EENT Flashcards
1
Q
red eye around periphery and clear around iris. dx?
A
conjuntivitis
2
Q
which type of conjunctivitis has eyes glued shut upon awakening?
A
bac
3
Q
in kids: bac or viral conjunctivitis more common?
A
bac
4
Q
in adults: bac or viral conjunctivitis more common?
A
viral
5
Q
tx for bac conjuntivitis w/o contacts
A
erythromycin 5mg/g ointment
6
Q
tx for bac conjuntivitis w/ contacts
A
fluoroquinolones (ofloxacin 0.3% drops, cipro 0.3% drops),
7
Q
pt education for bac conjuntivitis w/ contacts
A
Tell contacts wearers to stop wearing contacts, and if bac don’t wear again until eye is normal and 24 hrs after treatment completed; throw away old case and lenses
8
Q
leading cause of blindness in world
A
cataracts
9
Q
pt w/ gradual onset Blurred vision, glare, altered color perception, monocular diplopia . dx??
A
cataract
10
Q
difference in PE b/w immature and mature cataract
A
mature loses red reflex
11
Q
biggest RF for keratitis
A
contacts use, esp overnight
12
Q
what pathogen causes dendritic branching in the cornea visible upon fluorescience stain?
A
herpes (simplex or zoster)
13
Q
which is more likely to present w/ significant photophobia? conjunctivitis or keratitis
A
keratitis
14
Q
tx plan for keratitis
A
emergency opthalmology consult/referral
15
Q
painful, blurry vision w/ injection around iris and small mishapen pupil that is poorly reactive to light. dx?
A
iritis/ uveitis
16
Q
main difference between Chalazion and Hordeolum (sty)
A
Hordeolum (sty) is painful and inflammed (think hot). chalazion is painless (think cold)
17
Q
tx for entropions and ectropions
A
surgery
18
Q
painful loss of vision, decrease in color, central scotoma. Unilateral. Pain worse w/ movement.
dx?
A
optic neuritis
19
Q
special test to dx optic neuritis
A
Marcus-Gunn pupil (swing light from unaffected to affected eye and pupils dilate)
20
Q
tx for optic neuritis
A
IV methylprednisone. Then PO corticosteroids
21
Q
MCC of optic neuritis
A
MS
22
Q
med that can cause optic neuritis
A
ethambutol
23
Q
how to differentiate between orbital cellulitis and preseptal cellulitis
A
Preseptal cellulitis (no pain w/ eye movement, no proptosis)
orbitals: ocular pain esp w/ movment, extraocular muscle weakness (opthalmoplegia) with diplopia, proptosis, chemosis
24
Q
common precursor to orbital cellulitis
A
sinus infx
25
tx for dry macular degeneration (3 supplements)
zinc, vitamin C and E
26
tx for wet macular degeneration: inj
intra-vitreal VEGF inhibitors (bevacizumab, ranibuzumab, alfibercept).
27
sudden onset of new floaters in vision, photopsias (flickering lights), curtain-like shadow, no pain, no red eye. Persistent portion of visial field affected. dx?
retinal detachment
28
what position should retinal detachment pt try to stay in until opthal evaluation
stay supine w/ head turned toward side of detached retina
29
rx for proliferative diabetic retinopathy
VEGF inhibitors
30
laser tx for diabetic retinopathy
laser photocoagulation treatment
31
imaging for suspected blowout fx
CT of orbit
32
use an eye patch in corneal abrasion?
no
33
should you remove a FB that ruptured a globe?
no
34
MCC of retinal artery occlusion
carotid atherosclerosis
35
is CRAO or CRVO more common?
CRVO
36
4 RFs to def ask about for retinal vascular occlusion
HTN, DM, dyslipidemia, hypercoagulability
37
is CRAO and CRVO painless or painful?
painless
38
classic triad of closed angle glaucoma on PE
Classic triad of injected conjunctiva, cloudy cornea, and fixed dilated pupil
39
1st tx for angle closure glaucoma
IV Acetazolamide, followed by PO
40
1st line tx for open angle glaucoma
prostaglandin analogs--latanoprost, travoporst, trafluprost, bimatoprost
41
for suspected cerumen impaction, ask about what in PSH
use of Q tips
42
MCC of conductive hearing loss
cerumen impaction
43
MC pathogen causing otitis externa
pseudomonas
44
ask about what PSH for suspected otitis externa
swimming
45
otitis external will have pain when you palpate ____
tragus
46
1st line for otitis externa but can't be used w/ ruptured TM
cortisporin suspension (1st line; neomycin+polymyxin B+hydrocortisone) (not if TM ruptured, tubes, or not visible
47
alt 1st line for otitis externa if TM ruptured
Cipro+dexamethasone (ciprodex) drops (alt first line; $$$; ok to use on ruptured TM, tubes; for kids use penicillin or sulfa)
48
what dx is ASW b/l acoustic neuromas?
neurofibromatosis type 2 (NF2)
49
asymmetrical SNHL, tinnitus, vertigo, aural fullness
suspect which 2 dx?
acoustic neuroma, Meniere's
50
order what test for acoustic neuroma
MRI of post fossa and internal auditory canals
51
key sx present in acoustic neuroma but not Meniere's, difference in vertigo b/w them
facial numbness
vertigo in Meniere's is intermittent. it's continuous disequilibrium in acoustic neuroma +/- vertigo
52
what type of vertigo does labyrinthitis p/w?
acute onset continuous
53
labyrinthitis usually follows ____
viral URI
54
rx _____ for labyrinthitis (3)
prednisone PO X 10d. can also rx Vestibular suppresants (meclizine), Zofran
55
does vestibular neuritis have hearling loss or tinnitus?
no
56
central or peripheral vertigo? gradual onset, vertical nystagmus. NO auditory sx.
central
57
how to differentiate labyrinthitis vs vestibular neuritis
labrinthitis: acute onset + hearing loss + poss tinnitus
VN: develops over hours, NO hearing loss or tinnitus
58
3 MCCs of otitis media
H flu (causes otitis-conjunctitis), moraxella catarrhalis, strep pneumonia. SP says strep pyogenes instead of m catarrhalis
59
tx for severe AOM in kids
amoxicillin 90 mg/kg/day divided into 2 doses, up to 1500mg bid (3000mg) X 10d
60
preferred tx for mild AOM in kids >2
pref analgesics + waiting unless severe. if no improvment after 48hrs, abx.
61
tx for AOM in adults
augmentin 875/125 bid x7 days; x10days if severe
62
tx for AOM in pts w/ mild PCN allergy
cefdinir
63
is mastoiditis more common in kids or adults?
kids
64
classic triad of Meniere's
attacks of intermittent vertigo lasting 1-8 hrs, fluctuating low freq SNHL, tinnitus,
65
tx for Meniere's
low salt diet
66
what sx is ASW 90% of tinnitus cases?
SNHL
67
what pathogen is involved in 25% of oral CA and 66% of oropharyngeal CA?
HPV 16
68
MC type of oral CA
SCC
69
MC location of ant epistaxis
Kiesselback's plexis
70
MC location of post epstaxis
Woodruff's plexus
71
MCC of viral URI
rhinovirus
72
when is a viral URI most severe, and when does it resolve?
most severe on day 4-5. resolves in 10-14 days
73
MC form of rhinitis
allergic rhinitis
74
what is the difference in nasal mucosa appearance in viral URI vs allergic rhinitis?
viral URI: red beefy
allergic rhinitis: pale boggy
75
1st line tx for allergic rhinits (2)
corticosteroids (IN; start 1 month before allergies begin; flonase/fluticasone, nasacort, rhinocort/budesonide; preg: rhinocort is preg cat B), 2nd gen antihistamines (for kids, adults, elderly)
76
MCC of acute bac sinusitis
strep pneumo
77
is sinusitis more common in adults or peds?
adults
78
what age do maxillary sinuses dev?
by 4 y/o
79
consider bac sinusitis if sx of acute viral rhinosinusitis last > ___ days
10
80
kids w/ polyps: check for what dx?
cystic fibrosis
81
1st line med for bac sinusitis
augmentin
82
white on tongue is scraped off to reveal red, inflammed, poss bleeding tongue. dx?
candidiasis
83
suppurative thrombophlebitis of jugular vein after head/neck infx (usually pharyngitis)
Lemierre's syndrome
84
diffuse cellulitis of floor of mouth and neck
Ludwig's Angina
85
Lemierre's syndrome will have tenderness where?
under angle of jaw
86
imaging for suspected deep neck infx
CT
87
2 cause of epiglottitis to cover for
H flu, s aureus
88
stridor + drooling in a kid. suspect what dx?
epiglottitis
89
epiglottitis on xray
thumb sign on lat soft tissue film
90
tx for 1st outbreak of HSV
valacyclovir; first episode 1g bid x10d.
91
tx for recurrent genital herpes
valacyclovir 500mg bid x3d
92
tx for recurrent herpes labialis
valacyclovir 2g bid x1d
93
if trismus + sore throat, suspect ____
peritonsillar abscess
94
which is more common: viral or bacterial pharyngitis
viral
95
complications of GABHS pharyngitis (5)
untreated GABHS at 10+ days: acute rheumatic fever. post-strep glomerulonephritis (red to brown urine), strep TSS, post strep reactive arthritis. PANDAS syndrome
96
centor criteria
Centor criteria for GABHS: tonsillar exudate, swollen tender ant cervical nodes, absence of cough, fever >38, age<15. subtract 1 pt for age 45+.
97
do rapid strep test if centor score is ____ or more
2
98
1st line tx options for strep throat (2)
GABHS: 1) penicillin V (250mg bid x 10 days for kids), amoxicillin (50mg/kg Qd - tastes better)
99
strep throat tx reduces infectious period to _____ which is when pt can go back to school/work
24 hrs
100
what is Sialadenitis
inflammation of a salivary gland.
101
swelling in jaw after eating indicates ______
salivary gland stone.
102
preferred imaging for parotitis
US
103
white stuff on tongue cannot be scraped off. next step?
biopsy
104
MCC of croup
parainfluenza
105
stridor, consider what 3 dx:
FB, croup, epiglottis
106
test to order for croup and expected results
xray. steeple sign on AP soft tissue film. If bac, will also show suglottic irregularity of tracheal wall or intraluminal trachal membranes.
107
tx for mild croup
humidified air, oral corticosteroids (dexamthasone)
108
tx for mod-severe croup
humidified air, oral/IV/IM corticosteroids, nebulized epi, supplemental O2. hospitalise if they do not respond to these treatments.
109
preauricular LN drain: (4)
eyelids, conjunctivae, temporal region, pinna
110
post auricular LN drain: (3)
external auditory meatus, pinna, scalp
111
ant cervical LNS drain: (4)
internal throat, posterior pharynx, tonsils, thyroid
112
tonsillar LNs drain: (2)
tonsils and posterior pharynx
113
Sub‐Mandibular LNs drain: 1
floor of mouth
114
sub-mental LNs drain: (2)
teeth and intra‐oral cavity
115
When to give Timolol, apraclonidine, and pilocarpine in acute angle closure glaucoma?
Timolol, apraclonidine — 1 hour after start of acetazolamide
Pilocarpine — after that, once pressure falls
116
A 5-year-old boy presents with his mother due to concerns for fever for the past six days. She states that she initially thought he had a virus; however, he seems to be worsening over time. On physical exam, his vital signs are significant only for a fever of 38.4°C. He has bilateral conjunctival injection and fissured lips. There is a macular, erythematous rash on areas of the trunk and the extremities, as well as edema of the dorsal aspects of the hands. Which of the following is the most likely diagnosis?
kawasaki
117
kawasaki tx (2)
IVIG + high dose ASA
118
4 y/o w/ barky cough, fever, but looks toxic
bac tracheitis
