EENT
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| Acute sinusitis: etiology | Big 3, SA
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| Unilateral foul smelling or purulent nasal discharge in a pediatric patient | Nasal Foreign body
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| HA, sinus pressure, yellow – green nasal discharge | Sinusitis
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| Sneezing, clear rhinorrhea, post-nasal drip, nasal congestion seasonal occurance | Allergic rhinitis. Effective Tx includes H1 antagonists, mast cell stabilizers (eg nedocromil), steroid sprays
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| Pale, edematous, boggy turbinates | Allergic rhinitis
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| Fever/URI; potentially life threatening = | <3 mos; 101F (38.3C)
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| Viral rhinitis (3-8/yr): etiology | rhino, corona; more bronchial = adenovirus, RSV
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| Viral rhinitis (50% of URIs) transmission | hand, inhaled droplet; incubation 2-5 days; sx resolve 5-7 days
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| Viral rhinitis tx | tylenol; ibuprofen if >6 mos; no ASA; sudafed/ phenylephrine; poss Afrin >2 yo; DM for cough; No Role for antihistamines
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| FDA: viral rhinitis tx | no cough/cold meds for kids <2 yo
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| Purulent rhinitis s/s | persistent mucopurulent nasal d/c and irreg fever; often GAS / SP
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| Rhinosinusitis: 2 presentations in kids | 1: ≥10 days nasal congestion, purulent nasal drainage and/or persistent cough; 2: abrupt onset w/ fever >101F, facial pain & purulent nasal drainage
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| Rhinosinusitis agents: | Big 3, esp SP (declining) & H flu
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| Chronic Rhinosinusitis agents: | alpha-hemolytic strep; SA; GN anaerobes
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| Mild-mod Rhinosinusitis tx | 10-14d for acute (4-6 wks for chronic). Amox 500 TID; if allergy, 3G ceph or macrolide or Bactrim
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| Frontal osteomyelitis secondary to frontal sinusitis = | Pott puffy tumor; surgical drainage & IV Abx
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| Rhinosinusitis: indications for referral | need surgical drainage; need polypectomy; recurrent sinusitis (esp w/ exacerbation of asthma); rare/ resistant microbe; intracranial or orbital complications; suspected immunodeficiency
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| Sinusitis Emergencies | Periorbital cellulitis; Brain Abscess; orbital abscess
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| Non-displaced nasal fracture: mgmt | does not require reduction
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| Refractory sinus problem characterized by saddle nose deformity, may be: | Wegener
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| Flat or raised white oral lesion that cannot be rubbed off, more likely in a smoker = | Leukoplakia (need to rule out oral cancer)
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| Gray pharyngeal pseudomembrane, rash, splenomegaly, supraclavicular LAD | Diphtheria
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| commonly associated with an alveolar bone fracture | Lateral luxations
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| Intrusive luxations of teeth | Most serious; do not manipulate initially, allow it to extrude itself or refer (orthodontist)
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| Post extraction alveolar osteitis, aka: | dry socket; Plain films to R/O retained root tip
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| ANUG is most associated with: | HIV, stress, malnutrition, and/or prior ulcerative gingivitis; life threatening if left untreated
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| ANUG tx | Chlorhexidine or half-strength H2O2 rinses, debridement by oral surgeon or ENT, PO flagyl TID (vs PCN or tetracycline)
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| Can be d/t hereditary C1 esterase inhibitor deficiency, allergic rxn, ACEI, or idiopathic | Angioedema
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| Tonsillitis tx | GP coverage: Amox, EES, Quinolones, Bactrim
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| Parapharyngeal / peritonsillar Abscess sx | Nuchal rigidity, stridor; sore throat (usually more on one side), trismus, drooling
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| Acute viral laryngotracheitis, aka ___; sx/tx | Croup; stridor, seal-like cough; Glucocorticoids, Nebulized epinephrine
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| Epiglottitis etiology | HIB (no. 1), GAS, staph
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| Epiglottitis sx | Trismus, drooling, dysphagia; Lateral Neck X-Ray will show Thumb Sign
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| Airway Foreign bodies: surgical intervention: | rigid bronchoscopy
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| Mandible Dislocation sx | Jaw pain, trismus, malocclusion; anterior dislocation is the most common; Can also have posterior, lateral, or superior dislocations
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| Mandibular fx tx | Nondisplaced fx: closed reduction; Displaced or condylar fx: ORIF; Wire Osteosynthesis for 6 weeks
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| Strep throat complications | rheumatic fever, Ludwig angina, tonsillar abscess
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| Centor criteria are for dx of: | (strep) pharyngitis; >38C, cervical LAD, no cough, +exudates
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| Burning pain in tongue, cheek, throat; whitish can be scraped off | oral candidiasis; immunocompromised pts; magic mouthwash w/antifungal
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| Whitish, cannot be scraped off: | leukoplakia; bx to r/o cancer (5% malignant; erythroplakia more likely malignant)
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| Epiglottitis tx | controlled intubation & IV Abx
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| Temporal bone fx: complications | hearing loss, facial paralysis, CSF leak, vertigo, TM perforation, nystagmus
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| Temporal bone fx: dx | CT Temporal Bone, non-contrasted; ENT Consult
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| If pt has polyps and asthma: | do not give ASA (risk of bronchospasm)
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| posterior epistaxis: usual source is: | nasal branch of sphenopalatine artery (condition assoc with HTN and athersclerosis)
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| Nasal foreign body: if it contains battery: | emergency: must remove within 4 hrs
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| Sinusitis diagnostic studies | X-rays: Caldwell (frontal), submentovertical (ethmoid), Waters (maxillary), lateral (sphenoid)
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| HSV-1 (cold sore) dx studies | Tzanck smear (+ shows multinucleated giant cells)
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| HSV-1 (cold sore) tx | Self limiting. May give acyclovir 200mg 5x/day x5D, or famcyclovir 125mg BID x5D, or valacyclovir 500mg BID x5D
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| Gingival ulceration/edema, grayish membrane over inflamed gingiva, fever, LAD, malaise = | ANUG (2/2 variety of spirochetes & fusiform bacilli = normal oral flora)
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| Parotitis dx studies | Check RF, anti-SS-A & anti-SS-B. Sialography. Ultrasound. If suspected malignancy, CT & MRI with contrast
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| Sialadenitis bug = | SA
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| Erythroplakia vs Leukoplakia: which is more likely to be malignant? | Erythroplakia
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| Reddish velvety lesion on oral mucosa or tongue; presents with erythema = | Erythroplakia
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| Erythroplakia/Leukoplakia pathology | Increased keratin layer thickness, neovascularization. If epithelial dysplasia is present, lesion is considered precancerous
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| Erythroplakia/Leukoplakia management | ENT referral. May try beta-carotene, retinoids, vitamin E
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| Most common cancer of the tongue = | SCC (M>F, older pts, often FH aerodigestive cancers)
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| Most common location of cancer of the tongue = | lateral
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| Painful, indurated plaque on tongue that becomes nonhealing ulcer; may have LAD & otalgia, odynophagia = | cancer of tongue
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| Tongue SCC workup | Bx, CT w/contrast, CXR, LFT, ?bone scan, ?PET
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| Laryngitis bugs | Usually viral (adeno, flu; RSV, Coxcackie, rhinovirus); H flu, M cat
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| Pharyngitis/Tonsillitis: 80% are caused by: | Viral (adeno, HSV, rhino, corona). Usually in winter/spring
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| Pharyngitis/Tonsillitis: bacteria: | GABHS, mycoplasma, Group G & C Strep, N gono, Chlamydia
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| Pharyngitis w/petechiae of soft palate, strawberry tongue +/- scarlatiniform rash = | Strep
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| Bacterial Pharyngitis tx | PenVK or Ceftin; erythromycin (if suspect mycoplasma or Chlamydia). Amox or azithro if compliance concern
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| Acute inflammation of supraglottic larynx = | Epiglottitis
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| Epiglottitis: typical pts | Kids 2-7 yo (usually H flu type B), may occur in adults, especially with DM
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| Rapid onset of high fever, ST, odynophagia, drooling, inspiratory stridor, tripoding, hoarseness, restlessness, in kids = | Epiglottitis
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| Epiglottitis tx | Secure airway; ENT referral ASAP; NT intubation if needed; ICU, O2. IV Abx (Ceftin / ceftizoxime) +/- Decadron
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| Peripharyngeal cellulitis/abscess mgmt | I&D of abscess. Admit if severe pain, dyspnea, trismus. Peds: IV hydration & Abx. Broad-spectrum cephalosporin. May try Clinda + PO Amox to prevent abscess formation
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| Extrusive dental luxations | Reposition tooth manually & splint into place ASAP
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