Ear, Nose, and Throat Emergencies

Review Test


1. A 53-year-old man presents with new-onset epistaxis for which posterior nasal
packing was required to attenuate bleeding. Which of the following is the most
likely cause for this patients nosebleed?

(A) Local trauma
(B) Hypertension
(C) Foreign body
(D) Upper respiratory tract infection
(E) Blood dyscrasia

2. A 3-year-old boy presents with fever and malaise and tugs at his right ear.
Physical examination reveals a normal pinna and a bulging, erythematous
tympanic membrane. Which of the following treatments should be instituted at
this time?

(A) Steroid drops
(B) No treatment, because this probably is a viral syndrome
(C) Antibiotics against Pseudomonas species
(D) Antibiotics against gram-positive organisms
(E) Antibiotics should be withheld until results of blood cultures are obtained.

3. Which one of the following statements regarding diphtheria pharyngitis is
false?

(A) Complications include myocarditis and thrombocytopenia.
(B) Unimmunized children under the age of 12 should receive the diphtheria
vaccine.
(C) Patients should be admitted to the hospital under strict isolation.
(D) Diphtheria antitoxin is administered to all patients.
(E) The first-line antibiotic is penicillin

4. Which of the following is the fist priority in the treatment of epiglottitis?

(A) Administration of dexamethasone 10 mg intravenously (IV)
(B) Securing the airway
(C) Administration of cefuroxime 1 g IV every 8 hours
(D) 100 % oxygen
(E) Vaccination against Haemophilus influenzae type B


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5. Which one of the following statements regarding mastoiditis is false?

(A) It results most often from under-treated otitis media.
(B) It may be caused by a cholesteatoma that blocks drainage.
(C) It occurs most commonly in elderly patients.
(D) Indications for mastoidectomy include osteomyelitis and spread to the central
nervous system.
(E) The condition usually can be treated medically.























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Answers and Explanations


1-B. The most common cause of nosebleeds in adults is hypertension. Posterior
epistaxis accounts for only 10% of all nosebleeds, and usually is the result of
laceration of the sphenopalatine artery. A blood dyscrasia most likely would have
been discovered before the patient reached the age of 53 years. Local trauma is
very difficult to inflict in the posterior septum. Foreign bodies in the nose are
uncommon in adults. Upper respiratory tract infection can produce epistaxis, but it
usually is anterior. Neoplasm, a choice not listed here, is another common cause
of posterior epistaxis in adults.

2-D. Although otitis media may be viral, empiric antibiotic treatment against the
most common organisms (gram-positive organisms) is the standard of care.
Choices B, no treatment, and E, withholding of antibiotics until culture results are
obtained, are inappropriate. Empiric therapy is instituted to avoid suppurative
complications of otitis media such as mastoiditis and retropharyngeal and
peritonsillar abscesses. Steroid drops are appropriate for otitis externa, not otitis
media. Antipseudomonal coverage is required for malignant otitis externa ,seen in
diabetics, not for otitis media.

3-E. The antibiotic of choice is erythromycin. Penicillin can be used as an
alternative in patients who cannot tolerate erythromycin. Nonimmunized or
inadequately immunized children, adults, and close contacts of the patient who
were vaccinated more than 5 years ago are (re)vaccinated.

4-B. As always, and especially in epiglottitis, the airway, breathing, and
circulation (ABCs) must be considered. Airway comes first. All of the other
choices are correct treatments, but only after the airway is secured.





5-C. Mastoiditis is an infection that is seen predominantly in children and
adolescents, not in elderly patients. All the other statements listed are correct.


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