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EM Rotation 2018 > ENT > Flashcards

ENT Flashcards

1
Q

A patient is having inflammation of both eyelids. Patient reports eye irritation, and itching. On PE, you note erythema, crusting, scaling, red-rimming of the eyelid and eyelash flaking. What population groups are most likely to get this condition?

A

Blepharitis–Downs syndrome and eczema patients

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2
Q

A patient is having inflammation of both eyelids. Patient reports eye irritation; and itching. On PE, you note erythema, crusting, scaling, red-rimming of the eyelid and eyelash flaking. Patient is also experiencing entropion. Patient has a hx of rosacea and allergic dermatitis. What is the most likely diagnosis?

A

Posterior Blepharitis: Meibomian gland dysfunction

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3
Q

A patient is having inflammation of both eyelids. Patient reports eye irritation, and itching. On PE, you note erythema, crusting, scaling, red-rimming of the eyelid and eyelash flaking. What is the treatment for this patient?

A

Anterior and Posterior: eye hygeine

Anterior: Azithromycin ophthalmic solution or ointment; erythromycin or bacitracin

Posterior: Tetracyclin or Azithromycin

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4
Q

Orbital emphesyma is described as : ?

A

Eyelid swelling after blowing nose–air from the maxillary sinus

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5
Q

A patient is admitted for a head trauma. The patient was in a bar fight and got punched in the face. On PE, there is decreased visual acuity, diplopia upon upward gaze, and noticeable orbital emphysema. The patient is also complaining of epistaxis. What do you suspect to see on this patients CT?

A

A “teardrop” sign; CT is the scan of choice for orbital floor “blowout fractures”

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6
Q

A patient is admitted for a head trauma. The patient was in a bar fight and got punched in the face. On PE, there is decreased visual acuity, diplopia upon upward gaze, and noticeable orbital emphysema. The patient is also complaining of epistaxis. A CT is ordered and it reveals something resembling a “teardrop.” What is the best management for this patient?

A
  • Nasal decongestants are the INITIAL tx
  • Educate the patient to NOT BLOW their nose
  • Corticosteroids (reduces inflammation)
  • Antibiotics (Ampicillin/Sulbactam or Clindamycin)
  • Surgical repair: for severe cases
  • enophthalmos or for persistent diplopia
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7
Q

A patient is complaining of dysphagia, and unable to open her mouth completely (trismus). You notice a “hot potato voice” and a deviated uvula. The patient also has anterior cervical lymphadenopathy. What is the best test for this patient?

A

CT scan

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8
Q

A patient is complaining of dysphagia, and unable to open her mouth completely (trismus). You notice a “hot potato voice” and a deviated uvula. The patient also has anterior cervical lymphadenopathy. What is the most likely offending agent?

A

Polymicrobial: Strep pyrogens (GABH) and Staph. aureus

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9
Q

What is the hallmark of laryngitis?

A

Hoarseness

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10
Q

What is the most common cause of laryngitis?

A

Viral: adenovirus, rhinovirus, flu, RSV

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11
Q

What is the gold standard for “strep throat”?

A

throat culture

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12
Q

How is Ludwig’s angina diagnosed?

A

CT scan

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13
Q

What is the tx for Ludwig’s angina?

A

Unasyn: ampicillin/sulbactam
PCN + Metronidazole
Clinda

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14
Q

What can dental infections most commonly cause?

A

Ludwig’s angina

-cellulitis of the sublingual and submaxillary spaces in the neck

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15
Q

A patient is experiencing swelling and erythema of the upper neck and chin with pus on the floor of the mouth. What is the most likely diagnosis?

A

Ludwig’s angina

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16
Q

A 4 year old boy is seen in the ED for mucopurulent discharge. There is a foul odor in the room. The boy tells you his nose was also bleeding. Mom tells you she thinks he stuck a bead up his nose. What is the next step in evaluating the patient?

A

Look in his nose!

  • head light & otoscope
  • rigid or flex fiberoptic endoscopy
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17
Q

A 4 year old boy is seen in the ED for mucopurulent discharge. There is a foul odor in the room. The boy tells you his nose was also bleeding. Mom tells you she thinks he stuck a bead up his nose. What is the management of this patient?

A

Positive pressure technique: close the pts oppostive nostril and have him blow

-Instrumental removal

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18
Q

What are 2 risk factors for posterior epistaxis?

A
  1. HTN

2. Atherosclerosis

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19
Q

What is the most common bleeding site for posterior epistaxis?

A

palatine artery

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20
Q

What tx can be used for epistaxis when it lasts more than 15 min?

A

Topical decongestants/Vasoconstrictors

  • Phenylephrine
  • Oxymetazoline (Afrin)
  • Cocaine *

*cautious use in pts w/ HTN

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21
Q

If a septal hematoma is not removed, what can happen?

A

loss of cartilage

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22
Q

What is the most common rhinitis of all 3 types?

A

Allergic: IgE mediated mast cell histamine release

23
Q

What is the MC cause of infectious rhinitis?

A

Rhinovirus (common cold)

24
Q

A patient is complaining of sneezing, nasal congestion/itchiness and clear rhinorrhea. Upon PE, you notice pale, violaceous boggy turbinates and nasal polyps with cobblestone mucosa of the conjunctiva. What is the most likely diagnosis?

A

Allergic rhinitis

25
Q

A patient is complaining of sneezing, nasal congestion/itchiness and clear rhinorrhea. Upon PE, you notice pale, violaceous boggy turbinates and nasal polyps with cobblestone mucosa of the conjunctiva. What is the best management for this patient?

A

Intranasal sterioids

26
Q

What Allergic rhinitis medications cause rhinitis medicamentosa?

A

Intranasal decongestants = occurs if used > 3-5 days

Oxymetazoline (Afrin)
Phenylephrine
Naphazoline

27
Q

Which sinuses are affected most by acute sinusitis?

A
  1. Maxillary*
  2. Ethmoid
  3. Frontal
  4. Sphenoid
28
Q

What is the most common etiology for acute sinusitis?

A

Same as AOM: S. pneumo*

29
Q

A patient is having sinus pain and pressure that is worse with bending down and leaning forward. The patient is complaining of cheek pain/pressure that radiates down to the upper incisors. Where is this patients sinus infx? What test is needed to diagnose this patient?

A
  1. Ethmoid

CT scan

30
Q

A patient is having sinus pain and pressure that is worse with bending down and leaning forward. The patient is complaining of tenderness to the high lateral wall of the nose. Where is this patients sinus infx?

A

Ethmoid

31
Q

A patient is having sinus pain and pressure that is worse with bending down and leaning forward. The patient is having some CN VI palsy. Where is this patients sinus infx?

A

Frontal

32
Q

A patient is having sinus pain and pressure that is worse with bending down and leaning forward. The patient is complaining of mild head pressure. Where is this patients sinus infx?

A

Sphenoid

33
Q

A patient is having sinus pain and pressure that is worse with bending down and leaning forward. The patient is complaining of cheek pain/pressure that radiates down to the upper incisors. What will you likely see on PE?

A

Opacification with transillumination

34
Q

A patient is having sinus pain and pressure that is worse with bending down and leaning forward. The patient is complaining of cheek pain/pressure that radiates down to the upper incisors. What is the management of this patient?

A

Symptomatic

If longer than 10 days: Amoxicillin
2nd line: Doxy or Bactrim

35
Q

What is Labrinthitis?

A

Vestibular neuritis = inflammation of the vestibular portion of CN 8; MC after a viral infx

Vestibular neuritis + hearing loss/tinnitis*

36
Q

A patient is experiencing peripheral vertigo (continuous), dizziness, has N/V and is walking funny. She is also complaining of hearing loss. What is the most likely diagnosis? A what is the management of this patient?

A

Labrinthitis

  • Corticosteroids are 1st line
  • If sxs: Antihistamines: Meclizine or Benzos
37
Q

A child with a foreign body in their ear will have what kind of hearing loss?

A

Conductive hearing loss

38
Q

Where does tympanic membrane rupture most commonly occur?

A

At the pars tensa

39
Q

What should you avoid after a tympanic membrane rupture?

A
  • water
  • moisture
  • topical aminoglycosides
40
Q

Conduction hearing loss occurs with a tympanic membrane perforation. What Weber and Rinne results is this?

A

Weber: lateralization to the affected ear

Rinne: BC > or = AC

41
Q

What medications can be used for Vertigo, a false sense of motion?

A

1st Line: Antihistamines: Meclizine

  1. Dopamine agonists: Metroclopramide, Prochlorperazine or IV Promethazine (Phenergan)
  2. Anticholinergics: Scopolamine (good for motion sickness)
42
Q

What is episodic vertigo + hearing loss?

A

Meniere’s disease

-sxs tx

43
Q

What is continuous vertigo with no hearing loss?

A

Vestibular neuritis

44
Q

What is episodic vertigo with no hearing loss?

A

BPPV –MCC of vertigo

Tx via Epley maneuver

45
Q

What is the most common cause of Mastoiditis?

A

Usually a complication of prolonged or inadequately treated otitis media

46
Q

What is the abx tx for AOM and Mastoiditis?

A

Amoxicillin is the 1st line
Augmentin is 2nd line

  • Cefixime in children
  • Erythromycin-sulfamethoxazole if PCN allergic
47
Q

A DM patient with a hx of HIV is diagnosed with osteomyelitis at the skull base. What is the most likely organism?

A

Pseudomonas

48
Q

A DM patient with a hx of HIV is diagnosed with osteomyelitis at the skull base. What is the management of this patient?

A

Ceftazidime

Piperacillin +Fluoroquinolone OR Aminoglycoside

49
Q

What is the management for a pt who is diagnosed with Swimmers ear?

A

Otitis media: Ciprofloxacin/Dexamethazone

Ofloxacin if there is a TM perforation

50
Q

What is the most common cause of Keratitis/Corneal ulcer?

A

Bacterial*

Pseudomonas or acanthamoaba (contact lens wearers)

51
Q

A patient presents with pain, photophobia, reduced vision loss, tearing, and conjunctival erythema. There is ciliary injection (limbic flush) and a corneal ulceration is seen on a slit lamp exam. A hazy cornea is seen. What is the most likely diagnosis and what is the tx?

A

Bacterial ulcer/keratitis

Fluoroquinolone drop (Moxifloxacin) 
Do not patch the eye!
52
Q

A patient presents with pain, photophobia, reduced vision loss, tearing, and conjunctival erythema. There is ciliary injection (limbic flush) and a corneal ulceration is seen on a slit lamp exam. Dendritic lesions with branching seen with fluorescein staining is seen. What is the most likely diagnosis and what is the tx?

A

HSV keratitis/ulcer

topical antivirals: Trifluridine
PO acyclovir

53
Q

A patient is seen with purulent optic discharge and lid crusting. On PE, there is an absence of ciliary injection but no visual changes. What is the most likely diagnosis?

A

Bacterial conjunctivitis

Erythromycin
Moxifloxacin (Vigamox)

54
Q

If there is an “ice rink” on fluorescing staining, what is this indicative of?

A

Corneal abrasion

EM Rotation 2018 (7 decks)

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