ENT/Max Fax/Plastics/Opthal Flashcards
3 Ds of epiglotitis
Drooling, dysphagia and distress
Most common organisms causing epiglottitis
Streptococcus spp.
(Used to be H.influenzae prior to vaccine)
Immediate management of epiglottitis
Keep calm
DON’T EXAMINE THROAT
Oxygen
Nebulised adrenalne
Consider IV cefotaxime or ceftriaxone
Differentiate meniere’s disease and labrynthitits
People with meniere’s have a feeling of ‘fullness’ in their ear
What should be considered if a presentation of croup doesn’t respond to tx
Bacterial tracheitis
CFS rhinnorhea marker
Tau protein / Beta-2 transferrin
Which muscle is most likely damaged in an orbital floor #
What visual change does the impairement cause?
Inferior rectus - causing blurred vision on looking up
Antibiotics for dental abscess
If systemically ok but immunocompromised
If severe / spreading
- Penicillin
- Metronidazole
Le fort 1
of anteorlateral nasal fossa margin
(horizontal fracture)
Le fort 2
Inferior orbital rim involvement
Pyramidal shape #
Top is the naso frontal area but then extends down
Le fort 3
zygomatic arch involvement
Horizontal but starts at nasal frontal area and extends across the orbital walls to the zygoma
Complicated crown # =
Fracture that extends into the dental pulp of the tooth
Fever pain score
Fever in last 24 hours
Purulence
Attend rapidly under 3 days
Inflamed tonsils
No cough or coyza
Common cause of bacterial tracheitis
Staph areus
First steps in assessing tracheostomy patency?
Remove speaking valve / cap
And then any inner tubes
Then try and pass a suction catheter
Then deflate cuff, look/listen/feel
In what cases are oral abx given AOM in adults?
Don’t need admission to hospital but are systemically unwell or have risk factors for complications
Most common organism causing AOM and therefore mastoditis
Strep pneumoniae
Treatment for mastoiditis
Admit.
Brad spec abx - cef. & met
Glandular fever, findings on FBC
> 20% reactive lymphocytes
Gradenigo Syndrome
A clinical triad of otitis media, facial pain and abducens palsy that is most commonly developed from infection in the petrous temporal bone (i.e., petrous apicitis).
What is fractured in all Le fort injuries?
Pterygoid plate
Peri apical abscess
Infection of the root canal
Peridontal abscess
In the peridontal pocket between teeth and gum
Manchester mandibular fracture rule
The presence of any of five factors produced a 100% sensitive rule for x ray.
The factors are;
Malocclusion
Trismus
Pain with mouth closed
Broken teeth
Step deformity
Ellis tooth # classification
Which artery supplies the oculomotor nerve?
Posterior communicating
When does Ghonnorhea neonatal conjunctivitis present?
Birth to 5 day post partum
When does chlamydia neonatal conjunctivitis present?
5-14 days post birth
Zygomaticomaxillary complex # can be made up of
These injuries are usually caused by a direct blow to the malar eminence of the cheek and have four components:
Widening of the zygomaticofrontal suture
Fracture of the zygomatic arch
Fracture of the inferior orbital rim and anterior and posterior maxillary sinus walls
Fracture of the lateral orbital rim
Vestibular neuronitis vs Labyrinthitis
Both have severe vertigo, with nytagmus away from the lesion
But Labyrinthitis:
Vertigo can be positional
Can be sensorineural hearing loss and tinnitus
Meniere’s disease key features
Attacks of vertigo usually 2-3 hours in duration
Attacks of vertigo last less than 24 hours
Sensation of fullness or pressure in ear(s)
Sensorineural hearing loss
Which gland is sialolithiasis most commonly found in?
Submandibular
CENTOR score
History of a fever (Temp >38°C)
Exudate or swelling on tonsils
Tender or swollen anterior cervical lymph nodes
Absence of cough
Score 0 to 2 = 3-17% isolation of streptococcus, antibiotics not recommended
Score 3 to 4 = 32-56% isolation of streptococcus, consider immediate treatment with empirical antibiotics or ‘backup prescription.’
Epistaxis
Additional first aid measures alongside pinching the fleshy part of the nose etc.
Sucking on an ice cube, however, has been shown to reduce nasal blood flow, and applying an ice pack ice directly to the nose may also help.
Which vessel most likely to be responsible for a post tonsillectomy bleed?
External palatine vein
Mechanism causing Le Fort 1 #
usually result from a force directed in a downward direction against the upper teeth
Mechanism causing Le Fort type II fractures
usually result from a force through the lower or mid maxilla.
Mechanism causing
Le Fort type III fractures
usually result caused by force through the nasal bridge and upper part of the maxilla.
Which nerves pass through the superior orbital fissure
Lacrimal nerve (branch of CN V1)
Frontal nerve (branch of CN V1)
Trochlear nerve (CN IV)
Superior division of oculomotor nerve (CN III)
Nasociliary nerve (branch of CN V1)
Inferior division of oculomotor nerve (CN III)
Abducens nerve (CN VI)
Reactionary haemorrhage (post tooth extraction)
occurs 2-3 hours after the extraction when the vasoconstrictor effects of the local anaesthetic wear off
Secondary haemorrhage (post tooth extraction)
usually occurs at 48-72 hours and occurs if the clot becomes infected
2nd line treatment for bacterial conjunctivitis
Fusidic acid 1% eye drops
Differentiate conjunctivitis caused by Chlamydia and Gonnorrhoea
Chlamydia is more insidious in the onset
Seidel test…
Is used to evaluate ocular trauma.
It is performed as follows:
A 10% fluorescein strip is applied to the affected area
The area is then examined using a cobalt blue filter
If aqueous fluid is leaking through a corneal laceration, a stream of fluid will be seen in the pool of dye, as the aqueous fluid dilutes it.
Cement can cause what kind of necrosis of the eye?
colliquative necrosis (liquefactive)
Hyphaema
Blood in the anterior chamber of his eye
Displaced nasal fractures must be reduced with what timeframe?
14 days
Antibiotic choice in otitis externa where pseudomonas is suspected?
Ciprofloxacin or aminoglycoside
When should aminoglycosides be avoided in otitis externa?
Perforated ear drum
Antibiotics for epiglottitis
Antibiotic treatment for confirmed diagnosis once the airway has been secured is usually with intravenous ceftriaxone (2 g OD).
Levofloxacin plus teicoplanin is an alternative for penicillin-allergic patients. Local policy and guidelines should be followed.
Acute alveolar osteitis
Also known as ‘dry socket’. This occurs when the clot overlying the socket becomes dislodged and leaves the bone and nerve exposed. This can lead to infection and severe pain.
The most common locations of madibular fractures are:
Angle of the mandible (27%)
Mandibular symphysis (21%)
Mandibular condyle and subcondyle (18%)
Commonest cause of painful 3rd CN palsy?
Posterior communicating artery aneurysm
2nd line for bacterial conjunctivits
Fusidic acid drops
Hypopyon
a collection of white blood cells that forms a layer of fluid in the front part of the eye
Hyphema
which is blood in the anterior chamber of his eye.
Vitreous haemorrhage
School exclusion for conjunctivitis
Public Health England does not recommend an exclusion period for viral or bacterial conjunctivitis from school, nursery or childminders except if an outbreak or cluster of cases occurs.
Central retinal vein occlusion
Central retinal artery occlusion
Alkaline chemicals cause what damage to the eye
colliquative necrosis (liquefactive necrosis)
Alkaline chemicals cause what damage to the eye
