CCP 221 ENT Emergencies 👂👃

Question 1

cranial nerves associated with extra ocular movement

Answer 1

III, IV, VI (3,4,6)

Question 2

“S.H.O.R.T” acronym for predictors of difficult cricothyrotomy

Answer 2

S - Surgery (recent/prev neck surgery)
H - Hematoma (zone 2 hematoma)
O - Obese (lots of fatty tissue)
R - Radiation distortion (thick, fibrous tissue)
T - Tumor (zone 2 space occupying mass)

Question 3

peripheral vertigo (define, describe, differentiate from central vertigo)

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Answer 3

describes vertigo caused by lesions affecting the inner ear and cranial nerve VIII (vestibulocochlear nerve)

sudden onset, intermittent/fluctuating, more severe symptoms
affected by head position/movement
motor function/gait typically intact

CAUSES:

benign paroxysmal positional vertigo (BPPV)
vestibular neuritis
Meniere's disease
acoustic neuroma
aminoglycoside toxicity
semicircular canal dehiscence syndrome
perilymphatic fistula
herpes zoster oticus (Ramsay Hunt syndrome)

Question 4

central vertigo (define, describe, differentiate from peripheral vertigo)

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Answer 4

vertigo caused by lesions affecting the brainstem and cerebellum

gradual onset, constant, more mild symptoms
unaffected by head position/movement
motor function/gait unstable

CAUSES:

vestibular migraine
brainstem stroke
multiple sclerosis
ischemic or hemorrhagic damage to the cerebellum
cerebral edema
high altitude cerebral edema

Question 5

The four cranial nerves involved in vision and movement of the eyes

Answer 5

CN II optic nerve (sensory)
CN III oculomotor (motor)
CN IV trochlear (motor)
CN VI abducen (motor)

Question 6

What 3 cranial nerves directly control the eye muscles?

Answer 6

CN III oculomotor (motor)
CN IV trochlear (motor)
CN VI abducen (motor)

Question 7

cranial nerves controlling the position of the eyeballs

Answer 7

CN III oculomotor (motor)
CN IV trochlear (motor)
CN VI abducen (motor)

Question 8

what cranial nerve influences the position of the eyelids and the size of the pupils

Answer 8

oculomotor (III)

Question 9

3 zones of the neck

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Answer 9

Zone 3 - Angle of mandible to base of skull (UPPER ZONE)
Zone 2 - Cricoid to angle of mandible (MIDDLE ZONE)
Zone 1 - Clavicle to cricoid cartilage (LOWER ZONE)

Question 10

5 eye vital signs

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Answer 10

1) Visual acuity (Snellen chart)
2) IOP (Tonometer)
3) Pupils (pupil exam)
4) Extraoccular movement (H-test)
5) Visual Fields (visual field exam)

Question 11

hyphema (describe + define)

Answer 11

Blood pooling in the anterior chamber of the eye

Question 12

iridocyclitis (describe + define)

Answer 12

Inflammation of the iris

Question 13

iridodialysis (describe + define)

Answer 13

Tearing the iris root from the ciliary body causing a double pupil

Question 14

what ophthalmic condition is characterized by a patient complaint of seeing “flashes and floaters”

Answer 14

Vitreous hemorrhage

Question 15

what cranial nerve has been impacted to elicit a “down and out” pupil presentation?

Answer 15

CN III (oculomotor)

Question 16

what cranial nerve has been impacted to elicit a “medially deviated” pupil presentation?

Answer 16

CN IV (abducens)

Question 17

Ludwig’s angina (describe + define)

Answer 17

Bilateral infection of the submandibular space in the deep neck that begins as a cellulitis in the floor of the mouth

Question 18

LeFort fracture definition

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Answer 18

fractures of the midface, which collectively involve separation of all or a portion of the midface from the skull base

Question 19

Le Fort type I

Answer 19

Le Fort type I - horizontal maxillary fracture, separating the teeth from the upper face

Le Fort I is a floating palate (horizontal)

Question 20

Le Fort type 2

Answer 20

Le Fort type II - pyramidal fracture, with the teeth at the pyramid base, and nasofrontal suture at its apex

Le Fort II is a floating maxilla (pyramidal)

Question 21

Le Fort type 3

Answer 21

Le Fort type III - craniofacial disjunction

Le Fort III is a floating face (transverse)

Question 22

pathophysiology of trismus in deep space neck infections

Answer 22

local inflammation of the muscles of mastication or the direct involvement of these muscles by the infection

Question 23

“Hard Signs” of neck trauma

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Answer 23

1. Airway compromise
2. Air bubbling wound
3. Expanding or pulsatile hematoma
4. Active Bleeding
5. Shock, compromised radial pulse
6. Hematemesis
7. Neuro Deficit/Paralysis/Cerebral ischemia
8. Absent or unequal radial pulse

Question 24

“Soft Signs” of neck trauma

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Answer 24

1. Subcutaneous emphysema
2. Dysphagia, dyspnea
3. Non-pulsatile, non-expanding hematoma
4. Venous oozing
5. Chest tube air leak
6. Minor hematemesis
7. Paresthesias

Question 25

Zone III (upper neck) structures 🥼🥼🥼PIMP-ABLE TOPIC🥼🥼🥼

Answer 25

``` Distal portion of the internal carotid arteries Vertebral arteries Jugular veins Pharynx Spinal cord Cranial nerves IX, X, XI, XII Sympathetic chain Salivary and parotid glands ```

Question 26

Zone II (midneck) structures 🥼🥼🥼PIMP-ABLE TOPIC🥼🥼🥼

Answer 26

``` Common carotid arteries Internal and external branches of carotid arteries Vertebral arteries Jugular veins Trachea Esophagus Larynx Pharynx Spinal cord Vagus and recurrent laryngeal nerves ```

Question 27

Zone I (low neck) structures 🥼🥼🥼PIMP-ABLE TOPIC🥼🥼🥼

Answer 27

``` Thoracic outlet vasculature (subclavian arteries and veins, internal jugular veins) Proximal carotid arteries Vertebral artery Apices of the lungs Trachea Esophagus Spinal cord Thoracic duct Thyroid gland Jugular veins Cranial nerve X (vagus nerve) ```

Question 28

differentiating central vs peripheral vertigo 🥼🥼🥼PIMP-ABLE TOPIC🥼🥼🥼

Answer 28

PERIPHERAL: think SUDDEN ONSET, SEVERE, inner ear and cranial nerve VIII (vestibulocochlear nerve) involvement CENTRAL: think CHRONIC, GRADUAL ONSET, MORE MILD, brainstem involvement

Question 29

signs of impending airway failure in epiglottitis

Answer 29

1. Drooling 2. Muffled voice 3. Stridor 4. Hypoxia 5. Sniffing position (sitting upright with neck extended)

Question 30

characteristic XR finding in epiglottitis

Answer 30

1. Thumbprint sign of epiglottitis lateral neck XR | 2. Presence of a “thumb-like” epiglottis on lateral soft tissue neck radiograph is concerning for epiglottitis

Question 31

pathophysiology of epiglottitis

Answer 31

1. Inflammation of the epiglottis can lead to airway obstruction 2. Epiglottitis was previously seen primarily in children as a result of Haemophilus influenzae type b infection 3. Since the widespread adoption of vaccination against Haemophilus influenzae type B, the incidence of epiglottitis infections has decreased, and the mean age of patients with epiglottitis is now 45 years 4. In the era following Haemophilus influenzae type B vaccination, Streptococcus and Staphylococcus are now the leading causes of epiglottitis

Question 32

Physical exam findings concerning for oropharyngeal infection

Answer 32

1. Trismus (local inflammation of the muscles of mastication) 2. Nuchal rigidity 3. Uvular edema or deviation 4. Submental edema or tongue elevation

Question 33

pathophysiology of Peritonsillar abscesses (quincy)

Answer 33

1. Tonsillar inflammation and cellulitis can progress to PTA. 2. PTA can also result from obstruction of Weber glands (salivary glands in the soft palate). 3. Complications include abscess rupture and aspiration, erosion into the carotid sheath leading to hemorrhage, extension into the deep tissues of the neck and mediastinum, and airway obstruction

Question 34

pathophysiology of ludwig's angina

Answer 34

Infection and edema of the submandibular space (sublingual and submaxillary spaces) can rapidly lead to airway obstruction. classically results from the spread of odontogenic infection and is frequently polymicrobial.