CPEN Maxillofacial, Ocular, and ENT Emergencies

Question 1

A child presents after a chemical splash to the eye. The parent is unsure of the substance. What is the emergency nurse's first priority intervention?

Accepted Answer

Immediately irrigate the eye with copious normal saline or water

Answer

Immediate, copious eye irrigation is the priority for any chemical ocular injury — particularly alkaline substances, which penetrate deeply and cause progressive damage. Irrigation must begin before identifying the specific chemical, as any delay worsens outcomes. After irrigating to pH 7.0–7.4, further assessment and specialist consultation follow.

Question 2

A 4-year-old presents with ear pain after swimming. Examination reveals intense pain when the pinna is moved, an edematous external auditory canal, and purulent discharge. The tympanic membrane appears intact. What is the most likely diagnosis?

Accepted Answer

Otitis externa

Answer

Otitis externa ('swimmer's ear') is an infection of the external auditory canal, commonly caused by Pseudomonas aeruginosa. The hallmark finding is pain exacerbated by traction on the pinna or pressing the tragus, with an intact tympanic membrane. Otitis media involves the middle ear and does not cause tragal tenderness.

Question 3

A 7-year-old presents with a 2-day history of fever, periorbital swelling, proptosis, pain with eye movement, and limited extraocular motility. What is the most serious diagnosis to suspect?

Accepted Answer

Orbital cellulitis

Answer

Orbital cellulitis is a sight- and life-threatening emergency involving infection posterior to the orbital septum. Key distinguishing features from preseptal cellulitis are proptosis, pain and limitation with eye movement, and potential decreased visual acuity. Preseptal cellulitis is anterior to the septum and does not cause these findings. Orbital cellulitis requires urgent IV antibiotics and CT imaging.

Question 4

A 3-year-old is brought to the ED after a caregiver witnessed the child insert a small bead into the nostril. The child is comfortable and breathing normally. Which technique is the appropriate first-line approach for removal?

Accepted Answer

Occlude the unaffected nostril and have the parent deliver a short puff of air into the child's mouth ('mother's kiss')

Answer

The 'mother's kiss' technique — where positive pressure is delivered into the child's mouth while the unaffected nostril is occluded — is a safe, effective first-line method for anterior nasal foreign bodies in cooperative children. It avoids procedural sedation and has high success rates. Vigorous irrigation risks pushing the object further back and risks aspiration.

Question 5

A child struck by a ball presents with periorbital ecchymosis, numbness in the cheek and upper teeth, and diplopia on upward gaze. Which injury does this presentation most suggest?

Accepted Answer

Orbital floor (blowout) fracture

Answer

An orbital floor (blowout) fracture occurs when blunt orbital trauma forces the orbital floor into the maxillary sinus. Entrapment of the inferior rectus muscle causes restricted upward gaze and diplopia. Infraorbital nerve involvement produces numbness along the cheek and upper dentition. CT of the facial bones confirms the diagnosis.

CPEN - Certified Pediatric Emergency Nurse Practice Test

CPEN - Certified Pediatric Emergency Nurse Practice Test

CPEN Maxillofacial, Ocular, and ENT Emergencies