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Neurology > 24 Jan 24 > Flashcards

24 Jan 24 Flashcards

1
Q

Cholesteatoma RF

A

H/ORecurrent acute otitis media AOM
Chronic middle ear effusion
Tympanostomy tube placement
Cleft palate

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2
Q

Cholesteatoma pathogenesis

A

U/L and acquired
Due to chronic middle ear Dx there are retraction pocket (invaginations) of TM which trap epithellium and debris.

Clinical exam : pearly white mass in the Anterosuperior quadrant of TM or visible retraction pocket with draining debris

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3
Q

Complications of cholesteatoma

A

Chronic otorrhea (if infected)
Conductive hearing loss
Vertigo
Life threatening infections
Brain abscesses
Meningitibs

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4
Q

Ttt of cholesteatoma

A

Surgery

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5
Q

Nasal foreign body signs

A

Inorganic substance (toy) :

 Mild pain / discomfort

Organic substance(food) :

    U/L foul 
    smelling 
    purulent bloody 
    discharge

Button battery :

    Epistaxis 
    Purulent discharge 
    Black discharge
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6
Q

Ttt of foreign body

A

Positive pressure expulsion (forceful exhalation with unaffected naris occluded)

Mechanical extraction

If unable to see or remove object refer for endoscopic removal

🚑Do not manage expectantly bcz inflammation leads to obstruction of sinus outflow tract and cause sinusitis or periorbital cellulitis.

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7
Q

Complication of nasal foreign body

A

👃🏽Local irritation
👃🏽Infection (sinusitis)
👃🏽Aspiration
👃🏽Nasal septal perforation (button battery , multiple magnets)

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8
Q

Epiglottitis CF

A

H influenzae type B hib
Triad of : 3Ds

   Acute onset of S/S
   Distress (tripod positioning, sniffing    position , stridor )
   Dysphagia 
   Drooling 
   High fever

Tripod positioning(hyperextension if neck ) is to maximize airway diameter

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9
Q

Workup for epiglottitis

A

Xray ( thumb sign )

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10
Q

Management of epiglottitis

A

ETT
Antibiotics

Prevention: hib vaccine

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11
Q

Peritonsillar abscess management

A

Dx is mostly clinical
No additional testing if no signs of airway obstruction (tripod positioning , stridor) or deep neck space infection (chest pain , neck stiffness)

Ttt: Incision and drainage plus Antibiotics

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12
Q

Dx with VACTERL association

A

Vertebral
Anal
Cardiac
Tracheo-Esophageal
Renal
Limb anomalies

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13
Q

TEF with esophageal atresia patho

A

Defective division of foregut into esophagus and trachea

Most commonly results in prox esophageal pouch and fistula between distal trachea and esophagus

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14
Q

TEF CF and dx

A

🎗Coughing , choking , vomit with feeding
🎗Excessive oral secretions
Resp distress and coarse breath sounds (on Rt side) due to aspiration of regurgitated feeds from atretic pouch

Commonly part of VACTERL ass

Dx

   Inability to pass enteric tube into stomach 
   Xray : enteric tube coiled in proximal esophagus
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15
Q

Ttt of TEF

A

Surgical correction
VACTERL secreening : echo and renal USG

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16
Q

CHARGE syndrome

A

Coloboma
Heart defects
Atresia choanae
Retardation of growth
Genitourinary anomalies
Ear abnormalities

Charge syndrome is less commonly ass with TEF with esoohageal atresia

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17
Q

Laryngomalacia CF

A

Inspiratory stridor that worsens on supine position
Well appearing child
Crying and feeding worsen stridor
Loudest at 4-8Mo
Resolves by age 18months

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18
Q

Mech of laryngomalacia

A

Floppy supraglottic structures that collapse intermittently on mid-inspiration partially blocking airway.
Patients typically have omega shaped epiglottis , short aryepiglottic folds.

Prone positioning improves stridor as tongue moves anteriorly partially relieving the obstruction.

Any increase in breathing effort (feeding , crying) increases airflow and worsens supraglottic collapse , increasing stridor.

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19
Q

How to dx inspiratory stridor in an otherwise well child ?

A

Flexible laryngoscopy

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20
Q

Management of laryngomalacia

A

Resolves spontaneously
Antireflux ttt for those with concurrent GERD (also resolves some breathing issues )

Surgery for pts with feeding difficulties cyanosis failure to thrive

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21
Q

BL choanal atresia vs UL choanal atresia

A

BL choanal atresia presents shortly after birth with cyanosis worse when newborns cant breath thru mouth(feeding) and improve when they do (while crying).

UL choanal atresia presents as persistent UL nasal obstruction and diacharge.

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22
Q

Chronic suppurative otitis media Organism

A

Polymicrobial
Staph aureus , psudomonas
Fungi (aspergillus)

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23
Q

CSOM presentation

A

Chronic >6wk , purulent otorrhea with TM perforration
External canal is normal
Hearing loss
Absence of ear pain

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24
Q

CSOM RF

A

🥇Multiple episodes of AOM
🥇Conditions thatcause negative middle ear pressure , as TM weakens over time with pressure and perforates.
Eustachian tube dysfunction
Cholesteatoma
Bacteria from external auditory canal
Enter the middle ear and cause chronic inflammation and infection

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25
Otoscopic Examination of CSOM
TM perforation Normal EAC with purulent otorrhea
26
Ttt of CSOM
Topical FQ (ofloxacin) No response to oral AB as middle ear is poorly vascularized due to chronic inf and scarring Think about cholesteatoma (which also causes chronic ear drainage ) if pt doesnt respond to topical AB.
27
Complications of CSOM
Infection spread Mastoidoitis. Meningitis Intracranial abscess Permanent hearing loss
28
Choanal atresia CF
UL (common) : Chronic nasal discharge Symptomatic during childhood BL : Cyanosis that worsens with feeding and improves with crying in othwise well appearing chold Noisy breathing (stertor) Symptomatic shortly after birth Mayb associated with CHARGE syndrome
29
Choanal atresia Dx
Inability to pass catheter past nasopharynx Confirmation with CT or nasal endoscopy
30
Ttt
Oral airway Surgery
31
Why do choanal atresia babies cyanose on feeding and normalize with crying
Babies are obligate nasal breathrs. Hence cyanosis on feeding. BL atresia causes hypoxia and cyanosis. Hypercapnia makes babies cry temporarily relieving the obstruction
32
Acute bacterial rhinusinusitis Criteria
Any 1 of the following: 1. Severe onset Fever > 102.2 plus drainage for > 3 days 2. Persistent symptoms for >10 days without improvement 3. Worsening symptoms after initial improvement (biphasic illness). Fever mayb absent
33
Acute bact rhinosinusitis CF
Fever cough congestion Nasal discharge Facial pain aggravated by leaning forward. headache Pain with percussion of sinuses. ABRS is a complication of viral URTI Generally viral infection resolves in 7-10 days.
34
ABRS organism
HIB . Strep pneumo
35
ABRS ttt
Oral AB Amoxicillin Clavulanic acid
36
Subglottic stenosis Mech
Subglottic airway is less flexible and supported by ring of cartilage (cricoid). No change in calibre on insp or exp. Hence in subglottic stenosis there is biophasic stridor.
37
Tracheomalacia mech
During insp intrathoracic pressure is negative which allows air draw in. In pts with more collapsable intrathoracic airway , this negative pressure widens the intrathoracic tracheal airway. Exp increases intrathoracic pressure. This pressure narrows the tracheal airway leading to exp stridor.
38
Cholesteatoma CF
Continued ear drainage for several weeks despite AB ttt. HO reccurent middle ear infections in past. New onset hearing loss.
39
Complication of multiple ear infections in childhood
Conductive hearing loss Can be confused with behavioral/ developmental disorders Hearing tests should be done routinely in all children presenting with social and language deficits.
40
Ttt of thyroglossal duct cyst
Surgery due to risk of recurrent infection (do thyroid imaging before as it mayb ectopic thyroid issue and only source of thyroid function) Remove cyst, associated tract , cental portion of hyoid bone.
41
AB for epiglottitis in kids
Strept and h.influenzae. Ceftriaxone Staph aureus. Vancomycin
42
Acute Otitis media microbiology
Strept pneum Non typeable H influenzae Moraxella catarrhalis
43
CF of Acute otitis media
⚽️common in age 6-18m As eutachian tubes are straight and drain poorly ⚽️Bulging tympanic membrane ⚽️Middle ear effusion plus TM inflammation (fever otalgia erythema)
44
RF for AOM
🏀Day care attendance 🏀Cigarette smoking 🏀Recent URTI 🏀Non breast fed babies (BF babies have low incidence due to relative decrease in bacterial colonization of nasopharynx
45
DX of AOM
Otoscopy : Bulging TM Presence of middle ear effusion with erythematous TM Poor TM mobility on pneumatic insufflation
46
Ttt of AOM
First line: Amoxicillin 🎱For children <6m 🎱Children > 6m with high fever >102.2, severe pain , BL disease Second line : amoxicillin-clavulanic acid 🎱Refractory SS after 2-3 days of AB ttt 🎱Recurrent AOM (in 30days) after Antibiotic therapy Penicillin allergy: Clindamycin , azithromycin Children age >6mo with mild SS and low grade fever are treated supportively
47
Complication if AOM
TM perforation Conductive hearing loss Mastoiditis Meningitis
48
Tympanocentesis and culture in AOM
Patients with >3 episodes in 6months Or persistent middle ear effusion with hearing loss have to have (invasive intervention) tympanocentesis and culture during tympanostomy tube placement
49
Otitis media with Effusion CF
🍦Mayb A/S 🍦May cause mild discomfort (ear tugging and pulling) due to pressure on TM. 🍦The effusion limits TM vibration … leading to conductive hearing loss 🍦No fever or severe ear pain
50
OME examination
🍚 air fluid levels posterior to TM 🍚 poor mobility on pneumatic insufflation 🍚 effusion is non purulent (purulent in AOM) 🍚 no TM erythema or bulging
51
OME patho
🍏Young children age 6-24mo 🍏Fluid accumulation in Narrow straight eustachian tubes that drain poorly 🍏Effusions develop in setting of viral infection or after episode of AOM
52
Management of OME
Self resolving in a few weeks Observe after resolutiin as chronic OME > 3mo causes speech delay and long term hearing loss Tympanostomy tube is warranted for chronic OME with ass hearing loss
53
Pt with tinnitus popping sensation in ear with retracted TM
Eustachian tube dysfunction
54
Physiology of Eystachian tube
Eustachian tube normally open and close to: Equalize middle ear pressure Drain middle ear Prevent reflux of nasopharyngeal secretions in middle ear
55
Eustachian tube dysfunction pathophys
Inflammation (infection , allergies , env irritation ) ➡️ tube obstruction Causing pressure dysregulation and lack of middle ear ventilation
56
Ttt: of Eustachian tube dysfunction
Treat underlying cause E.g AB for acute bacterial rhinosinusitis Antihistamines for allergic rhinitis
57
CF of eustachian tube dysfunction
🧠Ear discomfort: fullness 🧠Tinnitus 🧠Hearing loss (muffled hearing) 🧠Intermittent popping sensation during changes in pressure (yawning, swallowing) as eustachian tube temporarily opens. Examination: retracted TM due to negative pressure in middle ear. Dilated blood vessels surrounding TM reflect inflammation
58
Eustachian tube dusfunction complications
Predisposing factor for AOM As children have short narrow floppy tubes Permanent hearing loss TM rupture Cholesteatoma
59
Acute rhinosinusitis etiology
Viral : No fever or early resolution of fever Mild symptoms (well appearing, mild facial pain ) Improvement and resolution by day 5-10 Bacterial : Fever >3days or New /recurrent fever after initial improvement or Persistent SS >10days.
60
Ttt of viral rhinosinusistus
Supportive care IN saline saline irrigation NSAIDs
61
Pathophy of otitis externa
Cerumen which coats EAC is displaced when exposed to flowing water Cerumen has antibacterial properties its loss causes inc bact growth Ear canal has acidic pH (which inhibits bacteria) water increases its pH . Excessive water exp causes maceration of skin of canal which disrupts skins protective barrier. Water also exposes pathogenic bacteria in EAC.
62
Acute otitis media vs OME
AOM: Bulging TM with middle ear inf Dec TM mobility or visible air fluid levels (middle ear effusion) Pale yellow opaque TM with bulge (purulent effusion) TM erythema OME : Poor TM mobiltity Air fluid levels LACK OF ACUTE INFLAMMATION (fever, TM bulge)
63
Fever bulging TM mastoid tenderness displaced EAC
Acute mastoiditis due to AOM
64
Etiology of acute mastoiditis due to AOM
Mastoid air cells are close to middle ear allowing spread of infection
65
Acute mastoiditis Due to AOM CF
Mastoid tenderness Inflammation causes outward and vertical displacement of auricle TM shows signs of AOM (TM may not be visible due to swelling of EAC)
66
TTT of acute mastoiditis
IV antibiotics (psudomonas is most common infection in recurrent cases or recent antibiotic use) Drainage if purulent material Via tympanostomy tube or mastoidectomy

Neurology (19 decks)

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