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Royal College > ENT > Flashcards

ENT Flashcards

1
Q

Symptoms and exam of a peritonsillar abscess

A

Severe sore throat
Fever
Trismus*
Hot potato voice
Dysphagia or odynophagia
Lymphadenopathy
Asymmetric tonsillar bulge with displacement of the uvula

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2
Q

Treatment of a peritonsillar abscess

A

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

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3
Q

Symptoms of a retropharyngeal abscess

A

Fever, irritability, decreased PO, dysphagia
Drooling*, trismus can occur
Neck stiffness/torticollis, refusal to move the neck, often held extended
May have sore throat, muffled voice, stridor, resp distress

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4
Q

Diagnosis and treatment of a RPA

A

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

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5
Q

Complications from RPA

A

Upper airway obstruction
Rupture leading to aspiration pneumonia
Extension to the mediastinum
Thrombophlebitis of the internal jugular vein
Erosion of the carotid sheath

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6
Q

Leimerre disease

A

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

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7
Q

Indications for tonsillectomy

A

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

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8
Q

Indications for adenoidectomy

A

Persistent mouth breathing
Repeated or chronic otitis media with effusion
Hyponasal speech
Adenoid facies
Persistent or recurrent nasopharyngitis related to hypertrophy

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9
Q

Differences between bacterial tracheitis and epiglottitis

A

Bacterial trach: can lie flat, no drooling, no dysphagia

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10
Q

Symptoms of bacteial tracheitis

A

Usually follows a viral URTI
Ill appearing with high fever, brassy productive cough, resp distress
Stridor does not respond to usual treatment

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11
Q

Management of bacterial tracheitis

A

Clinical diagnosis
Intubation/trach is frequently required
Abx (CTX and vanco)

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12
Q

Symptoms of epiglottitis

A

Fever, sore throat, drooling, stridor
Ill appearing
Tripod position with chin extended

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13
Q

Management of epiglottitis

A

Keep child calm, no tongue depressors d/t risk of airway spasm
Consult ENT or anesthesia for intubation
Abx (CTX and vanco)

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14
Q

Laryngomalacia symptoms

A

Inspiratory stridor
Worse with agitation, feeds, and lying supine
Exacerbated by viral resp infections, dysphagia, and GERD

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15
Q

Where is the obstruction with
1. Inspiratory
2. Expiratory
3. Biphasic
stridor?

A
  1. Extrathoracic (above cords)
  2. Intrathoracic (below cords)
  3. Fixed obstruction
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16
Q

Difference between laryngomalacia and tracheomalacia?

A

Laryngo = inspiratory stridor
Tracheo = expiratory stridor

17
Q

What other issue is associated with a vascular ring?

A

Stridor plus feeding issues
Causes esophageal compression

18
Q

Symptoms of vocal cord paralysis

A

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)

19
Q

Where is the obstruction (plus example) if the flow volume loop is truncated on the
1. Bottom
2. Top
3. Both sides

A
  1. Inspiratory (ex: vocal cord dysfunction)
  2. Expiratory (asthma)
  3. Fixed (hemangioma)
20
Q

Treatment for tube otorrhea

A

Topical quinolone drops
Do not need PO antibiotics unless systemic symptoms, cannot tolerate PO, or failed topical

21
Q

Which children with AOM can you use watchful waiting approach for?

A

Mild or moderately bulging TM
Mildly ill
Alert
Fever <39
Responding to antipyretics
Mild ear pain

22
Q

Which children with AOM can you NOT use watchful waiting approach for and must treat with abx

A

Bulging TM
Fever > 39
Moderately to severely ill
Severe otalgia
Significantly ill x48 hours
Perforated TM with purulent drainage

23
Q

Treatment choices for AOM

A

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

24
Q

How long to treat for AOM

A

2 years or older = 5 days
< 2 years, recurrent AOM, perforated AOM, failure of initial therapy = 10 days

25
Q

Symptoms of sinusitis

A

Nasal congestion, rhinorrhea, daytime cough for 10+ days
Temp 39+
Purulent nasal discharge for 3+ days
Recurrence after initial improvement or new symptoms

26
Q

Treatment for sinusitis

A

Amox +/- clav for 10-14 days

27
Q

Symptoms of mumps

A

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

28
Q

2 most common complications from mumps

A

Meningoencephalitis
Orchitis

29
Q

Thyroglossal duct cyst vs branchial cleft cyst vs dermoid cyst

A

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

30
Q

Which symptoms qualify a child for neb epi for croup

A

Moderate to severe croup
Stridor at rest, moderate retractions, more severe sxA

31
Q

ABCDs risk factors for hearing loss

A

Affected family member
Bilirubin
Congenital TORCH infection
Defect of the ears, nose, throat
Small at birth (<1500 g), low APGARs, NICU stay

32
Q

Ranula

A

Cyst associated with salivary gland in the sublingual area
Large, soft, painless, mucus containing
Tx with surgical excision

33
Q

Mucocele

A

Salivary gland lesion most common on lower lip
Appears like fluid filled vesicle or fluctuant nodule
Tx with surgical excision

34
Q

Development of the
1. Ethmoidal
2. Maxillary
3. Sphenoid
4. Frontal
Sinuses

A
  1. Present and pneumatized at birth
  2. Present at birth, pneumatized by 4 years
  3. Present by 5 years
  4. Begin development at 7-8 years, completed in adolescence
35
Q

When should children first see the dentist?

A

Within 6 months of first tooth eruption or no later than 12 months of age

36
Q

Most common cause of nasal polyposis

A

CF

37
Q

Treatment for nasal polyps

A

Intranasal steroid sprays
Decongestants for symptoms (but will not shrink the polyps)
Surgical removal for complete obstruction, uncontrolled rhinorrhea, or deformity of the nose

38
Q

Perichondritis symptoms and treatment

A

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

39
Q

Benign vertigo of childhood symptoms and treatment

A

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

Royal College (15 decks)

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