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FA17 HEENT > HNT Emergencies > Flashcards

HNT Emergencies Flashcards

1
Q

Pathogen in viral parotitis

A

Mumps

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2
Q

Clinical features of viral parotitis

A

Fever, Malaise, Headache, anorexia
Myalgia/arthralgia

Bilateral enlargement, tense and painful glands
ABSENCE OF PUS
Epididymo-orchitis MC extra salivary glands

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3
Q

Viral parotitis

Treatment

A

Mainly supportive

Can be prevented with vaccine

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4
Q

Suppurative parotitis

Risk factors

A

Diminished salivary flow

Advanced age
Dehydration
Diuretics

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5
Q

Common pathogens suggested in Suppurative parotitis

A

Staph aureus, strep pyrogens

Bactericides and fusobacteirum (anaerobes)

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6
Q

Suppurative parotitis

Clinical features

A

Rapid onset, FEVER, TRISMUS, erythema, pain over parotid gland

PUS is not able to be expressed

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7
Q

Management of Suppurative parotitis

A

Outpatient treatment - warm compress, milking of duct, lemon drops, oral ABx

Severe - IV abx

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8
Q

Clinical features of temporal arteritis

A

Ischemic optic neuropathy

UNILATERAL + vision changes

Jaw claudication, decreased temporal pulse, TIA/stroke symptoms

Sed rate/CRP elevated

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9
Q

temporal arteritis management

A

High dose systemic steroids , Opthalmologist consult, admission to hospital

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10
Q

Horner’s Syndrome

Classic triad

A

Ipsilateral ptosis (flaccid eyelid)

Ipsilateral mitosis (pupil constriction)

Ipsilateral anhydrousus (absence of sweat)

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11
Q

Horner’s syndrome

Cause

A

Impaired sympathetic nerve

CVA, tumors, internal carotid dissection, tumors, trauma

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12
Q

Papilledema

A

Bilateral via intracranial pressure

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13
Q

Inflammatory pupillitis

A

Unilateral papilledema

Caused by MS

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14
Q

Malignant Otitis externa

Pathophys

A

Simple otitis externa that spreads to deeper tissues and causes granulation of external canal and infects cartilage, periosteum, soft tissue and bone

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15
Q

Malignant Otitis externa

Pathogens

A

90% pseudomonas aeruginosa (MRSA 10%)

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16
Q

Malignant Otitis externa

People at risk

A

Elderly
Immunocompromised
Diabetics

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17
Q

Malignant Otitis externa

Diagnosis

A

Must have high suspicion

EXTREME pain
Green/gray discharge
Tissue granulation in the canal

CT scan the head (w/contrast) to determine bony erosion

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18
Q

Malignant Otitis externa

Treatment

A

IV Abx + pseudomonas coverage

ENT consult

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19
Q

Mastoiditis

Clinical features

A

Infection that spreads from middle ear to mastoid air cells of skull

Otalgia, fever, and post auricular erythema, swelling and tenderness

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20
Q

Mastoiditis

Management

A

IV Abx, hospital admission, HEENT consult

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21
Q

Lateral sinus thrombosis

Cause

A

Extension of mastoiditis that occuleds lateral venous sinuses and blocks sinus drainage

Infection goes right into brain

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22
Q

Lateral sinus thrombosis

Clinical features

A

Fever, HA

6th cranial nerve palsy (inability to abduct eye)

Convergent strabismus and complaint of diplopia

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23
Q

Lateral sinus thrombosis

Dx and tx

A

Contrast CT

IV abx, HEENT consult, likely mastoidectomy

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24
Q

TM perforation

Cause

A

Otitis media
Foreign body
Blast injury

Will result in CONDUCTIVE HEARING LOSS

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25
Q

TM perforation

Management

A

Typically supportive

No ear drops or water until healed

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26
Q

Basilar skull fracture

Look for (4)

A

Mc thru temporal bone

Otorrhea from external or auditory canal (clear/bloody drainage)
Hemotympanum (blood behind TM)
Battle sign (postauricular hematoma, develops following injuries)
Raccoon eyes

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27
Q

Correct management strategies for ear foreign body

A

Immobilize insects with lidocaine

Can be removed with forceps, Katz ear extractor, suction catheter

Irrigation possible if not organic material

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28
Q

Epistaxis anatomical locations

A

Anterior (90%) due to kiesselbach’s plexus

Posterior due to posterior ethmoid or sphenopalatine arteries

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29
Q

Risk factors of epistaxis

A

Younger adults are typically minor, elderly tend to have worse

Anticoagulants increase risk

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30
Q

Possible complications of posterior epistaxis

A

Usually arterial pattern and more profuse posterior

Aspiration of blood or airway compromise

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31
Q

Etiology of epistaxis

A

Local trauma (picking*, foreign body,facial trauma, nasal surgery)

Environmental

Coaguloptahies

Drugs

Other (congenital weakness, septum anomalies, tumors, HTN)

32
Q

Epistaxis management

STARTING

A

Ask if patient is on blood thinner
Keep calm and get them on IV
Have blow nose to clear out the space
Use light to find source of bleeding

33
Q

Anterior epistaxis management

A

Direct pressure on fleshy for 20 min and observe for 30 min.

Discharge and recommend daily lubrication

May insert cotton pledget w/local vasoconstriction

34
Q

Posterior epistaxis management

A

Dilate and grab rhino rocket

Insert and inflate nose

Observe for 30 min

35
Q

Septal hematoma

Pathology

A

Direct nasal trauma

Causes torn vessels and collection of perichondrium/septal cartridges

Anterior nasal septum is site

36
Q

septal hematoma complications

A

Abscess formation

Septal perforation

Saddle nose deformities

37
Q

septal hematoma

Clinical features

A

Signs of trauma (not always)

Medical nasal passage is asymmetric

38
Q

Cribriform plate fracture

Clinical features

A

CSF leak

Double ring sign (blood + CSF on test)

Drainage of clear rhinorrhea after trauma to mid face

39
Q

Cribriform plate fracture management

A

Hospital admit + neuro consult

Head elevation and lumbar drain

Prophylactic ABx and surgical repair

40
Q

Epidemiology of nasal foreign bodies

A

Pediatrics

2-5

41
Q

Nasal foreign body

Clinical features

A

Unilateral rhinorrhea +/- blood or odor

42
Q

Nasal foreign body

Management

A

Katz nasal extractor, alligator forcepts

If nec. Call ENT and maybe anesthesia

43
Q

Facial layers of the neck

A

Superficial (platysma)

Middle facial layer (pretrachial and retropharyngeal layer)

Deep cervical fascia layer (prevertebral)

44
Q

Major risk of facial injuries

A

Bleeding and inflammation - can cause airway compromise

45
Q

High risk clinical features in fascial injuries

A

Vocal change
Drooling
Stridor at rest
Persistent tachycardia

46
Q

Platysma space infection

Etiologies

A

Ludwig angina

Prolonged tracheostomy infection on ant. Surface

47
Q

Pre-tracheae middle space infection etiologies

A

Perforation of anterior esophageal wall

Contiguous extension from retropharyngeal space infection i

Prolonged tracheostomy

48
Q

Pre vertebral

Deep space infections

A

Originate from cervical spine infection (discitis or vertebral osteomyelitis)

Mc pathogens staph aureus and MRSA

49
Q

Peritonsillar abscess (PTA)

Risk factors

A

Prior PTA

Smoking

Peridontal dz

Chronic tonsillitis

Repeat abx

50
Q

PTA clinical features

A

Appear ill, fever, malaise

Sore throat, displaced uvula, odonophagia

Muffled voice, drooling

51
Q

PTA management

A

Aspiration with 18/20 gage needle (dont go more than 1cm in - carotid)

HEENT specialist

Clindamycin
Vanco if CA MRSA is suspected

52
Q

Retropharyngeal abscess

Risk factors

A

Intraoral procedures

Trauma

Foreign bodies (i.e. fishbone)

Extension of dental infection

53
Q

Clinical features retropharyngeal abscess

A

Sore threat

Cervical lymphadenopathy
Stridor
Neck pain
Poor intake

54
Q

Retropharyngeal v. PTA

A

PTA is up top, displaced uvula

RPA is down lower, gold standard dx is CT scan w/IV contrast
Sore NECK

55
Q

Anterior mandible dislocation

A

History of opening mouth extreme

Pain anterior to Travis

Clinical dx

Reduction to treat

56
Q

Lateral, posterior, superior dislocations

A

Requires SIGNIFICANT trauma

Dx with CT scan

Keep patient NPO and get surgical consult

57
Q

Severe facial fractures are associated with …

A

Injuries to brain, orbits, cervical spine, and lungs

58
Q

History if someone with facial trauma

A

Can you tell me name? What happened?

Does neck hurt?

Lose consciousness?

Numbness in face?

Bite feel normal?

59
Q

Le Forte fracture

A

Fracture that occurs when the internal bone structures are removed from the skull

60
Q

Inspection of facial trauma

Le Forte

A

In Le Forte II - lateral, fish face

Le Forte III - donkey face, frontal

Palpating face (rock hard pals with one hand, stabilize in other)

61
Q

Physical exam finding

Basilar skull fracture

A

Raccoon eyes

Battle signs

Hematypanum

CSF leak

62
Q

Facial trauma eye

Examine

A

Document acuity
Examine eyes thoroughly
Evaluate for orbital fractures
Asses pupil

63
Q

Le Fort I

A

Only fracture in hard palate and teeth

64
Q

Le Fort II

A

Movement of upper teeth, hard palate and nose

Dish face deformity

65
Q

Le forte III

A

Entire face shifts with globes held in place by optic nerve

Donkey face

66
Q

Posterior triangle borders

A

Posterior sternocleidomastoid
Anterior border of trapezius
Middle third of clavicle

67
Q

Anterior triangle borders

A

Border of mandible
Anterior midline of neck
Anterior border of sternocleidomastiod

68
Q

Components of anterior triangle

A 
Carotid a. 
Internal jugular v. 
Vagus n. 
Thyroid gland 
Larynx
Trachea 
Esophagus
69
Q

Posterior triangle components

A

Few vitals

Subclavian a. And brachial plexus at base

70
Q

Zones of anterior triangle

Zone 1 (5)

A

Clavicle to cricoid cartilage

Vertebral and carotid 
Major thoracic vessels 
Apex of lungs
Esophagus  
Trachea 
Spinal cord
71
Q

Zones of anterior triangle
Zone II

(5)

A

Inferior margin of carotid cartilage to angle of mandible

Vertebral and carotid a. 
Jugular vein 
Esophagus 
Trachea 
Spinal cord
72
Q

Zones of anterior triangle

Zone III (3)

A

Angle of mandible to base of skull

Vertebral and carotid a.

Pharynx

Spinal cord

73
Q

Etiologies of carotid a. neck injuries

A
  1. HyperEXTENSION that causes compression against transverse process
  2. HyperFLEXION that results in compression b/t mandible and c-spine
  3. Direct blows
  4. Intraoial injuries
  5. Basilar skull fracture = tearing of intracranial portion of Carotid
74
Q

Results of vascular neck injuries

A

Vertebral artery dissection

Subintimal hematoma
Complete thrombotic occlusion

75
Q

Clinical features of

Vascular neck injuries

A

Asymptomatic, intermittent, or delayed

Headache, neck pain

Ipsilateral facial paralysis

Horner Syndrome

76
Q

How are vascular neck injuries diagnosed?

A

CTA of head and neck

FA17 HEENT (8 decks)

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