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Emergency EOR > HEENT > Flashcards

HEENT Flashcards

1
Q

False sense of motion (or exaggerated sense of motion)

A

Vertigo

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2
Q

2 types of vertigo

A

Peripheral and central

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3
Q

Horizontal nystagmus indicates

A

Peripheral vertigo - due to labyrinth or vestibular issues

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4
Q

Episodic vertigo, no hearing loss

A

BPPV or

Vestibular neuritis

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5
Q

Episodic vertigo, hearing loss

A

Meniere or

Labyrinthitis

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6
Q

Management of N/V in pts with vertigo

A
  1. Antihistamines (Meclizine, cyclizine, dimenhydramine, diphenhydramine)
  2. Metoclopramide, prochlorperazine
  3. Scopolamine
  4. Lorazepam, diazepam
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7
Q

Inflammation of both eyelids. Common in pts with _________ and ________

A

Blepharitis
Down syndrome
Eczema

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8
Q

Two types of blepharitis

A
  1. Infectious (staph aureus or staph epidermidis)

2. Seborrheic

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9
Q

Signs/symptoms of blepharitis

A
  1. Eye irritation/itching

2. Eyelid burning, erythema, crusting, scaling, red-rimming and eyelash flaking

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10
Q

Management of blepharitis

A

Warm compresses, eyelid scrubbing/washing with baby shampoo

May give azithromycin ointment/solution

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11
Q

Most common etiology of conjunctivitis

A

Adenovirus

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12
Q

Most common cause of viral conjunctivitis

A

Swimming pools

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13
Q

Signs/symptoms of viral conjunctivitis

A

Foreign body sensation
Erythema
Itching
Normal vision

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14
Q

Preauricular lymphadenopathy, copious watery discharge from eyes, scanty mucoid discharge.
Often bilateral

A

Viral conjunctivitis

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15
Q

Management of viral conjunctivitis

A

Supportive - cool compresses, artificial tears

Antihistamines for itching/redness

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16
Q

Signs/symptoms of allergic conjunctivitis

A

Conjunctival erythema paired with other allergic symptoms

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17
Q

Cobblestone mucosa appearance to the inner/upper eyelid, itching, tearing, redness, stringy discharge. Usually bilateral, +/- conjunctival swelling

A

Allergic conjunctivitis

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18
Q

Treatment for allergic conjunctivitis

A

Topical antihistamine: olopatadine

Topical NSAID: ketorolac

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19
Q

Most common causes of bacterial conjunctivitis

A

S. aureus
Strep pneumoniae
H. influenzae

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20
Q

Purulent discharge from eye, lid crusting, usually no vision changes

A

Bacterial conjunctivitis

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21
Q

Management of bacterial conjunctivitis

A

Topical abx - erythromycin, fluoroquinolones (moxi), sulfonamides, aminoglycosides

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22
Q

Management of bacterial conjunctivitis if contact lens wearer

A

Cover pseudomonas

Fluoroquinolones or aminoglycoside

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23
Q

Blowout fracture:

A

Fracture to the orbital floor as result of trauma. May lead to trapping of eye structures

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24
Q

Signs/symptoms of blowout fracture

A
  1. Decreased visual acuity (trapped orbital tissue)
  2. Diplopia especially with upward gaze (if inferior rectus muscle entrapment)
  3. Orbital emphysema (eyelid swelling after blowing nose - air from maxillary sinus)
  4. Epistaxis, anesthesia to the anteromedial cheek
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25
Q

Diagnosis of blowout fracture

A

CT - may show teardrop sign

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26
Q

Management of blowout fracture

A
  1. Initial: nasal decongestants, avoid blowing nose, corticosteroids, antibiotics
  2. Surgical repair - severe cases, patients with enophthalmos
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27
Q

Foreign body sensation in the eye, tearing, red and pain that is relieved with instillation of ophthalmic analgesic drops

A

Ocular Foreign body

Corneal abrasion

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28
Q

Diagnosis of ocular foreign body /corneal abrasion

A

Pain relieved with instillation of ophthalmic analgesic drops
Fluorescein staining- abrasions

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29
Q

Management of ocular foreign body

A

Check visual acuity first
Remove foreign bodies with sterile irrigation
Avoid sending pts home with topical anesthetics
Antibiotic drops - erythro, polymyxin/trimethoprim

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30
Q

Management of corneal abrasion

A

Check visual acuity first
Patching not indicated for small abrasions and no longer than 24 hrs
Ciprofloxacin, erythromycin

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31
Q

Infection of the lacrimal sac

A

Dacryocystitis

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32
Q

Tearing, tenderness, edema and redness to the nasal side of lower eyelid

A

Dacryocystitis

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33
Q

Management of dacryocystitis

A

Antibiotics - clindamycin

Dacryocystorhinostomy

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34
Q

Signs/symptoms of foreign body in the ear

A

Ear pain, drainage, conductive hearing loss. May be asymptomatic

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35
Q

Management of foreign body in ear

A
  1. Lidocaine drops if insect (to paralyze)
  2. Foreign body removal
  3. Assess for tympanic membrane rupture or complications
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36
Q

Signs/symptoms of foreign body in nose

A 
Mucopurulent discharge
Foul odor
Epistaxis
Nasal obstruction (mouth breathing)
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37
Q

Management of foreign body in nose

A

Positive pressure technique (have pt close other nostril and blow)
Oral positive pressure (parent blows into mouth while occluding other nostril - small children)
Instrument removal

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38
Q

Increased intraocular pressure leads to optic nerve damage, leading to decreased visual acuity

A

Acute narrow angle-closure glaucoma

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39
Q

Decreased drainage of aqueous humor via trabecular meshwork and canal of schlemm in pts with preexisting narrow angle or large lens

A

Acute narrow angle-closure glaucoma

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40
Q

Leading cause of preventable blindness in US

A

Acute narrow angle-closure glaucoma

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41
Q

Precipitating factors for acute narrow angle-closure glaucoma

A

Mydriasis - pupillary dilation further closes the angle

Dim lights, sympathomimetics and anticholinergics

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42
Q

Severe, sudden onset of unilateral ocular pain +/- nausea, vomiting, headache. Vision changes, blurring, halos around lights, peripheral vision loss (tunnel)

A

Acute narrow angle-closure glaucoma

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43
Q

Conjunctival erythema, steamy cornea, mid-dilated, fixed, nonreactive pupil, eye may feel hard to palpation

A

Acute narrow angle-closure glaucoma

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44
Q

Diagnosis of acute narrow angle-closure glaucoma

A

Increased IOP by tonometry (> 21 mmHg)

Cupping of optic nerve on fundoscopy

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45
Q

Management of acute angle glaucoma

A

Ophthalmic emergency
Step 1: lower IOP (acetazolamide, BB, mannitol)
Step 2: open the angle (cholinergics -pilocarpine, carbachol)
Peripheral iridotomy definitive treatment

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46
Q

Medications to avoid with acute angle glaucoma

A

Anticholinergics

Sympathomimetics

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47
Q

Visible blood in the anterior chamber of the ey

A

Hyphema

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48
Q

Complication of hyphema

A

Can lead to blindness if not properly attended to - leads to ocular hypertension

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49
Q

Diagnostic testing for hyphema

A
  1. Screen for sickle cell disease

2. If serious injury, CT scan for further evaluation

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50
Q

Treatment of hyphema

A

Eye shield, elevated head to 30 degrees
Give adequate analgesia (topical cycloplegics) and antiemetics to prevent increased ocular pressure
Topical steroids
Topical BB if increased pressure

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51
Q

Surgery indications of hyphema

A

Early corneal blood staining > 1/2 of anterior chamber involved
Uncontrolled intraocular pressure

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52
Q

Risk factors for macular degeneration

A
  1. Age > 50
  2. Caucasian
  3. Females
  4. Smokers
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53
Q

Most common cause of permanent legal blindness and visual loss in the elderly

A

Macular degeneration

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54
Q

Small, round, yellow-white spots on the outer retina (scattered, diffuse). Accumulation of waste products

A

Drusen - seen in macular degeneration

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55
Q

New, abnormal vessels grow under the central retina which leak and bleed, leading to retinal scarring - rarer than dry

A

Wet (neovascular or exudative) macular degeneration

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56
Q

Bilateral blurred or loss of central vision (including detailed and colored vision), scotomas (blind spots, shadows)

A

Macular degeneration

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57
Q

Straight lines appear bent

A

Metamorphopsia

Macular degeneration

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58
Q

Object seen by the affected eye looks smaller than in the unaffected eye

A

Micropsia

Macular degeneration

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59
Q

Diagnosis of macular degeneration

A

Amsler grid

Wet: fluorescein angiography

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60
Q

Management of wet macular degeneration

A
  1. Bevacizumab - VEGF
  2. Laser photocoagulation
  3. Optical tomography done to monitor treatment response
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61
Q

Acute inflammatory demyelination of the optic nerve

A

Optic Neuritis (Optic Nerve/CN II Inflammation)

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62
Q

Etiologies of optic neuritis

A
  1. Multiple Sclerosis (MC)

2. Medications (ethambutol, chloramphenicol, autoimmune)

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63
Q

Signs/symptoms of otpic neuritis

A
  1. Loss of color vision, visual field defects, loss of vision over a few days
  2. Usually unilateral
  3. Associated with ocular pain that is worse with eye movement
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64
Q

During swinging-flashlight test from the unaffected eye into the affected eye, the pupils appear to dilate (delayed response from affected optic nerve)

A

Marcus-Gunn Pupil

Optic Neuritis

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65
Q

Diagnosis of optic neuritis

A
  1. Marcus-Gunn pupil
  2. Fundoscopy - 2/3 normal disc/cup ratio OR 1/3 optic disc swelling/blurring
  3. May use MRI in some cases
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66
Q

Management of optic neuritis

A

IV methylprednisolone followed by oral corticosteroids

Vision usually returns with tx

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67
Q

Usually secondary to sinus infections (ethmoid 90%)

A

Orbital cellulitis

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68
Q

Orbital cellulitis most commonly occurs in ___________

A

children

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69
Q

Signs/Symptoms of orbital cellulitis

A 
Decreased vision
Pain with EOM
Proptosis (bulging eye)
Eyelid erythema 
Edema
70
Q

Diagnosis of orbital cellulitis

A

High resolution CT scan
Infection of the fat and ocular muscles
MRI

71
Q

Management of orbital cellulitis

A

IV antibiotics - vancomycin, clindamycin, cefotaxime, ampicillin/sulbactam

72
Q

Management of preseptal cellulitis

A

Amoxicillin (no admit needed)

73
Q

Infection of the eyelid and periocular tissue - may have ocular pain and swelling but no visual changes and no pain with ocular movement

A

Preseptal cellulitis

74
Q

Optic nerve (disc) swelling secondary to increased intracranial pressure (classically bilateral)

A

Papilledema

75
Q

Etiologies of papilledema (4)

A
  1. Idiopathic intracranial HTN (pseudotumor cerebri)
  2. Space-occupying lesion (cerebral tumor, abscess)
  3. Increased CSF production
  4. Cerebral edema, severe HTN (malignant)
76
Q

Signs/symptoms of papilledema

A
  1. Headache
  2. Nausea/vomiting
  3. Vision usually well preserved, but may have changes
77
Q

Diagnosis of papilledema

A
  1. Fundoscopy
  2. MRI or CT scan to r/o mass
  3. LP for increased CSF pressure
78
Q

Management of papilledema

A

Diuretics (acetazolamide)

79
Q

Most common type of retinal detachment

A

Rhegmatogenous

Retinal inner sensory layer detaches from choroid plexus

80
Q

Most common predisposing factors for retinal detachment

A

Myopia (nearsightedness)

Cataracts

81
Q

Photopsia (flashing lights), floaters, progressive unilateral vision loss

A

Retinal detachment

82
Q

Shadow “curtain coming down” in peripheral initially, leading to loss of central visual field. No pain or redness of eye

A

Retinal detachment

83
Q

Diagnosis of retinal detachment

A

Fundoscopy: detached tissue flapping in vitreous humor

84
Q

Clumping of brown-colored pigment cells in anterior vitreous humor resembling tobacco dust

A

+ Shafer’s Sign

Retinal detachment

85
Q

Management of retinal detachment

A

Ortho emergency
Keep patient supine
Don’t use miotic drops
Laser, cryotherapy

86
Q

Central retinal thrombus, fluid backup in retina, acute sudden monocular vision loss

A

Central retinal vein occlusion (CRVO)

87
Q

Risk factors for CRVO

A
  1. HTN
  2. DM
  3. Glaucoma
  4. Hypercoagulable states
88
Q

Extensive retinal hemorrhages (blood and thunder appearance), retinal vein dilation, macular edema, optic disc swelling

A

Central retinal vein occlusion

89
Q

Management of CRVO

A

No known effective tx
+/- anti-inflammatories, steroids, laser photocoagulation
May resolve spontaneously or progress to permanent vision loss

90
Q

Excess H2O or local trauma changes the normal acidic pH of the ear, causing bacterial overgrowth

A

otitis externa

91
Q

Most common eteiology of otitis externa

A

Pseudomonas (MC)

Proteus, S. aureus

92
Q

1–2 days of ear pain, pruritus in the ear canal
May have had recent activity of swimming
Auricular discharge, pressure/fullness. hearing usually preserved

A

Otitis externa

93
Q

Management of otitis externa

A

Protect ear against moisture
Ciprofloxacin/dexamethasone
Ofloxacin safe
Aminoglycoside combination

94
Q

Management of malignant otitis externa

A

Seen in DM and immunocompromised

IV Ceftazidime or Piperacillin + fluoroquinolones

95
Q

Infection of middle ear, temporal bone, and mastoid air cells. Most commonly preceded by viral URI

A

Acute otitis media

96
Q

4 most common organisms of acute otitis media

A

S. pneumo, H. influenzae, M. catarrhalis, strep pyogenes

97
Q

Risk factors for otitis media

A 
Eustachian tube dysfunction
Young (ET is wider, shorter and more horizontal)
Daycare
Pacifier/bottle use
Parental smoking
Not being breastfed
98
Q

Fever, otalgia, ear tugging in infants, conductive hearing loss, stuffiness

A

Otitis media

99
Q

Rapid relief of ear pain + otorrhea

A

Tympanic membrane perforation

100
Q

Management of otitis media

A
  1. Amoxicillin 10-14 days
  2. Augmentin or Cefixime
  3. If PCN allergic, erythromycin, azithromycin, Bactrim
101
Q

Management for severe, recurrent cases of otitis media

A

Myringotomy (surgical drainage)

Tympanostomy

102
Q

Treatment for chronic otitis media - perforated TM + persistent or recurrent purulent otorrhea +/- pain

A

Topical ofloxacin or ciprofloxacin

Avoid water/moisture/topical aminoglycosides in ear with TM rupture

103
Q

Treatment for tympanic membrane perforation without infection

A

Most heal spontaneously. Follow up to ensure resolution

104
Q

Auricular hematoma occurs after ____________ to the ear, typically during spots (wrestling, rugby, boxing, etc)

A

Direct trauma

105
Q

If an auricular hematoma is not drained, disruption of blood supply to the auricular cartilage causes necrosis and usually results in:

A

Cauliflower ear

106
Q

Management of auricular hematoma

A

All should be drained ASAP after injury
If > 7 days old, refer to otolaryngologist or plastic surgeon for debridement
Regional auricular block using local anesthetic usually provides adequate anesthesias, then either needle aspiration or I&D is performed

107
Q

Inflammation of the vestibular portion of CN 8 - most commonly after viral infection

A

Vestibular Neuritis

108
Q

Vestibular neuritis plus hearing loss/tinnitus

A

Labyrinthitis

109
Q

Signs/symptoms of vestibular neuritis/labyrinthitis

A

Peripheral vertigo (usually continuous), dizziness, N/V, gait disturbances

110
Q

Management of vestibular neuritis/labyrinthitis

A

Corticosteroids first line

Meclizine, benzos for sx

111
Q

Inflammation of the mastoid air cells of the temporal bone

A

Mastoiditis

112
Q

Etiology of mastoiditis

A

Usually a complication of prolonged or inadequately treated otitis media

113
Q

Signs/symptoms fo mastoiditis

A
  1. Deep ear pain, fever

2. Mastoid tenderness, may develop cutaneous abscess

114
Q

Complications of mastoiditis

A

Hearing loss, labyrinthitis, vertigo, CN VII paralysis, brain abscess

115
Q

Diagnosis of mastoiditis

116
Q

Management of mastoiditis

A
  1. IV antibiotics + middle ear/mastoid drainage hallmark

2. Mastoidectomy if refractory or complicated

117
Q

Tonsillitis –> cellulitis –> _____________

A

Abscess formation

Peritonsillar abscess

118
Q

Most common causes of peritonsillar abscess

A 
Strep pyogenes (GABHS)
Staph aureus
119
Q

Signs/symptoms of peritonsillar abscess

A

Dysphagia, pharyngitis
Muffled “hot potato voice”
Difficulty handling oral secretions, trismus
Uvula deviation to contralateral side
Tonsillitis, anterior cervical lymphadenopathy

120
Q

Diagnosis of peritonsillar abscess

A

CT scan first line to differentiate cellulitis vs abscess

121
Q

Management of peritonsillar abscess

A

Antibiotics + aspiration or I&D
Unasyn, clindamycin, penicillin G + metronidazole
Tonsillectomy if recurrent

122
Q

Treatment for dental abscess

A

Augmentin and abscess drainage

123
Q

Inflammation of the larynx

A

Laryngitis

124
Q

Most common etiology of laryngitis

A

Viral - adenovirus, rhinovirus, etc.

Trauma (vocal abuse)

125
Q

Hallmark of laryngitis

A

Hoarseness

126
Q

Management of laryngitis

A

Vocal rest, warm saline gargles, anesthetics, lozenges, increased fluid intake

127
Q

Inflammation of the epiglottis that may interfere with breathing (medical emergency)

A

Epiglottitis

128
Q

Most common cause of epiglottitis

A

Haemophilus influenzae type B - reduced incidence due to Hib vaccination

129
Q

Signs/symptoms of epiglottitis

A

3 D’s - dysphagia, drooling, distress

Fever, odynophagia, inspiratory stridor, dyspnea, hoarseness, muffled voice, tripoding

130
Q

Suspect in pt with rapidly developing pharyngitis, muffled voice and odynophagia out of proportion to physical finddings

A

Epiglottitis

131
Q

Diagnosis of epiglottitis

A
  1. Laryngoscopy - direct visualization - cherry red epiglottis
  2. Lateral cervical radiograph - thumb sign
  3. If high suspicion, do not attempt to visualize the epiglottis with tongue depressor
132
Q

Management of mild epiglottitis - no stridor at rest, no respiratory distress

A

Cool humidified air mist, hydration
Dexamethasone provides significant relief as early as 6 hours after dose (oral or IM)
Supplemental O2 in pts with sats < 92%
Patients can be discharged home

133
Q

Management of moderate epiglottitis - stridor at rest with mild to moderate retractions

A

Dexamethasone PO or IM + supportive treatment
+/- nebulized epinephrine
Should be observed for 3-4 hours after clinical intervnetion
May be discharged home if improvement is seen

134
Q

Management of severe epiglottitis - stridor at rest with marked retractions

A

Dexamethasone + nebulized epinephrine and hospitalization

135
Q

Most common etiology of corneal ulcer? In contact lens wearers? With ocular trauma? Chronic topical steroid use?

A

HSV overall
pseudomonas
Bacterial
fungal

136
Q

Ulceration usually has regular borders and will have accompanying purulent exudate

A

Corneal ulcer

137
Q

Blue/green discharge with corneal ulcer

A

pseudomonas

138
Q

Dendrites on fluorescein staining with corneal ulcer

139
Q

Satellite lesions around ulceration with corneal ulcer

140
Q

3 main types of rhinitis

A

Allergic
Infectious
Vasomotor

141
Q

Nonallergic/noninfectious dilation of the blood vessels (ex temperature change)

A

Vasomotor rhinitis

142
Q

MC infectious cause of rhinitis

A

Rhinovirus (common cold)

143
Q

Sneezing, nasal congestion/itching, clear rhinorrhea. Eyes, ears, nose and throat may be involved. Allergic associated with nasal polyps and tends to be worse in the morning

144
Q

Pale/violaceous, boggy turbinates, nasal polyps with cobblestone mucosa of the conjunctiva

A

Allergic rhinitis

145
Q

Erythematous turbinates indicates

A

Viral rhinitis

146
Q

Management of viral rhinitis

A
  1. Intranasal corticosteroids
147
Q

Management of rhinitis

A
  1. Oral antihistamines

2. Decongestants - oral, intranasal

148
Q

Acute sinusitis is defined as:

149
Q

Etiologies of sinusitis

A

S. pneumo
H. flu
GABHS
M. catarrhalis (same as otitis media)

150
Q

Signs/symptoms of sinusitis

A 
Sinus pain/pressure - worse with bending down and leaning forward
Headache, malaise 
Purulent sputum or nasal discharge
Fever
Nasal congestion
151
Q

Physical exam of sinusitis

A

Sinus tenderness on palpation

Opacification with transillumination

152
Q

Diagnosis of sinusitis

A

Clinical diagnosis
CT scan diagnostic test of choice
Sinus radiographs- waters view

153
Q

Symptomatic management of sinusitis

A
  1. Decongestants, antihistamines, mucolytics, intranasal corticosteroids, analgesics, nasal lavage
    Indicated if sx < 7 days
154
Q

Antibiotic treatment for sinusitis

A

Sx should be present for > 10-14 days or earlier if: febrile, facial swelling, etc
Amoxicillin drug of choice x 10-14 days
Doxycycline, Bactrim

155
Q

Chronic sinusitis is defined as

A

> 12 consecutive weeks

156
Q

Most common bacterial cause of chronic sinusitis

157
Q

Most common epistaxis form

158
Q

Most common site of bleeding in anterior epistaxis

A

Kiesselbach’s Plexus

159
Q

Most common risk factors for posterior epistaxis

A

Hypertension and atherosclerosis

160
Q

Most common site of bleeding in posterior epistaxis

A

Palatine artery

161
Q

Management of epistaxis

A
  1. Pressure while seated and leaning forward
  2. Topical decongestants/vasoconstrictors
  3. Cauterization if bleeding can be seen
  4. Nasal packing
162
Q

Most common causes of pharyngitis

A

Adenovirus, rhinovirus, enterovirus

GABHS for streptococcal pharyngitis

163
Q

Signs/symptoms of pharyngitis

A
  1. Sore throat

2. Pain with swallowing

164
Q

Management of viral pharyngitis

A

Fluids, warm saline gargles, topical anesthetics, lozenges, NSAIDs

165
Q

Centor criteria for strep throat

A
  1. Fever > 100.4
  2. Pharyngotonsillar exudates
  3. Tender anterior cervical lymphadenopathy
  4. Absence of cough
166
Q

Centor criteria interpretation

A

Score 0-4
0-1 no abx or culture needed
2-3 throat culture
4-5 give abx

167
Q

Modified centor criteria

A

< 15 y/o add 1 point

> 44 y/o subtract 1 point

168
Q

Diagnosis of strep throat

A

Rapid antigen detection test

Throat culture - definitive diagnosis (gold standard)

169
Q

Management of strep throat

A

Penicillin G or VK first line, amoxicillin, augmentin

Macrolides if PCN allergic (azithromycin, clarithromycin, erythromycin)

170
Q

Complications of strep throat

A
  1. Rheumatic fever
  2. Glomerulonephritis
  3. Peritonsillar abscess, cellulitis

Emergency EOR (12 decks)

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