EENT Flashcards
Hordeolum (Stye) (-1-)
Def: a -2- abscess on the upper or lower eyelid, which is -3-
Causes/Incidence
> -2- -4-
- HOT (red, abrupt)
- staphylococcal/-us
- extremely common
- aureus
Hordeolum (Stye) - DDx > -1- > -2- > -3- > -4-
- conjunctivitis
- chalazion
- blepharitis
- dacryocystitis
Hordeolum (Stye) - S/S
> -1-
> -2- (acutely -3-) and edema
> -4- to the -5-
- Abrupt onset
- localized pain
- tender
- pain proportionate
- degree of edema
Hordeolum (Stye) - Mgmt
-1- several times a day
Often -2-
Topical bacitracin or -3- may be considered
Refer to -4- if there is -5- w/in approximately 48 hours
- warm compresses
- bursts/resolves spontaneously
- erythromycin ophthalmic ointment
- ophthalmologist for I&D
- no resolution
Chalazion (-1-)
Def: a granulomatous (beady nodule) on the eyelid; infection or -2- of the meibomian gland
Note: a chalazion is a hard, -3- cyst; it differs from styes in that chalazia are usually -4-
- Cold (not painful)
- retention cyst
- non-tender
- painless
Chalazion - S/S
> -1-
> -2-
> -3- if the cyst is -4- to impress the -5-; may cause astigmatism due to pressure on the -5-
- Red conjunctiva
- itching
- visual distortion
- large enough
- cornea
Chalazion - S/S
> -1- sensitivity
> Increased -2-
- Light
2. tearing
Chalazion - Mgmt
> -1-
> Referral -2- (-3-)
- warm compresses
- for surgical removal
- usually the course
Conjunctivitis
Def: the -1- eye disorder; a(n) inflammation/infection of the -2- that covers the front of the eye and lines the inside of the eyelids resulting from a(n) -3-
- most common
- mucous membrane
- variety of causes (allergies, chemical irritation, bacteria, viruses, gonococcus/chlamydia)
Conjunctivitis - S/S
> -1-, irritation
> -2-
> Eyelids may be -3- with -4-
- inflammation, redness
- increased tears
- crusty and sticky
- mucopurulent discharge
Conjunctivitis - Labs/Dx
-1- when indicated (e.g., if -2- is suspected)
- gram stain & culture
2. gonorrhea
Conjunctivitis - Mgmt
Type: -1-
Discharge: none
Tx considerations: -2-; flushing with -3-
- Chemical
- self-limiting
- normal saline
Conjunctivitis
Type: -1-
Discharge: -2-
Tx considerations: -3- ointment; -4- ophthalmic -5-
- bacterial
- purulent, thick
- erythromycin 0.5% ophthalmic (as young as newborn)
- Polytrim
- solution or ointment
Conjunctivitis
Type: -1-
Discharge: -2-, regardless of -3-
Tx considerations: -4- or -5-
- Gonococcal - EMERGENCY
- copious, green, purulent
- activity/sleep
- Emergent ceftriaxone
- cefotaxime IM
Conjunctivitis - Mgmt
Type: -1-
Discharge: none
Tx considerations: -2- opthalmic -3-; -4- ophtalmic -3-; -5-
- chlamydial
- erythormycin
- ointment
- tetracycline
- oral azithromycin
Conjunctivitis
Type: allergic
S/S - Discharge: -2-, -3-, -4-
Tx considerations: -5-; prescription antihistamine -6-
- stringy (clear)
- increased tearing
- bilateral
- oral antihistamines
- eye drops (olopatadine)
Conjunctivitis - Mgmt Type: -1- Discharge: -2- Tx considerations: > -3- care >> mild: -4- drops >> moderate: decongestants/antihistamines, NSAIDs > Sulfacetamide 10% ophthalmic solution for -7-
- Viral
- watery
- symptomatic
- saline (artificial tears, refrigerated is best)
- bacterial (secondary) prophylaxis
Conjunctivitis - Mgmt
Type: -1-; emergency
Discharge: -2- and -3-
Tx considerations: -4- to the -5-
- Herpetic
- bright red
- irritated
- emergency referral
- ED/ophthalmologist (esp. re: lesions on face near/approaching eye)
Cataracts
Def: an abnormal, uniform, -1- of the eye seen in children with co-morbid syndromes (e.g. -2-, -3-, -4-, atopic dermatitis)
- progressive opacity
- Down
- Marfan
- DM
Cataracts - Causes/Incidence > -1- > Prolonged -2- > -3- > -4- > -5-
- congenital
- steroid use
- infection
- injury
- radiation (onc)
Cataracts - S/S > -1- vision > -2- > Poor -3- > -4-
- clouded, blurred, dim
- white fundus reflex (absent red reflex)
- visual fixation
- photophobia
Cataracts > Lab/Dx >> -1- > Mgmt >> -2- removal
- none indicated
2. refer for surgical
Strabismus
Def: strabismus is a(n) -1- as a result of -2-. If acquired -3- of age, strabismus is usally related to an underlying problem
- ocular misalignment
- uncoordinated ocular muscles
- after 6 mo
Strabismus - S/S
> -1-: eyes deviate -2-
> -3-: eyes deviate -4-
- Esotropia
- inward
- exotropia
- outward
Strabismus - S/S
> -1-: eyes deviate -2-
> -3-: eyes deviate -4-
> Hirschberg: -5-
- hypertorpia
- up
- hypotropia
- down
- light reflex: asymmetric
Strabismus - Mgmt
-1-
> if fixed or -2- of age or more
> -3- for -4- (-5-)
- Refer to ophthalmology
- continuous at 6 months
- Immediately
- hyper-/hypotropia
- indicative of CNS lesion (also refer to neuro)
Otitis Externa (Swimmer's Ear) Def: inflammation of the -1- > Causes/Incidence >> Infection >>> -2- >>> -3- >> Recent history of -4-
- external auditory meatus
- bacterial (usually gram-neg)
- fungal
- water exposure
OE - S/S
> -1- (-2-)
> Purulent and sometimes, -3-
- otalgia
- esp. when pulling pinna/auricle
- malodorous discharge (pseudomonas)
OE - PE Findings
> -1- of the -2-
> -3- of the -2-
> -4- (sometimes with odor)
- erythema
- ear canal
- edema
- purulent exudate
OE - PE Findings
> -1- of -2- or when the -3-
> -4-
- pain upon manipulation
- auricle
- tragus is compressed
- TM: clear, flat
OE - lab/dx
Pneumatic -1- should -2-
- otoscopy (if possible r/t edema)
2. demonstrate mobility
OE - mgmt > -1- > -2- or injury > Topical ear mediations >> Bacterial >>> -3- and -4-
- remove purulent debris
- protect from moisture
- ciprofloxacin
- dexamethasone otic drops
OE - mgmt > Topical ear mediations >> Fungal >>> -1- (e.g., -2-) > Pain mgmt (-3-) > prevention; -4- afer bathing and/or swimming
- antifungal drops
- clotrimazole 1% solution
- acetaminophen or ibuprofen
- dry external ear
AOM
Def: a bacterial infection of the mucosally lined air-containing spaces of the temporal bone that can interfere with air conduction. -1- is repsonsible for anout 30-50% and -2- for about 20% of AOM cases
- S. pneumoniae
2. H. influenzae
AOM - S/S > Decreased -1- > -2- > -3- > -4-/-5-
- hearing
- fever
- otalgia
- nausea
- vomiting
AOM - PE Findigns > -1- >> -2- >> -3- > -4- exudate > -1- often -5-
- TM
- erythema
- edema
- purulent
- bulges (“hot ear”)
AOM - Lab/Dx
-1- of TM with -2-
- Impaired mobility
2. pneumatic otoscopy
AOM - MGMT
> -1- mgmt: -2-
> Observation period for healthy children: -3-
- pain
- acetaminophen
- 48-72 hours
AOM - MGMT
Meds
> -1- PO for -2-
> -3- recommended for -4-
- amoxicillin 80-90 (HIGH DOSE) mg/kg/day BID
- 10 days
- amox-clavu
- resistant strains
AOM - MGMT
Prevention
> -1-: -2-, -3-, annual -4-
> Avoid -5-
- vax
- Hib
- PCV13
- flu
- second hand smoke
Serous Otitis Media/Otitis Media w/ Effusion (OME)
Def: the presence of -1- in the -2- w/o s/s of AOM; also known as chronic OME.
S/S
> -3-
> -4- when pressure altered
> -5- ear
- fluid (clear)
- middle ear(s)
- hearing loss
- popping sensation
- fullness in the
OME - PE Findings
> -1- behind the -2-
> Decreased -3-
> -4- tests suggestive of -5-
- air bubbles
- TM
- membrane mobility
- Weber & Rinne
- conductive hearing loss
OME - Labs/Dx
-1- via -2-
- decreased hearing
2. audiometry
OME - Mgmt > watchful monitoring: -1- > abx therapy: -2- > -3-: -4- > -5- months
- 3 months
- no long-term efficacy
- antihistamines/decongestants
- ineffective
- re-evaluate in 3-6
Hearing Loss
def: any degree of -1- ability to -2-; may be -3-.
- impairment in the
- aprehend sound
- conductive, sensorineural, or mixed
Hearing Loss Conduction Causes > -1- impaction/foreign body (-2-) > -3- > -4- > -5-
- Cerumen
- most treatable
- hematoma
- OM
- perforated TM
Hearing Loss > Sensorineural Loss >> Impaired transmission of sound through the -1- >> Causes >>> -2- >>> -3- >>> -4- disease >>> -5-
- nervous system
- acoustic neuroma
- syphillis
- CNS
- medication toxicity
Understanding -1- & -2- tests
> Expected findings
» -1- test: Sound -3- and not lateralize
» -2- test: -4- > -5-
- Weber (weber-head)
- Rinne (like the wind!)
- should be heard equally in both ears
- air conduction
- bone conduction
Hearing Loss S/S Findings w/ Hearing Loss > Conductive hearing loss >> Weber: sound -1- to the -2- >> Rinne: -3- in affected ear (i.e. -4-)
- lateralizes
- affected ear
- abnormal
- AC < BC
Hearing Loss S/S Findings w/ Hearing Loss > -1- >> Weber: sound -2- to the -3- >> Rinne: -4- in the -5-
- Sensorineural hearing loss
- lateralizes
- unaffected ear
- AC > BC
- affected ear
Hearing Loss Lab/Dx > Otoscopic ex: -1- and TM > General -2- > -3- > -4- a neuro condition is suspected
- inspect canal
- neuro exam
- audiometric testing
- CT scan if
Hearing Loss Mgmt > remove -1- > -2- > Refer for -3-
- foreign body/cerumen
- refer for audiogram
- further evaluation/hearing aid
Allergic Rhinitis
Def: -1- to -2-
- immune-mediated response
2. allergens
Allergic Rhinitis S/S > -1- discharge > -2- > -3- eyes > -4- (from -5-)
- postnasal (clear/white)
- sneezing
- itchy
- HA
- nose blowing, even
Allergic Rhinitis Mgmt > -1- (often requires skin-prick test or other ID measure; not possible for all allgerns) > -2- antihistamines (e.g., -3-) > -4- (e.g., -5-)
- avoid allergens
- second-generation
- loratidine, cetirizine, fexofenadine
- Intranasal corticosteroids
- budesonide, fluticasone
Common Cold Def: -1-, a -2- URI S/S > -3- > -4-
- viral rhinitis
- self-limiting
- sore throat
- Malaise
Common Cold Mgmt > -1- and -2- > No -3-; avoid antitussives for children -4- > (-5-)
- rest
- hydration
- OTC cold preps (decongestants, antihistamines, antitussives, expectorants)
- < 6 years of age
- should be resolved by day 12 (consider DDx for longer)
Common Cold
Mgmt
> No -1-
> -2- mgmt w/ -3-
- abx
- pain/fever
- acetaminophen or ibuprofen
(Rhino-)Sinusitis
Def: Occurs when an undrained collection of pus accumulates in one or more of the paranasal sinuses in -1-. The -2- and -3- are the -4-.
- children age 4+
- maxillary
- ethmoid sinuses
- most commonly affected
(Rhino-)Sinusitis
Def: Typical pathogens are the same as those of -1- (-2-): -3-, -4-, -5-
- AOM
- all connected: sinuses, nasal, optical, and otic passages
- S. pneumoniae
- H. influenzae
- M. catarrhalis
(Rhino-)Sinusitis S/S > -1- over the -2- > -3- > Discolored -4- ; halitosis
- pain & pressure
- cheeks
- HA
- nasal discharge
(Rhino-)Sinusitis
S/S
> -1- and cough (usually during day, worse at night)
> -2-, worse when -3-
- post-nasal drip
- dull, throbbing pain
- head is dependent
(Rhino-)Sinusitis Labs/Dx > Dx is often made on -1- > Radiological studies are rarely needed >> -2- preferred over -3-: more sensitive but more expensive; only used for -4-
- clinical presenation
- CT scan
- x-ray
- more complicated sinusitis
(Rhino-)Sinusitis
Mgmt
Uncomplicated w/ mild symptoms, treat outpt:
-1- for -2- or -3- whichever’s longer; -4- to -5- if no -6-
- Amox-clav
- 10 days
- 7 days post-symptom
- change abx!
- a secondary abx such as Levaquin (levofloxacin)
- improvement by day 3
(Rhino-)Sinusitis
Mgmt
Uncomplicated w/ mild symptoms, treat outpt:
> -1- are not -2- in acute sinusitis but may be used in chronic sinusitis
> -3- managed with -4-
> -5- care
- Decongestants & antihistamines
- useful
- pain
- acetaminophen
- supportive
(Rhino-)Sinusitis
Mgmt
Chronic, refractory, or -1-: -2-
- recurrent sinusitis
2. referral to ENT
Epistaxis (Nosebleed)
S/S
> Bleeding usually only from -1- (-2-)
> -3- because of -4- the -5- into stomach
- one nostril
- 2 nostrils is concerning for coagulopathy
- stomach upset
- blood dripping from
- back of the throat
Epistaxis (Nosebleed)
S/S
-1-; septal erosion (may be caused by -2-)
- Friability
2. inhaled substance abuse
Epistaxis (Nosebleed) Mgmt > -1- > -2- (i.e., triangle): -3- of the -4- for 10 minutes > Apply -5-
- Sit upright
- pressure at Kiesselbach’s plexus
- anterior inferior aspect
- nasal septum (end of bony ridge)
- ice
Pharyngitis/Tonsilitis
Def: -1- of the -2- behind the nose and mouth and/or the -3- in the throat, to the side of the root of the tongue
- Inflammation
- membrane-lined cavity
- lymphoid masses
Pharyngitis/Tonsilitis
Causes/Incidence
> -1-
> -2-
- Viruses (EBV, flu, RSV)
2. GABHS
Pharyngitis/Tonsilitis Bacterial Causes/Incidence > -1- > -2- > -3- (-4-)
- N. gonorrheae*
- mycoplasma
- chlamydia trachomatis*
- *good history in adolescent pts
Pharyngitis/Tonsilitis S/S > -1- > Dysphagia; -2- > -3- > -4- (more pronounced in -5- infections)
- erythematous pharynx
- cough
- malaise
- fever
- bacterial
Pharyngitis/Tonsilitis S/S > -1- (bacterial) > -2- > -3- > -4- with sandpaper-like -5-
- anterior cervical adenopathy
- painful throat
- exudate
- scarlet fever
- rash
Pharyngitis/Tonsilitis
Labs/Dx
> -1- (fever, cough, sore throat, abdominal pain, n/v)
> -2- (15+)
> -3- (2-)
> -4- (-1-‘s symptoms + HA, malaise, myalgias; diarrhea?)
- Rapid strep
- heterophile antibody test (monospot)
- RSV PCR
- rapid flu
Pharyngitis/Tonsilitis Mgmt > -1- care >> -2- >> -3- >> antipyretics (-4-)
- supportive
- fluids/hydration
- warm saltwater gargles
- acetaminophen
Pharyngitis/Tonsilitis
Mgmt
> Abx only for -1-
» -2- 250 mg orally 2-3 times daily for 10 days
» If -3- 20 mg/kg orally 2 times daily for 10 days
» -4- at least -5- initiation
- Strep infection
- PCN VK
- allergic, then macrolide (even for mild allergy)
- return to school/day care
- 12 hours after treatment
Epiglottitis
Common pathogens include strept-, pneumococci, and -1-; NOT -2-
Causes/Incidence
Peak incidence occurs b/t the ages of -3-
- H. influenzae B
- Chlamydia Trachomatis
- 6 and 12 years
Epiglottitis S/S > -1- high fever > -2- appearance > -3- > -4- of the neck > Rapidly progressive signs of -5-
- sudden onset
- toxic
- restless, fearful, garbled speech
- leaning forward, hyperextending
- respiratory distress
Epiglottitis
Labs/Dx
-1- a -2-, appearing on a-3-
- Thumb sign
- thumb-shaped path
- radiograph of the neck
Epiglottitis Mgmt > -1- > Do not -2- > -3- as soon as possible > -4- until pathogen is identified
- immediate hospitalization
- perform pharyngeal exam
- Intubation capabilities
- IV 3rd gen cephalosporin (ceftriaxone, cefaxotime, cefdinir)
Croup
Def: … infection of the larynx
parainfluenza viral
Croup
Causes/Incidence
> -1- can -2- from mild to quite severe
> peak incidence is from -3-
- Severity
- range
- 6 mo to 3 years of age
Croup
Causes/Incidence
> Affects -1- than -2-
> Most common in -3-
- males more often
- females
- fall & winter
Croup S/S > Recent symptoms of a(n) -1- > -2- > Lungs -3-
- URI
- bark-like cough
- typically clear
Croup
Lab/Dx
> -1-: shows -2- in severe forms
> Appearance of a -3- of the -4- radiograph of the neck (-5-)
- Pulse ox
- hypoxia
- “steeple-shaped” narrowing
- trachea on frontal
- Croup Church–>steeple
Croup Mgmt > moderate disease: -1- support; -2- > may require -3- > short course of -4-
- hospitalize for respiratory
- IV fluids
- nebulized racemic epinephrine
- corticosteroids
Epiglottitis vs. Croup
> -1- infection vs. -2- infection
> 6-10 years of age vs. 6 mo to 3 years fo age
> X-ray: thumb sign vs. -3-
- bacterial
- viral
- steeple
Epiglottitis vs. Croup
> bacterial infection vs. viral infection
> -1- of age vs. -2- of age
> X-ray: -3- vs. steeple
- 6-10 years
- 6 mo to 3 years
- thumb sign
Infectious Mononucleosis
Def: an -1- due to the -2-, occuring most often between -3- of age
- acute infectious disease
- EBV
- 15 - 25
Mono Causes/Incidence > mode of -1- > incubation period: -2- > Usually -3-, but -4- may last for -5-
- transmission is saliva (resp. droplet)
- 1-2 months
- self-limited
- malaise & fatigue
- months
Mono
S/S
> -1-
> -2- (most severe)
- fever
2. pharyngitis
Mono PE Findings > -1- > -2- on -3- > -4- in 50% of cases, -5- in only 20% > -6- trunk
- posterior cervical lymphadenopathy
- white exudate
- tonsils
- splenomegaly
- HEPATOMEGALY
- maculopapular/petechial rash on
Mono Lab/Dx > lymphocytic leukocytosis; -1- > positive heterophil and -2- > -3- in EBV > -4- in EBV
- neutropenia
- Monospot
- early (acute convalescent stage) rise in IgM (IMmediate)
- permanent rise in IgG (Gone)
Mono
Mgmt
> -1- (e.g., -2-, warm saline gargles)
> Oral -3- when -4- threatens -5-
- supportive care
- NSAIDs
- corticosteroids
- enlarged lymph tissue (tonsils)
- airway obstruction
Mono
Mgmt
-1- (-2-) to -3- (even without clinically detectable splenomegaly)
- avoidance of contact sports
- 3 weeks to several (3) months
- avoid splenic rupture
Corneal Abrasion > -1- eye injury in children >> causing -2- > Can be detected by -3- >> Topical -4-
- Common
- pain, tearing, photophobia
- Wood’s lamp/fluorescein dye
- ophthalmic anesthetic (for Ax only, no repeat use)
Corneal Abrasion
> Mgmt
» topical ophthalmic -1- times a day for a few days
»> positive response to treatment: -2- days.
» Topical -3-
» Oral -4- intermittently
- antibiotic applied 4
- continue for 2-3
- steroids not recommended (lower resistance to infection)
- acetaminophen/ibuprofen & cool compresses
Corneal Abrasion > Mgmt >> Patching is -1- >>> does not -2- >>> barrier -3- >> Most steadily -4- >>> Persistent/increasing pain/discomfort -5-: refer to ophthalmology
- no longer recommended
- reduce discomfort/speed healing
- to antibiotic Tx
- heal in 24-48 hours
- after 24 hours
A one-week history of fever, exudative pharyngitis, cervical lymphadenopathy, and -1- in an adolescent raise suspicion for mononucleosis. The most -2- to order would be a -3-. This is a nonspecific test and is positive in 85% of adolescents with mononucleosis within the -4- of the illness but is often negative in children under the age of -5-.
- hepatosplenomegaly
- appropriate laboratory test
- heterophile antibody test (monospot)
- first two weeks
- 4 years
Mono
A -1- does not provide any specific diagnostic information. The -2- tests for recent strep infection, but -3- is a differentiating symptom from strep. CMV is a good differential diagnosis as it can cause -4-, but the presence of -3- & -5- are more specific for mono.
- complete blood count
- antistreptolysin O titer
- (hepato-)splenomegaly
- fatigue and adenopathy
- pharyngitis
The most common cause of mono is EBV. -1- can be used for -2- if heterophile antibody testing is negative and there is -3- of mononucleosis, or in -4- in which heterophile antibody tests are -5-.
- Epstein-Barr titers
- preliminary mono testing
- still strong suspicion
- young children
- unreliable
Croup is a common illness in children -1- years of age with a predilection for infants and toddlers -2- months of age. Croup can be caused by -3-. Presentation includes fever, rhinorrhea, -4-, -5-, retractions that range from mild to severe, and an increased respiratory rate.
- younger than 6
- 6 to 36
- viruses and allergens
- hoarse “barking” cough
- upper airway stridor
Croup
Symptoms usually worsen at night including the -1-, which can be -2- to parents and caregivers. Hypoxia occurs as a -3-. A fever of up to 102˚ F (38.9˚ C) may be -4- or an indication of a more severe illness but, in isolation, does not warrant -5-.
- cough and stridor
- especially frightening
- very late sign
- part of croup
- urgent re-evaluation
Croup
Severity progresses from symptoms that are present when -1-, to symptoms present -2-. A barky cough in the morning is a -3- of croup.
- crying/active/upset (mild)
- while at rest (severe)
- common feature