ENT Flashcards
(34 cards)
- Symptoms and clinical features of diffuse otitis externa
Symptoms
1) Earache;
2) The external part of the ear canal is painful (especially the tragus);
3) Discharge, itching;
4) Ear congestion, hearing loss;
5) Fever is uncommon.
Clinical findings
1) Swelling and hyperemia of the skin of the ear canal;
2) Serous or purulent discharge;
3) Accumulation of debris in the ear canal;
4) Tympanic membrane appears to be normal.
- Symptoms and clinical features of acute otitis media (AOM) – suppurative form
Symptoms
1) Earache;
2) Hearing loss;
3) Nasal discharge and congestion;
4) Fever, malaise;
5) If perforation is present: otorrhea
Clinical findings
1) Ear canal appears to be normal;
2) Hyperemia of tympanic membrane;
3) Later in the course of the disease: marked bulging of the tympanic membrane,
subsequently spontaneous perforation can develop.
- Causes of acute hearing loss
Conductive type:
1) wax, foreign body;
2) acute tubal occlusion, otitis media (OME/AOM);
3) trauma (e.g. perforation of the tympanic membrane).
Sensorineural type:
1) Noise (acute) induced hearing loss;
2) Viral infection;
3) Vascular causes;
4) Toxic damage (medication, chemicals);
5) Traumas.
- What is to be done in case of acute sensorineural hearing loss?
In case of acute sensorineural hearing loss, immediate intravenous nootropic/vasodilatating therapy or steroid bolus treatment is necessary with hospitalization; meanwhile detailed investigation is required to be carried out to clarify the etiology. The earlier the treatment is started, the better the outcome is.
- Recognition of hearing loss in childhood
Signs of hearing loss in childhood:
1) the newborn does not react to sounds;
2) tone of crying is unusual;
3) babbling period does not appear;
4) visual orientation is dominant;
5) speech development is delayed;
6) tone, pitch, intensity, melody and rhythm of the speech is pathologic;
7) articulation disorders;
8) worse reading and writing skills
- Causes of ear pain
Primary otalgia
1) Otitis;
2) Tumors of the ear;
Referred ear pain
1) Tumors and inflammations of the larynx, pharynx, tonsils, base of the tongue;
2) Dental inflammations, temporomandibular joint syndrome, neuralgic pain.
- Complications of acute otitis media (AOM)
Extracranial
1) Intratemporal
1. 1) Acute mastoiditis;
1. 2) Zygomaticitis;
1. 3) Petrositis;
1. 4) Facial nerve palsy;
1. 5) Labyrinthitis;
2) Extratemporal
2. 1) Abscess: subperiosteal, preauricular, suboccipital, Bezold’s abscess;
Intracranial
1) Extradural abscess;
2) Sinus phlebitis - sinus thrombosis;
3) Subdural abscess;
4) Meningitis, encephalitis;
5) Brain abscess;
General: sepsis.
- Clinical features and symptoms of acute mastoiditis
1) Associated with, or following acute otitis media;
2) The pinna is pushed forward;
3) Retroauricular pain, erythema;
4) The posterior wall of the external ear canal is swollen, seems to be lowered;
5) Pulsating, severe pain;
6) Pulsating otorrhea.
- Causes of unilateral otitis media with effusion (OME) in adults and childhood
Chronic dysfunction of the Eustachian tube (adenoid vegetation or nasopharyngeal tumor)
In adults, the possibility of a nasopharyngeal tumor must not be left out of consideration!
- How to diagnose vertigo caused by vestibular disorders
Patient history:
1) Type of vertigo (sensation of spinning or falling);
2) Vegetative symptoms, nausea, vomiting.
Examination:
1) deviation, tilting;
2) spontaneous nystagmus and nystagmus provoked by head movements.
- Causes of peripherial facial palsy (list)
1) Bell’s palsy;
2) Herpes zoster oticus;
3) Other viral or bacterial infections (HSV, EBV, Lyme);
4) Acute and chronic middle ear diseases (acute and chronic middle ear infections,
cholesteatoma, rarely tumors);
5) Tumors of the pontocerebellar angle, vestibular schwannoma;
6) Cranial traumas (pyramid bone fractures), extratemporal traumas;
7) Malignant tumors of parotid gland.
- Primary management of epistaxis/nosebleeding (at home/ambulance/by GP)
1) The patient should lean forward with open mouth, firm digital pressure should be applied to both nasal alae for 10 minutes;
2) Ephedrine/nasal drop/vasocontrictor solution-imbibed cotton or spongostan should be applied in nasal cavity;
3) Cold compress should be applied to the nape of the neck and to the nasal dorsum;
4) Blood pressure-measurement, antihypertensive treatment if needed.
- Management of epistaxis/nosebleeding (anterior, posterior) by ENT professionals
1) Blood pressure-measurement, antihypertensive treatment - if needed;
2) Visible bleeding source: chemical cauterization (trichloroacetate, silver nitrate) or
coagulation (bipolar electrocoagulation);
3) Anterior nasal bleeding: anterior nasal packing;
4) Posterior nose bleeding: posterior nasal packing (Bellocq tamponade), balloon
catheter.
- Management and complications of nasal folliculitis and furuncles
1) Circumscript folliculitis: local therapy with antibiotic and steroid containing creams, vapor coverage;
2) The patient should be told not to pick or squeeze the lesions;
3) For furunculosis and/or phlegmonous reaction, parenteral antibiotics should be
administered, along with vapor coverage;
4) The infection is usually caused by Staphylococcus aureus;
5) Possible complications: Facial phlegmone, angular vein thrombophlebitis,
cavernous sinus thrombosis.
- Types of rhinitis (list)
1) Common infections: Simple acute rhinitis, purulent rhinitis;
2) Specific forms of Rhinitis: TB, syphilis, sarcoidosis;
3) Allergic rhinitis
4) Atrophic rhinitis (oezena)
5) Rhinitis sicca anterior.
6) Other causes: idiopathic, vasomotoric, hormonal, drug-induced, rhinitis
medicamentosa, occupational (caused by irritants) foodstuffs. (3 causes are required from the “other” group)
- Clinical features and management of angioedema (Quincke-edema)
Symptoms and clinical features:
1) urticaria, edema in the head and neck region;
2) dysphagia, globus feeling or visible swelling in the throat, choking;
3) in a severe form: anaphylaxis;
Treatment: antihistamines, steroids, adrenaline, maintaining free airways: cricothyrotomy/tracheotomy – if needed.
- Complications of paranasal sinus infections (list)
Extracranial complications
1) Periorbital cellulitis;
2) Subperiosteal abscess;
3) Orbital phlegmone / abscess;
4) Osteomyelitis;
5) Sepsis;
Intracranial complications
1) Meningitis, encephalitis;
2) Epi/subdural or brain abscess;
3) Cavernous sinus thrombosis.
- Where does the patient localize the pain in cases of frontal, maxillary, ethmoidal or sphenoidal sinusitis?
1) Frontal sinusitis – forehead;
2) Maxillary sinusitis – face;
3) Ethmoidal sinusitis –periorbitally, between the eyes;
4) Sphenoid sinusitis – crown of the head, referring to the occipital area;
5) All forms of sinusitis can cause diffuse headache.
- Causes of unilateral nasal obstruction and discharge in childhood and in
adulthood
Childhood:
1) foreign body;
2) sinusitis;
3) nasopharyngeal angiofibroma;
4) congenital malformation: choanal atresia, meningoencephalocele.
Adulthood:
1) nasopharyngeal tumors;
2) deviation of the nasal septum;
3) hypertrophy of turbinates;
4) trauma and it’s late consequences;
5) diseases causing nasal cavity obstruction (polyp, benign and malignant tumors);
6) rhinosinusitis.
- ENT diseases causing headache
1) Viral infection of the upper airways;
2) Inflammation of nasal sinuses: (acute and chronic);
3) Benign and malignant tumors of nasal sinuses;
4) Cervical: cervical vertebra disorders, spondylosis, myalgia;
5) Complications of otitis and sinusitis: mastoiditis, meningitis, brain abscess,
inflammation of the petrous pyramid;
6) Neuralgias;
7) Pain of temporomandibular joint.
- Most frequent causes of dysphagia
1) GERD;
2) Globus feeling, psyhogenic disorders;
3) Inflammation in the mesopharyngeal, hypopharyngeal and laryngeal region;
4) Tumors in the mesopharyngeal, hypopharyngeal and laryngeal region;
5) Neuralgia (n. IX, n. X);
6) Sensorial and motor innervation disorders: sensorial disorders in supraglottical
region;
7) Foreign bodies in the hypopharynx and oesophagus;
8) Esophageal motility disorders, achalasia;
9) Diverticulum (e.g. Zenker);
10) Esophageal, hypopharyngeal stenoses;
- Indications of tonsillectomy (absolute and relative)
Absolute indications:
1) rheumatic fever;
2) peritonsillar abscess;
3) tonsillogenic sepsis.
Relative indications:
1) chronic tonsillitis;
2) recurrent tonsillitis;
3) tonsillogenic or posttonsillitis focal symptoms;
4) marked hypertrophy of the tonsils causing mechanical obstruction;
5) if a tonsillar tumor is suspected;
6) obstructive sleep-apnea syndrome or other obstructive sleep-related breathing disorders;
7) severe orofacial / dental disorders causing narrow upper airways.
- Clinical features and symptoms of peritonsillar abscess
1) Throat pain, referred ear pain;
2) Difficulty in swallowing;
3) Trismus, the speech is thick and indistinct;
4) Oral fetor;
5) Fever, insomnia, loss of appetite;
6) Swelling, redness and protrusion of the tonsil, faucial arch, palate and uvula; the
uvula is pushed towards the healthy side.
- Peritonsillar abscess – treatment
Drainage of the abscess - puncture, incision, daily opening of the abscess cavity;
Tonsillectomy:
1) abscess-tonsillectomy;
2) tonsillectomy 6 weeks after recovery;
Antibiotics, decreasing edema, analgesics, administration of fluids.
