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Foundations 2 > EENT > Flashcards

EENT Flashcards

1
Q

What is the Weber Test used for and what do the results indicate?

A
  • Test to determine hearing loss.

- Sound goes to crummy ear for conductive hearing loss and sound goes to good ear for sensorineural hearing loss.

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2
Q

What is the Rinne test used for and what do the results indicate?

A
  • Test to determine hearing loss.
  • BC>AC in conductive hearing loss.
  • AC>BC (normal) in sensorineural hearing loss.
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3
Q

What is the etiology of cerumen impaction?

A

Self induced by using Q tips.

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4
Q

What are the clinical presesentations of cerumen impaction?

A
  • Hearing loss
  • Earache or fullness
  • Itchiness
  • Reflex cough
  • Dizziness
  • Tinnitus
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5
Q

What are the treatments for cerumen impaction?

A
  • Detergent ear drops
  • Mechanical removal
  • Irrigation using body temperature water only when TM is intact
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6
Q

What are the clinical presentations of foreign body in the ear?

A
  • Often asymptomatic
  • Decreased hearing
  • Pain
  • Drainage
  • Chronic cough/hiccups
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7
Q

How do you treat foreign body in the ear?

A
  • Firm object: Remove with loop, hook, or irrigation
  • Organic: Do not irrigate for it will cause swelling
  • If there are living insects immobilize with lidocaine prior to removal
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8
Q

What is otitis externa (swimmer’s ear)?

A

Inflammation of external auditory canal

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9
Q

What are the etiologies of otitis externa

A
  • Allergy
  • Dermatologic
  • Bacterial infection with gram negative rods (Pseudomonas, S. epidermidis, S. aureus)
  • Fungal infection (Aspergillus, Candida)
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10
Q

What is the most common bacteria that causes otitis externa? What are the other bacterial species that cause otitis externa?

A
  • Pseudomonas (most common)
  • S. epidermidis
  • S. aureus
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11
Q

What are risk factors for otitis externa?

A

Warmer climates with high humidity

  • Increased water exposure like swimming
  • Debris from bermatologic conditions like psoriasis
  • Trauma
  • Occlusive devices
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12
Q

What are the clinical presentations of otitis externa?

A
  • Otalgia
  • Pruritis
  • Purulent discharge
  • Hearing loss
  • Fullness
  • History of recent water exposure
  • History of mechanical trauma
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13
Q

What are the physical exam findings for otitis externa?

A
  • Erythema and edema of ear canal skin
  • Purulent exudate
  • Tenderness with tragal pressure
  • Tenderness with manipulation of auricle
  • Erythematous TM
  • Mobile TM with pneumatic otoscopy
  • Possible obstructed vision of TM due to significant canal edema
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14
Q

What are possible differential diagnoses for otitis externa?

A
  • Middle ear disease
  • Contact dermatitis
  • Psoriasis
  • Chronic suppurative otitis media
  • Squamous cell carcinoma of external canal
  • Herpes simplex virus
  • Radiation therapy
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15
Q

What are diagnostic tests used to detect otitis externa?

A

-None needed.

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16
Q

What is the most common neoplasm of the ear canal

A

Squamous cell carcinoma of external canal

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17
Q

What is Ramsay Hunt Syndrome?

A
  • Rare vesicles on outer ear canal caused by herpes simplex virus.
  • Causes facial paralysis on side of affected ear.
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18
Q

How is otitis externa treated?

A
  • Treat for 7-10 days with topical aminoglycoside or fluroquinolone antibiotic with or without corticosteroids
  • Remove debris
  • Place wick if there is significant swelling
  • Recalcitrant cases or severe otitis media with cellulitis of periauricular tissue need oral antibiotics
  • Keep canal dry using drying agent
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19
Q

What are ways to prevent otitis externa?

A
  • Keep ear dry
  • Stop removing cerumen with Q tip
  • Avoid trauma to ear canal
  • Treat dermatologic conditions
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20
Q

What are complications of otitis externa?

A
  • Periauricular cellulitis
  • Contact dermatitis
  • Malignant otitis externa
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21
Q

What is malignant otitis externa (aka necrotizing otitis externa)?

A

-Osteomyelitis of temporal bone/skull base

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22
Q

What are the clinical presentations of malignant otitis externa?

A
  • Foul smelling discharge
  • Granulations in ear canal
  • Deep otalgia
  • Cranial nerve palsies
  • Headache
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23
Q

What diagnostic test is used to assess malignant otitis externa?

A

-CT scan which reveals osseous erosion

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24
Q

What population of patients are at risk for malignant otitis externa?

A

-Patients with diabetes or immunocompromised

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25
Q

What is hematoma of the external ear?

A

-It is a traumatic auricular hematoma that must be recognized promptly.

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26
Q

How do you treat hematoma of the external ear?

A

By draining.

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27
Q

What is a complication of hematoma of the external ear?

A

-Cauliflower ear: No blood supply to cartilage causes necrosis and distorted development of new cartilage. This will affect hearing and how the ears conduct sound .

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28
Q

What causes acute otitis media?

A
  • Bacterial infection of middle ear in most cases (Strep pneumoniae, H. influenza)
  • URI where eustachian tube becomes obstructed and fluid and mucous accumulated and is secondarily infected
  • Poor drainage of eustachian tubes because of age, inflammation/edema, congenital malformation
  • Recurrent cases associated with allergies and second hand smoke exposure
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29
Q

What are the most common organisms that cause acute otitis media?

A
  • Streptococcus pneumoniae

- Haemophilus influenza

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30
Q

What are the risk factors for acute otitis media?

A
  • Family history
  • Day care
  • Lack of breastfeeding
  • Tobacco smoke/air pollution
  • Pacifier use
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31
Q

Which group of people are most commonly affected by acute otitis media?

A

-Children 4-24 months

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32
Q

What are the clinical presentations of acute otitis media?

A
  • Otalgia
  • Pressure buildup
  • Hearing loss
  • Fever
  • URI symptoms
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33
Q

What are the physical exam findings for acute otitis media?

A
  • Immobile TM
  • Erythema and bulging of TM
  • Can also have retracted TM
  • Can also have bullae associated with mycoplasma infection
  • TM may be ruptured
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34
Q

What are the differential diagnoses for acute otitis media?

A
  • Otitis media with effusion
  • Otitis externa
  • Eustachian tube dysfunction
  • Herpes zoster
  • Head and neck infection
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35
Q

How is acute otitis media treated?

A
  • 1st line: high dose amoxicillin (80-90 mg/kg/day divided twice daily)
  • For patients allergic to penicillin use cephalosporin, doxycycline, and macrolide
  • 2nd line: High dose amoxicillin-clavulanate or 2nd or 3rd generation cephalosporin
  • Topical antibiotic with low ototoxicity (ofloxacin) if there is perforated TM
  • Analgesics
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36
Q

How can acute otitis media be prevented?

A

-Pneumo vax vaccination

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37
Q

What dose of amoxicillin should be given as a first line treatment for acute otitis media?

A

-80-90 mg/kg/day divided twice daily

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38
Q

What are complications of acute otitis media?

A
  • Labrynthitis
  • Hearing loss
  • Mastoiditis
  • No response to medication because of resistant organism
  • Recurrent infection
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39
Q

True or False: Tympanic membrane perforations cannot be healed.

A

False. Small ruptures close on their own while larger ones (rupture >25%) may require tympanoplasty.

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40
Q

What is the pathophysiology of otic barotrauma?

A
  • Inability to equalize the pressure exerted on the middle ear during air travel, rapid altitude change, underwater diving.
  • Poor eustachian tube function is a precursor and can be due to mucosal edema or congenital narrowing
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41
Q

What are the clinical presentations of otic barotrauma?

A
  • Otalgia

- Happens more during airplane descent than ascent

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42
Q

What is the treatment for otic barotrauma?

A
  • Take systemic decongestants a few hours before travel

- Use topical nasal decongestants one hour before descent

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43
Q

What are the complications of otic barotrauma?

A
  • TM rupture followed possibly by middle ear infection

- Persistent pressure after landing

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44
Q

What are ways to prevent otic barotrauma?

A
  • Swallow, yawn, or autoinflate during airplane descent
  • During diving equilibriate pressure in middle ears in stages to prevent hemotympanum or perilymphatic fistula complications
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45
Q

What are the treatments for eustachian tube dysfunction?

A
  • Topical (intranasal) or systemic (oral) decongestants
  • Autoinflation
  • Desensitization therapy
  • Intranasal corticosteriods
  • Surgery
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46
Q

What are complications of eustachian tube dysfunction?

A

-Increased risk for serous otitis media, cholesteatoma

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47
Q

What are the physical examination findings for eustachian tube dysfunction?

A
  • Retraction of TM

- Decreased mobility of TM on pneumatic otoscopy

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48
Q

What are ways to manage eustachian tube dysfunction?

A
  • Avoid air travel
  • Avoid altitude change
  • Avoid underwater diving
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49
Q

What is the etiology of eustachian tube dysfunction?

A
  • Edema of tubal lining. Air trapped in middle ear causing negative pressure
  • Viral URI
  • Allergies
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50
Q

What are the clinical presentations of eustachian tube dysfunction?

A
  • Fullness
  • Fluctuating hearing
  • Pain with pressure change
  • Popping or crackling sensation
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51
Q

What are the treatments for cholesteatoma?

A
  • Antibiotic drops

- Surgical removal

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52
Q

What are complications of cholesteatoma?

A

-Erosion into inner ear, facial nerve, brain abscess

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53
Q

What are the clinical presentations of cholesteatoma?

A
  • Asymptomatic
  • Hearing loss
  • Ear drainage in chronic infection
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54
Q

What are the physical examination findings for cholesteatoma?

A
  • TM pocket

- TM perforation exuding debris

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55
Q

What is the pathophysiology of cholesteatoma?

A

-It is a type of chronic otitis media

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56
Q

What is the etiology of cholesteatoma?

A
  • Prolonged eustachian tube dysfunction- most common cause
  • Chronic negative middle ear pressure retracts part of TM
  • Creates sac lined with squamous epithelium that produces keratin
  • Secondary infection with Pseudomonas or Proteus
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57
Q

What is the clinical presentation of serous otitis media?

A
  • No acute signs of illness or inflammation
  • Conductive hearing loss
  • Fullness
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58
Q

What are the physical examination findings for serous otitis media?

A
  • TM is dull and hypomobile
  • Visible bubbles
  • Conductive hearing loss
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59
Q

What are treatments for serious otitis media?

A
  • Nasal steroids if there is underlying allergy
  • In resistant cases use ventilating tubes
  • Possibly decongestants
  • Possibly antihistamines
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60
Q

What is the pathopysiology of serous otitis media?

A
  • Eustachian tube is blocked for long time

- Negative pressure causes transudation of fluid into middle ear

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61
Q

In what group of patients is serous otitis media most common?

A

-Children because eustachian tubes are narrower and more horizontal than in adults

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62
Q

What condition occurs in adults after URI, barotrauma, or with chronic allergies?

A

-Serous otitis media

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63
Q

What is the etiology of chronic otitis media?

A

Recurrent acute otitis media

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64
Q

What are the physical examination findings in chronic otitis media?

A
  • Perforated TM

- Conductive hearing loss

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65
Q

What are the treatments for chronic otitis media?

A
  • Removal of infected debris
  • Earplug use
  • Topical or oral antibiotics
  • Surgery for TM repair
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66
Q

What are the symptoms for mastoiditis?

A
  • Spiking fevers
  • Postauricular pain
  • Erythema
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67
Q

What are the treatments for mastoiditis?

A
  • IV antibiotics

- Mastoidectomy

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68
Q

Under what conditions are children with acute otitis media put in observation?

A
  • 6 months-2 years old with unilateral acute otitis media and mild symptoms
  • Greater than or equal to 2 years of age, unilateral or bilateral if not severe
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69
Q

Under what conditions are children with acute otitis media put on immediate antibiotics?

A
  • Children < 6 months
  • Children < 24 months if they are experiencing moderate or severe pain, pain for more than 48 hours, bilateral acute otitis media, and a body temperature of 102.2 F
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70
Q

What is the pathophysiology of conductive hearing loss?

A

-Dysfunction of external or middle ear.

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71
Q

What is the etiology of conductive hearing loss?

A

Most common in adults:

  • cerumen impaction
  • eustachian tube dysfunction

Other causes:

  • otitis media
  • otitis externa
  • TM perforation
  • trauma
  • otosclerosis
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72
Q

What is the pathophysiology of sensorineural hearing loss?

A
  • Sensory loss: dysfunction of cochlea from loss of hair cells
  • Neural loss: dysfunction of CN VIII or central auditory pathway
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73
Q

What is the etiology of sensorineural hearing loss?

A
  • Most common: presbycusis
  • Loud noise exposure
  • Meniere’s disease
  • Head trauma
  • Systemic disease (infection, inflammation)
  • Acoustic neuroma
  • MS
  • Auditory neuropathy
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74
Q

What are some ways to evaluate hearing loss?

A
  • Evaluate function of cranial nerves especially facial and trigeminal
  • Examine nose, nasopharynx, upper respiratory tract
  • Examine ear, ear canal, TM (penumatic otoscopy)
  • Check gross hearing with whispered voice test
  • Weber test
  • Rinne test
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75
Q

What are ways to treat or manage hearing loss?

A
  • Surgical correction to correct conductive hearing loss
  • Hearing aids for sensorineural hearing loss
  • Cochlear implants
  • Use hearing protectors
  • Avoid exposure to loud noise
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76
Q

What is the pathology of tinnitus?

A
  • Occurs from somatic sounds near cochlea
  • Loss of cochlear input to neurons in central auditory pathways causing abnormal neural activity in auditory cortex
  • Auditory seizures
  • Neurotransmitter abnormalities
  • Development of alternative neural synapses that lack normal inhibitory pathways
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77
Q

What are some treatments for tinnitus?

A
  • Treat underlying conditions
  • Stop ototoxic medications
  • Avoid exposure to loud sounds
  • Behavioral therapy
  • Vagus nerve stimulation

Experimental therapies:

  • Brain surface implants
  • Deep brain stimulation
  • Transcranial direct current stimulation
  • Transcranial magnetic stimulation of central auditory system
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78
Q

What is tinnitus in general?

A
  • Perception of continuous or intermittent sounds in ear or head
  • Mild high pitched sounds- buzzing, ringing, hissing
  • Often associated with sensory hearing loss
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79
Q

What are other forms of tinnitus?

A

Pulsatile and staccato

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80
Q

What is pulsatile tinnitus?

A
  • Described as hearing one’s own heartbeat

- Usually indicates a vascular abnormality

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81
Q

What is staccato tinnitus?

A
  • Rapid series of pops or clicks with sensation of ear fluttering
  • Occurs from middle ear muscle spasm
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82
Q

What are some diagnostic tests to assess tinnitus?

A
  • MRI if it is unilateral without obvious etiology

- Consider MRA, MRV, temporal bone CT for pulsatile tinnitus

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83
Q

What are the differential diagnoses of dizziness?

A
  • Vertigo
  • Disequilibrium
  • Presuncope
  • Nonspecific dizziness including fibromyalgia, psychiatric disorders, hyperventilation, medication side effect, etc.
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84
Q

What is vertigo?

A
  • Sense of motion when there is no motion
  • Spinning sensation
  • Sense of tumbling
  • Falling forward or backward
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85
Q

What is the primary symptom of vestibular disease?

A

-Vertigo

86
Q

What are the two causes of vertigo?

A
  • Peripheral
  • Central
  • Can also have mixed central and peripheral causes
87
Q

What are the clinical presentations of vestibular schwannoma?

A
  • Unilateral hearing loss
  • Continuous dysequilibrium
  • Tinnitus
88
Q

What diagnostic tests are used to detect vestibular schwannoma?

A
  • Audiometry

- MRI with contrast

89
Q

How is vestibular schwannoma treated?

A
  • Observation
  • Surgical excision
  • Radiotherapy
90
Q

What is the pathophysiology of vestibular schwannoma?

A
  • Benign tumor of CN VIII
  • Begins in internal auditory canal
  • Gradually grows to compress pons and cause hydrocephalus
  • Usually unilateral
91
Q

What is one of the most common intracranial tumors?

A

-Vestibular schwannoma

92
Q

What is the treatment for Meniere Disease?

A
  • Course is unpredictable so difficult to treat. Aimed at decreasing endolymph fluid pressure in inner ear
  • Diuretics like acetalzolamide
  • Low salt diet

In refractory cases:

  • Intratympanic corticosteroid injections
  • Endolymphatic sac decompression
  • Vestibular ablation
93
Q

How is Meniere Disease diagnosed?

A
  • Refere to ENT and audiology

- Caloric testing

94
Q

What is the clinical presentation of Meniere Disease?

A
  • Episodic vertigo with discrete spells lasting 20 min to several hours
  • Fluctuating sensorineural hearing loss for low frequency sounds
  • Tinnitus that has a low tone, blowing/roaring quality
  • Sensation of unilateral ear pressure (aural fullness)
95
Q

What is Meniere Disease?

A
  • aka Endolymphatic hydrops

- Vertigo syndrome due to a peripheral lesion

96
Q

What is the pathophhysiology of Meniere Disease?

A
  • Distention of endolymphatic compartment of inner ear
  • Symptoms wax and wane as pressure riseases and falls
  • Can permanently damage inner ear structures
97
Q

How is BPPV treated?

A
  • Epley maneuver
  • PT/OT referral
  • Vestibular suppressants
  • Bed rest if severe
98
Q

What is the etiology of Labryinthitis?

A
  • Inflammatory disorder of vestibular portion of CN VIII

- Occurs post-viral infection

99
Q

What are the clinical presentations of Labryinthitis?

A
  • Acute onset of continuous, severe vertigo
  • Commonly with hearing loss and tinnitus
  • Nausea and vomiting
  • Gait impairment
100
Q

What are diagnostic tests used to detect Labryinthitis?

A

-Neuroimaging with MRI/MRA

101
Q

What are treatments for Labryinthitis?

A
  • Antibiotics if patient is febrile or with symptoms of bacterial infection
  • Vestibular suppressants (anticholinergics, antihistamines, benzodiazepines)
  • Anti-emetics (ondansetron/Zofran)
  • Corticosteroids
102
Q

What are diagnostic tests used to detect vertigo?

A

-Dix-Hallpike maneuver
-Audiometry
ENG/VNG
-Caloric stimulation
-VEMP
MRI

103
Q

If the Dix-Hallpike maneuver is positive it indicates what?

A

-Delayed onset fatigable nystagmus which means it is a peripheral cause

104
Q

If nystagmus in Dix-Hallpike maneuver is non-fatigable it indicates what?

A

-Vertigo is due to central cause

105
Q

What are the characteristics of vertigo due to a central cause?

A
  • Gradual onset
  • Progressive increase in severity
  • Gait and posture impaired
  • No auditory symptoms
  • Non-fatigable nystagmus in any direction
106
Q

What are the characteristics of vertigo due to a peripheral cause?

A
  • Sudden onset
  • Acutely severe symptoms
  • Nausea and vomiting
  • Tinnitus
  • Hearing loss
  • Horizontal nystagmus with rotatory component
  • Eye motion in response to head turning
107
Q

Patient education in Labryinthitis includes?

A
  • Ressurance condition is benign and self-limited
  • Recovery is gradual
  • Improvement occurs over several weeks
  • Need for vestibular rehabilitation referral is possible
  • Risk of falls
108
Q

What type of nystagmus is present in peripheral vs. central cause of vertigo?

A
  • Peripheral: Horizontal with torsional component.

- Central: Can be in any direction

109
Q

What are some peripheral causes of vertigo?

A
  • Labryinthitis
  • Meniere disease
  • Alcohol intoxication
  • Inner ear barotrauma
  • Semicircular canal dehiscence
  • Benign positional vertigo
110
Q

What are the central causes of vertigo?

A
  • Seizure
  • MS
  • Wernicke encephalopathy
  • Chiari malformation
  • Cerebellar ataxia syndromes
111
Q

What are some mixed central and peripheral causes of vertigo?

A
  • Migraine
  • Stroke and vascular insufficiency
  • Vestibular schwannoma
  • Meningioma
  • Lyme disease
  • Syphilis
  • Vascular compression
  • Hyperviscosity syndromes
  • Endocrinopathies like hypothyroidism
112
Q

What vestibular disorders are associated with vertigo?

A
  • BPPV
  • Labryinthitis
  • Meniere disease
113
Q

What causes Benign Paroxysmal Positional Vertigo?

A
  • Sediment in semicircular canals (otoliths)
  • Provoked by changes in head position
  • Episodes are brief in duration but recurrent
  • Happens in clusters lasting several days
114
Q

What are some treatments for allergic conjunctivitis?

A
  • Cold compresses
  • Antihistamine drops (ketotifen, olopatadine)
  • Oral antihistamines (loratidine, diphenhydramine)
115
Q

What are some etiologies for red eye?

A
  • Blepharitis
  • Chalazion/hordeolum
  • Cellulitis
  • Conjunctivitis
  • Dacryoadenitis
  • Corneal ulcer (keratitis)
  • Uveitis
  • Subconjunctival hemorrhage
  • Foreign body
  • Hyphema
  • Glaucoma
  • Tumor
116
Q

What are some associated symptoms for red eye?

A
  • Vision
  • Discharge
  • Pain
117
Q

What is blepharitis?

A

-Chronic condition with inflammation of eyelids with intermittent exacerbations

118
Q

The two types of blepharitis are?

A
  • Anterior: due to seborrheic component or S. aureus

- Posterior: due to meibomian gland dysfunction

119
Q

What are the clinical presentations of blepharitis?

A
  • Red eyes
  • Gritty or foreign body sensation
  • Burning sensation
  • Excessive tearing
  • Crustiness in lashes
  • Light sensitivity
  • +/- blurry vision
120
Q

What are some physical examination findings?

A
  • Diffuse conjunctival injection
  • Eyelid margins often inflamed and red
  • Crusting or matting of eyelashes
  • Plugged glands with magnification
  • Collarettes
121
Q

What is the treatment for Blepharitis?

A
  • Warm compresses
  • Lid massage
  • Lid hygiene
  • Topical antibiotics (erythromycin)
  • Oral antibiotics in severe cases
  • Omega-3 supplements for prevention
122
Q

What are the clinical presentations of orbital cellulitis?

A
  • Eye pain
  • Eyelid swelling and erythema
  • Vision changes (possibly diplopia)
  • Fever
  • Pain with eye movements
123
Q

What are the physical examination findings of orbital cellulitis?

A
  • Proptosis
  • Ophthalmoplegia
  • Conjunctivitis
  • +/- discharge
124
Q

What is periorbital cellulitis?

A
  • An infection of soft tissues around eye that does not extend into the orbit
  • Not an infection that involves the globe
  • A more common infection
  • Common in children than adults
125
Q

What is orbital cellulitis?

A
  • An infection of fat and muscle tissue surrounding the globe
  • Not an infection that involves the globe
  • Common in children than adults
126
Q

What is the etiology of periorbital cellulitis?

A
  • Blepharitis
  • Insect bites
  • Foreign object
  • Sometimes sinusitis
127
Q

What is the etiology of orbital cellulitis?

A

-Extension of infection from paranasal sinuses (ethmoid sinuses)

128
Q

What are the clinical presentations of periorbital cellulitis?

A
  • Eye pain
  • Eyelid swelling and erythema
  • No vision change
  • No fever
  • No pain with eye movements
129
Q

What are the physical examination findings of periorbital cellulitis?

A
  • No proptosis

- No ophthalmoplegia

130
Q

What diagnostic tests are done to detect periorbital and orbital cellulitis?

A
  • CBC
  • Blood cultures
  • Culture of any discharge
  • CT scan of orbits and sinuses
131
Q

How is periorbital cellulitis treated?

A
  • Can managed as an outpatient (>1 years old)
  • Empiric antibiotic therapy for S. aureus, S. pneumoniae, MRSA
  • If MRSA: Oral trimethoprim-sulfamethoxazole (Bactrim), oral clindamycin plus one of the following: amoxicillin, amoxicillin-clavulanic acid, cefdinir, cefpodoxime
  • If not MRSA: amoxicillin-clavulanic acid
132
Q

What is the etiology for viral conjunctivitis?

A

-Adenovirus

133
Q

What are the associated symptoms for viral conjunctivitis?

A
  • Pharyngitis
  • Fever
  • Malaise
  • Watery discharge
  • Preauricular adenopathy
134
Q

What are the symptoms for acute pharyngitis?

A
  • Sore throat
  • Fever
  • Headache
  • Malaise
  • “Swollen glands”
  • URI symptoms
135
Q

What are the physical examination findings?

A
  • Pharyngeal erythema
  • Tonsillar hypertrophy
  • Purulent exudate
  • Tender and/or enlarged anterior cervical lymph nodes
  • Palatal petechiae
136
Q

What are treatments for acute pharyngitis?

A

-If not strep then supportive treatment (fluids, rest, tylenol). Should improve in 5-7 days

137
Q

What is the clinical presentatio of strep?

A
  • Sudden onset
  • Tonsillar exudate
  • Tender cervical adenitis
  • Fever
138
Q

What are diagnostic tests for acute strep?

A
  • Rapid antigen detection testing

- If rapid strep test is negative then want to do a throat culture

139
Q

What are treatments for strep?

A

-Penicillin V 500 mg PO BID – TID x 10 days
-Amoxicillin 500 mg BID x 10 days
-Penicillin G benzathine (Bicillin L-A) 1.2 million units IM single dose
-Cephalexin 500 mg PO BID x 10 days
-Penicillin allergic:
Macrolides (erythromycin, clarithromycin, azithromycin)

140
Q

What are complications from strep?

A
  • Acute rheumatic fever
  • Acute glomerulonephritis
  • Scarlet fever
  • Peritonsillar abscess
  • Otitis media
  • Mastoiditis
  • Sinusitis
  • Bacteremia
  • Pneumonia

-

141
Q

What are the guidelines/criteria for a tonsillectomy?

A
  • At least 7 episodes in the last year
  • At least 5 episodes in each of the past 2 years
  • At least 3 episodes in each of the past 3 years
  • Episode = ST plus fever >100.9 OR tonsillar exudate OR anterior cervical adenopathy OR culture confirmed GABHS
  • Appropriate antibiotic treatment for strept episodes
  • Recommend 12 month observation period
142
Q

What is peritonsillar abscess?

A
  • Common deep neck infection in children and adolescents
  • Occurs most frequently in adolescents and young adults
  • Annual incidence is 30 per 100,000 persons aged 5-59
143
Q

What is the etiology of peritonsillar abscess?

A

-Polymicrobial, -Predominant species being Streptococcus pyogenes (GABHS)

144
Q

What are the symptoms of peritonsilalr abscess?

A 
-Severe sore throat
Fever
-"Hot potato” or muffled voice
-Drooling
-Trismus
-Neck swelling/pain
-Ipsilateral ear pain
-Fatigue, irritability, decreased PO intake
145
Q

What are the physical examination findings?

A
  • Swollen, fluctuant tonsil with deviation of uvula to the opposite side
  • Fullness or bulging of posterior soft palate
  • Cervical LAD
146
Q

What are some differential diagnoses for peritonsillar abscess?

A
  • Infectious mono
  • Lymphoma
  • Peritonsillar cellulitis
  • Retropharyngeal abscess
  • Retromolar abscess
  • Ludwig’s angina
147
Q

What are treatments for peritonsillar abscess?

A

-Monitor for airway obstruction
-Drainage: Needle aspiration, incision and drainage, or tonsillectomy
-Antimicrobial therapy: Parenteral: ampicillin-sulbactam or clindamycin. Consider vancomycin if high rates of CA-MRSA,
Oral: amoxicillin-clavulanate or clindamycin X 14 days
-Supportive care
- +/- Hospitalization

148
Q

What are the causes for laryngitis?

A

Infectious causes:

-Respiratory viruses
Rhinovirus, influenza, parainfluenza, adenovirus, coxsackievirus, coronavirus, RSV
-Bacterial respiratory infections Streptococcus sp., M. catarrhalis, H. influenza, S. aureus

Noninfectious causes:

  • Vocal abuse
  • Intubation / trauma
  • Toxic exposure
  • GERD
  • Vocal cord nodules or laryngeal polyps
  • Vocal cord paralysis
  • Carcinoma of vocal cords
149
Q

What are the clinical presentations of laryngitis?

A
  • Hoarseness

- URI symptoms (rhinorrhea, nasal congestion, cough, strep throat)

150
Q

What are the differential diagnoses for laryngitis?

A
  • Irritant exposure
  • Croup
  • Acute epiglottitis
  • Chronic causes
  • Head/neck cancer
  • GERD
  • Vocal nodule
  • Tuberculosis
151
Q

What are the treatments for laryngitis?

A
  • Treat the underlying cause
  • Humidification
  • Voice rest
  • Hydration
  • Avoid smoking
152
Q

What are the etiologies for epiglottis?

A
  • Viral or bacterial
  • Haemophilus influenzae type B (HiB)
  • Streptococci
  • S. aureus
153
Q

What are risk factors for epiglottitis?

A
  • Incomplete or non-vaccination

- Immunodeficiency

154
Q

What are the clinical presentations of epiglottitis?

A
  • Fever (38.8 – 40.0 C / 101.8-104 F)
  • Respiratory distress
  • Anxiety
  • “Tripod” or “sniffing” position
  • Drooling
  • Odynophagia
  • Pain out of proportion
  • Muffled speech
  • Stridor
155
Q

What are diagnostic testing for epiglottitis?

A

-Labs – not until airway secured
CBC, blood culture, epiglottal culture (if intubated)
-Imaging-Lateral plain radiograph – “thumb sign”
-Direct laryngoscopy
-Fiberoptic nasolaryngoscopy

156
Q

What are treatments for epiglottitis?

A
  • Medical emergency
  • Airway protection
  • Hospitalization
  • IV antibiotics
  • 3rd generation cephalosporin & antistaphylococcal (vancomycin)
  • +/- Dexamethasone
157
Q

What is the cause for HSV?

A

Herpes simplex virus type 1

158
Q

What are the clinical presentations for HSV?

A

-Sudden onset of multiple painful vesicular lesions on inflamed, erythematous base

159
Q

How do you diagnose HSV?

A
  • Clinical
  • Viral culture
  • Serology
  • Immunofluorescence microscopy for antigens
160
Q

What are treatments for HSV?

A
  • Antivirals
  • Analgesics
  • Fluid management
161
Q

What is the cause of hand foot mouth disease?

A

Coxsackie A16

162
Q

What are the clinical presentations of hand foot mouth disease/

A
  • Prodrome: low-grade fever, malaise, abdominal pain, URI symptoms
  • Painful oral lesions- PAPULES on erythematous base
  • Lesions on hand, feet, mouth and buttocks
163
Q

How is hand foot mouth disease diagnosed?

A

-Clinically. No diagnostic tests are needed.

164
Q

How is hand foot mouth disease treated?

A

-Supportive care. Resolves in 2-3 days

165
Q

What is the etiology of aphthous ulcers?

A
  • Uncertain, but associated with HHV-6

- Also seen with celiac disease, IBD, HIV

166
Q

What are the clinical presentations of aphthous ulcers?

A
  • -Found on gums, tongue, lips, palate, buccal mucosa
  • Single or multiple (but usually single)
  • Recurrent
  • Painful small, shallow, round ulcers with gray base surrounded by red halo
167
Q

How is aphthous ulcers treated?

A
  • Topical corticosteroids in adhesive base

- Topical analgesics

168
Q

What is the etiology of Bechet’s?

A

-Inflammatory disorder

169
Q

What are the clinical presentations of Bechet’s?

A
  • Recurrent oral and genital aphthae [genital ulcers (ie. apthae) occur in ≈ 75%]
  • Lesions may occur at multiple sites
170
Q

How is Bechet’s diagnosed?

A

Recurrent oral ulcers ≥ 3 x per year + 2 other clinical findings (eg. recurrent genital ulcers, eye lesions, or skin lesions)

171
Q

How is Bechet’s treated?

A

-Refer to rheumatologist

172
Q

What is the etiology of oral candidiasis?

A

Candida albicans

173
Q

Who is commonly affected by oral candidiasis?

A
  • Infants

- Older adults who use dentures

174
Q

What are the risk factors associated with oral candidiasis?

A
  • Denture use
  • Poor oral hygiene
  • Diabetes mellitus
  • Anemia
  • Chemotherapy or local radiation
  • Corticosteroid use
  • Antibiotic use
  • HIV
175
Q

What are the clinical presentations of oral candidiasis?

A
  • Painful, creamy-white, curd-like patches over erythematous mucosa. Or may present as angular cheilitis
  • Easily scraped off- “thrush will brush”
  • “Cotton” mouth
  • Loss of taste
  • Pain with eating or swallowing
176
Q

How is oral candidiasis diagnosed?

A
  • Clinical
  • KOH wet prep. Budding yeasts with or without pseudohyphae
  • Culture
  • Biopsy

Other labs

  • HIV
  • Glucose
177
Q

How is oral candidiasis treated?

A

Antifungals:

  • Clotrimazole troches
  • Nystatin mouth rinses
  • Fluconazole
  • Ketoconazole
178
Q

What type of condition is oral lichen planus?

A

Chronic, inflammatory autoimmune disease

179
Q

What are the clinical presentations of oral lichen planus?

A
  • Reticular white plaques
  • Mucosal erythema
  • Erosions/ulcerations
  • Hyperkeratotic plaques
  • Painless or painful
180
Q

How is oral lichen planus diagnosed?

A
  • Exfoliative cytology

- Biopsy

181
Q

How is oral lichen planus treated?

A

-Manage pain/discomfort-

Corticosteroids, cyclosporines, retinoids, tacrolimus

182
Q

What kind of condition is oral leukoplakia?

A

Hyperplasia of squamous epithelium

183
Q

What is the cause of oral leukoplakia?

A

-Chronic irritaion (dentures, tobacco, lichen planus, etc.)

184
Q

What is the clinical presentation of oral leukoplakia?

A

-White lesion that cannot be removed by scraping

185
Q

How is oral leukoplakia diagnosed?

A
  • Biopsy

- Exfoliative cytology

186
Q

What is the presentation of erythroplakia?

A

-Red velvety plaque

187
Q

How is erythroplakia treated?

A

Refer to ENT

188
Q

How is erythroplakia diagnosed?

A
  • Clinically

- Biopsy

189
Q

How is erythroplakia treated?

A

-Refer to ENT

190
Q

What causes hairy leukoplakia?

A

-Epstein-Barr virus

191
Q

What group of people does hairy leukoplakia affect the most?

A

-HIV individuals

192
Q

What are the clinical presentations of hairy leukoplakia?

A

-White painless plaque on lateral tongue that cannot be scraped off

193
Q

What are mucoceles?

A

Fluid filled cavities with mucous glands lining the epithelium

194
Q

What is the cause?

A

Typically seen after mild oral trauma, may be seen on the labia

195
Q

How are mucoceles diagnosed?

A

Clinically

196
Q

How are mucoceles treated?

A
  • May rupture spontaneously

- Remove with cryotherapy or excision of entire cyst

197
Q

What is an amalgam tattoo?

A
  • Benign

- Seen adjacent amalgam filling

198
Q

What is torus palatinus?

A
  • Benign boney lesions

- Normally located on hard palate

199
Q

What causes dental caries?

A
  • Strep mutans
  • Metabolizes sugars into acid
  • Acid demineralizes enamel and causes cavity development
200
Q

What are the clinical presentations of dental caries?

A
  • Heat/cold intolerance

- Visually disturbing to patient

201
Q

How are dental caries diagnosed?

A

Clinically

202
Q

How are dental caries treated?

A

Refer to dentist

203
Q

What are complications of dental caries?

A
  • Intraoral abscess
  • Cellulitis
  • Brain abscess
204
Q

What is Sialolithiasis/Sialadenitis?

A

Stone and/or inflammation within the salivary glands or ducts

205
Q

What is the etiology of Sialolithiasis/Sialadenitis?

A

Uncertain, related to reduced salivary flow, inflammation, and localized injury

206
Q

What are risk factors for Sialolithiasis/Sialadenitis?

A

Dehydration, diuretics, anticholinergics, trauma, gout, smoking, history of kidney stones, chronic periodontal disease

207
Q

Where do stones in Sialolithiasis/Sialadenitis commonly occur?

A

Wharton’s duct

208
Q

What are the clinical presentations of Sialolithiasis/Sialadenitis?

A
  • Pain and swelling of gland aggravated by eating or anticipation of eating
  • Can be episodic or persistent
  • Worsening pain, erythema, fever may indicate infection
209
Q

How is Sialolithiasis/Sialadenitis diagnosed?

A

Clinically

210
Q

How is Sialolithiasis/Sialadenitis treated?

A

-Hydrate, heat, massage, “milk” the duct
-Sialagogues
-Discontinue aggravating medications
-NSAIDS
-Monitor for infection
S. aureus
-Referral if necessary
-For sialadenitis: IV or oral antibiotics; increase salivation

211
Q

What are complications of Sialolithiasis/Sialadenitis?

A
  • Abscess

- Duct obstruction

212
Q

What is suppurative parotitis?

A
  • Acute infection of parotid gland. Viral or bacterial

- Salivary stasis allows retrograde flow with the oral flora

Foundations 2 (2 decks)

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