Imaging & Procedures

Question 1

Purposes of X-ray

Answer 1

Detect sinusitis
Detect fluid in the sinuses
Detect polyps

Question 2

Indications of X-ray

Answer 2

Pain/pressure in the face

Clinical symptoms need supportive evidence

Question 3

Maxillary Sinus X-ray

Answer 3

Frontal view of the maxillary sinuses, orbits, nasal structures, zygomas
Permits direct comparison of sides

Question 4

Waters View

Answer 4

Posterior/anterior radiographic view of the skull with an angle of 37 degrees from the plane of the film to show the orbits and maxillary sinuses

Question 5

What disease has the thumbprint sign?

Answer 5

Epiglottitis

Question 6

What disease has the steeple sign?

Answer 6

Croup

Question 7

What is the imaging of choice for retropharyngeal abscess

Answer 7

CT of the neck

Question 8

CT is preferable to MRI in these situations

Answer 8

Larynx for neck nodes
Tumor volume
Cartilage sclerosis & destruction

Question 9

CT of Sinuses Useful for:

Answer 9

Further info about tumors
Provide info about obstruction
Detect fluid in sinuses
Detect if membranes are thickened
Assist with diagnosis

Question 10

Best Diagnostic Tool for Epiglottitis

Answer 10

Lateral Neck X-ray

Question 11

Best Diagnostic Tool for Retropharyngeal Abscess

Answer 11

CT

Question 12

Best Diagnostic Tool for Sinusitis

Answer 12

X-ray or CT

Question 13

Best Diagnostic Tool for Trauma

Answer 13

CT

Question 14

Best Diagnostic Tool for Ludwig’s Angina

Answer 14

CT

Question 15

Best Diagnostic Tool for Peri-tonsillar Abscess

Answer 15

CT

Question 16

Best Diagnostic Tool for Tumors

Answer 16

MRI

Question 17

Most Radiation exposure between x-ray, CT, or MRI

Answer 17

CT

Question 18

Indications for a Throat Swab or Culture

Answer 18

Sore throat
Fever of unknown origin
Chronic carriers with recurrent infection

Question 19

Indications for a Nose Swab or Culture

Answer 19

Nasal or sinus infections

Carriers of pathogenic bacteria

Question 20

When should cultures be performed?

Answer 20

Before antibiotic therapy is initiated

Question 21

Main bugs on throat cultures

Answer 21

Bordatella pertussis
Streptococci (esp. B-hemolytic)
Meningococci
Corynebacterium diptheriae

Question 22

Most common bugs on nasal swab

Answer 22

Staph aureus

MRSA

Question 23

Most common bugs on a nasopharyngeal swab

Answer 23

H-flu
RSV
Influenza
Pertussis

Question 24

How to perform a nasal swab

Answer 24

Raise tip of nose
Insert swab into nare
Rotate swab
Remove swab
Place in appropriate tube

Question 25

How to perform a nasopharyngeal swab

Answer 25

``` Raise tip of nose Insert FLEXIBLE swab into nare medially Gently move to posterior pharynx Rotate swab Place in appropriate tube ```

Question 26

Where do you swab for a rapid strep?

Answer 26

Posterior pharynx

Question 27

Cerumen Disimpaction

Answer 27

Removal of cerumen via an ear curette

Question 28

Treatment of Epistaxis

Answer 28

Topical vasoconstrictor/analgesic Direct pressure Silver nitrate cautery

Question 29

Topical Vasoconstrictors

Answer 29

Inhaled Afrin | Cotton balls soaked in Epi & Lidocaine

Question 30

How Long to Apply Direct Pressure?

Answer 30

20 minutes

Question 31

When do you use nasal cautery

Answer 31

After 20 minutes of direct pressure

Question 32

How long can one hold silver nitrate to a bleeding site?

Answer 32

10 seconds

Question 33

Why does one not cauterize both sides of the nasal septum?

Answer 33

Risk of septal perforation

Question 34

Which type of nasal packing is more common?

Answer 34

Anterior nasal packing

Question 35

What items are used for anterior nasal packing?

Answer 35

Gauze-petroleum soaked Rhino rocket Mercel

Question 36

How long until follow up is required after nasal packing is placed?

Answer 36

Within 24 hours

Question 37

How long is the packing usually left in place?

Answer 37

48-72 hours

Question 38

Complications of Nasal Packing

Answer 38

Necrosis if too tight Sinusitis Otitis media Toxic Shock Syndrome

Question 39

What is pneumatic otoscopy testing for?

Answer 39

Movement/mobility of the tympanic membrane

Question 40

Interpretation of Increased TM Mobility

Answer 40

Atrophy | Previous perforation or T-tube

Question 41

Interpretation of Absent or Decreased TM Mobility

Answer 41

Acute otitis media | Scarring

Question 42

Define Audiometry

Answer 42

Formal measurement of hearing

Question 43

What does audiometry involve?

Answer 43

Presentation of tones or speech to each ear testing frequencies

Question 44

Purpose of Weber/Rinne Testing

Answer 44

Determine whether the hearing loss is sensorineural or conductive

Question 45

How to Perform the Rinne Test

Answer 45

Place vibrating tuning for on mastoid process | Then move it in front of the ear canal

Question 46

Normal Result of Rinne Test

Answer 46

AC > BC

Question 47

What is the Rinne Test Looking For?

Answer 47

Conductive hearing loss

Question 48

If BC > AC there is what type of hearing loss?

Answer 48

Conductive hearing loss

Question 49

A normal Rinne is:

Answer 49

Positive

Question 50

An abnormal Rinne is:

Answer 50

Negative

Question 51

How to Perform a Weber Test

Answer 51

Place vibrating tuning fork on top of the head | Patient should hear equally in both ears

Question 52

What test must you use in addition to the Weber test to determine if the ear is normal or abnormal?

Answer 52

Rinne test

Question 53

If Rinne normal and Weber is lateralized, what kind of hearing loss is present?

Answer 53

Sensorineural hearing loss in the opposite ear of where Weber was lateralized

Question 54

If Rinne is abnormal in the ear that Weber lateralizes to, what kind of hearing loss is present?

Answer 54

Conduction hearing loss in that ear

Question 55

Define Tympanometry

Answer 55

Measurement of the impedance of the middle ear to sound

Question 56

What can tympanometry detect?

Answer 56

``` Fluid in the middle ear Negative middle ear pressure Disruption of ossicles Otosclerosis Hypercompliant TM ```

Question 57

How is tympanometry performed

Answer 57

Soft probe placed into ear canal Small amount of pressure applied Instrument measures movement of TM with varying pressures

Question 58

What is vestibular caloric testing used for?

Answer 58

Test disorders of the ear or brainstem

Question 59

What disorders of the ear or brainstem does vestibular caloric testing test?

Answer 59

Benign positional vertigo Perilymph fistula Vestibular neuritis Gentamycin ototoxicity

Question 60

What does cold water in the ear initiate?

Answer 60

Fast nystagmus | Eyes to move away from cold water

Question 61

What does warm water in the ear initiate?

Answer 61

Eyes move towards the warm water

Question 62

What can ice water caloric testing be used for in the ICU?

Answer 62

Determine brain function of a comatose patient