EENT Flashcards
What is the presentation with corneal ulcers
- severe eye pain
- foreign body sensation
- tearing
- photophobia
- whitish lesion on the cornea
What is the presentation of herpes keratitis
- acute onset
- severe eye pain
- photophobia
- tearing
- blurred vision in one eye
- fern like lines in the corneal surface on black lamp with fluorescein dye
The complication of herpes keratitis is that
it damages corneal epithelium that results in corneal blindess
What is the presentation of acute angle-closure glaucoma
- acute onset
- severe eye pain
- headache
- N/V
- halos around lights
- lacrimation
- decreased vision
- mid-dilated pupil
- cornea appears cloudy
- fundoscopic exam reveals cupping of the optic nerve
What condition may present with loss of visual acuity over hours to days, color vision is affected, there is a central scotom as well as other neuro symptoms such as (aphasia, paresthesias, abnormal gaity), fatigue
MS
What is the presentation of orbital cellulitis
- acute onset of erythematous swollen eye lid with proptosis and pain
- unable to perform full ROM of the eyes
- Hx of recent rhinosinusitis or URI
Sudden onset of floaters associated with “looking through the curtain” with sudden flashes of light (photopsia)
Retinal detachment
What is an auricular hematoma
-direct blunt trauma to the ear that causes bleeding in the auricular cartilage
What is the result if an auricular hematoma is not properly drained
cauliflower ear
What is the presentation of an acoustic neuroma
- unilateral hearing loss
- tinnitus
- unsteadiness when walking
- episodes of verring or tilting that fluctuates in severity
A cauliflower like mass behind the tympanic membrane
Cholesteatoma
When you have a basilar skull fracture these signs are often present
- Racoon eyes
- brusing behind the ear (mastoid area)
- clear or golden serous discharge from the ear or nose
- hemothympanum (blue or purple color of the TM)
If a permanent tooth is avulsed what should you do
- avoid touching the root
- rinse tooth with normal saline
- irrigate socket with normal saline and reimplant tooth
- have patient bite down on gauze and refer to dentist ASAP
- if unable to replant store in cool mil, saline or inside cheek
What is the presentation of a peritonsillar abscess
- severe sore throat
- difficulty swallowing
- odynophagia
- trismus
- hot potato voice
- unilateral swelling of the peritonsillar area and soft palate
- displaced uvula
What is the presentation of diptheria
- sore throat
- fever
- marked swelling of the neck
- hoarseness
- dysphagia
- grey to yellow pseudomembrane that is hard to displace covers the pharynx, tonsils, uvula and soft palate
What is virchow’s node or troisier’s sign
an enlarged and hard left sided supraventricular node
What is the significance of Virchow’s node or troisier’s sign
-associated with malignancy
In the eye the ____ are larger than the _____
veins are larger than the arteries
Cones are for ____ vision while rods are for ____ vision
- cones: color
- rods: low light vision and peripheral vision
The ____ is responsible for central vision
macula
What is presbyopia
-age related change due to a decreased ability of the eye to accommodate and focus due to stiffening of the lenses usually starting at age 40
What is blepharitis
-inflammation of the edges of the eyelids where the eyelashes grow
r/t tiny oil glands at the base of the eyelashes become clogged
The bones of the ear are the
- mallus
- incus
- stapes (smallest bone in the body)
What is a tympanogram
-the most objective measure to test for the presence pf fluid inside the middle ear
What is kisselbach’s plexus
-an area on the anterior-inferior aspect of the nose and is the most common place for anterior nosebleeds
There are 4 sinuses:
- Ethmoid (present at birth)
- Maxillary (present at birth)
- Front (present at 5 years)
- Sphenoid (present by 12 years)
What is a white to light gray patch that appears on the tongue, floor of the mouth or inside cheek and what does it make you concerned for?
Leukoplakia
-oral cancer
Painful shallow ulcers on soft tissue of the mouth that usually heal within 7-10 days
Aphthous stomatitis
There are 3 salivary glands:
parotid, submandibular and sublingual
What is the presentation of mumps
- acute onset
- fever
- headache
- fatigue
- myalgia
- anorexia
- within 48 hrs parotid gland becomes swollen and tender
What are the complications of mumps
-orchitis, meningitis, encephalitits, deafness
Painless bony protuberance midline on the hard palate
torus palatinus
Uvula that is split into 2 sections and resembles a fish tail
Fishtail or split uvula
On prolonged, extreme lateral gaze a few beats of nystagmus that resolves when the eye moves back towards midline in healthy patients is _____
normal; physiologic caze evoked nystagmus
Optic disc swelling with blurred edges due to increased ICP secondary to bleeding, brain tumor, abscess, pseudotumor cerebri is
Papilledema
Disc cupping is when ___ and is associated with ____
An abnormal cup to disc ratio and is associated with glaucoma
What are the hypertensive retinopathies?
- AC nicking
- retinal hemorrhages
- copper and silver wire arterioles
What are the diabetic retinopathies
- microaneurysms
- cotton wool spots
- neovascularizations
What are cataracts
-opacities of the lens of the eye
What are sx of cataracts
- difficulty with glare
- halos around lights
- blurred vision
Clusters of small red papules with white centers inside the cheeks by the lower cheeks are ____ which are pathognomonic for _____
- Koplik spots
- Measles (Rubeola)
What is the 1st line treatment for nasal polyps
-intranasal glucocorticoids
What are elongated papilla on the lateral aspect of the tongue and what is this pathognomonic fo
- Hair leukoplakia
- HIV
Painful skin fissures and macerations at the corner of the mouth are called
Cheilosis or angular cheilitis
What is the management of cheilosis
- Check B12 level
- Remove underlying cause of excess moisture
- use barrier creams with zinc or petroleum jelly at night
Hyperopia is
farsightedness; distance vision is intact but near vision is blurry
Myopia
Nearsightedness; near vision is intact but distance is blurry
The ______ chart is used to evaluate color blindness
Ishihara chart
In evaluating the results of snellen testing the
- top number is the distance in feet at which the patient stands from the snell chart
- The bottom number is the number of feet at which the patient can see compared with a patient with normal vision.
At what age should a child have normal visual acuity
6 years
Weber test
- tuning fork is placed midline on the forehead
- abnormal is lateralization:
Rinne test
- tuning fork on mastoid then in front of the ear time eat
- Normal is: AC > BC
If a weber and rinne are performed and lateralization is to the “normal ear” and AC > BC this suggests
-sensorineural hearing loss
If a weber and rinne are performed and lateralization is to the “bad ear and BC > AC this suggests
-conductive hearing loss
What is the presentation of a corneal abraison
- acute onset of eye pain
- feeling of foreign body sensation on eye surface
What is the management plan for keratitis
- check visual acuity
- pupils
- if infection suspected get C&S of discharge
- Use topical ophthalmic antibiotic with pseudomonal coverage such as Cipro, ofloxacin, trimethoprim-polyxicin B x 3-5 days
What is a Hordeolum
-an external abscess of a hair follicle and sebaceous gland in the upper or lower eyelid
What are symptoms of hordeolum
-acute onset of swollen, red and warm abscess on the upper or lower lid
What is the management of a hordeolum
-hot compresses
What is a chalazion
chronic inflammation of the meibomian gland of the eye lid
What is the presentation of chalazion
- gradual onset
- small superficial nodul of the upper eyelid that feels like a bead, is discrete and movable
What is the treatment for chalazion
I&D, or steroid injections so refer
What is a pinguecula
-a raised, yellow white, small round growth in the bulbar conjunctiva next to the cornea caused by chronic sun exposure
What is a pterygium
-a yellow triangular thickening of the conjunctiva that extends across the cornea is the result of chronic sun exposure
What is the management of pinguecula or pterygium
- during inflammatory periods: steroid eye drops
- sunglasses with UVA UVB coverage
- Surgical removal if encroaches on pupil
What are common risk factors for subconjunctival hemorrhage
- coughing
- sneezing
- heavy lifting
- vomiting
- local trauma
- spontaneously can occur
What is primary open angle glaucoma
-gradual onset of increased IOP >22mmHg r/t blockage of the drainage of aqueous humor inside the eye
What is the management of primary open angle glaucoma
-check IOP with tonometer
if >30 requires urgent referral
-Beta blocker eye drops (timolol; decrease aqueous production)
-Latanoprost: increase outflow
What is normal IOP
8-21
What are CI to timolol
- asthma
- 2nd or 3rd-degree heart block
- COPD
- Emphysema
- Heart failure
What is the presentation of anterior uveitis
- insidious onset of eye pain with conjunctival injection
- is a complication of autoimmune disorders, sarcoidosis, syphilis
- no purulent discharge
What is the management of anterior uveitis
Refer to opthalmologist as can result in blindness
What is the leading cause of blindness in the elderly
macular degeneration
Gradual or sudden and painless loss of central vision in one or both eyes.
- Describes straight lines as appearing distorted or curved
- peripheral vision is intact
Macular degeration
What is the test used to check on macular degeneration
Amsler grid
What is sjogren syndrome
-chronic autoimmune disorder characterized by decreased function of the lacrimal and salivary glands
What is the presentation of sjogren’s syndrome
- daily sx of
- dry eyes and dry mouth for > 3 months
What is the management of blepharititis
-use johnson’s baby shampoo until it resolves
An ______ is when the eyelid is turned inwards which causes the eyelashes to continuously rub resulting in irritation, watery eyes, redness, pain and foreign body sensation
Entropion
An ____ is when the eyelid is turned outwards and sags
Ectropion
Allergic rhinitis is
inflammatory changes of the nasal mucosa due to alleries
What is the presentation of allergic rhinitis
- chronic or seasonal nasal congestion with clear mucus
- rhinorrhea
- post nasal drip that worsens when supine
- nasal itch
- frequent sneezing
- click to clear mucus
- blue tinged, pale and boggy nasal turbinates
- undereye circles
- posterior pharynx shows cobblestoning
What is 1st line treatment of allergic rhinitis
-Topical nasal steroid sprays
The prolonged use of a topical nasal decongestant >3 days causes rebound effects that result in severe and chronic nasal congestion called
rhinintis medicamentosa
What are common causes of septal perforation
- Cocaine use
- snoring
- trauma
- prior septal surgery
- untreated septal hematoma
What is first line treatment for strep throat
Penicillin V 500mg BID-TID x 10 days
-If pen allergicy Z-Pak x 5 days
What are complications of untreated strep throat
- scarlet fever
- acute rheumatic fever
- pertionsillar abscess
- poststrep glomerulonephritis
What is the presentation of OM
- ear pain
- popping noises
- muffled hearing
- recent hx of cold or flare of allergic rhinitis
What is bullous myringitis
-Type of AOM infection that is more painful due to the presence of blisters on a reddened and bulging TM
What are objective findings of an OM
- weber lateralizes to bad ear
- rinne shows BC > AC
- TM may be bulging or retractions with dispalced light reflex, decreased TM mobility
- if TM is ruptured then draining purulent discharge
First line treatment for OM is
-Amoxicillin
What is the presentation of acute bacterial rhinosinusitis
- unilateral facial pain or upper molar pain
- nasal congestion for 10 days or longer
- purulent nasal and or postnasal discharge
- hyposmia
First line antibiotic treatment for acute bacterial rhinosinusitis
Augmentin 1000/62.5
What is the management of ABRS
- in mild uncomplicated cases: expectant mgmt
- in mod to sever cases or sx worsen after 10 days then treat with Augmentin (Levofloxacin if pen allergic)
What is the treatment of OM with effusion
Oral decongestants
Steroid nasal spray or saline spray
What is the presentation of OE
- external ear pain
- swelling
- discharge
- pruritus
- hearing loss
- purulent green discharge
- red/swollen ear canal
What is the management of OE
- Polymyxin B-neomycin hydrocortisone suspension 4gtt QID x 7 days
- Ofloxacin or ciprofloxacin otic ear drops BID x 7days
- In immunocompromised pts treat with topical and systemic ABx
- keep ear out of water during tx
- if recurrent episodes then Boric acid, or vinegar is prophylactic
What is the classic triad of mono
- fever
- pharyngitis
- lymphadenopathy
What is the classic presentation of mono
- sore throat
- enlarge posterior cervical nodes
- symmetric lymphadenopathy
- tonsillar exudate
- fatigue
- hepatosplenomegaly
What tests are done in mono
- CBC (atypical lymphocytes and lymphocytosis)
- LFTs
- Monospot (heterophile antibody test)
- U/S if spleno/hepatomegaly present and repeat in 4-6 weeks to document resolution
What is the treatment plan in mono
-limit physical activity x 4 weeks to reduce risk of splenic rupture
What is the gold standard test for BPPV
Dix-Hallpike
New onset urticaria consider
Benadryl or Zyrtec
Benadryl is more sedating
Acute or reactivated ___ can present at generalized maculopapular rash, enlarged tonsils with cryptic exudate, sore throat or enlarged cervical nodes
Mono
Treatment for OE is
Cortisporin drops (Antibiotic + Steroid)
Weber and Rinne test what cranial nerve?
VIII
______ is one of the most common OTC tx for ceruminosis
Carbamide
If a corneal abrasion or keratitis is suspected you should use _____
Fluorescein strips
Fundoscopic exam findings
- red reflex should be present
- optic disc should be sharply outlined
- cup to disc ratio should be <0.5
- veins pulsate in the eyes
What is the first sign of macular degeneration
scotoma
or central blind spot
A 70 year old patient presents to clinic with eye pain, conjunctival redness, and a pupil that reacts poorly to light what could be the cause?
- viral conjunctivitis
- angle closure glaucoma
- open angle glaucoma
- ocular foreign body
-angle closure glacuoma
What are xanthelasmas and what does this often indicate
- yellowish plaques on the inner canthus; cholesterol deposits
- elevated lipids
4 step assessment of all eye complaints
- Always start by assessing visual acuity and document for both eyes
- Examine with slit lamp or binocular loupe or penlight
- Lid eversion
- Fluorescein staining (will show corneal defect)
Red eye and change in vision warrants
Opthalmology referral
Red eye with photophobia warrants
Opthalmology referral
Red Eye with sensitivity and inability to keep eye open warrants
Opthalmology referral
What is a cataract
An opacity in the lens of the eye which decreases visual acuity
What are complications from Group A strep
- sinusitis
- retropharyngeal and peritonsillar abscesses
- acute rheumatic fever
- acute glomerulonephritis
MCENTOR
- Must be 3
- Cough absent
- Exudative tonsils
- Nodes present; anterior
- Temp >100.4
- Often young 3-14
- Rarely old -1
If the centor score is
- 2
- 3+
2- consider rapid strep
3+ likely strep rapid strep treat empircally
A 13 year old presents with fatigue, sore throat, enlarged and tender anterior and posterior cervical nodes . She has a + rapid strep test how should this be handled
- Rx penicillin
- Addition lab testing
- Order a CXR
- Rx azithromycin
-she should have additional lab testing
What is the screening test for mono
Monospot: Screening of heterophil antibodies
What is epiglottitis
-a life threatening infection of the epiglottis and surrounding tissues which can cause sudden and critical narrowing of the airway
What is presentation of epiglottitis
- sore throat
- fever
- muffled voice
- drooling
- stridor
- hoarseness
- thumb sign
How can you manage epistaxis
- if mild: pinch nose tightly for 10 minutes
- cautery: silver nitrate stick
- nasal packing balloon if cautery unsuccessful
A 30 year old patient has been diagnosed with rhinitis medicamentosa what drug has she been overusing
1) An antihistamine
2) A decongestant
3) A topical nasal steroid
4) A topical vasoconstrictor
4) A topical vasoconstrictor
A common side effect of topical nasal steroids is
Epistaxis
A patient takes cetirizine for allergic rhinitis what side effects are common? select all that apply 1. Adrenal suppression 2. Epistaxis 3. Sedation 4. Rebound stuffiness 5. Increased BP 6. Dry Mucous Membranes
- Sedation
6. Dry mucous membranes
A 78 year old with hearing aids complains of itching in both ears what is a likely diagnosis
Otitis externa
Presbycusis is
Hearing loss in aging
-lose the ability to hear high pitched tones
Conductive hearing loss involves the
External canal or middle ear
Weber: Lateralization to bad ear
Rinne: Bad Ear BC>AC
Sensorineural Hearin loss
involves the inner ear or CNIII
Weber: Lateralization to good ear
Rinne: Normal
What are examples of conductive hearing loss
- cerumen impaction
- ear plugs
- fluid in the middle ear
What are examples of sensorineural hearing loss
- hereditary hearing loss
- presbycusbis
- noise exposure
- meniere’s
- acoustic tumors
- trauma
A 78 year old has been diagnosed with presbycusis what are likely findings. Select all
- Hearing loss is symmetrical
- Sudden hearing loss
- Hearing deficits are worse with background noise
- Sensitivity to loud sounds
- Tinnitus present
- Audigoram shows loss of high pitched tones
- Most common beginning in the 6th decade
- Hearing loss is symmetrical
- Hearing deficits are worse with background noise
- Sensitivity to loud sounds
- Tinnitus present
- Audiogram shows loss of high pitched tones
- Most common beginning in the 6th decade
