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EMed Exam 2 > ENT Emergencies > Flashcards

ENT Emergencies Flashcards

1
Q

Cause of herpes simplex keratitis

A

HSV-1 Recurrent infection

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2
Q

Sx of herpes simplex keratitis

A
  • Eye Pain
  • Photophobia
  • Blurred/decreased vision
  • Tearing
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3
Q

PE for herpes simplex keratitis

A
  • Conjunctival injection (ciliary flush)
  • Decreased corneal sensation
  • Slit-lamp with fluorescein Dendritic lesions
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4
Q

Dx of herpes simplex keratitis

A

hx and exam

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5
Q

Tx of herpes simplex keratitis

A

urgent opthalmology referral
Topical/oral antivirals (trifluridine, ganciclovir, acyclovir)
NO TOPICAL GLUCOCORTICOIDS
Corneal Transplant (severe scarring or perforation)

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6
Q

UV keratitis (photokeratitis) presentation

A

UV radiation hx (6-12 hr latent period)

  • Bilateral intense eye pain (unable to open them)
  • Photophobia
  • Foreign body sensation
  • Distraught, pacing, rocking secondary to severe pain
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7
Q

PE for UV keratitis

A
  • Penlight: tearing, generalized injection and chemosis of the bulbar conjunctiva
  • Cornea – may be mildly hazy
  • Fluorescein – superficial punctuate staining of the cornea
  • Pupils may be miotic
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8
Q

Treatment: UV keratitis

A

Supportive (resolves 24-72 hrs)
Oral analgesics for severe pain (mild opiod maybe: oxycodone 5-10 mg q 4-6 hrs x 24 hrs)
Lubricant abx ointment
Education-prevention

f/u 1-2 days

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9
Q

Preseptal and orbital cellulitis

A

unilateral periorbital edema w/ erythema, warmth, tenderness

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10
Q

Cellulitis complication of

A

sinusitis
extension of infection from adjacent structure
Local disruption of skin

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11
Q

Preseptal cellulitis sx

A 
(children <5 YO)
tissue anterior of the orbital septum
swelling of eyelids, upper cheek
may not be painful
no pain w/ eye movement
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12
Q

Orbital cellulitis sx

A 
(children >5 YO)
TRUE EMERGENCY!!!
structure deep to the orbital septum
VISION LOSS, IMPAIRED EOMs, DIPLOPIA, AND/OR PROPTOSIS
Fever
Chemosis
Leukocytosis
Pain w/ eye movements
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13
Q

Dx of cellulitis

A

CT scan of orbits and sinuses WITH CONTRAST

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14
Q

Tx of preseptal cellulitis

A

Mild/No systemic symptoms - discharge home
Oral antibiotics
Follow up within 24-48 hrs

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15
Q

Tx of orbital cellulitis/preseptal cellulitis w/ concerning factors

A

Admit
IV abx
Stat optho/ENT consult

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16
Q

Cause of corneal abrasion and ulceration

A

Result from eye trauma, foreign bodies or improper contact lens use

abrasion: thin protective coating of anterior ocular epithelium
ulceration: break in epithelium exposing the underlying corneal stroma

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17
Q

Sx of abrasion/ulceration

A

• Severe eye pain and foreign body sensation
• Can lead to impaired vision secondary to scarring
- ciliary flush/injection if hours old

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18
Q

PE for abrasion/ulceration

A 
Penlight before stain
Visual acuity
EOMs
Fundoscopic exam (confirm red reflex)
Fluorescein exam! - use cobalt blue filter/wood's lamp - defect enhanced
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19
Q

Urgent optho referral for abrasion/ulceration

A

 Signs of penetrating or significant blunt trauma: large,
nonreactive pupil or irregular pupil
 Impaired visual acuity
 Ulceration
 Contact lens wearer
 Ophthalmology ASAP – r/o infiltrate or opacity Daily to r/o infiltrate or ulcer until healed

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20
Q

Tx for abrasion

A

Topic abx

Narcotics optional

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21
Q

Lid laceration usually has

A

ocular injury

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22
Q

Precautions of lid laceration

A

exclude globe injury
low threshold for CT of orbits
don’t attempt complicated lacerations
know eye anatomy!

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23
Q

Tx for superficial laceration (horizontal, follow skin lines)

A

<25% of eyelid: heal on own by secondary intention; clean, triple abx ointment, adhesive?

> 25% of eyelide: repair w/ 6-0 fast absorbable plain gut suture

  • simple interrupted or running sutures w/i 24 hrs
  • if non absorbable suture used, remove 5-7 days
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24
Q

When to refer lid laceration

A
  • Full thickness lid lacerations (suspicion for penetrating injury to globe)
  • Lacerations with orbital fat prolapse
  • Lacerations through lid margin
  • Lacerations through the tear drainage system
  • Orbital injury (Subconjunctival hemorrhage, chemosis)
  • Foreign body
  • Laceration with poor alignment
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25
Q

“blowout” fx

A

orbital floor fx

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26
Q

Presentation of orbital floor fracture

A

entrapement of inferior rectus muscle
- untreated = ischemia and loss of muscle function

Enopthalmos (may develop w/ posterior globe displacement)

Orbital dystopia (eye is lower) - may occur as entrapped muscle pulls eye down

Injury to infraorbital nerve secondary to fx
- decreased senation: cheek, upper lip, upper gingiva

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27
Q

Dx of orbital floor fx

A

Thin cut coronal CT of orbits in patients with:

  • evidence of fx on exam
  • limitation of EOM
  • decreased visual acuity
  • severe pain
  • inadequate exam (swelling,/AMS)
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28
Q

Tx of orbital floor fx

A
  • Surgical evaluation
  • Prophylactic antibiotics to cover sinus pathogens
  • Cold packs – first 48 hrs
  • Head of bed raised
  • Avoid blowing nose/sniffing
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29
Q

Open globe rupture cause

A

blunt eye injury (punching, baseball, etc.)

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30
Q

PE of open globe rupture tips

A
  • Likelihood of open globe injury
  • Avoid pressure to the eyeball
  • Eyelid retraction
  • IOP measurement
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31
Q

Dx of open globe rupture

A

axial and coronal CT of eye w/o contrast

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32
Q

CT w/ contrast

A

cellulitis

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33
Q

Tx of open globe rupture

A 
Abx
Emergent! optho consult
transfer to trauma center
EYE SHIELD
avoid manipulation
Bed rest
NPO!
No solutions in eye
IV antiemetics (ondansetron 4mg)
Pain med (no NSAIDS- bleed risk)
Sedation prn (lorazepam 0.05 mg/kg - max 2 mg)
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34
Q

Optic Neuritis

A

inflammatory, demyelinating condition causing acute, monocular vision loss

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35
Q

Optic neuritis associated w/

A

MS

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36
Q

Sx of optic neuritis

A
  • Vision loss - hours to days, peaking within 1-2 weeks
  • Eye pain worse with eye movement
  • Afferent pupillary defect - direct response to light is sluggish in the affected eye
  • Dyschromatopsia - loss/reduced color vision
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37
Q

Dyschromatopsia

A

loss/reduced color vision

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38
Q

Ddx for optic neuritis

A

> 50: DM, Giant cell arteritis, autoimmune

young child: infectious/post infectious

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39
Q

Dx of optic neuritis

A

Clinical: hx and optho exam

MS confirmed by MRI brain/orbits w/ GAD

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40
Q

Tx of optic neuritis

A

CORTICOSTEROIDS (IV methylprednisolone)

no oral prednisone- does not help visual outcomes, increases recurrent

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41
Q

Acute angle closure glaucoma

A

• Narrowing or closure of the anterior chamber angle
• Normal angle provides aqueous humor drainage
• Narrowing of the pathway
- Leads to elevated intraocular pressure (IOP)
- Damage to the optic nerve

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42
Q

Normal IOP

A

8-12 mm Hg

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43
Q

IOP in closed angle claucome

A

> 30 mmHg

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44
Q

Sx of acute angle closure glaucoma

A
  • Decreased vision
  • Halos around lights
  • Headache
  • Severe eye pain
  • Nausea and vomiting
  • Red eye
  • Corneal edema/cloudiness
  • Mid-dilated pupil 4-6mm that reacts poorly to light
  • Shallow anterior chamber
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45
Q

PE for acute angle closure glaucoma

A
  • emergent optho eval
  • Visual acuity
  • Evaluation of the pupils
  • IOP
  • Slit lamp
  • Visual field testing

pupillary dilation left for optho - may exacerbate

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46
Q

Dx of acute angle closure glaucoma

A

Gonioscopy (visualize angle b/w iris and cornea)

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47
Q

Tx of acute angle closure glaucoma

A 
optho!
If >1 hr delay give abx:
- 1 min: timolol
- 2 min: apraclonidine
- 3 min: pilocarpine

Oral and IV acetazolamide!!!!
- check pressure at 30-60 min after tx

48
Q

F/u after glaucoma tx

A

check pressure 30-60 min after tx

49
Q

Retinal detachment

A

retina separates from epithelium and choroid resulting in ischemia and progressive photoreceptor degeneration (vision loss)

50
Q

Presentation of retinal detachment

A
  • Sudden onset of floaters – cobweb
  • Monocular visual field loss
  • Vision loss
51
Q

Tx of retinal detachment

A

emergent eval w/ optho

52
Q

Ear FB cause

A

children - FB

adults- cerumen plugs

53
Q

Presentation of ear FB

A

hearing loss

ear pain/drainage

54
Q

Exam/tx for FB in ear

A

ID FB

  • remove under direct visualization
  • neutralize bugs w/ mineral oil
  • do not irrigate organic material - may cause infection

check for OE: ciprodex or cipro HC gtts

55
Q

Usually cause of AOE

A

pseudomonas aeruginosa

56
Q

Presentation of AOE

A
  • Ear fullness
  • Drainage
  • Pain – tragal motion tenderness
57
Q

Tx for AOE

A

• Debridement
• Antibiotic drops
- Ciprodex or CiproHC) +/- otowick
• Watch for malignant otitis

58
Q

Viral AOE cause

A

Ramsey-Hunt (Herpes zoster virus)

59
Q

Presentation of viral AOE

A
  • Vesicles in ear canal
  • Facial paralysis
  • Hearing loss
  • Vertigo
60
Q

Tx of viral AOE

A
  • Antivirals
  • Steroids
  • MRI brain to rule out skull base tumor
61
Q

viral AOE associated w/

A

brain tumor

62
Q

At risk for malignant OE

A

elderly
DM
immunocompromised

63
Q

Presentation of Malignant OE

A

• Symptoms consistent with AOE but patient appears acutely
ill
• Ear canal granulation tissue

64
Q

Dx of malignant OE

A

• CBC shows leukocytosis • Cultures
• Head CT
- Osteomyelitis - skull base

65
Q

Tx for malignant OE

A 
• Admit
• Debridement
• Parenteral antibiotics
- Ciprofloxacin 400mg IV Q 8 hrs
- Change to 750mg PO Q 12 hrs prior to discharge 
- Tx prolonged – 6-8 weeks
- ENT eval
66
Q

Complications of malignant OE

A
  • Cranial neuropathies
  • Brain abscess
  • Meningitis
  • Septicemia
  • Death
67
Q

TM perforation causes

A

OM
Closed head injury
direct ear trauma

68
Q

presentation of TM perforation

A
  • Pain
  • Hearing loss
  • Nausea/Vomiting
  • Vertigo
  • Otorrhea
  • Tinnitus
69
Q

PE for TM perforation

A

Direct visualization of TM
Audiogram

if suspect head trauma= CT, check for CSF drainage

70
Q

Tx for TM perforation

A

eval by otolarlyngology (if needed)
Water precautions
most resolve w/o tx

abx (ofloxacin otic drops) - if indicated
Tympanoplasty- refractory cases

71
Q

Cauliflower ear

A

auricular hematoma

72
Q

Auricular hematoma

A

blunt force trauma to auricle; presents w/ blood in cartilage

73
Q

Tx of auricular hematoma

A 
I&amp;D ASAP!!!
>7 days: otolaryngologist or plastic surgeon referral
educate:
- refrain from sports for 7 days
- f/u right away if worsening
74
Q

F/u for auricular hematoma

A

q 24 hours for 3-5 days

75
Q

Perichondritis

A

Acute inflammation and infection of the auricular cartilage

76
Q

cause of perichondritis

A

pseudomonas aeruginosa

77
Q

Presentation of perichondritis

A
  • Erythema
  • Pain
  • Abscess formation
  • Systemic symptoms
78
Q

Dx of perichondritis

A

C&S

79
Q

Tx of perichondritis

A 
I&amp;D if indicated
Empiric abx (Cipro)
80
Q

Presentation of nasal FB

A
  • Mucopurulent nasal discharge
  • Foul odor
  • Epistaxis
  • Nasal obstruction
  • Mouth breathing
81
Q

Exam for nasal FB

A

direct visualization of FB

make sure lungs are CTAB w/o abnormal breath sounds

82
Q

Nasal FB dx

A

no needed if FB is visible

button batter/magnet: order x-ray!

83
Q

Tx of nasal FB

A
  • Child must be adequately restrained
  • Must have good visualization
  • Manually retrieve with alligator forceps or suction
  • Avoid irrigation if FB is organic matter
  • If more than 2 unsuccessful attempts - refer to ENT
  • Always re-examine after 1 FB removed to rule out a second one…
  • Educate!!!
84
Q

Most common nose bleed

A

anterior epistaxis

85
Q

Most nosebleeds occur where?

A

Kiesselbach’s plexus

86
Q

Causes of epistaxis

A
  • Nose picking
  • Low moisture
  • Hyperemia secondary to allergic rhinitis
  • FB
  • Drug use or Trauma
87
Q

Vessel’s in Kiesselbach’s Plexus (anterior epistaxis)

A
  • Septal branch of the anterior ethmoidal artery
  • Lateral nasal branch of the sphenopalatine artery
  • Septal branch of the superior labial branch of the facial artery
88
Q

Posterior epistaxis vessels

A

posterolateral branches of sphenopalatine artery

less commonly from carotid artery

89
Q

Tx for nosebleed

A

conservative (blow nose)
• Oxymetazoline (Afrin) – 2 sprays
• Direct pressure of the alae tight against septum X 10 minutes
• If no further bleeding, nasal hydration

Cautery if doesn’t stop:

  • avoid large areas
  • remove excess silver nitrate w/ cotton tip applicator

Nasal packing?
Abx (antistaph - Kefleex, augmentin; entire course of packing)

90
Q

Risks of nasal cautery

A

ulceration

septal perforation

91
Q

Nasal packing timing

A

Remove in 3 days (normal) or 5 days (anticoagulated patient)

92
Q

Given w/ packing

A

Abx (prevent TSS)

  • cover staph (keflex, augmentin)
  • during entire course of packing
93
Q

Nasal trauma hx

A
  • Time frame
  • Mechanism of injury
  • Direction of force (pattern of fracture)
  • Prior nasal surgery or trauma
94
Q

PE for nasal trauma

A
  • Epistaxis
  • CSF rhinorrhea
  • Impaired EOMs
  • Orbital edema/ecchymosis
  • Lacerations
  • Septal hematoma
95
Q

Dx for nasal trauma

A

CT scan maxillofacial w/o contrast (r/o facial fx)

96
Q

Early complications of nasal trauma

A
  • Hematoma
  • Abscess
  • Uncontrolled epistaxis
  • CSF rhinorrhea
97
Q

Late complication of nasal trauma

A
  • Nasal deformity
  • Obstruction
  • Perforation
98
Q

Tx for nasal trauma

A

repair lacerations
if significant swelling: wait 4-6 weeks before surgical correction
Attempt closed reduction immediately: maximize airway, improve aethetics
Elecate HOB
cold compress
Pain management
Photos

99
Q

F/u for nasal trauma

A

3-5 days

100
Q

Causes of septal hematoma

A

trauma
septal surgery
bleeding disorders
more common in pediatrics

101
Q

Presentation of septal hematoma

A

nasal obstruction

pain

102
Q

PE for septal hematoma

A

soft, tender swelling along septum

103
Q

Tx for septam hematoma

A

I&D (prevent avascular necrosis)
pack nose
abx
outpatient ENT referral (remove packing in 24 hrs, recheck, re-pack)

104
Q

Untreated septal hematoma result

A

septal perforation

saddle nose deformity

105
Q

Presentation of mastoiditis

A

May be asymptomatic
ear pain
drainage
tenderness, erythema, edeam over mastoid

106
Q

Dx for mastoiditis

A

CT head

Culture if infection

107
Q

Tx for mastoidits

A

REFER TO ENT!
may start empiric oral abx if immuno-competant

mastoidectomy and IV abx if recalcitrant disease or immunocompromised

108
Q

Presentation of periodontal abscess

A
  • Fever
  • Pain
  • Red, fluctuant swelling of the gingiva
  • Tenderness to palpation
109
Q

Dx of periodontal abscess

A

panoramic radiograph
OR
CT for bone involvement

110
Q

Tx for periodontal abscess

A

Pain management
I&D
oral abx if limited infection (augmentin/clinda x 7-14 days)
F/u w/ dentist

111
Q

Presentation of dental injury

A
  • Pain
  • Tooth is completely displaced from the alveolar ridge
  • Periodontal ligament is severed
112
Q

If you can’t reimplant, what do you do with tooth?

A

Balanced saline solution
cold milk
container of patient’s saliva until seen by dentist

113
Q

Tx of dental injury

A 
• Maintain the vitality of the periodontal ligament 
• Handle tooth by crown
• Gently rinse in saline
• Insert tooth into the empty socket
- Hold in place with gauze
- Success of re-implantation 
- 85-97% at 5 min
- Nearly 10 0% at 1 hour 
• Urgent dental consultation

TETANUS PROPHYLAXIS AND ABX THERAPY

114
Q

When to repair tongue laceration

A

> 1 cm

  • extend in to mm.
  • completely through tongue
  • deep on lateral boarder
  • large flaps/gaps
  • significant hemorrhage
  • dysfunciton w/ improper healing
115
Q

Closure type of tongue laceration

A

absorbable suture
- 3-0, 4-3 chromic gut suture

give abx

EMed Exam 2 (6 decks)

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