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35 Cards in this Set
- Front
- Back
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_____________ are found in wrestlers, boxers, fighters & occur as a result of direct trauma.
Tx? |
Auricular Hematomas (Cauliflower ear)
Tx: Clean-> Auricular block-> Drain (aspirate or incision)-> compression-> antibiotics, daily rechecks (MUST tx w/i 7 days of trauma**) goal--> stop bleeding ASAP & expel hematoma to prevent deformity! |
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Pt comes in w/ ear pain (otalgia) following URI. PE reveals bulging red TM, loss of light reflex, & decreased movement on insufflation.
Dx? Tx? |
Dx: Acute Otitis Media
Tx: Amoxicillin or Erythromycin (plus sulfonamide or macrolide), pain meds if recurrent--> tympanocentesis (tubes) if severe--> surgical drainage |
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MC causes of acute otitis media are Strep pneumo, H. influenza, Strep pyogenes, Moraxella catarrhalis, & viral infections (esp from URI).
Tx is important to prevent what complications? |
Cranial nerve deficits (facial palsy)
Mastoiditis Labyrinthitis Intracranial infections |
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TM perforation (rupture) may occur d/t ____________. Pt may come in complaining of decreased hearing & drainage (purulent or sanguinous) from ear.
Tx? |
d/t;
trauma- blunt or penetrating (q-tip) infection- acute or chronic otitis, myringitis pressure change- unequal pressure on each side of TM (otic barotrauma) Tx: often heal spontaneously, if penetrating (early referral)--> surgical repair, avoid water in ear, if infection--> Abx *AVOID ototoxic (aminoglycoside- gentamicin, neomycin, tobramycin) ear drops |
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Pt comes in w/ painless foul-smelling otorrhea (ear drainage).
Dx? Tx? Tx ASAP bc drainage may contain bone-absorbing substances that can destroy inner ear structures** |
Dx: Cholesteatoma
Tx: surgical removal |
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Cerumen is a protective ear secretion. Cerumen impaction may occur, usually d/t self attempts to clean ear.
Tx? |
Tx: ear drops (soften cerumen), Hydrogen peroxide (mixed w/ water), OTC preps, + irrigation (remove from ear)
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Pt comes in complaining of painful purulent (yellow, brown, white, or gray) otorrhea. PE reveals pain on ear movement, erythema/ edema of the ear canal, & cellulitis.
Dx? Tx? |
Dx: Otitis Externa (swimmer's ear)
*inflammation of external auditory canal/auricle, dermatitis--> cellulitis--> chondritis--> osteomyelitis Tx: Ear cleaning--> Topical flouroquinolone (ofloxacin) Abx w/ steroids |
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What is the mc organism responsible for otitis externa?
Predisposing factors? |
Pseudomonas aeruginosa, staph aureus
Predisposing factors: Excessive cleaning/ scratching Swimming Occluding devices |
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_____________ may also occur d/t Pseudomonas infection, esp in elderly diabetic pts
*Pts present w/ painful ear drainage (otorrhea) & fever Tx? |
Malignant Otitis Externa
(invasive infection of external canal & skull base) Tx: IV Abx (flouroquinolones) Surgical debridement of infected bone if not responding |
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If a pt presents w/ Bullous Myringitis (painful vesicles/ bullae on the TM), how do you tx?
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TX: rupture bullae (relieve pain), Abx (dec risk of secondary infection)
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Pt presents w/ purulent nasal discharge & a headache, lasting more than a week. PE reveals postnasal drainage (diagnostic)
Dx? Tx? |
Dx: Acute sinusitis
Tx: Abx, nasal decongestants, ENT if tx failure |
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What complications can occur from untx Acute sinusitis?
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Brain abscess, meningitis
Cavernous sinus thrombosis Skull osteomyelitis (Pott's puffy tumor- osteomyelitis in frontal sinus, swollen forehead on one side)) orbital cellulitis |
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__________
Visible nose bleed (epistaxis) If recurrent--> coagulopathy or systemic dz Tx? |
Anterior (Kiesselbach's plexus)
Tx: silver nitrate cautery (go around vessel, then directly on) or pack |
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___________, less common than anterior epistaxis, NO visible bleed, assoc w/ atherosclerosis, mc in elderly hypertensive pts
Pack & admit ASAP to avoid what complications? |
Posterior epistaxis
Complications of posterior packing: infection (toxic shock), septal necrosis cardiac ischemia, arrhythmias, syncope dislodgement of packing into airway sinusitis, otitis media |
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An untx ________________ will cause a saddlenose deformity
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Septal hematoma (nasal fracture)
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Midfacial fractures can be described using Le Fort Classifications, define.
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Le Fort 1- horizontal maxillary fracture, free floating upper alveolar process
Le Fort 2- pyramid (triangular) fracture, free floating mid-face (maxilla, nose, cheeks) Le Fort 3- craniofacial distraction (can be a combo of these types) |
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Sialoadenitis is a bacterial infection of the salivary gland (parotid= MC), usually d/t _________
*firm, tender, swollen gland (UNILATERAL), fever, sxs WORSE w/ meals Tx? |
d/t obstruction* (caliculi/ stone) or hyposecretion (dehydration)
*caliculi--> usually submandibular tx: Abx |
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Pt presents w/ fever, adenitis, lymphadenopathy, sore throat, malaise/ fatigue. PE reveals pharyngeal exudates
Dx? Tx? What will happen if you give these pts ampicillin? |
Dx: Infectious mononucleosis
"kissing disease" d/t EBV in saliva Tx: Rest, no contact sports (splenic rupture*) *ampicillin causes a rash (not an allergy, response to EBV abs) |
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Pt presents w/ brawny, painful edema of submandibular area (huge swollen double chin), & restricted neck motion. PE reveals bilateral cellulitis of submandibular space.
Dx? Tx? |
Dx: Ludwig's Angina
**EMERGENCY--> can compromise airway Tx: Airway management ASAP (CRUCIAL) + Broad spectrum Abx |
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Pt presents w/ painful, swollen, red, ulcerated gums w/ a foul odor.
Dx? Tx? |
Dx: Acute Necrotizing Ulcerative Gingivitis "Trench Mouth" or "Vincents Stomatitis"
Tx: Metronidazole, clindamycin, improve oral hygeine |
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Adult pt presents w/ fever, sore throat, & tismus. PE reveals peritonsillar mass that displaces the soft palate & uvula.
Dx? Tx? |
Dx: Peritonsillar abscess
*MC deep facial infection in adults* Tx: ENT, needle aspiration *watch for airway obstruction (complication) |
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Young child presents w/ difficult swallowing & breathing, drooling, & "Cri du canard" (duck-like voice). Intraoral exam (& Lateral cervical X-ray) reveals anterior displacement of posterior pharyngeal wall. CT confirms posterior pharyngeal abscess.
Dx? Tx? |
Dx: Retropharyngeal abscess
Tx: Abx, ENT consult for surgery, intubate if airway compromise *monitor for airway obstruction (high mortality)** |
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Immigrant pt presents w/ sore throat. Intraoral exam reveals gray membrane covering pharynx & tonsils.
Dx? Tx? |
Dx: Diptheria (Corynebacterium diphtheriae)
Tx: Airway management, diptheria antitoxic + Abx (erythromycin/PCN) *Tx ASAP, may progress quickly to neuropathy & myocarditis--> respiratory failure (airway obstruction)--> death * |
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Pt presents w/ stridor & rapid onset progressive Dysphagia, Drooling, & Distress (Three D's). X-ray reveals "thumb shaped" epiglottis.
Dx? Tx? |
Dx: Epiglottitis
(*Now more common in adults than children) Tx: Intubate (if airway compromise, do 1st), notify ENT, Abx (ceftriaxone), send to OR if airway compromise is a concern*--> direct laryngoscopy |
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Young child presents w/ respiratory distress, barking seal cough. AP X-ray reveals "steeple sign".
(MC cause of upper resp obstruction in child*) Dx? Tx? |
Dx: Croup (Laryngotracheobronchitis)
* Parainfluenza infection Tx: Epi + steroids |
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Pt presents w/ malocclusion, decreased ROM of jaw, & mental nerve anesthesia.
Panoramic radiograph reveals multiple fractures. Dx? Tx? |
Dx: Mandible fracture
*may have multiple fractures (often bilateral) panoramic- shows entire mandible including condyles* Tx: Abx (for open fractures), ENT consult (surgical repair) |
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What are the risk factors for Candidiasis/ moniliasis?
*White curd-like plaques of C. albicans on erythematous base, CAN scrape off* Tx? |
Risk factors:
Very young or old Abx Dentures Steroids HIV Chemo Tx: nystatin, clotrimazole, fluconazole |
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What are the risk factors for Leukoplakia?
*White plaques on mucosal surface, CANNOT be scraped off* Tx? |
risk factors:
males smoking trauma Tx: biopsy (precancerous lesion**) |
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Child presents in summer time w/ sudden onset high fever, sore throat, & HA. Oral exam reveals multiple oral vesicles & painful ulcers on soft palate, uvula, gingiva, posterior pharynx, & tongue.
Dx? Tx? |
Dx: Herpangia (Coxsackie virus infection)
Tx: Self-limited, pain meds |
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What are the diff types of tooth (dental) abscesses?
These are tx w/ irrigation & debridement, PCN (penicillin) + clindamycin (or metroonidazole) |
Periapical abscess= inflammation, infection, necrosis of apical portion of tooth, can erode through cortical bone
Peridontal abscess= inflammation, infection, abscess of gums |
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____________ may occur 2-5 days post-extraction (tooth), pt presents as severe localized pain d.t osteomyelitis resulting from loss of protective clot.
Tx? |
Alveolar Osteitis (Dry socket)
Tx: Anesthetize--> Irrigate--> Pack (iodoform gauze plus eugenol)--> Abx *Early referral |
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When a tooth falls out (avulsed tooth), do NOT Scrub, put in saliva or milk & bring to ER ASAP.
For every minute that tooth is out, replantation survival decreases _________ |
1%
(if out for 30 mins--> 70% replantation survival) |
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Bell's palsy (idiopathic facial nerve palsy) presents w/ one sided facial droop, can't close eye.
Tx? |
Tx: steroids + valacyclovir, eye drops to prevent keratitis
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Pt comes in complaining or hearing loss, tinnitus, & vertigo. PE reveals grouped vesicles in the ear canal, tongue, & or hard palate (that DO NOT cross midline)
*Possible facial nerve palsy Dx? Tx? |
Dx: Herpes Zoster Oticus (Ramsey Hunt syndrome)--> reactivation of virus in geniculate ganglion
Tx: steroids + acyclovir |
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Pt comes in complaining of decreased vision, fever, malaise, & eye pain. PE reveals vesicular rash on eyelid & tip of nose (*Hutchinson sign), corneal dendrites, keratitis, iritis, glaucoma
Dx? Tx? |
Dx: Herpes Zoster Ophthalmicus--> reactivation of virus in the Trigeminal nerve
Hutchinson's sign = sight-threatening case** Tx: steroids + acyclovir + ENT referral (if HUtchinson's) |
