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Emed > #1: ENT > Flashcards

#1: ENT Flashcards

1
Q

3 y/o pt presents w/ ear fever, irritability, leathagy, otorrhea, ear tugging, poor sleeping habits and feeding.

Dx?
1st line Tx?

A

AOM

1st line Tx = Amoxicillin

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2
Q

27 y/o pt presents w/ hearing loss, tinnitus and ear pain. On exam you not a bulging TM w/ decreased mobility, no light reflex and or light reflex seen.

Dx?

A

AOM

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3
Q

AOM

  1. What is AOM usu preceded by
  2. major 2nd line Tx
  3. what is Tx if PCN allergic (class)
A

AOM

  1. usu preceded by viral URI
  2. 2nd line = Augmentin
  3. Tx if PCN allergy –> Macrolide
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4
Q

Supportive Care of AOM (pain/fever)

  1. PO meds for pain (2)
  2. OTC cold meds given
A

Supportive Care of AOM

  1. PO pain meds –> acetaminophen, ibuprofen
  2. OTC cold meds –> decongestants, antihistamines
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5
Q

19 y/o Pt presents w/ fever, hearing changes, otorrhea, and feeling of fullness in their ear. On exam you note ttp of the tragus as well as erythema, edema and debris in ear canal, but the TM has normal mobility. Pt tells you he is a collegiate swimmer.

Dx?

A

dx = Otitis externa

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6
Q

Types of Otitis Externa

  1. Which is MC (2 names)
  2. which a/w derm conditions
  3. what is MC in diabetics
  4. what 2 types a/w pregrossion into deeper tissues and is a/w DM or immunocompromised pts
A

Types of Otitis Externa

  1. MC = Acute/Swimmers ear
  2. Ezcematous = a/w derm conditions
  3. Pseudomonas = MC cause in diabetics
  4. Necrotizing/Malignant = a/w pregrossion into deeper tissues and is a/w DM or immunocompromised pts
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7
Q

What test used to Dx malignant OE or mastoiditis (Otitis externa that has progressed)

A

Dx malignant OE or mastoiditis

- high resolution CT w/ thin temporal cuts

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8
Q

Tx of Otitis Externa

  1. two major ways to tx
  2. what is tx for psuedomonas
  3. what type should you admit pts
A

Tx of Otitis Externa

  1. two major ways to tx = topical (various things) or PO ABX
  2. psuedomonas –> topical ABX drops
  3. necrotizing –> admit
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9
Q

TM perforation causes/presentation

  1. what presentation should you suspect child abuse
  2. what common thing inserted into ears = cause
  3. Exs of middle ear barotruma (2)
  4. traumatic perfs often lack what
  5. Weber test results
A

TM perforation causes

  1. bilat TM perforation =child abuse
  2. Qtips = common cause
  3. Exs of middle ear barotruma
    - scuba
    - air travel
  4. traumatic = often lack d/c (otorrhea)
  5. Weber: lateralize to affected side
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10
Q

24 y/o pt presents w/ otorrhea, hearing changes, tinnitus, and R sided ear pain after long flight. On exam Weber lateralizes to R side

Dx?

A

Dx = TM perforation

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11
Q

Tx of TM perforation

  1. what is main thing pts must do
  2. infectious cause Tx (2 options)
  3. Traumatic cause –> refer if what 2 Sxs
A

Tx of TM perforation

  1. must keep ear dry
  2. infectious cause Tx
    - cortisporin (otic)
    - cipro (opthalmic)
  3. Traumatic cause –> refer if:
    - hearing loss
    - vertigo
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12
Q

MC cause of HL

A

MC cause of HL = Cerumen impaction

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13
Q

Pt presents w/ muffled and decr hearing, pain, pressure in ear and vertigo. On exam the TM is obstructed.

Dx?
Best practice for Tx? (spp)

A

Dx = Cerumen impaction

best practice = ear irrigation w/WARM H2O

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14
Q

Tx of cerumen impaction

- what should you use if cerumen is hard (ex?)

A

Tx of cerumen impaction

- hard cerumen –> ear wax softners (debrox)

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15
Q

Pt presents w/ dizziness, hearing loss, tinnitus, ear fullness and N/V. On exam you note nystamus w/ head movementYou perform a dix hallpike test, which is postive

Dx?

A

Dx = Vertigo

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16
Q

Tx of Vertigo

  1. What supportive measure should be done for peripheral vertigo
  2. what is the 1st line med for peripheral vertigo
    - med if cant tolerate liquids
  3. what is management for pt w/ central vertigo
    - what 2 tests used to Dx
A

Tx of Vertigo

  1. Supportive measure for peripheral vertigo = IVF
  2. 1st line med for peripheral vertigo = Meclizine
    (scopolamine if cant tolerate liquids)
  3. Central vertigo –> admit
    - Dx w/ CT or MRI
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17
Q

D/o that presents w/ vertigo, dizziness, flutuating hearing loss, N/V, tinnitus, malaise and nystagmus. Tx for underlying prob and is to lie in dark room for acute attack and meds include ABX and anti-virals

A

Dx = Labyrinthitis

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18
Q

Pt presents w/ unilateral hearing loss, tinnitus and vertig w/sudden onset. Pt says this has happened before and it usually stops w/in 24 hrs but it very intense.

Dx?
Tx
1. what type of diet
2. what type of meds

A

Dx = Meniere’s Dz

tx

  • low salt diet
  • vertigo meds
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19
Q

Pt presents w/ fevers, chills, pain and swelling of ear after having otitis externa a few days ago. On exam you notice erythema and swelling of the back of the ear

dx?

A

Dx = mastoiditis

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20
Q

Tx of mastoiditis

  1. need to admit?
  2. 2 ABX Tx options?
  3. 3 MC organisms
A

Tx of mastoiditis
1. admit

  1. 2 ABX options (IV)
    - Cefotaxime
    - Ceftriaxone
  2. causes
    - S. pneumo/pygoenes, S aureus
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21
Q

Pt presents w/ abrupt onset of fullness, CHL, dizziness, tinnitus, vertigo, N/V, transient facial paralysis. Pt noticed these Sxs while flying.

A

Dx = Barotruama

Other common causes = scuba, rapid pressure change

22
Q

Tx for Barotrauma

  1. what can be done to open the eustachian tube (3 things)
  2. 3 meds
A

Tx for Barotrauma

  1. open eustachian tube
    - chew gum
    - yawn
    - drink during takeoff/landing
  2. 3 meds
    - antihistamines
    - decongestants
    - ABXs
23
Q

Pt presents w/ purulent rhinorrhea, postnasal drip, HA, facial pain, anosmia, cough and fever for 3 weeks. On exam pt has sinus tenderness w/ swollen and inflammed nasal turbinates, and temp of 102. Pt states they had a cold one week before Sxs started

Dx?

A

Dx = acute sinusitis

24
Q

Tx of Sinusitis

  1. medication for viral
  2. ABXs for bacterial (2)
A

Tx of Sinusitis

  1. medication for viral = Topical CCS
  2. ABXs for bacterial = cephalosporin, macrolide
25
Q

Pt w/ h/o asthma presents w/ nasal congestion, clear rhinorrhea, runny nose, cough, ichy/red eyes, nasal crease. On exam you see dark eye circles and pale, boggy turbinates. Pt says these Sxs usu are present early each fall

Dx?

A

Dx = Allergic Rhinitis

26
Q

Tx of Allergic Rhinitis

  1. what meds used short term
  2. what meds good b/c lack systemic SE
A

Tx of Allergic Rhinitis

  1. antihistamines= used short term
  2. intransal steroids = lack systemic SE
27
Q

MC site for epistaxis (2 names)

A

anterior septum/Kesselbach’s plexus

28
Q

Tx for anterior Epistaxis

  1. pretx w/
  2. hold long to hold pressure
  3. how long to leave packing in for
A

Tx for anterior Epistaxis

  1. pretx w/ oxymetazoline
  2. hold pressure 20 min
  3. leave packing in for 24-48hrs
29
Q

Tx for epistaxis (general)

  1. 1st line method for stopping bleeding
  2. 2nd line
  3. which site more serious/admit
  4. when should you give anti-staph ABX as post care
A

Tx for epistaxis (general): stop bleeding

  1. 1st line = cauterize
  2. 2nd line = packing
  3. posterior = more serious, admit
  4. anti-staph ABX if pt has comorbities
30
Q

Tooth Fracture: Ellis Classification System

what stage involves pulp
what stage involves enamel
what stage involves dentin

A

Tooth Fracture: Ellis Classification System

pulp = III
enamel = I
dentin = II
31
Q

Tooth Fracture Tx

  1. for I
  2. for II
  3. for III (how does it differ from II)
A

Tooth Fracture Tx

  1. for I –> no urgent tx
  2. for II –> cover w/ Ca hydroxide paste or foil
  3. for III –> II + dental consult w/in 24 hrs
32
Q

Tooth Subluxation Tx

  1. tx if < 2mm
  2. Tx if > 2mm
A

Tooth Subluxation

  1. tx if < 2mm –> soft food diet til dentist
  2. Tx if > 2mm –> reseating + splinting
33
Q

Tooth Avulsion Tx

  1. what to put tooth in at home
  2. what to put tooth in at dentist/ER
  3. what is the tx, urgent?
  4. what given as ppx
A

Tooth Avulsion Tx

  1. put tooth in milk at home
  2. put tooth in Hank’s solution at dentist/ER
  3. replant immed!!
  4. ABX ppx
34
Q

Acute Pharyngitis/Tonsillitis Types

  1. cough/rhinorrhea
  2. scarlatiniform rash
  3. gray pharyngeal membrane, myocarditis, neuritis
  4. HSM, jaundice, rash
  5. sexual abuse in kids, recurrent
A

Acute Pharyngitis/Tonsillitis Types

  1. cough/rhinorrhea = Viral
  2. scarlatiniform rash = GABHS
  3. gray pharyngeal membrane, myocarditis, neuritis = Diptheria
  4. HSM, jaundice, rash = Mono
  5. sexual abuse in kids, recurrent = Gonococcal
35
Q

Pt presents w/ sore throat, pharyngeal exudates, fever, odynophagia, cervical LAd, petechiae and decr oral intake. On exam you see a scarlatiniform rash in the throat. Pt meets Centor criteria

dx?
cause?

A

Dx = acute pharyngitis/tonsillitis

Cause = GABHS

36
Q

When to Tx acute pharyngitis/tonsillitis based on 2 diagnostics

  1. Main ABX Tx
  2. Tx for Sxs
A

Tx acute pharyngitis/tonsillitis

    • rapid strep test
  2. 3+ Centor score
  3. Tx = PCN VK (or other PCNS, macrolides)
  4. Tx for sxs = Steroids (dexamethasone)
37
Q

Pt presents w/ lateral progressive worsening sore throat, fever, dysphagia, otalgia, odynophagia. On exam you see swollen tonsil w/ contralateral uvula deviation, trismus, purulent exudate and drooling. When pt speaks sound likes a hot potato voice

dx?

A

Dx = Peritonsillar abscess

38
Q

Dx Pertonsillar Abscess

  1. main test to Dx
  2. Gold Std test
A

Dx Pertonsillar Abscess

  1. main test to Dx = Neck Ct w/ IV contrast
  2. Gold Std test = needle aspiration of pus
39
Q

Tx of Peritonsillar Abscess

  1. 2 methods of Tx
  2. 2 types of ABXs given
  3. class of med given
A

Tx of Peritonsillar Abscess

  1. 2 methods of Tx = I+D or needle aspiration
  2. ABXs = clinda or augmentin
  3. steroids
40
Q

Pt presents w/ painful unilateral facial swelling w/ purulent drainage from mouth and decr salivary secretion.

Dx?
most likely cause?

A

Dx = Sialoadenitis

Most likely cause = S. aureus

41
Q

Common Sx a/w Sialolithasis

A

Sialolithasis –> colicky abd pain

42
Q
  1. heat/cold compress w/ massage
  2. hydration
  3. lemon drops
  4. ABX = pen VK, erythromycin, augmentin, ceftin

tx for

A

Tx for Sialoadenitis/Sialolithasis

  1. heat/cold compress w/ massage
  2. hydration
  3. lemon drops
  4. ABX = pen VK, erythromycin, augmentin, ceftin
43
Q

3 y/o Pt presents w/ unilateral nasal d/c that is malodorous and pt has halitosis and epistaxis.

Dx?

A

Dx = nasal FB

44
Q

3 ways to Dx nasal FB

rare = CT

A

Dx Nasal FB

  1. visual it
  2. fiberoptic exam
  3. sinus XRs
45
Q
  1. Topical vasoconstrictors
  2. Positive pressure
  3. alligator forceps, balloon cath
  4. suction
  5. dermabond

tx for _____

A

Tx for Nasal FB

46
Q

5 y/o pt presents w/ otalgia, bloody/foul smelling otorrhea, hearing loss and N/V.

Dx?

A

Dx = FB in ear

47
Q
  1. irrigation (dont do if perf)
  2. Acetone (dissolves styrofoam or superglue)
  3. suction, forceps, cerumen loop
  4. lidocaine (kills insects)
  5. ABX drops (as needed)

tx for _____

A

tx for FB in ear

  1. irrigation (dont do if perf)
  2. Acetone (dissolves styrofoam or superglue)
  3. suction, forceps, cerumen loop
  4. lidocaine (kills insects)
  5. ABX drops (as needed)
48
Q

2 y/o pt presents w/ dysphagia, odynophaiga, aphagia, droooling, halitosis, dyspnea, wheezing and persistent cough. Object seen w/fiberoptic laryngoscopy

dx?

A

Dx = pharyngeal FB

49
Q

Dx of pharyngeal FB

  1. main method of removal
  2. types of XRs (2)
  3. Tx if esophageal perforation
A

Dx of pharyngeal FB

  1. main method of removal = fiberoptic laryngoscopy
  2. XRs = soft tissue neck, CXR
  3. Tx if esophageal perforation = barium swallow
50
Q

Tx of pharyngeal FB

  1. 2 ways to Tx if compromised airway
  2. Tx in OR
A

Tx of pharyngeal FB

  1. 2 ways to Tx if compromised airway
    - hemlich
    - cricothyrotomy
  2. Tx in OR = endoscopy

Emed (10 decks)

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