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Patho > EENT Emergencies > Flashcards

EENT Emergencies Flashcards

1
Q

What is glaucoma?

A

-Increase in intraocular pressure
-Primarily regulated by the aqueous humour
-The aqueous humour is continually getting replenished and reabsorbed so pressure in
the eye remains constant
-Glaucoma usually results from an imbalance between secretion, flow to the iris and reabsorption

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2
Q

What is aqueous humour?

A

Transparent fluid that fills the anterior cavity of the eye and nourishes the lens and cornea

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3
Q

What are the risk factors for glaucoma?

A

-advancing age
-Myopia
-HTN
-Type II DM

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4
Q

What are the clinical manifestations of glaucoma?

A

-ocular pain
-blurred vision
-enlarged/fixed pupils
-red eyes
-corneal edema (hazy appearance)
-significant headache with associated nausea/vomiting

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5
Q

What complications can occur due to glaucoma?

A

-Leading cause of irreversible blindness, caused by degenerative damage to the retina and optic nerve
-Retinal detachment

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6
Q

What is retinal detachment?

A

-Separation of the retina from the epithelium
-Occurs when a tear allows fluid (usually vitreous) accumulates between the two layers (retina and epithelium)

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7
Q

What are the risk factors for retinal detachment?

A

-advancing age
-HTN
-myopia
-intraocular tumours
-diabetes
-previous eye surgeries
-family hx of retinal detachment, congenital eye disease (glaucoma, cataracts), abnormal vitreous body

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8
Q

What are the clinical manifestations of retinal detachment?

A

-Usually a gradual progression
-Painless changes in vision (flashing lights/sparks followed by floaters or spots in the field of vision)
-Progresses to the perception of a shadow or “dark curtain” across the field of vision
-Usually begins in the periphery and spreads circumferentially
-If left untreated, can result in permanent vision loss or blindness

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9
Q

What is cataracts?

A

lens opacity that interferes a with the transmission of light to the retina

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10
Q

What is conjunctivitis?

A

inflammation of the conjunctiva (pink eye)

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11
Q

What is macular degeneration?

A

degenerative changes in the central portion of the retina (the macula)

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12
Q

What is myopia (nearsightedness)?

A

when the eyeball is too long (relative to the cornea and lens)

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13
Q

What is hyperopia (farsightedness)?

A

when the eyeball is too short

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14
Q

What is corneal trauma?

A

-Hydration of the cornea is important and must be kept within a limited range
-Damage to surrounding epithelium can cause corneal edema and loss of transparency
-Wearing contact lenses for too long can cause corneal edema, physical trauma causing minor abrasions to the cornea can be extremely painful but typically heals on its own
-Significant damage to the cornea can produce scar tissue post recovery leading to potentially permanent visual impairment

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15
Q

What is hyphema?

A

-A collection of blood in the anterior chamber of the eye
-Usually caused by blunt trauma to the eye but may also occur spontaneously in patients with decreased coagulability

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16
Q

What is otitis externa (swimmer’s ear)?

A

-Inflammation of the external ear caused by infectious agents, irritation or allergic reaction
-Bacterial infections are the most common cause
-External Ear - pinna, external auditory canal, tympanic membrane

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17
Q

What are the clinical manifestations of otitis externa?

A

-Pain
-Itchiness
-Redness
-Tenderness
-Discharge
-Impaired hearing
-Narrowing of the external auditory canal

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18
Q

What is otitis media?

A

-Inflammation of the middle ear usually caused by infectious process
-Middle Ear - auditory ossicles (malleus, incus, stapes), and eustachian tube
-Typically caused by a disorder of the Eustachian tube that allows reflux of fluid and bacteria into the middle ear

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19
Q

What are the clinical manifestations of otitis media?

A

-Otalgia (earache)
-Fever
-Otorrhea (ear discharge)
-Hearing loss
-Middle ear inflammation (pain, etc.)
-Perforation of the tympanic membrane

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20
Q

What is vertigo?

A

A disorder of vestibular function causing an “illusion of motion” described as a sensation
of spinning or falling

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21
Q

What is the vestibule?

A

part of the inner ear responsible for equilibrium

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22
Q

What is objective vertigo?

A

sensation of the person being stationary with the environment in motion

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23
Q

What is subjective vertigo?

A

sensation of the person in motion and the environment stationary

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24
Q

What is epistaxis?

A

-A nosebleed
-Non-traumatic epistaxis is spontaneous in origin and very rarely fatal
-Caused by a ruptured blood vessel within the nasal mucosa
-Can be a symptom of a more severe underlying medical condition: Altered coagulopathy (pharmacological/malignant), hypertension
-Accidentally swallowed blood/blood clots can cause irritation to the gastric mucosa resulting in GI discomfort, nausea, vomiting

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25
Q

What is rhinosinusitis?

A

-Inflammation of the nasal sinuses
-Paranasal sinuses are cavities within the facial bones that are lined with ciliated respiratory epithelium
-Connect to the nasal cavity through narrow openings called ostia
-Sinuses are labeled after the bone in which they are located: frontal, ethmoid, maxillary, and sphenoidal
-Commonly develops during an URTI that causes mucosal swelling, obstructs the ostia, and impairs mucociliary clearing

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26
Q

What are the clinical manifestations of rhinosinusitis?

A

-Facial pain
-Headache
-Purulent nasal discharge
-Decreased sense of smell
-Fever

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27
Q

What is an abscess?

A

a collection of pus that is restricted to a specific area in tissues, organs or confined spaces

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28
Q

What is a dental abscess?

A

-A dental abscess can form inside the teeth, in the gums or in the bone that holds the teeth
-Usually caused by a bacterial infection caused by tooth decay or an impacted tooth (not grown out of your mouth properly)
Clinical Manifestations:
-Pain
-Redness
-Swelling
-Cold/heat sensitivity
-Head/jaw ache
-Fever

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29
Q

What is a dental fracture?

A

-A fractured, cracked or chipped tooth as a result of trauma
-Can cause pain, inflammation, and may progress to abscess formation if left untreated
-May present a choking hazard or cause oropharyngeal/gastrointestinal trauma if a piece
is swallowed

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30
Q

What is trismus?

A

-A spasm of the jaw muscles causing the mouth to remain tightly closed
-Can be caused by: Tetanus, dental disorder/ illness/injury, head trauma, seizures
-Tetanic spasm of the jaw muscles mediated by the trigeminal (V) nerve
-May present a significant airway concern if activated

31
Q

What is epiglottitis?

A

-An acute inflammation of the epiglottis, typically caused by a bacterial infection
-Characterized by inflammatory edema of the supraglottic area (epiglottis and pharynx)
-Symptoms arise suddenly and can cause fatal airway obstruction and asphyxia if not
treated immediately (within hours)

32
Q

What are the clinical manifestations of epiglottitis?

A

-Pale, lethargic and distinct position (sitting up, mouth open, chin thrust forward)
-Difficulty swallowing causes drooling and muffled voice
-Moderate to severe dyspnea
-Stridor, nasal flaring, sternal retractions (accessory muscle use)
-Febrile

33
Q

What is tonsilitis?

A

-An inflammation of the tonsils caused by an infectious process
-A common occurrence in children, teenagers and young adults
-Causes sore throat, dysphagia and fever

34
Q

What is a peritonsillar abscess?

A

-An abscess behind the tonsil
-Typically a complication of tonsillitis and most commonly caused by an infectious process
-Not a very common problem provided that antibiotics are used to treat tonsillitis
-If left untreated, swelling and inflammation can cause airway obstruction

35
Q

What is a retropharyngeal abscess?

A

-An abscess in the back of the throat caused by an infectious process
-Can produce: Dysphagia, stiff neck, muffled voice, drooling, fever
-If swelling becomes significant may produce airway compromise and stridor
-More common in children

36
Q

What is a tracheostomy?

A

-A surgical, semi-permanent or permanent opening in the anterior neck through to the trachea
-A tracheostomy tube is placed in the stoma (whole/opening in the body) to provide a pathway for breathing
-Surgical procedure – tracheotomy
-There may be many reasons for the insertion of a tracheostomy including: Throat cancers, trauma, neurological compromise, anatomical abnormalities

37
Q

What is anemia?

A

-An abnormally low number of circulating red blood cells OR level of hemoglobin OR both
-Results in a diminished capacity for oxygen transport
-Blood loss Anemia, destruction of RBCs, defective RBCs, inadequate RBC production

38
Q

What is blood loss anemia?

A

-Loss of RBCs due to hemorrhage produces a decrease in the total quantity of hemoglobin and decrease in the ability to transport O2
-Symptoms and progression depend on whether the hemorrhage is acute or chronic
-Acute - decreased vascular volume results in hypovolemic shock and decreased circulating O2
-Chronic - doesn’t typically affect volume (RBCs lost are rapidly replaced)
-Rapid replacement RBCs quickly deplete iron levels, so they have little to no hemoglobin

39
Q

What is hemolytic anemia?

A

-Caused by the premature destruction of RBCs, usually due to an irregularity in the RBC or Hgb
-The ineffective RBCs get phagocytized
-Hemolytic anemia may be inherited or acquired
-Sickle Cell Disease is an inherited disease that results in malformed and ineffective RBCs
-Some acquired forms of hemolytic anemia include autoimmune disorders

40
Q

What is deficiency anemia?

A

-Results from the decreased production of erythrocytes by the bone marrow
-May be a direct result of the failure of the bone marrow or a deficiency in the requirements for erythropoiesis (ie. low iron)

41
Q

What is aplastic anemia?

A

decreased functional bone marrow causes a decrease in the production of all formed elements

42
Q

What is iron deficiency?

A

usually a result of nutritional deficit or blood loss but may result in an increased demand for iron elsewhere in the body (pregnancy)

43
Q

What are the clinical manifestations of anemia?

A

-Fatigue
-Weakness
-Dyspnea (severe on exertion)
-Pallor
-Confusion/altered LOA
-Compensatory symptoms (tachycardia, tachypnea, palpitations)
-Decreased SpO2 (significant on exertion)
-All symptoms may be significantly amplified with minimal physical exertion

44
Q

What are bleeding disorders?

A

-Bleeding disorders result when the blood lacks, or has impaired function of, certain clotting factors
-They are almost always inherited but may be acquired
-Most common forms include: Hemophilia (A and B) and Von Willebrand Disease

45
Q

What are clotting factors?

A

Plasma proteins that are crucial in the clotting process

46
Q

What is Disseminate Intravascular Coagulation (DIC)?

A

-Not a primary disease, but a complication of a wide variety of conditions: burns, trauma, acidosis, shock, infections, hypotension, etc.
-Results in massive, systemic, activation of the coagulation sequence
-The systemic coagulation produces significant quantities of microthrombi that cause vessel occlusion and tissue hypoxia
-This also uses up all available coagulation proteins and platelets, causing potential severe hemorrhage

47
Q

What is Acquired Immune Deficiency Syndrome (AIDS)?

A

-The disease caused by infection with Human Immunodeficiency Virus (HIV)
-A chronic illness characterized by profound immunosuppression with associated infections, malignancies and CNS degeneration

48
Q

What causes AIDS?

A

-HIV is a retrovirus that attacks the T helper cells responsible for coordinating immune responses
-Progressive deterioration of the immune system leaves the patient susceptible to severe infections from normally harmless pathogens
-Body manages to fight off the HIV virus quite well but, due to its persistence, the virus remains and eventually, over years, the amount of T-helper cells begins to decline and eventually the virus prevails
-An HIV infection becomes AIDS when the CD4+ count becomes very low (10-15 years from onset of infection)
-Virus itself does little to cause symptoms/harm to the patient; it is the secondary infections that produce symptoms and mortality

49
Q

How is AIDS transmitted?

A

-HIV is transmitted through sexual contact, blood-to-blood contact or perinatally
-Infected semen and vaginal fluids that may come in contact with any vascular mucous membranes
-t’s blood-borne nature makes it imperative to always be vigilant and wear appropriate PPE
-Patient is infectious regardless of symptoms

50
Q

What is tuberculosis (TB)?

A

-An infectious bacteria that can infect any organ but most often involves the lungs -thrives in an oxygen rich environment
-Transmitted by respiratory droplets (minute particles in water) from contaminated
people: talking, sneezing, coughing
-After recovery, the pathogen can remain dormant in the patient for years and can reinfect or transmit if the patient becomes immunocompromised

51
Q

What are the clinical manifestations of TB?

A

-Initial onset can be insidious (fever, weight loss, fatigue, night sweats)
-Can progress to: high fever, pleuritis and lymphadenitis
-Initially dry cough but can become productive with purulent or blood-tinged sputum
-Dyspnea and orthopnea with rales (fine crackles) on auscultation

52
Q

What is influenza?

A

-Viral upper respiratory tract infection (Type A, B and C)
-Infection rates are highest in children and older adults
-Very contagious - transmission occurs via droplet contamination
-Virus targets and kills cilia and epithelial cells in the upper respiratory tract
-Can progress to the lower tract causing damage to bronchi and alveoli
-Inhibiting the innate immunity of the respiratory tract leaves the patient open to secondary infections

53
Q

What are the clinical manifestations of influenza?

A

-Fever and chills
-Malaise
-Muscle aches
-Headache
-Watery nasal discharge
-Non-productive cough (dry)
-Sore throat
-Rhinotracheitis

54
Q

What are antibiotic resistant infections?

A

-Antibiotic resistance occurs when bacteria change in response to antibiotic medications
-These mutated bacteria become increasingly more difficult to fight
-There is a rising culture of over prescribing antibiotics and not allowing our own innate
and adaptive immunity do their jobs
-This problem can lead to the development of “superbugs” (MRSA, VRE, CRE, certain E.coli strains, C. diff)

55
Q

What is Meningococcemia?

A

-Meningococcal Septicemia/Sepsis
-Infection with meningococcus (one of the main bacteria that causes meningitis) that spreads to the blood stream
-Bacteria multiply in the blood stream and causes systemic damage to blood vessel walls and target tissues/organs
-Presents same as meningitis but with associated signs of sepsis

56
Q

What is sepsis?

A

a medical emergency that describes the body’s systemic immunological response to an infectious process that can lead to end stage organ dysfunction and death

57
Q

What is septicemia?

A

a bacterial infection in the blood stream that can cause sepsis

58
Q

What is SIRS (Systemic Inflammatory Response Syndrome)?

A

a systemic inflammatory response to a variety of illnesses or injuries

59
Q

What is SIRS criteria?

A

(2 or more of the following):
-HR > 90bpm
-RR > 20bpm
-Temp >38oC/<36oC
-Elevated WBCs
-Prehospital: low ETCO2 correlates to high risk of sepsis

60
Q

What is tetanus?

A

-A bacterial infection that produces painful muscle contractions and trismus
-The bacteria release a neurotoxin that travels to the central nervous system and interferes with neurotransmitters involved in muscle contraction
-Transmitted from contaminated soil, dust and feces making direct contact with an open wound

61
Q

What are the clinical manifestations of tetanus?

A

-Muscle spasms (painful)
-Dysphagia
-Opisthotonos (muscle spasms causing backward arching of the head, neck and spine)

62
Q

What is varicella/chicken pox?

A

-A common communicable childhood disease caused by the varicella-zoster virus (same virus that causes “shingles”)
-Causes characteristic skin lesions that develop rapidly

63
Q

What are the clinical manifestations of chicken pox?

A

-Lesions
-Pruritis
-Cough
-Runny nose
-Febrile
-Photosensitivity (rare)

64
Q

What is varicella/shingles?

A

-When a primary infection of chickenpox is “defeated”, the varicella virus remains dormant in the nervous system
-Later in life, and especially in immunocompromised people, it is possible for the virus to become reactivated

65
Q

What are the clinical manifestations of shingles?

A

-Produces fever
-Malaise
-Headache
-Periorbital pruritis
-Development of a progressive rash that usually isolates to “patches” that may or may not develop crusty skin lesions
-May or may not affect the eyes

66
Q

What is rubella?

A

-A mild disease similar to measles that produces a rash and other mild cold symptoms
-Rash typically starts in the trunk and spreads to the limbs
-Spreads via close contact

67
Q

What is West Nile virus?

A

A viral infection transmitted mostly via bites from infected mosquitos and then subsequent human to human contact

68
Q

What are the clinical manifestations of West Nile Virus?

A

-Fever
-Headache
-Malaise
-Body aches
-Nausea
-Vomiting
-Occasional skin rash
-Severe disease may develop meningitis, encephalitis and paralysis

69
Q

What is toxic shock syndrome?

A

-Similar to septic shock, the development of TSS occurs when bacteria release toxins that cause direct harm to vasculature and target organs/tissues
-Septic Shock - result of inflammatory/immune response
-Toxic Shock - direct result of exo/endotoxin damage
-Toxin - substances that alter the normal function of the host’s cells

70
Q

What are the clinical manifestations of TSS?

A

-Fever
-Chills
-Malaise
-Headache
-Fatigue
-+/- rash
-N/V/D

71
Q

What is a neoplasm?

A

an abnormal mass of tissue in which the growth exceeds, and is uncoordinated with, that of normal tissues

72
Q

What does the suffix -oma mean?

A

the suffix added to the parenchymal tissue from which the growth originated (ie. osteoma, neuroblastoma)

73
Q

What is a benign neoplasm?

A

usually do not cause death unless their location or size interferes with vital functions. Expand and grow but does not spread.

74
Q

What is a malignant neoplasm?

A

invade and destroy tissues and spread to other parts of the body

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