ENT

Question 1

Otitis externa tx

Answer 1

ciprofex or ofloxacin with an otowick

Question 2

TM perforation management

Answer 2

give ciprodex drops only if infected. have pt keep ear dry and follow up with ENT in 1-2 wks

Question 3

mastoiditis tx

Answer 3

admit for IV vancomycin + ceftriaxone

Question 4

management for live FB in ear

Answer 4

viscous lidocaine in ear and flush with syringe. If TM not intact flush with saline

Question 5

management of sudden onset hearing loss

Answer 5

start high dose, 60mg, PO prednisone and refer emergently to ENT

Question 6

Management of bells palsy

Answer 6

document full neuro exam- not forehead sparing. give prednisone and acyclovir and eye drops

Question 7

Management of Mono in ED

Answer 7

+ mono spot, check liver transaminases. supportive care

Question 8

Management of tonsillitis

Answer 8

r/o strep and mono. if strep give amoxil. supportive care

Question 9

Management of diphtheria

Answer 9

contact CDC, give anti-toxin and arithromycin. Admit. All contacts require diphtheria booster

Question 10

management of peritonsillar abscess

Answer 10

aspirate if needed. start on IV vanco + ceftriaxone. If can wait for aspiration send home on abx and schedule aspiration.

Question 11

management of acute pharyngitis

Answer 11

document if LAD, excavates, stridor, drooling, wheezing and last PO. give PO Pen G or clindamycin

Question 12

Strawberry tongue ddx

Answer 12

Kawasakis, scarlet fever/strep throat, Toxic shock syndrome

Question 13

Pt comes in with hot potato voice- tongue is pushed up and back. What does the pt have?

Answer 13

Ludwig angina. Will feel brawny induration on palpitation. Get CT and consult for surgical drainage. PT will be admitted.

Question 14

imaging findings of retropharyngeal abscess

Answer 14

when the retropharyngeal space at C2 is twice the diameter of the vertical body it is suggestive of an abscess. Contrast CT is test of choice

Question 15

management of retropharyngeal abscess

Answer 15

consult ENT immediately. Monitor and stabilize airway, obtain IV access and give fluids, clindamycin and CT contrast. May give steroids.

Question 16

Pt comes in with harsh barking cough and stridor. XR shows steeple sign.

Answer 16

This is croup. Sx worst at 3-4 days of illness.

Question 17

Most common cause of stridor in 6 mo- 3 yrs

Answer 17

croup

Question 18

Management of croup

Answer 18

keep child calm, Give nebulized epinephrine and either IV or PO dexamethasone. Must observe in ED for 3 hrs after epi.

Question 19

admission criteria for croup

Answer 19

Have had 2 epinephrine treatments and are still in distress

Question 20

Thumb sign

Answer 20

epiglottitis

Question 21

management of epiglottitis

Answer 21

nasotracheal intubation is preferred if they are in distress. Consult anesthesiology and ENT immediately. Start on clindamycin and give IV methylprednisone or epi. Do not lay the pt down- they should remain upright.

Question 22

management of sinusitis

Answer 22

sxs > 10 days is indication for tx. Will want to get a CT to confirm if not certain it is sinusitis or to r/o potts tumor if facial edema is significant. can give azithromycin

Question 23

Management of potts sinusitis

Answer 23

admit for IV abx and surgical debridement. Found on CT

Question 24

management of nasal injury.

Answer 24

stabilize airway and breathing. Get CT. if mild angulation and no displacement can reduce in the ED. if major deformity refer for f/u with ENT in 2-5 days

Question 25

management of septal hematoma

Answer 25

will see bluish filled sac at the nasal septum. will need to drain it and place anterior packing but ENT usually does this.

Question 26

Management of cribriform plate fx

Answer 26

if see halo sign/ copious clear nasal discharge. Stabilize breathing and airway, get a head CT and get a consult

Question 27

timeline for nasal packing removal

Answer 27

anterior pack 24-48 hrs, posterior pack up to 72 hrs

Question 28

management of nasal FB

Answer 28

attempt removal with katz extractor. attempt x2 before ENT consult. If alkaline battery do not use saline flush and call ENT right away.

Question 29

Ellis class 1 dental fx

Answer 29

enamel involvement only. Smooth any sharp edged and refer to dentist

Question 30

Ellis class 2 dental fx

Answer 30

involves the dentin of the tooth, which is creamy yellow in color. Will cover exposed dentin with ionomer dental cement and refer to see dentist within 24 hrs

Question 31

ellis class 3 dental fx

Answer 31

Dental pulp is exposed- tooth will not stop bleeding. Will need to cover pulp with calcium hydroxide and then cover that with glass ionomer cement. Urgent dental consult

Question 32

Dental concussion

Answer 32

injury to the supporting structures of a tooth with clinical tenderness to precision but there is no mobility

Question 33

Dental Subluxation

Answer 33

Injury to the tooth resulting in mobility but there is not evidence of dislodgment of tooth

Question 34

Dental extrusive luxation

Answer 34

the partial avulsion or dislodgment of a tooth from the alveolar bone

Question 35

Dental lateral luxation

Answer 35

displacement of a tooth laterally with fracture of the alveolar bone

Question 36

Dental Intrusive luxation

Answer 36

displacement of a tooth into its socket with associated alveolar fracture

Question 37

dental avulsion

Answer 37

total displacement of tooth from socket

Question 38

Management of dental avulsion

Answer 38

reimplant permanent teeth ASAP- best if in 2-3 hrs. Do not exceed 60 minute dry time

Question 39

acceptable transport solutions for tooth

Answer 39

balanced salt solution, sterile saline, milk or saliva.

Question 40

abx therapy for tooth avulsion

Answer 40

Doxycycline PO BID