EENT

Question 1

Blowout fracture

Answer 1

Et: eye trauma

Sxs:

• orbital pain, double vision, sunken in globe
• palpable inferior orbital rim, step off, inferior lid/cheek anesthesia

Dx: CT facial bones

Mgmt:

• don’t blow nose
• oral abx
• consider surgical repair at 1 week if persistent diplopia or enophthalmos (sunken in eye)

Question 2

Cataract

Answer 2

• natural clouding of eye lens w/age *

Causes:

• age >65 (MC)
• DM, Fhx, nutritional deficiency, previous surgery or injury

Sxs:
- painless gradual loss of vision in one or both eyes

Dx:

• reduced visual acuity on exam
• reduced red reflex
• discoloration of lens
• otherwise normal exam

Mgmt: 
outpt surgery indicated when: 
1. vision is 20/40 or worse
or
2. decreased vision is having negative effect on ADLs

Question 3

Chronic otitis media

Answer 3

Et: eustachian tube dysfunction may contribute

Sxs:
- effusion > 3mo hearing loss

Dx:

• purulent effusion > 3mo = chronic OM
• serous effusion >3mo = chronic serous OM (glue ear)

Mgmt:

• tympanostomy tubes or adenoidectomy for chronic serous OM
• potential TM repair in chronic OM

Biggest concern is speech delay in children

Question 4

Chronic sinusitis

Answer 4

Presentation: 
>12wk of (2/4 sxs): 
- mucopurulent drainage
- nasal obstruction
- facial pain/pressure
- decreased sense of smell 

Et: impaired mucociliary clearance, abnormal sinus ventilation, immune deficiency

Dx: endoscopic eval

Mgmt:

• systemic steroids + nasal steroids + abx for 4-6wk
• med failure = functional endoscopic sinus surgery to remove polyps, unroof ethmoid sinuses

Question 5

Nasal polyps

Answer 5

Pt w/allergic rhinitis

• kids = CF
• avoid aspirin therapy in pt w/polyps + asthma

Dx: PE
- middle meatus: pale, edematous, smooth masses

Mgmt: nasal steroids if small, surgical removal if large

Question 6

Peritonsillar abscess

Answer 6

Presentation:

• initial infection –> Hot potato voice*
• pain, trismus, malaise, odynophagia

Et:
- tonsillar capsule and surrounding pharyngeal muscle bed

Dx:
- bulging palate with affected tonsil shifted medially and uvula shifted beyond midline

Mgmt:

• IV abx (amoxicillin 1g)
• surgical options: I&D, needle aspiration, tonsillectmoy

Question 7

Acoustic neuroma

Answer 7

Presentation:

• 40-60yo w/unilateral hearing loss (sudden or gradual)
• tinnitus, disequilibrium

Et:

• 8th cranial nerve schwannoma
• one of the MC intracranial tumors

Dx: enhanced MRI

Mgmt:
- surgical excision, observation, radiation

Question 8

SCC of larynx

Answer 8

Presentation:

• change in voice quality
• dysphagia, hemoptysis, wt loss, neck mass, stridor

Et:

• MC malignancy of larynx
• RF: smoking, alcohol
• HPV 16, 18 especially in non-smokers

Dx:

• direct laryngoscopy w/bx and then CT/MRI to determine extent of lesion
• surgical excision