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Concepts / Lists > EENT > Flashcards

EENT Flashcards

1
Q

ectropion

A

eyelid + lashes turned outward (relaxed orbicularis oculi)

-mc bilateral elderly, but can be congenital, infx or CN7 palsy

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2
Q

entropion

A

eyelid + lashes turned inward (spasms of orbicularis oculi)

-mc in elderly

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3
Q

dacrocystitis

A

infx of lacrimal sac

  • mc s. aureus, strep
  • redness to medial canthal (nasal side) of lower lid
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4
Q

blepharitis

A

inflam of both eyelids - common in down’s + eczema

  • anterior (skin + base of eyelashes) - infx or seborrheic
  • posterior - meibomian gland dysfunction (rosacea or allergic derm)
  • tx - eyelid hygiene, compress, massage (posterior), abx if unresponsive
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5
Q

chalazion

A

painless lipogranuloma of either a meibomian gland or a Zeis gland

  • eyelid lump/swelling, nontender
  • hygiene, compress, abx not necessary, cortico injection or incision if large/affecting vision
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6
Q

pterygium

A

triangular-shaped, “growing”, fibrovascular mass - nasal side of eye

  • assoc w/ inc UV exposure, sand, wind, dust
  • observe, remove if vision affected
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7
Q

pinguecula

A

yellow, elevated nodule on nasal side of sclera (fat/protein)

  • doesnt grow!
  • observe, cosmetic removal
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8
Q

orbital floor “blowout” fracture

A
  • decreased vision, diplopia esp w/ upward gaze (if inferior rectus entrapped), epistaxis, dyesthesias, hyperalgesia or anesthesia to cheek (due to infraorbital nerve)
  • nasal decongestant (dec pain), abx, corticosteriords, surgical repair
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9
Q

macular degeneration

A

rf: >50yo, caucasian, F, smoker
- mc cause of permanent legal blindness in elderly >75yo
- macula responsible for central vision and detail/color

-MC dry (atrophic) type: gradual breakdown; DRUSEN = small, round, yellow-white spots on outer retina (accum of waste products)
-wet (neovascular or exudative): new, abnormal vessels grow under central retina and leak blood –> scars
(rare and faster progression)

-sx: bilateral blurred or loss of central vision (detail/color), scotomoas (blind spots), metamorphosia (straight lines appear bent), micropsia (objects look smaller)

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10
Q

diabetic retinopathy

A
  • mc cause of new, permanent vision loss/blind 25-74yo
  • glycosylation of collagen of BV –> capillary wall breakdown–> ischemia, edema

Nonproliferative (background): microaneurysms (cotton wool spots, hard exudates, blot + dot hemorrhages)
-tx: panlaser tx, strict glucose control

Proliferative: neovascularization (new BV), vitreous hemorrhage
-tx: VEGF inhibitors (bevacizumab), laser photocoag tx, glucose control

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11
Q

hypertensive retinopathy grades

A

I: arterial narrowing –> copper wiring (mod), silver wiring (sev)
II: AV nicking - venous compression at arterial-venous jx by increased arterial pressure
III: flame-shaped hemorrhages, cotton wool spots
IV: papilledema (malignant HTN)

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12
Q

retinal detachment

A

Rhegmatogenous MC type: retinal tear –> retinal inner sensory layer detaches from choroid plexus

  • mc predisposing factors: myopia + cataracts
  • sx: photopsia (flashing lights) –> floaters –> progressive unilateral vision loss (curtain coming down) in periphery initially –> central vision loss
  • dx: fundoscopy = retinal tear, +shafer’s sign (clumping of brown pigment cells in anterior vitreous humor (“tobacco dust”)
  • OPTHO EMER - keep supine, no drops –> laser, cryotherapy, ocular sx
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13
Q

chemical burns (eye)

A

OPTHO EMER - immediate irrigation

  • alkali worse than acid (liquefactive necrosis vs. coagulative necrosis)
  • irrigate w/ lactated ringers or normal saline; LR ph higher and closer to tears (pH 7.1) x30 min, at least 2L
  • check pH and visual acuity after irrigation
  • abx like moxifloxacin + 0.25% atropine drops (cycloplegic agent), optho f/u
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14
Q

periorbital cellulitis

A
  • usually 2ry to sinus infx, ethmoid mc
  • mc children
  • DECREASED VISION, pain w/ eye movement, proptosis (eye bulge), erythema + edema
  • dx - CT scan
  • tx - IV abx - cover for STAPH/MRSA - vanc, clinda, cefotaxime, amp/sulbactam

preseptal cellulitis - infx of eyelid and periocular tissue, pain/swell but NO VISUAL CHANGE and NO PAIN w/ MOVEMENT
-tx- amox/clav

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15
Q

keratitis (corneal ulcer/inflam)

A
  • bacterial mc, pseudomonas, acanthamoeba (contacts)
  • sx: pain, photophobia, reduced vision, red, tearing
  • bacterial: hazy cornea, ulcer –> FQ drops, no patch!
  • HSV: dendritic lesions (branching w/ fluoro stain) –> topical antivirals
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16
Q

anterior uveitis (iritis)

A

inflam of iris or ciliary body (cyclitis)

  • systemic inflam dz (esp if reocurrs) or infectious
  • unilateral pain/red/photophobia, usually after trauma
  • ciliary injection (limbic flush), consensual photopohobia, inflammatory cells and flare w/in aq humor

-tx- topical corticosteroids, scopolamine, topical cycloplegics to relieve pain

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17
Q

posterior uveitis

A

choroid inflammation

  • blurred/decreased vision, floaters, no pain, no sx of anterior involvement
  • ciliary injection (limbic flush), consensual photopohobia, inflammatory cells and flare w/in aq humor

-tx- systemic corticosteroids

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18
Q

RF for cataracts

A

aging (mc >60), smoker, corticosteroids
DM, UV light, malnutrition, trauma

-congenital: ToRCH syndrome (toxoplasmosis, rubella, CMV, HSV)

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19
Q

papilledema

A

optic nerve (disc) swelling 2ry to increased intracranial pressure (bilat)

  • mc idiopathic intracranial HTN
  • space-occupying lesion, inc CSF, cerebral edema, malignant/sev HTN
  • sx- HA, N/V, vision preserved but maybe changes
  • exam- swollen optic disc, blurred margins
  • MRI/CT to r/o mass effect; LP for inc CSF
  • tx- diuretics (acetazolamide - dec production of aq humor and CSF)
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20
Q

optic neuritis (optic nerve CN2 inflam)

A

acute inflam demylination of optic nerve

  • mc young 20-40yo
  • MULTIPLE SCLEROSIS mc, meds - ethambutol, chloramphenicol
  • loss of color vision, central scotoma/blind spot, usually unilateral, loss of vision over a few days
  • ocular pain that is worse w/ movement

MARCUS-GUNN PUPIL (positive)

-tx: IV methylprednisolone, followed by oral corticosteroids

21
Q

acute narrow angle-closure glaucoma

A

decreased drainage of aqueous humor in pt w/ preexisting narrow angle or large lens (elderly, far-sighted, asians)

  • preciptating factor = mydriasis (pupil dilation futher closes angle) like dim lights, sympathomimetics and anticholinergics
  • sx - severe, sudden, UNILATERAL ocular pain, vision changes, halos around lights, tunnel vision
  • exam - conjunctival erythema, steamy cornea, mid-dilated, fixed, nonreactive pupil, cupping of optic nerve via fundo
  • tx- lower IOP (acetazolamide) and open angle (cholinergics), topical BB
22
Q

chronic (open angle) glaucoma

A

slow, progressive BILATERAL vision loss

  • normal anterior chamber and angle, reduced aqueous drainage through trabeculum
  • RF: AA, >40yo, fam hx, DM
  • sx- painless, tunnel vision –> central loss
  • exam- cupping of optic discs (inc ratio)
  • tx- prostaglandin analogs 1st line, BB, a-2 agonists; laser tx if fails
23
Q

central retinal artery occlusion (CRAO)

A

retinal artery thrombus or embolus

  • mc 50-80yo w/ atherosclerotic disease; OPTHO ER
  • sx- acute, sudden monocular vision loss, often preceded by amaurosis fugax
  • dx- pale retina w/ cherry-red macula (red spot) due to obstx; “box car” appearance of retinal vessels
  • tx- decrease IOP, revascularize by laying supine and orpital massage to dislodge clot
24
Q

central retinal vein occlusion (CRVO)

A

central retinal vein thrombus –> fluid backup in retina

  • RF: HTN, DM, glaucoma, hypercoagulable
  • sx- acute, sudden, monocular vision loss
  • exam- extensive retinal hemorrhages (blood + thunder appearance), macular edema, optic disc swelling
  • tx- +/- antiinflammatories, steroids, laser photocoag
25
Q

mastoiditis

A

usually complication of prolonged/untreated otitis media

  • sx- deep ear pain (worse at night), F, mastoid tenderness
  • complications- hearing loss, vertigo, CN7 paralysis, abscess
  • dx- CT scan
  • tx- IV abx + middle ear/mastoid drainage (myringotomy)
26
Q

etiologies of conductive hearing loss

A

CERUMEN IMPACTION MC
external or middle ear - defect in sound conduction (obstx of object or cerumen), damage to ossicles (otosclerosis, cholesteatoma), mastoiditis, OM

27
Q

etiologies of sensorineural hearing loss

A 
PRESBYACUSIS MC (natural aging)
internal ear disorders - presbyacusis, chronic loud noise exposure, CNS lesions (acoustic neuroma), labyrinthitis, Meniere's syndrome
28
Q

TM perforation

A

mc due to penetrating or noise trauma (mc occurs at pars tensa), otitis media
-may lead to cholesteatoma devo
+/-conductive hearing loss
-most heal spontaneously
-avoid water/moisture, no topical aminoglycosides

29
Q

cholesteatoma

A

abnormal keratinized collection of desquamated squamous epithelium –> mastoid bony erosion

  • granulation tissue that erodes the ossicles over time –> conductive hearing loss
  • sx- painless otorrhea (brown/yellow w/ strong odor) +/- vertigo/dizzy
  • dx- granulation tissue/cellular debris +/- perf of TM, vertigo, conductive hearing loss
  • tx- surgical excision and reconstruction of ossicles
30
Q

otosclerosis

A

abnormal bony overgrowth of stapes –> conductive loss

  • sx- slowly progressive hearing loss, tinnitus
  • tx- stapedectomy w/ prosthesis
31
Q

benign paroxysmal positional vertigo

A

sudden, episodic, provoked by change of head position

  • usually lasts 10-60 seconds
  • pos DIX-HALLPIKE TEST/NYLAN BARANY –> fatigable, horizontal nystagmus
  • tx- EPLEY maneuver; antihistamines
32
Q

vestibular neuritis

A

inflam of the vestibular portion of CN8

  • MC after viral infx
  • sx- peripheral vertigo (continuous), dizzy, N/V, gait disturbances; +/- horizontal nystagmus, away from affected side
  • tx- CORTICOSTEROIDS, antihistamines for symptoms
33
Q

labyrinthitis

A

vestibular neuritis + hearing loss/tinnitus

  • sx- cochlear involvement so hearing loss + continuous peripheral vertigo, dizzy, N/V, gait disturb, horiz nystagmus
  • tx- CORTICOSTEROIDS
34
Q

meniere’s disease (idiopathic endolymphatic hydrops)

A

idiopathic distention of endolymphatic compartment of inner ear by excess fluid –> increased pressure –> hearing and balance disorders

  • sx- episodic vertigo lasting min-hours, tinnitus, ear fullness, fluctuating hearing loss
  • dx- transtympanic electrocochleography during active
  • tx- symptomatic - antihistamines, anticholinergics, benzos; decompress if refractory or severe
  • prevent- diuretics reduce endolymph pressure, avoid salt/caffeine/chocolate/ETOH (bc inc endolymph pressure)

*meniere syndrome due to identifiable cause, meniere disease is idiopathic

35
Q

acoustic (vestibular) neuroma

A

CN8 / schwannoma - benign tumor of schwann cells

  • sx- gradual hearing loss unilateral, tinnitus, balance disturbance (not episodic)
  • dx- MRI
36
Q

sinusitis area frequency

A

maxillary > ethmoid > frontal > sphenoid

37
Q

peritonsillar abscess

A

tonsillitis –> cellulitis –> abscess formation

  • mc strep (then staph, polymicrobial)
  • sx- muffled “hot potato voice”, diffulty w/ oral secretions, trismus, UVULA DEVIATES to CONTRALATERAL SIDE
  • dx- CT scan differentiate cellulitis vs abscess
  • tx- abx + aspiration or I+D (ampicilin/sulbactam) - tx clinically if not worried about deep neck involvement
38
Q

oral leukoplakia

A

precancerous hyperkeratosis due to chronic irritation (tobacco, smoking, ETOH, dentures)

  • sx- painless, white patches can’t be scraped off
  • tx- cryotherapy, laser ablation, biopsy for cancer risk
39
Q

erythroplakia

A

precancerous lesions similar to leukoplakia but w/ erythematous appearance
*90% is either dysplastic or evident of SCC

40
Q

oral hairy leukoplakia

A

caused by EBV (human herpes virus 4)

  • mc in immunocompromised
  • painless, white plaque along lateral tongue or buccal mucosa +/- smooth or irregular “hairy” lesions, can’t be scraped off, may change appearance daily
  • tx- no tx required, may spont resolve, antiretroviral tx
41
Q

sialothiasis

A

mc in wharton’s duct (submandibular); stensen’s duct

  • postpranidal salivary gland pain/swell
  • tx- sialogogues, increased fluids, massage; avoid anticholinergics –> lithotripsy
42
Q

acute bacterial sialadenitis (suppurative sialadenitis)

A

bacterial infx of parotid or submanibular salivar glands

  • STAPH MC, dehydration, chronic illness
  • sx- pain, swell, erythema near gland esp w/ meals, tenderness at opening, +/- puss if massaged
  • dx- CT SCAN (for associated abscess/extent)
  • tx- sialogogues, abx (dicloxacillin or nafcillin)
43
Q

oral lichen planus

A

idopathic cell-medicated autoimmune response (inc in pt w/ HCV infx)

  • sx- lacy leukoplakia of oral mucosa (wickham striae)
  • tx- local or systemic corticosteroids
44
Q

acute herpetic gingivostomatitis

A

primary manifestation of HSV-1 in children (mc 6mo-5y)
-sx- sudden onset F, anorexia –> gingivitis
vessicles on oral mucosa (gray/yellow lesions)
-tx- usually self-limiting, acyclovir if severe

45
Q

actue herpetic pharyngotonsillitis

A

primary manifestation of HSV-1 in adults

  • sx- F, malaise, HA, sore throat, vesicles that rupture –> ulcerative lesions w/ grayish exudates in post pharynx
  • tx- oral hygiene, resolve 1-2 wks
46
Q

ludwig’s angina

A

cellulitis of sublingual and submaxillary spaces in neck

  • MC 2ry to dental infx (anaerobes)
  • sx- swelling/erythema of upper neck and chin w/ PUS ON FLOOR OF MOUTH
  • dx- CT SCAN
  • tx- AMP/SULBACTAM (unasyn) or PCN + metro or clinda
47
Q

tinnitus

A

Evaluation should include a review of the patients blood pressure, allergies, serum lipids and thyroid function. Since most cases are due to presbycusis (age-related, cumulative hearing damage and loss), effective therapies are limited. Medication management involves trials of diuretics, antihistamines, anticonvulsants, tricyclic antidepressants and benzodiazepines.

Acoustic neuroma: CN VIII, hearing loss + tinnitus + disequilibrium
Ménière disease: recurrent vertigo + tinnitus + hearing loss
​Ramsay Hunt syndrome: facial paralysis, zoster lesions, tinnitus
Labyrinthitis: sudden severe vertigo, hearing loss, tinnitus, not recurrent
Head trauma
Electrical injury
Diving
Ototoxic agents:
Salicylates: respiratory alkalosis + anion gap metabolic acidosis + tinnitus
NSAIDs
Quinine
ABX (aminoglycosides, erythromycin, vancomycin)
Chemotherapeutic agents

48
Q

sinusitis classification / duration

A

< 4 weeks - acute
subacute
>12 weeks - chronic

49
Q

Retropharyngeal Abscess

A

Patient will be a toxic-appearing child 3–5 years-old w/ hx of trauma or URI

  • sx- fever, sore throat, dysphagia, trismus, stridor, nuchal rigidity, muffled voice, cri du canard (duck “quack”)
  • neck X-ray will show widened retropharyngeal space twice the size of the vertebral body
  • dx- CT scan
  • MC S. aureus, group A streptococcus, anaerobes, foreign body
  • tx- intravenous antibiotics, +/- I+D

Concepts / Lists (16 decks)

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