EENT Test 3 Flashcards
1
Q
Things to consider for complicated sore throat
A
GT/CT, other STI
2
Q
who are at risk for HPV sore throat? How do you screen?
A
head and neck tumors in younger people
can screen with oral wash
3
Q
How do you diagnose peritonsillar abscess?
A
needle aspiration - gold standard
PE: enlarged tonsil with displaced uvula. Palpate for fluctuance. Tender cervical LA
4
Q
What is the treatment of peritonsillar abscess
A
Incise and drainage or aspiration of abscess and IV antibiotics
refer to ER
5
Q
Complications of peritonsillar abscess?
A
airway obstruction, pneumonia,
brain abscess,
nerve damage, thrombophlebitis
6
Q
Think about diptheria when?
A
Blue grey membrane on posterior pharynx
7
Q
Sx of retropharyngeal abscess
A
stiff neck
swollen pharynx/neck
8
Q
What is ludwigs angina?
What are the sx?
A
Infection in submental space
Trismus drooling airway obstruction chin jutted for air collar of brawny (neck edema)
EMERGENCY
9
Q
what causes necrotizing fascitis in deep neck infections
A
complication of any deep neck infection
10
Q
When is a sore throat chronic?
A
> 6 weeks
11
Q
DDX for chronic sore throat
A
Reflux pharyngitits post nasal drip toxins/sick house syndrome improper vocal cord use/abuse neoplastic
12
Q
Kawasaki DZ Presentation
A
fever of unknown origin for 5 days, then conjunctivitis and other vasculitis things desquamation in hands and feet strawberry tongue diffuse rash, heart dz
13
Q
What is a globus
A
sensation of persistent nonpain lump or foreign body in the throat
14
Q
What can cause a globulus?
A
GERD Abnormal upper esophageal spincter Esophageal motor disorder Thyroid Dz Psychological/stress Pharyngeal inflammation Upper aerodigestive malignancy Hypertrophy of the tongue base Cervical osteophytes Laryngopharyngeal tumors
15
Q
Management for globulus
A
evaluate for head and neck malignancy then treat the GERD
16
Q
Epiglottitis is prevented by which vaccine
A
HIB
17
Q
Epiglottitis presentation
A
Hot potatoe voice Stridor Sore throat high fever >102 Drooling Sit upright with head extended
Refer to ER
Do not look in mouth
18
Q
How do you diagnose epiglottitis?
A
thumb print sign on x-ray
19
Q
Croup DDX
A
foreign body, croup, other viral URI
20
Q
Croup presentation?
A
barking seal like paroxysmal cough
worse at night
URI with low fever
spring steeple sign on xray
21
Q
Croup sequelae
A
Tracheitis, hypoxia
22
Q
Pertussis stages
A
- catarrhal phase
- paroxysmal phase
- convalescent phase
23
Q
pertussis treatment
A
only effective in stage 1
24
Q
How does one work up hoarsness, when do you refer?
A
laryngoscopy, Targeted history PE stroboscopy CT MRI
Refer: threat of airway compromise, presence of abscess or cellulitis in throat, failture to respond to ND treatment
25
What are the suppurative complications of poorly or untreated pharyngitis?
Peritonsillar abscess (quinsy)
retropharyngeal absess
26
Define trismus
spasm of facial and jaw muscles
unable to fully open mouth,
drooling
muffled voice
27
What are the typical findings in a patient with sleep apnea
overweight
snoring
daytime fatigue
chronic rhinitis
nasal polyps
septal deviation
28
What is the morbidity of sleep apnea
the risk of long-term mortality increases when patients have two or more respirator events per hour during sleep.
heart failure
depression
29
How do you diagnose sleep apnea?
Sleep Study
30
What are the treatment options for mild sleep apnea?
Get sufficient sleep
Abstain from alcohol and sedatives
Lose weight
Avoid supine sleeping
31
What are the treatment options for clinically significant sleep apnea?
Best= C-PAP (continuous positive airway pressure)
Oral appliances (inconsistent)
Partial surgery (may not help the apnea but will help snoring)
More invasive surgery if severe
32
How is pertussis spread?
airborne droplets
33
What are the three phases of pertussis
Catarrhal: Most Contagious, lasts 1-2 weeks, resembles URI
Paroxysmal: 1-6 weeks of coughing, emesis, cyanosis
Convalescent: Paroxysms improve over 2-12 weeks
34
CDC criteria for pertussis testing?
- Cough >2 weeks that develops paroxysms
- Inspiratory whooping
- Post-tussive emesis
- Infants with severe cough, apnea, or bradycardia of any length of time
35
How effective are pertussis vaccines?
How long is immunity covered?
Immunity from vaccinations is short-lived and incomplete.
Tends to decline after 4-12 years causing an increase in adolescent and adult susceptibility.
36
What age group is most at risk for complications from pertussis?
Infants <12 months.
37
What complications might arise in an infant with pertussis?
```
50% apnea
20% pneumonia
1% seizures
1% death
0.3% encephalopathy
```
38
What complications might arise in an adult with pertussis?
- Weight loss
- Urinary Incontinence
- Syncope
- Rib Fracture
39
What diagnostic test is best for pertussis?
PCR - 94% sensitive, 97% specific. Collected from a nasopharyngeal swab and aspirate specimen.
40
Is pertussis a reportable disease?
Yes, through the NNDSS.
Report both probable and confirmed cases.
41
What does amblyopia mean?
When a child doesn't use one eye so the retina doesn't fully develop.
42
What are the three main causes of amblyopia?
- Strabismus
- Congenital Cataracts
- Refractive Errors
43
What are a couple of screening tests for amblyopia?
- Hirschberg Corneal Reflection
| - Cover/Uncover Testing
44
What should you definitely not do when evaluating eye trauma?
Do NOT PRESS on EYE
45
When should you refer eye trauma (5)?
- Diminished Vision
- Asymmetric pupils
- Evidence of retinal damage
- Ocular misalignment
- Hyphema(can lead to angle-closure glaucoma)
46
What are some common eye trauma ND treatments?
- Ice day 1
- Heat day 2-3.
- Bromelain, curcumain, boswellia, zingiber.
Homeopathy:
-Aconite (abrasions)
- Symphytum (esp. blunt trauma)
- Arnica
47
What are two commonly involved structures with painful eye?
Cornea and iris because they are highly innervated.
48
What should you consider with a painful eye that isn't red?
- Referred pain from sinuses, orbit, or nose.
| - Neuropathy: Trigeminal, zoster, CNS disorder.
49
What's the DDx for painful red eye? (8)
- Corneal abrasion
- Foreign body
- Ulcer or infection
- Keratitis
- Scleritis/episcleritis
- Acute angle closure glaucoma
- Iritis
- Uveitis
50
What is the DDx for red eye that isn't painful? (2)
- Subconjunctival Hemorrhage
| - Conjunctivitis
51
What is the DDx for red eye with impaired vision? (4)
- Allergic
- Acute glaucoma - REFER
- Iritis
- Corneal Disease
52
What is the DDx for red eye with abrupt onset? (4)
- Trauma
- Foreign body
- Chemical irritation
- UV exposure
53
What is the DDx for red eye with subacute onset?
-Conjunctivitis, unless it's gonococcal conjunctivitis.
54
What is the DDx for chronic or persistent red eye? (3)
- Staph (blepharitis)
- Chlamydia
- Moraxella (genus confused with neiseeria)
55
What is the DDx for recurrent red eye? (2)
- Allergic conjunctivitis
| - Recurrent iritis - reactive arthritis
56
What are some PE findings for iritis?
- Small, irregular pupil (muddy)
| - Pupil is poorly reflective to light
57
What are is anterior uveitis?
The presence of cells and flare in the anterior chamber as seen with a slit lamp exam.
58
How is the injection different in conjunctivitis vs iritis?
CV will have injection more towards the periphery.
Iritis will have ciliary injection.
59
How can you visualize corneal abrasions?
Use fluorescein dye to look for the characteristic apple-green areas of abrasion (under a cobalt blue light).
You should also evert the upper and lower lids to check for an occult foreign object.
60
What is in Geller's conjunctivitis formula?
```
Berberis
Hydrastis
Hamamelis
Fennel
Calendula
```
61
What are some general treatments for bacterial conjunctivitis?
- Breast milk
- ABX (erythromycin ointment)
- Hydro/eye washes
- Treat the terrain
- Homeopathy
62
Much burning in the eye, edema around the eye with hot, excoriating intense photophobia and discharge; > external heat
Arsenicum Album
63
Streaming eyes and nose associated with much sneezing, discharge makes nose sore
Allium Cepa
64
Catarrhal conjunctivitis, eyes water al the time, DC burning and acrid, burning and swelling of lids, constant blinking
Euphrasia
65
Profuse yellow DC, no excoriation, itching and burning in eyes,
Pulsatilla
66
Localized infection of the margin of the lid. Painful and red lower. May involve glands of zeiss or moll. More painful. Staph.
External hordeolum (sty)
67
Most commonly involves meibomian glands.
Internal hordeolum (called a chalazion when chronic)
68
inflammation of the eyelids causing red, irritated, itchy eyelids and dandruf like scales. Not contagious, no permanent damage.
Blepharitis
69
Chronic internal hordeolum, sterile, nodular, lipogranulomatous inflammaiton of the meibomian gland.
Chalazion
70
Swelling and redness of the lacrimal sac from infection. Excess tears overflow, pressing on lacrimal sac and causing mucopurulent DC from lacrimal puncta.
Dacrocystitis
71
What is a typical history for cataracts?
Gradual loss of vision, hard to drive at night because of increased glare.
72
What might you find on PE in a pt with cataracts?
Decreased or absent red reflex.
73
What are some risk factors for cataracts? (8)
- Ocular disease, injury, surgery.
- Diabetes mellitus
- Galactosemia
- UV light
- Smoking
- Genetics and epigenetics
- Poor liver detox
- Statins
74
What are some general Tx principles for cataracts?
Avoid UV light to decrease free radicals.
Increase antioxidants by various sources.
75
What kind of eyedrops are good for cataracts?
N-Acetylcarnosine
76
What botanicals might you use for cataracts?
- Chaparral (prevention)
- Cineraria maritime (increase circulation to intraocular tissue)
- Vaccinium (stops progression)
- Gingko (protects against oxidants)
77
What is the diagnostic criteria for glaucoma
- Loss of peripheral vision (progresses to central loss)
- Increased cup to disc ratio.
- Increased intra-ocular pressure.
78
How does acute closed-angle glaucoma present?
- Severe eye pain.
- Red eye, nausea, vomiting, diminished vision, COLORED HALOS, headache.
- Sx begin after dark enviornment
- Perilimbal injection, cloudy cornea, narrow anterior angle.
- Pupil is fixed and dilated.
- EMERGENCY
79
What are some mechanisms of glaucoma?
- Mechanical - correlated with IOP but not causative.
- Vascular: HTN and POAG can lead to poor optic nerve perfusion.
- Glutamate toxicity: Retinal apoptosis after glutathione deficiency leading to high intraocular glutamate.
80
What is the allopathic treatment for glaucoma.
- Beta-blockers
- Cholinergic agents
- Surgery to increase drainage
81
What can you give IV for glaucoma?
High dose vitamin C. Decreases IOP osmotically.
82
What are two botanical eyedrops for glaucoma?
increases flow rate.
Foeniculum has oculohypotensive activity.
83
What is the hypothetical mechanism by which cannabis can lower IOP?
It might decrease aqueous formation in the ciliary body.
84
What is the IOP in Acute AC glaucoma?
40-80mm Hg
85
How does keratitis typically present?
- Photophobia, pain, lacrimation, decreased visual acuity
- Begins with patchy inflammation in mid-stroma that causes opacification.
- Cornea develops a ground glass appearance, obscuring the iris.
- Neovascularization of the limbus leads to orange-red salmon patches.
86
What STI can lead to keratitis?
Syphilis
87
Risks for acute open-angle glaucoma
- AF. Am.
- Increased IOP
- Myopia
- DM
- Systemic HTN
- Increased Alcohol
- Hypothyroid
- Fhx of glaucoma
88
Pathogenesis of acute open-angle glaucoma?
| 3 theories
1) Mechanical: aqueous humor produced by ciliary body doesn’t drain adequately thru trabecular mesh-work ↑ IOP
2) Vascular mechanism – dt HTN – poor optic n. perfusion & loss of retinal ganglion cells from apoptosis
3) Glutamate toxicity: glutathione deficiencies from oxidative stress lead to ↑introcular levels of glutamate (neurotoxin)
89
Ciliary vs Peripheral Injection
Ciliary: Inflm of BV radiating around iris
Peripheral: Inflm of BV in Sclera
90
What is scotoma
- Partial loss of vision
| - Blind spot in otherwise normal visual field
91
What are the SX of Wet ARMD
- New vessels form to improve the blood supply to oxygen-deprived retinal tissue, however the vessels are delicate and break easily, causing bleeding and damage to surrounding tissue
- vision loss that occurs acutely over a period of day or week
- URGENT
- May look like flame hemorrhages or pooling of blood
- Tx: IV injection of anti-VEGF (Vascular endothelial growth factor) monoclonal Abs is a very promising tx
92
What are the Symptoms of Dry ARMD
- Gruadual loss of vision in one or both eyes with difficulty reading or driving.
- Scotomas, or increased reliance on brighter light or a magnifying lens for tasks that require fine visual acuity
- onset is slow and peripheral vision remains intact
- presence of drusen bodies increases the likelihood by 23%
93
What are drusen bodies?
- buildup of extracellular material in the eye.
| - can be a normal finding but excessive quantities indicate ARMD
94
Treatments for ARMD
- Control atherosclerosis.
- STOP SMOKING
- Improve metabolic and vascular fxn
- Antioxidants
- Ozone therapy
- Exercise
- Reduce exposure to UV light
- Dark leafy greens (carotenoids)
95
What are some supplements for ARMD? (12)
- Bilberry
- Lutein and zeaxanthin
- Zinc
- Copper
- Beta carotene
- Vit E
- Vit C
- ALA
- Omega 3
- Folic acid
- Pyridoxine
- Vit B12
96
What supplements can you give specifically for high homocysteine in ARMD (3)?
Folinic acid
Pyridoxal 5'-phosphate
Methylcobalamine
97
What are the components of the IV protocol for ARMD?
-Every week for 1 month, then every 2 weeks.
- Zinc
- Selenium
- Glutathione
- Test vision before and after each Tx
- Oral Taurine as well.
98
which condition presents with sudden, painless vision loss and upon ophthalmoscopic exam displays milky-white retina with cherry red spot at macula?
Central Retinal Artery Occlusion
99
which condition presents subacutely, upon ophthalmoscopic exam create the dramatic appearance of "blood and thunder" fundus?
Central Retinal Vein Occlusion-Thrombosis
100
this condition presents with painless, sudden onset of floaters and black dots with flashes of light
retinal detachment
| -PE diminished red reflex
101
these patients often have a central blind spot - what condition is it and what two conditions predispose an individual to this?
acute maculopathy
often result of:
severe ARMD
DM
102
which homeopathics should be considered for croup?
Aconite (sudden onset, predicting time of death)
| Drosera (cough, cough, exaggerated inhale)
