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Clinical Medicine I > EENT > Flashcards

EENT Flashcards

1
Q
A

Bacterial Conjunctivitis

  • Staph aureus (adults)
  • Strep pneumoniae, Haemophilus influenzae, Moraxella catarrhalis (children)
  • S/s: rapid onset, drainage causing sticky/matting of eyes
  • Tx
    • Azithromycin (1gt bid 2d, then 1gt daily 5d)
    • Bacitracin (1-2gtt q3-4h 7-10d)
    • Trimethoprim (1-2gtt q3-4h 7-10d)
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2
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Hyperacute Bacterial Conjunctivitis

  • Neisseria gonorrhoeae
  • S/s: severe discharge, lid swelling, chomosis (swelling of conjunctiva), VISION LOSS
  • Tx: hospitalization
    • Trimethoprim (1-2gtt q3-4h 7-10d)
    • Bacitracin (1-2gtt q3-4h 7-10d)
    • Azithromycin (1gt bid 2d, then 1gt daily 5d)
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3
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Viral Conjuntivitis

  • adenoviruses (common cold virus)
  • S/s: “scratchy/gritty” eye, may have hx upper respiratory prior, drainage thicker in morning/clearer as day progresses
  • Tx:
    • allow 2-3 weeks to resolve on its own
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4
Q
A

Allergic Conjunctivis

  • IgE mediated mast cell degranulation with release of histamine & others
  • S/s: itching, no significant discharge
  • Tx:
    • Olopatadine hydrochloride 0.1%/0.2% (Patanol)
    • Azelastine hydrochloride 0.05% (Optivar)
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5
Q

Nonallergic Conjuntivis

A
  • irritant or chemical exposure
  • Tx:
    • removal of foreign body
    • irrigation after chemical splash
    • removal of irritant and time
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6
Q

Dx of Conjunctivitis

A
  • no dx testing unless:
    • The presence of ocular pain, headache, foreign body sensation, fixed pupil and/or vision changes requires further investigation
    • always ask about contact lens wear
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7
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A

Uveitis (irititis)

  • inflammation of uvea structures: iris, ciliary body (anterior), choroid (posterior)
  • causes: infections, SID, drug rx, ocular disease
  • S/s:
    • anterior: PAIN, redness at limbus, photophobia
    • posterior: less pain, vision change/floaters
  • Tx:
    • refer to opthalmologist - slit lamp exam reveals leukocytes
    • ocular steroids (MD Rx only)
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8
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A

Bacterial Keratitis

Infection of the cornea: anterior surface of eye

  • Staph aureus, Pseudomonas, Strep pneumoniae, Klebsiella pneumoniae
  • contact lens wear, corticosteroid eye drops
  • Dx:
    • corneal round, white opactity visible w/ penlight
    • also acute red eye, discharge, foreign body sensation, photophobia
  • Tx:
    • emergency requiring same-day referal to opthalmology
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9
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A

Viral Keratitis

Infection of the cornea: anterior surface of eye

  • Herpes simplex 1 & 2 (latent HSV1 recurrence primarily)
  • laser UV tx; eye rx: corticosteroids, epiniphrine, b-blockers, prostaglandins; immunosuppressed
  • Dx:
    • dendritic lesions seen w/ fluorescein stain
    • blurred vision, injection near limbus, decr. corneal sensation, variable pain, watery drainage, photophobia
  • Tx:
    • refer to opthalmologist- will Rx topical antivirals NO topical steroids
    • Trifluorothymidine drops, ganciclovir gel, oral acyclovir
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10
Q
A

Episclaritis

inflammation of fine vascular tissue covering anterior sclera

  • idiopathic (rarely systemic: dry eye, TB/syphilis, immune-mediated rxn)
  • Dx:
    • very vascular: bright red, NO PAIN, no vision change
    • if recurring: CBC, CMP, UA, ESR, CRP for underlying disease
  • Tx:
    • referral to optholmologist
    • self-limited, resolves in ~3wks, artificial tears & NSAIDs for pain
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11
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A

Scleritis

white avascular, fibrous outer coating of eye

  • associated with systemic disease 50% of time - inflammation/infection
  • Dx:
    • deep red/purplish color to sclera
    • pain w/ palpation, severe, constant “boring” pain, radiating to periorbital region, worse with eye movement, can impair sleep
  • Tx:
    • URGENT refer to opthalmology - NSAIDs and immunosuppressants
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12
Q
A

Blepharitis

inflammation of both eyelids

  • thought to be staph colonization
  • Dx:
    • crusty/flaking skin on lashes, red/itchy eyes, gritty/burning, incr. tear, eyelid swelling/erythema, blurred vision
  • Tx:
    • lid hygiene: warm compress, massage, q-tip wash
    • topical Azithromycin (erythromycin topical, bacitracin oinment also)
    • oral abx: azithromycin, doxycycline, tetracycline
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13
Q
A

Corneal Abrasion

  • foreign body impacting the eye - history important
  • Dx:
    • fluorscein stain uptake
  • Tx (all topical):
    • rythromycin ointment -or- sulfacetamide
    • contanct lens abrasion:
      • ofloxacin
      • ciprofloxacin
      • tobramycin drops
    • REFER IF:
      • corneal infiltrate, white spot, ulceration (top & middle pic)
      • hypopyon: pus in anterior chamber (bottom pic)
      • increasing pain
      • significant vision change (2 lines on Snellan chart)
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14
Q
A

Hordoleum (“stye”)

  • Staph aureus (most commonly) but can be sterile
  • Dx:
    • acute/rapid onset w/ erythema
    • arises from eyelash follicle
  • Tx:
    • warm compresses qid
    • Abx not helpful unless cellulitis present
    • usually resolves on its own in 7-10 days
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15
Q
A

Chalazion “lazy one”

  • may begin as hordoleum and result with Zeis or Meibomian gland obstruction
  • Dx:
    • rubbery and painless, lacks erythema
  • Tx:
    • hot compresses - but can take weeks
    • refer to opthalmololgist for I&D or glucocorticoid injection if no resolution
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16
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A

Dacryoadenitis (Dacryo = tears)

  • S. aureus, S. pneumoniae, Pseudomonas, N. gonnorhoeae, measles, mumps, flu infection of lacrimal gland
  • Dx:
    • S-shaped eyelid
    • fever, fatigue, red/swollen eyelid, erythema of bulbar conjunctiva, tender to palpation
  • Tx:
    • CT of orbits and sinuses to rule out involvement
    • Abx:
      • Cephalexin (beware MRSA)
      • Clindamycin 150-300mg q6h
      • IV vancomycin followed by TMP-SMX PO
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17
Q
A

Daryocystitis (daryo = tears)

  • S. aureus, S. pneumoniae, H. influenza infection of lacrimal duct
  • Dx:
    • rapid onset of erythema/swelling of lacrimal gland
    • infection can spread to orbital cellulitis, abscess, or enter conjunctiva
    • infants & old w/ obstruction or narrowing of duct
  • Tx:
    • refer to opthalmologist
    • Abx:
      • cephalexin (beware MRSA)
      • clindamycin 150-300mg qid
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18
Q
A

Orbital Cellulitis

  • mcc: S. aureus, streptococci in ethmoid sinuses then extends
    • orbital (inflammation of extraocular mm. and fatty tissue):
      • ocular pain/swelling, fever, PAIN w/ EYE MOVEMENT, ophthalmoplegia/diplopia
      • can lead to abscesses, vision loss, cavernous sinus thrombosis, death
      • Tx:
        • CT to distinguish from preseptal
        • opthalmology consult w/ hospitalization
        • vancomycin+ceptriaxone/ampicillin-sulbactam/pipercillin-tazobactam
    • preseptal cellulitis (outside orbit):
      • ocular pain and swelling (milder)
      • clindamycin or TMP-SMX
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19
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A

Pterygium (the triangle)

  • triangular wedge of fibrous conjuntival tissue forming medially and extending laterally, due to UV exposure causing RNA/DNA change
  • mainly cosmetic but can involve cornea, impair vision, restrict movement
  • Tx:
    • supportive: artificial tears
    • surgery (but frequently recur)
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20
Q
A

Pinguecula

  • white to yellow thickened area of limbus, looks “fatty” and adjoins the limbus
  • often bilateral and more common with age
  • Tx:
    • topica corticosteroids and opthalmic NSAIDs (both carry long-term risks)
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21
Q
A

Entropion

  • INWARD rotation of eyelids
  • can cause corneal abrasions and scarring, sensation of foreign body, tearing and irritation worsens with time
  • Tx:
    • referral to opthalmologist for surgery
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22
Q
A

Ectropion

  • OUTWARD turning eyelid
  • acquired and congenital causes
  • exposes conjuntival surface causing keratinization of epithelium, foreign body sensation, dryness, photophobia, tearing, conjunctivitis, vision can be affected
  • Tx:
    • referral to opthalmology
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23
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A

Hyphema

  • blood in anterior chamber most commonly from trauma or spontaneous: tumors/melanoma, neovascularization disease (ex. diabetes), clotting disorders, warfarin/aspirin, sickle cell, surgery - in children possible abuse
  • Dx:
    • significant pain, vision loss, NAV, photophobia
  • Tx:
    • opthalmologist referral
    • address any trauma, eye sheild, bed rest/elevate head, avoid light
    • ocular anesthetics: Proparacaine
    • oral/IV narcotics
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24
Q
A

Subconjunctival Hemorrhage

  • bleeding in small vessels in conjunctiva that can look like blood will “pour out of eye” from sneezing, coughing, straining, vomiting
  • usually benign - no pain, photophobia, vision loss
  • resolves over 1-2 weeks
  • caveats:
    • in presense of trauma evaluate rupture of globe - opthalmologist referral
    • if recurrent evaluate for bleeding or dyscasias (imbalance in blood)
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25
Q
A

Cataracts

  • leading cause of blindness - progressive “myopic shift” from increasing opacity of lens
  • Dx:
    • darkened red reflex
    • opacities visible within red reflex
    • obscure fundus exam
  • Tx:
    • non-urgent referral to opthalmologist
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26
Q
A

Strabismus

  • misaligned eyes the majority of cases thought to be genetic but also palsy of cranial nerves controlling eyes, prematurity and low birth weight increase risk
  • if adult: think thyroid disease or myasthenia gravis
  • Eval:
    • history: birth & family hx, age of onset, freq., trauma, toxins, other med cond.
    • physical: complete incl neuro, PERRLA (pupils equal round reactive light accommodation), EOMI (extra occular movement intact), corneal light reflex, cover test
    • Bruckner Test: red reflection more intense in deviated eye
  • Tx: referral to pediatric opthalmologist
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27
Q

causes and treatments

A

Amblyopia (Lazy Eye)

  • any disorder where one eye functions better die to visual cortex development in early childhood - dominant eye “takes over” and other does not develop normally
  • crucial time period is age months to 7-8
  • Causes:
    • strabismus- varying images causes one to be suppressed (training, surgery)
    • anisometric amblyopia (unequal refraction)- born with significant refraction differences between eyes (glasses)
    • deprivation amblyopia- obstruction of image, usally results in vision loss if not treated quickly (remove/correct problem)
  • this is a referral
  • eye terminology:
    • hypotropia
    • hypertropia
    • exotropia
    • esotropia
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28
Q
A

Central Retinal Artery Occlusion (CRAO)

  • “stroke of the arteries of the eye” most commonly caused by atherosclerosis
  • S/s:
    • acute onset vision loss (painless) - can be preceeded by transient loss
  • Dx:
    • cherry red spot on macula (“Jupiter”)
    • complete or relative pupillary afferent defect
    • >50 get ESR and CRP to check for temporal arteritis
  • Tx:
    • SEND TO ER: opthalmic emergency
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29
Q
A

Central Retinal Vein Occlusion (CRVO)

  • 2nd most common vascular cause of blindness after diabetes
  • Types:
    • CRVO- entire retina affected by thrombus
    • branch RVO- distal retina involved
    • HemiRetinal VO- half of retina involved
  • Dx:
    • acute onset of painless vision loss
    • “blood and thunder” appearance (Venus/venous)
    • “cotton wool” spots
  • Tx: immediate referral to opthalmologist
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30
Q
A

Retial Detachment

  • separation of neurosensory retina from underlying retinal pigment epithelium and choroid (“folded appearance” of retina) - typically due to trauma, surgery, CMV retinitis, myopia, flouroquinolones
  • S/s:
    • photopsia (flashing light), floaters, “curtain falling”
  • Dx:
    • visual acuity test, confrontational visual field test, opthalmoscopy
  • Tx:
    • immediate referral to opthalmologist
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31
Q
A

Age Related Macular Degeneration (AMD)

  • degeneration of macula due to age, tobacco, genetics, CVD, hx cataract surgery
  • Dry:
    • slow/gradual vision loss
    • scotomas (blind spot)
    • difficulty reading
  • Wet:
    • loss of central vision over weeks/months (can start in one and progress
    • Metamorphopsia (distortion in visual field- Amsler grid)
  • Tx: opthalmology referral
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32
Q
A

Open Angle Glaucoma (90%)

  • diminished drainage of aqueous humor through trabecular meshwork
  • risks: AA >40, diabetes, myopia, fam hx
  • Dx:
    • cupping of optic disc head
    • asymptomatic peripheral vision loss
    • increased intraocular pressure (33-50% of pts.)
  • Tx: w/ opthalmologist (topical tx or surgery)
    • incr. outflow: prostaglandins, a-adrenergic/cholinergic agonists
    • decr. aq. prod.: a-adrenergic agonists, b-blockers, carbonic anydrase inhib.
33
Q

headache

decreased vision

halos

eye pain

NAV

cloudy cornea, conjuntival redness, shallow anterior chamber, poorly reactive pupil

A

Angle Closure Glaucoma

  • lens too far foward and abducts iris stopping flow of aqeuous humor
  • S/s:
    • dramatic vision loss in hours-days
  • Tx:
    • EMERGENCY- send to ER or opthalmology immediately
    • b-blocker and other meds then laser iridotomy
34
Q
A

Diabetic Retinopathy

  • prolonged/chronic hyperglycemia
  • Non-proliferative:
    • early in disease (end 10-20yrs)
    • microaneurysms, hemorrhages, cotton-wool spots (nerve infarcts), lipid deposits
  • Proliferative:
    • growth of new vessels (neoplasia)
  • Tx:
    • annual monitoring/exams
    • laser photocoagulation of vessels
35
Q
A

Vitreous Hemorrhage (clear gel-like substance filling eye)

  • aging/trauma/DM causes liquification and shrinking then posterior vitreous detachment (PVD) and bleeding
  • Dx:
    • bleeding, vision loss, floaters, blurring, cobwebs
  • Tx:
    • emergent opthalmology referral if trauma/tear
    • surgery by retinal specialist
36
Q

flame hemorrhages

hard exudates (“yellow fat”)

AV nicking and narrowing

cotton wool spots

A

Hypertensive Retinopathy

  • malignant HTN causing changes in retina, choroid and optic nerve - blindness or vision changes rare
  • Tx:
    • treat underlying HTN
37
Q
A

Malignant Hypertension

  • optic disk swelling: BP > 200/130, increased ICP
  • S/s:
    • headache, scotoma, diplopia, decreased vision, photopsias (flashes of light)
    • more damaging than chronic HTN
  • Tx:
    • rapid lowering of BP: 10-15% first hr and 25% by end of day
38
Q

warm, swollen, red auricle

A

Perichondritis

  • Pseudomonas (mcc), S. aureus, S. pyogenes: piercings, cuts, burns, sports
  • Dx:
    • compare ears facing forward
  • Tx:
    • Flouroquinolones-
      • Levofloxacin 750mg qd x 7d
      • Ciprofloxacin 500mg bid x 7d
    • remove all ear jewelry
    • 48-72hr follow-up and ENT immediately if no improvement
39
Q
A

Cerumen Impaction

  • apocrine and eccrine gland secretions mix with squamous epithelium to form ph4-5 protective cerumen
  • Dx:
    • visual observation, hearing loss, pain or onset of otalgia

Tx (removal):

  • OTC Debrox (carbamide peroxide)
  • irrigation w/ hydrogen peroxide
  • DO NOT FLUSH if TM perforated or cannot confirm
40
Q

rapid onset of pain

tenderness w/ tragus palpation

otorrhea

white/yellow cerumen appearance

edamatous canal

A

Otitis Externa (“swimmer’s ear”)

  • Principles of Tx:
    • pain management
    • remove debris
    • topical meds
    • avoid contributing factors (water, etc)
41
Q
A

Acute Infective Otitis Media

  • typically swimmers
  • Tx:
    • debridement
    • topical therapy:
      • ciprofloxacin/hydrocortisone (Cipro HC)
      • ciprofloxacin/dexamethasone (Ciprodex)
      • hydrocortosone/acetic acid (bacterial or fungal)
    • ruptured TM: Ofloxacin otic drops
    • Otowick if canal swollen
42
Q
A

Necrotizing Malignant Otitis Media

  • granulation tissue or exposed bone, purulent otorrhea > 1mo, persistent otalgia
  • cranial n. involvement and facial palsy
  • Tx:
    • Hospital admission
    • CT scan for temporal bone involvement and culture
    • surgical debridment
    • IV Ciprofloxacin
43
Q
A

Fungal Otitis Externa (Otomycosis)

  • aspergillus (mcc) often from abx overtreatment or trapped moisture
  • Dx:
    • thick white/gray discharge or fuzzy appearance
  • Tx:
    • Acetic acid otic (VoSol) EXCEPT if TM perforated - refer to ENT
44
Q
A

Eczematous Otitis Media

  • includes: atopic dermatitis, psoriasis, lupus, eczema
  • dry, itchy, flaky skin
  • Tx:
    • topical steroid drops
      • Fluoinolone otic (DermOtic)
45
Q
A

Herpes Zoster Oticus

  • “shingles of the ear” - burning pain followed by eruption of rash
  • Ramsay-Hunt Syndrome
  • Tx:
    • antivirals
      • Acyclovir
      • Famciclovir
      • Valcyclovir
    • oral steroid: prednisone
46
Q
A

Normal Tympanic Membrane

  • cone of light indicates no fluid or infection behind membrane
48
Q
  • retracted tympanic membrane (measured w/ tympanogram)
  • short process of malleolus at 12 o’clock position appears shorter
  • S/s:
    • conductive hearing loss
    • sensation of fullness
    • gurgling, crackling, popping/snapping noises in ear
    • decreased TM mobility
    • allergic symptoms
A

Eustacian Tube Dysfunction (ETD)

  • Tx (treat the source):
    • oral decongestant- pseudoefedrine (Sudafed) 60mg PO q8hr
    • intranasal decongestant - oxymetabolism (Afrin)
    • antihistamines
      • Allegra 180mg/day
      • Loratadine 10mg/day
    • expectorant - Mucinex OTC
    • no improvement after 6 weeks consider myringotomy with tubes
49
Q

Non-Otologic Causes of Otalgia (ear pain)

A

normal appearance of canal and TM

  • malignancy:
    • nasopharynx, pharynx, tonsil, tongue, larynx
    • tobacco/alcohol
  • infection
    • herpes zoster, tonsillitis
  • neurologic
    • trigeminal neuraligia (Tx: carbamazepine- anticonvulsant)
  • TMJ
    • pain/clicking with jaw movement, bruxism - grinding
      • refer to dentist, NSAIDs, mm relaxants, mouth splints
50
Q
A

Serous Otitis Media

  • “honey” behind TM
  • Tx
    • watchful waiting (3mo) as often resolves spontaneously- eval hear/speech
    • autoinsufflation (“popping ears”)
    • decongestants
      • pseudoepedrine (Sudafed) / phenylephrine (Sudafed PE)
    • antihistamines
    • myringotomy for persistent cases
    • Abx not recommended (but often used)
51
Q

mild to severe/disabling otalgia (unilateral or bilateral)

children may have fever, NAV, diarrhea

hearing loss, irritability

A

Acute Otitis Media

  • bacterial or viral infection (may be associated with upper respiratory symtoms and fever)
    • bacteria (head big 3): H. influenza, M. catarrhalis, Group A strep
    • virus: RSV, corona virus, adenovirus, influenza, human metapneumovirus
  • if neurologic signs (headache, confusion, facial paralysis, vertigo) - send to ER
52
Q
A

Acute Otitis Media Bullous Myringitis

  • appearance of hemorrhagic blebs on TM resulting from infection
54
Q

Otitis Media Definitions

A
  • Acute “suppurative” OM
    • inflammation of the middle ear and TM - viral or bacterial infection
  • Serous “non-suppurative” OM
    • residual effusion post-acute infection or related to ETD
    • acute: <3wk, subacute: 3wk-3mo, chronic: >3mo
  • Chronic OM
    • infection present in middle ear with tympanic membrane perforation
    • may have cholesteatoma
55
Q
A

Mastoiditis

  • complication of acute otitis media days-weeks after onset
  • strep pneumoniae infection of mastoid air cells
  • Tx:
    • Vancomycin + ceftriaxone IV
    • culture if no improvement with Abx after 48hrs
    • mastoidectomy if tx fails
  • Cx:
    • perforation of TM or postauricular subperiosteal abscess
    • temporal lobe abscess or septic thrombosis of the lateral sinus
56
Q
A

Chronic Otitis Media

  • can result from AOM or eustachian tube obstruction, mechanical trauma, blasts, PE tube, thermal/chemical burns
  • Dx:
    • P. aeruginosa, Proteus species, S. aureus infections
    • Drainage cultured if: choleseatoma or other complications suspected
      • febrile patient / vertigo / otalgia
    • CT or MRI to check for labyrinthitis, ossicular, temporal erosion and abscesses
57
Q
A

Cholesteatoma

  • prolonged ETD and retraction of TM creating squamous lined sac filled with desquamated keratin leading to chronic infection
  • erodes bone and ossicular chain, affects facial nerve over time
  • Tx:
    • surgery
59
Q
A

Tympanosclerosis

  • hard white plaque on the TM (“scarring” of the TM)- fibrosis due to frequent infections causing hemorrhage in the layers of the TM
  • asymptomatic but cat lead to conductive hearing loss
  • Tx:
    • none if asymptomatic
    • if hearing loss: explore tympanotomy or tympanoplasty
    • hearing aid
60
Q
A

Tympanic Membrane Perforation

  • due to infection, trauma, PE tube placement
  • S/s:
    • sudden severe pain (if traumatic) then bleeding from ear
    • hearing loss is ossicular chain disrupted
    • tinnitus
    • vertigo suggests inner ear injury
    • audible whistling during sneezing/nose blowing
    • purulent otorrhea- may begin after 24-48hrs if water enters
  • Tx:
    • NO air or irrigation of canal until perforation is ruled out
    • no tx if acute due to trauma- keep ear dry
    • topical abx if due to infection or contaminated water
    • surgery if perforation lasts >2mo
      • spontaneous closure if right size, location, associated patho condition
        *
63
Q

Tx of Acute Otitis Media in Children

A
  • acetaminophen or ibuprophen for pain
  • antihistamines & decongestants NOT effective in children unless allergies
  • NO OTC COLD MEDS if <6
  • Auralgan drops OTC
  • Tx or watchful waiting:
    • <6 mo OR 6mo-2yr w/ bilateral OM - treat
    • 6mo-2yr w/ unilateral - observe 48-72hr or treat
    • 2+yr - treat is severe symptoms, if mild can observe w/ follow-up and agreement b/t parents and HCP
    • Abx:
      • Amoxicillin 90mg/kg divided 2 doses (max 3gm/d) unless:
        • given in last 30 days (resistance)
        • concurrent purulent conjunctivitis
        • PCN allergy
      • Cefdinir
64
Q

Tx of Otitis Media in Adults

A
  • Amoxicillin 875 mg PO BID -or- 500mg TID 5-7d / 10d if severe
  • if PCN allergy:
    • Azithromycin (Z-pak) 500mg on day 1, then 250mg days 2-5
    • Clarithromycin 500mg bid
68
Q

Chronic OM Tx

A
  • keep ear dry, cleaned/debrided, granulation tissue removed
  • topical corticosteroids and abx
  • systemic abx and surgery for severe cases only
    • attic perforations or chronic central TM- tympanoplasty
    • cholstesteatoma or mastoid invovlement w/ TM perf- mastoidectomy and tympanoplasty
71
Q
  • SERIOUS: abnormal replacement of normal bone with sponiotic or sclerotic bone- leads to fixation of stapes to margins of oval window
  • results in progressive bilateral conductive hearing loss
  • strong genetic inheritance
  • mostly caucasians and 2x more likely in females
A

Otosclerosis

  • Dx:
    • hx, audiogram, progressive conductive HL
    • exacerbated by pregnancy and estrogen therapy
    • often presents in 3rd decade of life
  • Tx:
    • hearing aids (temporary)
    • surgery: total/partial stapedectomy
72
Q
A

Leukopenia

pre-malignant lesion

  • white keratotic plaque that cannot be wiped away
  • may show dysplasia
73
Q
A

Erythroplakia

premalignant lesion

  • red plaque-like lesion with HIGHER risk of developing into oral cancer than leukoplakia
  • more likely to occur on buccal & mandibular mucosa, palate, tongue, floor of mouth- may show dysplasia
74
Q

Oral Cancer Exam

A
  • if SMOKER/DRINKER and mouth/neck issues keep CA in differential
  • cervical lymph node enlargement
  • difficulty speaking if tongue affected
  • numbness of chin if lesion on lip and affects mental nerve
75
Q

Features Suggestive of Oral Cancer

A
  • tooth mobility of unknown cause**
  • non-healing dental extraction site**
  • unexplained ulceration
  • unexplained red and white patches that are painful, swollen, bleeding
  • unexplained ear pain/neck pain - esp. w/ limited mouth opening but normal otoscopy
  • irregular pigmented mucosal areas (suggestive of melanoma)
  • tongue numbness or fixation
  • TX:
    • referral to dentist
76
Q
A

Geographic Tongue (benign migratory glossitis)

Non-cancerous lesion

  • cause unknown (may be linked to psoriasis)
  • Tx:
    • no tx necessary and not contageous
77
Q
A

Torus Palatinus

Non-cancerous lesion

  • bony prominance of the hard palate- composed of bone, linked to genetics
  • Tx:
    • surgically removed if causes pain or discomfort
79
Q
A

Paranasal Sinus Cancer

  • CA usually affecting maxillary sinuses (sometimes ethmoid), uncommon
  • Risks: chem exposure/pollution, tobacco, HPV
  • Dx:
    • looks like sinusitis or asymptomatic
    • facial pain, dental pain, nasal obstruction, epistaxis- perisistant/chronic
    • CT of mass
  • Tx:
    • surgical resection (endoscopic)
    • radiation (sometimes chemo)
80
Q
  • Risk:
    • acohol, tobacco, HPV infection (16,18,31,33)
    • young men if no alc/tob, mult sexual partners
  • S/s:
    • dysphagia
    • throat pain/fullness
    • oral bleeding
    • referred ear pain
    • voice changes
  • 2 WEEK time limit on throat pain/symtoms
A

Orophryngeal Cancer

86
Q
  • cancer associated with salted/cured foods, Chinese herbs, rancid butter/sheep’s fat and my be triggered by reactivation of EBV
  • In US/Europe associated with tobacco and alcohol use (maybe HPV)
  • S/s (triad):
    • neck mass
    • serous OM and resultant hearing loss / tinnitis
    • nasal obstruction or pain
  • Tx:
    • referral to ENT
    • CT, small mirror/nasophayngoscope visualization, biopsy
A

Nasopharyngeal Cancer

89
Q

Diagnosing Tumors of Head & Neck

A
  • Thorough Hx:
    • tobacco and alcohol use especially
    • length of symptoms (normal throat pain/symtoms resolve in 2 weeks)
    • fatigue, weight loss, appetite loss/dysphagia, spread to other organs
  • Complete physical:
    • Full HEENT and oral exam
    • Full lymphantic system exam
    • Full cardiovascular and respiratory exam
  • ENT referral
    • CT -> panendoscopy -> biopsy -> Tx based on TNM staging (tumor, lymph node, metastases)
90
Q

Infection & Allergy Symptoms

A
  • Bacterial
    • mild/moderate pain, red eye, foreign body sensation, purulent discharge, glued eyes on awakinging, unilateral
  • Viral
    • no/mild pain, gritty sensation, watery discharge, unilateral, upper respiratory infection (URI)
  • Herpes
    • pain and tingling followed by rash and conjunctivitis
  • Allergic
    • BILATERAL, tearing, intense itching, stringy discharge, diffuse hyperemia
91
Q

Infective Agents

A
  • Bacterial
    • S. pneumoniae, H. flu, S. aureus, chlamydia, gonorrhea
  • Viral
    • adenovirus, herpes zoster
  • Contact lenses - pseudomonas
92
Q

Viral Tx

A
  • No meds usually
  • NO STEROIDS- prevent healing, glaucoma risk
  • cold compresses
  • ocular decongestants to reduce redness (avoid)
    • oxymetazoline, tetrahydozoline (eg. Visene)
  • artificial tears
  • Herpes:
    • trifluridine drops (Viroptic)
    • oral antivirals for systemic infections
93
Q

Bacterial Tx

A
  • normally self-limiting and resolve within a week (except gonorrhea)
  • think about what is most likely to cause infection, cost, friendliness of course
  • Gentamicin/Tobramycin toxic- but may need to be used b/c G-
  • Frequent:
    • Moxifloxacin
94
Q

Allergic Conjuntivitis Tx

A
  • Antihistamines:
    • Azelastine (Optivar)
    • Emedastine (Emadine)
    • Ketotifen (Zaditor, Alaway, etc) OTC
  • Mast cell stabilizers
    • not as effective
95
Q

Ocular NSAIDs & Steroids

A
  • NSAIDs:
    • block COX-1 (platelett aggregation) & COX-2 (pain, inflammation)
    • use: opthalmic procedures post op
    • SE: delayed woud healing, keratitis, reactivate HPV
  • Steroids:
    • block phospholipase A2 -> blocks COX-1 & COX-2
    • opthalmic injury, post op, anterior uveitis
    • SE: do not use if infection (may cause), glaucoma/nerve damage/cataracts, increased intraocular pressure, delayed healing, no contact wear with loteprednol
96
Q

Glaucoma Tx

A
  • prostaglandin analogs
    • reduce IOP via increases uviscleral outflow in open-angle glaucoma
    • SE:
      • increased/misdirected eyelash growth, herpes activation, allergy, hyperpigmentation, migrane, keratitis
    • Rx (1x at night):
      • Latanoprost (Xalatan)
      • Bimatoprost (Lumigan)
      • Travoprost (Travatan Z)
      • Tafluprost (Zioptan)
  • Beta-blockers
    • decrease beta-receptor stimulation production of aqueous humor
    • SE: allergy, keratitis, systemic effects (cardio)
    • Rx (BID):
      • Betaxolol (Betoptic-S)

◦Far more selective for beta-2

    * Timolol (Betimol, Istalol, Timoptic, Timoptic-XE)

◦Non-selective

◦Short-term escape, long-term drift

    * Carteolol
    * Levobunolol (Betagan)
    * Metipranolol

Clinical Medicine I (8 decks)

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