EENT Flashcards
Proper way to conduct an eye exam
right hand, right eye, right eye start with wheel at 0 start 12' away move in to 1-2" away after red reflex, then exam from the optic disc and end with the fovea of each eye
what is the shape of the optic disc
Doughnut-like with an orange/pink neuroretinal rim and a central white depression (physiologic cup)
What should the cup/disc ratio be?
cup should not be more than 1/2 the size of the disc diameter
consider________ if the cup is more than 1/2 the size of the disc diameter
glaucoma
describe retinal vessels
arteries are brighter red and narrower than veins
A:V ratio 2:3 or 4:5
Where is the macula located
centered 2-2.5 disc diameters temoral to the optic disc and is avascular
What are the characteristics of the fovea centralis
2.5mm diameter reflective area that looks slightly darker and lies in the center of the macula region
have the patient look______ if the macula is difficult to visualize
directly into the light
What is hyperopia
Farsightedness, gero patient
What is myopia
Nearsightedness, younger patients
What is presbyopia
lessing of the crystalline lens and weakening of the ciliary muscles which controls the lens focusing leading to greater difficulty maintaining a clear focus at a near distance. Common after age 40
At what snellen do you refer a patient
20/30
What is arcus senilis
cloudy appearance of the cornea with a gray/ white arc or circle around the limbus due to the disposition of LIPID material. No affect on vision
S/SX of a hordeolum (stye)
abrupt onset, pain, erythema
localized tender mass developing in the eyelid
management of the hordeolum
warm compresses to bring to a head
Topical bacitracin or erythromycin opthalmic ointment
Refer to ophthla if no resolution in 2 days
Chalazion definition
beady nodule on the eye lid, infection or retention cyst of a meibomian gland, usually on the upper eyelid
What differentiates a hordeolum and a chalazion
hordeolum hurts
S/SX of chalazion
swelling on the eyelid eyelid tenderness sensitivity to light increased tearing if large: can cause astigmatism due to pressure on the cornea
Management of chalazion
warm compresses, refer for surgery
define blepharitis
staph or seborrheic dermatitis of the lid edge
s/sx of blepharitis
red, scaly, greedy flakes Thickened crusted lid margins Burning itching tearing
management of blepharitis
Hot compresses
Topical antibiotics, bacitracin or erythromycin
vigourous scrub
What should conjunctivitis not include in s/sx
pain
type of discharge with bacterial conjunctivitis
purulent
type of discharge with gonococcal or chlamydial conjunctivitis
copious purulent
Treatment for bacterial conjunctivitis
self limiting
Antibiotics drops: Levo, ofloxacin, cipro, tobra, gent
type of discharge with allergic conjunctivitis
stringy, increased tearing
Discharge for viral conjunctivitis
watery
management of allergic conjunctivitis
oral antihistamines, not gtt because can worsen glaucoma
What is the pathology of glaucoma
Increased intraocular pressure
Open angle- chronic
Closed angle- acute
s/sx of open angle glaucoma
chronic asymptomatic elevated IOP cupping of the disc Constriction of the visual fields
s/sx of closed angle glaucoma
acute Extreme pain blurred vision halos around lights Pupil fixed or dilated
diagnostics of glaucoma
tonometry, screening nationally recommended by age 40
Management of open angle glaucoma
Alpha 2-adrenergic agonists- brimonidine, alphagan
Beta-adrenergic blockers- timolol
Miotic agents- pilocarpine
Pathology of cataracts
Clouding and opacification of the normally clear lens of the eye
s/sx of cataracts
Painless, clouded blurred or dim vision Halos around lights, NOT PAINFUL Difficulty with vision at night Sensitivity to light and glare fading/ yellowing of colors diplopia (2x vision) in a single eye The need for brighter light for reading NO RED REFLEX Opacity of the lens
s/sx of retinal detachment
Flashes of light (photopsia) especially in peripheral vision
FLOATERS IN THE EYE
blurred vision
shadow or blindness in a part of the visual field of one eye
Management of otitis externa
Cleansing and debridement of the ear
Topical otic drops: Cortisporin otic, others
Pain control: NSAIDS, topical corticosteroids
What is streptococcus pneumoniae the key bacterial pathogen of?
Otitis media,
Sinusitis
Meningitis
CAP
What is the most common source of otitis media in adults
viral
What are the 3 phases of otitis media and what does it entail?
Local inflammation: erythema with diminished light reflex, fluid in the middle ear
Exudative phase: middle ear serous excudate
Suppurartive phase (serous)- purulent excudates; retraction and poor motility of the ™. Membrane becomes bulging and convex (IS SUPPOSED TO BE CRESENT). membrane may rupture
Management of otitis media in the adult
uncomplicated will resolve itself hydration avoid irritants topical or oral decongestants cool mist antibiotic if suspected: AMOX
Define Cholesteatoma
Type of chronic otitis media consisting of peeling layers of scaly or keratinized epithelium; if untreated may erode the middle ear causing nerve damage and deafness
define vertigo
sensation of motion of either of the the person or the environment
define benign paroxysmal positional vertigo
most common form of vertigo- characterized by the sensation of motion initiated by sudden head movements
Causes of vertigo
brain tumors medications otitis media or labrinthitis Meniere's disease Acoustic neuroma Head trauma or neck injury Migraines Cerebellar hemorrhage
Labs/ diagnostics of vertigo
CT scan VDRL/RPR serum medication levels hearing exam Blood glucose and ECG may be helpful
Management of vertigo
Diazepam Meclizine hydrochloride diphenhydramine scopolamine patch antiemetics
What are some of the medications that cause sensorineural hearing loss?
OTOTOXIC DRUGS: Aminoglycosides diuretics salicylates NSAIDS Antineoplastics
What are some infections that cause sensorineural hearing loss?
Mumps, measles, herpes zoster, syphilis, meningitis
What are the 3 components of meniers disease?
sensorineural hearing loss, tinnitus, vertigo
What do the weber and rinne test show in conductive hearing loss?
weber: sound lateralizes to the affected ear
Rinne test: Abnormal in the affected ear (AC
What will the weber and rinne test show in sensorineural hearing loss?
Weber: Sound lateralized to the unaffected ear
Rinne: Normal in the affected ear
define the common cold
Viral rhinitis: self-limiting (5-10 days) caused by any 1 or more of the 200 viruses (Rhinovirus, coronavirus, RSV, adenovirus…)
What is the Centor Criteria?
clinical features most suggestive of group A B-hemolytic strep pharyngitis (FLEA) Fever >38C or 100.4F Lack of cough Exudate Anterior cervical adenopathy If 2 or 3- rapid strep test
management of pharyngitis
Fluids/ hydration salt water gargles asa/ tylenol ANX for strep- PCN V, erythromycin) Ceftriaxone for gonococcal infection
Lab/diagnostic for pharyngitis
rapid streptococcal antigen test
Monospot
CBC with diff
labs/ diagnostic for influenza
virus isolation from nasal or throat swab or sputum specimen (most rapid)
When would you RX a antibiotic in influenza
if bacterial infection is suspected or patient is asthma, COPD, or immune compromised
What are neuraminidase inhibitors and what do they do?
Shorten the duration of symptoms by 2 days, effective for both influenza A and B. Must give within 48 hours or exposed
Zanamivir
Osteltamivir (tamiflu)
What virus causes mononucleosis
epstein-barr virus
What age group is most common for mono?
15-24 yo
What kind of adenopathy is seen with mononucleosis
posterior cervical region
What is the most severe symptom of mono?
pharyngitis, white tonsillar excavates
What occurs usually during the 2nd week of mono illness?
Spelnomegaly
What are the labs/ diagnostics of mono
Monospot positive
Increased WBC and relative lymphocytosis and neutropenia
What are the indications of a bacterial rhino sinusitis
purulent nasal drainage
fever
How long is mono incubation?
1-2 months, usually self limited, but malaise and fatigue may last months
What is the management of rhinosinusitis
Hyrdation Oral decongestants (sudafed, mucinex) Analgesics Antibiotics only if bacterial is suspected- AMOX+CLAV= Augmentin, or clarithromycin (Biaxin) supportive care
What is the most frequent location of nose bleeds
anterior spetum
What might uncontrolled nose bleeds be an indication of?
posterior septum nose bleed- more complicated, artery in the back of the nose.
If no resolution of nosebleed after____ minutes, refer to ENT
10
what kind of eye drops are used in the management of open angle glaucoma
miotic agents to produce miosis which symptomatically lowers IOP (pilocarpine)
what teeth erupt by 12.5 years
all teeth except the third molar
the second molar erupts by 11.9 (lower) and upper by 12.25
