Otorrino Parcial 1 Flashcards
(145 cards)
2
Q
functions nose
A
warming, humidifying, and cleansing
3
Q
Type of nasal ephitelium
A
ciliated, pseudostratified, columnar
4
Q
Structures thta drain into inferior meatus
A
Nasolacrimal duct
5
Q
Structures thta drain into middle meatus
A
- Frontal
- maxillary
- anterior ethmoid sinuses
6
Q
Structures thta drain into superior meatus
A
Posterior ethmoid sinuses
7
Q
Most important artery for irrigation of the nose
A
sphenopalatine artery
8
Q
The venous drainage of the nose is primarily through the
A
pterygoid and ophthalmic plexuses
9
Q
Rhinitis classification
A
- Allergic: seasonal, perennial
- Infectious: viral, bacterial
- Non-allergic: metabolic, medication, vasomotor (abrupt temperature changes), pregnancy, polyposis, chemical exposure
10
Q
- Clear mucous
- Nasal obstruction
- Incidence related to aging
Are symptoms of:
A
Non-Allergic rhinitis
11
Q
Common cause of Rhinitis medicamentosa
A
Afrin = Oximetazolina
12
Q
Non allergic rhinitis Caused by indoor and outdoor pollutants producing dryness, reduced airflow, rhinorrhea, and sneezing.
Also decreased ciliary movement can be seen.
A
Occupational
13
Q
Non allergic rhinitis in which patients frequently experience more severe exacerbations, including the development of sinusitis and polyposis.
A
With eosinophilia
14
Q
allergic rhinitis phases
A
early - alelrgen exposure cause mast c release histamine and symptoms
late - influx of inflamatory cell in the area
15
Q
concentration of which substance rises throughout pregnancy causing rhinitis
A
Estrogens –> Hialuronic acid –> edema
16
Q
Rhinitis classification related to incidence and intensity:
A
Incidence
* Intermitent (< 4 days a week or < 4 weeks)
* Persistent (> 4 days a week and for >4 weeks)
Intensity
* Mild (normal life, no interference)
* Moderate/Severe (abnormal sleep, impairment of activities, abnormal work/school, troublesome symptoms)
17
Q
Tx for rhinitis <4 days a week or < 4 weeks without troublesome symptoms
Mild&Intermitent
A
First line: Intranasal antihistaminic
Second line: Intranasal corticosteroid
NOT ORAL
18
Q
Tx for rhinitis <4 days a week or < 4 weeks with abnormal sleep
Moderate&Intermitent
A
First line: intranasal antihistaminic (Acelanine)
Second line: Intranasal corticosteroid (Mometasone)
Third line: Both of above
add third line
19
Q
Tx for Mild rhinitis which lasts >4 days or >4 weeks
Persistent
A
Same as intermittent one but you can add pseudo ephedrine (AFRIN) if needed
20
Q
Tx for Moderate/severe & Persistent rhinitis
A
First line: intranasal antihistamine + intranasal corticosteroid
Second line: Intranasal antihistaminic + pseudo ephedrine
Third line: Intranasal corticosteroid + pseudo ephedrine
21
Q
Type of rhinitis that is Ig mediated inflammation resulting from an allergen induction. It may have its onset at any age, but the incidence of onset is greatest in adolescence
A
Allergic rhinitis
22
Q
- sneezing
- Itching
- Rhinorrhea
- congestion
Are symptoms of:
A
Allergic rhinitis
23
Q
Classification of allergic rhinits (other tan incidence and intensity)
A
Seasonal (outdoor)
Perennial (indoor)
24
Q
Hypersensibility reaction related to allergic rhinitis
A
Hypersensibility type 1 - IgE mediated
25
Cells related to response of allergic rhinitis
Mast cells
26
Seasonal (outdoor) clinic
| 4
* usually related to pollination
* **sneezing**
* **watery** rhinorrhea
* itching of the nose, **eyes**, ears, and throat
* red and watering eyes
* Worsen during **morning**
27
Perennial (indoor) clinic
| 2
* commonly **nasal congestion**
* **blockage**
* postnasal drip
Food allergens are also known for causing this, as well as infections.
28
Gold Standard for diagnosis of allergic rhinitis
Skin allergy testing
29
common manifestations of allergic rhinitis in children
* Asthmatic wheezing
* Nasal salute
* mouth breathing
* shiners (dark circles under eyes)
30
Antihistamines (first generation cause sleepiness bc they cross hematoencephalic barrier)
True
31
Tx for mild&intermitent allergic rhinitis
First line: **Oral** antihistamine (60min onset) OR Intranasal antihistamine (<10-15min onset)
Second line: Oral Antihistamine + Pseudoephedrine
| INAH: fenofenadina 2da generación
32
Tx for moderate&intermitent allergic rhinitis
First line: Oral antihistamine (60min onset) OR Intranasal antihistamine (<10-15min onset)
Second line: Intranasal Corticosteroids (1-3hrs onset)
33
Tx for mild&persistent allergic rhinitis
First line: Intranasal **Corticosteroids**
Second line: Oral antihistamine or Intranasal antihistamine
34
Tx for moderate&persistent allergic rhinitis
**Intranasal** antihistamines + **Intranasal** Corticosteroids (in one drug or separated)
35
Symptomatic inflammation of the paranasal sinuses and nasal cavity. It’s almost always accompanied by inflammation of the contiguous nasal mucosa.
Sinusitis
36
Classification of sinusitis acording to time
Acute: <4 weeks
Sub acute: 4-12 weeks
Chronic: >12 weeks
Recurrent: >4 episodes in a year
37
Acute or chronic sinusitis should be acompanied by 2+ symptoms, 1 of which should be either:
1) nasal **blockage**/obstruction/congestion
2) nasal **discharge** (anterior/posterior nasal drip)
± facial pain/pressure
± reduction or loss of smell
38
Acute viral and bacterial etiologies:
Viral: **Rhinovirus**, respiratory syncytial
Bacterial: **Streptococcus pneumoniae**, Haemophilus influenzae, and Moraxella catarrhalis.
39
Chronic bacterial etiologies:
Staph aureus, Pseudomona aeru, Haemophilus influenzae
40
4 pair sinuses
1. frontal
2. maxillary
3. ethmoidal (anterior and posterior divided by lamella of the middle turbinate)
4. sphenoidal
41
Sinuses that form osteomeatal complex
* maxillary ostium
* infundibulum
* ethmoid bulla
* uncinate process
* hiatus semilunaris
42
sinus that can communicate if **complication with sella turca** creating neurologic pathologies
Sphenoidal
43
Clinic triade for **bacterial** acute sinusitis
* Purulent nasal drainage
* Nasal obstruction
* Facial pain or feeling of pressure
44
Difference between viral and bacterial clinic in sinusitis (time related)
VIRAL: Symptoms **don’t worsen** and are present <10 days
Bacterial: Symptoms **worsen within 10 days** after an initial improvement and are present 10+ day
45
In chronic sinusitis ther isnt fever
True
46
samter triad
* asthma
* nasal polyps
* aspirin intolerance
47
Gold standar image study for sinusitis and scale to evaluate it
CT scan with Lund Mackey Score
48
Sinus visible in Caldwell , Waters and Lateral X-ray projections
Caldwell: Ethmoid and frontal
Waters: Maxillary
Lateral: **Sphenoid**, Frontal, ethmoids and maxillary
49
system classification for complications common to use in acute rhinosinusitis
Chandler System
50
Chandler System grades
1. Inflamatory edema (preseptall cellulitis, only in skin)
2. Orbital cellulitis (postseptal)
3. Subperiosteal abscess (infection in the ethmoid cells) –m**eye movement affected**
4. Orbital access (neuroinfection)
5. Cavernous sinus thrombosis (3, 4, 6 nerve affected) – **hemiplejia, ptosis, diplopia**
51
Sinusitis complication: Fungal infection which causes necrosis in immunosuppressed patients
Mucormicosis
52
Lund Mackay Score findings
Examinate 5 pairs of sinuses and ostiomeatal complex
1. Evaluate R&L side
2. Each side must be punctuated 0= normal// 1: partially occupated // 2: occupation
3. Except for ostiomeatal complex 0: no occupation // 2: ocuppated
53
Lund Mackay Score according to results:
Normal: 0
Leve: 1-3
Moderada: 4-10
Severa: >10
54
Chronic RS dx
1. >12 weeks
2. **2+** of the following symptoms: Mucopurulent **drainage** (anterior, posterior, or both), Nasal obstruction (**congestion**), **Facial pain**-pressure-fullness or Decreased sense of **smell**
3. **1+** signs of **image** inflamation: Purulent mucus or edema in the middle meatus or ethmoid region, Polyps in the nasal cavity or the middle meatus or X-Ray positive
55
Tx for Mucormicosis
Amphotericin B and srugery for necrosed areas
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development of a **noninvasive** conglomeration of fungal hyphae into a mass. Patients are usually **immunoCOMPETENT** with no other risk factors.
Fungal ball
57
* poorly controlled **diabetes**, HIV/AIDS, hematologic malignancies, and pharmacologic **immunosuppression**
rapid development of progressive angioinvasive fungal infection that may extend to the **orbit**, pterygopalatine fossa, cavernous sinus, or intracranial cavity
Acute invasive fungal sinusiti
58
osteomyelitis of the **frontal bone** with the development of a subperiosteal abscess manifesting as a puffy swelling on the forehead or scalp. It usually occurs as a **complication of frontal sinusitis**. Treatment is prompt surgical drainage and initiation of broad-spectrum antibiotics.
Pott’s Puffy Tumor
59
# sinusitis
**MRI** scanning should be the imaging **method of choice** in
the evaluation of soft-tissue masses, **complicated** **sinus** inflammatory diseases, and **intracranial** or **intraorbital** extension of sinus pathology.
| potts, chandler, murcormic, meninigitis, fungall
60
Tx for acute non bacterial sinusitis
- Antihistaminics
- Decongestants <10 days
- Paracetamol
- AVOID antibiotics
61
Tx for acute bacterial sinusitis
(**>10 days or worsen in 5 days**)
| FEVER >38°C, unilateral, severe pain
- **Inhaled corticosteroids**
- Decongestants >10 days
- Saline rinses
- Antibiotics: **amoxiciline/calvulanate**
62
Tx chronic sinusitis
- Inhaled corticosteroids
- Saline rinses
63
Definitive tx for chronic sinusistis
Functional endoscopic sinus surgery (except for frontal sinus)
64
Monoclonal antibodies (additional therapy but expensive) and where they work
Omalizumab (IgE)
Mepolizumab (IL-5)
Dupilumab (IL-4r) best option for nasal polyps
65
patient with bleeding from the nostril, nasal cavity, or nasopharynx that is sufficient to warrant medical advice or care.
Epistaxis
66
Principal cause of posterior epistaxis in children
Leukemia
67
3 principal causes of epistaxis
1. Idiopathic/spontaneous
2. Trauma [fracture], picking
3. Postop/iatrogenic
68
The reference point to calssify epistaxis in anterior or posterior
maxillary sinus ostium
69
Blood flows forward through the nose. Epistaxis in this area can result in blood flowing into the orbit
Anterior epostaxis
70
Major blood loss and it goes through the oral cavity with aspiration risk into the lungs; therefore is more dangerous
Posterior epistaxis
71
he majority of posterior idiopathic bleeds are from the **septum**, usually from the septal branch of the
**sphenopalatine**
72
Located on the cartilage is the most common site of anterior nosebleed because various arteries conflux
Kieselbach’s plexus/Little’s area
73
Initial management on non complicated epistaxis patients
1. Nasal compression for 20min with head inclined forward
2. Children: petroleum jelly
74
If patient still bleeding after 20min of compression:
1. Examination to identify bleeding site
2. Topical tx: cautery or nasal packing
75
If patient still bleeding after topical treatment
1. posterior nasal packing with a foley catheter (ONLY otorrinos)
2. surgical ligation
3. embolization
76
GS tx for posterior epistaxis
**endoscopic** sphenopalatine artery cautery
77
most common benign SINUS neoplasm
inverted papilloma
78
most common malignant sinus tumor
squamous cell carcinoma (SCC)
79
The nasal cavity and paranasal sinuses are lined by
Schneiderian mucosa
80
Tumors located **superior and posterior** to Ohngren’s line re more likely to involve the skull base and carry a worse prognosis
(plane from the medial canthus to angle of mandible)
81
clinical symptoms can suggest a neoplastic process
* **unilateral** swelling
* Pain
* **Epistaxis**
## Footnote
IF big enough can cause orbital and hearing manifestations
82
Image study helpful in defining the tumor relationship to **arteries and veins** , and in evaluating cervical lymph node **metastatic**
Contrast CT scan
83
Image study good for evaluating **soft tissue extension of tumor**, perineural invasion (PNI), cranial nerve involvement,
RM
84
Contraindication of tumor biopsy
highly vascular tumors or encephaloceles which shouldn't be biopsied.
85
Highly **vascular benign** tumors seen almost exclusively in adolescent/children males.
**Hollman Miller sign**
JUVENIL NASOPHARYNGEAL ANGIOFIBROMA
86
Percentaje of inverted papilloma that can become malignant
5-15%
87
Benign tumors
| 3
* Osteoma
* Inverted papilloma
* Juvenile angiosarcoma
88
Malignant tumors
| 4
* SCC
* Olfatory neuroblastoma
* Rabdomyosarcoma
* Lymphoma
89
Tx for lymphoma
ONLY QT and RT
90
sinus tumor in which histoiology presents eosinophils
SCC
91
sinus tumor related to EBV
Lymphoma
92
General treatment for sinus tumors
Surgery to remove most of tumor + adjuvant RT
| *Except for JAF which needs previous embolization and lymphoma
93
loss of active movement of the “true” VC, or vocal fold (VF), secondary to disruption of the motor innervation of the larynx.
Vocal cord paralysis
94
muscle that open the vocal cords
Posterior cricoarythenoiod
95
ALL the intrinsic laryngeal muscles are supplied by the recurrent laryngeal nerve.
| ADDUCTORS AND POSTERIOR CRYCOARYTENOID
FALSE, the **cricothyroid muscle** is inervated by **external superior laringeal nerve**
96
Nerve that gives sensibility to the larynx
Internal superior larynx nerve
97
Vocal cords epithelium
Stratified squamous
98
Three types of vocal chord positions
Speaking: true vocal cords must reach midline
Paramedia: movement between 10°-30°
Intermediate/Cadaveric: too separated almost 45°
99
Types of vocal chord paralysis
Vagal nerve
* unilateral
* bilateral
Recurrent laryngeal nerve
* unilateral
* bilateral
100
Vocal cord position in vagal paralysis
Vocal chords position: Intermediate
101
Vocal cord position in recurrent laryngeal nerve paralysis
Vocal chord position: Paramedium
102
* **Dysphonia**.
* “Bovine” cough (como si tuviera hollín)
* Voice may tire with use
VC paramedium
Clinic of
| NO DISNEA
Recurrent larygeal nerve unilateral paralisis
103
* Weak, breathy hoarseness.
* Possible history of aspiration.
* Site of injury above the origin of the superior laryngeal nerve
VC intermediate
Clinic of
| NO DISNEA
Vagal nerve unilateral paralisis
104
Most common type of laryngeal paralisis
Recurrent laryngeal nerve paralysis
105
* Often presents with **stridor**. --> Disnea
* **Voice** may be normal.
* Usually a history of **thyroid surgery**.
VC paramedian position
***EMERGENCYYYYYYYY***
| NO DYSPHONIA
Recurrent laryngeal nerve BILATERAL paralysis
106
* Weak voice or **NO VOICE**
* History of aspiration and choking.
* Satisfactory glottic aperture at rest. --> VC intermediate
Vagal nerve BILATERAL paralysis
107
Tx unilateral VN paralysis
Thyroplasty
108
Tx unilateral RLN paralysis
Speech therapy
+/OR
Injection of hyaluronic acid or fat
OR
Thyroplasty
109
Tx bilateral RLN paralysis
Lateralization of vocal cord (will breathe but wont speak)
OR
Cordectomy (cut the vocal cord to create more space for breathing)
OR
Tracheotomy as last resource
110
Larynx cartilages
3 unpaired cartilages: **epiglottis**, **thyroid** and **cricoid** cartilages.
3 paired: **arytenoid**, **corniculate** and **cuneiform**
111
Cartilage that protects vocal chords
Thiroyd
112
divides the larynx and the hypopharynx
Aryepiglottic fold
113
Differential diagnosis in children who are hoarse
vocal cord nodules and juvenile papillomatosis.
114
* Most common pathology
* **1 cause** of **dysphonia** in adults and children
* Common in **singers**
* **bilateral**
Vocal cord nodules
115
Tx for vocal nodules
Speech therapy 3 moths
NO srugery
116
* **unilateral** unique lession of the vocal cords
* **Pedunculated** lesion red colored
* Inflammation of the mucosa
* AP **reflux** or excessive voice use
Vocal cords polyps
117
Tx polyps vocal cord
Microsurgery + Speech therapy
IF reflux: Add IBP
118
Benign tumor related to patients that have been intubated; located near to the arytenoid cartilage
Can present dysphonia
Intubation granuloma
119
Tx Intubation granuloma
Corticosteroids or botox to avoid touching and infamation
120
* **Bilateral** in the lamina propia
* **Diffuse polyposis** of the vocal cord (like they have water inside)
* Risk factor: **smoking**
* Clinic: **raspy voice** (like alejandra guzman)
Reinke edema
121
Tx Reinke edema
Speech therapy + avoid irritants
IF doesnt work: surgery
122
it’s **inside of the vocal cord** and can contain **mucus** or epithelial cells
Clinic: dysphonia
Laryngeal cyst
| DONT KNOW DIFFERENCE BETWEEN THIS AND SACULAR
123
Full of **air** because of the herniation of the mucosa
Common in **wind instrument musicians**
Clinic: **valsalva**
Diagnosis: *CT Scan*
Laringocele
124
Tx for larinogcele, larynx cyst and papillomatosis
Surgery
125
* Common in **children** (through the birth-canal)
* **Wardy** lesions located in the larynx and they can block the airway
* HPV **6&11** virus
* Clinic: dysphonia and if big enough they can cause **disnea**
Papillomatosis
126
3 areas of the larynx
Supraglottic
Glotis
Subglottic
127
Most common site of larynx SCC
Glotis = vocal cords
128
**T3 and T4 **- Advanced stage is common that SCC has spreaded to
| VOCAL CORD FIXATION
**supraglottis** metastasis
129
Masculine 50 years with History of smoking, alcohol comes to the doctor for bleeding when **coughing** (it has lasted **>3 months**) presenting **dysphonia** , dyspnea. At PE neck lymph nodes, leucoplaquia
You decide to:
1. Laringoscopy and if something found
2. Biposy partially
130
Tx larynx SCC
Early stage (single modal therapy: RT or cordectomy)
Advanced stage (surgery + RT/QT)
131
Two pillars that delimitate the tonsillar fossa
Anterior: **palatoglossal** muscle
Posterior: **palatopharyngeal** muscle
132
**Coxsackie virus**
* Adults: Inmnuosupression & Children: Hand-feet-mouth sindrome
* EF: Hafts (**ulcers**) on the cavity: **anterior pilar**, soft palate, **conjunctival** involvement
* Clinic: High fever, very painful sore through, anorexia
* Tx: symptomatic
Herpangina
133
* AHF: **chicken pox **
* EF: **vesicles** in soft palate (**gums and oral mucus**), tonsils, lesions follow dermatomes
* Clinic: very painful
* Tx: NAIDs, frozen foods, antivirals: **Acyclovir**
Herpes zoster
134
* **Epstein-Barr**
* EF: **lymphadenopathy** with tonsil growth that doesn’t allow food to pass through, and exudate (**white-gay membrane** that appear over the tonsils)
* Clinic: high fever
* Complications: **hepatosplenomegaly**
* Dx: heterophil antibodies
* Tx: steroids, pain relievers, mouth washes with Vantall
Mononucleosis
135
Most common baterial patogen for adenotonsillar disease
Streptococo b-hemilytic group A
136
* EF: **purulent** exudate generalized, hyperemia
* Clinic: sore through, **fever**, painfull
* Dx: Blood agar (+)
Acute Streptococcus
137
Non suppurative complications
| S.B-Hem
**rheumatic** fever (Jones criteria), **scarlet fever** (exantema), post streptococcal **glomerulonephritis**, PANDAS
138
suppurative complications
peritonsilar **abscess**, pharyngeal abscess
139
Criteria for tonsillectomy caused by an infection
Paradise criteria
140
Tonsillectomy criteria for infectious causes from the book
* 7+ ep a year // 5+ ep e/y for 2years // 3+ ep e/y for 3 years
* Febrile seizure or cardiac dissease
* chronic unresponsive tonsillitis
* peritonsillar abscess with recurrency
141
Centro criteria points and when to give antibiotic
Each one = 1 point
* Fever
* Exudate
* NO cough
* Anterior cervical lymphadenopaty
* Age <14
>44 years (-1 point)
3+ = ANTIBIOTICS
142
Eradication treatment Reumathic fever
Benzathine penicillin 1200UI every 21 days for 3 dosis)
143
Chronic tonsillitis is an indication of tonsilectomy
TRUE
144
BIOPSY is contraindicated on suspected adenotonsilar tumors because irrigation, it needs to be fully removed (excisional) with Tonsillectomy (both) and then sent to the pathologist
TRUE
145
Paradise criteria
1. Sore throats: 7+ a year OR 5+ each year last 2 years OR 3+ each year last 3 years
2. **1+** of the following:
Fever >38.3
Exudate
Lymphadenopathy
Culture (+) SBH
3. Previous **antibiotic** medication with no result
