ENT Disorders Test 4-2

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9A Test 4-2

Treatment of foreign bodies in ear

DO NOT flush out, manually remove, if unable to remove refer.

Treatment for insect, bee, ect

Try enticing out with light, verify TM intact, flush with MINERAL OIL and remove with hemostats- immobilize c Lidocaine

Signs and Symptoms of external otitis

Inflammation of EXTERNAL AUDITORY CANAL wall, moderate to severe earache, TENDERNESS OF PENNA and PRESSURE over tragus, normal temp, PRE/POST auricular/ CERVICAL lymphadenopathy, normal hearing unless swelling present.

Medicine treatment for external otitis

Tylenol, ASA/ asprine (acetylsalicylic acid), E-mycin, keflex.

Antibiotics treatment for external otitis

Emycin, Cephalexin (Keflex)

Serous otitis media

when the EUSRACHIAN TUBE REMAINS BLOCKED for prolonged periods of time, fluid accumulated in the middle ear resulting in a negative pressure.

Signs and Symptoms of otitis media

FEELING of FULLNESS IN EAR, impaired hearing-CONDUCTIVE HEARING LOSE, 0 ear ache, TM NOT injected, DIMININISHED/ DISPLACED light reflex, accentuation of landmarks, impaired mobility of TM.

Med treatment of otitis media

pseudoephedrine hydrochloride (sudafed), entex PSE (pseudoephedrine HCL), oxymetazoline hydrochloride (afrin),

Treatment of otitis media

valsalva after each instillation of nose dropsand frequently throughout day

Differntial DX of otitis media

Eustatian tube dysfunction

Signs and Symptoms of eustatian tube dysfunction

sensation of fullness in the ear, RETRACTED TM and decreased mobility

Medicine treatment of eustatian tube dysfunction

decongestants, antihistamines, auto-inflation

Afrin (oxymetazoline HCI)

is to be taken no longer than 3 days

Otitis media/ purulent media

a BACTERIAL or VIRAL INFECTION of MIDDLE EAR

Signs and Symptoms of otitis media/ purulent media

mild to severe earache may radiate, over same side of the face, tinnitus, full feeling and pressure in ear, conductive hearing loss, fluid or pus seen behind TM, TM may appear red then yellow/ white dulness, Buldging may be present under pressure, fever

Treatment of otitis media/ purulent otitis media

tylenol/ mortin, apply heat, decongenstant ie sudafed, afrin gtts, amoxicillin, augmentin, or trimethoprim/ sulfaamethixazole (bactrim) if allergic to PCN. F/U manditory

Sinusitis (rhinosinusitis)

infection of the ACCESSORY nasal sinuses, result of coryza virus, strep, staph, pneumococci, H. influenza

Signs and Symptoms of Sinusitis

gradual or sudden on set, sharpe throbbing headache over sinuse boggy & red nasal mucosa C exudate, clear watery discharge or purulent nasal and post nasal discharge, positive head tilt C or S cough

TX of sinusitis

sudafed, afrin gtts, analgesic prn, contact preceptor for antimicrobial therapy, amoxicillin... give septra (bactrim) if allergic to PCN

complications of sinusitis

brain abcess, encephalitis, meningitis, osteomyelitis, palsy of CN V

Epistaxis (nose bleed)

hx of trauma, acute infection, violent sneezing, hyoertensive PT

Signs and Symptomes of epistaxis

bleeding for nares, most common sites kiesselbach and tip of inferior turbinate, cough up or vomit blood, shock

Management of epistaxis

PT sits erect, forward head tilt, compress (5-10 mins), ice, pack nostrils, cauterize with visual inspection, consult, foley

Rhinitis

a reaction of the NASAL MUCOSA RESULTING in EDEMA< SNEEZING and INCREASED muscosa secreations. from virus or allergens

Signs and Symptoms of viral rhinitis

non specific, nasal congestion, WATERY rhinorrhea, sneezing nasal mucosa hyperemic and edematous

Signs and Symptoms of allergic rhinitis

YEARLY SYMPTOMS, congestion, rhinorreha, sneezing, pale nasla mucosa, polyps

TX of viral rhinitis

sudafed, entex PSE, afrin

TX of allergic rhinitis

avoid agent, antihistimine (loraradine (claritin), fexofenadine (allegra), cetirizine HCl (zertec), benadryl)

TX allergic rhinitis

afrin, increase fluids, acetaminophen

Pharyngitis

inflammation of the pharynx

Most common pharyngitis

Viral pharyngitis, caused by strepococci, pneumococci, rarly diptheria

Viral Pharyngitis

may extend from infection of tonsils, nose or sinuses, associated with other diseases, inhaled irritation.

General Signs and Symptoms of Viral pharyngitis

dry/scratchy throat, hyperemic pharyngeal mucosa, swollen/ tender cervical lymphadenopathy, malaise, HA, fever, pain, dysphagia

General Signs and Symptoms of Bacterial pharyngitis

exudates, fever over 38C (100.5F), lymphdenopathy

Treatment for viral pharyngitis

rest, light diet, stop smoking, ASA/ Tylenol, throat cult, warm saline gargle, throat lozenges PO fluids

Treatment for bacterial pharyngitis

throat cult, OR based of symptomes ie CENTOR CRITERIA, rest, light diet, stop smoking, ASA/ Tylenol, throat cult, warm saline gargle, throat lozenges PO fluids. Antibiotics include pen VK (PCN), or erythromycin (if allergice to PCN)

Differental DX for pharyngitis

mono, diptheria

Sign and Symptoms of mono

same as pharyngitis, C prolonged course longer than 1 week, EXCESSIVE MALAISE, general lymphadenopathy, microptechei of soft palate, splenomegaly, heptomegally, confirm with CBC Cdiff and mono spot.

TX of mono

bed rest avoid strenuous activity to include contact sports, concider EVAC if spleen is enlarged

Signs and Symptoms of diptheria

same as bacterial pharyngitis, presence of membrane covering tonsils and extended tissue, DIRTY GRAY, TOUGH, possibly firmly adherent and bleeding, GRAM STAIN + rods.

TX of diptheria

same as bacterial pharyngitis, DIPTHERIA ANTITOXINS, EVAC

Tonsillitis

an acute inflammation of the TONSILS , commonly DUE TO STREP A beta hemolytic strep, common in military

Signs and Symptoms of Tonsillitis

sudden onset, sore throat on swallowing, kids don't eat, TONSILS are edematous and hyperemic, purulent exudates from TONSILLAR crypts, white thin membrane that peels away easily S bleeding, malaise, cervical lympadenopathy

TX medication for tonsillitis

ASA/ acetaminophen, throat cult, PCN, bicillin, erythromycin

peri tonsillar abcess

Common in YOUNG ADULTS usually caused by GROUP A BETA STREP

Signs and Symptoms of peritonsillar abcess

SEVERE PAIN upon swollowing, head tilt towards abcess, marked trismus, TONSIL DISPLACED medially, soft palate hyperemic and edeemous, UVULA DISPLACED TO OPPISITE SIDE OF INFECTED TONSIL

TX for perinsillabcess

contact preceptor, Tylenol/T3 cellulitis S pus give PCN, pus not draining within 2 days EVAC, PCN VK, augmentin or clindamycin if PCN allergy

Aphthous ulcer

signs and symptoms NON-KERATIZED BUCCAL, LABIAL mucosa, not on gingiva or palate, single or multi LESIONS

Signs and Symptoms of apthous ulcer

painful, 1-2mm ROUNG YELLOW- GREY fibrinoid center surrounded by red halos, pain lasts 7-10 days, resolved 1-3 weeks

Med TX for apthous ulcer

vicious lidocane, orabase dental paste, triamcinolone acetone (kenolog), contact dental preceptor if not resloved in 7-10 days

Laryngitis

inflamation of larynx (smokers voice)

Signs and symptoms of laryngitis

UNNATURAL CHANGE IN VOICE, horseness to aphonia, feeling of tickeling, rawness and constant clearing of throat, dysphagia, edema and hyperemia of LARNGEAL mucosa C or S exudates, stridor and dyspnia,

TX of laryngitis

stop smoking, rest voice, humidified air, tylenol and antibiotic

Upper Respitaroty Infection

an ACUTE VIRAL INFECTION of the respiratory tract C inflammation in any or all airways

Signs and Symptoms of URI

RHINORRHEA, laryngitis, sneezing, pharyngitis, cough, sinus congestion, usually afebrile

TX for URI

ASA/ acetaminophen, decongestant, cough suppressant

Barotrauma

individual with auditory tube dysfunction due to CONGENITAL NARROWING or ACQUIRED MUCOID EDEMA. inable to equalize BAROMATIC stress exerted on the middle ear by wir travel, RAPID ALTIUDE CHANGE or under water diving

TX Barotrauma

yawn/swollow/ valsalva, sudephed , afrin, tylenol. myringotomy in severe cases

Labrynthitis

acute onset of CONTINUOUS SEVER VERTIGO lasting days or weeks, C hearing loss and tinnitus. unknown cause but follows URI

TX of Labrynthitis

bed rest, treat underlying disease, diazepam, or benadryl, meclizine

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