Oro, Nasal, ENT EM Flashcards
What is peritonsillar abscess’ clinical presentation?
collection of pus between tonsil and pharyngeal muscles, dysphagia, dysphonia, foul breath, fever, sore throat, difficulty opening mouth, uvular deviation, trismus, lymphadenopathy, drooling
What bacteria causes peritonsillar abscesses?
Strep, but often poly microbial
How do you Dx peritonsillar abscess?
Oral exam, MUST check neck for cord and spiked fever, for that would be Lemierre’s syndrome and need urgent attention
How do you treat peritonsillar abscesses?
I&D drainage and antibiotics – amoxicillin & clavulanate (augmentin), or clindamycin/ciprofloxacin if g+
send to ER if obstructed airway
What is the clinical presentation of epiglottitis?
swelling and limiting air flow in lungs, dysphagia, odynophagia, dyspnea, “hot potato voice”, drooling, stridor, hoarse voice, sore throat
How is epiglottitis caused?
Burns from hot liquids, injury/trauma, infection from staph aureus, h influenzae
How can you diagnose epiglottitis?
See the enlarged epiglottitis in a sagittal CT “thumbprint”, keep pt leaned forward and DO NOT LAY DOWN
How do you treat epiglottitis?
Immediate otolaryngology consult. CANNOT intubate, must perform tracheostomy, start IV antibiotics, and support with oxygen
Abx-ceftizoxime, cefuroxime w dexamethasone
What is mandibular dislocation?
Jaw pain, difficulty talking/swallowing, malocclusion, caused by yawning, vomiting, dental, intubation
How do you treat mandibular dislocation?
Lateral - open reduction
Posterior- fixation of auditory canal
Superior - brain damage consult
What is the clinical presentation of an aphthous ulcer?
canker sores, tender/round oval shapes, usually 1 or a few on soft tissues in mouth
How do you treat an aphthous ulcer?
Topical steroids
What is the clinical presentation of acute laryngitis?
loss of voice, other common URI symptoms
What causes acute laryngitis?
Overuse, misuse, abuse
How to diagnose acute laryngitis?
Palpate neck and check quality of voice, cough, and ability to swallow/drink (unable to drink is a paralyzed vocal cord)
How do you treat acute laryngitis?
Avoid stress for voice
Diaphragm breathing
Avoid antihistamines
Hydration
Hoarseness >3 weeks, consult ENT
What causes chronic laryngitis?
Occupation, inhaled irritants, chronic sinusitis, cancer, infections
Consult ENT
What is the clinical presentation of median rhomboid glossitis?
Rhomboid-ish area of tongue smooth and without taste buds (asymptomatic)
Men more than women, often caused by candidal infection
How do you treat median rhomboid glossitis?
Antifungals
What is fissured tongue glossitis?
Grooves on tongue due to aging, down syndrome, acromegaly, psoriasis, Sjorgen syndrome…tongue brushing, but normal
What is geographic tongue glossitis?
Migratory glossitis that resolves and migrates, which is benign and localized, no treatment necessary, steroid/antihistamine if needed
What is hairy tongue glossitis?
Tongue discoloration due to tobacco use, poor oral hygiene, antibiotic use, solved by tongue brushing
What is atrophic glossitis?
Atrophy of taste buds, which is a manifestation of underlying conditions and requires testing for malnutrition, vitamin deficiency, disease, xerostomia, amyloidosis
What is the clinical presentation of lichen planus?
Reticular, white “lacy” pattern affecting mucosa of the tongue, risk factors including smoking, alcoholism, hep C infection
How do you diagnose lichen planus?
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)
What is the clinical presentation of acute pharyngitis/tonsillitis?
Viral = slow buildup of 5-7 days of URI symptoms and cough
Bacterial = sudden onset URI, fever, tender nodes, scarlatiniform rash, tonsillar exudate
What is the cause of acute pharyngitis/tonsillitis?
Usually viruses. Bacteria would be strep pyogenes, or a STD, or EBV.
How to diagnose pharyngitis/tonsillitis?
Rapid strep test, throat culture*, monospot testing, EBV, xray if suspect epiglottitis, CT if abscess is found on palpation.
How do you treat pharyngitis/tonsillitis?
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.
What are complications of pharyngitis/tonsillitis?
abscess, acute rheumatic fever, glomerulonephritis, airway obstruction
What is the clinical presentation of sialadenitis?
Submandibular gland (chin) or parotid (front of ear) swelling, stone in gland, pain which worsens with eating, tenderness, edema, purulence, trismus
What is the cause of sialadenitis?
Staph aureus, strep, h. influenzae
How can you diagnose sialadenitis?
Palpate and look at gland areas during oral exam, can use US or CT to check for stones.
How do you treat sialadenitis?
IV ampicillin/sulbactam … naficillin?
OR amoxicillin/clavulanate (augmentin)
Sialogogues to increase salivary flow (lemon!)
MRSA requires sulfamethoxazole/trimethoprim (bactrim) or vancomycin
What is the clinical presentation of oral leukoplakia?
White patches or lesions that cannot be removed with abrasion.
What are the causes/risk factors for oral leukoplakia?
Chronic tobacco use, alcohol, HPV, EBV
How do you treat oral leukoplakia?
Should be referred to ENT or oral surgery for biopsy if cancer is suspected; white patches with red are more indicative
What is the clinical presentation of Ludwig’s angina?
Gangrenous cellulitis and edema of neck, rock hard firm, purulence
What are risk factors for Ludwig’s angina?
Low SE, unhoused, no dental care, AIDS, trauma, diabetes, malnutrition
What is the treatment for Ludwig’s angina?
Airway emergency! Send to ER, need IV access and antibiotics #1 pencillin & metronizadole, ampicillin and sulbactam, trach needed (cannot intubate)
How can you tell if there is a foreign body in the nasal passage?
Unilateral nose drainage, foul smelling
How do you handle a nasal foreign body?
Force blow out, nasal speculum, balloon catheter, small tool, suction, Afrin (oxymetazoline) to minimize bleeding
How do you manage epistaxis?
Direct pressure, lean forward, install vasoconstrictor (Afrin). Can cauterize, tampon, hospitalization if unstable
What is the clinical presentation of nasal polyps?
Soft, painless “grapes” causing congestion, nasal obstruction, loss of smell/taste, recurrent infections
What are the risk factors for nasal polyps?
Chronic inflammation, asthma, allergies, drug sensitivities, immune disorders
How do you treat nasal polyps?
CT of sinuses, ask about tobacco, smoking, atopy, and prescribe with fluticasone (flonase), mometasone (nasonex), steroid/saline washes, immunotherapy…refer to ENT
What is the clinical presentation of allergic rhinitis?
Itchy, watery red eyes, sneezing, itching, rashes. From environment, animals, seasonal
What in the nasal exam is helpful to diagnose allergic rhinitis?
Nasal passages may be pale instead of dark pink/red, cobblestoning in throat, “allergic shiner”
vasomotor can be similar
How do you treat allergic rhinitis?
Intranasal steroids & antihistamines, loratadine (claritin), fexofenadine (allegra), cetrizine (zyrtec), diphenhydramine (benadryl), eye drops olopatdine (pataday).. can get shots
How is vasomotor rhinitis different from allergic rhinitis?
Caused by changes to air, temp, odors, light, hard to distinguish, but also can just treat with intranasal steroid spray
What is the clinical presentation of rhinitis medicamentosa?
Addiction to Afrin- rebound nasal congestion, with erythematous, edematous appearance
How do you treat rhinitis medicamentosa?
Nasal steroids or anticholinergics
What is the clinical presentation of acute viral sinusitis?
Sneezing, congestion, fever, watery discharge, <10 day duration, not getting worse. Erythematous, edematous nasal appearance (irritated)
What is the treatment for acute viral sinusitis?
OTC nasal decongestants (phenylephrine, oxymetazoline) for 2 days, sinus rinse, nasal strips
What is the clinical presentation of acute bacterial sinusitis?
Purulent discharge, cloudy/colored, facial pressure, fullness, discomfort when bending over
What is the cause of acute bacterial sinusitis?
Strep. pnuemoniae, h. influenza, s. aureus.
Progressed viral sinusitis, smoking, ciliary dysfunction, URI, rhinitis, osteomatal complex in sinus cannot drain (swollen shut)
How do you diagnose acute bacterial sinusitis?
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.
How do you treat acute bacterial sinusitis?
Amoxicillin or amoxicillin/clavulanate (augmentin), doxycycline, clindamycin. can add Afrin for 2-3 days with saline washes
What are complications from bacterial sinusitis?
orbital cellulitis, osteomyelitis, cavernous sinus thrombosis, intracranial abscess
What is the clinical presentation of chronic sinusitis?
12+ weeks of 2+ signs of mucopurulent drainage, nasal obstruction, facial fullness, limited sense of smell, inflammation
Mostly caused by p. aeruginosa, staph aureus
How to diagnose chronic sinusitis?
Meet criteria and CT of sinus, nasal endoscopy, culture
How do you treat chronic sinusitis?
Saline washes, amox/clav (augmentin), levofloxacin (levaquin), clarithromycin
What ROS should you do regarding throat, nose?
• Sore throat?
• Trouble swallowing? Trouble talking?
• Hoarseness? Voice changes?
• Reflux?
• Nasal drainage?
• Cough?
• Nosebleeds?
• Change in taste or smell?
• Swollen Lymph nodes?
• Congestion?
- headache?
What’s the Center Criteria?
1) fever > 38
2) tender anterior cervical lymphadenopathy
3) no cough
4) pharyngotonsillar exudate
What is sialolithiasis?
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
