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EENT > EENT Test 3 > Flashcards

EENT Test 3 Flashcards

1
Q

Things to consider for complicated sore throat

A

GT/CT, other STI

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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

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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

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4
Q

What is the treatment of peritonsillar abscess

A

Incise and drainage or aspiration of abscess and IV antibiotics

refer to ER

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5
Q

Complications of peritonsillar abscess?

A

airway obstruction, pneumonia,
brain abscess,
nerve damage, thrombophlebitis

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6
Q

Think about diptheria when?

A

Blue grey membrane on posterior pharynx

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7
Q

Sx of retropharyngeal abscess

A

stiff neck

swollen pharynx/neck

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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

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9
Q

what causes necrotizing fascitis in deep neck infections

A

complication of any deep neck infection

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10
Q

When is a sore throat chronic?

A

> 6 weeks

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11
Q

DDX for chronic sore throat

A 
Reflux pharyngitits
post nasal drip
toxins/sick house syndrome
improper vocal cord use/abuse
neoplastic
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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
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13
Q

What is a globus

A

sensation of persistent nonpain lump or foreign body in the throat

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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
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15
Q

Management for globulus

A

evaluate for head and neck malignancy then treat the GERD

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16
Q

Epiglottitis is prevented by which vaccine

A

HIB

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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

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18
Q

How do you diagnose epiglottitis?

A

thumb print sign on x-ray

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19
Q

Croup DDX

A

foreign body, croup, other viral URI

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20
Q

Croup presentation?

A

barking seal like paroxysmal cough
worse at night
URI with low fever
spring steeple sign on xray

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21
Q

Croup sequelae

A

Tracheitis, hypoxia

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22
Q

Pertussis stages

A
  1. catarrhal phase
  2. paroxysmal phase
  3. convalescent phase
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23
Q

pertussis treatment

A

only effective in stage 1

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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

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25
Q

What are the suppurative complications of poorly or untreated pharyngitis?

A

Peritonsillar abscess (quinsy)

retropharyngeal absess

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26
Q

Define trismus

A

spasm of facial and jaw muscles
unable to fully open mouth,
drooling
muffled voice

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27
Q

What are the typical findings in a patient with sleep apnea

A

overweight

snoring

daytime fatigue

chronic rhinitis

nasal polyps

septal deviation

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28
Q

What is the morbidity of sleep apnea

A

the risk of long-term mortality increases when patients have two or more respirator events per hour during sleep.

heart failure
depression

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29
Q

How do you diagnose sleep apnea?

A

Sleep Study

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30
Q

What are the treatment options for mild sleep apnea?

A

Get sufficient sleep

Abstain from alcohol and sedatives

Lose weight

Avoid supine sleeping

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31
Q

What are the treatment options for clinically significant sleep apnea?

A

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

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32
Q

How is pertussis spread?

A

airborne droplets

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33
Q

What are the three phases of pertussis

A

Catarrhal: Most Contagious, lasts 1-2 weeks, resembles URI

Paroxysmal: 1-6 weeks of coughing, emesis, cyanosis

Convalescent: Paroxysms improve over 2-12 weeks

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34
Q

CDC criteria for pertussis testing?

A
  • Cough >2 weeks that develops paroxysms
  • Inspiratory whooping
  • Post-tussive emesis
  • Infants with severe cough, apnea, or bradycardia of any length of time
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35
Q

How effective are pertussis vaccines?

How long is immunity covered?

A

Immunity from vaccinations is short-lived and incomplete.

Tends to decline after 4-12 years causing an increase in adolescent and adult susceptibility.

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36
Q

What age group is most at risk for complications from pertussis?

A

Infants <12 months.

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37
Q

What complications might arise in an infant with pertussis?

A 
50% apnea
20% pneumonia
1% seizures
1% death
0.3% encephalopathy
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38
Q

What complications might arise in an adult with pertussis?

A
  • Weight loss
  • Urinary Incontinence
  • Syncope
  • Rib Fracture
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39
Q

What diagnostic test is best for pertussis?

A

PCR - 94% sensitive, 97% specific. Collected from a nasopharyngeal swab and aspirate specimen.

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40
Q

Is pertussis a reportable disease?

A

Yes, through the NNDSS.

Report both probable and confirmed cases.

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41
Q

What does amblyopia mean?

A

When a child doesn’t use one eye so the retina doesn’t fully develop.

42
Q

What are the three main causes of amblyopia?

A
  • Strabismus
  • Congenital Cataracts
  • Refractive Errors
43
Q

What are a couple of screening tests for amblyopia?

A
  • Hirschberg Corneal Reflection

- Cover/Uncover Testing

44
Q

What should you definitely not do when evaluating eye trauma?

A

Do NOT PRESS on EYE

45
Q

When should you refer eye trauma (5)?

A
  • Diminished Vision
  • Asymmetric pupils
  • Evidence of retinal damage
  • Ocular misalignment
  • Hyphema(can lead to angle-closure glaucoma)
46
Q

What are some common eye trauma ND treatments?

A
  • Ice day 1
  • Heat day 2-3.
  • Bromelain, curcumain, boswellia, zingiber.

Homeopathy:
-Aconite (abrasions)

  • Symphytum (esp. blunt trauma)
  • Arnica
47
Q

What are two commonly involved structures with painful eye?

A

Cornea and iris because they are highly innervated.

48
Q

What should you consider with a painful eye that isn’t red?

A
  • Referred pain from sinuses, orbit, or nose.

- Neuropathy: Trigeminal, zoster, CNS disorder.

49
Q

What’s the DDx for painful red eye? (8)

A
  • Corneal abrasion
  • Foreign body
  • Ulcer or infection
  • Keratitis
  • Scleritis/episcleritis
  • Acute angle closure glaucoma
  • Iritis
  • Uveitis
50
Q

What is the DDx for red eye that isn’t painful? (2)

A
  • Subconjunctival Hemorrhage

- Conjunctivitis

51
Q

What is the DDx for red eye with impaired vision? (4)

A
  • Allergic
  • Acute glaucoma - REFER
  • Iritis
  • Corneal Disease
52
Q

What is the DDx for red eye with abrupt onset? (4)

A
  • Trauma
  • Foreign body
  • Chemical irritation
  • UV exposure
53
Q

What is the DDx for red eye with subacute onset?

A

-Conjunctivitis, unless it’s gonococcal conjunctivitis.

54
Q

What is the DDx for chronic or persistent red eye? (3)

A
  • Staph (blepharitis)
  • Chlamydia
  • Moraxella (genus confused with neiseeria)
55
Q

What is the DDx for recurrent red eye? (2)

A
  • Allergic conjunctivitis

- Recurrent iritis - reactive arthritis

56
Q

What are some PE findings for iritis?

A
  • Small, irregular pupil (muddy)

- Pupil is poorly reflective to light

57
Q

What are is anterior uveitis?

A

The presence of cells and flare in the anterior chamber as seen with a slit lamp exam.

58
Q

How is the injection different in conjunctivitis vs iritis?

A

CV will have injection more towards the periphery.

Iritis will have ciliary injection.

59
Q

How can you visualize corneal abrasions?

A

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
Q

What is in Geller’s conjunctivitis formula?

A 
Berberis
Hydrastis
Hamamelis
Fennel
Calendula
61
Q

What are some general treatments for bacterial conjunctivitis?

A
  • Breast milk
  • ABX (erythromycin ointment)
  • Hydro/eye washes
  • Treat the terrain
  • Homeopathy
62
Q

Much burning in the eye, edema around the eye with hot, excoriating intense photophobia and discharge; > external heat

A

Arsenicum Album

63
Q

Streaming eyes and nose associated with much sneezing, discharge makes nose sore

A

Allium Cepa

64
Q

Catarrhal conjunctivitis, eyes water al the time, DC burning and acrid, burning and swelling of lids, constant blinking

A

Euphrasia

65
Q

Profuse yellow DC, no excoriation, itching and burning in eyes,

A

Pulsatilla

66
Q

Localized infection of the margin of the lid. Painful and red lower. May involve glands of zeiss or moll. More painful. Staph.

A

External hordeolum (sty)

67
Q

Most commonly involves meibomian glands.

A

Internal hordeolum (called a chalazion when chronic)

68
Q

inflammation of the eyelids causing red, irritated, itchy eyelids and dandruf like scales. Not contagious, no permanent damage.

A

Blepharitis

69
Q

Chronic internal hordeolum, sterile, nodular, lipogranulomatous inflammaiton of the meibomian gland.

A

Chalazion

70
Q

Swelling and redness of the lacrimal sac from infection. Excess tears overflow, pressing on lacrimal sac and causing mucopurulent DC from lacrimal puncta.

A

Dacrocystitis

71
Q

What is a typical history for cataracts?

A

Gradual loss of vision, hard to drive at night because of increased glare.

72
Q

What might you find on PE in a pt with cataracts?

A

Decreased or absent red reflex.

73
Q

What are some risk factors for cataracts? (8)

A
  • Ocular disease, injury, surgery.
  • Diabetes mellitus
  • Galactosemia
  • UV light
  • Smoking
  • Genetics and epigenetics
  • Poor liver detox
  • Statins
74
Q

What are some general Tx principles for cataracts?

A

Avoid UV light to decrease free radicals.

Increase antioxidants by various sources.

75
Q

What kind of eyedrops are good for cataracts?

A

N-Acetylcarnosine

76
Q

What botanicals might you use for cataracts?

A
  • Chaparral (prevention)
  • Cineraria maritime (increase circulation to intraocular tissue)
  • Vaccinium (stops progression)
  • Gingko (protects against oxidants)
77
Q

What is the diagnostic criteria for glaucoma

A
  • Loss of peripheral vision (progresses to central loss)
  • Increased cup to disc ratio.
  • Increased intra-ocular pressure.
78
Q

How does acute closed-angle glaucoma present?

A
  • 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
Q

What are some mechanisms of glaucoma?

A
  • 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
Q

What is the allopathic treatment for glaucoma.

A
  • Beta-blockers
  • Cholinergic agents
  • Surgery to increase drainage
81
Q

What can you give IV for glaucoma?

A

High dose vitamin C. Decreases IOP osmotically.

82
Q

What are two botanical eyedrops for glaucoma?

A

increases flow rate.

Foeniculum has oculohypotensive activity.

83
Q

What is the hypothetical mechanism by which cannabis can lower IOP?

A

It might decrease aqueous formation in the ciliary body.

84
Q

What is the IOP in Acute AC glaucoma?

A

40-80mm Hg

85
Q

How does keratitis typically present?

A
  • 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
Q

What STI can lead to keratitis?

A

Syphilis

87
Q

Risks for acute open-angle glaucoma

A
  • AF. Am.
  • Increased IOP
  • Myopia
  • DM
  • Systemic HTN
  • Increased Alcohol
  • Hypothyroid
  • Fhx of glaucoma
88
Q

Pathogenesis of acute open-angle glaucoma?

3 theories

A

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
Q

Ciliary vs Peripheral Injection

A

Ciliary: Inflm of BV radiating around iris

Peripheral: Inflm of BV in Sclera

90
Q

What is scotoma

A
  • Partial loss of vision

- Blind spot in otherwise normal visual field

91
Q

What are the SX of Wet ARMD

A
  • 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
Q

What are the Symptoms of Dry ARMD

A
  • 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
Q

What are drusen bodies?

A
  • buildup of extracellular material in the eye.

- can be a normal finding but excessive quantities indicate ARMD

94
Q

Treatments for ARMD

A
  • Control atherosclerosis.
  • STOP SMOKING
  • Improve metabolic and vascular fxn
  • Antioxidants
  • Ozone therapy
  • Exercise
  • Reduce exposure to UV light
  • Dark leafy greens (carotenoids)
95
Q

What are some supplements for ARMD? (12)

A
  • Bilberry
  • Lutein and zeaxanthin
  • Zinc
  • Copper
  • Beta carotene
  • Vit E
  • Vit C
  • ALA
  • Omega 3
  • Folic acid
  • Pyridoxine
  • Vit B12
96
Q

What supplements can you give specifically for high homocysteine in ARMD (3)?

A

Folinic acid

Pyridoxal 5’-phosphate

Methylcobalamine

97
Q

What are the components of the IV protocol for ARMD?

A

-Every week for 1 month, then every 2 weeks.

  • Zinc
  • Selenium
  • Glutathione
  • Test vision before and after each Tx
  • Oral Taurine as well.
98
Q

which condition presents with sudden, painless vision loss and upon ophthalmoscopic exam displays milky-white retina with cherry red spot at macula?

A

Central Retinal Artery Occlusion

99
Q

which condition presents subacutely, upon ophthalmoscopic exam create the dramatic appearance of “blood and thunder” fundus?

A

Central Retinal Vein Occlusion-Thrombosis

100
Q

this condition presents with painless, sudden onset of floaters and black dots with flashes of light

A

retinal detachment

-PE diminished red reflex

101
Q

these patients often have a central blind spot - what condition is it and what two conditions predispose an individual to this?

A

acute maculopathy

often result of:
severe ARMD
DM

102
Q

which homeopathics should be considered for croup?

A

Aconite (sudden onset, predicting time of death)

Drosera (cough, cough, exaggerated inhale)

EENT (4 decks)

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