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SD- ER pt 2 > ENT/Ophthalmic Lecture > Flashcards

ENT/Ophthalmic Lecture Flashcards

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1
Q

Cellulitis/abscess to bilateral sublingual and submandibular space
*upward displacement of the tongue

often caused by poor dental hygiene

A

Ludwig’s Angina

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2
Q

Only option to secure Lugwig Angina airway?

A

Emergency trach ASAP

(cannot intubate or cric these pts)

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3
Q

MC age group for retropharyngeal abscesses

A

used to be kids (~under 3)

but now with the HiB vaccine, more common in adults who were not vaccinated as kids

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4
Q

“hot potato voice”
cannot swallow own secretions
tripod
especially if unimmunized

A

Retropharyngeal abscess

OR

Epiglottitis

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5
Q

Trismus
Tripod position
Drooling
Sore throat odynophagia
Thumb sign

A

Epiglottitis

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6
Q

MC age for epiglottitis?

A

Use to be kids, but now with HiB vaccine, 40 yo adults who were not vaccinated as kids are MC

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7
Q

Localized cellulitis of supraglottic area with potential for abscess formation

A

Epiglottitis

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8
Q

Spectrum of symptoms from mild pain to SOB, depending on amount of swelling

Uvula deviation
+/- stridor, drooling, trismus

A

Peritonsillar abscess

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9
Q

Disruption of conjunctival blood vessels
may occur from trauma, sneezing, gagging or Valsalva

will resolve spontaneously in 2 weeks

A

Subconjunctival hemorrhage

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10
Q

Present with a foreign body sensation
Tearing, photophobia, blepharospasm, severe pain

can be seen under fluorescein slit lamp

A

Corneal abrasion

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11
Q

Eye foreign bodies can usually be removed with a…

A

moist cotton applicator

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12
Q

Superficial conjunctival lesions are treated with erythromycin ointment for how long?

A

2-3 days

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13
Q

Contact lens abrasions are treated with ciprofloxacin, ofloxacin or tobramycin drops to cover ____________

A

pseudomonas

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14
Q

Should you wear an eye patch for an abrasion?

A

NO

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15
Q

True or False..

Topical anesthetics for home use are strictly contraindicated!!!

A

True

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16
Q

Ophthalmology follow up is advised within _____ hours for all corneal abrasions

A

24 hours

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17
Q

Fine needle tip
Eye spud
Eye burr

(after applying a topical anesthetic)

can be used for…

A

removing corneal foreign bodies

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18
Q

Rust rings are associated with metallic foreign bodies and may be removed with an….

A

eye burr

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19
Q

trauma which causes….

Abnormal anterior chamber depth
Irregular pupil
Blindness

..indicate what? (unti proven other wise)

A

Ruptured globe

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20
Q

Blood in the anterior chamber
can occur spontaneously (sickle cell or coagulopathy pts) or following trauma

blood in the iris

A

Hyphema

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21
Q

Place the pt upright to allow the blood to settle inferiorly
Place protective eye shield
Pupillary dilation may be indicated

always consult with ophthalmology

A

Hyphema

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22
Q

Inferior and medial wall (lamina papyracea) of the orbit may be fractured from blunt trauma

A

Blowout fractures

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23
Q

True or False…

1/3 of blowout fractures are associated with ocular trauma

A

True

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24
Q

Exam shows…

-Evidence of inferior rectus entrapment (diplopia on upward gaze)

-Parasethesia of infraorbital nerve

-subcutaneous emphysema (esp when sneezing or blowing nose)

A

Blowout fracture

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25
Q

Image of choice for a blowout fracture?

A

CT

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26
Q

What complication must you worry about with a blowout fracture?

A

Entrapment of inferior rectus muscle

27
Q

Can result from both blunt and penetrating trauma

Hisk risk mechanisms:
Hammering metal on metal
Use of high-speed machinery
Explosion related injuries

A

Ruptured globe

28
Q

Severe subconjunctival hemorrhage
Irregular or tear drop shaped pupil
Afferent pupillary defect
Shallow or deep anterior chamber, compared to other eye
Hyphema
Limitation of EOM
Extrusion of globe contents
Lens dislocation
Significant reduction in visual acuity

A

Ruptured globe

29
Q

Fluorescein streaming (Seidel’s test) is pathognomonic for…

A

Ruptured globe

(although it may be absent)

30
Q

Should you measure IOP in a ruptured globe pt?

A

NO!!

31
Q

Place pt upright
NPO
Protective metallic eye shield
IV broad spectrum abx
Analgesia
Sedation
Anti-emeic
Tetanus

A

ED Management for ruptured globe

32
Q

Eye should be immediately flushed in prehospital setting
Sterile normal saline or Ringer’s lactate Morgan Lens irrigation should be continued in ED upon arrival until the pH is normal (7.0-7.4)

A

Management for chemical burn to eye

(Acid and Alkali burns are managed similarly)

33
Q

Once pH is normal, fornices should be swept to remove residual particles and any necrotic conjunctiva

pH should be recheck in 10 mins

A

Chemical ocular injury

34
Q

After irrigation, a full slit lamp exam should be done
IOP should be measured
Pain meds
Tetanus

A

Chemical ocular injury

35
Q

Presents with…

Eye pain
HA
Cloudy vision
Colored halos around lights
Cloudy or steamy appearance of cornea
Conjunctival injection
A fixed, mid-dilated pupil
increased IOP of 40-70 mmHG

A

Acute angle closure glaucoma

36
Q

normal IOP= 10-20 mmHg

what is the IOP in acute angle closure glaucoma?

A

40-70 mmHg

37
Q

Timolol (topical beta blocker)
Apraclonidine (topical alpha agonist)
Acetazolamide
Mannitol
Topical pilocarpine

…can all be used in management of?

A

Acute angle closure glaucoma

(lowers IOP)

38
Q

For a diagnosis, need 2+ of the following:

Eye pain
Blurred vision
N/V
Intermittent halos

A

Acute angle closure glaucoma

39
Q

For a diagnosis, need 3+ of the following:

IOP > 21 mmHg
Conjunctival injection
Corneal epithelial edema
Mid-dilated, non reactive pupil

A

Acute angle closure glaucoma

40
Q

Causes include:

Embolus
Thrombosis
Giant-cell arteritis
Vasculitis
Sickle cell dz
Vasospasm (migraines) glaucoma
Hypercoaguable states
Low retinal blood flow
Trauma

A

Central artery occlusion

41
Q

amaurosis fugax= painless, transient monocular or binocular visual loss (caused by blood clot or a peice of plaque)

..this often precedes what?

A

Central retinal artery occlusion

42
Q

Vision loss is often painless, with complete or near complete vision loss

Afferent pupillary defect
Fundascopic exam reveals a pale fundus with narrowed arterioles with segmented flow (“box cars”) with bright red macula (“cherry red spot”)

A

Central retinal artery occlusion

43
Q

ED managament= ocular massage (digital pressure for 15 seconds followed by sudden release)

A

Central retinal artery occlusion

44
Q

MC cause of blindness in western world

A

Herpes simplex keratitis

45
Q

Seen as linear branching lesion under fluorescein dye and slit lamp

tx= acyclovir

A

Herpes simplex keratitis

46
Q

Causes:

Infection
Demyelination
Autoimmune disorders

may present with various degrees of vision loss (often with poor color perception), pain during EOM , visual field cuts and afferent pupillary defect

A

Optic neuritis

47
Q

Diagnosis made with red desaturation test (after staring at a bright red object with the normal eye only, the object may subsequently appear pink or light red in the affected eye)

A

Optic neuritis

48
Q

Flashing lights
Floaters
A dark curtain or veil
Diminished visual acuity

A

Retinal detachment

49
Q

True or False…

Vision loss from acute glaucoma is irreversible

A

True

50
Q

Cellulitis involving the submandibular spaces and the sublingual spaces that can spread to the neck and mediastinum, causing airway compromise, overwhelming infection and death

tx= broad spectrum abx
airway management ASAP

A

Ludwig’s angina

51
Q

Gold standard image for retropharyngeal abscess

A

CT with IV contrast

(allows differentiation between cellulitis and abscess)

52
Q

1-2 days hx of worsening dysphagia, odynophagia and dyspnea (worse w supine)

Upright, leaning forward position
drooling, inspiratory stridor

lateral soft tissue radiographs may show a “thumbprint sign”

A

Epiglottitis

53
Q

Tx:

Remain in upright position
Supplemental humidified oxygen
Ceftriaxone IV
Steroids may be given to reduce airway inflammation

A

Epiglottitis

54
Q

Infection ususally polymicrobial

Fever, sore throat, torticollis, dysphagia
Neck pain, stiffness, muffled voice, cervical LAD, respiratory distress

improvement with lying supine with neck in slight extension
(sitting up may worsen dyspnea)

A

Retropharyngeal abscess

(tx= IV clinda)

55
Q

uvula deviation
+/- stridor, drooling, trismus

tx= drainage, abx

A

Peritonsillar abscess

56
Q

Polymicrobial infection that develops betwen the tonsillar capsule and the superior constrictor and palatopharyngeus muscle

risk factors: smoking, periodontal dz, chronic tonsillitis, repeat courses of abx

MC in young adults during winter and spring months

A

Peritonsillar abscess

57
Q

Needle aspiration of purulent material is diagnostic and therapeutic for peritonsillar abscesses and will treat more than __% of these pts

A

90%

(give Penicillin post drainage)

58
Q

Oxymetazoline can be used in the tx of…

A

Epistaxis

59
Q

Complication of infection spreading from the middle ear

otalgia
fever
postauricular erythema, swelling, tenderness

*can have CN V, VI, VII palsy

A

Mastoiditis

(CT scan will show extend of bony involvement)

60
Q

AOM tx

A

Amoxicillin 250-500 mg PO TID x 7-10 days

61
Q

ALWAYS check for this with nasal trauma

**if left untreated, can result in abscess formation of necrosis of the nasal septum

tx= local incision and drainage with anterior nasal pack

A

Septal hematoma

62
Q

MC source of nose bleeds

A

Kesselbach’s plexus

63
Q

parainfluenza type 1 causes…

A

croup

“steeple sign” = croup

SD- ER pt 2 (6 decks)

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