Acpnp Heent

Front 1

Choanal Atresia

Back 1

• assoc w/ CHARGE & Treacher Collins syndromes
• resp distress shortly after birth, noisy breathing, poor fdg, nasal drainage or discharge, cyclic breathing when crying
• DX: close mouth, auscultate nares, pass thin NGT, flex nasal endoscopy or CT
• TX: surgery

Front 2

mastoiditis

Back 2

• most common causative orgs: S. pneumo, GAS
• AOM w/ erythema, dullness & bulging of TM w/ tenderness, swelling of mastoid process
• post auricular changes (>18mos pinnna pushed up & out, infants pinnna down), edema, fluctuance, lethargy, irritability, fever, poor fig, facial weakness, LAD
• Acute coalescent mastoiditis: otalgia, auricular proptosis, & bulging, erythematous TM
• DX: CT, BC
• TX: abx -> outpt w/out periosteitis (HD Amox); IP BS IV abx if ill appearing, periosteal abscess, or refractory to oral abx
• compliction: thrombosis of lateral or sigmoid venous sinus, labyrinthitis, osteo
• CNS can be assoc -> subdural empyema, abscess, meningitis

Front 3

Orbital Cellulitis

Back 3

• most common cause bacterial sinusitis -> S. aureus, Streptococcus -> ^ in winter
• erythema & edema of eyelid and surrounding skin, tenderness to palpation, pain , fever, fatigue, HA, proptosis, painful/ltd EOMs, diplopia
• DX: CT of orbits and paranasal sinus w/ & w/out contrast, BC, CBC, LP if meningeal signs/CNS dysfunc
• TX: IP admission, HD IV abx (Vanc + 2nd/3rd gen cephalosporin) until afebrile & clinically improving then 2-3 wks oral abx (cephalosporin)
• repeat CT if changes in vision, EOMs, pupillary run
• surgical drainage of abscess not responding to abx

Front 4

Vocal Cord Dysfunction/Paralysis

Back 4

• sxs mimic asthma
• originating from 10th CN
• congenital or assoc w/ brain stem compression (arnold-chiari malformation) or thoracic surgery
• insp/exp wheezing -> unresponsive to tx
• DX: obs, flex laryngoscopy
• TX: remove precipitating fx, speech tx, anticholinergic meds