ENT Flashcards
Symptoms and exam of a peritonsillar abscess
Severe sore throat
Fever
Trismus*
Hot potato voice
Dysphagia or odynophagia
Lymphadenopathy
Asymmetric tonsillar bulge with displacement of the uvula
Treatment of a peritonsillar abscess
Clinical dx, can use CT with contrast if debating cellulitis vs abscess
Surgical drainage + abx
Tonsillectomy if failure to improve within 24 hrs of abx, hx of recurrent PTAs or recurrent tonsillitis, or complications
Symptoms of a retropharyngeal abscess
Fever, irritability, decreased PO, dysphagia
Drooling*, trismus can occur
Neck stiffness/torticollis, refusal to move the neck, often held flexed w refusal to extend
May have sore throat, muffled voice, stridor, resp distress
Diagnosis and treatment of a RPA
Low suspcision = can do lateral neck XR
CT with contrast is preferred
Tx with IV abx (CTX + clinda for anaerobes, vanco if not responding)
Drainage if resp distress or failure to improve with IV
Complications from RPA
Upper airway obstruction
Rupture leading to aspiration pneumonia
Extension to the mediastinum
Thrombophlebitis of the internal jugular vein
Erosion of the carotid sheath
Leimerre disease
Infection from the oropharynx extends to cause septic thrombophlebitis of the internal jugular vein and embolic abscesses in the lungs (Fusibacterium necrophorum)
Prev healthy adolescent with recent pharyngitis, acutely ill with fever, hypoxia, tachypnea, and resp distress
CT shows cavitary nodules and pleural effusion
TX with IV abx (penicillin) +/- surgical drainage
Indications for tonsillectomy
Recurrent pharyngitis: 7 episodes in 1 year, 5 in each of the past 2 years, or 3 in each of the past 3 years
Marked/severe adenotonsillar hypertrophy
Severe sleep apnea
Indications for adenoidectomy
Persistent mouth breathing
Repeated or chronic otitis media with effusion
Hyponasal speech
Adenoid facies
Persistent or recurrent nasopharyngitis related to hypertrophy
Differences between bacterial tracheitis and epiglottitis
Bacterial trach: can lie flat, no drooling, no dysphagia
Symptoms of bacteial tracheitis
Usually follows a viral URTI
Ill appearing with high fever, brassy productive cough, resp distress
Stridor does not respond to usual treatment
Management of bacterial tracheitis
Clinical diagnosis
Intubation/trach is frequently required
Abx (CTX and vanco)
Symptoms of epiglottitis
Fever, sore throat, drooling, stridor
Ill appearing
Tripod position with chin extended
Management of epiglottitis
Keep child calm, no tongue depressors d/t risk of airway spasm
Consult ENT or anesthesia for intubation
Abx (CTX and vanco)
Laryngomalacia symptoms
Inspiratory stridor
Worse with agitation, feeds, and lying supine
Exacerbated by viral resp infections, dysphagia, and GERD
Where is the obstruction with
1. Inspiratory
2. Expiratory
3. Biphasic
stridor?
- Extrathoracic (above cords)
- Intrathoracic (below cords)
- Fixed obstruction
Difference between laryngomalacia and tracheomalacia?
Laryngo = inspiratory stridor
Tracheo = expiratory stridor
What other issue is associated with a vascular ring?
Stridor plus feeding issues
Causes esophageal compression
Symptoms of vocal cord paralysis
Absent or weak cry
Risk for aspiration (if unilateral, cord open)
Subdued or hoarse raspy voice
Bilateral tends to have more resp distress and stridor (closed cords)
Where is the obstruction (plus example) if the flow volume loop is truncated on the
1. Bottom
2. Top
3. Both sides
- Inspiratory (ex: vocal cord dysfunction)
- Expiratory (asthma)
- Fixed (hemangioma)
Treatment for tube otorrhea
Topical quinolone drops
Do not need PO antibiotics unless systemic symptoms, cannot tolerate PO, or failed topical
Which children with AOM can you use watchful waiting approach for?
Mild or moderately bulging TM
Mildly ill
Alert
Fever <39
Responding to antipyretics
Mild ear pain
Which children with AOM can you NOT use watchful waiting approach for and must treat with abx
Bulging TM
Fever > 39
Moderately to severely ill
Severe otalgia
Significantly ill x48 hours
Perforated TM with purulent drainage
Treatment choices for AOM
Amoxicillin
Use amox clav if tx with amox in past 30 days OR if amox fails as it could be due to H flu or Moraxella
How long to treat for AOM
2 years or older = 5 days
< 2 years, recurrent AOM, perforated AOM, failure of initial therapy = 10 days
Symptoms of sinusitis
Nasal congestion, rhinorrhea, daytime cough for 10+ days
Temp 39+
Purulent nasal discharge for 3+ days
Recurrence after initial improvement or new symptoms
Treatment for sinusitis
Amox +/- clav for 10-14 days
Symptoms of mumps
Prodrome for 1-2 days with fever, headache, vomiting and ache
Then develop parotitis - often unilateral but can spread to bilateral
Ear is pushed up and out
2 most common complications from mumps
Meningoencephalitis
Orchitis
Thyroglossal duct cyst vs branchial cleft cyst vs dermoid cyst
TDC: midline, moves with swallowing and tongue protrusion, often appears after viral URTI
BCC: lateral, usually presents infected
DC: midline, does NOT move with swallowing
All require surgical excision
Which symptoms qualify a child for neb epi for croup
Moderate to severe croup
Stridor at rest, moderate retractions, more severe sxA
ABCDs risk factors for hearing loss
Affected family member
Bilirubin
Congenital TORCH infection
Defect of the ears, nose, throat
Small at birth (<1500 g), low APGARs, NICU stay
Ranula
Cyst associated with salivary gland in the sublingual area
Large, soft, painless, mucus containing
Tx with surgical excision
Mucocele
Salivary gland lesion most common on lower lip
Appears like fluid filled vesicle or fluctuant nodule
Tx with surgical excision
Development of the
1. Ethmoidal
2. Maxillary
3. Sphenoid
4. Frontal
Sinuses
- Present and pneumatized at birth
- Present at birth, pneumatized by 4 years
- Present by 5 years
- Begin development at 7-8 years, completed in adolescence
When should children first see the dentist?
Within 6 months of first tooth eruption or no later than 12 months of age
Most common cause of nasal polyposis
CF
Treatment for nasal polyps
Intranasal steroid sprays
Decongestants for symptoms (but will not shrink the polyps)
Surgical removal for complete obstruction, uncontrolled rhinorrhea, or deformity of the nose
Perichondritis symptoms and treatment
Infection of skin and perichondrium of the auricular cartilage
Pain, swelling, erythema, +/- purulent discharge
Lobe is classically spared
Treat with abx that cover pseudomonas!
Surgery may be needed for abscess drainage
Benign vertigo of childhood symptoms and treatment
Common migraine equivalent
Brief episodes of vertigo, postural imbalances, nystagmus, may have diaphoresis, N/V
Normal EEG and MRI
Tx: diphenhydramine for cluster of attacks, preventative therapy with cyproheptadine may be rarely used
