ENT Quiz on Epistaxis and Mastoiditis

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Questions and Answers

What is the most common cause of anterior epistaxis in children and young adults?

Neoplasm

Atherosclerosis

Coagulopathy

Trauma (correct)

Which condition is a complication resulting from untreated mastoiditis?

Brain abscess (correct)

Vertigo

Hemorrhage

Nasal polyps

What should be the first step in managing a patient with epistaxis?

Administer antibiotics

Calm the patient (correct)

Perform a CT scan

Initiate nasal packing

Which of the following is typically a cause of posterior epistaxis?

Neoplasm Signup and view all the answers

What vascular supply primarily affects the anterior part of the nasal cavity?

Branches of internal carotid Signup and view all the answers

What is the recommended treatment for an auricular hematoma?

Drainage, antibiotics, and bulky ear dressing Signup and view all the answers

What condition is often associated with cellulitis in the auricle due to its poor blood supply?

Chondritis Signup and view all the answers

In cases of foreign bodies in the ear canal, which method is typically contraindicated if the patient has a perforated ear drum?

Ear lavage Signup and view all the answers

What is a potential complication of untreated diabetic patients with otitis externa?

Malignant otitis externa Signup and view all the answers

When dealing with a child who has ingested a foreign body and refuses to eat, what is the most common indication for intervention?

Visible foreign body in the mouth Signup and view all the answers

For patients with nasal foreign bodies presenting with unilateral purulent discharge, what is the ideal management approach?

Move the foreign body forward for removal Signup and view all the answers

What is the first step you should take when managing a patient who has a life-threatening airway obstruction from a foreign body?

Perform the Heimlich maneuver Signup and view all the answers

Which condition is characterized by the presence of granulation tissue and is often associated with untreated infections in diabetics?

Malignant otitis externa Signup and view all the answers

What is the appropriate management for anterior epistaxis?

Pressure and/or cautery and antibiotic prophylaxis Signup and view all the answers

Which of the following is considered a complication of epistaxis?

Hypoxia and necrosis of nasal structures Signup and view all the answers

What characteristic differentiates a peritonsillar abscess from other types of throat abscesses?

Displacement of the uvula and tonsil Signup and view all the answers

In cases of retropharyngeal abscess, which age group is most commonly affected?

Children under 4 years old Signup and view all the answers

What is the first-line treatment for Ludwig's angina?

ICU admission and airway management Signup and view all the answers

What is the recommended treatment for acute necrotizing ulcerative gingivitis (ANUG)?

Oral rinses and antibiotics Signup and view all the answers

When managing posterior epistaxis, what additional measures should be taken?

Administer analgesics and sedation with oxygen saturation monitoring Signup and view all the answers

Which symptom is NOT typically associated with epiglottitis?

Coughing fits Signup and view all the answers

What are the potential causative organisms of acute sinusitis?

Viral and gram-negative bacteria Signup and view all the answers

What characterizes facial cellulitis in terms of causative organisms?

Usually caused by streptococcus and staphylococcus Signup and view all the answers

Study Notes

ENT Emergencies Overview

ENT emergencies encompass various disorders affecting the ears, nose, and throat.
Specific categories include otologic disorders, nasal disorders, facial, oral, and pharyngeal infections, and airway obstruction.

Otologic Disorders Anatomy

Auricle (outer ear)
Ear canal
Tympanic membrane
Middle ear and mastoid disorders
Inner ear

Traumatic Disorders of the Auricle

Hematoma: Cartilaginous necrosis, requiring drainage, antibiotics, and a bulky dressing. Close follow-up is necessary.
Lacerations: Single layer closure, perichondrium pick up, and bulky ear dressing. Posterior auricular block for anesthesia.

Aspiration of Auricular Hematoma

Procedure involves aspiration of the hematoma.
Perichondrium and cartilage are visualized.

Auricle - Chondritis/Cellulitis

Infections, difficult to treat due to poor blood supply.
Includes S. Aureus and Pseudomonas.
Requires extra care in diabetics.
Inflammatory causes, sometimes indistinguishable from infection, often sparing the ear lobe.

Otitis Externa

Infection and inflammation caused by bacteria (Pseudomonas, staph) and fungi.
Treatment involves antibiotic-steroid drops.
Tight canals may require a wick.
Diabetics are at risk for malignant otitis externa, characterized by granulation tissue.

Foreign Bodies in Ear Canal

Often self-inserted or windblown debris.
Treatment involves mineral oil, lidocaine, forceps, suction, or tissue adhesive removal.

Foreign Body in the Nose

Common presentations include purulent discharge (unilaterally), nasal bleeding, and one-sided obstruction.
Treatment involves moving the foreign object using appropriate tools.

Foreign Bodies in Ear Canal (Children)

Children, individuals with mental retardation, and adults using cotton swabs may introduce foreign bodies into the ear canal.
Microscopic examination and specialized tools are often required.
Ear lavage may be necessary.
Perforated eardrums contraindicate lavage.
Edema should be relieved.
A liquid solution of lidocaine or boric acid can be used to remove certain foreign bodies.
Surgery is rarely needed.

Pharyngeal Foreign Bodies

Common in children.
Foreign body may be seen in the mouth.
Patients may refuse to eat.
Children with difficulty swallowing may have difficulty tolerating saliva.
Fishbone, tonsils, soft palate, are common sources.
Palpation is contraindicated.
Flexible nasopharyngolaryngoscopy is useful (FNFL).

Laryngotracheobronchial Foreign Bodies

Life-threatening due to airway obstruction potential.
Use Heimlich maneuver if necessary.
Bronchoscopy in the operating room is frequently required.

Tympanic Membrane Perforation

Difficult to detect, frequently preceded by middle ear pressure due to fluid or barotrauma.
External trauma can sometimes cause perforations.
Most heal on their own, but otology follow-up is required.
Perforations associated with vertigo and facial nerve involvement require immediate medical care.
Treatment typically involves antibiotics.
Ear drops are sometimes required, but avoid gentamicin.

Middle Ear

Serous Otitis Media: Eustachian tube dysfunction. Treatment includes decongestants and maneuvers.
Otitis Media: Middle ear infection, often viral or bacterial.
Mastoiditis: Venous connection to the brain, a serious condition. aggressive treatment is required. Brain abscess or meningitis may result.

Inner Ear

Peripheral Vertigo: Vestibulopathy, including BPPV and labyrinthitis. Characterized by sudden onset without central signs, often with horizontal nystagmus in younger patients.
Ménière's Disease: Vertigo, sensorineural hearing loss, and tinnitus.
Treatment: Valium, fluids, rest, and manipulation for BPPV are common interventions.

The Nose - Vascular Supply

Supply from branches of the internal carotid artery and external carotid artery.
Key areas include the anterior and posterior regions.

Epistaxis (Anterior)

Most common in children and young adults.
Usually due to Kisselbach's plexus (Little's area).
Etiologies include trauma, winter syndrome, allergies, irritants, and pregnancy.

Epistaxis (Posterior)

Less common, occurring mostly in the elderly.
Etiologies include coagulopathy, atherosclerosis, neoplasm, and hypertension (debatable).

Epistaxis Management

Pain medication and blood pressure control.
Patient preparation (gown, mask, suction, speculum, medications, and packing).
Clot evacuation.
Topical vasoconstrictors and anesthetics.
Identifying the source of bleeding.

Epistaxis Management (Anterior Sites)

Pressure, cautery, and tamponade.
Antibiotic prophylaxis for packs.

Epistaxis Management (Posterior Packing)

Analgesia and sedation.
Hospital admission and oxygen saturation monitoring are often necessary.

Epistaxis Complications

Severe bleeding, hypoxia, hypercarbia, sinusitis, otitis media, and necrosis of the columella or nasal ala.

7th Nerve Palsy

Typically idiopathic.
No proven effectiveness of steroids or antivirals, but many recommend them.
Consider Lyme's disease in endemic areas.
Surgical decompression is sometimes required for non-improving cases after two weeks with >90% ENOG (ear-nose-throat) out.

Facial Infections - Sinusitis

Symptoms includes headache, sinus pain, yellow-green nasal discharge, and fever.
CT scans are more sensitive than plain X-rays in detecting sinusitis.
Causative organisms include gram-positive bacteria like Streptococcus and Haemophilus influenzae (acute sinusitis), and anaerobes or gram-negative bacteria for chronic cases.

Facial Infections - Sinusitis - Treatment

Treatment for acute sinusitis often involves amoxicillin or septra.
Chronic cases might require amoxicillin-clavulanate, clindamycin, or quinolones.
Decongestants, analgesics, and heat are frequently included.

Facial Infections - Sinusitis - Complications

Ethmoid sinusitis can lead to orbital cellulitis and abscess.
Frontal sinusitis can potentially erode the bone and lead to complications like Potts puffy tumor or brain abscess.

Facial Cellulitis

Most common causes include Streptococcus and Staphylococcus.
Haemophilus influenzae is sometimes involved.
Facial cellulitis can progress rapidly.

Parotiditis

Typically viral, often caused by paramyxovirus.
Bacteria can also cause parotiditis, particularly in the elderly and immunocompromised patients, sometimes associated with dehydration.
Common bacterial culprits include Staphylococcus and anaerobes.

Pharyngitis

Irritants (reflux, trauma, gases), viruses (EBV, adenovirus), and bacteria (GABHS, mycoplasma, gonorrhoea, diphtheria) can all lead to pharyngitis.

Peritonsillar Abscess

Complication of suppurative tonsillitis.
Inferior-medial displacement of the tonsil and uvula.
Dysphagia, ear pain, muffled voice, fever, and trismus are possible symptoms.
Treatment usually involves antibiotics, incision and drainage (I&D), and sometimes steroids.

Epiglottitis (Clinical Picture)

Incidence has decreased in children due to vaccinations.
Symptoms include rapid onset, toxic appearance, preference for sitting posture, muffled voice, dysphagia, drooling, and restlessness.

Epiglottitis (Management)

Avoid agitation; direct visualization if possible.
Assess soft tissues of the neck, including signs like thumb printing and valecula signs.
Prepare for emergency airway management.
Steroids may be used.

Retropharyngeal Abcess

Located anterior to the prevertebral space and posterior to the pharynx.
Common in young children due to lymphoid tissue.
Symptoms include pain, dysphagia, dyspnea, fever, and retropharyngeal space swelling on lateral X-rays.
Potential complication: mediastinitis.

Masticator-Parapharyngeal Space Infection

Infection of the lower molars extending to the masticator space.
Symptoms include swelling, pain, fever, and trismus (restricted jaw movement).
Treatment: IV antibiotics (penicillin or clindamycin). ENT admission.

ANUG (Acute Necrotizing Ulcerative Gingivitis)

Bacterial infection that causes acute necrosis, destroying the periodontium.
Treatment includes oral rinses and antibiotics (penicillin, clindamycin, tetracycline).

Ludwig's Angina

Rapidly progressing cellulitis of the floor of the mouth, usually affecting elderly, debilitated patients.
Frequently precipitated by dental procedures.
Massive swelling, sometimes with impending airway obstruction.
Treatment: ICU admission, antibiotics, and airway management.

Angioedema

Can be life-threatening.
May be hereditary or related to ACE inhibitors.
Treatment involves antihistamines and steroids.

Airway Obstruction

Aphonia: Complete upper airway obstruction.
Stridor: Incomplete upper airway obstruction.
Wheezing: Incomplete lower airway obstruction.
Loss of breath sounds: Complete lower airway obstruction.

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Description

Test your knowledge on common causes of epistaxis and complications of mastoiditis. This quiz covers essential management steps and vascular supplies related to nasal conditions. Perfect for students in medical or health-related fields!