EENT Flashcards
To dx strep you have a sore throat + Centor Criteria. What is Centor Criteria?
- Fever >38C or 100.4F
- Pharyngotonsillar exudates
- Tender ANTERIOR cervical LAD
- NO cough
- High negative predictive value
Definitive dx for strep throat is ____.
Throat culture
Treatment for strep is ____.
1st line: Pen G or VK, Amoxicillin, Augmentin
____ is MC sinus affected in sinusitis.
Maxillary
Maxillary>Ethmoid>Frontal>Sphenoid
How is sinusitis diagnosed?
Clinical dx
CT scan is diagnostic test of choice
How is sinusitis treated?
<7 days= symptomatic
10-14+ or lots of facial swelling or febrile= AMOXICILLIN
Chronic sinusitis lasts > ___ weeks.
12
Fungal sinusitis is treated with _____.
IV Amphotericin B
*May be associated with black eschar on palate, face
Aphthous ulcers (canker sores) are treated with:
- topical analgesics
- topical oral steroids (Triamcinolone in orabase)
Inflammation of BOTH eyelids is known as ____.
Blepharitis
*Esp w/ Down syndrome and eczema
Two types of blepharitis are ____ and ____.
- Anterior- involves skin and base of eyelashes
- Posterior- meibomian gland dysfunction (associated with rosacea and allergic derm)
* Often see red-rimming of eyelid with these
Treatment of blepharitis involves:
- Anterior- eyelid hygiene +/- ABX like azithro solution/ointment
- Posterior- eyelid hygiene, regular massage/expression of the Meibomian gland
Preauricular LAD, copious watery d/c from eyes, often bilateral, +/- punctate staining is associated with _____.
Viral conjunctivitis
*Treatment- supportive +/- antihistamines
Mgmt of allergic conjunctivitis:
Topical antihistamines like Olopatadine and Naphcon A, topical NSAID- Ketorolac
Purulent ocular d/c, crusting, and NO visual changes are associated with ______.
Bacterial conjunctivitis
*Treatment- Erythromycin, FQs (Moxifloxacin), if contact lens wearer cover Pseudo w/ FQ or AG
- *GC Conjuntivitis- IV Rocephin
- **Chlam Conjunctivitis- Azithro
Neonatal conjunctivitis is most likely…
If shows up on…
- Day 1: Silver nitrate
- Day 2-5: Gonococcal
- Day 5-7: Chlamydia
- Day 7-11: HSV
*Prophylaxis immediately after birth= Erythro ointment
Infxn of the lacrimal sac is known as _____.
Dacryocystitis
*Treatment for acute- PO ABX (clinda, vanc + rocephin)
Local abscess of the eyelid margin MC caused by Staph Aureus is known as _____.
Hordeolum (Stye)
- External- infxn of eyelash follicle or external sebaceous glands
- *Internal- inflammation/infxn of Meibomian gland
Warm compresses mainstay of treatment!
*topical ABX if actively draining
A painless granuloma of the internal meibomian sebaceous gland w/ focal eyelid swelling is known as _____. It is often larger, firmer, and slower growing/less painful than a hordeola.
Chalazion
Inflammation of the vestibular portion of CNVIII that is MC after a viral infxn w/ associated peripheral vertigo (usually continuous), dizziness, and horizontal nystagmus is known as _____.
Vestibular Neuritis
Vestibular neuritis + hearing loss/tinnitus is known as _____.
Labyrinthitis
What is the treatment of Vestibular neuritis and Labyrinthitis?
CORTICOSTEROIDS. If symptomatic then Meclizine, benzos
An abnormal sound in the ear that is often a neurologic response to hearing loss or meds (ASA) is known as _____.
Tinnitus
Treatment-
- SNHL: no proven tx
- Correctable HL: wax, fluid, TM perf, stop meds, avoid caffeine/nicotine
MC cause of Swimmer’s ear is _____.
Pseudomonas
How is otitis externa managed?
- Protect ear against moisture- isopropyl alcohol and acetic acid
- Topical Abx: Ofloxacin is safe w/ TM perf (Cipro + Dexamethasone)
- Aminoglycoside combo- NOT if TM is perforated
- Fungal: Amphotericin B
- Malignant OE- Osteomyelitis at skull base- treat with EMERGENT IV antipseudomonal ABX
____ is MC preceded by viral URI and the peak age of onset is 6-18 months. It is due to eustachian tube dysfunction in kids with wider, shorter, and more horizontal tubes.
Otitis Media
PE findings for otitis media are:
Bulging, erythematous TM w/ effusion and loss of landmarks.
-If bullae on TM suspect Mycoplasma pneum.
In children w/ recurrent otitis media you should order what imaging and labwork?
CT scan and workup for iron deficiency anemia
______ often develops as a cyst that sheds layers of old skin. It can develop in the middle section of your ear behind your eardrum and is most commonly caused by repeated cases of AOM.
Cholesteatoma
Chronic otitis media is managed with:
Topical ABX- Ofloxacin or Ciprofloxacin
-Avoid water/moisture/topical AGs in ear with TM rupture
Acute ear pain, hearing loss, +/- bloody otorrhea, +/- tinnitus/vertigo is associated with ____.
TM rupture
*MC due to penetrating/noise trauma
When eyelid and lashes turn outward this is known as ____.
Ectropion
-usually bilateral and in elderly
When eyelid and lashes turn inward this is known as _____.
Entropion
- MC in elderly
- Eyelashes may cause corneal abrasions/ulcerations
W/ suspected corneal abrasion you want to do what first?
Check visual acuity!!
Then…
- FB removal w/ sterile irrigation
- Patch eye if abrasion is >5mm, but no more than 24hrs OR if contacts/pseudo
- ABX drops- Erythromycin, Cipro, etc.
*24hr Ophtho f/u!!!
Pain, photophobia, reduced vision, tearing, and conjunctival erythema/injection is MC associated with _____. Usually bacterial cause.
Corneal ulcer/Keratitis
CILIARY INJECTION (LIMBIC FLUSH) on PE is associated with _____.
Corneal ulcer
Hazy cornea, ulcer, stromal abscess, +/- hypopyon is associated with _____.
Bacterial keratitis
*Treat with FQ drops. DO NOT PATCH EYE
Dendritic lesions (branching seen w/ fluorescein staining) are associated with _____.
HSV keratitis
*Treat w/ topical antivirals or PO acyclovir
_______ is an ophtho emergency that is associated w/ increased IOP and is precipitated by dim lights, sympathomimetics, and anticholinergics.
Acute angle closure glaucoma
S/s of acute angle closure glaucoma are:
Severe, sudden onset of unilateral ocular pain +/- N/V, HA
- Vision changes: intermittent blurring, halos around lights, tunnel vision
- PE: non-reactive pupil that feels hard on palpation
Treatment of acute angle closure glaucoma involves lowering the IOP and opening the angle. This is done with:
- Lowering IOP- Acetazolamide, BB (Timolol), mannitol
- Opening angle- Cholinergics
* Definitive treatment= peripheral iridotomy!!
Slow, progressive BILATERAL peripheral vision loss that is the 2nd MC cause of blindness in the world after cataracts is _____.
Chronic Open Angle Glaucoma
- PAINLESS
- *PE= increased cup to disc ratio!
Treatment options for open angle glaucoma are:
1st line- PGE analogs (Latanoprost): greater reduction in IOP!
- Timolol, Brimonidine (a-2 agonist), Acetazolamide (reduces IOP)
- Laser therapy if all else fails, Surgery is last line
Blood in the anterior chamber of the eye is known as _____.
Hyphema
*Requires immediate eval by ophtho!!
MC cause of permanent legal blindness and visual loss in elderly is _____. RFs include: >50y, caucasian, females, smokers.
Macular degeneration
Gradual blurring of central vision w/ DRUSEN bodies seen on eye exam is associated with ____ (dry/wet) macular degeneration.
Dry (Atrophic)
When new, abnormal vessels grow under the central retina and leak causing retinal scarring this is known as _____.
Wet macular degeneration
Bilateral blurred or loss of central vision w/ scotomas (blind spots/shadow) is associated with _____.
Macular degeneration
Wet macular degeneration is dx with _______.
Fluorescein angiography
How are dry and wet macular degeneration managed?
Dry: Amsler grid at home, zinc, vitamin A, C, and E may slow progression
Wet: Bevacizumab- VEGF inhibitor that reduces neovascularization
WBCs in the anterior chamber is known as _____.
Hypopyon
The leading cause of blindness worldwide is _____.
Cataracts
Progressive blurring of vision that is painless and usually bilateral w/ decreased color perception, decreased visual acuity, and possible double vision is associated with what eye abnormality?
Cataracts
Eye exam of cataracts reveals translucent, yellow discoloration in the ____.
Lens
*Treatment initially- eyeglasses or contacts Rx changes, tobacco cessation, UV protection. Surgical extraction is recommended for functional impairment.
Optic nerve (disc) swelling secondary to increased ICP- usually bilateral- is associated with what diagnosis?
Papilledema
Some causes of papilledema are:
- Idiopathic intracranial HTN
- Space-occupying lesion: tumor or abscess
- CSF production
- Cerebral edema, severe HTN
S/s of papilledema are:
HA, N/V, vision is usually well preserved
Dx of papilledema entails first getting a ___ or ____ to r/o mass effect.
MRI or CT
Papilledema treated with diuretics like Acetazolamide to decrease production of aqueous humor and CSF.
FYI
See table on p. 34
Just take a peak!
Optic neuritis is MC in what age group?
20-40y
The MC cause of optic neuritis is ____.
Multiple Sclerosis
S/s of optic neuritis are:
Loss of color vision, UNILATERAL vision loss over a FEW DAYS. Associated with OCULAR PAIN that is worse with movement.
Marcus-Gunn Pupil is associated with what diagnosis?
Optic neuritis
What is the mainstay of treatment for optic neuritis?
Methylprednisolone followed by oral corticosteroids- vision usually returns
An elevated, superficial fleshly triangular shaped “growing” fibrovascular mass is known as _____.
Pterygium
- MC in inner corner/nasal side of eye
- *Assoc with UV exposure and sand, wind, and dust exposure
- **Usually just observe it- can remove if growth affects vision
A yellow, elevated nodule on the nasal side of the sclera that DOES NOT GROW is known as ____.
Pinguecula
*Can usually just observe
Photopsia (flashing lights) with floaters and progressive vision loss is associated with _____. May also see a shadow “curtain coming down” in periphery initially.
Retinal detachment
*NO PAIN/REDNESS
How is retinal detachment managed?
Emergency!! Keep patient supine while awaiting consult. Treated with laser, cryotherapy, ocular surgery.
Transient retinal ischemia with associated monocular blindness is known as ______.
Amaurosis fugax
*Usually only lasts an hour
______ is MC in 50-80yo w/ atherosclerosis. It is an ophtho emergency!! You will have acute, sudden monocular vision loss; often preceded by amaurosis fugax.
Central Retinal Artery Occlusion
What are the PE findings for CRAO?
Pale retina w/ cherry red macula (red spot)
*No treatment proven truly effective. Can try to decrease IOP and placing patient supine and doing an orbital massage to dislodge clot
_____ is MC in patients with either HTN, OM, glaucoma, or hypercoaguable state. Results in acute, sudden monocular vision loss. On fundoscopy you find extensive retinal hemorrhages (BLOOD AND THUNDER APPEARANCE) and retinal vein dilation.
Central Retinal Vein Occlusion
*No effective treatment. May resolve spontaneously or progress to perm vision loss
Glycosylation that leads to capillary wall breakdown, microaneurysms, cotton wools spots, hard exudates, retinal vein beading, and not associated with vision loss is known as ______.
Nonproliferative Diabetic Retinopathy
____ diabetic retinopathy is associated with NEOVASCULARIZATION and treated with VEGF inhibitors.
Proliferative Diabetic Retinopathy
Damage to retinal blood vessels due to longstanding HTN is known as HTN Retinopathy. There are 4 grades which are:
I: Arterial Narrowing- copper wiring= moderate; silver wiring= severe
II: AV nicking
III: Flame-shaped hemorrhages and cotton wool spots
IV: Papilledema
*Treatment= BP control
If you have painless otorrhea (brown/yellow discharge with strong odor) +/- vertigo/dizziness you should suspect a ______.
Cholesteatoma
Episodic vertigo (peripheral, 1-8 hrs); SNHL; and roaring tinnitus are associated with _____.
Menieres dz
Menieres is diagnosed with ______.
Transtympanic electrocochelography (during an active episode)
Idiopathic distention of the compartment of the inner ear by excess fluid is associated with _____.
Menieres dz
- Treatment- symptomatic (antiemetic, antihistamines, benzos, anticholinergics) and preventative (diuretics)
- *Avoid salt/caffeine/chocolate/ETOH
***Menieres SYNDROME is due to identifiable cause, DISEASE is idiopathic
BPPV in a nutshell…
- Assoc with sudden head movements and displaced otoliths
- Usually lasts 10-60 seconds
- Can use Dix-Hallpike to test
*Treatment- Epley maneuver, medications usually not needed (but if you do then antihistamines, anticholinergics, or benzos)
____ is the MC type of rhinitis
Allergic
*Cobblestone mucosa of conjunctiva, allergic shiners
How is rhinitis treated?
- Allergic: intranasal corticosteroids
- Oral antihistamines
- Decongestants: intranasal= Phenylephrine, Naphazoline
- Intranasal steroids: most effective!!!
*IF YOU USE INTRANASAL DECONGESTANTS >3-5D YOU ARE AT RISK FOR RHINITIS MEDICAMENTOSA (REBOUND CONGESTION)
_____ is the MC site of epistaxis.
Anterior; Kiesselbachs plexus
Posterior nosebleeds most often occur around the _____ artery.
Palatine
*HTN and atherosclerosis or RFs
Therapies for epistaxis include:
- Direct pressure for 10-15 min w/ pt leaning forward
- Topical decongestants/vasoconstrictors- phenylephrine, afrin, cocaine
- Cauterization
- Nasal packing
- Surgical ligation/embolization
MC culprit of peritonsillar abscess is ____.
GABHS
S/s of peritonsillar abscess are:
- Hot potato voice
- Uvula deviation to contralateral side
- trismus
How is peritonsillar abscess diagnosed?
CT scan 1st line to differentiate cellulitis v. abscess
- Treatment- ABX + aspiration or I&D
- *ABX- Unasyn, Clinda, or Pen G + Flagyl
An asymmetric parotid gland that often results from MMR is known as _____.
Parotitis
- Other causes: calculi, tumors, cysts, starch, iodides, DM, etc.
- *Treatment: supportive, hydration, analgesic, antipyretic
_____ is MC in Wharton’s duct (submandibular) and Stensen’s duct (parotid). S/s include postprandial salivary gland pain and swelling.
Sialolithiasis
Treatment of sialolithiasis includes:
Sialogogues- tart, hard candies, lemon drops, increased fluid intake, gland massage
*AVOID anticholinergics
A little about acute bacterial sialadenitis:
- Acute pain, swelling, and erythema near gland
- tenderness at duct opening
- local pain, dysphagia, trismus
- Dx- CT scan, assess for abscess/extent of tissue involvement
- *Treatment- Sialogogues, warm compresses, ABX (anti-staph), Suppurative- I&D
