EENT trigger Flashcards
pain with EOM is a red flag for what diagnosis
orbital cellulitis
Antiparkinsons, antispasmodics, antipsychotics, MAOIs and TCAs all increase the risk of what disorder?
glaucoma
also dilating eye drops
treat with keflex or augmentin. PCN allergy = clinda
periorbital cellulitis (OUTPATIENT adults and older children w/ mild symptoms)
IV rocephin OR Unasyn +vanc OR FQ + metro/clinda (PCN allergy)
- periorbital cellulitis for young children/severe presentation
- orbital cellulitis (add topical nasal decongestant)
when is the only time you use HOT or warm compresses?
HOT = periorbital cellulitis
Warm = hordeolum or chalazion
a young child presents with a hx of maxillary sinusitis and now has symptoms of erythema, edema and pain with movement of the eye. The child will not hold still long enough for a proper exam. What imaging will be used for this child? will you use contrast?
orbital CT and YES YOU WILL USE CONTRAST
this is suspicious of orbital cellulitis
when do you treat with polymyxin B?
bacterial conjunctivitis
unless they wear contact lenses, then treat with FQ or tobramycin d/t pseudomonas
when do you treat with topical antihistamines
viral conjunctivitis and allergic conjunctivitis
when do we see preauricular lymphadenopathy
- HSV keratoconjunctivitis
- viral conjunctivitis
ciliary flush with diminished VA and poor pupillary reactivity to light. photophobia is also present
anterior uveitis/iritis
“ciliary flush”
“consensual photophobia”
poor reactivity to light = miosis
diminished VA = clouding of aqueous humor
intense itching with papillae on inferior conjunctiva and cobblestoning
allergic conjunctivitis
photophobia with consensual photophobia is hallmark for which diagnosis. what else would you see in these patients?
Iritis/ anterior uveitis
also see:
conjunctival injection/ciliary flush
miosis w poor reactivity
diminished VAs d/t clouded aqueous humor
pt presents with periorbital edema but no chemosis and IOP is normal. you decide to treat them outpatient but they have a PCN allergy, what will you treat them with?
Clindamycinnnn
this is periorbital cellulitis
Slit lamp exam shows keratic precipitates and aqueous flares. you could also see hypopyons in these patients
anterior uveitis / Iritis
3 year old patient presents with periorbital edema and erythema. Orbital CT is negative for orbital cellulitis. you decide to still admit this patient d/t their young age and presentation. you find they have a PCN allergy, what is the tx
FQ + Metro/clinda
periorbital cellulitis
when would you use prednisolone drops and a long acting cycloplegic (cyclogyl, cyclopentolate or homatropine)?
anterior uveitis (iritis)
remember anterior uveitis can be seen in other diagnoses such as HZV ophthalmicus and blunt eye trauma. prednisolone would also be given if it is seen in those scenarios.
DO NOT give topical steroids if infectious anterior uveitis or if there is an abrasion or elevated IOP.
Fluorescein stain shows a staining defect with a white hazy infiltrate.
can also see hypopyon or iritis
corneal ulcer (culture this ulcer!!!!)
When do we use ophthalmic FQs (ofloxacin, cipro or tobramycin) and topical cycloplegics
corneal ulcers
ALSO for contact wearers who develop bacterial conjunctivitis or a corneal abrasion
when should we avoid eye patching and topical steroids
corneal ulcers
fluorescein stain shows geographic ulcer upake pattern
HSV keratoconjunctivitis
you could also see a dendritic lesion uptake
topical trifluridine (viroptic) with erythromycin ointment along with oral acyclovir is used in what diagnosis?
HSV keratoconjunctivitis
what nerve does HZV ophthalmicus affect
V1 of the trigeminal nerve
Fluorescein stain shows small, elevated dendrites with no terminal bulbs or central ulcerations.
herpes zoster ophthalmicus (these stain findings are called peudodendrites)
slit lamp showing diffuse, punctate corneal edema. Fluorescein shows punctate corneal abrasions
UV keratitis
when do we use ketorolac drops with erythromycin ointment?
corneal abrasions. (unless contact wearer, then FQ/tobra)
DO NOT PRESCRIBE TOPICAL ANESTHETICS TO THESE PATIENTS!!!!
when is the seidel test indicated
any time there is a suspected globe perforation such as with a corneal foreign body.
this test reveals leakage of the aqueous humor.
when do you treat with oral keflex, erythromycin and a cold compress
lid laceration (also stitch it up w soft 6/7-0 sutures if its >1mm)
tear drop pupil and limited EOM suggest what diagnosis? what test can confirm
globe rupture
seidel test can confirm as long as the wound is unsealed
if you have one of these you also wanna get a CT scan of the orbit
Vanc + ceftazidime + zofran
globe rupture
give eye shield, NPO, sit upright (avoid IOP increase)
emergent oph consult
restricted upward/lateral gaze with associated bruising around the eye suggest what diagnosis
orbital blow out fracture
when would we get a CT of facial bones WITHOUTTTT contrast
blunt eye trauma
Cupping of the optic disc on PE
glaucoma
describe sniffing position
lean forward
neck neutral
nose straight
sudden onset eye pain with fixed midposition pupil and a hazy cornea. PE shows increased IOP
Acute angle closure glaucoma
you would also see halos around lights with nausea and vomiting
sudden onset eye pain w halos around lights and N/V
acute angle closure glaucoma
also:
increased IOP
fixed midposition pupil
HA
sudden onset eye pain
Gonioscopy showing iridocorneal angle
gold standard test for acute angle closure glaucoma
definitive tx is laser peripheral iridotomy
acute angle closure glaucoma
painless color vision loss with a positive afferent pupillary defect and a swollen optic disc on exam
anterior optic neuritis
(retrobulbar ON has a normal optic disk)
painless color vision loss with a positive afferent pupillary defect and a normal optic disc on exam
retrobulbar optic neuritis
(anterior ON has a swollen optic disc)
cherry red spot on exam with segmented arterioles in a boxcarring fashion
central retinal arterial occlusion
diffuse retinal hemorrhages on fundoscopic exam
central retinal vein occlusion (this is a blood and thunder fundus)
floaters, flashes of light and a dark veil/curtain sensation. PE shows visual field by confrontation has been affected
retinal detachment
tenderness of external ear that is worse w auricle palpation
acute otitis externa
also:
clear/purulent discharge
erythema/edema of external canal
tx for AOE
- tylenol/motrin
- oflox or cipro drops
- acetic acid or hydrocortisone drops
- ear wick
CI in perforated TM or when TM cant be visualized
ciprofloxacin
hydrocortisone
(you CAN use ofloxacin)
CT head w contrast shows bone erosion
malignant otitis externa
IV tobramycin + piperacillin or rocephin or cipro
malignant otitis externa
fever and otalgia with a bulging and erythematous TM
Acute otitis media
tx with amoxicillin or cefdinir if PCN allergy
acute otitis media
tx w augmentin if recent abx use or recurrent OM
postauricular pain, swelling, erythema and tenderness w associated otalgia and fever
acute mastoiditis
CT head WITH contrast shows loss of bony septae and periosteal thickening.
acute mastoiditis
also shows mastoid clouding and destruction/irregularity of mastoid cortex
granulation tissue on the floor of the ear canal is suggestive of what diagnosis
malignant otitis externa
external auditory canal with bullae that spread along the TM. pt has severe otalgia and middle ear infusion
bullous myringitis
sudden onset pain and hearing loss with vertigo and tinnitus. possible bloody otorrhea
TM perforation
MC area is kiesselbachs plexus
anterior nose bleed
MC area is sphenopalantine artery
posterior nose bleed
bilateral nose bleed and bleeding into the nasopharynx
posterior nose bleed
when is a lateral canthotomy used
orbital cellulitis with increased IOP or optic neuropathy
hemodynamic instability is MC in which type of epistaxis
posterior
pt presents with a hx of purulent drainage from the right eye. you see that the conjunctiva are injected however hte cornea is clear w/o flourescent uptake. the pt wears contacts, what is the treatment
FQ or tobramycin
oxymetazoline or phenylephrine is used in what scenario
management of epistaxis
(vasoconstrictor)
CI in active hemorrhage, bilateral bleeding, recent cauterization
chemical management of anterior epistaxis (silver nitrate)
ONLY USED IN ANTERIOR NOSE BLEEDS
thrombogenic foam, oxidized cellulose and floseal gelatin matrix are all used when
anterior epistaxis when chemical cauterization w silver nitrate fails.
can also do nasal packing at this point
what muscle can become entrapped with an orbital blowout fracture
inferior rectus
a 72 year old diabetic pt comes to your office complaining of a continued ear infection despite being on otic ofloxacin for like 2-3 weeks. on exam you see granulation tissue resting on the floor of the ear canal. What imaging do you get to confirm diagnosis on this patient? what will you see? what cranial nerve is known to sometimes be affected in these pts?
CT head WITH WITH WITH WITH CONTRAST
youd see bone erosion because this dude has malignant otitis externa
sorry for the yelling. my brain refuses to remember that this is with contrast.
cranial nerve VII
A patient who presented with a posterior nose bleed is now undergoing nasal packing. the plan is to leave it in for 3 days. what should this patient also be sent home with.
- augmentin or cephalosporin or bactrim
- DO NOT TAKE NSAIDS
contralateral deflection of uvula with associated unilateral tonsillar enlargement suggests what diagnosis.
peritonsillar abscess
muffled voice with cervical adenopathy and neck pain. may also see respiratory distress and stridor
retropharyngeal abscess
can be assessed with a neck Xray, however hte gold standard testing for this diagnosis is a CT neck WITH contrast
retropharyngeal abscess
with contrast with contrast with contrast
immaging shows nonsuppurative edema, mild fat stranding and linear fluid.
retropharyngeal abscess early on
later on will see: necrotic nodes, low attenuation, ring enhancement
ct neck WITH contrast
prep for airway placement in these patients and administer IVF, IV clinda and cefoxitin.
what is this diagnosis? what is used if they have PCN allergy
this is retropharyngeal abscess.
if PCN allergy use zosyn or unasyn
anterior neck tenderness with progressive dysphagia and dyspnea. pt is sitting criss cross and leaning forward on arms to aid in breathing.
what is dx, diagnostic studies, and tx
epiglottitis
neck Xray showing thumbprint sign
prep airway, humidified O2, IVF and give IV cefotaxime + vanc + methylprednisolone
give resp FQ if PCN allergy
Xray shows thumbprint sign. what is the Gold standard for this diagnosis?
transnasal fiberoptic laryngoscopy
this is epiglottitis
When do you use IV glucagon?
relaxation of the LES to hopefully allow a swallowed FB in the distal esophagus to pass
when is IVF, NPO unasyn + clinda + cipro used?
TOXIC odontogenic abscesses
nontoxic = oral PCN VK or amoxicillin or clinda for PCN allergy
what swallowed items warrant an emergent endoscopy and surgery consult
food impaction
coins
sharp objects
when do you see ludwigs angina and what does it consist of?
Odontogenic abscess
includes: trismus, fever, edema of floor, displacement of tongue)
