ORALS - ENT/HEENT/OPTHO Flashcards
HEARING LOSS CASE
- Weber / rinne test
- focal neuro deficits
- MRI in 3 months
- referral for audiometry
- steroids => glucocorticosteroids 60mg daily x10d
- valacylovir 1g TID within first 48H
FOLLOW UP
1. DDX for SSNHL
=> infection (lyme, HSV, syphillis)
=> drugs (aminoglycosides, loop diuretics, antimalarials)
=> neoplasms (acoustic neuroma, lymphoma)
=> autoimmune => RA, wegners
=> CVA
=> complex migraine
=> menires
=> MS
EPIGLOTTITIS CASE
- XR findings of epiglottitis
thumbprint sign
enlarged epiglottis
thickened aryepiglottic folds
lack of air in vallecula
dilated hypopharynx - List most common organisms causing epiglottits
H flu, GAS, S aureus, S pneumoniae
ABX:
1) ADULT => CTX / piptaz + Vanco
2) PEDS => cefotaxime 50mg/kg TID or CTX 50mg/kg
EYE EXAM
- Components
Soft tissue
Visual acquity
visual fields
EOM
pupil
pressure
PH
slit lamp
fundoscopy - Describe red flags on eye exam
loss of vision
unreactive pupil (globe rupture, glaucoma, uveitis, optic neuritis, incr ICP)
Propotosis (cellulitis, orbital tumor, graves, FB)
Corneal opacity
ciliary flush
lid laceration (margin, lacrimal duct, gland, large tissue loss, through and through)
APPROACH TO ORBITAL COMPARTMENT SYNDROME
Ophthalmologic emergency
- consult optho
- HOB up
- analgesia
- medications: TAAM PP
- correct coagulopathy
- suppress cough, vomit, excessive straining
- lateral canthotomy (PROCEDURE)
VISION LOSS
- List causes of painful vs non painful vision loss
painful => GCA, glaucoma, uveitis/keratitis/scleritis, trauma, retrobulbar hematoma, post op
painless => retinal detachment, vitreous detachment / hemorrhage, CRAO/CRVO, optic nerve (ischemia, toxins - methanol, compression), lens dislocation (marfans), mass
- Traumatic causes of vision loss
globe rupture
orbital compartment syndrome
retinal detachment
traumatic optic neuritis
laceration
vitreous hemorrhage
dissection
AACG CASE
CASE presentation: elevated IOP (>30), painful, cloudy, red eye, fixed pupil, NV, ciliary flush
ophthalmologic emergency
MGMT
HOB 30deg, analagesia, anti-emetics
TAAM PP
treatment end point IOP 25%
**FOLLOW UP QUESTIONS **
1. List triggers / causes for for AACG
low light
mydriatic medication
sympathomimetic
anticholinergic
emotional stress
lens d/c
tumor
retrobulbar hematoma
CRAO CASE
CASE presentation:painless vision loss, pale macula, cherry red macula
optho emergency , consult for IA TPA vs anterior chamber paracentesis
meds: timolol (2 drops), acetazolamide 500mg IV
elevate HOB
intermittent ocular massage (improve blood flow, dislodge blood clot)
vasodilate => breath into bag (higher CO2), administer nitro
local HBOT for consideration
OCULAR BURNS CASE
CASE - MVC (airbag - alkali, car mechanic)
- eye exam
- topical analgesia + oral analgesia
- morgan lens x2L for 20min (acid) / 4L for 40min (alkali)
- Check pH = irrigate more if not 7.0
- check IOP - if greater than 30 = acetazolamide
- Cycloplegic (C/I - glaucoma, incr ICP, trauma, shallow abteruir angle, ruptured globe, lens implant)
- TDAP
- topical cipro drops
- consult optho
follow up questions
1. list complications of ocular burns
perforation
corneal scarring
adhesion of lid to eye
glaucoma
cataracts
retinal injruy
ORBITAL FLOOR FRACTURE INJURY
FINDINGS
- Painful EOM
- upward gaze palsy
- enophthalmos
- ptosis
- anesthesia
- SC emphysema
- step deformity
- hyphema
MGMT
- surgery if persistent diplopia
- Don’t blow nose
- abx if infected sinus
FACIAL TRAUMA CASE
(ORBITAL COMPARTMENT SYNDROME)
- PPE/MOVID
analgesia
tono pen - MGMT
optho emergency - consult optho
elevate HOB
analgesia / antiemetics
meds: timolol, apraclonidine, pilocarpine, acetazolamide
if IOP >40 = lateral canthotomy
AC reversal / correct coagulopathy - Approach to traumatic hyphema:
goal - prevent complications (i.e. rebleeding, corneal staining, glaucoma, incr IOP)
HOB 30
eye shield to prevent light from interacting with blood
limit eye movement
analgesia
if IOP incr => timolol, acetazolamide
consult optho for F/U or admission (IOP), VA decr, SCD, or gr 3 hyphema
follow up questions
1. indications for lateral canthotomy (DIP ACONE)
Decr visual acuity
increased IOP >40
proptosis
ACONE:
Afferent pupillary defect
Cherry red macula
Ophthalmoplegia
Nerve head pallor
eye pain
- Contraindications to lateral canthotomy
globe rupture - Facial wounds that require ABX
bite
devascularized wounds
through and through buccal
cartilage of ear or nose
open fractures
extensive contamination
fracture through sinus
RUPTURED GLOBE
- PPE/MOVID
- MGMT
optho emergency
eye shield
imaging
antiemetics, analgesia
TDap
abx - piptaz, vanco
NPO
FOLLOW UP QUESTIONS
1. Signs of ruptured globe
large subconjunctival hemorrhage
hyphema
enophthalmous
iris prolapse through wound
teardrop pupil
flat shallow anterior chamber
seidel sign
