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Clinical Medicine I > Oro, Nasal, ENT EM > Flashcards

Oro, Nasal, ENT EM Flashcards

1
Q

What is peritonsillar abscess’ clinical presentation?

A

collection of pus between tonsil and pharyngeal muscles, dysphagia, dysphonia, foul breath, fever, sore throat, difficulty opening mouth, uvular deviation, trismus, lymphadenopathy, drooling

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2
Q

What bacteria causes peritonsillar abscesses?

A

Strep, but often poly microbial

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3
Q

How do you Dx peritonsillar abscess?

A

Oral exam, MUST check neck for cord and spiked fever, for that would be Lemierre’s syndrome and need urgent attention

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4
Q

How do you treat peritonsillar abscesses?

A

I&D drainage and antibiotics – amoxicillin & clavulanate (augmentin), or clindamycin/ciprofloxacin if g+
send to ER if obstructed airway

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5
Q

What is the clinical presentation of epiglottitis?

A

swelling and limiting air flow in lungs, dysphagia, odynophagia, dyspnea, “hot potato voice”, drooling, stridor, hoarse voice, sore throat

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6
Q

How is epiglottitis caused?

A

Burns from hot liquids, injury/trauma, infection from staph aureus, h influenzae

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7
Q

How can you diagnose epiglottitis?

A

See the enlarged epiglottitis in a sagittal CT “thumbprint”, keep pt leaned forward and DO NOT LAY DOWN

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8
Q

How do you treat epiglottitis?

A

Immediate otolaryngology consult. CANNOT intubate, must perform tracheostomy, start IV antibiotics, and support with oxygen

Abx-ceftizoxime, cefuroxime w dexamethasone

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9
Q

What is mandibular dislocation?

A

Jaw pain, difficulty talking/swallowing, malocclusion, caused by yawning, vomiting, dental, intubation

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10
Q

How do you treat mandibular dislocation?

A

Lateral - open reduction
Posterior- fixation of auditory canal
Superior - brain damage consult

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11
Q

What is the clinical presentation of an aphthous ulcer?

A

canker sores, tender/round oval shapes, usually 1 or a few on soft tissues in mouth

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12
Q

How do you treat an aphthous ulcer?

A

Topical steroids

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13
Q

What is the clinical presentation of acute laryngitis?

A

loss of voice, other common URI symptoms

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14
Q

What causes acute laryngitis?

A

Overuse, misuse, abuse

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15
Q

How to diagnose acute laryngitis?

A

Palpate neck and check quality of voice, cough, and ability to swallow/drink (unable to drink is a paralyzed vocal cord)

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16
Q

How do you treat acute laryngitis?

A

Avoid stress for voice
Diaphragm breathing
Avoid antihistamines
Hydration
Hoarseness >3 weeks, consult ENT

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17
Q

What causes chronic laryngitis?

A

Occupation, inhaled irritants, chronic sinusitis, cancer, infections

Consult ENT

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18
Q

What is the clinical presentation of median rhomboid glossitis?

A

Rhomboid-ish area of tongue smooth and without taste buds (asymptomatic)

Men more than women, often caused by candidal infection

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19
Q

How do you treat median rhomboid glossitis?

A

Antifungals

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20
Q

What is fissured tongue glossitis?

A

Grooves on tongue due to aging, down syndrome, acromegaly, psoriasis, Sjorgen syndrome…tongue brushing, but normal

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21
Q

What is geographic tongue glossitis?

A

Migratory glossitis that resolves and migrates, which is benign and localized, no treatment necessary, steroid/antihistamine if needed

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22
Q

What is hairy tongue glossitis?

A

Tongue discoloration due to tobacco use, poor oral hygiene, antibiotic use, solved by tongue brushing

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23
Q

What is atrophic glossitis?

A

Atrophy of taste buds, which is a manifestation of underlying conditions and requires testing for malnutrition, vitamin deficiency, disease, xerostomia, amyloidosis

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24
Q

What is the clinical presentation of lichen planus?

A

Reticular, white “lacy” pattern affecting mucosa of the tongue, risk factors including smoking, alcoholism, hep C infection

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25
Q

How do you diagnose lichen planus?

A

Palpate lips, tongue, buccal surface, and make sure it is not a Candida thrush infection (Does it scrape off? Lichen cannot, if concerned, treat fungal infection to see)
Biopsy for definitive, but just topical steroid needed if desired (generally asymptomatic)

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26
Q

What is the clinical presentation of acute pharyngitis/tonsillitis?

A

Viral = slow buildup of 5-7 days of URI symptoms and cough

Bacterial = sudden onset URI, fever, tender nodes, scarlatiniform rash, tonsillar exudate

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27
Q

What is the cause of acute pharyngitis/tonsillitis?

A

Usually viruses. Bacteria would be strep pyogenes, or a STD, or EBV.

28
Q

How to diagnose pharyngitis/tonsillitis?

A

Rapid strep test, throat culture*, monospot testing, EBV, xray if suspect epiglottitis, CT if abscess is found on palpation.

29
Q

How do you treat pharyngitis/tonsillitis?

A

For viral you don’t - provide education for gargling and rest, maybe NSAIDS.

Bacterial—> penicillin V potassium, amoxicillin , cefuroxime, erythromycin, cephalosporins, clindamycin.
Not contagious 24 hours after treatment.

30
Q

What are complications of pharyngitis/tonsillitis?

A

abscess, acute rheumatic fever, glomerulonephritis, airway obstruction

31
Q

What is the clinical presentation of sialadenitis?

A

Submandibular gland (chin) or parotid (front of ear) swelling, stone in gland, pain which worsens with eating, tenderness, edema, purulence, trismus

32
Q

What is the cause of sialadenitis?

A

Staph aureus, strep, h. influenzae

33
Q

How can you diagnose sialadenitis?

A

Palpate and look at gland areas during oral exam, can use US or CT to check for stones.

34
Q

How do you treat sialadenitis?

A

IV ampicillin/sulbactam … naficillin?
OR amoxicillin/clavulanate (augmentin)
Sialogogues to increase salivary flow (lemon!)
MRSA requires sulfamethoxazole/trimethoprim (bactrim) or vancomycin

35
Q

What is the clinical presentation of oral leukoplakia?

A

White patches or lesions that cannot be removed with abrasion.

36
Q

What are the causes/risk factors for oral leukoplakia?

A

Chronic tobacco use, alcohol, HPV, EBV

37
Q

How do you treat oral leukoplakia?

A

Should be referred to ENT or oral surgery for biopsy if cancer is suspected; white patches with red are more indicative

38
Q

What is the clinical presentation of Ludwig’s angina?

A

Gangrenous cellulitis and edema of neck, rock hard firm, purulence

39
Q

What are risk factors for Ludwig’s angina?

A

Low SE, unhoused, no dental care, AIDS, trauma, diabetes, malnutrition

40
Q

What is the treatment for Ludwig’s angina?

A

Airway emergency! Send to ER, need IV access and antibiotics #1 pencillin & metronizadole, ampicillin and sulbactam, trach needed (cannot intubate)

41
Q

How can you tell if there is a foreign body in the nasal passage?

A

Unilateral nose drainage, foul smelling

42
Q

How do you handle a nasal foreign body?

A

Force blow out, nasal speculum, balloon catheter, small tool, suction, Afrin (oxymetazoline) to minimize bleeding

43
Q

How do you manage epistaxis?

A

Direct pressure, lean forward, install vasoconstrictor (Afrin). Can cauterize, tampon, hospitalization if unstable

44
Q

What is the clinical presentation of nasal polyps?

A

Soft, painless “grapes” causing congestion, nasal obstruction, loss of smell/taste, recurrent infections

45
Q

What are the risk factors for nasal polyps?

A

Chronic inflammation, asthma, allergies, drug sensitivities, immune disorders

46
Q

How do you treat nasal polyps?

A

CT of sinuses, ask about tobacco, smoking, atopy, and prescribe with fluticasone (flonase), mometasone (nasonex), steroid/saline washes, immunotherapy…refer to ENT

47
Q

What is the clinical presentation of allergic rhinitis?

A

Itchy, watery red eyes, sneezing, itching, rashes. From environment, animals, seasonal

48
Q

What in the nasal exam is helpful to diagnose allergic rhinitis?

A

Nasal passages may be pale instead of dark pink/red, cobblestoning in throat, “allergic shiner”
vasomotor can be similar

49
Q

How do you treat allergic rhinitis?

A

Intranasal steroids & antihistamines, loratadine (claritin), fexofenadine (allegra), cetrizine (zyrtec), diphenhydramine (benadryl), eye drops olopatdine (pataday).. can get shots

50
Q

How is vasomotor rhinitis different from allergic rhinitis?

A

Caused by changes to air, temp, odors, light, hard to distinguish, but also can just treat with intranasal steroid spray

51
Q

What is the clinical presentation of rhinitis medicamentosa?

A

Addiction to Afrin- rebound nasal congestion, with erythematous, edematous appearance

52
Q

How do you treat rhinitis medicamentosa?

A

Nasal steroids or anticholinergics

53
Q

What is the clinical presentation of acute viral sinusitis?

A

Sneezing, congestion, fever, watery discharge, <10 day duration, not getting worse. Erythematous, edematous nasal appearance (irritated)

54
Q

What is the treatment for acute viral sinusitis?

A

OTC nasal decongestants (phenylephrine, oxymetazoline) for 2 days, sinus rinse, nasal strips

55
Q

What is the clinical presentation of acute bacterial sinusitis?

A

Purulent discharge, cloudy/colored, facial pressure, fullness, discomfort when bending over

56
Q

What is the cause of acute bacterial sinusitis?

A

Strep. pnuemoniae, h. influenza, s. aureus.
Progressed viral sinusitis, smoking, ciliary dysfunction, URI, rhinitis, osteomatal complex in sinus cannot drain (swollen shut)

57
Q

How do you diagnose acute bacterial sinusitis?

A

CANNOT administer based on headache or facial pressure alone - can be a lot of other things. Must not improve within 10 days, worsen within 10 days… fit other criteria.

58
Q

How do you treat acute bacterial sinusitis?

A

Amoxicillin or amoxicillin/clavulanate (augmentin), doxycycline, clindamycin. can add Afrin for 2-3 days with saline washes

59
Q

What are complications from bacterial sinusitis?

A

orbital cellulitis, osteomyelitis, cavernous sinus thrombosis, intracranial abscess

60
Q

What is the clinical presentation of chronic sinusitis?

A

12+ weeks of 2+ signs of mucopurulent drainage, nasal obstruction, facial fullness, limited sense of smell, inflammation

Mostly caused by p. aeruginosa, staph aureus

61
Q

How to diagnose chronic sinusitis?

A

Meet criteria and CT of sinus, nasal endoscopy, culture

62
Q

How do you treat chronic sinusitis?

A

Saline washes, amox/clav (augmentin), levofloxacin (levaquin), clarithromycin

63
Q

What ROS should you do regarding throat, nose?

A

• Sore throat?
• Trouble swallowing? Trouble talking?
• Hoarseness? Voice changes?
• Reflux?
• Nasal drainage?
• Cough?
• Nosebleeds?
• Change in taste or smell?
• Swollen Lymph nodes?
• Congestion?
- headache?

64
Q

What’s the Center Criteria?

A

1) fever > 38
2) tender anterior cervical lymphadenopathy
3) no cough
4) pharyngotonsillar exudate

65
Q

What is sialolithiasis?

A

Stones in salivary gland, most common in Wharton (large and opaque) and Stensen glands (smaller and opalescent)

Dilate or incise duct, recurrent = removal of duct

Clinical Medicine I (27 decks)

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