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3. E Med & Surgery > 1- EENT Emergencies > Flashcards

1- EENT Emergencies Flashcards

1
Q

What type of herpes is responsible for herpes simplex keratitis?

A

HSV-1 (presumed recurrent)

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2
Q

Pt presents w/ acute onset eye pain, photophobia, blurred/ decreased vision, and tearing. What might you be concerned for?

A

Herpes simplex keratitis

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3
Q

On PE you note conjunctival injection, ciliary flush, and decreased corneal sensation. What might you be concerned for?

A

Herpes simplex keratitis

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4
Q

On slit-lamp with fluorescin of pt with suspected herpes simplex keratitis, what might you notice?

A

Dendritic lesions

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5
Q

What is the management for herpes simplex keratitis?

A

Urgent ophthalmology referral

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6
Q

What topical and oral med management is given for herpes simplex keratitis?

A
  • Topical
    • Acyclovir 3% ophthalmic ointment
    • Ganciclovir 0.15% gel
  • Oral
    • Acyclovir 400mg
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7
Q

What treatment should be avoided in a pt with herpes simplex keratitis?

A

Topical glucocorticoids

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8
Q

What are the indications for a corneal transplant in the treatment of herpes simplex keratitis?

A

Severe scarring or perforation

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9
Q

What optical emergency is due to UV radiation exposure, has a latent period of 6-12 hrs and is intensely painful but generally self limited?

A

UV keratitis

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10
Q

Pt presents with severe bilateral eye pain (distraught, pacing, rocking, unable to open eyes), photophobia, and foreign body sensation. What are you concerned for?

A

UV Keratitis

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11
Q

On PE you note tearing, generalized injection/ chemosis of the bulbar conjunctiva, mildly hazy cornea and miotic pupils. What are you concerned for?

A

UV Keratitis

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12
Q

What might be noticed on fluorescein stain on the eye of a pt with UV keratitis?

A

Superficial punctuate staining of the cornea

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13
Q

What is the management for UV keratitis?

A

Supportive (resolves in 24-72 hrs)

Oral analgesics for severe pain (mild oral opioid, lubricant abx ointment)

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14
Q

After dx of UV keratitis, how soon should a pt f/u to check for improvement?

A

1-2 days

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15
Q

What condition is defined as unilateral, periorbital edema with erythema, warmth, and tenderness?

A

Preseptal and orbital cellulitis

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16
Q

What condition may be a complication of sinusitis, extension of infection from adjacent structure, or local disruption of the skin?

A

Preseptal and orbital cellulitis

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17
Q

What are the most common pathogens that result in preseptal and orbital cellulitis?

A

S. pneumo, S. aureus, S. pyrogenes, H. flu

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18
Q

Is preseptal or orbital cellulitis a true emergency?

A

Orbital

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19
Q

Pt presents with swelling of eyelids and upper cheek. Are you concerned for preseptal or orbital cellulitis?

A

Preseptal (involves tissues anterior to orbital septum)

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20
Q

Pt presents with vision loss, impaired EOMs, diplopia, and proptosis. What ophthalmalogic emergency are you concerned for?

A

Orbital cellulitis (involves structures deep to the orbital septum)

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21
Q

How is preseptal and orbital cellulitis diagnosed?

A

CT scan of the orbits and sinuses with contrast

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22
Q

In which type of cellulitis (preseptal or orbital) is it more common to have the following sxs?

Eye pain/ tenderness, pain w/ eye movements, proptosis, ophthalmoplegia, vision impairment, chemosis, fever, leukocytosis?

A

Orbital

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23
Q

What is the tx for preseptal cellulitis if mild infection or no systemic sxs?

A

Discharge home with oral abx, f/u with ophthalmologist w/i 24-48 hrs

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24
Q

What is the tx for orbital cellulitis or preseptal cellulitis with any concerning factors?

A

Admit to hospital, IV abx, consult ophthalmology and ENT

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25
Q

What results from eye trauma, foreign bodies or improper contact lens use?

A

Corneal abrasian and ulceration

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26
Q

What is defined as any defect of the corneal surface epithelium (thin protective coating of anterior eye surface)?

A

Corneal abrasion

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27
Q

What is defined as a break in the epithelium exposing the underlying corneal stroma?

A

Corneal ulceration

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28
Q

What are the sxs of a corneal abrasion and ulceration?

A

Severe eye pain and foreign body sensation

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29
Q

What can corneal abrasion and ulceration lead to?

A

Impaired vision secondary to scarring

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30
Q

If suspicion of corneal abrasion or ulceration, when is the penlight exam performed?

A

Prior to fluorescein stain application

(should also perform visual acuity, EOMs, fundoscopic)

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31
Q

What will be noted on fluorescein exam of a pt with suspected corneal abrasion or ulceration?

A

Basement membrane exposed in areas of epithelial defect

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32
Q

How can visualization of a corneal abrasion or ulceration be enhanced?

A

Cobalt blue filter/ Wood’s lamp

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33
Q

What is the treatment for corneal abrasion?

A

Topical lubricants and topical abx +/- oral pain meds

(erythromycin ointment, sulfacetamide 10%, polymyxin/ trimethoprim, ciprofloxacin, ofloxacin drops QID x 5 days)

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34
Q

What should be avoided if suspicion of corneal abrasion?

A

Topical anesthetic/ steroid, patching

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35
Q

When should you refer for an urgent ophthalmology consult for a pt with a corneal abrasion or ulcertaion? (4)

A
  • Penetrating/ significant blunt trauma (large, nonreactive/ irregular pupil)
  • Impaired visual acuity
  • Ulceration
  • Contact lens wearer
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36
Q

What is the protocol for a contact lens wearer with corneal abrasion?

A

Ophthalmology ASAP to r/o infiltrate/ opacity, daily f/u to r/o infiltrate/ ulcer until healed

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37
Q

A lid laceration that is horizontal and follows skin lines would likely be classified as what?

A

Superficial/ uncomplicated

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38
Q

Uncomplicated lid laceration affecting < 25% indicated what management?

A

Heal by secondary intention

(clean, apply abx ointment, consider surgical tape/ adhesives)

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39
Q

Uncomplicated lid laceration affecting > 25% indicates what management?

A

Repair w/ 6-0 fast absorbable plain gut suture

(simple interrupted/ running if w/i 24 hrs, if non-absorbable suture used- remove in 5-7 days)

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40
Q

What is the protocol for lid lacerations if:

Full thickness, w/ orbital fat prolapse, through lid margin, through tear drainage system, orbital injury, foreign body, or poor alignment?

A

Refer to ophthalmologist or surgeon

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41
Q

You should keep a high threshold for suspicion of what for all full thickness lid lacerations?

A

Penetrating injury to globe

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42
Q

What are the significant findings a/w an orbital floor fracture (aka “blowout” fracture)? (4)

A

Entrapment of inferior rectus muscle, enopthalmos (if post globe displacement), orbital dystopia (eye is lower), injury to infraorbital nerve secondary to fracture

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43
Q

Untreated entrapment of the inferior rectus muscle (as seen with orbital floor fracture) can result in what?

A

Ischemia and subsequent loss of muscle function

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44
Q

Orbital floor fracture w/ decreased sensation to cheek, upper lip, and upper gingiva would indicate what finding?

A

Injury to infraorbital nerve

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45
Q

What diagnostic study is used for an orbital floor fracture?

(if evidence of fracture on exam, limitation of EOM, decreased visual acuity, severe pain, inadequate exam due to swelling/ AMS)

A

Thin cut coronal CT

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46
Q

What is the management for orbital floor fracture? (5)

A
  • Surgical eval
  • Prophylactic abx
  • Cold packs (first 48 hrs)
  • Raise head of bed
  • Avoid blowing nose/ sniffing
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47
Q

Open globe rupture often occurs following what?

A

Blunt eye injury

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48
Q

What should be avoided on PE if suspicion of open globe rupture?

A

Avoid pressure to eyeball

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49
Q

What diagnostic study is used for an open globe rupture?

A

Axial and coronal CT of the eye without contrast

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50
Q

What is the management for open globe rupture?

A

Transfer to tertiary trauma center, emergent ophthalmology consult, avoid manipulation , meds

(also eye shield, bed rest, NPO, no solutions in eye)

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51
Q

What meds are used in the treatment of an open globe rupture?

A

Abx, IV antiemetics, pain meds, sedation prn

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52
Q

What is defined as an inflammatory, demyelinating condition that causes acute, monocular vision loss and has a high associated with MS?

A

Optic neuritis

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53
Q

Pt presents with vision loss (hrs- days), eye pain worse w/ eye movement, afferent pupillary defect, and dyschromatopsia. What are you concerned about?

A

Optic neuritis

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54
Q

What is the treatment for optic neuritis?

A

Corticosteroids (IV methylprednisone)

(NOT oral prednisone- no effect on visual outcomes and may increase recurrence risk)

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55
Q

What is defined as narrowing or closure of the anterior chamber anlge leading to elevated IOP and damage to the optic nerve?

A

Acute angle closure glaucoma

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56
Q

What is normal IOP? What is IOP in closed angle glaucoma?

A

N = 8-21 mmHg

Closed angle glaucoma = > 30 mmHg

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57
Q

Pt presents w decreased vision, halos around lights, HA, severe eye pain, N/V, red eye, corneal edema/ cloudiness, mid-dilated pupil, and a shallow anterior chamber. What are you concerned for?

A

Acute angle closure glaucoma

58
Q

What specific exam should be deferred if suspected angle closure glaucoma?

A

Pupillary dilation (may exacerbate condition)

59
Q

What is the gold standard for dx of acute angle closure glaucoma?

A

Gonioscopy (slit lamp lens- visualization of angle between iris and cornea)

60
Q

What is used in the treatment of acute anlge closure glaucoma?

A

Emergent ophtho eval, pressure lowering eyedrops (if >1 hr delay), oral/ IV acetazolamide (check 30-60 min after admin)

61
Q

What pressure lowering eyedrops are given at 1, 2 and 3 min for acute angle closure glaucoma if > 1 hr delay?

A

1 min- 0.5% tomolol

2 min- 1% apraclonidine

3 min- pilocarpine

62
Q

Retinal detachment (retina separates from epithelium and choroid) results in what?

A

Ischemia and progressive photoreceptor degeneration

63
Q

Pt presents with sudden onset of floaters (cobweb), monocular visual field loss, and vision loss. What are you suspicious for?

A

Retinal detachment

64
Q

What is the treatment for retinal detachment?

A

Emergent eval with ophthalmologist

65
Q

What will be seen on US of retinal detachment?

A

Detached retina seen floating in vitreous with tethering at optic nerve

66
Q

Pt presents with hearing loss, ear pain, and ear drainage. What is the likely cause?

A

EAC FB

(children- FBs, adults- cerumen plugs)

67
Q

What is the treatment for EAC FB?

A

Otoscope exam- remove FB under direct visualization

Neutralize bugs w mineral oik

Check for otitis externa

68
Q

If organic material noted on otoscopic exam, what should be avoided?

A

Do not irrigate- may cause infection

69
Q

If evidence of OE on otoscope exam of pt with FB in EAC, what should you give?

A

Ciprodex or Cipro HC drops

70
Q

What is the most common cause of AOE?

A

Bacterial (P. aeruginosa)

71
Q

Pt presents with ear fullness, drainage, and pain (tragal motion tenderness). What are you concerned for?

72
Q

What is the management for AOE?

A

Debridement, abx drops (Ciprodex/ Cipro HC +/- otowick), watch for malignant otitis

73
Q

Pt presents with vesicles in ear canal, facial paralysis, hearing loss, and vertigo. What are you concerned for?

A

Viral AOE (Herpes zoster aka Ramsey-Hunt)

74
Q

What is the treatment for viral AOE (Herpes zoster)?

A

Antivirals, steroids, MRI brain (r/o skull base tumor)

75
Q

What is the most common cause of malignant OE?

A

P. aeruginosa

76
Q

Pt presents with ear fullness, drainage, and pain but appears acutely ill. You note granulation tissue in the ear canal. What are you concerned for?

A

Malignant OE

77
Q

What is diagnostic of malignant OE?

A

CBC- leukocytosis, cultures, head CT (r/o osteomyelitis- skull base)

78
Q

What is the treatment for malignant OE?

A

Admit, debridement, parenteral abx, ENT eval

79
Q

What parenteral abx are used in the treatment of malignant OE?

A

Cipro 400mg IV q 8 hrs

Change to 750mg PO q 12 hrs prior to discharge

Tx prolonged (6-8 weeks)

80
Q

The following are complications of what?

Cranial neuropathies, brain abscess, meningitis, septicemia, death

A

Malignant OE

81
Q

Otitis media, closed head injury, and direct ear trauma are all possible causes of what?

A

TM perforation

82
Q

Pt presents with pain, hearing loss, N/V, vertigo, otorrhea, and tinnitus. What are you concerned for?

A

TM perforation

83
Q

What is important to perform on PE if suspicion for TM perf besides direct visualization of TM?

A

Audiogram, CT/ CSF drainage (if suspect head trauma)

84
Q

Although 95% of TM perforations resolve without treatment, what might be indicated for management?

A

Orolarlyngology, water precautions, abx (ofloxacin otic drops), tympanoplasty (refractory)

85
Q

For a TM perf, if < 25% of total surface is involve, spontaneous tx should occur in how long?

A

Within 4 weeks

86
Q

Cauliflower ear is aka? And due to what?

A

Auricular hematoma, due to blunt force trauma to auricle

87
Q

Pt presents with collection of blood in the cartilage of the ear and hx of blunt force trauma to the auricle. What are you concerned for?

A

Auricular hematoma

88
Q

What is the treatment for auricular hematoma?

A

Drain/ aspirate ASAP, f/u eval q 24 hrs for 3-5 days, pt edu

89
Q

What pt edu should be provided for auricular hematoma?

A

Refrain from sports for 7 days

90
Q

What is defined as acute inflammation and infection of the auricular cartilage?

A

Perichondritis

91
Q

What is the most common pathogen a/w perichondritis?

A

P. aeruginosa

92
Q

Pt presents with erythema, pain, abscess formation, and systemic sxs. (ear) What are you concerned for?

A

Perichondritis

93
Q

What diagnostic study is used for perichondritis?

94
Q

What is the treatment for perichondritis?

A

I and D if indicated, empiric abx (Ciro)

95
Q

Do pts with a nasal foreign body typically present with sxs or asx?

96
Q

Pt presents with mucopurulent nasal discharge, foul odor, epistaxis, nasal obstruction, and mouth breathing. What are you concerned for?

A

Nasal foreign body

97
Q

For pt with nasal foreign body, exam includes direct visualization of FB as well as what?

A

Make sure lungs are CTAB w/o abn breath sounds

98
Q

Are diagnostic tests typically indicated with nasal FB?

A

Not if fully visible. Xray if suspect button battery or magnet

99
Q

What is the management for nasal FB once the child is adequately restrained and there is good visualization of the FB?

A

Manually retrieve w/ alligator forceps or suction

Avoid irritation if FB is organic matter

If >2 unsuccessful attempts, refer to ENT

100
Q

What should you do once removing a nasal FB?

A

Re-examine to r/o a 2nd one

101
Q

Bloody nose is aka and classified as what?

A

Epistaxis, classified as anterior or posterior (location of bleed)

102
Q

Are anterior or posterior nose bleeds more common?

A

Anterior (Kiesselbach’s plexus)

103
Q

Nose picking, low moisture, hyperemia secondary to allergic rhinitis, FB, drug use, or trauma are possible causes of what?

A

Epistaxis (nose bleed)

104
Q

The anastomosis of 3 primary vessels (septal branch of ant ethmoidal artery, lateral nasal branch of sphenopalatine artery, and septal branch of superior labial branch of facial artery) is known as what?

A

Kiesselbach’s plexus (location for anterior epistaxis)

105
Q

Where does a posterior epistaxis most commonly arise from?

A

Posterolateral branches of sphenopalatine artery

(less commonly from carotid artery)

106
Q

What is considered conservative treatment for epistaxis?

A

Afrin- 2 sprays

Direct pressure (tight against septum) x 10 min

Nasal hydration if no further bleeding

107
Q

What might be included in the management of epistaxis if the source of bleeding is easily identified?

A

Cautery (avoid large areas and remove excess silver nitrate)

108
Q

What are the risks of cautery in the treatment of epistaxis?

A

Ulceration, septal perforation

109
Q

In the use of nasal packing for epistaxis, how long after placement should you remove the packing?

A

3 days in N pt, 5 days for anticoagulated pt

110
Q

What abx might be used in the management of epistaxis?

A

Anti-staph (Keflex, Augmentin)

(along w/ entire course of packing)

111
Q

The following are important to ask as part of hx in eval of what?

Time frame, mech of injury, direction of force, prior nasal surgery/ trauma

A

Nasal trauma

112
Q

The following are important to include on PE of what?

Epistaxis, CSF rhinorrhea, impaired EOMs, orbital edema/ ecchymosis, lacerations, septal hematoma

A

Nasal trauma

113
Q

What diagnostics are used in the management of nasal trauma?

A

CT maxillofacial without contrast

(r/o any additional facial fractures)

114
Q

What early complications are a/w nasal trauma?

A

Hematoma, abscess, uncontrolled epistaxis, CSF rhinorrhea

115
Q

What late complications are a/w nasal trauma?

A

Nasal deformity, obstruction, perforation

116
Q

What is included in the treatment of nasal trauma?

A

Repair skin lacerations, attempt closed reduction (maximize airway and improve aesthetics) BUT if significant swelling consider waiting 4-6 weeks before surgical correction

(also elecate head of bed, cold compress, pain management, photos)

117
Q

What is the f/u for a pt with nasal trauma?

118
Q

What are the causes of a septal hematoma?

A

Trauma, septal surgery, bleeding disorders

119
Q

Pediatric pt presents with nasal obstruction and pain. On PE you note soft, tender swelling along the septum. What are you concerned for?

A

Septal hematoma

120
Q

What is included in the treatment of a septal hematoma?

A

I+D (prevents avascular necrosis), pack nose, abx, outpatient ENT referral (remove packing in 24 hrs, re-check, re-pack)

121
Q

Untreated nasal hematomas may cause what?

A

Septal perforation and/ or “saddle nose” deformity

122
Q

How is mastoiditis defined?

What is the timefram for acute mastoiditis and what is this often a complication of?

A

Suppurative infection/ inflammation of mastoid air cells

Acute = sxs < 1 month, complication of AOM

123
Q

Pt presents with ear pain and drainage along with tenderness, erythema, and edema over the mastoid process. What should you be concerned for?

A

Mastoiditis (can also be asx w/ N exam)

124
Q

On PE you note postauricular erythema, tenderness, swelling, fluctuance, a mass, as well as protrusion of auricle, oralgia, and fever. What are you concerned for?

A

Mastoiditis

125
Q

What diagnostic studies are used for mastoiditis (if not characteristic finding)?

A

CT head w/ contrast (visualize temporal bone changes), culture if infection

126
Q

What is the treatment of mastoiditis?

A

Refer to ENT, empirial oral abx if IMC, mastoidectomy/ consideration of IV abx if recalcitrant disease/ IMC

127
Q

Pt presents with fever and pain, as well as red, fluctuant swelling of the gingiva and TTP. What are you concerned for?

A

Periodontal abscess

128
Q

What diagnostics are used in the management of periodontal abscess?

A

Panoramic radiograph or CT for bone involvement

129
Q

What is the treatment for periodontal abscess?

A

Pain management, I+D, oral abx (limited infection, Augmentin/ Clinda x 7-14 days), f/u with dentist

130
Q

What dental injury is a true dental emergency?

A

Avulsion of permanent tooth

131
Q

Pt presents with pain, a completely displaced tooth from alveolar ridge, and a severed periodontal ligament. What are you concerned for?

A

Dental injury (avulsion of permanent tooth)

132
Q

In the management for an avulsion of a permanent tooth, if unable to re-implant immediately, what should you store the tooth in?

A

Balanced saline solution, cold milk, or pts saliva

(until seen by dentist)

133
Q

What is included in the management of a dental injury (avulsion of permanent tooth)?

A

Urgent dental consult, maintain vitality of periodontal ligament, handle tooth by crown, rinse in saline, re-implant tooth

134
Q

How do you re-implant an avulsed tooth?

A

Inset into empty socket and hold in place with gauze

(85-97% success at 5 min, nearly 100% at 1 hr)

135
Q

What should be included in the management of an avulsed tooth to avoid complications?

A

Tetanus prophylaxis and abx

136
Q

Tongue lacerations are usually related to injury that involves what?

137
Q

Under what circumstances should repair of a tongue laceration be considered?

A
  • Large (> 1 cm, extends into muscular layer, completely through tongue)
  • Deep on lateral border
  • Large flaps/ gaps
  • Significant hemorrhage
  • Possibility of dysfunction w/ improper healing
138
Q

When is repair of a tongue laceration not considered?

(heal by secondary intention)

A

< 1cm, non-gaping

(also “assessed to be minor in clinical judgement”)

139
Q

What suture should be used in a tongue laceration repair?

A

Absorbable, 3-0 or 4-0 chromic gut or vicryl

140
Q

What should be included in the management of a tongue laceration if it was the result of an injury?

A

Abx (tetanus prophylaxis)

3. E Med & Surgery (19 decks)

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