EENT

Question 1

Epistaxis

- posterior

Answer 1

• rare
• Spenopalatine artery
• Emergency: foley cath down nose, blow up, clamp, call ENT
  Anterior

Question 2

Epistaxis

- anterior

Answer 2

• Kiesselbach Plexus
• Pinch nose, ice pack
• Phenylephrine spray (Afrin)
• Silver nitrate stick to cauterize if can ID site of bleed
• Rhino rocket: last resort (Michelle)

Question 3

Angioedema

Answer 3

• MC drug cause: ACEi or ARB
• Hereditary: C1 esterase dysfunction, minor trauma can cause
• Best tx: stop offending agent and admit, watchful waiting and spO2 monitoring.
• Airway!! If need intubation, very difficult

Question 4

Dental Abscess

• describe
• RF

Answer 4

• Infection of dental pulp
• Poly microbial (mouth)
• RF: poor oral hygiene, low socioeconomic, DM, smoking, substance abuse

Question 5

Dental Abscess Tx

Answer 5

• Abx (PCN, clindamycin)
• Most do not require I&D, if so, consult ENT
• Pain meds: this is a common complaint of drug seekers, instead offer oragel or clove oil

Question 6

Dental blocks

- three types

Answer 6

• Infraorbital: upper front teeth and gingiva (aim towards pupil)
• Submental: lower front teeth and gingiva
• Infralveolar: good for molars, only do if well trained
• good way to tell if they are drug seeking: if they turn it away and want meds instead

Question 7

Ludwig’s Angina

- describe

Answer 7

• true dental emergency!

- Rapidly expanding infection of submandibular space, rare, potentially life threatening

Question 8

Ludwig’s Angina

- s/sx

Answer 8

• mouth pain
• drooling
• Trismus
• Tongue protrusion
• sublingual edema**
• Neck swelling
• Can look like cellulitis on the outside!

Question 9

Ludwig’s Angina

• MC cause
• Tx

Answer 9

• MC from odontogenic source, spread from lower molar abscess
• Tx: airway, IV abx, possible sx

Question 10

Peritonsillar abscess

• describe
• Dx
• Tx

Answer 10

• Commonly triaged as sore throat
• S/sx: One sided pain, trismus, fever, myalgia, raspy voice (hot potato voice), trouble swallowing spit

Dx:
- CBC, BMP, CT neck w/contrast

Tx:

• ENT consult, admit to watch airway, possible sx I&D
• IV fluids, steroids, abx (Clindamycin, Zosyn), salt gargle

Question 11

Retropharyngeal Abscess

- describe

Answer 11

• Very rare, can looks similar to peritonsillar abscess!
• Lymph drainage dt upper respiratory and oral infections
• Poly microbial, MRSA is increasing cause

Question 12

Retropharyngeal Abscess

• s/sx
• PE

Answer 12

• s/sx: sore throat, fever, dysphasia, neck pain, dyspnea
• PE: posterior pharyngeal edema, nuchal rigidity, cervical adenopathy, drooling, stridor, trismus, torticollis
• Kids pathopneumonic: retropharyngeal bulge

Question 13

Retropharyngeal Abscess

- Tx

Answer 13

• Airway (prep for cricothyrotomy)
• ENT consult
• IV fluids
  IV abx (clindamycin, zosyn)

Question 14

Foreign body

- ear

Answer 14

MC: bugs

• If still alive: lidocaine 1% in ear
• Cockroach legs stick to TM
• Easiest method to remove is irrigation
• Dig: alligator forceps
• Low suction great for plastic pieces of hearing aids

Question 15

Foreign body

- nose

Answer 15

• Smellier = been there longer
• Good nose blow (30% success), mouth to mouth blow for parents to kids
• Katz Extractor: small balloon catheter
• Beware of magnets stuck together: can bleed profusely when take off, get ENT consult for this

Question 16

Foreign body

- Eye

Answer 16

• Get visual acuity: both eyes for baseline measurement prior to procedure, CYA.
• MC: metal from grinding

Tx:

• 1st: irrigation
• Fluorescein stain, slit lamp exam: allows to see how embedded it is, can see corneal abrasion also
• Invert lid, sweep with Q-tip
• Eye burr

Question 17

Foreign body

- Throat

Answer 17

- MC: male eating too quickly
Tx:
- Glucagon (smooth muscle relaxor), Ativan
- Should not stay impacted >24 hours
- Bones or hard debris: endoscopy (GI)

Swallowed (kids, mentally unstable)

• 2 view XR
• Most will pass
• Emergent GI: batteries, magnets, sharp/pointy

Question 18

Mastoiditis

Answer 18

• Complications of OM: fluid blocked in mastoid air cells
• Presents with pain, swelling, erythema to postauricular area
- Ear canal should not be involved (OE), might be air or fluid, erythema, purulence behind TM
• Dx: CT w/contrast
• Admit to ENT for IV abx and/or typanocentesis
• Tx: rocephin or levofloxacin
• Differentiate from lymphadenopathy or abscess!