ENT

Function of the tympanic membrane (TM)? || Transmits sound from external environment to middle ear.
Structure of the TM? || Pars flaccida (fragile, 2 layers) and pars tensa (robust, 3 layers).
How is middle ear pressure maintained? || Air absorption through mucosa and reaccumulation via Eustachian tube.
What happens when the Eustachian tube collapses? || TM retracts or ruptures, causing ear pain with flying or diving.
Purpose of the Weber test? || Compares bone conduction between ears to identify hearing loss type.
Interpretation of Weber test? || Louder in affected ear = conductive; louder in unaffected = sensorineural.
Purpose of the Rinne test? || Compares air vs bone conduction.
Interpretation of Rinne test? || Air > bone = normal/SNHL; bone > air = conductive loss.
Common causes of conductive hearing loss? || Wax impaction, TM rupture, ossicle damage, middle-ear fluid.
Common causes of sensorineural hearing loss? || Cochlear or nerve damage, CNS issue.

Symptoms of cerumen impaction? || Ear fullness, otalgia, nausea, vertigo, disequilibrium, hearing loss.
Indications for cerumen impaction treatment? || Pain, hearing loss, vertigo, disequilibrium.
Contraindications to ear irrigation? || TM perforation, myringotomy, absent TM, infection.
Cerumen impaction treatment method? || Soften with Colace, irrigate warm water while upright, pinna pulled back.
Warning before irrigation? || Possible nausea and vertigo.
Why avoid Q-tips? || Stimulates more cerumen production.

Symptoms of ear foreign body? || Ear pain, buzzing, crawling sensation.
First step for live insect in ear? || Lay on unaffected side, instill mineral oil or alcohol to kill insect.
Methods for ear foreign body removal? || Irrigation, Dermabond, magnets, curettes, suction, forceps.
Agent to dissolve Styrofoam FBs? || Ethyl chloride.

Causes of ruptured TM? || Diving, explosion, trauma, barotrauma.
Symptoms of ruptured TM? || Sudden otalgia, tinnitus, conductive HL, vertigo, nausea, bleeding.
Type of hearing loss with ruptured TM? || Conductive.
Treatment for ruptured TM? || Cotton pledget, avoid water, analgesics, ENT follow-up.
When to use antibiotics for ruptured TM? || Only if infection suspected.

Symptoms of otitis externa? || Ear pain, pruritus, discharge, hearing loss, red edematous canal.
Causes of otitis externa? || Swimming, trauma, hearing aids, earbuds, allergy, dermatitis.
Bacteria in otitis externa? || Pseudomonas, Staph aureus, Staph epidermidis, Bacteroides, Peptostreptococci.
Treatment for otitis externa? || Irrigation, suction, pope wick, Ciprofloxacin-Hydrocortisone drops, analgesia, warm compress.
Follow-up for otitis externa? || Recheck 3–4 days or ENT; remove wick when swelling improves.

Risk factors for necrotizing otitis externa? || Elderly, diabetics, immunocompromised.
Pathophysiology of necrotizing otitis externa? || Invasive infection of canal and skull base → osteomyelitis/CNS spread.
Main organism in necrotizing otitis externa? || Pseudomonas.
Symptoms of necrotizing otitis externa? || Severe otalgia, profuse discharge, cellulitis, TMJ pain, facial palsy.
Complications of necrotizing otitis externa? || Osteomyelitis, nerve palsy, meningitis, sinus thrombosis, CNS abscess.
Diagnosis of necrotizing otitis externa? || Clinical, ↑WBC/CRP, CT/MRI for bone or CNS.
Treatment for necrotizing otitis externa? || Ciprofloxacin and IV antibiotics; avoid steroids.

Definition of otitis media with effusion (OME)? || Middle ear fluid without acute infection or inflammation.
Causes of OME? || Post-AOM, barotrauma, allergy, ET dysfunction, nasopharyngeal carcinoma.
Symptoms of OME? || Crackling, aural fullness, conductive HL, dull TM with fluid, no erythema.
Treatment for OME? || Auto-insufflation, nasal spray, intranasal steroid, decongestant.
Severe or chronic OME treatment? || Myringotomy tubes.

Definition of acute otitis media (AOM)? || Infection with middle ear fluid and mucosal inflammation.
Common pathogens in AOM? || H. flu, GAS, Staph aureus, M. catarrhalis.
Symptoms of AOM? || Unilateral ear pain, fever, hearing loss, rhinorrhea, post-URI.
Diagnosis of AOM? || Clinical.
Treatment for AOM? || Amoxicillin or cephalosporin; supportive care with NSAIDs or Tylenol.
Complications of AOM? || Mastoiditis, facial paralysis, labyrinthitis, otic meningitis, epidural abscess.

Definition of mastoiditis? || Infection of mastoid air cells after AOM → pus and bone erosion.
Symptoms of mastoiditis? || Tender, red mastoid with fever after ear infection.
Diagnosis of mastoiditis? || Clinical, ↑WBC/CRP, CT with contrast.
Treatment for mastoiditis? || Admit, ENT consult, IV antibiotics.

Mechanism of nasal bone fracture? || Direct blow to nose from sports, falls, or trauma.
Structures to assess with nasal fracture? || Head injury, C-spine, orbits, zygoma, maxilla, mandible.
Clinical signs of nasal fracture? || Swelling, bruising, deformity, epistaxis, crepitus.
Complication of septal hematoma? || Must be drained to prevent necrosis.
When to suspect CSF leak? || Halo sign or high glucose in nasal drainage.
Treatment for nasal fracture? || Ice, elevate HOB, avoid sports 6 weeks, nasal spray, ENT follow-up.
Antibiotic for open nasal fracture or laceration? || Cephalosporin.

Most common site of anterior epistaxis? || Kiesselbach’s plexus.
Posterior epistaxis source? || Sphenopalatine or carotid artery.
Common causes of epistaxis? || Nose picking, dry air, rhinitis, trauma, anticoagulation.
Who is high risk for epistaxis? || Anticoagulated patients, bleeding disorders.
Does hypertension cause epistaxis? || No, but prolongs bleeding.
Post-treatment note for nasal packing? || Possible tear duct bleeding; antibiotics if packed.

Definition of sialolithiasis? || Salivary duct stone, usually submandibular.
Who gets sialolithiasis? || Older men.
Symptoms of sialolithiasis? || Unilateral swelling and pain during eating.
Causes of sialolithiasis? || Dehydration, diuretics, anticholinergics, gout, smoking, Parkinson’s meds.
Diagnosis of sialolithiasis? || CT scan.
Treatment for sialolithiasis? || Sour candy or ENT removal if unresolved.

Causes of pharyngitis? || Viral, bacterial, non-infectious.
Symptoms of pharyngitis? || Sore throat, odynophagia, fever, LAD, HA, congestion, rhinorrhea, cough, ear pain.
Diagnosis of pharyngitis? || Exam, rapid strep, or culture.
Reason to treat Group A strep? || Prevent rheumatic fever and heart disease.
Treatment for pharyngitis? || Decadron, saltwater gargles, NSAIDs, penicillin, or amoxicillin.
Complications of strep throat? || Rheumatic fever, glomerulonephritis.
Signs of rheumatic fever? || Migratory arthralgia, subQ nodules, carditis.
Signs of post-strep GN? || AKI, edema, hematuria, HTN.
Treatment for post-strep GN? || Supportive care.

Symptoms of peritonsillar abscess? || Unilateral sore throat, “hot potato” voice, drooling, trismus, swollen tonsil, deviated uvula.
Diagnosis of peritonsillar abscess? || CBC, rapid strep, culture, CT neck with contrast.
Treatment for peritonsillar abscess? || IV fluids, analgesia, antibiotics (Unasyn or Clindamycin), needle aspiration or I&D, admit.
Complication of peritonsillar abscess? || Retropharyngeal abscess.

Cause of retropharyngeal abscess? || Untreated bacterial sore throat spreading to deep neck space.
Main risk of retropharyngeal abscess? || Airway compromise.
Sources of deep neck infections? || Mandibular teeth, parotids, middle ear, sinuses, FB.
Symptoms of retropharyngeal abscess? || Sore throat, fever, dysphagia, neck pain, pharyngeal edema, drooling, stridor.
Diagnosis of retropharyngeal abscess? || CBC, GAS swab, CT with contrast.
Treatment for retropharyngeal abscess? || Airway support, fluids, steroids, Unasyn or Clindamycin, ENT and anesthesia bedside.

Definition of Ludwig’s angina? || Life-threatening cellulitis of floor of mouth from dental infection.
Symptoms of Ludwig’s angina? || Fever, tachycardia, submental woody edema, dysphagia, dysphonia, SOB.
Treatment for Ludwig’s angina? || Airway management and IV antibiotics.

Cause of Ramsay Hunt syndrome? || Reactivation of VZV in geniculate ganglion of facial nerve.
Symptoms of Ramsay Hunt syndrome? || Unilateral facial droop, ear pain, ↓ taste, dry mouth/eye, vesicular rash.
Treatment for Ramsay Hunt syndrome? || Valacyclovir.

Definition of Lemierre’s syndrome? || Complication of bacterial pharyngitis causing septic thrombophlebitis of IJV.
Bacteria causing Lemierre’s syndrome? || Fusobacterium necrophorum.
Cardinal features of Lemierre’s syndrome? || Tonsillopharyngitis, bacteremia, IJV thrombosis, metastatic abscess.
Typical patient with Lemierre’s syndrome? || Young, healthy, febrile, hypotensive, tachycardic.
Treatment for Lemierre’s syndrome? || Airway management and IV antibiotics such as Zosyn, Clindamycin, or Flagyl.