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ER Part 2 > ENT > Flashcards

ENT Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What should you document when you look in the ENT area?

A

No trismus, no stridor, handling secretions well, normal respiratory mechanics (aka no respiratory distress)

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2
Q

What is Ludwig’s Angina?

A

cellulitis/abscess to bilateral sublingual and submandibular spaces. With rapid progressive swelling of the neck

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3
Q

Who is at the biggest risk of Ludwig’s angina?

A

Immunosuppressed & those with bad teeth

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4
Q

What’s the key thing to remember with Ludwig’s angina?

A

Look at the floor under the tongue – if it is swollen and red intubate ASAP

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5
Q

How do you treat Ludwig’s?

A

PCN G 24 million units + Flagyl (of clinda)

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6
Q

You MUST secure an airway for Ludwigs, what airway is most common for them?

A

Trach… unless you would have intubated them immediately once you suspect it (in 30 mins they will fall)

Wouldn’t do a cracheotomy since the mid neck is completely swollen

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7
Q

If a patient with trismus, stridor, drooling, and talking in 2-3 words sentences but you look in the mouth and it is totally normal, but their neck hurts – what diagnosis?

A

Retropharyngeal abscess (or epiglottitis)

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8
Q

How would the voice of a retropharyngeal abscess sound?

A

Like a hot potato!

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9
Q

What is the most common age group you see retropharyngeal abscess in?

A

Used to be children (since we vax for hemophilus)

Now it’s mid-later aged adults who were never vax

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10
Q

How do you work up a retropharyngeal abscess?

A

Soft-tissue Lateral neck xray (trachea anterior to abscess)

But it’s sub-glottic so you don’t have the same concern for the airway when you view it (like in epiglottitis)

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11
Q

How do you treat retropharyngeal abscess?

A

Oxacillin or cephalosporin

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12
Q

If a patient has a significant problem with trismus (difficulty opening the mouth) – what diagnosis is this most common in?

A

Epiglottitis (again a hot potato voice)

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13
Q

What are the pathogens that cause epiglottitis?

A

Haemophilus influenza type B

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14
Q

Who do we commonly see epiglottitis in?

A

Disease of unvaccinated children

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15
Q

What would you see on xray with epiglottitis?

A

Thumb sign

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16
Q

How do you treat epiglottitis?

A

Cefuroxime, ceftriaxone, Bactrim

Steroids

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17
Q

If you see a uvula displaced to one side and the person has a sore throat, with possible stridor, drooling, and trismus, what do you think of?

A

Peritonsillar abscess

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18
Q

How do you treat a peritonsillar abscess?

A

Drainage and Abx (pen VK)

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19
Q

When you drain a peritonsillar abscess what do you need to be concerned about?

A

Their internal carotid

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20
Q

What are the take home points for Life Threatening ENT conditions?

A

Diagnosis less important than recognition of warning signs

Trismus, stridor, respiratory distress, unable to handle secretions

Document lack of warning signs if no concern

Definitive airway early

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21
Q

Where is the first & last tooth, when numbering?

A

First = Top back right

Last = Bottom back right

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22
Q

How many teeth are on the top?

A

16

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23
Q

If a patient presents with dental pain with asymmetrical facial swelling but no stridor, trismus, or difficulty breathing. The swelling is in between the teeth and the cheek – what diagnosis?

A

Abscess

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24
Q

How would you treat a dental abscess?

A

Drainage (just a little nick!) & Abx (PCN or Keflex)

25
Q

How else can you control dental pain besides giving pain meds?

A

Give a dental block (periapical, infraorbital, inferior alveolar)

If you use Marcaine it will take longer to start but will last much longer than lido

26
Q

If you break a tooth you need to have a filling, but what if it’s Friday night?

A

They sell temporary dental filling at the pharmacy (without Rx) until they see a dentist

27
Q

If a patient presents with ear fullness and pain or fussy/inconsolable child – what diagnosis do you think of?

A

OM

28
Q

What Abx do we use for OM?

A

Amoxicillin

29
Q

Besides Abx, what else can you do for OM?

A

Aralgan (or benzocaine otic) drops

30
Q

If you have a perforated TM – what should you not do?

A

no drops or anything goes inside the ear!

31
Q

When you suspect OM, what should you always do on PE?

A

Examine/percuss the mastoid!!

32
Q

What’s the fear with mastoiditis?

A

Infection can go to the brain = meningitis

33
Q

What typically causes otitis externa?

A

S. aeruginosa & S. aureus

34
Q

How does the PE differ from OM and OE?

A

The tragus is uncomfortable with a narrow canal & debris = otitis externa

35
Q

What do you treat OE with?

A

Polymixin (Abx/steroid/fungal combo) + wick

36
Q

What type of nerve palsy can you get with mastoiditis?

A

CN VI, VII, and V

37
Q

What would cause mastoiditis?

A

S. pneumo, Group A Strep, S aureus, M catarrhalis

38
Q

What age? does mastoiditis most often present?

A

6-13 months

39
Q

What subtle PE findings will you see with mastoiditis?

A

Lack of crease behind the ear

40
Q

What should you always document with nasal trauma?

A

The presence or absence of a septal hematoma

41
Q

How do you treat a septal hematoma?

A

Call ENT, and most likely drain → ENT f/u

42
Q

If you suspect a nasal FB in a patient, what do you always need to check for?

A

always assess for possibility of aspiration of other FB

43
Q

What’s a great technique to remove a marble from a child’s nose?

A

Foley catheter

44
Q

If an elderly person has epistaxsis, what should we ask about their history?

A

Are they on a blood thinner

45
Q

Where should you look for on PE with epistaxis?

A

Look in the back of throat to see if blood is pouring down the throat

46
Q

Where’s the most common place to bleed in a nose?

A

Hassel bach’s plexus (anterior)

47
Q

If it’s a posterior bleed how do you treat?

A

Call ENT

48
Q

How do you treat epistaxis?

A

Vacoconstrictors (medical grade cocaine)

Clamps

Inserted devices (nasal tampons)

Cautery

49
Q

If you pack someone’s nose what else do they need?

A

Abx!!

And stuff it STRAIGHT back (not at an angle)

50
Q

What if the nose bleed has stopped by the time you see them?

A

Can give meds & clamp for if it bleeds again later tonight

51
Q

When’s the most common time to see nose bleeds?

A

November

52
Q

If your patient has a sore throat with posterior lymph adenopathy – what diagnosis?

A

mono

53
Q

IF a patient has a sore throat with anterior lymph adenopathy – what diagnosis?

A

strep

54
Q

If you suspect mono what else do you need to check?

A

Spleen! See if it’s tender

55
Q

What will you see on PE with strep throat?

A

White bilateral exudate, red mucosa, and uvula midline

56
Q

What will you see on PE for mono?

A

Exudate often gay, huge swelling

57
Q

If you start a patient on amox with mono – what can occur?

A

Rash

58
Q

What will mono respond well to?

A

Steroids

59
Q

How do you treat strep?

A

Amox; magic mouthwash; salt water gargles

ER Part 2 (7 decks)

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