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Quarter 2 > Clin Med Exam 2 > Flashcards

Clin Med Exam 2 Flashcards

1
Q

Acoustic Neuroma

“Vestibular Schwannoma”

A

CN 8 tumor
Unilateral hearing loss and tinnitus
MRI, Surgery/raditaion

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2
Q

Allergic Rhinitis

A

Rhinorrhea, Sneezing, Congestion
Pale, bluish, boggy mucosa
Nasal steroid spray (1st line tx)

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3
Q

Non-Allergic Rhinitis

A

“Vasomotor Rhinitis”
Rhinorrhea, Congestion, Post Nasal Drip
(NO sneezing or itching!)

Nasal steroid, Antihistamine, or Ipratropium spray (rhinorrhea)

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4
Q

Rhinitis Medicamentosa

A

(Afrin)
Rebound congestion

Stop using Afrin spray!
Start nasal steroid spray

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5
Q

Zyrtec/Cetirizine

A

approved for children 6 months or older

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6
Q

Mod-Severe Allergic Rhinitis

A

Glucocorticoid Nasal Spray is 1st line tx (most effective single agent)

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7
Q

Allergic Rhinits WITH Asthma

A

Montelukast (Singulair) is best

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8
Q

Allergic Rhinitis WITH Conjunctivitis

A

Steroid nasal spray and Ophthalmic Antihistamine drops

*Avoid nasal steroid spray in pts w/cataracts or glaucoma

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9
Q

Viral Conjunctivitis

A

BILATERAL

burning, soreness, SEVERE injection, watery discharge

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10
Q

Bacterial Conjunctivitis

A

burning, MUCOPURULENT discharge, adherent lids, TOPICAL ABX +/- systemic abx

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11
Q

Allergic Conjunctivitis

A

Chronic, BILATERAL, itching, STRINGY mucoid discharge, Topical/Oral Antihistamines

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12
Q

Acute Otitis Media AOM

A

Pain, bulging TM, conductive hearing loss, Red TM or TM Perforation
SMH pathogens

1st line:Amoxichillin
2nd line: Augmentin

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13
Q

Mastoiditis

A

Pain, tenderness, and swelling behind ear
Red,fluctuant mass

same suspects as AOM: S.PNA, F.influenzae, M.catarrhalis

Tx: IV Abx, Surgery

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14
Q

Chronic Otisis Media

A

painless hearing loss, TM perforation w/intermittent purulent drainage

Pseudomonas, S.Aureus, Klebsiella

Surgery & ENT

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15
Q

Otitis Media w/Effusion

A

fluid in middle ear w/o signs of infection
“watchful waiting” or T tube placement
Type B

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16
Q

Otitis Externa

A

Pain worse w/manipulation of external ear

Pseudamonas and staph most common!

Tx: Topical abx, no aminoglycosides if TM rupture

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17
Q

Malignant Otitis Externa

A

IV Cipro and surgical debridement

Deep pain, swelling of EAC

Pseudomonas is the bad guy

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18
Q

Labryinthitis

A

Vertigo, N/V, ataxia, Unilateral hearing loss
NO CNS deficit

preceding viral infection is often cause

tx: symptomatic, Meclizine, Benzodiazepine

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19
Q

Abx are of no value to Common Cold.

Instead, Supportive care:

A

Analgesics: NSAID, Acetaminophen, Chloraseptic spray/Sucret
Anthistamine/Decongestant: Sudafed, Benadryl
Expectorant/Antitussive: Robitussin

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20
Q

All testing for influenza should be done w/in

A

3-4 days of illness

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21
Q

Gold standard for lab diagnosis of Influenza

Not for initial but to confirm screening

A

Viral Culture, takes 3-10 days

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22
Q

Antiviral given for Influenza A and B

A

Oseltamivir (Tamiflu)
Zanamivir (Relenza)- not to pts with Asthma, resp conditions, or milk protein allergy!
Peramivir (Rapivab)
Baloxavir (Xofluza)

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23
Q

Tx for HSV Pharyngitis

A

Acyclovir, Famciclovir, support tx

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24
Q

Management in general for Viral Pharyngitis

A

supportive, hydration, antipyretics/analgesics, “Magic mouthwash”
HIV- antivirals, ID consult

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25
Mono Viral Pharyngitis
Epstein barr virus sore throat, throat edema, tonsular EXUDATES Splenomegaly 50% Dx: Monospot, CBC w/diff -increased atypical lymphocytes lasts 2-4 weeks can be contagious up to 3 MONTHS tx: supportive, avoid contact sports
26
Cornebacteriam Diphtheriae Pharyngitis
Grey exudate tightly adherent to throat Consider in UNVACCINATED pts and recent TRAVEL tx: Diphtheria anti toxin AND PCN or Erythromycin
27
Mycoplasma PNA
Tx: Azithromycin (Zithromax)
28
Neisseria Gonorrhoeae Pharyngitis
MSM population associated w/oral sex Tx: Rocephin (Ceftriaxone)
29
Group A Strep Pharyngitis | "Strep Throat"!!!
Center Criteria: 1. Exudates 2. Tender nodes 3. Fever 4. Abscence of cough pts with 3 of 4 sx should undergo testing- rapid antigen detecting
30
If a patient meets center criteria for Strep with negative rapid strept est
child or teen: order culture clinical judge for adults, can treat w/o culture Empiric ABX until culture results
31
First line therapy for Strep Throat (GAS, Group A Strep)
Penicillin G 1.2 IM single dose Penicillin V 500 TID 10 d Amoxicillin 500 BID 10 d Cephalexin (Keflex) 500 BID 10 d
32
2nd line Strep treatment (or PCN allergy)
Azithromycin | Clindamycin
33
Complications of Strep Throat (GAS)
Acute rheumatic fever, Post strep glomerulonephritis, Strep Toxic shock syndrome, Scarlet Fever
34
Scarlet fever
requires previous exposure to Strep pyogenes infection
35
Scarlet fever
delayed hypersensitivity | Rash, desquamation (skin loss finger picture), Pastia's lines, facial flushing w/circumoral pallor, "strawberry tongue"
36
Acute rheumatic fever
delayed onset 2-3 wks post infection | May result in cardiac valvae abn, arthritis
37
Peritonsillar Abscess
Most common cause: | STREP Pyogenes & STAPH Aureus
38
Peritonsillar Abscess
``` severe sore throat- unilateral drooling trismus ipsilateral ear pain fatigue, anxiety "Hot potato voice" uvula deviation! Cervical LAD ```
39
Parenteral tx for Peritonsillar Abscess after drainage
"VUC" Vancomycin Unasyn Clindamycin THEN switch to Oral: Augmentin, Clindamycin 14 d course
40
Epiglottitis
drooling STRIDOR RESPIRATORY DISTRES toxic appearance danger of airway obstruction, can progress rapidly
41
Epiglottitis
Lateral X Ray shows: "Thumb Sign"
42
Laryngitis: vocal cord disease
Virus most common etiology
43
Bacterial causes of Laryngitis (vocal cord disease)
The SMH pathogens- S. Pna M. Catarrhalis H. Influenzae
44
Laryngitis main sx
HOARSENESS
45
Diagnosing Laryngitis
Hoarseness >2 weeks in the absence of URI sx Tx: Treat underlying cause
46
Acute Rhinosinusitis
most common Viral | This is abbreviated AVRS
47
ABRS Acute Bacterial Rhinosinusitis AKA Bacterial Sinus Infection
The SMH pathogens- S. Pna M. Catarrhalis H. Influenzae
48
Rhinosinusitis sx
purulent nasal drainage AND congestion and/or facial pain with pressure and fullness
49
Acute VIRAL Rhinosinusitis dx
<10 days of sx that are not worsening no need for imaging or cultures at this point tx: supportive care bc 98% of time this is viral Days 1-9: Analgesics, Saline irrigation, Mucolytics, Intranasal decongestant and glucocorticoids
50
AVRhinosinusits is often followed by BACTERIAL bc viral leads to mucosal edema which obstructs sinus and traps bacteria (SMH pathogens)
initiate ABX if: persistent >10 days w no improvement OR onset severe sx fever >102, purulent nasal d/c, facial pain lasting 3-4 consecutive days at beg of illness OR viral uri that lasted 5-6 days, was improving, followed by "Double worsening"
51
1st line tx for ABRS Acute Bacterial Rhinosinusitis (sinus infection)
If pt is not at high risk for abx resistance: ``` Augmentin 875/125 mg Doxycycline Levoflaxacin Moxifloxacin 5-7 days ```
52
2nd line tx for: | ABRS bacterial sinus infection IF pt is not responding to first line or IF they are high risk for abx resistance
``` Augmentin but greater dose! 2000 mg/125 Levofloxacin Moxifloxacin Doxy 7-10 days ```
53
Labs for Bacterial sinus infection | ABRS
Sinus Aspirate Culture= gold standard **
54
``` Chronic Rhinosinusitis (sinus infection) 4 cardinal criteria ```
Four cardinal sx adults: 1. Mucopurulent 2. Congestion 3. Facial pain, pressure 4. Loss smell (in children, cough is 4th sx, not loss smell)
55
Dx Chronic Rinosinusitis CRS
``` presence of 2 of 4 cardinal sx AND infection lasting 12 weeks or greater w/meds PLUS EITHER CT findings OR findings on nose exam ```
56
Glaucoma 3 factors
Pressure increase >30 mmHg Nerve damage Loss of vision
57
Angle Closure Glaucoma
Outflow obstruction | Penlight test- shadow on nasal iris means chamber is narrow
58
Angle Closure Glaucoma
``` Halos around lights Ciliary flush Steamy, cloudy cornea Severe eye pain Injected red eye ```
59
Gold standard for diagnosing Angle CLOSURE Glaucoma
Gonioscopy- measures angle
60
Tx for Angle-closure Glaucoma
``` Topical anti HTN meds- beta and alpha Osmotic agents- Mannitol Laser peripheral iridotomy Surgical trabeculectomy NO DILATING DROPS ```
61
Angle-Open Glaucoma
Increased Cup:disc ratio Early: asymptomatic Late: chronic painless visual loss
62
Tx for Angle-Open Glaucoma
Topical Anti HTN meds Laser Trabeculo Surgical Trabeculo
63
Tx that is unique to Angle-Closure glaucoma
osmotic agents
64
Cataracts
Opacity d/t clumps of protein Diff night driving "Glare from headlights"
65
Tx for Cataracts
Good prognosis! Glasses or Surgery Surgery for those who struggle w/ADLs- cataract extraction or lens implant
66
Macular Degeneration
degeneration of retina (macula) | Meds can cause: Nitro, beta blockers, ASA
67
Macular Degeneration two types
Dry: drusen deposits, slow progression Wet: neovascularization, "leaky vessels", RAPID vision loss, metamorphopsia
68
Tx for Macular degeneration (both dry and wet)
Vitamins/Omega 3 Fatty Acids Stop smoking Amsler grid daily ``` Add for Wet: Photocoagulation Photodynamic therapy Intra-vitreal steroid Monoclonal Antibodies ```
69
Retinal detachment
risk factors: Myopia, use of Fluoroquines (abx)
70
Two types of retinal detachment
Rhegmatogenous: full thickness tear when vitreas shrinks and detaches pulling retina with it NonRhegmato: vitreous traction pulls on retina, DIABETES, scar tissue
71
Retinal detachment
Sudden onset: FLOATERS, PHOTOPSIAS, VISUAL LOSS urgent referral
72
Tx of Retinal detachment
small tear: Laser photocoagulation Frank large tear: Surgery- Scleral buckle, Vitrectomy- instead fill with Gas or Silicone oil
73
HTN Retinopathy
Copper wiring Silver wiring AV nicking Cotton wool spots treat HTN. if hemorrhage- photocoagulation
74
DM HTN
Non proliferative vs proliferative Non: blurred vision, hard exudates, cotton wool spots Proliferative: new vessels, hemorrhage!!
75
Tx of DM HTN
blood sugar control laser photocoagulation vitrectomy
76
CRAO- Artery
Embolic- clot from elsewhere Acute, TOTAL loss "black as night" "Cherry Red Spot"
77
CRVO- Vein
Thrombotic- blood comes in but can't get out, forms clot Variable degree of loss "Blood and thunder" appearance
78
Tx for CRAO
Ocular emergency no tx, poor prognosis Find reason- prevent future stroke
79
Tx for CRVO
Aspirin observe Treat retinal edema or ischemia Is pt hypercoaguable? WHy did they clot? evaluate this
80
Optic Neuritis
Acute, inflammatory, demyelination of optic nerve!! hrs-days, peaks at 1-2 wks link to MS
81
Optic Neuritis sx
Central scotoma PAINFUL, worse with EOM optic disc edema optic nerve PALE and SHRUNKEN
82
Tx for Optic Neuritis
Methylprednisolone IF severe vision loss or 2 or more white brain lesions
83
Optic Neuritis management
no tx | improves on own in 2-3 wks, but poor vision by 1 year, 35% chance recurs in 10 yrs
84
Most common cause of Otitis externa
Pseudomonas and Staph!!! | swimmer's ear
85
Floxin Otic
to treat Otitis Externa if TM is perforated! this is a solution
86
Which feels better to patient? Suspension or solution?
Suspension- less acidic
87
Malignant Otitis Externa
necrotizing | granulation tissue
88
Treat Malignant Otitis Externa
IV Cipro (eventually --> oral) and Surgery!
89
Most common cause of Malignant Otitis Externa
Pseudomonas
90
+ head thrust postviral or viral acute onset vertigo
Vestibular neuritis | Labyrinthitis
91
Anterior Uveitis
Ciliary flush

Quarter 2 (16 decks)

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