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56 Cards in this Set
- Front
- Back
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External auricle
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Visible part of ear
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Tympanosclerosis
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White patches on the tympanic membrane Are often a sign of significant past infection |
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What should a normal eardrum look like?
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Pearly gray, shiny, concave, translucent
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Weber test
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Test for both conductive and sensorineural hearing loss. A tuning fork is placed on the center of the skull. Conductive hearing loss: sound will lateralize and be perceived as louder in the affected ear Sensorineural hearing loss: sound will be perceived in the unaffected ear |
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Rinne's test
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Tuning fork is placed outside the external auditory canal (over mastoid process), allowing bone conduction hearing to be assessed. In conductive hearing loss, the tuning fork is louder behind the ear (because bone conduction will be better than air conduction in conductive hearing loss) |
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Mastoid process
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Stenson's duct
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Where the parotid duct empties into the mouth (on buccal mucosa, opposite upper second molar) |
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Wharton's ducts
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Where the submandibular and sublingual glands empty into the floor of the mouth
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VITAMIN C pneumonic
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System of disease categories to use for differential diagnoses Vascular Infectious Trauma Autoimmune Metabolic Idiopathic Neoplastic Congenital |
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Otalgia
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Earache
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Otorrhea
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Discharge from the ear
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Odynophagia
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Painful swallowing
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Torticollis
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Twisting and frequent jerking of the muscles controlling the neck
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Pars tensa
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Part of tympanic membrane where most tears occur
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Pars flaccida
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Less common location of tympanic tears, but difficult to heal
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Nasal turbinates
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Sulci in nose that humidify and warm air
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Uvula
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Keeps liquid and food from entering the nasopharynx
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Kiesselbach's Plexus
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Network of arteries in the front nasal cavity Cause of most nosebleeds |
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Ethmoid arteries
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Network of arteries that can cause posterior nosebleeds - can be significant bleeds that drain into GI tract
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Why can Afrin nasal spray be problematic?
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Causes rebound medicomentosa. The mucus membrane can't handle the medication for more than a few days; if used for more, patient constantly needs to use the spray to decrease mucosal swelling Should only be used on a very short-term basis (e.g. before going on a plane) |
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If you're thinking of performing a tracheotomy.....
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DO IT! Right between the cricoid and thyroid cartilage is best (cricothrotomy), because there is less blood If you do need to do a lower tracheotomy, go as low as possible on the trachea |
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Choanal atresia
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Congenital disorder where the nasal choana is occluded by soft tissue, bone, or a combination of both - Presents with unilateral or bilateral mucopurulent discharge - Since babies are obligate nasal breathers, this is an ENT emergency |
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Pierre Robin syndrome
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Congential micrognathia (small chin) and macroglossia (large tongue) that can make intubation difficult |
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Ludwig's angina
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Infection of the floor of the mouth that causes the tongue to be pushed up and back, eventually causing airway obstruction - Most common cause: teeth infection - If spread to submandibular/parapharyngeal space: unilateral neck swelling - Treatment requires incision and drainage, abx for oral cavity anaerobes - A tracheotomy is usually needed - swelling can develop quickly, especially post-I&D |
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Angioneurotic edema
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Acute supraglottic swelling that can occlude airway - Oral intubation may be impossible - Txs include surgical airway, IV steroids, histamine blockers |
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Peritonsillar abscess
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Collection of purulence in the space between the tonsil and the pharyngeal constrictor muscle - Symptoms: sore throat that has gotten worse on one side, uvular deviation away from abscess, "hot potato" voice - Tx: Drainage, pain management, abx |
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Bronchial foreign bodies
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- Require operative bronchoscopy for removal - Always think of foreign body aspiration when pt presents with unexplained cough or pneumonia |
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Ball-valve obstruction
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Obstruction of lung by a foreign body Hyperinflation of the obstructed lung can occur on expiration |
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Mucormycosis
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Fungal infection of the sinonasal cavity that occurs in immunocompromised hosts - Fungus grows in blood vessels, causing thrombosis, ischemia, and tissue necrosis - Fungus thrives in acidic environments (why especially dangerous for diabetics in acidosis) - S/S: Black mucosa - Tx: Debridement, removal of affected structures, Amphotericin B |
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Bleeding from the back of the nose in a juvenile male is considered to be a......
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Juvenile nasopharyngeal angiofibroma, until preven otherwise
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Epistaxis
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- Usually caused by trauma to Keisselbach's plexus - Can be cause by blood-thinning meds and/or high blood pressure - Tx: 5 minutes of direct pressure, topical vasoconstrictors (oxymetazoline, phenylephrine), electrocautery, packing balloons |
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Necrotizing Otitis Externa
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- Severe infection of the auditory canal - Usually d/t Pseudomonas organisms - Infection can spread to temporal bone and base of the skull, can be fatal - Occurs in AIDS pts and diabetics - S/S: Deep ear pain, temporal headaches, purulent drainage, granulation tissue at bony cartilaginous junction - Tx: |
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Odontogenic infection
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An infection that originates in the tooth or in the closely surrounding tissues. - May remain localized or spread |
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What microbes usually cause odontogenic infections?
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Usually part of normal flora in mouth, and infections are usually polymicrobial - Gram + streptococci (streptococci, peptostreptococci) - Gram - rods (Prevotella, Parphyromonas, Fusobacterium) |
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2 origins of tooth decay
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1. Periapical (tooth decay, pulpal necrosis, periapical infection) - most common 2. Periodontal (infection of the gums leading to infection of the underlying soft tissues) |
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2 factors that affect the progression of tooth decay
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1. The thickness of bone overlying the apex (root) of the tooth 2. How close the site of infection is to muscle attachments |
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Most common odontogenic infection
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vestibular abscess - Can create a sinus that drains in the mouth or tunnels extra-orally |
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4 steps to managing odontogenic infections
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1. Determine severity (history & exam) 2. Surgery (dental tx, I&D) 3. Antibiotics 4. Close follow-up |
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Dental tx for an infection limited to the periapical region includes...
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1. Root canal therapy 2. Extraction |
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When is I&D required for an odontogenic infection?
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When the infection has spread beyond the periapical region
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Pericoronitis
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Pericoronitis is a dental disorder in which gum tissue becomes swollen and infected around the wisdom teeth
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Trismus
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spasm of the jaw muscles, causing the mouth to remain tightly closed
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Indications for antibiotics for dental problems
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- Acute onset infection - Diffuse swelling - Immunocompromised host - High fever - Facial involvement - Trismus |
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First-line antibiotics for oral infections
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1. Penicillin/amoxicillin (can prescribe augmentin if resistance is suspected) 2. Clindamycin for penicillin allergies 3. Can be combined with metronidazole to cover gram - bacteria |
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Refer to an oral surgeon if.....
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- Pt has difficulty breathing - Difficulty swallowing - Rapid progression of swelling - Severe trismus (can't open mouth >10 mm) |
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Ludwig's Angina
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- Bilateral submandibular swelling, airway obstruction - Can be life threatening d/t elevated tongue - Can be d/t an infected tooth, post-extraction infection, submandibular gland infection |
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Cleft lip
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- Can be with/without cleft palate - 10-20% of cases are associated w/ syndromes (eg Trisomy 13) - Can also be caused by teratogen exposure (rubella, thalidomide, Accutane) |
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Cleft palate
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- Incidence of cleft palate alone is half incidence f cleft lip (and/or palate) - 50% have the condition as part of a syndrome |
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Otosclerosis
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-10% of caucasians (esp women) are affected - Most cases are genetic - Causes overgrowth of bones of the middle ear - Can cause uni-, bilateral, sensorineural and conductive hearing loss |
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Acoustic neuroma
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- Benign tumor of vestibulocochlear nerve - 5% of cases are familial - Can cause hearing loss, tinnitus, balance issues - Can impact facial nerve as well |
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Waardenburg syndrom
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- Sensorineural hearing loss - White forelock - Hyperchromatic eyes |
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Usher syndrome
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Linked with hearing loss and retinitis pigmentosa
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Alport syndrome
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- Deafness - Nephritis - Eye abnormalities |
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HPV and ENT CA
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HPV is associated with squamous cell carcinoma of the tongue, tonsil, larynx, and pharynx
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P53 tumor suppressor gene and ENT
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- Most common abnormality in head/neck CA - Cigarettes and/or alcohol strongly associated with mutations in the gene |
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Nasopharyngeal carcinoma
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- More common in pts from southern China & southeast Asia - Environmental factors - Epstein-Barr virus - Genetic factors |
