EENT + Toxic Ingestion Flashcards by Sarah Sanchez

how to record visual acuity?

lowest line patient can read with 2 or less mistakes
test both eyes with glasses/contacts

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how does red light reflex reveal opacities?

appear as black silhouettes

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during a fluorescein staining, what are we looking for?

green uptake

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if there is pain/redness in eye, what test should we do?

intra-ocular pressure test

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shining light from side and should be able to see the entire iris; if shaded, light is not able to move across the iris

anterior chamber depth assessment

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what is the most common etiology of conjunctivitis?

viral

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a patient presents with a feeling of irritation of the eye. Dx? treatment? (3)

conjunctivitis

anti-histamine
lubricants
antibiotics

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patient presents with eye pain and foreign body sensation. fluorescein shows corneal dendrite; Hutchinson sign. Dx? treatment? (2)

herpes simplex keratitis

antiviral
consult ophthalmologist

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a patient presents with eye pain, FB sensation; you see a opaque ulcer with fluorescein showing ulcer. Dx? treatment? (2)

corneal ulcer

compounded drops q hour
ophtho consult

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what is the most common cause of corneal ulcer?

contact lens use

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a patient presents with a deep, boring eye pain, headache, N/V, photophobia, halos around bright lights. Patient states lots of pain when exposed to light. Dx? treatment options (2)?

acute angle closure glaucoma

ophtho consult
DROPS: timolol / pilocarpine
ORAL: acetazolamide / osmotic diuretics

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patient presents with pain in left eye when the right eye is exposed to light. Dx? management?

iritis / uveitis
ophtho consult

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a patient presents with a sector/portion of the eye that feels painful and has FB sensation. Dx? treatment? (3)

episcleritis

lubricating drops
optho consult
ocular NSAIDS

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a patient presents with eye pain, normal vision, but the eye is very tender with pain during EOM use. Dx? treatment?

scleritis

oral NSAIDS
ophtho f/u

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a patient presents with sudden monocular vision loss and fundoscopic exam reveals cherry red spot. Dx? treatment options (3)?

central retinal artery occlusion

CO2 for arterial dilation
eyeball massage
timolol / acetazolamide
consult ophtho

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a patient presents with rapidly progressive vision loss and fundoscopic exam reveals blood and thunder fundus. Dx? management?

central retinal vein occlusion

consult ophtho

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a patient presents with decreased visual fields (curtain drop in certain area) with visual floaters. Exam reveals hazy gray billowing retina. Dx? management?

retinal detachment

ophtho consult

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a patient presents with periorbital edema, without vision changes or pain with EOM use. Dx? treatment?

periorbital cellulitis

PO antibiotics

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what is the most common cause of periorbital cellulitis? what can it lead to?

sinusitis

meningitis

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a patient presents with edematous lid, proptosis (bulging eyes), painful EOM use, diplopia, and vision loss. Dx? treatment?

orbital cellulitis

IV antibiotics

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what are 4 diagnostics for orbital cellulitis?

CT orbits / sinuses
CBC
culture
+/- LP

a patient presents with pain and FB sensation. Fluorescein uptake shows abrasion. Dx? treatment?

corneal abrasion

antibiotic drops

a patient presents with pain, FB sensation, very decreased vision. Fluorescein shows seidel sign - leaking aqueous humor. Dx? treatment?

penetration of globe

protect globe by covering both eyes
consult ophtho

a patient presents with inability to move eyes upwards. Dx? management?

blowout fracture (entrap inferior rectus + orbital fat)

CT orbits
ophtho consult

when do most eye complaints require a follow up?

in 24 hours

otitis externa that extend into underlying tissues and possible skull

malignant otitis externa

what is the criteria for malignant otitis externa?

persistent despite 2-3 weeks of topical antimicrobial

how is malignant otitis externa confirmed? treatment?

CT / MRI IV antibiotics

a patient presents with postauricular erythema, swelling, and tenderness, with protrusion of the auricle and obliteration of the postauricular crease. Dx? treatment?

acute mastoiditis IV antibiotics / myringotomy / tympanocentesis

how is acute mastoiditis confirmed?

CT / MRI

caused by trauma to the ear sheering blood vessels from cartilage to skin

auricular hematoma

treatment for auricular hematoma?(2)

remove fluid collection maintain pressure x several days

what to do when insect is identified in external auditory canal? (3)

pour lidocaine into ear canal remove with forceps antibiotic drops

4 treatment options for anterior epistaxis?

afrin (oxymetazoline) lidocaine + epi packing silver nitrate (chemical cautery) Rhino Rocket

patient presents with blood coming out of both nostrils and mouth. Dx? 2 treatment options?

posterior epistaxis Rhino Rockets until ENT f/u foley catheter

management for closed nasal fracture?

refer to ENT w/in 6-10 days PO antibiotics

management for grossly open nasal fracture?

emergent ENT consult

management for nasal septal hematoma? (3)

incise and drain to avoid ischemic necrosis antibiotics ENT follow up

a patient presents with dental pain followed by local swelling that spreads within the facial plane. Dx? treatment? (3)

dental abscess incision penicillin VK / amoxicillin dental f/u

a patient presents with swollen, erythematous, and indurated submandibular space. Dx? treatment? (3)

ludwig angina IV antibiotics emergency surgical consult prep intubation

a patient presents with sensitivity to hot/cold stimuli and air passing over exposed surface during breathing. Dx? treatment? (3)

enamel-dentin fracture dental sealant antibiotics dental f/u

treatment for crown-root fracture? (3)

splint x 4 weeks dental f/u within 24-48 hours antibiotics

treatment for luxation dental fracture?

splint dental f/u

treatment for avulsion dental fracture? (3)

rinse tooth x 10 secs with water replace tooth with splint antibiotics

a patient presents with severe sore throat, displacement of tonsils, deflection of swollen uvula, and tender cervical lymphadenopathy. They also have trismus and muffled voice. Dx? Treatment? (3)

peritonsillar abscess drainage 1 dose IV steroids antibiotics x 10 days

a patient presents with drooling, dysphagia, and distress. They are sitting up, leaning forward, with their mouth open, and panting. Dx? treatment? (4)

epiglottitis humidified O2 IV hydration IV antibiotics IV steroids

what is seen on radiographs of epiglottitis?

thumb sign

treatment for post-tonsillectomy bleeding? (2)

immediate ENT consult direct pressure with gauze w/ lidocaine or epi

what 3 diagnostics should be done for ingestion-related esophagitis?

chest xray acute abdominal series xrays upper endoscopy

what diagnostic is used for possible battery ingestion?

abdominal xray

treatment for ingestion-related esophagitis from battery? (2)

stabilize airway remove via endoscopy

what should NEVER be done to treat ingestion-related esophagitis? (2)

induce vomiting use neutralizing agents