EENT #1 Flashcards
Symptoms of an acoustic neuroma
- Unilateral sensorineural hearing loss
- Tinnitus, vertigo, facial numbness, facial paresis
Diagnostic imaging for Acoustic Neuroma
- MRI (imaging of choice)
- Audiometry is the lab of choice
Management of acoustic neuroma
Surgery or focused radiation therapy
Pathophysiology of acute angle closure glaucoma
Decreased drainage of aqueous humor via trabecular meshwork and canal of Schlemm in patients with pre-existing narrow angle or large lens
True or False: Acute angle closure glaucoma is the leading cause of preventable blindness in the US
True
Precipitating factors for acute angle closure glaucoma attack
Mydriasis (dilation), dim lights, sympathomimetics, anticholinergics
Symptoms of acute angle closure glaucoma
- Sudden onsets of severe, unilateral ocular pain
- Halos round lights and loss of peripheral vision
- N/v, headache
- Conjunctival erythema, cloudy cornea, mid-dilated and fixed pupil
Diagnostics for acute angle closure glaucoma
- Increased IOP > 21 mmHg
- Fundoscopy: optic disc blurring or cupping
Treatment for acute angle closure glaucoma
- Acetazolamide with Topical BB (Timolol) without affecting visual acuity
- Definitive: Iridotomy
MCC of acute otitis media (SMH)
Strep Pneumo (MC); GABHS
Moraxella Catarrhalis
H. Influenzae
Symptoms of AOM
- preceded by URI
- Fever, otalgia, ear tugging in infants, conductive hearing loss
- Bulging and erythematous TM with effusion
- Decreased TM mobility (most sensitive)
What is the definitive diagnostic for AOM for recurrent cases
Tympanocentesis for a sample of fluid for culture
If the TM perforates, what symptoms present?
Rapid relief of pain + otorrhea (usually heals in 1-2 days)
Treatment for AOM
Amoxicillin (1st line) x 10-14 days
- Augmentin or Cefaclor second line
- Azithromycin if PCN allergy
Acute sinusitis, if bacterial, is caused by
Strep Pneumo
Acute sinusitis, if viral, is caused by
Rhinovirus, influenza, and parainflueza
Symptoms of acute sinusitis
- Facial pain or pressure worse with bending or leaning forward
- Headache
- Purulent nasal discharge
- Worsening symptoms after period of improvement
- Malaise
- Nasal congestion
Diagnostic of choice, if needed, for acute sinusitis
CT scan
However, diagnostic that is gold standard for acute sinusitis is
Biopsy or aspirate
If sinus radiographs are ordered for acute sinusitis, what view is most helpful?
Water’s View
Treatment for acute sinusitis
Decongestants, analgesics, antihistamines, mucolytics, nasal lavage
However, in acute sinusitis, if symptoms are present for _______, or if they have worsening symptoms, you can start ABX. What are the ABX that you can start?
10-14 days
- Augmentin
- Second line is Doxycycline
What is the MCC of pharyngitis (acute tonsillitis)
Viral (Adenovirus, Rhinovirus, EBV)
However, bacterial is also a cause. Group A Strep (Strep Pyogenes) is the MC bacterial cause
Treatment for acute tonsillitis
Symptomatic, warm fluids, saline gargles, topical anesthetics, lozenges
If the acute tonsillitis is due to S. Pyogenes, you should use what ABX?
Amoxicillin
MCC of permanent legal blindness and vision loss in older adults
Macular degeneration
Symptoms of macular degeneration
Bilateral, progressive central vision loss.
- Metamorphopsia (blurred lines)
- Micropsia (objects are smaller in affected eye)
Risk factors for Macular degeneration
Age > 50
Caucasians
Females
Smokers
Fundoscopic exam for macular degeneration (dry and wet)
Dry: Drusen bodies (small yellow-white spots on retina)
Wet: New, abnormal vessels that cause retinal hemorrhaging and scarring
Management of Dry Macular Degeneration
- Zinc and Vitamins A & C
- Amsler grid monitoring at home
Management of Wet Macular Degeneration
Intravitreal VEGF inhibitors (Bevacizumab)
-Laser photocoagulation
Symptoms of allergic rhinitis
- Clear, watery rhinorrhea
- Pale or boggy turbinates
- Nasal polyps
- Cobblestone mucosa of conjunctiva
- Allergic Shiner
- Allergic Salute
Treatment for allergic rhinitis
- Intranasal corticosteroids
- Intranasal glucocorticoids (Mometasone, Fluticasone) if nasal polyps
- Decongestants
What is the risk with decongestants?
Intranasal decongestants used > 3-5 days can cause rhinitis medicaments (rebound congestion)
What is Amaurosis Fugax?
-Transient monocular vision loss with complete recovery due to retinal emboli or ischemia
Symptoms of Amaurosis Fugax
Vision loss descending over visual field described as a curtain or shade, that lifts up and resolves within 1 hour
Fissures at the side of the mouth
Angular Cheilitis
bacterial conjunctivitis causes
- Staph A (MC)
- Strep Pneumo
- H. Influenzae
- M. Catarrhalis
Symptoms of bacterial conjunctivitis
-Purulent discharge, lid crusting (eye stuck shut in the morning), conjunctival erythema, no visual changes
Treatment for bacterial conjunctivitis
-Erythromycin ointment
However, for a contact lens wearer for bacterial conjunctivitis, what should you cover for and what ABX should you use?
Pseudomonas
-Topical Ciprofloxacin or Ofloxacin
with a bitemporal hemianopsia, where would you expect a lesion to be?
Lesion of optic chiasm
Risk factors for cataracts (lens opacification/thickening)
- Aging
- Smoking
- Glucocorticoid use
- DM
- Trauma
- UV light
Symptoms of cataracts
- Absent red reflex, opaque lens
- Painless, slow progressive vision loss over years
- Difficulty driving at night, reading signs
