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PANRE > EENT > Flashcards

EENT Flashcards

1
Q

ectropion

A

eyelashes and lashes turned outwear- dryness, tearing irritaton

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2
Q

entropion

A

eyelid adn lashes turned inward- cornea abrasions from eyelashes. lubrication eye drops or surgery

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3
Q

dacrocystitis

A

mc. s. aureus

abx: clinda, vacnco plus ceftriaxone

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4
Q

blephritis

A

both eyelids
anterior: infectious or seborrheic
incfectious from staph aureus
posterior: mbemobian gland dysfucntion
red rimming, crusting, scaling of eyelid and eleash flaking
eyelid hygeine, regular massage/expression of meibomian gland

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5
Q

stye

A 
staph arues
near the lid margin
warm compress
i and d if not drained after 48 hours
erythro, bacitracin if active draining
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6
Q

chalazion

A

painless granuloma of the internal meibomian sebacious gland- nontender eyelid sweeling
eyelid hygeine, warm compresses

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7
Q

globe rupture

A

penetrating trauma, visual acuity decreased
enopthalmos- recession of globe in the robit
severe conjunctival hemorrhage
+seidel’s test: parting of flouresceine dye
teardrop or irreg shaped pupil, hyphema
rigid eye shield- dont remove impaled ojbect
hyphema: place at 45 degrees

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8
Q

blow out fractures

A

decreased visual acuity,
diplopia especially with upward gaszze- inferior rectus muscle entrapped
orbital emphysema
epistaxis
nasal decongestion, avoid blowing nose, abx- unasyn or clinda

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9
Q

macular degeneration

A

mc permanent legal blindness and visual loss- color vision and central vision gone
dry-drusen- small, round, yellow-white spots on the outer retina
NEOVASCULARIZATION- new abnormal vessels- WET
straight lines seem bent
amsler grid to monitor stability
bevacizumab- inhibits vascular endothelial growth - reduces neovasc
laser photocoag

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10
Q

Diabetic retinopathy

A

new, permanent loss- most common reason- 25-76
glycolyation of collage of blood veselss- capillary wall breakdown- microaneurysms
blot and dot hemorrhage, cotton wool spots, hardexudates!!- nonproliferative due to microaneurysms- not associated with vision loss- strict glucose control at this point

proliferative: neovasc- vitreus hemorrhage- use bvacizumab
maculopathy: central vision loss, macular edema or exudates- do laser

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11
Q

htn retinopathy

A

arterior narrowing- silver wiring is severing copper is moderative
av nicking
flame shaped hemorrhage, cotton wool spots
papilledema

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12
Q

retinal detach

A

retinal tear- detaches from the choroid plexus- myopia and cataracts at risk
flashing lights,floaters, curtain coming down in peripherary intially- loss of central visual field- no PAIN!
keep patient supine- don’t use miotic DROPS!

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13
Q

corneal abrasion or foreign body

A

contact lesne wearers- cipro
abx: topical erythro, polymixin/trimethoprim, cipro, sulfacetamide
rust ring- rotating burr
CHECK ACUITY FIRST

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14
Q

viral conjunctivitis

A

ADENOVIRUS!- same cause as acute bronchitis!
watery, punctate staining on slit lamp
supportive

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15
Q

allergic

A

cobble stone mucosa- chemosis (conjunctiva swelling)
olapatdine- topical h1 blockers!- antihistamine
pheniramine/naphazoline
topical corticosteroids

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16
Q

bacterial

A

most comon is S. arruesus, s. pneumo
erythro, fluroquinolines, sulfonamides, aminoglycosides
if chalmydia or gonorrea- admit for IV

2-5 day old- gonocooccal
day 5-7: chalmydai

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17
Q

chemical burns

A 
IMMEDIATE IRRIGATION!!!
alkali is worse than ACID
use lactated ringers or normal saline
ph and visual acuity after irrigation
irrigate until 7 to 7.3
ABX: moxi and CYCLOPLEGIC AGENTS- atropine drops
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18
Q

orbital cellulitis

A

usually SECONDARY to sinus infections- ETHMOID
proptosis, decreased vision, pain with ocular movement
high resoluation CT SCAN!!!- inection of the fat and ocular muscles
IV ABX : vanco, clinda, cotaxime, unasyn
amox if preseptal
preseptal: no changes in vision and no pain with ocular movemnt- eyelid and periocular tissue infected

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19
Q

strabismus

A

deviated inward - esotropia
exotropia- deviated outward

hirschberg corneal light reflex testing
cover and uncover test- to determin eangle of strabismus
patch therapy-
corrective surgery
treat before 2 years old- can’t be corrected after

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20
Q

ekratitis

A

MC- bacterial- psueodmonas!!
ciliary injection, corneal ulceration
hazy cornea- bacterial-
hsv - dendritic lesions- trifluradine, po acyclovir

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21
Q

uveitis

A

anterior: iris and ciliar body
posterior: choroid inflammation
HLA b027!!
infectious: cmv, toxoplasmosis, syphillis, TB
unilateral ocular pain , redeness, photophobia
consensual photophobia- ciliary infection, inflammatory cells and flare within the aqueous humor
anterior- topical corticosteroids- cycloplegics!
posterior- systeic cortciosteroids

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22
Q

cataract

A

lens opacification- agining- cigg smoking

blurred vision over month/years
TORCH- toxo, rubella, CMV, HSV, syphillis

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23
Q

retinoblastoma

A

absent red reflex- white pupil

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24
Q

papilledema

A

optic nerve disc swelling- increased intracranial pressure
HTN- pseudotumor cerebri, or lesion, severe HTN, cerebral edema
tx: DIURETICS AND ACETAZOLAMIDE- decreases production of queous humor and CSF

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25
Q

optic neuritis

A

MC- MULTIPLE SCLEROSIS, ethmabutol!!
demyelination of optic nerve
loss of color vision, loss of vision in one side- central scotoma, visual fields defects, worse with eye momvement pain
MARCUS GUNN PUPIL- affected eye seems to dilate in the flashlight swinging test- AFFERENT pupillary defect
IV methylprednisolone with corticosteroids

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26
Q

argyll-robertson pupil

A

pupil constricts on accomodation but does not react to bright light!!
neurosyphillis

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27
Q

optic nerve defect

A

total blindeness of same eye

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28
Q

optic chiasm defect

A

bitemporal heteronymous hemianopsia- sides can’t see peripheral on both eyes

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29
Q

optic tract defect

A

other side homonymous hemianopsia

so if left optic tract gone—> right of both eye can’t see

30
Q

angle closure glaumcoma

A

optic nerve damage- increased iop
decreased draining of aqueous humor via trabecular meshwork and canal of schelmm
anticholienergics, or sympathomimetics make it worse
uniltaeral ocular pain, nausea, vomiting, headache, peripheral vision loss
steamy cornea
mid dilated fixed nonreactive pupil- eye feels hard to palpation
cupping of optic nerve
ACETAZOLAMIDE- 1st line
topical beta blockers- timolol reduces iop pressure
miotics/cholinergics: pilocarpiene, carbachol -
peripheral iridotomy def treatment

31
Q

acute angle closure glaucoma

A

AVOID sympathomimetics and anticholinergics

32
Q

chronic open angle glaucoma

A

bilateral peripheral vission loss- slow- cupping of optic discks
LATANOPROST, timolol, acetazolamide (carbonic anhydrase inbhitiors)
laser therapy - surgery

33
Q

central retinal artery oclusion

A

ATHEROsclerotic disease- retial artery thrombus or embolus
amaurosis fugax
pale retina with cherry red macula
, BOX CAR
ACETAZOLAMIDEE!!- decreased pressure!!, revasc

34
Q

central retinal vein occlusion

A

acute , sudden, monocular vision loss, EXTENSIVE retinal hemorrhage, blood and thunder appearnace
no known effetive TX

35
Q

otitis externa

A

swimmer’s ear- pseudomonas mc
auricular discharge, pressure, fullness, ear pain, pain on traction of ear canal/tragus
cipro/dexamethasone- ofloxacin is safe for TM perforation!!
keep ear dry
aminoglycosdes- NOT USED IF TM perforation

36
Q

malig otitis externa

A

osteomyleitis at skull base- 2ndry to pseudomonas- DM and immunocompromised
IVantispeduo- piperacillin, fouroquinolones, aminoglyco

37
Q

mastroiditsi

A

inadequate treated OTITIS MEDIA!!
deep ear pain, mastoid tenderness

IV ABX:- myringotomy

CT SCAN

38
Q

AOM

A

mc viral URI first comes
s. pneumoa, h.influeza, moraxella cat, strep pyogenes- same as acute sinusitis- same as pneumonia
ET dysfunction, young (et is narrower , shorter and more horizontal)
otalgia, ear tugging in infants, fever,
if tm perfor: rapid relief of pain WITH OTORRHEA!!
bulging, erythematous tympanic emembrane with EFFUSION!!
decreased tympanic membrane motility
aBX: amoxcillin, cefixime in children
if pcn allergic: erythro,

39
Q

aom recurrent

A

myringotomy- surgical drainage

40
Q

otitis media with effusion

A

OBSERVATION IN MOST CASES

41
Q

chronic otitis media

A

pseudomonas, most likely reason,
PERFORATED TM AND PERSISTENT OR RECURRENT PURULENT OTTORHEA
CONDUCTIVE HEARING LOSS
CHOLESTEATOMA CAN FORM
topical ABX: OFLOXACIN , avoid moisture/water or aminoglycosides in the EAR WHENEVER THERE IS TM rupture

42
Q

eustacian tube dysfunction

A

Eustacian tube swelling inhibits ET’s autoinsufflation ability
often follows VIRAL URI or allergic rhinitis
ear fullness, poppin of ears, underwater feeling, fluctuating conductive hearing loss, tinnitus
may see fluid behind TM if acute serous otitis media
decongestants like pseudoephedrine , phenylephrine nasal spray, autoinsfflation- yawn, swallow, or corticosteroids
ACute serous otitiscan become infected

43
Q

barotraum

A

rapid pressure change- inability of Et to equalize pressure
flight on airplane, scuba drivers
1. autoinsfflation, decongestants or antihistamines

44
Q

TM perforation

A

can lead to cholesteatoma development

45
Q

cholesteatoma

A

abnormal keratinized collection of squamous epithelium
erodes ossicles over time- leads to conductive hearing loss
PAINLESS OTORRHEA!!, conductive hearing loss!!
weber lateralizes to the affected ear, bone conduction better than air in the affected ear

46
Q

otosclerosis

A

bony overgrowht of the stapes bone- conductive hearing loss!!!
stapedectomy with prothesis is the tx

47
Q

foreign body in the ear

A

ear pain, drainage, conductive hearing loss

48
Q

BPV

A

episodic vertigo, no hearing loss- changes with position
displaced otoliths- mc cause of vertigo- changes with head position
epley maneuver

49
Q

menier’s

A

episodic vertico and hearing loss
idiopathic distention of the endlymphatic compartment of the inner ear by excess fluid
diuretics as preventative
AVOID salt, caffeine, chocolate, ETOH

50
Q

vestibular neuritis:

A

inflammation of the vestibular portion of CN 8- after viral infection!!
continuous vertigo , no hearing loss

51
Q

labyrinthisi

A

cochlea is involved which allowes for hearing- continuous vertigo with hearing loss

CORTICOSTEROIDS - TX!!- cuz it is due to inflmaation

52
Q

peripheral vertigo

A

horizontal nystagmus- fatigable

53
Q

central vertigo

A

brainstem or cerebellar- vertical nystagmus, nonfatiguable

54
Q

vertigo tx

A

antihistamines- meclizine- anticholinergic properties
dopamine blockers: metocopramide, prochlorperazine, iv promethazine- used to treate severe nasueavomiting
anticholinergics: scopolamine-
benzo

55
Q

acoustic neruoma

A

benign tumor of the schwann cells which produce myelin sheath- cranial nerve 8!!
unilateral senosrineural hearing loss iS AN acoustic neuroma until proven otherwise!!
tinitus, headache, facial numbness!!
MRI!

56
Q

acute sinusitis

A

ACUTE otitis media caues- s.pneumo, h flu, gabhs, m.cat
maxillary MC- worse with bending down and leaning forward, headache, purplent sputum or nasal discharge
opacification with transillumination
CT SCAN DOC
amoxicillin
doxy, bactrim- second line

57
Q

chronic sinusitis

A

s. auresus MC!!!- wegener;s- more than 12 weeks of sinus symptoms

58
Q

rhinitis

A

rhinovirus mc
nasal pollyps
allergic: pale/violaceous, boggy turbinates, nasal polyps
viral: erythematous turbinates
INTRANASAL CORTICOSTEROIDS IF ALLERGIC
decongestant- can cause rhinits medicametosa- rebound congestion- such as oxymetazoline
oral antihistamines- cetrizine, loratidine
intranasal steroids- Most effective for allergic rhinitis

59
Q

nasal polyps

A

intransal corticosteroids toc

60
Q

epistaxis

A

kiesselbach’s plexus mc- anterior
posteriro- palatine artery!!bleeding in both narse and posterior pharynx
direct pressure- 1st line- lean forward
topical decongestants- phenylephrine, oxymetazoline
cauterization- silver nitrate
nasal pack

61
Q

strep pharyngitis

A

tender anterior cervical lymphadenopathy, absense of cough, fever, exudates
pen G or VK
macrolides if pcn allergic
make sure it doesn’t become rhumeatic fever

62
Q

peritonsilar absess

A

most common strep pyogenes, staph arues, polymicrobial (anaerobes)
muffled hot patato voice- can’t handle oral secretions- trismus, uvula devation to other side
CT SCAN FIRST!
ABX- aspiration or ID
unasyn, clinda

63
Q

oral hairy leukoplakia

A

lateral tongue borders or bucal murocas- painless whie plaque- epstein barr virus- hhp4- HIV, immunocomp patients

64
Q

sialolithiasis

A

stones in mc in wharton’s duct- subamndibular gland duct
stensen’s duct- partoid glad duct
sialogogues is treatment

65
Q

suppurative sialedinitis

A

s. aureus MC

tx: dicloxacillin or naficillin plus metro or clinda if severe

66
Q

oral lichen plansu

A

lacy leukoplakia of the oral mucosa common (wickham striae)- increased in patients iwth HCV infectsion

67
Q

acute herpetic gingivostomatisi

A

primary manifestation of hsv 1 in children- gingitivits, gum swell, friable/bleed bums
acyclovir if severe

68
Q

ludwig’s angina

A

swellingand erythema of the upper neck chin with pus on the floor of the mouth
CT SCAN
unasyn, pen plus metro or clinda

69
Q

osteomyletisi of the otitis externa

A

DM patients- tx is cipro- but needs to be IV- so admit

70
Q

topical cyclosporin

A

D. Topical cyclosporine
Cyclosporine (Restasis) is used to increase tear production in patients with chronic dry eyes. Ophthalmic antihistamines or antibiotics are not usually indicated in the treatment of dry eye.

71
Q

dry eyes

A

Causes of dry eye is classified into two classes: 1) decreased tear production and increased evaporative loss. Both primary and secondary Sjogren’s result in decreased tear production. MGD is the most common cause of increased evaporative loss, where accessory lacrimal glands responsible for the lipid component of the tear film are dysfunctional.

72
Q

hand foot disease mouth

A

coxsackie virus

PANRE (18 decks)

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