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- Macrolides (azithromycin, erythromycin)
- Aminoglycosides (gentamicin, streptomycin, tobramycin, amikacin)
- Beta-lactams (PCNs, cephalosporins, carbopenems)
Definition of sudden SNHL:
drop of 30dB in 3 or more consecutive frequencies
- SGT KAN = Vestibulotoxic to Ototoxic
- Furosemide (Lasix) - changes in endolymph electrolyte composition
- Cisplatin/Carboplatin - loss of outer hair cells at the basal cochlear turns --> HF HL
- Salicylates - reversible
1. What is the MOA of botox?
2. How does it wear off?
3. What is the dosing for the following otolaryngological conditions:
Primary Axillary Hyperhydrosis
- 1. Irreversibly blocks the presynaptic release of acetylcholine resulting in localized muscle paralysis
- 2. Regeneration of presynaptic clefts
- 3. Cervical dystonia: 200 - 300 units
- Blepharospasm: 1.25 - 2.5 units
- Strabismus: 1.25 - 5 units IM
- Primary Axillary Hyperhydrosis: 25 - 50 units intradermally
Which immunoglobulin crosses the placenta?
IgG also can fix complement --> neutralization --> opsonization --> bacteriolysis, agglutination, & hemolysis
Autosomal dominant ENT syndromes
- Non-syndromic hearing losses
- Waardenburg syndrome (dystopia canthorum, broad nasal root, confluence of the medial portion of the eyebrows, partial/total heterochromia iridis, white forelock, SNHL)
- Branchiootorenal syndrome (branchial, otic, and renal anomalies in deaf individuals)
- Treacher-Collins syndrome (maldevelopment maxilla & mandible, abnl canthi, ocular colobomas, choanal atresia, CHL 2/2 ossicular fixation)
What is the most common postoperative electrolyte abnormality?
- From Up to Date:
- During and after surgery, surgical stress results in the release of antidiuretic hormone (ADH; ie, vasopressin). Antidiuretic hormone acts in the kidney to retain water . In normovolemic postsurgical patients, the administration of additional sodium (ie, 0.9% saline) can result in a paradoxical fall in sodium concentration because the sodium contained in these solutions is excreted in the urine, resulting in net retention of electrolyte-free water. As a result, hyponatremia is commonly observed in postsurgical patients. It can also occur if too much LR or a balanced salt solution is administered.
Autosomal recessive ENT syndromes
- nonsyndromic deafness
- Pendred's syndrome (congenital deafness with thyroid goiter)
- Usher's syndrome (retinitis pigmentosa, SNHL, +/- vestibular deficits)
- Alstrom's syndrome (cone-rod dystrophy, hearing loss, obesity, type 2 diabetes mellitus, dilated cardiomyopathy, and progressive hepatic and renal dysfunction)
A 45 year old man presents with a neck mass anterior to the SCM. The mass is mobile laterally but not vertically. T1 MRI shows a soft tissue mass at the level of the carotid bifurcation that displaces the internal carotid artery posteriorly and the external carotid artery anteriorly. The mass enhances intensely and homogenously with gadolinium. What is the tumor?
Carotid body tumor
Where are most esophageal foreign bodies found?
Just below the cricopharyngeus muscle
A 3yo sustains bilateral subcondylar fractures of the mandible. Occlusion is normal and radiological studies demonstrate minimal displacement. What is the recommended management?
A soft diet and physical therapy aimed at maintaining range of motion.
What is the most common cause of massive hemoptysis (>600ml of blood in 24h)?
An 8yo boy has a draining ear filled with friable tissue. CT scan demonstrates a punched out lytic lesion of the temporal bone. Biopsies show only lipid-laden histiocytes. What is the most likely diagnosis?
What fungus produces a granulomatous tissue reaction and can cause the triad of pneumonitis, erythema nodosum, and arthralgias known as valley fever?
What is the most common cause of vertigo in a child?
A patient with HIV presents with gingival pain and a foul mouth odor. Exam reveals fever and cervical lymphadenopathy; examination of his oral cavity is shown below. What is the most likely diagnosis?
- Acute necrotizing ulcerative gingivitis (ANUG)
- aka trench mouth or Vincent's disease
- The punched out ulcerations of the interdental papillae are pathognomonic.
A patient with frontal sinusitis presents with a large forehead abscess. What is the most likely diagnosis?
- Pott's puffy tumor
- = frontal osteomyelitis with associated subperiosteal abscess of the frontal bone.
What physical features constitute the Pierre-Robin sequence?
- Cleft palate (U-shaped, sometimes V-shaped)
An ill-appearing patient presents with a fever of 103F, bilateral chemosis, third nerve palsy, and sinusitis. What is the most likely diagnosis?
Cavernous sinus thrombosis.
Retropharyngeal abscess is most common in what age group?
- 6mo to 3 years
- Retropharyngeal lymph nodes regress in size after age 3
What is a ranula?
A mucous retention cyst involving the sublingual gland in the floor of the mouth characterized by a bluish surface
A 48yo M presents with a high fever, trismus, dysphagia, and swelling inferior to the mandible in the lateral neck. What is the most likely diagnosis?
Parapharyngeal space abscess
True/False: A patient can lose more of the upper lip than the lower lip without cosmetic problems.
- Up to 1/3 of the lower lip can be avulsed or debrided and the patient may still have an acceptable cosmetic appearance. The upper lip is less forgiving due to the relationship with the columella, alar bases, and philtrum
What are the components of the CHARGE sequence?
- Heart defects
- choanal Atresia
- Retarded growth
- Genital hypoplasia
- Ear anomalies
What is scrofula?
Tuberculous or nontuberculous cervical adenopathy.
What percent of parotid and SMG calculi are radiopaque on CT scan?
In which Le Fort fracture is CSF rhinorrhea most common?
What is the treatment of choice for bullous myringitis?
The incidence of stones is highest in which salivery gland?
What organism causes Lemierre's syndrome?
A toddler sustains an electrical injury to the commissure of his mouth after biting through an electrical cord from a floor lamp. What post injury warning should be given to the parents?
- The labial artery may hemorrhage if the overlying soft tissue of the commissure breaks down.
- The parents should be instructed to hold digital pressure on the lip with their thumb & index finger to control the bleeding and seek help immediately.
Fourth & sixth arch derivatives are innervated by which nerves?
- 4th - superior laryngeal nerve
- 6th - recurrent laryngeal nerve
Nystagmus is defined by which component?
Which syndromes are associated with hearing loss and renal abnormalities?
- Fanconi anemia
A 6yo M is referred because of hearing loss. Audiometric studies reveal a 40-dB conductive hearing loss in the left ear. He is also noted to have downward sloping palpebral fissures, depressed cheek bones, deformed pinnas, receding chin, and a large fishmouth. What is the most likely diagnosis?
Treacher Collins syndrome
A 32yo sailor presents with a 6mo hx of vertigo. On eval, he has rotatory nystagmus, scanning speech, an intention tremor, and bilateral intranuclear ophthalmoplegia. What is the most likely diagnosis?
An 88yo white M presents with a painless mass just below his ear that has been slowly enlarging over 2-3 years. Pathology shows round, plump, granular eosinophilic cells with small indented nuclei. What is the most likely diagnosis?
Where would you expect to find the parathyroid glands in a 10yo patient with a lingual thyroid gland?
in the tracheoesophageal groove
A 3yo boy presents with a midline anterior neck mass just below the hyoid bone that moves with deglutition and tongue protrusion. What is believed to be the cause of this congenital mass?
Failure of complete obliteration of the thyroglossal duct cyst.
An infant presents with coughing, choking, and cyanosis during feeding. This clinical triad suggests what process?
a tracheoesophageal fistula
What is the minimum systolic arterial pressure required to maintain cerebral perfusion?
What diagnosis must be investigated in a patient presenting with pulsating exophthalmos?
What are the disadvantages of using technetium scans to monitor therapy for necrotizing otitis externa?
It reflects osteoblastic activity and bone remodeling but is not specific for osteomyelitis. It also has poor spatial resolution and may remain positive long after clinical resolution.
Why is facial electroneurography (ENoG) an unreliable prognostic indicator more than 3 weeks after the onset of facial paralysis?
Asynchronous discharge from regenerating nerve fibers can give a false-positive or false-negative report of nerve status.
Bilateral facial paralysis associated with progressive ascending motor neurophathy of the lower extremities and elevated CSF protein is characteristic of what clinical entitiy?
How would you grade facial nerve function in a patient with facial asymmetry at rest, incomplete eye closure, and minimal motion of the mouth with maximal effort?
House grade V
In the tonotopic organization of the cochlea, where are the low frequencies located?
at the cochlear apex
Recurrent facial paralysis, facial edema, furrowed tongue, and cheilitis are consistent with what diagnosis?