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ENT
ENT med surg review
112
Other
Graduate
12/12/2009

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Term
most common malignant tumor of the skin. presents as chronic sun exposure, painless ulcer/nodule, >40yo, telangiectias, rolled, pearly border.biopsy this.
Definition
BCC
Term
clinical presentation is prolonged UV light exposure, often arises from actinic keratosis, hard,non-tender, red, indurated papule, nodule or plaque, incidence increases with age.most common external auditory canal neoplasms.
Definition
Squamous cell carcinoma
Term
usually asymptomatic, common around the ear, well defined, non-tender, soft, mobile, cystic mass, slow growing
Definition
epidermal inclusion cyst
Term
painful swelling following blunt trauma, common in boxers, wrestlers, rugby. pts need to be counseled to protect ears. this occurs due to shearing force.
Definition
auricular hematoma
Term
clinical presentation is inflammation of auricular cartilage, tender, red, tense auricle, spares the lobe. secondary to cellulitis, frostbite, trauma.
Definition
perichondritis
(tx- corticosteroids and ENT referral)
Term
you will see light to dark yellow, brown, red or black appearing mass in EAC, hx of impaction or Q-tip use, decreased hearing, intra-aural fullness.
Definition
cerumen impaction
(tx-rule out perf first!irrigation)
Term
common problem in children. pt may be asymptomatic, pain, discharge, bleeding, aural fullness, hearing loss, itching,tinnitus
Definition
foreign bodies
(tx-local anesthesia or sedation, kill insect with mineral oil first. do NOT irrigate for battery or vegetable in ear)
Term
seen mostly in summer months secondary to retained moisture in EAC. pt presents with otalgia out of proportion to PE findings, pain with traction to tragus. "swimmers ear"
Definition
otitis externa
Term
aka "skull base osteomyelitis". bacterial infection of EAC and skull base. most frequent in elderly diabetics and the immunocompromised. often caused by pseudomonas aeruginosa.pt will have persistent fould otorrhea.
Definition
malignant external otitis
(tx prolonged antipseudomonal IV antibiotics)oral cipro for milder disease
Term
most common pathogen of AOE...
Definition
pseudomonas
Term
complication of auricular hematoma is...
Definition
cauliflower deformity
Term
treatment for cerumen impaction is...
Definition
debrox or H20 and H202 solution
Term
treatment for cerumen impaction is...
Definition
debrox or H20 and H202 solution
Term
tube does not open with yawning swallowing. pt will present with hx of URI or allergies,intra-aural fullness, ears crackle/pop with swallowing. TM is normal color, retracted with decreased mobility with valsalva.
Definition
eustachian tube dysfunction
(NO antibiotics.tx underlying problems- allergies - use oral decongestants)
Term
aka "otitis media with effusion". commonly follows URI, persistant hearing loss, "blocked or plugged" feeling, air fluid levels/ bubbles. weber/rinne decreased hearing.
Definition
Serous Otitis media
(tx- time..most resolve on their own, decongestants, oral or intranasal corticosteroids, adenoidectomy)
Term
inability to equalize middle ear pressure during descent in diving or aircraft. TM may rupture or retract.
Definition
middle ear barotrauma
(tx-oral decongestants, antibiotics if indicated)
Term
treatment for AOM...
Definition
if >2, antipyretics and analgesics at first, <2, amoxicillin in high doses x 10 days. if older than 2, antibiotics for 5-7 days.
Term
chronic/recurrent OM...
Definition
3 episodes in 4 months or > or eaual to 4 in 12 mo. these pts may need PET (pneumatic equalizing tubes)
Term
AKA tubotympanic. pt will have chronic or recurrent otorrhea or both, hearing loss, tympanic membrane perf
Definition
chronic suppurativ otitis media
Term
variant of AOM where blisters begin to form on the outer surface of the tympanic membrane. extremely painful and pt needs oral and topical analgesics. pain subsides when blisters burst.
Definition
bullous myringitis
Term
most frequen serious complication of middle ear infections- extends into mastoid air cells.
Definition
mastoiditis- CT scan study of choice. hopsitalization, high dose IV antibiotics, possible surgery.
Term
the presence of squamous epithelium in the middle ear, mastoid, or epitympanum.
Definition
cholesteatoma
(primary acquired most common from eustachian tube dysfunction; PET insertion)surgical excision is tx.
Term
abnormal removal of mature bone, abnormal remodeling, and a lesion at footplate of the stapes at the oval window indicate this. these patients speak softly due to increased bone conduction. they hear better in noisy environments.
Definition
otosclerosis
Term
most common tumor in the middle ear.
Definition
paraganglioma, AKA glomus tympanicum
Term
rare benign tumors that arise from middle ear mucosa. conductive hearing loss due to mass.
Definition
adenoma
Term
presents as painful chronically draining ear.
Definition
carcinoma
Term
what is the purpose of PET?
Definition
vent the ear NOT drain the ear
Term
most common cause of SNHL
Definition
presbycusis
Term
common in elderly, short episodes of vertigo brought on by head movements. sudden onset of N/V and tinnitus, may be unable to walk or stand, characteristic nystagmus with dix-hallpike test, no assoc. hearing loss. 20% have hx of ear trauma or infection. a result of debris in the semicircular canals.
Definition
BPPV
Term
what test do you perform with BPPV?
Definition
dix-hallpike test
(if no nystagnmus or neuro findings=MRI)
Term
What is the tx for BPPV?
Definition
epley maneuver
Term
aka "idiopathic endolymphatic hydrops". episodes last minutes to hours. triad of hearing loss, tinnitus, vertigo. episodes can be disabling. recur in several months to years. typically in 5th decade. caused from distention of endolymphatic compartment. 1-8 hrs of episodic vertigo. tinnitus low tone "BLOWING".usually unilateral.
Definition
meniere's disease
(tx is valium, dietary modifications, diuretics,aminoglycoside therapy, steroid therapy, refer to ENT, may need surgical tx)
Term
acute vestibular nerve inflammation without any cochlear involvement. isolated vertigo, NO hearing loss. occurs days after an URI, occurs in middle aged and young adults, lasts for 24-48 hours.
Definition
vestibular neuronitis
(tx is symptomatically and vestibular rehab)
Term
recent hx of viral URI followed by severe vertigo and hearing loss. involves the cochlea and labyrinth. acute temporary vertigo, nausea, and vomiting, sx last days to 2 weeks.
Definition
acute labyrinthitis
(tx- IV fluids, valium, antivert, antihistamines, sedative hypnotics, and anticholinergics)
Term
more permanent form of positional vertigo. constant positional vertigo and severe nausea, has been labeled "DISABLING POSITIONAL VERTIGO"
Definition
vascular compression of the vestibular nerve
Term
these can injure the peripheral vestibular apparatus. streptomyacin and gentamycin are the most injurious to vestibular portion of CN VIII. salicylates, NSAIDS, loop diuretics, and several antineoplastic agents. may occur at therapeutic doses.
Definition
ototoxins
Term
most worrisome peripheral lesion in retrocochlear location. one of the most common intracranial tumors. benign schwannoma of CN VIII. can produce serious brainstem compression. pt may have facial numbness/weakness.decline of speech discrimination. pts need surgery.
Definition
acoustic neuroma
Term
most common cause of vertigo post head injury.
Definition
labyrinthine concussion
Term
leakage of perilymphatic fluid from round or oval window. vertigo and SNHL. seen in divers, blunt head trauma, ear boxing, surgery. tx is bed rest and surgery.
Definition
perilymphatic fistula
Term
brainstem and cerebellar dysfunction. common in the elderly with known cerebrovascular disease. dizziness associated with diplopia, dysarthria, HA, altered mental status
Definition
central vertigo
(most common cause= NSAIDS, antibiotics and muscle relaxers)
Term
demyelination in vestibular pathway. autoimmune disease. pt <55yr at onset, greater in young adults, F>M, west european lineage. SX- transient nature of attacks, vertigo in some pts, slight facial numbness or huskiness of voice. MRI shows discrete CNS lesions.
Definition
MS
Term
this occurs when the vertebrobasilar artery is compromised. usually produces vertigo in conjunction with diplopia, sensory loss, dysarthria, dysphagia, hemiparesis, and other brain stem deficits. this may begin as only transient vertigo later episodes almost always include other brainstem symptoms. characteristic "DROP ATTACKS" without LOC. (older women getting hair washed)may be manifestations of TIA.
Definition
vertebrobasilar insufficiency
Term
for patients with this disease, you tx them with low salt diet, HCTZ diuretics
Definition
meniere's dz
Term
sudden vertigo that develops without ear symptoms and lasts for 24-48 hours is most likely...
Definition
vestibular neuronitis or labyrinthitis
Term
would you prescribe antibiotics for viral rhinitis (common cold)?
Definition
no, you can use afrin nasal spray for no more than 3 days, tylenol, ibuprofen, OTC meds
Term
in these patients you will see pale or bluish turbinates, possibly nasal polyps, nasal "salute" with nasal crease, clear rhinorrhea
Definition
allergic rhinitis
Term
first line tx for allergic rhinitis?
Definition
nasal corticosteroid sprays, advise pts to try to avoid environmental triggers
Term
symptoms of nasal obstruction, rhinorrhea, and congestion without another etiology. alcohol, spicy foods, emotions, certain odors and environmental factors such as temp, barometric pressure changes, and bright lights are symptoms. Allergy tests ARE NEGATIVE.
Definition
vasomotor rhinitis/ chronic nonallergic rhinitis
Term
chronic inflammatory condition with a hx of chronic decongestant nasal spray use or cocaine use. PE reveals erythema, edema and clear rhinorrhea. no nasal obstruction.
Definition
Rhinitis medicamentosa
Term
samter's triad...
Definition
asthma, polyposis, and aspirin insensitivity.
Term
infection in the paranasal sinuses that usually follows a URI. impaired mucociliary clearance and obstruction of osteomeatal complex.
Definition
sinusitis
Term
a sinus infection that lasts <4 weeks..
Definition
acute sinusitis
Term
sinusitis that lasts for 5-8 weeks
Definition
chronic sinusitis
Term
what is the GOLD standard for sinusitis?
Definition
limited coronal CT without IV contrast
Term
for sinusitis, you can use antibiotics on these patients..
Definition
pts given decongestants/ analgesics for 7 days, pts with maxillary/facial pain, pts with purulent nasal discharge, pts with severe illness(pain, fever)
Term
sinusitis in children presents with these symptoms...
Definition
persistent cough, fever, purulent rhinorrhea and post nasal drip.
Term
tx for sinusitis in peds...
Definition
amoxicillin 40mg/kg/day q 8hrs
augmentin 20-40mg/kg/day q8hrs
if child is >40kg, treat as an adult
Term
inflammation/ infection of the nasal vestibule. staph aureus from folliculitis is cause.
Definition
vestibulitis
Term
tx for vestibulitis...
Definition
bactroban, systemic antibiotics. I&D furuncle if present is tx of choice.
Term
rare but serious opportunistic infection of the sinuses and brain caused by saphrophytic fungi. may be lethal if not detected early.usually immunocompromised pts. this is a medical and surgical emergency. wide debridement and amphotericin B is given. symptoms are similar to bacterial sinusitis (facial pain is more severe, palate/ nasal mucosa with black, necrotic eschar, cranial neuropathies) if spreads to brain, 80% fatality. mortality rate is 20%.
Definition
rhinocerebral mucormycosis
Term
this nose bleed is common in kids- nose pickers, foreign bodies, URI.
Definition
anterior epistaxis
Term
this nose bleed may be life threatening. HTN frequently associated. pts on coumading and other blood thinners at risk. tend to occur in elderly.
Definition
posterior epistaxis
Term
most common site of bleeding is posterior to the inferior turbinate from this artery...
Definition
sphenopalatine artery
Term
these are pale, edematous masses covered with mucosa commonly seen in patients with allergic rhinitis. pts can present with nasal obstruction, diminished sense of smell.
Definition
nasal polyps
(tx nasal or oral steroids, surgery)
Term
uncommon benign tumor that presents with unilateral obstruction/ epistaxis. it is a wart-like tumor lateral nasal wall. diagnosed by biopsy. tx is surgery. 10% changes to SCC. recurrence is common. early referral to ENT.
Definition
nasal papilloma
Term
highly vascular invasive neoplasm of nasopharynx. common in adolescent males. presents as triad nasal obstruction, epistaxis, and nasal drainage.
Definition
juvenile angiofibroma
(tx- close follow up b/c it may resolve on its own; surgery)
Term
usually found late when invades other local tissue. presents with proptosis, pain/expansion of cheek or ill-fitting maxillary dentures. SCC most common. tx is radiation, chemo, surgery
Definition
malignant nasopharyngeal and paranasal sinus tumor
Term
this condition has a triad of necrotizing granulomas of upper/lower airways, glomerulonephritis and disseminated vasculits. pt is typically 30-40yo male with unresolved URI symptoms. diagnosis is nasal biopsy.
Definition
wegner's granulomatosis
Term
this condition has unknown etiology with widespread granulomatous lesions that may affect any organ or tissue. females 20-40yo/ african american/ hispanic more prone to this. chronic nasal/ sinus inflammation.
Definition
sarcoidosis
Term
this condition has unknown etiology with widespread granulomatous lesions that may affect any organ or tissue. females 20-40yo/ african american/ hispanic more prone to this. chronic nasal/ sinus inflammation.
Definition
sarcoidosis
Term
this condition has unknown etiology with widespread granulomatous lesions that may affect any organ or tissue. females 20-40yo/ african american/ hispanic more prone to this. chronic nasal/ sinus inflammation.
Definition
sarcoidosis
Term
a white, non-removable lesion due to chronic irritaion from dentures, tobacco, lichen planus. 2-6% represent SCC
Definition
leukoplakia
Term
erythematous. 90% lead to dysplasia or CA. ETOH and tobacco are the most significant risk factors.
Definition
erythroplakia
Term
most common cancer of the tongue due to hx of tobacco/ETOH use.
Definition
SCC
Term
creamy-white curd-like removable patches overlying erythematous mucosa, usually painful. commonly seen in denture wearers, debilitated pts, diabetics, corticosteroids, chemo or local radiation, broad spectrum antibiotics. may be the first manifestation in HIV
Definition
candidiasis
Term
necrotizing ulcerative gingivitis. common in young adult smokers under stress. these pts need antibacterial mouthwash.
Definition
trench mouth/ Vincent's infection
Term
mouth lesion associated with herpesvirus 6. steroid tx may help with pain.
Definition
aphthous ulcer, AKA canker sore
Term
an oral manifestation of primary herpes simplex seen primarily in children and adolescents. caused by HSV1
Definition
herpetic stomatitis
Term
pt presents with minimal signs and symptoms. cough, rhinorrhea, and hoarseness. minimal exudate except with Mono. conjunctivitis, coryza, cough, diarrhea are symptoms of this.
Definition
viral pharyngitis/ tonsillitis
Term
symptoms are severe in pts with this condition. sudden onset of sore throat, fever, HA, nausea, vomiting, and abdominal pain, tender, enlarged anterior cervical nodes. pts are usually between 5-15yo. presents in winter or early spring.
Definition
bacterial pharyngitis/ tonsillitis
Term
what are the tx for viral and bacterial pharyngitis?
Definition
viral- treat symptomatically
bacterial- analgesics, warm salt water gargles, hydration, antibiotics (penicillins, erythromycin)
Term
with this condition pts presents with fever, sore throat, fatigue, white exudate extending into nasopharynx, tender posterior and anterior cervical lymphadenopathy, and hepatosplenomegaly.
Definition
mononucleosis
Term
this is an infection of the tonsillar fossa, complication of tonsillitis. pt presents with hx of tonsillits, fever, dysphagia, otalgia, "HOT POTATO" VOICE, trismus, drooling, uvula deviation away from abcess,unilateral
Definition
peritonsillar abcess
Term
this is the most commonly encountered neck space infection. cellulitis of the sublingual and submaxillary space. may have hx of dental abcess. pt presents with edema and erythema upper neck, displacement of tongue up and back, respiratory distress due to airway compromise= EMERGENCY
Definition
ludwig's angina
Term
a collection of pus in the tissues in the back of the throat.infection is due to peritonsillar abcess, dental or lateral space infections, penetrating trauma. EMERGENCY- airway compromise, may spread to mediastinum, may cause sepicemia, typically affects children ages 2 and under.
Definition
retropharyngeal abcess
Term
pts present with fever, dysphagia, odynophagia, drooling, may look toxic, asymmetrical swelling in posterior pharynx, pain with ROM,
Definition
retropharyngeal abcess
Term
this is a throat infection that leads to a secondary infection and clot formation in the internal jugular vein. symptoms are severe sore throat, SOB, chest pain, severe pneumonia, lethargy, fever, septicemia
Definition
lemierre's syndrome
Term
risk factor for obstructive sleep apnea include...
Definition
neck > 17inches male, or 15in in female, BMI >27
Term
a bacterial infection that is located mainly in parotid or submandibular area.usually due to dehydration, chronic illness, and poor oral hygiene. pt will have a reduction in salivary flow. S. aureus is most common organism.
Definition
Sialadenitis
(tx- need rehydration and IV antibiotics)
Term
calculus formation in salivary ducts. usually in wharton's ducts. pts will present with local edema, palpable stone. tx is moist heat/ massage, dilation of duct, excision
Definition
sialolithiasis
Term
common congenital anaomaly of face. may involve nostril/lip/hard and soft palate. infants will have feeding problems. these pts need surgical repair
Definition
cleft lip/palate
Term
common abnormality of oral cavity- up to 20% of population. benign bony exostosis, midline hard palate. problematic with denture wear.
Definition
torus palatinus (if on floor of mouth= torus madibularis)
Term
aka "tongue tied". short, thickened lingular frenulum that presents at an early age with speech problems, malocclusion of teeth, and dyphagia. these pts need a frenectomy at age 4.
Definition
ankyloglossia
Term
1. lesions above vocal cords make this sound
2. lesions below vocal cords cause this sound
Definition
1. inspiratory stridor
2. expiratory stridor
Term
this is more common in children, onset 2-4 years old. caused by HPV. multiple warty lesions of true and false vocal cords. usually presents with dysphonia, but stridor occurs over weeks to months.
Definition
laryngeal papillomas
Term
this is the most common cause of hoarseness and is self-limited. loss of voice associated with URI or cough or voice strain. mostly viral. diffuse erythema of cords/larynx.
Definition
acute laryngitis
Term
usually associated with one or more chronic irritants over time that leads to laryngeal injury. (GERD, inhaled toxins, chronic sinusitis with postnasal drip...)
Definition
chronic laryngitis
Term
this causes chronic inflammation and hoarseness. associated with asthma, throat clearing, chronic cough, PND sensation and esophageal spasm.
Definition
Gastroesophageal reflux
Term
common cause of hoarseness. secondary to vocal cord abuse. (shouting, smoking, chemical irritants) give these pts inhaled corticosteroids
Definition
vocal cord nodules
Term
this most commonly arises in smokers.this may develop into SCC
Definition
laryngeal leukoplakia
Term
most common CA in the larynx. tobacco and excessive ETOH are predisposing factors. pt will complain of hoarseness, odynophagie, "lump" in throat and change in voice. these pts need radiation therapy.
Definition
squamous cell CA of the larynx
Term
laryngeal surgery is the most common cause for this condition.
Definition
vocal cord paralysis
unilateral= breathy voice
bilateral= insp and exp stridor
Term
this condition causes vocal cord closure during inspiration, expiration, or both. most commonly in females 20-40yo. usually has underlying psychiatric component. usually misdiagnosed as asthma.
Definition
vocal cord dysfunction
Term
what is the causative agent for epiglottitis? is croup viral or bacterial?
Definition
haemophilus influenza type B; croup is VIRAL (steeple sign on xray)
Term
this procedure is used to access the patient's hearing levels
Definition
pure tone audiometry
(>80dB= profound hearing loss)
Term
if air-bone gap between the air and bone conduction threshold on audiogram...
Definition
conductive hearing loss
Term
if air conduction and bone conduction thresholds are equal but higher than 25dB then this signifies...
Definition
sensorineural hearing loss
Term
this test assesses the mobility of the TM, looks at the change in compliance of the middle ear with changes in ear canal pressure.
Definition
tympanometry
Term
this test assesses the neural synchrony of the auditory system. provides useful info about 8th cranial nerve. used to screen children or test individuals who are UNWILLING or unable to provide accurate audiometry. patients must be still or be seated.
Definition
BAER or ABR
Term
Uses electrods to record eye movements.
Definition
electronystagmography
Term
this type of hearing aid converts waves into electrical signals that are amplified.
Definition
analog aids
Term
this type of hearing aid converts sound waves into numerical codes before amplifying them.
Definition
digital aids
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