HEENT ER Flashcards by cortney davis

Causes of preseptal cellulitis

Ascending URI

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I have preseptal cellulitis what organisms are most likely responsible

Staph aureus
S. Epidermidis
Strep species
Anerobes

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I have orbital cellulitis and my eye hurts when I move it, do I have preseptal or post septal

Post septal

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Treat me if I have preseptal cellulitis

Outpatient

Augmentin 875 PO BID for 14 days

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If i am very sick and a young child how should you treat my preseptal cellulitis

Hospitalize, ceftriaxone, Vanco (for MRSA), call Opthalmology

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I have post setptal cellulitis what type of infection did I have before this

Sinusitis

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What organisms are the culprits in post septal cellulitis

Often polymicrobial 
S. aureus
S. pneumonia
anaerobes 
H. influenzae (unimmunized young children)

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How do you definitively diagnose post septal cellulitis

CT with IV contrast

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Treatment of post septal

IMMEDIATE OPHTHAMOLOGIC CONSULT

IV antibiotics - 2nd or 3rd gen cephalosporin, unycin, Timentin

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I am allergic to Penicillin treat me for post septal cellulitis

Flouroquinalone and metronidazole or clinda

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What is Augmentin

amoxicillin/clavulanic acid

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What is Unacyn

Ampicillin-sulbactam

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What is Timentin

ticarcillin-clavulanate

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I have a stye! What bacteria caused it

Staph

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How will you treat my stye

warm compresses

Erythromycin ophthalmic ointment one ribbon in eye 2-3 times a day for 7 to 10 days

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I have a painless lump on my eye what is it?? What do you do for me?

Chalazoin, refer to ophthalmology

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I have unilateral mucopurulent discharge from my eye, what do I have and treat me!

Bacterial Conjunctivitis
Topical ocular antibiotic four times daily for 5 to 7 days
Trimethoprim and polymyxin B or Erythromycin TID

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I have unilateral clear discharge from my eyes what type of adenopathy do I have

Preauricular

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I have Viral conjunctivitis give me antibiotics!!

No- cool compresses, and artificial tears

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If I have symptoms of viral conjunctivitis what should you have in your diferntial and document

That you ruled out Scleritis and iritis or AAC. Use slit lamp

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I have profuse watery red itching eyes, please give me something

viral- cool compresses, eye drops, antihistamine

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I have a vesicular rash near my eye what should you do for me

Shingles–> refer to ophthalmology, IV acyclovir

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How are all eyes examined in the ER

Visual acuity
Stained
Slit lamp

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my eye is really painful an i have decreased vision and photophobia- it looks like I have conjunctivitis. Treat me!!

Iritis-
Tx pain
Refer to ophthalmology- they will get steroid drops

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My eye has a huge blood spot on it-- treat me!!

Deal with it - will resolve in 2 weeks

Ouch ouch I thinkI scratched my eye- what do you do to diagnose me

Corneal abrasion- | Flouresceen stain

Treat my corneal abrasion

``` Topical NSAIDs (Ketorolac) Opth follow up Erythromycin eye ointment ```

If I got my corneal abrasion from my contacts what type of antibiotics should you give me

Pseudomonas coverage - cipro, tobramycin

I have a corneal abrasion give me topical anesthetic please...

No. will delay your healing

I have a piece of metal in my eye what may I have now..

Rust ring

How do you get rid of my rust ring

Drill it out

FB in eye what do you do to remove

1) anesthetize 2) Irrigate with NS 3) Dislodge with cotton 4) Flip eye back 5) 25 gauge needle bevel up

After you remove my FB where do I need to go in the next few days

Opth

I have a rust ring what type of shot do I need

Tetanus

I was punched in the eye what 2 big things do you need to make sure I do not have

Blow out fracture | Glob rupture

I have a tear drop pupil treat me!

Glob rupture, call eye doc NOW

What exams do you need to do when I have blunt trauma to my eye

Stain it | Slit lamp

I as punched in the eye now only my right eye can look up, what happened

Blow out fracture

How do you treat a blow out Fx

Opth referala

my eye sounds like rice crispies...what do I have

Subcutaneous emphysema, prob a blow out fx

Ahhh I got a toxic chemical in my eye help me!

1) Irrigate 1-2 L NS 2) Identify agent 3) Take eye pH 4) Call posin control 5) Apply erythromycin QID 6) Tetanus 7) If have corneal clouding or epithelial defect- prompt opth referal

Is a chemical burn a true ocular emergency or not

True!!

I have a steamy cornea, how will you diagnose me

Tono pen

What is Acute Angle Closure Glaucoma (AACG) caused by

pupillary dilation

Treat my AACG

IV mannitol | Call opth

I have a painless monocular, sudden vision loss what will you see on my fundoscopic exam

Cherry red spot- Central artery retinal occlusion

Treat my CRAO

Call neuro +Opth

Who gets malignant otitis externa

Diabetics

What causes OE

Pseudomonas

Treat my malignant OE

Admit | IV antibiotics - Children (imipenem or aminoglycosilide) Adults (antiseudomonal penicillin, cephalosporin or quinalone)

I have mastoiditis, how did I get it

Untreated OM that traveled to my mastoid air cells

Treat my Mastoditis

Admit IV Vanvo or nafcillin Call ENT

I have a nose bleed, whats that called?

Epistaxis

How do you figure out where my epistaxis is coming from

Try and pack anterior and if doesn't work then its posterior

Why is my nose bleeding

I prob did cocaine...or trauma, prior head and neck procedures, uncontrolled htn, winter months, im elderly

How do you treat my epistaxis

1) Blow the clots out 2) Instill nasal spray 3) Apply pressure - 15 min X2 4) nasal packing 4) ENT follow up and packing removal in 2-3 days

If you put one of the nasal packings up my nose what do you need to give me

Antibiotics that cover staph- Augmentin

How do you diagnose my nasal Fx

Clinically

What do you need to r/o when I break my nose

septal hematoma

Tx of nasal Fx

supportive care and follow up with plastics | Drain septal hematoma and put on antibiotics

My mouth really hurts and one of my teeth is tender to palpate, what do you do with me

Dental abscess- 1) drain 2) penicillin VK, 500mg PO QID or Clinda 300mg PO QID 3) Analgesia - nsaid or opiate

If I have an abscess in my lower teeth what do you need to look out for

Ludwigs angina

Presentation of ludwigs

Dysphagia, odonophagia, trismus, edema

Tx of ludwigs

Airway!! ICU Systemic antibiotics- cover anerobes and oral flora

I have a hot potato voice with trismus treat me

peritonsilar abscess 1) needle aspiration or I&D 2) ENT consult/follow up 3) CT if worried for deeper infection 4) Augmentin 875 BID for 10 days - or clinda 5) steroids to decrease swelling

Retrophayngeal abscess classic symptoms

Sore throat, fever, TORTICOLLIS, dysphagia

Diagnose me with retropharyngeal abscess

CT of neck with IV contrast

Treat my retropharyngeal abscess

IV antibiotics, admit, airway managment, ENT referral

I am a child who has dysphagia, drooling and distress what is likely to have caused my infection

Eiglotitis- H. Flu

Diagnose me with Epiglotitis

Lateral soft tissue- thumbprint sign | Clinical suspicion

Treat my epiglotitis

ICU, monitor, Airway, IV Ceftriaxone

HEENT ER Flashcards

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