EENT

Question 1

Most common bacterial pathogen in bacterial sinusitis, acute otitis media, & community acquired pneumonia?

Answer 1

Streptococcus pneumoniae (gram + diplococci)

Question 2

Common pathogen in bacterial rhino sinusitis, comm acquired pneumonia (particularly with tobacco use).

Answer 2

H. Influenza (gram - bacillus)

Question 3

Less common pathogen in bacterial rhino sinusitis, uncommon cause of comm acquired pneumonia

Answer 3

M. Catarrhalis (gram - coccus)

Question 4

Antibiotic resistance risk factors

Answer 4

Age 65
Daycare
Prior abt in the past month
Prior hospitalization w/in the past 5 days
Comorbidities 
Immunocompromised

Question 5

Symptomatic treatments for bacterial rhino sinusitis

Answer 5

Nasal saline irrigation
Intranasal corticosteroids (when accompanying allergic rhinitis)
Topical or systemic decongestant

Question 6

Treatment of bacterial rhino sinusitis (adults)

Answer 6

Duration- 10-14 days
1st line- amox./clavulanate 500/125mg po TID or 875/125mg BID, TMP/SMX (Bactrim), doxycycline

2nd line- amox/clavulanate 2000/125mg BID (? Resistance) or doxycycline 100mg BID or 200mg QD

PCN/ceph. Allergy- doxycycline 100mg BID or 200mg QD, or Levaquin 500mg QD (? Resistance) or Moxifloxacin 400mg QD (? Resistance)

Question 7

CYP450 3A4 substrate

Answer 7

Utilizes a specific enzymatic pathway.

Medication that is metabolized by the isoenzyme, utilizing this enzyme in order to be modified so it can reach drug site of action &/or be eliminated

Question 8

CYP450 3A4 inhibitor

Answer 8

Blocks a specific enzymatic pathway, keeps substrate (medication) from exiting (leads to toxicity)

Blocks the activity of the isoenzyme limiting substrate excretion, allowing increase of substrate levels & possible risk of substrate induced toxicity.

Question 9

CYP450 3A4 inducer

Answer 9

Pushes the substrate out the exit pathway.

Accelerates the activity of the isoenzyme so that substrate is pushed out the exit pathway, leading to reduction in substrate (medication) level.

Question 10

Treatments of allergic rhinitis

Answer 10

• Avoidance measures
• Controller meds (1st line- Intranasal corticosteroids, ex. Flonase, nasocort), add on treatment- singulair.
• Reliever meds (2nd gen antihistamines- Claritin, Zyrtec), Intranasal antihistamine- asteline, astepro) ocular antihistamine- patanol, pataday.
• Immunotherapy- ex-Xolair

Question 11

Characteristics of eye discharge with allergic conjunctivitis?
Bacterial conjunctivitis?
Viral conjunctivitis?

Answer 11

Allergic- ITCHING, stringy, rope like discharge, tearing, mild lid edema, bilateral conjunctival hyperemia.

Bacterial- UNILATERAL, mucopurulent discharge, crusty drainage in eyelids, conjunctival injection/hyperemia

Viral- watery discharge, acute onset, highly contagious, conjunctival hyperemia, edema.

Question 12

Clinical findings in closed-angle glaucoma?

Answer 12

A deeply cupped optic disc
Usually unilateral, acutely red, & painful (due to sudden increase in intraocular pressure)
Vision changes including halos around lights.

Question 13

Pt complaints with open-angle glaucoma?

Answer 13

Peripheral vision loss (due to gradual onset of increased intraocular pressure leading to optic atrophy)
Avoidable with appropriate, ongoing intervention

Question 14

Pt complaints with macular degeneration?

Clinical findings?

Answer 14

Painless vision changes including distortion of central vision (due to thickening, sclerotic changes in retinal basement membrane complex)
Clinical- Drusen (soft yellow deposits in the macular region) often visible with funduscopic exam.

Question 15

Ophthalmologic test for early detection of Macular degeneration?

Answer 15

Amsler grid test

Question 16

Ophthalmologic test for measuring intraocular pressure (test for glaucoma)

Answer 16

Tonometry

Question 17

Definition of Anosmia/hyposmia?

Answer 17

Diminished sense of smell, with resulting decline in fine taste discrimination (due to neural degeneration)
*accelerated by tobacco use

Question 18

Definition of presbycusis?

Answer 18

Difficulty with conversation in noisy environment. Person can hear, but it’s hard to understand what is said (due to loss of 8th CN sensitivity)

Question 19

Treatment of suppurative (purulent) conjunctivitis?

Answer 19

1st line- ophthalmic fluroquinolone (levofloxicin, Moxifloxacin)
Alternative- polymixin B with trimethoprim solution or azithromycin 1% ophthalmic solution. Tobramycin 0.3%, gentamicin 0.3% solution.

Question 20

Treatment of otitis externa?

Answer 20

Mild- acetic acid with propylene glycol & hydrocortisone gtts.
Moderate to severe- ciprofloxacin with hydrocortisone gtts.

Question 21

Treatment of Malignant otitis externa in pt with DM, HIV, or on chemotherapy? (Invasive form that can lead to osteomyelitis of cartilage/bone)

Answer 21

Oral ciprofloxacin for early disease, suitable for outpatient use.
Send to ER or ENT

Question 22

Treatment of exudative pharyngitis?

Answer 22

1st line- PCN VK po x10 days, or benzathine Pcn IM x1dose

Alternative- erythromycin x10 days, 2nd generation cephalosporin x4-6 days, azithromycin x5 days

Question 23

Treatment of otitis media?

Answer 23

Amoxicillin, azithromycin, augmentin, cefdinir (omnicef), clindamycin for persistent AOM

Question 24

What are nasal polyps?

What conditions are they seen with?

Answer 24

Pale, sack-like growths of tissue, that may be inflamed.

May be present with chronic allergic rhinitis, chronic sinusitis, asthma, ASA sensitivity, & cystic fibrosis.

Question 25

Diabetic retinopathy definition?

3 stages?

Answer 25

Damage to the retina caused by complications of Diabetes. 
Stages: 
1. Background DM retinopathy 
2. Pre-proliferative DM retinopathy 
3. Proliferative DM retinopathy

Question 26

Subjective & objective findings with DM retinopathy?

Answer 26

Sub- visual changes
Obj- microaneurysms, intra-retinal hemorrhage, macular edema, & lipid deposits.
Nerve layer infractions, COTTON WOOL SPOTS, venous dilation & retinal hemorrhage.

Question 27

Only pharmacological agent found to slow progression of DM retinopathy?

Answer 27

ACE inhibitor- Lisinopril

Question 28

Risk factors for Tinnitus?

Answer 28

Ménière’s disease, labyrinthitis, HTN, head trauma, thyroid dysfunction.
Meds with reversible effects-salicylate, quinine, indocin, alcohol.
Meds with irreversible effects- streptomycin, gentamicin, vancomycin (aminoglycosides)

Question 29

Management of tinnitus?

Answer 29

Avoidance of offending med- (such as ASA, NSAIDS)
Antidepressants may be helpful.
Supplements- (vitamin A, C, B12, nicotinic acid, magnesium or copper).
Tinnitus-masking devices.
Learning to cope with tinnitus is necessary.

Question 30

Temporomandibular Joint Disease TMJ definition & symptoms?

Answer 30

A cluster of disorders related to mastication.

Sx- (most common)-pain in the muscles of mastication, preauricular area, & tenporomandibular area.

Question 31

Treatment of TMJ?

Answer 31

PT, behavioral therapy.

Meds- NSAIDS, muscle relaxants, antidepressants, topical analgesics.