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EOR - Family Med > ENOT/Ophthalmology > Flashcards

ENOT/Ophthalmology Flashcards

1
Q

Sinus pain/pressure (worse with bending down and leaning forward). Facial tap elicits pain.

A

Acute sinusitis ; MC after URI

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2
Q

MCC of sinusitis & what are the MC organisms

A
  • Viral: Most common, symptoms < 7 days. Bacterial: Symptoms 7+ days and associated with bilateral purulent nasal discharge.
    • Organisms: S. pneumoniae, H. influenzae, M.catarrhalis
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3
Q

When would sinusitis be considered to be chronic

A
  • Chronic = lasts 12 weeks or longer
    • Chronic: Plainview X-ray (waters view) is a good initial screening, CT is the Gold Standard
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4
Q

Indications for abx for sinusitis

A

antibiotics in rhinosinusitis include the duration of symptoms >10 days without improvement. Treatment is for five to seven days

  • Amoxicillin (500 mg orally three times daily or 875 mg orally twice daily) or amoxicillin-clavulanate (500 mg/125 mg orally three times daily or 875 mg/125 mg orally twice daily)
  • Penicillin-allergic: Doxycycline 100 mg orally twice daily or 200 mg orally daily
  • Macrolides (clarithromycin or azithromycin) and trimethoprim-sulfamethoxazole are not recommended for empiric therapy because of high rates of resistance of S. pneumoniae
  • kids Amoxicillin x 10-14 days
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5
Q

Dx of Blepharitis

A

DX is usually by slit-lamp examination

TX: 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

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6
Q

painless otorrhea, brown/yellow discharge with a strong odor

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7
Q

Causes of Cholesteatoma

A
  • Caused by chronic eustachian tube dysfunction which results in chronic negative pressure and inverts part of the TM causing granulation tissue that over time, erodes the ossicles and leads to conductive hearing loss

TX: Surgical removal

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8
Q

MCC of conjuncitivits

A
  • MC caused by adenovirus; highly contagious, transmission via direct contact/swimming pools
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9
Q

will present with purulent (yellow) discharge from both eyes (“glued shut”), crusting, usually worse in the morning; May be unilateral

A

Bacterial conjunctivitis

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10
Q

Abx tx for bacterial conjunctivitis

A
  1. Gentamicin/tobramycin (Tobrex): aminoglycoside antibiotic used for gram-negative bacterial coverage. Most cases of bacterial conjunctivitis will respond to this agent
  2. Erythromycin ointment (E-Mycin) Chlamydia for newborns
  3. 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.
  4. Ciprofloxacin (Ciloxan)
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11
Q

Contact wearers abx for bacterial conjunctivitis

A

Contact lenses use = pseudomonas tx=fluoroquinolone (ciprofloxacin / Ciloxan drops)

  • Neisseria conjunctivitis warrants prompt referral and topical + systemic antibiotics
  • Chlamydial conjunctivitis systemic tetracycline or erythromycin x 3 weeks, topical ointments as well, assess for STD or child abuse
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12
Q

Allergic conjunctivitis tx

A

epinastine (Elestat)

  • azelastine (Optivar)
  • Emedastine difumarate (Emadine)
  • Levocabastine (Livostin)
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13
Q
A

Corneral ulcer

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14
Q

MCC of corneal ulcer

A

Contact lens wearers, caused by a deep infection in the cornea by bacteria, viruses or fungi

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15
Q
  • Inflammation of the nasolacrimal duct or the nasolacrimal gland (supratemporal)
A

Dacryoadenitis

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16
Q
A

Dacrocystitis

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17
Q

Tx of dacrocystitis

A

Tx: systemic antibiotics: Clindamycin + 3rd gen. cephalosporin

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18
Q

(eversion of the eyelid) occurs when the eyelid turns outward exposing the palpebral conjunctiva, conjunctiva will appear red from air exposure and inflammation

A

Ectropion

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19
Q
  • Peripheral to central gradual visual loss (versus macular degeneration which is a central loss)
A

Open angle glaucoma

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20
Q

Classic triad of acute narrow angle-closure glaucoma

A
  • Classic triad: injected conjunctiva, steamy cornea, and fixed dilated pupil, this is an ophthalmic emergency
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21
Q
  • Sudden dull or severe eye pain (unilateral), worse in dark rooms
A

Acute narrow angle-closure glaucoma:

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22
Q

Tx of Acute narrow angle-closure glaucoma

A
  • Acetazolamide IV is the first-line agent - decrease IOP by decreasing aqueous humor production
  • Topical beta-blocker (ex. timolol) reduces IOP without affecting visual acuity
  • Miotics/cholinergics (ex. Pilocarpine, Carbachol)
  • Peripheral iridotomy is the definitive treatment
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23
Q
  • A gradual loss of peripheral vision; Painless
A

Chronic open-angle glaucoma

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24
Q

painful red infection in a gland at the margin of the eyelid

A

Hordeolum

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25
Q

Painful vs painless eyelid lesion

A
  • Painful warm (hot), swollen red lump on the eyelid = Hordeolum
  • Chalazion which is painless
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26
Q

MC organism in Hordeolum

A

S.aureus

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27
Q

Hordeolum Tx

A

Warm compress and topical antibiotics

  • A hordeolum that does not respond to hot compresses can be incised with a sharp, fine-tipped blade
    • Systemic antibiotics (eg, dicloxacillin or erythromycin 250 mg PO QID) are indicated when cellulitis accompanies a hordeolum
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28
Q

Trauma causes blood in the anterior chamber of the eye (between the cornea and the iris) and may cover iris

A

Hyphema

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29
Q

Dx of Hyphema

A

DX: orbital CT if indicated + ophthalmology consult

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30
Q

Tx of Hyphema

A

TX: 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)
31
Q

Acute onset, vertigo + hearing loss, tinnitus of several days to a week

32
Q

MCC of Labyrinthitis

A
  • Usually viral, an absence of neurologic deficits
  • Associated with nausea and vomiting
33
Q

hoarseness following a URI

A

Laryngitis

34
Q

In Laryngitis, if hoarseness persists > 2 weeks, history of ETOH and or smoking, laryngoscopy is required for symptoms persisting > 3 weeks

A

Consider squamous cell carcinoma

35
Q

Laryngitis tx

A

TX: Relax voice (vocal rest), supportive therapy

  • Oral or IM corticosteroids may also hasten recovery for performers but requires vocal fold evaluation before starting therapy
  • Bacterial → erythromycin, cefuroxime, or Augmentin for cough or hoarseness
36
Q

Gradual painless loss of central vision. The macula is responsible for central visual acuity which is why macular degeneration causes gradual central field loss.

A

Macular degeneration

37
Q

Difference between dry vs wet macular degeneration

A
  • Dry (85% of cases): atrophic changes with age – a slow gradual breakdown of the macula (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
38
Q

Tx of wet macular degeneration

A
  • VEGF inhibitors (e.g., bevacizumab)
  • Photodynamic therapy
  • Zinc and antioxidant vitamins
39
Q

Tx of dry macular degeneration

A

Dry age-related macular degeneration

  • Zinc and antioxidant vitamin
40
Q

Meniere dz etiology

A

Excessive endolymph fluid in cochlea overstimulates hairs causing vertigo and sudden hearing loss with aural fullness - Unknown etiology

41
Q

Sx of Meinere dz

A
  • Vertigo attacks lasting hours, classic triad of low-frequency hearing loss, tinnitus with aural (ear) fullness and vertigo
42
Q

Tx of meniere dz

A

TX: Low salt diet, diuretics (HCTZ + triamterene) to reduce aural pressure

43
Q

Samters triad

A

Samter’s triad for nasal polyps

  1. asthma
  2. aspirin sensitivity
  3. nasal polyps
44
Q

Otitis externa

A

Bacterial otitis externa “swimmer’s ear”

45
Q
  • Ear pain (especially with movement of tragus or auricle), pain with eating, purulent cheesy white discharge, palpation of the tragus is painful
    • Tuning fork ⇒ bone conduction > air conduction
A

Bacterial otitis externa

46
Q

Otitis externa organisms

A
  • Pseudomonas aeruginosa (swimmer’s ear) vs. S. aureus (digital trauma)
47
Q

Diabetic otitis externa

A
  • Malignant otitis externa is commonly seen in diabetics
48
Q

Tx of otitis externa

A

TX: Antibiotic drops ⇒ (aminoglycoside or fluoroquinolone +/- corticosteroids) + avoid moisture

  • If perforated or chance of perforation: Ciprofloxacin 0.3% and dexamethasone 0.1% suspension: 4 drops BID × 7 days or ofloxacin: 0.3% solution 10 drops once a day × 7 days
  • Diabetic/immunocompromised: malignant otitis externa ⇒ necrotizing infection ⇒ hospitalization with IV abx (caused by aspergillus)
49
Q

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

A

Otitis media

50
Q

MC bugs in otitis media

A

S. pneumoniae 25%, H. influenzae 20%, M. catarrhalis 10%

51
Q

Dx of otitis media

A

otoscopic ⇒ bulging, loss of landmarks, redness, TM injection

52
Q

Otitis media tx

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: tympanostomy, tympanocentesis, myringotomy
  • Complications: Mastoiditis and bullous myringitis
53
Q

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

A

Papilladema

54
Q

Common causes of papilledema

55
Q

Mumps parotitis MCC

A
  • Mumps is caused by a paramyxovirus.Likely in achild without a complete vaccination series.Transmitted viarespiratory droplets
  • Typically, it begins with a few days of fever, headache, myalgia, fatigue, and anorexia, followed by parotitis
  • In adult males look for an associated orchitis
56
Q

Viral parotitis mcc

A
  • Viral infections associated with parotitis include influenza A virus, parainfluenza, adenovirus, coxsackievirus, Epstein-Barr virus (EBV), cytomegalovirus, herpes simplex virus, human immunodeficiency virus (HIV), and lymphocytic choriomeningitis virus
57
Q

Peritonsillar abscess

A
  • Presents with a hot potato (muffled) voice, severe sore throat, lateral uvula displacement, bulging tonsillar pillar
58
Q

Tx of peritonsillar abscess

A

Aspiration, incision and drainage, and/or antibiotics

  • IV antibiotics ⇒ amoxicillin, amoxicillin-sulbactam, and clindamycin
  • In less severe cases, oral antibiotics can be used for 7 to 10 days (i.e., amoxicillin, amoxicillin-clavulanate, clindamycin)
  • Tonsillectomy may also be considered in about 10% of patients
59
Q

Viral pharyngitis mcc

A

Usually viral - 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
60
Q

Strep pharyngitis centor criteria

A
  • Group A B-hemolytic streptococci (GABHS)
  • Centor criteria: 1. Absence of a cough, 2. exudates, 3. fever (> 100.4 F), 4. cervical lymphadenopathy
  • Not suggestive of strep - coryza, hoarseness, and cough
  • If 3 out of 4 Centor criteria are met get a rapid streptococcal test (sensitivity > 90%)
  • If negative → throat culture is the gold standard
61
Q

Elevated, superficial, fleshy, triangular-shaped “growing” fibrovascular mass (most common in the inner corner/nasal side of the eye)

A

Pterygium

62
Q

Pterygium tx

A

Tx: Only surgically remove when vision is affected

63
Q

Retinal detachment

A

Separation of the retina from the pigmented epithelial layer causing the detached tissue to appear as a flap in the vitreous humor

64
Q

Tx for retinal detachment

A

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
65
Q

Retinal vascular occlusion

A

⇒ Central retinal artery occlusion (cherry-red spot, ischemic retina)

66
Q
  • Sudden, painless, unilateral, and usually severe vision loss (Amaurosis fugax)
67
Q

tx of retinal vascular occlusion

A

TX: 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 massage over the closed eyelid or anterior chamber paracentesis
  • If patients 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 90 min; Poor prognosis
68
Q

Blood and thunder fundus

A

⇒ Central retinal vein occlusion; blood and thunder retina (dilated veins, hemorrhages, edema, exudates)

69
Q

Tx of central vein occlusion

A

TX: vision resolves with time (partially); workup for thrombosis

  • Neovascularization treated with intravitreal injection of VEGF inhibitors
70
Q

Prolonged hyperglycemia affects eyes

A
  • Prolonged hyperglycemia causes basement membrane thickening, decreased pericytes (hyperproliferation), microaneurysms, and neovascularization
71
Q

2 types of diabetic retinopathy

A
  • Diabetic retinopathy falls into two main classes: nonproliferative (early) and proliferative (late, advanced)
72
Q

pain, otorrhea, and hearing loss/reduction

73
Q

Tympanic membrane perforation

A

TX: 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 that impedes closure
  • The only class of antibiotics that are non-ototoxic are the Floxin drops and should be used if you are going to be prescribing drops with a perforated TM
  • Surgery if persists past 2 months

EOR - Family Med (5 decks)

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