EENT #2 Flashcards
Symptoms of blepharitis
-Crusting, scaling, and red-rimming of the eyelid and flaking of the eyelashes or lid margins
Treatment for blepharitis
-Eyelid hygiene is the mainstay of treatment
Blepharitis is common in _____ and _____
Down’s Syndrome and Eczema
MC etiology of central retinal artery occlusion
-Emboli from carotid artery atherosclerosis
Symptoms of CRAO
- Acute, sudden painless monocular vision loss
- May have ipsilateral carotid bruit
Fundoscopy is used to diagnose a CRAO. What is seen on exam?
- Pale retina with cherry red macula
- Boxcar appearance of retinal vessels
Symptoms of cerumen impaction
- Conductive hearing loss (lateralization to affected ear on Weber)
- Bone conduction > air conduction
Treatment of cerumen impaction
-Hydrogen peroxide or carbamide peroxide
What is a cholesteatma
-Abnormal keratinized collection of desquamated squamous epithelium in the middle ear that can lead to bony erosion of the mastoid
Symptoms of cholesteatoma
- Painless otorrhea (brown or yellow discharge with a strong odor)
- May have vertigo, tinnitus, dizziness, cranial nerve palsies
On otoscopy for a cholesteatoma, what is seen?
- Granulation tissue (cellular debris)
- Conductive hearing loss
Treatment for cholesteatoma
-Surgical excision of debris and cholesteatoma with reconstruction of the ossicles
In conductive hearing loss, explain what happens in Weber and Rinne tests
- Weber: lateralizes to affected ear
- Rinne: BC > AC
What is conjunctival chemosis
-Irritation, allergies, watery eyes, excessive tearing, itchiness, blurry or double vision, swelling/inflammation
On a fluorescein stain, what is seen with a corneal abrasion?
“Ice rink” linear abrasion
-Evert eyelid to check for anything
Management for corneal abrasion
- Non contact lens wearers: Erythromycin ointment
- Contact lens wearers: Ciprofloxacin or Ofloxacin
Regarding patching with corneal abrasions, what should be done?
- Do not patch is Pseudomonas is suspected
- May patch in large abrasions (> 5 mm), but not for more than 24 hours
Symptoms of Dacryocystitis
- Tearing and signs of infection (tenderness, warmth, edema, erythema)
- To Medial (canthal) side of the lower lid area
Treatment of Dacryocystitis
- Acute: warm compresses + ABX (Clindamycin, Vancomycin, Ceftriaxone)
- Chronic: Dacryocystorhinostomy
What is the MCC of new, permanent vision loss in 20-74 years old
Diabetic retinopathy
Two types of diabetic retinopathy. Name and describe them.
- Nonproliferative: micro aneurysms, cotton wool spots, blot and dot hemorrhages, flame-shaped hemorrhages, sharp margins circinate (roll up at ends)
- Proliferative: Neovascularization (growth of new abnormal blood vessels), can lead to vitreous hemorrhage
Treatment of nonproliferation diabetic retinopathy
-strict glucose control, laser treatment
Treatment for proliferative diabetic retinopathy
-VEGF inhibitors, laser treatment, strict glucose control
How often should a diabetic have an eye exam?
Yearly (1 per year)
Symptoms of Diphtheria
- Tonsillopharyngitis or Laryngitis
- Pseudomembranes (friable, gray/white membrane that bleeds if scraped)
- Bull Neck
- Myocarditis, Arrhythmias, or Heart Failure
Diagnostic for Diphtheria
- Clinical diagnosis
- PCR/Culture to confirm
Treatment for Diphtheria
Diphtheria Antitoxin (horse serum) + Erythromycin or Penicillin x 2 weeks
MC site for anterior epistaxis
-Kesselbach Plexus
Etiology for anterior nose bleeds
-Nasal trauma (nose picking, blowing nose forcefully), alcohol, foreign body, low humidity
MC site for posterior epistaxis
-Sphenopalatine artery branches & Woodruff’s Plexus
What is unique about posterior epistaxis?
It can cause bleeding from both nares
Treatment for anterior epistaxis
- Direct pressure (first line), leaning forward
- Topical vasoconstrictors (Oxymetazoline)
- Cauterization or silver nitrate if above measures fail
- Nasal packing if everything else fails or if severe bleeding
Most common treatment for posterior epistaxis
Balloon catheters
Esotropia means that both eyes are deviated
-Inward. “Cross-eyed”
MC type or orbital floor fracture
Inferior
Symptoms of orbital floor fracture
- Diplopia with upward gaze (inferior rectus muscle entrapment)
- Orbital emphysema (eyelid swelling)
- Anesthesia to anteromedial cheek (stretching of infraorbital nerve)
What is the diagnostic of choice for orbital fracture?
CT scan: shows a Teardrop sign
Treatment for orbital fracture
-Decongestants
Avoid blowing nose or sneezing
-Antibiotics (Unasyn or Clindamycin)
Symptoms of hypertensive retinopathy
- I: Arterial narrowing: abnormal light reflexes, copper or silver wiring
- II: AV nicking
- III: Flame shaped hemorrhages, cotton wool spots
- IV: Papilledema, blurring of optic disc (ophthalmic emergency!)
Greatest risk factor for bacterial keratitis
-Improper contact lens wear
(Other risk factors): Dry ocular surfaces such as inability to close eye due to Bell Palsy, Topical corticosteroid use and immunosuppression
Exam findings of keratitis
-Ciliary injection (limbal flush), hazy cornea, blurry vision, ocular pain, eye redness, vision changes
Treatment for bacterial keratitis
- Fluoroquinolone topical
- Do not patch the eye
How to diagnose herpes keratitis
-Dendritic (branching) corneal ulceration with fluorescein staining
treatment for herpes keratitis
-Topical Antivirals: PO Acyclovir, Ganciclovir
Treatment for Laryngeal Cancer
-Surgical resection +/- chemo/radiation
Leukoplakia
Painless, white patchy lesions that cannot be scraped off
If a patient has leukoplakia, you should biopsy to rule out
Squamous Cell Carcinoma
In comparison, erythroplakia is
Painless, erythematous, soft, velvety, patch in the oral cavity
Oral Hairy Leukoplakia is seen almost exclusively in
Patients with HIV
Oral Hairy Leukoplakia is caused by
EBV
Symptoms of oral hairy leukoplakia
-Painless, white smooth or corrugated “hairy” plaque along lateral tongue borders that cannot be scraped off
Treatment for oral hairy leukoplakia
No specific treatment required.
Antiretroviral therapy in patients with HIV
Risk factors for oral candidiasis (Thrush)
-Immunocompromised states, use of inhaled corticosteroids without a spacer, Denture Use
Symptoms of oral candidiasis
white curd-like plaques that can be easily scraped off, but may leave behind erythema or friable mucosa if scraped
Diagnostic for oral thrush
-KOH prep: budding yeast and pseudohyphae
Treatment for Thrush
-Nystatin liquid, Clotrimazole troches, or Miconazole buccal tablets
