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Random CM ENT

CMI - Fall 2011

Nerves to TM? Mandibular, Vagus, Glossopharyngeal
Blood supply to ossicles? Ext carotid
Innerv of larynx? 2 branches of vagus: Superior and inferior/recurrent laryngeal nerves
Blood supply to nose? Ex and int carotid
MC cause of URI? rhinovirus
Acute vs chronic sinusitis? <4wks; >12wks
MC sinuses involved in bact sinusits? Maxillary #2-ant ethmoid
Early introduction of formula and food and maternal smoking in first yr of life can increase likelihood of pt to develop? Allergic rhinitis
Late phase response of alleg rhinitis involves which cells? 4-8 hrs later: Macrophages, Lymphocytes, neutrophils, eosinophils
Shiners and dennie morgan lines assoc w/? Allergic rhinitis
Intranasal steroids are not for? KIDS
What is the idiopathic rhinitis that is assoc w/ enhanced reactivity of nasal mucosa to various triggers? Vasomotor rhinitis (NO allergic component)
COngenital condition involving blockage or narrowing of the posterior nasal airway by membrane or bone? Choanal Atresia
What occurs exclusively in males age 7-19 yrs and presents with recurrent epistaxis, obstrux? Juvenile nasal angiofibroma
A risk of juvenile nasal angiofibroma is that it can expand into where? Base of skull, sinuses
80% of genetic HL is....? non-syndromic
Eyes of those w/ Down Synd? Brushfield's Spots (light spots on irises of eyes)
Who @ risk for cleft lip/palate? American Indian, Asian, Male
Which condition involves a mutation in the type IV collagen protein? ALport's
When do you see kidney failure in ALport's? Teens-Recessive and X-linked 40's-Dominant
What kind of HL w/Alport's and when do you see it? SNHL; not present at birth, but develops by late childhood
What condition involves a gene mutation during fetal devt that is involved in the production of 3 difft types of collagen? Stickler SYndrome
Those w/ stickler synd are usually deaf by? Teen years
Which condition is assoc w/ MVP? Stickler synd
Goldenhar synd aka? Oculoauricular dysplasia
Which condition involves abn devt of pharyngeal arches #1 and 2 on one side of face? Goldenhar synd
What condit is assoc w/ preauric pits/tags? Goldnhar
When can fix pinna and jaw in goldnhar? Jaw-3yo Pinna-6yo
Which condition involves alteration of chrom 5? Treacher collins synd
Which condit involved hypoplasia of zygoma and mandible? Treacher collins
OF the congenital synds learned--which have SNHL? Alport's , STickler
Which congen conditions are assoc w/cleft issues and what kind? Down-Cleft L or P Stickler-Cleft P Treacher-CLeft P
Sjogren's synd involves? Swelling of parotid or submandub glands w/ xerostomia and xerophthalmia
Sjogren's seen more in who? Women (9:1) and >40yo
Sjogrens is #2 mc rheumatol d/o..what is #1? SLE
GOld std for sjogrens dx? bx of lip-----lymphocytic infil, ductal hyperplasia
Schirmer's test? For sjogren's....filter paper at lower conjunctival sac....less than 5mm wetness in 5min = +
TX for sjogrens? Steroids for inflamm, sx trtmen
Parotitis? Swellin of one parotid gland-seen in elderly
PSeudomembranous thrush? Can be wiped away
Atrophic thursh? Loss of papilla and burning sensation
Hyperplastic thrush? Chronic condit-stuck on
Etiology of glossitis? Vit B defic, anemia, irrita, infex, poorly fit dentures, rought teeth, trauma, burns, alc, tobacco
Herpetic stomatitis is primarily seen in? Children 9m0-5yrs
When should herpetic stomatitis resolve? 1-2 wks
Which stomatitis assoc w/fever? Herpetic stomatitis (aphthous=afebrile)
Who gets aphthous stomatitis? Females>m, age 10-19
When should expect aphthous stoma to go away? 1-2 wks
High anterior who? where? Anterior ethmoid A (& above midd turbinate) -Older, HTN
What labs can be checked for ant bleed? Pt/PTT, hct, INR
What labs can be checked w/high ant bleed? Hct and evaluate for shock!
Who gets post bleeds? Smokers, older, htn
Labs to order for post bleed? Hct/hgb, coags, electrolytes, EKG
When would a bleed develop with a frx of temp bone? w/in first 48 hrs
Most temp bone frxrs are? longitudinal (80%)
HL w/ longitudinal temporal frx? CHL (SNHL possibly from concussion to area)
Longitudinal temporal bone frx happen in what area? what about transverse frxrs? Parietal; Occipital
HL w/ transverse temp frxr? SNHL (loss of vestibular fxn, blood behind TM, and CSF from nose)
What might you see later, after a transverse temporal frxr? Bruising behind ear...mastoid
What 2 things are indicative of transverse temporal skul frxr? Raccooon eyes and battle sign
W/flat, depressed nasal bridge, need facial films and to check what? Extra ocular movement -- for entrappment of CN 3,4,6
Order an orthopentogram and panorex to check for what? Mandible frxr (very rare to be unilat...usually see on both sides)
Penetrating laryngeal trauama always needs what, even if stbale? Surgical referral
Major concern with facial frxrs? Resp probs
Nerves involved with face numbness? 5 and 7
3 grades of Le Fort frxrs 1. Transverse frxr above teeth 2. +involv of inferior orbital rim 3. Complete disruption-involvement of zygomatic arch
Name of bilat submandibu space infex w/ diffuse cellulitis usualy an odontogenic etiology from periodontal dz/signif dental caries? Ludwig's angina
Etiology of adults and children w/retropharyngeal/prevert abscess? Children=infectious Adult=trauma
Causative orgs or prevert/retropharyn absces? Strep pyogenes, staph aureus, anaerobes
Imaging for ludwigs angina and prevert/retrophar abscess? CT w/contrast
Most head and neck CA is? SCC (90%)
Pattern of SCC? Regnl lymph system>lungs>liver>bones
Gradual unilateral SNHL w/ tinnitus and possibly vertigo/unsteadiness may sugg? Acoustic neuroma
85% of malignant tumors of ear will be where? Pinna/Auricle
Type of CA of external ear and canal? 1/3 BC, 2/3SC
Causes of nose/sinus CA? Expos to nickel, wood dust, thorotrast (usually not d/t tobacoo)
Usual first finding for nasophar ca? Asymptomatic enarged cervical node or unilateral serous OM in adult (w/no URI sx)
Risks for nasophar ca? Mono, smoking, EBV expos, Asian
What kind of CA is usually foudn in the ethmoid sinus and is slow-growing? Adenocarcinoma (under 40 yo)
What cancer has a 20% chance of metas and is slow-growing, in the roof of the nose and usually found in the 20's? Esthesioneuroblastoma
sxs of esthesioneuroblastoma? Unilat nasal obtrux, loss of smell, epistaxis
Lymph nodes with CA of larynx? Will only feel with late dz! BAD! usualy = metas
Major contrib of larynx ca? smokin and alc
To determine laryngeal ca...must do 5 of what 6 things? 1. palpate cervical soft tiss 2. indir laryngoscoyp w/ mirror 3. direct laryngos w/bx 4. xray neck n chest 5. ct or MRI larynx 6. other contrast studies
15% of those with what will also have LUNG ca? laryn ca
types and mc laryn ca? glottic>subglottic>marginal zone
cauliflwr looking tumor? glottic
oral and pharyn can accounts for 50% in which 2 popus? asian and indian (betel nut)
SC lip ca? Verm border - mets late
BC lip ca? lower lip - mets early
is erythroplakia or leukoplakia more assoc w/ malig? eryth
Pharyngitis is most common in which seasons? winter and early spring
EBV is a member of what virus grp? Herpes virus group
If mono is caused by EBV, what will the monospot detect? Heterophile ab positive
incub pd for mono? 4-6 wks
mono virus can lay dormant in? B cells
If mono is caused by a V other than EBV, what will see? negative heterophile ab
If pt has mono and strep, dont give? why? Amox/pen...bad rash
minimal elevation of what with mono? LFTS
for strep thrt, abx therapy should be initiated w/in how many days to reduce risk for rheu fever? 9 days
Scarlet fever typically casued by? Pharyngtis
SB tongue can present w/? scarlet fever
peritonsillar abscess aka? Quinsy, pta
Airway narrowing above vs below folds? above=inspir stridor below=expir stridor or both
3 D's assoc w? epiglottitis --drooling, dysphagia, distress
h.flu/epiglottitis px/eradication via? rifampin
Croup usualy follows? WHen? URI; fall, early winter
MC cause of stridor in kids? Croup
etiology of croup? parainflu viruses
steeple sign? croup - subglottic narrowing
MC cause of hoarseness? acute laryngitis
common major manifestations of rheu fev? carditis, polyarth, chroea
rheu fever is an immune response to? M-assoc surface prtein molecules of BHStrep
usually start to see rheu fev sxs when? in 3-4 wks from infec
tx for rheu fev? Aspirin, PCN, prednisone for carditis is present, PCN px
For irrigation to remove wax impaction...water should be what temp? why? body temp, otherwise can cause vertigo
best way for manual cerumen removal? otomicroscope exam
if otorrhea is present with perf...need to treat with? FQ drops
which perfs should heal and which dont? traumatic one does; tube and COM dont
What is a complication of untreated auricular hematoma? cauliflower ear
BPPV benign paroxysmal positional vertigo -prev trauma <50, >50 idiopathic -otoconia displaced into Post SCC -hallpike maneuver
Epley maneuver for BPPV, canolith repositioning
Classic menierres intermitt vertigo, low freq SNHL, buzzing/roaring tinnitus, aural fullness
menieres synd w./ autoimmune
vestibular neuronitis viral cause, inflamm of vestibular N, sudden onset vertigo lasting days-wks-mo's -no hring loss or pain
Labyrinthitis infec of inner ear, severe vertigo and hring loss, viral or bact
bacterial labrynthitis can lead to? bact meningitis
may be mc cause of vertigo? migrain-assoc vert
mig-assoc vert not always HA, motion sickness, n and v, no HL/tinnitius
swimmers ear caused by pseudomonas, staph aureus
rfs for laryngeal ca? smoking, alc, hpv, (NOT NODULES)
what is the 1-3-6 model? screen by 1 mo, dx by 3 mo, have approp interven by 6 mo.....for hring loss
MC cause of genetic HL? loss of mutation in connexin 26 gene on chrom 13 (SNHL)
bell's palsy? swelling of CN7 at labyrinth segment -herpes simplex
ramsey-hunt synd -herpes zoster oticus -severe hring pain, loss, vertigo **Poor prognosis
Created by: ferrier.kath
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