Viral Croup _____ sign
Steeple
Epiglottitis _____ sign
presentation
Thumb print
Pt sits in tripod breathing position, drooling, dysphagia, soft stridor, sudden airway obstruction, high fever
Epiglottitis special consideration from PA/Stiner
if you see it in the neck, never look again because the pt will loose their airway!
Tonsillitis/Pharyngitis
Tx:
Strep: fever, tonsillar exudate
Tx: PCN
Centor Criteria
Absence of cough
Tonsillar exudate
Hx of fever
Tender cervical lymph nodes/adenopathy
Peritonsillar Absess
presentation
tx
Can’t completely open mouth, pain, HOT POTATO voice, deviation in soft palate
Tx: aspiration I & D, IV abx
Retropharyngeal abcess
Fever, drooling, stiff neck, MUFFLED VOICE, stridot, bulding pharynx
Tx: IV abx, soft tissue neck xray
Deep tissue infx of submandibular space, sialdenitis, neoplasm, pharyngeal infx, staph, strep, bactericides, submental, sublingual swelling, drooling, fever, hard, tender, red
Ludwings Angina
Tx: soft tissue x-ray, IV abx
Herpes Simplex Virus
Tx and Labs
Tx: topical abreva or acyclovir
Labs: Tzank smear– see large, multi-nucleated cells
Oral HPV
MC HPV 16
inc. partners, inc. risk
Pathology making cancer in the neck more common. (risks)
Oral HPV
chewing tobacco is also a risk
Nasopharynx Cancer Risks
Smoking, ETOH, cervical adenopathy, squamous cell CA w/WHO type 3, lymphoepitheimoas.
asian culture with EBV
Cervical Adenopathy
Tx: Abx, radial neck dissection for lmphectomy, advanced radiation at site with chemo
(Tx complications on test)
Ceruminosis
ear wax.
remove only if: difficult to see TM, Otitis Externa, hearing loss, pt request, hearing air impressions
Otitis Externa
Presentation/causes
Maceration from loss of protective fxn of cerumen and inc. moisture, inc pH in canal, 2º infx from OM w/TM perforation
Otic drops (+/-) steriod, EAR WICKS with edematous canal, moist heat, no h2O in ear, no oral abx given in 1º
Tx Otitis Externa
Otitis Media
Tx Guidelines
> 24 mo old Watchful Waiting!!
Otitis Media
Tx
Abx 1st Line: AMOX
2nd is Augmentin
Otitis Media tubes guidelines
only after 3-4 mo of ears- constant effusion and audiogrammed hearing loss
Mastoiditis Tx
Myrinectomy w/o or w/PE tubes, IV abx, plus eardrops, surgical drain of mastoid in 24-48 hrs if no improvement.
Foreign Body in Ear
Adults: insects, ear stuffing
Kids > 9 mo old- toys beads, food
Conductive Hearing Loss happens in
Cholesteatoma
Cholesteatoma
TM perforation, white, cheesy material
Sensorineural Hearing Loss happen in
Presbyacusis and Meniere’s Disease
Presbyacusis
age associated hearing loss
>40 yo
Meniere’s Disease
vertigo associated with intermittent hearing loss
Acoustic Neuroma
tumor- arises from vestibular branch of schwann cells in the cerebellopotine angle in the posterior fossa of the brain
Acoustic Neuroma
Facial Droop-CN7: pressure involvement of close structures, affect cerebellar fxn, asymmetric sensorineural hearing loss, poor word discrimination, tinnitus, disequilibrium
Bacterial Parotitis/ Sialendenitis
Tx
Tx: stimulate salivary fxn, warm compress, hydrate, massage, abx off culture, surgery I&D, is CN7 involved (bc parotid gland)
Sialolithasis Tx
support!, analgesics, hydrate, antipyretic
REFER ENT- lithotropsy, sialoendoscopy
External Hematoma Tx
I&D unless hematoma is older than 7 days or recurrent/chronic. Always apply a compression dressing around/over the wound/head.
Lidocaine is never used in the ear.
TM perforation MC cause
MC from infection/mass (cholesteatoma).
also trauma- q-tip and iatrogenic
“Cauliflower Ear”
External Hematoma
Central vertigo
non positional vertigo, occurs as result of pathology or lesion involving the brainstem, cerebellum or peripheral labyrinths
Labyrinthitis
risk, presentation
Viral URI
causes n/v and hearing loss, positions make it worse!
BPPV
Benign paroxysmal positional vertigo
peripheral
Meniere’s Triad
Hearing loss, tinnitus
Vertigo
n/v
Aphthous Ulcers
aka
present
“canker sore”
recurrent apthos somatitis, starts in childhood. 2-4m round/oval ulcer in he mouth, yellow-gray
Dental Caries bacteria
MC is Strep mutans
Tetracycline abx tx considerations
NO PREGNANT WOMEN
NO KIDS
Don’t give it to a 7 yo. 14 is tolerable.
“Trench Mouth” gum infection
Acute Necrotizing Ulcerative Gingivitis
Acute Necrotizing Ulcerative Gingivitis
risks
smokers, immune compromised, poor oral hygiene, nutrition deficiencies, very foul breath, ulcerations of gingival
Nasal Foreign bodies
present
sneezing, discomfort, pain, unilateral discharge, foul odor, epistaxis, mouth breathing
Nasal Foreign bodies
check the nose but don’t forget the
Ears!
Epistaxis mc location
Kisselbachs plexus
Epistaxis
tx:
first rapid rhino
second epistat
Candidia Albicans MC
Thrush- it is FRIABLE (bleeds easy and scrapes off easy), white gray plaque, common in babies
Thrush Tx
sterilize bottles better also maybe yogurt if child is old enough
Canalolithiasis
delayed unilateral activation of fluid in semicircular canal due to impaired endolymph flow in cochlea caused by clump otoliths “rocks falling off hair cells”