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Emergency/surg > E1: EENT Emergencies > Flashcards

E1: EENT Emergencies Flashcards

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1
Q

What is the clinical presentation of Herpes simplex keratitis?

A

Eye pain, photophobia, blurred/decreased vision, and tearing

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2
Q

On physical exam, patient has conjunctival injection, ciliary flush, decreased corneal sensation, and slit lamp with fluorescein stain shows dendritic lesions. What are you concerned about?

A

Herpes simplex keratitis

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3
Q

How is herpes simplex keratitis diagnosed?

A

Primarily based on hx and physical

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4
Q

What is the treatment for herpes simplex keratitis?

A
  • Urgent ophthalmology referral
  • topical or oral antivirals
  • corneal transplant
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5
Q

What are the antiviral options for herpes simplex keratitis?

A
  • Topical: Acyclovir 3% ophthalmic ointment or ganciclovir 0.15% gel
  • Oral: Acyclovir 400mg
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6
Q

What should you avoid in patient with herpes simplex keratitis?

A

NO topical glucocorticoids!

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7
Q

What is UV keratitis?

A

AKA photokeratitis, causes by UV exposure

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8
Q

What is the presentation of UV keratitis?

A

Bilateral intense eye pain (unable to open), photophobia, FB sensation

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9
Q

On eye exam you see the following:
-Penlight exam shows tearing, generalized injection and chemosis of the bulbar conjunctiva
-the cornea is mildly hazy
-Fluorescein statingin show superficial punctuate staining of the cornea
-Pupils are miotic
What are you concerned about?

A

UV keratitis

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10
Q

What is the treatment for UV Keratitis?

A
  • Supportive, should resolve in 24-72 hours
  • Oral analgesics (consider mild opioid and lubricant Abx ointment)
  • Education
  • Follow up in 1-2 days
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11
Q

Preseptal and orbital cellulitis are often complications of what conditions?

A
  • Sinusitis
  • extension of infection from adjacent structure
  • local disruption of skin
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12
Q

What is the most common etiology of preseptal and orbital cellulitis?

A

S pneumoniae, S aureus, S pyogenes, and H influenzae

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13
Q

Is preseptal or orbital cellulitis a true emergency?

A

Orbital

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14
Q

What is the difference between preseptal and orbital cellulitis?

A
  • Preseptal cellulitis affects tissues anterior to the orbital septum and results in swelling of the eyelids and upper cheek
  • Orbital cellulitis affects structures deep to the orbital septum and results in vision loss, impaired EOMs, diplopia, and/or proptosis
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15
Q

How is preseptal and orbital cellulitis diagnosed?

A

CT scan of the orbits and sinuses with contrast

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16
Q

What is the treatment for preseptal cellulitis?

A
  • Mild infection with no systemic symptoms: discharge home
  • Oral antibiotics
  • Follow up with ophthalmologist in 24-48 hours
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17
Q

What is the treatment for orbital cellulitis?

A
  • Admit
  • IV abx
  • consult ophthalmology and ENT
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18
Q

What is a corneal abrasion?

A

Any defect of the corneal surface epithelium- thin protective coating of anterior eye surface

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19
Q

What is a corneal ulcer?

A

A break in the epithelium exposing the underlying corneal Strom a

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20
Q

What are the symptoms of a corneal abrasion/ulcer?

A
  • Severe eye pain and FB sensation

- Can lead to impaired vision secondary to scarring

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21
Q

On eye exam, you see the following:
-Penlight exam shows anterior chamber is clear, deep, and has normal contour, pupils are round, and mild conjunctival injection
-Fluorescein staining shows fluorescein uptake
What are you concerned about?

A

Corneal abrasion/ulcer

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22
Q

What is the treatment for a corneal abrasion?

A
  • Topical lubricants
  • Topical Abx
  • oral pain meds
  • NO TOPICAL ANESTHETIC
  • no patching
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23
Q

What are the abx options for a corneal abrasion?

A
  • Erythromycin ointment
  • Sulfacetamide 10%
  • Polymyxin/trimethoprim
  • Ciprofloxacin
  • Ofloxacin drops QID x5 days
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24
Q

When should you refer for urgent ophthamology consult on a patient with a corneal abrasion or ulceration?

A
  • if there are signs of penetrating or significant blunt trauma, large non reactive pupil or irregular pupil
  • impaired visual acuity
  • ulceration
  • contact lens wearer (R/o infiltrate or opacity)
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25
Q

What should you do for a superficial lid laceration if < 25% of the lid?

A
  • Can heal by secondary intention
  • clean and apply triple abx ointment
  • Consider adhesive surgical tape
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26
Q

What should you do for a superficial lid laceration that is >25%?

A
  • repair with 6-0 fast absorbable plain gut sutures

- simple interrupted or running sutures within 24 hours

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27
Q

When should you refer to an ophthalmologist for a lid laceration?

A
  • Full thickness lid laceration
  • lacs with orbital fat prolapse
  • Lacerations through the lid margin
  • orbital injury
  • Foreign body
  • Laceration with poor alignment
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28
Q

What are the risks associated with an orbital floor fracture?

A
  • Entrapment of the inferior rectus muscle
  • enopthalmos
  • Orbital dystopia
  • injury to the infraorbital nerve secondary to fracture
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29
Q

What can entrapment of the inferior rectus muscle lead to?

A

Untreated can result in ischemic and subsequent loss of muscle function

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30
Q

What is enopthalmos?

A

Posterior globe displacement

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31
Q

What is orbital dystopia?

A

One eye is lower than the one, may occur as entrapped muscle from orbital floor fracture pulls eye downward

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32
Q

How do you diagnose an orbital floor fracture?

A

Thin cut coronal CT or the orbits on patients with evidence of fracture, limitation of EOM, decreased visual acuity, severe pain, or inadequate exam due to swelling or AMS

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33
Q

What is the treatment of an orbital floor fracture?

A

-Surgical evaluation
-prophylactic antibiotics to cover sinus pathogens
-cold packs
Head of bed raised
-avoid blowing nose and sniffing

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34
Q

What causes an open globe rupture?

A

Blunt eye injury

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35
Q

What should you avoid in patients with an open globe rupture?

A

Avoid pressure to the eyeball, such as eyelid retraction or IOP measurement

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36
Q

How are open globe ruptures diagnosed?

A

Axial and coronal CT of the eye without contrast

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37
Q

What is the treatment for an open globe rupture?

A
  • Transfer to tertiary trauma center
  • Emergent Ophthamology consult
  • avoid any manipulation
  • eye shield
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38
Q

What medications should be used for an open globe rupture?

A
  • Initiate abx
  • IV antiemetic
  • pain med (avoid NSAIDs)
  • Sedation PRN
39
Q

What is optic neuritis?

A

Inflammatory, demyelinating condition that causes acute, monocular vision loss (10% bilateral)
-high association with MS

40
Q

What are the symptoms associated with optic neuritis?

A
  • Vision loss (hours to days, peaking within 1-2 weeks)
  • Eye pain worse with movement
  • afferent pupillary defect (direct response to light is sluggish)
  • Dyschromatopsia (loss/reduced color vision)
41
Q

What is the treatment of optic neuritis?

A
  • Corticosteroids (IV methylprednisolone)

- Do NOT recommend oral prednisone because it does not affect visual outcomes and may increase risk for recurrence

42
Q

What is acute angle closure glaucoma?

A

-Narrowing or closure of the anterior chamber angle, leading to increased IOP and damage to the optic nerve

43
Q

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

A

Normal: 8-21

Closed angle glaucoma: >30

44
Q

What is the clinical presentation of acute angle closure glaucoma?

A

-decreased vision, halos around lights, headache, severe eye pain, nausea and vomiting, red eyes, corneal edema, mild dilated pupil, and shallow anterior chamber

45
Q

What is the gold standard for diagnosing acute angle closure glaucoma?

A

Gonioscopy: slit lamp lens allows visualization of the angle between the iris and cornea

46
Q

What is the treatment for acute angle closure glaucoma?

A
  • Emergent ophthamology referral
  • If >1 hr delay, empirically treat with pressure lowering eye drops
  • Oral or IV acetazolmide
47
Q

If a patient with acute angle closure glaucoma has >1 hr delay in seeing ophthalmology, what should you do?

A

Empirally treat with pressure lowering eye drops

  • 1min: 0.5% timolol
  • 2 min: 1% apraclonidine
  • 3 min: Pilocarpine
48
Q

What is the clinical presentation of retinal detachment?

A
  • Sudden onset of floaters
  • monocular visual field loss
  • vision loss
49
Q

What is the most common cause of bacterial acute otitis externa?

A

Pseudomonas aeruginosa

50
Q

What is the clinical presentation of acute otitis externa?

A

Ear fullness, drainage, and pain

51
Q

What is the treatment of acute otitis externa?

A
  • Debridement
  • abx drops: Cipro Deb or CiproHC
  • Watch for malignant otitis
52
Q

What is Ramsay hunt Viral AOE?

A

AOE caused by herpes zoster

53
Q

What is the presentation of Ramsey hunt AOE?

A
  • Vesicles in the ear canal
  • facial paralysis
  • hearing loss
  • vertigo
54
Q

What is the treatment of Ramsey hunt AOE?

A
  • Antivirals
  • steroids
  • MRI brain to r/o skull base tumor
55
Q

What is the most common etiology of malignant otitis externa?

A

P. Aeruginosa

56
Q

What is the presentation of malignant OE?

A
  • Symptoms consistent with AOE, but patient appears acutely ill
  • ear canal granulation tissue
57
Q

How is malignant OE diagnosed?

A
  • CBC shows leukocytosis
  • cultures
  • Head CT with osteomyelitis of the skull base
58
Q

What is the treatment of malignant OE?

A
  • Admit
  • Debridement
  • Parenteral abx: Cipro 400mg IV Q 8 hrs, Change to 750mg PO Q12 hrs prior to DC, Tx prolonged 6-8 weeks
  • ENT evaluation
59
Q

What are the possible causes of TM perforation?

A
  • Otitis media
  • Closed head injury
  • Direct ear trauma
60
Q

What is the clinical presentation of a TM perforation?

A

Pain, hearing loss, nausea, vomiting, vertigo, otorrhea, and tinnitus

61
Q

What is the treatment for TM perforation?

A
  • Otolarlyngology
  • water precautions
  • 95% resolve w/o treatment
  • Abx: ofloxacin OT ic drops
  • tympanoplasty
62
Q

What is auricular hematoma also known as?

A

Cauliflower ear

63
Q

What is the treatment for auricular hematoma?

A
  • Drain/aspirate asap

- Follow up evil Q24 hrs for 3-5 days

64
Q

What is the perichondritis?

A

Acute inflammation and infection of the auricular cartilage

65
Q

What is the most common etiology of perichondritis?

A

P. Aeruginosa

66
Q

What is the presentation of perichondritis?

A

Erythema, pain, abscess formation, and systemic symptoms

67
Q

How is perichondritis diagnosed?

A

Culture and sensitivity

68
Q

What is the treatment of perichondritis?

A
  • I&D if indicated

- Ciprofloxacin

69
Q

What is the presentation of a nasal foreign body?

A

Much purulent nasal discharge, foul odor, epistaxis, nasal obstruction, and mouth breathing

70
Q

Are anterior or posterior nosebleeds more common?

A

Anterior

71
Q

Where do up to 90% of nose bleeds occur?

A

Kiesselbachs plexus

72
Q

What is Kiesselbachs plexus?

A

Anastomosis of 3 primary vessels:

1) septal branch of the anterior ethmoidal artery
2) Lateral nasal branch of the sphenopalatine artery
3) septal branch of the superior labial branch of the facial artery

73
Q

Where do posterior nosebleeds more often arise from?

A

The posterolateral branches of the sphenopalatine artery

74
Q

What is the treatment of epistaxis?

A
  • Oxymetazoline (Afrin) 2 sprays
  • direct pressure tight against septum x10 minutes
  • if no further bleeding, nasal hydration
  • cautery if source is easily identified
75
Q

What is used to cauterize nose bleeds and what are the associated risks

A

Silver nitrate, may cause ulceration and septal perforation

76
Q

When can you remove nasal packing in a normal patient? In an anticoagulated patient?

A

Normal: 3 days
Anticoagulated: 5 days

77
Q

What antibiotics should you give for a patient with nasal packing for a nose bleed? How long?

A

Anti-staphylococcal: keflex, Augmentin for the entire course of packing

78
Q

What type of imaging should you order to assess for nasal trauma?

A

CT scan maxillofacial without contrast

79
Q

What are the early complications of nasal trauma?

A

Hematoma, abscess, uncontrolled epistaxis, and CSF rhinorrhea

80
Q

What is the treatment of nasal trauma?

A
  • Repair skin lacerations immediately
  • if significant swelling, consider waiting 4-6 weeks until resolved for surgical correction
  • Attempt closed reduction to maximize airway and improves aesthetics if there is significant deformity
  • pain management
  • Follow up in 3-5 days
81
Q

What are the causes of septal hematoma?

A

Trauma, septal surgery, or bleeding disorders

82
Q

What are the physical exam findings consistent with septal hematoma?

A

Soft, tender swelling along the septum

83
Q

What is the treatment of septal hematoma?

A
  • I&D: helps prevent a vascular necrosis and untreated hematomas may cause septal perforation
  • pack nose
  • abx
  • outpatient ENT referral
84
Q

What is mastoiditis?

A
  • suppurative infection of the mastoid air cells

- acute = symptoms < 1 month

85
Q

What are the characteristic findings associated with mastoiditis?

A
  • postauricular erythema, tenderness, swelling, fluctuance, and mass
  • protrusion of the auricle, otalgia, and fever
86
Q

How is mastoiditis diagnosed if there are not characteristic findings?

A

-CT head with contrast (best to visualize temporal bone changes

87
Q

How is mastoiditis treated?

A
  • Refer to ENT
  • Empiric abx if immuno-competent
  • mastoidectomy and considerationof IV antibiotics if recalcitrant disease or immunocompromised
88
Q

What is the presentation of periodontal abscess?

A

-Fever, pain, red and fluctuant swelling of the gingiva, and tenderness to palpation

89
Q

How is a periodontal abscess diagnosed?

A

Panoramic radiograph or CT for bone involvement

90
Q

What is the treatment of a periodontal abscess?

A
  • pain management
  • I&D
  • Oral abx if limited infection (Augmentin or Clindamycin for 7-14 days)
  • Follow up with dentist
91
Q

If a patient has a completely displaced tooth and you are unable to re-implant, how should you store the tooth?

A

-In a balanced saline solution, cold milk, or a container of the patients saliva until seen by a dentist

92
Q

What is the treatment of a dental injury?

A
  • Maintain the vitality of the periodontal ligament
  • handle tooth by the crown and gently rinse in saline. Insert tooth into the empty socket and hold in place with gauze
  • urgent dental consult
  • tetanus prophylaxis and abx therapy
93
Q

When should you repair a tongue laceration?

A
  • If it is large (>1cm) and extends into the muscular layer or completely through the tongue
  • deep on the lateral border or there are large flaps or gaps
  • significant hemorrhage
94
Q

What kind of sutures should you use for a tongue lac repair?

A

3-0 or 4-0 chromic gut or vicryl

Emergency/surg (9 decks)

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