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PANCE review > EENT > Flashcards

EENT Flashcards

1
Q

infection of eyelid

A

blepharitis

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2
Q

blepharitis treatment

A
  • Hygiene: clean off scales, warm wet washcloth with mild shampoo
  • Antibiotic ointment for acute exacerbations (Bacitracin or Erythromycin every 3 hrs)
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3
Q

Staphylococcal abscess in the eyelid

A

Hordeolum (Sty)

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4
Q

Internal vs external hordeolum/sty

A 
Internal = meibomian gland abscess
External = sty and usually on the margin of the eyelid
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5
Q

Hordeolum (Sty) treatment

A
  • Warm compress x 48 hours
  • Antibiotic ointment may be necessary (Bacitracin or Erythromycin q3 hrs)
  • I&D may be necessary
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6
Q

How is sty different than chalazion?

A

Chalazion is usually painless while sty is tender

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7
Q

Pathophysiology of Chalazion

A

Cyst of a clogged meibomian gland

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8
Q

Chalazion treatment

A
  • Steroid injection may be helpful

- Surgical excision definitive tx

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9
Q

Entropion vs Ectropion

A 
Entropion = eyelid folding inward
Ectropion = eyelid folding outward
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10
Q

What is a blowout fracture?

A

fracture of orbit

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11
Q

How to treat foreign object in eye?

A
  • Use sterile wet cotton tipped applicator or hypodermic needle to remove object
  • Polymyxin-bacitracin ointment should be applied
  • Do not apply an eye patch
  • REFER intraophthalmic foreign body. Do not attempt to remove!
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12
Q

How can a corneal abrasion be dx’d?

A

h/o trauma

Fluorescein stains abrasion darker than rest of cornea

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13
Q

Corneal abrasion treatment

A

Polymyxin-bacitracin ointment

NSAIDS

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14
Q

Infections that can cause Corneal Ulcer (Ulcerative Keratitis)?

A

Bacterial keratitis: Staph, Strep, E. coli, Pseudomonas
Viral keratitis: Herpes
Fungal keratitis

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15
Q

Labs, Studies and Physical Exam Findings of Ulcerative Keratitis

A

Aqueous flare – protein in the aqueous humor
Small Pupil
Slit lamp is used for diagnosis
Fluorescein stain may help with visualization
Corneal scraping for Gram stain or KOH

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16
Q

Inflammation of the nasolacrimal sac, commonly in newborns.

A

Dacryocystitis

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17
Q

Typical infection of viral and bacterial conjunctivitis

A

viral: Adenovirus
bacterial: Strep pneumo, Staph Aureus, Haemophilus, Moraxella, Chlamydia (more rare, more severe), Neisseria

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18
Q

Treatment of viral and bacterial conjunctivitis

A

viral: saline flush BID, hot compress
bacterial: fluoroquinolone, Polymyxin B drops

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19
Q

Orbital cellulitis is usually secondary to a ______ or a _______ infection.

A

chronic sinus

dental

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20
Q

Orbital cellulitis treatment

A

Patients will usually be admitted for IV antibiotic therapy to cover Staph and Strep (Vancomycin, clindamycin, or doxycylcine)

Surgical intervention may be necessary for abscess

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21
Q

An opacification of the lens obstructing the flow of light to the retina

A

Cataracts

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22
Q

Symptoms of acute angle glaucoma

A 
* Halos around lights
Pain
N/V
Blurred vision
Photophobia
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23
Q

What changes in vision seen in chronic (open angle) glaucoma?

A

gradual peripheral vision loss

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24
Q

Pathophysiology of glaucoma

A

Increased intraocular pressure leading to damage to optic nerve. Aqueous humor is constantly being produced within the eye and constantly draining out through an area of eye called the angle.

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25
Q

open vs closed angle glaucoma

A

Open angle glaucoma which is a the chronic form

Closed angle glaucoma which is an acute clogging of the drainage of aqueous humor

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26
Q

PE findings that indicate glaucoma

A

Tonometry: IOP > 21
Pupils unreactive to light
Visual field test: decreased peripheral vision
Fundoscopy: vessels bending over edge of disc, cup:disc ratio >0.5 (increasing cup size)

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27
Q

Glaucoma treatment

A

Meds:

  • Prostaglandins to promote drainage
  • Beta Blockers to decrease aqueous humor production
  • Alpha Adrenergic agonists to decrease aqueous humor production and promote drainage

Surgical correction
Laser trabeculoplasty – open the clogged channels
Filtering trabeculectomy – removing a piece of the sclera to allow drainage

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28
Q

Optic DISC swelling secondary to intracranial pressure

A

papilledema

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29
Q

Blood in the anterior chamber of eye

A

hyphema

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30
Q

Signs of papilledema on PE

A

Fundoscopy: venous engorgement, hemorrhages, blurring of optic disc margins

Blurred vision, enlarged blind spot

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31
Q

hyphema treatment

A 
SUPPORTIVE
Blood reabsorbed in a few days
Sleep with head of bed at 45 degrees
Recommend patient not read or watch television
Eye patch
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32
Q

Pterygium

A

A benign wedge shaped growth of conjunctiva which grows from the nasal side to over the cornea

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33
Q

Pinguecula

A

A yellowish deposit on the conjunctiva which does not grow over the cornea

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34
Q

65 yo patient comes in with loss of central vision (scotoma) and wavy vision (metamorphopsia)

A

Macular Degeneration

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35
Q

Hallmark finding on PE of macula in macular degeneration

A

Drusen (yellow deposits of debris)

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36
Q

2 types of age-related macular degeneration

A

dry (atrophy of retina) and wet (neovascular; only about 10%)

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37
Q

macular degeneration treatment

A 
Laser photocoagulation
Dietary supplements (Vit A, C, E B6, B12, zinc copper, etc.)

Wet ARMD: intravitreal injection of vascular endothelial growth factor inhibitors

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38
Q

“curtain coming down” vision changes

A

retinal detachment

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39
Q

cotton wool spots on fundoscopic exam

A

DM retinopathy

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40
Q

Cherry red spot Central

boxcarring of arterioles

A

Retinal artery occlusion

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41
Q

Vision pathology with curtain descends and then goes back up?

A

Amaurosis fugax

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42
Q

Involuntary eye movement - up and down, side to side, rotary

A

Nystagmus

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43
Q

Strabismus

A

cross-eyed

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44
Q

Amblyopia

A

A loss of vision in an otherwise normal eye.

Most often this is secondary to a strabismu

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45
Q

How to describe direction of strabismus? (up, down, in, out)

A

Hypotropia – one eye goes down
Hypertropia – one eye goes up
Exotropia – one eye out
Esotropia – one eye goes in

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46
Q

PE tests to do for suspected strabismus

A

Cover/uncover test (look for movement)

Hirschberg corneal reflex test (light reflection should be in same place on each eye)

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47
Q

Strabismus treatment

A

Children – the goal is to avoid amblyopia: glasses, eye patch, surgery

Adults: glasses, surgery

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48
Q

I came in to see my physician assistant today because of…

Acute painful vision loss or blurred vision
Loss of color vision
Pain with eye movement

A

optic neuritis

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49
Q

Causes of optic neuritis

A

Autoimmune – MS is #1 cause, scleroderma, lupus
Fungal infection
Bacterial infection – lyme, TB, syphilis
Viral infection – herpes zoster, mumps, rubella
Vitamin B deficiency

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50
Q

PE findings of retinal detachment

A

Retina may appear to be hanging

Asymmetric red reflex

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51
Q

Treatment of retinal detachment

A

REFER for surgery

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52
Q

Causes of retinopathy

A

DM, HTN, premature birth, radiation damage (acute pain), Sickle Cell

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53
Q

Fundoscopy findings of diabetic retinopathy

A

Preproliferative

  • hemorrhages
  • exudates
  • cotton wool spots

Proliferative

  • neovascularization
  • edema
54
Q

Fundoscopy findings of HTN retinopathy

A

Arteriolar narrowing:

  • copper wire
  • silver wire sclerosis
  • AV nicking
55
Q

I came in to see my physician assistant today because of…

ACUTE vision loss
Partial
Complete
NO PAIN

A

Retinal Artery Occlusion

56
Q

Fundal exam of Retinal Artery Occlusion

A

Boxcarring – narrowing of arterioles
Cherry red spot – its actually that the rest of the retina is pale
Optic atrophy
Pale disc

57
Q

Retinal Artery Occlusion treatment

A

EMERGENCY
Referral
Intermittent pressure
tPA

58
Q

Pathology with “blood and thunder fundus”, dilated veins, exudates on fundus exam?

A

Central Vein Occlusion

59
Q

I came in to see my physician assistant today because of…

Transient ACUTE vision loss
Curtain descends and then goes back up
Unilateral

A

Amaurosis Fugax

60
Q

Amaurosis Fugax treatment

A

Treat underlying cause of ischemia
Heparin

  • Think TIA of eyeball
61
Q

Amsler grid

A

used to diagnose wavy vision in macular degeneration

62
Q

Acute otitis media vs chronic organisms

A

acute: strep pneumo, strep pyogenes, H-flu
chronic: staph aureus, pseudomonas, proteus

63
Q

PE findings of otitis media

A
  • TM: erythema, decreased mobility with a pneumatic otoscope

- Tenderness over mastoid

64
Q

acute otitis media treatment

A

Amoxicillin x 10 days

Erythromycin x 10 days

65
Q

DDX of ear discharge

A

otitis externa, chronic otitis media, mastoiditis, perforated eardrum, cholesteatoma

66
Q

Causes of chronic otitis media

A

Recurrent acute otitis media

Rupture of tympanic membrane

67
Q

Abx for chronic otitis media exacerbations

68
Q

Etiology of otitis externa

A

Trauma
Excessive moisture
Pseudomonas
Proteus

69
Q

Pain with movement of the auricle
Tympanic membrane moves with a pneumatic otoscope
Eardrum is intact

A

otitis externa

70
Q

otitis externa management

A

Behavior: don’t put things in ear canal, careful use of earplugs, drying agent after swimming may be helpful (50% alcohol or white vinegar)

Abx: Fluoroquinolones or Aminoglycosides

71
Q

What is malignant otitis externa and how is it treated?

A

complication of otitis externa with osteomyelitis of the temporal bone

tx: IV cipro

72
Q

I came in to see my physician assistant because of…

Redness and swelling behind the ear
High fever
Ear pain
Drainage from the ear
Loss of hearing
A

mastoiditis

73
Q

Mastoiditis treatment

A

Prevention! treat ear infections with abx

IV abx – cefazolin is broad spectrum abx of choice

Surgery

  • myringotomy (whole to drain the middle ear)
  • removal of the mastoid may be necessary
74
Q

I came in to see my physician assistant because of…

Sudden unilateral hearing loss
Episodic or continuous vertigo
Tinnitus

A

Acoustic Neuroma (Vestibular Schwannoma)

75
Q

Acoustic neuroma is a slow growing benign tumor located where?

A

vestibulocochlear nerve, CN VIII

76
Q

3 types of hearing loss

A

Conductive – sound waves can’t get to ear structure
Sensory – damage to cochlea and usually related to loss of hair cells
Neural hearing loss – damage to vestibulocochlear nerve

77
Q

Common causes of conductive hearing loss

A

Cerumen impaction

Osteosclerosis

78
Q

Common causes of sensory hearing loss

A

Age related hearing loss due to loss of the hair cells
Head trauma
Significant noise exposure

79
Q

Common causes of neural hearing loss

A

Acoustic neuroma

Multiple sclerosis

80
Q

How are Weber and Rinne tests done?

A

Weber test – Tuning fork placed against the forehead equidistant from both ears. A patient without hearing loss will hear the tuning fork equally in both ears.
Rinne test – Place tuning fork on mastoid process and then remove it and place it next to the ear. Normal hearing or a positive test will be louder with air conduction rather than bone conduction

81
Q

Conductive hearing loss findings on Weber and Rinne test

A

Weber test – Patient will report the sound louder in the affected ear.
Rinne test – The sound will be louder on the mastoid with bone conduction. This is referred to as a negative Rinne’s test

82
Q

Sensory hearing loss findings on Weber and Rinne test

A

Weber test – Louder in unaffected ear
Rinne test – The sound will be louder off the mastoid with air conduction. This is referred to as a positive Rinne’s test

83
Q

High pitched ringing in the ears is _______.

84
Q

DDX of vertigo and their duration

A

BPPV (under several minutes)
Meniere’s disease (20 min to several hours)
Ototoxic drugs
Labyrinthitis

85
Q

Meds for vertigo

A

Meclizine 1st line (anticholinergic)
Diazepam for acute phase
Anti-histamines
Compazine or zofran for nausea

86
Q

I came in to see my physician assistant because of…

Acute onset of vertigo
Involuntary eye movements
Unilateral hearing loss
nausea and vomiting
Tinnitus
A

Labyrinthitis

87
Q

Predisposing factors to labyrinthitis

A 
Fatigue
Alcohol consumption
Allergies
Upper respiratory infection
Smoking
Stress
Drugs
88
Q

I came in to see my physician assistant because of…

Episodic vertigo
Low frequency hearing loss
Tinnitus
Unilateral ear pressure

A

Meniere’s Disease

89
Q

Inflammation of the inner ear

A

Labyrinthitis

90
Q

Meniere’s disease treatment

A

Low salt diet
Diuretics
Intratympanic steroid injection
Labyrinthectomy or ablation

91
Q

I came in to see my physician assistant because of…

Conductive hearing loss
Tinnitus
Earache
Discharge of fluids

A

perforated tympanic membrane

92
Q

Treatment of perforated eardrum

A

Be careful of getting water in ear
Most heal within weeks
Surgery if needed (Tympanoplasty)

93
Q

OTC meds that may help with barotrauma

A

Decongestants

94
Q

I came in to see my physician assistant because of…

Fullness in the ears
Decreased hearing
Popping or crackling with yawning or swallowing

A

Eustachian tube dysfunction - tubes narrow

95
Q

Narrow eustachian tube PE findings

A
  • Retraction of TM

- Decreased TM motility with pneumatic otoscope

96
Q

A cyst in the middle ear which is filled with keratin

A

cholesteatoma

97
Q

PE findings of cholesteatoma

A

Unilateral hearing loss
Ear discharge
Ear canal filled with debris

98
Q

Cholesteatoma treatment

A

Surgical removal of the cyst

99
Q

Ways to evaluate patient with suspected sinus infection?

A

Transillumination
Tender over sinuses
Nasal endoscopy may be helpful with chronic sinusitis
CT may be helpful with chronic sinusitis

100
Q

Sinusitis treatment

A

Supportive: nasal irrigation with saline, steam, increased fluids, humidifier, Tylenol or ibuprofen, decongestants

Antibiotics after 10 days
Amoxicillin

Surgical correction

101
Q

Allergic rhinitis treatment

A 
Prevention! Avoid triggers
Best choice – intranasal corticosteroids (Beclomethasone or Flunisolide BID)
Antihistamines
Decongestants
Desensitization
102
Q

Epistaxis treatment

A

Direct pressure – pinch the bridge of the nose for 15 minutes
Have patient lean forward to avoid swallowing blood leading to nausea and vomiting
Topical vasoconstrictor ie cocaine or oxymetazoline
If you can visualize the source silver nitrate may be used to cauterize the vessels
Packing for 24 hrs if necessary
Pneumatic tamponade
Surgical correction

103
Q

What are 2 types of nosebleeds?

A

Anterior nosebleed - most common, originates from Kiesselbach’s plexus
Posterior nosebleed - less common, much more difficult to treat

104
Q

Nasal polyps commonly exist with what other conditions?

A

allergic rhinitis and asthma

105
Q

Nasal polyp treatment

A

Topical nasal steroid for 1-3 months
Oral steroid may be helpful
Surgical removal

106
Q

Causes of acute pharyngitis

A

viral: EBV (mono), Adenovirus, cold viruses, Herpes
bacterial: **strep pneumo, Neisseria gonnorhea, Mycoplasma, Chlamydia

107
Q

Acute pharyngitis treatment

A

MOST VIRAL
Symptomatic: NSAIDS or tylenol, increase fluids

abx if strep throat
Penicillin 500 mg BID
Amoxicillin 500 mg TID

108
Q

hot potato voice =

A

peritonsillar abscess

109
Q

Most common etiology of epiglottitis

A

Haemophilus influenzae

110
Q

signs/sx’s of epiglottitis

A 
High fever
Difficulty swallowing
Drooling
Stridor
Cyanosis
111
Q

XR hallmark of epiglottitis

A

Thumbprint sign

112
Q

Treatment of epiglottitis

A

ABC’s; be prepared for intubation

IV abx may be necessary: Cephalosporins (ceftriaxone) or racemic epinephrine

113
Q

Laryngitis treatment

A 
Rest voice
Humidifier
Fluids
Treat for GERD if appropriate
Antibiotics if appropriate
114
Q

Who is likely to get oral candidas?

A 
Newborns
Uncontrolled Diabetes
HIV/AIDS
Chemotherpy
Side effect of inhaled steroids
Side effect of antibiotics
Dentures or poor hygiene
115
Q

Thrush treatment

A

Address underlying cause
Fluconazole 100mg x 7 days for non-immunocompromised patients
½ hydrogen peroxide mouth rinse

116
Q

thrush vs oral leukoplakia

A

thrush: patches painful/bleed when scraped off

oral leukoplakia: patches cannot be scraped off

117
Q

oral leukoplakia causes

A

HPV, smoking, alcohol

118
Q

An inflammation of one or both salivary glands

119
Q

Infections that cause parotitis

A 
Viral
- Historically, #1 cause was Mumps
- Parainfluenza and EBV now most common
- HIV
Bacterial
- Staph Aureus
120
Q

aphthous ulcers commonly known as _______.

A

Canker sores

121
Q

Treatment of aphthous ulcers

A

Self-limiting
½ hydrogen peroxide solution
Corticosteroids

122
Q

Most common bugs that cause acute OM, chronic OM, and OE

A

acute OM: strep
chronic OM: Pseudo, H flu, staph, proteus
OE: E. coli, Aspergillus

123
Q

Cause of amaurosis fagut

A

carotid artery disease

124
Q

How to treat cauliflower ear?

A

evacuation + abx + splinting

125
Q

Risk of leaving cauliflower ear untreated?

A

cartilage necrosis

126
Q

When to refer child for poor vision?

A

less than 20/40 or +2 line difference in eyes

127
Q

ototoxic meds

A

furosemide (Lasix), gentamycin, aspirin

128
Q

What treatment is contraindicated if herpes simplex keratitis suspected?

A

ophthalmic corticosteroids

129
Q

eye with dendritic/branching ulcers =

A

HSV keratitis

130
Q

Painless vision loss with optic DISC edema?

A

retinal vein occlusion

PANCE review (18 decks)

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