EENT Flashcards
What are Apthous ulcers? Symptoms?
AKA Canker sores,
Painful, recurrent with yellow/white fibrinous center and red rim or halo
7-10 days duration
Most common cause of acute unilateral hearing loss?
Cerumen impaction (conductive hearing loss)
What are the sxs of External ear barotrauma?
Pain and bloody discharge; may note petechiae, hemorrhagic blebs, or rupture of the TM on PE
What are the sxs of Middle ear barotrauma?
Due to impaired eustachian tube functioning secondary to URI, allergy, or trauma
**NOted in patients with URI and flying in a plane** Unable to “pop” ears
What are the sxs of Decompression sickness (“the bends”)?
Occurs most after divers descend and remain deeper than 10 meters
Due to Nitrogen becoming insoluble and forming bubbles in the blood and tissue
Present with steady, throbbing pain in the joints, pruritus, HA, seizures, hemiplegia, and visual disturbances
Pulmonary effects include substernal pain, dyspnea, and cough
How can you prevent barotrauma on flights?
Systemic decongestants 1-2 hours before flights
What is the main way to differentiate Otitis externa from otitis media?
Pneumatic otoscopy–>In otitis externa, the TM will move normally
What is the most common cause of otitis Externa?
Most common fungal cause?
Pseudomonas Aeuruginosa
fungal cause: Apergillus
What is the TOC for Otitis Externa?
Topical Ciprofloxacin
What is malignant otitis externa? HOw do you diagnose Malignant Otitis externa? How do you treat it?
Severe necrotizing infxn! Seen in diabetic patients.
Sx: deep excrutiating pain, foul smelling purulent discharge, presence of granulation tissue within auditory canal
May have CN palsies
Dx: CT scan-osseous erosion of the floor of the ear cana
Tx: Ciprofloxacin 1 gram BID x 2 months or more
Need a gallium scan to ensure reduction in inflammatory process
How do you treat acute bacterial otitis media?
first line: Amoxicillin
If PCN allergy: Erythromycin or clarithromycin
What is a common complication of Chronic otitis media?
Cholesteatoma
Caused by chronic negative middle ear pressure, which invaginates squamous epithelium sac and chronically obstructs keratin filled sac (can erode bone and invade cranium)
What is acute mastoiditis? S/S? tx?
Infection of mastoid air cells caused by multiple ear infections
S/S: Post auricular pain, redness behind the ear, displaced Pinna
Tx: IV abx; Myringotomy if failure of abx
What does the PE show with sensorineural hearing loss? What are common causes?
Weber test: sound louder in unaffected ear (sensorineural problem of Rt ear–>weber lateralizes to the Left)
Rinne is normal (AC>BC)
- Presbycusis is the most common cause
- Acoustic neuroma
- Meniere’s dz
What are common causes of Conductive hearing loss?
What does the weber and rinne test show?
- Cerumen impaction (most common)
- Acute otitis externa
- otosclerosis
Weber: Sound louder in affected ear
Rinne: abnormal on the affected side (BC >AC)
What are drug-induced causes of Sensorineural hearing loss?
Damage to teh haircells of the organ of corti
Salicylates, quinine, aminoglycosides, cisplatin, loop diuretics
What is an Acoustic Neuroma? What are the sxs?
Vestibular schwannoma (benign tumor of the acoustic nerve, CN 8)
Type of sensorineural hearing loss
Sxs: UNILATERAL tinnitus, vertigo, ataxia, brain stem dysfunction
What causes Peripheral Vertigo? what are the sxs?
Caused by labyrinthisis, Meniere’s disease, Benign paroxysmal positional vertigo, acoustic neuroma, and ototoxic drugs
Sxs: SEVERE! Sudden onset, Tinnitus, hearing loss, Horizontal nystagmus with fatiguable fixation, normal neuro exam
What causes Central vertigo? Sxs?
Causes: Brain stem vascular dz, AV malformation, brain tumors, MS
Sxs: Slower onset, vertical nystagmus >horizontal, non fatiguable, motor-sensory cerebellar defects
What are the pharmologic txs for the symptoms of vertigo?
Acute attacks: Diazepam
Mild attacks: Meclizine
Severe: Scopolamine
What does the Dix-hallpike maneuver test for? How is this condition treated?
Benign Paroxysmal positional vertigo
Tx:
Often self-resolving in months;
Epley maneuver
What is Meniere’s dz? S/S? tx?
Malfunction of the endolymphatic sac in the inner ear; Fluid imbalance, raised endolymphatic pressure eventually causes the cells to burst
- S/S: majority is unilateral, Episodic vertigo with aural fullness, hearing loss, and tinitis
- “feel like I have water in my ear and can’t get it out”
- May lead to permanent sensorineural hearing loss
Tx: HCTZ, low sodium diet, Diazepam
Avoid caffeine, alcohol, and smoking
What is Labyrinthitis? sxs? How long does it last?
AKA vestibular neuronitis
- sudden acute unilateral infxn or inflammation of the vestibular system
- usually follows an acute viral infxn, URI
- may last 7-10 days, self-limiting
- Sxs: rotational vertigo,horizontal nystagmus, N/V; (ABSENCE of tinnitus or hearing loss); Constant sxs
Centor criteria for Acute pharyngitis
Criteria for GABHS pharyngitis
- Fever >38
- Tender anterior cervical nodes
- NO cough
- pharyngotonsillar exudate\
3 of 4 points: highly suggestive o Group A strep
2 points; consider culture
1 point: unlikely Group A strep
Tx: erythromycin or PCN
What is a common PE finding for a Peritonsillar abscess? oTher sxs? How is it treated?
Sxs: trismus (painful to open mouth), hotpotato voice
PE: Uvualr Deviation (uvula deviates towards unaffected side)
Tx: I&D, Clindamycin or PCN
What is Sampter’s triad?
Nasal polyps + Asthma +ASA sensitivity
What is a common fungal cause of Chronic sinusitis? How do you treat it?
Aspergillus Fumigatus
Tx: Amphotericin B
What is the most common anatomical location for epistaxis?
Kiesselbach plexus: Anterior bleeding
Where does epistaxis most commonly occur in the elderly?
Woodruff’s plexus: Posterior
Due to atertiosclerosis
Sxs: blood noted draining down throat
What is the hallmark of Viral conjunctivitis?
Lymphoid aggregates (lumpy bumps in the palpebral conjunctiva)
What type of conjuctivitis results from contact lenses?
Giant papillary conjunctivitis (a type of allergic conjunctivitis)
What are the sxs of Acute Iritis?
Presents with ciliary flush or diffuse redness
Moderate deep aching pain with decreased visual acuity
Cornea: clear or slightly cloudy
Pupil may appear small or slightly irregular
Treatment of Corneal abrasions?
- Treat pain-cycloplegia (homatropin 5%)
- Erythromycin drops x 5 days
- IF contact lens wearer–think Pseudomonas!
- tx: Tobramycin or Fluoroquinolone
- avoid contact lens x 1 wk
What is the leading cause of preventable blindness in the US?
Glaucoma
What is glaucoma?
Optic nerve damage and visual field loss USUALLY due to high IOP
What is normal IOP?
10-20 mmHg
Angle-closure glaucoma vs. open-angle glaucoma; which one is an emergency? which one is most common? causes?
- Angle-closure glaucoma: EMERGENCY
- restricted flow of aqueous humor
- **unilateral **
- Precipitated by pupilary dilation (sitting in dark room), Stress, or pharmacologic mydriasis-dilation of the pupil)
- Open-Angle:Most common, BILATERAL
- inadequate drainage
- asymptomatic early on; peripheral vision loss, and halo around lights
- No clear cause
- slight cupping of the optic disc
What are the sxs of acute angle-closure glaucoma? Dx?
Acute onset of unilateral deep aching eye pain, peripheral field vision loss, halos around lights, steamy cornea
PE: dilated, nonreactive pupil on affected side, no response to light, hard eye to palpation (like a rock)
- Dx: Schiotz tonometry-measures IOP
- Genioscopy-determines if anterior chamber is open, narrow, or closed?
How do you treat glaucoma?
- Decrease aqueous humor production
- Topical Beta-adrenergic blocker (Timolol)
- Alpha-adrenergic agonists
- Carbonic anhydrase inhibitors-Acetazolamide IV (initially)
- facilitation of aqueous outflow
- Parasympathetic agents
- (topical pilocarpine)
- Prostaglandin analogues
- Parasympathetic agents
Definitive tx: Laser peripheral iridotomy: tiny hole is created in the peripheral iris through which aqueous humor can flow
Lesions of optic chiasm would cause?
Bitemporal hemianopia
Lesions of Left optic tract would cause?
Right homonymous hemianopsia
Lesions of the Right optic tract would cause?
Left homonymous hemianopsia
What is the leading cause of blindness in the world?
Cataracts
What are the sxs of cataracts?
Gradual, painless blurring of vision, usually bilateral, halos around lights;
Absent red reflex
Pinquecula vs. Pterygium?
Pinquecula: yellow, elevated conjunctival nodula that develops on the nasal side of the eye; can be bilateral
Pterygium: painless, fleshy triangular vascularized encroachment onto the cornea also on the nasal side
What is the most common location of a retinal detachment/
Superior temporal area
S/S of retinal detachment; who does it occur in?
Opthamologic emergency!
Shower of floaters, flashing lights
Peripheral curtain spreading across field of vision; no pain or erythema;
Emergency if macula involved–>permanent loss of central vision
RF: People over 50 y/o, Severe myopia (nearsightedness)
Retinal vascular occlusion: Arterial
S/S, tx
Emergency!
sxs: sudden, painless monocular vison loss, arterial narrowing, Cherry red spot (seen on macula)
-
Central retinal artery
- often preceded by Amaurosis Fugax
- Painless monocular vision loss
- cherry-red spot noted on macula
-
Branch retinal artery
- sudden loss of visual field
- cotton-wool spots
Tx: IV acetazolamide-decreases IOP, and a thrombolytic agent is infused into the artery; Give within 8 hours to perserve vision!
Poorer prognosis than a venous occlusion.
What is Amaurosis Fugax?
Amaurosis Fugax: fleeting blindness (curtain falls and then rises); due to TIA of the eye–>emboli get stuck, then dissolve downstream
Retinal vascular occlusion: Venous
Sxs, Tx
- Central retinal vein
- sudden painless vision loss; usually noted on awakening,
- “blood and thunder” retina
- small retinal hemorrhages
- RF: HTN or DM
- cotton wool spots
Tx: Refer to ophthamologist!
Laser Photocoagulation with ASA if neovascularization is present
How does orbital cellulitis present?How do you treat it?
- Refer to ENT for I&D
- IV abx:
- Mild-Amoxicillin
- Severe-Ceftriaxone + vanco
Presents with periorbital edema, erythema, exophthalmos, blurry vision
Key finding: painful decreased extraocular movements
Define Anisocoria
Inequality of the size of the pupils
define chemosis
Edema of the mucous membrane of the eyeball and eyelid lining
What is the most common orbital fracture? How does it present? Dx?
Blow out fracture
Presents with Enophthalmos (recession of the eyeball within the orbit–eyeball sinking, diplopia)
- **limited ocular movements of upper gaze. ***
Associated sxs: may have anesthesia of the maxillary teeth and upper lip
- Dx: Plain Xray:
- Hanging tear drop sign
- open bombaby door sign
Ct-confirms diagnosis
What is the leading cause of central vison loss?
Macular degeneration
What are the s/s of macular degeneration?
Leading cause of blindness in the elderly
- Progressive, central vision loss (usually bilateral)
- Metamorphopsia (distorted images)
- Hallmark: Drusen deposits on fundoscopic exam
- Wet: exudative, abnormal vessels behind retina leak blood/fluid–>severe vision loss
- Dry: nonexudative, light sensitive cell in macular area break down
What is the most common type of Strabismus?
Esotropia=crossed eyes
Define Scotoma
Loss of vision in part of the visual field–>“blind spot”
Define Amblyopia
Also known as “lazy eye;” Most common cause of vision problems in childhood
Decrease in visual acuity that results from failure of the retinas to receive clear visual images;
Complication of Strabismus (when the brain “turns off” the visual processing of one eye to prevent double-vision)
internal hordeolum vs. External
Internal=meibomian glands
External=glands of Zeis
Optic neuritis
Inflammation of the optic nerve
Sudden visual loss and pain with eye movement
highly associated with MS
Tx: Steroids
What is a cholesteatoma? how is it caused? What are the sxs?
A sqaumous epithelium-lined sac that gradually increases in size and by pressure necrosis can eventually erode through bone
often acquired from chronic ear infections or TM perforation; can be congenital
Sxs: Hearing loss, otorrhea, tinnitus, vertigo, and facial nerve symptoms
What are some etiologies of Parotitis?
Viral–>Mumps
bacterial, TB, HIV
Autoimmune–>Sjogren’s syndrome
Blockage from stone
Occlusion of the central retinal artery may cause what kind of visual field defect?
Horizontal defect in one eye
A lesion of the right optic nerve would cause what kind of visual defect?
Blind right eye
A lesion at the optic chiasm would cause what kind of visual defect?
Bitemporal hemianopsia
(visual loss involving the temporal half of BOTH eyes)
A lesion of the Right optic tract would cause what kind of visual disturbance?
Left homonymous hemianopsia
Lesion of the optic tract interrupts fibers origination on the same side of both eyes
A partial lesion of the Right optic radiation would cause what kind of visual disturbance?
Homonymous Left superior quadrantic defect
A complete interruption of fibers in the right optic radiation would cause what kind of visual defect?
Left homonymous hemianopsia
How does a subconjunctival hemorrhage present? How is it treated?
Acute, painless bright red patch on the sclera; normal visual acuity
No tx necessary -caused by rupture of small conjunctival vessel and may be associated with sneezing or coughing.
Blood should be reabsorbed within 2 weeks
How does Myasthenia gravis of the eye present? How is it confirmed?
Unilateral ptosis is usually presenting sign and worsens with fatigue; can improve with a nap; absence of pupilary or sensory deficits
Often it will become bilateral eventually.
affects 20 to 40 y/o and often occurs after illness, stress, injury, or pregnancy
Dx: Tensilon (Edrophonium) testing
How can you rule out a preforation of the eyeball?
Perform a test using Fluoresceine dye–The Seidel test
If a leak is present, the fluoresceine dye will be diluted by aqueous fluid from the injured site–> Dark stream within a pool of bright greend dye=positive Seidel sign
What fundoscopic findings do you find in diabetic retinopathy and not in HTN retinopathy?
Diabetic retinopathy=microanyersms and hard exudates
Facial paralysis: Central lesion (brain tumor/stroke) vs. Peripheral lesion (bells palsy)
CEntral lesion: Sparing of the forehead in pts with facial paralysis is evidence of lesion superior to the nucleus of the CN 7; Central lesion causes paralysis fo the lower face on the contralateral side with sparing of the forehead
Peripheral lesion (middle ear infxn, bells palsy): Ipsilateral paralysis involving all subsection of CN7, including the forehead
How would you treat sudden neurosensory hearing loss (without a known cause)?
Corticosteroids and antiviral medications ASAP (within 2 weeks of the hearing loss
What are the symptoms of TMJ dysfunction?
Unilateral ear pain, worsend with chewing, Normal ear examination
PE: tenderness to palpation of the external canal meatus anteriorally (tenderness over the TMJ)
What is Rhinitis of Pregnancy? What trimester is it the worse?
Nasal congestion can peak in the third trimester; The rise in estrogen leads to a rise in hyaluronic acid in the nasal tissue, which can result in increasing nasal edema and congestion.
Resolves after delivery
What nasal finding in a child should make the clinician suspicious for cystic fibrosis?
Nasal polyps
WHat is a common cause for brisk unilateral epistaxis in an adolscent male?
Juvenile angiofibromas
What should you worry about with injuries in the region of the nasal bones and nasal process of the frontal bone? How do you diagnose this complication?
Fractures through the cribiform or ethmoid bones causing release of CSF.
CSF nasal drainage is most commonly unilateraly, coming in short, rapid gushes or may be a steady flow.
Dx: Check for glucose levels in the fluid;
“bulls eye” test–>seen when CSF is mixed with blood and allowed to dry on a white sheet
What is the most common cause of chonric cough in adults?
Postnasal drip
A defect in the hypoglossal nerve (CN12) will cause what PE abnormality?
Deviation of the tongue towards the side of the lesion
(ex Left CN lesion–>tongue will deviate towards the left)
What is bell’s palsy? how is it tx?
idiopathic inflamation of CN VII.
Unilateral facial paralysis
Tx: Antiviral medication and 10-day course of steroids
HOw do you manage Posterior epistaxis?
ENT CONSULTATION! Use foley catheter and anterior pack to stop bleeding while awaiting for ENT.
What term is used to describe rebound nasal congestion after the CHRONIC use of topical alpha adrenergic decongestant sprays?
Rhinitis Medicamentosa
