EENTO - 15% Flashcards
MC pathogen involved in viral conjunctivitis
adenovirus
who is most likely to get viral conjunctivitis
kids, swimming pool
presentation of viral/bacterial/allergic conjunctivitis
VIRAL:
preauricular LAD
watery/scant-mucoid discharge
bilateral
BACTERIAL:
purulent discharge w lid crusting, no visual changes (mild pain), no ciliary injection
ALLERGIC:
conjectural erythema, other allergic sx, cobblestone mucosa, itching, tearing, redness, stringy discharge, usu bilateral
tx of viral/bacterial/allergic conjunctivitis
VIRAL: cool compress, artificial tears, antihistamines
BACTERIAL: e-micin (topical)
ALLERGIC: topical antihistamines (olopatadine, pheniramine/naphazoline), topical ketorolac, topical corticosteroids
MC pathogen in bacterial conjunctivitis + others
S.aureus
S.pneumo
H.flu
how is bacterial conjunctivitis transmitted
direct contact + autoinoculation
which types of conjunctivitis are usu bilateral
viral + allergic
if pt is contact wearer and has bacterial conjunctivitis, how do you treat and why?
fluoroquinolone or AMG because of pseudomonas
if pt has chlamydia conjunctivitis how do you treat
azithro
if pt has gonorrhea conjunctivitis how do you treat
ceftriaxone
what is the MC type of orbital cellulitis
ethmoid
what is orbital cellulitis usu 2ry to
sinus infxn; also can be dental/facial infix or bacteremia
what are the MC organisms to cause orbital cellulitis
s.aureus, s.pneumo, GABHS, h.flu
what are the sx of orbital cellulitis
dec vision
pain w EOMM
proptosis
eyelid erythema + edema
dx of orbital cellulitis
high resolution CT scan
tx of orbital cellulitis
IV vanco, clinda, cefotaxime, amp/sulbactam
what is perceptual cellulitis, how is it different from orbital cellulitis and how do you treat it?
infix of eyelid + periocular tissue- may have ocular pain/swelling but NO VISUAL CHANGES OR PAIN W EOMM
amoxicillin
what is a strabismus
misalignment of the eyes- stable ocular alignment isn’t normal until 2-3mo
how do you dx a strabismus
hirschberg corneal light reflex testing (screening)
how do you tx a strabismus
patch tx, corrective surgery if severe
no tx before 2yo
why can’t you treat strabismus before 2yo
amblyopia may occur- dec visual acuity not correctable by refractive means
MC pathogens involved in OM
S.pneumo (MC)
H.flu
M.cat
S.pyo
if there are bullae on the TM, what should you suspect
M.pneumo infection
tx of OM
amox (DOC- azithro/e-micin if allergic), cefixime
2nd line- augmentin or cofactor
MC cause of rhinitis
allergic- IgE
what is the MC infectious cause of rhinitis
rhinovirus
sx of rhinitis
sneezing, itching, congestion, clear rhinorrhea
allergic- nasal polyps, worse in AM, pale/violaceous boggy turbinates, cobblestone mucosa of conjunctiva
viral- erythematous turbinates
tx of rhinitis
PO antihistamines
decongestants (oxymetazoline, phenylephrine, naphazoline, pseudophed)
intranasal corticosteroids if allergic
what usu precedes mastoiditis
inadequately tx or prolonged OM
presentation of mastoiditis
deep ear pain, worse at night, fever
mastoid tenderness, may have cutaneous abscess
dx of mastoiditis
CT scan
tx of mastoiditis
IV abx + middle ear/mastoid drainage
mastoidectomy if complicated/refractory
complications of mastoiditis
hearing loss, labyrinthitis, vertigo, CN VII paralysis, brain abscess
what causes otitis externa
swimmers ear- excess H2O or local trauma changes acidic pH of ear –> bacterial overgrowth
what is the MC pathogen in otitis externa
pseudomonas
indicating PE finding for otitis externa
pain on tragal traction
tx of otitis externa
keep dry- isopropyl alcohol, acetic acid
topical cipro, ofloxacin
can use AMG (neomycin/polytrim) only if no perf suspected (ototoxic)
what is malignant otitis externa
osteomyelitis @ skull base 2ry to pseudomonas
who most commonly gets malignant otitis externa
diabetics, immunocompromised
tx of malignant otitis externa
IV ceftazidime or piperacillin + FQ/AMG
pseudomonas coverage
what can TM perfs lead to
cholesteatoma development
what type of hearing loss do you see with TM perforation
conductive
what is the MC type of epistaxis
anterior
what are the causes of anterior epistaxis
nasal trauma low humidity + hot environment rhinitis ETOH antiplt meds
what is the MC site of anterior epistaxis
kiesselbach’s plexus
what causes posterior epistaxis
HTN
atherosclerosis
what is the MC site of posterior epistaxis
palatine artery
how to tell difference btw anterior + posterior epistaxis
posterior- there is blood in posterior pharynx
tx of epistaxis
direct pressure 10-15min, seated + leaning FORWARD
topical decongestants/vasoconstrictors (phenylephrine, oxymetazoline, cocaine), cauterization, nasal packing
what is septal hematoma associated with
loss of cartilage if hematoma isn’t removed
what is the MC cause of acute pharyngotonsillitis
viral- adeno, rhino, enero, EBV, RSV, flu a+b, herpes zoster
what is the MC bacterial cause of acute pharyngotonsillitis
GABHS
what do you treat bacterial pharyngotonsillitis with?
PCN, amox (E-micin or clinda if allergic)
what is the MC pathogen involved in epiglottis
H.flu
what age group is highest risk for epiglottitis
3mo-6yo
what gender is highest risk for epiglottitis
males
what is the definitive dx for epiglottitis
laryngoscopy- cherry red epiglottis w swelling
what do you see on cervical XR in pt w epiglottis
thumb print sign
if you suspect epiglottis what should you avoid
tongue depressors + agitating pt!
tx of epiglottitis
maintain airway, dexamethasone, intubation if severe
ceftriazone or cefotaxime +/- PCN/ampicillin
what do you see on KOH smear if candidiasis
budding yeast + pseudohyphae
tx of oral candidiasis
nystatin liquid DOC
clotrimazole, PO fluconazole
pathophysiology of peritonsilar abscess
tonsillitis –> cellulitis –> abscess
MC pathogen involved in peritonsilar abscess
s.pyo (GABHS)
1st line dx test for peritonsilar abscess
CT scan
tx of peritonsilar abscess
amp/sul, clinda or PenG+flagyl
+ aspiration or I&D
