Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

X Emergency Med Exam 2 > ENT Emergencies > Flashcards

ENT Emergencies Flashcards

1
Q

Cause of herpes simplex keratitis

A

HSV-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Presentation of herpes simplex keratitis

A

Acute onset of eye pain, photophobia, blurred/decreased vision and clear tearing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is assumed about herpes simplex keratitis?

A

That it is recurrent (due to a past infection that is living in the trigeminal ganglion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Physical exam for herpes simplex keratitis

A

Conjunctival infection (ciliary flush)
Decreased corneal sensation
Slit-lamp with fluorescein dendritic lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is ciliary flush?

A

Red/violet ring around the cornea that gets worse as the herpes infection gets worse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Tx for herpes simplex keratitis

A

Urgently refer to ophtho
Use topical or oral antivirals
Corneal transplant (if severe scarring or perforation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What to remember about the tx of herpes simplex keratitis

A

NO TOPICAL GLUCOCORTICOIDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cause of UV keratitis (photokeratitis)

A

UV radiation exposure (epithelial layer takes it in and gets damaged)
-Think with tanning bed, water skiing or skiing without goggles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Presentation of UV keratitis

A

Bilateral intense eye pain (unable to open-maybe during the night it comes on)
Photophobia
FB sensation
Distraught, packing or rocking secondary to severe pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is seen on the penlight exam in UV keratitis?

A

Tearing, generalized infection and chemosis (edema) of the bulbar conjunctiva (conjunctivitis would also affect palpebral so differentiates)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Other physical exam components for UV keratitis

A

Cornea (mildy hazy)
Fluorescein (superficial punctuate staining of cornea)
Pupils may be miotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Tx of UV keratitis

A

Supportive b/c resolve in 24-72 hrs
Oral analgesics for pain (may nee oral opioid like oxycodone but transition to NSAID)
Lubricant abx ointment
Prevention education and f/u in 1-2 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

General presentation of preseptal and orbital cellulitis

A

Unilateral periorbital edema with erythema, warmth and tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What can preseptal and orbital cellulitis result from?

A

Complication of sinusitis, extension of infection from adjacent structure or local disruption of skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Difference in presentation between preseptal and orbital cellulitis

A

Preseptal (usually <5): tissues anterior to the orbital septum with swelling of eyelids and upper cheek
Orbital (>5): structures deep to the orbital septum so see vision loss, impaired EOMs, diplopia and proptosis!!!–usually will have a fever too

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What test will differentiate preseptal and orbital cellulitis?

A

CT scan of orbits and sinuses with contrast! (orbital is a true emergency!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Tx of preseptal cellulitis

A

Mild/no systemic sxs: discharge home

Oral abx and follow up 24-48 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Tx of orbital cellulitis (or preseptal with concerning factors)

A

Admit and IV abx

Consult ophtho and ENT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does corneal abrasion/ulceration result from?

A

Eye trauma, FBs or improper contact lens use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is damaged in a corneal abrasion?

A

Thin protective coating of anterior ocular epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is damaged in a corneal ulceration?

A

Break in the epithelium exposing the underlying corneal stroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Sxs of corneal abrasion/ulceration

A

Severe eye pain and FB sensation

Can lead to impaired vision secondary to scarring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Parts of PE for corneal abrasion/ulceration

A 
Penlight exam
Visual acuity
EOMs
Fundoscopic to confirm red reflex
Flourescein exam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is seen on the penlight exam for corneal abrasion/ulceration?

A

Do this prior to fluorescein stain application!
Anterior chamber is clear, deep and normal contour
Pupil is round with clear tears
Mild conjunctival infection if >2 hrs
Ciliary flush if several hrs old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the fluorescein exam?
Fluorescein stains the basement membrane which is exposed in areas of epithelial defect Visualization is enhanced with cobalt blue filter and maybe use Woods lamp
26
When do you need an urgent ophtho referral with corneal abrasion/ulceration?
Signs of penetrating of significant blunt trauma (large, nonreactive pupil or irregular pupil) Impaired visual acuity Ulceration Contact lens wearer (to rule out infiltrate or opacity-do daily until healed)
27
What are contact wearers at increased risk for?
Pseudomonas infection
28
Tx for corneal abrasion
Topical abx (erythro ointment, sulfacetamide, polymixin, cipro, ofloxacin) Optional narcotics NO TOPICAL ANESTHETIC OR STEROID
29
What is present in 2/3 of lid laceration pts?
Ocular injury
30
What to remember with lid lacerations?
Exclude a globe injury Low threshold for CT of the orbits Don't attempt complicated lacerations Know the anatomy
31
What is an uncomplicated lid laceration?
Superficial laceration that is horizontal and follows skin lines
32
Tx for uncomplicated lid laceration if <25% of lid can heal by secondary intention
Clean and apply triple abx ointment | Consider adhesive surgical tape
33
Tx for uncomplicated lid laceration if >25% repairs with absorbable plain gut suture
Simple interrupted or running sutures within 24 hrs | Remove in 5-7 days if non absorbable
34
When to refer to ophtho/surgeon with lid lacerations?
``` Full thickness lid lacerations Lacerations with orbital fat prolapse Lacerations through lid margin Lacerations through tear drainage system Orbital injury (hemorrhage or chemosis) FB Laceration with poor alignment ```
35
Another name for orbital floor fracture
Blowout fracture
36
Significant findings for orbital floor fracture
Entrapment of inferior rectus muscle Enopthalmos Orbital dystopia (eye is lower) Injury to infraorbital nerve secondary to fracture
37
What can happen with untreated entrapment of inferior rectus?
Ischemia and subsequent loss of muscle function
38
When might you see enophthalmos?
With posterior globe displacement
39
When does orbital dystopia occur?
As entrapped muscle pulls the eye down
40
What does a pt with injury to intraorbital nerve secondary to the orbital fracture look like?
Decreased sensation to cheek, upper lip and upper gingiva
41
In which patients do you a thin cut coronal CT on the orbits?
``` Evidence of fracture on exam (step off or extreme pain) Limitation of EOMs Decreased visual acuity Severe pain Inadequate exam due to swelling or AMS ```
42
Tx for orbital floor fracture
Surgical eval Prophylactic abx to cover sinus pathogens Cold packs for first 48 hrs Raise head of bed Avoid blowing nose/sniffing (extra pressure)
43
After what does an open globe rupture happen?
Blunt eye injury (think baseball player)
44
Diagnostic for open globe rupture
Axial and coronal CT of the eye without contrast
45
Tx for open globe rupture
Initiate abx, NPO, no solutions in eye Emergent ophtho consult and transfer to tertiary trauma center Eye shield (no manips) Bed rest IV emetics Pain meds (avoid NSAIDs b/c increase bleeding risk) Sedation as needed
46
What is optic neuritis associated with?
Inflammatory demyelinating condition with high association with multiple sclerosis
47
Sxs of optic neuritis
Acute, monocular vision loss sometimes bilaterally (hrs to days and pks within 1-2 wks) Eye pain worse with eye movement Afferent pupillary defect (direct response to light is sluggish in affected eye) Dyschromatopsia (loss/reduced color vision)
48
Differentials for optic neuritis over 50 YO
DM, giant cell arteritis, autoimmune
49
Differentials for optic neuritis in young kids
Infectious or post infectious causes
50
How to confirm MS association with optic neuritis?
MRI of brain/orbits with GAD
51
Tx for optic neuritis
Corticosteroids (IV methylprednisolone) | Do not recommend oral prednisone (may increase risk of recurrence)
52
Intraocular pressure for acute angle glaucoma
Normal is 8-12 and in close angle it is >30 mmHg
53
Presentation of acute angle closure glaucoma
``` Decreased vision and halos around lights HA, severe eye pain, red eyes N/v Corneal edema and cloudiness Mid dilated pupil 4-6 mm that reacts poorly to light Shallow anterior chamber *immediate ophtho eval ```
54
What not to do on exam for acute angle closure glaucoma?
No pupillary dilation b/c might exacerabate this
55
Gold standard testing for acute angle closure glaucoma
Gonioscopy (special lens for slit lamp so that they can visualize angle between iris and cornea in order to diagnose it)
56
Tx for acute angle closure glaucoma
Refer pt to ophtho if available in 1 hr If >1 hr delay empirically treat (dif flashcard with meds!!) Oral or IV acetazolamide (check pressures 30-60 min after)
57
Dosing to empirically treat acute angle closure glaucoma by lowering the pressure
1 min: .5% timolol 2 min: 1% apraclonidine 3 min: pilocarpine
58
What happens with retinal detachment?
ischemia and progressive photoreceptor degeneration
59
Presentation of retinal detachment
Sudden onset of floaters (cobweb) Monocular visual field loss Vision loss
60
Most common causes of "FB" in ear
Kids: actual FB Adults: cerumen plug
61
Presentation of FB in ear
Hearing loss | Ear pain and drainage
62
Tx for FB in ear
ID the fb (remove if can see it, neutralize bugs with mineral oil, do not irrigate organic material) Ciprodex or cipro HC gtts if otitis externa
63
Most common cause of acute otitis externa
Pseudomonas
64
Presentation of bacterial otitis externa
Ear fullness and drainage | Pain with tragal motion tenderness
65
Tx of otitis externa
``` Debridement Abx drops (cipro HC maybe with wick) ```
66
Viral cause of otitis externa
Ramsey hunt (herpes zoster virus)-suspicious when not better with abx
67
Presentation of viral otitis externa
Vesicles in ear canal Facial paralysis Hearing loss Vertigo
68
Tx of viral otitis externa
Antivirals Steroids MRI of brain to r/o skull base tumor
69
Who is at high risk for malignant otitis externa?
Elderly Diabetics Immunocompromised
70
Presentation of malignant otitis externa
(also pseudomonas) AOE sxs but pt is acutely ill Ear canal granulation tissue sloughing off
71
Diagnostics for malignant otitis externa
Leukocytosis on CBC Cultures Head CT (osteomyelitis-skull base)
72
Tx for malignant otitis externa
``` Admit and debridement Parenteral abx (Cipro 6-8 wks_ ```
73
Complications associated with malignant otitis externa
``` Cranial neuropathies Brain abscess Meningitis Septicemia Death ```
74
Causes of tympanic membrane perf
Otitis media (b/c it was bulging and then perfed) Closed head injury Direct ear trauma
75
Presentation of tympanic membrane perf
Pain Hearing loss N/v, vertigo Otorrhea and tinnitus
76
Exam for tympanic membrane perf
Direct visualization of TM Audiogram Appropriate components if suspect head trauma (CT and check for CSF drainage)
77
Tx for tympanic membrane perf
Most resolve without tx (<25% total SA will be within 4 wks) Ofloxacin otic drops if indicated Tympanoplasty in refractory cases
78
Cause of auricular hematoma
(cauliflower ear) | Due to blunt force trauma to the auricle (so presents wth collection of blood in the cartilage)
79
Tx for auricular hematoma
Drain/ aspirate ASAP > 7 days (otolaryngologist or plastic surgeon) F/u eval Q24 hrs for 3-5 days No sports for 7 days and f/u if worse
80
What is perichondritis?
Acute inflammation and infection of auricular cartilage | Usually due to pseudomonas (do C&S)
81
Presentation of perichondritis
Erythem and pain Abscess formation Systemic sxs
82
Tx for perichrondritis
``` I&D if indicated Empiric abx (cipro) ```
83
Presentation of nasal FB
``` Mucopurulent nasal discharge Foul odor Epistaxis Nasal obstruction Mouth breathing ```
84
What must be checked with nasal FB?
That lungs are CTAB w/o abnormal breath sounds
85
When do you need diagnostics with a nasal FB?
Usually not if it is fully visible | Is suspect button battery or magnet then get x-ray
86
Tx for nasal FB
Restrain child to get good visualization Retrieve with alligator forceps or suction No irrigation if organic Refer to ENT if more than 2 unsuccessful attempts! Re-examine after 1 FB removed to look for second
87
Types of epistaxis
Anterior and posterior Anterior is more common Most can be conservative tx Most at Kiesselbach's plexus
88
Causes of epistaxis
``` Nose picking Low moisture Hyperemia secondary to allergic rhinitis FB Drug use or trauma ```
89
What is Kiesselbach's plexus?
Anterior epistaxis Anastamosis of 3 vessels (septal branch of anterior ethmoidal artery, lateral nasal branch of sphenopalantine artery and septal branch of superior labial branch of facial artery)
90
Where does a posterior epistaxis occur?
Usually posterolateral branch of sphenopalatine artery | less commonly is carotid artery
91
Conservative tx for epistaxis
Oxymetazoline (Afrin) for 2 sprays Direct pressure of the alae tight against septum for 10 min Nasal hydration if no more bleeding
92
When do you do cautery with epistaxis?
If you can easily visualise and ID it (avoid large areas, remove excess silver nitrate with cotton tip applicator)
93
Risks of cautery with epistaxis
Ulceration and septal perf
94
Removal of nasal packing
3 days in a normal pt and 5 days in anticoagulated pt
95
Abx also given with nasal packing for epistaxis
Antistaphylococcal (Keflex, Augmentin) | Entire course of packing (prevent toxic shock syndrome)
96
History important for nasal trauma
Time fram MOI Direction of force (pattern of fracture) Prior nasal surgery or trauma
97
What is seen on PE for nasal trauma?
``` Epistaxis CSF rhinorrhea Impaired EOMs Orbital edema/ecchymosis Lacerations Septal hematoma ```
98
Diagnostics for nasal trauma
CT scan maxillofacial (WITHOUT contrast) to rule out other facial fractures
99
Early complications with nasal trauma
Septal hematoma Abscess Uncontrolled epistaxis CSF rhinorrhea
100
Late complications of nasal trauma
Nasal deformity Obstruction Perf
101
Tx of nasal trauma
Repair skin lacerations immediately If significant swelling, wait 4-6 wks until resolved for surgical correction Attempt closed reduction immediately (maximize airway and improve aesthetics) Elevate head of bed, cold compress, pain management F/u in 3-5 days
102
Causes of septal hematoma
Trauma Septal surgery Bleeding disorders
103
Presentation of septal hematoma
(more common in peds) | Nasal obstruction and pain with soft tender swelling along the septum
104
Tx of septal hematoma
I&D (prevent vascular necrosis of septum) Pack nose Abx ENT referral (remove packing in 24 hrs, recheck and repack)
105
What can happen with untreated septal hematomas?
May cause septal perf and/or saddle nose deformity
106
Presentation of mastoiditis
Maybe asymptomatic with normal exam Ear pain Drainage Tenderness, erythema and edema over mastoid process
107
Diagnostics for mastoiditis
CT head without contrast | Culture if needed for infection
108
Tx of mastoiditis
Refer to ENT Empiric oral abx if immunocompetent Mastoidectomy and maybe IV abx if recalcitrant disease or immunocompromised
109
Presentation of periodontal abscess
Fever Pain Red, fluctuant swelling of gingiva TTP
110
Diagnostics for periodontal abscess
Panoramic radiograph or CT for bone involvement
111
Tx for periodontal abscess
Pain management I&D Oral abx if limited infection (augmentin or clinda 7-14 days) F/u with dentist
112
Presentation of tooth avulsion
Pain Tooth is completely displaced from alveolar ridge Periodontal ligament severed
113
What to do if cannot reimplant tooth immediately
Store tooth in balanced saline solution, cold milk or container of their saliva until can get to dentist
114
Tx for dental avulsion
Maintain vitality of periodontal ligament Handle tooth by crown Rinse in saline Insert tooth into empty socket (hold in place with gauze-- if reimplant within 5 min good but success is 0% if wait an hour) Tetanus prophylaxis and abx therapy
115
What usually occurs with tongue laceration?
Injury to teeth too (oral cavity and tongue are very vascular so lots of bleeding)
116
When would you repair a tongue laceration?
Large (>1 cm)--extends into muscle layer or completely through tongue Deep on lateral border Large flaps or gaps Significant hemorrhage Any that may cause dysfunction with improper healing (use absorbable suture 3-0 or 400 chromic gut thingy and give abx)
117
When do you NOT repair a tongue laceration?
<1 cm Non-gaping Assessed to be minor by examiner

X Emergency Med Exam 2 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions