ENT Disorders - clinical approach Flashcards
(89 cards)
1
Q
moononucleosis sx (8)
A
- fever
- fatigue
- sore throat
- HA
- myalgia
- exudate
- lymphadenopathy (posterior cervical)
- enlarged liver or spleen
2
Q
If a pt gets a rash after taking ampicillin or amoxicillin for URI, what is the most likely dx?
A
mono
(95% EBV-induced Ab to ampicillin)
3
Q
infectious mononucleosis tx (2)
A
- rest
- salt-water gargles
(no Abx, cause = EBV)
4
Q
Danger of mono for sports
A
splenic trauma
5
Q
presentation of strep (6)
A
- strawberry tongue
- petechiae of palate
- red pharynx
- tonsilar exudate
- severe sore throat & fever
- tender lymphadenopathy (anterior cervical)
6
Q
if rapid strep comes back neg. what do you do?
A
culter (if high suspicion)
7
Q
complications of strep pharyngitis
A
- peritonsillar abscess
- glomerulonephritis
8
Q
strep pharyngitis tx (2)
A
- penicillin
- erythromycin (if allergin to PCN)
(goal of tx: prevent acute rheumatic fever)
9
Q
scarlet fever: 2 key clues
A
- circumoral pallor
- sandpaper rash
10
Q
pharyngitis is always caused by which microbial group?
A
viral
(conjunctivitis, no pus)
11
Q
onset pharyngitis vs. strep
A
pharyngitis: slow
strep: rapid
12
Q
laryngitis is most commonly caused by what?
A
- viral
- chemical
- overuse
tx: rest
13
Q
laryngitis f/u
A
2 weeks if persists –> check for CA
14
Q
A
ludwig’s angina: celullitis in submandibular space
15
Q
complication of ludwig’s angina?
A
airway obstruction
16
Q
sx of ludwig’s angina
A
- brawny, painful edema of submandibular area]
- trismus
- fever
17
Q
tx of ludgwig’s angina (4)
A
- ENT and dental consult
- airway management: intubate or trac
- surgical drainage
- broad spectrum abx (PCN + metronidazole, ampicillin/sulbactam, clindamycin)
18
Q
A
ANUG (acute necrotizing ulcerative gingivitis) aka “Trench Mouth”
(rapid progression of gingivitis)
19
Q
microbe responsible for trench mouth (2)
A
fusobacterium (anaerob) or spriochete (treponema denticola)
20
Q
Tx: trench mouth
A
- abx: metronidazole, PCN, clindamycin
- peroxide rinse
21
Q
A
peritonsillar abscess: cellulitis behind tonsilar capsule that extends onto soft palate
22
Q
MC deep facial infection in adults?
A
peritonsillar abscess
23
Q
sx (4)
A
- dysphonia “hot potato” voice
- trismus (can’t open mouth)
- peritonsillar mass that displaces soft palate
- drooling
(prior throat infection, presents unilaterally)
fever & dehydration also
24
Q
tx: peritonsillar abscess (3)
A
- I & D
- needle aspiration
- abx
extreme caution of internal carotid a.
25
Diphtheria: tenacious gray membrane covers pharynx & tonsils
(tenacious: can't scrap easily)
26
diphtheria sx (5)
1. tenacious gray membrane
1. drooling
1. nasal discharge
1. hoarsness
1. malaise
1. fever
27
complications of exotoxin from diphtheria (5)?
1. heart
1. nerves
2. liver
3. kidney
4. respiratory failure
28
Diphtheria neuropathy (2)
early bulbar weakness, followed by weakness of the trunk, then extremities
(Guillan-barre is opposite)
29
Diphtheria tx (3)
1. airway management
1. diphtheria **antitoxin**
1. abx: PCN/Emycin
30
tx: auricular hematomas
1. stop bleeding
1. expel hematoma (prevents deformity)
(tx w/in 7 days)
31
2 signs of otitis media w/effusion
1. TM is dull w/no erythema
1. decreased hearing
(do not give abx prophylaxis)
32
causes (3)?
1. trauma (slap)
1. infection
1. pressure changes
| heals sponatneously
33
sx (2)
1. decreased hearing
1. drainage
(pain?)
34
tx (3)
1. penetrating traumas = surgery
1. keep dry
1. topical + systemic abx (avoid aminoglycosides)
**(no ear drops!)**
35
complication of this condition
bone destruction (cholesteatoma)
36
Define cholesteatoma
congenital or acquired overgrowth of keratin producing squamous epithelium in middle ear and/or mastoid
37
Cholesteatoma sx (2)
1. fould-smelling drainage
1. bone destruction (secretes bone-absorbing substances)
38
tx (2)
1. abx
1. surgery
39
cerumen impaction: tx (3)
1. ear drops
1. hydrogen peroxide (1:1 w/water)
2. irrigation
40
progression of this condition
dermatitis -> cellulitis --> chondritis --> osteomyelitis
| otitis externa
41
predisposing factors (4)
1. excessive cleaning/scratching
1. swimming
1. occlusive devices (headphones)
1. eczema
(otitis externa)
42
findings on physical exam
(otitis externa)
1. edema
1. erythema
1. thick otorrhea
2. significant pain w/manipulation (ear tugging)
43
tx
1. ear cleaning
1. topical abx (fluoroquinolones)
1. steroids
(use systemic abx only if immunocompromised or DM)
44
malignant otitis externa (infection of skull base) is usually seen in which patients (2)?
1. DM
1. immune compromised
| (pseudomonas)
45
epiglottitis MC caused by
h. influenzae
46
epiglottitis presentation: kids
**(becoming more prevalent in adults due to anti-vaxxers)**
1. toxic appearing
1. pain w/thyroid cartilage movment
1. drooling, dysphagia, distress
47
dx: epiglottitis
1. severe sore throat w/ neg oropharynx exam
1. right image: "thumb sign" on xray
48
epiglottitis tx
1. ENT consult, anesthesia, OR for safe intubation, not surgery
1. abx: **ceftriaxone**
1. steroids
(do NOT upset child)
49
candidiasis/moniliasis dx
white, curd-like plaques of C. albicans on erythematous base easily scraped off
(leukoplakia does NOT easily scrape off)
50
risk factors: candidiasis/moniliasis
1. age: young or old
1. abx
1. dentures
1. steroids
1. HIV
1. chemo
51
Leukoplakia is common in which population?
male smokers
**(precancer: must bx)**
52
red macules w/ulcerations aka
ophthous ulcer (canker sore)
(tx: control pain)
53
MC cause of tooth pain
periapical abscess
54
MC tooth loss
periodontal abscess
55
tx: dental abscess (2)
1. I & D (incise & drain)
1. augmentin, clindamycin, or metronidazole
| (if <2cm --> needle aspiration)
56
alveolar osteitis (aka dry socket): severe pain due to localized osteomyelitis
| occurs 2-5 days post-extraction
57
Alveolar osteitis tx
1. **pack w/iodoform gauze + eugenol**
1. irrigate
1. abx
2. pain meds
58
how do you determine prognosis of saving an avulsed tooth?
every minute an avulsed tooth is out of the socket, lose a percent of survival
(50 min out of socket = 50% chance of saving tooth)
59
describe tooth fracture types
60
causes of facial nerve palsy
1. bells palsy
1. lyme diz
1. herpes zoster (ramsey hunt)
61
cause of herpes zoster oticus (ramsay hunt syndrome)
geniculate ganglion
62
manifestations of herpes zoster oticus (6)
1. vesicles in the ear canal, tongue or hard palate
1. severe otalgia
1. tinnitis
1. vertigo
1. hearing loss
2. bells palsy
(tx: acyclovir)
63
herpes zoster ophthalmicus is caused by invovlement of the ______ nerve.
trigeminal
(ophthalmic division)
64
herpes zoster ophthalmicus sx (6)
1. eye pain/redness
1. vesicular rash
1. keratitis
1. iritis
1. glaucoma
1. tip, side and root of nose
65
herpes zoster ophthalmicus involves which dermatome?
nasociliary
(tip, side and root of nose="hutchinson's sign")
66
herpes zoster ophthalmicus tx (3)
(dx: woods lamp/fluoroscein stain visualizes dendrites)
1. antiviral
1. steroids
1. ENT/ophtho referral
67
malignant otitis externa sx
1. drainage from ear
1. severe ear pain
68
malignant otitis externa: dx
osseous erosion on CT & radionuclide scanning
69
tx (2)
1. IV abx: flouroquinolones
1. surgical debridement (if meds fail)
70
acute bacterial sinusitis (5)
1. purulent nasal discharge
1. HA
1. facial pain (toothache-like)
1. swelling/erythema of sinuses
1. fever
| sinusitis=rhinosinusitis
71
dx: acute sinusitis
1. pain over area
1. postnasal drainage
(clinical)
72
acute sinusitis complications (5)
1. brain abscess
1. meningitis
1. cavernous sinus thrombosis
1. skull osteomyelitis (pott's puffy tumor)
1. orbital cellulitis
73
acute sinusistis treatment
(uncomplicated, mild pain)
decongestants (pills & spray)
**(abx after 7-10 days w/o improvement)**
74
acute sinusistis treatment
(severe pain + discolored discharge)
abx
75
patients at risk for posterior epistaxis (3)
1. elderly
1. HTN
1. anticoagulants
76
epistaxis tx (3)
1. afrin
1. compression
1. packing
(posterior bleeds = pack, then admit)
77
6 complications of posterior packing (epistaxis)
1. infection (toxic shock)
1. septal necrosis
1. cardiac ischemia, arrhythmia
1. syncope
1. sinusitis
1. otitis media
78
4 risk factors for severe hypoxia and CO2 retension after tx (epistaxis)
1. posterior packing
1. elderly patients
2. COPD
3. CHF
79
which complication of nasal fx can lead to deformity, abscess or septal perforation?
septal hematoma
80
septal hematoma can lead to what?
saddle nose deformity
81
What are the LeForte classifications?
type I: horizontal maxilla
type II: maxilla, nose cheeks
type III: craniofacial distraction
82
concerns for type I & II LeFort fx
1. CSF rhinorrhea
1. airway compromise
83
Le Fort fx tx
1. ENT consult
1. secure airway
1. analgesia
***(do NOT use nasotracheal intubation!!!)***
84
Sialoadentitis typically affects which population?
1. dehydration
1. chronic illness (DM)
85
How do you differentiate sialoadenitis from mumps?
mumps = bilateral
86
sx: sialoadenitis (3)
1. gland is firm
1. erythema/edema on skin over salivary gland
1. worse with eating
(can massage pus from duct)
87
Sialoadenitis is usually due to what?
1. obstructing stone
1. hyposecretion
(calcifications may be seen on xray)
88
Which gland is MC affected by sialoadenitis?
submandibular
89
sialoadenitis: tx (5)
1. abx (oral or IV)
1. hydration
1. warm compress
1. lemon drop
1. surgery
