Chapter 4 Eye, Ear, Nose, Throat

Question 1

What is the definition of Acute Rhinosinusitis?

Answer 1

Inflammation of the mucosal lining of nasal passages and paranasal sinuses lasting up to 4 weeks, caused by allergens, environmental irritants, and/or infection (viruses, bacteria or fungi)

Question 2

What is the definition of acute bacterial rhinosinusitis?

Answer 2

Secondary bacterial infection of the paranasal sinuses, usually following viral URI. Less than 2%. Not common.

Question 3

What is the most common gram positive organism that cause ABRS?

Answer 3

S. pneumoniae

Question 4

What is the most common gram negative organism that causes ABRS?

Answer 4

H. influenzae

Question 5

What is the second most common gram negative organism that causes ABRS?

Answer 5

M. catarrhalis

Question 6

What are the most common features of acute bacterial rhinosinusitis?

Answer 6

fever and symptom duration of more than 10 days (discharge, malaise)
Maxillary toothache
Initial symptom improvement and then worsening of symptoms
Cacosmia (sense of bad odor in nose)
Unilateral facial pain

Question 7

What is the initial therapy for ARBS?

Answer 7

Amoxicillin 500 mg TID or Amoxicillin-clavulanate PO BID

Question 8

What is the initial therapy for ARBS in beta-lactam allergy?

Answer 8

Cefdinir 600 mg/day
Cefpodoxime 200 mg PO
Cefuroxime

Floxacin (if allergy)

Question 9

What is the therapy for ARBS if treatment failure after 3-5 days of therapy?

Answer 9

Mild/ moderate: Augmentin 2000mg/125 mg PO BID or
2nd or 34rd gen cephalosporin (cefpodoxime, cefprozil, cefdinir)
Severe: levofloxacin 750 mg PO daily or Moxifloxacin 400 mg PO daily

Question 10

What is the most common drug Substrate that causes interactions?

Answer 10

CYP450: Viagra, atorvastatin, simvastatin, alprazolam

Question 11

What is a substrate?

Answer 11

A medication or substrate that is metabolized/bio transformed by the isoenzyme, utilizing this enzyme in order to be modified so it can reach the drug site of action and/or eliminated

Question 12

What is an inhibitor?

Answer 12

A drug or other substance that blocks the activity of the isoenzyme, limiting substrate excretion, allowing increase in substrate levels, with possible risk of substrate- induced toxicity

Question 13

What are common drug inhibitors?

Answer 13

Erythromycin, clarithromycin

Question 14

What is a drug inducer?

Answer 14

Accelerates the activity of the isoenzyme so that the substrate is pushed out the exit pathway, leading to a reduction in substrate level

Question 15

What is an example of drug inducer??

Answer 15

St. John’s Wort
leads to reduced target drug levels and diminished therapeutic effect, possible treatment failure

Question 16

Is weber test conductive or sensiornueral?

Answer 16

Conductive (sound is blocked)

Question 17

Is Rhine test conductive or sensiornueral?

Answer 17

Sensorineural (inner ear or nerve damage)

Question 18

What is the first line intervention for allergic rhinitis?

Answer 18

1st line = avoid the allergen

Question 19

What is the controller therapy to prevent symptoms of allergic rhinitis?

Answer 19

Intranasal corticosteroids (INCS)
Intranasal antihistamine (IAH)

Question 20

What is the reliever therapy of acute allergic rhinitis?

Answer 20

2nd generation oral antihistamines
Ocular antihistamines for allergic conjunctivitis signs and symptoms

Question 21

Characteristic of infectious nodes

Answer 21

soft/ tender- infection

Question 22

Characteristic of cancerous nodes

Answer 22

firm/nontender- cancer

Question 23

What are the most potent risk factors for squamous cell carcinoma

Answer 23

longstanding HPV (16), tobacco use, alcohol misue

Question 24

What is the clinical presentation of squamous cell carcinoma?

Answer 24

painless, ulcerating oral lesions, usually present many months prior to presenting clinically.
Adjacent lymphadenopathy. Immobile, nontender

Question 25

What are the characteristics of veins and arterioles of the eye

Answer 25

Veins are darker & wider Arterioles are narrower and brighter

Question 26

Strep throat vs viral pharyngitis: clear nasal discharge

Answer 26

viral

Question 27

Strep throat vs viral pharyngitis: hoarseness

Answer 27

viral

Question 28

Strep throat vs viral pharyngitis: significant aneterior cervical lymphadenopathy

Answer 28

bacterial

Question 29

Strep throat vs viral pharyngitis: frontal headache without body aches

Answer 29

bacterial

Question 30

Strep throat vs viral pharyngitis: patchy exudates in posterior pharynx

Answer 30

bacterial

Question 31

Strep throat vs viral pharyngitis: scattered small vesicles on soft palate and tonils

Answer 31

viral

Question 32

Strep throat vs viral pharyngitis: generalized body aches

Answer 32

viral

Question 33

Strep throat vs viral pharyngitis: sore throat started all of a sudden

Answer 33

bacterial

Question 34

Strep throat vs viral pharyngitis: sore throat started after nose started to run

Answer 34

viral

Question 35

Standard of care for diagnosis and treatment of strep throat

Answer 35

Penicillin or amoxicillin Always swab

Question 36

Presbyopia

Answer 36

Hardening of lens causing close vision problems Usually requires reading glasses

Question 37

Senile cataracts

Answer 37

lens clouding causing progressive vision dimming, distance vision problems, close vision usually retained RF: tobacco use, poor nutrition, sun exposure, systemic corticosteriods

Question 38

Senile cataracts

Answer 38

lens clouding causing progressive vision dimming, distance vision problems, close vision usually retained RF: tobacco use, poor nutrition, sun exposure, systemic corticosteroids

Question 39

Open-angle glaucoma

Answer 39

painless, gradual onset of increased intraocular pressure leading to optic atrophy loss of peripheral vision if untreated, avoidable with appropriate intervention TX: topical miotics, beta-blockers

Question 40

Angle-closure glaucoma

Answer 40

sudden increase in intra-ocular pressure Usually unilateral, acutely red, painful eye with vision change including halos around lights; eyeball firm Immediate referral

Question 41

Age-related maculopathy (mascular degeneration)

Answer 41

thickening, sclerotic changes in retinal basement membrane complex painless vision changes including distortion of central vision. Drusen (soft yellow deposits in the macular region) RF: aging, tobacco, sun exposure Dry: prevention, no treatment available Wet: laster treatment

Question 42

Age-related maculopathy (mascular degeneration)

Answer 42

thickening, sclerotic changes in retinal basement membrane complex painless vision changes including distortion of central vision. Drusen (soft yellow deposits in the macular region) RF: aging, tobacco, sun exposure Dry: prevention, no treatment available Wet: laser treatment

Question 43

Anosmia, hyposmia

Answer 43

diminished sense of smell, with resulting decline in fine taste discrimination accelerated by tobacco use

Question 44

Presbycusis

Answer 44

loss of 8th cranial nerve sensitivity difficulty with conversation in noisy environments person can her but cannot understand what is being said.

Question 45

Cerumen impaction

Answer 45

conductive earing loss general diminution of hearing

Question 46

Suppurative conjunctivitis

Answer 46

Primary: Opthalmic treatment with cipro ocular solution Alternative: azithromycin Opthalmic solution relieve irritating symptoms with use of cold artificial tear solution

Question 47

Otitis externa (swimmer's ear)

Answer 47

milder: acetic acid with propylene glycol and hydrocortisone drops moderate to severe disease: optic drops with ciprofloxacin with hydrocortisone or dexamethasone Ear canal cleansing important: 1:2 mixture of white vinegar and rubbing alcohol after swimming DO NOT USE neomycin if punctured TM is suspected

Question 48

Malignant otitis externa in person w/ DM, HIV/AIDS, or on chemotherapy

Answer 48

oral ciprofloxacin for early disease risk for osteomyelitis of the skull or TMJ

Question 49

What does a normal TM look like

Answer 49

pale, gray, translucent cone of light and bony landmarks visible

Question 50

What are the characteristics of otitis media with effusion? AKA serous otitis

Answer 50

sensation of ear fullness or pressure, itch, and/or otalgia conductive hearing loss air-fluid level visible, often with air bubbles opaque yellow or blue color cone of light and bony landmarks diminished or absent

Question 51

treatment for serous otitis

Answer 51

treatment of underlying cause such as allergic rhinitis

Question 52

What are the characteristics of acute otitis media

Answer 52

sensation of ear fullness, pressure and otalgia conductive hearing loss fever common TM redness, bulging cone of light and bony landmarks absent Otorrhea possible with TM rupture

Question 53

treatment of acute otitis media

Answer 53

analgesia, antimicrobial