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ENT/Opth Flashcards

1
Q

Inflammation of the middle ear, temporal bone & mastoid air cells w/ rapid onset + s/sx of inflammation

A

Acute otitis media

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2
Q

MC bugs in otitis media

A

Strep pneumoniae (MC), H. Influenza, Moraxella Catarrhalis, group A Streptococcus

*If effusion, h. flu most likely

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3
Q

Acute vs chronic otitis media

A

Acute: less than 3 weeks

Chronic: more than 3 months, clear serous fluid in the middle ear without s/sx of an ear infx

Recurrent: 3 episodes in 6 months OR 4 episodes in 12 months

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4
Q

Tx of Otitis media

A

TOC: Amoxicillin 80-90 mg/kg/day x10-14 days (HIGH DOSE)

2nd line: Amoxicillin-Clavulanic acid, Cefuroxime, Cefdinir, Cefpodoxime

Penicillin allergy? Azithromycin, Clarithromycin, Erythromycin-Sulfisoxazole, Bactrim

Severe or recurrent? Myringotomy (surgical drainage) w/ tympanostomy tube insertion

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5
Q

Pathophys of otitis media

A

Preceded by viral URI leading to blockage of Eustachian tube

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6
Q

Viral vs fungal acute Pharyngotonsillitis tx

A

Viral = Mainstay: symptomatic treatment – fluids, warm saline gargles, topical anesthetics, lozenges, NSAIDs

Fungal = Clotrimazole troches (one 10-mg troche dissolved slowly 5x daily) • Miconazole mucoadhesive buccal tablets (50 mg qd applied to mucosal surface over canine fossa) • Nystatin swish and swallow (400,000- 600,000 units 4x/d) • HIV+ patient: Fluconazole

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7
Q

Acute Pharyngotonsillitis – Bacterial mcc

A

Group A Streptococcus (Streptococcus pyogenes)

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8
Q

Acute Pharyngotonsillitis – Bacterial mcc

A

Group A Streptococcus (Streptococcus pyogenes)

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9
Q

Acute Pharyngotonsillitis dx

A

Rapid antigen detection test: best initial test (if negative then obtain throat culture (esp. children 5-15))

Throat culture: definitive diagnosis (gold standard)

→ Centor Criteria: GABHS-suggestive manifestations: fever 100.4+, tender anterior cervical lymphadenopathy, lack of cough, pharyngotonsillar exudate

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10
Q

Acute Pharyngotonsillitis tx

A

First line: Penicillin (PCN G or VK, Amoxicillin);

PCN Allergy? Macrolides, Clindamycin, Cephalosporins

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11
Q

Diffuse skin eruption that occurs in the setting of Group A Streptococcus (S. pyogenes) infection

A

Scarlet fever

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12
Q

Sx of scarlet fever

A

Fever, chills, pharyngitis

Rash: diffuse erythema that blanches with pressure + multiple small (1-2mm) popular elevations w/ a *sandpaper texture •

Rash usually starts in the axillae & groin & spreads to trunk & extremities (spares palms & soles)

Flushed face w/ circumoral pallor & strawberry tongue

Pastia’s lines: linear petechial lesions seen at pressure points, axillary, antecubital, abdominal or inguinal areas

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13
Q

Tx of scarlet fever

A

Penicillin G or VK = first line, Amoxicillin

Macrolides if penicillin-allergic

Children may return to school after 24 hours of antibiotic administration

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14
Q

Immunoglobulin E (IgE)-mediated mast cell histamine release due to airborne antigens [allergens]

Sneezing, nasal congestion, itching, clear, watery rhinorrhea

A

Allergic rhinitis

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15
Q

Supraglottic inflammation/obstruction of the airway

A

Epiglottitis

Medical emergency

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16
Q

MC bug in epiglottits

A

MCC: H. influenza type B (HiB) – kids in underserved areas or without vaccinations

Immunized? Suspect Streptococcal species (Group A Strep or S. pneumoniae), H. influenza, or S. aureus

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17
Q

Sx of Epiglottitis

A

3 D’s: drooling, dysphagia, distress

Fever, odynophagia, inspiratory stridor, dyspnea, hoarseness, muffled “hot potato” voice, restlessness

Tripod/Sniffing dog position: leaning forward, elbow on lap, neck hyperextended, chin protruding

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18
Q

Definitive dx for epiglottitis

A

Definitive diagnosis: Laryngoscopy (cherry-red epiglottis w/ swelling) performed when securing airway

Soft tissue lateral cervical XR: thumb/thumbprint sign –

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19
Q

Tx of epiglottitis

A

Most important: maintain airway – keep child calm, OR best place to intubate, Dexamethasone for airway edema

2nd or 3rd gen-cephalosporin (Ceftriaxone/Cefotaxime); Penicillin, Ampicillin or anti-staph coverage (Vanco) may be added Prevention: Rifampin to close contact; routine use of HiB vaccine

20
Q

MC bugs of bacterial conjunctivitis

A

S. aureus = MC, S. pneumoniae, M. catarrhalis

N. gonorrhea, C. trachomatis

Transmitted by direct contact & autoinoculation

H. influenza: MCC in preschool children

MCC neonates: Chlamydia trachomatis

21
Q

Tx of bacterial conjunctivits

A

Topical abx: Erythromycin ointment, Trimethoprim-Polymyxin B (Polytrim), Fluoroquinolones = Moxifloxacin or Ofloxacin

22
Q

Tx of anterior epistaxis (step approach)

A

1.Direct pressure: first-line therapy in most cases, apply 5-15 minutes seated position, leaning forward [to reduce vessel pressure]

**Untreated septal hematomas can lead to septum destruction if not evacuated

2. Adjunct medications: topical vasoconstrictors (Oxymetazoline nasal, lidocaine w/ epinephrine, 4% cocaine) – cautious use in patients w/ HTN

3. Cauterization: electrocautery or silver nitrate if the above measures fail & the bleeding site can be visualized

4. Nasal packing: if direct pressure, vasoconstrictors & cautery are unsuccessful or in severe bleeding

May consider antibiotic (Cephalexin or Clindamycin) to prevent toxic shock syndrome if packed (controversial)

23
Q

Tx of posterior epistaxis

A

Sphenopalatine artery branches & Woodruff’s plexus = most common site (may cause bleeding in both nares & posterior pharynx)

Balloon catheters = most common initial management

Foley catheter, cotton packing

Diagnose with direct visualization – if recurrent or severe get a CBC, PT, & PTT • CT if foreign body, tumor or sinusitis suspected

24
Q

MCC of sensorineural vs conductive hearing impairment

A

Sensorineural = MCC: Presbycusis

Conductive= MCC: Cerumen impaction

25
Clinical manifestations of sensorineural hearing loss
Normal Ear = **Weber: no lateralization;** Rinne: normal air conduction \> bone conduction SensoriNeural = **Weber: lateralization to normal ear** ; Rinne: normal air conduction \> bone conduction Difficulty hearing their own words/voice
26
Clinical manifestations of conductive hearing loss
Conductive: **Weber: lateralization to abnormal ear** ## Footnote **Rinne: abnormal (negative) bone conduction \> air conduction**
27
Sensorineural lateralizes to
Lateralizes to Normal ear + Normal Rinne “your ear has been fucked too many times”
28
Complication from preceding acute otitis media or recurrent acute otitis media
Mastoiditis = Inflammation of the mastoid air cells of the temporal bone
29
Sx of mastoiditis
**Deep ear pain (worse @ night), fever, lethargy, malaise** **Signs of otitis media (bulging & erythematous TM), mastoid (postauricular) tenderness w/ edema & erythema** Forward protrusion of the auricle
30
Dx of mastoiditis
First-line diagnostic test: CT scan w/ contrast of temporal bone
31
Tx of mastoiditis
IV antibiotics [**IV Vancomycin + Ceftazidime/Cefepime/Piperacillin-Tazobactam]** + middle ear or mastoid drainage (myringotomy) w/ or without tympanostomy tube placement Tympanocentesis for cultures Complicated or refractory? = Mastoidectomy
32
Infection of the orbit (fat & ocular muscles) posterior to the orbital septum
Orbital septal cellulitis
33
MCC of orbital cellulitis +MC bugs
Often polymicrobial: S. aureus, Streptococci, GABHS, H. influenzae ## Footnote **MC secondary to untreated sinus infections (ethmoid), in children 7-12 years old**
34
Sx of orbital cellulititis
**Eyelid edema & erythema + pain with EOM** Ocular pain especially with eye movement, ophthalmoplegia (extraocular muscle weakness) w/ diplopia, proptosis (bulging) & visual changes
35
Dx and Tx of orbital cellulitis
Dx = **Clinical diagnosis that is confirmed with CT** ; CT scan with contrast: infection of the fat & ocular muscles behind the septum Ophthalmology evaluation • Admit + IV antibiotics = Vancomycin + Ceftriaxone or Cefotaxime
36
Inflammation of the external auditory canal; Often secondary to trauma (Q-tips, ear wax, 7-12 years old) or a moist environment (swimmer’s ear)
Otitis externa
37
Tx of otitis externa
Protect the ear against moisture (drying agents = isopropyl alcohol & acetic acid) + removal of debris & cerumen + topical antibiotics w/ coverage against Pseudomonas & Staphylococcus (w/ or w/out glucocorticoids for inflammation) **Fungal source:** Topical therapy – 2% acetic acid 3-4 drops QID, or clotrimazole 1% solution, or Itraconazole oral **Topical antibiotics: Ciprofloxacin-dexamethasone, Ofloxacin • Aminoglycoside combination: Neomycin/Polymyxin-B/Hydrocortisone – not used if tympanic perforation suspected or if TM cannot be visualized – aminoglycosides are ototoxic** \*\*\*
38
Abscess between the palatine tonsil & the pharyngeal muscles
Peritonsillar abscess
39
MCC of peritonsillar abscess
Results from a complication of tonsillitis or pharyngitis ; Most common in adolescents & young adults 15-30 years
40
MC bug in peritonsillar abscess
Polymicrobial – **predominant species is Group A Streptococcus (S. pyogenes)**, S. aureus, & respiratory anaerobes (Bacteroides)
41
Sx of peritonsillar abscess
Dysphagia, severe unilateral pharyngitis, high fever • **Muffled “hot potato” voice, difficulty handling oral secretions (drooling), trismus (lockjaw)** Swollen or fluctuant tonsil → uvula deviation to the contralateral side, bulging of the posterior soft palate, & anterior cervical lymphadenopathy
42
Tx of peritonsillar abscess
Drainage (Aspiration [preferred] or I&D) + antibiotics **Antibiotics: PO (Amoxicillin, Augmentin, clindamycin); parenteral (Ampicillinsulbactam, Clindamycin)** Tonsillectomy: for patients who fail to respond to drainage, PTA w/ complications, hx of prior episodes, or recurrent severe pharyngitis • Secure the airway early in a severe infection **Prevention: Prompt treatment of streptococcal infections**
43
convergent strabismus – deviated inward (nasally) “cross-eyed” divergent strabismus – deviated outward (temporally)
Esotropia Exotropia
44
Dx of strabsimus
**Hirschberg corneal light reflex testing:** initial testing – asymmetric deflection of the corneal light reflex in one eye is seen in strabismus Cover test: refixation of the uncovered eye is consistent w/ manifest strabismus (tropia) Cover-uncover test: looks for latent strabismus (phoria) – misalignment will appear to deviate inward or outward, convergence testing
45
Tx of strabismus
**First-line: patch (occlusive) therapy** – cover the normal eye to stimulate & strengthen the affected eye, typically used for amblyopia and not strabismus → but may improve vision and improve prognosis Eyeglasses = primary treatment for accommodative esotropia Corrective surgery: severe or unresponsive to conservative therapy
46
Acute ear pain, hearing loss, tinnitus, vertigo; Patients w. otalgia prior to rupture may develop sudden pain relief w/ bloody otorrhea
Tympanic membrane perforation
47
Tx of perforated tympanic membrane
**Most heal spontaneously, surgery may be needed if TMP 2m+** • Topical antibiotics if there is infection – **Ofloxacin drops** Avoid water & topical aminoglycosides in the ear whenever there is a TM rupture

EOR- PEDS (9 decks)

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