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Emergency Medicine > EM: EENT just ENT > Flashcards

EM: EENT just ENT Flashcards

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1
Q

Infection/inflammation of the external auditory canal and auricle

A

Otitis externa

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2
Q

Historical findings of otitis externa

A
  • Pruritis
  • Otalgia
  • Tenderness of external ear, worse with mastication/movement of auricle
  • Otorrhea and decreased hearing in more severe presentations
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3
Q

;

Physical exam of otitis externa

A
  • Erythema and edema of external auditory canal, spreading to tragus and auricle
  • Clear-purulent discharge with crusting of external canal
  • Severe cases: complete occlusion of auditory canal, periauricular edema/erythema, lymphadenopathy
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4
Q

Management of otitis externa

A
  • Analgesics: tylenol/motrin
  • Cleansing of external canal with hydrogen peroxide 1:1 with warm saline or water and gentle suction under direct visualization
  • Otic drops: acetic acid/hydrocortisone
  • Ofloxacin or ciprofloxacin/hydrocortisone
  • Ear wick
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5
Q

When would acetic acid/hydrocortisone be contraindicated?

A
  • perforated TM or unable to visual TM
  • Can only be used alone in mild disease
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6
Q

When should ciprofloxacin HC be avoided in otitis externa? What could you use instead?

A
  • if suspected or confirmed TM perforation
  • Ofloxacin
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7
Q

When is an ear wick indicated?

A

If swelling severe and prevents full application of ear drops

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8
Q

Clinical presentation of malignant otitis externa

A
  • Potentially life-threatening extension of infection to deeper tissues of EAC
  • Red flags: elderly, diabetic/immunocompromised
  • Persistent symptoms despite standard therapy (2-3 weeks)
  • Severe otalgia and edema; granulation tissue on floor may be seen
  • CN VII first to be affected
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9
Q

Diagnosis of malignant otitis externa

A

CT head with contrast, bone erosion noted on report

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10
Q

Management of malignant otitis externa

A
  • Urgent ENT consult
  • IV antibiotics: tobramycin plus piperacillin OR ceftriaxone OR ciprofloxacin
  • Pain control: IV opiate usually needed
  • Admission with ENT consult

Grandma toby and piper or roce or cipro

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11
Q

Infection of inner ear

A

Otitis media

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12
Q

Clinical presentation of otitis media

A

History of otalgia +/- fever, otorrhea, hearing loss
* PE: TM erythema, yellow/white exudate behind intact TM or in canal if TM perforated, retracted or bulging with impaired mobility

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13
Q

Management of otitis media

A
  • Oral antibiotics: amoxicillin (cefdinir or zithromax alternatives)
  • Augmentin or cefdinir if recent abx use or recurrent OM
  • Analgesics: tylenol/motrin

media= moxi augment it or eat dinner if recent abx or recurrent

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14
Q

Disposition of otitis media

A

Home to f/u with PCP in 3-5 days

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15
Q

Complication of OM in which infection spreads to mastoid cells

A

Acute mastoiditis

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16
Q

Clinical presentation of acute mastoiditis

A
  • History of otalgia, fever, postauricular pain and swelling
  • PE findings same as OM + protrusion of auricle with loss of postauricular crease, postauricular erythema, swelling and tenderness
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17
Q

Diagnosis of acute mastoiditis

A

CT head with contrast: mastoid “clouding” early in disease; loss of bony septae of mastoid air cells, destruction/irregularity of mastoid cortex, periosteal thickening

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18
Q

Management of acute mastoiditis

A

Emergent ENT consult, IV vancomycin and ceftriaxone, admission

three mastifs in vans

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19
Q

complication of OM characterized by bullae formation on TM and deep external auditory canal

A

Bullous myringitis

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20
Q

History in bullous myringitis

A
  • Severe otalgia
  • Intermittent otorrhea due to ruptured bullae
  • Hearing loss (reversible)
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21
Q

PE in bullous myringitis

A
  • Intact bullae along TM and EAC
  • Blood filled, serous, serosanguineous
  • Middle ear effusion
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22
Q

Treatment of bullous myringitis

A
  • Amoxicillin (or cefdinir, zithromax)
  • Augmentin or cefdinir if recent abx or recurrent OM
  • Tylenol/motrin

same as otitis media!

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23
Q

Accumulation of blood between the skin adn the cartilage of tha uricle due to blunt trauma

A

Hematoma

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24
Q

Clinical presentaiton of hematoma

A
  • Swelling
  • Pain
  • Ecchymosis of auricle
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25
Q

Management of hematoma and complciation

A
  • Consult ENT: immediate I&D with evacuation of hematoma followed by compressive dressing to prevent reaccumulation
  • If left untreated: scarring with deformity leading to cauliflower ear
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26
Q

History and physical exam on foreign body in the ear

A

History of insertion of FB, visualization of FB, sensation of movement in ear, ear pain or loss of hearing
* PE: FB visualized, look for signs of TM perforation and infection

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27
Q

Management of foreign body in the ear

A
  • Immobilize live insects with lidocaine prior to removal
  • FB removal with forceps or hooked probe under visualization or suction
  • irrigation with warm water or saline for small non organic objects (organic might soak up liquid)
  • Consult ENT if TM perforation present or object can’t be removed
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28
Q

S/S of tympanic membrane perforation

A
  • History of barotrauma, blunt/penetrating/acoustic trauma, lightning strikes
  • Sudden onset of pain and hearing loss
  • +/- bloody otorrhea, vertigo, tinnitus
  • Rupture of TM, ensure full visualization of TM and canal
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29
Q

Management of TM perforation

A
  • Most heal spontaneously
  • Uncomplicated TM perforations can be discharged home:blunt or noise trauma that are isolated injuries and ENT follow up in 7-10 days
  • Penetrating TM ruptures- f/u with ENT in 24 hours
  • Otic abx if foreign material remains in canal
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30
Q

What are the 2 classifications of epistaxis?

A
  • Anterior bleed: visualized on external exam MC @ Kiesselbach plexus
  • Posterior bleed: unable to directly visualize, blood from bilat nares or in posterior pharynx, failure to control with anterior packing MC @sphenopalatine artery
  • Use nasal speculum to attempt visualization of bleed
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31
Q

Management of epistaxis

A
  • If severe bleed/hemodynamic instability: type and crossmatch blood (MC in posterior bleed and anticoag)
  • Place in sniffing position: lean forward, neck in neutral position, nose straight
  • Direct pressure after nose blow (to evacuate clots) via intranasal vasocontrictor –> oxymetazoline or phenylephrine followed by pinching nose for 10-15 minutes without disturbing pressure
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32
Q

What can you do if epistaxis is anterior and direct pressure has failed and bleeding vessel visualized?

A

Chemical cauterization with 1:1 oxymetazoline and lidocaine then silver nitrate on bleeding vessel

33
Q

What are CI for chemical cauterization?

A

Active hemorrhage, bilateral bleeding, recent cauterization (within last 4-6 weeks)

34
Q

What is used for epistaxis if chemical cautery fails?

A
  • Thrombogenic foams and gels (gelfoam and surgical) applied directly to bleeding mucosa
  • Floseal: thrombin injected directly into bleeding nare and nare filled completely, breaks down after 3-5 days
35
Q

What are indications for nasal packing to treat epistaxis?

A
  • Failure of chemical cautery
  • Gel/foam not available
  • Posterior epistaxis suspected
36
Q

What are the 3 types of packing

A

Epistaxis ballon: easier to use and more comfortable, fabric with cellulose for platelet aggregation
Nasal tampons/sponge: coat with antibiotic, insert along nasal floor, irrigate if doesn’t expand, and tape to face, remove in 2-3 days
Ribbon gauze: last packing resort, most uncomfortable for patient and most difficult to insert

37
Q

What is a posterior packing alternative?

A
  • 14-French foley catheter
38
Q

What are complications of epistaxis?

A
  • Vasovagal syncope
  • Dislodgement of packing
  • Recurrent bleeding
  • Sinusitis
  • Toxic shock syndrome
39
Q

When would you admit and consult ENT for epistaxis?

A
  • Posterior packing required or anterior epistaxis not controlled
40
Q

If packing will be present >48 hours, what should you add to epistaxis treatment?

A

Amoxicillin/clavulanic acid (or cephalosporin or bactrim for PCN allergy)

41
Q

What is follow up for epistaxis?

A

all packing removed in 2-3 days by ENT or ED 2 days ideal

42
Q

What is patient education for epistaxis?

A

Avoid NSAIDs for 3-4 days

43
Q

s/s of viral pharyngitis

A
  • Fever
  • Odynophagia
  • Petechial or vesicular lesions along soft palate and tonsils
  • Cough
  • Rhinorrhea
  • Nasal congestion
44
Q

s/s of bacterial pharyngitis

A
  • Fever
  • Headache
  • Sore throat
  • Odynophagia
  • Tonsillar exudates/erythema
  • Cervical lymphadenopathy
45
Q

If 2 or more what are met perform a strep test. What is this?

A

Centor criteria: tonsillar exudates, tender anterior cervical adenopathy, absence of cough, fever

younger than 15 adds a point older than 15 but younger than 45 0 point, older than 45 -1

46
Q

What is almost always viral pharyngitis?

A

ulcers

47
Q

treatment of pharyngitis/tonsillitis?

A

based on rapid strep results
* non-bacterial: antipyretics, analgesics, IV fluids if dehydrated
* Bacterial: single dose of PCN G or amoxicillin (keflex/cefdinir/cephalosporins if PCN allergic reaction of rash and azithromycin/clindamycin if anaphylaxis)

48
Q

Patient education for pharyngitis/tonsillitis

A
  • Change toothbrush after 24 hours
  • Not contagious any longer after 24 hours of treatment
  • Strep will go away on its own without antibiotics, however will remain contagious for 2-3 weeks after symptoms
49
Q

History for peritonsillar abscess`

A
  • Fever
  • Malaise
  • Sore throat
  • Odynophagia
  • Dysphagia
  • Hot potato voice
  • Otalgia +/- trismus
50
Q

Physical exam for peritonsillar abscess

A
  • UNilateral tonsillar enlargement
  • Palatal and uvula edema
  • Contalateral deflection of uvula
  • Tender ipsilateral anterior lymphadenopathy
  • Drooling
  • Dehydration
51
Q

Diagnostic studies for peritonsillar abscess

A
  • Imaging often not needed due to classic presentation of disease
  • Intraoral US: confirms presence of abscess when differentiating between cellulitis and abscess
  • CT scan with contrast of neck
52
Q

Management of peritonsillar abscess

A
  • Needle aspiration or I&D (consult ENT if necessary)
  • Non-toxic patients with successful drainage and who can tolerate PO meds can be discharged with oral abx
  • PCN VK + metronidazole for 10 days (clindamycin + metronidazole for PCN allergy)
  • Toxic patients: sepsis workup, IV pip/taz

peritons- pen on the metro

53
Q

Collection of pus in space anterior to prevertebral fascia that extends from the base of the skull to tracheal bifurcation

A

Retropharyngeal abscess

54
Q

History for retropharyngeal abscess

A
  • Look for source: recent intraoral procedure, trauma, foreign bodies, or extension from odontogenic infection
  • Sore throat
  • Dysphagia
  • Neck pain/torticollis
  • Stridor in children
55
Q

Physical exam of retropharyngeal abscess

A
  • Muffled voice
  • Cervical adenopathy
  • Respiratory distress
56
Q

Diagnostic studies for retropharyngeal abscess

A
  • Lateral soft tissue neck x-ray: thickening and protrusion of retropharyngeal wall
  • CT neck with IV contrast: GOLD standard (do if xray not definitive with high suspicion) –> early findings: nonsuppurative edema, mild fat stranding, linear fluid, minimal mass effect; later findings: necrotic nodes with central low attenuation and ring enhancement
57
Q

Management of retropharyngeal abscess

A
  • Prepare for emergent airway placement
  • Urgent ENT consult for surgical intervention and admission
  • IV fluids, NPO
  • IV clindamycin or cefoxitin`

you gotta clin that retro(pharyngeal) fox

58
Q

Inflammatory condition of the epiglottis, often infectious in nature

A

Epiglottitis

59
Q

History in epiglottitis

A
  • 1-2 day progressive dysphagia, odynophagia, and dyspnea
  • +/- drooling, inspiratory stridor, fever
  • Symptoms worse when supine, improved when upright
  • Tripod: upright, leaning forward, neck extended with mouth open
60
Q

Physical exam in epiglottitis

A
  • Tachycardia
  • Cervical adenopathy
  • Tenderness of the anterior neck with gentle palpation of the larynx and upper trachea
61
Q

Diagnostic studies for epiglottisi

A
  • Lateral soft tissue neck x-ray
  • THUMBPRINT SIGN
  • transnasal fiberoptic laryngoscopy ** gold standard for confirming diagnosis, risk of airway obstruction during exam
62
Q

Management of epiglottitis

A
  • Emergent ENT consult and admission
  • Prepare for emergent airway placement (cardio monitors, do not leave unattended, should remain upright)
  • Humidified oxygen, IV fluids
  • IV cefotaxime + vancomycin (severe PCN allergy - resp FQ)
  • IV methylprednisolon to reduce inflammation and edema

Epic van but it has taxes and meth

63
Q

Extension of dental abscess in a surrounding structure or deep neck space, can be retropharyngeal, parapharyngeal, floor of mouth

A

Odontogenic abscess

64
Q

Clinical presentaiton of odontogenic abscess

A
  • Hx of dental pain/abscess
  • Erythema edema of the labia or buccal gingiva, intraoral or dento-cutaneous fistula
  • Tismus, fever, edema of upper neck/floor of mouth, displacement of tongue, airway compromise
  • Sore throat
  • Dysphagia
  • Dyspnea (retro-pharyngeal)
65
Q

Diagnostic imaging for odontogenic abscess

A
  • Superficial infection- bedside US
  • Deep space - CT neck with IV contrast
66
Q

Complications of odontogenic abscess

A

Ludwig’s angina: cellulitis of sublingual and submaxillary space that is rapidly progressive and needs airway established
Necrotizing infection: toxic with hemodynamic instability, skin discoloration, crepitus of SQ tissu, confusion –> needs immediate surgical fasciotomy

67
Q

Management of odontogenic abscess

A

Non-toxic appearing: oral PCN VK or amoxicillin (clindamycin if PCN allergy)
Toxic: urgent ENT consult and admission, IV fluids, NPO, IV abx –> amp-sulbactam + clindamycin +ciprofloxacin

well odont pens have a moxi or una clin cip

68
Q

What is the MC food that becomes lodged in esophagus

A

Meat

69
Q

Clinical presentation of swallowed foreign bodies

A
  • Children: refusal or inability to eat, vomiting, gagging and choking, stridor, neck or throat pain, drooling
  • Adults: retrosternal pain, dysphagia, vomiting, choking, coughing, aspiration if attempting to wash down FB
70
Q

Physical exam of swallowed foreign bodies

A

Assess airay, nasopharynx, oropharynx, neck and chest
FB may be visualized in oropharynx

71
Q

Diagnostic studies of swallowed foreign bodies

A
  • Foreign body film: chest and abd with radiopaque objects, coins with circular face on AP/PA in the esophagus and if trachea will show circular face in lateral view
  • CT chest without contrast: will show non-opaque objects and provide information on perforation and signs of infection
72
Q

Interpretation of imaging for swallowed foreign object

A
  • If passes pylorus can usually move through GI tract
  • Increased risk of obstruction past pylorus if irregular or sharp or wide/long
73
Q

Management of swallowed FB

A
  • Assess for airway compromise and risk of aspiration
  • Determine need for urgent endoscopy
  • Expectant therapy: if object past pylorus and meets no red flags for obstruction
    Distal esophagela objects: IV glucagon may relax lower sphincter and allow passage
    Successful endoscopy without complications: discharge home
74
Q

What should be done for food impaction

A

Complete esophageal obstruction –> emergency endoscopy
Partial obstruction: treat expectantly with f/u in 12-24 hours to ensure passage, if no passage endoscopy required

75
Q

What should be done for coin ingestion

A

Coins in esophagus should be removed with endoscopy

76
Q

What shoul dbe done for sharp objects

A
  • If in esophagus, stomach, or duodenum, immediate endoscopy
  • If distal to duodenum and asymptomatic daily xrays until passage
  • If passage not within 3 days, general surgery
  • COnsult surgery immediately if s/s of perforation: pain, emesis, fever, GI bleed
77
Q

What should be doen for button battery ingestion

A

True emergency! Prompt removal if in esophaguse will cause rapid mucosal injiury and necrosis, perforation within 6 hours of ingestion
* If passed esophagus f/u in 24 hours for repeat exam
* Repeat x rays at 48 hours to ensure passage through pyloruys

78
Q

What should be done for narcotic ingestion

A
  • Commonly ingested inside condom
  • Rupture can be fatal
  • Endoscopy CI due to risk of rupture
  • Often visible on plain film
  • Admit for observation until packet reaches rectum

Emergency Medicine (13 decks)

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