Head & Neck Flashcards
This deck covers Chapters 60-62 in Rosens, compromising all of Dentistry, ENT, and Ophthalmology.
Outline the grading of hyphema
Grading
- Grade 1 - 0 to ⅓
- Grade 2 - ⅓ to ½
- Grade 3 - ½ to 99%
- Grade 4 - 100%
List 4 complications of an orbital floor fracture
- Globe rupture
- EOM entrapment
- Orbital emphysema
- Retro-orbital hematoma
Describe the flow of aqueous humour in the eye
- Made by the ciliary process in the posterior chamber
- Enters anterior chamber through the pupil
- Moves peripherally, then through trabecular meshwork
- From meshwork to Canals of Schlemm to episcleral veins
List 4 indicators of poor prognosis with globe rupture
- RAPD
- Retinal detachment
- Decreased VA
- No red reflex
What is dacryocystitis?
Acute infection (Staph) of the lacrimal sac, usually from an obstructed nasolacrimal gland.
- Warm compress, gentle massage
- Keflex PO + Vigamox drops QID
32 yo male with lower incisor pain and metallic taste. He has the worst breath you’ve ever smelt. Diagnosis?
Acute Necrotizing Ulcerative Gingivitis
- Vincent’s Angina
- Fusobacterium/Spirochetes
- Invade gingival issue
- Ulcerated, blunted interdental papillae
Treatment
- Saline rinses
- Flagyl/Amox-Clav/Clinda x7d
- Dentistry
How many primary teeth are there? When do they erupt?
How many permanent teeth are there? When do they erupt?
Primary Teeth
- 20 in total (5 in each quadrant)
- Erupt at 6 months
- Present by 3 years
Permanent Teeth
- 32 in total (8 in each quadrant)
- Erupt at 5-6 years
Differentiate periorbital and orbital cellulitis
Periorbital
- Pre-septal
- Normal VA, non-painful EOM, white sclera
- Staph, Strep, H. flu
- Amox-Clav x14d
Orbital
- Post-septal
- Decreased VA, painful EOM, red sclera
- Proptosis, RAPD
- Staph, Strep, H. flu
- CT orbit
- Pip-Tazo + Vanco IV
List 5 reasons to consult a corneal FB to ophthalmology
- Multiple FBs
- Rust ring
- Deep
- Perforation risk is high
- Large portion of the visual axis involved
List 6 risk factors for cataracts
- Age
- Smoking
- Alcohol
- Sunlight
- Low education
- Malnutrition
- Diabetes
- Steroids
List 6 causes of binocular diplopia
- Hematoma
- Abscess
- CN palsy
- Thyroid disease (Graves)
- EOM fibrosis syndrome
- INO
- MS
- Myasthenia
List 4 treatments given in Bell’s Palsy
- Eye patch
- Antivirals
- Steroids
- ENT
List 5 symptoms/signs of an orbital floor fracture
- Diplopia
- Limited upward gaze
- Facial paresthesias (V2)
- SubQ air
- Enophthalmos
- Ptosis
- Step deformity
List 5 slit-lamp findings in blunt trauma to the anterior chamber
- Cells
- Flare
- Hyphema
- Iridodialysis
- Traumatic miosis
- Traumatic mydriasis
What is glaucoma?
An optic neuropathy from high IOP
Peripheral to central progression
Normal IOP 10-20 mmHg
Name 3 treatments for HSV keratitis
- Topical antiviral - trifluridine 1% q2h x2-3 weeks
* Oral acyclovir/valacyclovir also work - Cycloplegic
- Ophthalmology referral
- Avoid steroids
List 6 steps in the management of an alkaline burn to the eye
- Analgesia
- Irrigate
- Check IOP
- Topical antibiotics
- Cycloplegic
- Ophthalmology
List 5 causes of CN7 paralysis
- Bell’s palsy
- Lyme
- DM
- Facial nerve tumor
- Parotitis
- CVA
- AOM
- Basilar skull fracture
What is the most serious complication of a dental infection that has spread to the periorbital area?
CVST
What is the treatment of AOM?
- Kids <2 yr = Treat x10d
- Kids >2 yo = Treat if unwell (perf, T>39, severe pain), or in 48h x5d
- Adults = Treat x10d
- Kids with tubes and drainage get Ciprodex BID x7d
Treatment
- Amoxicillin 90 mg/kg div BID x5-10d
- 10 days in perf, chronic/recurrent
- Amox-Clav if treatment failure
- CTX if treatment failure
- ENT for drainage if treatment failure
Outline (in order) your management of anterior epistaxis
- Blow nose to remove clots
- Direct pressure w/ clamp x15 min
- Examine for bleeding vessel amenable to cautery
- Pack with vasoconstrictor soaked pledgets
- Pack with TXA soaked pledgets
- Pack with Rhinorocket x48h
* ABx prophylaxis no longer recommended
Provide 8 DDx for superficial punctate keratitis

- UV light
- Conjunctivitis
- Blepharitis
- Dry eyes
- Contact lens issues
- Exposure keratopathy (incomplete lid closure, Bell’s)
- Minor trauma
- Mild chemical injury
- Topical eye drops
- Trichiasis (lashes rubbing inside)
List 8 causes of sudden hearing loss
Conductive
- Wax
- Foreign body
- Trauma
- Otitis media
- Otitis externa
Sensorineural
- Acoustic neuroma
- Aminoglycosides
- Loop diuretics
- ASA
- Bell’s palsy
- DM
- Pregnancy
- Leukemia
- HSV
- VZV
- EBV
- CMV
- Stroke
- Meningitis
List 4 signs of globe rupture
- Loss of AC depth
- Blood in AC
- Teardrop pupil
- Iris prolapse
- Siedel’s test +
4 yo girl has pain and redness behind her ear. What is the diagnosis? Workup? Treatment?
Mastoiditis
Workup
- CT Head, r/o abscess
- Full septic workup
Treatment
- Ceftriaxone
- Admission
- ENT
List 4 arteries responsible for anterior epistaxis and 2 arteries responsible for posterior epistaxis.
Anterior
- Superior Labial artery
- Greater Palantine artery
- Anterior Ethmoid artery
- Septal branch of the Sphenopalatine artery
Posterior
- Posterior Ethmoid artery
- Sphenopalatine artery
List 4 causes of post-chiasmal vision loss
- Stroke
- Tumour
- AVM
- Migraine
- MS
List 4 causes of pre-chiasmal vision loss
- Optic neuritis
- Methanol
- GCA
- Retinal detachment
- Aneurysm
List 5 intra-temporal and 5 intracranial complications of AOM.
Intra-temporal
- TM rupture
- Mastoiditis
- Hearing loss
- Labryinitis
- Facial paralysis
Intra-cranial
- Meningitis
- Encephalitis
- Abscess
- Subdural empyema
- Lateral venous sinus thrombosis
How do you manage a TMJ dislocation? What are 3 things you’ll tell patients post-reduction?
- Thumbs in mouth, in buccal recess, not teeth
- Downward then backward pressure
DC Instructions
- Soft diet x1 weeks
- NSAIDs PRN
- Avoid opening mouth to maximum (yawns, laughing)
- Consider Barton bandage for chronic dislocation
List 3 causes of chiasmal vision loss
- Pituitary tumor
- Craniopharyngioma
- Meningioma
List 6 drugs for acute angle-closure glaucoma
TAMPA-P
- Timolol 0.5% 1 ggt (beta)
- Decrease aqueous humour
- Acetazolamide 500 mg IV (CAi)
- Decrease aqueous humour
- Mannitol 1 g/kg (diuretic)
- Osmotic shift
- Prednisolone 1% 1 ggt (steroid)
- Anti-inflammatory
- Aproclonidine 1% 1 ggt (alpha)
- Decrease aqueous humour
- Pilocarpine 1% 1 ggt (cholinergic)
- Pupillary constriction
Is an acidic or alkaline burn to the eye worse?
Alkaline
Deeper penetration causes corneal sclerosis
List 3 risk factors for retinal detachment
- Trauma
- Myopia
- FHx
- Diabetes
- PVD
List 5 causes of each:
- CN3 palsy
- CN4 palsy
- CN6 palsy
Same 5 for all
- Trauma
- Tumour
- Aneurysm
- DM
- CVST
CN3 palsy
- MS
- Myasthenia
CN4 palsy
- Myasthenia Gravis
CN6 palsy
- ICP
- Meningitis
- MS
List 5 treatment priorities for CRAO
- Call ophthalmology
- HOB 30
- Breath into bag (increase CO2 –> vasodilation)
- Digital globe massage
- Timolol 0.5%
- Acetazolamide 500 mg IV
- tPA
Outline 6 treatment priorities for hyphema
Treatment
- HOB 30
- Stop OAC/Antiplatelets
- Cycloplegics
- Antiemetics
- Manage IOP
* Alpha, Beta, CAi, Anticholinergic, Mannitol, Prednisolone - Ophthalmology
Regarding gonorrhea and chlamydia of the eye in neonates, which happens first?
- Gonorrhea = 0-4 days old
- Chlamydia = 5-14 days old
List 5 signs/symptoms of a retrobulbar hematoma
- Proptosis
- Restricted EOM
- Increased IOP
- Decreased V/A
- Pain
- Cherry red macula
- RAPD
What is the endpoint in the treatment of acute angle-closure glaucoma?
IOP <35 mmHg
>25% reduction in pressure
List 6 treatment strategies for managing an intraocular foreign body? (Not corneal FB)
Same as globe rupture, but get a CT
- CT
- ABx - fluoroquinolone
- Antiemetic
- Analgesia
- Tetanus
- Rigid shield
- Ophthalmology
List 5 complications of wearing contact lens.
- Corneal ulcer
- Corneal chemical burn
- Corneal abrasion
- Corneal neovascularization
- Superficial punctate keratitis
- Bacterial conjunctivitis
Woman presents with ear pain, itching, and whitish discharge. Diagnosis? Etiology (3)? DDx (3)? Treatment?
Otitis Externa
Etiology
- S. aureus
- P. aeruginosa
- Gram-negative organisms
DDx
- AOM + Rupture
- Malignant Otitis Externa
- Otomycosis
- Furunculosis
- Ramsay Hunt Syndrome
Treatment
- Cipro-Dex 4 drops BID x7d
What is the difference between a pterygium and a pinguecula?
P_t_erygium _T_OUCHES cornea
- Pinguecula = involves sclera
- Pterygium = invovles sclera + cornea
How is the diagnosis different if a patient presents with severe pain within 1d vs within 3-4d following a dental extraction?
Within 1 day
- Periostitis
Within 3-4 days
- Acute alveolar osteitis (dry socket)
- Pain + Smell
- Caused by loss of the healing blood clot in the socket
- Pack with iodine soaked gauze
- PCN VK 500 mg QID or Clinda 300 mg QID
- Dental F/U in 24h
Regarding malignant otitis externa:
- List 2 bacterial causes
- List 3 risk factors
- List 2 treatment options
- List 3 complications
Malignant Otitis Externa
Etiology
- P. aeruginosa
- S. aureus
- S. epidermidis
Risk Factors
- Elderly
- Immunocompromised
- AIDS
Treatment
- Ciprofloxacin 750 mg PO BID x6-8 weeks
- Close ENT follow-up
- HBOT
Complications
- Skull base osteomyelitis
- Meningitis
- Venous sinus thrombosis
List 6 treatment steps in managing a globe rupture
- Ophthalmology
- Antiemetics
- Analgesia
- Tetanus
- IV ABx
- Ceftaz + Gent + Vanco
- Rigid shield
List 5 long-term complications of caustic eye burns
- Corneal clouding
- Corneal perforation
- Corneal neovascularization
- Glaucoma
- Cataracts
- Symblepharon
- Retinal damage
How do you manage a primary tooth avulsion in a child?
Do nothing!
Re-implanting it will cause bony fusion
Name 4 organisms associated with bullous myringitis
- S. pneumoniae
- M. catarrhalis
- H. influenzae
- M. pneumoniae
List 5 complications of posterior epistaxis
- Apnea
- Arrhythmia
- Bradycardia
- MI
- CVA
- Aspiration
- Nasopulmonary reflex (hypoxia/hypercarbia)
What is the triad of Horner’s syndrome? List 5 causes.
- Ptosis
- Miosis
- Anhydrosis
Causes
- Pancoast tumor
- Lung cancer
- Thyroid mass
- Carotid dissection
- Stroke
- Tumour
- Cluster headache
- Acute otitis media
List 8 DDx for acute painless vision loss
- CRAO
- CRVO
- BRAO
- BRVO
- Retinal detachment
- PVD
- Vitreous hemorrhage
- Optic neuritis
- Amaurosis fugax
Give a DDx of 8 causes of an RAPD
Retinal
- Ischemia
- CRAO
- CRVO
- Macular degeneration
- Retinal infection
- Retinal tumour
- Methanol toxicity
Optic Nerve
- Infection
- Inflammation
- Tumour
- Trauma
- GCA
- Radiation
- Post-operative eye surgery
List 6 indications to refer a lid lac to ophthalmology
- Into lid margin
- Into canalicular system (medial)
- Into canthal tendons (lateral)
- Through septum
- Through tarsal plate
- Tissue loss
- Full thickness
List 2 emergent complications of orbital cellulitis
- Meningitis
- CVST
List 7 causes of papilledema
- IIH
- Brain tumour
- Brain abscess
- Brain bleed
- Hydrocephalus
- CVST
- Meningitis
- Optic neuritis
- Methanol toxicity
List 4 reasons to admit a hyphema
- Decreased VA
- Increased IOP
- Severe pain
- Sickle cell
- Hypema >50% (Grade 3+)
Describe the Ellis classification
Ellis Classification
Dental Fractures
- I - through the enamel
- II - through dentin (?ABx)
- III - through pulp (ABx)
Cover II/III with calcium hydroxide paste
List 8 DDx for a neck mass
- Goiter
- Thyroid nodule
- Thyroid cancer
- Thyroglossal duct cyst
- Brachial cleft cyst
- Adenopathy
- Lymphoma
- Salivary gland tumour
- AVM
- Lipoma
List 3 precipitants for primary closed-angle glaucoma attacks
Anything that makes your pupils big
- Dark
- Strong emotion
- Sympathomimetics
- Anticholinergic
List 3 causes of monocular diplopia
- Refractive error
- Lens dislocation
- Iridiodialysis
- Conversion disorder
List 8 causes of epistaxis
- Digital trauma
- Fracture
- URTI
- FB
- OAC
- Dry air
- Cocaine
- Tumour
- Hemophilia
- Diabetes
List 6 risk factors for otitis media
- Male
- Daycare
- Parental smoking
- Pacifier use
- FHx
- Cleft palate
- Down syndrome
- HIV
- Immunocompromise
What should you be concerned about with an orbital wall fracture?
Globe Rupture
Differentiate a chalazion from a hordeolum
Chalazion
- Obstructed Meibomian gland
- Chronic, non-painful
- Warm compresses
Hordeolum (Hurts)
- Inflammed Gland of Zeis
- Acute Staph infection
- Warm compresses
Antibiotics only if concomitant blepharitis
List 5 complications of hyphema
- Increaesd IOP
- Rebleeding
- Corneal blood staining
- Glaucoma
- Synechia
List 6 risk factors for CRAO
- Age
- Carotid disease
- HTN
- Diabetes
- DLD
- Smoking
- Valvular disease
- Vasculitis
- Sickle cell
- Cardiac disease
- Collagen disease
- Any condition with higher IOP
When would you give antibiotics in an orbital fracture?
If fractured into infected sinus
Amox-Clav
In anisocoria, how do you determine which pupil is the abnormal one?
Anisocoria greater in light
- The larger pupil is abnormal
- Should constrict in the light
Anisocoria greater in dark
- The smaller pupil is abnormal
- Should dilate in the dark
Name 6 structures with the cavernous sinus
- Internal carotid artery
- CN III
- CN IV
- CN V1
- CN V2
- CN VI