Chapter 13 - Eye, Ear, Nose, and Throat Disorders Flashcards
1
Q
Sinusitis pathophysiology
A
- Bacterial is most common cause for the acute care setting
- Undrained collection of pus occurs in the sinuses
- Frequently proceeded by insult to sinuses (i.e., viral URI, allergic rhinitis, nasal instrumentation)
- Occurs more frequently in patients with anatomical abnormalities
2
Q
Sinusitis common pathogens
A
- Strep. pneumoniae (Gram+) [most common bacterial cause]
- H. influenzae (Gram-) [most common among smokers]
- Moraxella catarrhalis (Gram-)
- Consider pseudomonas species in ventilated patients
3
Q
Sinusitis symptoms
A
- Headache at its worst when the head is dependent
- Stuffy nose
- Pressure behind eyes
4
Q
Sinusitis diagnostics
A
- CT scan is diagnostic study of choice when one is required
- However – diagnosis is usually clinical
5
Q
Sinusitis treatment
A
- Antibiotics, typically empiric
- First-line: amoxicillin-clavulanate (Augmentin) 500/125mg PO TID or 875/125 mg BID
- Second-line (or if allergic to PCNs): doxycycline 100 mg PO BID or 200 mg PO daily
6
Q
Conjunctivitis etiology/pathophysiology
A
- Inflammation of the conjunctiva caused by bacteria, virus, or allergies
- No matter the cause, there is a high risk of bacterial infection secondary to how fragile the conjunctiva is
- Always treat bacterial pathogens prophylactically (because of conjunctival fragility)
7
Q
Conjunctivitis common pathogens
A
- Viral pathogens (most common) – adenovirus, herpes simplex
- Bacterial pathogens – staph (MRSA), strep pneumoniae, H. influenzae, gonococcal, chlamydial
8
Q
Conjunctivitis symptoms/exam findings
A
- Common symptoms – pruritus, foreign body sensation, “gritty eye”
- Pain is almost never a symptom
- Conjunctival erythema, conjunctival injection, ocular discharge (consistent with etiology of infection)
9
Q
Conjunctivitis – viral etiology specific symptoms and treatment
A
- May present unilateral or bilateral (typically will start unilateral and spread bilaterally)
- Watery discharge
- Consider prophylactic antibiotics (because of fragile conjunctiva)
- Symptomatic treatment – artificial tears, topical antihistamines, cold compresses
- Discontinue contact use
10
Q
Conjunctivitis – bacterial etiology specific symptoms and treatment
A
- Typically will start unilateral (may spread bilaterally)
- Purulent discharge
- Gonococcal/chlamydial = PROFUSE discharge, eyelid edema, refer to ophthalmology
- Bacterial treatment – gentamycin 1-2 gtt daily x1 week, ciprofloxacin 1-2 gtts QID x1 week (good for contact wearers)
- Gonococcal/chlamydial treatment – refer to ophthalmology; ceftriaxone 1g IM once + azithromycin 1 g once
- Discontinue contact use
11
Q
Conjunctivitis – allergic etiology specific symptoms and treatment
A
- Typically noted around times of high seasonal allergies
- Presentation is typically bilateral
- Stringy discharge with itching
- Decongestants, antihistamines (oral or topical), cold compresses, discontinue contact use
12
Q
Corneal abrasion – common causes
A
- Scratch
- Flying debris
- Dry eyes
- Iatrogenic
13
Q
Corneal abrasion – symptoms/physical exam findings
A
- Gradual throbbing pain that intensifies over 12-24 hours
- Sensation of foreign body
- Erythema
- Tearing
- Interrupted endothelial surface on fluorescein stain
14
Q
Corneal abrasion – diagnostics
A
- Fluorescein stain
- Clinical diagnosis
- Orbital CT or MRI if high velocity injury or retained foreign body suspected
15
Q
Corneal abrasion – treatments
A
- Initial anesthesia of the eye (tetracaine)
- Topical NSAID drops – diclofenac or ketorolac
- Topical antibiotics – must cover for bacteria – bacitracin, cipro
- Oral opiate (1 day prescription should be enough)
- Tetanus shot if penetrating injury
- Refer to ophthalmology if no improvement in 48 hours or initial presentation is severe
- Do not order – corticosteroid drops, eye patching, continued use of topical anesthetic
16
Q
Glaucoma cause (chronic [open] vs. acute [narrow])
A
- Chronic – elevated pressure reduces flow to of aqueous humor → GRADUAL rise in pressure
- Acute – variety of anatomic abnormalities resulting in reduced flow of aqueous humor, acute blockage of flow → ACUTE rise in pressure
17
Q
Glaucoma symptoms – (chronic [open] vs. acute [narrow])
A
- Chronic – gradual, PAINLESS loss of peripheral vision, usually asymtpmatic until discovered on routine screening. Rarely symptomatic – may present with ocular discomfort, halos, or blurry vision
- Acute – SEVERE ocular pain, SUDDEN vision loss, halos around objects
