ENT problems

Question 1

tonsils

Answer 1

lymph tissue that filter pathogens

Question 2

adenoids

Answer 2

nasopharynx

Question 3

palatine tonsils

Answer 3

both sides of the oropharynx

Question 4

tubal tonsils

Answer 4

entrance to the eustachian tubes

Question 5

lingual tonsils

Answer 5

base of the tongue

Question 6

tonsillitis

Answer 6

infection/inflammation of the palatine tonsils

Question 7

adenitis

Answer 7

infection/inflammation of the adenoids

Question 8

etiology of tonsillitis

Answer 8

-can be either viral or bacterial -viral: most common in children <3 yrs -bacterial: GABHS in school age children -incidence peaks from 4-7 years old

Question 9

s/s of bacterial tonsillitis

Answer 9

-swollen uvula -whitish spots -red swollen tonsils -throat redness -gray furry tongue **come to the health center

Question 10

s/s of viral tonsillitis

Answer 10

-red swollen tonsils -throat redness **monitor at home, gargle with salt water

Question 11

general s/s of tonsillitis

Answer 11

-painful or difficulty swallowing -drooling -high fever -pus

Question 12

s/s of adenoiditis

Answer 12

-nasal speech -mouth breathing -difficulty hearing -halitosis (bad breath) -sleep apnea GABA -HA -abd pain -N/V

Question 13

tx of viral tonsillitis

Answer 13

-analgesic/antipyretic -fluids -rest -saline gargles -throat sprays

Question 14

tx of bacterial tonsillitis

Answer 14

antibiotics

Question 15

tonsillectomy

Answer 15

removes palatine tonsils

Question 16

adenoidectomy

Answer 16

removes pharyngeal tonsil

Question 17

reasons for surgery for tonsillitis

Answer 17

-recurrent throat infections (>3yo, x3) -tonsils interfere with eating, sleeping & breathing

Question 18

frequent swallowing and throat clearing in tosillitis

Answer 18

sign of swallowing blood

Question 19

foods to avoid with tonsillectomy

Answer 19

-dairy will increase mucus -popsicle & jello okay -avoid red jello (d/t bleeding)

Question 20

otitis media

Answer 20

middle ear infection or effusion

• viral or bacterial
• presence of uninfected fluid

Question 21

if otitis media is left untreated…

Answer 21

• permanent hearing loss
• mastoiditis
• meningitis

Question 22

increased incidence of otitis media

Answer 22

• 6-36 mo
• 4-6 yrs
• males
• Alaskan and Native American
• home w/ smoker
• cleft palate
• formula fed infants (bottle propping)
• winter/spring
• pacifier use

Question 23

infant s/s of otitis media

Answer 23

• rub and pulling affected ear
• rolls head from side to side
• crying, fussy, restless, irritable
• difficulty comforting child
• loss of appetite

Question 24

older child s/s of otitis media

Answer 24

• verbalizes pain
• irritability
• lethargy
• loss of appetie

Question 25

objective s/s of acute otitis media

Answer 25

- reddened membrane, inflamed - malleus - no cone of light - fluid present

Question 26

s/s of acute otitis media

Answer 26

rapid onset of - sharp pain - rhinitis, URI - sudden fever

Question 27

causative organisms of acute otitis media

Answer 27

- strep pneumoniae - HIB - moraxella catarrhalis - staph

Question 28

if tx of acute otitis media is unsuccessful

Answer 28

tympanocentesis is done to obtain culture

Question 29

tx of acute otitis media

Answer 29

- watchful waiting - antibiotics - analgesics/antipyretics - nasal decongestants

Question 30

parent teaching for acute otitis media

Answer 30

- complete antibiotics - conductive hearing loss up to 6mo - do not clean ears with q-tips - dont use nasal decongestants for 3+ days - offer liquids and soft foods (hurts to chew) - return to clinic if no improvement in 24-48 hrs

Question 31

otitis media with effusion

Answer 31

- result of chronic OM - children 3-10yrs

Question 32

assessment of otitis media with effusion with otoscope

Answer 32

- retracted tympanic membrane - malleus prominent - absent cone of light - no movement with puff of air

Question 33

s/s of otitis media with effusion

Answer 33

- c/o fullness, ringing or popping - hearing loss (temporary)

Question 34

management of otitis media with effusion

Answer 34

- goal: to supply air - control the cuase of allergies, enlarge adenoids - meds: antihistamines, decongestants - surgeries (for hearing loss \>20dB): tympanocenesis; tubal myringotomy with pressure equalizing tube insertion; tympanostomy tubes (PE tube)

Question 35

PE tube

Answer 35

tympanostomy tube - depending on tube size, lasts 6 mo to 2-3 yrs - as ears grow, tubes will fall out - place in 5-10 minutes under brief general anesthesia

Question 36

parent teaching for myringotomy

Answer 36

- no water in ears - bathe rather than shower - shower/swimming w/ ear plugs - possible temp hearing problem (notify teacher, PE tube falls out)

Question 37

croup

Answer 37

narrow, swollen airway - acute laryngotracheobritis (viral) - acute spasmodic laryngitis (viral) - acute (bacterial) tracheitis - acute (bacterial-Hib) epiglottis (life threatening)

Question 38

assessment of croup

Answer 38

- respiratory assessment: croupy/barking cough; inspiratory stridor, resp distress - history of recent ear infections - xrays, labs, cultures

Question 39

common s/s of respiratory distress

Answer 39

- contractions - nasal flaring

Question 40

treatment of croup

Answer 40

- airway mgmt: corticosteroids, racemic epinephrine(vasoconstricts) - fluids - rest - humidification - humidified O2 - antibiotics

Question 41

acute laryngotracheobronchitis vs acute spasmodic laryngitis

Answer 41

- viral - LTB gradual onset : spasmodic rapid onset - LTB more severe - can be managed with O2, hospitalization, IV fluids, racemic epi, rest

Question 42

s/s of acute tracheitis

Answer 42

- purulent secretions - high fever - tripod position (helps with breathing)

Question 43

tx of acute tracheitis

Answer 43

- humidified O2 - possible intubation - antipyretics - IV antibiotics - fluids

Question 44

s/s of acute epiglottis

Answer 44

- drooling - dysphagia - dysphonia - distress - fever

Question 45

tx of acute epiglottis

Answer 45

- do not inspect throat - humidified O2 - emergency intubation - antipyretics - IV antibiotics - fluids - racemic epi