Flashcards in ENT Deck (78)
What is the correct diagnosis and treatment for a 9 y/o male with purulent right ear discharge for several months despite several antibiotics...exam shows retraction of TM and squamous debris?
Cholesteatoma - referral to ENT
What antibiotics are ototoxic? What are 2 other medications that cause reversible hearing loss ?
Aminoglycosides (gentamicin, tobramycin)
Loop diuretics & salicylate
What diagnosis should you consider in a patient with foul smelling discharge despite treatment of perforated TM?
What is the most common cause of sudden bilateral sensorineural deafness?
What are the 4 most common viral causes of sensorineural hearing loss?
What is the most common cause of neonatal hearing loss? How can this be prevented
Bacterial meningitis - can't prevent despite treatment with antibiotics
What are the two newborn hearing screens and when should this be performed by?
Auditory brainstem response (ABR) and otoacoustic emissions (OAE)
Identification of hearing loss by 3 months with treatment by 6 months
What test is used to detect bilateral hearing loss in infants and toddlers?
Visual reinforcement audiometry (VRA)
What is indicated by a flat line (low amplitude) on tympanogram?
Stiff membrane or middle ear fluid or obstructed tympanostomy tube
How does tympanometry measure hearing sensitivity?
Tympanometry does NOT measure hearing sensitivity (you can have normal tympanogram with sensorineural hearing loss)
What is indicated by a high amplitude line on tympanometry?
What is measured by the area under the tympanogram curve? And what does a high volume of this area indicate?
The area of the external canal - high volume indicates perforated TM
You are presented with a 4 y/o with chronic drainage through left TM, what is the likely cause and how would you treat?
Pseudomonas causing chronic suppurating otitis media
What diagnosis should you consider in a patient with persistent otitis media despite appropriate antibiotics who presents with headache and vomiting ?
What diagnosis should you consider in a patient with tympanostomy tubes who presents with copious bloody discharge and large red mass in the ear?
Tympanostomy tube granuloma
What should you do in a patient with swelling and deformity of the external ear after trauma?
Needle aspiration of hematoma
What is the diagnosis and 4 most common cause of postauricular swelling and erythema ?
Mastoiditis - strep pneumoniae, h flu, strep pyogenes and staph aureus
How would you confirm diagnosis of mastoiditis? How would you treat?
CT and tympanocentesis with culture - IV antibiotics and surgery
What 4 things are associated with nasal polyps and what study should you order in a patient with this finding?
Chronic allergic rhinitis
**sweat chloride test**
What diagnosis presents as cyanosis while feeding but resolution with crying? What syndrome is this commonly found in?
Choanal atresia - CHARGE syndrome
Which sinuses are present at birth?
Maxillary and ethmoid
When are the sphenoid and frontal sinuses developed ?
Sphenoid: age 3 - 7 years
Frontal: teen years
What should be done in a patient with fracture of the frontal sinus? Why?
Surgery for repair to avoid CNS infection
When is a CT indicated in the diagnosis of sinusitis?
Only for chronic recurrent sinusitis
You are presented with a 13 y/o make with recurrent epistaxis. Bleeding is increasing in frequency, severity and duration. What is the next step?
CT scan to rule out posterior nasopharyngeal mass such as nasopharyngeal angiofibroma
What clinical finding can differentiate strep pharyngitis from mono?
Only mono presents with hepatosplenomegaly
You are presented with a child with high fever, swollen lymph nodes, pharyngitis and hepatomegaly. Strep is positive. Monospot is negative. What is the next step?
What would you do for a sexually active teenager who presents with sore throat and erythematous patches of the pharynx?
Test for GC pharyngitis and other STD testing
What treatment would you consider for a patient who presents with sore throat and difficulty opening the mouth as well as muffled voice...exam shows swelling around one tonsil and uvula deviation?
Needle aspiration plus ampicillin/sulbactam or clinda or augmentin