ent d/o's Flashcards
painful erythema and edema of ear canal skin
purulent exudate
gram neg; pseudomonas, fungi. grows in excessive moisture
external otitis
three types of hearing loss?
Conductive - cerumen impaction, treat if hearing loss
middle ear effusion, Eustachian tube dysfunction
Sensory - presbyacusis - loss of high frequency, trauma/noise exposure, environmental
Neural - lesion involving eighth cranial nerve, auditory nuclei, auditory cortex, tumors and the like.
how to tx external otitis
avoid excess moisture, polymixin, cortisporin otic qid
if excessive cellulitis of periauricular tissue use flouroquinolones
found pillowcase to be wet, synonymouse with swimmers ear
f/u in 10 days
otalgia with uri (often)
erythema and hypomobility of TM
most common bacteria; streptococcus pneumoniae, haemophilus influenza, and streptococcus pyogenes.
acute otitis media
how to tx otitis media
amox or erythomycin and sulfonamide for 10 days one or the other
or… cefaclor, amoxicillin-clavulanate (augmentin)
what is peripheral vertigo
onset sudden, associated with tinnitus and hearing loss; horizontal nystagmus may be present
what is central vertigo
onset is gradual, no associated auditory symptoms
vertigo assessment
duration of vertigo, associated symptoms, triggers, stress/fatigue,lights, diet????
physical; heent, nystagmus - usually horizontal away from the disease side. dix hallpike test for bppv. extending head 30 degrees down. work up includes; eng, vng, mri, vemps- vestibular evoked myogenic potentials
bpv - benign positional vertigo
recurrent spells, especially with changes in position
tx physical therapy - floating otoconia within a semicircular canal
signs of central lesions
verticle nystagmus
cn palsy
motor sensory deprivation
ENG helpful test
acoustic neuroma
8th cranial nerve
pressure on pons which creates hydrocephalus
unilateral hearing loss deterioration of speech discrimination
constant disequilibrium vs. vertigo
MRI - observation/ microsurgical evaluation
multiple sclerosis
episodic vertigo and chronic imbalance
Unilateral hearing loss
Dx MRI - refer to neurology
viral rhinitis
caused by rhinovirus, adenovirus
can lead to otitis media, sinusitis
usually self limiting
treat with otc’s
acute sinusitis
impaired mucociliary clearance and obstruction of the osteomeatal complex. typical pathogens: s aurreas, m. cat, s. pneumonia, streptococi, h-influenza
s/s unilateral pain, purulent nasal d/c, teeth hurt, halitosis, hyposmia, uri >10 days, tender forehead, h/a middle head, high lateral wall pain in ethmoid btween eyes orbital pain
.
sinusitis tx
coronal ct best, no use for plain films
decongestant up to 240mg day.. sudafedrin rx
amox fist line… or augmentin bid
macrolide 2nd line- ent’s dont like it
refer to ent if fail atbx, tx ten, then tx 14, ct if not any better w/in 3-4 days.
sinusitis - complications
orbital cellulitis, osteomylitis, intracranial extention and cavernous sinus thrombosis.
ct for any changes in ocular exam
refer for failures and ct if symptoms longer than 4-12 wks.
sinusitis, when to admit
any facial swelling, proptosis, vision changes, mental status changes.
allergic rhinitis
exposure to airborne pollens and spores
s/s = hay fever, eye irritations, pruritis, excessive tearing
PE: thickened mucosa in the turbinates
tx: antihistamines, intranasal corticosteroids, antileukotriene meds
oral candidas
white patchy overlay erythematous mucosa
common in pt’s w/ dentures, immonsuppressed, dm, poor hygiene, anemia, chemo, atbx, steroids.
tx: nystatin s/s 5ml qid x 14days or mycelex troches lozenger 5 times a day.. diflucan for systemic - po qd.
pharyngitis/tonsillitis - strep throat
Centor criteria: fever, tender anterior cervical adenopathy, lack of cough, and pharyngotonsillar exudate.
group A beta strep -GABS common agent., other causes; N.Gonorrhoeae, mycoplasma, chlamydia.
s/s = lymphadenopathy and shaggy white-purple tonsillar exudate suggests mono, 1/3 have strep. test monospot, cbc for elev. lymphocyte count. avoide ampicillin in these pt.s
treat strep
penvk 250mg po tid, or 500mg bid x 10 days
zithromax 500mg po qd x 3 days.
atbx tx usually avoids the streptococcol complications of scarlet fever, glomerulonephritis, rheumatic myocarditis, and local abcess formation.
salt water gargle, benzocaine lozenges
rheumatic fever pt’s tx with prophylaxis for 5 years
peritonsillar abscess
severe sore throat, odynophagia, trismus, medial deviation of the soft palate and peritonsillar fold and abnormal muffles voice (hot potatoe).
abcess is unilateral
treat with atbx and i&d
needs referral to ent
sialadenitis
caratid gland infection - bacterial affects parotid or submandibular gland
acute swelling, increased pain, swelling with meals -pus can be massaged from duct. most common is staph aureus.
tx: iv nafcillin or augmentin, clindamycin if allergy to aug.
hydration warm compresser, lemondrops, fireball.
can use atbx for ten days
check amylase level - typically elevated.
