistula
A
Head trauma
Barotrauma
Ultimately leads to leakage of fluid from semi circular canal
11
Q
How Perilymphatic (Labyrinthine) fistula presents?
A
Vertigo/. Hearing loss / nystagmus and tinnitus whenever sneezing , straining Or loud noises (Tullio phenomenon)
12
Q
Name the risk factors which causes otitis externa
A
Water exposure
Trauma like cotton swabs Or Ear candling
Foreign material like headphones or hearing aid
Skin infection like eczema Or contact Dermatitis
13
Q
Name the organisms causing otitis externa
A
S.auerus
P.aeruginosa
14
Q
Triad of Otitis externa
A
Ear pain with hearing loss and discharge
Pain with auricle manipulation
Without involvement of tympanic membrane
15
Q
How to manage Otitis externa?
A
Topical quinolones with or without steroid
16
Q
Name the risk factors for for leukoplakia
A
Tobacco and alcohol use
17
Q
How aphthous ulcer present?
A
Localized shallow painful ulcer with a gray base
18
Q
Name the condition causing Referred Otalgia
A
TMJ joint pathology
Dental caries
19
Q
Triad of TMJ disorder
A
Referred Otalgia with normal ear
examination
Sign of bruxism (worn and
Jaw pain and TMJ tenderness)
20
Q
How to managed TMJ disorder
A
NSAIDs Dental splint (if bruxism suspected) Avoidance of triggers , use of soft diet
21
Q
How eustachian tube dysfunction presents?
A
Ear pain with popping sound
Hearing loss
Tympanic membrane changes
22
Q
Define Necrotizing (malignant) otitis externa
A
Life threatening infection of the external auditory canal
23
Q
Risk factors for Necrotizing (malignant) otitis externa
A
Age above 60
Diabetes mellitus
Aural irrigation (cerumen removal)
24
Q
Name the bacteria causing Necrotizing (malignant) otitis externa
A
P.aeruginosa
25
Triad of Necrotizing (malignant) otitis externa
Severe unremitting pain more at night and with chewing in elderly patient
Granulation tissue at the bony cartilaginous junction and edematous external canal with Purulent Drainage
S'times cranial nerve 7/10/11 affected
26
How to t/m Necrotizing (malignant) otitis externa?
IV cipro with or without surgical debridement
27
Triad of Ramsay hunt syndrome (herpes zoster oticus)
Vesicular rash on the auditory canal or auricle
U/L facial paralysis
Antiviral (valacyclovir) but facial palsy remain
28
Triad of HSV 1
Bell palsy
| Vesicular lesions on oral mucosa
29
Name the most common suppurative complication of AOM
Acute mastoiditis
30
Triad of Acute mastoiditis
Fever
Ear pain
Inflamed mastoiditis with displacement of auricle
31
Examination findings of AOM
Bulging tympanic membrane due to inflammation
| Decrease TM mobility on pneumatic insufflation on visible air fluid levels indicate middle ear effusion
32
How to manage acute mastoiditis?
IV antibiotics
| Drainage of Purulent fluid required via tympanostomy (with or withou ear tube placement) OR mastoidectomy
33
How to manage Epiglottitis?
After securing the airway via ETT, give ABx ceftriaxone and vancomycin
34
What is the main rain factor for Epiglottitis?
Un vaccination
35
Triad of Epiglottitis
Fever with dysphagia and drooling
Lean forward and hyperextend neck to maximaze airway
Stridor and muffled hot potato voice
36
Why stridor doesn't occur in bronchiolitis?
B/c stridor occurs in upper airway obstruction
37
Triad of Croup
Seen in children age 6months to 3 years
Fever with stridor
Barky cough
38
At what age foreign body aspiration is Common?
Age less than 3 years
39
Triad of Peritonsillar abscess
Seen in older children and adolescent
Gradual onset fever and muffled voice
U/L tonsillar swelling with tonsillar ulceration
40
Define Otitis media with effusion
Middle ear fluid without inflammation
41
Triad of Otitis media with Effusion
Seen in children age 6-24 months with episode of AOM or Viral infection
Air fluid levels posterior to the TM and poor TM mobility on pneumatic insufflation
Ear tugging and pulling ear without fever or ear pain
42
How to manage Otitis media with effusion
Resolve within weeks and doesn't require t/m
Chronic OME (>3months) need close follow up and warrant t/m like tympanostomy tube placement as it causes speech delayed and long term hearing loss
43
How to Manage Thyroglossal duct cyst?
Confirm the presence of normal thyroid tissue
| Do surgical resection of cyst associated tract and central portion of hyoid bone
44
How non TB mycobacterial lymphadenitis present?
Slowly enlarging Lateral neck mass
| Overlying violaceous skin discoloration
45
Name the ABx for Neonatal sepsis
Ampicillin and Gentamicin
46
How laryngomalacia occurs?
Chronic stridor due to laryngeal hypotonia, redundant supraglottic soft tissue and inflammation (due to reflux).Floppy supra glottic structures which collapse during inspiration
47
Triad of laryngomalacia
chronic inspiratory stridor in infants age 4-8 months
worse in supine position and improves in prone position
Dx via flexible fiberoptic laryngoscopy which shows ''omega shaped epiglottis and collapse supraglottic structures during inspiration
48
How to manage laryngomalacia?
In most cases resolves and just need follow up Supra glottoplasty needs in severe cases like feeding difficulties, FTT, cyanosis or tachypnea
49
How vascular rings present?
Biphasic or expiratory stridor due to tracheal compression and feeding difficulties due to esophageal compression
50
Imaging of vascular rings shows
barium swallow can identify indentations of the esophagus dx confirmed via contrast CT Or MR angiography
51
How choanal atresia presents?
If U/L --> chronic nasal discharge If B/L-->noisy breathing with cyclic cyanosis worsen with oral obstruction like feeding and improves when breath via mouth like during crying
52
How to dx choanal atresia?
Initial test is unable to pass the catheter through nares into oropharynxConfirmed test is Ct scan Or nasal Endoscopy
53
How to manage choanal atresia?
Oral airway Surgical airway
54
What is CHARGE SYNDROME?
```
C COLOBOMA
H HEART DEFECTS
A ATRESIA CHOANAE
R RETARDATION OF GROWTH
G GENITAL ABNORMALITIES
E EAR ABNORMALITIES
```
55
Important point
Vertical transmission of HPV causes recurrent respiratory papillomatosis which cause hoarseness due to finger shaped nodules on the vocal cordsRequire surgical debridement as mainstay as medicine has limited efficacy
56
What are the risk factors for Acute otitis media?
Recent URI
Smoking
Day care center
No breast feeding
57
How to manage acute otitis media?
first line is Amoxicillin for infant age less than 6 months and for children more than 6 months with high grade fever, severe pain Or B/L disease
2nd line augmentin for recurrent sxs after 2-3 days of ABx therapy Or Recurrent AOM (within 30 days) after ABx therapy.
If penicillin allergic---> give azomax OR clindamycin
58
Important Point of AOM Tx
if penicillin allergy give clindamycin or Azomax as alternate
59
When to consider tympanocentesis in AOM?
Tympanocentesis and culture during tympanostomy tube placement when:-Multiple episodes of AOM (>3episodes in 6months)- Or persistent (>3months) middle ear effusion with hearing loss
60
Name the MCC of non-inherited sensorineural deafness in children
Congenital CMV infection
61
Important point
sensorineural deafness due to noise exposure is rare at age <5 years
62
How is otomycosis present?
characteristic appearance of white fungal debri with fruiting bodies or Spores
63
Triad of Chronic suppurative Otitis media
Otitis media for more than 6 wks
Otorrhea and hearing loss
Tympanic perforation on examination
64
What are the risk factors for Cholesteatoma?
Recurrent AOM
Chronic middle ear effusion
tympanostomy tube placement
65
Important Point of Cholesteatoma
The dx should be suspected in any patient with continued otorrhea for several weeks despite ABx therapy
66
Triad of Cholesteatoma
Otorrhea
Conductive hearing loss.
pearly white mass behind the tympanic membrane or visible retraction pocket with draining debri
67
Triad of Peritonsillar abscess
fever with pharyngeal pain and earache
Uveal deviation away from enlarged tonsil
trismus and muffled hot potato voice
68
How to manage Peritonsillar abscess?
Needle aspiration or incision and drainage
| ABx to cover Group A-hemolytic streptococci
69
Important point
Recurrent URI would cause AOM not OE
70
What is Landau Kleffner syndrome?
An epileptic condition that presents with regression in language milestones after normal development
71
Important Point
Frontal sinuses are absent at birth and progressively pneumatized from age 2 through puberty
72
Important Point of Nasal discharge
;If U/L---> think of retained foreign body
| if B/L---> allergic rhinosinusitis / adenoidal hypertrophy / acute bacterial sinusitis
73
Name the condition which shows Biphasic stridor
Subglottic stenosis
74
Name the condition which shows Expiratory stridor
tracheomalacia
75
Important Point of tracheomalacia
Inspiration decreases the intra thoracic pressure widens the intrathoracic tracheal airway Expiration increases the intra thoracic pressure narrow the intrathoracic tracheal airway result expiratory stridor
76
How otomycosis presents and t/m?
whitish fungal debris with fruiting bodies or Spores
| Topical clotrimazole
77
-Important Point
There is perioral numbness in Vertebrobasilar insufficiency(Not Hemifacial)
78
Name the complication due to Retropharyngeal abscess
acute necrotizing mediastinitis
79
How does sialadenosis present?
Non tender B/L enlargement of salivar gland
| Does not fluctuate and not associated with eating
80
Name the risk factors for sialadenosis
Alcoholic
Bulimia
malnutrition
81
How salivary stones (sialolithasis) are presented?
Tender swelling of salivary gland
fluctuating
painful and increased on eating
82
Why is levothyroxine given in post thyroidectomy due to thyroid cancer?
To replace thyroid gland function
| also suppresses TSH as tsh will stimulate thyroid tissue resulting in recurrence of cancer.
83
What features in U/S which suggest thyroid cancer?
micro-calcifications
irregular margins
increase vascularity
nodule more than 1cm
84
Important Point
FNAC is considered as safe procedure during pregnancy
| U/S is initial modality of choice for workup of thyroid nodules
85
Name the dx test for CSF Rhinorrhea
CSF specific protein (B2 transferrin / B-trace protein)
86
Classified the pediatric neck mass on basis of location
if middle--> thyroglossal duct cyst / dermoid cyst
if lateral---> branchial cleft cyst / reactive adenopathy / MAC
If posterior--> cystic hygroma
87
Triad of laryngocele
outpouching of the laryngeal mucosa
lateral neck mass enlarges with valsalva maneuver due to air inflation
acquired laryngocele seen in glassblowers / trumpet players due to repeated intense oropharyngeal pressure
88
important point
dermoid cyst in neck doesn't move with protrusion of tongue
89
How d/f types of infections are present on larynx(vocal cords)?
fungal --> thick white patches on an erythematous base-
| HPV--> irregular exophytic growth in clusters
90
How to d/f nasal septal hematoma and deviated nasal septum?
Nasal septal hematoma---> soft fluctuant on examination
| DNS---> firm
91
Important Point
nasal septal has no direct blood supply and receives nutrients via diffusion.
Destruction of nasal cartilage leads to septal perforations / saddle nose / nasal obstruction
92
How to manage nasal septal hematoma?
Incise and drain the nasal septum initially
| Do anterior nasal packing with ice packs and NASIDS to reduce edema
93
What is torus palatinus?
benign bony growth located at the midline suture of hard palate
94
Name the conditions which would cause Whistling sound (nasal septal perforation)?
```
Rhinoplasty
nose trauma
syphilis / tb
cocaine nose
sarcoidosis/wegner disease
```
95
How auricular hematoma present?
There is tender fluctuant blood collection in ANTERIOR pinna
96
How to manage auricular hematoma?
Immediate incision and drainage
| Pressure swelling
97
What are the complications of auricular hematoma?
Re collection of hematoma
Bacterial superinfection
Cauliflower ear due to fibrocartilage overgrowth
98
How to treat Barotrauma of the EAR complicated by Rupture of the tympanic membrane?
Only Reassurance and follow up Examination
99
Important point of Non scrapped hairy cell leukemia
Though occur due to EBV but it is seen in immunodeficient patient such as HIV
So get the test of HIV or underlying cause of immunodeficient before biopsy or any invasive imaging
