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EENT Flashcards

1
Q

Meds for severe UR disease c copious nasal drainage

Meds to prevent allergy symptoms

A

Topical decongestant (afrin nasal spray): 2 sprays q nostril BID x3d

Singulair (leukotriene modifier) to prevent s/s if used 1-4wks before

Benadryl or antihistamine spray can provide quick symptom relief in mild cases

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2
Q

Chalazion
Vs
Hordeolum

A

Chalazion is a chronic inflammatory lesion r/t blocked Zeis or meibomian tear glands
*Eyelid swells ~ painless ~ red ~ results in hard nodule.
RF: blepharitis, rosacea, carcinoma

Small= no tx; Med= warm compress; large/symptomatic = ophthalmologist for incision, curettage, drainage and glucocorticoid injection

Hordeolum is acute, painful, infectious and associated c blepharitis 
External lid (stye) tear gland or eyelid follicle 
Internal= meibomian gland under conjunctival eyelid

Hordeolum can scar and become chalazion

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3
Q

Weber Rine testing

Types of hearing loss

A

sensorineural hearing loss= lateralizes to the unaffected ear

conductive hearing loss= lateralizes to affected ear

Sound should be heard equally in both ears

Conductive think impaction
Sensorineural r/t infection= refer to specialist
Presbycusis is age related NOT conductive

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4
Q

Optic disc cupping

Cup-disc ratio

A

Abnormal finding associated c glaucoma

Caused by increased intraocular pressure and decreased blood flow leading to nerve damage

Donut like with central, white depression

The cup should be no more than half of the diameter of the disc

If the cup is too large suspect glaucoma and refer

WDL: sharp disc margins, A:V ratio of 2:3 or 4:5, + red reflex

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5
Q

Amsler Grid

A

Detects changes in the retina such as macular degeneration

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6
Q

Arcus senilis

A

Cornea appears cloudy with gray circle around the limbus. This is caused by deposits of cholesterol

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7
Q

Conjunctivitis

Viral vs bacterial

A

Eyelid swelling, itchiness, redness & burning

Purulent discharge is indicative of bacterial infection

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8
Q

Otorrhea

A

Painless drainage d/t ruptured eardrum but may also be present c otitis externa or cholesteatoma

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9
Q

Cholesteatoma

A

Keratinizing squamous epithelium in middle ear

S/s: recurrent ear infections, hearing loss (d/t nerve damage), otorrhea, destroys bones in middle ear, is often painless

Cholesteatoma is EMERGENCY

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10
Q

Myopia

Vs

Hyperopia

A

Nearsightedness – close objects can be seen

Farsightedness – close objects cannot be seen

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11
Q

Chronic open angle glaucoma

Vs

Primary closed angle glaucoma

A

Characterized by slow progression and increased interocular pressure >21mmhg
Tx: miotic agents (increase aqueous drainage), beta blockers (decrease pressure), alpha 2 adrenergnic receptor agonist (increase drainage & decrease aqueous production)

Characterized by acute increase in interocular pressure >40 mmHg
Tx: IV mannitol

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12
Q

Meds for allergic rhinitis

A

1st line is ID and avoid triggers

topical nasal steroid

Antihistamines: eye drops, nasal sprays & POs control s/s
*POs reduce inflammation, runny nose, congestion & itching

Anti-cholinergic nasal spray’s (atrovent) can be used to control symptoms such as runny nose

Corticosteroids are used only if inflammation is present

Avoid oral decongestant c HTN b/c their action on andrenergic receptors can increase BP

Avoid oral anticholinergics c other cholinergics (aricept) or sedatives (Xanax)

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13
Q

Polymylagia and vasculitis (giant cell temporal arteritis)

A

Giant cell temporal arteritis is the most common form of vasculitis

Referred to a rheumatologist

The most serious side effect is blindness

A blood clot could form leading to a stroke

S/s: non compressible temporal artery (giant cell temporal arteritis), HA (NOT migraine),
*often seen in pts c polymyalgia rheumatica (s/s shoulder, neck & hip stiffness)

Tx: long-term low dose corticosteroids

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14
Q

Streptococcus pneumoniae

A

1 cause of: acute bacterial rhinosinusitis, AOM and community acquired pneumonia

It’s gram positive

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15
Q

Meds for AOM

A

First line is Amoxicillin

Tx within last 30 days or at high risk for resistance then use Augmentin

PCN Alx: Azithromycin

Ampicillin IV is alt first line tx

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16
Q

Causes of vertigo

A

Meniere’s (vertigo and tinnitus)
MS
Migraines
benign positional - Dix-Hallpike test

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17
Q

Levofloxacin

A

Use Levaquin if patient has been treated with anti-microbial in the past 4 to 6 weeks

Otherwise: bactrim, azithromycin and doxycycline are good options

Levaquin is used to tx bacterial infections of skin, sinuses, kidneys, prostate and bladder

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18
Q

Dix-Hallpike test

A

Used to assess benign positional vertigo

Lie back quickly with head at 20 degree angle and observe eyes for rotational nystagmus

19
Q

Anti-cholinergic side effects

A

Dry mouth, blurred vision, sedation, constipation, hallucinations, memory impairment and difficulty urinating

20
Q

Malignancies

Squamous cell carcinomas

Basal cell carcinoma

Actinic keratosis

Seborrheic keratosis

A

Color variation, elevation, >6cm =biopsy this lesion

Irregular shaped papules c ulcerations that may crust and bleed

Basal: Slow growing, waxy/pearly, telangiectasias

AK: Flesh or pink hyperpigmentation, itch, burn, rough texture, bleed, tender located in sun exposed areas
Hypertrophic= thick scale on erythematous base
Atrophic= smooth red macules
Tx: liquid nitro or 5-fluorouracil

SK: nontender, brown or black or beige plaques
Tx:

21
Q

Psoriasis

A

Tar/salicylic acid shampoo and topical steroids if on scalp

22
Q

Tinea

A

Woods lamp test uses uv light to id fungal infection

Tinea capitis: scalp & beard
Tx: oral antifungal c topical

Tinea pedis
Tx: aluminum subacetate soaks

Tinea cruris- jock itch
Tx:

Tinea unguium- nails
Tx:

Tinea versicolor- hypo & hyperpigmentation
Tx: topical antifungal, selenium sulfide (Selsun blue) or ketoconazole

Griseofulvin can be used if topicals fail

23
Q

Lyme disease

A

Deer tick must be on skin for 36 hours

Rash takes 3 days to months to develop

Erythema migrans is ‘bullseye’, Western blot, enzyme-linked immunosorbent assay

Doxycycline is common first line tx >9yo

*most common vector born disease in US

24
Q

Keflex

A

Tx infections of the bone, middle ear, skin, respiratory tract and UTI
*no effective against MRSA

25
``` Atopic dermatitis (eczema) Vs Contact dermatitis Vs Psoriasis ```
Dry, itchy skin c plaques on hands, antecubital and popliteal folds, face and trunk Tx: colloidal oatmeal, moisturizers, systemic steroids & topical steroids Redness, erythema, swelling and scaling Hyperproliferative inflammation of the skin often appearing on extensor surfaces: scalp, knees, hands, nails and elbows. Silvery scales. *Auspitz sign (small bleeding points in scales)
26
Topical steroids
Hydrocortisone Triamcinalone Betamethasone (mid-medium range) Fluocinolone Clobetasol (highest potency)
27
Cat bite | *Pasteurella multocida
Tx wound by cleaning and dressing, PO augmentin Administer rabies vaccine Augmentin is 1st choice for wild animal bites Clindamycin is 2nd
28
Impetigo and Ecthyma
Topical antibiotics should be used except in severe cases Bullous & non bullous impetigo tx: Topical mupirocin or retapamulin BID x5d Oral tx x7d c agent effective against s. Aureus (unless culture shows only streptococci=PCN) S. Aureus impetigo or ecthyma tx: Dicloxacillin Cephalexin Suspicious for MRSA then tx: Bactrim Doxycycline Clindamycin DO NOT USE: erythromycin or azithromycin to tx impetigo d/t growing drug resistance
29
Pityriasis rosea
Acute inflammatory disorder herald patch -followed by Christmas tree distribution of lesions in folds/trunk lasts 6-8 weeks
30
Frostbite
1st degree: pain and tingling 2nd degree: redness swelling and sloughing 3rd degree: 4th degree: gangrene
31
Staphylococcus aureus Common causative agent in HS, carbuncles, foruncles and impetigo *when purulent
HS tx c Keflex, excision and drainage Impetigo tx c topical mupirocin or retapmulin OR PO x7d If MRSA suspected use doxy, clindamycin or bacterium
32
Cellulitis Erysipelas
Both are most commonly caused by streptococcus 1st is cellulitis purulent or nonpurulent? Evidence of SIRS? *healthy c no SIRS= PO abx as outpatient Nonpurulent= PO Clindamycin, cephalexin & amoxicillin-clauvinate Purulent= Bactrim, drainage, gram stain & cultures Erysipelas has sharply defined edges differentiating it from cellulitis
33
Burns
1st: skin is dry & eythematous 2nd: skin appears wet c blisters. Only epidermis is involved 3rd: skin is pale & white both epidermis and dermis age injured
34
Smallpox Vs Chickenpox
Both have 2-3mm vesicles Chickenpox: lesions should be in different stages of healing and child otherwise feels well Smallpox: lesions in same stage and child is seriously ill
35
Terms: Presbycusis Hyposomia Hypogeusia Presbyopia
Diminished hearing c age Decreased sense of smell '' taste '' focus on near objects
36
Sinusitis Acute vs chronic Viral vs bacterial
S/s: nasal congestion, facial pressure, cough, thick d/c Acute <10d vs chronic >12w ``` Bacterial: >10d Cleared then returns Purulent drainage Facial or tooth pain T >39 ``` Risk factors: allergic rhinitis, asthma Bacterial: augmentin PCN Allx doxycycline or levofloxacin/moxifloxacin
37
Sinusitis treatment
``` 1st line is augmentin since it covers H. Flu OR Doxycycline if allergic to PCN 2nd line respiratory fluoroquinolone *levoquin ``` X5-7d
38
GAS Symptoms Treatment
Cervical lymphadenopathy, ST, fever, PEDs stomach ache and rash, NO cough Centaur criteria before throat swab Tx: amoxicillin or augmentin (if tx <30d) Cephalosporin (cefdinir) If alx to PCN use azithromycin Tx to avoid acute glomerulonephritis, rheumatic fever, PANDAS, scarlet fever
39
Mononucleosis | *Epstein-Barr (EBV) or CMV
S/s: fatigue, ST, posterior symmetrical adenopathy, CBC c lymphocytes, elevated liver enzymes, atypical lymphocytes Return to sports after 3-4w without symptoms to avoid splenic rupture
40
Epistaxis
Tx: locate the site of bleeding and cauterize it. Referral if I can't find the site because it may be posterior. Cauterize c afrin or silver nitrate stick for anterior bleed or pediatric catheter balloon
41
Pharyngitis
Abx only for GAS PCN: 50mg/kg/day 7-10 days OR: omnicef, vantin, ceftin, keflex, bactocill, bactrim, duracef PCN Alx: azithromycin
42
AOM
>6m without symptoms tx c watchful waiting Tx: PCN 80-90mg/kg/day x7-10d PCN Alx Omnicef, Vantin or Ceftin Poor compliance Rocephin IM Recurrent Augmentin 80-90mg/kg/day (diarrhea) Supportive: Tylenol/ibuprofen (10mg/kg/q6-8h), fluids,
43
Acute otitis externa
tx: ciprofloxin, polymycin, oxyfloxin ear drops x7days No swimming x7d consider cost

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