ENT emergencies

Question 1

subperichondrial hematoma d/t shear force trauma

Answer 1

auricular hematoma

Question 2

cauliflower ear is seen with _____

Answer 2

auricular hematoma

Question 3

how do you treat auricular hematoma

Answer 3

I/D or aspiration (if <2cm and 1-2 days old)
abx

Question 4

ear discomfort d/t pressure changes, eustachian tube blockage or ear infection

Answer 4

barotrauma (airplane air)

Question 5

on exam the TM bulges out/in slightly and you can use insufflation to see if liquid build-up behind ear

Answer 5

barotrauma

Question 6

how is barotrauma tx (3)

Answer 6

yawning, chewing gum
decongestants
abx if infection

Question 7

blood in tympanic cavity of middle ear d/t basilar skull fracture

Answer 7

hemotympanum

Question 8

how do you tx hemoptypanum

Answer 8

address underlying condition

Question 9

pt has ear pain or fullness, difficulty hearing, tinnitus, discharge/odor. Normal ear exam but cannot see TM. what is the likely cause?

Answer 9

cerumen impaction

Question 10

two things that can cause acute tympanic membrane perforation

Answer 10

infection (including otitis)
direct trauma (q-tip, etc)

Question 11

which medication should be avoided with acute tympanic membrane perforation? which should you use?

Answer 11

avoid corticosporin
use oflaxacin or ciprofloxacin

Question 12

how do you treat acute TM perforation? (2)

Answer 12

heals spontaneously but large ones need surgery
oral or drop abx if infected

Question 13

most common location for epistaxis

Answer 13

Kiesselbach’s plexus (anterior)

Question 14

what do you do if after 10mins of pressure, the epistaxis doesn’t stop? (5)

Answer 14

if you can see it cauterize it
topical vasoconstrictor (oxymetaxoline)
hemostatic agents
nasal packing
arterial ligation

Question 15

what must you do if packing an epistaxis

Answer 15

give prophylaxis abx and remove packing a week later

Question 16

minor epistaxis patient education (including 4 things to avoid)

Answer 16

use nasal saline spray
avoid hard nose blowing/sneezing
avoid digital trauma
avoid hot showers or hot/spicy foods
avoid NSAIDs

Question 17

5 ways to remove nasal foreign bodies

Answer 17

positive pressure (farmers blow, mothers kiss)
alligator forceps or hooked probe
lido jelly + balloon catheter
suction
glue

Question 18

2 imaging for facial fractures

Answer 18

CT for facial bones
Xray for nasal bones

Question 19

frontal fracture management (1)

Answer 19

immediate neurosurgery consultation

Question 20

orbital fracture management (2)

Answer 20

support + convo w/ ophtho or oral maxillo-facial surgery
if it involves sinus, should get prophylaxis abx

Question 21

zygomatic fracture management (1)

Answer 21

surgery

Question 22

maxillary (Le fort) fracture management (2)

Answer 22

often surgery
if CSF rhinorrhea then consult neurosurgery

Question 23

nasal fracture management (4)

Answer 23

reduce if severely angulated
control epistaxis and support w/ analgesics
wait 10-14 days for surgery
abx for open wounds

Question 24

mandible fracture management

Answer 24

fixation w/ admission
abx (PCN or clindamycin)