EENT part 2

Question 1

MC bacterial pathogens of otitis externa

Answer 1

P. aeruginosa

S. aureus

Question 2

Bacterial pathogens of otitis externa with tympanostomy tubes

Answer 2

S. aureus
S. pneumoniae and with chewing
M. catarrhalis
Proteus
Klebsiella
Occasionally anaerobes

Question 3

Clinical findings of otitis externa

Answer 3

Pain
Tenderness
Aural d/c
Fever absent
Hearing unaffected
Tenderness with movement of the pinna
Lining of the auditory canal is inflamed with mild to severe erythema and edema
Scant to copious d/c from the auditory canal

Question 4

Tx of otitis externa

Answer 4

Ofloxacin
Ciprofloxacin with hydrocortisone or dexamethasone
Polymyxin B-neosporin-hydrocortisone

Question 5

Seasonal allergic rhinitis

Answer 5

Caused by airborne pollens, which have seasonal patterns
Trees in spring
Grasses in late spring to summer
Weeds in summer and fall

Question 6

Perennial allergic rhinitis

Answer 6

Primarily caused by indoor allergens, such as house dust mites, animal dander, mold, and cockroaches

Question 7

Episodic rhinitis

Answer 7

Occurs with intermittent exposure to allergens

Question 8

Sx of allergic rhinitis

Answer 8

Thin rhinorrhea
Nasal congestion
Paroxysms of sneezing
Pruritis of the eyes, nose, ears, and palate

Question 9

PE of allergic rhinitis

Answer 9

Pale pink or bluish gray, swollen, boggy nasal turbinates with clear, watery secretions
Frequent nasal itching and rubbing of the nose with the palm of the hand (allergic salute)
Allergic shiners- dark periorbital swollen areas
Swollen eyelids or conjunctival injection

Question 10

Labs for allergic rhinitis

Answer 10

Allergy testing

Question 11

Tx of allergic rhinitis

Answer 11

Allergen avoidance
Intranasal corticosteroids
2nd generation antihistamines
Decongestants
Immunotherapy

Question 12

What is the most common cause of mild to moderate hearing loss in children?

Answer 12

Conduction abnormality

Question 13

What is more common in severe hearing loss?

Answer 13

Sensorineural hearing loss

Question 14

Causes of sensorineual deafness

Answer 14

Congenital infections
Tumors and their treatments
Genetic deafness

Question 15

Dx of hearing impairment

Answer 15

Auditory brainstem response
Otoacoustic emissions
Audiologic assessment for young, neurologically immature, or behaviorally difficult children
Pneumatic otoscopy
Tympanometry

Question 16

Tx of sensorineural hearing loss

Answer 16

Speech-language therapy
Hearing aids
ASL
Special ed
Cochlear implants

Question 17

Indication for cochlear implants

Answer 17

Children >12 mos with profound sensorineual hearing loss who have limited benefit from hearing aids, have failed to progress in auditory skill development, and have no radiologic or medical contraindications

Question 18

S/sx of mastoiditis

Answer 18

Posterior auricular tenderness, swelling, and erythema

Pinna is displaced downward and outward

Question 19

Dx of mastoiditis

Answer 19

Radiographs or CT of the mastoid reveals clouding of the air cells, demineralization, or bone destruction

Question 20

Tx of mastoiditis

Answer 20

Systemic abx and drainage

Question 21

Causes of epistaxis

Answer 21

Trauma
Mucosal irritation
Septal abnormality
Inflammatory diseases
Tumors
Blood dyscrasias
Arteriosclerosis
Hereditary hemorrhagic telangiectasia
Idiopathic

Question 22

Labs for epistaxis

Answer 22

Persistent heavy bleeding: hematocrit and type and cross-match
Hx of recurrent epistaxis, platelet d/o, or neoplasia: CBC with differential
Suspicion of a bleeding d/o: bleeding time
Taking warfarin or if liver dz is suspected: INR/PT

Question 23

Tx for epistaxis

Answer 23

Manual hemostasis
Humidification and moisturization
Cauterization
Nasal packing
Arterial ligation
Embolization

Question 24

Medications for epistaxis

Answer 24

Oxymetazoline
Lidocaine
Mupirocin ointment
Silver nitrate

Question 25

MC organisms in tonsillitis

Answer 25

``` HSV EBV CMV Adenovirus Measles virus ```

Question 26

Organisms noted in chronic tonsillitis

Answer 26

Alpha and beta-hemolytic strep S. aureus H. influenzae Bacteroides

Question 27

S/sx of acute tonsillitis

Answer 27

``` Fever Sore throat Foul breath Dysphagia Odynophagia Tender cervical lymph nodes Resolve in 3-4 days but may last up to 2 wks despite adequate therapy ```

Question 28

How to diagnose recurrent tonsillitis

Answer 28

7 culture-proven episodes in 1 yr 5 infections in 2 consecutive years 3 infections each year for 3 years consecutively

Question 29

PE of acute tonsillitis

Answer 29

Fever Enlarged inflamed tonsils that may have exudates Open-mouth breathing and voice change Tender cervical lymph nodes and neck stiffness

Question 30

Labs for tonsillitis

Answer 30

Throat cultures Monospot CBC Serum electrolyte

Question 31

Tx of tonsillitis

Answer 31

Corticosteroids for EBV PO PCN for GABHS infection Tonsillectomy for recurrent tonsillitis

Question 32

What was historically the cause of epiglottitis in children in the US?

Answer 32

Hemophilus influenzae type B

Question 33

S/sx of epiglottitis

Answer 33

``` Rapid onset and progression of sx Sore throat Odynophagia/dysphagia Fever Muffled or hoarse voice Drooling, dysphagia, distress ```

Question 34

PE of epiglottitis

Answer 34

``` Stridor Voice muffling Tripod position or sniffing position Drooling/inability to handle secretions Cervical adenopathy Toxic appearance ```

Question 35

Workup of epiglottitis

Answer 35

Nasopharyngoscopy/laryngoscopy Lateral neck soft-tissue radiography Blood cultures

Question 36

Tx of epiglottitis

Answer 36

Have intubation equipment ready Airway management Third-generation cephalosporin

Question 37

MCC of oral candidiasis

Answer 37

Candida albicans

Question 38

Causes of oral candidiasis

Answer 38

Inhaled corticosteroid use Immunocompromised pts Antibiotic use

Question 39

S/sx of oral candidiasis

Answer 39

Infants: pain, poor feeding, fussiness Others: Itching, burning, soreness

Question 40

PE of oral candidiasis

Answer 40

White plaques that may affect the lips, tongue, gums, and palate Scraping may reveal erythema and bleeding at the base

Question 41

Labs of oral candidiasis

Answer 41

KOH slide preparation

Question 42

Tx of oral candidiasis

Answer 42

Nystatin oral suspension

Question 43

S/sx of peritonsillar abscess

Answer 43

Sore throat/dysphagia and neck swelling and pain: usually for 5-7 days, not improving on abx Trismus Fever Pooling of saliva and drooling Tiredness, irritability, and reduced oral intake Muffled voice Referred ear pain

Question 44

PE of peritonsillar abscess

Answer 44

Potential respiratory distress Moderately uncomfortable appearing Asymmetric swelling of the soft tissues with displacement of the affected tonsil medially and anteriorly Tonsil may have erythema and exudates Uvula is displaced to the contralateral side Halitosis Cervical and submandibular LAD

Question 45

Causes of peritonsillar abscess

Answer 45

``` GABHS S. aureus Alpha-hemolytic streptococci Coagulase-neg staphylococci S. pneumoniae ```

Question 46

Labs for peritonsillar abscess

Answer 46

CBC with diff Serum electrolytes if oral intake has declined Throat culture

Question 47

Imaging for peritonsillar abscess

Answer 47

CT with IV contrast when dx is unclear, pt is uncooperative with the exam, and when infectious process is thought to involve deeper structures

Question 48

Tx of peritonsillar abscess

Answer 48

``` Hydration Analgesia Drainage Outpatient: Augmentin IV ceftriaxone ```