EENT Flashcards
Trismus, “hot potato” voice and a uvula displaced. Dx?
Peritonsillar Abscess
What classic corneal finding is seen with herpes simplex keratitis?
Dendritic lesions (ONLY in HSV)
Ultraviolet (UV) Keratitis Tx
-Top. NSAIDs
-PO pain meds
+/- Abx
+/-Cycloplegics
MCC of Mastoiditis and patho:
- AOM
- Strep pneumoniae
MC patho of Peritonsillar Abscess
-Strep pyogenes (GABHS)
MC site involved in oral CA
Tongue
Tx for MATURE cataracts
PhacoEmulsification then lens implant
Peritonsillar Abscess Tx
- I and D or FNA
- Abx after (Augmentin or Clinda)
Pt. presents with painless blurry vision and lens opacity. Dx?
Cataract
2nd line Tx for Chalazion
Corticosteroid injection
Which derm condition is associated with recurrent hordeola?
Rosacea
Biggest RF for Oral Leukoplakia
Smokeless tobacco
For acute closure glaucoma, what is the preferred Tx?
- BB drops
- Severe: IV Acetazolamide
Tx for Sinusitis <10 days
Supportive: Decongestants, NSAIDs
1st and 2nd line for Retropharyngeal Abscess
1st: IV Abx
2nd: I and D
Retropharyngeal vs. Peritonsillar Abscess
Retro: Bulge posterior to pharyngeal wall (oropharynx).
Peri: uvula displaced
1st line Tx for Strep Pharyngitis
PCN
Order of mgmt for Mastoiditis
-1st line IV Abx (Cefepime + Vanco)
2nd line Myringotomy (mastoid draining) with tube.
If no response: Mastoidectomy
Salivary gland infxn
Sialadenitis
Monocular afferent pupil defect worse with moving seen in MS:
Optic Neuritis
MCC Chalazion
Blocked oil Meibomian gland
When can we give Rx Augmentin for Sinusitis?
After 10 days
Sialadenitis is associated with:
Sjogren disease
Tx for Optic Neuritis
IV Steroid
Dx for Corneal Abrasion
Fluorescein stain
SE of steroid injections
Hypopigmentation
MCC Hand, Foot, Mouth Disease (HFMD)
Coxsackie virus A
1st and 2nd line Tx for AOM
1st: Amoxi
2nd: Augmentin
Trismus is seen in:
Retropharyngeal and Peritonsillar Abscess
Inspiratory stridor is seen in:
Epiglottitis
Most likely pathos causing epiglottitis in adults
Staph or strep
Tx for traumatic corneal abrasion D/T FB
Lid eversion (check for FB) + Top. Abx
MCC lens opacity
Cataracts
SE of Phenytoin
Gingival hyperplasia
Dx for Retropharyngeal Abscess
CT with contrast
Eye condition associated with Bell Palsy:
Keratitis
-Nasal polyps
-Asthma
-ASA sensitivity
What is this triad?
Samter’s
Pt. has a Hx of tubes in ears. You note a yellow/white mass behind TM. Dx?
Cholesteatoma
Which sinus borders the orbit and is MC route of infection of the orbit?
Ethmoid sinus
Tx for Orbital Cellulitis
- CT scan
- IV Vanco + Ceftriaxone (or piperacillin-tazobactam)
After 1st (compress) and 2nd line (steroid inj.) Tx of Chalazion, what would be the next step in mgmt?
Ophtho referral for I and D
AOM Tx 2nd line or d/t allergy
Cefdinir
Dx for Epiglottitis
Laryngoscopy
MC patho in Sialadenitis
Staph aureus
Allergic Rhinitis Tx
Steroid nasal spray
Dx for Infectious Mononucleosis
Heterophile antibody test (monospot)
What does a corneal ulcer look like on PE?
- White hazy irregularity of cornea
- Oval ulcer with ragged edges
1st line Abx for corneal ulcer
Topical FQ
Young kids with nasal polyps should be screened for which hereditary disorder?
Cystic fibrosis
What should be advised as post-op care for Infectious Mononucleosis?
NO contact sports for 4 wks post-infection
PainLESS eye conditions:
- Central Retinal Vein Occlusion
- Central Retinal Artery Occlusion
- Retinal detachment
- Chronic (open) Glaucoma
Cherry-red spot on fovea seen in:
- Central Retinal Artery Occlusion
- A is near C
MCC of Infectious Mononucleosis
EBV
MCC Blepharitis
Dysfunctional Meibomian Gland
What is the mgmt with posterior packing for epistaxis?
- Admit patients to a monitored bed
- Give Augmentin
What is Tonometry and what does it help Dx?
- Test to measure IOP
- Glaucoma
How long does it take for a subconjunctival hemorrhage to resolve?
10-14 days
Mgmg of a corneal abrasion with rust ring:
Ophtho referral ASAP
MC patho of external otitis
Pseudomonas
Tx for Otitis Externa
1st: irrigate
2nd: Top. antimicrobials +/- steroids
Croup Sxs but TOXIC appearing. Dx?
Bacterial Tracheitis
Acute onset supratemporal orbital edema and tenderness. Dx?
Dacryoadenitis
Esophageal Foreign Body coin on AP/PA frontal film
We see flat side of coin
What is the name of the eye pus infection that resembles hyphema?
Endophthalmitis
Dx for Mastoiditis
CT Contrast
Prophy for Gono Conjunctivitis in newborns:
Topical Erythromycin
Episodic vertigo is seen in:
- Meniere’s Disease
- Benign paroxysmal positional vertigo
What type of diet can be recommended for a patient with Meniere’s disease?
Low sodium diet
Tx for Necrotizing Otitis Externa
IV FQ and admit
In a single anterior nose bleed, what is the next step in mgmt if gauze fails?
Add 4% cocaine or lidocaine
MC site for Cholesteatoma to occur
Pars flaccida
Tx for Dacryocystitis
Top. ocular + PO anti-staph Abx (Clinda or Vanco + Ceph)
Strabismus medially:
Esotropia
Itchy, mildly swollen ear canal with thickened, white, creamy exudate. Dx?
Otomycosis (fungal infxn)
Likely cause of Pterygium
Excessive sunlight exposure
(Usu.) painless loss of vision, floaters, flashing lights D/T injury or spontaneous. Dx?
Retinal Detachment
Cotton wool spots and flame hemorrhages are common PE findings on eye exam in:
Diabetic retinopathy
Bilateral, gradual central field vision loss common in elderly. Dx?
Macular Degeneration
Acoustic Neuroma Dx
MRI with gadolinium
Which 2 eye tumors present with hyphema?
Retinoblastoma and melanoma of the iris
Bacterial Conjunctivitis Tx
Abx drops (Ofloxacin)
In Retinal Detachment, separation occurs from:
Choroid (MC Rhegmatogenous)
MC chronic illness of childhood
Dental caries
Necrotizing Otitis Externa (OE) will affect CN ___ and pt. complaint of:
- VII
- Trismus
What is Amaurosis Fugax?
Temporary MONOcular vision loss for minutes and full recovery.
“Curtain coming down”
In Benign paroxysmal positional vertigo (BPPV), where is a stone likely to be stuck?
Posterior semicircular canal
Acoustic Neuroma Tx
Excision microsurgery
Gradual hearing loss, tinnitus, balance disturbance. Dx?
Acoustic Neuroma
MCC of Acoustic Neuroma
CN VIII (vestibulocochlear) tumor
Amaurosis Fugax is seen in what 3 Dx?
- Central Retinal ARTERY Occlusion
- Giant Cell (Temporal) Arteritis
- Transient Ischemic Attack (TIA)
Tool used to Dx Macular Degeneration
Amsler grid (tik-tac-toe)
Hyphema Mgmt
- Eye protection
- Limitation activity
- Head elevation
Dacryoadenitis vs. Dacryocystitis
Adenitis: A comes 1st so it’s at the top (lac gland)
Cystitis: C comes after A so it’s at the bottom (duct)
Dx for Benign paroxysmal positional vertigo (BPPV)
Dix-Hallpike
Mononucleosis: posterior or anterior cervical chain?
Posterior
Bacterial conjunctivitis Tx
Abx Polymyxin B + Trimethoprim solution
In Central Retinal Artery Occlusion, after giving appropriate meds, what test should be done?
ECG → identify source of emboli
Tx for Sialadenitis
IV Nafcillin
When treating Strep Pharyngitis, what is true in regards to rheumatic fever and glomerulonephritis?
Prevents acute RF but NOT post-strep glomerulonephritis
MC type of conjunctivitis in adults
Adenovirus
Tx for Herpes Simplex Keratitis
- Top. Antivirals: Trifluridine, Vida.
- Ointment: Gancyclovir
- PO Acyclovir
Tx for Sinusitis with PCN allergy
Doxy
In peripheral vestibular nystagmus, in what direction do the eyes go?
Opposite side
Abrasion vs. ulceration
A: D/T trauma to cornea
U: D/T infxn
Chlamydia vs. Gono Conjunctivitis
G: within 3-5 days of birth
C: 1-2 wks after birth
Tx for Macular Degeneration
Ranibizumab
What symptom is most characteristic of acute conjunctivitis?
Serous or clear discharge
Tx for Hereditary Angioedema
-FFP
or
-C1 esterase inhibitor replacement
What med causes severe angioedema?
ACE-I
What topical med should be avoided in conjunctivitis D/T possible exacerbation of infection?
Corticosteroids
Use of systemic corticosteroids can cause what adverse effects in the eye?
Glaucoma
Which PE finding distinguishes allergic rhinitis from other rhinitis etiologies?
Pale nasal turbinates
How do we know the difference between gingival hyperplasia d/t medication and gingivitis?
Gingivitis: gums tender, soft, red, bleed easily.
Hyperplasia: gums firm, light pink, do not bleed easily.
Patient presents to the ED, has peritonsillar abscess Sxs, and is stable. The supervising MD is busy with another pt. I spoke to the ENT who told me to perform I&D myself even though I had never done it but I had seen it done before. ENT told me all the steps, which I understood. Pt then starts having respiratory distress. What is the next step?
Intubation
Tx for Bacterial Keratitis
FQ drops
Tx for Sialolithiasis
- 1st: Lozenges
- 2nd: Lithotripsy
What would cause Bitemporal Hemianopsia?
Compression at optic chiasm
What 2 would cause Homonymous Hemianopsia?
- Putamen Hemorrhage
- Ischemic Stroke @ middle artery
Loss of color vision over a few days, usually unilateral. Ocular pain worse with movements. Affarent pupil defect. Dx?
Optic Neuritis
Chronic Sinusitis is likely D/T
Foreign body
Pt. presents with itchy eyes and chemosis (swollen lids). What is the treatment of choice?
- Azelastine
- “-tine” is for allergies
Best Tx for bacterial conjunctivitis
Genta
Tx for Dacryocystitis
Cephalexin
Pt. presents with strabismus. What test would you like to order?
MRI
51 yo presents reporting dizziness this morning that has since subsided. What is your next step in management?
- CT or MRI
- Worry about stroke
A pt. presents with vertigo and hearing loss. He reports a URI 2 wks ago. What is the likely Dx?
- Labyrinthitis
- Vertigo + HL + URI
Pt. presents with a retinoblastoma. What would you like to do?
Bone scan D/T asociation with Osteosarcoma