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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
Q

Otoscopic Examination of CSOM

A

TM perforation
Normal EAC with purulent otorrhea

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26
Q

Ttt of CSOM

A

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.

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27
Q

Complications of CSOM

A

Infection spread
Mastoidoitis.
Meningitis
Intracranial abscess
Permanent hearing loss

28
Q

Choanal atresia CF

A

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
Q

Choanal atresia Dx

A

Inability to pass catheter past nasopharynx

Confirmation with CT or nasal endoscopy

30
Q

Ttt

A

Oral airway

Surgery

31
Q

Why do choanal atresia babies cyanose on feeding and normalize with crying

A

Babies are obligate nasal breathrs.
Hence cyanosis on feeding.
BL atresia causes hypoxia and cyanosis. Hypercapnia makes babies cry temporarily relieving the obstruction

32
Q

Acute bacterial rhinusinusitis Criteria

A

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
Q

Acute bact rhinosinusitis CF

A

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
Q

ABRS organism

A

HIB . Strep pneumo

35
Q

ABRS ttt

A

Oral AB
Amoxicillin
Clavulanic acid

36
Q

Subglottic stenosis Mech

A

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
Q

Tracheomalacia mech

A

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
Q

Cholesteatoma CF

A

Continued ear drainage for several weeks despite AB ttt.

HO reccurent middle ear infections in past.

New onset hearing loss.

39
Q

Complication of multiple ear infections in childhood

A

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
Q

Ttt of thyroglossal duct cyst

A

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
Q

AB for epiglottitis in kids

A

Strept and h.influenzae. Ceftriaxone
Staph aureus. Vancomycin

42
Q

Acute Otitis media microbiology

A

Strept pneum
Non typeable H influenzae
Moraxella catarrhalis

43
Q

CF of Acute otitis media

A

⚽️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
Q

RF for AOM

A

🏀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
Q

DX of AOM

A

Otoscopy :

     Bulging TM
     Presence of middle ear effusion with erythematous TM 
     Poor TM mobility on pneumatic insufflation
46
Q

Ttt of AOM

A

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
Q

Complication if AOM

A

TM perforation
Conductive hearing loss
Mastoiditis
Meningitis

48
Q

Tympanocentesis and culture in AOM

A

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
Q

Otitis media with Effusion CF

A

🍦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
Q

OME examination

A

🍚 air fluid levels posterior to TM
🍚 poor mobility on pneumatic insufflation
🍚 effusion is non purulent (purulent in AOM)
🍚 no TM erythema or bulging

51
Q

OME patho

A

🍏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
Q

Management of OME

A

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
Q

Pt with tinnitus popping sensation in ear with retracted TM

A

Eustachian tube dysfunction

54
Q

Physiology of Eystachian tube

A

Eustachian tube normally open and close to:

Equalize middle ear pressure 
Drain middle ear
Prevent reflux of nasopharyngeal secretions in middle ear
55
Q

Eustachian tube dysfunction pathophys

A

Inflammation (infection , allergies , env irritation ) ➡️ tube obstruction
Causing pressure dysregulation and lack of middle ear ventilation

56
Q

Ttt: of Eustachian tube dysfunction

A

Treat underlying cause
E.g AB for acute bacterial rhinosinusitis
Antihistamines for allergic rhinitis

57
Q

CF of eustachian tube dysfunction

A

🧠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
Q

Eustachian tube dusfunction complications

A

Predisposing factor for AOM
As children have short narrow floppy tubes

Permanent hearing loss

TM rupture

Cholesteatoma

59
Q

Acute rhinosinusitis etiology

A

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
Q

Ttt of viral rhinosinusistus

A

Supportive care
IN saline saline irrigation
NSAIDs

61
Q

Pathophy of otitis externa

A

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
Q

Acute otitis media vs OME

A

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
Q

Fever bulging TM mastoid tenderness displaced EAC

A

Acute mastoiditis due to AOM

64
Q

Etiology of acute mastoiditis due to AOM

A

Mastoid air cells are close to middle ear allowing spread of infection

65
Q

Acute mastoiditis Due to AOM CF

A

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
Q

TTT of acute mastoiditis

A

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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