EENT Flashcards
leading cause of blindness in the US
Glaucoma
What can develop secondary as a result of an infection, inflammation, tumor, hemorrhage or trauma?
Glaucoma
Who is at risk for open-angled glaucoma
People over 40 yrs old, hereditary links, African-Americans
Does open-angled glaucoma happen fast or gradual?
Its a problem that happens gradually
What is open-angled glaucoma
chronic, gradual increase of IOP
What happens if you have glaucoma?
Tunnel-vision, increased IOP & gradual loss of vision
What tests are done to see if you have glaucoma?
Eye exam, Dilated eye exam, Tonometry (measurement of tension)
Open-Angle medications
Miotics: Pilocarpine; Beta-adrenergic blockers: Timolol; Carbonic anhydrase inhibitors: Diamox
Miotic is a drug category used for what? And what is an example of a Miotic
constricting pupils; Pilocarpine-Reduces IOP
What is an example of a Beta-adrenergic blocker & what is its function
Timolol: decreases the production of aqueous humor
What is an example of a Carbonic amhydrase inhibitor & what is its function
Diamox: decreases queous humor
if Open-angle cannot be controlled by eye drops then what surgical treatment is available
Trabeculoplasty (argon laser) which is the preferred ethod, outpatient, no incision OR Trabeculectomy which is a permanent fistula
Does Angle-closure happen fast or gradually?
Fast, its a medical emergency, if not treated right away it can cause permanent damage to eyes
What causes angle-closure?
the iris bows forward & cuts off eye angle completely which prevent the aqueous humor to drain
What does angle-closure cause
IOP
What medication is given to patients who are having angle-closure surgery?
Mininitol-given IV
What type of surgery is used for angle-closure?
Iridoctomy(laser): iris segment is removed
Cataracts
blurry
What does the eye look like with someone who has cataracts?
white/yellowish
Who is likely to get Cataracts
old people, people who have UVB damage, trauma, diabetics
Cataract manifestations
Decreased vision, Glare, dimness, Difficulty adjusting from light to dark (“I cant drive at night, its too dark”) & frequent prescription to eyewear changes
What can determine cataracts during a opthalmoscopic exam?
Change in lens color, absent red reflex. this exam is done when the Dr. turns off the light & tells you to look ahead & shines a light in eye
What do you teach patient during periop for cataract surgery
Teach patient how to put in eye drops, give local anesthetic, they will have limited visual field postop, no straining, bending, lifting, no driving
Treatment option for Cataracts?
Surgery is the only option. The intraocular lens gets replaced
Cataract surgery post op eye drops
maxitrol
The patient should be in what position after cataract surgery?
Semi fowlers
What kind of pain med is given post op with cataract surgery
Tylenol for mild discomfort
What is a detached retina?
Small holes or tears in the retina. Looks like a curtain is being pulled over eye
Which eye problems are medical emergencies
Angle-closure glaucoma & a detached retina
What treatments are offered for a detached retina?
laser photocoagulation, cryopexy (intense cold) & pneumatic retinopexy (gas bubble)
laser photocoagulation, cryopexy (intense cold) & pneumatic retinopexy (gas bubble) are used to treat?
detached retina
advanced detached retina treatment options
Scleral buckling & virectomy
Scleral buckling & virectomy are used to treat?
Advanced detached retina
Macular Degeneration
Cant see center. There is a big black thing in center of view. It eventually gets bigger
Treatment goals for a detached retina
try to prevent it from getting worse
treatment goals for macular degeneration
try to prevent form getting worse
Treatment options for macular degeneration
intraocular injections, eye drops, photodynamic therapy, surgery, vitamin & mineral supplements
intraocular injections, eye drops, photodynamic therapy, surgery, vitamin & mineral supplements are used to treat?
Macular degeneration
A healthy ear drum looks
clear, shiny, pearly gray
Otitis media with effusion
sterile fluid builds up in the middle ear
Symptoms of otitis media with effusion
popping or snapping noises, decreased hearing, can cause perforation if not treated
What happens to the Tympanic membrane (ear drum) If perforation occurs
it ruptures therefore nothing is protecting us from middle ear
Is otitis media with effusion an acute infection?
No
Acute otitis media can be caused by
strep, pneumonia, haemophilic influenze & Moraxella catarrhalis, exposure to smoke, pus formation, followed by URI
If acute otitis media is not resolved for more than 3 months what does it lead to?
Chronic otitis media
What does an ear drum (tympanic membrane) look like in acute otitis media?
Red, inflamed, dull, bulging, decreased movement
Symptoms of acute otitis media
elevated temp, diminished hearing, dizziness, tinnitus (ringing), vertigo, possible perforation, severe pain
Otitis Media treatments
antibiotic therapy-up to 10 days, local heat application, analgesics, antipyretics, decongestants, possible corticosteriods
What do we want to prevent in ear infections?
Chronic ear infections
What is a huge concern in macular degeneration?
Safety
Does an ear infection have to be cleared up before surgery?
Yes
surgical treatments for otitis media
tympanocentesis, myringotomy
Tympanocentesis
drainage of fluid from the middle ear by using a small gauge needle to puncture the tympanic membrane
Myringotomy
tubes put in ears
what is the purpose of ear tubes
It is placed in the ear drum to allow for air to enter & keep middle ear healthy by preventing fluid from collecting in the middle ear
After getting ear tubes, ears should not get…
wet.
Sinusitis usually occurs after what?
a URI/flu
What causes your sinuses to become infected?
swelling of the sinuses block drainage openings & so the sinuses fill with fluid. Bacteria will start growing in the fluid & the sinuses will become infected and produce a foul smelling mucus.
How does bacteria spread to the sinus?
openings in the nasal turbinates
Sinusitis risk factors
smoking, habitual use of nasal sprays, swimming/diving trauma, rhinitis, nasal polyps, immunocompromised people
Symptoms of sinusitis
pain, halitosis (bad breath), N/V r/t swallowed drainage, purulent discharge, nasal congestion,
Potential complications with sinusitis
meningitis, orbital cellulitis/abscess (looks like a big welt on eye), osteomyelitis (inflammation of bone), brain abscess, venous sinus thrombosis
orbital cellulitis/abscess
looks like a big welt on eye
osteomyelitis
inflammation of bone
endoscopic sinus surgery options
irrigation, Caldwell-Luc, sphenoethmoidectomy
epistaxis
bloody nose
what can cause a bloody nose?
picking nose, trauma, during respiratory illness, during strenuous exercise, in conjunctive with a systemic disease(hypertension, coagulation disorders), sinusitis, allergic rhinitis, substance abuse
What are some interventions for a bloody nose?
put pressure to anterior nasal septum, alleviate fear, choking sensation, apply ice for vasoconstriction, calm individual to stop crying which will reduce pressure in blood vessels & allow bleed to stop sooner
Bloody nose treatment?
Epinephrine may be applied topically, inflatable balloon, nasal pack (tampon etc), surgical cautery
Epinephrine may be applied topically, inflatable balloon, nasal pack are treatments for?
a bloody nose
which two infectious conditions pertain to nasal packing?
toxic shock syndrome & bacterial rhinosinusitis
Pharyngitis
acute inflammation of pharynx
how is pharyngitis spread?
droplet nuclei
Pharyngitis treatment options
hydration, rest, antipyretics, mild analgesics, antibiotics, rapid throat culture is done
How many hours after taking an antibiotic is the patient not contagious?
24 hours
Potential complications of pharyngitis
acute streptococcal glomerulonephritis, rheumatic fever, toxic shock syndrome, scarlet fever, abscess
acute streptococcal glomerulonephritis, rheumatic fever, toxic shock syndrome, scarlet fever, abscess are potential complications for?
Pharyngitis
tonsillitis
acute inflammation of the palatine tonsils
how is tonsillitis spread by? is it a bacteria or virus
droplet nuclei. Usually due to streptococcal infection
Pharyngitis is caused by bacteria or virus?
bacteria. Group A beta-hemolytic streptococcus ( strep throat)
Group A beta-hemolytic streptococcus (strep throat) causes
pharyngitis
pharyngeal tonsils are also called
Adenoids
how many pairs of tonsils do you have?
3
tonsillitis symptoms
sore throat, halitosis, fever, headache, decrease in appetite, N/V, dysphagia (inability to swallow), redness or drainage in throat, stomach ache
dysphagia
inability to swallow
Tonsillitis diagnostics
CBC, throat C/S, monospot & chest xray with respiratory complications
non-surgical management of tonsillitis
warm saline throat gargles, analgesics, antipyretics, lozenges for topical relief, antibiotics
surgical management of tonsillitis
remove palatine tonsillitis/adenoids
When would you surgically remove palatine tonsillitis/adenoids?
its obstructing airway, recurrent acute/chronic infections that aren’t responding to antibiotics, abscess, malignancy (tonsil cancer)
adenotonsillectomy
surgical removal of tonsils & adeniods
First line of treatment for snoring in children?
adenotonsillectomy. It provides temporary relief
What happens to children who gain weight rapidly after having a adenotonsillectomy to treat snoring?
They can relapse or get worse
best position to have child postop after adenotonsillectomy & second best position
prone (face down) with head turned to side, next best: on side with head turned
1 concern after adenotonsillectomy post op?
bleeding, its not obvious
What do you check for adenotonsillectomy pre-op
loose teeth
What kinds of sugery for adenotonsillectomy
laser, ligation ( process of binding or tying), dissection & snare, for adenoids-curette (scraping)
adenotonsillectomy post op care
container for expectoration of bloody slavia, observe for obstructions, talking crying can increase pain, diet
What discharge instructions do you give patient who had a adenotonsillectomy
observe for frequent swallowing, clearing throat, increasing restlessness, elevated pulse rate, no toast or anything with crumbs, caution dairy, soft food only, can use an ice pack & liquid analgesia
How long does a patient who had a adenotonsillectomy have to wait until they can go back to school & why?
10 days. risk of hemorrhage occurs between 5-7 days due to sloughing of tissue (adults more likely to do this)
What symptoms should a patient who had a adenotonsillectomy call the Dr?
Fever, pain, bleeding
Cerumen
substance secreted by glands at the outer third of the ear canal
Diplopia
2 images seen at the same time
Conjunctivitis
inflammation of the mucus membrane that lines eyelid
chalazion
a benign lesion developing on eyelids
cycloplegic
paralysis of the bladder
enucleation
eye removal
exophthalmos
abnormal protrusion of the eyeball
Hordeolum
a sty; localized inflammation of glands in eyeball
hyperopia
farsightedness
tinnitus
ringing
retinopathy
any noninflammatory retinal damage. can cause loss of vision
strabismus
cant focus?
ptosis
dropping of organ
presbyopia
permanent loss of accommodation that occurs when people are in their 40s
optician
specializes filling prescriptions
ophthalmologist
specializes in treating eye disorders
nystagmus
eye movement back & forth
myopia
cant see up close
Ketorolac (Toradol)
Don’t give to patients c heart disease. Only can be given for 5 days. Relieves pain. NSAID
