Chapter 4 Eye, Ear, Nose, Throat Flashcards
What is the definition of Acute Rhinosinusitis?
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)
What is the definition of acute bacterial rhinosinusitis?
Secondary bacterial infection of the paranasal sinuses, usually following viral URI. Less than 2%. Not common.
What is the most common gram positive organism that cause ABRS?
S. pneumoniae
What is the most common gram negative organism that causes ABRS?
H. influenzae
What is the second most common gram negative organism that causes ABRS?
M. catarrhalis
What are the most common features of acute bacterial rhinosinusitis?
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
What is the initial therapy for ARBS?
Amoxicillin 500 mg TID or Amoxicillin-clavulanate PO BID
What is the initial therapy for ARBS in beta-lactam allergy?
Cefdinir 600 mg/day
Cefpodoxime 200 mg PO
Cefuroxime
Floxacin (if allergy)
What is the therapy for ARBS if treatment failure after 3-5 days of therapy?
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
What is the most common drug Substrate that causes interactions?
CYP450: Viagra, atorvastatin, simvastatin, alprazolam
What is a substrate?
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
What is an inhibitor?
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
What are common drug inhibitors?
Erythromycin, clarithromycin
What is a drug inducer?
Accelerates the activity of the isoenzyme so that the substrate is pushed out the exit pathway, leading to a reduction in substrate level
What is an example of drug inducer??
St. John’s Wort
leads to reduced target drug levels and diminished therapeutic effect, possible treatment failure
Is weber test conductive or sensiornueral?
Conductive (sound is blocked)
Is Rhine test conductive or sensiornueral?
Sensorineural (inner ear or nerve damage)
What is the first line intervention for allergic rhinitis?
1st line = avoid the allergen
What is the controller therapy to prevent symptoms of allergic rhinitis?
Intranasal corticosteroids (INCS)
Intranasal antihistamine (IAH)
What is the reliever therapy of acute allergic rhinitis?
2nd generation oral antihistamines
Ocular antihistamines for allergic conjunctivitis signs and symptoms
Characteristic of infectious nodes
soft/ tender- infection
Characteristic of cancerous nodes
firm/nontender- cancer
What are the most potent risk factors for squamous cell carcinoma
longstanding HPV (16), tobacco use, alcohol misue
What is the clinical presentation of squamous cell carcinoma?
painless, ulcerating oral lesions, usually present many months prior to presenting clinically.
Adjacent lymphadenopathy. Immobile, nontender
What are the characteristics of veins and arterioles of the eye
Veins are darker & wider
Arterioles are narrower and brighter
Strep throat vs viral pharyngitis:
clear nasal discharge
viral
Strep throat vs viral pharyngitis:
hoarseness
viral
Strep throat vs viral pharyngitis:
significant aneterior cervical lymphadenopathy
bacterial
Strep throat vs viral pharyngitis:
frontal headache without body aches
bacterial
Strep throat vs viral pharyngitis:
patchy exudates in posterior pharynx
bacterial
Strep throat vs viral pharyngitis:
scattered small vesicles on soft palate and tonils
viral
Strep throat vs viral pharyngitis:
generalized body aches
viral
Strep throat vs viral pharyngitis:
sore throat started all of a sudden
bacterial
Strep throat vs viral pharyngitis:
sore throat started after nose started to run
viral
Standard of care for diagnosis and treatment of strep throat
Penicillin or amoxicillin
Always swab
Presbyopia
Hardening of lens causing close vision problems
Usually requires reading glasses
Senile cataracts
lens clouding causing progressive vision dimming, distance vision problems, close vision usually retained
RF: tobacco use, poor nutrition, sun exposure, systemic corticosteriods
Senile cataracts
lens clouding causing progressive vision dimming, distance vision problems, close vision usually retained
RF: tobacco use, poor nutrition, sun exposure, systemic corticosteroids
Open-angle glaucoma
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
Angle-closure glaucoma
sudden increase in intra-ocular pressure
Usually unilateral, acutely red, painful eye with vision change including halos around lights; eyeball firm
Immediate referral
Age-related maculopathy (mascular degeneration)
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
Age-related maculopathy (mascular degeneration)
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
Anosmia, hyposmia
diminished sense of smell, with resulting decline in fine taste discrimination
accelerated by tobacco use
Presbycusis
loss of 8th cranial nerve sensitivity
difficulty with conversation in noisy environments
person can her but cannot understand what is being said.
Cerumen impaction
conductive earing loss
general diminution of hearing
Suppurative conjunctivitis
Primary: Opthalmic treatment with cipro ocular solution
Alternative: azithromycin Opthalmic solution
relieve irritating symptoms with use of cold artificial tear solution
Otitis externa (swimmer’s ear)
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
Malignant otitis externa in person w/ DM, HIV/AIDS, or on chemotherapy
oral ciprofloxacin for early disease
risk for osteomyelitis of the skull or TMJ
What does a normal TM look like
pale, gray, translucent
cone of light and bony landmarks visible
What are the characteristics of otitis media with effusion? AKA serous otitis
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
treatment for serous otitis
treatment of underlying cause such as allergic rhinitis
What are the characteristics of acute otitis media
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
treatment of acute otitis media
analgesia, antimicrobial
