EENT 9% Flashcards
Inflammation of both eyelids =
Common in pts w/ ____.
Blepharitis
Common in Down’s syndrome, Eczema
Painful, warm, swollen red lump on eyelid
Tx:
Hordeolum (Stye)
Tx: Warm compresses +/- topica abx (Erythromycin, Bacitracin)
I+D if no drainage after 48 hrs
PainLESS granuloma of internal meibomian sebaceous gland
Presentation:
Chalazion
Hard, non-tender eyelid swelling
Infection of lacrimal gland =
MC cause:
Tx:
Dacrocystitis
MC: S. aureus, GABHS, S. epidermis, H. flu, S. pneumo
Tx: Clindamycin + 3rd gen cephalosporin
Fleshy, triangular-shaped GROWING fibrovascular mass =
Pterygium
Associated w/ increased UV exposure in sunny climates
Yellow, elevated nodule on nasal side of eye (fat and protein) =
Pinguecula
Orbital floor “blowout” fracture causes diplopia especially with ___ d/t ____.
Tx:
upward gaze
inferior rectus muscle entrapment
Tx: Initial –> nasal decongestants, avoid blowing nose, prednisone
Abx (Unasyn, Clindamycin)
Positive Seidel’s test seen in ___.
Globe rupture
= parting of fluorescein dye by clear stream of aqueous humor from anterior chamber
Drusen =
Seen in ___.
small, round yellow-white spots on outer retina
Dry (atrophic) macular degeneration
Dx of wet macular degeneration =
Flurescein angiography
Scotomas =
Metamorphopsia =
Micropsia =
Seen in ____
Scotomas = blind spots, shadows Metamorphopsia = straight lines appear bent Micropsia = object seen by affected eye looks smaller than in unaffected eye
Macular degeneration
Amsler Grid used for ___
management of DRY macular degeneration to monitor stability at home
Tx of WET macular degeneration
Anti-angiogenics (Bevacizumab)
What can be used to slow progression of DRY macular degeneration?
Vit A, C, E, zinc
Presentation of Hypertensive Retinopathy based on stage
I: Arterial narrow –> Copper wiring (moderate), Silver-wiring (severe)
II: AV nicking
III: Flame shaped hemorrhages, cotton wool spots
IV: Papilledema = malignant HTN
patient’s pupils constrict less (therefore appearing to dilate) when a bright light is swung from the unaffected eye to the affected eye =
Positive in ___ (2)
Marcus Gunn
Positive in Papillitis, Retrobulbar neuritis
Photopsia =
Progression:
Seen in ___.
Flashing lights
–> floaters* –> unilateral vision loss/shadow “curtain” in peripheral –> central visual fields*
Retinal detachment
Positive Schaffer’s sign =
Seen in ___.
T/F: Normal or decreased intraocular pressure.
clumping of pigment cells in anterior vitreous
Retinal detachment
True.
T/F: Acidic burns is worse than alkali burns.
Tx:
False. Alkali burns are worse –> liquefactive necrosis
Tx: Immediate irrigation (Lactated Ringers, NS)
Broad spectrum abx (Moxifloxacin)
Infection of eyelid and periocular tissue =
T/F: Associated w/ visual changes and pain w/ ocular movement.
PRESEPTAL cellulitis
False: Associated w/ POSTseptal cellultis
Tx of Postseptal cellultis
Tx: IV Vancomycin, Clindamycin, Cefotaxime
Halo around lights, “steamy cornea”, mid-dilated nonreactive pupil, eye hard to palpation seen in ___.
Acute narrow-angle closure glaucoma
Dx of Acute narrow-angle closure glaucoma
Tx:
Increase IOP by Tonometry (>21 mmHg)
“Cupping” of optic nerve
Tx:
1st line: Acetazolamide IV
Topical beta blocker: does NOT affect visual acuity
Miotic/cholinergics: Pilocarpine, Carbachol
Definitive tx: Peripheral iridotomy
Slow progressive Bilateral peripheral vision loss =
Tx:
Chronic open angle glaucoma
“Tunnel vision”
1st line: Prostaglandin analogs (Latanoprost)
Timolol
Viral conjunctivitis MC caused by ___ pathogen
Adenovirus
Keratitis (A.k.a ____)
Bacterial presents w/ ____. Tx:
HSV presents w/ ____. Tx:
Corneal ulcer/inflammation
Bacterial: Hazy cornea
Tx: FQ (Moxifloxacin)
HSV: Dendritic lesions
Tx: Trifluridine, vidarabine, Acyclovir (ointment/PO)
MC etiology of Optic Neuritis
PE:
Tx:
Multiple Sclerosis
= inflammation of optic nerve CN II
PE: Marcus Gunn Pupil
Tx: IV methylprednisolone –> PO steroids
Anterior or posterior Uveitis?
Unilateral, ocular pain, redness, photophobia
Anterior
Anterior or posterior Uveitis?
Blurred/decreased vision
Floaters
NO pain
Posterior
Ciliary injection (limbic flush), consensual photophobia, inflammatory cells and flare seen in ____
Tx:
Uveitis
Anterior: topical steroids
Posterior: systemic corticosteroids
Pale retina w/ cherry-red macula (red spot)
Box car appearance of veins
Central Retinal ARTERY Occlusion
Blood and thunder appearance
Extensive retinal hemorrhages
Central retinal VEIN occlusion
____ artery commonly involved in Amaurosis Fugax
External carotid artery
Tx of Otitis Externa
- Ciprofloxacin/dexamethasone
- Neomcin/polytrim-B/hydrocortison (do NOT use if TM perforation if suspected)
MC cause of acute otitis media
S. pneumo
If bullae on TM, suspect ___ as cause of acute otitis media.
Mycoplasma
Tx of Otitis Media
Drug of choice: Amoxicillin x 10-14 days
If PCN allergy: Erythromycin-Sulfisoxazole
Tx of mastoiditis
IV Abx (Ampicillin, Cefuroxime) w/ myringotomy Refractory --> mastoidectomy
UNIlateral hearing loss is ____ until proven otherwise.
Acoustic (vestibular) CN 8 Neuroma
Epley Maneuver
Management of Benign Paroxysmal Positional Vertigo
= canalith repositioning
Vestibular neuritis + hearing loss/tinnitus =
Tx:
Labyrinthitis
Tx: corticosteroids
(Vertical/horizontal) nystagmus seen in central vertigo.
Vertical
(Vertical/horizontal) nystagmus seen in pheripheral vertigo.
Horizontal
Weber lateralizes to (normal/affected) ear in sensorineural loss.
Normal
SensoriNeural lateralizes to Normal ear + Normal Rhinne
Weber lateralizes to (normal/affected) ear in conductive loss.
Affected
Rinne test has AC ( > or < ) BC in normal hearing.
AC > BC
Rinne test has AC ( > or < ) BC in sensorineural loss.
NORMAL: AC > BC
Rinne test has AC ( > or < ) BC in conductive loss.
AC < BC
X ray view to dx acute sinusitis
Water’s view
CT scan = diagnostic test of choice
Tx of acute sinusitis
Amoxicillin x 10-14 days**
Doxycyline
Bactrim
Mucormycosis
Tx:
Fungi that invades sinuses that may enter CNS
Immunocompromised pts
Affects orbits, sinuses, lungs, CNS
Tx: Amphotericin B, Posaconazole
____ associated w/ nasal polyps worse in AM
ALLERGIC Rhinitis
MC type of Rhinitis
MC infectious cause of rhinitis
MC type: Allergic = IgE mediated mast cell histamine release
Rhinovirus
Intranasal decongestants used > 3-5 days may cause ____
Rhinitis medicamentosa = rebound congestion
Sialolithiasis: Salivary stones MC in ___.
Wharton’s duct (submandibular)
Stenson’s duct = parotid glands
Oral lichen planus has increased incidence in pts/ with ___
HCV
Lacy leukoplakia lesions of oral mucosa
Oral lichen plancus
White patchy lesion that canNOT be rubbed off
Oral leukoplaia
T/F: 90% of oral leukoplakia are precancerous for dysplastic or evident of adenocarcinoma.
False. 90% of erythroplakia precancerous for SQUAMOUS CELL carcinoma
6% of oral keukoplakia are precancerous for squamous cell carcinoma
Oral hairy leukoplakia is caused by ____.
MC in pts with ____.
T/F: Can be scrapped off.
Epstein Barr Virus
HIV/immunocompromised
False. Can NOT be scrapped off
T/F: Oral candidiasis can be scraped off but leaves behind erythema/bleeds.
True
Tx of RECURRENT aphthous ulcers.
Cimetidine
Tx of peritonsillar abscess
Drainage + Abx (Unasyn or Clindamycin)
Tx of epiglottitis
IV Ceftriaxone +/- clindamycin
Rifampin for prophylaxis
Primary manifestation of HSV-1 in children
Acute herpetic gingivostomatitis
6 mo-5 y/o
Primary manifestation of HSV-1 in adults
Acute herpetic pharyngotonsillitis
Cellulitis of sublingual and sumaxillary spaces in the neck =
Presentation:
Tx:
Ludwig’s angina
Swelling and erythema of upper neck and chin w/ pus on floor of mouth.
PCN + Metronidazole
Clindamycin
Ampicillin/Sulbactam (Unasyn)
Ramsay-Hunt Syndrome =
Caused by:
Tx:
Herpes zoster oticus = acute facial palsy + otalgia and varicella or vesicular-type lesions.
Lesions on pinna**
Facial paralysis
Herpes varicella virus
Oral steroids, antiviral, pain medication
Hutchinson’s sign =
Suggestive of ____
Involvement of tip of nose w/ herpes virus
Involvemnt of cornea w/ herpes –> urgent ophtho referral
Tensilon test (A.K.A. ___) used to dx ___
edrophonium testing
Myasthenia gravis (MG)
Permanent decrease in visual acuity in child caused by abnormal visual exposure during maturation process =
Amblyopia
Hutchinson’s incisors (notching of incisors) can be caused by ____.
congenital syphilis
“Tree branch” pattern on fluorescein stain
Herpetic infection of cornea = Herpetic keratitis
Otosclerosis causes (conductive/sensorineural) hearing loss
Conductive
Familial condition
Bones of middle ear soften and then harden at joints
Presbycusis causes (conductive/sensorineural) hearing loss
Senorineural
= age related hearing loss
T/F: Myringosclerosis causes conductive hearing loss.
False. Scarring of TM does NOT cause hearing loss
CN3 palsy is frequently associated with ____
unruptured cranial aneurysm
Ptosis, dilated pupils, lateral deviation of eye, double vision
Painful gingivitis and stomatitis d/t spirochetal and fusiform bacterial infection
Vincent’s angina
Enlargement skull compresses ____ in Paget’s disease.
auditory nerve (CN8) –> neural deafness
Medications that may worsen psoriasis
BB
Anti-malarials
Lithium
Condyloma lata is caused by
Treponema pallidum
=fused, weeping papules in perineum