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HEENT ER Flashcards

1
Q

Causes of preseptal cellulitis

A

Ascending URI

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2
Q

I have preseptal cellulitis what organisms are most likely responsible

A

Staph aureus
S. Epidermidis
Strep species
Anerobes

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3
Q

I have orbital cellulitis and my eye hurts when I move it, do I have preseptal or post septal

A

Post septal

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4
Q

Treat me if I have preseptal cellulitis

A

Outpatient

Augmentin 875 PO BID for 14 days

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5
Q

If i am very sick and a young child how should you treat my preseptal cellulitis

A

Hospitalize, ceftriaxone, Vanco (for MRSA), call Opthalmology

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6
Q

I have post setptal cellulitis what type of infection did I have before this

A

Sinusitis

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7
Q

What organisms are the culprits in post septal cellulitis

A 
Often polymicrobial 
S. aureus
S. pneumonia
anaerobes 
H. influenzae (unimmunized young children)
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8
Q

How do you definitively diagnose post septal cellulitis

A

CT with IV contrast

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9
Q

Treatment of post septal

A

IMMEDIATE OPHTHAMOLOGIC CONSULT

IV antibiotics - 2nd or 3rd gen cephalosporin, unycin, Timentin

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10
Q

I am allergic to Penicillin treat me for post septal cellulitis

A

Flouroquinalone and metronidazole or clinda

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11
Q

What is Augmentin

A

amoxicillin/clavulanic acid

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12
Q

What is Unacyn

A

Ampicillin-sulbactam

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13
Q

What is Timentin

A

ticarcillin-clavulanate

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14
Q

I have a stye! What bacteria caused it

A

Staph

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15
Q

How will you treat my stye

A

warm compresses

Erythromycin ophthalmic ointment one ribbon in eye 2-3 times a day for 7 to 10 days

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16
Q

I have a painless lump on my eye what is it?? What do you do for me?

A

Chalazoin, refer to ophthalmology

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17
Q

I have unilateral mucopurulent discharge from my eye, what do I have and treat me!

A

Bacterial Conjunctivitis
Topical ocular antibiotic four times daily for 5 to 7 days
Trimethoprim and polymyxin B or Erythromycin TID

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18
Q

I have unilateral clear discharge from my eyes what type of adenopathy do I have

A

Preauricular

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19
Q

I have Viral conjunctivitis give me antibiotics!!

A

No- cool compresses, and artificial tears

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20
Q

If I have symptoms of viral conjunctivitis what should you have in your diferntial and document

A

That you ruled out Scleritis and iritis or AAC. Use slit lamp

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21
Q

I have profuse watery red itching eyes, please give me something

A

viral- cool compresses, eye drops, antihistamine

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22
Q

I have a vesicular rash near my eye what should you do for me

A

Shingles–> refer to ophthalmology, IV acyclovir

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23
Q

How are all eyes examined in the ER

A

Visual acuity
Stained
Slit lamp

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24
Q

my eye is really painful an i have decreased vision and photophobia- it looks like I have conjunctivitis. Treat me!!

A

Iritis-
Tx pain
Refer to ophthalmology- they will get steroid drops

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25
Q

My eye has a huge blood spot on it– treat me!!

A

Deal with it - will resolve in 2 weeks

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26
Q

Ouch ouch I thinkI scratched my eye- what do you do to diagnose me

A

Corneal abrasion-

Flouresceen stain

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27
Q

Treat my corneal abrasion

A 
Topical NSAIDs (Ketorolac)
Opth follow up
Erythromycin eye ointment
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28
Q

If I got my corneal abrasion from my contacts what type of antibiotics should you give me

A

Pseudomonas coverage - cipro, tobramycin

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29
Q

I have a corneal abrasion give me topical anesthetic please…

A

No. will delay your healing

30
Q

I have a piece of metal in my eye what may I have now..

31
Q

How do you get rid of my rust ring

A

Drill it out

32
Q

FB in eye what do you do to remove

A

1) anesthetize
2) Irrigate with NS
3) Dislodge with cotton
4) Flip eye back
5) 25 gauge needle bevel up

33
Q

After you remove my FB where do I need to go in the next few days

34
Q

I have a rust ring what type of shot do I need

35
Q

I was punched in the eye what 2 big things do you need to make sure I do not have

A

Blow out fracture

Glob rupture

36
Q

I have a tear drop pupil treat me!

A

Glob rupture, call eye doc NOW

37
Q

What exams do you need to do when I have blunt trauma to my eye

A

Stain it

Slit lamp

38
Q

I as punched in the eye now only my right eye can look up, what happened

A

Blow out fracture

39
Q

How do you treat a blow out Fx

A

Opth referala

40
Q

my eye sounds like rice crispies…what do I have

A

Subcutaneous emphysema, prob a blow out fx

41
Q

Ahhh I got a toxic chemical in my eye help me!

A

1) Irrigate 1-2 L NS
2) Identify agent
3) Take eye pH
4) Call posin control
5) Apply erythromycin QID
6) Tetanus
7) If have corneal clouding or epithelial defect- prompt opth referal

42
Q

Is a chemical burn a true ocular emergency or not

43
Q

I have a steamy cornea, how will you diagnose me

44
Q

What is Acute Angle Closure Glaucoma (AACG) caused by

A

pupillary dilation

45
Q

Treat my AACG

A

IV mannitol

Call opth

46
Q

I have a painless monocular, sudden vision loss what will you see on my fundoscopic exam

A

Cherry red spot- Central artery retinal occlusion

47
Q

Treat my CRAO

A

Call neuro +Opth

48
Q

Who gets malignant otitis externa

49
Q

What causes OE

A

Pseudomonas

50
Q

Treat my malignant OE

A

Admit

IV antibiotics - Children (imipenem or aminoglycosilide) Adults (antiseudomonal penicillin, cephalosporin or quinalone)

51
Q

I have mastoiditis, how did I get it

A

Untreated OM that traveled to my mastoid air cells

52
Q

Treat my Mastoditis

A

Admit
IV Vanvo or nafcillin
Call ENT

53
Q

I have a nose bleed, whats that called?

54
Q

How do you figure out where my epistaxis is coming from

A

Try and pack anterior and if doesn’t work then its posterior

55
Q

Why is my nose bleeding

A

I prob did cocaine…or trauma, prior head and neck procedures, uncontrolled htn, winter months, im elderly

56
Q

How do you treat my epistaxis

A

1) Blow the clots out
2) Instill nasal spray
3) Apply pressure - 15 min X2
4) nasal packing
4) ENT follow up and packing removal in 2-3 days

57
Q

If you put one of the nasal packings up my nose what do you need to give me

A

Antibiotics that cover staph- Augmentin

58
Q

How do you diagnose my nasal Fx

A

Clinically

59
Q

What do you need to r/o when I break my nose

A

septal hematoma

60
Q

Tx of nasal Fx

A

supportive care and follow up with plastics

Drain septal hematoma and put on antibiotics

61
Q

My mouth really hurts and one of my teeth is tender to palpate, what do you do with me

A

Dental abscess-

1) drain
2) penicillin VK, 500mg PO QID or Clinda 300mg PO QID
3) Analgesia - nsaid or opiate

62
Q

If I have an abscess in my lower teeth what do you need to look out for

A

Ludwigs angina

63
Q

Presentation of ludwigs

A

Dysphagia, odonophagia, trismus, edema

64
Q

Tx of ludwigs

A

Airway!!
ICU
Systemic antibiotics- cover anerobes and oral flora

65
Q

I have a hot potato voice with trismus treat me

A

peritonsilar abscess

1) needle aspiration or I&D
2) ENT consult/follow up
3) CT if worried for deeper infection
4) Augmentin 875 BID for 10 days - or clinda
5) steroids to decrease swelling

66
Q

Retrophayngeal abscess classic symptoms

A

Sore throat, fever, TORTICOLLIS, dysphagia

67
Q

Diagnose me with retropharyngeal abscess

A

CT of neck with IV contrast

68
Q

Treat my retropharyngeal abscess

A

IV antibiotics, admit, airway managment, ENT referral

69
Q

I am a child who has dysphagia, drooling and distress what is likely to have caused my infection

A

Eiglotitis- H. Flu

70
Q

Diagnose me with Epiglotitis

A

Lateral soft tissue- thumbprint sign

Clinical suspicion

71
Q

Treat my epiglotitis

A

ICU, monitor, Airway, IV Ceftriaxone

ED (7 decks)

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