6. ENT Flashcards
Acute otitis media in infants/kids:
- common causes
- Organisms
- Tx
- URI, daycare, formula, cig smoke exposure
- S pneumo, non-typeable H influenzae, M catarrhalis
- Oral amoxicillin prevents mastoiditis
Otitis externa
- common causes
- organisms
- swimming outdoors, excess ear cleaning
2. pseudomonas
What causes tinnitus, episodic vertigo and sensorineural hearing loss?
Meniere disease - inc vol and pressure of endolymph
Brief episodes of vertigo triggered by head movement
BPPV - dix-Hallpike maneuver causes nystagmus
Acute, single episode of vertigo that can last days, often following viral syndrome
Vestibular neuritis
Note: presents similar to Meniere disease, but lasts shorter time (weeks vs years)
Rapidly progressive cellulitis of the submandibular space. Sx include fever, chills, drooling, dysphagia, airway compromise. Dx? Where does it most commonly arise from?
Ludwig angina
Most arise from dental infections in the mandibular molars –> submaxillary space.
Polymicrobial. Anaerobic bacteria may cause crepitus
Firm, non-tender, solitary neck lymph node in an older patient with a significant smoking history is suspicious of what?
Squamous cell carcinoma
Firm, solitary LN are highly suspicious for LN mets.
Wheezing after ingestion of naproxen + rhinitis, post-nasal drip suggests what?
Aspirin-exacerbated respiratory disease. Assoc with development of NASAL POLYPS
Patient with fever, chills, sore throat, difficulty swallowing, muffled voice, uvula deviation, and enlarged cervical lymph nodes is suspicious for what? Tx?
peritonsillar abscess - ca be caused by worsening of tonsillitis.
Tx - needle peritonsillar aspiration. IV abx
Note: deviation of uvula distinguishes peritonsillar abscess from epiglottitis
Young pt with fleshy immobile mass on midline hard palate is what?
Torus palatinus: congenital, benign bony growth. Environ factors may also be related.
Surgery if mass is symptomatic or interferes with speech or eating.
White patches or plaques over oral mucoas that cannot be scrapped off is what? RF are similar to those for SCC (tobacco and ETOH). If there is area of induration or ulceration what is the next step?
Leukoplakia
Bx to rule out malignant transformation of the lesion (SCC)
an infant with inspiratory stridor that worsens in the supine position and improves in prone is a sign of what? Next step to diagnose?
Laryngomalacia
Direct laryngoscopy
Resolves spontaneously by 18mo
What should be suspected in kids who present with fever, dysphagia, inability to extend the neck, muffled voice, and lateral x-ray showing a widened prevertebral space? Dangerous complication?
Retropharyngeal abscess.
Note: epiglottitis would have drooling, and thumb sign seen on lateral xray
Spread to carotid sheath –> CN IX ,X, XI, anad XII deficits. Extension into the danger space
Acute necrotizing mediastinitis - requires urgent surgical intervention.
