ENT Emergencies

Question 1

What is the main sign that a patients ear pain is reffered?

Answer 1

A normal ear exam

Question 2

What is the treatment for an ear abscess?

Answer 2

I&D and antibiotics

Question 3

A patient presents with sudden hearing loss and severe pain after they were playing the “slap” game with friends. What is the likely dx and treatment?

Answer 3

ruptured tympanic membrane (tympanic perforation)
tx is ABX drops to avoid infection and allow to heal on its own

Question 4

A patient presents with sudden deafness, and paralysis on the left side of their face. Upon exam you see vesicles inside the left ear. What is the dx and tx?

Answer 4

Ramsey Hunt syndrome (herpes zoster otticus)
Valacyclovir and prednisone (antiviral and steroids)
*ENT consult, too!

Question 5

A patient presents to the ED with acute ear pain, discharge, and states they were diagnosed with “swimmers ear” and took their prescribed ABX but pain has returned and now the ear is insanely itchy. What is the likely dx that the first provider missed, what will you see on ear exam, and what is the tx?

Answer 5

DX is likely fungal ear infection (otomycosis)
exam will show little fuzzies in ear (usually black or yellow dots)
TX is acetic acid or clotrimazole drops

Question 6

A patient Presents with pain, swelling, drainage, inflammation, and you see narrowing and redness of the external auditory canal. What is the likely dx and tx?

Answer 6

otitis externa
ABX drops or ABX wick if ear is closed shut

Question 7

A patient presents with severe ear pain that feels like its spreading into their head, they report green, smelly ear discharge, and their hx is positive for diabetes. What is the likely dx and tx for this condition?

Answer 7

malignant otitis externa
tx is to admit to hospital for IV ABX because this can cause necrosis of bone

Question 8

What is the pathogen that causes malignant OE?

Answer 8

pseudomonas aeruginosa

Question 9

Which ear infection is hearing loss a common complaint?

Answer 9

otitis media

Question 10

A patient presents with gradual hearing loss, ear pain, and drainage from the painful ear. No trauma is reported. What is the likely dx, PE finding, and tx?

Answer 10

otitis media
See white fluid behind TM
tx is augmentin

Question 11

A 7y/o patient presents to the ED with a recent middle ear infection. Today they have a fever and appear ill. Their ear is TTP, and upon exam you see redness and swelling behind the ear. This child needs a CT, what will it show, what is the likely dx, and tx?

Answer 11

CT shows coalescence of mastoid air cells
dx is mastoiditis
tx is Admit to hospital, give IV ABX, and ENT consult

Question 12

A patient presents with a CP of an intensely painful left ear, PE of outer ear is NL, but upon otoscope exam you see blisters on the ear drum. What is the DX and TX for this condition?

Answer 12

Bullous myringitis
Opioids for px and MACROLIDE ABX

Question 13

A patient presents to the ED with hearing loss in the right ear with no trauma, no pain, fever, or drainage, and on PE you see amber fluid and bubbles when the PT tries to clear ears. What is the likely DX and tx?

Answer 13

OM with effusion (non-infectious OM)
watchful waiting for self-resolution; or can consult to ENT for tube and drainage (not in ED)

Question 14

This condition causes hearing loss from rapid pressure from negative pressure (flying) will show bloody effusion on exam; & can take 1-2 months to heal?

Answer 14

barotrauma

Question 15

This type of hearing loss is an emergency consult to ENT & is confirmed dx when tuning fork sound travels to good ear but is absent in effected ear?

Answer 15

Sudden sensorineural hearing loss

Question 16

What are the three causes of vertigo?

Answer 16

BPPV; Meiner’s, labyrinthitis

Question 17

This type of vertigo lasts 15-20 seconds and is initiated when the PT lays down?

Answer 17

Benign paroxysmal positional vertigo

Question 18

What is the diagnostic test and tx for BPPV?

Answer 18

DX: dix Hallpike maneuver-will see nystagmus for + result

TX: Epley maneuver

Question 19

This type of vertigo can last up to 8H, is caused by an increase in endolymphatic fluid that causes the PT to feel ear fullness, and is treated with low salt diet and diuretics?

Answer 19

Menier’s

Question 20

Vertigo accompanied by sensorineural hearing loss that last 24-48H and is debilitating?

Answer 20

labyrinthitis

Question 21

What is the only type of vertigo that presents with hearing loss?

Answer 21

Labyrinthitis

Question 22

What is Vestibular neuronitis?

Answer 22

severe debilitating vertigo 24-48H long; NO HEARING LOSS

Question 23

A nasal fracture must be fixed within ___H or ___ days of trauma?

Answer 23

3H or 7 days (before and after major swelling)

Question 24

A two year old presents to the ED with epistaxis, chronic nasal discharge and a foul odor coming from their left nostril. What is the likely cause of this condition?

Answer 24

foreign object in the nose

Question 25

Most common location of nose bleed and treatment?

Answer 25

Anterior
Pinch front of nose and lean forward

Question 26

What are the indications for giving ABX in a case of sinusitis (3 reasons)?

Answer 26

Had sx for 10 days or more
had fever for 3-4 days
Sx resolved then got worse in a couple days (double sick)

Question 27

This type of tooth fracture is when the tooth is in the socket but not in correct space; fell out and you just push tooth into place and do dental splinting?

Answer 27

subluxation

Question 28

This tooth trauma is when a tooth is out of socket completely?

Answer 28

avulsion

Question 29

What is angioedema and how is it treated?

Answer 29

Rapid swelling of oral tissue (lips, tongue)
Give Benadryl, steroids, and establish airway

Question 30

A patient presents with <5 days of sore throat, fever, cough, congestion, and has a positive rapid strep test. What is the dx and tx?

Answer 30

Strep pharyngitis
penicillin

Question 31

A patient present with a hot potato voice, trismus, drooling. Upon exam you see the back of the throat is deviated. What is the likely dx and tx?

Answer 31

peritonsillar abscess
tx with I&D and ABX

Question 32

What are signs of a retropharyngeal abscess?

Answer 32

nuchal rigidity, stridor, sore throat, drooling, very ill appearing patient

Question 33

What is an abscess of spaces under tongue that blocks the airway?

Answer 33

Ludwig’s angina

Question 34

This presents with a barking cough in children & can cause cyanosis and death if child cannot breath?

Answer 34

Laryngotracheitis or “Croup”