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EM/Surg > EENT Emergencies (Exam #1) > Flashcards

EENT Emergencies (Exam #1) Flashcards

1
Q

What condition involves conjunctival injection/ciliary flush, dendritic lesions on slit lamp with fluorescein?

A

Herpes Simplex Keratitis

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2
Q

What is the recommended pharm treatment for Herpes Simplex Keratitis (3)?

A

EMERGENT referral

  • Acyclovir 3% ophthalmic ointment
  • Ganciclovir 0.15% gel
  • Acyclovir 400mg (oral)
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3
Q

What five eye trauma conditions warrant an emergent/urgent referral?

A
  • Herpes Simplex Keratitis
  • Orbital Cellulitis
  • Open Globe Rupture
  • Acute Angle Closure Glaucoma
  • Retinal Detachment
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4
Q

What medication should be avoided in the treatment of Herpes Simplex Keratitis?

A

NO topical steroids

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5
Q

What condition involves severe bilateral eye pain; photophobia, FB sensation?

A

UV Keratitis (Photokeratitis)

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6
Q

What condition involves superficial punctate staining of cornea on slit lamp with fluorescein?

A

UV Keratitis (Photokeratitis)

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7
Q

What is the recommended treatment for UV Keratitis (Photokeratitis)? What is the recommended follow up?

A

Supportive care

- Close F/U (1-2 days)

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8
Q

What condition involves unilateral periorbital edema with erythema/warmth/tenderness?

A

Preseptal/Orbital Cellulitis

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9
Q

What condition can be a complication of sinusitis, local or extension of infection?

A

Preseptal/Orbital Cellulitis

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10
Q

What condition involves anterior to orbital septum; swelling of eyelids and upper cheek?

A

Preseptal Cellulitis

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11
Q

What condition involves vision loss, impaired EOMs, diplopia, proptosis?

A

Orbital Cellulitis

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12
Q

What is the recommended diagnostic test for Preseptal/Orbital Cellulitis?

A

CT WITH contrast (of orbits and sinuses)

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13
Q

With Preseptal Cellulitis and Orbital Cellulitis, which is an emergency? How does treatment differ for each?

A

Preseptal Cellulitis
- Home with oral abx, ophthalmology follow up within 1-2 days

Orbital Cellulitis = EMERGENCY
- Admit with IV abx, consult

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14
Q

What condition involves severe eye pain, FB sensation; can have impaired vision?

A

Corneal Abrasion or Ulceration

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15
Q

Differentiate Corneal Abrasion from Corneal Ulceration.

A
  • Abrasion: defect on corneal surface epithelium

- Ulceration: deeper = break in epithelium exposing underlying corneal stroma

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16
Q

What two tests can be used to diagnose Corneal Abrasion or Ulceration?

A
  • Slit lamp with fluorescein

- Woods Lamp

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17
Q

What are the three recommended treatments for Corneal Abrasion or Ulceration? What three treatments are NOT recommend?

A
  • Topical lubricants
  • Topical abx
  • Oral pain meds

NO topical anesthetics, steroids or patching

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18
Q

What five topical abx can be used to treat Corneal Abrasion or Ulceration?

A
  • Erythromycin ointment
  • Sulfacetamide
  • Polymyxin/Trimethoprim
  • Cipro
  • Ofloxacin drops
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19
Q

Under what four conditions should a patient with Corneal Abrasion or Ulceration be referred?

A
  • Large/nonreactive or irregular pupil
  • Impaired visual acuity
  • Ulceration
  • Patient wears contacts
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20
Q

What type of injury is often associated with an eyelid laceration, and what should be ruled out?

A

Eyelid Laceration often includes ocular injury

- R/O globe injury

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21
Q

What three characteristics constitute an uncomplicated Eyelid Laceration?

A
  • Superficial
  • Horizontal
  • Follows skin lines
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22
Q

For Eyelid Laceration, if it is <25% of the eyelid, what is the recommended treatment? What if it is 25+%?

A
  • <25% of lid = triple abx ointment

- 25+% of lid = repair using 6-0 fast absorbable plain gut suture

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23
Q

Under what seven conditions should a patient with Eyelid Laceration be referred (considered complicated)?

A
  • Full thickness
  • Lac with orbital fat prolapse
  • Lac through lid margin
  • Lac through tear drainage system
  • Orbital injury
  • FB present
  • Laceration with poor alignment
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24
Q

What is a “Blowout” Fracture?

A

Orbital Floor Fracture

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25
Q

What four findings may be seen with an Orbital Floor Fracture?

A
  • Entrapment of inferior rectus muscle
  • Enophthalmos
  • Orbital dystopia (eye is lower)
  • Injury to infraorbital nerve
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26
Q

What diagnostic tool can be used for an Orbital Floor Fracture?

A

Thin cut coronal CT of orbits

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27
Q

With what condition should you AVOID pressure to eyeball (no eyelid retraction or IOP measurement)?

A

Open Globe Rupture

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28
Q

What diagnostic tool can be used for an Open Globe Rupture?

A

Axial/coronal CT of eye WITHOUT contrast

29
Q

What three medications can be used to treat an Open Globe Rupture? What medication should be avoided?

A
  • Start abx
  • IV antiemetics (Ondansetron)
  • Pain meds (NO NSAIDs)
30
Q

What condition is an inflammatory and demyelinating condition; high association with MS?

A

Optic Neuritis

31
Q

What condition involves acute/monocular vision loss over hours/days (peaks at 1-2 weeks)?

A

Optic Neuritis

32
Q

What condition involves eye pain worse with movement, afferent pupillary defect, dyschromatopsia?

A

Optic Neuritis

33
Q

What is the recommended treatment for Optic Neuritis? What medication should be avoided?

A

Steroids (IV Methylprednisone)

- NO oral steroids

34
Q

What condition involves high IOP (30+ mmHg), optic nerve damage?

A

Acute Angle Closure Glaucoma

35
Q

What condition involves decreased vision, halos around lights, HA, severe eye pain, N/V, red eye, corneal edema/cloudy?

A

Acute Angle Closure Glaucoma

36
Q

What is the gold standard diagnostic test for Acute Angle Closure Glaucoma?

A

Gonioscopy

37
Q

What is the recommended treaetment for Acute Angle Closure Glaucoma?

A

Oral/IV Acetazolamide

38
Q

What condition involves sudden onset floaters?

A

Retinal Detachment

39
Q

What is the recommended diagnostic tool for Retinal Detachment?

A

US

40
Q

What condition involves hearing loss, ear pain/drainage?

A

FB of EAC

41
Q

What is the most common etiology of Acute Otitis Externa (AOE)? What is an alternative etiology?

A

Bacterial = Pseudomonas aeruginosa

- Viral = Ramsey-Hunt (HZV)

42
Q

What is the recommended treatment for Acute Otitis Externa (AOE) (2)?

A
  • Debridement

- Abx drops (Ciprodex/CiproHC drops) +/- otowick

43
Q

What is the most common etiology of Malignant Otitis Externa (MOE)? In what three populations is this more common?

A

Bacterial = Pseudomonas aeruginosa

- More common in elderly, DM, IC

44
Q

What condition involves acutely ill + AOE sxs; ear canal granulation tissue?

A

Malignant Otitis Externa (MOE)

45
Q

What is the recommended treatment for Malignant Otitis Externa (MOE) (3)?

A
  • Admit
  • Debridement
  • Abx (Cipro 400mg IV Q8 hours then 750mg PO Q12 hours = 6-8 weeks)
46
Q

What is the dosage for abx in treatment of Malignant Otitis Externa (MOE)?

A

Cipro 400mg IV Q8 hours

- THEN 750mg PO Q12 hours = 6-8 weeks

47
Q

What two diagnostic tests should be added for Malignant Otitis Externa (MOE)?

A
  • Cultures

- CT Head (R/O osteomyelitis)

48
Q

What condition involves pain, hearing loss, N/V, vertigo, otorrhea, tinnitus?

A

TM Perforation

49
Q

What condition involves direct visualization of TM, audiogram; if head trauma, consider CT and CSF drainage?

A

TM Perforation

50
Q

What is the recommended treatment for TM Perforation (2)?

A
  • Self-limiting + water precautions
    vs.
  • Otolaryngology
51
Q

What condition involves blood collects in cartilage?

A

Auricular Hematoma

52
Q

What condition is Cauliflower Ear a nickname for?

A

Auricular Hematoma

53
Q

What is the recommended treatment for Auricular Hematoma? What is the recommended follow up?

A

Drain/aspirate ASAP

- F/U every 24 hours for 3-5 days

54
Q

What condition involves acute inflammation/infection of auricular cartilage? What is the most common bacterial pathogen if infection is present?

A

Perichondritis

- Pseudomonas aeruginosa

55
Q

What condition involves erythema, pain +/- abscess formation of ear, systemic sxs?

A

Perichondritis

56
Q

What is the recommended treatment for Perichondritis (2)?

A
  • I&D (if needed)

- Empirical abx (Cipro)

57
Q

What condition involves mucopurulent nasal discharge, foul odor, epistaxis, nasal obstruction?

A

Nasal FB

58
Q

What is the more common type of Epistaxis, and what area is most affected?

A

Anterior

- Kiesselbach’s plexus

59
Q

If packing is required for Epistaxis, what is the recommended tx and removal time?

A
  • Abx

- Remove in 3 days vs. 5 days (3 = normal patient, 5 = anticoagulated patient)

60
Q

If a patient presents with nasal trauma, what two treatments should be performed immediately (if present/needed)?

A
  • Repair lac

- Closed reduction

61
Q

What nose/sinus trauma is more common in peds?

A

Septal Hematoma

62
Q

What treatment is recommended for Septal Hematoma, and what is this used to prevent?

A
  • I&D to prevent avascular necrosis of septum
63
Q

What are two possible risks/complications associated with a Septal Hematoma?

A
  • Risk of perforation

- “Saddle nose” deformity

64
Q

Although typically diagnosed clinically, what diagnostic test can be used for Mastoiditis?

A

CT head WITH contrast

65
Q

What is the recommended treatment for Mastoiditis (2)?

A
  • Refer to ENT

- Start empirical abx

66
Q

What two abx are recommended for treatment of Periodontal Abscess?

A
  • Augmentin

- Clindamycin

67
Q

What oral cavity trauma is considered an emergency?

A

Dental Injury/Avulsion

68
Q

For tongue laceration, under what four conditions should a repair be performed?

A
  • Large (1+ cm)
  • Muscular involvement
  • Large flap/gap
  • Significant hemorrhage
69
Q

For Tetanus prophylaxis, when should it always be given? If the last 3+ doses are known, when would you give it (clean/minor vs. all others)?

A

ALWAYS if <3 previous doses/unknown

IF 3+ previous doses known…

  • Clean/minor, only if last dose was given 10+ years ago
  • All other wounds, only if last dose was given 5+ years ago

EM/Surg (16 decks)

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