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EENT > Quiz 1 > Flashcards

Quiz 1 Flashcards

1
Q

Function - Outer Ear

A

Collect sound energy and channel it into head

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2
Q

Function - Middle Ear

A

TM captures/transmits sound energy to ossicles

Ossicles converts sound energy to mechanical energy, amplifies it, and transfers it to the oval window of the cochlea

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3
Q

Function - Eustachian Tube

A

Pressure adjustments
Drainage
Protection from nasopharyngeal secretions and bacteria

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4
Q

Eustachian tube is opened by contraction of what muscle?

A

tensor veli palantini during swallowing/yawning

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5
Q

Perilymph

A

Found in the bony labyrinth

High Na, low K (similar to CSF)

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6
Q

Endolymph

A

Found in the membranous labyrinth

Low Na, high K

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7
Q

Function - Vestibule

A

Proprioception and balance

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8
Q

Function - Cochlea

A

Conversion of sound energy into electrical energy

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9
Q

How is sound transmitted in the ear?

A

Sound is collected by the outer ear
TM captures sound, transmits to ossicles
Ossicles convert sound energy into mechanical energy, transmits to cochlea
Mechanical energy moves endolymph in membranous labyrinth, causing flow of K+ ions across negatively-charged hairs on Organ of Corti, causing synapse firing
Information is conveyed by CNVIII to auditory area of temporal lobe, where it is interpreted as sound

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10
Q

Where is the only vascularized epithelium in the body?

A

inner ear

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11
Q

Function - Stria vascularis

A

“back-up battery” for Organ of Corti

Maintains endolymph

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12
Q

DDX - Ear pain (outer ear)

A 
Lichen simplex chronicus
Seborrheic dermatitis
Contact dermatitis
Atopic dermatitis
Acute cellulitis
Erysipelas
Infectious chondritis
Relapsing polychondritis
Auricular hematoma
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13
Q

Tx: Lichen simplex chronicus

A

education, cut nails, soothing lotion

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14
Q

What are other common locations to find seborrheic dermatitis?

A

scalp, eyebrows

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15
Q

What are other common locations to find atopic dermatitis?

A

flexural folds, ear canal

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16
Q

DDX: atopic derm vs. otitis externa

A

AD - sterile, no WBC, not infected

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17
Q

Acute cellulitis and erysipelas occur secondary to ___.

A

dermatitis, trauma

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18
Q

DDX: cellulitis vs. erysipelas

A

Cellulitis: more superficial, smaller area, usu caused by GABHS

Erysipelas: deeper infection, involves entire auricle, pt will be sicker (fever, chills)

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19
Q

Infectious chondritis is usually secondary to ___.

A

erysipelas

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20
Q

DDX: Erysipelas vs. Infectious chondritis

A

IC involves cartilage

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21
Q

DDX: Relapsing polychondritis vs. Infectious chondritis

A

RP - non-infectious, bilateral, spares lobes, nasal/ocular chondritis or arthritis possible

IC - infectious, involves the lobe, systemic sxs

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22
Q

Tx: Auricular hematoma

A

Remove fluid with 18g needle and 10 cc syringe, cover w/ compression dressing for 48 hours

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23
Q

DDx - Ear pain (ear canal)

A 
Otitis externa
Malignant otitis externa
Otitis media (acute, serous)
Otic barotrauma
Impacted cerumen
Foreign bodies
Osteoma
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24
Q

Risk factors: OE

A

Change in pH from acid to alkaline
Inc. temp/humidity
Mild trauma/freq. cleaning

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25
Q

SSx: OE

A

TTP ear canal and auricle, aural fullness, hearing loss, unilateral or b/l

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26
Q

Risk factors: MOE

A

Diabetics
Alcoholics
Severe malnourished

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27
Q

SSx: MOE

A

Ear pn, purulent d/c, no fever, no swelling, granulation tissue at junction of temporal bone

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28
Q

Most important sign of MOE?

A

granulation tissue at junction of temporal bone

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29
Q

MC causative agent of MOE?

A

Pseudomonas aeruginosa

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30
Q

Complications: MOE

A

Osteomyeltitis, hearing loss, facial nerve paralysis, death

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31
Q

Tx: MOE

A

Refer to ENT, anti-pseudomonal agents

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32
Q

AOM is usu 2˚ to __.

A

URI

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33
Q

SSx: AOM

A

Usu unilateral, begins w/ sensation of blockage/hearing loss (fluid, loss of bony landmarks, red TM, small/distorted light reflex), progression to fever (>99.5˚F), < evening

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34
Q

What are the best clues for AOM in infants?

A

insomnia, irritability, anorexia

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35
Q

Which sign, if present, can be used to rule in AOM?

A

Bulging TM

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36
Q

Which sign, if absent, can be used to rule out AOM?

A

Immobile TM

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37
Q

Risk factors: Otic barotrauma

A

air travel

scuba diving

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38
Q

SSx: Otic barotrauma

A

Ear pn < yawning, hearing loss, dizziness

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39
Q

SSx: Impacted cerumen

A

discomfort to ear pn, hearing loss, dizziness, reflex cough

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40
Q

Cerumen impaction is mc in which populations?

A

elderly, pts w/ cognitive impairment

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41
Q

Tx: impacted cerumen

A

cerumenolytic agents, irrigation, manual removal

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42
Q

What is the main contraindication to ear lavage?

A

Perforated TM

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43
Q

Why should irrigation should not be done with beans?

A

They can swell.

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44
Q

What are osteomas?

A

Exostoses of the external auditory meatus

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45
Q

SSx: osteoma

A

Usu asx, occasional conductive hearing loss

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46
Q

Tx: osteoma

A

Surgery

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47
Q

What homeopathic is indicated for osteomas?

A

Hekla lava

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48
Q

DDx: Referred ear pain (normal otoscopic exam)

A

TMJ dysfunction (MC), molars, head/neck malignancies

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49
Q

What are red flags for serious occult cause of referred ear pain?

A

Smokers, alcoholics, >50 years old, diabetics

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50
Q

SSx: Serous Otitis Media (OME)

A

Usu painless, plugged feeling, aural fullness

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51
Q

What are the MC causes of OME?

A

Allergies, viral infection

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52
Q

PE: OME

A 
TM yellow/amber
Bubbles, fluid level
Retraction
Tympanogram flat-type B
Little/no movement of insufflation
Conductive hearing loss
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53
Q

Tympanometry: Type A vs B vs C

A

A: Normal
B: early AOM, OME
C: Eustachian tube dysfunction

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54
Q

Eosinophilic otitis media mainly occurs in pts with __.

A

bronchial asthma

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55
Q

SSx: Infectious Myringitis

A

Red/painful ear, no middle ear involvement, vesicles on TM (if S. pneumoniae)

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56
Q

SSx: Herpes Zoster Oticus (Ramsay Hunt Syndrome)

A

Otalgia, facial palsy, hearing loss, vertigo, pathognomonic vesicular rash of the pinna, ext. auditory canal, TM

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57
Q

Cause: Herpes Zoster Oticus (Ramsay Hunt Syndrome)

A

Reactivation of VZV

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58
Q

Hearing loss and vertigo in Ramsay Hunt Syndrome is due to ___.

A

movement of virus from CN VIII to CN VII

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59
Q

What is the facial nerve deficit in Herpes Zoster Oticus (Ramsay Hunt Syndrome)?

A

Cannot close eyelid/lift eyebrow/smile

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60
Q

DDx: Mastoiditis vs. AOM

A

Mastoiditis will have ear pain like AOM, but also have pain behind the ear

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61
Q

SSx: Mastoiditis

A

Otalgia, tender/red mastoid, bulging of TM, protrusion of auricle, spasm of ipsilateral SCM

62
Q

Complications: Mastoiditis

A

Abscess into brain, meningitis, death

63
Q

Etiology: Mastoiditis

A

AOM that spreads to mastoid air cells

64
Q

What is the best way to soften cerumen prior to irrigation?

A

Debrox

65
Q

Why is infectious myringitis sometimes called “bullous?

A

If caused by Strep. pneumoniae, there may be vesicles on TM

66
Q

PE: AOM vs. OME

A

AOM - Bulging

OME - Retraction

67
Q

Hx: AOM vs. OME

A

AOM - Pain

OME - Usu painless

68
Q

MC cause of OE?

A

Excessive moisture

69
Q

What population of pts w/ OE are more likely to need systemic tx?

A

Diabetics, those taking systemic corticosteroids

70
Q

OE - Homeopathy

A

Hepar sulph: < heat, < touch

71
Q

What are the most important reasons for treatment to fail in Otitis externa?

A

Failing to clean out the canal, wrong dx (chondritis, MOE), fungal infx, underlying systemic imbalance (dermatitis)

72
Q

MC fungal pathogens in OE?

A

Aspergillus nigra, Candida

73
Q

MC bacterial pathogens in OE?

A

P. aeruginosa, S. aureus

74
Q

Tx: OE d/t Aspergillus nigra

A

Tea tree oil 1:10

75
Q

Complication: OE

A

Furuncle

76
Q

Risk Factors for OM: Season

A

Fall, Winter (peaks in Feb.)

77
Q

Risk Factors for OM: Age

A

Peaks 6-18 mos and 5 yrs

78
Q

Risk Factors for OM: Food

A

Dairy at early age
Early intro of solid foods/reliance on formula
Breast feeding <6 mos
Food allergy

79
Q

Risk Factors for OM: Feeding position

A

Supine

80
Q

Toynbee phenomenon

A

Supine bottle feeding causing aspiration into Eustachian tube

81
Q

Risk Factors for OM: Sleep position

A

Prone

82
Q

Risk Factors for OM: Environmental

A 
2nd/3rd hand smoke
"Sick" buildings
Sibling with URI
Daycare attendance
Pacifier use
83
Q

Risk Factors for OM: Nutritional deficiencies

A

Vit A, Vit D, Zinc

84
Q

Risk Factors for OM: Race

A

Eskimo, Native American

85
Q

Risk Factors for OM: Structural

A

Fetal alcohol syndrome, Down’s syndrome, cleft palate

86
Q

Risk Factors for OM: Conditions

A

GERD
Overweight
Genetics

87
Q

Risk Factors for OM: Drugs

A

Early antibiotic use

88
Q

Twins studies for AOM showed higher rates for (monozygotic/dizygotic) twins.

A

monozygotic

89
Q

How are children’s ears different than an adults, and how does that make them more at risk for Otitis media?

A

Shorter, narrower, and horizontal compared to adults

90
Q

__% of aspirates for AOM are viral.

A

30

91
Q

MC bacterial pathogens: AOM

A

Strep. pneumonia, H. influenza, Moraxella catarhalis

92
Q

Homeopathy for AOM: Aconite

A

Early stage, non-suppurative, violent pain, after exposure to cold, < warm applications

93
Q

Homeopathy for AOM: Belladonna

A

Throbbing pain, red/flushed dry face, thirstless, deranged mind

94
Q

Homeopathy for AOM: Calc carb

A

Red/hot/throbbing high fever, moist head/face, sensitive to cold, mucus in chest/nose

95
Q

Homeopathy for AOM: Chamomile

A

Painful ear, otitis w/ dentition capricious, intolerant, irritable, one cheek red/other white, desires to be carried

96
Q

Homeopathy for AOM: Hepar sulph

A

Sensitive to touch/cold, < drafts, irritable, wants to be wrapped

97
Q

Homeopathy for AOM: Medorrhinum

A

thick/green d/c, eardrums will perforate

98
Q

Homeopathy for AOM: Lycopodium

A

R-sided otitis, eczema behind the auricle, irritable, < 4-8pm, > warm drinks

99
Q

Homeopathy for AOM: Mercurius

A

bloody d/c, abscessed ears. mastoiditis, profuse salivation, indented tongue, child smells sick, < temp. extremes

100
Q

Homeopathy for AOM: Pulsatilla

A

OE/OM, thick/yellow d/c, thirstless, mild, > open air, > sympathy, >being carried

101
Q

Homeopathy for AOM: Ferrum Phos

A

High fever, red TM, R-sided, vague sxs, thirst for cold drinks, red spots on cheeks

102
Q

Homeopathy for AOM: Kali sulph

A

More irritable puls.

103
Q

Clark’s rule for dosing in children

A

Wt. of child / 150 x Adult dose

104
Q

NNT for antibiotics in AOM in children

A

20

105
Q

When are antibiotics most beneficial for AOM?

A

Children <2 yo w/ bl AOM, children with both AOM/otorrhea, reducing risk of mastoiditis in populations where it is mc

106
Q

Risks: Antibiotics for AOM

A

D, stomach pain/rash, increase resistance to antibiotics, inc. rate of recurrence in OME

S/E: D, abd. pain, rash

107
Q

What are the advantages of breast-feeding in preventing otitis media?

A

Provides sIgA, prostaglandins, better feeding position, develops musculature of the face/nasopharynx, no need for dairy/soy (common allergens), ideal mix of nutrients

108
Q

Complications: AOM

A

Mastoiditis, Meningitis, TM perforation, Cholesteatoma, Chronic Suppurative Otitis Media

109
Q

MC bacteria: CSOM

A

P. aeruginosa, S. aureus

110
Q

NNT: AOM w/ otorrhea

A

3

111
Q

Best antibiotic choice for empiric treatment of AOM?

A

Augmentin (Amoxicillin + clavulanate)

112
Q

Supplement options: AOM

A

Vitamins A/C/D, Fish oil, Zinc picolinate, probiotics

113
Q

DDx: Patulous Eustachian Tube

A

Superior semicircular dehiscence syndrome, perilymphatic fistula

114
Q

What type of dizziness might pts describe as “being on a merry-go-round or on a boat”?

A

Vertigo

115
Q

What is difficult about diagnosing CO poisoning?

A

Vital signs are not helpful

116
Q

DDx: dizziness d/t hypovolemia vs. autonomic dysfxn

A

Hypovolemia = drop in SBP 15-20 mmHg w/ increased pulse rate

Autonomic = drop in SBP 15-20 mmHg w/ low pulse rate

117
Q

MC neurologic causes of syncope or pre-syncope

A

SAH, stroke, TIA

118
Q

Impaired balance when walking

A

Disequilibrium

119
Q

What is the MC cause of disequilibrium?

A

Multiple Sensory Deficit

120
Q

Why is it so important to recognize Multiple Sensory Deficit?

A

Common in geriatrics, inc. risk of falls

121
Q

What type of dizziness might pts describe as “in my legs, not my head”?

A

Disequilibrium

122
Q

Imaging when stroke needs to be ruled out?

A

MRI (CT too insensitive)

123
Q

Lab testing identifies the cause of vertigo in __% of cases.

A

less than 1%

124
Q

Location of problem: Peripheral vs. central vertigo

A

Peripheral: middle/inner ear

Central: CNS (brain stem, cerebellum)

125
Q

DDx (Peripheral vs. Central vertigo): Vestibular Ocular reflex

A

P: Corrective saccade if 40% vestibular fxn difference between ears

C: Intact

126
Q

How is the Vestibular Ocular relex elicited?

A

Rapid head impulse test

127
Q

DDx (Peripheral vs. Central vertigo): Spontaneous nystagmus direction

A

P: Unidirectional, primarily horizontal, slow phase in direction of defunct labyrinth

C: Bidirectional, rotational/downbeat/pure vertical

128
Q

DDx (Peripheral vs. Central vertigo): Spontaneous nystagmus suppressed w/ visual fixation

A

P: Yes

C: No

129
Q

DDx (Peripheral vs. Central vertigo): Smooth pursuit on EOM

A

P: Intact

C: Broken

130
Q

DDx (Peripheral vs. Central vertigo): Dix-Hallpike

A

P: Latency, Adaptability, Fatiguability

C: None of the above

131
Q

How long can the latency be in BPPV before nystagmus occurs in Dix-Hallpike test?

A

20 seconds

132
Q

DDx (Peripheral vs. Central vertigo): Diminished hearing, tinnitus

A

P: Common

C: Rare

133
Q

DDx (Peripheral vs. Central vertigo): Caloric test

A

P: Abnormal

C: Normal

134
Q

DDx (Peripheral vs. Central vertigo): Tullio’s phenomena

A

P: Abnormal

C: Normal

135
Q

What is Tullio’s phenomena?

A

Nystagmus and vertigo after a loud noise

136
Q

What are the MC causes of vertigo?

A

BPPV, Meniere’s disease, vestibular neuritis

137
Q

Normal findings: Caloric testing

A

Unilateral nystagmus w/ fast component away from cold water and slowly back, dizziness

138
Q

Abnormal findings: Caloric testing

A

In peripheral lesions, lack of nystagmus or no effect on spontaneous nystagmus

139
Q

Hennebert’s sign

A

Vertigo after pushing on tragus and external auditory meatus

+ in perilymphatic fistula

140
Q

If symptoms and/or nystagmus are elicited by insufflation, this is a sign of ___.

A

perilymphatic fistula

141
Q

Inability to complete past pointing exam suggests ___.

A

cerebellar lesion

142
Q

If Romberg test is positive with eyes open, suspect ___.

A

cerebellar disorder

143
Q

If Romberg test is positive with eyes closed, suspect ___.

A

peripheral neuropathy or vestibular disorder

144
Q

DDx (Peripheral vs. Central vertigo): Type of nystagmus elicited by Dix-Hallpike

A

P: upbeat (BPPV)

C: downbeat

145
Q

What three things should be noted with spontaneous nystagmus?

A

direction, plane, ability to suppress

146
Q

What tool can be used to prevent visual fixation?

A

Frenzel lens

147
Q

What other way can visual fixation be eliminated other than Frenzel lens?

A

Blank sheet of paper

148
Q

If valsalva causes pre-syncope, suspect ___.

A

cardiovascular reason instead of vestibular

149
Q

Red flags for stroke with vertigo

A

Hyperacute onset vertigo, occipital HA, gait ataxia

150
Q

DDx (VEMPs): sensorineural vs. conductive hearing loss

A

Conductive: obliterates VEMPs

Sensorineural: No change in VEMPs

151
Q

What is the only test to differentiate unilateral and bilateral hearing loss?

A

Caloric testing (as part of VNG)

152
Q

What is the gold standard for testing inner ear function?

A

Videonystagmography

EENT (3 decks)

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