EENT Flashcards
What can “AV nicking” on fundoscopic exam signify?
Hypertension
Inspection of the macula
- patient should look directly into the light if macula is difficult to visualize
- Centered 2-2.5 disc diameters temporal to the optic disc; avascular
- Fovea centralis is a reflective area that looks darker and lies in the middle of the macula (Fovea centralis controls one’s sharpest vision)
Hyperopia
“Farsightedness”
Hard to see close
Myopia
“Nearsightedness”
Hard to see far away
Presbyopia
Common after age 40; difficulty maintaining clear focus at a near distance due to weakening and less flexibility in the lens
Arcus sinilis
Cloudy appearance of cornea with gray/white/blue arc or circle around the limbis due to deposition of lipid material; no effect on vision
Check lipid panel
Ptergyium
Raised, wedge-shaped growth of thin, noncancerous tissue over the conjunctiva
Often occurs with repeated exposure to wind, dry air
Hordeolum vs Chalazion
Usually caused by staph aureas
Hordeolum- acute, painful
Chalazion- beady nodule, painless, insidious
Blepharitis
Red, scale, greasy flakes
Thickened, crusted lid margins
Burning, itching, tearing
Hot compresses, topical abx (bacitracin, EEC), vigorously scrub lashes with eyes closed and rinse
Bacterial conjunctivitis
Purulent; self-limiting usually 72 hours max
Abx drops: levofloxacin, ofloxacin, ciprofloxacin, tobramycin, gentamycin
For copious green mucopurulent, consider gonococcal or chlamydial conjunctivitis
Tx: Ceftriaxone 250mg IM x1, 1gm azithromycin PO x1
Allergic conjunctivitis
Stringy, increased tearing
Tx: Oral antihistamines
Viral conjunctivitis
Watery
Symptomatic care
Does conjunctivitis present with pain?
No: May be burning or itching but no pain.
If PAINFUL red eye, consider corneal abrasion.
Inspection of the optic disc
Donut-like shape with orange/pink neuroretinal rim and central white depression
Cup should note be more than 1/2 size of the disc diameter (if larger, papilledema, consider glaucoma)
Glaucoma: open-angle
chronic increased IOP
cupping of disc, constriction of visual fields (tunnel vision)
Tx: refer, eye drops
Glaucoma: closed-angle
acute increased IOP
extreme PAIN, blurred vision, halo around lights, pupil dilated or fixed
Tx: refer, surgery
Tonometry
Annual screening for glaucoma
Start for all patients by age 40, all diabetics annually
Cataracts
Highest cause of treatable blindness
Causes: aging, trauma, drugs, alchohol, smoking, congenital, diabetes, AV sunlight exposure
S/sx: painLESS, clouded/blurred vision, halos around lights, difficulty with night vision, photosensitivity, diplopia in one eye, no red reflex, clouding/opacity of lens
Tx: Refer, surgery
Retinal detachment
Flashes of light (photopsia), especially in peripheral vision
Floaters in eye
Blurred vision
Shadow/blindness in part of visual field in one eye
Immediate referral for surgery
Otitis Externa
Acute localized furunculitis
Bacterial (usually Staph aureas), chronic, fungal, eczema, etc.
Tx: Clean/debride ear, topical otic drops (cortisporin), pain control (NSAIDs, topical corticosteroids)
Acute otitis media
most common: viral URI
most common bacterial pathogens: Strep pneumoniae, H. influenzae, M. catarrhalis
Erythema alone of TM is NOT diagnostic
Most uncomplicated cases resolve spontaneously; antibiotics only for suspected bacterial cases (Amoxicillin; if doesn’t work in 3 days, change to Augmentin)
Cholesteatoma
Chronic otitis media; may erode middle ear leading to nerve damage and deafness
S/sx: chronic infection, painless otorrhea, hearing loss, TM perforation
Tx: refer for surgery
Vertigo: causes
Most common: BPPV
Common causes: brain tumor, medications, OM, Meniere’s disease, acoustic neuroma, head or neck trauma, migraines, cerebellar hemorrhage
Vertigo: S/sx, Dx, Management
S/sx: positive Dix-Hallpike, n/v, sweating, nystagmus, tinnitis
Dx: CT scan, VDRL/RPR, serum medication levels, hearing exam, blood glucose/EKG may be useful
Tx: Diazepam, Meclizine, Diphenhydramine, Scopolamine, Antiemetics
Meniere’s disease
Sensorineural hearing loss + vertigo + tinnitis
Conductive hearing loss
Causes: Foreign body/cerumen, Perforated TM, Otitis media/externa
Weber: Sound lateralizes to AFFECTED ear
Rinne: Abnormal in affected ear (AC
Sensorineural hearing loss
Causes: damage to hair cells and/or nerves that sense sound waves: acoustic trauma, barotrauma, head trauma, ototoxic drugs, Meniere’s disease, Acoustic neuroma, infections
Weber: Sound lateralizes to UNAFFECTED ear
Rinne: Normal in affected ear (AC>BC)
Viral rhinitis
Common cold
self limiting 5-10 days
Rhinovirus, coronavirus, RSV, adenovirus
Pharyngitis/Tonsillitis: causative organisms
Viruses: RSV, flu A/B, Epstein Barr virus
Bacteria: Strep (only 10 percent of adult sore throats), gonorrhea
Strep throat: Centor criteria
Fever greater than 100.4F Lack of cough Exudate Anterior cervical adenopathy If strep +, treat with Penicillin V or erythromycin
Mononucleosis (Epstein Barr Virus)
fever, chills, MALAISE, severe pharyngitis, exudates, POSTERIOR cervical adenopathy, splenomegaly
Tx: prednisone taper for severely enlarged tonsils, avoid contact sports 3 weeks to 3 months, supportive care
Influenza
Fever, HA, myalgias, coryza, malaise, cough
Flu swab
Tx: antipyretics, neuraminidase inhibitors (Tamiflu)
Rhinosinusitis: causative organisms, Dx, Tx
Cause: Strep pneumonia, H. influenzae
Dx: culture as needed, CT scan, decreased transillumination
Tx: Antibiotics- Augmentin, clarithromycin (Biaxin)
