EENT Flashcards
ectropion
eyelashes and lashes turned outwear- dryness, tearing irritaton
entropion
eyelid adn lashes turned inward- cornea abrasions from eyelashes. lubrication eye drops or surgery
dacrocystitis
mc. s. aureus
abx: clinda, vacnco plus ceftriaxone
blephritis
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
stye
staph arues near the lid margin warm compress i and d if not drained after 48 hours erythro, bacitracin if active draining
chalazion
painless granuloma of the internal meibomian sebacious gland- nontender eyelid sweeling
eyelid hygeine, warm compresses
globe rupture
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
blow out fractures
decreased visual acuity,
diplopia especially with upward gaszze- inferior rectus muscle entrapped
orbital emphysema
epistaxis
nasal decongestion, avoid blowing nose, abx- unasyn or clinda
macular degeneration
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
Diabetic retinopathy
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
htn retinopathy
arterior narrowing- silver wiring is severing copper is moderative
av nicking
flame shaped hemorrhage, cotton wool spots
papilledema
retinal detach
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!
corneal abrasion or foreign body
contact lesne wearers- cipro
abx: topical erythro, polymixin/trimethoprim, cipro, sulfacetamide
rust ring- rotating burr
CHECK ACUITY FIRST
viral conjunctivitis
ADENOVIRUS!- same cause as acute bronchitis!
watery, punctate staining on slit lamp
supportive
allergic
cobble stone mucosa- chemosis (conjunctiva swelling)
olapatdine- topical h1 blockers!- antihistamine
pheniramine/naphazoline
topical corticosteroids
bacterial
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
chemical burns
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
orbital cellulitis
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
strabismus
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
ekratitis
MC- bacterial- psueodmonas!!
ciliary injection, corneal ulceration
hazy cornea- bacterial-
hsv - dendritic lesions- trifluradine, po acyclovir
uveitis
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
cataract
lens opacification- agining- cigg smoking
blurred vision over month/years
TORCH- toxo, rubella, CMV, HSV, syphillis
retinoblastoma
absent red reflex- white pupil
papilledema
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
optic neuritis
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
argyll-robertson pupil
pupil constricts on accomodation but does not react to bright light!!
neurosyphillis
optic nerve defect
total blindeness of same eye
optic chiasm defect
bitemporal heteronymous hemianopsia- sides can’t see peripheral on both eyes
optic tract defect
other side homonymous hemianopsia
so if left optic tract gone—> right of both eye can’t see
angle closure glaumcoma
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
acute angle closure glaucoma
AVOID sympathomimetics and anticholinergics
chronic open angle glaucoma
bilateral peripheral vission loss- slow- cupping of optic discks
LATANOPROST, timolol, acetazolamide (carbonic anhydrase inbhitiors)
laser therapy - surgery
central retinal artery oclusion
ATHEROsclerotic disease- retial artery thrombus or embolus
amaurosis fugax
pale retina with cherry red macula
, BOX CAR
ACETAZOLAMIDEE!!- decreased pressure!!, revasc
central retinal vein occlusion
acute , sudden, monocular vision loss, EXTENSIVE retinal hemorrhage, blood and thunder appearnace
no known effetive TX
otitis externa
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
malig otitis externa
osteomyleitis at skull base- 2ndry to pseudomonas- DM and immunocompromised
IVantispeduo- piperacillin, fouroquinolones, aminoglyco
mastroiditsi
inadequate treated OTITIS MEDIA!!
deep ear pain, mastoid tenderness
IV ABX:- myringotomy
CT SCAN
AOM
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,
aom recurrent
myringotomy- surgical drainage
otitis media with effusion
OBSERVATION IN MOST CASES
chronic otitis media
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
eustacian tube dysfunction
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
barotraum
rapid pressure change- inability of Et to equalize pressure
flight on airplane, scuba drivers
1. autoinsfflation, decongestants or antihistamines
TM perforation
can lead to cholesteatoma development
cholesteatoma
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
otosclerosis
bony overgrowht of the stapes bone- conductive hearing loss!!!
stapedectomy with prothesis is the tx
foreign body in the ear
ear pain, drainage, conductive hearing loss
BPV
episodic vertigo, no hearing loss- changes with position
displaced otoliths- mc cause of vertigo- changes with head position
epley maneuver
menier’s
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
vestibular neuritis:
inflammation of the vestibular portion of CN 8- after viral infection!!
continuous vertigo , no hearing loss
labyrinthisi
cochlea is involved which allowes for hearing- continuous vertigo with hearing loss
CORTICOSTEROIDS - TX!!- cuz it is due to inflmaation
peripheral vertigo
horizontal nystagmus- fatigable
central vertigo
brainstem or cerebellar- vertical nystagmus, nonfatiguable
vertigo tx
antihistamines- meclizine- anticholinergic properties
dopamine blockers: metocopramide, prochlorperazine, iv promethazine- used to treate severe nasueavomiting
anticholinergics: scopolamine-
benzo
acoustic neruoma
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!
acute sinusitis
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
chronic sinusitis
s. auresus MC!!!- wegener;s- more than 12 weeks of sinus symptoms
rhinitis
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
nasal polyps
intransal corticosteroids toc
epistaxis
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
strep pharyngitis
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
peritonsilar absess
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
oral hairy leukoplakia
lateral tongue borders or bucal murocas- painless whie plaque- epstein barr virus- hhp4- HIV, immunocomp patients
sialolithiasis
stones in mc in wharton’s duct- subamndibular gland duct
stensen’s duct- partoid glad duct
sialogogues is treatment
suppurative sialedinitis
s. aureus MC
tx: dicloxacillin or naficillin plus metro or clinda if severe
oral lichen plansu
lacy leukoplakia of the oral mucosa common (wickham striae)- increased in patients iwth HCV infectsion
acute herpetic gingivostomatisi
primary manifestation of hsv 1 in children- gingitivits, gum swell, friable/bleed bums
acyclovir if severe
ludwig’s angina
swellingand erythema of the upper neck chin with pus on the floor of the mouth
CT SCAN
unasyn, pen plus metro or clinda
osteomyletisi of the otitis externa
DM patients- tx is cipro- but needs to be IV- so admit
topical cyclosporin
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.
dry eyes
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.
hand foot disease mouth
coxsackie virus
