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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
Q

Mono Viral Pharyngitis

A

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

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26
Q

Cornebacteriam Diphtheriae Pharyngitis

A

Grey exudate tightly adherent to throat
Consider in UNVACCINATED pts and recent TRAVEL
tx: Diphtheria anti toxin AND PCN or Erythromycin

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27
Q

Mycoplasma PNA

A

Tx: Azithromycin (Zithromax)

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28
Q

Neisseria Gonorrhoeae Pharyngitis

A

MSM population
associated w/oral sex
Tx: Rocephin (Ceftriaxone)

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29
Q

Group A Strep Pharyngitis

“Strep Throat”!!!

A

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

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30
Q

If a patient meets center criteria for Strep with negative rapid strept est

A

child or teen: order culture
clinical judge for adults, can treat w/o culture
Empiric ABX until culture results

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31
Q

First line therapy for Strep Throat (GAS, Group A Strep)

A

Penicillin G 1.2 IM single dose
Penicillin V 500 TID 10 d
Amoxicillin 500 BID 10 d
Cephalexin (Keflex) 500 BID 10 d

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32
Q

2nd line Strep treatment (or PCN allergy)

A

Azithromycin

Clindamycin

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33
Q

Complications of Strep Throat (GAS)

A

Acute rheumatic fever, Post strep glomerulonephritis, Strep Toxic shock syndrome, Scarlet Fever

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34
Q

Scarlet fever

A

requires previous exposure to Strep pyogenes infection

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35
Q

Scarlet fever

A

delayed hypersensitivity

Rash, desquamation (skin loss finger picture), Pastia’s lines, facial flushing w/circumoral pallor, “strawberry tongue”

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36
Q

Acute rheumatic fever

A

delayed onset 2-3 wks post infection

May result in cardiac valvae abn, arthritis

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37
Q

Peritonsillar Abscess

A

Most common cause:

STREP Pyogenes & STAPH Aureus

38
Q

Peritonsillar Abscess

A 
severe sore throat- unilateral
drooling
trismus
ipsilateral ear pain
fatigue, anxiety
"Hot potato voice"
uvula deviation!
Cervical LAD
39
Q

Parenteral tx for Peritonsillar Abscess after drainage

A

“VUC”
Vancomycin
Unasyn
Clindamycin

THEN switch to

Oral: Augmentin, Clindamycin 14 d course

40
Q

Epiglottitis

A

drooling
STRIDOR
RESPIRATORY DISTRES
toxic appearance

danger of airway obstruction, can progress rapidly

41
Q

Epiglottitis

A

Lateral X Ray shows: “Thumb Sign”

42
Q

Laryngitis: vocal cord disease

A

Virus most common etiology

43
Q

Bacterial causes of Laryngitis (vocal cord disease)

A

The SMH pathogens-
S. Pna
M. Catarrhalis
H. Influenzae

44
Q

Laryngitis main sx

A

HOARSENESS

45
Q

Diagnosing Laryngitis

A

Hoarseness >2 weeks in the absence of URI sx

Tx: Treat underlying cause

46
Q

Acute Rhinosinusitis

A

most common Viral

This is abbreviated AVRS

47
Q

ABRS Acute Bacterial Rhinosinusitis
AKA
Bacterial Sinus Infection

A

The SMH pathogens-
S. Pna
M. Catarrhalis
H. Influenzae

48
Q

Rhinosinusitis sx

A

purulent nasal drainage AND congestion and/or facial pain with pressure and fullness

49
Q

Acute VIRAL Rhinosinusitis dx

A

<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
Q

AVRhinosinusits is often followed by BACTERIAL bc viral leads to mucosal edema which obstructs sinus and traps bacteria (SMH pathogens)

A

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
Q

1st line tx for ABRS Acute Bacterial Rhinosinusitis (sinus infection)

A

If pt is not at high risk for abx resistance:

Augmentin 875/125 mg
Doxycycline
Levoflaxacin
Moxifloxacin
5-7 days
52
Q

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

A 
Augmentin but greater dose! 2000 mg/125
Levofloxacin
Moxifloxacin
Doxy
7-10 days
53
Q

Labs for Bacterial sinus infection

ABRS

A

Sinus Aspirate Culture= gold standard **

54
Q 
Chronic Rhinosinusitis (sinus infection)
4 cardinal criteria
A

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
Q

Dx Chronic Rinosinusitis CRS

A 
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
Q

Glaucoma 3 factors

A

Pressure increase >30 mmHg
Nerve damage
Loss of vision

57
Q

Angle Closure Glaucoma

A

Outflow obstruction

Penlight test- shadow on nasal iris means chamber is narrow

58
Q

Angle Closure Glaucoma

A 
Halos around lights
Ciliary flush
Steamy, cloudy cornea
Severe eye pain
Injected red eye
59
Q

Gold standard for diagnosing Angle CLOSURE Glaucoma

A

Gonioscopy- measures angle

60
Q

Tx for Angle-closure Glaucoma

A 
Topical anti HTN meds- beta and alpha
Osmotic agents- Mannitol
Laser peripheral iridotomy
Surgical trabeculectomy
NO DILATING DROPS
61
Q

Angle-Open Glaucoma

A

Increased Cup:disc ratio
Early: asymptomatic
Late: chronic painless visual loss

62
Q

Tx for Angle-Open Glaucoma

A

Topical Anti HTN meds
Laser Trabeculo
Surgical Trabeculo

63
Q

Tx that is unique to Angle-Closure glaucoma

A

osmotic agents

64
Q

Cataracts

A

Opacity d/t clumps of protein
Diff night driving
“Glare from headlights”

65
Q

Tx for Cataracts

A

Good prognosis!
Glasses or Surgery
Surgery for those who struggle w/ADLs- cataract extraction or lens implant

66
Q

Macular Degeneration

A

degeneration of retina (macula)

Meds can cause: Nitro, beta blockers, ASA

67
Q

Macular Degeneration two types

A

Dry: drusen deposits, slow progression

Wet: neovascularization, “leaky vessels”, RAPID vision loss, metamorphopsia

68
Q

Tx for Macular degeneration (both dry and wet)

A

Vitamins/Omega 3 Fatty Acids
Stop smoking
Amsler grid daily

Add for Wet:
Photocoagulation
Photodynamic therapy
Intra-vitreal steroid
Monoclonal Antibodies
69
Q

Retinal detachment

A

risk factors: Myopia, use of Fluoroquines (abx)

70
Q

Two types of retinal detachment

A

Rhegmatogenous: full thickness tear when vitreas shrinks and detaches pulling retina with it

NonRhegmato: vitreous traction pulls on retina, DIABETES, scar tissue

71
Q

Retinal detachment

A

Sudden onset: FLOATERS, PHOTOPSIAS, VISUAL LOSS

urgent referral

72
Q

Tx of Retinal detachment

A

small tear: Laser photocoagulation

Frank large tear: Surgery- Scleral buckle, Vitrectomy- instead fill with Gas or Silicone oil

73
Q

HTN Retinopathy

A

Copper wiring
Silver wiring
AV nicking
Cotton wool spots

treat HTN. if hemorrhage- photocoagulation

74
Q

DM HTN

A

Non proliferative vs proliferative

Non: blurred vision, hard exudates, cotton wool spots

Proliferative: new vessels, hemorrhage!!

75
Q

Tx of DM HTN

A

blood sugar control
laser photocoagulation
vitrectomy

76
Q

CRAO- Artery

A

Embolic- clot from elsewhere
Acute, TOTAL loss
“black as night”
“Cherry Red Spot”

77
Q

CRVO- Vein

A

Thrombotic- blood comes in but can’t get out, forms clot
Variable degree of loss
“Blood and thunder” appearance

78
Q

Tx for CRAO

A

Ocular emergency
no tx, poor prognosis

Find reason- prevent future stroke

79
Q

Tx for CRVO

A

Aspirin
observe
Treat retinal edema or ischemia
Is pt hypercoaguable? WHy did they clot? evaluate this

80
Q

Optic Neuritis

A

Acute, inflammatory, demyelination of optic nerve!!
hrs-days, peaks at 1-2 wks
link to MS

81
Q

Optic Neuritis sx

A

Central scotoma
PAINFUL, worse with EOM
optic disc edema
optic nerve PALE and SHRUNKEN

82
Q

Tx for Optic Neuritis

A

Methylprednisolone IF severe vision loss or 2 or more white brain lesions

83
Q

Optic Neuritis management

A

no tx

improves on own in 2-3 wks, but poor vision by 1 year, 35% chance recurs in 10 yrs

84
Q

Most common cause of Otitis externa

A

Pseudomonas and Staph!!!

swimmer’s ear

85
Q

Floxin Otic

A

to treat Otitis Externa if TM is perforated! this is a solution

86
Q

Which feels better to patient? Suspension or solution?

A

Suspension- less acidic

87
Q

Malignant Otitis Externa

A

necrotizing

granulation tissue

88
Q

Treat Malignant Otitis Externa

A

IV Cipro (eventually –> oral) and Surgery!

89
Q

Most common cause of Malignant Otitis Externa

A

Pseudomonas

90
Q

+ head thrust
postviral or viral
acute onset vertigo

A

Vestibular neuritis

Labyrinthitis

91
Q

Anterior Uveitis

A

Ciliary flush

Quarter 2 (16 decks)

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