Trans 27 ENT Emergencies

Question 1

Secondary complications of foreign body in ear.

Answer 1

Infection and mucosal erosion

Question 2

When not to use irrigation in foreign body?

Answer 2

If organic foreign body

Question 3

Foreign body in the nose symptoms?

Answer 3

Purulent unilateral nasal discharge

• Usually lodge on the floor of anterior or middle third

Question 4

Management foreign body in the nose?

Answer 4

Good visualization: head lamp & nasal speculum
• Alligator forceps should be used to remove cloth, cotton, or
paper
• Other hard FB are more easily grasped using bayonet
forceps

Question 5

Most common site of lodgement of foreign body

Answer 5

Anatomicconstrictions:cricopharyngeus-MC

Question 6

 3 anatomic constrictions which are:

Answer 6

Cricopharyngeus, aortic notch, hiatus. But most FB will

lodge here in the cricopharyngeus, the opening of the esophagus.

Question 7

3 stages of symptoms of foreign body in the esophagus

Answer 7

• First stage
o Violentparoxysmsofcoughingorgagging
 When they swallow, they’ll try to expel it. And if it is not
expelled, there will be a stage where you don’t feel
anything, it’s just there • Second stage
o Symptomless interval
 Might not be present in most cases. When the FB is in the
esophagus, they will not be able to drink, they won’t eat
because they will vomit it out • Third stage
o Complications

Question 8

True OR false Esophageal FBs require more urgent treatment than those in the tracheobronchial tree

Answer 8

True

Question 9

Tree or false FBs that have reached the stomach will pass through the remainder of the GIT without difficulty

Answer 9

true

Question 10

In complete obstruction, the FB must be disimpacted or alternate airway established in

Answer 10

4 minutes

Question 11

you go behind the patient, upward thrust with your thumb. Goal is to put abdominal pressure, which will transmit into the thoracic cage and remove FB. Once you do this without success and your patient is unconscious, then start doing your CPR

Answer 11

heimlich maneuver

Question 12

step by step what to do if there is airway obstruction?

Answer 12

1. Heimlich meneuver- airway compromise  Abdominal thrust
2. Mouth-to-mouth resuscitation 3. Cricothyrotomy
3. Tracheostomy

Question 13

how to know if the FB is in the larynx or trachea?

Answer 13

FB LODGED IN LARYNX
• Discomfort, hoarseness, cough, dysnea FB LODGED IN TRACHEA
• Audible slap, palpable thud

Question 14

how to know if the FB is in the larynx or in the trachea?

Answer 14

FB LODGED IN LARYNX
• Discomfort, hoarseness, cough, dysnea FB LODGED IN TRACHEA
• Audible slap, palpable thud

Question 15

A foreign body lodged in the tracheobronchial tree, not totally occluding the airway, is not as great an emergency as one that is lodged in the esophagus unless:

Answer 15

o It is sharp
o Uncooked
o Dehydrated
which can absorb fluids and swell within the lumen

Question 16

Aggressive and potentially life-threatening infection of the soft tissues of the external ear and surrounding structures, quickly spreading to involve the periosteum and bone of the skull base

Answer 16

malignant otitis externa

Question 17

hallmark finding in malignant otitis externa?

Answer 17

Granulation tissue on floor of the ear canal at the bony-cartilaginous junction

with pain and high fever

Question 18

microbio associated with mlignant otitis externa?

Answer 18

Pseudomonasaeruginosa(95%)
o Fungus (A. Fumigatus, A. Flavus, A. Niger)

Question 19

predisposing factors in malignant otitis externa

Answer 19

Diabetesmellitus

o Immune-compromisedstatus

Question 20

CLINICAL FEATURES
• Long-standing otalgia (worst at night)
• Otorrhea
• Cranial nerve palsy
• Headaches, fever
• Neck stiffness
• Altered levels of consciousness

these are features of what?

Answer 20

malignant otitis externa

Question 21

medical tx for early and advanced stages of malignant otitis externa?

Answer 21

Early infections- oral fluoroquinolone

o Advancedstages-parenteralantibioticsmaybeindicated

Question 22

• Preceded by AOM
• Young children
• Severe pain, fever, edema over mastoid area
• Intravenous ATB
• Myringotomy ± PE tube

Answer 22

Acute mastoiditis

Question 23

CLASSIFICATION OF ORBITAL INFLAMMATION

Answer 23

1 inflammatory edema (periorbital cellulitis)
2 orbital cellulitis
3 subperiosteal abscess
4 orbital abcess
5 cavernous sinus thrombosis

Question 24

• Periorbital erythema, edema, pain & fever
• Purulent nasal discharge
• S. pneumoniae, S. aureus, coagulase-negative staphylococci
• Broad-spectrum antibiotics

Answer 24

periorbital cellulitis

Question 25

orbital complications of sinusitis?

Answer 25

• Periorbital swelling & pain, fever
• Proptosis, chemosis, restriction of ocular movement & visual
disturbance

Question 26

managment of orbital complications?

Answer 26

• CT scan – subperiosteal & orbital abscess
• Admission & IV broadspectrum antibiotics

• Surgery (drainage) if
o Failed medication
o Progress of abscess o Visual acuity drop

Question 27

intracranial complications of sinusitis?

Answer 27

Cavernous sinus thrombosis, meningitis, extradural abscess, intracranial abscess & subdural empyema
• Purulent rhinorrhea, fever, frontal/retro-orbital headache
• Personality change/lethargy, seizure, N/V/, focal neurological
deficits

Question 28

management of intracranial complications of sinusitis?

Answer 28

Diagnosis – contrast CT/MRI scan with gadolinium

• Admission, IV broad-spectrum antibiotics & surgical drainage

Question 29

airway obstruction causes in neonatal?

Answer 29

Congenital tumors, cysts, webs
• Laryngomalacia
• Subglottic stenosis

Question 30

causes of airway obs in children?

Answer 30

Laryngotracheobronchitis • Supraglottitis (epiglottitis)

Foreign body
• Retropharyngeal abscess
• Respiratory papilloma

Question 31

causes of airways obs in adult?

Answer 31

Laryngeal cancer
• Laryngeal trauma
• Epiglottis & deep neck infection

Question 32

Pus forms between tonsils capsule & superior constrictor
• Group A streptococcus
• Hot potato voice
• Uvula potato voice
• Swollen tonsils
• Severe, unilateral sore throat, fever

what condition?

Answer 32

peritonsillar abscess

Question 33

management of peritonsillar abscess?

Answer 33

I and D to drain the abscess

Question 34

• Rapid swelling cellulitis of sublingual & submaxillary spaces
• Dental infection, floor of mouth, salivary gland
• Fever, edema & erythema of neck under chin & floor of mouth
 Especially if this patient is obese with very short neck very difficult that can be cause of infection.

Open mouth
• Tongue → upward & backward → airway obstruction
• Streptococci, bacteroides, S. aureus

Answer 34

ludwigs angina

Question 35

management of ludwigs angina?

Answer 35

Tracheostomy
• IV antibiotic
• I&D, tooth extraction

Question 36

Age 3-7 yrs old
• H. influenzae type B, group A streptococcus
• Severe sore throat & fever, dysphagia, drooling
 Because it is swollen the patient is difficulty in breathing
• Stridor
• Breathing with raised chin & open mouth

CBC: leukocytosis
• Film lateral neck → thumb shaped epiglottis

Answer 36

epiglottitis

Question 37

management of epigottitis

Answer 37

Avoid tongue depressor
• Controlled intubation
• Intravenous ATB

intravenous antibiotic given
 Intubation is largely avoided because this is just temporary. If
you can avoid intubation much better to this patient. Because difficult to intubate this patient.