ENT Flashcards
What is the treatment for Acute Otitis Externa?
Ciprodex (most $) or Cipro Otic (has hydrocortisone)
or Oxfloxacin or acetic acid sol (cheapest)
3-4 ggts BID x 1 week
What is the potentially lethal complication of OE?
Malignant otitis externa that can involve the bone (osteomyelitis), and spread into head and neck.
- sigmoid sinus thrombosis
- meningitis
What are risk factors for malignant otitis externa (OE)?
Immunocompromised
Diabetes
- is generally a pseudemonal infection
What are some complications of AOM?`
- perforation of TM
- Acute labyrinthitis
- Mastoiditis
- Meningitis
- Brain abcess
- Lateral sinus/sigmoid sinus thrombosis (MRI>CT)
- Facial nerve paralysis
- Chronic OM
Explain the pathophysiology of boxer’s ear?
Cauliflower ear
- the cartilage depends on the perichondral blood supply and any interruption can lead to necrosis. Stimulation of the overlying perichondrium can result in asymmetric formation of cartilage and a resultant deformed auricle.
What is the treatment for an ear hematoma?
I+D - clot needs to be completely evacuated to avoid deformity and pressure on area for several days to prevent re-accumulation of fluid.
F/U in 24 hours to check for re-accumulation
What area do anterior nosebleeds bleed from?
Kisselbach plexus (littles area)
is a Plexus made from:
1. Anterior ethmoidal artery (from the ophthalmic artery)
2. Sphenopalatine artery (terminal branch of the maxillary artery)
3. Greater palatine artery (from the maxillary artery)
4. Septal branch of the superior labial artery (from the facial artery)
What is the source of most posterior nose bleeds?
SPA (sphenopalatine artery)
is from the IMA (terminal branch of internal maxillary a. which comes off the external carotid a.)
In patient with posterior bleed and ant and post packing has been done, what is the next step? what other sx options are there?
- ENT consult
- Abx (Amox- Clav, Cephalexin)
- Their options
- IMA - internal maxillary a., or SPA embolization
- endoscopy
- open surgical approaches
What are complications of posterior nose packing? (reasons why we admit)
- Reflex bradycardia (stimulation of deep post. pharynx)
- Airway compromise
- Sleep Apnea (studies say not severe tho..)
- Nasal septal pressure necrosis
- Abscesses
- Neurogenic syncope
- Toxic shock syndrome
- Persistent bleeding and restart of bleeding
Patient with nasal fracture that is severely swollen, what is the f/u time frame needed with ENT for elective closed reduction?
6-10 days for adults
Peds within 4 days and ER may not reduce - may need GA
What is F/U duration for ENT after septal hematoma incision and drainage and packing?
24 hours.
When do the sinuses development in children?
Born with ME (Maxillary and ethmoid)
Sphenoid at 5 years old
Frontal at 7 years old
Paranasal fully developed around 12
What are some serious complications of sinusitis?
- Meningitis
- Cavernous sinus thrombosis
- Intra-cranial abcess
- Osteomyelitis (Pott’s Puffy Tumor of frontal bone)
What is the risk of long term use of topical nasal decongestants?
if used >3 days can have rebound mucosal congestion or edema
When do you treat sinusitis with Abx?
what Abx do you use?
If suspect bacterial (purulent d/c)
- Amoxicillin
- if allergic then erythromycin or septra
- If Abx in past 4-6 weeks consider Amox Clav or Flouroquinolone
Cochrane review showed no difference in Abx classes
What type of cancer are 90%of oral cancers?
Squamous cell carcinoma
this is followed by lymphomas, kaposi sarcoma, melanoma
What is the ddx for a peritonsillar abcess?
- peritonsillar cellulitis
- Infectious mononucleosis
- Lymphoma
- Herpes simplex tonsillitis
- Retropharyngeal abcess
- Neoplasm
- Foreign body
- internal carotid a. aneursym
What is the non-surgical management of a PTA after aspiration or I+ D?
- 125 mg methylprednisone
- Abx:
Amox Clav 875 PO BID + Flagyl 500 mg QID
If penicillin allergic:
Clindamycin 150 mg PO QID
What are the potential complications of a PTA?
- Airway obstruction
- Rupture and aspiration
- Carotid sheath erosion causing hemorrhage
- Retrophargyneal abscess
- Mediastinitis
- Post streptococcal sequelae (rheumatic fever, post strep GN, PANDAs etc)
What are the complications of GAS infection?
- Peritonsillar abcess
- Retropharyngeal abcess
- Rheumatic fever
- PANDAS - acute OCD
- Post strep GN
- Scarlet fever
- Toxic shock syndrome
- Otitis Media
- Cervical adneitis
- Post Strep Arthritis
- Meningitis
- Bacteremia
- Cellulitis (not from strep throat tho)
What organism typically causes adult epiglottitis?
Strep and Staph
in peds classically Hib
What is the ddx of a neck mass? aside from reactive lymphadenopathy
- Lymphoma
- Squamous cell carcinoma
- Brachial cleft cyts
- Ranula (mucus retention cyst of sublingual gland)
- Thyroglossal duct cyts
- Acute retroviral syndrome
- Tumors from parotid, submandibular, thyroid gland
- Metastases
what is the definition of angioedema?
paroxysmal non-demarcated swelling of dermal or submucosal layers of skin or mucosa
What are the 4 etiologies of angioedema?
- Congenital or acquired loss of C1 esterase inhibitor (autosomal dominant)
- immunoglobulin E mediated Type I allergic rxn
- Rxn to ACEI
- idiopathic
What is the C1 esterase inhibitor?
regulates the complement pathway. deficiency results in angioedema…
In pt with this presenting with edema, can give epi and support airway + prepare for surgical aw if severe.
How do ACE-i cause angioedema?
Acei alter conversion angiotensin I to II, and inactivate bradykinin. They get a local incr in bradykinin which causes vasodilation and incr vascular permeability.
What are risk factors for OM in children?
- male
- daycare
- parental smoking
- pacifier use
- Fam Hx ear problems
- Anatomical abN (downs - eustachian tube Abn anatomy)
Breastfeeding is protective
What are the 2 major categories of layers in the cervical fascia?
- Superficial layer
- Deep Layers
- Includes: Superficial, middle and deep portions
What comprises the superficial layer of the Deep cervical fascia?
- Muscles
- Sternocleidomastoid
- Trapezius - Glands
- Submandibular
- Parotid - Spaces
- Posterior Triangle
- Suprasternal space of Burns
What comprises the superficial superficial layer of neck fascia?
Platysma, and muscles of facial expression.
What are the 6 anatomical spaces within the DEEP neck fascia? and where do they connect?
- these run the whole course of the neck which is why they are clinically important.
- Anterior Viceral (also pretracheal) space
- connects to anterior mediastinum - Carotid Space - connects to mediastinum
- Retropharygneal space
- connects to posterior mediastinum - Danger space: between retropharyngeal space to perivertebral space
- connects to diaphragm - Posterior cervical space
- Perivertebral space
- posterior aspect connects to coccyx
What is another name for the carotid sheath? what vessels does it contain?
- Lincoln’s hiway
2. Carotid a. Internal jugular v., vagus nerve.
Whats in the middle layer of the deep cervical fascia?
- Muscular Division
- Infrahyoid Strap - Muscles
- Visceral Division
- Pharynx, Larynx, Esophagus, Trachea, Thyroid
- The viceral layer is part of this. - Buccopharyngeal Fascia
Anatomically where is the retropharyngeal space?
- Posterior to pharynx and esophagus
- Anterior to alar layer of deep fascia
- Extends from skull base to T1-T2
- Connects to mediastinum
Anatomically where is the ‘Danger space’?
- Anterior border is alar layer of deep fascia
- Posterior border is prevertebral layer
- Extends from skull base to diaphragm
Anatomically where is the Prevertebral space? aka. Perivertebral space
- Anterior border is prevertebral fascia
- Posterior border is vertebral bodies and
deep neck muscles - Extends along entire length of vertebral
column to coccyx
Anatomically where is the Anterior viceral/pretracheal space?
- Surrounds trachea, thyroid and esophagus
- Middle layer of deep fascia
- Contains thyroid, trachea, esophagus
- Extends from thyroid cartilage into superior
mediastinum
