ENOT - 7% Flashcards
Acute Otitis Media
Middle Ear
Infx of middle ear
MC preceded by viral infx
MC bacterial - S. pneump, H. influ
Sxs:
- Otalgia
- fever
- middle ear effusion
- Erythematous TM
- acute < 3 wks
- chronic > 3 mos
- Recurrent 3 eps in 6 mo or 4 in 12 w/ clearning in btwn
Dx: otoscopic
- bulging of TM
- acute sxs of inflammation (above)
- limited mobility of TM with pneumotoscopy
Tx
Amoxicillin 80-90 mg/kg
- <2yo for 10 days
- > 2yo 5-7 days
Augmentin 2nd line
Acute Rhinosinusitis
Nose/Sinus Disorders
Often follows URI > 10d - viral or
bacterial (MC nontypeable H. influ > S. pneumo >M. catar)
RF - cig smoking, hx of trauma, presence of foreign body
Sxs
- purulent nasal dc
- focal facial pain and pressure
- nasal obstruction
- fever
- tenderness to palp on affected sinus
Dx - clinical, bacterial more likely in IMC pts
Tx
-
Self limited for viral, lasts < 10 days
- NSAIDs, saline washes, steam, PO/nasal decongestants
- Abx for symptoms > 10d
- Amoxicillin 500 mg TID x 5-10d
- Augmentin 500 mg TID
- Doxy 100 mg PO BID if pcn allergic
- NOT REC’d macrolides
Amblyopia (lazy eye)
Vision Abnormalities
reduced visual acuity = not correctable by refractive means
early in childhood - nerve pathway btwn brain and eye aren’t properly stimulated. Brain favors other eye
Can be due to strabismus, uremia, or toxins - etoh, tobacco, lead, other toxic sub
Sxs
- wandering eye, eye that dont work together
- poor depth preception
- blurred vision or double vision
Dx
- screening for children < 5yo
- visual screening at 3, 4, 5 yo
Tx
- Correction of refraction error = glasses** patching better eye so amblyopic eye can work harder to focus
- treat as early as possible
Apthous Ulcers
Oropharyngeal Infectious Disorders
Canker sores - triggered by stress
Sxs
- Painful ovoid or round ulcerations on mucous membranes of mouth, tongue or genitals
- Prodrome burning/prickling sensation of oral mucosa 1-2d prior to ulcer appearance
Dx
- H&P, clinical
- bx if > 3 wks
- R/o systemic dz
Tx
- Self limited - avoid acidic food
- Topical anesthetic - Mg Hydroxide, viscous lidocaine 2-5%
Barotrauma
Tissue damage d/t pressure related change in body gas volume
Sxs:
- ear pain
- hearing loss persist after inciting event
- sinus pain
- epitaxis
- abd pain/dyspnea
- LOC
Dx - clinical.0 may bneed imaging
Tx
- Supportive - anti inflammatories
- Pseudoephedrine for prophy - for divers
Blepharitis
Lid Disorders
Chronic infl of lid margins - seborrhea, staph or strep - dysfx of Meibomian agents
Sxs:
- Anterior - lid margins
- ulcerative (S aureus) - dry scales
- seborrheic - greasy scales, foamy tears
- Red-rimmed eyelid
- eyelash flanking
- Posterior - meibomian gland inflammation - express glands
Dx - slit lamp examination
Tx - warm compressions, daily lid wash w/ baby shampoo
topical abx - azithro solution or erythro ointment
Candidiasis
Oropharyngeal Infectious Disorders
Skin infx with MC Candida albicans
Sxs
- Erythematous base, bleeds w/ scraped and easily scraped off
- if recurrent, look for underlying disx (IMC, ICS use)
Dx
- KOH prep - budding yeast or hyphae
- wet prep or bx
Tx
- Antifungals - Nystatin liquid rinses or ketaconazole/fluconazole orally
Cataract
Corneal Disorders
Eye lens clouding => decr in vision, one of both.
MCC reversible blindness
Sxs
- blurred vision over months and years
- halos around light
- clouding of lens
Dx
- Fundoscopy - black on red background
Tx
- Surgical removal - lens implant
Chalazion
Lid Disorders
Non-infectious obstruction of a meibomian gland, MC in upper eyelid
Sxs
- Hard, non tender eyelid swelling, not red
- insidious onset w/ min irritation
- Chronic and cold
Dx - Clinical
Tx
- warm compresses, eyelid hygiene
- Injection of CS or Incision and curettage - for large obstructing vision
- bx to r/o cancer
- recur
Cholesteatoma
Middle ear
Abn growth of skin in middle ear behind eardrum; from recurring ear infx, chronic ET dysfx (neg pressure inverts part of TM => granulation of tissue => errodes ossicles = conductive hearing loss)
Sxs
- painless otorrhea - brown/yellow dc w/ strong odor
- conductive hearing loss
- Tinnitus
- Dizziness, otorrhea, CN palsies
Dx
- Otoscopic visualization of granulation tissue
- Confirm with CT scan and audiogram
Tx
- reconstruction of ossicles
Allergic Conjunctivitis
Red eyes, itiching and tearing, bilateral
cobblestone mucosa
blue oropharynx
Tx
- systemic antihistamines and topic AHs
- Naphcon A
Viral Conjunctivitis
MCC Adenovirus, more common than bacterial
highly contagious - direct contact or swimming pool
- URI
- Acute onset unilateral or bilateral erythema of conjunctiva
- copious watery discharge
- red oropharynx
Tx -
- eye lavage w/ normal saline BID 7-14d
- antihistamine drops
- warm to cool compresses
Bacterial Conjunctivitis
MCC - S aureus, S pneumo
M. Cat and Gonoccocal - copious purulent dc not responding to conventional tx
Chlamydia - newborn, Giemsa stain - inclusion body, scant mucopurulent dc
sxs:
- purulent dc from both eyes - glued shut
- crusting - worse in AM
Tx
- FQ for contact lens
- 0.5 in of ointment in lower lid or 1-2 drops instilled QID 5-7 days
- Gentamicin/tobramycin - aminoglycoside abx for G neg coverage
- Erythromycin - chlamydia for newborns
- Trimethoprim and polymixin B - ocular infx
- Contact lense user - pseudomonas - tx with FQ/Cipro
Corneal Abrasion
Usu from minor trauma - finger nail, contact lens, eyelash, small foreign body
Sudden onset of
- Eye pain
- photophobia
- tearing
- foreign body sensation
Dx - fluorescein dye - incr abs in devoid area
Tx
- topic anesthestic for dx
- saline irrigation
- abx ointmen t- gentamicin or sulfacetamide
- Tylenol for pain
- NO PATCHING
Dacryoadenitis/Dacryocystitis
Lacrimal Disorders
Inflammation of lacrimal (tear-producing) glands - usu bacteria or virus
MCC mumps, EBV, staph, gonococcus
Sxs:
- unilateral severe pain, swelling, redness, tearing drainage
Dx - clinical or CT orbits if chronic
Tx
- if Viral eti - rest and warm compresses
- massage
- Tx cause - opthal or systemic abx
Deep Neck Infection
Oropharyngeal Infectious Disorders
MC from septic of mandibular teeth, tonsils, parotid gland, deep cervical LNs, middle ear, or sinuses
MC Strep viridans
Sxs
- high fever, systemic toxicity
- facial edema, erythema, fluctuance
Dx
- CT ** gold
- MRi for soft tissue involvement
Tx
- aspiration or surgical if + drainable collection
- Abx - Nafcillin, Vanc, Cipro
- Parapharyngeal, retropharyngeal, or prevertebral space - tx for 2-3 weeks
Dental Abscess
Oropharyngeal Infectious Disorders
Dental caries destroys hard surface of tooth –> dental pulp –> abscess formation
- Pain
- swelling
- Fever
Dx w/ CT scan
Tx - Ceftriaxone, followed by PO amox
Ectropion
Lid Disorders
Eversion of the lower eyelid;
usu from age related tissue relaxation, CN VII palsy, posttraumatic or postsurgical changes
Sxs:
- tearing and symptoms of dry eyes - poor tear drainage
Clinical Dx
Tx
- Tear supplement
- surgery
- Ocular lubricants at night
- Definitive sx
Epiglottis
Oropharyngeal Infectious Disorders
Supraglottic inflammation & obstruction of airway d/t infx w/ H. influ
Med EMERGENCY
Sxs:
- Stridor, restlessness, fever, cough, dyspnea
- Sniffing dog posture
- 3 D’s
- Drooling
- Dysphagia
- Respiratory Distress
Dx
- Secure airway - culture for H. influ
- Lateral neck film - thumbprint sign
Tx
- intubation
- supportive care
- ceftriaxone
Epistaxis
Nose/Sinus Disorders
Eti - nasal trauma, dryness, HTN, cocaine, etoh
Kiesselbach’s Plexus MC site for anterior bleeds
Woodruff’s plexus - MC site for posterior - less common
Tx:
- Anterior - stop with pressure - leaning forward for 10-15 mins
- Short acting topical decongestants - Afrin, phenylephrine, cocaine
- Anterior nasal packing - tx w/ abx/Cephalosporin for TSS
- Cauterize
-
Posterior balloon packing for posterior bleeds
- high risk of complications
If recurrent nosebleeds - r/o HTN or clotting disorder
Entropion
lower eyelid turns inwards; same eti as ectropion
eyelashes rub against eyeball and may lead to corneal ulceration and scarring
Sxs
- foreign body sensation
- tearing, red eyes
Dx - clinical
Tx
- tear supplements and ocular lubs
- botox injections
- Surgery
Foregin body - Ear
Sxs - pain, decrease earing, fullness
dx - visualization
tx - removal w/ warm irrigation w/ syringe or alligator forcep
Insects - drown with mineral oil or viscous lidocaine before trying to remove
Foreign Body - Nasal
Persistent, foul smelling, unilateral nasal dc
Tx - oxymetazoline to shrink mucous membrane, then remove
Foreign Body - Occular
Metallic foreign body - Rust ring - refer to opthal if can’t remove
Dx - slit lamp - XR or CT
Tx - irrigation after topical anesthetic - visualized and extra
Acute Angle Closure
Glaucoma
Women, China, eskimo
Increased IOP w/ optic n damage - Aqueous humor blockage through trabecular meshwork
Canal of Schlemm - increasing pressure in anterior chamber
Sxs:
- Opthalmic EMERGENCY
- Triad
- Injected conjunctiva
- Fixed dilated pupil
- Steamy cornea
- painful eye/loss of vision, tearing, N/V, diaphoresis
- IOP >50
Tx:
- REFER to ophthal
- start MEDS
- IV Carbonic anhydrase inhibitor (acetazolamide)
- topical B blocker - timolol
- osmotic diuresis
- laser/surgical iridotomy
- mydriatics - dilate pupils - do not administered
Open Angle Closure
Glaucoma
Chronic, asymptomatic, insidious; older black myopic (nearsighted)
Sxs:
- Increased IPO
- incr cup to disc ratio
- asymptomatic until late - loss of peripheral vision = main symptoms - TUNNEL vision
Dx:
- elevated IOP w/o optic disc damage or
- optic n damage w/o increased IOP
Tx
- Refer to opthalmologist
- Prostaglandin analogs - latanoprost - 1st line
- B blocker timolol
- carbonic anhydrase Inhibitor - Acetazolamide to decr production
- Laser or surgical treatment
- Mydriatics c/i - atropine*
Globe Rupture
Eye Traumatic Disorders
Blunt or penetrating trauma (face punch, or acid) = vitreous and/or aqueous humour drain through site of rupture (eye deflate)
full thickness injury to cornea, sclera or both
Sxs
- Decreased visual acuity
- afferent pupillary defect
- eccentric or teadrop pupil
- Incr anterior chamber
- low intraoccular pressure
Dx
- CT scan non contrast
Tx
- Ophthal emergency - Surgery!
- Begin IV Ancef or FQ
- fox/rigid eye shield over affected eye, avoid pressure examinations
- Sedation, analgesics, antiemetic
- keep head elevated 30-40 degrees
Herpes Simplex Virus
Oropharyngeal Infectious Disorders
HSV1 - above the waist; HSV 2 - below the waist
Sxs
- Primary infx - fever, irritability
- Severe pain/burning of oral mucosa
- Vesicular and ulcerative lesion on lips, gingiva and tongue
- lasts for 2-3 weeks, viral shedding continue for several more weeks
Dx
- clinical, confirm with culture
- PCR, direct immunofluorescence
Tx
- First episode - PO Acyclovir 400 mg TID x 7-10d, if started within 72 hrs of onset
- Recurrent episode - Acyclovir 400 mg TID x 5, Valacyclovir 1g PO BID x 1d or Famciclovir 1g PO BID x 1d
- Suppressive
- Acyclovir 400 TID
- Famciclovir 500 mg BID
- Valacyclovir 1g BID
Hordeolum
Stye; infection of glands of the eyelid - meibomian gland
Sxs
- painful, warm/hot, swollen red lum on eyelid
- Staph abscess
Dx - clinical
Tx
- warm compress and topical antibiotics
- I &D
- Systemic abx if + cellulitis - dicloxacillin or erythromycin 250 mg PO QID
Hyphema
Trauma causing blood acc in anterior chamber of eye (btwn cornea and iris)
Dx:
- orbital CT + ophthal consult
Tx
- blood reabsorbed over days/wks
- ele head 30d at night
- NSAID c/i
- patch/shield
Keratitis
Corneal Disorders
Inflammation of the cornea;
Eti - Infectious keratitis caused by fungi, parasites, or
- Virus - HSV - dendritic ulcer
- Bacteria - pseudomonas - improper contact lens wear
Sxs
- pain, impaired eyesight
- photophobia, red eye
- foreign body sensation
Dx
- Fluorescein staining - dendritic lesion for virus
- bacterial keratitis - corneal opacity or infiltrate - round white spot
Tx
- topical antivirals for herpetic keratitis - idoxuridine, vidarabine, trifluridine
- bacterial keratitis = urgent ophthal ref + topical bactericidal abx
Labyrinthitis
Preceded by viral respiratory illness
Sxs:
- Acute Severe vertigo, hearing loss (days to a week)
- vertigo can resolve but not hearing loss (Sensorineural)
- Tinnitius
- Imbalance
Dx - clinical, no neuro deficit
- Vestibular Sx - peripheral vertigo w/ vertical nystagmus (away from affected side)
Tx - Vestibular suppresants - diazepam or meclizine (anticholinergic)
Resolves in 3-6 wks
Acute Laryngitis
Oropharyngeal Infectious Disorders
Inflammation of Larynx - usu Viral following URI or change in voice
- Consider Squamous Cell Caricinoma if hoarseness > 2wks + hx of ETOH and smoking
- consider GERD if no viral eti
- M. Cat or H. flu
Sxs
- no pain or sore throat
Dx - clinical, laryngoscopy if sx > 3wk
- Deviation of soft palate -> abscess
Tx
- Symptomatic - cough suppressant, voice rest, steam inhalant
- Viral - self limited, oral or IM steroids for vocal performers
- Bacterial - erythromycin, cefuroxime, or augmentin
Leukoplakia
Other Oropharyngeal Disorders
Benign and asymptomatic condition but can progress to squamous cell carcinoma;
RF - smoking, etoh, HPV infx
Sxs
- White patches of oral mucosa - can’t be wiped off
Dx - biopsy and surgical excision
Tx
- surgical excision
- laser ablation
- cryosurgery
Oral hairy Leukoplakia - a/w EBV in HIV pts, lateral tongue, not to progress to SCC
- Tx w/ Zidovudine, acyclovir, etc.
Macular Degeneration (Wet)
Retinal Disorders
Gradual loss of central vision; non reversible
advanced form of dry age-related macular degeneration
Dry - Drusen - daily amsler grid
- PO antioxidants, carotenids
- rapid and severe vision loss
Wet - Neovasculization
- new blood vessel growth beneath retina (neovascularization) leak blood and fluid -> damage retinal cells
- VEGF Inhibitors - bevacizumab
- photodynamic therapy
- Zinc and antioxidant vitamin
Mastoiditis
Complication of AOM - Suppurative infx of mastoid air cells; MC Down Syndrome
MC S. pneumo, H. influ, M. cat, S. aureus, S. pyogenes
Sxs:
- Fever
- otalgia
- pain
- Erythema posterior to ear and fwd displacement of external ear
Dx
- Clinical
- CT scan temporal bone w/ contrast for complicated - toxic appearing
Tx
- Simple - PO or IV Ceftriaxone/Vanco
- ENT referral in more complicated
- Drainage of middle ear fluid
Ménière Disease
Sxs
- Episodic vertigo - 20 mins to 24 hrs
- Sensorineural hearing loss - fluctuating + varying in severity
- Tinnitus - in affected ear and fullness
- aural fullness
Dx - MRI of head to r/o other eti
Tx - Na, caffeine, nicotine, and etoh restriction
Benzo, antihistamines, antiemetics for acute symptoms
Nystagmus
dx, tx
Neuro-ophthalmologic disorders
Dx
-
Caloric reflex - ear canal irrigated with warm or cold waterl stimulate horizontal semicircular
- eye movement then recorded by electronystagmography (ENG) [external electrodes) or videonystagmograph (VNG) [small cameras built into head masks
- Optokinetic drum, or electrooculography - assess pt eye movements
Tx
- Congenital - untreatable
- Baclofen - stop periodic alt nystagmus
- gabapentin
- Tenotomy
- Acupuncture
- PT
- Contacts and low vision rehab
Nystagmus
types, sxs
Neuro-ophthalmologic Disorders
Involuntary, rapid, repetitive movement of eyes
Two types
-
Congenital nystagmus - infancy btwn 6 wks and 3 mos of age
- sensory nystagmus + poor vision from cataracts, strabismus, optic nerve hypoplasia, will develop less clear vision
-
Acquired nystagmus - later in life
- a/w med conditions, adults may see world as shaky
Sxs
- Down/Up beat - CNS dysfunction
- Vestibular (horizontal) - labyrinth or vestiular n dysfx
- Gaze evoked - MC and often benign
Optic Neuritis
Neuro-ophthalmologic Disorders
Acute inflammation and demyelination of optic n. leading to
- acute monocular vision loss/blurriness
- loss of color vision
- pain on EOM
- a/w Multiple Sclerosis - MCC and initial presenting Sxs
- eti - ethambutol (TB drug)
Dx
- fundoscopy - inflammation of optic disc, confirmed by MRI
Tx
- Corticosteroids - methylpredinsolone IV
- r/o MS
- Recovery in 2-3 wks
Orbital Blowout Fracture
Eye Traumatic Disorders
Hx of blunt trauma, muscle entrapment, eyelid swelling
Sxs
- vertical gaze restriction (inferior rectus muscle)
- pain with EOM, double vision - diplopia
- ecchymosis*
- Anesthesia or paresthesia in gums, upper lips and cheek = infraorbital n damage
Dx - CT scan
Tx - opthalmic referral = surgery
abx for infx
Orbital Cellulitis
Infx of orbital muscles and fat behind eye
MC in children 7-12yo
Sxs:
- decreased EOM
- pain w/ mvmt of eye
- Proptosis
- Signs of infx
- a/w with sinusitis
dx - CT scans of orbits - confirmatory
tx - hospitalization with IV broad spectrum abx - Vanco
EMERGENCY
Surgery
Otitis Externa
Swimmer’s ear
infx of auditory canal 2/2 trauma or consistently moist env
MCC - Pseudomonas (green dc), S aureus
malignant OE in DM - MC aspergillus -fluffy white black dots
Sxs:
- Ear pain w/ tragus or auricle movement
- purulent cheesy white dc
- erythematous canal
Dx
- clinical
- tuning form - bone conduction > air conduction
Tx
- Ofloxacin 0.3% solution 10 drops QD x 7d
- if perforated or chance of - ciprofloxacin 0.3% and dexamethasone 0.1% 4 drops BID x 7 days
- Clotrimazole for Aspergillus
Papilledema
Neuro-ophthalmologic Disorders
Optic disc swelling d/t increased ICP - bilateral & occurs over period of hrs to wks
Eti - malignant HTN, brain tumor/abscess, meningitis, pseudotumor cerebri, encephalitis
Sxs - asymptomatic or present with transient visual alterations (seconds)
Dx - neuroimaging to r/o lesions, CSF analysis
Tx underlying cause
EMERGENT Meds
Parotitis
Salivary Disorders
Inflammation of parotid glands;
Eti
- DeH2O, eldery post op
- Autoimmune - Sjogren’s and Sarcoidosis
- Infectious
- Bacterial - S aureus
- Viral - Mumps - paramyxovirus (no immunization)
- Fever, HA, mylagia, fatigue, anorexia, => parotitis
- Self limited
- Look for associated orchitis
Sxs
- Fever, chills
- Periauricular, mandibular pain, and swelling
- trismus, dysphagia, purulent drainage
Dx
- Clinical
- Sample purulent exudate
- US and CT for surrounding tissue assessment
- Viral - IgM against mumps
Tx
- Self limited with Hydration and rest
- vaccination
- contagious 9d after onset of parotid swelling
Peritonsillar Abscess
Oropharyngeal Infectious Disorders
Penetration of infx through tonsillar capsule-> tonsillitis -> cellulitis -> abscess formation
MC GABHS*, S aureus
- Hot potato/muffled voice
- medial deviation of soft palate
- Uvula deviation to contralat side
- Dysphagia
- trismus
Dx - CT to diff btwn cellulitis and abscess
Tx
- I&D
- IV abx - Amoxicillin, Amox-Sulbactam (Unasyn), Clinda
- Tonsillectomy
Acute Pharyngitis (Bacterial)
Oropharyngeal Infectious Disorders
Usu GAS
Centor Criteria - if +3/4, get rapid strep test
- Fever > 100.4 or 38C
- Absence of cough
- Pharyntonsillar Exudate
- Tender anterior cervical lymphadenopathy
Dx - throat culture - gold std
Tx
- Symptomatic - fluids, NSAIDs, saline gargles, CS
- Bacterial - Penicillin or Amoxicillin
Acute Pharyngitis (Viral)
Oropharyngeal Infectious Disorders
Less likely exudative (CMV, EBV, adenovirus)
Mononucleosis - EBV, rash w/ penicillin
Dx
- atypical lymphocytes
- Heterophile agglutination tests (monospot)
- Splenomegaly - splenic rupture
- non contact sports - 3 wks after sxs onset
- contact sport - 4 wks
Tx supportive
Pterygium
Corneal Disorders
a/w increased sun exposure and climate where there is wind, sand, and dust
Sxs
- elevated, superficial, fleshy, triangular-shaped “growing” fibrovascular mass
- mc in inner corner/nasal side of eye
Dx - clinical
Tx
- Observation - artificial tears
- Surgically remove only if central vision affected
Retinal Arterial Occlusion
Retinal Disorders
Central retinal artery occlusion
eti - a/w Afib, carotid dz, or giant cell arteritis
Sxs:
- Sudden, painless, unilat, and severe vision loss - Amaurosis fugax
Dx:
- Fundoscopy - perifoveal atrophy - Cherry red spots on pale macula
- R/o carotid artery stenosis w/ carotid US
Tx:
- EMERGENT OPTHAL consult - immediate tx if occlusion <24 hrs
- Reduce IOP w/ ocular hypotensive drugs - topical timolol 0.5% & acetazolamide 500 mg IV or PO
- Intermittent digital massage over closed eyelid
- irreversible damage to retina if > 90 mins
Retinal Detachment
Retinal Disorders
Separation of retina from pigmented epithelial layer; usu from choroid, lens implant
Sxs:
- acute onset painless blurred or blackened vision
- monoccular blindness
- vertical curtain coming down - vision does not return
- Floaters and flashes
Dx:
- Fundoscopic - asymmetric red reflex
- IOP is decreased
Tx
- Stay supine- lying face upward - head turned towards detached retina
- Pneumatic retinopexy - air bubbles in vitreous
Central Retinal Venous Occlusion
Retinal Disorders
Blood and thunder fundus
MC >50yo, HTN, DM***, primary open angle glaucoma, HLD, hyperviscosity (polycythemia and leukemia)
Occurs 2/2 to thrombotic event
Sxs:
- Sudden, painless, unilat vision loss
- blurred vision or complete loss of vision
Dx:
- Fundoscopy - retinal hemorrhages in all quadrants
- optic disc swelling
- blood and thunder retina
Tx:
- vision resolves with time
- tx neovascularization w. intravitreal injections of VEGF inhibitors
Allergic Rhinitis
Nose/Sinus Disorders
Eti - fam hx of atopy, IgE mediated mast cell histamine release
Sxs:
- clear nasal dc
- rhinorrhea
- itchy, watery eyes
- allergic shiners - blue discoloration under eye
- Transverse nasal crease
Tx
- Avoid allergens
- nasal CS - beclomethasone, mometasone
- Intranasal decongestants dont use more than 3-5 days –> causes rhinitis medicamentosa
Scleritis
Vision Abnormalities
Inflammation of sclera; usu from systemic immunologic dz (RA)
Sxs
- bilateral Significant eye pain
- worsen at night
- radiates to face and periorbital region
Dx
- PE - ocular redness and pain on palpation of eyeball
- can cause visual impairment
- Labs for syst immunologic dz - ANCAs, ANA, CRP, ESR, Lyme, RA, ACE< RPR
Tx
- Prompt eval to opth
- Topical vs syst CS
Sialadenitis
Salivary Disorders
bacterial infection of salivary (parotid or submandibular) gland; caused by sialolithiasis (obstructing stone)
MCC S aureus, mumps
Sxs
- Swelling, pain, redness, tenderness
- a/w with Sjogren syndrome
Dx - clinical, CT or MRI can help
Tx -
- IV or PO Nafcillin/dicloxaciilin 250 mg QID, 1st gen ceph or Clinda
- dilation of salivary duct; sialogogues for incr salivary flow
Sialolithiasis
Salivary Disorder
Ca salt stones obstructing salivary glands; MC in Wharton’s duct (submandibular gland) and Stenson’s (parotid)
Sxs
- post prandial salivary gland pain and swelling
Dx - clinical , non-contrast CT
Tx
- Cephalosporin
- dilation of salivary gland duct
- Incr PO hydration + sialogogues
Sore Throat ddx
Viral > bacterial - adenovirus MC
Eti:
- Mononucleosis
- EBV, fever, sore throat, lymphadenopathy
- atypical lymphocytes
- Heterophile agglutination test/ monospot
- Gonorrhea pharyngitis for recent sexual encounters or non resolving pharyngitis
- Fungal in pts Inhaled steroids
GABHS
- Fever, tender anterior cervical adenopathy, no cough, pharyngo tonsillar exudate
- 3/4 Centor - rapid strep test, only 1/4 Centor - not likely strep
Dx
- Rapid strep - if negative
- Throat culture is confirmatory
Tx
- IM PCN if pt incompliance
- PO PCN/ Cefuroxime
- Erythromycin if pcn allergy
Strabismus
Vision Abnormalities
“Lazy eye” Ocular misalignment; can be intermittent or constant
Sxs
- Exotropia - out turning eyes
- Esotropia - in turning eyes
Dx
- Cover/uncover test
- asymmetrical corneal light reflex
tx
- Glasses*, occlusion therapy
- Eye exercises - ortho exercises
Tympanic Membrane Perforation
ETi - infx (AOM) or trauma (barotrauma, direct impact, or explosions)
Sxs:
- pain
- otorrhea
- hearing loss/reduction
Tx
- Resolves on own, surgery if persistent hearing loss
- keep dry -> water 2ry to infx
- Floxin drops
- Surgery if > 2mos
Vertigo
Sensation of Movement in the absence of movement -Spinning
Sensorineural HL
Peripheral - Inner ear –> labyrinthitis, BPPV, Meniere, vestibular neuritis, head injury -> sudden onset, n/v, tinnitus, hearing loss, horizontal nystagmus
Central - brainstem vascular dz, AVM, tumor, MS -> gradual onset/Rotary + vertical nystagmus, no auditory symptoms (vertigo+symptom = vertebrobasilar insufficiency )
BBPV - positional, no hearing loss, tinnitus, ataxia
- dx - Dix Hallpike, tx with Epley’s manuveur
Vestibular Neuritis: not positional, no hearing loss/tinnitus
Labyrinthitis: acute, self-resolving episode; vertigo, hearing loss, tinnitus
- tx - meclizine + steroids
Meniere’s Disease: chronic, relapsing, remitting; vertigo + hearing loss + tinnitus
- tx - diuretics, salt restriction, CN VIII ablation for severe cases
Perilymph fistula: a history of trauma; vertigo from trauma
- tx - fix damage surgically
Acoustic neuroma: ataxia, neurofibromatosis type II, MRI findings. Hearing loss, tinnitus, and ataxia;
- tx - surgery
Vestibular Schwannoma aka Acoustic Neuroma
Schwann cell derived tumor - from CN VIII (growth as a fetus)
Sxs - unilateral SNHL + tinnitus
Dx - MRI is gold
Tx - surgery, radiation for older ppl
