EENT

Question 1

Acute rhinosinusitis (ARS)

Answer 1

inflammation of the mucosal lining of the nasal/paranasal sinuses lasting up to 4 weeks

primarily c/b viruses, can also be c/b bacteria or fungi

Question 2

Acute bacterial rhinosinusitis

Answer 2

Secondary bacterial infection of the paranasal sinuses, usually following viral URI

Question 3

Clinical pearls of sinusitis - patho, s/s, diagnostics, common pathogens, treatment, complications

Answer 3

• patho - undrained collection of pus in sinuses
• s/s - headache when bending over
• diagnostics - typically clinical diagnosis, can do CT
• Pathogens - strep pneumonia, consider Pseudomonas in vent patients, H. influenza in smokers
  Treatment- Augmentin, if PCN allergy doxycycline (Pregnancy category D)
  Complications - orbital cellulitis, osteomyelitis, sinus thrombosis

Question 4

causative pathogens in ABRS

Answer 4

s. pneumoniae - gram + (most common)
h. influenzae - gram - (recurrent infection, tobacco users)
m. catarrhalis - gram - (uncommon)

Question 5

initial empiric therapy for ABRS

Answer 5

first-line - amoxicillin-clavulanate (augmentin)
second line - doxycycline (pregnancy category D) levofloxacin, or moxifloxacin
Patients on vent - imipenem or meropenem
risk for MRSA - vancomycin

Question 6

conjunctivitis etiology/patho

Answer 6

inflammation of the conjunctiva c/b bacteria, viruses, or allergies
no matter the cause there is a high risk of bacterial infection secondary to the fragility of the conjunctiva

• always treat with antibiotics, always remove contacts

Question 7

conjunctivitis s/s

Answer 7

common symptoms - pruritis, foreign body sensation, “gritty eye”
type of discharge based on infection type
- if a patient presents w/ pain - its not conjunctivitis

Question 8

conjunctivitis physical exam findings

Answer 8

conjunctiva erythema, injection, ocular discharge

Question 9

viral conjunctivitis - diagnosis and treatment

Answer 9

• unilateral or bilateral (typically seen first unilaterally, then spread bilaterally)
• treatment - consider abx, artificial tears, topical antihistamine, cold compress
• d/c contact use

Question 10

bacterial conjunctivitis - diagnosis and treatment

Answer 10

• typically will start unilaterally (maybe spread bilaterally by the patient)
• purulent discharge - gonococcal/chlamydial, eyelid edema, corneal infiltrates/ulcerations
• antibiotics - gentamicin drops, Cipro (ointment or drops), azithromycin drops
• gonococcal or chlamydial - refer to optho, ceftriaxone + azithromycin
• d/c contact use

Question 11

allergic rhinitis - diagnosis and treatment

Answer 11

• typical during high allergy season
• unilateral, stringy discharge
• decongestants, antihistamines (oral or topical), cold compress
• d/c contact use

Question 12

common causes of corneal abrasion

Answer 12

scratch, flying debris, dry eyes, iatrogenic

Question 13

corneal abrasion symptoms

Answer 13

gradual throbbing pain, intensifies over 12-24 hrs, sensation of foreign body

Question 14

corneal abrasion physical findings

Answer 14

erythema, tearing, interrupted endothelial surface on fluorescein stain

Question 15

corneal abrasion diagnosis

Answer 15

fluorescein stain
clinical diagnosis
orbital CT or MRI if high-velocity injury or retained foreign body suspected

Question 16

treatment of corneal abrasion

Answer 16

initial anesthesia of the eye - tetracaine
topical NSAID drops - diclofenac, ketoralac
topical antibiotics - bacitracin, chloramphenicol, cipro
if the patient wears contacts cover for Pseudomonas (cipro)
oral opiates
tetanus - if penetrating injury
refer to optho if no improvement in 48hrs

Question 17

cause/risk factors of chronic (wide or open-angle) glaucoma

Answer 17

elevated pressure in the trabecular meshwork reduces flow –> gradual rise in pressure
risk factors - age, extreme near sighted ness, diabetes, and ethnicity (AA)

Question 18

s/s of chronic glaucoma

Answer 18

gradual, painless, loss of peripheral vision
usually asymptomatic and discovered upon routine exam
rarely symptomatic, but may present with ocular discomfort (burning, stinging, soreness), halos, and blurry vision

Question 19

PH findings for chronic glaucoma

Answer 19

elevated IOP (not as high as acute)
gross PE - may appear normal, abnormalities of specific structures may be visible to optho

Question 20

chronic glaucoma treatment

Answer 20

ophthalmic medications to reduce pressure by either improving flow or reducing the production of aqueous humor
- prostaglandin analogs (Xlantin) or beta-adrenergic antagonists (1st line)
- systemic abs is v. high
- refer to optho

Question 21

Acute (narrow or closed-angle) glaucoma cause

Answer 21

variety of anatomic abnormalities (including narrow angle) resulting in reduced flow of aqueous humor
acute blockage of flow produces acute pressure elevations

Question 22

acute glaucoma s/s

Answer 22

severe ocular pain
sudden vision loss
pain with eye movement
ipsilateral HA
blurry vision
“halos” around objects **
N/V

Question 23

acute glaucoma physical exam findings

Answer 23

decreased visual acuity
corneal and scleral injection
ciliary flush
edematous and cloudy cornea
mid-dilated nonreactive pupil
firm globe
IOP elevated (normal 10-20)

Question 24

acute glaucoma treatment

Answer 24

treat as emergency
systemic carbonic anhydrase inhibitors - acetazolamide (diamox)
topical BB (quick to reduce IOP)
laser peripheral iridectomy
refer to optho

• watch for Na+ abnormalities and metabolic acidosis