ENT 3 highlights Flashcards
Chronic rhinosinusitis (CRS) is an inflammatory condition involving paranasal sinuses & linings of the nasal passages lasting ______________ weeks
> /12 weeks
What does CRS (chronic rhinosinusitis) diagnosis require?
Objective evidence of mucosal inflammation
Four (4) cardinal signs & symptoms of CRS in adults and kids
1) Mucopurulent drainage
2) Congestion (bilateral)
3) Facial pain
4) Reduction or loss of sense of smell
-in kids: cough
True or false: fever, any eye changes, or change beyond the sinuses (meningeal signs, etc) with CRS require immediate evaluation
True
What are the 4 steps of gathering objective evidence to evaluate chronic rhinosinusitis (CRS)?
1) Clinical Hx
2) Objective documentation of mucosal disease
3) Allergy eval (optional)
4) Consideration of immunologic defects & infectious complications (recurrent episodes, etc)
What type makes up 60-65% of CRS cases?
CRS without nasal polyps
1) Most cases of what kind of CRS are found in immunosuppressed individuals?
2) What is the most common cause of this kind?
1) Invasive fungal rhinosinusitis
2) Aspergillus
1) How do you confirm an invasive fungal rhinosinusitis Dx?
2) What is the first step to treating this condition?
1) Tissue biopsy
2) Hospital admission & ENT referral
Where else should you look for FBs besides the nose?
Ears
What is a concern/ complication with nasal fractures? What does it require?
Septal hematoma; urgent ENT referral
What is the most common neoplasm found in sinuses & nasopharynx?
Squamous cell carcinoma (SCC)
What are 2 nasal cancer-related symptoms?
Pain and recurrent hemorrhage
Are inverted papillomas benign or malignant? Explain.
Benign, but malignant potential; SCC seen in 10% of cases
Painful, acute gingival inflammation & necrosis are the classic symptoms of what?
Necrotizing ulcerative gingivitis
(aka “Vincent’s Angina, Trench Mouth”)
Apthous stomatitis are also called what? Are they common?
Canker sores; common (5-21%)
What should you do if you aren’t sure if someone has a canker sore, or if it’s something else?
Incisional biopsy
Candida albicans is the typical cause of what?
Oral candidiasis (thrush)
Oral candidiasis (thrush):
1) List 3 factors for immunocompetent ppl
2) What is 1 risk factor relating to being immunocompromised that increases risk of thrush?
1) Antibiotic and/or steroid use, DM, anemia
2) HIV/AIDS
1) What is pseudomembranous?
2) What is it a Sx of?
1) White plaques on buccal mucosa, palate, tongue, & oropharynx that can be scraped off
2) Oral candidiasis (thrush)
HIV/AIDS patients may need longer duration of therapy for what oral condition?
Oral candidiasis (thrush)
What is the most commonly-encountered neck space infection?
Ludwig’s angina
How can Ludwig’s angina occlude the airway?
Tongue may be displaced upward & backward
What test would augment your clinical exam to Dx Ludwig’s angina?
CT with contrast
What are two complications that could occur if a deep neck abscess is inadequately/ not treated?
May spread to mediastinum or cause sepsis
What emergency interventions may a deep neck abscess warrant?
Intubation or tracheotomy
List the clinical features of epiglottitis
1) Severe sore throat
2) Dysphagia (hard to swallow)
3) Odynophagia
4) Drooling
5) Fever
6) Muffled or hoarse voice
7) Stridor
8) Dyspnea
9) Mostly normal OP exam
10) Minimal respiratory distress
Severe sore throat is a classic Sx of what emergency condition?
Epiglottitis
1) Who should you not perform an indirect laryngoscopy to examine for epiglottitis?
2) What position may a child be standing in if they have epiglottitis?
1) Children
2) “Tripod” position
1) What is the preferred way of imaging for epiglottitis?
2) What would you expect to see on this image of an epiglottitis case?
1) Xray
2) “Thumb print sign”
True or false: Epiglottitis is not an emergency
FALSE
What are two important components of epiglottitis Tx?
1) Airway management and evaluation
2) Hospitalization for IV antibiotics
1) What causes herpes labialis?
2) Is it rare or common?
1) Reactivation of HSV-1
2) Common
What are the two steps of signs/ symptoms of herpes labialis?
1) Prodrome
2) Eruption of clustered vesicles
What are the 3 treatment strategies for herpes labialis?
1) No Tx
2) Episodic therapy
3) Chronic suppressive therapy
What treatment is NOT necessary for acute laryngitis most of the time?
Antibiotics (usually not necessary)
Muffled voice “hot potato voice” is a common symptom of what?
Peritonsillar abscess
When you see deviation of the uvula on an exam, what may you also expect to see? What condition causes these?
Tender cervical lymphadenopathy; peritonsillar abscess
How should you treat peritonsillar abscesses? (3 steps)
1) Drainage of abscess larger than 1cm
2) Antibiotics
3) Hydration, analgesia, airway management
Name one critical complication of peritonsillar abscesses
Airway obstruction
Is pharyngitis rare or common?
Very common
What testing should you consider for acute pharyngitis?
SARS-CoV-2
Most common cause of pharyngitis is what?
Viral pharyngitis
Pharyngitis with significant fatigue is a symptom of what?
Infectious mononucleosis
What would you expect to see upon exam of a pt with infectious mononucleosis?
Posterior cervical & auricular lymphadenopathy (and shaggy exudates)
Infectious mononucleosis:
1) What would you expect to see on CBC?
2) What abt on peripheral smear?
1) Lymphocytosis
2) Atypical lymphocytosis
What requires no contact sports for minimum 3-4 weeks?
Infectious mononucleosis
GABHS pharyngitis (step throat):
1) Who is it most common in?
2) List 3 supportive features
1) Children
2) Palatal petechiae, scarlatiniform rash, & strawberry tongue
Which adults should you test for GABHS pharyngitis (step throat)?
Those who lack symptoms of a respiratory viral syndrome (i.e. no runny nose, cough, but have strep Sx)
Centor criteria helps ID what?
GABHS pharyngitis
List the 4 Centor criteria
1) Pharyngotonsillar exudates
2) Tender anterior cervical lymphadenopathy
3) Fever
4) Absence of cough
-Also consider patient age (more likely in those 3-14 yrs old)
(3 or more criteria present: intermediate likelihood (test these patients)
When is it appropriate to use the Centor criteria?
When the need for testing for strep (GABHS pharyngitis) is unclear
How can you Dx most patients with suspected GAS pharyngitis?
Rapid antigen detection test (RADT)
If the RADT for a suspected strep (GABHS pharyngitis) case is negative, when should you then do a throat culture? (give 2 examples)
Children or high clinical suspicion for GAS (i.e., exposure to persons with GAS, > 3 Centor criteria)
What is the first line of defense for treating GABHS pharyngitis (strep)?
Penicillin VK PO
List 3 complications of GABHS
1) ARF (acute rheumatic fever)
2) Poststreptococcal glomerulonephritis
3) Scarlet fever
1) What is scarlet fever a potential complication of?
2) What are its classic symptoms?
1) GABHS pharyngitis
2) Sandpaper rash and strawberry tongue
Adherent grayish membrane on the tonsils is a sign of what type of bacterial pharyngitis?
Diphtheria
1) Name 2 conditions in which you may see Sialadenitis
2) What’s it often caused by?
1) Sjogren’s syndrome, dehydration
2) S. aureus
What would you expect to see on PE of sialadenitis
Pus often massaged from the duct
Sialagogues (lemon drops) can help treat what?
Sialadenitis
1) Suppurative parotitis is often seen in who?
2) When should you consider mumps as a DDx for this?
3) What is a main symptom?
1) Elderly postoperative pts
2) In children & young adults
3) Pain and tenderness [of jaw/ inferior mandible]
1) What is leukoplakia?
2) List 3 risk factors
1) White adherent patch or plaque (premalignant)
2) Tobacco, dentures, lichen planus
1) White, corrugated & painless plaques that cannot be scraped off [often on lat. tongue] is characteristic of what?
2) Is it premalignant?
1) Oral hairy leukoplakia
2) No, NOT premalignant
Raised, firm, white lesions with ulcers at base on the lateral surface of the tongue should make you think of what condition?
Squamous cell carcinoma (SCC)
1) What does SCC look like in the mouth?
2) Where is it usually located?
1) Raised, firm, white lesions with ulcers at base
2) Lateral surface of tongue
1) Who are upper airway FBs most common in?
2) Where are 52% found?
1) Children
2) Right main bronchus
Wheezing, coughing, or stridor are three Sx of what?
Upper airway FB
1) What usually causes esophageal FB?
2) What are 2 Sx of complete obstruction?
1) Food bolus
2) Drooling, inability to handle secretions
