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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
open vs closed angle glaucoma
Open angle glaucoma which is a the chronic form | Closed angle glaucoma which is an acute clogging of the drainage of aqueous humor
26
PE findings that indicate glaucoma
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)
27
Glaucoma treatment
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
28
Optic DISC swelling secondary to intracranial pressure
papilledema
29
Blood in the anterior chamber of eye
hyphema
30
Signs of papilledema on PE
Fundoscopy: venous engorgement, hemorrhages, blurring of optic disc margins Blurred vision, enlarged blind spot
31
hyphema treatment
``` SUPPORTIVE Blood reabsorbed in a few days Sleep with head of bed at 45 degrees Recommend patient not read or watch television Eye patch ```
32
Pterygium
A benign wedge shaped growth of conjunctiva which grows from the nasal side to over the cornea
33
Pinguecula
A yellowish deposit on the conjunctiva which does not grow over the cornea
34
65 yo patient comes in with loss of central vision (scotoma) and wavy vision (metamorphopsia)
Macular Degeneration
35
Hallmark finding on PE of macula in macular degeneration
Drusen (yellow deposits of debris)
36
2 types of age-related macular degeneration
dry (atrophy of retina) and wet (neovascular; only about 10%)
37
macular degeneration treatment
``` Laser photocoagulation Dietary supplements (Vit A, C, E B6, B12, zinc copper, etc.) ``` Wet ARMD: intravitreal injection of vascular endothelial growth factor inhibitors
38
"curtain coming down" vision changes
retinal detachment
39
cotton wool spots on fundoscopic exam
DM retinopathy
40
Cherry red spot Central | boxcarring of arterioles
Retinal artery occlusion
41
Vision pathology with curtain descends and then goes back up?
Amaurosis fugax
42
Involuntary eye movement - up and down, side to side, rotary
Nystagmus
43
Strabismus
cross-eyed
44
Amblyopia
A loss of vision in an otherwise normal eye. | Most often this is secondary to a strabismu
45
How to describe direction of strabismus? (up, down, in, out)
Hypotropia – one eye goes down Hypertropia – one eye goes up Exotropia – one eye out Esotropia – one eye goes in
46
PE tests to do for suspected strabismus
Cover/uncover test (look for movement) | Hirschberg corneal reflex test (light reflection should be in same place on each eye)
47
Strabismus treatment
Children – the goal is to avoid amblyopia: glasses, eye patch, surgery Adults: glasses, surgery
48
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
optic neuritis
49
Causes of optic neuritis
Autoimmune – MS is #1 cause, scleroderma, lupus Fungal infection Bacterial infection – lyme, TB, syphilis Viral infection – herpes zoster, mumps, rubella Vitamin B deficiency
50
PE findings of retinal detachment
Retina may appear to be hanging | Asymmetric red reflex
51
Treatment of retinal detachment
REFER for surgery
52
Causes of retinopathy
DM, HTN, premature birth, radiation damage (acute pain), Sickle Cell
53
Fundoscopy findings of diabetic retinopathy
Preproliferative - hemorrhages - exudates - cotton wool spots Proliferative - neovascularization - edema
54
Fundoscopy findings of HTN retinopathy
Arteriolar narrowing: - copper wire - silver wire sclerosis - AV nicking
55
I came in to see my physician assistant today because of… ACUTE vision loss Partial Complete NO PAIN
Retinal Artery Occlusion
56
Fundal exam of Retinal Artery Occlusion
Boxcarring – narrowing of arterioles Cherry red spot – its actually that the rest of the retina is pale Optic atrophy Pale disc
57
Retinal Artery Occlusion treatment
EMERGENCY Referral Intermittent pressure tPA
58
Pathology with "blood and thunder fundus", dilated veins, exudates on fundus exam?
Central Vein Occlusion
59
I came in to see my physician assistant today because of… Transient ACUTE vision loss Curtain descends and then goes back up Unilateral
Amaurosis Fugax
60
Amaurosis Fugax treatment
Treat underlying cause of ischemia Heparin * Think TIA of eyeball
61
Amsler grid
used to diagnose wavy vision in macular degeneration
62
Acute otitis media vs chronic organisms
acute: strep pneumo, strep pyogenes, H-flu chronic: staph aureus, pseudomonas, proteus
63
PE findings of otitis media
- TM: erythema, decreased mobility with a pneumatic otoscope | - Tenderness over mastoid
64
acute otitis media treatment
Amoxicillin x 10 days | Erythromycin x 10 days
65
DDX of ear discharge
otitis externa, chronic otitis media, mastoiditis, perforated eardrum, cholesteatoma
66
Causes of chronic otitis media
Recurrent acute otitis media | Rupture of tympanic membrane
67
Abx for chronic otitis media exacerbations
Cipro
68
Etiology of otitis externa
Trauma Excessive moisture Pseudomonas Proteus
69
Pain with movement of the auricle Tympanic membrane moves with a pneumatic otoscope Eardrum is intact
otitis externa
70
otitis externa management
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
What is malignant otitis externa and how is it treated?
complication of otitis externa with osteomyelitis of the temporal bone tx: IV cipro
72
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 ```
mastoiditis
73
Mastoiditis treatment
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
I came in to see my physician assistant because of… Sudden unilateral hearing loss Episodic or continuous vertigo Tinnitus
Acoustic Neuroma (Vestibular Schwannoma)
75
Acoustic neuroma is a slow growing benign tumor located where?
vestibulocochlear nerve, CN VIII
76
3 types of hearing loss
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
Common causes of conductive hearing loss
Cerumen impaction | Osteosclerosis
78
Common causes of sensory hearing loss
Age related hearing loss due to loss of the hair cells Head trauma Significant noise exposure
79
Common causes of neural hearing loss
Acoustic neuroma | Multiple sclerosis
80
How are Weber and Rinne tests done?
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
Conductive hearing loss findings on Weber and Rinne test
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
Sensory hearing loss findings on Weber and Rinne test
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
High pitched ringing in the ears is _______.
tinnitis
84
DDX of vertigo and their duration
BPPV (under several minutes) Meniere’s disease (20 min to several hours) Ototoxic drugs Labyrinthitis
85
Meds for vertigo
Meclizine 1st line (anticholinergic) Diazepam for acute phase Anti-histamines Compazine or zofran for nausea
86
I came in to see my physician assistant because of… ``` Acute onset of vertigo Involuntary eye movements Unilateral hearing loss nausea and vomiting Tinnitus ```
Labyrinthitis
87
Predisposing factors to labyrinthitis
``` Fatigue Alcohol consumption Allergies Upper respiratory infection Smoking Stress Drugs ```
88
I came in to see my physician assistant because of… Episodic vertigo Low frequency hearing loss Tinnitus Unilateral ear pressure
Meniere's Disease
89
Inflammation of the inner ear
Labyrinthitis
90
Meniere's disease treatment
Low salt diet Diuretics Intratympanic steroid injection Labyrinthectomy or ablation
91
I came in to see my physician assistant because of… Conductive hearing loss Tinnitus Earache Discharge of fluids
perforated tympanic membrane
92
Treatment of perforated eardrum
Be careful of getting water in ear Most heal within weeks Surgery if needed (Tympanoplasty)
93
OTC meds that may help with barotrauma
Decongestants
94
I came in to see my physician assistant because of… Fullness in the ears Decreased hearing Popping or crackling with yawning or swallowing
Eustachian tube dysfunction - tubes narrow
95
Narrow eustachian tube PE findings
- Retraction of TM | - Decreased TM motility with pneumatic otoscope
96
A cyst in the middle ear which is filled with keratin
cholesteatoma
97
PE findings of cholesteatoma
Unilateral hearing loss Ear discharge Ear canal filled with debris
98
Cholesteatoma treatment
Surgical removal of the cyst
99
Ways to evaluate patient with suspected sinus infection?
Transillumination Tender over sinuses Nasal endoscopy may be helpful with chronic sinusitis CT may be helpful with chronic sinusitis
100
Sinusitis treatment
Supportive: nasal irrigation with saline, steam, increased fluids, humidifier, Tylenol or ibuprofen, decongestants Antibiotics after 10 days Amoxicillin Surgical correction
101
Allergic rhinitis treatment
``` Prevention! Avoid triggers Best choice – intranasal corticosteroids (Beclomethasone or Flunisolide BID) Antihistamines Decongestants Desensitization ```
102
Epistaxis treatment
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
What are 2 types of nosebleeds?
Anterior nosebleed - most common, originates from Kiesselbach’s plexus Posterior nosebleed - less common, much more difficult to treat
104
Nasal polyps commonly exist with what other conditions?
allergic rhinitis and asthma
105
Nasal polyp treatment
Topical nasal steroid for 1-3 months Oral steroid may be helpful Surgical removal
106
Causes of acute pharyngitis
viral: EBV (mono), Adenovirus, cold viruses, Herpes bacterial: **strep pneumo, Neisseria gonnorhea, Mycoplasma, Chlamydia
107
Acute pharyngitis treatment
MOST VIRAL Symptomatic: NSAIDS or tylenol, increase fluids abx if strep throat Penicillin 500 mg BID Amoxicillin 500 mg TID
108
hot potato voice =
peritonsillar abscess
109
Most common etiology of epiglottitis
Haemophilus influenzae
110
signs/sx's of epiglottitis
``` High fever Difficulty swallowing Drooling Stridor Cyanosis ```
111
XR hallmark of epiglottitis
Thumbprint sign
112
Treatment of epiglottitis
ABC's; be prepared for intubation | IV abx may be necessary: Cephalosporins (ceftriaxone) or racemic epinephrine
113
Laryngitis treatment
``` Rest voice Humidifier Fluids Treat for GERD if appropriate Antibiotics if appropriate ```
114
Who is likely to get oral candidas?
``` Newborns Uncontrolled Diabetes HIV/AIDS Chemotherpy Side effect of inhaled steroids Side effect of antibiotics Dentures or poor hygiene ```
115
Thrush treatment
Address underlying cause Fluconazole 100mg x 7 days for non-immunocompromised patients ½ hydrogen peroxide mouth rinse
116
thrush vs oral leukoplakia
thrush: patches painful/bleed when scraped off | oral leukoplakia: patches cannot be scraped off
117
oral leukoplakia causes
HPV, smoking, alcohol
118
An inflammation of one or both salivary glands
parotitis
119
Infections that cause parotitis
``` Viral - Historically, #1 cause was Mumps - Parainfluenza and EBV now most common - HIV Bacterial - Staph Aureus ```
120
aphthous ulcers commonly known as _______.
Canker sores
121
Treatment of aphthous ulcers
Self-limiting ½ hydrogen peroxide solution Corticosteroids
122
Most common bugs that cause acute OM, chronic OM, and OE
acute OM: strep chronic OM: Pseudo, H flu, staph, proteus OE: E. coli, Aspergillus
123
Cause of amaurosis fagut
carotid artery disease
124
How to treat cauliflower ear?
evacuation + abx + splinting
125
Risk of leaving cauliflower ear untreated?
cartilage necrosis
126
When to refer child for poor vision?
less than 20/40 or +2 line difference in eyes
127
ototoxic meds
furosemide (Lasix), gentamycin, aspirin
128
What treatment is contraindicated if herpes simplex keratitis suspected?
ophthalmic corticosteroids
129
eye with dendritic/branching ulcers =
HSV keratitis
130
Painless vision loss with optic DISC edema?
retinal vein occlusion

PANCE review (18 decks)

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