ENT Study Guide

What is the most common cause of Hoarseness and follows URI?

What is the most common cause of Hoarseness and follows URI?

Laryngitis

What disease has symptoms: hoarseness, difficulty talking, cough, odynophagia?

Laryngitis

What is the treatment for Laryngitis?

Conservative, rest, fluids, avoid singing and shouting

Reoccurrence of which disease will lead to nodules?

Laryngitis

Which disease has etiology: Bacterial (Grp A Beta Hemolytic strep), N. Gonorrhea, S. pneumonia, C. diphtheriae, Fungal (Candida albicans), Tobacco smoke, post nasal drainage, Irritants?

Pharyngitis

Which disease has hoarseness, cough, runny nose?

Pharyngitis

What tests should be done for Pharyngitits/ Tonsillitis?

Rapid Strep Antigen Test (immediate)

Throat Culture (24-48 hrs)

What is the medication/ treatment given for Pharyngitis?

Analgesics

Anti-inflammatory NSAIDS

Salt Water Gargles

Anesthetic gargles/ lozenges (viscous lidocaine)

Which disease can have an atypical symptom of bellyaches?

Strep

What are the different lengths of time to differentiate rhinosinusisits?

Acute: <4 weeks

Subacute: 4-12 weeks

Chronic: >12 weeks

Recurrent acute: 4 or more episodes per year

Which type of acute rhinosinusitis does NOT have a fever?

Acute Viral Rhinosinusitis

What diagnostic imaging should be done for Rhinosinusitis?

Plain sinus x-ray (Water’s view)

CT scan (most diagnostic, air fluid levels and mucosal edema)

What triad of symptoms would you see in Acute Bacterial Rhinosinusitis?

Headaches, Facial pain/pressure, Fever

also nasal congestion and purulent rhinorrhea

What would cause you to believe it is an acute bacterial rhinosinusitis?

Symptoms >7-10 days, Fever >39C or 102F, Purulent nasal discharge/facial pain for 3-4 consecutive days

Double sickening patter: New onset headaches, fever, increase in rhinorrhea after 5-6 days of initial improvement

What imaging or testing should be done for Acute Bacterial Rhinosinusitis?

CT scan; culture

What is the first line treatment for Acute Bacterial Rhinosinusitis?

Beta Lactam
Amox-clav (Augmentin)

PCN Allergy
Azithromycin, Doxycycline, Fluoroquinolone (levofloxacin)

5-7 days for adult
7-10 days for kids
Can use 3rd gen ceph w/ vancomycin

If symptoms of acute bacterial rhinosinusitis persists past 12 weeks what should you do?

Refer to Otolaryngologist

What are the pathogens and symptoms for chronic sinusitis?

Pathogens: Gram neg (S. aureus, anaerobes)

Symptoms: > 3 months, sinus mucosa inflamed, persistent low grade infection w/ flare ups, sinus infections more than 3x in past 6 months

What are the complications of chronic sinusitis?

Chronic nasal obstruction, Sleep apnea, Anosmia, Chronic score throats, Orbital cellulitis, Cavernous sinus thrombosis, Brain abscess, Osteomyelitis, Meningitis and septicemia, General malaise and chronic headaches

What is the treatment for Chronic sinusitis?

3-6 week abx course

amoxicillin-clav, 3rd gen ceph, levofloxacin, clindamycin

OR

Surgery if refractory to medical Rx

What are the 3 conditions of Samter’s Triad?

Severe bronchial asthma
Nasal polyps
Aspirin sensitivity

What is the treatment for Samter’s triad/syndrome?

ASA desensitization, Oral or topical nasal steroids, Nasal polypectomy prn

*Limit or avoid alcohol

Which disease has rhinorrhea, inflamed lower turbinates (pale and boggy), eye irritation (pruritus, erythema, tearing), and eosinophilia in nasal discharge/serum)?

Allergic rhinitis aka Hay fever

What are the antihistamines used for allergic rhinitis?

Fexofenadine (allegra/ non sedatin), Levocetirizine (Xyzal), Cetirizine (Zyrtec), Loratidine (Claritin)

What are the antihistamine sprays used for allergic sprays?

Azelastine (Astelin)

What are Intranasal corticosteroids used for in allergic rhinitis?

Decreased inflammation, shrinks polyps
Beclomethasone, Flunisolide, Mometasone furoate, fluticasone propionate

What is the leukotriene receptor antagonists used for allergic rhinitis?

Montelukast

What are the symptoms for Viral rhinitis “common cold”?

Clear rhinorrhea, Nasal congestion/ pressure, Dec sense of smell, sneezing, general malaise, throat discomfort, H/A, watery discharge from ears

Edematous/ erythematous nasal mucosa and/or post oral pharynx; watery discharge; purulent nasal discharge/ double sickening (poss bacterial infection)

What are treatment options for viral rhinitis based on symptoms?

Pseudoephedrine, Afrin nasal spray, Tylenol, Ibuprogen, OTC meds, Abx discouraged

Which disease has an etiology of increased sensitivity of vidian nerve (warm or cold air, odors or scents, particulate matter)?

Vasomotor rhinitis, non allergic/ chronic in nature

What is the treatment for vasomotor rhinitis?

Intranasal steroid sprays (fluticasone)

What is the treatment for rhinitis medicamentosa?

Discontinue nasal decongestant, normal saline gtts QID, Nasal steroid spray BID, PO corticosteroids

What are the symptoms for a peritonsillar abscess?

Severe throat and odynophagia, Trismus, Abnormally muffled voice “hot potato”, Inflammation of soft palate or uvula

What imaging or tests should be done for peritonsillar abscess?

CT soft tissue of neck w/ contrast, Needle aspiration for culture

What is the treatment for a peritonsillar abscess?

Needle aspiration, I&D, or tonsillectomy w/ recurrence

IV abx

Which disease typically follows suppurative URI?

Retropharyngeal abscess

Which disease has symptoms of sore throat, fever, neck stiffness, stridor, drooling, hyoid tenderness?

Retropharyngeal abscess

What is the treatment for a retropharyngeal abscess?

Send to ER immediately, Referral emergent ENT, Intubation or tracheostomy, Surgical I&D, IV abx

What is the etiology for epiglottitis?

Viral or bacterial
In children, infection with Haemophilus influenzae type B (HiB)

*Vaccines have made it rare in kids

What are the symptoms of Epiglottitis?

1-2 days worsening dysphagia, odynophagia, dyspnea
Fever, tachycardia, cervical adenopathy
Drooling, stridor
Patient posturing
Secretions
Minimal to no cough

What are physical findings found for Epiglottitis in adults?

Rapidly developing sore throat, odynophagia out of proportion to exam, drooling, tripod

What is the imaging or testing ordered for Epiglottitis?

Lateral neck x-ray (enlarged Epiglottitis shows a “thumbprint” sign)

Indirect laryngoscopy (swollen, red epiglottitis)

What is the treatment for Epiglottitis?

-Monitor airway (pulse oximetry)

-Intubation (<10% of adults, severe dyspnea, rapid course)

-Hospitalization for IV abx (3rd gen cephalosporins)

-Corticosteroids (Dexamethasone)

What must you visualize when inspecting for nasal fracture?

Nasal septum to r/o septal hematoma (can be medical emergency)

What are symptoms that can be seen for nasal fracture?

Hx of trauma, pain, epistaxis, nasal obstruction, periorbital ecchymosis, edema

What imagine or tests need to be ordered for a nasal fracture?

Nasal X ray (Lateral View)

CT Face to r/o Le forte fracture

What is the treatment for a nasal fracture?

Manage hemorrhage

Topical vasoconstrictors

What is the lower 2/3 of the nasal pyramid made up of?

Cartilage

upper 1/3 is nasal bones

What are complications that can occur due to nasal fracture?

Septal hematoma, saddlenose deformity from hematoma, unmanageable/ uncontrollable hemorrhage

What antibiotics should be given if a nasal septal hematoma were to occur?

Topical anti-staph ointment, systemic antibiotics are controversial

Which type of Le Fort fracture has swelling of upper lip, buccal surface bruising, malocclusion, and loosening of teeth?

Type I

Which type of Le Fort fracture has deformity/ swelling of midface, widening of intercanthal space, mobility of upper jaw and nose, malocclusion, periorbital edema and ecchymosis, epistaxis, bruising and vestibule plate bruising, cerebrospinal fluid rhinorrhea?

Type II

Which type of Le Fort fracture has lengthening & flattening of face, orbital hooding, enophthalmos, mastoid region bruising, ear drainage, and hemotympanum?

Type III

Which type of Le Fort fracture is horizontal: alveolar ridge aka “speak no evil”? (no not the movie)

Type I

Which type of Le Fort Fracture is pyramidal: nasofrontal suture aka “see no evil”?

Type II

Which type of Le Fort fracture is horizontal: craniofacial dislocation aka “hear no evil”?

Type III

What is the etiology for tympanic membrane perforation?

Trauma (direct or penetrating)

Pressure changes (water or air)

Chronic Otitis Media

Iatrogenic (FB removal)

Marginal vs central (Marginal less common and extends more to tympanic membrane edge)

What are the symptoms of Tympanic membrane perforation?

Ear pain, vertigo, Tinnitus, Hearing change after a specific event

What would you see on an otoscopic exam if you suspect tympanic membrane perforation?

Slit-shaped tear or larger irregular defect

What is the treatment for tympanic membrane perforation?

Keep cotton ball in affected ear to prevent moisture from getting into ear canal and refer to ENT

What medications are given for tympanic membrane perforation?

-Abx if it was caused by otitis media
-NO topical steroids (it can impede closure)

What are risk factors of Tympanosclerosis?

-Scarring of your eardrum
-Can become damaged by injury, recurrent infection, surgery
-Calcium deposits can cause eardrum to harden, thicken, and become rigid

For what type of vertigo would you use the Dix-Hallpike test in order to diagnose?

Benign Paroxysmal Positional Vertigo

For what type of vertigo would you use the Epley manuever in order to treat?

Benign Paroxysmal Positional

In which type of vertigo do you have marked nausea and vomiting common ?

Peripheral

In which vertigo do you have bilateral, unidirectional, rotatory/horizontal, never vertical, fast phase usually opposite to side of lesion nystagmus that improves with visual fixation?

Peripheral

Which type of vertigo is often mild?

Central

Which type of vertigo has bilateral/ unilateral, bidirectional/unidirectional, may be vertical nystagmus with usually no change with visual fixation?

Central

What are risk factors of leukoplakia?

HPV, Syphilis, EBV, Immunocompromised, EtOH, Tobacco

Which disease has white lesion 50% on tongue but can be buccal mucosa, CANNOT be scraped off, tobacco stain, recession of gingiva?

Oral Leukoplakia

What imaging or tests would you order for oral leukoplakia?

Biopsy or cytological exam (scraping)

What is the treatment for oral leukoplakia if it is benign or minimally dysplastic?

Close f/u or elective excision

What is the treatment for oral leukoplakia if premalignant/ moderate dysplasia?

Excision; if multiple or larger consider cryotherapy or laser

Which disease is a T cell mediated autoimmune disease in which auto cytotoxic CD8T cells trigger apoptosis of oral epithelial cells?

Oral Lichen Planus

Which disease has a lacy leukoplakia reticular pattern (Wickham Striae bilaterally)?

Oral Lichen Planus

Which medication is given to treat Oral Lichen Planus?

Corticosteroids (topical and oral in some cases)

What is the etiology for herpetic stomatitis?

HSV-1: Oral form, acquired in childhood, 85% of adults

HSV-2: genital acquired by sexual contact, 25% of population

Recurrent/self limiting episodes

*Can occur after minor infections, trauma, stress, sun exposure

What symptoms would you see with Herpetic Stomatitis?

Burning, stinging small grouped vesicles, anywhere on body most often the vermillion border

What is the treatment for herpetic stomatitis?

Systemic agents for 7-10 days aka Acyclovir, Valacyclovir

*Most recurrent-mild —> no treatment

What should a patient NOT use if they have herpetic stomatitis?

Magic mouthwash, Maalox, Benadryl, Viscous lidocaine

*Systemic absorption of med can cause toxicity

Oral candidiasis is seen in what kind of patients?

Denture wearers, debilitated pts, DM, anemic, chemo/ radiation patients

What disease could be the first sign of HIV or DM?

Oral thrush

What findings are seen with Oral candidiasis?

Pain, creamy-white, curd-like plaques overlying erythematous mucosa, CAN be scraped off leaving underlying/ irregular erythema causing bleeding

What test should be done with Oral Candidiasis?

Wet prep w/ KOH revealing spores hyphae

What is the treatment for Oral Candidiasis?

Nystatin Oral Suspension (swish and swallow) 7-14 days

OR

Clotrimazole troches “lozenges”

What is seen in pts with nutritional deficiencies ( B vitamins such as Riboflavin), immunocompromised (HIV), baybays (maceration of skin from overexposure to saliva)?

Angular Cheilitis (Angular stomatitis, commissural cheilosis)

What is a majority of Oral cancer and what does is have a strong association to?

90% are SCC

-Strong association to HPV type 16 or 18 (majority is 16)

What can be seen in oral cancer?

Ulcerations

Early lesions appear as leukoplakia or erythroplakia
-Lateral border of tongue can be underneath tongue, lips, in oropharynx
-Palpable mass lesion (if <4 mm unlikely to metastasize)

What is the treatment for Oral cancer?

Complete resection (lymph node biopsy prn)
Large tumors (combination resection, neck dissection, radiation)

What would you see in perichondritis?

Edematous auricle, tenderness, erythema, pain on deflection of auricle, possible discharge and crusting

What medication would you give for perichondritis?

Abx FQ ( cipro, leva) —> have good pseudomonal coverage; PO/IV may be needed

*Referral to ENT

What should be done for relapsing polychondritis?

Biopsy, Referral to ENT and Rheumatology

What medication would you give for relapsing polychondritis?

Systemic corticosteroids

What would you see in auricular hematoma?

Painful swelling following blunt trauma, fluctuant bluish swelling in anterior superior auricle

What would you do to treat auricular hematoma?

I&D, Pressure dressing

Abx

What complications can arise from Auricular hematoma?

Cauliflower deformity, Aseptic or septic necrosis

Which disease is the single most common neck mass, may persist longer than underlying cause?

Reactive lymphadenopathy

Which disease has infections involving pharynx, salivary glands, and scalp can cause tender cervical lymph node enlargement?

Cervical adenopathy

Would soft and tender lymph nodes be an indicator of benign or malignant lymphadenopathy?

Benign

Would firm and nontender lymph nodes be an indicator of benign or malignant lymphadenopathy?

Malignant