2) EENT Flashcards
Tx of blepharitis
Lid scrub w/ baby shampoo on q-tips
topical abx if infection is suspected
Blowout fx presentation
(fx of orbital floor max, pal, zygo)
-inability to look up (entrapment of infraorbital nerve and musculature)
-swelling and misalignment of eyes
-double vision
Tx: Ophthalmology (decongest, ice packs, cold compresses, abx)
Cataract presentation
- insidious onset of decreased vision
- dbl vision, fixed spots, reduced color perception
- ext = discoloration of lens
- int = cataract appears black on red background
tx: intracapsular or extracapsular extractions of cataract w/ lens replacement
Viral conjunctivitis cause
Adenovirus type 3, 8, 19
can be transmitted in swimming pools
-tender lymphadenopathy & watery d/c
Tx: eye lavage w/ normal saline bid; compresses
Bacterial conjunctivitis cause
s. pneumo, s. aureus, h. aegyptius and moraxella species
-copious purulent d/c
Tx: topical abx (ex: ciprofloxacin)
Rare pathogens in bacterial conjunctivitis
Chlamydia (no organism on stain) & gonorrhea (gram neg diplococci)
- sever conjunct and keratitis w/ develo perm vision loss
- tx: systemic abx (ceftriaxone/doxy)
Follow up on corneal abrasions
within 1-2 days is essential
Corneal ulcer tx
Eye specialist immediately
HSV=dendritic, s. aureus
Hyphema tx
refer to optham asap (risk for more hemorrhage)
how long is it ok to patch an eye for?
up to 24h
What is glaucoma?
Increased IOP w/ optic nerve damage
Open Angle Glaucoma
Chronic, asymptomatic potentially blinding dz
- defects in PERIPHERAL vision
- increased disc to cup ratios
tx: refer to optham (topical or systemic rx to decrease IOP)
Angle Closure Glaucoma
Painful eye, loss of vision
circumlimbal injection, steamy cornea, fixed mid-dilated pupil
-nausea, vomiting, diaphoresis
Tx: opthalmic emergency (start IV carbonic anhydrase inhibitor, topical beta blocker and osmotic diuresis)
Leading cause of irreversible central visual loss
Macular Degeneration
Macular Degeneration
- Causes: age related, choloroquine or phenothizine
- Drusen on buch’s membrane
- Mottling, serous leaks, hemorrhages on the retina
- NO EFFECTIVE TX
Central Retinal ARTERY occlusion
-sudden, painless, marked unilateral loss of vision
-emoblic, thrombotic, vasculitides
-arteriolar narrowing, box-carting, retinal edema, perifoveal atrophy (cherry red spot), gangioloinc seat heads to optic atrophy and pale retina
Tx: Opthalm Emergency w/ poor prognosis regardless if tx immediately
Central Retinal VEIN occlusion
-sudden, U/L, painless blurred vision or complete vision loss
-Causes: secondary to thrombic event
-afferent pupillary defect and bood and thunder retina
AKA: dilated veins, hemorrhages, edema, exudates
-vision is typical resolved w/ time, at least partially
Retinal Detachment
Causes: spontaneous, secondary to trauma, extreme myopia
-acute onset of blurred or blackened vision that occurs over several hours and progress to complete or partial monocular blindness (curtain being drawn over eye)
-floaters or flashing lights at initiation of sump
-relatively afferent pupillary defect
-rgous retina flapping in the vitreous humor
Tx: opthalm emergency
Leading cause of blindness in adults in US
Diabetic retinopathy (yearly dilate eye exam)
Prolif diabetic retinopathy
-neovascularization, vitreous hemorrhage
Non prolif diabetic retinopathy
-venous dilation, microaneurysms, retinal hemorrhages, retinal edema, hard exudates
Tx of diabetic retinopathy
Optimized clusoe control, regulation of BP, laser photocoag, vitrectomy
Optic Neuritis
Occurs in 15-40 y/o
- idiopathic but 20-50% develop MS
- globe is tender, visual field defects, altered color vision
Orbital cellulitis
More common in kids than adults (7-12y/o)
- sinusitis, dental infections, facial infections, infection of the globe or eyelids, ing of lacrimal system)
- s. pneumo, s. aureus, h. influ, gram neg bact
- PTOSIS, EYELID EDEMA, EXOPTHALMOS, PURULENT D/C AND CONJUNCTIVITIS
- FEVER, DECREASE ROM OF EYE MUSCLES AND SLUGGISH PUPILLARY RESPONSE
tx: medical emergency (hospitalization and IV abx)
Amblyopia
reduce VA not correctable by refractive means (most common cause is strabismus not tx by age 2)
Bullae in AOM suggests
mycoplasmal infection
Cholesteatoma
Complication of OM; chronic neg pressure creastes sac which may dil w/ desquamated keratin and become chronically infected
Tx: marsupialization of the sac or complete removal
Tx of eustachian tube dysfunction
Systemic or intranasal deoncgestatnts
Causes of Conductive hearing impairment
(dysfunction of the external or middle ear)
1) obstruction (cerumen impaction)
2) Mass loading (middle ear effusion)
3) Stiffness (otosclerosis)
4) Discontinuity (ossicular disruption)
- conductive hearing disorders in adults are commonly due to cerumen impaction or transient eustachian tube dysfunction associated w/ viral URI
- persisitnent conductive losses susually result from chronic ear infection, trauma, or otosclerosis
- Tx: Often correctable w/ medical or surgical therapy
Causes of Sensorineural Hearing impariement
- sensory hearing loss = deterioration of the cochlea due to loss of hair cells from organ of corti
- presbyacusis = most common (gradual; predominantly high freq loss)
- others: excessive noise exposure, head trauma, systemic dz
- neural hearing loss = lesions involving the eight nerve, auditory nuclei, ascending tracts or auditory cortex
- Causes: acoustic neuroma, multiple sclerosis, auditory neuropathy
Tx of sensorineural hearing loss
- Tx: often not correctable w/ medical or surgical therapy but often may be prevented or stabilized
- *sudden sensory hearing loss may respond to CORTICOSTEROIDS if delivered w/in wks of onset
Weber test info
-Conductive: sound appears louder in the poorer hearing ear -Sensorineural: radiates to better side
Rinne Test info
- Conductive: bone exceeds air
- Sensorineural: air exceeds bone
Drugs that cause hearing loss
- Caused by: Streptomycin, kanamycin, neomycin, ethacrynic acid, chlormaphneical -insidious onset, tends to be high frequency loss
- tinnitus may be the first symptom
tx of tinnitus
oral antidepressants (amitryptiline) have been effective
Pulsatile tinnitus
aka listening to ones heartbeat should be distinguished -may indicate a vascular abnormality
-MRI and venography
Meniere Dz
recurrent and usually progressive group of symp: acquired chronic hearing loss, tinnitus, and dizziness/vertigo secondary to distention of the endolymmph compartment of inner ear -unknown cause
- Dx: CT or MRI
- Tx: Surgical
Acoustic Neuroma
- aka Vestibular schwannoma
- neoplastic cause of hearing loss
- more predominant in females
- usually U/L hearing loss w/ a deterioration of speech discrimination
- *anyone with U/L or asymmetric senosorineural hearing loss should be evaluated for intracranial mass -diagnosted via CT or MRI
- Tx: Surgical
Peripheral Vertigo
-labryinthitis, Menier’s Dz, positional, vestibular neuronitis, migrainous and obstructing antomic abn -characterized by: sudden onset, nausea, vomiting, tinnitus, decreased hearing
-nystagmus is hornizontal w/ a rotary componenet, fast-phase beats away fom the diseased side
and fixation inhibition
Central Vertigo
- brain stem vascular disease, AV malformations, tumors of the brainstem or cerebellum, MS or vertebrobasilar migraine syndrome
- characterized by: slower-onet, nonfatiguable nystagmus, vertical greater than horizontal plane and no latency or suppression by vixation
- there are usually accompanying motor, sensory, or cerebellar deficits
Tx of Vertigo
depends on cause
- Acute attacks =diazepam
- Mild vertigo = meclizine, cyclizine, dimenhydrinate
- Severe vertigo = scopolamine
- Bed rest may be necessary during acute attacks but pts w/ chronic dz should be encouraged to move
Labryinthitis
- phenomenon of severe acute vertigo, hearing loss, and tinnitus -unknown etiology: possibly = otitis or viremia
- Tx: Meclizine, promethazine, and dimenhydrinate
Auricular Hematoma tx
All auricular hematomas should be drained as soon as possible after injury. Auricular hematomas that are more than seven days old warrant referral to an otolaryngologist or plastic surgeon for debridement of new perichondrial growth and any remaining hematoma.
-Although evidence is lacking, because of the risk of infection to an area with tenuous blood supply, Uptodate suggests that all patients who undergo auricular hematoma drainage receive a 7 to 10 day course of empiric antibiotics with activity against skin flora and Pseudomonas aeruginosa
Nasal polyps
- pale, edematous, mucosally covered masses commonly seen in pts w/ allergic rhinitis
- polyps in children should suggest the possibility of cystic fibrosis
- in pts w/ polyps and hx of asthma, aspirin should be avoided (Samter triad/ triad asthma) because they have have an immunologic salicylate sensitivity
- Tx: Topical intranasal steroids x 1-3 mo; short course of oral steroids; if refractive or massive = surgical
centor criteria
- fever >38/100.4
- tender anterior cervical adenopathy
- lack of a cough
- pharyngotonsillar exudates
- *3/4 criteria is highly suggestive for GABHS; 1⁄4 criteria makes GABHS very unlikely; 2 = do culture
Oral Leukoplakia
- painless white area around the tongue, inside the cheek, on the lower lip or on the floor of the mouth -seen in those who chew tobacco, smoke, have AIDS, and w/ ETOH abuse
- CANNOT be scraped off
- *biopsy to R/o malignancy
Oral Candidiasis
-causes burning pain of the tongue, inside the cheek or in the throat

-can be scraped off–> leaves raw, erythematous, friable area afterward
-often seen in immunocomprised pts and those on broad spectrum abx
-Tx: liquid antifungal (swish and swallow) or in a tab/lozenge that dissolves in mouth
