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ENOT - 7% Flashcards

1
Q

Acute Otitis Media

Middle Ear

A

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

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2
Q

Acute Rhinosinusitis

Nose/Sinus Disorders

A

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
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3
Q

Amblyopia (lazy eye)

Vision Abnormalities

A

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
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4
Q

Apthous Ulcers

Oropharyngeal Infectious Disorders

A

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%
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5
Q

Barotrauma

A

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
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6
Q

Blepharitis

Lid Disorders

A

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

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7
Q

Candidiasis

Oropharyngeal Infectious Disorders

A

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
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8
Q

Cataract

Corneal Disorders

A

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
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9
Q

Chalazion

Lid Disorders

A

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
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10
Q

Cholesteatoma

Middle ear

A

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
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11
Q

Allergic Conjunctivitis

A

Red eyes, itiching and tearing, bilateral

cobblestone mucosa

blue oropharynx

Tx

  • systemic antihistamines and topic AHs
    • Naphcon A
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12
Q

Viral Conjunctivitis

A

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
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13
Q

Bacterial Conjunctivitis

A

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
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14
Q

Corneal Abrasion

A

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
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15
Q

Dacryoadenitis/Dacryocystitis

Lacrimal Disorders

A

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
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16
Q

Deep Neck Infection

Oropharyngeal Infectious Disorders

A

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
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17
Q

Dental Abscess

Oropharyngeal Infectious Disorders

A

Dental caries destroys hard surface of tooth –> dental pulp –> abscess formation

  • Pain
  • swelling
  • Fever

Dx w/ CT scan

Tx - Ceftriaxone, followed by PO amox

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18
Q

Ectropion

Lid Disorders

A

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
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19
Q

Epiglottis

Oropharyngeal Infectious Disorders

A

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
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20
Q

Epistaxis

Nose/Sinus Disorders

A

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

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21
Q

Entropion

A

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
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22
Q

Foregin body - Ear

A

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

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23
Q

Foreign Body - Nasal

A

Persistent, foul smelling, unilateral nasal dc

Tx - oxymetazoline to shrink mucous membrane, then remove

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24
Q

Foreign Body - Occular

A

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

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25
Q

Acute Angle Closure

Glaucoma

A

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
26
Q

Open Angle Closure

Glaucoma

A

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*
27
Q

Globe Rupture

Eye Traumatic Disorders

A

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
28
Q

Herpes Simplex Virus

Oropharyngeal Infectious Disorders

A

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
29
Q

Hordeolum

A

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
30
Q

Hyphema

A

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
31
Q

Keratitis

Corneal Disorders

A

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
32
Q

Labyrinthitis

A

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

33
Q

Acute Laryngitis

Oropharyngeal Infectious Disorders

A

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
34
Q

Leukoplakia

Other Oropharyngeal Disorders

A

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.
35
Q

Macular Degeneration (Wet)

Retinal Disorders

A

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
36
Q

Mastoiditis

A

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
37
Q

Ménière Disease

A

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

38
Q

Nystagmus

dx, tx

Neuro-ophthalmologic disorders

A

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
39
Q

Nystagmus

types, sxs

Neuro-ophthalmologic Disorders

A

Involuntary, rapid, repetitive movement of eyes

Two types

  1. 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
  2. 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
40
Q

Optic Neuritis

Neuro-ophthalmologic Disorders

A

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
41
Q

Orbital Blowout Fracture

Eye Traumatic Disorders

A

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

42
Q

Orbital Cellulitis

A

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

43
Q

Otitis Externa

A

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
44
Q

Papilledema

Neuro-ophthalmologic Disorders

A

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

45
Q

Parotitis

Salivary Disorders

A

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
46
Q

Peritonsillar Abscess

Oropharyngeal Infectious Disorders

A

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
47
Q

Acute Pharyngitis (Bacterial)

Oropharyngeal Infectious Disorders

A

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
48
Q

Acute Pharyngitis (Viral)

Oropharyngeal Infectious Disorders

A

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

49
Q

Pterygium

Corneal Disorders

A

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
50
Q

Retinal Arterial Occlusion

Retinal Disorders

A

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
51
Q

Retinal Detachment

Retinal Disorders

A

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
52
Q

Central Retinal Venous Occlusion

Retinal Disorders

A

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
53
Q

Allergic Rhinitis

Nose/Sinus Disorders

A

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
54
Q

Scleritis

Vision Abnormalities

A

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
55
Q

Sialadenitis

Salivary Disorders

A

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
56
Q

Sialolithiasis

Salivary Disorder

A

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
57
Q

Sore Throat ddx

A

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
58
Q

Strabismus

Vision Abnormalities

A

“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
59
Q

Tympanic Membrane Perforation

A

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
60
Q

Vertigo

A

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
61
Q

Vestibular Schwannoma aka Acoustic Neuroma

A

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

pance (15 decks)

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