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Flashcards in ENT cases Deck (47)
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1
Q

What is the general anatomy of the respiratory epithelium and what disease is closely related?

A

has cilia or hair fibers = whisk broom to clear mucus out of the sinus

has mucociliary clearance ability

Asthma, sinus disease is closely related

2
Q

Common cold symptoms and what are common causes?

A

benign, self limited, w/ symptoms hours to days post infection:

sore throat/nasal congestions/rhinorrhea/sneeze/cough

Almost always viral

Rhionvirus = 50%

Corona virus, influenza, RSV or parainfluenza

3
Q

Common cold transmission

A
  • Direct contact
  • Aerosolized droplets
  • Virus enters nose
  • Mucociliary clearance to nasopharynx
4
Q

Mechanism of infection in common cold

A

Virus enters epithelial cells
– Via intercellular adhesion molecule-1
• Virus replicates once enters cell
– 75% of patients become symptomatic
– Viral shedding peaks by day 2
– Virus can be present for several weeks
• Vasodilation, increase mucus secretion, extensive respiratory epithelium damage

5
Q

Otitis Media
• Very commonly diagnosed childhood illness
• 2.2 million episodes diagnosed yearly
• Risk factors:

A

– Daycare, smoke exposure, l_ack of breast-feedin_g, ethnicity, family history, older siblings, low socioeconomic status, other health conditions (e.g. Downs’)

6
Q

Most common cause for Acute otitis media

A
  • Streptococcus pneumoniae– 40%
  • Haemophilus influenza– Nontypeable– 25%
  • Moraxella catarhalis– 12%
7
Q

Causes of Chronic otitis media

A

Haemophilus influenza– Nontypeable– 15%
Moraxella catarhalis– 10%
Streptococcus pneumoniae– 7%

8
Q

What does a normal tympanic membrane look like?

A

Don’t need to memorize, just appreciate

9
Q

What is our first line tx for otitis media?

A

AMOXICILLIN

10
Q

What type of ear tubes are placed in child and why do they help?

How long do they last?

A

– Pressure equalizing (PE) tubes
– Myringotomy tubes
– Tympanostomy tubes
• Allows the middle ear to ventilate until the eustachian tube is mature

Ventilate middle ear space
• Usually last 6-18 months

11
Q
A
12
Q

What are three indications for ear tubes?

A

• Chronic middle ear effusion ± conductive hearing loss
• Recurrent suppurative otitis media
• Atelectasis of middle ear
– Inadequate ventilation by auditory tube
– Retraction/deformation of tympanic membrane

13
Q

What are paranasal sinuses and how many do we have?

A

– Air filled cavities that are found in the bones of the face/head.

– Immature at birth, develop with age
• Named for the bone in which they form; 4 sets of sinuses
• Ethmoid
• Maxillary
• Sphenoid
• Frontal

14
Q
A
15
Q

What is sinus disease?

A

Called Rhino-Sinusitis
– Inflammation/infection of the nasal passage and paranasal sinuses
• Several different types:

Acute bacterial/ recurrent acute rhinosinusitis and chronic rhinosinusitis

16
Q

What are causes of acute rhinosinusitis?

A

– Acute Rhinosinusitis
• Acute Bacterial
– Streptococcus pneumoniae, Haemophilus influenza, Moraxella catarhalis
• Acute Viral

17
Q
A
18
Q

What is the mechanism that leads to a sinus infection?

A

disease causes swelling–> narrows sinus ostia–> impedes draining

==> mucus fills sinus–> bacteria grow–> Sinus infection

(can also start right from ‘narrows sinus ostia’)

19
Q

What causes inflammation of the sinuses?

A
  • Viral infections
  • Environmental allergens
  • Environmental irritants
  • Mucus
  • Medications
  • Bacterial Infections
  • Fungus
20
Q

guy has pain in mouth when eating spicy or acidic food. PMH of AIDs, not on meds, no temp and erythema of hard palate; flat, smooth areas of dorsal tongue but no white patches. Dx

A

Erythematous candidiasis!

Has candida infection even though no white plaques (thrush or pseudomembranous candidiasis)

21
Q

• Adherent white plaques
– Tongue, buccal mucosa, hard palate
– Plaques wipe off and underlying mucosa is erythematous
• Most common in infants and immunocompromised
• Can affect oropharynx and esophagus
• 2nd most common AIDS-defining opportunistic
infection (Pneumocystis carinii pneumonia is #1)

A

Psuedomembranous candidiasis = thrush

22
Q

HIV, poorly controlled diabetes, Sjorgens disease, steoid inhalers, broad spectrum antibiotics, head adn neck radiation predispose you to:

A

oral candidiasis

23
Q

What is the most common form of oral candidiasis?

A

Erythematous (atrophic) candidiasis

24
Q

What is this a picture of?

What agents are generally responsible?

A

Angular chelitis = subtype of oral candidiasis

  • Combination of bacterial and fungal infections
  • Most caused by C. albicans and S. aureus
  • Soreness, erythema, and fissuring at commissures
  • Seen in patients who wear dentures (pooling of saliva at commissures)
25
Q

How do we Dx candidiasis?

A

Typically based on clinical signs/symptoms
Cytology
Mucosal biopsy
Culture

26
Q

– Acute atrophic
– Chronic atrophic
– Angular chelitis
– Median rhomboid glossitis
– Chronic multifocal

Are all subtypes of:

A

Oral candidiasis

27
Q

What is stomatitis and what are causes?

A

broad term for infection/inflammation of mouth

laundry list for: bacterial/ viral/ fungal

28
Q

Case: 14 yo boy, hurts to swallow, fever, chills, temperature. Has aches and headache and stomach ache.

Diffuse rash, lungs clear, bilater anterior cervical lymph adenopathy

throat injected, bilateral tonsillar hypertorphy + exudate, ill appearing

How would you make a correct Dx before kid leaves clinic?

A

Obtain rapid antigen detection test

29
Q

Pt has sore throat.. dx as strep.

How does organism adhere to the epithelial cells on surface of oropharnyx?

A

Via pili on the surface of the organism

30
Q

How does streptococcus (in strep throat) evade phagocytosis?

A

via hyaluronic acid in capsule of organism and via antiphagocytic proteins made and secreated by organism

31
Q

What causes constitutional illness we see associated with strep?

A

from exotoxins made by organism

32
Q

How is strep throat transmitted?

A

via large droplets containing organism; coughing, sneezing, conversation with sick individual or asymptomatic colonization of other students in John’s class

33
Q

What is waldyers ring?

A

• Waldeyer’s ring: aggregate lymphoid tissue upper
aerodigestive tract

34
Q

What are indicatiosn of adenotonsillectomy?

A

Upper airway obstruction (most common)

• Recurrent/chronic infection
– Tonsillitis from ß hemolytic strep Group A or Peritonsillitis / peri-tonsillar abscess
• Neoplasia (lymphoma/carcinoma): see unilateral hypertrophy

35
Q

You are deciding whether or not your pt has strep throat as it seems highly likely he has strep. What do you do next?

A

Rapid strep test or empiric antibiotics

36
Q

Pt you are seeing has a moderate probability of having strep.. what are your next steps?

A

Order rapid strep test

if positive treat

if negative consider other diagnosis

37
Q

If your patient is 10 - 25 years of age, what special considerations do we take into account when we suspect strep throat?

A

if rapid strep comes back negative, order a throat culture.

Test for mononucleosis

38
Q

How do you obtain a good throat culture?

A

Culture each tonsil + posterior pharngeal wall

twist, rotate swab into tissue to get good specimen

avoid touching the tongue and immediately transfer to tranpsort medium

39
Q

A kid comes in with a huge swelling on the side of his neck and when it is drained it’s full of pus. Dx?

A

Cervical abscess; kids with URI can get abcess in their cervicle lymph nodes

40
Q

A concerened father brings high son in. The son is drooling, has a fever and appears very sick. The boy as an inspiratory stridor and sitting upright in bed. Dad says this happened very quickly. What are you suspicious of right now?

A

Supraglottitis

rapid onset/ drooling/sitting up/fever/inspiratory stirdor

41
Q

What is the etiology and tx for supraglottis?

A

H. flu (type B)

Tx is antibiotics and secure airway

42
Q

A mother brings in her son because of his cough. She states this happened gradually and he had low grade fevers so she thought it was just a cold. He recently has had loud, barking like coughs. You note he has a biphasic stridor. What is a likely dx at this point?

A

Croup; subglottic infection

gradual onset/low fevers/barking cough/biphasic stridor

43
Q

What is the cause and tx for croup?

A

cause of croup is viral

tx with racemic epi, steroids and humidifier

44
Q

What do you notice on xray? This is typical of what illness?

A

Steeple sign seen in Croup

45
Q

What is the xray pointing to? When do we see this?

A

Thumb sign in Epiglottitis

46
Q

Young girl comes in with a bad cough, stridor, fever and toxic looking. Your attending does a physical and orders a PA and lateral chest xray as he suspects bacterial tracheitis

What would you see if this Dx was correct?

A

Tracheal air column ragged and irregular on PA and lateral

47
Q

Common cause for bacterial trachetis and treatement

A

S. Aureus

IV antibiotics, hydration and rigid bronchoscopy with debridement of tracheal crusts and exudate

(may need to intubate to prevent obstruction)