ENT Flashcards
Most common cause of conductive hearing loss?
Middle ear effusion (OME)
What are clues to mild conductive hearing loss?
Ignoring commands, slight increase in television volume
How does a cholesteatoma present?
Ear discharge (with canal debris) or hearing loss or both in the affected ear; foul-smelling debris after TM perforation
Treatment of cholesteatoma?
Surgical removal
Presentation of viral labyrinthitis?
Sudden onset of bilateral sensorineural hearing loss
Causes of sensorineural hearing loss?
Loop diuretics, aminoglycosides, salicylate, viral (CMV, MMR, toxo)
Most common neonatal cause of hearing loss?
Bacterial meningitis (usually in first 24 hours)
Most common cause of chronic suppurative OM?
Pseudomonas
What is the dx if chronic suppurative OM does not respond to treatment?
Cholesteatoma
Treatment of choice for chronic otitis media?
Tubes (not antibiotics)
When and why to change antibiotics in AOM?
Fever and/or pain 2-3 days after starting PO antibiotics
Complication of of tympanostomy tubes causing bloody otorrhea?
Tympanostomy tube granuloma
Most common cause of otitis externa?
Pseudomonas
Prevention of otitis externa?
Ear plugs, acidifying ear canal (boric acid or acetic acid)
Treatment of external ear hematoma?
Needle aspiration
Treatment of mastoiditis?
IV abx and surgery
FACES–mnemonic for causes of chronic rhinitis?
Foreign body Allergies Cystic fibrosis Extra tissue (polyps) Sinusitis
Presentation of choanal atresia?
Cyanosis while feeding and resolution with crying
What is CHARGE syndrome?
Coloboma Heart defects Atresia choanae Retardation of growth and development GU abnormalities Ear abnormalities (including SNHL)
What test to order in patient with nasal polyps?
Sweat chloride (rule out CF)
When do sinuses develop?
Maxillary–at birth
Ethmoid–at birth
Sphenoid–start at 3yo, finished at 7yo
Frontal–finished in early teen years
CNS Complication of AOM?
Meningitis
CNS complication of acute sinusitis?
Orbital cellulitis (ethmoid sinusitis--ethmoid/eye) Brain abscess (frontal sinusitis)
Risk factors for chronic sinusitis?
Allergies, immune deficiency, primary ciliary dyskinesis, CF
Test of choice with worsening epistaxis?
CT (rule out posterior NP mass, like nasopharyngeal angiofibroma)
Can GAS be positive with EBV mono?
YES–asymptomatic carriers!! (Does not necessarily differentiate EBV and GAS pharyngitis–look for HSM with EBV)
Difference between CMV and EBV mono?
Kids with CMV are older; however, preschool kids with EBV are usually asymptomatic
At what age is monospot most INsensitive?
Less than 4yo–do viral titers (can also be negative and become positive weeks into disease)
Presentation of GC pharyngitis?
Sexually active teen, usually with hx of STD’s, pharyngitis with erythematous patches; test for GC pharyngitis and for other STD’s
What is trismus?
Inability to open the mouth
Presentation of peritonsillary abscess?
Dysphagia, trismus, drooling, cervical adenopathy, unilateral peritonsillary swelling, deviation of uvula; dx with CT
Treatment of PTA?
Needle aspiration, abx–Unasyn/Augmentin, clinda
Presentation of RPA?
Hyperextended or stiff neck, drooling, respiratory difficulties, adenopathy, fever, dysphagia
Diagnosis of RPA?
CT (widening of retraphyngeal space)
Treatment of RPA?
Needle aspiration, abx–Unaysn/Augmentin, clinda
Compare/contrast RPA and epiglottitis.
Both have drooling and may have respiratory difficulties; epiglottitis lean forward, while RPA hyperextendes neck
Age difference between PTA and RPA?
RPA more common in kids <4yo
Presentation of cold-induced panniculitis?
Tender red nodules on cheek, afebrile, good PO, sleeping with something very cold like teething pacifier
Causes of delayed tooth eruption (4H + Rickets)?
Hypothyroidism Hypopituitarism Hypoplasia (ectodermal) Hypohidrosis Rickets
Treatment of dental abscess?
Penicillin (clinda or azithro if allergic)
Mnemonic for causes of inspiratory stridor (INSP)?
Immobile cords (paralyzed–bilateral)
Noid (adenoid and tonsillary enlargement)
Soft cartilage (laryngomalacia)
Pharyngeal and hypopharyngeal masses
Most common cause of congenital stridor?
Laryngomalacia
Cause of vocal cord paralysis?
Traumatic injury to recurrent laryngeal nerve at birth or to CNS injury/impairment
Do kids with laryngomalacia have feeding problems or FTT?
NO!!
What finding does tracheomalacia cause?
Expiratory stridor or wheezing (trachea is intrathroracic, so increased pressure during expiration causes collapse); stridor may be biphasic if lesion is high enough
Hint for vascular ring causing expiratory stridor?
Feeding problems
Presentation of epiglottitis?
4 or 5yo, inspiratory (or biphasic) stridor, drooling, dysphagia, dysphonia, distress, leaning forwards, no vaccines; NO cough
Epiglottitis finding on lateral neck XR?
Thumb sign (edematous epiglottis)
Treatment of epiglottitis?
Airway emergency–prep for intubation if necessary; ceftriaxone (HiB)
Serious complication of croup?
Bacterial tracheitis super-infection
Presentation of spasmodic croup?
Usually allergic, nightly symptoms, hx of atopic issues, no preceding URI symptoms
Treatment of spasmodic croup?
Same as viral croup
Cause of laryngeal papillomas?
HPV–cause hoarseness, treat with laser, consider child abuse
Presentation of thyroglossal cyst?
Midline anterior neck lesion, moves vertically with swallowing or sticking out tongue, may be communicating with skin
Treatment of thyroglossal cyst?
NO surgery–may be only functioning thyroid tissue
Presentatio of adenviral lymphadenopathy?
Preauricular LAD and conjunctivitis
Most common cause of bacterial parotitis?
Staph aureus
Treatment of atypical mycobacterial lymphadenitis?
Surgical excision
