ENT Flashcards
Three upper respiratory bacteria to always consider?
H. inf, S. pneumo, Moraxella catarrhalis
Difference in bacteria above and below the gingival margin?
- above = facultative
- below = anaerobic
Four organisms found above the gingival margin?
Strep spp., Lactobacillus, Enterobacteriaceae (more in chronically ill patients), Moraxella
Six organisms found below the gingival margin?
- Peptostrep
- Actinomyces
- Fusobacterium
- Spirochetes
- Prevotella
- Veillonella
Three special pathogens associated with ENT system?
- Corynebacterium diphtheria
- S. aureus
- P. aeruginosa
Top four viruses responsible for the common cold?
- Rhinovirus
- Influenza
- Coronavirus
- Adenovirus
- Others are paramyxoviruses
What is the term for inflammation of mucous membranes lining the nose often associated with nasal discharge?
Coryza
Two common causes of serous otitis media associated with Eustachian tube dysfunction?
viral infection and allergic disease –> blockage and fluid build-up
Why are children more prone to middle ear infections?
Eustachian tube is more horizontal
What kind of treatment does malignant otitis externs warrant?
- systemic IV antibiotics
- hospitalization
Two common bacterial causative agents of purulent otitis media?
S. pneumo and H. inf
Three complications associated with purulent otitis media?
- conductive hearing loss
- mastoiditis
- meningitis
What is the most common manifestation of otitis media in adults?
serous otitis media (viral, allergic)
Three symptoms of otitis media serous?
- ear FULLNESS (vs. pain in purulent cases)
- popping with jaw movement
- decreased hearing
Causes of acute and chronic forms of otitis externs?
- acute = 50% P. aeruginosa
- chronic = >3 months, fungal and allergic dermatitis
How can the tragus sign be used to distinguish otitis media and externa?
- for pain in otitis externa
- negative for pain in otitis media
Complication of otitis externa?
malignant otitis externa
Who gets malignant otitis externa?
- IC
- poorly controlled DM
- transplant patients
Two pathogens associated with malignant otitis externa? Two complications?
- P. aeruginosa and S. aureus (cellulitis)
- systemic infection and osteomyelitis
Drainage to superior meatus?
- sphenoid
- posterior ethmoid air cells
Drainage to middle meatus?
- frontal, maxillary, anterior and middle ethmoid air cells
Drainage to inferior meatus?
lacrimal duct
What can sinus transillumination be used to diagnose?
- EXCLUDE maxillary sinusitis (sensitive but not specific)
- frontal sinusitis
- detects opacification of sinuses
Four complications of acute sinusitis?
- periorbital cellulitis
- meningitis
- subdural empyema
- cranial sinus thrombosis
What causes Pott’s puffy tumor?
- initial trauma breaks skin of forehead
- frontal sinusitis develops and causes osteomyelitis of the calvarium
Four complications seen with Pott’s puffy tumor?
- scalp abscess
- brain abscess
- chronic osteomyelitis of frontal bone
- subdural empyema
Why enzyme produced by mucormycosis allows it to proliferate well in poorly controlled diabetics?
- ketone reductase
- poorly controlled DM are often in diabetic ketoacidotic state
- mucor can survive on the ketones
Invasion of rhino cerebral mucormycosis? Tx?
- sinuses, orbit, brain
- best chance is IV anti-fungals and surgery
When you see necrotic nasal eschar, think…
rhinocerebral mucormycosis
What factors are associated with acute necrotic ulcerative gingivitis?
- poor nutrition
- smoking
- bacterial overgrowth
What is and who gets noma (canchrum oris)? Mortality?
- anaerobic infection that begins as non-odontogenic and progresses to face via gingiva
- severely malnourished children
- 70-90%
When are sulfur granules seen?
- Orofacial actinomycosis
- yellow granules observed in pus that consist of WBC’s containing actinomyces
Progression of orofacial actinomycoses? Tx?
- arises from gingival crevice
- associated with poor dentition and causes slowly developing purulent jaw abscess and lung infections
- PENICILLIN
Three predisposing conditions to oral candidiasis (thrush)?
- steroids (poor technique w/ inhaled steroids)
- diabetes
- IC (HIV/AIDS)
What causes a painless white plaque of the tongue that is difficult to scrap off?
Oral candidiasis (thrush)
What virus is causative in Kaposi’s sarcoma and who gets it?
- HHV-8
- IC (HIV/AIDS)
Where do Kaposi’s sarcomas usually appear on the body? What are they?
- palate, gingiva, skin, viscera
- hyperplastic purple vascular lesions
What is oral leukoplakia and what should be done about it?
- white plaques anywhere on oral mucosa
- may be response to chronic irritation, pre-malignant lesion
- BIOPSY
What virus is hairy leukoplakia associated with? Where is it seen?
- EBV-induced epithelial hyperplasia in HIV/AIDS patients
- corrugated white lesion seen on lateral aspect of tongue
Typical causal agent of acute epiglottitis?
H. inf Type B (HiB)
Radiological sign of acute epiglottitis?
- thumb sign in lateral neck film
- enlarged epiglottis appears like a thumb
If exudate is present in acute pharyngitis, what 5 organisms should be suspected?
- GAS
- EBV
- HSV
- adenovirus
- Gonorrhea
Three clinical S&S associated with GAS pharyngitis?
- exudate
- ipsilateral tender tonsillar LN
- fever
If bilateral tonsillar notes are palpated in associated with acute pharyngitis, what virus should be suspected?
EBV
Untreated GAS pharyngitis is a risk for…
rheumatic fever
What is Lemierre’s syndrome?
odontogenic/pharyngitic anaerobic infection that extends into carotid sheath producing septic thrombosis of internal jugular vein
What lung symptoms are associated with Lemierre’s?
infected thromboemboli travel to lungs producing nodules and masses
Three predisposing factors to Lemierre’s?
DM, malnutrition, smoking
4 clinical signs of Lemierre’s?
- fever
- SCM and jaw angle tenderness
- neck stiffness
- dysphagia
Where is the cervical danger space found and what does it allow access to?
- between alar fascia and pre vertebral fascia posterior to the retropharyngeal space
- allows access to diaphragm
What is Ludwig’s angina?
begins as odontogenic infection that progresses to submandibular space
Complications associated with Ludwig’s angina? Tx?
- elevated tongue and floor of mouth pushes into roof of the mouth causing airway obstruction
- antibiotics and surgical debridement (+ tracheostomy)
In addition to antibiotics, what do closed source infections require for treatment?
SOURCE CONTROL - drainage, debridement
Gram stain morphology of C. diphtheria?
GPB
What are most C. diphtheria symptoms due to?
toxin elaboration
Two unique exam findings associated with C. diphtheria?
- pseudomembrane
- bull’s neck adenopathy
- also pharyngitis, fever, malaise, hoarseness; carditis and neuropathy
