ENT/Ophthalmic Lecture Flashcards by Cassidy Ruocco

Cellulitis/abscess to bilateral sublingual and submandibular space
*upward displacement of the tongue

often caused by poor dental hygiene

Ludwig’s Angina

How well did you know this?

Not at all

Perfectly

Only option to secure Lugwig Angina airway?

Emergency trach ASAP

(cannot intubate or cric these pts)

How well did you know this?

Not at all

Perfectly

MC age group for retropharyngeal abscesses

used to be kids (~under 3)

but now with the HiB vaccine, more common in adults who were not vaccinated as kids

How well did you know this?

Not at all

Perfectly

“hot potato voice”
cannot swallow own secretions
tripod
especially if unimmunized

Retropharyngeal abscess

Epiglottitis

How well did you know this?

Not at all

Perfectly

Trismus
Tripod position
Drooling
Sore throat odynophagia
Thumb sign

Epiglottitis

How well did you know this?

Not at all

Perfectly

MC age for epiglottitis?

Use to be kids, but now with HiB vaccine, 40 yo adults who were not vaccinated as kids are MC

How well did you know this?

Not at all

Perfectly

Localized cellulitis of supraglottic area with potential for abscess formation

Epiglottitis

How well did you know this?

Not at all

Perfectly

Spectrum of symptoms from mild pain to SOB, depending on amount of swelling

Uvula deviation
+/- stridor, drooling, trismus

Peritonsillar abscess

How well did you know this?

Not at all

Perfectly

Disruption of conjunctival blood vessels
may occur from trauma, sneezing, gagging or Valsalva

will resolve spontaneously in 2 weeks

Subconjunctival hemorrhage

How well did you know this?

Not at all

Perfectly

Present with a foreign body sensation
Tearing, photophobia, blepharospasm, severe pain

can be seen under fluorescein slit lamp

Corneal abrasion

How well did you know this?

Not at all

Perfectly

Eye foreign bodies can usually be removed with a…

moist cotton applicator

How well did you know this?

Not at all

Perfectly

Superficial conjunctival lesions are treated with erythromycin ointment for how long?

2-3 days

How well did you know this?

Not at all

Perfectly

Contact lens abrasions are treated with ciprofloxacin, ofloxacin or tobramycin drops to cover ____________

pseudomonas

How well did you know this?

Not at all

Perfectly

Should you wear an eye patch for an abrasion?

How well did you know this?

Not at all

Perfectly

True or False..

Topical anesthetics for home use are strictly contraindicated!!!

True

How well did you know this?

Not at all

Perfectly

Ophthalmology follow up is advised within _____ hours for all corneal abrasions

24 hours

How well did you know this?

Not at all

Perfectly

Fine needle tip
Eye spud
Eye burr

(after applying a topical anesthetic)

can be used for…

removing corneal foreign bodies

How well did you know this?

Not at all

Perfectly

Rust rings are associated with metallic foreign bodies and may be removed with an….

eye burr

How well did you know this?

Not at all

Perfectly

trauma which causes….

Abnormal anterior chamber depth
Irregular pupil
Blindness

..indicate what? (unti proven other wise)

Ruptured globe

How well did you know this?

Not at all

Perfectly

Blood in the anterior chamber
can occur spontaneously (sickle cell or coagulopathy pts) or following trauma

blood in the iris

Hyphema

How well did you know this?

Not at all

Perfectly

Place the pt upright to allow the blood to settle inferiorly
Place protective eye shield
Pupillary dilation may be indicated

always consult with ophthalmology

Hyphema

How well did you know this?

Not at all

Perfectly

Inferior and medial wall (lamina papyracea) of the orbit may be fractured from blunt trauma

Blowout fractures

How well did you know this?

Not at all

Perfectly

True or False…

1/3 of blowout fractures are associated with ocular trauma

True

How well did you know this?

Not at all

Perfectly

Exam shows…

-Evidence of inferior rectus entrapment (diplopia on upward gaze)

-Parasethesia of infraorbital nerve

-subcutaneous emphysema (esp when sneezing or blowing nose)

Blowout fracture

How well did you know this?

Not at all

Perfectly

Image of choice for a blowout fracture?

What complication must you worry about with a blowout fracture?

Entrapment of **inferior rectus** muscle

Can result from both blunt and penetrating trauma Hisk risk mechanisms: Hammering metal on metal Use of high-speed machinery Explosion related injuries

Ruptured globe

Severe subconjunctival hemorrhage **Irregular or tear drop shaped pupil** Afferent pupillary defect Shallow or deep anterior chamber, compared to other eye Hyphema Limitation of EOM Extrusion of globe contents Lens dislocation Significant reduction in visual acuity

Ruptured globe

Fluorescein streaming (**Seidel's test**) is pathognomonic for...

Ruptured globe (although it may be absent)

Should you measure IOP in a ruptured globe pt?

NO!!

Place pt upright NPO Protective metallic eye shield IV broad spectrum abx Analgesia Sedation Anti-emeic Tetanus

ED Management for **ruptured globe**

Eye should be immediately flushed in prehospital setting **Sterile normal saline or Ringer's lactate Morgan Lens irrigation should be continued in ED upon arrival until the pH is normal (7.0-7.4)**

Management for chemical burn to eye (Acid and Alkali burns are managed similarly)

Once pH is normal, fornices should be swept to remove residual particles and any necrotic conjunctiva ## Footnote **pH should be recheck in 10 mins**

Chemical ocular injury

After irrigation, a full slit lamp exam should be done IOP should be measured Pain meds Tetanus

Chemical ocular injury

Presents with... Eye pain HA Cloudy vision Colored halos around lights Cloudy or steamy appearance of cornea Conjunctival injection A fixed, mid-dilated pupil **increased IOP of 40-70 mmHG**

Acute angle closure glaucoma

normal IOP= 10-20 mmHg what is the IOP in acute angle closure glaucoma?

40-70 mmHg

Timolol (topical beta blocker) Apraclonidine (topical alpha agonist) Acetazolamide Mannitol Topical pilocarpine ...can all be used in management of?

Acute angle closure glaucoma (lowers IOP)

For a diagnosis, need 2+ of the following: Eye pain Blurred vision N/V Intermittent halos

Acute angle closure glaucoma

For a diagnosis, need 3+ of the following: IOP \> 21 mmHg Conjunctival injection Corneal epithelial edema Mid-dilated, non reactive pupil

Acute angle closure glaucoma

Causes include: Embolus Thrombosis Giant-cell arteritis Vasculitis Sickle cell dz Vasospasm (migraines) glaucoma Hypercoaguable states Low retinal blood flow Trauma

Central artery occlusion

**amaurosis fugax=** painless, transient monocular or binocular visual loss (caused by blood clot or a peice of plaque) ..this often precedes what?

Central retinal artery occlusion

Vision loss is often painless, with complete or near complete vision loss Afferent pupillary defect Fundascopic exam reveals a **pale fundus with narrowed arterioles with segmented flow ("box cars") with bright red macula ("cherry red spot")**

Central retinal artery occlusion

ED managament= ocular massage (digital pressure for 15 seconds followed by sudden release)

Central retinal artery occlusion

MC cause of blindness in western world

Herpes simplex keratitis

Seen as linear branching lesion under fluorescein dye and slit lamp tx= acyclovir

Herpes simplex keratitis

Causes: Infection Demyelination Autoimmune disorders **may present with various degrees of vision loss (often with poor color perception), pain during EOM , visual field cuts and afferent pupillary defect**

Optic neuritis

**Diagnosis made with red desaturation test** (after staring at a bright red object with the normal eye only, the object may subsequently appear pink or light red in the affected eye)

Optic neuritis

Flashing lights Floaters A dark curtain or veil Diminished visual acuity

Retinal detachment

True or False... Vision loss from acute glaucoma is irreversible

True

**Cellulitis involving the submandibular spaces and the sublingual spaces** that can spread to the neck and mediastinum, causing airway compromise, overwhelming infection and death tx= broad spectrum abx airway management ASAP

Ludwig's angina

Gold standard image for retropharyngeal abscess

CT with IV contrast (allows differentiation between cellulitis and abscess)

1-2 days hx of worsening dysphagia, odynophagia and dyspnea (worse w supine) Upright, leaning forward position drooling, inspiratory stridor **lateral soft tissue radiographs may show a "thumbprint sign"**

Epiglottitis

Tx: Remain in upright position Supplemental humidified oxygen **Ceftriaxone IV** Steroids may be given to reduce airway inflammation

Epiglottitis

Infection ususally polymicrobial Fever, sore throat, torticollis, dysphagia Neck pain, stiffness, muffled voice, cervical LAD, respiratory distress **improvement with lying supine with neck in slight extension** (sitting up may worsen dyspnea)

Retropharyngeal abscess (tx= IV clinda)

**uvula deviation** +/- stridor, drooling, trismus tx= drainage, abx

Peritonsillar abscess

Polymicrobial infection that develops betwen the tonsillar capsule and the superior constrictor and palatopharyngeus muscle risk factors: smoking, periodontal dz, chronic tonsillitis, repeat courses of abx MC in young adults during winter and spring months

Peritonsillar abscess

Needle aspiration of purulent material is diagnostic and therapeutic for peritonsillar abscesses and will treat more than \_\_% of these pts

90% (give Penicillin post drainage)

**Oxymetazoline** can be used in the tx of...

Epistaxis

Complication of infection spreading from the middle ear **otalgia fever postauricular erythema, swelling, tenderness** **\*can have CN V, VI, VII palsy**

Mastoiditis (**CT scan will show extend of bony involvement**)

AOM tx

Amoxicillin 250-500 mg PO TID x 7-10 days

ALWAYS check for this with nasal trauma \*\*if left untreated, can result in abscess formation of necrosis of the nasal septum tx= local incision and drainage with anterior nasal pack

Septal hematoma

MC source of nose bleeds

Kesselbach's plexus

parainfluenza type 1 causes...

croup **"steeple sign" = croup**