Week 2: ENT Flashcards
Cholesteatoma: Presentation & Management
P: hearing loss, vertigo; pearly white lesion on or behind the TM
M: Refer to ENT; avoid water entering the canal
What are the causes of the following types of tinnitus:
- High-pitched, continuous
- Low-pitched
- Pulsating
- Ocean
- Clicking
High-pitched, continuous: sensorineural Low-pitched: idiopathic tinnitus or Meniere Pulsating: vascular origin Ocean: eustachian tube dysfunction Clicking: TMJ
What are some ddx for tinnitus?
vestibular schwannoma, excessive noise exposure, presbycusis, somatization, acoustic neuroma
Otitis externa: common name and causative agents?
swimmers’ ear
staph aureus or pseudomonas
Otitis externa: Presentation & Management
Pain of the ear and auricle
Fullness or itching, clogged feeling
Drainage from the affected ear, hearing loss
Pain/tenderness on palpation
Canal erythematous and edematous; discharge or debris in the canal; TM normal
Topical abx: ofloxacin, cipro
Should improve within 5-7 days
Don’t use Q-tips, keep ears try
Acute Otitis Media: Causative agents?
s. pneumoniae, h. influenzae, M. catarrhalis
Acute Otitis Media: risk factors?
URI, allergies, cleft palate, adenoid hypertrophy, tobacco exposure
Acute Otitis Media: Presentation
Otalgia, worse in prone position: ear rubbing, rhinorrhea, vomiting, diarrhea, fever
bulging TM, otorrhea, pain, erythema, middle ear effusion
What instrument is used to diagnose acute otitis media?
pneumatic otoscope
What is a mild vs. severe case of AOM?
Mild: T <39, sx less than 48 hours
Severe: T>39, sx greater than 48 hours
What is the treatment plan for these patients w/ AOM?
6-23 months with non-severe unilateral AOM
24mo+
Watchful waiting w/ close follow-up in 48-72 hours
If no improvement after 72 hours, start abx
What is the treatment plan for these patients w/ AOM?
Severe symptoms, bilateral or unilateral >6mo
Treat w/ abx
What is the treatment plan for these patients w/ AOM?
<24 mo, bilateral
Treat w/ abx
What abx can be used for peds vs. adults to treat AOM?
Adults: Amoxicillin
Peds: Amoxicillin, cephalosporin
What can be added to the tx regimen for Peds if AOM not improving within 3 days?
augmentin
AOM complications - mastoiditis: Presentation & Management
P: fever, pain, posterior ear swelling
M: urgent ENT referral
AOM complications - perforation: Presentation & Management
P: severe pain w/ rapid relief, whistling sound
M: cipro ear drops, oral abx; avoid water in the ear
AOM complications - OM w/effusion: Presentation & Management
P: increased pressure, hearing loss
M: Audiogram if hearing loss present x3 months and consult w/ ENT
Acute bacterial rhinosinusitis: Presentation
URI x 10 days not improving or did improve and feeling worse
Severe sinus pain, facial pain or pressure depends on affected sinuses
Nasal congestion, purulent nasal dc, headache that worsens when bending forward
Fever
Acute bacterial rhinosinusitis: Management
What can be used as an alternative for PCN allergy in children vs. adults? How long do you treat adults for vs. adults?
Tx: Augmentin or amoxicillin + intranasal saline irrigation and intranasal corticosteroids Doxycycline if PCN allergy (if > 8 y.o) Levofloxacin if < 8 y.o and PCN allergy Adults treat 5-7 days Children 10-14 days
Acute bacterial rhinosinusitis: Causative agents
Strep PNA, h flu, moraxella catarrhalis
What is idiopathic or vasomotor rhinitis?
Nonallergic, noninfectious cause of perennial nasal congestion and rhinorrhea
In response to triggers: cold air, strong smells, increased estrogen
Idiopathic/vasomotor rhinitis: Management
avoid triggers, oral decongestants, saline irrigations, nasal steroids, ipratropium
Allergic rhinitis: Presentation & Management
P: sneezing, pharyngeal itching, post-nasal drip
M: reduce exposure to allergens, intranasal steroids, oral antihistamines, montelukast
Aphthous ulcers: Presentation & Management
P: painful, shallow ulcerations of the oral mucosa - prodrome of burning or pricking
M: benzocaine OTC, miracle mouthwash if recurrent
HSV 1: Presentation, Workup & Management
P: prodromal sx - localized pain, tingling, burning with erythema followed by eruption of vesicles that evolve into painful lesions (vesicular with erythematous base)
W: Tzanck smear, viral culture, antibody titer
M: antiviral meds (valacyclovir, acyclovir); avoid triggers
Herpangina: Presentation & Management
P: high fever 1-4 days, loss of appetite, sore throat, dysphagia, malaise; vomiting, abd pain; vesicles appear and enlarge to shallow ulcers in the mouth
M: pain relievers, fever control, hydration
Children can return to school 24 hours after the fever has come down
Hand, foot and mouth disease: Presentation & Management
P: fever, vesicular eruptions in the oropharynx (anywhere) that may ulcerate, maculopapular rash that evolves to vesicles (may peel 1 week later)
M: pain relievers, fever control, hydration
Children can return to school 24 hours after the fever has come down
What is the causative agent of herpangina and hand/foot/mouth disease?
coxsackievirus
Angular cheilitis: Cause, Presentation & Management
Cause: candida, triggered by saliva pooling in the corners of the mouth
P: cracking on inner corners of the lips
M: OTC topical antifungal, topical abx (mupirocin, bactroban)
What is the major difference between oral candidiasis vs. geographic tongue?
Will be able to scrape off candida infection but not geographic tongue
Oral candidiasis: Workup & Management
W: oral scrapings, cultures on a mycologic medium, KOH exam
M: nystatin oral suspension, nystatin powder applied to dentures, oral clotrimazole or miconazole buccal tablet; antifungal creams under dental appliances; fluconazole
Peritonsillar Abscess: Causative agents
Group A strep; strep, staph aureus and fusobacterium
Peritonsillar Abscess: Presentation
Fever, worsening sore throat, dysphagia, odynophagia, pooling of saliva/drooling, difficulty opening mouth, displaced deviation of uvula; anterior cervical lymphadenopathy
Peritonsillar Abscess: Management
ED referral - may need I&D, abx etc.
What are non-infectious causes of pharyngitis?
acid reflux, post-nasal drip, allergies, canker sores
What are common infectious causes of pharyngitis?
viral (EBV, adenovirus, rhinovirus, ect) or bacterial (Strep A, C, G, Gonorrhea, arcanobacterium haemolyticum, fusobacterium necrophorum)
How does viral pharyngitis present?
afebrile or low grade, mild erythema w/ no or sm amt of exudate, typically no tender lymph nodes
How does GAS pharyngitis present?
What are the s/s of scarlet fever?
Abrupt onset, fever, malaise, HA, lymphadenopathy, tonsillar exudate
Scarlet fever: sore throat, fine sandpaper-like rash (scarlatina rash), circumoral pallor and strawberry tongue; pastia lines in the inguinal or axillary area
What is the CENTOR criteria?
C: Absence of cough +1 E: Exudate +1 N: Tender anterior cervical lymphadenopathy +1 T: Fever +1 OR: Age modifier • Age less than 15 +1 • Age greater than 45 -1
What are the scoring categories of the CENTOR criteria?
Score 2-5 🡪 test and treat if positive
Score 6+ 🡪 empiric treatment appropriate
If rapid strep is negative, follow up with regular culture for peds - do not need to do this in adults
What is the management plan for GAS pharyngitis?
APAP or NSAIDs + abx
1st line: PCN or amoxicillin
2nd line: cephalexin or clindamycin or macrolide if PCN allx
Treat x 10 days
Refer for tonsillectomy if 7+ episodes of sore throat in one year or more than 5 episodes of throat infections in the last 2 years
When can kids go back to school after starting tx for GAS pharyngitis?
Can go back to school in 12-48 hours after being on abx
What is the Mono triad of sx?
fever, sore throat, posterior cervical lymphadenopathy
What else might you see on exam for mono?
petechiae at the hard and soft palate, hepatomegaly, splenomegaly; rash
What is the specific dx test for mono?
Mono spot - takes up to 2 weeks to turn positive after developing sx
What are considerations for a patient with mono?
Acute symptoms resolve within 1-2 weeks, may have persistent fatigue for 1-2 months
Avoid alcohol d/t liver inflammation
Avoid strenuous exercise of any contact sport (r/f splenic rupture)
If given amoxicillin will develop a rash
What is the causative agent of mono?
Epstein-Barr Virus
