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EM/Surg > EENT Emergencies (Exam #1) > Flashcards

EENT Emergencies (Exam #1) Flashcards

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1
Q

What condition involves conjunctival injection/ciliary flush, dendritic lesions on slit lamp with fluorescein?

A

Herpes Simplex Keratitis

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2
Q

What is the recommended pharm treatment for Herpes Simplex Keratitis (3)?

A

EMERGENT referral

  • Acyclovir 3% ophthalmic ointment
  • Ganciclovir 0.15% gel
  • Acyclovir 400mg (oral)
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3
Q

What five eye trauma conditions warrant an emergent/urgent referral?

A
  • Herpes Simplex Keratitis
  • Orbital Cellulitis
  • Open Globe Rupture
  • Acute Angle Closure Glaucoma
  • Retinal Detachment
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4
Q

What medication should be avoided in the treatment of Herpes Simplex Keratitis?

A

NO topical steroids

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5
Q

What condition involves severe bilateral eye pain; photophobia, FB sensation?

A

UV Keratitis (Photokeratitis)

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6
Q

What condition involves superficial punctate staining of cornea on slit lamp with fluorescein?

A

UV Keratitis (Photokeratitis)

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7
Q

What is the recommended treatment for UV Keratitis (Photokeratitis)? What is the recommended follow up?

A

Supportive care

- Close F/U (1-2 days)

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8
Q

What condition involves unilateral periorbital edema with erythema/warmth/tenderness?

A

Preseptal/Orbital Cellulitis

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9
Q

What condition can be a complication of sinusitis, local or extension of infection?

A

Preseptal/Orbital Cellulitis

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10
Q

What condition involves anterior to orbital septum; swelling of eyelids and upper cheek?

A

Preseptal Cellulitis

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11
Q

What condition involves vision loss, impaired EOMs, diplopia, proptosis?

A

Orbital Cellulitis

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12
Q

What is the recommended diagnostic test for Preseptal/Orbital Cellulitis?

A

CT WITH contrast (of orbits and sinuses)

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13
Q

With Preseptal Cellulitis and Orbital Cellulitis, which is an emergency? How does treatment differ for each?

A

Preseptal Cellulitis
- Home with oral abx, ophthalmology follow up within 1-2 days

Orbital Cellulitis = EMERGENCY
- Admit with IV abx, consult

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14
Q

What condition involves severe eye pain, FB sensation; can have impaired vision?

A

Corneal Abrasion or Ulceration

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15
Q

Differentiate Corneal Abrasion from Corneal Ulceration.

A
  • Abrasion: defect on corneal surface epithelium

- Ulceration: deeper = break in epithelium exposing underlying corneal stroma

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16
Q

What two tests can be used to diagnose Corneal Abrasion or Ulceration?

A
  • Slit lamp with fluorescein

- Woods Lamp

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17
Q

What are the three recommended treatments for Corneal Abrasion or Ulceration? What three treatments are NOT recommend?

A
  • Topical lubricants
  • Topical abx
  • Oral pain meds

NO topical anesthetics, steroids or patching

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18
Q

What five topical abx can be used to treat Corneal Abrasion or Ulceration?

A
  • Erythromycin ointment
  • Sulfacetamide
  • Polymyxin/Trimethoprim
  • Cipro
  • Ofloxacin drops
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19
Q

Under what four conditions should a patient with Corneal Abrasion or Ulceration be referred?

A
  • Large/nonreactive or irregular pupil
  • Impaired visual acuity
  • Ulceration
  • Patient wears contacts
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20
Q

What type of injury is often associated with an eyelid laceration, and what should be ruled out?

A

Eyelid Laceration often includes ocular injury

- R/O globe injury

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21
Q

What three characteristics constitute an uncomplicated Eyelid Laceration?

A
  • Superficial
  • Horizontal
  • Follows skin lines
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22
Q

For Eyelid Laceration, if it is <25% of the eyelid, what is the recommended treatment? What if it is 25+%?

A
  • <25% of lid = triple abx ointment

- 25+% of lid = repair using 6-0 fast absorbable plain gut suture

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23
Q

Under what seven conditions should a patient with Eyelid Laceration be referred (considered complicated)?

A
  • Full thickness
  • Lac with orbital fat prolapse
  • Lac through lid margin
  • Lac through tear drainage system
  • Orbital injury
  • FB present
  • Laceration with poor alignment
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24
Q

What is a “Blowout” Fracture?

A

Orbital Floor Fracture

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25
What four findings may be seen with an Orbital Floor Fracture?
- Entrapment of inferior rectus muscle - Enophthalmos - Orbital dystopia (eye is lower) - Injury to infraorbital nerve
26
What diagnostic tool can be used for an Orbital Floor Fracture?
Thin cut coronal CT of orbits
27
With what condition should you AVOID pressure to eyeball (no eyelid retraction or IOP measurement)?
Open Globe Rupture
28
What diagnostic tool can be used for an Open Globe Rupture?
Axial/coronal CT of eye WITHOUT contrast
29
What three medications can be used to treat an Open Globe Rupture? What medication should be avoided?
- Start abx - IV antiemetics (Ondansetron) - Pain meds (NO NSAIDs)
30
What condition is an inflammatory and demyelinating condition; high association with MS?
Optic Neuritis
31
What condition involves acute/monocular vision loss over hours/days (peaks at 1-2 weeks)?
Optic Neuritis
32
What condition involves eye pain worse with movement, afferent pupillary defect, dyschromatopsia?
Optic Neuritis
33
What is the recommended treatment for Optic Neuritis? What medication should be avoided?
Steroids (IV Methylprednisone) | - NO oral steroids
34
What condition involves high IOP (30+ mmHg), optic nerve damage?
Acute Angle Closure Glaucoma
35
What condition involves decreased vision, halos around lights, HA, severe eye pain, N/V, red eye, corneal edema/cloudy?
Acute Angle Closure Glaucoma
36
What is the gold standard diagnostic test for Acute Angle Closure Glaucoma?
Gonioscopy
37
What is the recommended treaetment for Acute Angle Closure Glaucoma?
Oral/IV Acetazolamide
38
What condition involves sudden onset floaters?
Retinal Detachment
39
What is the recommended diagnostic tool for Retinal Detachment?
US
40
What condition involves hearing loss, ear pain/drainage?
FB of EAC
41
What is the most common etiology of Acute Otitis Externa (AOE)? What is an alternative etiology?
Bacterial = Pseudomonas aeruginosa | - Viral = Ramsey-Hunt (HZV)
42
What is the recommended treatment for Acute Otitis Externa (AOE) (2)?
- Debridement | - Abx drops (Ciprodex/CiproHC drops) +/- otowick
43
What is the most common etiology of Malignant Otitis Externa (MOE)? In what three populations is this more common?
Bacterial = Pseudomonas aeruginosa | - More common in elderly, DM, IC
44
What condition involves acutely ill + AOE sxs; ear canal granulation tissue?
Malignant Otitis Externa (MOE)
45
What is the recommended treatment for Malignant Otitis Externa (MOE) (3)?
- Admit - Debridement - Abx (Cipro 400mg IV Q8 hours then 750mg PO Q12 hours = 6-8 weeks)
46
What is the dosage for abx in treatment of Malignant Otitis Externa (MOE)?
Cipro 400mg IV Q8 hours | - THEN 750mg PO Q12 hours = 6-8 weeks
47
What two diagnostic tests should be added for Malignant Otitis Externa (MOE)?
- Cultures | - CT Head (R/O osteomyelitis)
48
What condition involves pain, hearing loss, N/V, vertigo, otorrhea, tinnitus?
TM Perforation
49
What condition involves direct visualization of TM, audiogram; if head trauma, consider CT and CSF drainage?
TM Perforation
50
What is the recommended treatment for TM Perforation (2)?
- Self-limiting + water precautions vs. - Otolaryngology
51
What condition involves blood collects in cartilage?
Auricular Hematoma
52
What condition is Cauliflower Ear a nickname for?
Auricular Hematoma
53
What is the recommended treatment for Auricular Hematoma? What is the recommended follow up?
Drain/aspirate ASAP | - F/U every 24 hours for 3-5 days
54
What condition involves acute inflammation/infection of auricular cartilage? What is the most common bacterial pathogen if infection is present?
Perichondritis | - Pseudomonas aeruginosa
55
What condition involves erythema, pain +/- abscess formation of ear, systemic sxs?
Perichondritis
56
What is the recommended treatment for Perichondritis (2)?
- I&D (if needed) | - Empirical abx (Cipro)
57
What condition involves mucopurulent nasal discharge, foul odor, epistaxis, nasal obstruction?
Nasal FB
58
What is the more common type of Epistaxis, and what area is most affected?
Anterior | - Kiesselbach’s plexus
59
If packing is required for Epistaxis, what is the recommended tx and removal time?
- Abx | - Remove in 3 days vs. 5 days (3 = normal patient, 5 = anticoagulated patient)
60
If a patient presents with nasal trauma, what two treatments should be performed immediately (if present/needed)?
- Repair lac | - Closed reduction
61
What nose/sinus trauma is more common in peds?
Septal Hematoma
62
What treatment is recommended for Septal Hematoma, and what is this used to prevent?
- I&D to prevent avascular necrosis of septum
63
What are two possible risks/complications associated with a Septal Hematoma?
- Risk of perforation | - “Saddle nose” deformity
64
Although typically diagnosed clinically, what diagnostic test can be used for Mastoiditis?
CT head WITH contrast
65
What is the recommended treatment for Mastoiditis (2)?
- Refer to ENT | - Start empirical abx
66
What two abx are recommended for treatment of Periodontal Abscess?
- Augmentin | - Clindamycin
67
What oral cavity trauma is considered an emergency?
Dental Injury/Avulsion
68
For tongue laceration, under what four conditions should a repair be performed?
- Large (1+ cm) - Muscular involvement - Large flap/gap - Significant hemorrhage
69
For Tetanus prophylaxis, when should it always be given? If the last 3+ doses are known, when would you give it (clean/minor vs. all others)?
ALWAYS if <3 previous doses/unknown IF 3+ previous doses known... - Clean/minor, only if last dose was given 10+ years ago - All other wounds, only if last dose was given 5+ years ago

EM/Surg (16 decks)

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