Imaging & Procedures Flashcards
Purposes of X-ray
Detect sinusitis
Detect fluid in the sinuses
Detect polyps
Indications of X-ray
Pain/pressure in the face
Clinical symptoms need supportive evidence
Maxillary Sinus X-ray
Frontal view of the maxillary sinuses, orbits, nasal structures, zygomas
Permits direct comparison of sides
Waters View
Posterior/anterior radiographic view of the skull with an angle of 37 degrees from the plane of the film to show the orbits and maxillary sinuses
What disease has the thumbprint sign?
Epiglottitis
What disease has the steeple sign?
Croup
What is the imaging of choice for retropharyngeal abscess
CT of the neck
CT is preferable to MRI in these situations
Larynx for neck nodes
Tumor volume
Cartilage sclerosis & destruction
CT of Sinuses Useful for:
Further info about tumors Provide info about obstruction Detect fluid in sinuses Detect if membranes are thickened Assist with diagnosis
Best Diagnostic Tool for Epiglottitis
Lateral Neck X-ray
Best Diagnostic Tool for Retropharyngeal Abscess
CT
Best Diagnostic Tool for Sinusitis
X-ray or CT
Best Diagnostic Tool for Trauma
CT
Best Diagnostic Tool for Ludwig’s Angina
CT
Best Diagnostic Tool for Peri-tonsillar Abscess
CT
Best Diagnostic Tool for Tumors
MRI
Most Radiation exposure between x-ray, CT, or MRI
CT
Indications for a Throat Swab or Culture
Sore throat
Fever of unknown origin
Chronic carriers with recurrent infection
Indications for a Nose Swab or Culture
Nasal or sinus infections
Carriers of pathogenic bacteria
When should cultures be performed?
Before antibiotic therapy is initiated
Main bugs on throat cultures
Bordatella pertussis
Streptococci (esp. B-hemolytic)
Meningococci
Corynebacterium diptheriae
Most common bugs on nasal swab
Staph aureus
MRSA
Most common bugs on a nasopharyngeal swab
H-flu
RSV
Influenza
Pertussis
How to perform a nasal swab
Raise tip of nose Insert swab into nare Rotate swab Remove swab Place in appropriate tube
How to perform a nasopharyngeal swab
Raise tip of nose Insert FLEXIBLE swab into nare medially Gently move to posterior pharynx Rotate swab Place in appropriate tube
Where do you swab for a rapid strep?
Posterior pharynx
Cerumen Disimpaction
Removal of cerumen via an ear curette
Treatment of Epistaxis
Topical vasoconstrictor/analgesic
Direct pressure
Silver nitrate cautery
Topical Vasoconstrictors
Inhaled Afrin
Cotton balls soaked in Epi & Lidocaine
How Long to Apply Direct Pressure?
20 minutes
When do you use nasal cautery
After 20 minutes of direct pressure
How long can one hold silver nitrate to a bleeding site?
10 seconds
Why does one not cauterize both sides of the nasal septum?
Risk of septal perforation
Which type of nasal packing is more common?
Anterior nasal packing
What items are used for anterior nasal packing?
Gauze-petroleum soaked
Rhino rocket
Mercel
How long until follow up is required after nasal packing is placed?
Within 24 hours
How long is the packing usually left in place?
48-72 hours
Complications of Nasal Packing
Necrosis if too tight
Sinusitis
Otitis media
Toxic Shock Syndrome
What is pneumatic otoscopy testing for?
Movement/mobility of the tympanic membrane
Interpretation of Increased TM Mobility
Atrophy
Previous perforation or T-tube
Interpretation of Absent or Decreased TM Mobility
Acute otitis media
Scarring
Define Audiometry
Formal measurement of hearing
What does audiometry involve?
Presentation of tones or speech to each ear testing frequencies
Purpose of Weber/Rinne Testing
Determine whether the hearing loss is sensorineural or conductive
How to Perform the Rinne Test
Place vibrating tuning for on mastoid process
Then move it in front of the ear canal
Normal Result of Rinne Test
AC > BC
What is the Rinne Test Looking For?
Conductive hearing loss
If BC > AC there is what type of hearing loss?
Conductive hearing loss
A normal Rinne is:
Positive
An abnormal Rinne is:
Negative
How to Perform a Weber Test
Place vibrating tuning fork on top of the head
Patient should hear equally in both ears
What test must you use in addition to the Weber test to determine if the ear is normal or abnormal?
Rinne test
If Rinne normal and Weber is lateralized, what kind of hearing loss is present?
Sensorineural hearing loss in the opposite ear of where Weber was lateralized
If Rinne is abnormal in the ear that Weber lateralizes to, what kind of hearing loss is present?
Conduction hearing loss in that ear
Define Tympanometry
Measurement of the impedance of the middle ear to sound
What can tympanometry detect?
Fluid in the middle ear Negative middle ear pressure Disruption of ossicles Otosclerosis Hypercompliant TM
How is tympanometry performed
Soft probe placed into ear canal
Small amount of pressure applied
Instrument measures movement of TM with varying pressures
What is vestibular caloric testing used for?
Test disorders of the ear or brainstem
What disorders of the ear or brainstem does vestibular caloric testing test?
Benign positional vertigo
Perilymph fistula
Vestibular neuritis
Gentamycin ototoxicity
What does cold water in the ear initiate?
Fast nystagmus
Eyes to move away from cold water
What does warm water in the ear initiate?
Eyes move towards the warm water
What can ice water caloric testing be used for in the ICU?
Determine brain function of a comatose patient
