ENOT and Ophthalmology Flashcards
1
Q
What is acute laryngitis?
A
inflammation of the larynx, usually from virus/overuse
- change in voice (decreased volume/hoarse)
- consider cell carcinoma if hoarseness persists > 2 weeks, history of ETOH/smoking
- consider GERD if no associated viral etiology
- M. cat, H. flu
2
Q
How is acute laryngitis dx?
A
clinical, laryngoscopy required for sx persisting > 3 weeks
-deviation of soft palate = abscess
3
Q
How is acute laryngitis tx?
A
symptomatic (cough suppressant, voice rest, steam inhalant)
- viral = self-limiting, oral and IM steroids for vocal performers to hasten recovery
- bacterial - erythromycin, cefuroxime, or augmentin for cough or hoarseness
4
Q
What is a hyphema?
A
trauma causes blood in the anterior chamber of the eye (between the cornea and the iris) and may cover iris
- the blood may cover part or all of the iris (the colored part of the eye) and the pupil, and may partly or totally block vision in that eye
- usually from blunt/penetrating trauma = ensure no other type of injury (skull fracture, orbital fracture)
5
Q
How is hyphema dx?
A
orbital CT if indicated + ophthalmology consult
6
Q
What is the tx of hyphema?
A
usually, blood is reabsorbed over days/weeks
- elevate head at night at 30 degrees, acetaminophen for pain, patch/shield
- may use beta-adrenergic blockers or carbonic anhydrase inhibitors
- surgery if high pressure/persistent bleeding
- NSAIDs contraindicated (may increase bleeding)
7
Q
What is acute otitis media?
A
the clinical diagnosis of AOM requires 1) bulging of the tympanic membrane or 2) other signs of acute inflammation (eg marked erythema of the tympanic membrane, fever, ear pain) and middle ear effusion
8
Q
What are the characteristics of acute otitis media?
A
- bugs: s. pneumonia 25% H. influenzae 20%, M. catarrhalis 10%
- acute: < 3 weeks, chronic >3 mo, recurrent: 3 episodes in 6 mo or 4 in 12 with clearing between
- chronic > 3 mo: clear serous fluid in the middle ear without s/sx of ear infection (may have hearing loss/asymptomatic) - no abx
9
Q
How is acute otitis media dx?
A
otoscopic = bulging, loss of landmarks, redness, TM injection
-a key finding is limited mobility of the TM with pneumotoscopy
10
Q
What is the tx for acute otitis media?
A
first- line amoxicillin, augmentin = 2nd line (PCN allergy = azithromycin, erythromycin, Bactrim)
- treat < 2 y for 10 days and > 2 y for 5-7 days
- recurrent: tympanovstomy, tympanocentesis, myringotomy
- complications: mastoiditis and bulluous myringitis
11
Q
What is labyrinthitis?
A
acute severe vertigo, hearing loss (several days to a week), tinnitus; vertigo progressively improves, hearing loss may not resolve, usually preceded by viral respiratory illness
12
Q
How is labyrinthitis dx?
A
clinical - an absence of neurological deficits
13
Q
What is the tx for labyrinthitis?
A
- antibiotics indicated with fever or signs of bacterial infection
- vestibular suppressants - meclizine (lorazepam, clonazepam) are helpful during initial acute symptoms
14
Q
What is bacterial acute pharyngitis?
A
Usually GAS - group A strep
- centor criteria: fever > 38 (100.4 F), anterior lymphadenopathy, lack of cough, pharyngotonsillar exudate
- If 3 out of 4 centor criteria are met get a rapid streptococcal test (sensitivity >90%)
- dx: throat culture = gold standard; think rheumatic fever/glmoerulonephritis
- s/sx: fever, sore throat, no cough, exudates, cervical LAD
- tx: penicillin to prevent acute rheumatic fever (erythromycin with allergy)
15
Q
What is viral pharyngitis?
A
less likely exudative (CMV, EBV, adenovirus)
- mononucleosis (caused by Epstein Barr virus) - rash with penicillins
- Dx: atypical lymphocytes + heterophiles agglutination test (mono spot)
- splenomegaly = splenic rupture possible with contact sports
- for athletes planning to resume non-contact sports three weeks from symptom onset
- for strenuous contact sports four weeks after illness onset
- tx: supportive
16
Q
What is fungal acute pharyngitis?
A
common to pt with inhaled steroids
- s/sx: sore throat, dysphagia, white patches in the oropharynx, seen in HIV pt
- dx: clinical/endoscopy
- tx: clotrimazole troches, miconazole, nystatin swish, fluconazole
17
Q
What is macular degeneration?
A
gradual painless loss of central vision
- the macular is responsible for central visual acuity which is why macular degeneration causes gradual central field loss
- (versus glaucoma which presents with a peripheral = central loss)
18
Q
What is dry vs. wet macular degeneration?
A
- dry (85% of cases): atrophic changes with age - a slow gradual breakdown of the macular (macular atrophy), with drusen (dry) = yellow retinal deposits
- wet = an advanced form of dry age-related macular degeneration
- new blood vessels growing beneath the retina (neovascularization) leak blood and fluid, damaging the retinal cells
- these small hemorrhages usually result in rapid and severe vision loss
19
Q
How is macular degeneration dx?
A
dilated funduscopic findings are diagnostic = hemorrhage or fluid in the sub retina; macular grayish-green discoloration; Amsler grid = distortion on Amsler grid
20
Q
What is the tx of macular degeneration?
A
wet age-related macular degeneration -VEGF inhibitors (e.g becaxizumab) -photodynamic therapy -zinc and antioxidant vitamins dry age-related macular degeneration -zinc and antioxidant vitamin
21
Q
What is acute sinusitis?
A
often follows URI - can be viral or bacterial (bacterial = S. pneumonia, H. influenzas, M. catarhalis)
- risk factors: cigarette smoke/exposure, history of trauma, presence of foreign body
- purulent nasal discharge, facial pain and pressure, nasal obstruction, fever
- tenderness to palpation over the affected sinus, decreased ligh transmission with transillumination
22
Q
How is acute sinusitis dx?
A
clinical, XR not recommended, MRI indicated if malignancy or intracranial spread of infection is suspected
23
Q
What is the tx for acute sinusitis?
A
NSAIDs for pain, saline washes, steam, oral/nasal decongestants - improvement in 2 weeks
- Indications for antibiotics in rhino sinusitis include the duration of symptoms > 10 days without improvement, treatment five to seven days
- amoxicillin (500 mg orally three times daily or 875 mg twice daily) or amoxicillin-clavulanate (500 mg/125 mg orally three times daily or 875 mg/125 mg orally twice daily)
- pencillin-allergic: doxycycline 100 mg orally twice daily or 200 mg orally daily
- macrolides (clarithromycin or azithromycin) and trimethoprim-sulfamethozaole are not recommended for empiric therapy because of high rates of resistance of S. pneumoniae
- kids amoxicillin x 10-14 days
24
Q
What is mastoiditis?
A
suppurative infection of mastoid air cells = usually a complication of acute otitis media
- organisms: s. pneumonia, H. influenzas, M. catarrhalis, S. aureus, S. pyrogens
- fever, otalgia, pain, erythema posterior to ear and forward displacement of the external ear
25
How is mastoiditis dx?
clinical, CT scan temporal bone with contrast for complicated/toxic appearing
26
What is the tx of mastoiditis?
simple = oral antibiotics, IV antibiotics (ceftriaxone)
- ENT referral in more serious cases or pt with unreliable follow up
- drainage of middle ear fluid
27
What is allergic rhinitis?
clear nasal drainage, rhinorrhea, itchy, watery eyes, sneezing nasal congestion, pale, bluish boggy mucosa
- allergic shines (blue discoloration below eyes), transverse nasal verses
- IgE mediated mast cell histamine release
28
What is the tx of allergic rhinitis?
avoid any known allergens and use antihistamines, cromolyn sodium, nasal or systemic corticosteroids, nasal saline drops or washes, and immunotherapy
-Intranasal decongestants not be used more than 3-5 days may cause rhinitis medicamentosa
29
What are the ddx of nasal congestion?
seasonal allergies, common cold, sinusitis, upper respiratory infection, animal allergy, etc.
30
What is barotrauma?
tissue injury caused by a pressure-related change in body compartment gas volume - affects air-containing areas (lungs, ears, sinuses, GI tract, air spaces in teeth, space in diving face mask)
-barotrauma presents with ear pain and hearing loss that persists past the inciting event = sinus pain, epistaxis, abdominal pain/dyspnea, and LOC
31
How is barotrauma dx?
clinical but sometimes needs imaging tests; exam: signs of trauma without signs of infection (redness without building pus, or effusion)
32
What is the tx of barotrauma?
supportive (anti-inflammatories) then consider prophylaxis
-pseudoephedrine or Afrin can be good for prophylaxis (not be used for > 3 days - you must be careful when recommending this to divers, depending on dive times
33
What is optic neuritis?
acute inflammation and demyelination of the optic nerve leading to acute monocular vision loss/blurriness and pain on extraocular movements
- typically occurs over hours to days
- associated with multiple sclerosis = MC cause and initial presenting symptoms
- can also be from ethambutol
34
How is optic neuritis dx?
fundoscopy: inflammation of the optic disc, confirmed by MRI
35
What is the tx of optic neuritis?
corticosteroids (methylprednisolone IV)
| -refer to neurology for evaluation of Multiple Sclerosis
36
What is blepharitis?
chronic inflammation of lid margins caused by seborrhea, staph, or strep = dysfunction of Meibomian glands
37
What are the characteristics of blepharitis?
- anterior blepharitis: eyelid skin, eyelashes; may be ulcerative (s. aureus) or seborrheic
- posterior: inflammation of Meibomian gland; may be infectious (s. aureus) or caused by glandular dysfunction
- crusting, scaling, red-rimming of the eyelid and eyelash flaking, adherent eyelashes, hyperemic lid margins, dandruff-like deposits (scurf) and fibrous scales (collarettes); clear or slightly injected conjunctiva; thick cloudy discharge visible when Meibomian glands obstructed
38
How is blepharitis dx?
usually by slit-lamp examination
39
What is the tx of blepharitis?
warm compresses, daily lid wash with diluted baby shampoo on cotton-tipped swabs; lid massage to express the gland; topical antibiotics used if infection suspected
40
What is orbital cellulitis?
infection of orbital muscles and fat behind the eye (periorbital = infection only of skin)
- decreased extraocular movement, pain with movement of the eye and proptosis, signs of infection
- often associated with sinusitis, occurs more often in children than adults - ages 7-12 y/o
- decreased vision is a rare manifestation of orbital cellulitis
41
How is orbital cellulitis dx?
CT scan of orbits (confirmatory)
- focused assessment on extraocular muscles
- CBC and blood cultures in some settings
42
What is the tx of orbital cellulitis?
hospitalization and IV broad-spectrum antibiotics (vancomycin)
43
What is a blowout fracture?
history of blunt trauma, muscle entrapment, eyelid swelling, gaze restriction, double vision, decreased visual acuity, enophthalmos (sunken eye)
- pain with EOM, epistaxis, erythema/ecchymosis, "raccoon eyes"
- anesthesia/paresthesia in the gums, upper lips, and cheek indicate damage to the infraorbital nerve
44
What is the tx for a blowout fracture?
prompt ophthalmic referral = treatment with surgery
| -antibiotics to prevent infection
45
What is bacterial otitis externa?
"swimmer's ear"
- ear pain (especially with movement of tragus or auricle) pain with eating, purulent cheesy white discharge, palpation of tragus is painful
- tuning fork = bone conduction > air conduction
- pseudomonas aeruginosa (swimmer's ear), S. aureus (digital trauma)
- malignant otitis externa is commonly seen in diabetics
46
What is the tx of bacterial otitis externa?
antibiotic drops = (aminoglycoside or fluoroquinolone +/- corticosteroids) + avoid moisture
- if perforated or chance of perforation: ciprofloaxacin 0.3% and dexamethasone 0.1% suspension: 4 drops BID x 7 days or ofloxacin: 0.3% solution 10 drops once a day x 7 days
- diabetic/immunocompromised: malignant otitis externa = necrotizing infection = hospitalization with IV abx (caused by aspergillus)
47
What is fungal otitis externa?
- prititus, weeping, pain, hearing loss
- swollen, moist, wet appearance
- aspergillus niger (black), A. flavus (yellow) or A. fumigatus (gray), Candida albicans
48
What is the tx of fungal otitis externa?
topical therapy, anti-yeast for candida or yeast: 2% acetic acid 3-4 drops QID, clotrimazole 1% solution, itraconazole oral
49
What is viral conjunctivitis?
acute onset unilateral or bilateral erythema of conjunctiva, copious watery discharge, tender preauricular lymphadenopathy, scant mucoid discharge
-MC caused by adenovirus; highly contagious, transmission via direct contact/swimming pools
50
What is bacterial conjunctivitis?
will present with purulent (yellow) discharge from both eyes ("glued shut"), crusting, usually worse in the morning, may be unilateral
- S. pneumonia, S. aureus (common) - acute mucopurulent
- M. catarrhalis, gonococcal - copious purulent discharge, in a patient who is not responding to conventional treatment
- Chlamydia - newborn, Giemsa stain - inclusion body, scant mucopurulent discharge
51
What is allergic conjunctivitis?
red eyes, itching and tearing, usually bilateral, cobblestone mucosa on the inner/upper eyelid
52
What is the tx for bacterial conjunctivitis?
hand washing, avoid contamination
- treatment(s) in order of suggested use - the dose is 0.5 inch (1.25 cm) of ointment (preferable in children) deposited inside the lower lid or 1 to 2 drops instilled four times daily for five to seven days
- gentamicin/tobramycin (tobrex): aminoglycoside antibiotic used for gram-negative bacterial coverage, most cases of bacterial conjunctivitis will respond to this agent
- erythromycin ointment (e-mycin) chlamydia for newborns
- trimethoprim and polymyxin B (polytrim) this combination is used for ocular infections, involving cornea or conjunctiva, resulting from strains of microorganisms susceptible to this antibiotic
- ciprofloxacin (ciloxan)
- contact lenses use = pseudomonas tx = fluoroquinolone (ciprofloxacin/ciloxan drops)
- neisseria conjunctivitis warrants prompt referral and topical + systemic antibiotics
- chlamydial conjunctivits systemic tetracycline or erythromycin x 3 weeks, topical ointments as well, assess for STD or child abuse
53
What is the tx for viral conjunctivitis?
eye lavage with normal saline bid 7-14 days; antihistamine drops, warm to cool compresses
54
What is the tx for allergic conjunctivitis?
systemic antihistamines and topical antihistamines or mast cell stabilizers (Naphcon-A, ocuhist, generics)
- epinastine (elestat)
- azelastine (optivar)
- emedastine difumarate (emadine)
- levocabastine (livostin)
55
What is papilledema?
optic disc swelling that is caused by increased intracranial pressure
-the swelling is usually bilateral and can occur over a period of hours to weeks
56
What are the characteristics of papilledema?
- causes include malignant hypertension, brain tumor/abscess, meningitis, cerebral hemorrhage, encephalitis, pseudotumor cerebri
- asymptomatic or may present with transient visual alterations (seconds)
- bilateral, develops over hours to weeks, the disc appears swollen, margins blurred, obliteration of the vessels, ICP: increased
57
How is papilledema dx?
immediate neuroimaging to rule out mass lesion, then CSF analysis
58
How is papilledema tx?
treat underlying cause
59
What is a corneal abrasion/ulcer?
sudden onset of eye pain, photophobia, tearing, foreign body sensation, blurring of vision, and/or conjunctival injection
-usually caused by minor trauma (fingernail, contact lens, eyelash, small foreign body)
60
How is a corneal abrasion/ulcer dx?
slit lamp with fluorescein dye demonstrates increased absorption in the devoid area
61
How is corneal abrasion/ulcer tx?
topical anesthetic ONLY to assist in confirming the diagnosis (don't prescribe = delayed healing), saline irrigation, antibiotic ointment (gentamicin or sulfacetamide), tylenol for pain
-no patching
62
What is a peritonsillar abscess?
results from penetration of infection through tonsillar capsule and involvement of neighboring tissue
- presents with a hot potato (muffled) voice, severe sore throat, lateral uvula displacement, bulging tonsillar pillar
- + streptococcus pyogens
63
How is a peritonsillar abscess tx?
aspiration, incision and drainage, and/or antibiotics
- IV antibiotics = amoxicillin, ampicillin-sulbactam, and clindamycin
- in less severe cases, oral antibiotics can be used for 7 to 10 days (i.e. amocicillin, amoxicillin-clavulanate, clindamycin)
- tonsillectomy may also be considered in about 10% of patients
64
What is dacryoadenitis?
inflammation of lacrimal (tear-producing) glands usually caused by bacteria or a virus that initiates the inflammation
- s/sx: unilateral severe pain, swelling, redness, tearing, drainage
- common causes include mumps, Epstein-Barr virus, staphylococcus, and gonococcus
65
How is dacryoadenitis dx?
usually clinical; CT orbits if chronic
66
What is the tx for dacryoadenitis?
if the cause of dacryoadenitis is a viral condition such as mumps, simple rest and warm compresses may be all that is needed
-for other causes, the treatment is specific to the causative disease
67
What is retinal detachment?
separation of the retina from pigmented epithelial layer; commonly begins at superior temporal retinal area; tear can happen spontaneously or be secondary to trauma, extreme myopia, or inflammatory changes in the vitreous, retina or choroid
68
What are the characteristics of a retinal detachment?
- acute onset painless blurred or blackened vision that occurs over several minutes to hours and progresses to complete or partial monocular blindness
- vertical curtain coming down (curtain of darkness) across the field of vision may sense floaters or flashes at the onset, loss of vision over several hours (acute and painless)
- fundoscopic exam = asymmetric red reflex
- IOP is normal or reduced
69
What is the tx for a retinal detachment?
stay supine (lying face upward) with head turned towards the side of the detached retina
- consult ophthalmologist
- pneumatic retinopexy is a procedure for the management of retinal detachment that involves cryoretinopexy followed by injection of an air bubble in the vitreous
70
What is a dental abscess?
dental caries begin asymptomatically as a destructive process of the hard surface of the tooth
- over time, dental caries extend to the tooth pulp, which can lead to abscess formation
- abscesses are characterized by swelling, pain and fever
71
What are the characteristics of dental abscess?
- poor dental health is a risk factor for dental abscess or facial cellulitis
- refer a complicated abscess to an oral surgeon for I and D
- diagnose with CT scan
72
What is the tx of a dental abscess?
ceftriaxone IM, followed by PO amoxicillin
73
What is a retinal vascular occlusion?
central retinal artery occlusion (cherry-red spot, ischemic retina)
- flow-through CRA occluded
- atherosclerotic thrombosis, embolism from the same side (ipsilateral) carotid artery, ophthalmic artery, and heart, or giant cell arteritis
- sudden, painless, unilateral, and usually severe vision loss (amaurosis fugax)
- rule out carotid artery stenosis by carotid ultrasound
74
What does a fundoscopy exam show of a retinal vascular occlusion?
- look for perifoveal atrophy (cherry-red spot) and pale opaque fundus with red fovea and arterial attenuation
- arteriolar narrowing, separation of arterial flow, retinal edema, ganglionic death leads to optic atrophy and pale retina
75
What is the tx of retinal vascular occlusion?
- emergent ophthalmologic consult - immediate treatment is indicated if occlusion occurred within 24 h of presentation
- reduction of intraocular pressure with ocular hypotensive drugs (eg, topical timolol 0.5%, acetazolamide 500 mg IV or PO)
- intermittent digital message over the closed eyelid or anterior chamber paracentesis
- if patient present within the first few hours of occlusion, some centers catheterize the carotid/ophthalmic artery and selectively inject thrombolytic drugs
- workup and management of atherosclerotic disease
- irreversible damage to the retina after 90min; poor prognosis
76
What is a central retinal vein occlusion?
(blood and thunder fundus)
- sudden, painless, unilateral vision loss, blurred vision or complete visual loss
- most common in ages 50+, associated with HTN, primary open-angle glaucoma (POAG), diabetes, hyperlipidemia, hyperviscosity states (polycythemia, leukemia)
- usually occurs secondary to a thrombotic event
77
How is a central retinal vein occlusion dx?
funduscopy: retinal hemorrhages in all quadrants, optic disc swelling; blood and thunder retina (dilated veins, hemorrhages, edema, exudates)
78
What is the tx for central retinal vein occlusion?
vision resolved with time (partially); workup for thrombosis
-neovascularization treated with intravitreal injection of VEGF inhibitors
79
What are the ddx of ear pain?
otitis externa, malignant (necrotizing) otitis externa, otitis media, mastoiditis, cerumen impaction, acoustic neuroma, barotrauma, eustachian tube dysfunction, labyrinthitis, cholesteatoma, otitis media, tympanic membrane perforation, mastoiditis, tinnitus
80
What is a sore throat?
viral > bacterial - adenovirus most common
- mononucleosis: epstein barr virus, fever, sore throat, lymphadenopathy, splenomegaly, atypical lymphocytes, + heterophile agglutination test (monospot)
- consider gonorrhea pharyngitis in patients with recent sexual encounters, or with non-resolving pharyngitis
- fungal in patients using inhaled steroids
81
What are the characteristics of GABHS causing a sore throat?
fever, tender anterior cervical adenopathy, no cough, pharyngo tonsillar exudate
- presence of all four (centor) = likely GABHS; 3/4 = rapid strep test > 90% sensitivity; only one centor - GABHS not likely
- coryza, hoarseness, cough = not suggestive of strep
82
How is a sore throat dx?
rapid strep has 90-99% sensitivity; if negative and still suspected, a throat culture is confirmatory
83
What is the tx for sore throat?
IM penicillin if doubt pt. compliance; oral penicillin/cefuroxime; erythromycin with allergy
-inadequate tx = scarlet fever, glomerulonephritis, acute rheumatic fever, abscess formation
84
What is epiglottitis?
supraglottic inflammation and obstruction of airway due to infection with Haemophilus influenzae type B (Hib)
- this is a medical emergency
- caused by Hib - usually unvaccinated children (hib vaccine at 2, 4, 6, 12-15 mo) or underserved areas
- stridor, restlessness, cough, dyspnea, fever, dysphagis, drooling, respiratory distress (tripod/"sniffing dog" posture - neck extended)
85
What are the 3 D's of epiglottitis?
- dysphagia
- drooling
- respiratory distress
86
How is epiglottitis dx?
secure airway then culture for H. flu
| -the classic finding is thumbprint sign on x-ray lateral neck film from swelling
87
What is the tx for epiglottitis?
intubating if necessary, supportive care, ceftriaxone, may treat as an outpatient if stable
88
What is a subperichondrial hematoma?
(cauliflower ear)
-blunt trauma to pinna may = subperichondrial hematoma and accumulation of blood between perichondrium and cartilage; can interrupt blood supply to cartilage and render all or part of pinna shapeless, reddish-purple mass = avascular necrosis of cartilage = cauliflower ear
89
What is a laceration of the external ear?
can be partial or all the way through ear
90
What is a avulsion of the external ear?
ear may be torn away from the head
91
What is a fracture of the external ear?
a forceful blow to the jaw may fracture bones around the ear canal and distort canal's shape, narrowing it
92
How is trauma/hematoma (external ear) dx?
of auricular hematoma made by the characteristic clinical appearance in pt with a history of blunt trauma to the auricle
- temporal bone CT without contrast for a pt with head trauma
- hearing tests
93
What is the tx for cauliflower ear?
refer immediately for I&D by ENT specialist = can result in permanent damage; prone to infection/abscess formation = oral antibiotic against staph (kephlex x 5 days)
94
What is the tx for a laceration of the external ear?
meticulous debridement of devitalized tissue and prophylactic abx; wounds <12 hr can be closed but older wounds should heal secondary with cosmetic deformities treated later
- laceration of pinna = skin margins sutured whenever possible
- cartilage penetration: externally splinted with benzoin-impregnated cotton with protective dressing; oral antibiotics
- human bite: high-risk infection; potentially severe complcations
95
What is the tx for an avulsion of the external ear?
repaired by an otolaryngologist or facial plastic surgeon
96
What is the tx for fracture ear?
surgical correction of the shape
97
What is epistaxis?
nasal trauma, dryness, HTN, nasal cocaine, alcohol
- Kiesselbach's plexus or little's area is the most common site for anterior bleeds
- posterior bleed = less frequent (woodruff plexus)
98
What is the tx for epistaxis?
most nosebleeds are anterior and stop with direct pressure
- apply direct pressure at least 10-15 minutes, seated leaning forward
- short-acting topical decongestants (afrin, phenylephrin, cocaine)
- anterior nasal packing
- patients with nasal packing must be treated with antibiotics (cephalosporin) to prevent toxic shock syndrome and the patient has to return to take the packing out
- if there is no packing in the nose, place a small amount of petroleum jelly or antibiotic ointment inside the nostril 2 times a day for 4-5 days
- cauterize if able to visualize bleeding source
- posterior balloon packing is used to treat posterior epistaxis
- high-risk for complications - specialist eval and inpatient monitoring; nasal arterial supply ligation via surgery in some cases
99
What needs to be ruled out with recurrent epistaxis?
must rule out hypertension of hypercoagulable disorder
100
What is a tympanic membrane perforation?
presents with pain, otorrhea, and hearing loss/reduction
| -can occur from infection (acute otitis media) or trauma (barotrauma, direct impact, explosions)
101
What is the tx for tympanic membrane perforation?
usually resolve on own; surgical repair may be necessary with persistent hearing loss
- keep dry = water/moisture to the ear should be avoided to prevent secondary infection the impedes closure
- the only class of antibiotics that are non-ototoxic are floxin drops and should be used if you are going to be prescribing drops with a perforated TM
- surgery if persists past 2 months
102
What is an ocular foreign body?
metallic foreign bodies = rust-ring - if can't be easily removed refer to an ophthalmologist
103
How is an ocular foreign body dx?
slit lamp/XR or CT
104
What is the tx for an ocular foreign body?
irrigation after instillation of topical anesthetic = attempt to visualize and extract
-intraocular: surgical removal by an ophthalmologist with systemic/topical antimicrobials (especially for bacillus cereus if the injury involved soil/vegetation)
105
What is an ear foreign body?
dx = visualization
tx = removal with either warm irrigation with syringe or alligator forceps
-insects: drown with mineral oil or viscous lidocaine before trying to remove
106
What is a nasal foreign body?
s/sx: persistent foul-smelling unilateral nasal discharge
dx = clinical
tx = oxymetazoline drops to shrink mucous membrane then remove
-refer to otolaryngology with non-visualized posterior FBs, impacted FBs, or unsuccessful initial attempts at FB removal
107
What is vertigo?
a sensation of movement in the absence of movement
108
What is peripheral vertigo?
inner ear = labyrinthitis, BPPV, Meniere, vestibular neuritis, head injury = sudden onset, n/v, tinnitus, hearing loss, horizontal nystagmus
109
What is central vertigo?
brainstem vascular disease, AVM, tumor, MS, certebrobasilar migraine = more gradual onset/vertical nystagmus, no auditory symptoms (vertigo + syncope = vertebrobasilar insufficiency)
110
What is BPPV vertigo?
positional, no hearing loss, tinnitus, ataxia,
| -dx: Dix Hallpike for diagnosis, treat with Epley's maneuver, meclizine
111
What is vestibular neuritis?
not positional, no hearing loss/tinnitus,
| tx: meclizine
112
What is labyrinthitis?
acute, self-resolving episode; vertigo, hearing loss tinnitus
tx = meclizine + steroids
113
What is Meniere's disease?
chronic, relapsing, remitting; vertigo + hearing loss + tinnitus
tx = diuretics, salt restriction, CN VIII ablation for severe cases
114
What is a perilymph fistula?
a history of trauma; vertigo from trauma
| tx = fix damage surgically
115
What is an acoustic neuroma?
ataxia, neurofibromatosis type II
MRI findings: vertigo, hearing loss, tinnitus and ataxia
tx = surgery
116
What is glaucoma (acute angle-closure)?
increased IOP with optic nerve damage
- an impediment to the flow of aqueous humor through trabecular meshwork
- canal of Schlemm's with increasing pressure in the anterior chamber
- open-angle = more common = 40 yo, African Americans + family history
117
What is acute angle-closure glaucoma?
ophthalmic emergency - complete closure of the angle
- classic triad: injected conjunctiva, steamy cornea, and fixed dilated pupil
- painful eye/loss of vision, tearing, nausea, vomiting, diaphoresis
- IOP acutely elevated
118
What is the tx for acute angle-closure glaucoma?
immediately refer to ophthalmology - start IV carbonic anhydrase inhibitor (acetazolamide), topical b-blocker (timolol), osmotic diuresis; laser/surgical iridotomy
-mydriatics (to dilate pupils) should NOT BE ADMINISTERED
119
What is open-angle glaucoma?
chronic, asymptomatic, potentially binding disease
- increased IOP, defects in the peripheral visual fields, increased cup to disc ratio
- asymptomatic until late in the disease, loss of peripheral vision = main symptoms
120
How is open-angle glaucoma dx?
can have elevated IOP without optic disc damage or optic nerve damage without increased IOP
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What is the tx of open-angle glaucoma?
should be referred to an ophthalmologist for close monitoring
- postaglandin analogs are the 1st line (ex. latanoprost), beta-blocker (timolol), alpha-agonist, a carbonic anhydrase inhibitor to decrease production
- laser or surgical treatment
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What is vision loss?
approach: complete eye exam (visual acuity, visual fields, external inspection, periorbital soft tissue/bone, EOM, pupils, slit lamp, fundoscopy, full neuro exam)
- painful: trauma, glaucoma, uveitis, corneal ulcer, temporal arteritis, optic neuritis
- painless: amaurosis fugax/TIA, central retinal artery/vein occlusion, vitreous hemorrhage, retinal detachment, lens dislocation, hypertensive encephalopathy, pituitary tumors, macular disorders, toxic ingestions
