ENT + Ophthalmo Flashcards
Type of tympanogram for hearing loss
Type B
When should OME resolve?
90% resolve within 3 months
When should someone get ear tubes
- recurrent AOM with middle ear effusion
- 4x/6m or 6x/12m
- bilateral OME (>3 mos) with CHL
- unilat/bilat OME (>3 mos) with other problems (vestibular, behavioural problems, discomfort, school performance)
- at-risk children
- other uncommon indication
- complications of AOM (i.e. mastoiditis)
- lack of response to medical therapy
- chronic retraction of TM
Extracranial Complications of AOM?
- TM Perforation
- mastoiditis
- post-auricular abscess
- labyrinthitis
- labyrinthine fistula
- facial nerve paresis/paralysis
- Bezold’s Abscess
- cholesteatoma
What are char’s of a cholesteatoma:
older persistent/recurrent stinks like pseudomonas unilaterral responds to steroid drops but recurs
What are intracranial complications of AOM?
meningitis brain abscess subdural/epidural sino-venous thrombosis Gradenigo’s Syndrome (Petrositis) otic Hydrocephalus CSF Leak
How to tx epistaxis?
humidify lubrificate cauterize ant and post pack treat underlying coagulopathy
Red flags for periorbital cellulitis?
Proptosis Diplopia Altered Vision Severe Pain / HA Altered LOC
Complications of OSA?
Poor school performance Daytime somnolence Eneurusis ADHD FTT Cor pulmonale
Indications for T&A?
absolute: OSA (AHI>5/hr) and large tonsils Cor pulmonale suspected malignancy hemorrhagic tonsillitis severe dysphagia
relative: tonsillar hypertrophy recurrent tonsillitis 7 episodes in the previous year, or 5 episodes in each of the previous 2 yr, or 3 episodes in each of the previous 3 yr complications of tonsillitis tonsilloliths and halitosis
Peritonsillar abscess
- characteristics + age
- invest
- tx
unilateral tonsil bulge in palate
uvular deviation
trismus
older children/teenagers
invest
none
treatment
- antibiotics
- surgical drainage
Retropharyngeal abscess
- characteristics + age
- invest
- tx
midline bulge in retropharynx
posterior to palate
younger children
limited lateral ROM neck torticollis
invest:
lat xray - prevertebral bulge
CT to confirm
treatment
- antibiotics
- +/- drainage
What test to screen for hearing in infants?
If fail, next step?
otoacoustic emissions (OAE)
auditory brainstem response (ABR)
Midline Neck Mass Ddx?
Thyroglossal duct cyst Dermoid cyst Teratoma Cervical Cleft Foregut duplication cyst Ranula Vascular Malformation
Lateral Neck Mass Ddx?
Branchial cleft cyst Fibromatosis Colli Hemangioma Thymic cyst Vascular malformation Laryngocele
Most common midline nasal mass
Dermoid cyst
CHARGE?
Coloboma Heart defect Atresia chonae Retarded growth/development Genital / urinary anomalies Ear anomalies/deafness
Thrombosis of IJ?
Lemierre syndrome
from deep neck infections
Nerves of Eye movement?
CN3
SO4
LR6
Eyelid nerves
CN3»_space;> Sympathetic
Horner syndrome?
ptosis
miosis (small pupil)
anhydrosis
Cause of periorbital/preseptal cellulitis vs orbital cellulitis
Periorbital - scratch/bite
Orbital - sinusitis
Signs of Orbital cellulitis
Red eye Proptosis Pain/limited EOM RAPD possible UNWELL
Treatment for orbital cellulitis
IV abx
- cefuroxime, ceftriaxone/vanco
congenital nasolacrimal duct obstruction?
name and tx
complications?
Dacryostenosis
Crigler massage
Dacryocystocele
Dacryocystitis
Urgent Ophthalmo referral
Keratitis
Pain
White spot on cornea
vision loss
How to screen for uveitis In JIA?
Slit lamp
Who to screen for ROP?
When?
EITHER
<31wga
or
< 1250g
At 31cga if born <27wga
At 4weeks old
What do you see in ROP on fundoscopy?
Dilated tortuous vessels
Demarcation line
Strabismus definition?
where is the problem?
Ocular misalignment of any kind
Problem usually in the BRAIN
Amblyopia definition?
where is the problem?
Functional loss of visual acuity
(even when all eye problems have been fixed)
Problem is in the BRAIN
Indications for surgical intervention with laryngomalacia?
FTT
Apnea
Cyanosis
Rapidly worsening stridor
Most common cause of lung absess
Aspiration pneumonia
Vocal cord paralysis - PFT
spirometric lung function testing reveals truncated and inconsistent inspiratory and expiratory flow-volume loops,
Order of development of sinuses?
Ethmoid > Maxillary >Sphenoid > Frontal
pseudomembrane keratoconjunctivis
Adenovirus keratoconjunctivitis
condition assoc w bifid uvula
Submucosal cleft palate
DiGeorge
When to refer to ophthalmologist for dacryostenosis/blocked nasolacrimal duct
1 year
How long is strabismus normal for?
Strabismus is normal until 3-4 months
After 6 months - refer
What is one investigation that she should have done before T&A surgery?
Echo- to rule out cor pulmonale
Risk of post obstructive pulmonary edema
Hyphema - list 2 steps in immediate management
What is the big risk?
Refer to optho
Head elevated
Limited activity
No ASA, ibuprofen
Rebleeding in 3-5 days
Gradenigo’s Syndrome
complication of mastoiditis or AOM
fever
retroorbital pain
abduncens palsy
tx: IV ceftriaxone and flagyl
