ENT and Ophtho Flashcards
Peritonsillar abscess S+Sx
Typical pt: Adolescent with a recent hx of acute pharyngotonsillitis
S+Sx:
- Sore throat
- Fever
- Trismus
- Dysphagia
Physical exam:
- Asymmetric tonsillar bulge with displacement of uvula
(Asymmetric bulge is diagnostic but may be poorly visualized because of trismus)
Absolute indications for adenotonsillectomy (5)
Absolute:
- OSA (AHI >5/hr) and large tonsils
- cor pulmonale
- suspected malignancy
- hemorrhagic tonsillitis
- severe dysphagia
Relative indication for adenotonsillectomy (# of infections)
Recurrent tonsillitis indications: - 7 episodes in 1 yr - 5-6 episodes/year x 2 years - 3-4 episodes / year x 3 years (other relative indications: tonsillar hypertrophy, complications of tonsillitis, tonsilloliths and halitosis)
Differentiating acute bacterial sinusitis from a cold
More suggestive of sinusitis if:
- Persistence of nasal congestion, rhinorrhea and daytime cough >=10 days without improvement - Severe symptoms e.g. temp >= 39C with purulent nasal discharge for 3-4 consecutive days - Worsening symptoms either by recurrence of sx after initial improvement or new sx of fever, nasal discharge and daytime cough
Treatment for mumps
analgesia and antipyretics, warm and cold packs, NSAIDs,
Complications of mumps
- Orchitis
- Oophoritis
- Meningitis (aseptic)
- Encephalitis
- Deafness
Vocal cord paralysis features on laryngoscopy
ADDUCTION during inspiration (indicates paralysis)
Associations with bilateral vocal cord paresis
Associations with bilateral paralysis: CNS lesions e.g. myelomeningocele, Chiari malformation and hydrocephalus
Unilateral paralysis: most often iatrogenic from surgical treatment for GI e.g. TEF and CV (PDA repair)
Visual development - Babies
- 31 weeks GA
- <1 week
- birth to 4 weeks
- 6-8 weeks
- 2-3 months
- 3-4 months
> 31 weeks gestation: pupillary response
< 1 week: blink/aversion to bright light
Birth to 4 weeks: face follow
6-8 weeks: eye contact and react to facial expression
2-3 months: interest in bright objects (can follow through 180 degrees)
3-4 months: eyes properly aligned (no strabismus), fix and follow toy
ROP screening
< 31 weeks
< 1250 grams birth weight
Orbital cellulitis vs. preseptal cellulitis
Orbital cellulitis has pain with eye movements, proptosis, may have visual impairment, ophthalmoplegia +/- diplopia, may have chemosis and is more likley to have fever and leukocytosis
DDx for acute visual impairment with red eye (7)
- Cornear ulcer (from abrasion/contact lens)
- Hyphema (from trauma)
- Endophthalmitis (infectious)
- posterior uveitis (no signs of erythema)
- orbital cellulitis (infectious)
- Keratitis
- Anterior uveitis
- Foreign body
Leukocoria DDX (10)
- Cataract
- Persistent hyperplastic primary vitreous
- Cicatricial retinopathy of prematurity
- Retinal detachment and retinoschisis
- Larval granulomatosis
- Retinoblastoma
- Endophthalmitis
- Organized vitreous hemorrhage
- Leukemic ophthalmopathy
- Exudative retinopathy
Infant born to mother with untreated gonorrhea
- conjunctival culture
- single dose of ceftriaxone before cultures return
- if unwell: then blood and CSF cultures and if established gonoccocal disease, then require additional investigations and treatment in consultation with specialists.
How to differentiate pseudostrabismus from strabismus
To differentiate from true misalignment:
- Corneal light reflex is centred in both eyes
- Cover-uncover test shows no refixation movement
