ENT

Question 1

Bacterial Tracheitis

Answer 1

• mean 5-8 yrs old
• often secondary to viral URI
  
  • sudden worsening with sore throat & tracheal tenderness, high fever, stridor, productive thick cough
• xray not needed, but may show subloglottic narrowing + irregular tracheal margins
• same management as epiglottitis

Question 2

Retropharyngeal Abscess

Answer 2

• neck pain, fever, drooling, dysphagia, bulging of posterior pharynx
• lateral neck xray
  
  • retropharyngeal space @ C2 > 2x diameter of vertebral body or > 1/2 width of C4 vertebral body

Question 3

Management of Epiglottitis

Answer 3

• nebulized epi
• IV Ceftriaxone/cefuroxime +- vanco
• +- dex
• lateral xray if stable + unclear dx

Question 4

Croup

Answer 4

• Clinical
  
  • 6 months to 3 years (older consider a anatomic abnormality)
• Tx
  
  • Dexamethasone 0.6 mg/kg PO or IM (giving IV preparation PO is a good idea, as smaller volume) (max 10 mg) X1 prevents hospitalization
  • Racemic (L-epinephrine) 0.25 mL mixed with 3-5 mL saline or 1:1000 epi 0.5 mL/kg max 5 mL Watch for at least 3h if thinking of sending home.
  • Admit if still stridor at rest, nasal flaring, or needed > 2 epi treatments.
  • Do not use beta-agonists (vasodilate tracheal mucosa)
  • Impending resp failure: epinephrine 0.01 mL/kg 1:1000 (max 0.3 mL)

Question 5

Pediatric Neck Masses

Answer 5

Review Evernote “Neck Masses”

Question 6

Sialolithiasis and Parotitis

Answer 6

Sialolithiasis

• clinical Dx
• can be hard to tell apart from/can coexist with parotitis
• imaging only if abscess
• lemon drops, massage

Parotitis

• mumps will not cause redness
• suppurative parotitis
  
  • purulent DC from Stenson’s duct
  • swab
  • Clavulin or Clinda or Keflex + Flagyl
  • US/CT only if not responding/fluctuant

Question 7

Lateral Sinus Thrombosis

Answer 7

• From AOM
• headache, occasional CN palsies
• CT/MR Venogram
• IV Abx

Question 8

Bullingous Myringitis

Answer 8

• treat same as AOM

Question 9

Malignant Otitis Externa

Answer 9

• infection of deeper ear structures (cartilage, bone, skull)
• ~80% pseudomonas aeruginosa, 15% MRSA
• sometimes fungal in diabetics
• suspect if AOE persists despite 2-3 weeks of topical therapy
• granulation tissue may be present on floor of canal
• Contrast CT or MRI to diagnose
• check for CN involvement
• Tx:
  
  • children: imipenem
  • adults: gent + cipro or cefotaxime
    
    • mild cases may settle with outpatient oral quinolone therapy

Question 10

TM Perforation

Answer 10

• no need for Abx unless FB/trauma/water
• keep dry, ENT 1-2 weeks (within 24h if posterosuperior quadrant affected, or from penetrating trauma)

Question 11

Rinne and Weber Tests

Answer 11

• Weber Test: tune forehead –> louder ear has conductive loss or quieter ear has SN loss
• Rinne Test: tune mastoid, then move in front of ear –> ear louder (normal), bone louder (conductive loss)

Review Evernote “Ear EM” if still unclear

Question 12

Tinnitus/Hearing Loss

Answer 12

Review Evernote Ear EM

Question 13

Trach Complications

Answer 13

See Evernote

Question 14

Angioedema

Answer 14

Review Evernote