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Emergency/Surgery > Exam 1 - EENT Emergencies > Flashcards

Exam 1 - EENT Emergencies Flashcards

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1
Q

What are some exam findings associated with Herpes Simplex Keratitis?

A
  • Conjunctival injection
  • Ciliary flush
  • Decreased corneal sensation
  • Dendritic lesions on slit-lamp with fluorescein stain
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2
Q

What is the treatment for Herpes Simplex Keratitis?

A

Urgent Ophthalmology referral

Topical antiviral:

  • Acyclovir 3% ophthalmic ointment
  • Ganciclovir 0.15% gel

OR

Oral antiviral:
- Acyclovir 400 mg

***NO TOPICAL GLUCOCORTICOIDS

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3
Q

What are exam findings associated with UV Keratitis?

A
  • Penlight: tearing, generalized injection and chemosis of the bulbar conjunctiva
  • Cornea may be mildly hazy
  • Superficial punctuate staining of the cornea with fluorescein
  • Pupils may be miotic
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4
Q

What is the treatment for UV Keratitis?

A
  • Typically self-limited within 24-72 hours
  • Oral analgesics for severe pain (consider mild opioid for severe pain and lubricant antibiotic ointment)
  • Prevention with eye protection
  • Follow-up in 1-2 days
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5
Q

What are the most common pathogens associated with preseptal and orbital cellulitis?

A
  • S. pneumoniae
  • S. aureus
  • S. pyogenes
  • H. influenzae
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6
Q

What is affected in orbital cellulitis and what are some symptoms associated with it?

A
  • Structures deep to the orbital septum
  • Eyelid swelling, vision loss, pain with eye movements, impaired EOMs, diplopia, fever, and/or proptosis

***TRUE EMERGENCY

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7
Q

How is preseptal and orbital cellulitis diagnosed?

A

CT scan of the orbits and sinuses with contrast

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8
Q

What is the treatment for a mild preseptal cellulitis with no systemic symptoms?

A
  • Oral antibiotics

- Follow up with ophthalmologist in 24-48 hours

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9
Q

What is the treatment for orbital cellulitis or preseptal cellulitis with concerning factors?

A
  • Admit to hospital
  • IV antibiotics
  • Consult ophthalmology and ENT
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10
Q

What is the treatment for a corneal abrasion?

A
  • Topical lubricants
  • Topical abx (erythromycin ointment)
  • Consider oral pain medication

***NO topical anesthetic, steroid, or patching

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11
Q

When should you get an urgent ophthalmology consult for a corneal abrasion or ulceration?

A
  • Signs of penetrating or significant blunt trauma: large, nonreactive pupil or irregular pupil
  • Impaired visual acuity
  • Ulceration
  • Contact lens wearer
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12
Q

What is the treatment for superficial eyelid lacerations?

***these are horizontal and follow skin lines

A

If < 25% of lid, can heal by secondary intention

  • Clean and apply triple abx ointment
  • Can consider adhesive surgical tape

> 25%, repair with 6-0 fast absorbable plain gut suture

  • Simple interrupted or running suture within 24 hours
  • If non-absorbable suture used, remove in 5-7 days
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13
Q

When should you refer an eyelid laceration to an ophthalmologist or plastic/oromaxillofacial surgeon?

A
  • Full thickness lid lacerations
  • 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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14
Q

What are significant findings associated with an orbital floor “blowout” fracture?

A
  • Entrapment of the inferior rectus muscle
  • Enopthalmos (receeding of eye)
  • Orbital dystopia (eye is lower)
  • Injury to infraorbital nerve secondary to fracture (decreased sensation to cheek, upper lip, upper gingiva)
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15
Q

How is an orbital floor fracture diagnosed?

A

Thin cut coronal CT or the orbits on patient with:

  • Evidence of fracture on exam
  • Limitation of EOM
  • Decreased visual acuity
  • Severe pain
  • Inadequate exam due to swelling/altered mental status
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16
Q

What is the treatment for an orbital floor fracture?

A
  • Surgical evaluation
  • Prophylactic abx
  • Cold packs for first 48 hours
  • Head of bed raised
  • Avoid blowing nose/sniffing
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17
Q

How is an open globe rupture diagnosed?

A

Axial and coronal CT of the eye without contrast

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18
Q

What should you be careful of during an exam if you suspect an open globe rupture?

A

Avoid pressure on the eyeball

  • Eyelid retraction
  • IOP measurement
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19
Q

What is the treatment for an open globe rupture?

A
  • Emergent ophthalmology consult
  • Avoid manipulation
  • Eye shield and no solutions in eye
  • Bed rest
  • NPO
  • Abx
  • IV antiemetics (ondansetron)
  • Pain medications (avoid NSAIDs)
  • Sedation prn (lorazepam)
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20
Q

What is optic neuritis and what can it cause?

What is it highly associated with?

A
  • Inflammatory, demyelinating condition
  • Causes acute, monocular vision loss
  • Highly associated with MS
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21
Q

What are symptoms associated with optic neuritis?

A
  • Vision loss (peaks within 1-2 weeks)
  • Eye pain worse with eye movement
  • Afferent pupillary defect (direct response to light is sluggish)
  • Dyschromatopsia (loss/reduced color vision)
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22
Q

What is the treatment for optic neuritis?

A
  • Corticosteroids (IV methylprednisolone)

DO NOT recommend oral prednisone as does not affect visual outcomes and may increase risk for recurrence

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23
Q

What can acute angle closure glaucoma lead to?

A
  • Leads to elevated IOP as aqueous humor cannot drain

- Damage to optic nerve

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24
Q

What is a normal IOP compared to an IOP seen in closed angle glaucoma?

A

Normal: 8-21 mmHg

Closed angle glaucoma: > 30 mmHg

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25
Q

What are some sypmtoms associated with closed angle glaucoma?

A
  • Decreased vision
  • Halos around lights
  • Headaches, nausea, vomiting
  • Severe eye pain
  • Red eye
  • Corneal edema/cloudiness
  • Mid-dilated pupil 4-6 mm which reacts poorly to light
  • Shallow anterior chamber
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26
Q

What should you avoid in cases of closed angle glaucoma?

A

Pupillary dilation should be deferred as this may exacerbate the condition

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27
Q

What is the gold standard diagnostic test for closed angle glaucoma?

A

Gonioscopy

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28
Q

What is the treatment for acute angle closure glaucoma?

A

Emergency ophthalmology evaluation

If > 1 hour delay, empirically treat with pressure lowering eye drops

  • 1 min: 0.5% timolol
  • 2 min: 1% apraclonidine
  • 3 min: pilocarpine

Oral or IV acetazolamide
- Check pressure 30-60 minutes after giving treatment

29
Q

What is the presentation associated with retinal detachment?

A
  • Sudden onset of floaters (may describe as cobwebs)
  • Monocular visual field loss
  • Vision loss
30
Q

What is the treatment for a retinal detachment?

A

Emergent ophthalmology evaluation

31
Q

What is the most common causative agent of AOE?

A

Bacterial:

Pseudomonas aeruginosa

32
Q

What is the presentation associated with AOE?

A
  • Ear fullness
  • Drainage
  • Ear pain and tragal motion tenderness
33
Q

What is the treatment for AOE?

A
  • Debridement
  • Abx drops (Ciprodex or CiproHC) +/- otowick

***watch for malignant otitis

34
Q

What is the most common causative agent of viral AOE?

A

Ramsey-Hunt

- Herpes zoster virus

35
Q

What are symptoms associated with viral AOE?

A
  • Vesicles in ear canal
  • Facial paralysis
  • Hearing loss
  • Vertigo
36
Q

What is the treatment for viral AOE?

A
  • Antivirals
  • Steroids
  • MRI brain to rule out skull base tumor
37
Q

What populations are at the highest risk for malignant otitis externa?

A

Elderly, diabetics, immunocompromised

38
Q

What presentation is associated with malignant otitis externa?

A
  • Symptoms consistent with AOE (ear fullness, tragus pain, drainage) but patient appears acutely ill
  • Ear canal granulation tissue
39
Q

How is malignant otitis externa diagnosed?

A
  • CBC shows leukocytosis
  • Cultures
  • Head CT shows to rule out osteomyelitis at the skull base
40
Q

What is the treatment for malignant otitis externa?

A
  • Admit
  • Debridement
  • Parenteral abx
  • ENT evaluation
41
Q

What course of abx are given for malignant otitis externa?

A
  • Ciprofloxacin 400 mg IV Q 8 hours
  • Change to 750 mg PO Q 12 hours prior to discharge
  • Treatment is 6-8 weeks
42
Q

What is the treatment for a TM perforation?

A
  • Most resolve without treatment (if <25 % total surface, will heal within 4 weeks)
  • Ofloxacin otic drops if indicated (puncture from dirty object)
  • Tympanoplasty in refractory cases
43
Q

What is the treatment for auricular hemotoma/”Cauliflower Ear”?

A
  • Drain/aspirate
  • If > 7 days, refer to otolaryngologist or plastic surgeon
  • Follow-up every 24 hours for 3-5 days
  • Refrain from sports for 7 days
44
Q

What is perichondritis?

What is the causative agent of perichondritis?

A

Acute inflammation and infection of the auricular cartilage

Pseudomonas aeruginosa

45
Q

What is the treatment for perichondritis?

What diagnostic studies should you obtain?

A
  • Incision and drainage
  • Empiric abx (Ciprofloxacin)
  • Obtain culture and sensitivity
46
Q

What presentation is associated with a nasal foreign body?

A
  • Mucopurulent nasal discharge
  • Foul odor
  • Epistaxis
  • Nasal obstruction
  • Mouth breathing
47
Q

Are anterior or posterior nosebleeds more common?

Where do most occur?

A

Anterior are more common.

Up to 90% occur at Kiesselbach’s plexus

48
Q

Where do posterior epistaxis most commonly arise from?

Least common?

A

Most common: Posterolateral branches of the sphenopalaine artery.

Least common: Carotid artery

49
Q

What is the treatment for epistaxis?

A

Conservative treatment:

  • Oxymethazoline (Afrin) - 2 sprays
  • Direct pressure tight against septum x 10 minutes
  • If no further bleeding, encourage nasal hydration and avoid trauma to area

Cautery if source easily identified:

  • Avoid large areas
  • Remove excess silver nitrate with cotton tip applicator

Nasal packing

50
Q

If using nasal packing for epistaxis management, when should it be removed and what antibiotics should you prescribe?

A

Timing of removal:

  • Normal patient: 3 days
  • Anticoagulated patient: 5 days

Anti-staphylococcal abx:

  • Keflex, Augmentin
  • Entire course of packing
51
Q

If patient presents with nasal trauma, what diagnostic studies should you order?

A

CT scan maxillofacial w/o contrast to rule out any additional facial fractures

52
Q

What is the treatment for nasal trauma?

A
  • Repair skin lacerations immediately
  • If significant swelling, consider waiting 4-6 weeks until resolved before surgical correction
  • Attempt a closed reduction immediately to maximize airway and improve aesthetics
  • Elevate head of bed
  • Cold compress
  • Pain management
  • Obtain photos for progress comparisons
  • Follow-up 3-5 days
53
Q

What will be seen on exam if patient has a septal hematoma?

A

Soft, tender swelling along the septum

54
Q

What is the treatment of a septal hematoma?

What can occur if a septal hemotoma is not treated?

A
  • Incision and drainage
  • Pack nose
  • Abx
  • Outpatient ENT referral to remove packing in 24 hours and recheck
55
Q

What can occur if a septal hemotoma is not treated?

A
  • Avascular necrosis of the septum

- May cause septal perforation and/or “saddle nose” deformity

56
Q

What is the presentation of mastoiditis?

A
  • May be asymptomatic
  • Postauricular erythema, tenderness, swelling, fluctuance, mass
  • Protrusion of auricle
  • Otalgia
  • Fever
57
Q

How is mastoiditis diagnosed?

A
  • Clinically with characterisitc findings

- If no characteristic findings, CT head w/ contrast and possible cultures

58
Q

What is the treatment for mastoiditis?

A
  • ENT referral
  • May start empiric abx if immunocompetent
  • Mastoidectomy and consideration of IV abx if recalcitrant disease or immunocompromised
59
Q

What is the treatment for a periodontal abscess?

A
  • Pain management
  • Incision and drainage
  • Oral abx if limited infection (Augmentin or Clindamycin x 7-14 days)
  • Follow-up with dentist
60
Q

If unable to re-implant a displaced tooth, what should you do?

A

Immediately store tooth in balanced saline solution, cold milk, or container of patient saliva until seen by dentist

61
Q

How do you treat an avulsion of a permanent tooth?

A
  • Maintain vitality of periodontal ligament
  • Handle tooth by crown
  • Rinse in saline
  • Insert into empty socket and hold in place with gauze
  • Urgent dental consultation
  • Tetanus prophylaxis and abx therapy
62
Q

When would you consider repairing a tongue laceration?

A
  • Large ( > 1 cm)
  • Extends into the muscular layer or goes completely through the tongue
  • Deep on the lateral border
  • Large flaps or gaps
  • Significant hemorrhage
  • Any that may cause dysfunction with improper healing
63
Q

What type of tongue lacerations would you NOT consider for repair?

A
  • < 1 cm
  • Non-gapping
  • Assessed to be minor
64
Q

What type of sutures do you use for tongue lacerations and should you prescribe abx?

A

Absorbable suture material
- 3-0 or 4-0 chromic gut or vicryl

Prescribe abx

65
Q

What can enhance your visualization of a corneal abrasion or ulceration?

A

Cobalt blue filter on fluorescein exam with Wood’s lamp

66
Q

If patient is >50 years old with optic neuritis, what should you consider as a cause?

What about in a young child?

A

> 50: DM, giant cell arteritis, autoimmune

Young child: infectious or post infectious cause

67
Q

What are some risks associated with cautery treatment for epistaxis?

A

Ulceration, septal perforation

68
Q

What diagnostic study should you obtain if patient presents with periodontal abscess?

A

Panoramic radiograph or CT for bone involvement

Emergency/Surgery (3 decks)

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