Emergency Medicine (Eyes, Ears, Nose, Throat)

Front 1

Why should fluorescein staining of the cornea be performed in patients with suspected conjuctivitis?

Back 1

to avoid missing abrasions, ulcers, and dendritic lesions

Front 2

What is the treatment for bacterial conjuctivitis for a non-contact lens wearer? contact lens wearer? pt < 2 months?

Back 2

• non-contact lens wearer: polymyxin B-trimethoprim
• contact lens wearer: ciprofloxacin, oflxacin, or tobramycin (to cover Pseudomonas)
• pt < 2 months: sulfacetamide

Front 3

A patient presents with a conjuctivitis with a hyperacute onset (within 12-24 hrs) and a severe purulent discharge. What etiology should be considered?

Back 3

gonococcal conjunctivitis

Front 4

What are treatment options for gonococcal conjunctivitis?

Back 4

• ceftriaxone
• ciprofloxacin
• tobramycin
• doxycycline

Front 5

What medication can be used to relieve conjuctival itching or congestion?

Back 5

Naphazoline/pheniramine

Front 6

What are treatment options for allergic conjunctivitis?

Back 6

• elimination of the inciting agent
• cool compress
• artifical tears
• naphazoline/pheniramine
• diphenhydramine (in moderate to severe cases)
• fluorometholone (a mild topical steroid for severe cases)

Front 7

What is the hallmark finding of herpes heratitis on slit lamp examination?

Back 7

linear branching, epithelial defect with terminal bulbs that stain brightly with fluorescein dye

Front 8

What type of medication should be strictly avoided in patients with herpes keratitis?

Back 8

steroids

Front 9

What is the herpes zoster ophthalmicus (HZO)?

Back 9

shingles in a trigeminal distribution with ocular involvement

Front 10

What is a Hutchinson sign?

Back 10

• shingles involving the tip of the nose
• presence or eventual development of HZO should be suspected

Front 11

What are characteristics of endophthalmitis?

Back 11

• infection involving the deep structure of the globe (ex. anterior, posterior, & vitreous chambers)
• presents with pain and visual loss
• seen as a complication of globe violation from trauma or ocular surgery

Front 12

What are pathogens that can cause endophthalmitis?

Back 12

• Bacillus
• Haemophilus
• Staph
• Strep

Front 13

What is the initial empiric treatment for endophthalmitis?

Back 13

• vancomycin
• ceftazidime

Front 14

What is the most important step in managing periorbital cellulitis?

Back 14

to exlucude orbital cellulits

Front 15

How can you clinically distinguish periorbital cellulitis from orbital cellulits?

Back 15

periorbital cellulits has no:
• painful eye movement
• restriction of ocular motility
• acuity deficit
• impairment of pupillary function
• proptosis

Front 16

What is the treatment for simple periorbital cellulitis in adults and children older than 5?

Back 16

Augmentin

Front 17

What is the treatment for periorbital cellulitis in children < 5 y/o OR patients with comorbidities?

Back 17

• Ceftriaxone IV
• Vancomycin IV

Front 18

Typically, orbital cellulitis spreads from where?

Back 18

ethmoid sinuses

Front 19

What is the treatment for conjuctival abrasions?

Back 19

erythromycin

* should rule-out ocular foreign body

Front 20

What is the test of choince to confirm the presence of an orbital fracture?

Back 20

CT of the orbit and face

Front 21

What needs to be ruled out in a patient that presents with hyphema?

Back 21

• ruptured globe
• increased intraocular pressure

Front 22

What are medical treatment options for increased intraocular pressure?

Back 22

• timolol
• apraclonidine
• acetazolamide
• mannitol

Front 23

What portion of the orbit are commonly fractured in an orbital blowout fracture?

Back 23

inferior and medial wall

Front 24

What is a Seidel test?

Back 24

• a bright-green streaming appearance to fluorescein stain
• pathognomonic for ruptured globe

Front 25

What is the most common cause of contact lens-related bacterial ulcers?

Back 25

Pseudomonas

Front 26

What is the most common form of glaucoma?

Back 26

primary open angle glaucoma

Front 27

What are signs and symptoms fo acute angle closure glaucoma?

Back 27

• cloudy vision
• colored halos around lights
• conjunctival injection
• eye pain
• fixed mid-dilated pupil
• headache
• increased IOP
• nausea/vomiting

Front 28

What are characteristics of optic neuritis?

Back 28

• inflammation at any point along the optic nerve
• presents with acute vision loss (particularly reduction in color vision)

Front 29

What test can be used to diagnose a decrease in color vision?

Back 29

• Red desaturation test
• patient looks at a drak red object with one eye; the affected eye will see the object as pink or light red

Front 30

A sudden painless loss of vision in one eye most likely represents what?

Back 30

central retinal artery occlusion

Front 31

What are classic signs of central retinal artery occlusion?

Back 31

• complete or nearly complete vision loss
• afferent pupillary defect
• whitening of the retina in the posterior pole
• bright red macula ("cherry red spot")

Front 32

Fundoscopic examin shows optic disc edema, cotton wool spots, and retinal hemorrhages in all 4 quadrants. These findings, described as "blood-and-thunder fundus" suggests what diagnosis?

Back 32

central retinal vein occlusion

Front 33

Bullous impetigo is caused by what pathogen?

Back 33

Staph aureus

Front 34

Non-bullous impetigo is caused by what pathogens?

Back 34

• Strep pyogenes
• Staph aureus

Front 35

What is the treatment for impetigo?

Back 35

• mupirocin ointment (treatment of choice for localized infections)

• pediatric cases:
- dicloxacillin OR
- cephalexin OR
- augmentin

Front 36

What pathogen causes erysipelas?

Back 36

Strep pyogenes

Front 37

What is the most common cause of viral parotitis in children < 15 y/o?

Back 37

mumps

Front 38

What is the incubation period for mumps?

Back 38

2-3 weeks

Front 39

What is the treatment of viral parotitis?

Back 39

supportive tx (analgesics & antipyretics)

Front 40

What is the most common extrasalivary manifestation of mumps?

Back 40

epididymoorchitis

Front 41

This condition is a potentially fatal bacterial infection that occurs in patients with diminshed salivary flow?

Back 41

suppurative parotitis

Front 42

What are factors that lead to decreased salivary flow?

Back 42

• advanced age
• dehydration
• medications (ex. diuretics, ß-blockers, antihistamines, phenothiazines, TCAs)
• prematurity
• recent anesthesia
• sialolithiasis

Front 43

What are physical exam findings of suppurative parotitis?

Back 43

• erythema, induration, & tenderness to palpation of the cheek and angle of the mandible
• pus from the Stensen duct

Front 44

Most cases of sialolithiasis occur in which duct?

Back 44

submandibular (Wharton) duct

Front 45

What is the most common dislocation of the mandible?

Back 45

anterior dislocation

Front 46

What is the most common cause of sudden hearing loss?

Back 46

idiopathic

Front 47

What complication may result if a dental infection spreads to the ingraorbital space?

Back 47

cavernous sinus thrombosis

Front 48

How can a patient with a cavernous sinus thrombosis present?

Back 48

• coma
• limitation of lateral gaze
• meningeal signs
• sepsis

Front 49

What is the treatment for acute necrotizing ulcerative gingivitis ("Trench Mouth)?

Back 49

• metronidazole
• chlorhexadine mouth rinses

Front 50

What virus causes herpangina?

Back 50

coxsackie A virus

Front 51

How does herpangina present?

Back 51

• presents with high fever, sore throat, headache, & malaise
• followed by eruption of oral vesicles which rupture to form painful, shallow ulcers
• soft palate, uvula, & tonsillar pillars are typically affected
• buccal mucosa, tongue, & gingiva are spared

Front 52

What system is used to classify the anatomy of fractured teeth?

Back 52

ellis system

Front 53

Describe the classes of ellis fractures

Back 53

• class 1: involve only the enamel of the tooth
• class 2: involves the creamy yellow dentin underneath the white enamel
• class 3: tooth-threatening pfractures that involve the pulp; indentified by a red blush on the exposed dentin OR a visble drop of blood after wiping the tooth

Front 54

What is the most common cause of peritonsillar abscess (PTA)?

Back 54

GABHS

Front 55

Patients with this type of abscess tend to gravitate toward a supine position, with the neck in slight extension to minimize compression of the upper airway.

Back 55

retropharyngeal abscess