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EENT Flashcards

1
Q

Tx dacrocystitis

A

= blockage/infection of medial canthal lacrimal sac = swelling/erythema +/- purulence

Tx = Clindamycin

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2
Q

Crusting, scaling, & red-rimming of eyelids bilaterally = ?

A

Blepharitis = inflammation of the eyelids - BILATERAL

Anterior = skin & base of eyelash - more likely infectious (staph), viruses, or seborrheic

Posterior = moeibomian gland dysfunction (a/w rosacea and allergic rhinitis)

Tx anterior = eyelid hygiene = warm compresses, +/- abx

Tx posterior = eyelid higiene, massage

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3
Q

Stye (hordeolum) vs chelazion?

A

Both cause swelling/lump in eyelid

Chelazion is NOT painful & stye is SUPER painful, red, warm etc.

Chelazion is under the eyelid itself, stye is at the lid margin

Stye = sudden onset
Chelazion is larger, firmer (= RUBBERY nodule) slower growing than a stye (= abscess)

Tx for stye = warm compresses

Tx for chelazion = eye hygiene (warm compresses, washing etc)

Abx may be necessary with stye if actively draining but are usually not necessary with chelazion

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4
Q

Pterygium vs pinguecula

A

Ptyergium = triangular-shaped growing fibrovascular mass on inner corner of eye & grows laterally

A/w inc UV exposure, sand, wind dust exposure etc

Mnemonic: Pterygium is like a terrarium that grows to inner eye

Tx - needs removed if affects vision. Otherwise observe.

Pinguecla = yellow deposit of fat/protein on nasal side of sclera that does NOT grow

Pinguecula has a C in it & it’s a Cute lil deposit that just needs observed

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5
Q

Globe rupture - dx, signs & tx

A

Dx:
Hx penetrating trauma, +enopthalmos or exopthalmos,

+ seidel’s sign (fluorescein dye is parted by a stream of clear aqueous humor streaming from the anterior chamber) - DO NOT USE FLUOROSCEIN IF SUSPECT THO….

Teardrop or irregularly shaped pupil

Tx: RIGID eye shield, immediate ophtho consult, IV abx, leave impaled objects in place

DO NOT PRESSURE PATCH - EYE CUP & EMERGENT REFERRAL

If hyphema, keep at 45 deg angle to prevent RBC staining of cornea

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6
Q

Orbital floor blowout fx -CP, dx, tx

A

Fracture of orbital floor 2/2 TRAUMA - can lead to entrapment of eye structures

Diplopia w/ upward gaze = entrapment of inferior rectus muscle

Orbital emphysema = eyelid swelling after blowing nose 2/2 air from maxillary sinus

Anesthesia to anteriomedial check 2/2 stretching of infraorbital nerve

Dx: CT

Tx: Nasal decongestants, no nose blowing, steroids, antibiotics (unasyn or clinda)

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7
Q

Macula is responsible for what kind of vision?

A

Central vision
Detail
Color vision

C = central vision, color vision

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8
Q

Dry macular degeneration

A

Gradual breakdown of the maucla = gradual blurring of central vision

Dry = DRUSEN bodies = small, round, yellow-white spots on the outer retina (scattered, diffuse)

Drusen = DIFFUSE spots

Drusen = accumulation of waste products from the retinal pigment epithelium

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9
Q

Wet macular degeneration

A

Called wet b/c there’s neovascularization and exudates

New abnormal vessels grow under the central retina which leak & bleed = retinal scarring –> more rare than dry but progresses more rapidly

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10
Q

CP macular degeneration

A

B/l blurred central vision & loss of detail/color

Scotomas (blind sports, shadows)

Metamorphopsia (strait lines appear bent, can test w/ amsler grid)

Dry also = drusen bodies = DIFFUSE small round yellow-white spots on outer retina

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11
Q

Dx of wet macular degenration

A

Fluorescein angiography

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12
Q

Tx dry macular degeneration

A

Amsler grid at home to monitor stability

Zinc, and vitamins A, C, E = slows progression

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13
Q

Tx wet macular degeneration

A

Intravitreal anti-angiogenics = Bevacizumab

`= VEGF inhibitors = dec neovascularization

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14
Q

Patho diabetic retinopathy

A

Sugar attaches to collagen of blood vessels = capillary wall breakdown (glucose is toxic to our vessels!) = retinal ischemia = edema

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15
Q

Types of diabetic retinopathy

A
  1. Nonproliferative = microaneurysms = leak & cause… blot & dot hemorrhages, flame-shaped hemorrhages, cotton wool spots, hard exudates, retinal vein beading (tortuous & dilated veins). NOT as/w vision loss
  2. Proliferative = neovascularization = new abnomral blood vessel growth, vitreous hemorrhage –> Tx = same as wet macular degeneration = VEGF inhibitors & strict glucose control
  3. Maculopathy - macular edema and exudates = blurred central vision & central vision loss - can occur at any stage –> 2/2 microaneurysm leakage = edema and damage
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16
Q

Cotton woll spots a/w? What are they actually?

A

A/w non-proliferative diabetic retinopathy (also a/w hypertensive retinopathy stage III)

A type of “soft” exudate from leaking of microaneurysms & nerve layer microinfarctions

= Fluffy white gray spots = why they’re named cotton wool spots - larger and more irregularly shaped than the small round drusen bodies at edge of retina 2/2 dry macular degeneration

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17
Q

Hard exudates - what are they? A/w?

A

Hard exudates are yellow spots with SHARP margins - well-demarcated (unlike fluffy cotton spots)

A/w nonproliferative diabetic retinopathy

Due to microaneuysm leakage - lipids leak out and form the hard exudates - seen in hpertensive retinopathy as well

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18
Q

Vitreous hemorrhage = what? a/w?

A

Vitreous hemorrhage is a/w proliferative diabetic retinopathy

It is

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19
Q

Flame shaped and blot hemorrhages are what? a/w what?

A

they are small hemorrhages in the eye 2/2 to microaneurysm rupture and vascular occlusions

Seen in diabetic retinopathy and stage III HTN retinopathy

They are a/w cotton wool spots b/c distal to the hemorrhage or ischemia the cotton wool spot is created

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20
Q

Is non-proliferative diabetic retinopathy a/w vision loss?

A

NO

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21
Q

What are dilated tortious retinal artery/veins a sign of?

A

Neo-vascularization ….

“Proliferation of the endothelial cells of retinal veins results in marked changes in the caliber of the veins with formation of tortuous loops”

Occurs in diabetic retinopathy AND hypertensive retinopathy

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22
Q

HTN retinopathy = ?

A

Damage to retinal blood vessels 2/2 long-standing HTN

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23
Q

Grade I HTN retinopathy

A

Arterial narrowing - abnl ligt reflexes on dilated tortuous arteroile shows up as colors:

Copper-wiring (moderate)
Silver wiring (severe)
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24
Q

Grade II HTN retinopathy

A

AV nicking (venous compression at arterial-venous junctions 2/2 increased arterial pressure)

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25
Q

Grade III HTN retinopathy

A

Retinal hemorrhages (“flame-shaped”) and associated cotton wool spots

Note stages are alphabetical - Artrial narrowing, AV nicking, Cotton wool, flame hemorrhages, then papilledema!

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26
Q

Stage IV HTN retinopathy

A

Papilledema

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27
Q

Normal cup:disc ratio

A

<0.5

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28
Q

Retinal detachment - etio

A

Etio - 3 types:
1. Rhegmatogenous - MC type= retinal tear - RF = myopia & cataracts

  1. Traction - adhesions separate the retina from its base - proliferative DM retinopathy, trauma
  2. Exudative (serous) - fluid accumulates behind retina & = detachment - HTN, central retinal v. occ, papilledema

Flashes of light come first = retina tugging then the “curtain over eye” as it actually detaches

MCC = VITREOUS DETACHMENT/hemorrhage - vitreous separation tears hold in retina - vitreous detachment caused by neovascularization (proliferative DM retinopathy

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29
Q

Retinal detachment dx, tx

A

Dx:
Retinal tear = detached tissue”flapping” in vitreous humor

+ SHAFER’s sign = clumping of brown-colored pigment cells in the anterior vitreous humor resembling tobacco dust

Tx:
OPHTHO EMERGENCY

Keep supine, don’t use miotic drops

Laser, cryotherapy, ocular surgery

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30
Q

First thing to check in EVERY pt with eye complaint (besides chemical burns)

A

Visual acuity

If got chemical in eye then wash out first but

ALL OTHERS = get visual acuity FIRST

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31
Q

Common antihistamine eye drop for itching/redness in viral or allergic conjunctivitis

A

Olopatadine = H1 blocker eye drop = benadryl for the eyes

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32
Q

Viral conjunctivitis a/w what other PE finding?

A

Preauricular LAD

BILATERAL

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33
Q

Gonococcal conjunctivitis

A

ADMIT

IV CEFTRIAXONE and topical abx

OPHTHO EMERGENCY!

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34
Q

MCC bacterial conjunctivitis

A

staph aureus

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35
Q

Dx bacterial conjunctivitis

A

Clinical dx BUT you must still do fluorescein staining to rule out an abrasion & keratitis!!!

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36
Q

Allergic conjunctivitis pathognomonic finding

A

Cobblestone appearance to inner eyelid and upper eyelid, itching, tearing, redness, bilateral

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37
Q

What is pheniramine and naphazoline drops?

A

They are an antihistamine and decongestant eye drop used for allergic conjunctivitis

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38
Q

Orbital cellulitis - occur when? CP? Dx? Tx?

A

Occur: MC ofter sinus infection (ethmoid) - staph, s. pna, gabhs, h. flu or after dental and facial infections - MC in CHILDREN

CP: Decreased vision, pain with ocular movement, proptosis, eyelid erythema & edema

Tx: emergent referral, admission for systemic abx & orbital imaging

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39
Q

Preseptal (preorbital) cellulitis vs orbital?

A

Orbital = pain with EOM, and VISUAL changes

Pre-orbital (infection of eyelid and periocular tissue) & NO pain with EOM, NO visual changes

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40
Q

Si/sx keratitis (corneal ulcer)

A

Corneal ulcer AKA keratitis

Corneal ulceration/defect on slit lamp exam

Ciliary injection (limbic flush)

Tx: Cipro drops

DO NOT PATCH EYE

There are various types of keratitis, but most commonly it occurs after an injury to the cornea, dryness or inflammation of the ocular surface or contact lens wear.

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41
Q

PE bacterial keratitis

A

Hazy cornea, ulcer, +/- hypopyon

Tx: CIPRO DROPS - DO NOT PATCH EYE

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42
Q

Uveitis (iritis)

A

Autoimmune dz, unilateral

CP: Pain w/ direct & consensual light in BOTH eyes b/c iris will constrict (pain) & dilate (pain) along with the unaffected eye when light is shone in unaffected eye. Also inflammatory cells (WBC) & flare (protein) in aqueous humor

IF ALL OF THE FLARE IS AROUND THE IRIS
= LIMBIC FLUSH OR UVEAL FLARE = BAD
(SLCERA IS CLEARER)

Tx:
URGENT referral for topical steroids & cycloplegic drops for pain (cyclopentolate or homatropine)

Workup: HLA-B27 (a. spondylitis), ANA (SLE), RPR (syphilis), ESR (general inflammation), CCP (RA)

BFTP - SARCO-Not ME mnemonic, the A = anterior uveitis = one of CP of sarcoidosis AI dz!

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43
Q

Scary reasons for red eye

A

Red eye w/ ciliary injection = ALL SCARY:

Corneal ulcer (keratitis)
Iritis (uveitis)
Acute angle closure glaucoma

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44
Q

Cataract -what is it? RF, CP, d/dx, Tx

A

What: lens opacification

RF: Age, cigs, sun, DM, steroids, ToRCH syndrome

CP: Painless loss of vision over months to years - one or both eyes, reduced visual acuity on exam, NO RED REFLEX

PE: Absent red reflex, opaque lens

Tx: Surgical - done when dec vision affects ADLs

Ddx: Retinoblastoma - absent red reflex + white pupil

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45
Q

Papilledema definition, etio, CP, dx, tx

A

Definition: Optic disc (nerve) swelling

Etio: IIHT, space-occupying lesions, Ceregral edema, malignant HTN

CP: Headache, N/V

Dx: Fundoscopy - swollen optic disc w/ blurred margins. MRI or CT 1st to rule out mass effect then an LP (will show inc opening pressure)

Tx: Diuretics - acetazolamide (dec production of aqueous humor & CSF)

46
Q

Papilledema vs optic neuritis vs glaucoma

A

Papilledema is 2/2 inc CSF pressure = edema of optic nerve head, BILATERAL, visual defect = enlarged blind spot. Tx = reduce ICP.

Optic neuritis = edema of the optic nerve head IN the orbit, usu UNILATERAL, Visual defect: range from central scotoma to complete loss of vision, + RAPD (marcus gun pupil) & Tx = corticosteroids. A/w MS, pain w/ EOM

Glaucoma = edema of optic nerve from increased intraocular pressure - acute = unilateral, chronic = bilateral. Visual defect = halos around lights –> blindness. Tx = reduce IOP.

All look like blurred disc cup on fundoscopy. Optic neuritis = ONLY one with marcus gun pupil. And only one that’s unilateral besides acute angle closure.

47
Q

Optic neuritis- MCC, CP, TX

A

ON= acute inflammatory demyelination fo the optic nerve - mc in young pt 20-40 YO

Etio: MCC = MS

CP: UNILATERAL, loss of color vision, visual field defects (central scotoma or blind spot), loss of vision over a few days (papilledema 2/2 inc ICP = BILATERAL and macular degeneration w/ loss of color vision is also BILATERAL!!!)

PE: RAPD (marcus gunn), fundoscopy = optic disc swelling and blurring 2/2 papillitis

Tx: IV methylprednisolone & oral corticosteroids

Note: Retrobulbar neuritis is very similar to optic neuritis except the inflammation is in the optic nerve BEHIND the eye - everything’s the same as above except the pt can have a NORMAL fundoscopy exam b/c swelling is behind eye w/ all of same other features

48
Q

MCC RAPD

A

Optic neuritis

Also seen in severe retinal dz –> CRVO, CRAO, significant retinal datachment

49
Q

Describe argyll robertson pupil, MCC?

A

Argyll robertson pupil menomic: ARP =

——————>
Accomodation reflex present
Pupilary Reflex Absent

50
Q

Visual pathway defects:

Total blindness of ipsilateral eye caused by…

A

Lesion AFTER the optic chiasm

Optic nerve or retinal issue

51
Q

Visual pathway defects:

Ipsilateral nasal hemianopsia caused by….

A 
Ipsilateral = same side
Hemi = half of vision lost
Nasal = side of vision lost is closest to nose

Caused by lesion lateral to the optic chiasm

nasaL = Lateral

52
Q

Visual pathway defects:

Bitemporal heteronymous hemianopsia

A

Bitemporal = both sides by temples

Hemianopsia = loss of half of visual field

Heteronymous = opposite sides of vision lost

Caused by lesion at hte midline of the optic chiasm AKA PITUITARY ADENOMA

53
Q

Visual pathway defects:

Contralateral homonymous hemianopsia

A

Half of vision lost, homonymous = same half lost in both eyes- left side or right side - side lost = contra (opposite) the side of hte lesion

Lesion at the optic tract or occipital lobe stroke

54
Q

RF for acute angle closure glaucoma

A

Elderly
Hyperopia (far-sighted)
Asians

W/ anything that causes mydriasis (makes angle smaller) being a precipitating factor (dim lights, anti-cholinergics)

55
Q

Eye appearance in acute angle closure glaucoma

Naked eye
During fundoscopic exam

A

MId-dilated fixed nonreactive pupil

Eye feels hard to palpation

Conjunctival erythema (in ciliary pattern)

“Steamy” cornea - corneal epithelial edema or cloudiness, shallow chamber

Fundoscopic exam; Disc “cupping,” blurred disc-cup

Remember blurred disc-cup occurs in papiledema (any cause), optic neuritis, and glaucoma

56
Q

Tx acute angle closure glaucoma

A
  1. IV Acetazolamide (dec aq humor producttion)
  2. Topical bb - timilol (reduces IOP)
  3. Miotics/cholinergics - Pilocarpine, carbachol

Peripheral iridotomy is defnitive treatment - avoid anticholinergics & sympathomimetics

57
Q

CP Acute angle closure glaucoma

A

TUNNEL VISION = MC

A for acute - you lose vision AROUND the edges

Can also have HALOS around lights = PATHOGNOMONIC

58
Q

Chronic open angle glaucoma - RF, si/sx

A

RF: > 60, AA, severe near-signtedness, family hx

Si/sx: Painless, vision only affected LATE in course so you need proper SCREENING!!! AKA GET EYE PUFF TEST or tonopen at optometrist yearly & examine optic nerve for cupping or blurring

Tx: 1st line: Prostaglandin agonist (Latanoprost, travatan) 2nd line: Beta-blockers (timolol)

Pressure checks q3-6 mo, formal visual field exams yearly

59
Q

Eye disorders a/w diabetes

A 
Dry eye (keratits sica) 
Cataract
Glaucoma
Retinopathy
Retinal vein occlusion
Cranial nerve abnl
60
Q

What is the leading cause of blindness in US under age 65?

A

Diabetic retinopathy

61
Q

Prevention of diabetic retinopathy

A

Maintain tight control of blood sugar (A1c < 7)

Control BP

STOP smoking

Reinforce need for annual dilated eye exams - can do laser surgery to prevent progression (panretinal photo-coagulation to reduce neovascularization and dec risk vitreous hemorrhage & retinal detachment)

62
Q

Etiology retinal vein occlusion, CP

A

Etio: HTN retinopathy 2/2 AV nicking, DM, hypercoagulable states

CP: sudden painless vision loss

PE: DARK HUSKY RETINAL BACKGROUND - b/c blood is coming in (via artery) but not going out, retinal hemorrhages, cotton-wool etc

Prognosis depends on visual acuity - urgent referral - may lead to severe neovascular glaucoma

Tx: no effective tx - urgent referral. +/- antiinflam, steroids, laser photocoagulation

63
Q

Retinal artery occlusion - etio, CP, PE, Tx

A

CP: sudden painless unilateral vision loss, usually permanent

Patho: MC in 50 - 80YO 2/2 atherosclerotic disease or an emboli

PE: PALLOR across entire retina (think of arterial occlusion in leg), cherry red spot (Macula will stay red b/c gets blood supply from a different artery
See it now because everything else gets white - white & pale just like arterial occlusion ) - OFTEN PRECEDED BY AMAUROSIS FUGAX

Tx: Place supine, ocular massage to dislodge emboli - vision loss permanent after 90 min of occlusion, decrease IOP to prevent anterior chamber involvement (acetazolamide)

URGENT REFERRAL
Exclude temporal arteritis (jaw claudication, headache) as the cause of the CRAO

64
Q

Ddx sudden painless vision loss

A

CRAO
CRVO
Retinal detachment
Vitreous hemorrhage

65
Q

Ddx sudden PAINFUL vision loss

A

Acute angle closure glaucoma

66
Q

Vitreous hemorrhage - etio, sx, tx

A

Caused by bleeding from neovascularization (proliferative DM retinopathy, wet macular degeneration etc)

May lead to scarring and tractional retinal detachment 2/2 adhesions

Sx: New floaters, cobwebs, sudden loss of vision

Tx: Vitrectomy if hemorrhage doesn’t clear

67
Q

Causes of tunnel vision

A

Acute angle closure glaucoma (sudden, unilateral, painful)

Chronic (open angle) glaucoma (slow, progressive, painless, bilateral)

Acute = AROUND the eye vision loss

68
Q

Causes of central vision loss

A

MaCular degeneration (central vision blurry & color loss, bilateral)

Optic neuritis = “Central scotoma”, unilateral

Papilledema = “enlarged blind spot” if severe which may progress to bigger visual field defects & central vision loss, bilateral

69
Q

Amaurosis fugax definition, causes

A

Temporary monocular vision loss (lasting minutes) with COMPLETE recovery - due to retinal emboli or ischemia - can be seen w/ TIA, giant cell arteritis, CRAO, SLE & other vasculitic d/o

70
Q

Ocular trauma can cause….?

What to do first?

A

Blowout fracture
Ruptured globe
Foreign body
Hyphema

VISUAL ACUITY = FIRST THING

71
Q

Why can hyphemas be dangerous?

A

B/c blood sitting in anterior chamber can clot and cause acute angle closure glaucoma

Has to stay sitting AT ALL TIMES until it clears

Needs urgent referral to ophtho

72
Q

Which form of cipro is safe in otitis externa w/ perforated TM?

A

Can use ofloxacin (floxin otic) or ciproDEX otic

CiproHC otic is NOT sterile & contraindicated in TM Perf

NO HC IN TM perf

73
Q

Which drops MUST be avoided if there is a TM perf?

A

Aminoglycoside drops = OTOTOXIC!!!

74
Q

Chronic otitis media definiton

A

Chronic otitis media — COM is defined as an ear with a tympanic membrane perforation in the setting of recurrent or chronic ear infections

The most common symptom of CSOM is the presence of recurrent or persistent purulent ear drainage. CSOM is most often painless, and patients usually present without fever or other systemic signs of infection. The drainage may be foul smelling.

Pseudomonas aeruginosa and Staphylococcus aureus are the most commonly isolated aerobic bacteria in several large case series

NO AMG DROPS, NO CIPRO HC DROPS!!!

75
Q

CP Eustachian tube dysfunction

Tx

A

Occurs after URI or allergic rhinitis - the blockage means tube can’t equilibrate pressure like normal = negative pressure

CP: feeling of fullness, underwater feeling, intermittent ear pain

Dx: Otoscope normal. +/- fluid behind TM

Tx: Decongestants (pseudoephedrine, phenylephrine, oxymeatzoline nasal spray)

Auto-insufflation (swallowing yawning, blowing against pinched nostril

Intranasal corticosteroids

Complications - may develop acute serous otitis media or infectious otitis media if blockage is prolonged

76
Q

Causes of conductive hearing loss

A

Think of all the things involved with conduction of sound -

Otosclerosis (Fusion of stapes to round window - young women, familial - resect stapes) = CHL

Cholesteoma = CHL

OME= CHL

Chronic OM = CHL

Cerumen impaction = CHL

77
Q

Point of the weber test?

A

Weber = whether or not your nerves are working

We are trying to vibrate acoustic nerve on side person says they can’t hear (bypass the conduction system to test the sensorineural system)

Pt will feel vibration more in ear without SNHL b/c the nerves are more intact - so lateralizes to the GOOD ear in SNHL

Mnemonic: SensoriNeural lateralizes to Normal ear & NORMAL rinne - focus on the “N”

78
Q

What is a positive Rinne?

A

A positive Rinne = normal meaning that air conduction lasts longer than bone conduction

Remember SensoriNeural has NORMAL rinne & lateralizes to normal ear in SNHL

Conductive hearing loss - ear can’t conduct sound like its supposed to anymore - has lost conduction ability - and conduction straight thru the bone (mastoid) is better

79
Q

Causes of SNHL

A

Anything that damages the nerves

AGEING = MC = PREBYACUSIS (acusis sounds like acoustic), chronic loud noise exposure, labyrinthitis, CNS lesions(acoustic neuroma_ meniere syndrome etc, MEDICATIONS (AMG TOBRAMYCIN, ASA, loop)

80
Q

Signs of an acoustic neuroma

A

Sudden SNHL w/ poor speech discrimination w/o vertigo

MRI dx

Surgical removal tx

**Most common intracranial tumor, benign

81
Q

Vertigo - central vs peripheral

A

Central - gradual in onset, insidious, scary, NO significant hearing loss, milder sx of vertigo, VERTICAL/ROTARY nystagmus that DOES NOT FATIGUE

+/- abnormal gait –> (more gait abnl than peripheral!) abnormal rhomberg, other CNS FOCAL DEFICITS

***Note: If pance Q give you an abnormal neuro exam then do NOT choose something benign like BPPV or labrynthitis - an issue w/ the labrytnth of the ear will not cause a focal neurological deficit….duh

Peripheral - abrupt onset, intense nausea & vomiting, HORIZONTAL nystagmus that FATIGUES EASILY, a/w hearing loss and tinnitus

Why epley maneuver is a tx for peripheral b/c it fatigues easily!

82
Q

Causes of central vertigo vs peripheral

A

Central:

CNVIII tumor(acoustic neuroma) 
Cerebellar hemorrhage/ischemia
Cerebellar tumor
Infection
MS

Peripheral:
BPPV
Acute labrynthitis
Meniere’s disease

83
Q

Classic Meniere’s disease syndrome

Two known causes

Tx

A

Etio: 2/2 distension of the endolymphatic compartment of the inner ear = AKA endolymphatic hydrops

Classic syndrome: 
WAXES &amp; WANES 
Episodic vertigo
Low-frequency SNHL
Tinnitus
Sensation of ear pressure

Two known causes: Syphilis, head trauma

Tx: Refere to ENT, dec Na+ diet, meclizine

84
Q

Acute labrynthitis

A

Acute onset of CONTINUOUS SEVERE VERGITO (meniere’s = episodic)

+ hearing loss & tinnitus

frequently follows a URI

Try meclizine

85
Q

Two causes of peripheral vertigo that cause episodic vertigo

A

BPPV - NO SNHL

Meniere’s + SNHL & TINNITUS

Bowel Movements (BM = BPPV, meniere) are EPISODIC

LV are continuous vertigo

86
Q

Two causes of peripheral vertigo that cause continuous vertigo

A

Vestibular neuritis - no hearing loss

Labyrinthitis + hearing loss (labyrinth is part of cochlea so inflam = hearing loss)

In a vestibule you can hear people talking = no hearing loss

If you’re in a labyrinth (maze) then you cannot hear anything (+ hearing loss)

87
Q

First line treatment vertigo, next line

A

First line = meclizine (anticholinergic)

2nd line = dopamine blockers - metoclopramide, prochlorperazine (compazine), IV promethazine (phenergan)

Often given together or the D2 blockers are given with benadryl so that the anticholinergic doesn’t cause a dystonic reaction

88
Q

BPPV

A

Etio - displaced otoliths = vertigo sx = one of causes of PERIPHERAL vergtigo

Remember BM - so episodic

Sudden onset, episodic, severe vertigo lasting 10-60 seconds, provoked with changes of head positioning

Dx: Dix-halpike - elicit delayed fatigable horizontal nystagmus = positive dx - if nystagmus vertical or non-fatiguable then check for central causes

Tx: Epley maneuver - canalith repositioning - meds usu not needed

89
Q

First line tx vestibular neuritis & acute labyrinthitis

A

Corticosteroids

If sx - meclizine

90
Q

What should you be thinking of if someone just had a URI and now have sx of vertigo?

A

Acute labyrinthitis or vestibular neuritis

91
Q

Acute sinusitis - etio, CP, Dx, Tx

A

Etio - same as AOM = S. pneumo, H. flu, M, catarrhalis, GABHS

Often occurs w/ concurrent rhinits or follows viral URI b/c URI = edema = blocks drainage of sinuses = fluid build up = bacterial colonization

CP: Sinus pain/pressure worse bending over (maxillary MC), headache, malaise, purulent nasal discharge

Dx TOC = CT scan

Tx -Supportive/sx therapy

If sx > 10-14 days, fever etc then augmentin x 10-14 d = now the ABX of choice (used to be amoxicillin)

Note: If someone has had two appropriate courses of abx & the infection is not going away…it’s probably not being treated right - THINK FUNGAL!!!- get imaging!

92
Q

Etio chronic sinusitis

A

S. aureus = MC bacterial cause

Aspergillus MC fungal cause

2nd MC fungal cause = MUCORMYCOSIS

Note: Chronic = > 12 weeks time

93
Q

Mucormycosis

A

Causes chronic sinus infection

May enter CNS

Seen in immunocompromised pt (DM, HIV, chemo etc)

CP: Acute sinusitis sx and BLACK ESCHAR ON PALATE OR FACE

Tx: IV amphotericin B = 1st line

94
Q

Allergic rhinitis - 2 unique clinical features

A

Worse in morning

A/w nasal polyps

95
Q

Allergic rhinitis PE, Tx

A

PALE turbinates

Nasal polyps

Cobblestone mucosa of the conjunctiva

Tx = Intranasal corticosteroids = most effective tx!

Also avoidance and environmental control, exposure reduction

Oral anti-histamines for itching, sneezing, pruritis etc

96
Q

Viral sinusitis PE

A

ERYTHEMATOUS turbinates (allergic = pale turbinates)

Think of viral strep throat = beefy red

MCC rhinovirus (common cold)

97
Q

Etio, TOC nasal polyps

A

Nasal polyps MCC = allergic rhinitis - look for signs of that an look fro nasal polyps on inspection

**Note: Can also be caused by cystic fibrosis –> ESPECIALLY IF POLYPS ARE IN KIDS - think CF!

Tx = Refer to ENT (don’t biopsy), intranasal corticosteroids

98
Q

MCC anterior nose bleed vs posterior nose bleed

A

Anterior = nose picking, dry environment

Posterior = hypertension and atherosclerosis –> note: they present w/ hematemesis not epistaxis

Tx = direct pressure, vasoconstrictors (phenylephrine, oxymetazoline, cocaine –> if medications fail do a packing & give antibiotics! (prevent TSS)

**Note: Septal hematomas are a/w loss of cartilage if the hematoma is not removed!!!

99
Q

Nasal foreign body - MC in? CP? Tx?

A

MC in children

CP: Mucopurulent nasal discharge, foul odor, epistaxis

Tx: FB removal via positive pressure technique or instrumental removal

100
Q

Strep Throat - 4 points in modified CENTOR criteria & how to use it

A 
C –Cough absent / Can't Cough
E –Exudate.
N –Nodes.
T –Temperature (fever)
OR –young OR old modifier

0-1 - no abx or throat x
2-3 - throat cx
4-5 - give abx (56% chance)

**The OR age modifier: < 15 YO add one point, > 44 YO minus one point

**Note: If 5-15 YO, throat cultures should be sent in all cases

Tx: Pen G or VK is 1st line. PCN allergy - give Macrolide

101
Q

Complications of strep throat

A

Rheumatic fever (preventable w/ abx)

PSGN (not preventable w/ abx)

Peritonsillar abscess (PTA)

102
Q

Patho peritonsillar abscess, CP, Dx, Tx

A

Patho: tonsillitus –> cellulitis –> abscess formation

CP: Dysphagia, pharyngitis, muffled “hot potato” voice, difficulty handling oral secretions, trismus, uvula deviation to the CONTRALATERAL side, tonsillitis anterior cervical LAD

Dx: CT scan first line (differentiates cellulitis vs abscess)

Tx: Abx (unasyn, clinda, Pen G plus metro) & aspiration I&D

103
Q

Layringitis - MCC, CP, Tx

A

MCC = virus (adeno, rhino etc)

CP: Hoarseness = HALLMARK, also aphonia

Tx: Supportive - voice rest, warm saline gargles, fluids, etc

104
Q

TOC oral thrush

A

Nystatin liquid = x of choice

Candida part of normal flora but can become pathogenic 2/2 local or systemic immunosuppression (HIV, chemo, steroid inhalers w/o spacer, diabetics etc)

105
Q

Oral leukoplakia = ? CP? Tx?

A

= precancerous hyperkeratosis 2/2 chronic irritation

CP: Painless white patchy lesion that CANNOT be scraped off (PLATED ON, plakia…oral candida = PAINFUL & CAN be scraped off)

Tx: Cryptherapy, laser ablation, bx to assess for cancer risk

106
Q

Erythroplakia

A

precancerous lesions similar to leukplakia but with erythematous appearance

> 90% are dysplastic or cancerous (Sq cell carcinoma)

107
Q

Oral hairy leukoplakia

A

Etio = epstein barr virus (HHV4)

Painless, white plaque along LATERAL tongue borders or buccal mucosa +/- irregular, “Hairy” or “feathery” lesions with prominent folds or projections - cannot be scraped off

No tx required - often resolve spontaneously

108
Q

Acute bacterial siladenitis - Etio, CP, Dx, Tx

A

Acute bacterial siladenitis aka suppurative sialadenitis

Etio = staph aureus or mixed aerobic/anaerobic infection

CP = tenderness, swelling, erythema near the gland, especially w/ meals, + pus if duct is massaged, fever& chills if severe

Dx = CT scan - assesses for associated abscess and the extent of tissue involvement

Tx = sialogogues (tart hard candies = inc salivary flow) + antibiotics (Dicloxacillin) OR if severe infection cover for anaerobes (clind, metro) too

109
Q

Ludwig’s angina = what? occus after? etio? CP? Dx? Tx?

A

Ludwig’s = cellulitis of the sublingual and submaxillary spaces of the neck = MC neck space infection - lots of pockets for stuff to grow!!!

MC 2/2 dental infections (anaerobic infections)

CP = Swelling & erythema of the upper neck & chin with pus on the floor of the mouth

Dx = CT scan

Tx = Hospitalize, IV abx (Unasyn or PCN plus Metro or clinda), monitor airway

Dangerous b/c the swelling = airway compromise

110
Q

Why are we super quick to give antibiotics in a suspected dental infection?

A

Because it can quickly turn into ludwig’s angina = BAD!!

Always cover w/ abx if toot pain, sensitive to percussion/temperature etc

Tx = Pen VK or clinda ($$$)

111
Q

Chronic hoarseness workup

A

Indirect laryngoscopy –> have pt say “ah” –> do cords move??

IF YES –> then hoarseness could be 2/2 vocal cord nodules (overuse, singers etc) or squamous cell carcinoma of larynx so REFER TO ENT

IF NO –> then it’s vocal cord paralysis 2/2 recurrent laryngeal nerve abnormalities 2/2 something wrong in the thorax (mediastinal/apical mass (lung CA), thoracic aneurysm, marked LAD etc –> GET IMAGING OF THORAX

112
Q

Salivary gland tumors

A

80% are parotid- mostly BENIGN

SMALLEST glands = HIGHEST risk of malignancy –> 50% of submandibular tumors are malignant & EVEN MORE of SUBMENTAL

If pt says they can “feel something” In their salivary gland, sent them to ENT b/c they can look into the gland

*PANCE by subspecialty (22 decks)

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