ENT Flashcards
(43 cards)
Name the anatomical landmarks for the three zones of the neck.
Zone 1: Clavicle to cricoid (can image first)
Zone 2: Cricoid to angle of the mandible (go to OR)
Zone 3: Angle of the mandible to base of skull (can image first)
What ingestions can cause peripheral vertigo (name 4)?
aminoglycosides, furosemide, salicylates, ethanol
Symptoms of a basilar migraine (name 4)
occipital headache + sx of brainstem dysfunction – vertigo, ataxia, tinnitus, dysarthria
DDX Pseudovertigo (list 8)
- Psych: Depression, Anxiety
- Hyperventilation
- Orthostatic hypotension
- Heat exhaustion or stroke
- Arrhythmia, Cardiac disease
- Anemia
- Hypoglycemia
- Pregnancy
- Ataxia
- Visual disturbance
- Psychogenic disturbance
- Dehydration
Step-wise management of epistaxis
- Apply steady pressure to anterior nasal septum 5-10 minutes, leaning forward; cotton dental roll under lip to compress labial artery
- Cotton pledgets with epinephrine for vasoconstriction
- Anterior nasal packing (absorbable gel foam or Vaseline impregnated gauze) or expandable nasal tampons (ie. Merocel) for severe bleeding, or rapid Rhino (inflatable nasal tampon) –> give amox-clav if packing
- Cautery of anterior bleeding site with silver nitrate
- Posterior packing (ENT)
- Surgical ligation for more severe bleeds or angiography (embolization)
Complications of nasal packing
Bacterial rhinosinusitis, toxic shock, necrosis, septal ulcer/ perforation, hypoxemia/ resp distress from sedation and nasal airway obstruction
List the steps in managing aspirated foreign body in upper airway
Back blows and chest compressions in infants
Heimlich in older kids if conscious
CPR if unresponsive with direct visualization and manual extraction
Syndromes associated with sensorineural hearing loss (4)
Waardenburg syndrome (white forelock) Jervell and Lange Nielson Syndrome (with prolongation of QTc) Usher syndrome (retinitis pigmentosa) Alport syndrome (males)
Life threatening causes of acute hearing loss (list 4)
Acute head injury, brain tumor, leukemic infiltrate, vascular insufficiency
Findings of a neck lymph node that are concerning for malignancy
supraclavicular node, >2cm, enlargement of node for more than 2 weeks, no regression of node after 4-6 weeks, lack of inflammation, firm or rubbery, ulceration, failure to respond to antibiotics, systemic symptoms
What is Lemierre syndrome and what bacteria commonly causes it?
Thrombophlebitis of internal jugular vein with septic pulmonary emboli
Gram neg bacilli Fusobacterium necrophorum
Common causes of cervical lymphadenitis, and what is the antibiotic of choice?
- staphylococcal aureus, GAS, H. influenza, anaerobes
- amox-clav, keflex (clindamycin for MRSA)
Common causes of parotitis?
- Viral causes are most common: mumps virus, parainfluenza types 1 and 3, influenza A, Coxsackie virus A, EBV, CMV
- Bacterial causes less common, usually severe and unilateral (except in neonates - can be bilateral)
Complications of mumps (6)
- parotitis
- orchitis
- encephalitis, meningitis
- pancreatitis
- labyrinthitis
- myocarditis
How to differentiate rotary subluxation vs. muscular torticollis?
- Rotary atloantoaxial subluxation (C1 and C2 “locked” in rotated position) = SCM spasm and neck tenderness on same side as the chin. Treat with NSAIDS and soft collar.
- Muscular torticollis = tender SCM opposite direction of the chin
What is Grisel’s syndrome?
Rotary atlantoaxial subluxation from local inflammatory or ENT procedure (RA, SLE, tonsillitis, pharyngitis, OM, RPA, T+A) ; due to ligamentous laxity
What bacteria cause otitis externa?
Staphylococcal aureus and pseudomonas
Treatment of otitis externa?
- Debride ear canal
- Ciprodex otic drops for 10 days
- If narrow canal can place wick in ear soaked in drops to help reach inflammation – expands with the drops, change every 24 hours
- Analgesia
Auricular perichondritis - causes, bacteria involved, treatment?
- Infection of cartilage of ear that occur in setting of trauma or surgery or piercing
- Caused by pseudomonas
- Treatment: pseudomonas coverage such as ceftazidime or ciprofloxacin usually IV
Otitis media - causes?
- viral most common
- streptococcus pneumoniae, haemophilus influenza, Moraxella catarrhalis, GAS
Otitis media complications (list 6)?
- perforated AOM
- mastoiditis
- suppurative labyrinthitis
- facial nerve palsy
- CN VI palsy (Gradenigo syndrome)
- venous sinus thrombosis
- meningitis
- intracranial abscess
Otitis media - treatment
< 6 months: treat high dose amox
> 6 months - mild: watchful waiting
> 6 months - severe: amoxicillin 80-90 mg/kg/day divided BID (5 days if > 2 yo, 10 days if < 2 yo)
If perforated, can add ciprodex drops
Mastoiditis - clinical features (4)
- fever, malaise, lethargy
- swelling / erythema of mastoid process
- displaced the auricle forward and downward
- TM red and bulging
Mastoiditis - complications (6)
- subperiosteal abscess
- CN palsy V and VI most common (then VI and VIII)
- meningitis
- intracranial abscess, extradural abscess
- venous sinus thrombosis
- labyrinthitis
- Bezold abscess
