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CKPeds > ENT DIseases > Flashcards

ENT DIseases Flashcards

1
Q

Normal flora of external canal includes________

A

Pseudomonas aeruginosa (most common
cause), S. aureus (second most common cause), coagulase-negative Staphylococcus,
diphtheroids, Micrococcus spp., and viridans streptococci

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2
Q

____________ is invasive to temporal bone and skull base—with facial paralysis, vertigo, other cranial nerve abnormalities

A

Malignant external otitis

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3
Q

Mx of Malignant external otitis`

A

Requires immediate culture, intravenous antibiotics, and imaging (CT scan) → may need surgery

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4
Q

Etiology of OM

A

° S. pneumoniae (40%)
° Nontypeable H. influenzae (25–30%)
° Moraxella catarrhalis (10–15%)

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5
Q

Some Correlated Factors of Otitis Media

A
  • Age: most in first 2 years
  • Sex: boys > girls
  • Race: more in Native Americans, Inuit
  • SES: more with poverty
  • Genetic: heritable component
  • Breast milk versus formula: protective effect of breast milk
  • Tobacco smoke: positive correlation
  • Exposure to other children: positive correlation
  • Season: cold weather
  • Congenital anomalies: more with palatal clefts, other craniofacial anomalies, and Down syndrome
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6
Q

Pathogenesis of OM

A

Interruption of normal eustachian tube function (ventilation) by obstruction → inflammatory response → middle ear effusion → infection; most with URI

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7
Q

What makes children predisposed to OM

A

Shorter and more horizontal orientation of tube in infants and young children allows for reflux from pharynx (and in certain ethnic groups and syndromes)

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8
Q

Otoscopy of OM

A

fullness/bulging or extreme retraction, intense erythema

some degree of opacity (underlying effusion)

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9
Q

_______ is the most sensitive and specific factor to determine presence of a middle ear effusion (pneumatic otoscopy)

A

Mobility

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10
Q

Dx of OM

A

– Acute onset
– Tympanic membrane inflammation
– Middle ear effusion

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11
Q

First-line drug of choice for OM =

A

amoxicillin (high dose)

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12
Q

OM Tx

Alternate first-line drug or history of penicillin allergy = __________

A

azithromycin

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13
Q

OM Tx

Second-line drugs—if continued pain after 2–3 days

A

° Amoxicillin — clavulinic acid (effective against β-lactamase producing strains)

° Cefuroxime axetil (unpalatable, low acceptance)

° Also maybe cefdinir (very palatable, shorter duration

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14
Q

OM Tx

_________ (may need repeat 1–2×; for severe infection if oral not possible), if patient is not taking/tolerating oral medications

A

IM ceftriaxone

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15
Q

OM Tx

If clinical response to good second-line drug is unsatisfactory, perform ___________

A

myringotomy or tympanoscentesis

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16
Q
  • Generally after repeated infections with insufficient time for effusion to resolve
  • Fullness is absent or slight or TM retracted; no or very little erythema
A

Otitis media with effusion (OME)

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17
Q

T or F

Recent studies suggest that in otherwise healthy children an effusion up to 9 months in both ears during first 3 years of life poses no developmental risks at 3–4 years of life

A

T

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18
Q

Mx of Otitis media with effusion (OME)

° Suggested for children with bilateral OME and impaired hearing for >3 months; prolonged unilateral or bilateral OME with symptoms (school or behavioral problems, vestibular, ear discomfort); or prolonged OME in
cases of risk for developmental difficulties (Down syndrome, craniofacial disorders, developmental disorders

A

Tympanostomy tubes

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19
Q

Complications of Otitis media with effusion (OME)

_________—displacement of pinna inferiorly and anteriorly and inflammation of posterior auricular area; pain on percussion of mastoid process

A

Acute mastoiditis

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20
Q

CX of OME

cyst-like growth within middle ear or temporal bone;
lined by keratinized, stratified squamous epithelium

A

Acquired cholesteatoma

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21
Q

PE of Cholesteatoma

A

Discrete, white opacity of eardrum through a defect in TM or persistent
malodorous ear discharge

22
Q

Acquired cholesteatoma Tx

A

tympanomastoid surgery

23
Q

Unilateral or bilateral bony (most) or membranous septum between nose and pharynx

A

Choanal atresia

24
Q

SSx of unilateral Choanal atresia

A

asymptomatic for long time until first URI, then persistent nasal discharge with obstruction

25
Q

Dx of Choanal atresia

A

– Inability to pass catheter 3−4 cm into nasopharynx
– Fiberoptic rhinoscopy
– Best way to delineate anatomy is CT scan

26
Q

polyps, aspirin sensitivity, asthma. What is the dx?

A

Samter triad

27
Q

Presents with _______ → hyponasal speech and mouth breathing; may have profuse mucopurulent rhinorrea

A

obstruction

28
Q

Treatment of polyps—

A

intranasal steroids/systemic steroids may provide some shrinkage(helpful in CF

29
Q

Sinus development

– Ethmoid and maxillary present at birth, but only ethmoid is_______

A

pneumatized

30
Q

Sinus development

– Sphenoid present by______
– Frontal begins at________ years and not completely developed until adolescence

A

5 years

7–8

31
Q

Etiology of sinusitis

A

S. pneumonia, nontypeable H. influenzae, M. catarrhalis; S. aureus in chronic cases

32
Q

Cause of chronic sinusitis

A

immune deficiency, CF, ciliary dysfunction, abnormality of phagocytic function, GERD, cleft palate, nasal polyps, nasal foreign body

33
Q

What is the dx?
° Rapid onset
° Severe sore throat and fever
° Headache and gastrointestinal symptoms frequently

A

Strep pharyngitis

34
Q

PE of Strep phra

A

red pharynx, tonsilar enlargement with yellow, blood-tinged exudate, petechiae on palate and posterior pharynx, strawberry tongue, red swollen uvula, increased and tender anterior cervical nodes

35
Q

T or F

in Scarlet fever

exposure to each confers a specific immunity to that
toxin, and so one can have scarlet fever up to three times

A

T

36
Q

PE of Scarlet fever?

A

° Findings of pharyngitis plus circumoral pallor
° Red, finely papular erythematous rash diffusely that feels like sandpaper
° Pastia’s lines in intertriginous areas

37
Q

Coxsackie: virus causes what diseases?

A

 Herpangina
 Acute lymphonodular pharyngitis
Hand-foot-mouth disease

38
Q

What dse

small 1–2 mm vesicles and ulcers on posterior pharynx

A

Herpangina

39
Q

What dse

small 3–6 mm yellowish-white nodules on posterior pharynx with lymphadenopathy

A

Acute lymphonodular pharyngitis

40
Q

What dse?

inflamed oropharynx with scattered vesicles on tongue, buccal mucosa, gingiva, lips, and posterior pharynx
→ ulcerate; also on hands and feet and buttocks; tend to be painful

A

Hand-foot-mouth disease

41
Q

Diagnosis of strep
– First—_______; if positive, do not need throat culture
° But must confirm a negative rapid test with cultures if clinical suspicion is high

A

rapid strep test

42
Q

Treatment of Strep—early treatment only hastens recovery by 12–24 hours but prevents

A

acute rheumatic fever if treated within 9 days of illness

43
Q

CX of Strep

A

Retropharyngeal and lateral pharyngeal abscess

44
Q

PE of Retropharyngeal and lateral pharyngeal abscess

A

Examination—bulging of posterior or lateral pharyngeal wall

45
Q

Cultures of Retropharyngeal and lateral pharyngeal abscess

A

S—most polymicrobial (GABHS, anaerobes, S. aureus)

46
Q

Tx of Retropharyngeal and lateral pharyngeal abscess

A

 Intravenous antibiotics + surgical drainage
 Third-generation cephalosporin plus ampicillin/sulbactam or clindamycin
 Surgical drainage needed if respiratory distress or failure to improve

47
Q

Examination of Peritonsillar abscess—

A

asymmetric tonsillar bulge with displacement of uvula away from the affected side is diagnostic

48
Q

TX of Peritonsillar abscess—

A

 Antibiotics and needle aspiration
 Incision and drainage
 Tonsillectomy if recurrence or complications (rupture with aspiration

49
Q

Indications for tonsillectomy

A

– Rate of strep pharyngitis: ≥7 documented infections within past year or 5/year for 2 years or 3/year for 3 years
– Unilateral enlarged tonsil (neoplasm most likely but rare)

50
Q

Indications for Adenoidectomy

A

– Chronic nasal/sinus infection failing medical treatment
– Recurrent/chronic OM in children with tympanostomy tubes and persistent
otorrhea
– Nasal obstruction with chronic mouth-breathing and loud snoring

51
Q

Tonsillectomy and adenoidectomy Indication

A

– > 7 infections

– Upper airway obstruction secondary to hypertrophy resulting in sleep-disordered breathing and complications

CKPeds (20 decks)

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