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EENT and Upper Respiratory Disorders > EENT and Upper Respiratory Disorders > Flashcards

EENT and Upper Respiratory Disorders Flashcards

1
Q

In a normal eye, what is the cup to disk ratio?

A

Cup should not be more than 1/2 the size of the disc diameter

If larger - ? glaucoma

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2
Q

What is the normal A/V ratio?

A

Arteries are brighter red and more narrow than veins

2:3 or 4:5

AV nicking - ? HTN

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3
Q

Where is the macula located?

A

Centered, 2-2.5 disc diameters temporal to optic disc and is avascular

Fovea Centralis - Looks slightly darker and lies in the center of the macular region

Macular Degeneration - deterioration of central portion of vision - Leading cause of blindness

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4
Q

If you are having difficulty visualizing the macula on your opthalmic exam, what should you instruct the patient to do?

A

Look into the light of the opthalmoscope

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5
Q

Define hyperopia

A

farsightedness

Increased in Gero’s

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6
Q

Define myopia

A

Nearsightedness

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7
Q

What is presbyopia?

A

difficulty focusing up close… common after age 40 due to weakening of ciliary muscles and less flexible lens

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8
Q

What is the primary pathogen implicated in Hordeolum?

A

Staph aureus

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9
Q

Differentiate between hordeolum, chalazion, and blepharitis

A

Hordeolum: stye and is painful. refer if not better with warm compresses in 2 days.
Chalazion: beady painless nodule. May cause light sensitivity and increased tearing. Refer for I&D if no improvement with warm compresses.
Blepharitis: inflammation of eyelash base, red, scaly, greasy flakes requiring hot compresses and thorough lid scrubbing

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10
Q

If using topical products for hordeolum or blepharitis, what do you use?

A

bacitracin or erythromycin ointment

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11
Q

What symptoms would you expect to see in bacterial conjunctivitis and how would you treat it?

A

You would expect to see purulent drainage among the other expected symptoms of itching, burning, redness, tearing, swelling of eyelids, and sensation of foreign body in the eye.

Painless

It is self-limiting, but you could treat with a antibiotic drops… levofloxacin, ofloxacin, ciprofloxacin, tobramycin, gentamycin

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12
Q

What would you expect to see if chlamydial or gonoccocal conjunctivitis?

A

Very copius, purulent drainage.
Treat Gonorrhea with Ceftriaxone 250mg IM
Treat chlamydia with erythromycin opthalmic ointment or oral tetracycline, erythromycin, clarithromycin, azithromycin, doxycyline

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13
Q

What would you expect to see in allergic conjunctivitis?

A

Stringy discharge with increased tearing

Treat with oral antihistamines.

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14
Q

What would you expect to see if viral conjunctivitis?

A

Watery discharge… symptomatic care

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15
Q

When is screening with tonometry recommended and what does it screen for?

A

It is recommended by age 40. Used to screen for glaucoma.

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16
Q

What is Open-Angle Glaucoma?

How is it treated?

A

Open-angle: chronic, often asymptomatic, cupping of disc, constriction of visual fields - tunnel vision secondary to peripheral vision loss.

Managed with drops:
alpha2 adrenergic agonists - brimonidine, alphagan
beta-adrenergic - timolol
miotic agents - pilocarpine

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17
Q

If a patient tells you they are seeing halos around light, what are your top 3 differential diagnoses?

A

Cataracts
Closed-angle glaucoma
Digoxin toxicity

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18
Q

What are some causes of cataracts?

A 
Aging
Heredity 
Trauma
Toxins such as drugs, smoking, and alcohol
Diabetes
AV sunlight exposure - tanning beds
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19
Q

What are some signs/symptoms of cataracts?

A 
Painless
Clouded, blurred or dim vision
Halos around lights
Difficulty with night vision
Sensitivity to light/glare
Fading/yellowing of colors
Diplopia - double vision in a single eye
Need or brighter light
No red reflex
Opacity of the lens
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20
Q

If you diagnose cataracts, what are your next steps?

A

Have patient change glasses as cataract develops

Refer to opthalmology

Surgery

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21
Q

What is retinal detachment?

A

It is the separation of the light-sensitive membrane in the back of the eye from it’s supporting layers

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22
Q

What are signs/symptoms of retinal detachment?

A

Flashes of light (photopsia) especially in peripheral fields
Floaters
Blurred vision
Shadow or blindness in part of the visual field of one eye.

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23
Q

What is otitis externa?

What is the primary pathogen indicated in otitis externa?

A

Inflammation and/or infection of the external auditory canal (and/or auricle & TM).

Tyes:
Acute localized (furunculosis)
Acute diffuse bacterial (swimmer’s ear)
Others… chronic, fungal, eczema

Staph aureus causes furuncles and pustules in the outer third of the ear canal that cause severe pain (otalgia) with area of cellulitis, itching, erythema, scaling, fissures, crusting, possible exudate

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24
Q

How is OE managed?

A

Cleansing and debridement of the ear
Topical otic drops (cortisporin otic)
Analgesics (NSAIDs, topical corticosteroids)

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25
In order of commonality, what bacteria are the most common in acute OM/serous OM?
#1 Step pneumoniae (40-50%) #2 H. Influenza (20-30%) #3 Moraxella catarrhalis (10-15%)
26
What are signs/symptoms of acute OM/serous OM?
Otalgia (slight-to-severe) spreading to temporal region Otorrhea Vertigo Nystagmus Tinnitus Fever Lethargy N/V Anorexia Local inflammation - erythema with diminished light reflex, fluid in middle ear Exudative phase - middle ear serous exudate Suppurative phase (serous) - Purulent exudate, retraction and poor mobility of the TM, membrane becomes bulging and convex, membrane may rupture
27
What is the treatment of acute OM/serous OM?
Viral - Most uncomplicated cases resolve spontaneously or with hydration, avoidance of irritants, use of topical or oral decongestants and cool mist humidifiers Antibiotic for suspected bacterial infections only - ***Amoxicillin***
28
What causes cholesteatoma?
Chronic otitis media consisting of peeling layers of scaly or keratinized epithelium... if untreated, may erode the middle ear and lead to deafness and nerve damage
29
What are some signs/symptoms of cholesteatoma?
*Squamous epithelium lined sac, filled with desquamated keratin *Chronic infection *Painless otorrhea, either unremitting or frequently recurrent *Hearing loss (ossicular damage) *Canal filled with mucopus and granulation tissue *TM perforation in 90% of cases ***Surgery - Referral***
30
What is the most common type of vertigo?
Benign paroxysmal positional vertigo (BPPV) Sensation of motion either of the person or the environment
31
What are common causes of BPPV?
``` Brain tumors Medications OM or labrynthitis Meniere's disease Acoustic neuroma Head trauma Neck injury Migraines Cerebellar hemorrhage ```
32
Vertigo S/S
``` Sensation or disorientation or motion Positive Dix-Hallpike N/V Sweating Nystagmus Hearing loss Tinnitus Visual disturbance Weakness/difficulty walking Difficulty speaking Decreased level of consciousness ```
33
How many decibels do you need to have lost in order to have definitive hearing loss.
20 dB or more
34
What is the Weber test? Interpret it.
It is a tuning fork test that lateralizes to affected ear in conductive hearing loss and unaffected ear in sensorineural hearing loss. *Normal finding - it does not lateralize
35
What is the Rinne test? Interpret it.
It is a tuning fork test that measures air and bone conduction. A normal finding is AC>BC. In conductive hearing loss, BC>AC in the affected ear. In sensorineural hearing loss, normal in the affected ear.
36
In addition to a otoscopic exam if hearing loss is suspected, what other tests would you perform?
General neurological exam, cranial nerve testing Audiometry testing CT scan if neurologic condition is suspected Serum blood tests as needed
37
You diagnoses a patient with viral rhinitis (otherwise known as the common cold). How long do you tell him you expect it to last? And how do you advise him to manage it?
5-10 days. | Warm salt water gargles. Hydration. Tylenol/Motrin for sore throat or fever= supportive care.
38
What is the FLEA criteria and what does it mean?
``` Centor Criteria - suggestive of Group A strep F= Fever L= Lack of cough E= Exudate A= Anterior cervical adenopathy ``` If 1 or more of these are present, it is a good indicator the patient has strep throat and a strep test should be performed.
39
If your patient has a positive strep test, which antibiotic do you prescribe. What if allergies?
PCN V. If allergic, erythromycin.
40
What is the primary pathogen implicated in strep throat?
group A beta hemolytic streptococcus
41
What is an example of a neuraminidase inhibitor? | How does it work?
Oseltamivir (Tamiflu). Shortens flu-symptoms by 2 days.
42
What is the incubation period for mono?
1-2 months
43
What are two symptoms that distinguish mono from strep?
Splenomegaly and posterior cervical adenopathy... AND they cannot play contact sports for 3 weeks to several months.
44
What pathogens are implicated in sinusitis if bacterial? What makes you think it may be bacterial vs viral? How would you treat?
Most likely bacterial if fever and purulent nasal drainage present Strep pneumoniae H. influenzae Treat with Amox/Clav or Clarithromycin
45
Ophthalmoscope
My R hand, my R eye, patient's R eye Start wheel at 0 Start 12" from pt with both eyes open After obtaining red reflex, exam should proceed from optic disk and end with fovea
46
Optic Disc
Doughnut-shaped with orange/pink neuroretinal rim with a central white depression (cup)
47
Snellen 20/20
Patient can see what a normal person can see at 20' The larger the denominator, the poorer the patient's vision 20/30 - pt can see at 20' what a normal person can see at 30' - Needs referral
48
Arcus Senilis
Cloudy appearance of the cornea with a gray/white/bluish arc or circle around the limbus due to deposition of lipid material - hyperlipidemia **Has no effect on vision** **Permanent and Benign**
49
What is pterygium?
Raised, wedge-shaped growth of thin, noncancerous tissue over the conjuntiva Conjuncitva is clear
50
What is a hordeolum?
*Stye* It HURTS *Staph* Acute inflammatory, most commonly infectious process affecting the eyelid, usually caused by staph aureus
51
S/S of hordeolum
Abrupt onset Pain Erythema of eyelid Localized, tender mass
52
Hordeolum treatment
Warm compresses, try to bring to a head Topical bacitracin or erythromycin ointment Refer if not resolved in 2 days
53
What is a chelazion?
Nodule on eyelid Infection or retention cyst of meibomian gland, usually on the upper eyelid **Painless** apart from tenderness secondary to localized swelling.
54
S/S of chelazion
``` **Painless** Nodule on eyelid Swelling Tenderness Sensitivity to light Increased tearing May cause astigmatism if very large ```
55
Chelazion Treatment/Management
Warm compresses | Referral for surgical removal
56
What is blepharitis?
Staphylococcus infection or Seborrheic dermatitis of eyelid
57
S/S of blepharitis
Red, scaly, greasy flakes, thickened, crusted lid Burning Itching Tearing
58
Blepharitis treatment/management
Hot compresses, topical antibiotics *bacitracin or erythromycin* Vigorously scrub lashes and lid margins with eyes closed followed with thorough rinsing - use old toothbrush
59
What is the most common eye disorder?
Conjunctivitis
60
What is pathophys of glaucoma
Increased IOP
61
What is Closed-Angle Glaucoma? | How is it treated?
Closed-angle: acute, extremely painful, blurred vision, halos around lights, with fixed or dilated pupil. Refer to surgery Managed with: Carbonic anhydrase inhibitor - acetazolamide (Diamox) Osmotic diuretics - mannitol
62
What are cataracts?
Clouding and opacification of the normally clear lens of the eye Highest cause of treatable blindness Most common surgical procedure in patients >65d -senile cataracts-
63
What is Acute OM/Serous OM?
Presence of fluid in the middle ear accompanied by S/S of infection. ***Most common: URI (viral)***
64
Vertigo Labs/Diagnostics
``` CT scan VDRL/RPR Serum medication levels Hearing exam Blood glucose and EKG may be helpful ```
65
Vertigo Management
``` Diazepam (Valium) - Benzo's Meclizine (Antivert) - antihistamine Diphenhydramine (Benadryl) - antihistamine Scopolamine patch Antiemetics ```
66
What are some causes of conductive hearing loss?
Foreign body in ear canal/cerumen build up - Most common cause of hearing loss, most treatable Hematoma Perforated TM OM OE Otosclerosis
67
What are some causes of sensorineural hearing loss?
Damage to hair cells and/or nerves that sense sound waves Acoustic trauma Barotrauma (usually in divers) Head trauma Ototoxic drugs - aminoglycosides, diuretics, salicylates, NSAIDs, antineoplastics Meniere's disease Acoustic neuroma Infections - mumps, measles, herpes zoster, syphilis, meningitis, etc.
68
Ototoxic drugs
``` Aminoglycosides Diuretics Salicylates NSAIDs Antineoplastics ```
69
What is Pharyngitis/Tonsillitis? | Causes?
Inflammation of the pharynx or tonsils. Viral (influenza A&B, Epstein-Barr, etc.) Bacterial
70
Strep Throat S/S
``` Erythematous pharynx Rhinorrhea Fever Anterior cervical adenopathy Painful throat Maculopapular rash Lack of cough ```
71
What is influenza? What are S/S? Management?
Acute febrile illness caused by infection with influenza type A and B viruses S/S: Abrupt onset of - fever, HA, myalgias, coryza, anoexia, malaise, cough ``` Management: Supportive care Neuraminidase inhibitor zanamivir (Relenza) - inhaler oseltamivir (Tamiflu) - oral ```
72
What is mononucleosis? S/S? Labs? Management?
Symptomatic infection caused by Epstein-Barr virus, common in young adults 15-24 yo **Kissing Disease** S/S: Fever, chills, malaise/fatigue, anorexia, pharyngitis (most severe symptom), white tonsillar exudate, POSTERIOR cervical lymphadenopathy, splenomegaly Labs: Monospot, increased WBC with relative lymphocytosis and neutropenia Management: Supportive care, prednisone taper if severely enlarged tonsils, NO contact sports for weeks to months
73
What is sinusitis? | Causes?
Inflammation of the mucous membranes lining one or more of the paranasal sinuses, almost always accompanied by inflammation of the nasal mucosa Causes: Streptococcus pneumonaie Haemophilus influenzae
74
Sinusitis S/S and Treatment/Management
S/S: Often hx of recent URI with some improvement then relapse Red nasal mucosa Pain/pressure over face, nose, cheeks, teeth/molars Purulent nasal drainage (Bacterial) Fever (Bacterial) Tenderness over sinuses HE in supine or bending position - dull/throbbing Foul smelling nasal or post-nasal drainage Tx: Supportive, Abx only if bacterial... Amox/clav (Augmentin) clarithromycin (Biaxin) Consider 2nd line agent if no improvement after 72 hrs
75
What is most common site of nose bleeds?
Anterior Septum **Kiesselbach plexus**

EENT and Upper Respiratory Disorders (2 decks)

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