HEENT Flashcards

Question

Otitis media with effusion | - acute onset in adult, what is concern

Answer 1

nasopharyngeal tumor

Answer 2

PE - serous effusion, mucoid effusion - membrane appearance

Answer 3

- Adults and kids: short course oral or nasal steroids to reduce swelling - >3 months, send to ENT for tubes - tonsillectomy or adenoidectomy if they are the cause

Answer 4

- AOM, pressure change, slap over ear - acute pain, hearing loss - AOM, AOM with effusion, barotrauma

Answer 5

- PE: look in ear - Usually self healing, can refer to ENT for tympanoplasty if necessary - hearing loss, infection, cholesteatoma

Answer 6

pars flacida

Answer 7

- commonly dt spread of AOM to mastoid portion of the temporal bone - red, swollen mastoid area, ear projects anteriorly - AOM

Answer 8

- strep pyogenes (GAS), pseudomonas, h. flu - PE, CT, treat empirically - Children often inpatient for IV abx, might need tubes if no improvement

Answer 9

- wet ear | - pain, pain with ear manipulation, swelling, purulent discharge

Answer 10

- pseudomonas MC, also staph and other gram neg | - ear debridement, topical abx drops (wick if necessary), oral analgesics

Answer 11

fungal will have black flecks

Answer 12

history!! | AOM more likely if preceding fever

Answer 13

- "malignant otitis externa" - severe infection of EAC, EMERGENCY, send to ER - often due to trauma (q-tips??), also common in DM and HIV pts

Answer 14

pseudomonas (fluoroquinolone)

Answer 15

- granulation tissue at bony joint in ear - deep ear pain - HA - purulent drainage

Answer 16

- important for speech and language - genetic and non-genetic causes - Infections during pregnancy, environmental causes, complications after birth = 30% hearing loss - 70% non-syndromic, 30% syndromic - Screened at birth but sometimes may manifest later in life - Gentamycin is ototoxic

Answer 17

- conductive - sensorineural - mixed

Answer 18

- mild: can hear some speech, soft sounds are hard to hear - moderate: hard to hear normal speech - severe: can't hear speech, can hear loud sounds - profound: cannot hear speech, can only hear VERY loud sounds

Answer 19

- does not startle - does not turn toward source of sound >6 mo - does not say single words by age 1 - turns head when they see you but not when you call their name - seems to hear some sounds but not others

Answer 20

- delayed speech - unclear speech - does not follow directions (??) - "huh"? - Volume high on devices

Answer 21

- infants no later than 1 mo - If at risk for acquired, progressive, or delayed onset hearing loss, hearing test by 2-2.5 yo - fail hearing screening = audiogram evaluation

Answer 22

no one answer - early intervention - sign language - hearing devices - support groups

Answer 23

broad range of inflammatory diseases of the nasal lining - acute viral rhinitis - allergic rhinitis - nonallergic rhinitis with eosinophilia (NARES)

Answer 24

- MC is rhinovirus - runny nose, congestion, sneezing, cough, HA, low-grade to no fever - mucus is yellow or green (not clear like allergic)

Answer 25

- day care / school - winter (inside) - travel

Answer 26

- Self limiting, lasts 7-10 days | - Supportive care

Answer 27

- runny nose (clear), congestion, watery eyes, PND, itching, cough, sneeze - allergic salute and allergic shiners - pale and boggy turbinates - RF: allergens, fam hx, smoke in house

Answer 28

- IgE type 1 hypersensitivity testing | - oral antihistamines, nasal corticosteroids

Answer 29

- paroxysmal sneezing, watery rhinorrhea and clear nasal sx - Occurs throughout the entire year - negative IgE on allergy testing - is a disorder of eosinophil metabolism

Answer 30

- asthma - aspirin intolerance - nasal polyps

Answer 31

nasal steroids or singulair

Answer 32

- broad spectrum of inflammatory disorders that concomitantly affect both the parental sinuses and nasal cavity - Acute: <4 weeks, >10 days - Recurrent acute: 4+ episodes in 12 month period with sx free months in between - Chronic: >12 weeks with constant sx

Answer 33

- 2 major - 1 major and 2 minor * Facial pain w/o another major nasal ss is NOT RS * Fever alone without other major nasal sx is NOT RS

Answer 34

- facial pain/pressure - nasal obstruction/blocakge - nasal discharge, purulence, discolored PND - hyposmia/anosmia - purulence in nasal cavity - fever (acute RS)

Answer 35

- HA - Fever - halitosis - fatigue - dental pain - cough - ear pain/pressure/fullness

Answer 36

- purulent rhinorrhea lasting >10 days - associated with fever - strep pneumo, m. cat, h. flu

Answer 37

- mild: can hold off tx for 48 hours - moderate: amoxicillin, then augmenting if strep pneumonia - Guaifenesin to thin nasal mucus so can clear, decongestants, nasal rinses

Answer 38

- immunodeficiency, CF, GERD - PE: assess adenoid size, try to figure out why keep recurring - treat each acute episode with abx - refer to ENT, child may need adenoidectomy

Answer 39

- 3-6 weeks abx, topical nasal steroids, nasal irrigation - ENT, allergist - sx only when refractor to standard tx

Answer 40

- orbital cellulitis - meningitis - osteomyelitis

Answer 41

- Anterior: 80%, Kiesselbach plexus | - Posterior: 20%, sphenopalatine artery (from maxillary)

Answer 42

- nose picker MC! also dry air - look in nose for PE - Cauterize with silver nitrate, pack, spray with Afrin, stop anticoagulants for a week if possible, humidifier for prevention

Answer 43

- posterior nasal packing

Answer 44

- airway and feeding difficulties | - MC sx is snoring in children

Answer 45

0: sx removed 1: hidden within pillars 2: extend to pillars 3: beyond pillars 4: kissing uvula (midline)

Answer 46

- lymphoid tissue on posterior pharyngeal wall and roof of nasopharynx, behind soft palate and adjacent to torus tubarius (ET opening) - enlargement can = airway issues - nasal obstruction, chronic mouth breathing, snoring - 2ndary ETD, AOM, sinusitis

Answer 47

- EBV (mono) - Coxsackie - HHV - sore throat, rhinorrhea, cough, hoarse, PND

Answer 48

- GAS pyrogenes - fever, lymphadenopathy and sore throat - URI, sick contact, allergies

Answer 49

- Abx: amoxicillin, cephalexin, penicillin V - tonsillectomy: 7+ documented strep positive infections in one year, 5+ in previous 2 years, 1 per year last three years

Answer 50

- low-grade infection of tonsils - large, cryptic tonsils collect food and debris - lymphadenopathy d/t tonsillar infection - chronic halitosis (retained food/debris) - sore throat better on abx, comes back when stop med

Answer 51

Have to consider life: if missing work/school, frequent infections, sleep apnea, etc.

Answer 52

- tonsillar infection that penetrates the tonsillar capsule, spreads to surrounding tissue, if untreated necrosis occurs and creates abscess - high fever, severe sore throat, unilateral tonsils swelling, deviation of uvula, trismus

Answer 53

- cellulitis: abx | - Abscess: I and D

Answer 54

- the retropharyngeal lymph nodes that drain the adenoids, nasopharynx, and paranasal sinuses become infected, untreated = abscess - High fever, SOB, drooling, dyspnea, neck hyperextension

Answer 55

- GAS MC | - staph also possible

Answer 56

- history and PE - neck film: thickening of prevertebral soft tissue and air fluid levels - Admit for IV abx, drain abscess

Answer 57

- C. albicans - white spots in mouth (maybe on mom's breast too) - Very common in nl infants during first few weeks of life, not common in older children unless they've had abx - RF: abx, dm, inhalers - oral nystatin or gentian violet (mom too)

Answer 58

- infection of subraglottic structures - Tripodding, respiratory distress - strep pneumo - XR: thumbprint sign - Tx: IV abx, send home on 7-10d oral abx