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FA17 HEENT > HNT Emergencies > Flashcards

HNT Emergencies Flashcards

1
Q

Pathogen in viral parotitis

A

Mumps

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2
Q

Clinical features of viral parotitis

A

Fever, Malaise, Headache, anorexia
Myalgia/arthralgia

Bilateral enlargement, tense and painful glands
ABSENCE OF PUS
Epididymo-orchitis MC extra salivary glands

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3
Q

Viral parotitis

Treatment

A

Mainly supportive

Can be prevented with vaccine

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4
Q

Suppurative parotitis

Risk factors

A

Diminished salivary flow

Advanced age
Dehydration
Diuretics

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5
Q

Common pathogens suggested in Suppurative parotitis

A

Staph aureus, strep pyrogens

Bactericides and fusobacteirum (anaerobes)

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6
Q

Suppurative parotitis

Clinical features

A

Rapid onset, FEVER, TRISMUS, erythema, pain over parotid gland

PUS is not able to be expressed

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7
Q

Management of Suppurative parotitis

A

Outpatient treatment - warm compress, milking of duct, lemon drops, oral ABx

Severe - IV abx

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8
Q

Clinical features of temporal arteritis

A

Ischemic optic neuropathy

UNILATERAL + vision changes

Jaw claudication, decreased temporal pulse, TIA/stroke symptoms

Sed rate/CRP elevated

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9
Q

temporal arteritis management

A

High dose systemic steroids , Opthalmologist consult, admission to hospital

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10
Q

Horner’s Syndrome

Classic triad

A

Ipsilateral ptosis (flaccid eyelid)

Ipsilateral mitosis (pupil constriction)

Ipsilateral anhydrousus (absence of sweat)

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11
Q

Horner’s syndrome

Cause

A

Impaired sympathetic nerve

CVA, tumors, internal carotid dissection, tumors, trauma

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12
Q

Papilledema

A

Bilateral via intracranial pressure

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13
Q

Inflammatory pupillitis

A

Unilateral papilledema

Caused by MS

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14
Q

Malignant Otitis externa

Pathophys

A

Simple otitis externa that spreads to deeper tissues and causes granulation of external canal and infects cartilage, periosteum, soft tissue and bone

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15
Q

Malignant Otitis externa

Pathogens

A

90% pseudomonas aeruginosa (MRSA 10%)

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16
Q

Malignant Otitis externa

People at risk

A

Elderly
Immunocompromised
Diabetics

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17
Q

Malignant Otitis externa

Diagnosis

A

Must have high suspicion

EXTREME pain
Green/gray discharge
Tissue granulation in the canal

CT scan the head (w/contrast) to determine bony erosion

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18
Q

Malignant Otitis externa

Treatment

A

IV Abx + pseudomonas coverage

ENT consult

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19
Q

Mastoiditis

Clinical features

A

Infection that spreads from middle ear to mastoid air cells of skull

Otalgia, fever, and post auricular erythema, swelling and tenderness

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20
Q

Mastoiditis

Management

A

IV Abx, hospital admission, HEENT consult

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21
Q

Lateral sinus thrombosis

Cause

A

Extension of mastoiditis that occuleds lateral venous sinuses and blocks sinus drainage

Infection goes right into brain

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22
Q

Lateral sinus thrombosis

Clinical features

A

Fever, HA

6th cranial nerve palsy (inability to abduct eye)

Convergent strabismus and complaint of diplopia

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23
Q

Lateral sinus thrombosis

Dx and tx

A

Contrast CT

IV abx, HEENT consult, likely mastoidectomy

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24
Q

TM perforation

Cause

A

Otitis media
Foreign body
Blast injury

Will result in CONDUCTIVE HEARING LOSS

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25
TM perforation Management
Typically supportive No ear drops or water until healed
26
Basilar skull fracture Look for (4)
Mc thru temporal bone Otorrhea from external or auditory canal (clear/bloody drainage) Hemotympanum (blood behind TM) Battle sign (postauricular hematoma, develops following injuries) Raccoon eyes
27
Correct management strategies for ear foreign body
Immobilize insects with lidocaine Can be removed with forceps, Katz ear extractor, suction catheter Irrigation possible if not organic material
28
Epistaxis anatomical locations
Anterior (90%) due to kiesselbach’s plexus Posterior due to posterior ethmoid or sphenopalatine arteries
29
Risk factors of epistaxis
Younger adults are typically minor, elderly tend to have worse Anticoagulants increase risk
30
Possible complications of posterior epistaxis
Usually arterial pattern and more profuse posterior Aspiration of blood or airway compromise
31
Etiology of epistaxis
Local trauma (picking*, foreign body,facial trauma, nasal surgery) Environmental Coaguloptahies Drugs Other (congenital weakness, septum anomalies, tumors, HTN)
32
Epistaxis management STARTING
Ask if patient is on blood thinner Keep calm and get them on IV Have blow nose to clear out the space Use light to find source of bleeding
33
Anterior epistaxis management
Direct pressure on fleshy for 20 min and observe for 30 min. Discharge and recommend daily lubrication May insert cotton pledget w/local vasoconstriction
34
Posterior epistaxis management
Dilate and grab rhino rocket Insert and inflate nose Observe for 30 min
35
Septal hematoma Pathology
Direct nasal trauma Causes torn vessels and collection of perichondrium/septal cartridges Anterior nasal septum is site
36
septal hematoma complications
Abscess formation Septal perforation Saddle nose deformities
37
septal hematoma Clinical features
Signs of trauma (not always) Medical nasal passage is asymmetric
38
Cribriform plate fracture Clinical features
CSF leak Double ring sign (blood + CSF on test) Drainage of clear rhinorrhea after trauma to mid face
39
Cribriform plate fracture management
Hospital admit + neuro consult Head elevation and lumbar drain Prophylactic ABx and surgical repair
40
Epidemiology of nasal foreign bodies
Pediatrics 2-5
41
Nasal foreign body Clinical features
Unilateral rhinorrhea +/- blood or odor
42
Nasal foreign body Management
Katz nasal extractor, alligator forcepts If nec. Call ENT and maybe anesthesia
43
Facial layers of the neck
Superficial (platysma) Middle facial layer (pretrachial and retropharyngeal layer) Deep cervical fascia layer (prevertebral)
44
Major risk of facial injuries
Bleeding and inflammation - can cause airway compromise
45
High risk clinical features in fascial injuries
Vocal change Drooling Stridor at rest Persistent tachycardia
46
Platysma space infection Etiologies
Ludwig angina Prolonged tracheostomy infection on ant. Surface
47
Pre-tracheae middle space infection etiologies
Perforation of anterior esophageal wall Contiguous extension from retropharyngeal space infection i Prolonged tracheostomy
48
Pre vertebral Deep space infections
Originate from cervical spine infection (discitis or vertebral osteomyelitis) Mc pathogens staph aureus and MRSA
49
Peritonsillar abscess (PTA) Risk factors
Prior PTA Smoking Peridontal dz Chronic tonsillitis Repeat abx
50
PTA clinical features
Appear ill, fever, malaise Sore throat, displaced uvula, odonophagia Muffled voice, drooling
51
PTA management
Aspiration with 18/20 gage needle (dont go more than 1cm in - carotid) HEENT specialist Clindamycin Vanco if CA MRSA is suspected
52
Retropharyngeal abscess Risk factors
Intraoral procedures Trauma Foreign bodies (i.e. fishbone) Extension of dental infection
53
Clinical features retropharyngeal abscess
Sore threat Cervical lymphadenopathy Stridor Neck pain Poor intake
54
Retropharyngeal v. PTA
PTA is up top, displaced uvula RPA is down lower, gold standard dx is CT scan w/IV contrast Sore NECK
55
Anterior mandible dislocation
History of opening mouth extreme Pain anterior to Travis Clinical dx Reduction to treat
56
Lateral, posterior, superior dislocations
Requires SIGNIFICANT trauma Dx with CT scan Keep patient NPO and get surgical consult
57
Severe facial fractures are associated with ...
Injuries to brain, orbits, cervical spine, and lungs
58
History if someone with facial trauma
Can you tell me name? What happened? Does neck hurt? Lose consciousness? Numbness in face? Bite feel normal?
59
Le Forte fracture
Fracture that occurs when the internal bone structures are removed from the skull
60
Inspection of facial trauma Le Forte
In Le Forte II - lateral, fish face Le Forte III - donkey face, frontal Palpating face (rock hard pals with one hand, stabilize in other)
61
Physical exam finding Basilar skull fracture
Raccoon eyes Battle signs Hematypanum CSF leak
62
Facial trauma eye Examine
Document acuity Examine eyes thoroughly Evaluate for orbital fractures Asses pupil
63
Le Fort I
Only fracture in hard palate and teeth
64
Le Fort II
Movement of upper teeth, hard palate and nose Dish face deformity
65
Le forte III
Entire face shifts with globes held in place by optic nerve Donkey face
66
Posterior triangle borders
Posterior sternocleidomastoid Anterior border of trapezius Middle third of clavicle
67
Anterior triangle borders
Border of mandible Anterior midline of neck Anterior border of sternocleidomastiod
68
Components of anterior triangle
``` Carotid a. Internal jugular v. Vagus n. Thyroid gland Larynx Trachea Esophagus ```
69
Posterior triangle components
Few vitals Subclavian a. And brachial plexus at base
70
Zones of anterior triangle Zone 1 (5)
Clavicle to cricoid cartilage ``` Vertebral and carotid Major thoracic vessels Apex of lungs Esophagus Trachea Spinal cord ```
71
Zones of anterior triangle Zone II (5)
Inferior margin of carotid cartilage to angle of mandible ``` Vertebral and carotid a. Jugular vein Esophagus Trachea Spinal cord ```
72
Zones of anterior triangle Zone III (3)
Angle of mandible to base of skull Vertebral and carotid a. Pharynx Spinal cord
73
Etiologies of carotid a. neck injuries
1. HyperEXTENSION that causes compression against transverse process 2. HyperFLEXION that results in compression b/t mandible and c-spine 3. Direct blows 4. Intraoial injuries 5. Basilar skull fracture = tearing of intracranial portion of Carotid
74
Results of vascular neck injuries
Vertebral artery dissection Subintimal hematoma Complete thrombotic occlusion
75
Clinical features of Vascular neck injuries
Asymptomatic, intermittent, or delayed Headache, neck pain Ipsilateral facial paralysis Horner Syndrome
76
How are vascular neck injuries diagnosed?
CTA of head and neck

FA17 HEENT (8 decks)

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