EENT trigger Flashcards by Billie Roberts

pain with EOM is a red flag for what diagnosis

orbital cellulitis

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Antiparkinsons, antispasmodics, antipsychotics, MAOIs and TCAs all increase the risk of what disorder?

glaucoma

also dilating eye drops

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treat with keflex or augmentin. PCN allergy = clinda

periorbital cellulitis (OUTPATIENT adults and older children w/ mild symptoms)

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IV rocephin OR Unasyn +vanc OR FQ + metro/clinda (PCN allergy)

periorbital cellulitis for young children/severe presentation
orbital cellulitis (add topical nasal decongestant)

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when is the only time you use HOT or warm compresses?

HOT = periorbital cellulitis
Warm = hordeolum or chalazion

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a young child presents with a hx of maxillary sinusitis and now has symptoms of erythema, edema and pain with movement of the eye. The child will not hold still long enough for a proper exam. What imaging will be used for this child? will you use contrast?

orbital CT and YES YOU WILL USE CONTRAST

this is suspicious of orbital cellulitis

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when do you treat with polymyxin B?

bacterial conjunctivitis

unless they wear contact lenses, then treat with FQ or tobramycin d/t pseudomonas

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when do you treat with topical antihistamines

viral conjunctivitis and allergic conjunctivitis

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when do we see preauricular lymphadenopathy

HSV keratoconjunctivitis
viral conjunctivitis

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ciliary flush with diminished VA and poor pupillary reactivity to light. photophobia is also present

anterior uveitis/iritis

“ciliary flush”
“consensual photophobia”
poor reactivity to light = miosis
diminished VA = clouding of aqueous humor

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intense itching with papillae on inferior conjunctiva and cobblestoning

allergic conjunctivitis

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photophobia with consensual photophobia is hallmark for which diagnosis. what else would you see in these patients?

Iritis/ anterior uveitis

also see:
conjunctival injection/ciliary flush
miosis w poor reactivity
diminished VAs d/t clouded aqueous humor

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pt presents with periorbital edema but no chemosis and IOP is normal. you decide to treat them outpatient but they have a PCN allergy, what will you treat them with?

Clindamycinnnn

this is periorbital cellulitis

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Slit lamp exam shows keratic precipitates and aqueous flares. you could also see hypopyons in these patients

anterior uveitis / Iritis

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3 year old patient presents with periorbital edema and erythema. Orbital CT is negative for orbital cellulitis. you decide to still admit this patient d/t their young age and presentation. you find they have a PCN allergy, what is the tx

FQ + Metro/clinda

periorbital cellulitis

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when would you use prednisolone drops and a long acting cycloplegic (cyclogyl, cyclopentolate or homatropine)?

anterior uveitis (iritis)

remember anterior uveitis can be seen in other diagnoses such as HZV ophthalmicus and blunt eye trauma. prednisolone would also be given if it is seen in those scenarios.

DO NOT give topical steroids if infectious anterior uveitis or if there is an abrasion or elevated IOP.

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Fluorescein stain shows a staining defect with a white hazy infiltrate.

can also see hypopyon or iritis

corneal ulcer (culture this ulcer!!!!)

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When do we use ophthalmic FQs (ofloxacin, cipro or tobramycin) and topical cycloplegics

corneal ulcers

ALSO for contact wearers who develop bacterial conjunctivitis or a corneal abrasion

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when should we avoid eye patching and topical steroids

corneal ulcers

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fluorescein stain shows geographic ulcer upake pattern

HSV keratoconjunctivitis

you could also see a dendritic lesion uptake

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topical trifluridine (viroptic) with erythromycin ointment along with oral acyclovir is used in what diagnosis?

HSV keratoconjunctivitis

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what nerve does HZV ophthalmicus affect

V1 of the trigeminal nerve

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Fluorescein stain shows small, elevated dendrites with no terminal bulbs or central ulcerations.

herpes zoster ophthalmicus (these stain findings are called peudodendrites)

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slit lamp showing diffuse, punctate corneal edema. Fluorescein shows punctate corneal abrasions

UV keratitis

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when do we use ketorolac drops with erythromycin ointment?

corneal abrasions. (unless contact wearer, then FQ/tobra) DO NOT PRESCRIBE TOPICAL ANESTHETICS TO THESE PATIENTS!!!!

when is the seidel test indicated

any time there is a suspected globe perforation such as with a corneal foreign body. this test reveals leakage of the aqueous humor.

when do you treat with oral keflex, erythromycin and a cold compress

lid laceration (also stitch it up w soft 6/7-0 sutures if its >1mm)

tear drop pupil and limited EOM suggest what diagnosis? what test can confirm

globe rupture seidel test can confirm as long as the wound is unsealed if you have one of these you also wanna get a CT scan of the orbit

Vanc + ceftazidime + zofran

globe rupture give eye shield, NPO, sit upright (avoid IOP increase) emergent oph consult

restricted upward/lateral gaze with associated bruising around the eye suggest what diagnosis

orbital blow out fracture

when would we get a CT of facial bones WITHOUTTTT contrast

blunt eye trauma

Cupping of the optic disc on PE

glaucoma

describe sniffing position

lean forward neck neutral nose straight

sudden onset eye pain with fixed midposition pupil and a hazy cornea. PE shows increased IOP

Acute angle closure glaucoma you would also see halos around lights with nausea and vomiting

sudden onset eye pain w halos around lights and N/V

acute angle closure glaucoma also: increased IOP fixed midposition pupil HA sudden onset eye pain

Gonioscopy showing iridocorneal angle

gold standard test for acute angle closure glaucoma

definitive tx is laser peripheral iridotomy

acute angle closure glaucoma

painless color vision loss with a positive afferent pupillary defect and a swollen optic disc on exam

anterior optic neuritis (retrobulbar ON has a normal optic disk)

painless color vision loss with a positive afferent pupillary defect and a normal optic disc on exam

retrobulbar optic neuritis (anterior ON has a swollen optic disc)

cherry red spot on exam with segmented arterioles in a boxcarring fashion

central retinal arterial occlusion

diffuse retinal hemorrhages on fundoscopic exam

central retinal vein occlusion (this is a blood and thunder fundus)

floaters, flashes of light and a dark veil/curtain sensation. PE shows visual field by confrontation has been affected

retinal detachment

tenderness of external ear that is worse w auricle palpation

acute otitis externa also: clear/purulent discharge erythema/edema of external canal

tx for AOE

* tylenol/motrin * oflox or cipro drops * acetic acid or hydrocortisone drops * ear wick

CI in perforated TM or when TM cant be visualized

ciprofloxacin hydrocortisone (you CAN use ofloxacin)

CT head w contrast shows bone erosion

malignant otitis externa

IV tobramycin + piperacillin or rocephin or cipro

malignant otitis externa

fever and otalgia with a bulging and erythematous TM

Acute otitis media

tx with amoxicillin or cefdinir if PCN allergy

acute otitis media tx w augmentin if recent abx use or recurrent OM

postauricular pain, swelling, erythema and tenderness w associated otalgia and fever

acute mastoiditis

CT head WITH contrast shows loss of bony septae and periosteal thickening.

acute mastoiditis also shows mastoid clouding and destruction/irregularity of mastoid cortex

granulation tissue on the floor of the ear canal is suggestive of what diagnosis

malignant otitis externa

external auditory canal with bullae that spread along the TM. pt has severe otalgia and middle ear infusion

bullous myringitis

sudden onset pain and hearing loss with vertigo and tinnitus. possible bloody otorrhea

TM perforation

MC area is kiesselbachs plexus

anterior nose bleed

MC area is sphenopalantine artery

posterior nose bleed

bilateral nose bleed and bleeding into the nasopharynx

posterior nose bleed

when is a lateral canthotomy used

orbital cellulitis with increased IOP or optic neuropathy

hemodynamic instability is MC in which type of epistaxis

posterior

pt presents with a hx of purulent drainage from the right eye. you see that the conjunctiva are injected however hte cornea is clear w/o flourescent uptake. the pt wears contacts, what is the treatment

FQ or tobramycin

oxymetazoline or phenylephrine is used in what scenario

management of epistaxis (vasoconstrictor)

CI in active hemorrhage, bilateral bleeding, recent cauterization

chemical management of anterior epistaxis (silver nitrate) ONLY USED IN ANTERIOR NOSE BLEEDS

thrombogenic foam, oxidized cellulose and floseal gelatin matrix are all used when

anterior epistaxis when chemical cauterization w silver nitrate fails. can also do nasal packing at this point

what muscle can become entrapped with an orbital blowout fracture

inferior rectus

a 72 year old diabetic pt comes to your office complaining of a continued ear infection despite being on otic ofloxacin for like 2-3 weeks. on exam you see granulation tissue resting on the floor of the ear canal. What imaging do you get to confirm diagnosis on this patient? what will you see? what cranial nerve is known to sometimes be affected in these pts?

CT head **WITH WITH WITH WITH** CONTRAST youd see bone erosion because this dude has malignant otitis externa sorry for the yelling. my brain refuses to remember that this is with contrast. cranial nerve VII

A patient who presented with a posterior nose bleed is now undergoing nasal packing. the plan is to leave it in for 3 days. what should this patient also be sent home with.

* augmentin or cephalosporin or bactrim * DO NOT TAKE NSAIDS

contralateral deflection of uvula with associated unilateral tonsillar enlargement suggests what diagnosis.

peritonsillar abscess

muffled voice with cervical adenopathy and neck pain. may also see respiratory distress and stridor

retropharyngeal abscess

can be assessed with a neck Xray, however hte gold standard testing for this diagnosis is a CT neck WITH contrast

retropharyngeal abscess with contrast with contrast with contrast

immaging shows nonsuppurative edema, mild fat stranding and linear fluid.

retropharyngeal abscess early on later on will see: necrotic nodes, low attenuation, ring enhancement ct neck WITH contrast

prep for airway placement in these patients and administer IVF, IV clinda and cefoxitin. what is this diagnosis? what is used if they have PCN allergy

this is retropharyngeal abscess. if PCN allergy use zosyn or unasyn

anterior neck tenderness with progressive dysphagia and dyspnea. pt is sitting criss cross and leaning forward on arms to aid in breathing. what is dx, diagnostic studies, and tx

epiglottitis neck Xray showing thumbprint sign prep airway, humidified O2, IVF and give IV cefotaxime + vanc + methylprednisolone give resp FQ if PCN allergy

Xray shows thumbprint sign. what is the Gold standard for this diagnosis?

transnasal fiberoptic laryngoscopy this is epiglottitis

When do you use IV glucagon?

relaxation of the LES to hopefully allow a swallowed FB in the distal esophagus to pass

when is IVF, NPO unasyn + clinda + cipro used?

TOXIC odontogenic abscesses nontoxic = oral PCN VK or amoxicillin or clinda for PCN allergy

what swallowed items warrant an emergent endoscopy and surgery consult

food impaction coins sharp objects

when do you see ludwigs angina and what does it consist of?

Odontogenic abscess includes: trismus, fever, edema of floor, displacement of tongue)