Ludwig Angina and Dental Health Quiz
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Questions and Answers

Which of the following is NOT a treatment option for Angioedema?

  • Epinephrine (correct)
  • C1 esterase inhibitor
  • Antihistamines
  • Icatibant

    • In the management of Hereditary Angioedema, what is the primary treatment approach?

  • Administering C1 esterase inhibitor (correct)
  • Antihistamine and steroid administration
  • Oral antibiotics
  • Immediate airway management
  • Intravenous antibiotics

    • What is the main bacterial species commonly implicated in Ludwig Angina?

  • Staphylococcus aureus
  • Streptococcus pyogenes
  • Streptococcus viridans (correct)
  • Pseudomonas aeruginosa

    • What is a characteristic clinical finding associated with Ludwig Angina?

    <p>Hypersalivation and drooling (D)</p> Signup and view all the answers

    A patient presents with a dental abscess. Which of the following is NOT a typical clinical presentation?

    <p>Severe neck pain without local tenderness (D)</p> Signup and view all the answers

    Which of the following risk factors is NOT mentioned in the text as a risk factor for Ludwig Angina?

    <p>HIV (C)</p> Signup and view all the answers

    What is the characteristic appearance of the induration in Ludwig Angina?

    <p>Tender, symmetric, and 'woody/brawny' (C)</p> Signup and view all the answers

    What is the primary pathophysiological mechanism leading to dental caries?

    <p>Demineralization of enamel due to bacterial byproducts (D)</p> Signup and view all the answers

    Which of the following is NOT a radiological finding indicative of Ludwig Angina?

    <p>Enlarged lymph nodes (B)</p> Signup and view all the answers

    Which of the following is the most common cause of Ludwig Angina?

    <p>Dental infections (B)</p> Signup and view all the answers

    What is the most likely imaging modality used for diagnosis?

    <p>CT scan (C)</p> Signup and view all the answers

    What is the primary function of fluoride in dental health?

    <p>To reduce susceptibility of enamel to demineralization (B)</p> Signup and view all the answers

    Why might a patient with Ludwig Angina present with a muffled voice?

    <p>Swelling of the soft tissues in the throat (D)</p> Signup and view all the answers

    Which of the following is a potential complication of a dental abscess?

    <p>All of the above (D)</p> Signup and view all the answers

    Ludwig angina is often associated with a life-threatening complication. Which of the following is that complication?

    <p>Airway compromise (C)</p> Signup and view all the answers

    Which of the following antibiotic regimens is appropriate for the management of Ludwig Angina?

    <p>Augmentin (C)</p> Signup and view all the answers

    What is the primary reason for increased difficulty breathing in Ludwig Angina?

    <p>Airway obstruction (D)</p> Signup and view all the answers

    In addition to IV antibiotics and close monitoring, what other aspect of management is crucial for patients presenting with Ludwig angina?

    <p>Intubation and mechanical ventilation (B)</p> Signup and view all the answers

    What is the most likely reason for the floor of the oral cavity to be elevated and tender to palpation?

    <p>Infection and swelling of the submandibular space (B)</p> Signup and view all the answers

    Which of the following clinical signs is least likely to be seen in a patient with peritonsillar abscess?

    <p>Unilateral purulent otitis media (C)</p> Signup and view all the answers

    Which of the following is the most accurate statement regarding the management of a peritonsillar abscess?

    <p>Needle aspiration or incision and drainage followed by antibiotics is the most common treatment approach. (C)</p> Signup and view all the answers

    Which of the following is a potential complication of needle aspiration for a peritonsillar abscess?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following statements is true regarding the use of steroids in the management of peritonsillar abscess?

    <p>Steroids may be used to reduce inflammation and swelling. (B)</p> Signup and view all the answers

    What is a common clinical presentation associated with peritonsillar abscess?

    <p>Dysphagia (B)</p> Signup and view all the answers

    Which of the following is a common contributing factor to peritonsillar abscess?

    <p>Bacterial pharyngitis (B)</p> Signup and view all the answers

    Which of the following imaging modalities is considered the most sensitive for diagnosing a peritonsillar abscess?

    <p>CT scan (C)</p> Signup and view all the answers

    When a foreign body in the ear canal is visualized on otoscopy, which of these situations requires urgent removal?

    <p>A foreign body composed of a button battery (D)</p> Signup and view all the answers

    Which of these foreign bodies should NOT be removed with irrigation?

    <p>A button battery (B)</p> Signup and view all the answers

    Which of these instruments is NOT typically used for removal of ear canal foreign bodies?

    <p>Nasal Speculum (A)</p> Signup and view all the answers

    A patient presents with a foreign body in the ear canal that cannot be easily removed. What is the appropriate course of action?

    <p>Refer to an ENT specialist (A)</p> Signup and view all the answers

    Which of these scenarios would likely NOT require sedation for foreign body removal?

    <p>An adult with a small pebble lodged in the ear canal (D)</p> Signup and view all the answers

    What is a common presentation of a foreign body in the nasal passage?

    <p>Purulent nasal discharge (D)</p> Signup and view all the answers

    Which of these characteristics is NOT typically associated with nasal foreign bodies in children?

    <p>They are more common in children with hearing impairments (A)</p> Signup and view all the answers

    Which of these foreign bodies requires urgent removal?

    <p>Button batteries (B)</p> Signup and view all the answers

    Positive pressure is a technique used to remove foreign bodies from which location?

    <p>Nasal passage (C)</p> Signup and view all the answers

    What is an appropriate method of removing small inorganic objects or insects from the ear canal?

    <p>Irrigation with warm water (C)</p> Signup and view all the answers

    A patient presents with facial trauma, exhibiting crepitus and tenderness upon palpation of the nasal bridge. Which of the following is the most likely diagnosis?

    <p>Nasal bone fracture (C)</p> Signup and view all the answers

    A patient with a suspected LeFort II fracture presents with a CSF leak. The clinical presentation suggests an extension of the fracture into which of the following anatomical structures?

    <p>Sphenoid bone (D)</p> Signup and view all the answers

    A patient with a suspected mandibular fracture is being evaluated. Which of the following imaging modalities is most appropriate for visualizing the fracture?

    <p>CT scan (B)</p> Signup and view all the answers

    A patient presents with a large hematoma on the outer ear after blunt trauma. What is the most important reason for promptly evacuating this hematoma?

    <p>To avoid a permanent cauliflower ear deformity (B)</p> Signup and view all the answers

    A patient with a traumatic nasal fracture is being managed. Which of the following is the most appropriate management for a grossly displaced fracture in the first few hours after the injury?

    <p>Immediate referral to ENT for reduction (A)</p> Signup and view all the answers

    If a patient continues to have a nose bleed after 15 minutes, what is the next step in treatment?

    <p>Topical Vasoconstrictors (A)</p> Signup and view all the answers

    What antibiotics help reduce staph post epistaxis? (Select all that apply)

    <p>Cephalexin (A), Clindamycin (B)</p> Signup and view all the answers

    What is the difference between peritonsillar cellulitis and peritonsillar abscess?

    <p>Peritonsillar cellulitis involves swelling without pus, while peritonsillar abscess involves pus formation. (A)</p> Signup and view all the answers

    What medication can cause angioedema?

    <p>ACE inhibitors (A)</p> Signup and view all the answers

    What is the first line management of ACEI induced angioedema?

    <p>C1 esterase inhibitor (B)</p> Signup and view all the answers

    Which of the following antibiotics are commonly prescribed for dental caries and dental abscesses? (Select all that apply)

    <p>Augmentin (A), Clindamycin (B)</p> Signup and view all the answers

    Which of the following physical exam findings could indicate dental caries or abscesses? (Select all that apply)

    <p>Stridor (A), Drooling (B), Trismus (C)</p> Signup and view all the answers

    A patient presents with bilateral infection of submandibular, sublingual, and submental spaces in the floor of the mouth. What is the most likely diagnosis?

    <p>Ludwig's angina (A)</p> Signup and view all the answers

    What is Woody cellulitis?

    <p>A localized inflammation that resembles wooden-like hardness (C)</p> Signup and view all the answers

    A patient presents with fever, chills, malaise, and a muffled voice. What is the most likely diagnosis?

    <p>Ludwig's Angina (A)</p> Signup and view all the answers

    What are the first-line antibiotics for the management of patients with Ludwig's Angina?

    <p>Amoxicillin (A), Clindamycin (B), Penicillin (D), Ceftriaxone and Metronidazole (@)</p> Signup and view all the answers

    A patient's X-ray shows a thumb sign. What is the most likely diagnosis?

    <p>Epiglottitis (B)</p> Signup and view all the answers

    A patient presents with a barking cough and stridor, what is the most likely diagnosis?

    <p>Croup (A)</p> Signup and view all the answers

    A patient's X-ray shows a steeple sign. What is the most likely diagnosis?

    <p>Croup (A)</p> Signup and view all the answers

    What is the treatment for moderate to severe croup?

    <p>Racemic epinephrine nebulizer (A), Corticosteroids (B)</p> Signup and view all the answers

    Coins align ______ in tracheal

    <p>Sagittally</p> Signup and view all the answers

    Coins align _____ in the esophagus

    <p>coronal plane</p> Signup and view all the answers

    A tripod fracture involves which of the following facial bones?

    <p>Maxilla (B), Zygomatic bone (A), Lateral Orbit (@)</p> Signup and view all the answers

    A patient presents with widening of the anterior septum, what is the most likely diagnosis?

    <p>Septal Hematoma (A)</p> Signup and view all the answers

    What are some complications of septal hematoma?

    <p>Septal Necrosis (A), Infections (B)</p> Signup and view all the answers

    Which of the following antibiotics provide coverage against Pseudomonas aeruginosa? (Select all that apply)

    <p>Piperacillin-tazobactam (B), Meropenem (D)</p> Signup and view all the answers

    Seidel's Sign is seen in which condition?

    <p>Open Globe (B)</p> Signup and view all the answers

    Signup and view all the answers

    Study Notes

    HEENT Emergencies Study Notes

    • Epistaxis (Nosebleed):

      • Typically uncomplicated, but can be complicated (posterior, bilateral, high volume).
      • Most bleeds are anterior (Kiesselbach's plexus).
      • Important history includes duration, frequency, quantity, any trauma, and medications (especially bleeding disorders).
      • Etiology includes nasal trauma, mucosal drying, rhinitis, deviated septum, telangiectasias, inhaled drugs, alcohol abuse, and poorly controlled hypertension (HTN).
      • Pathophysiology: Anterior bleeds originate from the Kiesselbach's plexus; posterior bleeds come from branches of the sphenopalatine artery.
      • Exam should include light source, suction, tongue blade, PPE, and patient communication (stressful).
      • Management: Initial exam may be limited by hemorrhage; establish airway, breathing, circulation (ABCs), and manage with pressure, vasoconstrictors, anesthetics, and packing if needed.
      • Consider use of TXA (Tranexamic Acid)
      • Potential need for ENT consult if conservative measures fail.
      • Posterior bleeds often require packing or ENT consult.

    • Peritonsillar Cellulitis & Abscess:

      • Peritonsillar cellulitis: Inflammation btwn palatine tonsil and pharyngeal muscles. Usually resolves with meds.
      • Peritonsillar abscess ("Quinsy"): Pus collection in same space. Requires drainage.
      • Often preceded by pharyngitis/tonsillitis.
      • Presentation: Muffled "hot potato" voice, usually worse on one side.
      • Evaluation: Clinical evaluation, CT scan (more sensitive/specific), Ultrasound.
      • Management: Needle aspiration and/or incision and drainage (I&D) by ER physician. Topical anesthesia can be used. Risks include aspiration of pus or blood into airway and possible carotid artery puncture. IV antibiotics are often used. ENT consult frequently needed.

    • Ludwig's Angina:

      • Bilateral infection of submandibular, sublingual, and submental spaces.
      • Begins in floor of mouth.
      • Most common causative organisms are polymicrobial (strep, viridans, anaerobes).
      • "Woody" cellulitis; progresses rapidly.
      • Risk factors include diabetes, lupus, alcoholism, and immunocompromise.
      • Airway compromise is a potential complication.
      • Evaluation: Clinical evaluation, CT scan (especially useful).
      • Treatment: IV antibiotics, close observation; surgical intervention may be needed if fluid collection warrants.

    • Epiglottitis:

      • Inflammation of the epiglottis.
      • Usually affects children, Less common in adults (especially DM, HTN, immunocompromised).
      • Presents with abrupt symptom onset.
      • Signs include anxiety, tripod position, muffled voice, stridor.
      • Assessment: Direct visualization (flexible laryngoscopy is key)
      • Imaging useful (X-ray may show "thumb sign" or "steeple sign."
      • Management: Immediate airway management (most important). Advanced airway skills needed. Bag-valve-mask with 100% O2. Intubation ideally done in OR.
      • Cricothyroidotomy if intubation fails. IV antibiotics (typically 3rd gen cephalosporins + vancomycin). Consider steroids too.

    • Croup:

      • Viral laryngotracheobronchitis (larynx and subglottic airway inflammation).
      • Most often viral (parainfluenza viruses, RSV, adenovirus) with some bacterial involvement.
      • Young children; frequent in the fall and winter.
      • "Barking cough" is common sign.
      • Clinical presentation of respiratory distress.
      • Management: Typically mild, treated with at-home management (cool air/steam), supportive care, occasional steroids.
      • Severe cases may necessitate hospitalization, intubation, and racemic epinephrine nebulization.

    • Foreign Bodies (FB):

      • FB in any HEENT area (eye, ear, nasal, upper airway) is a possible emergency.
      • Potential risks include: significant pain, impaired breathing, and airway blockage.
      • Symptoms can be varied and depend on the location and type of FB.
      • Treatment varies by the location and nature of FB. Important to consider urgency for removal vs. waiting.

    • Facial Trauma:

      • Common mechanisms include sports, MVA, assaults, falls.
      • Assess for airway, control hemorrhage (with direct pressure and suction).
      • Initial physical exam is crucial—including visual acuity (eyes); tenderness and crepitus in the nose, face and mouth; dental malocclusion evaluation; TMJ tenderness; and detailed ear assessment (including CSF leak/otorrhea).
      • Establish diagnosis with CT facial bones (contrast-enhanced).
      • Consider additional imaging, consider the need for ENT, ophthalmology consultation.
      • Treat with close f/u vs. urgent/emergent surgery.

    • Auricular Hematoma:

      • Blood accumulation between the cartilage and skin of external ear.
      • Potential for "cauliflower ear" deformity.
      • Treatment: Evacuation via needle or incision. Compression dressing to prevent reaccumulation.

    • Ear Lacerations:

      • Need to consider cartilage involvement—if involved, layered closure is required.
      • Auricular block can be beneficial.
      • Prophylactic antibiotics for perichondritis (pseudomonas coverage) are often needed (do this if you see dog or cat bites).

    • Extra - penetrating neck trauma:

      • Neck zones I, II, III
      • Airway, Vascular assessment crucial
      • CTA/ angiography to assess vasculature (especially carotid and vertebral arteries.)

    • Extra - facial lacerations: Detailed areas of possible lacerations (forehead, eyelids, cheeks, mouth, inside of mouth, tongue) to be noted.

    • Eye/Orbital Trauma:

      • Common complaints include corneal abrasions, foreign bodies, hyphema, lacerations, subconjunctival hemorrhage, open globes, and orbital wall fractures.
      • Detailed physical exam of structures around eye.
      • Imaging if needed.

    • Cricothyroidotomy/Tracheostomy:

      • Procedures to establish an airway.
      • Indications (most common): Can't intubate can't oxygenate.
      • These are high-risk surgical procedures with potential complications.
      • Conditions warranting these procedures frequently involve hemorrhage or potentially obstructing lesions of the airway.

    • General HEENT Wrap Up:

      • Airway is always first priority.
      • Utilize specialists (ENT, ophthalmology, anesthesia) when patients are critically ill or not responding to treatment.
      • Thorough and fast clinical assessment is preferred in all cases.

    • Important note: This is a general overview. Specific situations will require a more in-depth assessment & specialized care.

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    Related Documents

    HEENT Emergencies and Eye Trauma PDF

    Description

    Test your knowledge on Ludwig Angina, its causes, clinical presentations, and treatment options. This quiz also covers essential dental health information, including the role of fluoride and dental caries. Perfect for medical students and healthcare professionals.

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