HEENT Emergencies

Question 1

Decreases nasal arterial pressures and prevents aspiration in patient with a nosebleed

Answer 1

have patient sitting in a 45 degree position

Question 2

Where is the most common location of a nosebleed in adults and children?

Answer 2

adults- posterior to Kiesselbach’s. kids-anterior to Kiesselbach’s

Question 3

What is the treatment for an anterior nosebleed?

Answer 3

vasoconstrictive agents (afrin) followed by direct pressure to nose

Question 4

How long can you leave nasal packing in place?

Answer 4

2-3 days

Question 5

What is the treatment for a posterior nosebleed?

Answer 5

posterior packing, admit for observation, call ENT

Question 6

Patient presents with edema, erythema of the EAC possibly with exudate. Pinna is tender

Answer 6

external otitis media

Question 7

Treatment of external otitis media

Answer 7

application of wick and cortisporin otic; local heat,

Question 8

How do you differentiate between central and peripheral vertigo?

Answer 8

peripheral has nystagmus, hearing loss, N/V, and diaphoresis whereas these are absent in central

Question 9

Which type of vertigo may have one of the following etiologies: drug toxicity, cerebellar or brain stem stroke?

Answer 9

central vertigo

Question 10

Which type of vertigo may have one of the following etiologies: Meniere’s, labrynthitis, acoustic neuroma, supprative labryinth?

Answer 10

peripheral vertigo

Question 11

What is the treatment for BPV?

Answer 11

Epley maneuver

Question 12

Fluctuating, progressive, sensorineural deafness.
Episodic, characteristic definitive spells of vertigo lasting 20 minutes to 24 hours with no unconsciousness, vestibular nystagmusalways present.
Usually tinnitus

Answer 12

Meniere’s disease

Question 13

Fever, exudate, adenopathy common. Bacterial cause is Strep

Answer 13

actue tonsillitis

Question 14

Infection/inflammation of epiglottis and surrounding soft tissue. Usually seen in children. What is your initial step in management?

Answer 14

obtain soft-tissue lateral of neck and call ENT/Pediatrics. DO NOT examine epiglottitis

Question 15

Severe pain, hoarseness, “hot potato voice”, drooling, dysphagia. Cervical lymphadenopathy, fever. Soft palate bulging and uvula deviating AWAY

Answer 15

peritonsillar abscess

Question 16

What is the antibiotic treatment of a peritonsillar abscess after it has been drained by ENT?

Answer 16

High dose PCN. Augmentin or Clindamycin if allergic

Question 17

Parainfluenza airway infection. Most common in kids 3 months – 3 years. Hoarse, barking coup, possibly inspiratory stridor. How would you proceed with management of this patient?

Answer 17

racemic epi

Question 18

Submandibular pain, trismus, and dysphagia. Markedly swollen submandibular/sublingual tissues with a “woody” apprearance. Most often in patients with poor dental hygiene or after dental procedures

Answer 18

Ludwig’s Angina

Question 19

Severe pain, halos around lights, blurred vision, photophobia, and N&V. Affected eye is red, nonreactive midrange (often irregular) pupil, hazy cornea, shallow anterior chamber angle

Answer 19

acute angle closure glaucoma

Question 20

Starts in ethmoid sinus. Hx of sinusitis or trauma to orbital area. Limitation in cardinal fields of gaze. Blurred disk margins, elevated WBC, and fever. What is used to diagnose this condition?

Answer 20

CT scan (this is orbital cellulitis)

Question 21

A patient presens with painless DECREASES in vision with flashes of light and sparks. May be described as curtain dropping. IOP is normal or low. Retina appears gray w/white folds. What is you plan of action?

Answer 21

bilateral patch and optho consult (this is retinal detachment)

Question 22

What abx is used to treat conjunctivitis in non-contact wearers?

Answer 22

polymyxin

Question 23

Painful, non-vision threatening. Anesthesia is diagnostic. Tx is
bilateral eye patch, analgesia, rest

Answer 23

Ultraviolet keratitis (welder’s burn)

Question 24

Stops at margin of iris. NEVER involves the visual axis

Answer 24

Subconjunctival hemorrhage

Question 25

Treatment of a chalazion or hordeolum

Answer 25

hot compresses

Question 26

How can you distinguish iritis from conjunctivitis?

Answer 26

Photophobia with iritis is severe while it is absent in conjunctivitis

Question 27

What diagnosis is the term “steamy cornea” associated with?

Answer 27

acute glaucoma

Question 28

How can you distinguish iritis from acute glaucoma?

Answer 28

The pupil in iritis is constricted with poor response while in acute glaucoma is mid-dilated, fixed and irregular with no light response