EENT part 2 Flashcards
MC bacterial pathogens of otitis externa
P. aeruginosa
S. aureus
Bacterial pathogens of otitis externa with tympanostomy tubes
S. aureus S. pneumoniae and with chewing M. catarrhalis Proteus Klebsiella Occasionally anaerobes
Clinical findings of otitis externa
Pain Tenderness Aural d/c Fever absent Hearing unaffected Tenderness with movement of the pinna Lining of the auditory canal is inflamed with mild to severe erythema and edema Scant to copious d/c from the auditory canal
Tx of otitis externa
Ofloxacin
Ciprofloxacin with hydrocortisone or dexamethasone
Polymyxin B-neosporin-hydrocortisone
Seasonal allergic rhinitis
Caused by airborne pollens, which have seasonal patterns
Trees in spring
Grasses in late spring to summer
Weeds in summer and fall
Perennial allergic rhinitis
Primarily caused by indoor allergens, such as house dust mites, animal dander, mold, and cockroaches
Episodic rhinitis
Occurs with intermittent exposure to allergens
Sx of allergic rhinitis
Thin rhinorrhea
Nasal congestion
Paroxysms of sneezing
Pruritis of the eyes, nose, ears, and palate
PE of allergic rhinitis
Pale pink or bluish gray, swollen, boggy nasal turbinates with clear, watery secretions
Frequent nasal itching and rubbing of the nose with the palm of the hand (allergic salute)
Allergic shiners- dark periorbital swollen areas
Swollen eyelids or conjunctival injection
Labs for allergic rhinitis
Allergy testing
Tx of allergic rhinitis
Allergen avoidance Intranasal corticosteroids 2nd generation antihistamines Decongestants Immunotherapy
What is the most common cause of mild to moderate hearing loss in children?
Conduction abnormality
What is more common in severe hearing loss?
Sensorineural hearing loss
Causes of sensorineual deafness
Congenital infections
Tumors and their treatments
Genetic deafness
Dx of hearing impairment
Auditory brainstem response Otoacoustic emissions Audiologic assessment for young, neurologically immature, or behaviorally difficult children Pneumatic otoscopy Tympanometry
Tx of sensorineural hearing loss
Speech-language therapy Hearing aids ASL Special ed Cochlear implants
Indication for cochlear implants
Children >12 mos with profound sensorineual hearing loss who have limited benefit from hearing aids, have failed to progress in auditory skill development, and have no radiologic or medical contraindications
S/sx of mastoiditis
Posterior auricular tenderness, swelling, and erythema
Pinna is displaced downward and outward
Dx of mastoiditis
Radiographs or CT of the mastoid reveals clouding of the air cells, demineralization, or bone destruction
Tx of mastoiditis
Systemic abx and drainage
Causes of epistaxis
Trauma Mucosal irritation Septal abnormality Inflammatory diseases Tumors Blood dyscrasias Arteriosclerosis Hereditary hemorrhagic telangiectasia Idiopathic
Labs for epistaxis
Persistent heavy bleeding: hematocrit and type and cross-match
Hx of recurrent epistaxis, platelet d/o, or neoplasia: CBC with differential
Suspicion of a bleeding d/o: bleeding time
Taking warfarin or if liver dz is suspected: INR/PT
Tx for epistaxis
Manual hemostasis Humidification and moisturization Cauterization Nasal packing Arterial ligation Embolization
Medications for epistaxis
Oxymetazoline
Lidocaine
Mupirocin ointment
Silver nitrate
MC organisms in tonsillitis
HSV EBV CMV Adenovirus Measles virus
Organisms noted in chronic tonsillitis
Alpha and beta-hemolytic strep
S. aureus
H. influenzae
Bacteroides
S/sx of acute tonsillitis
Fever Sore throat Foul breath Dysphagia Odynophagia Tender cervical lymph nodes Resolve in 3-4 days but may last up to 2 wks despite adequate therapy
How to diagnose recurrent tonsillitis
7 culture-proven episodes in 1 yr
5 infections in 2 consecutive years
3 infections each year for 3 years consecutively
PE of acute tonsillitis
Fever
Enlarged inflamed tonsils that may have exudates
Open-mouth breathing and voice change
Tender cervical lymph nodes and neck stiffness
Labs for tonsillitis
Throat cultures
Monospot
CBC
Serum electrolyte
Tx of tonsillitis
Corticosteroids for EBV
PO PCN for GABHS infection
Tonsillectomy for recurrent tonsillitis
What was historically the cause of epiglottitis in children in the US?
Hemophilus influenzae type B
S/sx of epiglottitis
Rapid onset and progression of sx Sore throat Odynophagia/dysphagia Fever Muffled or hoarse voice Drooling, dysphagia, distress
PE of epiglottitis
Stridor Voice muffling Tripod position or sniffing position Drooling/inability to handle secretions Cervical adenopathy Toxic appearance
Workup of epiglottitis
Nasopharyngoscopy/laryngoscopy
Lateral neck soft-tissue radiography
Blood cultures
Tx of epiglottitis
Have intubation equipment ready
Airway management
Third-generation cephalosporin
MCC of oral candidiasis
Candida albicans
Causes of oral candidiasis
Inhaled corticosteroid use
Immunocompromised pts
Antibiotic use
S/sx of oral candidiasis
Infants: pain, poor feeding, fussiness
Others: Itching, burning, soreness
PE of oral candidiasis
White plaques that may affect the lips, tongue, gums, and palate
Scraping may reveal erythema and bleeding at the base
Labs of oral candidiasis
KOH slide preparation
Tx of oral candidiasis
Nystatin oral suspension
S/sx of peritonsillar abscess
Sore throat/dysphagia and neck swelling and pain: usually for 5-7 days, not improving on abx
Trismus
Fever
Pooling of saliva and drooling
Tiredness, irritability, and reduced oral intake
Muffled voice
Referred ear pain
PE of peritonsillar abscess
Potential respiratory distress
Moderately uncomfortable appearing
Asymmetric swelling of the soft tissues with displacement of the affected tonsil medially and anteriorly
Tonsil may have erythema and exudates
Uvula is displaced to the contralateral side
Halitosis
Cervical and submandibular LAD
Causes of peritonsillar abscess
GABHS S. aureus Alpha-hemolytic streptococci Coagulase-neg staphylococci S. pneumoniae
Labs for peritonsillar abscess
CBC with diff
Serum electrolytes if oral intake has declined
Throat culture
Imaging for peritonsillar abscess
CT with IV contrast when dx is unclear, pt is uncooperative with the exam, and when infectious process is thought to involve deeper structures
Tx of peritonsillar abscess
Hydration Analgesia Drainage Outpatient: Augmentin IV ceftriaxone
