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ER > 10) ENT & Opthalmic > Flashcards

10) ENT & Opthalmic Flashcards

1
Q

Who does retropharyngeal abscess occur in?

A

96% occur in children <6 years of age & immunocompromised adults
-beleived to originate from an infected lymph node and progress to cellulitis and ultimately abscess formation

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2
Q

Common pathogens in retropharyngeal abscess

A

polymicrobial infection

strep, s. aureus, prvotella, bacteroides, peptostrepto, fusobacterium

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3
Q

Imaging in retropharyngeal abscess

A 
CXR = mediastinal extension
CT = more sensitive and better delineates the extent of the disease
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4
Q

Peritonsillar abscess

A
  • believed to originate from an infection of the palatine tonsil that invade surrounding tissue
  • polymicrobial
  • hot potato voice (aka muffled)
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5
Q

Tx of peritonsillar abscess

A

needle aspiration or I&D

-if not as severe = abx, analgesics, close follow-up

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6
Q

Most common age of epiglottitis

A

2-6y/o

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7
Q

Most common pathogens of epiglottitis

A

s. pyogenes, s. pneumo, s. aureus

b/c of HIB vaccine

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8
Q

Epiglottiis on X-ray

A

thumb sign

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9
Q

Tx of epiglottitis

A

Maintain airway

-IV fluids, humidified O2, IV abx, steroids, ?heliox (helium and oxygen)

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10
Q

What is Ludwig Angina

A

cellulitis of the floor of the mouth and neck originating in the submandibular space
**most commonly occurs at the site of dental trauma

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11
Q

Pathogens in ludwig’s angina

A
  • strep
  • staph
  • peptostrepto
  • prevotella
  • bacteroides
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12
Q

Tx of Ludwig angina

A

ensure a patent airway, analgesia, IV abx, otolaryn consult, surgical drainage

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13
Q

Tx of OE

A

topical antiinflmmatory and antibiotics (polymyxin, neomycin and hydrocortisone)

  • use wick if selling obstructs the canal lumen
  • *if the TM can’t be visualized oral abx should be considered for presumed concurrent OM
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14
Q

Epistaxis are nearly all located

A

arterial (anterior = kiesselbach pluxus)

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15
Q

Complications of hyphema

A

reduced vision, corneal blood staining, acute or chronic glaucoma, synechiae formation (adhesion from the iris to the cornea or lens)

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16
Q

Common cause of hyphema

A

blunt trauma to the eye

-may also complain of eye pain, decreased vision, or photophobia

17
Q

Tx of traumatic hyphema

A
  • head elevation, limit eye movements, analgesics, avoiding use of antiplatelets or anticoags
  • topical mydriatic, topical steroid, eye sheild
18
Q

Tx of eleven IOP

A

topical timolol
oral actezomainde
IV mannitol
(use of these should be guided by an ophthalmologist)

19
Q

Things to keep in mind w/ corneal abrasion

A
  • tetanus status

- contact lens use (more susceptible to p. aeruginosa)

20
Q

Tx of corneal abrasion

A

Tetracaine drops for analgesia

  • 2-3 day course of broad spectrum topical eye abx like erythromycin or polysporin
  • *if contact wearer: aminoglycoside or fluoroquinolone
  • **do not patch
  • **do not give tetracaine to go home
  • **refer to optham for follow-up in 24h
21
Q

Central retinal artery occlusion

A

EMERGENCY: retina ischemai and painless vision loss

  • may lead to retinal infarction and irreparable damage if not corrected w/ in 90 min
  • *usually presents between age of 50 and 70
22
Q

Blood supply to the retina

A

primarily via the internal carotid artery

**thromboembolic events are the most common cause of CRAO

23
Q

Hx & PE given in CRAO

A

acute, painless, monocular vision loss

  • afferent pupillary defect
  • cherry red spot on macula
24
Q

Tx of CRAO

A

emergency opthalmologic consultation

-tx is generally tulle if it has persisted for >90min

25
Q

Periorbital Cellulitis

A 
conjectival injection more common
fever commonly present
edeamtous erytheamtous periorbital soft tissue
EOM non-tender
normal IOP
normal VA
normal sensation
tx: abx PO or IV depending on severity = 2 or 3rd gen cephalosporin w/ vanco
26
Q

Orbital Cellulitis

A 
conjectival injection less common
fever commonly present
edmatous erythematous periorbtial soft tissue
**tenderness w/ EOM
**elevated IOP
**impaired visual acuity
-sometimes impaired sensation
tx: often requires surgical drainage
--IV 2nd or 3rd gen cephalospoin w/ vanco
27
Q

About orbital and periorbital cellulitis in general

A
  • tend to be U/L and occur in youth
  • *should be tread aggressively to avoid infection extension into the munges and brain via the cavernous sinus
  • *most common cause = sinus infections and local skin trauma
28
Q

Acute Angle Closure Glaucoma

A

sudeen onset of eye pain, blurred vision, headache, nausea, and vomiting

  • *may report halo around lights
  • *cloudy or steamy cornea
  • *IOP >20mmHg
29
Q

Tx of Acute Angle Closure glaucoma

A

Ophthalmology consult emergently

  • Pilocarpine 2% = mitotic (until constriction occurs & prophylactically to other eye)
  • Timolol decrease IOP w/in 1 hr
  • Acetazolamide - reduce IOP w/in 1 hr
  • IV mannitol - slowly and temporarily reduce IOP by osmotically drawing water out

ER (11 decks)

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