ENT - SD

Question 1

Acute onset of ear pain – red, bulging TM

Answer 1

Otitis media

Question 2

Do we use ototoxic drops in ears? why or why not?

Answer 2

No – in case there is a rupture/perf

Question 3

Is otitis externa typically caused by one or multiple bacteria?

Answer 3

Multiple

Question 4

What is a known complication of otitis media?

Answer 4

Mastoiditis

Question 5

What are some findings on PE that indicate mastoiditis?

Answer 5

Tender over mastoid

Can see pinna displaced outwards and down

Obliteration of postauricular crease

Question 6

If untreated, what can mastoiditis lead to?

Answer 6

Meningitis, brain abscess, epidural hematoma

Question 7

Blood between mucoperichondrium and cartilage of septum

Answer 7

Septal hematoma

Question 8

grape-like swelling to nasal septum, boggy to palpation

Answer 8

Septal hematoma

Question 9

When someone has a nasal foreign body, what else must you assess for?

Answer 9

Possibility of aspiration of another FB

Question 10

Are posterior or anterior nose bleeds more common?

Answer 10

Anterior (kiesselbach plexus)

Question 11

When someone comes in with a bloody nose where else do you need to look besides their nose?

Answer 11

Always look in back of throat

Question 12

What are out treatment options for epistaxis?

Answer 12

1. Mechanical
2. Vasoconstriction spray
3. Cautery (but only if you can see the bleed)
4. Inserted devices/techniques if nothing else works

Question 13

If we pack someone’s nose because it won’t stop bleeding, what other actions do we have to take?

Answer 13

Start abx therapy – they can go into toxic shock

Question 14

How long do we leave a nose packed?

Answer 14

2-3 days

Question 15

Cellulitis/abscess to bilateral sublingual and submandible spaces

Answer 15

Ludwig’s angina

Question 16

What is the cause of Ludwig’s angina?

Answer 16

Immunosuppressed state + bad teeth (dental infection dives in submandibular space)

Question 17

Is Ludwig’s angina an emergency?

Answer 17

Yes! 50% intubation failure – people will die if not diagnosed early

Question 18

how do we treat Ludwig’s angina?

Answer 18

Crash tracheotomy, penicillin and flagyl

Clinda if PCN allergy

Question 19

Patient will appear toxic, will be in a tripod position, drooling, and muffled voice. On exam you look inside their mouth and it looks perfectly normal, but you can’t see posterior pharynx. Dx?

Answer 19

Retropharyngeal abscess

Question 20

How do we treat retropharyngeal abscess?

Answer 20

Oxacillin or cephalosporins

Also Hib vaccine can help prevent

Question 21

Localized cellulitis of the supraglottic area with potential for abscess formation

Answer 21

Epiglottitis

Question 22

thumb sign on x-ray

Answer 22

Epliglottitis

Question 23

What causes epiglottitis?

Answer 23

Haemophilus influenzae

Question 24

How do we treat epiglottitis?

Answer 24

Penicillin based or cefuroxime, ceftriaxone, bactrim

Steroids to get swelling down

Question 25

These patients will present with mild pain to desperately short of breath. On PE you see uvula deviation, stridor, and drooling

Answer 25

Peritonsillar abscess

Question 26

How do we treat a peritonsillar abscess?

Answer 26

I&D, IM Pen VK

Question 27

What is a great way to treat pain for a dental abscess?

Answer 27

Dental block (periapical, infraorbital, inferior alvelolar)

Question 28

Will anterior or posterior lymph nodes be enlarged with strep? what about mono?

Answer 28

Strep -- anterior Mono -- posterior

Question 29

how do we treat streptococcal pharyngitis?

Answer 29

amoxicillin

Question 30

Besides cervical lymphadenopathy, what other signs will a patient with mono have?

Answer 30

tender spleen, grey exudate

Question 31

what is the most common cause of stridor in kids?

Answer 31

Croup

Question 32

What causes croup?

Answer 32

Parainfluenza virus

Question 33

Steeple sign on x-ray -- think of?

Answer 33

croup

Question 34

Pain and swelling of parotid gland?

Answer 34

Parotiditis