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