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Emergency Med > ENT > Flashcards

ENT Flashcards

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1
Q

List the 3 si/sx’s of an orbital floor “blowout” fracture

A
  1. Decreased VA
  2. Diplopia esp. w/ upward gaze=inferior rectus muscle entrapment
  3. Orbital emphysema
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2
Q

What is the imaging of choice to evaluate for an orbital floor fracture? Findings on CT?

A

CT- “Teardrop” sign

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3
Q

3 initial management/treatments in an orbital floor fracture?

A
  1. Nasal decongestants- decrease pain
  2. Avoid blowing nose
  3. Abx: Clindamycin or Ampicillin/Sulbactam
  4. Corticosteroids: reduce swelling
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4
Q

What is the MC type of retinal detachment?

A

Rhegmatogenous: Retinal tear–> retinal inner sensory layer detaches from choroid plexus

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5
Q

What are the MC predisposing factors in a Rhegmatogenous retinal tear?

A
  1. Myopia: Near-sighted

2. Cataracts

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6
Q

Si/Sx’s of retinal detachment

A
  1. Photopsia: flashing lights
  2. Floaters
  3. PAINLESS unilateral vision loss: Shadow of “curtain coming down” in peripheral initially–>loss of central visual field
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7
Q

Exam findings in retinal detachment

A
  1. Retinal tear: detached tissue “flapping” in vitreous humor
    • Shafer sign/tobacco dust: clumping of brown-colored pigment cells in ant. vitreous humor
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8
Q

Corneal abrasion si/sx’s

A
  1. FB sensation
  2. Tearing
  3. Red
  4. Painful
  5. Blurred vision, photophobia
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9
Q

Corneal abrasion treatment?

A
  1. Abx drops: Erythromycin, Polymyxin/Trimethoprim

2. Patch w/ large abrasion (>5 mm)

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10
Q

Treatment for corneal abrasion in contact lens wearers

A
  1. Ciprofloxacin: covers pseudomonas

2. DO NOT PATCH THE EYE

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11
Q

FB treatment

A
  1. Removal w/ sterile irrigation

2. Avoid sending pt’s home with topical anesthetics!

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12
Q

Define Hyphema

A

Blood in anterior chamber
Painful
d/t trauma

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13
Q

Hyphema treatment

A
  1. Keep head elevated
  2. Control IOP
  3. Optho consult
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14
Q

What is orbital cellulitis MCly 2ry to?

A

Sinus infections: Ethmoid=90%

-S. aureus, S. pneumo, GABHS, H. flu

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15
Q

Si/sx’s of orbital (septal) cellulitis

A
  1. Decreased vision (there are no vision changes in preseptal cellulitis)
  2. PAIN w/ ocular movements (no pain in preseptal)
  3. Proptosis/Exopthalmos
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16
Q

Orbital cellulitis treatment

A
  1. IV abx: Vancomycin, Ceftriaxone, Clindamycin
  2. Hospitilization
  3. Surgical drainage
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17
Q

Who is predisposed to acute narrow angle-closure glaucoma?

A

Pre-existing narrow angle or large lens=

  1. Elderly
  2. Hyperopes=Far-sighted
  3. Asians
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18
Q

List the main precipitating factor in acute narrow angle-closure glaucoma

A

Mydriasis (pupillary dilation further closes the angle)

  1. Dim lights
  2. Sympathomimetics
  3. Anticholinergics
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19
Q

acute narrow angle-closure glaucoma si/sx’s

A
  1. Severe, sudden UNILATERAL OCULAR PAIN
  2. Vision changes: halos, tunnel vision
  3. Conjunctival eryrthema, “steamy cornea”
  4. Mid-dilated, fixed, nonreactive pupil
20
Q

Diagnosis of acute narrow angle-closure glaucoma

A

Increased IOP: >21 mmHg (normal is 10-20)

-Usu. 40-70

21
Q

acute narrow angle-closure glaucoma treatment

A
  1. Acetazolamide=1st line*: decreases IOP by decreasing aqueous humor production
  2. Topical beta blocker: Timolol
  3. Cholinergics/Miotics: Pilocarpine, Carbachol
22
Q

Retinal vein cclusion si/sx’s

A

UNILATERAL, PAINLESS blurred vision/visual loss

23
Q

Fundoscopic findings in Retinal vascular occlusion

A

“Blood and Thunder” retina= dilated veins, hemorrhage, edema, exudates

24
Q

Who is retinal artery occlusion MC in?

A

50-80 y.o. w/ ATHEROSCLEROTIC DZ

25
Q

Retinal artery occlusion si/sx’s

A
  1. commonly preceded by Amaurosis fugax

2. Acute, sudden, monocular vision loss

26
Q

Retinal artery occlusion fundoycopic findings

A

Pale retina w/ cherry red spot

27
Q

Retinal artery occlusion treatment

A
  1. Decrease IOP: Acetazolamide

2. Revascularization: Supine + Orbital massage

28
Q

What is Giant Cell Arteritis highly associated with?

A

Polymyalgia Rheumatica

29
Q

List the MC sx’s of Giant Cell Arteritis

A
  1. Headache=MC*
  2. Jaw Claudication and mastication
  3. Vision changes: Amaurosis Fugax
  4. Thickened temporal artery
  5. Fever
30
Q

Giant Cell Arteritis diagnostic lab test?

A

ESR, CRP

31
Q

Giant Cell Arteritis temporal artery bx findings

A

Mononuclear lymphocytic infiltration

Multinucleated giant cells

32
Q

Giant Cell Arteritis treatment

A

High dose corticosteroids

33
Q

Otitis externa treatment

A
  1. Ciprofloxacin/Dexamethasone

2. Aminoglycoside combo: Neomycin/Polytrim B/Hydrocortisone otic- NOT if TM perforation *

34
Q

Complication of otitis externa

A

Osteomyelitis @ skull base 2ry to pseudomonas

35
Q

MC organism in otitis media?

A

S. pneumo

36
Q

Otitis media abx treatment

A

AMOXICILLIN x 10-14 days

37
Q

Otitis media abx treatment if PCN allergy?

A

Macrolide: Erythromycin

38
Q

Si/sx’s of Labrynthitis

A
  1. Vestibular sx’s: Peripheral Vertigo, dizziness, N/V, gait disturbances
  2. Cochlear sx’s: Hearing loss, tinnitus
39
Q

Labrynthitis treatment

A
  1. Corticosteroids

2. Antihistamines: Meclizine

40
Q

Meniere’s dz si/sx’s

A
  1. Episodic horizontal vertigo= lasting hrs
  2. Tinnitus
  3. Ear fullness
  4. Flucturating hearing loss: primarily low-tone hearing loss
  5. N/V
41
Q

Meniere’s dz treatment

A
  1. Sx: Meclisine, diazepam, anticholinergics (Scopolamine)
  2. Diuretics: HCTZ= reduce endolymphatic pressure
  3. Avoid salt/caffine/ETOH (because they increase endolyphatic pressure)
42
Q

What is the MC site of bleeding in an anterior nose bleed?

A

Kiesselbach’s Plexus

43
Q

What is the diagnostic TOC in acute sinusitis?

A

CT maxillofacial

44
Q

Sinus radiograph findings in acute sinusitis?

A

Water’s view

45
Q

When would you give abx in treatment of acute sinusitis? what abx treatment?

A

> 10-14 days

  1. Amoxicillin x10-14 days*
  2. Doxycycline or Bactrim=2nd line
46
Q

Peritonsillar abscess abx treatment

A
  1. Ampicillin/Sulbactam (Unasyn)

2. Clindamycin

47
Q

Ludwig’s angina abx treatment

A
  1. Ampicillin/Sulbactam (Unasyn)

2. PCN + Metronidazole or Clindamycin

Emergency Med (10 decks)

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