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