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5. EENT Flashcards

1
Q

Bacterial Conjunctivitis

Pathogen/SX/PE/TX/Lens wearer

A
  • Pathogen: Staph A
  • Sx: Crusting, worst in the morning, discharge
  • PE: Purulent yellow
  • Tx: Erythromycin
  • Lens wearer for long time: Psudomonas, Tx: Cipro
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2
Q

Allergic conjuctivitis

SX/PE/TX/Lens wearer

A
  • Sx: itch
  • PE: Cobblestone
  • Tx: olopatadine
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3
Q

Viral conjunctivitis

Pathogen/Sx/PE/Tx

A
  • Pathogen: adenovirus
  • Sx: bilateral pink eye
  • PE: copious watery discharge, scant mucoid
  • Tx: Supportive (cool compress, itch for antihistamine)
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4
Q

Chlamydia/Gonorrhea conjunctivitis

Pathogen/Patient/PE/Dx/Tx

A
  • Pathogen: chlamydia
  • Patient: Neonate (5-14D old), 0-5D old - gonorrhea
  • PE: eye swelling, mucopurent discharge
  • Dx: culture
  • Tx: Oral erythromycin
  • Tx for gonorrhea: Oint erythromycin
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5
Q

Bacterial vs Iritis vs keratitis vs acute close glaucoma

A

Bacterial: Normal vision, discharge

Iritis: blurred vision, pupil constrict, pain

Keratitis: Blurred vision, severe pain

Acute-closure glaucoma: Coudy, dilated pupil

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6
Q

Cataract

Patient/Sx/PE/Tx/Comment

A

Patient: Old

Sx: gradual blurred vision

PE: Cloudy lens

Tx: Remove and replace lens

Comment: MC blindness in elders

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7
Q

Corneal Ulcer

Pathogen/Hx/PE/Dx/Tx

A
  • Pathogen: Staphy, Lens wearer - Pseudomona
  • Hx - trauma, lens
  • PE: Ragged edge
  • Dx: Flurescein stain
  • Tx: ER consult
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8
Q

Ultraviolet keratitis

Patient/Sx/PE/Tx

A
  • Patient: Welder, Skier
  • Sx: bilateral vision acuity decrease
  • PE: mutiple punctate lesion
  • Dx: Fluoresein stain
  • Tx: NSAID
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9
Q

Herpe simplex Keratitis

Pathogen/Clonize/PE/Tx

A
  • Pathogen: HSV
  • Colonize: trigeminal ganglion (V1)
  • PE: Slit lamp (dedrite)
  • Tx: Acyclovir
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10
Q

Pterygium

Hx/PE/Tx

Pinguecula

PE

A
  • Hx: Sunlight, sandy, windy, dusty
  • PE: triangular shape cornea involve
  • Tx: Observe
  • Yellow fleshy mass on conjuntiva but do no involve cornea
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11
Q

Dacryocytitis vs Dacryoadenitis

Cause/Location/Sx/Complication/Tx

A
  • Cause: infection of lacrimal gland
  • Location: Supratemporal (adenitis), inframedial (cyctitis)
  • Sx: Pain, swelling
  • Complication: preseptal, orbital cellulitis
  • Tx: Mild - clinda, Severe - vancomycin
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12
Q

Blepharitis

Cause/Sx/PE/Dx/Tx

A
  • Cause: dyfunction of meibomian gland
  • PE: Scaling, red-rimming
  • Dx: Slit-lamp exam
  • Tx: Warm compress, abx for flare up: erythromycin
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13
Q

Hordeolum vs Chalazion

Cause/Sx/Location/Tx

A

Hordeolum

  • Cause: MC bacterial infection
  • Sx: Painful
  • Location: near foliicle
  • Tx: Warm compress + I&D

Chalazion

  • Cause: MC
  • Sx: Painless
  • Location: upper lid
  • Tx: Warm compress (if prolonged I&D)
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14
Q

Ectropion vs Entropion

PE/Tx

A
  • Entropion: inward, surgical fix
  • Ectropion: outward, surgical fix
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15
Q

Nystagmus

Up/down, horizontal, gaze-evoke

A
  • Down/up: CNS dysfunction
  • Horizontal: labyrinth or vestibular
  • Gaze-evoke: MC and often benign
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16
Q

Optic neuritis

Cause/Related Dx/Medication/Sx/PE/Dx/Tx

A
  • Cause: demyelinating inflammation of the optic nerve
  • Related dz: MS (multiple sclerosis)
  • Medication: ethambutal
  • Sx: pain with movement + Mono vision loss (red color)
  • PE: Marcus-gunn pupil
  • Dx: MRI
  • Tx: Methyprednisone (return to normal if tx)
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17
Q

Papilledema

Cause/Sx/PE/Tx

A
  • Casue: ICP high
  • Sx: Sudden HA, blurred vision
  • PE: optic disk swelling
  • Tx: Acetazolamide
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18
Q

Orbital cellulitis

Cause/PE/Dx/Tx/Preseptic difference

A
  • Cause: infection by bacterial rhinosinusitis
  • PE: Pain with move
  • Dx: CT scan
  • Tx: IV vanco + ceftx
  • Preseptic: Normal vision, No pain
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19
Q

Macular degeneration

2type/Onset/Risk factor/Sx/PE/Dx/Tx

A
  • 2 type: dry and wet
    • Dry - drugen (waste pile up)
    • Wet - abnormal vessel
  • Onset
    • Dry - gradual
    • Wet - sudden
  • Risk factor: age< 50
  • Sx: Center vision loss, wavy or bent vision
  • Dx: Amsler grid (dry), Fluorescein angio (wet)
  • Tx: Dry - Zinc ACE vitamin, Wet - zumab meds
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20
Q

Retinal detachment

Cause/Sx/Dx/Tx/Avoid/Other confuse dz

A
  • Cause: Retinal tear
  • Sx: Painless Curtain down vision loss, flash, floater
  • Dx: Fundoscpy - white folds
  • Tx: Optho ER
  • Avoid: No miotic drop
  • Confused dz: amaurosis fugax - curtain lift up
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21
Q

Diabetic retinopathy

Hx/Sx/PE/Tx

A
  • Hx: DM
  • Sx: Progressive vision loss
  • PE: Microaneurysms
  • Tx: DM control, laser surgery or vitrectomy
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22
Q

Retinoblastoma

Cause/PE/Comment

A
  • Cause: loss of retinoblastoma gene
  • PE: white pupil (leukocoria) + no red reflex
  • Comment: MC eye tumor in children
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23
Q

Orbital floor fx

Cause/Muscle trapped/MC site/Sx/Dx/Tx/Avoid

A
  • Cause: Trauma
  • Muscle trapped: inferior rectus
  • MC site: Maxillary
  • Sx: limited upward gaze
  • Dx: CT scan
  • Tx: Nasal decon, corticosteriod, abx, surgery
  • Avoid: Do not blow nose,
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24
Q

Corneal Abrasion

Cause/Sx/Dx/Tx

A
  • Cause: Trauma
  • Sx: Foreign body sensation, pain
  • Dx: Slit exam (dye)
  • Tx
    • if lens wearer - Cipro
    • abrasion - abx, if more than 5 mm use patch for 24hr only
    • Rust ring - wait 24 hour to remove
    • just foregin body - remove
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25
Q

Globe Rupture

Cause/PE/Dx/Tx/Avoid

A
  • Cause: Trauma
  • PE: teardrop pupil, hyphema
  • Dx: CT
  • Tx: Emergency
  • Avoid: IOP meansure
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26
Q

Hyphema

Cause/PE/Tx

A
  • Cause: Trauma
  • PE: blood in the anterior chamber
  • Tx: eye protection + head of bed at 30-45 degree
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27
Q

CRAO vs CRVO

Cause/sx/Dx/Tx

A

CRAO

  • Cause: atherosclerotic dz (OPTHALMO ER)
  • Sx: sudden mono vision loss, NO pain
  • Dx: fundoscopy (cherry red spot)
  • Tx: Immediate ophthalmology consult + Lower IOP

CRVO

  • Cause: hx of HTN, DM
  • Sx: sudden mono vision loss, NO pain
  • Dx: Fundoscopy (thunder and blood), tort
  • Tx: Ophtalmology consult
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28
Q

Amaurosis fugax

Cause/Sx

A
  • Cause: Embolism
  • Sx: curtain lift up or vertical curtain coming down
29
Q

Glaucoma (open vs close)

Cause/Sx/PE/Dx/Tx

A

Open

  • Cause: slow bloackage of drainage canal
  • Sx: slow painless peripheral vision loss (tunnel)
  • PE: Cupping of optic disk
  • Tx: Prostaglandin (if med fail laser surgery)

Close

  • Cause: Fast blockage of drainage canal
  • Sx: Sudden painful vision loss
  • PE: fixed pupil, cloudy cornea
  • Dx: Tonometry (IOP >21)
  • Tx: Timolol (reduce IOP 1st)
30
Q

Strabismus

Cause/4 type/Dx/Tx

A
  • Cause: muscle misalignment
  • Type
    • Esotropia - in
    • Exotropia - out
    • Hypertropia - up
    • Hypotropia - down
  • Dx: Cover/Uncover test (hirshberg)
  • Tx: Patchy, surgical
31
Q

Chemical burn

Type/Tx

A
  • Ophtho Emergency
  • Type
    • Alkali burn - worse than acid, denature protein
    • Acid burn - coagulative necrosis
  • Tx
    • Irrigation with Lactaed ringers or Normal saline
    • PH & visual acuity after irrigation
    • ABX - moxifloxacin
32
Q

Scleritis

Casue/hx/Dx/Tx

A
  • Cause: inflammation (may vision loss)
  • Hx: Autoimmune dz (RA, SLE)
  • Sx: Deep eye pain, hyperemic (blood vessel shows), necrotizing if severe
  • Dx: Slit exam
  • Tx: Prednisone Oral
33
Q

Amblyopia

Cause/Risk/Sx/Dx/Tx

A
  • Cause: Brain favors one of eye, (if dont tx, brain start ignored bad eye blurred vision which lead to vision impairtment)
  • Risk: child
  • Sx: One eye blurred, one eye vision clear
  • Dx: Eye exam
  • Tx: Patchy therapy, atropine drop to good eye
    • Concept is try to use blurre vision only
34
Q

Cerumen impaction

Cause/Tx

A
  • Cause: conductive hearing
  • Tx: carbamide peroxide, irrigation, manual removal
35
Q

Otitis externa

Cause/Hx/Sx/PE/Tx/Complication

A
  • Cause: Infection Pseudomonas
  • Hx: swimming
  • Sx: Malodorous discharge
  • PE: tenderness pinna or tragus
  • Tx: Cipro
  • Complication Nacrotizing OE
    • Immunosupressant pt
    • Tx: IV piperacilin or ceftazidime + FQ
36
Q

Auricular hematoma

Cause/PE/Tx

A
  • Cause: Blunt trauma
  • PE: Cartilage thicken (cauliflower ear)
  • Tx: I&D if less than 7 days + cephalexin
    • More than 7 days ENT f/u
37
Q

Acoustic neruroma (vestibular schwannoma)

Cause/Sx/Dx/Tx

A
  • Cause: Tumor in CN 8
  • Sx: Gradual hearing loss (sensorineural hearing)
  • Dx: MRI
  • Tx: Surgery
38
Q

Barotitis

Cause/Hx/Tx

A
  • Cause: Rapid pressure change, ET can’t equalize
  • Hx: flying or diver
  • Tx: Autoinsufflation (swallowing, yawning), decongestant
39
Q

Vertigo

4type/Cause/Dx/Tx

A
  1. BBPV
    • Cause: displaced otolith
    • Sx: Episodic Dizz + No hearing loss
    • Dx: Dix Hallpike (30 ->90 spinned head, check delayed nystagmus (POSITIVE)
    • Tx: Epley Maneuver
  2. Meniere
    • Cause: Inner ear distended by Excessive fluid
    • Sx: Episodic Dizz + hearing loss + tinnitus
    • Tx: Vestibular rehap (main) + remove fluid (Low salt diet and diuretic) + Meclizine (dizz)
  3. Vestibular Neuronitis
    • Cause: Inflammation of vestibular by virus
    • Sx: Continue Dizz + No hearing loss
    • Tx: Corticosteriod + Meclizine
  4. Labyrinthitis
    • Cause: infection, recent URI at cochlear
    • Sx: Continue Dizz + Hearing loss + Tinnitus
    • Tx: Corticosteriod + Meclizine
40
Q

Difference Central vs Peripheral vertigo

Onset/Head position/Nystagmus/Neuro Finding

A

Central

  • Gradual
  • Minimal effect by head position
  • Bidirection of nystagmus
  • Neurologic finding

Peripheral

  • Sudden
  • Worsen by head position
  • Unidirection of nystagmus (never vertical)
  • No neruologic finding
41
Q

Cholesteatoma

Cause/Sx/PE/Tx

A
  • Cause: chronic ET
  • Sx: painless otorrhea and conductive hearing loss
  • Dx: mass behind TM by otoscopy
  • Tx: TM surgery
42
Q

Dysfunction of ET

Cause/Sx/Dx/Tx

A
  • Cause: URI or allergy
  • Sx: Ear poping or fullness
  • Dx: Otoscopy (normal)
  • Tx: Decongestant
43
Q

Acute Otitis Media

Cause/Sx/Dx/Tx/PCN allergy/can’t afford

A
  • Cause: infection (Staphy Pneumo, H flu, Morax cat, Strep pyo)
  • Sx: Ear pain
  • Dx: Otoscopy (red bulging TM)
  • Tx: Amox (1st) -> PCN allergy (Cefixime, cefidinir)
    • Persistant (augmentin) -> Clinda + Cefixrme or cefidinir
    • If anyone can’t afford abx -> acetic drop
44
Q

Chronic OM

Cause/Hx/Tx

A
  • Cause: Pseudomona, Staph A
  • Hx: Persistant OM several times
  • Tx: Ofloxacin
    • Perforated TM: keep clean, no aminoglycoside
45
Q

TM perforation

Sx/Tx

A
  • Sx: sudden pain with hearing loss
  • Tx: Most heal its own, if need Ofloxacin
46
Q

Conductive hearing vs Sensorineural hearing loss

Explain/Example

A

Conductive

  • Webber test (lateralization (hearing louder) to affected ear)
  • Rhinne test (BC >AC)
  • Example: Cerumen impaction MC

Sensorineura

  • Webber test (lateralization Equal or Non Affected ear)
  • Rhinne test (AC>BC, normal)
  • Example: Presbyacusis(Aging) MC
47
Q

Mastoiditis

Hx/Sx/PE/Dx/Tx

A
  • hx: hx of OM
  • Sx: Swelling behing ear, fever
  • PE: displaced ear due to swelling and tender
  • Dx: CT scan
  • Tx: IV abx + addmission + drainage
    • Refractory: Mastoidectomy
48
Q

Foreign body(bug) in ear

Risk/Tx

A
  • Risk: 6y>
  • Tx: kill the bug with mineral oil or lidocain then remove
49
Q

Tinnitus

Sx/Tx

A
  • MC cause: cerumen impact, presbyacusis
  • Sx: high pitch ringing sound
  • Dx: otoscopy
  • Tx: underlying cause
50
Q

Epistaxis

Cause/Location/Tx

A
  • Cause: Truma
  • Location
    • Anterior - kiesselbach
    • Posterior - sphenopalatine
  • Tx
    • Anterior - gauze packing, direct pressure leaning forward
    • Posteior - gauze packing, if continue admission for monitor hypoxia
51
Q

Allergic rhinitis

Cause/Triad/Sx/PE/Dx/Tx

A
  • Cause
    • Allergic - IgE mediated mast cell histamin release
    • Viral - rinovirus
  • Triad (Atopy) Samter - asthma, nasal polyp, allerigy (NSAID + ASA)
  • PE
    • Allergy - cobblestone, nasal crease, orbital edema
    • Viral - erythmatous terbinate
  • Dx: IgE high
  • Tx: Flonase(1st), Azeletine (2nd)
    • Nasal decongestant (Not use for monotherapy)
      • 3-5 days use no more than 5 days due to rebound congestion
52
Q

Nasal Polyps

Cause/Triad/Tx

A
  • Cause: Allergy MC
  • Triad: Samter - Allergy (NSAID + ASA) + asthma + nasal polyp (atopy)
  • Tx: Flonase
53
Q

Nasal foreign body

Risk/Sx/Dx/Tx

A
  • Risk: Children
  • Sx: Malodorous smell
  • Dx: Rigid or flexible fiberoptic endoscopy
  • Tx: Remove
54
Q

Gingivitis

3 type/Cause/Tx/Special counsel for both

A

Linear gingival erythema

  • Cause: HIV
  • Sx: bleed easy and painful
  • PE: bright inflamed
  • Tx: Oral hygiene, Not responsive - debridement + abx

Gingival hyperperplasia

  • Cause: drug induced (phenytoin)
  • Sx: thicken gum may block teetch
  • PE: large gum
  • Tx: Stop medication

Acute Necrotizing Ulcerative gingicitis (Trench mouth)

  • Cause: immunosupressant and smokers
  • Sx: painful, Foul smell pesudomembrane formation
  • PE: bacterial plaque
  • Tx: PCN VK or Clinda

Special counsel: increased risk of CV event

55
Q

Other gum teeth

  1. Dental periapical abscess
    • Cause/PE
  2. Dental abscess
    • Cause/Tx
A
  1. Cause: dental cary, PE: pain with tapping tooth (percussing)
  2. Cause: poor dental health, Tx: IM Amox, Ceftx
56
Q

Strep throat

Cause/4 sx/Criteria interpretation/Dx/Tx/Complication

A
  • Cause: GAS
  • Strep throat 4 sx
    • Fever (101.5)
    • Lymadenopathy (neck)
    • No cough
    • Exudate
  • Criteria interpretation
    • 0-1 point - No abx No culture
    • 2 - Rapid test(1st) if Neg do culture
    • 3-4 - Rapid test(1st) and culture + Abx
  • Dx
    • Rapid strep test (1st screening) if negative should do culture
    • Culture (Definitive)
  • Tx
    • PCN
    • Macrolide if PCN allergy
  • Complication: Glomerulonephritis, Rheumatic fever
57
Q

Quinsy (peritonsillar abscess)

Cause/Sx/Dx/Tx

A
  • Cause: GAS
  • Sx: Muffle voice
  • PE: Uvula deviated
  • Dx: CT
  • Tx: I & D(aspiration) + Augmentin
58
Q

Laryngitis

Cause/Sx/Hx/Tx

A
  • Cause: inflammation of the larynx (Viral MC)
  • Sx: Horseness
  • Hx: singling, screamming
  • Tx: supportive
59
Q

Oral Candidiasis (thrush)

Cause/Sx/Hx/Dx/Tx

A
  • Cause: Candida albican
  • Sx: White curled like plaque, able to scrap off and bleed
  • Hx: DM (check glucose)
  • Dx: KOH (Pseudohyphae)
  • Tx: Fluconazole, Nystatin
60
Q

Retropharyngeal abscess

Cause/Sx/PE/Dx/Tx

A
  • Cause: Staph A, GAS
  • Sx: Fever, throat pain
  • PE: muffle voice, trsimus, pain when neck extend
  • Dx: Lateral X-ray (widened retropharyngeal space twice the size of the vertebral body in C2-4)
  • Tx: IV abx then I&D (SECURE AIRWAY)
61
Q

Leukoplakia

2 type/PE/Dx/Tx

A

Luekoplakia (precancerous)

  • Sx: white patch can’t scraped off
  • Dx: bx
  • Tx: Cryotherapy, laser surgery

Hairy Leukoplakia (HIV, epstein-barr)

  • Sx: White plaque along tongue (hairy looking)
  • Tx: No tx, Acyclovir
62
Q

Aphthous ulcers (Canker sore, ulcerative stomatitis)

Sx/PE/Tx

A
  • Sx: Painful
  • PE: Small ulcer, yellow centered surrounded by red halo
  • Tx: viscous lidocain 2-5%
63
Q

Sialadenitis vs Sialolthiasis

Cause/Sx/Tx

A

Sialadenitis

  • Cause: Staph A infection
  • Sx: Trismus, Ductal discharge, Gland swelling
  • Involve duct: Submandibluar or parotid
  • Dx: CT
  • Tx
    • Sialogogues (Tart hard candies or lemon drop)
    • IV dicloxacillin or nafcillin + Metronidazole or Clindamycin if severe

Sialolthiasis

  • Cause: stone blocks salivary gland cause inflammation
  • Sx: NO Trismus, No ductral disharge, Gland swelling pain after meal
  • Involve duct: Submandibluar or parotid
  • Dx: Clinical
  • Tx: Sialogogues (Tart hard candies or lemon drop)
64
Q

Oral lichen planus

Cause/Sx/Tx

A
  • Cause: Hep C
  • PE: Wickham striae, lacy luekoplakia
  • Tx: Corticosteriod
65
Q

Hepetic mouth dz

Cause/Risk/Tx

A
  • Cause: HSV oral
  • Patient: MC children
  • Sx: Painful, fever
  • PE: Vesicle, gum swelling, bleeding
  • Tx: Supporitve, oral hygine (self limited)
66
Q

Ludwig’s angina

Cause/Sx/Dx/Tx

A
  • Cause: Cellulitis (submandible, submaxilla)
  • Sx: Swelling upper neck
  • PE: tongue position displaced, Pus on the floor of mouth
  • Dx: CT
  • Tx: AMP/sulbactam
67
Q

Pariotitis

Cause/Sx/Hx/Tx

A
  • Cause: Staph A
  • Sx: Swelling angle of mandible
  • Hx: recent intubation, dehyration
  • Tx: IV Abx
68
Q
  1. Shine on unaffected eye both constrict but shine on affected eye both dilate = Name/MC cause
  2. Accomodation but does not react to light = Name/MC cause
  3. Bitemporal heteronymous hemianopsia = MC cause
  4. Vision curtain lift up usually within 1 hour called as?
A
  1. Marcus gunn pupil - MC Optic neuritis (MS)
  2. argyll-robertson pupil - MC neurosyphilis
  3. Pituitary adenoma
  4. Amaurosis fugax
69
Q

Torus palatine

Cause/Sx/Dx/Tx

A
  • Cause: genetic
  • Sx: painless mass top of palatine
  • Dx: CT to rule out cancer
  • Tx: Obeserve, if sx, interfere airway, or eating then surgical remove

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