ENT & Ophtho Flashcards
A pt presenting with respiratory distress, drooling, torticollis and limited ROM of neck following a URI most likely suffers from….
Retropharyngeal abscess
preferred dx w/ CT with contrast if stable
An infant presenting with excessive tearing, photophobia, and blepharospasm (abnormal contraction of eyelid muscle) most likely suffers from …
Infantile Glaucoma
(can have corneal enlargement/ edema, abnormal red reflex)
(needs immediate Ophtho eval)
What is the most appropriate treatment for newborn with bilateral choanal atresia?
place an oral airway
followed by surgical correction of nasal patency
What is the best management for a cholesteatoma (abnormal growth of desquamated squamous epithelium & kertain in the middle ear) especially after recurrent otitis media?
surgical excision
complications of cholesteatoma including ossicle destruction, abscess formation, meningitis, cranial nerve palsies
What is the most likely diagnosis for a pt presenting with a firm, nontender nodular mass of the upper or lower eyelid without the presence of drainage/ pus?
Chalazion
tx with surgical excision is does not resolve or distorts vision
What is the best treatment for chronic sinusitis?
2-4 weeks of antibiotics
cough upon lying down & awakening, halitosis, nasal congestion
What is the most likely diagnosis for a discrete, cystic mass overlying the anterior margin of the right sternocleidomastoid muscle?
Branchial cleft cyst
can become seconardily infected at which time should be surgical removed
What is the characteristic sign of a retropharyngeal abscess (respiratory distress, fever, stiff/ hyperextended neck, drooling, soft palate injury, sore throat, difficulty speaking, torticollis) on lateral neck Xray?
widened retropharyngeal space with anterior airway displacement on lateral neck film
What is the characteristic sign of epiglottis on on lateral neck Xray?
Thumbprint sign (thickened radio-opaque epiglottis on Xray) (definitive diagnosis is with direct visualization of cherry red epiglottis)
What imaging finding is consistently found in patients with orbital cellulitis (red painful swollen eye, limited EOM, proptosis)?
CT scan shows acute sinusitis (usually opacification of ethmoid sinuses)
what is the best initial treatment for orbital cellulitis?
IV ceftriaxone/ unasyn and vancomycin
Staph. Strep, rhinosinusitis organisms
What are the most common organisms to cause chronic rhinosinusitis (inflammation of the sinuses for > 12 weeks, facial pain, tenderness, mucopurulent nasal discharge, cough, fever, hailtosis) ? (4)
- Staph Aureus
- fungi
- gram negative bacilli
- anaerobes
What tympanogram is consistent with eustacian tube dysfunction?
Type C
peak is shifted to left due to negative pressure in middle ear
What tympanogram is consistent with middle ear effusion or perforated eardrum?
Type B (poorly defined peak suggesting poorly mobile ear drum)
What is the expected number of viral URIs in a pediatric patient?
3-8 episodes a year
daycare increases episodes
What is the best treatment for retropharyngeal abscess?
IV unasyn (amp sub) or Clindamycin
IV until afebrile and clinically improved; then oral for completion of 14 days
What is the most common complication of acute URI?
otitis media
what is the treatment for an auricular hematoma (tender, fluctuant, swollen hematoma in the anterior superior auricle following external ear trauma)?
drainage followed by pressure dressing of auricle
complication of cartilage necrosis due to interrupted blood supply
What are possible causes of sensorineural hearing loss in neonate? (6)
- Aminoglycoside
- loop diuretics (furosemide)
- Salicylate toxicity
- congenital CMV
- Congenital Rubella
- Congenital Toxoplasmosis
What is the most common cause for development of obstructive sleep apnea in children?
tonsillar and adenoid hypertrophy
What is the most likely diagnosis of a patient with ill appearance, fever, severe dysphagia, trismus (difficulty opening mouth), stiff neck, respiratory distress (leaning forward to breath), and symmetrical, indurated, tender and tense submandibular swelling with crepitus?
Ludwig angina
(rapidly spreading, bilateral poly microbial cellulitis of submandibular and sublingual spaces as complication of infected molar)
(dx w/ CT scan)
(tx w/ amp/sulb or clindamycin)
What is the most likely diagnosis for a patient presenting with unilateral ear pain, fever, postauricular tenderness/ erythema/ swelling, and displaced auricle?
Mastoiditis
(CT shows clouding of middle ear & mastoid, loss of definition of bony septae & coalescence of mastoid air cells)
(tx: IV abx & myringotomy or mastoidectomy if severe)
What is the likely diagnosis for a child 6-24 months old presenting with intermittent/ asymmetric horizontal nystagmus, head nodding and torticollis with normal brain MRI & EEG?
Spasmus nutans (acquired nystagmus)
- resolves in months to years
- need to rule out space occupying lesion, drug ingestion & CNS infection
What is the most likely diagnosis for pt presenting with fever, sore throat, dysphagia, trismus, asymmetric tonsillar swelling and deviation of uvula?
Peritonsillar abscess
(ENT consult for possible drainage and IV antibiotics
What is the normal tympanogram for a pediatric patient?
well defined peak with compliance pressures between +50 and -150 mmH2O and peak compliance between 0.2-1.8
What is the best initial treatment for dacryostenosis (congential nasolacrimal duct obstruction)?
gentle massage 3-4 times daily
-usually resolves by 6 months; if not refer to ENT for lacrimal duct probing
What are risk factors for retinopathy of prematurity? (5)
- elevated arterial oxygen tension exposure
- low birth weight
- low gestational age
- surfactant therapy
- prolonged assisted ventilation
What is the most likely cause of leukocoria (white pupillary light reflex)?
Retinoblastoma
What is the most likely diagnosis of a pt presenting with prolonged ear drainage with visualization of whitish-gray cystic like mass in the posterior-superior quadrant of eardrum?
Cholesteatoma
When should you refer to ENT for possible cholesteatoma? (3)
- whitish-gray mass behind intact TM
- drainage > 2 weeks despite appropriate tx
- new-onset hearing loss in previously operated ear
What is the major complication of strabismus (intermittent or continuous misalignment of one or both eyes)?
loss of visual acuity
(tx with patching better eye)
(esotropia- inward deviation of eye towards nose is most common form of strabismus)
What is the most likely diagnosis if pt presents with limited vertical gaze, lower lid ecchymosis, nosebleed, orbital emphysema (crepitus), diplopia, and hypesthesia (decreased sensation) of ipsilateral cheeck & upper lip after eye injury?
Orbital floor fracture
dx: CT of orbit
(tx: immediate ophtho consult- surgery if EOM entrapment or nasal decongestants & ice packs)
What are the clinical features associated with CHARGE syndrome?
C: coloboma (keyhole liek defet of pupil &irirs w/ nystagmus
H: heart defect (usually septal or conotruncal)
A: atresia of chonae (nasal passage)
R: retarded growth
G: genital anomalies
E: ear anomalies
What is the most common cause of unilateral foul smelling nasal discharge?
Foreign body
What is the best initial treatment for simple corneal abrasions?
topical antibiotic ointment and oral analgesia with recheck in 1-2 days
-can use topical anesthetic in office for pain but not sent home with it
What is a common ENT manifestation of cystic fibrosis?
nasal polpys (glistening grayish masses between the nasal turbinates and septum)
What is the most common cause of otitis externa (unilateral ear pain exacerbated by movement of pinna & tragus, usually after swimming?
Pseudomonas aeruginosa
