ENT Flashcards
(36 cards)
what are the signs of a peritonsillar abscess? how do you tx?
sx: ST for several days that has worsened on one side, fullness of anterior tonsilla pillar, uvular deviation from side of abscess, hot potato voice, trismus tx: drainage or aspiration, adequate pain control, abx, tonsillectomy for some. If in back of throat call ENT.
what are these a sign of: high fever, sore throat, dyspnea, rapidly progressive respiratory obstruction and prostatration.presents over 2-4 hours. Look for 4 Ds: drooling, dysphagia, dysphonia-hoarseness, distress/stridor. how do you tx it?
epiglottitis.tx: do not leave unattended in exam room! Establish and maintain airway or all ENT for surfical airway. Give abx and corticosteroids to reduce edema: cefotaxime or ceftriaxone + vancomycin.can give racemic epi. DO NOT LEAVE UNATTENDED. Tx all in householdwith rifampin if they have any other members that are immunocompromised, or if they are not yet completely vaccinated.
stridor, barking cough + steeple sign on CXR. how to tx?
croup. don’t do any procedures to make them nervous b/c you can lose an airway. Use racemic epi + dose of steroids. If still hear stridor, keep them overnight.
what should you always check with people with facial trauma? what kind of tests do you do?
ABCs and always check ocular movement and vision for nerve entrapment! always check ocular movement and vision for nerve entrapment! Look at symmetry from top down and down up. Get spiral CT of head, face, and NECK. Get whole spine if you suspect cervical spine fracture.
what kinds of signs might you see in a le fort fracture?
le fort fractures you may see swelling of face, elongated depressed facial features, palpable depressed fractures, CSF may be coming out of nose +/-blood. teeth might not fit togther and there may be a septal hematoma.
what bones are involved in a tripod fracture?
Tripod fracture is a set of 3 bone fractures: maxillary sinus (includees anterior and postero-lateral and floor of orbit), zygomatic arch, and the lateral orbit rim at zygomatico frontal suture. +/- involvement of sphneozygomatic suture.
what kind of tests do you do and how do you tx someone with laryngeal trauma?
chest and c-spine xrays, +/-endoscoy if airway stable or neck CT.. for penetrating and blunt trauma: ABCs, close observation, admit to ICU, best rest with hOB elevated. Voice rest (no whispering!), humdified air, clear liquid diet, steroids possibly in first few days. +/- surgical exploration and repair for penetrating wounds.
what sx will you see with longitudinal or transverse temporal bone fractures?
with longitudinal temporal bone fracture you can have TM bleeding, +/-conductive hearing loss, possible sensorineural loss. With a transverse fractureyou can get the same symptoms plus CSF from nose, loss of vestibular fcn and brusing behind mastoid bone.
which test is not helpful for nasal trauma? which is most helpful? what other things should you check?
X-rays; most helpful is PE. PE best. Look for deformity, septal hematomas,. Make sure they can breathe on both sides and check ocular movements.
how do you identify ludwig’s angina? what tests should you do? how to tx?
may have hx of recent dental procedures, URI, resp difficulty, immune compromise or trauma. Usu have mouth pain, drooling, stiff neck, muffled voice. +/- tongue sticking out which is really bad. tests: CT with contrast. tx: abcS. May need trach. Abx to cover anaerobes. Surgical drainage as needed. THINK LUDWIGS ANGINA ANY TIME YOU HEAR TROUBLE SWALLOWING + SWELLING.
what other infection can have the same sx as ludwigs angina of fever, stiff neck, drooling, and dysphagia? ? how do you distinguish the two?
retropharyngeal and prevertebral space abscess. use CT with contrast to distinguish also ludwigs angina would have more swelling. you tx them the same with ABCs, abx and surgical drainage.
what’s in the ddx for ST?
viral pharyngitis MC, bacterial pharyngitis, mononucleosis, peitonsillar abscess, retropharyngeal abscess, candidiasis, sinusitis (PND), allergy, dryness, GERD, thyroiditis, epiglottis laryngitis, neoplasm/cx, foreign body, chemical exposure, referred pain (dental, ear, LN, chest) influenza
what are the center criteria/indicaitons for rapid strep test?
indications for rapid strep test: fever by hx, tender anterior cervical lymph nodes, exudate on tonsils, lack of cough +/- exposure to strep, odynophagia HA, nausea, vomiting and/or abdominal pain, rash
what’s the tx and pt ed for mono?
tx: mostly non pharm and pt ed: rest, fluids, analgesics. Can use abx for strep throat but they’ll get a rash. pt ed: contagious via saliva. If splenomegaly can’t play contact sport for at least 7-8 wks, 4 wks can do sports, just not contact. Reevaluate.the fatigue can linger for 2-3 mo.but the sore throat will only last 1-2 wks.
signs/sx of epiglottis
high fever, sore throat, dyspnea, rapidly progressive respiratory obstruction and prostatration.presents over 2-4 hours. Look for 4 Ds: drooling, dysphagia, dysphonia-hoarseness, distress/stridor
how do you distinguish croup from epiglottiis?
there will be more reps distress in epiglottis, there will be drooling, abscensce of barking cough. croup preceded by URI.
what’s on your ddx for neck mass?
how old? How long has it been there? Pain? Cough? Bleeding? Do they smoke or drink? Other medical issues? Size?consistency? Where is it?
ddx: infectious/inflammatory: LAD from virus, fungus, bacteria, TB, abscess, sialadenitis (swollen saliva gland) congenital: thyroglossal duct cyst, branchial cleft cyst, dermoid neoplastic masses benign: lipoma, schwannoma (nerve tumor), salivar gland tumor, thyroid tumor, neoplastic masses malignant: metastatic squamous cancer, lymphoma, salivary gland cx, thyroid cx
what are important questions to ask someone with a neck mass?
how old? How long has it been there? Pain? Cough? Bleeding? Do they smoke or drink? Other medical issues? Size?consistency? Where is it? Prior tx for anything? Travel? Pets? (toxoplasmosis), inciting events. Wt loss? Dysphagia, hoarseness (>2-3 wks), hemoptysis, fever (infection), chills, sweats, frequent uRI or strep throats? previous masses? tobacco and etoh use (synergistic=25x more likely to have cx, sexual partners (HPV), work history
which neck mass is in the center of the neck, usu comeson after a URI, moves with swallowing, and is usu non tender unless infected. is it worrisome?
its a thyroglossal duct cyst, not worrisome, its congential
what is the tx for masses in thyroid and parotid gland?
surgery is mainstay
what’s the last resort for biopsying masses in throat?
open biopsy b/c you can change the way their lymph nodes drain and its hard to know where the cx could go next. fine needle aspiration is best.
what are the RFs for head and neck cx?
etoh, smoking synergism of these, betel nut, HPV (on the rise), general sources of inflammation
which cx patients are most likely to commit suicide?
those with head and neck cx
what are worrisome signs or sx of head and neck cx?
any of the following lasting 3 wks or more: hoarseness, hemopytsis, dysphagia, odynophagia, oral bleeding, ST, loose tooth not explained by trauma, otalgia, lumps/bumps in Hand N area, cranial nerve dysfcn–NEEDS IMMEDIATE CONSULT.
