ENT

Question 1

Auricular Hematoma General Info (6)

Answer 1

1. Typically results from blunt trauma to the auricle in a young, healthy athlete who participates in sports such as wrestling, rugby, martial arts, or boxing.
2. Daily follow-up is recommended for the first 3 to 5 days to evaluate for hematoma reaccumulation or evidence of infection
3. In an auricular hematoma, torn perichondrial vessels can cause a blood collection within this subperichondrial space, creating a mechanical barrier between the cartilage and the perichondrial blood supply.
4. If the hematoma is not properly drained, if it recurs, or if it is leN untreated, the lack of blood supply may lead to necrosis of the cartilage and fibrocarLlage overgrowth, ultimately leading to a deformity called cauliflower ear.
5. Antibiotics are not routinely indicated for patients with hematoma of the auricle.
6. Patients with acute auricular hematoma should avoid additional trauma to the affected ear until the injury is fully healed. When it is healed and the patient returns to athletics, appropriate headgear is recommended

Question 2

Auricular hematoma tx (7)

Answer 2

1. Evacuate quickly because they begin to clot, organize, and become firmer only about 24 hours after the injury.
2. Incision and drainage is the primary method for acute hematoma evacuation
3. A scalpel is used to incise along the natural skin folds, with care not to damage the perichondrium.
4. The hematoma should be expressed and the resulting pocket irrigated with normal saline.
5. To ensure continued drainage, the incision may be leN completely open, partially sutured, or have a small drain placed within it.
6. A simple, noninvasive compression dressing can then be applied.
7. Needle aspiration is used by some clinicians for hematomas smaller than 2 cm.

Question 3

Mono general info (3)

Answer 3

1. Can be from EBV or other viruses including CMV
2. Infection allows entry of the EBV into oropharynx
3. Transmission occurs with direct contact with saliva

Question 4

Mono incubation (4)

Answer 4

1. Incubation is 2-6 weeks (Usually 20 to 30 days)
2. Rate of transmission is as high as 55% in sibling contacts
3. 70 to 90% of children from low socioeconomic groups get this virus by age 5 years
4. 30 to 50% in upper middle class
   * Can look like mono from a variety of viruses
   * Mono like picture = bad sore throat, exudate, hepatosplenomegaly, malaise, fatigue
   * Day care centers = rather benign case of mono
   * Adolescent = upper middle case America

Question 5

Mono clinical presentation (7)

Answer 5

1. Fever
2. Severe sore throat
3. Lymphadenopathy
4. Vague symptoms: malaise, fatigue, anorexia
5. Can involve every organ system: hepatosplenomegaly, hepatitis with infrequent jaundice
6. Rash can occur which can be erythematous, petechial erythema multiforme like, urticarial and scarlatiniform in 20%
7. With Amoxil goes to 70 to 90 %
   i. Rash = 20% of patients = morbilliform, petechial, rash isnt specific
   ii. Won’t help you make diagnosis
   iii. Adenopathy, large tonsils, exudative, fatigue, not getting better
   iv. Need to have mono on index of suspicion
   v. Amox = awful morbilliform rash
   vi. Mono and EBV = PCN and Cephalosporin

Question 6

Mononucleosis: Management (9)

Answer 6

1. Supportive care
2. Rest
3. No contact sports for at least one month or until spleen is not palpable
4. Rest
5. Corticosteroids should not be used routinely
6. Use in significant airway obstruction
7. Use in neurological manifestations—seizures, meningitis, encephalitis, facial nerve palsy
8. No antiviral approval
9. Risk of Burkeg’s lymphoma in African American

Question 7

Mono management for prolonged cases of lymphoproliferative disease (7)

Answer 7

1. EBV can cause neurological — Alice and Wonderland Syndrome
2. Form of migraine headache and occurs following EBV infection
3. Makes her look bigger and smaller
4. Risk of Burkett’s lymphoma
5. African children when they get EBV at young age = Burketts
6. No antiviral*
7. Support, rest, fluids, Tylenol for fever