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Royal College: Emergency Medicine > Head & Neck > Flashcards

Head & Neck Flashcards

This deck covers Chapters 60-62 in Rosens, compromising all of Dentistry, ENT, and Ophthalmology.

1
Q

Outline the grading of hyphema

A

Grading

  • Grade 1 - 0 to ⅓
  • Grade 2 - ⅓ to ½
  • Grade 3 - ½ to 99%
  • Grade 4 - 100%
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2
Q

List 4 complications of an orbital floor fracture

A
  1. Globe rupture
  2. EOM entrapment
  3. Orbital emphysema
  4. Retro-orbital hematoma
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3
Q

Describe the flow of aqueous humour in the eye

A
  • 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
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4
Q

List 4 indicators of poor prognosis with globe rupture

A
  1. RAPD
  2. Retinal detachment
  3. Decreased VA
  4. No red reflex
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5
Q

What is dacryocystitis?

A

Acute infection (Staph) of the lacrimal sac, usually from an obstructed nasolacrimal gland.

  • Warm compress, gentle massage
  • Keflex PO + Vigamox drops QID
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6
Q

32 yo male with lower incisor pain and metallic taste. He has the worst breath you’ve ever smelt. Diagnosis?

A

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
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7
Q

How many primary teeth are there? When do they erupt?

How many permanent teeth are there? When do they erupt?

A

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
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8
Q

Differentiate periorbital and orbital cellulitis

A

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
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9
Q

List 5 reasons to consult a corneal FB to ophthalmology

A
  1. Multiple FBs
  2. Rust ring
  3. Deep
  4. Perforation risk is high
  5. Large portion of the visual axis involved
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10
Q

List 6 risk factors for cataracts

A
  1. Age
  2. Smoking
  3. Alcohol
  4. Sunlight
  5. Low education
  6. Malnutrition
  7. Diabetes
  8. Steroids
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11
Q

List 6 causes of binocular diplopia

A
  1. Hematoma
  2. Abscess
  3. CN palsy
  4. Thyroid disease (Graves)
  5. EOM fibrosis syndrome
  6. INO
  7. MS
  8. Myasthenia
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12
Q

List 4 treatments given in Bell’s Palsy

A
  1. Eye patch
  2. Antivirals
  3. Steroids
  4. ENT
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13
Q

List 5 symptoms/signs of an orbital floor fracture

A
  1. Diplopia
  2. Limited upward gaze
  3. Facial paresthesias (V2)
  4. SubQ air
  5. Enophthalmos
  6. Ptosis
  7. Step deformity
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14
Q

List 5 slit-lamp findings in blunt trauma to the anterior chamber

A
  1. Cells
  2. Flare
  3. Hyphema
  4. Iridodialysis
  5. Traumatic miosis
  6. Traumatic mydriasis
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15
Q

What is glaucoma?

A

An optic neuropathy from high IOP

Peripheral to central progression

Normal IOP 10-20 mmHg

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16
Q

Name 3 treatments for HSV keratitis

A
  1. Topical antiviral - trifluridine 1% q2h x2-3 weeks
    * Oral acyclovir/valacyclovir also work
  2. Cycloplegic
  3. Ophthalmology referral
  4. Avoid steroids
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17
Q

List 6 steps in the management of an alkaline burn to the eye

A
  1. Analgesia
  2. Irrigate
  3. Check IOP
  4. Topical antibiotics
  5. Cycloplegic
  6. Ophthalmology
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18
Q

List 5 causes of CN7 paralysis

A
  1. Bell’s palsy
  2. Lyme
  3. DM
  4. Facial nerve tumor
  5. Parotitis
  6. CVA
  7. AOM
  8. Basilar skull fracture
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19
Q

What is the most serious complication of a dental infection that has spread to the periorbital area?

A

CVST

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20
Q

What is the treatment of AOM?

A
  • 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
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21
Q

Outline (in order) your management of anterior epistaxis

A
  1. Blow nose to remove clots
  2. Direct pressure w/ clamp x15 min
  3. Examine for bleeding vessel amenable to cautery
  4. Pack with vasoconstrictor soaked pledgets
  5. Pack with TXA soaked pledgets
  6. Pack with Rhinorocket x48h
    * ABx prophylaxis no longer recommended
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22
Q

Provide 8 DDx for superficial punctate keratitis

A
  1. UV light
  2. Conjunctivitis
  3. Blepharitis
  4. Dry eyes
  5. Contact lens issues
  6. Exposure keratopathy (incomplete lid closure, Bell’s)
  7. Minor trauma
  8. Mild chemical injury
  9. Topical eye drops
  10. Trichiasis (lashes rubbing inside)
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23
Q

List 8 causes of sudden hearing loss

A

Conductive

  1. Wax
  2. Foreign body
  3. Trauma
  4. Otitis media
  5. Otitis externa

Sensorineural

  1. Acoustic neuroma
  2. Aminoglycosides
  3. Loop diuretics
  4. ASA
  5. Bell’s palsy
  6. DM
  7. Pregnancy
  8. Leukemia
  9. HSV
  10. VZV
  11. EBV
  12. CMV
  13. Stroke
  14. Meningitis
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24
Q

List 4 signs of globe rupture

A
  1. Loss of AC depth
  2. Blood in AC
  3. Teardrop pupil
  4. Iris prolapse
  5. Siedel’s test +
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25
Q

4 yo girl has pain and redness behind her ear. What is the diagnosis? Workup? Treatment?

A

Mastoiditis

Workup

  • CT Head, r/o abscess
  • Full septic workup

Treatment

  • Ceftriaxone
  • Admission
  • ENT
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26
Q

List 4 arteries responsible for anterior epistaxis and 2 arteries responsible for posterior epistaxis.

A

Anterior

  1. Superior Labial artery
  2. Greater Palantine artery
  3. Anterior Ethmoid artery
  4. Septal branch of the Sphenopalatine artery

Posterior

  1. Posterior Ethmoid artery
  2. Sphenopalatine artery
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27
Q

List 4 causes of post-chiasmal vision loss

A
  1. Stroke
  2. Tumour
  3. AVM
  4. Migraine
  5. MS
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28
Q

List 4 causes of pre-chiasmal vision loss

A
  1. Optic neuritis
  2. Methanol
  3. GCA
  4. Retinal detachment
  5. Aneurysm
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29
Q

List 5 intra-temporal and 5 intracranial complications of AOM.

A

Intra-temporal

  1. TM rupture
  2. Mastoiditis
  3. Hearing loss
  4. Labryinitis
  5. Facial paralysis

Intra-cranial

  1. Meningitis
  2. Encephalitis
  3. Abscess
  4. Subdural empyema
  5. Lateral venous sinus thrombosis
30
Q

How do you manage a TMJ dislocation? What are 3 things you’ll tell patients post-reduction?

A
  • 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
31
Q

List 3 causes of chiasmal vision loss

A
  1. Pituitary tumor
  2. Craniopharyngioma
  3. Meningioma
32
Q

List 6 drugs for acute angle-closure glaucoma

A

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
33
Q

Is an acidic or alkaline burn to the eye worse?

A

Alkaline

Deeper penetration causes corneal sclerosis

34
Q

List 3 risk factors for retinal detachment

A
  1. Trauma
  2. Myopia
  3. FHx
  4. Diabetes
  5. PVD
35
Q

List 5 causes of each:

  • CN3 palsy
  • CN4 palsy
  • CN6 palsy
A

Same 5 for all

  1. Trauma
  2. Tumour
  3. Aneurysm
  4. DM
  5. CVST

CN3 palsy

  1. MS
  2. Myasthenia

CN4 palsy

  1. Myasthenia Gravis

CN6 palsy

  1. ICP
  2. Meningitis
  3. MS
36
Q

List 5 treatment priorities for CRAO

A
  1. Call ophthalmology
  2. HOB 30
  3. Breath into bag (increase CO2 –> vasodilation)
  4. Digital globe massage
  5. Timolol 0.5%
  6. Acetazolamide 500 mg IV
  7. tPA
37
Q

Outline 6 treatment priorities for hyphema

A

Treatment

  1. HOB 30
  2. Stop OAC/Antiplatelets
  3. Cycloplegics
  4. Antiemetics
  5. Manage IOP
    * Alpha, Beta, CAi, Anticholinergic, Mannitol, Prednisolone
  6. Ophthalmology
38
Q

Regarding gonorrhea and chlamydia of the eye in neonates, which happens first?

A
  • Gonorrhea = 0-4 days old
  • Chlamydia = 5-14 days old
39
Q

List 5 signs/symptoms of a retrobulbar hematoma

A
  1. Proptosis
  2. Restricted EOM
  3. Increased IOP
  4. Decreased V/A
  5. Pain
  6. Cherry red macula
  7. RAPD
40
Q

What is the endpoint in the treatment of acute angle-closure glaucoma?

A

IOP <35 mmHg

>25% reduction in pressure

41
Q

List 6 treatment strategies for managing an intraocular foreign body? (Not corneal FB)

A

Same as globe rupture, but get a CT

  1. CT
  2. ABx - fluoroquinolone
  3. Antiemetic
  4. Analgesia
  5. Tetanus
  6. Rigid shield
  7. Ophthalmology
42
Q

List 5 complications of wearing contact lens.

A
  1. Corneal ulcer
  2. Corneal chemical burn
  3. Corneal abrasion
  4. Corneal neovascularization
  5. Superficial punctate keratitis
  6. Bacterial conjunctivitis
43
Q

Woman presents with ear pain, itching, and whitish discharge. Diagnosis? Etiology (3)? DDx (3)? Treatment?

A

Otitis Externa

Etiology

  1. S. aureus
  2. P. aeruginosa
  3. Gram-negative organisms

DDx

  1. AOM + Rupture
  2. Malignant Otitis Externa
  3. Otomycosis
  4. Furunculosis
  5. Ramsay Hunt Syndrome

Treatment

  • Cipro-Dex 4 drops BID x7d
44
Q

What is the difference between a pterygium and a pinguecula?

A

P_t_erygium _T_OUCHES cornea

  • Pinguecula = involves sclera
  • Pterygium = invovles sclera + cornea
45
Q

How is the diagnosis different if a patient presents with severe pain within 1d vs within 3-4d following a dental extraction?

A

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
46
Q

Regarding malignant otitis externa:

  • List 2 bacterial causes
  • List 3 risk factors
  • List 2 treatment options
  • List 3 complications
A

Malignant Otitis Externa

Etiology

  1. P. aeruginosa
  2. S. aureus
  3. S. epidermidis

Risk Factors

  1. Elderly
  2. Immunocompromised
  3. AIDS

Treatment

  1. Ciprofloxacin 750 mg PO BID x6-8 weeks
  2. Close ENT follow-up
  3. HBOT

Complications

  1. Skull base osteomyelitis
  2. Meningitis
  3. Venous sinus thrombosis
47
Q

List 6 treatment steps in managing a globe rupture

A
  1. Ophthalmology
  2. Antiemetics
  3. Analgesia
  4. Tetanus
  5. IV ABx
  6. Ceftaz + Gent + Vanco
  7. Rigid shield
48
Q

List 5 long-term complications of caustic eye burns

A
  1. Corneal clouding
  2. Corneal perforation
  3. Corneal neovascularization
  4. Glaucoma
  5. Cataracts
  6. Symblepharon
  7. Retinal damage
49
Q

How do you manage a primary tooth avulsion in a child?

A

Do nothing!

Re-implanting it will cause bony fusion

50
Q

Name 4 organisms associated with bullous myringitis

A
  1. S. pneumoniae
  2. M. catarrhalis
  3. H. influenzae
  4. M. pneumoniae
51
Q

List 5 complications of posterior epistaxis

A
  1. Apnea
  2. Arrhythmia
  3. Bradycardia
  4. MI
  5. CVA
  6. Aspiration
  7. Nasopulmonary reflex (hypoxia/hypercarbia)
52
Q

What is the triad of Horner’s syndrome? List 5 causes.

A
  1. Ptosis
  2. Miosis
  3. Anhydrosis

Causes

  1. Pancoast tumor
  2. Lung cancer
  3. Thyroid mass
  4. Carotid dissection
  5. Stroke
  6. Tumour
  7. Cluster headache
  8. Acute otitis media
53
Q

List 8 DDx for acute painless vision loss

A
  1. CRAO
  2. CRVO
  3. BRAO
  4. BRVO
  5. Retinal detachment
  6. PVD
  7. Vitreous hemorrhage
  8. Optic neuritis
  9. Amaurosis fugax
54
Q

Give a DDx of 8 causes of an RAPD

A

Retinal

  1. Ischemia
  2. CRAO
  3. CRVO
  4. Macular degeneration
  5. Retinal infection
  6. Retinal tumour
  7. Methanol toxicity

Optic Nerve

  1. Infection
  2. Inflammation
  3. Tumour
  4. Trauma
  5. GCA
  6. Radiation
  7. Post-operative eye surgery
55
Q

List 6 indications to refer a lid lac to ophthalmology

A
  1. Into lid margin
  2. Into canalicular system (medial)
  3. Into canthal tendons (lateral)
  4. Through septum
  5. Through tarsal plate
  6. Tissue loss
  7. Full thickness
56
Q

List 2 emergent complications of orbital cellulitis

A
  1. Meningitis
  2. CVST
57
Q

List 7 causes of papilledema

A
  1. IIH
  2. Brain tumour
  3. Brain abscess
  4. Brain bleed
  5. Hydrocephalus
  6. CVST
  7. Meningitis
  8. Optic neuritis
  9. Methanol toxicity
58
Q

List 4 reasons to admit a hyphema

A
  1. Decreased VA
  2. Increased IOP
  3. Severe pain
  4. Sickle cell
  5. Hypema >50% (Grade 3+)
59
Q

Describe the Ellis classification

A

Ellis Classification

Dental Fractures

  • I - through the enamel
  • II - through dentin (?ABx)
  • III - through pulp (ABx)

Cover II/III with calcium hydroxide paste

60
Q

List 8 DDx for a neck mass

A
  1. Goiter
  2. Thyroid nodule
  3. Thyroid cancer
  4. Thyroglossal duct cyst
  5. Brachial cleft cyst
  6. Adenopathy
  7. Lymphoma
  8. Salivary gland tumour
  9. AVM
  10. Lipoma
61
Q

List 3 precipitants for primary closed-angle glaucoma attacks

A

Anything that makes your pupils big

  1. Dark
  2. Strong emotion
  3. Sympathomimetics
  4. Anticholinergic
62
Q

List 3 causes of monocular diplopia

A
  1. Refractive error
  2. Lens dislocation
  3. Iridiodialysis
  4. Conversion disorder
63
Q

List 8 causes of epistaxis

A
  1. Digital trauma
  2. Fracture
  3. URTI
  4. FB
  5. OAC
  6. Dry air
  7. Cocaine
  8. Tumour
  9. Hemophilia
  10. Diabetes
64
Q

List 6 risk factors for otitis media

A
  1. Male
  2. Daycare
  3. Parental smoking
  4. Pacifier use
  5. FHx
  6. Cleft palate
  7. Down syndrome
  8. HIV
  9. Immunocompromise
65
Q

What should you be concerned about with an orbital wall fracture?

A

Globe Rupture

66
Q

Differentiate a chalazion from a hordeolum

A

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

67
Q

List 5 complications of hyphema

A
  1. Increaesd IOP
  2. Rebleeding
  3. Corneal blood staining
  4. Glaucoma
  5. Synechia
68
Q

List 6 risk factors for CRAO

A
  1. Age
  2. Carotid disease
  3. HTN
  4. Diabetes
  5. DLD
  6. Smoking
  7. Valvular disease
  8. Vasculitis
  9. Sickle cell
  10. Cardiac disease
  11. Collagen disease
  12. Any condition with higher IOP
69
Q

When would you give antibiotics in an orbital fracture?

A

If fractured into infected sinus

Amox-Clav

70
Q

In anisocoria, how do you determine which pupil is the abnormal one?

A

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
71
Q

Name 6 structures with the cavernous sinus

A
  1. Internal carotid artery
  2. CN III
  3. CN IV
  4. CN V1
  5. CN V2
  6. CN VI

Royal College: Emergency Medicine (25 decks)

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