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Family Medicine > EENT > Flashcards

EENT Flashcards

1
Q

Blepharitis

A

Eyelid acne dt blockage of memobian gland
Sx: itching, burning, crusting eyes, no pus
Mgmt
Warm compress + baby shampoo
Optic abx to dec bacterial load but it’s not a true infection

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2
Q

Cataract

A

1 cause of blindness worldwide dt natural clouding of lens

Sx: painless gradual loss, reduced visual acuity, reduced red reflex
Mgmt
Tx indicated if vision 20/40 or worse or affects QOL
Outpt- phacoemulsification

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3
Q

Chalazion

A

Internal eyelid
Slow developing chronic blockage of oil gland

Mgmt
Aggressive warm compress
1-2wk no improvement - steroid injection or I/d
Resolve spontaneously

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4
Q

Corneal abrasion

A 
Irritability in an infant 
Sx:
Pain worse w blinking
Photophobia
FB sensation
Conjunctival injection

Dx: evert lid, flourescein stain w Woods lamp

Tx:
Topical anesthetic (if it’s iritis, pain won’t be reduced)
Remove FB
Tetanus prophylaxis
Erythromycin or gentamicin gtt… FQ if contacts or freshwater exposure
Ophtho f/u 1-2d

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5
Q

Dacryoadenitis

A

Mc in infants
Sx: red, swollen inferior/medial canthus; mucopurulent dc w lid crusting

Tx: warm compress w massage
Refer acute lacrimal infection for dx confirmation and abx

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6
Q

Ectropion

A

Older pt w eyelid turned out
Dryness*
Tx: lubrication

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7
Q

Entropion

A

Older pt w eyelid turned in
Irritation*

Tx: lubrication

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8
Q

Hordeolum (Stye)

A

Acute inflammation of memobian gland
Painful

Mgmt
Aggressive warm compress -4x per day for 20min
I&d if persisting more than 1-2wk
Spontaneous resolution

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9
Q

Pterygium

A

Dt chronic sun exposure
White vascular growth on nasal or temporal cornea
Concern for dry eye

Tx: artificial tears
Inflammation = ophtho for steroid or excision

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10
Q

Acoustic neuroma (“Vestibular Schwannoma” - CN 8)

A

Almost all unilateral; one of the MC intracranial tumors
A/w NF 1 (bilateral = NF 2)
Sx
- auditory: unilateral SNHL (gradual or sudden)
- vestibular: tinnitus, vertigo (continuous)

Dx: enhanced MRI
Tx: radiotherapy* - prevents further growth, does not shrink
- may require surgical excision if larger

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11
Q

Barotrauma

A

Inability to equalize barometric stress on middle ear during flight/dive

Sx: tinnitus, vertigo, NV, hearing loss

Middle ear: pressure decreases with descent; if the eustachian tube does not open, fluid fills middle ear space and may rupture TM

Inner ear: difficulty equalizing inner ear pressure suddenly able to open the eustachian tube, the rush of air can cause oval or round window rupture

Tx: refer, bed rest, antivertigo meds, steroid taper, avoid Valsalva

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12
Q

Cholesteatoma

A

Et: ETD, recurrent AOM, chronic OM –> epidermal structure replaces middle ear mucosa and resorbs underlying bone

Sx: recurrent/persistent otorrhea, hearing loss, tinnitus

Tx: surgery

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13
Q

Conductive hearing impairment

A

MC cause: cerumen impaction, ETD a/w URI
Dysfunction of external or middle ear

Tx:

  • AOM = abx
  • cerumen removal, TM repair, ear tubes, ossicular reconstruction, hearing aids
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14
Q

Sensory hearing impairment

A

MC cause: age (presbycusis) d/t loss of hair cell function
- autoimmune: Lupus, GPA, Cogan

Sxs:

  • presbycusis: high frequency loss
  • sudden sensory hearing loss: unilateral, peaks in 5th decade, idiopathic (no middle ear path = refer)
  • autoimmune: bilateral wax and wane; may have vestibular/balance issues

Dx: MRI if suspecting acoustic neuroma

Mgmt:

  • prevent further loss, hearing aids for amplification, cochlear implants
  • steroids for disease specific
  • SSHL - improved odds of full recovery with quick admin of steroids
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15
Q

Neural hearing impairment

A

D/t lesions affecting CN 8

E.g. acoustic neuroma, MS, auditory neuropathy

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16
Q

Labyrinthitis

A

Inner ear inflammation d/t viral
Sxs: continuous vertigo (days-wks), hearing loss, tinnitus
- no hearing loss = vestibular neuritis

Dx:

  • serous: coexisiting or recent URI/ear infection, may have hearing loss, nontoxic, may have mild fever
  • bacterial: coexisting OM, severe sx, hearing loss, fever, toxic [only peripheral cause warranting admission]

Tx:

  • febrile: abx
  • supportive care; vertigo - meclizine
  • may take several weeks to resolve, hearing may or may not return
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17
Q

Meniere’s disease

A

Idiopathic disorder of inner ear

Sx: spontaneous, recurrent attacks of episodic vertigo lasting hours; tinnitus; aural fullness; fluctuating SNHL
- w/out hearing loss = vestibular migraine

Dx: audiometric confirmation; r/o syphilis

Tx:

  • acute: meclizine or short burst of steroids*
  • 1st line: salt restriction, diuretics
  • ablation - aminoglycosides
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18
Q

Tinnitus

A

Ddx: Meniere’s; acoustic neuroma; otosclerosis; otitis media; MS; salicylate OD; chronic; cerebrovascular disease

D/t: h/o noise exposure, episodic sounds, hearing loss; persistence indicates SNHL

Dx: audiology screening*

  • labs, imaging, med history
  • pulsatile: MRI & venography to r/o aneurysm or vascular tumor

Tx: refer to audiology*

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19
Q

TM Perf

A

Trauma - slap injury, foreign body
Infection - complication of otitis media

Dx: audiology eval

Tx: refer for tympanoplasty if hearing loss persists
- infection = abx

20
Q

Vertigo

A

Sensation of disorientation in space w/sensation of motion/spinning

Central - MS, vestibular schwannoma
Peripheral - labyrinthitis/vestibular neuritis, Meniere’s, BPPV, inner ear barotrauma
Seconds: no HL - BPPV; HL - cholesteatoma
Minutes: no HL - migraines
Hours: HL - Meniere’s
Days: no HL - vestibular neuritis; HL - labyrinthitis
Weeks: no HL - Lyme, MS, central NS; HL - acoustic neuroma, psychogenic, autoimmune

21
Q

Central vertigo

A 
RF: older male vasculopath
Sx: 
- gradual, progressive, constant; presents later in course; mild/mod intensity 
- vertical nystagmus**
- mild nausea, HA, not affected by mvmt

Dx:

  • Head CT: r/o hemorrhage
  • MRI**
22
Q

Peripheral vertigo

A

Usually not emergent
Sx:
- acute, intermittent, brief; presents early in course; severe intensity
- nystagmus always present: unidirectional, fatigable, horizontal, or rotary* (never vertical)
- intense NV; provoked by mvmt; +/- hearing loss

23
Q

Peripheral vertigo DDx

A
  • BPPV
  • Labyrinthitis
  • Vestibular neuronitis
  • Meniere’s
  • Acoustic neuroma
24
Q

BPPV

A

Positional vertigo d/t calcium debris w/in posterior semicircular canal
MC older females

Sx:

  • recurrent vertigo lasting 1 min or less provoked by specific head movements; episodes for wks-mos
  • +/- NV w/out other neuro complaints

Dx: Dix-Hallpike Maneuver
Tx: Epley Maneuver

25
Q

Acute sinusitis

A

Duration <4wk
Starts URI –> edema –> ostial blockage, mucus stasis, bacterial proliferation
MC: S. pneumo, H. flu, S. pyogenes **

Sxs:

  • URI > 10d w/no improvement
  • severe sxs w/high fever w/purulent nasal d/c or facial pain (3-4d)
  • worsening sxs w/new onset HA, fever, INC nasal d/c following URI w/initial improvement

Tx: Amoxicillin, Augmentin, Doxycycline* or Resp FQ
- nasal saline for irrigation, nasal steroids, antihistamines

26
Q

Chronic sinusitis

A

> 12wk d/t impaired mucociliary clearance, abnormal sinus ventilation, or immune deficiency

  • nasal polyps + chronic sinusitis = CF
  • different bugs: Staph, Pseudomonas, anaerobes

Dx: consider CT sinuses
Tx: ENT referral; FQ culture-directed therapy for 3-6wk
- steroids dec inflammation

27
Q

Allergic rhinitis

A

Early phase: 10-15min histamine - sneezing, rhinorrhea, itching [antihistamines - loratadine, fexofenadine, cetirizine]
Late phase: 4-6hr cytokines/leukotrienes - inflammation, nasal congestion, postnatal drip [nasal steroid - triamcinolone, fluticasone, mometasone]

Seasonal: worse in AM and dry/windy conditions*
Perennial: pet dander, dust mite, worse PM*

Sxs: edematous, bluish/boggy turbinates
- kids: allergic shiners, mouth breathing, salute

Montelukast (Singulair): allergies + asthma

28
Q

Epistaxis

A

90% anterior - Kesselbach’s Plexus
MC d/t URI
Posterior source - heavy, brisk, may compromise airway and be life threatening

Dx: H/H (prolonged bleed) / INR (warfarin)

Mgmt:
Anterior:
- oxymetazoline (Afrin) 3 spray + hold pressure 15 min
- continued bleed - lubricated nasal tampon
- d/c w/48hr f/u w/abx for TSS (clindamycin, augmentin)
- abx ointment to spot for 1wk
Posterior:
- double balloon device OR pass foley cath thru nose and inflate balloon
- admit w/ENT consult

29
Q

Nasal polyp

A

Child w/allergic rhinitis
Nasal polyp + chronic sinusitis = CF

Sx: pale edematous, smooth masses arising from middle meatus

Small - nasal steroid
Large - surgical removal

30
Q

Acute pharyngitis

A

Normal oropharynx colonization: staph, non-hemolytic strep, lactobacillus, Bacteroides
Peds - 80-90% viral infection

Sxs:

  • sore throat, erythema w/out exudate a/w other URI sxs (rhinorrhea, coryza, cough)
  • if oral ulcers or hoarseness, almost always viral (no need to swab)

Mgmt: self limiting

31
Q

Strep throat

A

MC: group A beta-hemolytic strep

Sxs:

  • sudden onset* sore throat; age 5-15
  • fever, HA, NV, abdominal pain, pharyngeal inflammation, palatal petechiae, anterior cervical LAD
  • winter/early spring

Dx:
- culture negative rapid strep in children to verify

Modified Centor Criteria*

  • absence of cough
  • swollen, tender anterior cervical nodes
  • T > 100.4
  • tonsillar exudates/swelling
  • 3-14yo
  • 45+ = -1pt

Mgmt:

  • 4: abx [Penicillin, amoxicillin, cefdinir, azithro]
  • 2-3: swab
  • 0-1: unlikely to swab

No improvement after 48hr - cefuroxime or augmentin

32
Q

Strep Complication: Scarlet Fever

A

Erythrogenic exotoxin produced by strep

  • diffuse sandpaper rash, facial flushing
  • petechiae in body folds (groin), strawberry tongue, desquamation
33
Q

Strep Complication: Acute Rheumatic Fever

A

Inflammatory disease caused by ab cross-reactivity presenting 1-6wk after infection; sudden onset - fever, arthralgia, carditis

*Jones Criteria: 2 Major OR 1 Major and 2 minor + evidence of strep infection

Major: carditis, migratory polyarthritis, erythema marginatum, subcutaneous nodules, chorea

Minor: fever, arthralgia, previous RF or RHD, leukocytosis, elevated ESR/CRP, prolonged PR on ECG

Tx: treat strep, sxs treatment
- continue for 5y w/out carditis; 10y w/carditis [Benzathine PCN shot q month]

34
Q

Strep Complication: Post-strep glomerulonephritis

A

Acute nephrotic syndrome, 10d after strep infection
Protein in urine
Swelling of eyes/face

35
Q

Strep Complication: PANDAS

A

Pediatric autoimmune neuropsychiatric diagnosis associated with strep

New onset OCD sxs w/in a few weeks - tics, fears, anxiety, ritual

Tx: SSRI, CBT, plasmapheresis

36
Q

Strep Complication: Peritonsillar Abscess

A

Strep infection invading beyond tonsil

Strep infection initial improvement w/meds, then abscess develops

  • severe odynophagia
  • trismus
  • malaise
  • hot potato voice

Mgmt: IV abx, I/D, quinsy tonsillectomy

37
Q

Apthous ulcers

A

Et: stress, acid, hormone, trauma, genetic

Sxs: painful, swallow, yellow-grey ulcer w/red halo on non-keratinized mucosa (lips, gums)
- lasts 7-10d

Dx:

  • magic mouthwash: benadryl + maalox
  • occlusive: orabase
  • anesthetics: benzocaine
  • cleansing agents, antiseptics

Mgmt:

  • avoid trigger
  • Rx: viscous lidocaine
  • other: topical steroid, cimetidine, tetracycline
  • chemical cautery (silver nitrate)
38
Q

Necrotizing Ulcerative Gingivitis (“Trench Mouth”)

A

Bacterial infection d/t overgrowth of mouth bacteria [bacteroides, fusobacterium, spirochetes]
- young adults; I/C

Sxs: gingival inflammation/necrosis

  • “punched out” interdental papillae
  • bleeding, pain, halitosis, fever, cervical LAD

Mgmt:

  • salt water, peroxide rinse
  • augmentin, penicillin
  • oral hygiene, pain control, refer
39
Q

Oral candidiasis

A

Candida albicans on oral mucosa and tongue
RF: dentures, debilitated, DM, anemia, radiation, corticosteroids or abx

Sxs:

  • creamy white curd-like patches overlying erythematous mucosa, mouth pain
  • CAN rub off
  • angular cheilitis: another manifestation; dry cracking in corners of mouth

Tx: PO Fluconazole (Diflucan)

  • clotrimazole troches
  • nystatin suspension, swish and spit
40
Q

Oral leukoplakia

A

May progress to dysplasia or early invasive SCC
Hyperkeratosis of mucosa in response to irritant (tobacco)

Sx: buccal mucosa or tongue; does NOT scrape off

Tx: referral if bx cancerous

41
Q

Laryngitis

A

MC cause of hoarseness
- hoarseness may persist a week or two after sx of URI resolve

Mgmt:
- pt should avoid singing and shouting until voice returns to normal; persistent use may lead to polyps, nodules, cysts

Longer than 3 weeks = chronic. Requires ENT eval.

42
Q

Herpetic stomatitis

A

Possible presentation for 1st time oral HSV outbreak (kids)

Sx: lesions on gums, tongue, oral mucosa, lips

  • vesicles rupture, become ulcers
  • a/w high fever, mouth pain, swollen bleeding gums, irritability, anorexia

Tx: 7-10d PO acyclovir
- pain control w/magic mouthwash, liquid/soft diet

43
Q

Herpes labialis

A

Recurrent HSV d/t UV light, stress, fatigue, menses

Sx: itching, burning, tingling
- 1-2d later a vesicle forms on red base, ruptures, crusts and heals

Tx: PO or topical acyclovir ASAP when feel sensation or lesion coming on

44
Q

Parotitis

A

Parotid gland - Stenson’s duct
Submandibular gland - Wharton’s duct
Mumps - bilateral swelling of parotid glands
- fever, malaise, pain, tenderness, erythema, trismus, kids 4-6yo

Sx: tender glands

45
Q

Sialadenitis

A

MC cause: staph aureus

  • predisposing factor: dehydration
  • bacterial infection of salivary gland

Sx: acute unilateral swelling, erythema, pain, tenderness, trismus, purulent ductal discharge, induration, fever

Tx: IV abx, rehydration, sialogogues, oral hygiene
- no improvement in 48hr: refer to I/D to investigate potential abscess

Family Medicine (17 decks)

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