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SMUPASPG19-MED 1 > HEENT-Ear > Flashcards

HEENT-Ear Flashcards

1
Q

AOM- acute otitis media

A

1- Viral

#1 office vistis PEDS < 1
middle ear inf. Pn due to enclosed pressure of fluid
Factors- smoke, daycare, supine drinking(anatomic tube structure), M, anatomic

#2. Strep. pneumoniae 30-40%
3. H influenza 21%
4. Moraxella Catarrhalis 12%

S/s- irritable, fever, ea, otorrhea or vertigo. TM: bulging, retract, perforate (holes), dec. hearing. Purlent-yellow section, red, no/displaced cone of light, dull vs shiny

PE- pneumaic otoscopy #1 sign- dec. mobility w/ air puff
Pinna pain w/ movement

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2
Q

AOM TX & complications

A 
TX
#1 Abx Amoxicillin (peniclin) esp <2yo
Mryingotomy
Tympanostomy tubes-drainage
NEVER steroid drops

Comps
Perforations, Chronic OM- chronic s/s, w. drainage in canal. Itch #1 sx
Cholesteoma-keratinized, desquamous cell d/t TM perforation. ASX or hearing loss, dizzy

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3
Q

AOM serous

A

clear fluid in middle ear- VIRAL

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4
Q

Otiis Externa

A 
Infection and inflammation of the external auditory canal
#1 sx: local pain (severe-tragus) and itching, erythema, heat, crust
Assoc sx- Associated periauricular adenopathy >5yo
TX
#1 Staph aureus-crusty
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5
Q

Diffuse OE

A

“Swimmer’s ear”, P aeruginosa
Hot, humid climate, hot tubs

SX-Canal is erythematous, edematous, some hemorrhagic
white flakes,

TX- topical antibiotic drops w/ steroid. DRY out.
Neo

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6
Q

Malignant OE

A

Severe necrotizing bacteria infection external auditory canal with invasion into the surrounding tissues including blood vessels, cartilage, and bone.

SX-Immunocompromised, elderly, HIV, DM
Osteomyelitis at base of skull, TMJ, Elevated ESR, CRP typical, local heat, erythmetous

TX- P aeruginosa in >95% of cases

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7
Q

MOE TX complications

A

TX
Topical ABX don’t work, need systemic
Systemic Cipro treatment of choice
IV until improving, then switch to oral (6-8wks)

Levofloxacin probably acceptable, no data

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8
Q

Vertigo

A

vestibular disease-Sense motion when there is no motion, or exaggerated sense of motion in response to body movements
ETI-labyrinthitis, BPPV, Meniere’s syndrome, migraine
triggers (salt, stress, bright lights)

DX:-Asso sx, Duration is key DX, CN exam, cerebeller
eyes (nystagmus), ears, Dix-Hallpike maneuver Gold

Peripheral: sudden onset, hearing loss and tinnitus, nausea, no fever, no other neuro

Central: gradual onset, no auditory sx

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9
Q

BPPV TX & complications

A

TX- ENT or Neurology if vertigo persists or CNS lesion suspected

D-H: quickly lowering supine with head extending over edge of bed 30 degrees lower than body, turned either to left or right; elicit delayed nystagmus in BPPV; nonfatigable nystagmus indicates CNS etiology

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10
Q

Conductive Hearing Loss

A

Eti:
dysfunction of external or middle ear
Acute: cerumen impaction, middle ear effusion (URI), otosclerosis

Chronic: chronic ear infection, trauma, otosclerosis

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11
Q

Sensioneural Hearing Loss

A

deterioration of the cochlea, loss of hair cells
Progressive, high frequency loss related to aging
Noise, head trauma, DM or other systemic diseases
Surfer’s ear.

Neural: CN 8 or auditory tract/cortex lesions; least common, Acoustic neuroma, MS, cerebrovascular disease

DX-Perform thorough PE including CN 8 testing, Weber/Rinne tests

TX- Refer unless cause is easily treated

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12
Q

Cold-Viral

A

Common Cold- 200 viruses cause

Mild, self-limited syndrome caused by infection of the upper respiratory tract mucosa

S/S-one or more: nasal discharge, obstruction; sneezing; sore throat; cough; hoarseness
Clinical: mild malaise, rhinorrhea, sneezing, sore throat, variable loss of taste or smell, 2nd-4th day max sx
< 99° F, Cough and hoarseness (worse in smokers)
1-2 weeks.
Sx- 6-8wks (cough or hoarsness)

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13
Q

Cold TX, complications

A

TX-Symptomatic, ASA/APAP, NSAIDs
Nasal congestion topical sprays- Gold <5d d/t rebound, humidifier, fluids, rest, netti pot w. saline
Oral decongestants / combination antihistamine-decongestants

Expectorants and ABX not useful

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14
Q

Influenza

A

S/S: sudden onset, > 106°F (41°C) 3 days,HA, myalgias (back, arms, legs), nonproductive cough, nasal discharge, hoarseness, sore throat, Flushed face, hot skin, red watery eyes, clear nasal discharge, cervical LAD.
Mild neutropenia with lymphocytosis
Duration 3-14d. Recover 1-4wks.
aerosolized particles; incub. 18-72 hours
Viral shedding 5-10 days; highest titer in secretions first 48 hours. Infectious 24h after fever breaks

ETI: influenza v., other parainfluens, RSV (kids) andenovirus

TX-Antiviral agents: amantadine (Symmetrel); rimantadine (Flumadine), oseltamivir (Tamiflu)
reducing fever and shortening the course of illness by 1-2 days. effective 24-48 hours of onset of illness
Treat all high risk pts: chronic disease; pts with associated pneumonia
OTC supportive therapy

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15
Q

Mononucleosis

A

ETI-Epstein-Barr virus
S/S- Malaise, fever, sore throat (sometimes exudates)
Palatal petechiae, LAD, splenomegaly, sometimes maculopapular rash. Kids stomach pain.
Contagious prior, Recovery 2-8mo. No sharing saliva, drinks, towels etc.
US athletes

PE- HEENT, Abdomen (kids), Cardio (kids fever murmurs)

Labs- Monospot, lymphocytes and lymphocytosis on CBC and peripheral blood smear
Secondary strep infection

TX-Supportive, APAP

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16
Q

Allergic Rhinitis

A

ETI- 3yrs after moving,
S/S- persistent, seasonal, Sneezing, itching, rhinorrhea or congestion; ocular irritation, itching, watering, erythema. HX of eczema, asthma, Nasal turbinates pale (atrophy) or violaceous; polyps in chronic AR

Labs- IgE

TX- #1 Nasal steroids, antihistamines, Leukotriene antagonists, avoidance (new cat bird), netti pot,
Allergy testing.

17
Q

Acute sinusitis- Viral

A

sinus cavities produce mucus, propelled by cilia, through the ostia/duct of turbinates/chocha. If cilia damage, fluid sits, bacteria grows. Maxillary common

ETI- viral or bacterial of one or more sinuses when drainage is blocked, Viral URI’s block drainage, 0.5% develop bacteria.

PE- HEENT, sinus, teeth palpate
10% dental abscess

S/S- Pts fewer than 10d sx, no high fever, complicated illness, should be managed with supportive care.
dull ache, cought inc sx. re

Bacterial-Purulent dc, nasal congestion, and facial pain lasting > 7 days, sx improve and then worsen; nasal decongestants don’t help

Ddx: dental abscess, cluster HA, trigeminal neuralgia, migraine

18
Q

Acute sinusitis-TX

A

TX- w/o culturing
60% Strep pneumoniae or H influenza
Less common: anaerobes, S pyogenes, M catarrhalis, β-hemolytic Strep, Mycoplasma pneumoniae, Staph aureus

Topical decongestants and/or topical steroids; irrigation saline. Oral decongestants and antihistamines complicate sinusitis

Oral antibiotics
Amoxicillin or Augmentin, Bactrim, macrolides (azithromycin)

Toxic patients (esp ethmoid sinusitis) require hospitailization, IV abx, drainage and culture

Complication of noninfectious rhinosinusitis, polyps, foreign bodies, swimming/diving, anatomic nasal obstruction, nasogastric tubes

19
Q

Chronic Sinusitis

A

loss of normal ciliated epithelial lining of the sinus cavity
anaerobic and aerobic bacteria - Strep pneumoniae orH influenza

S/S-facial pain, purulent drain, relapsing pattern >3 mo. Persistent through entire day, cough (post nasal drip)

Lab: CT prn,

Comps-periorbital cellulitis: proptosis, erythematous,
Intracranial extension, meningitis.

TX- Topical steroids. Otolaryngologist- surgical drain, ABX only for acute, Anithistamine or decongestants

20
Q

Pharyngitis

A

1 identify and treat group A Strep (10%);

Eti- bacterial and viral pathogens
β-hemolytic Strep groups A and G, Mycoplasma pneumoniae, Chlamydia pneumoniae, (Corynebacterium diphtheriae, Neisseria gonorrhea, RSV, influenza A;B, parainfluenza, HSV, adenovirus, Epstein-Barr virus, coronavirus, rhinovirus, adenovirus, enterovirus, HIV

21
Q

Strepococcal Pharyngitis

A

Shedding, Incubation 2-4 days
Abrupt onset of sore throat, malaise, fever, HA
Only 10% have classic syndrome.
hoarseness, rhinorrhea are absent
scarlitinaform rash: blanches, w/in one week

*Clinical Predictive Criteria
Tonsillar exudate
Tender anterior LAD
Fever
NO cough

If 3-4 of these criteria met, positive predictive value is 40%-60%

22
Q

Strepococcal Pharyngitis-TX/ Complications

A

TX: Treat all patients w/ h/o rheumatic fever
#1 relief of sx, prevention of spread
PRN do not wait for culture results in very sx Pts.
Preferred tx: 1.2 million units benzathine PCN given IM;
or Pen VK 500mg PO QID x 10 days
Amoxicillin, or macrolides (PCN allergy)

Complications of Strep Throat
Nonsuppurative -Rheumatic fever

Suppurative -Pharyngeal abscess, Otitis media
Sinusitis

23
Q

Acute Rheumatic Fever (scarlet fever)

A

inflammatory lesions of the heart, joints, and CNS w/ group A Strep pharyngeal infection, ages 6-15 years
2-4 weeks, Latent period between strep and ARF

TX- PCN x 10d
Jones Criteria-
Major- carditis, polyarthralgis, chorea (movement), nodules, erythema marginatum
Minor- fever, arthralgia, Prev hx RF or RHD

DX- 2 major sx OR 1 major and 2 minor.

24
Q

Pharyngeal Abscess

A

Complication of URI
Peritonsillar most common: severe odynophagia (drool)
Unable to swallow, Muffled voice, trismus(jaw tight), fever, malaise, systemic toxicity

Swelling of the superior anterior tonsillar pillar; tonsil is displaced medially

25
Q

Sialolithiasis

A

*stone in submandibular glands, Wharton’s duct
ETI- dehydration, anticholinergic meds, trauma

S/S-intermittent pain, swelling, tender, erythema
purulent dc if infected (parotitis)

26
Q

Sialolithiasis- TX/Complications

A

TX-Hydration, “milk” the gland, hard candy
NSAIDs, ABX if purulent, Dicloxacillin or cephalexin
Refer to ENT lon or recurrent

27
Q

Cold Transmission

A

Rhinoviruses: 25-30% with seasonal peaks in early fall and mid to late spring

Coronaviruses: 10-15% with seasonal peak in mid winter

Influenza, parainfluenza, respiratory syncytial virus and adenovirus : 10-15%; typical influenza syndrome

Bacterial etiology associated with pharyngitis, sinusitis, or otitis accounts for less than 10% of all colds

Incidence
Decreases with age
Adults have 2-4/y
Children have 6-8/y

Transmission:
Direct contact
Aerosolized particles
Fomites 
Incubation -24-72 hours
28
Q

AS S/S

A

Sinus pain caused by periosteal reaction due to purulent inflammation behind an obstructed ostium
Initially pain described as

29
Q

Labyrinthitis:

A

acute, severe vertigo lasting days to a week with hearing loss, idiopathic, maybe viral

30
Q

BPPV:

A

benign paroxysmal positional vertigo; changes in head position cause vertigo after 10-15 sec delay, vertigo gone 10-60 sec, but pt feels “imbalanced;”

ETI- theory, otoconia (crystals) floating in the semiciruclar canal become dislodged and irritate inner ear during head position changes

31
Q

Meniere’s:

A

endolymphatic hydrops, distention of endolymphatic inner ear;
ETI- Migraine, syphilis and head trauma, largely unknown in

SX-episodic vertigo, fluctuating low frequency hearing loss, tinnitus, and aural pressure; low salt diet and diuretics, HA w/o hearing loss or tinnitus

32
Q

Pharyngitis Clinical Variations- Pathogens

A

Corynebacterium haemolyticum: exudative, scarlitinaform rash, fever, and adenopathy

Mononucleosis: sore throat, fever, LAD, hepatosplenomegaly, maculopapular rash

Adenovirus: conjunctivitis and influenza-like symptoms

Coxsackie A, herpes simplex: mucosal vesicles or ulcers

33
Q

Pharyngitis Culture

A

Exudate AND LAD w/ >100
43% + culutre and TX

Exudate OR LAD w/ >100
14% + culture DEFER ABX until results

Kids Rapid strep

SMUPASPG19-MED 1 (27 decks)

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