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
Indications for tympanostomy tubes
- recurrent AOM with middle ear effusion
- bilateral OME (> 3mos) with CHL
- unilat/bilat OME (>3mos) with other problems (vestibular, behavioural, pain, school)
- at risk children
- Other: complications of AOM, lack of response to tx, chronic retraction of TM
(**Recurrent AOM = 3+ well documented and separate AOM in past 6 months or 4+ in past 12 months with at least 1 in past 6 months)
Bifid uvula is associated with…
- Think submucosal cleft palate
also Loey-Doetz and connective tissue diseases
Tracheostomy and respiratory distress
- call for help
- manually ventilate with 100% oxygen
- suction via tracheostomy
- change tracheostomy
Perinatal risk factors for SNHL (5)
- Fam history
- craniofacial abN involving ext ear
- physical findings consistent with hearing loss syndrome
- congenital infections (TORCH)
- Nicu > 2 days or NICU with assested ventialtion, ototoxic drugs, hyperbili requiring exchange
Laryngomalacia natural history
Presents in first few days of life worsens for first 6 months plateaus 6-12 months resolves by 18-24 months (improvement can start at any time)
Laryngomalacia indications for surgery
- acute airway distress
- failure to thrive
- uncertain diagnosis
Complications of mastoiditis
Complications
- Meningitis - Epidural abscess - Subdural abscess - Focal encephalitis - Brain abscess - Sigmoid sinus thrombosis - can be complicated by dissemination of infected thrombi with septic infarcts in various organs - Otitis hydrocephalus = form of psudeotumor cerebri - Gradenigo syndrome = triad of suppurative OM, paralysis of external rectus muscle, pain in ipsilateral orbit
Complications sinusitis
- Orbital: periorbital and orbital cellulitis,
- Intracranial: epidural abscess, meningitis, cavernous sinus thrombosis, subdural empyema, brain abscess
- Pott puffy tumor - osteomyelitis of the frontal bone
Post-op complications of tonsillectomy/adenoidectomy
10
- Hemorrhage
- Airway obstruction from edema of tongue, palate, or nasopharynx, or retropharyngeal hematoma
- Central apnea
- Prolonged muscular paralysis
- Dehydration
- Palatopharyngeal insufficiency
- Otitis media
- Nasopharyngeal stenosis
- Refractory torticollis
- Facial edema
