5. EENT Flashcards
Bacterial Conjunctivitis
Pathogen/SX/PE/TX/Lens wearer
- Pathogen: Staph A
- Sx: Crusting, worst in the morning, discharge
- PE: Purulent yellow
- Tx: Erythromycin
- Lens wearer for long time: Psudomonas, Tx: Cipro
Allergic conjuctivitis
SX/PE/TX/Lens wearer
- Sx: itch
- PE: Cobblestone
- Tx: olopatadine
Viral conjunctivitis
Pathogen/Sx/PE/Tx
- Pathogen: adenovirus
- Sx: bilateral pink eye
- PE: copious watery discharge, scant mucoid
- Tx: Supportive (cool compress, itch for antihistamine)
Chlamydia/Gonorrhea conjunctivitis
Pathogen/Patient/PE/Dx/Tx
- 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
Bacterial vs Iritis vs keratitis vs acute close glaucoma
Bacterial: Normal vision, discharge
Iritis: blurred vision, pupil constrict, pain
Keratitis: Blurred vision, severe pain
Acute-closure glaucoma: Coudy, dilated pupil
Cataract
Patient/Sx/PE/Tx/Comment
Patient: Old
Sx: gradual blurred vision
PE: Cloudy lens
Tx: Remove and replace lens
Comment: MC blindness in elders
Corneal Ulcer
Pathogen/Hx/PE/Dx/Tx
- Pathogen: Staphy, Lens wearer - Pseudomona
- Hx - trauma, lens
- PE: Ragged edge
- Dx: Flurescein stain
- Tx: ER consult
Ultraviolet keratitis
Patient/Sx/PE/Tx
- Patient: Welder, Skier
- Sx: bilateral vision acuity decrease
- PE: mutiple punctate lesion
- Dx: Fluoresein stain
- Tx: NSAID
Herpe simplex Keratitis
Pathogen/Clonize/PE/Tx
- Pathogen: HSV
- Colonize: trigeminal ganglion (V1)
- PE: Slit lamp (dedrite)
- Tx: Acyclovir
Pterygium
Hx/PE/Tx
Pinguecula
PE
- Hx: Sunlight, sandy, windy, dusty
- PE: triangular shape cornea involve
- Tx: Observe
- Yellow fleshy mass on conjuntiva but do no involve cornea
Dacryocytitis vs Dacryoadenitis
Cause/Location/Sx/Complication/Tx
- Cause: infection of lacrimal gland
- Location: Supratemporal (adenitis), inframedial (cyctitis)
- Sx: Pain, swelling
- Complication: preseptal, orbital cellulitis
- Tx: Mild - clinda, Severe - vancomycin
Blepharitis
Cause/Sx/PE/Dx/Tx
- Cause: dyfunction of meibomian gland
- PE: Scaling, red-rimming
- Dx: Slit-lamp exam
- Tx: Warm compress, abx for flare up: erythromycin
Hordeolum vs Chalazion
Cause/Sx/Location/Tx
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)
Ectropion vs Entropion
PE/Tx
- Entropion: inward, surgical fix
- Ectropion: outward, surgical fix
Nystagmus
Up/down, horizontal, gaze-evoke
- Down/up: CNS dysfunction
- Horizontal: labyrinth or vestibular
- Gaze-evoke: MC and often benign
Optic neuritis
Cause/Related Dx/Medication/Sx/PE/Dx/Tx
- 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)
Papilledema
Cause/Sx/PE/Tx
- Casue: ICP high
- Sx: Sudden HA, blurred vision
- PE: optic disk swelling
- Tx: Acetazolamide
Orbital cellulitis
Cause/PE/Dx/Tx/Preseptic difference
- Cause: infection by bacterial rhinosinusitis
- PE: Pain with move
- Dx: CT scan
- Tx: IV vanco + ceftx
- Preseptic: Normal vision, No pain
Macular degeneration
2type/Onset/Risk factor/Sx/PE/Dx/Tx
- 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
Retinal detachment
Cause/Sx/Dx/Tx/Avoid/Other confuse dz
- 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
Diabetic retinopathy
Hx/Sx/PE/Tx
- Hx: DM
- Sx: Progressive vision loss
- PE: Microaneurysms
- Tx: DM control, laser surgery or vitrectomy
Retinoblastoma
Cause/PE/Comment
- Cause: loss of retinoblastoma gene
- PE: white pupil (leukocoria) + no red reflex
- Comment: MC eye tumor in children
Orbital floor fx
Cause/Muscle trapped/MC site/Sx/Dx/Tx/Avoid
- 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,
Corneal Abrasion
Cause/Sx/Dx/Tx
- 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
Globe Rupture
Cause/PE/Dx/Tx/Avoid
- Cause: Trauma
- PE: teardrop pupil, hyphema
- Dx: CT
- Tx: Emergency
- Avoid: IOP meansure
Hyphema
Cause/PE/Tx
- Cause: Trauma
- PE: blood in the anterior chamber
- Tx: eye protection + head of bed at 30-45 degree
CRAO vs CRVO
Cause/sx/Dx/Tx
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
Amaurosis fugax
Cause/Sx
- Cause: Embolism
- Sx: curtain lift up or vertical curtain coming down
Glaucoma (open vs close)
Cause/Sx/PE/Dx/Tx
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)
Strabismus
Cause/4 type/Dx/Tx
- Cause: muscle misalignment
- Type
- Esotropia - in
- Exotropia - out
- Hypertropia - up
- Hypotropia - down
- Dx: Cover/Uncover test (hirshberg)
- Tx: Patchy, surgical
Chemical burn
Type/Tx
- 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
Scleritis
Casue/hx/Dx/Tx
- 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
Amblyopia
Cause/Risk/Sx/Dx/Tx
- 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
Cerumen impaction
Cause/Tx
- Cause: conductive hearing
- Tx: carbamide peroxide, irrigation, manual removal
Otitis externa
Cause/Hx/Sx/PE/Tx/Complication
- 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
Auricular hematoma
Cause/PE/Tx
- Cause: Blunt trauma
- PE: Cartilage thicken (cauliflower ear)
- Tx: I&D if less than 7 days + cephalexin
- More than 7 days ENT f/u
Acoustic neruroma (vestibular schwannoma)
Cause/Sx/Dx/Tx
- Cause: Tumor in CN 8
- Sx: Gradual hearing loss (sensorineural hearing)
- Dx: MRI
- Tx: Surgery
Barotitis
Cause/Hx/Tx
- Cause: Rapid pressure change, ET can’t equalize
- Hx: flying or diver
- Tx: Autoinsufflation (swallowing, yawning), decongestant
Vertigo
4type/Cause/Dx/Tx
- BBPV
- Cause: displaced otolith
- Sx: Episodic Dizz + No hearing loss
- Dx: Dix Hallpike (30 ->90 spinned head, check delayed nystagmus (POSITIVE)
- Tx: Epley Maneuver
- 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)
- Vestibular Neuronitis
- Cause: Inflammation of vestibular by virus
- Sx: Continue Dizz + No hearing loss
- Tx: Corticosteriod + Meclizine
- Labyrinthitis
- Cause: infection, recent URI at cochlear
- Sx: Continue Dizz + Hearing loss + Tinnitus
- Tx: Corticosteriod + Meclizine
Difference Central vs Peripheral vertigo
Onset/Head position/Nystagmus/Neuro Finding
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
Cholesteatoma
Cause/Sx/PE/Tx
- Cause: chronic ET
- Sx: painless otorrhea and conductive hearing loss
- Dx: mass behind TM by otoscopy
- Tx: TM surgery
Dysfunction of ET
Cause/Sx/Dx/Tx
- Cause: URI or allergy
- Sx: Ear poping or fullness
- Dx: Otoscopy (normal)
- Tx: Decongestant
Acute Otitis Media
Cause/Sx/Dx/Tx/PCN allergy/can’t afford
- 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
Chronic OM
Cause/Hx/Tx
- Cause: Pseudomona, Staph A
- Hx: Persistant OM several times
- Tx: Ofloxacin
- Perforated TM: keep clean, no aminoglycoside
TM perforation
Sx/Tx
- Sx: sudden pain with hearing loss
- Tx: Most heal its own, if need Ofloxacin
Conductive hearing vs Sensorineural hearing loss
Explain/Example
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
Mastoiditis
Hx/Sx/PE/Dx/Tx
- 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
Foreign body(bug) in ear
Risk/Tx
- Risk: 6y>
- Tx: kill the bug with mineral oil or lidocain then remove
Tinnitus
Sx/Tx
- MC cause: cerumen impact, presbyacusis
- Sx: high pitch ringing sound
- Dx: otoscopy
- Tx: underlying cause
Epistaxis
Cause/Location/Tx
- Cause: Truma
- Location
- Anterior - kiesselbach
- Posterior - sphenopalatine
- Tx
- Anterior - gauze packing, direct pressure leaning forward
- Posteior - gauze packing, if continue admission for monitor hypoxia
Allergic rhinitis
Cause/Triad/Sx/PE/Dx/Tx
- 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
- Nasal decongestant (Not use for monotherapy)
Nasal Polyps
Cause/Triad/Tx
- Cause: Allergy MC
- Triad: Samter - Allergy (NSAID + ASA) + asthma + nasal polyp (atopy)
- Tx: Flonase
Nasal foreign body
Risk/Sx/Dx/Tx
- Risk: Children
- Sx: Malodorous smell
- Dx: Rigid or flexible fiberoptic endoscopy
- Tx: Remove
Gingivitis
3 type/Cause/Tx/Special counsel for both
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
Other gum teeth
- Dental periapical abscess
- Cause/PE
- Dental abscess
- Cause/Tx
- Cause: dental cary, PE: pain with tapping tooth (percussing)
- Cause: poor dental health, Tx: IM Amox, Ceftx
Strep throat
Cause/4 sx/Criteria interpretation/Dx/Tx/Complication
- 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
Quinsy (peritonsillar abscess)
Cause/Sx/Dx/Tx
- Cause: GAS
- Sx: Muffle voice
- PE: Uvula deviated
- Dx: CT
- Tx: I & D(aspiration) + Augmentin
Laryngitis
Cause/Sx/Hx/Tx
- Cause: inflammation of the larynx (Viral MC)
- Sx: Horseness
- Hx: singling, screamming
- Tx: supportive
Oral Candidiasis (thrush)
Cause/Sx/Hx/Dx/Tx
- Cause: Candida albican
- Sx: White curled like plaque, able to scrap off and bleed
- Hx: DM (check glucose)
- Dx: KOH (Pseudohyphae)
- Tx: Fluconazole, Nystatin
Retropharyngeal abscess
Cause/Sx/PE/Dx/Tx
- 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)
Leukoplakia
2 type/PE/Dx/Tx
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
Aphthous ulcers (Canker sore, ulcerative stomatitis)
Sx/PE/Tx
- Sx: Painful
- PE: Small ulcer, yellow centered surrounded by red halo
- Tx: viscous lidocain 2-5%
Sialadenitis vs Sialolthiasis
Cause/Sx/Tx
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)
Oral lichen planus
Cause/Sx/Tx
- Cause: Hep C
- PE: Wickham striae, lacy luekoplakia
- Tx: Corticosteriod
Hepetic mouth dz
Cause/Risk/Tx
- Cause: HSV oral
- Patient: MC children
- Sx: Painful, fever
- PE: Vesicle, gum swelling, bleeding
- Tx: Supporitve, oral hygine (self limited)
Ludwig’s angina
Cause/Sx/Dx/Tx
- Cause: Cellulitis (submandible, submaxilla)
- Sx: Swelling upper neck
- PE: tongue position displaced, Pus on the floor of mouth
- Dx: CT
- Tx: AMP/sulbactam
Pariotitis
Cause/Sx/Hx/Tx
- Cause: Staph A
- Sx: Swelling angle of mandible
- Hx: recent intubation, dehyration
- Tx: IV Abx
- Shine on unaffected eye both constrict but shine on affected eye both dilate = Name/MC cause
- Accomodation but does not react to light = Name/MC cause
- Bitemporal heteronymous hemianopsia = MC cause
- Vision curtain lift up usually within 1 hour called as?
- Marcus gunn pupil - MC Optic neuritis (MS)
- argyll-robertson pupil - MC neurosyphilis
- Pituitary adenoma
- Amaurosis fugax
Torus palatine
Cause/Sx/Dx/Tx
- 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
