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R2 - Family Medicine > ENOT/Ophthalmology > Flashcards

ENOT/Ophthalmology Flashcards

1
Q

sinusitis (acute, subacute, chronic, recurrent) etiology, RF, and sxs

A
  • Acute sinusitis: mostly viral, MCC S. pneumo, H flu, M. cat
    • cofactor: air pollution, nasal polyps, pregnancy, rhinitis medicamentosa, oral antihypertensives, anti-osteoporosis agents or HRT sprays, mucociliary dysfunction
    • sxs: follows URI, up to 4 wk, 2 or more major signs and sxs, 1 major and 2+ minor, nasal purulence on exam, rapid onset
      • Major: facial pain, pressure, nasal obstruction, PND, purulence, hyposmia, anosmia, fever
      • Minor: HA, halitosis, fatigue, dental pain, cough, ear pain, pressure, fullness
    • signs: TTP over affected sinus
  • Subacute sxs: same as acute, but complications include orbital cellulitis, osteomyelitis, cavernous sinus thrombosis
  • chronic: MCC = S. aureus, sxs are same as acute but 12+ wks
  • Recurrent sxs: 4+ eps of acute dz per year, lasting 7+ d
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2
Q

sinusitus (acute, subacute, chronic, recurrent) dx and tx

A
  • dx: clinical dx - routine radiographs not recommended, nasal endoscopy for pts who dont respond to tx, CT >>> MRI
  • tx: supportive - NSAIDs, hydration, nasal saline sprays, steam, mucolytic (guaifenesin like mucinex, robitussin)
    • oral decongestant: sudafed, topical nasal casoconstrictors (phenylephrine or afrin), intranasal steroids
    • oral abx x 1-2wk: amox (1st line), augmentin, macrolide or bactrim if PCN allergy, FQ, 3rd gen ceph.
  • consider bact if sxs worsen after 5d, persist 10+d, or out of proportion to viral infxn
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3
Q

Meniere disease

A
  • endolymphatic hydrops
  • excessive endolymph in cochlea overstim hairs causing vertigo and sudden hearing loss with aural fullness, unknown etiology
  • sxs: sudden, recurrent vertigo (minutes to hrs), lower range hearing loss, tinnitus, one sided aural pain/pressure/fullness, N/V
  • signs: nystagmus on impaired side
  • dx: audiometry, caloric testing
  • tx: low sodium/high H2O diet, diuretics (acetazolamide), intratympanic gentamicin, referral to ENT
  • avoid ETOH, caffeine, tobacco
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4
Q

labrynthitis

A
  • unkown etiology, likely viral, head injury, stress or allergy related
  • sxs: acute severe vertigo, lasting several days to a week, improves over a few weeks, but hearing loss may or may not resolve, imbalance, hearing loss, nausea or vomiting
  • signs: severe nystagmus
  • tx: abx for fever or signs of infxn, vestibular suppressants for acute sxs (diasepam, meclizine), sxs regress after 3-6wk
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5
Q

tinnitus

A
  • sxs: ringing in the ears
  • dx: comprehensive audiologic examination for unilateral persistent tinnitus or associated hearing impairment, imaging for unilateral tinnitus, pulsatile tinnitus, asymmetric hearing loss, or focal neuro deficits
  • tx: hearing aids for tinnitus with hearing loss, CBT or sound tx for persistent, bothersome tinnitus
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6
Q

Tympanic membrane perforation (barotrauma/TM perforation)

A
  • MCC: infxn (AOM), trauma (barotrauma, direct impact, explosion)
  • sxs: most are asxatic, audible whistling sounds during blowing nose and sneezing, decreased hearing, increased tendency of ear infxn during colds and with water immersion
  • signs: copious sanguineous purulent d/c, painless if no overlying infxn or cholesteatoma
  • dx: clinical dx, tympanometry
  • tx: most self-resolve and asx not requiring tx, no tx for nonswimming pts w/ minimal hearing loss, systemic abx (bactrim, amox), trichloroacetic acid to cauterize edges of TMP, surg repair of TM
  • avoid water exposure, avoid eardrops containing gentamicin, neomicin sulfate, tobramycin
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7
Q

otitis externa - bacterial

A
  • “swimmers ear”; MCC = pseudomonas, proteus, fungi
  • RF: water, trauma, exfoliative skin conditions (psoriasis, eczema)
  • sxs: ear pain (especially w/ mvmt of auricle, tragus, or eating)
  • signs: redness, swelling of ear canal or purulent exudate, foul smelling, pre- or postauricular LAD
  • dx: tuning fork BC > AC
  • tx: abx drops - aminoglyc (neomycin, polymyxin), FQ (ofloxacin), +/- topical steroid
  • complications: in DM or immunocomp - malignant otitis ex may develop (needs hosp and IV abx), periauricular cellulitis, cranial nerve palsies
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8
Q

otitis externa - fungal (mycotic otitis externa)

A
  • MCC: aspergillus niger (black), A. flavus (yellow), or A. fumigatus (gray), candida albicans (white)
  • sxs: pruritis, weeping, pain, hearing loss, aural fullness
  • signs: swollen, hyphae +/- spores, moist/wet
  • tx: hygiene, topical antifungal powder + antifungal otic drops (acetic acid, vosol)
  • prophylaxis: 1:1 ethanol/white vinegar in each ear after showering
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9
Q

acute otitis media

A
  • viral URI - eustachian tube dysfn or blockage, buildup of fluid/mucus, anatomic deformities or edema
    • in infants and children - S. pneumo, H flu, M. cat, S. pyogenes; adults - mostly viral
  • sxs: fever, otalgia, ear pressure/fullness, hearing loss
  • otoscopic exam: TM erythema, pneumotoscopy, bulging, pre or postauricular LAD
  • dx: tuning fork (BC > AC), tympanometry
  • tx: watch and wait for older kids, HD amox (1st line), ceftriaxone, resistant = cefaclor or augmentin, recurrent = tympanostomy, tympanocentesis, myringotomy
  • complications: mastoiditis, Bell’s palsy, central venous sinus thrombosis, hearing loss, speech delay, bact meningitis, intracranial abscess, TM perf
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10
Q

chronic otitis media

A
  • repeated eps of AOM, trauma or cholesteatoma
  • MCC: S aureus, pseudomonas, proteus, anaerobes
  • sxs: TM perf and chronic clear dc w/ or w/out pain, TM and/or ossicular damage leads to hearing loss
  • tx: removal of infxed debris, avoid H2O, topical abx drops (cipro and dex = CIPRODEX), surgery is definitive (TM repair or reconstruction), tympanostomy tubes for COM and complications, recurrent AOM, and abx failure in kids
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11
Q

serous OM

A
  • effusion without infxn, retention of transudate fluid in middle ear
  • hx: recent viral URTI, sinus infxn, allergies, flying while congested, AOM, adenoid hypertrophy, nasopharyngeal mass
  • sxs: fullness, pressure, hearing loss, popping/gurgling after yawn or blowing nose, dizziness or swimming sensation
  • signs: retracted TM, amber-or coca cola colored fluid, displaced cone of light, air bubbles behind TM
  • dx: pneumatic otoscopy (dec mvmt TM), BC >AC
  • tx: resolves slowly, nasal steroid sprays, short course PO roids, consider tympanostomy after 3mo
  • **avoid decongestants, antihistamines, abx
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12
Q

Cholesteatoma

A
  • chornic neg pressure thins TM and retracts, adhering TM to middle ear → squamous ep forms inside and expands
  • sxs: hx of AOM or previous surg - worsening hearing loss, chronic dc, fullness, not painful
  • signs: pearly white mass, squamous debris, dc, conductive hearing loss
  • dx: weber (lat to affected ear), rinne test (bone >air conduction on affected side)
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13
Q

blepharitis

A
  • chronic conjunctival and lid margin inflamm
  • causes: seborrhea, staph or strep, dysfn of meibomian glands
  • post more common, inflamm of inner eyelid at level of meib gland
  • sxs: rims red, eyelashes adhere, dandruff like deposits, clear to red conjunctiva, thick, cloudy discharge, gritty or burning, excessive tearing, itchy eyelids, photophobia
  • signs: greasy appearance of lid margin w/ scaling around lashes
  • dx: slit lamp
  • tx: warm compress, lid massage, lid washing, topic abx if infxn (azithro), oral abx (azithro, doxy, tetra)
  • associated probs: rosacea, seb derm
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14
Q

Bacterial conjunctivitis

A
  • associated: steroid or OTC eye drops, contact lens, age, sexual activity, immunodef.
  • MCC: S. pneumo, S. aureus, H. aegyptius, M. cat
    • transmission: direct contact or fomites (autoinnoc)
  • rare: chlamydia or gonorrhea
    • direct contact, fomites, nonchlorinated swimming pool, sexual contact, SVD
  • sxs: injection, purulent dc, difficulty prying lid open upon awakening
  • signs: no preauric LAD, yellow-green dc, bilateral injection
  • tx: self-limiting but secondary keratitis may dev., topical sulfonamide (TMP-SMX), gentamicin, tobramicin, norfloxacin, or TMP-polymyxin B sulfate, good handwashing, avoid contaminated pillows/makeup, etc
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15
Q

viral conjunctivitis

A
  • MC = adenovirus, midsummer to early fall
  • highly contagious
  • transmission: direct contact, swimming pools
  • sxs: recent URTI, no resolution w/ eye drops, unilateral or bilateral, ipsilateral preauricular lymphadenopathy, epiphora (watery dc)
  • signs: hyperemia, chemosis, follicular conjunctival injection, subconjunct. hemorrhage
  • tx: eye lavage w/ nl saline, vasoconstrictor anthistamine drops, opthalmic sulfonamide drops, supportive (cold, lubricants, hand hygiene)
  • prognosis: self-limiting 2-4wks
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16
Q

hordeolum

A
  • acute development of small, painful nodule or pustule on upper or lower eyelid
  • MCC: s aureus, not contagious
    • inflamm of meibomian gland with pustular formation, deep
    • glands of Zeis (external, stye) infection at eyelid margin, points out
  • sxs: acute, edema, palpable induration w/ central purulence and erythema
  • tx: spontaneously resolves, warm compress, topical abx for 2ary infxn, IandD if no resolution
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17
Q

dacrocystitis

A
  • inflamm of lacrimal gland caused by obst.
  • Acute: s. aureus and B-hemolytic strep, s. epidermidis, candida
  • Chronic: candida, anaeropic strep, s. epidermidis
  • sxs: painful erythema over tear duct at nasal side of eye (swelling, TTP), tearing or purulent drainage
  • tx: hot compress, abx, if abscess forms →I and D required, if recurrent → dacryocystorhinostomy or dacryocystectomy
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18
Q

ectropion

A

outward turning of eyelid

19
Q

entropion

A

inward turning of eyelid

20
Q

corneal abrasion

A
  • MCC: contact lenses; other causes: fingernail, eyelash, small FB
  • sxs: pain, FB sensation, photophobia, tearing, injection, blepharospasm, blurred vision
  • signs: multiple vertical linear abrasions under upper eyelid suggests FB, record visual acuity before exam
  • dx: slit lamp or fluorescein stain
  • tx: topical anesthetic, saline irrigation, abx ointment (gent, sulfacetamide), tylenol for pain, patchin no longer than 24h, daily FU and referral
21
Q

corneal ulcer

A
  • MCC: pseudomonas, staph, strep, HSV, acanthamoeba
  • etiology: contact lenses, trauma, poor lid apposition
  • sxs: pain, photophobia, dc, tearing, decreased vision, FB sensation
  • signs: circumcorneal injection, watery to purulent dc
  • dx: stains and cultures ASAP, slit lamp, dendritic lesion = herpes keratitis
  • tx: immediate ophthalmology consult, intensive topical abx (FQ, ceph or vanco +/- aminoglyc), STEROIDS AND PATCHING CONTRAINDICATED (dc contact lenses, discard opened lens and solutions, sterilize lens equipment)
22
Q

glaucoma

A
  • increased IOP with optic nerve damage
  • dx: visual field testing, opthalmoscopy, gonioscopy (determines cause), tonometry to measure IOP
  • Normal IOP: 10-21 mmHg
23
Q

acute angle closure glaucoma

A
  • peripheral iris blocks outflow of aqueous humor from anterior chamber, associated with papillary dilation
  • RF: old, asian, hyperopes
  • sxs: sudden dull or severe eye pain (bilateral), worse in dark rooms, blurry vision, frontal HA, tearing, N/V, sweating
  • PE: conjunctival hyperemia, ciliary flush, cloudy or hazy cornea, midposition or middilated and nonreactive pupil
  • dx: penlight test - project from lateral to nasal, will project shadow on nasal side; tonometry (markedly increased IOP), cornea edematous
  • tx: immediate referral, first line topical agents = BB, alpha antag (brimonidine, apraclonidine0, prostaglandin analogues (latanoprost)
    • topical miotic: pilocarpine
    • adjunct cycloplegic agents: IV acetazolamide, IV mannitol
    • laser iridotomy (definitive)
    • DO NOT administer mydriatics to these pts
24
Q

Chronic (primary open angle) glaucoma

A
  • more common than acute
  • RF: >40yo, AA, FHx of glaucoma or diabetes
  • MCC: outflow obstruction through trabecular meshwork
  • sxs: gradual loss of periph vision, PAINLESS
  • dx: increased IOP, defects in periph visual field, increased cup-to-disc ratio
  • tx: refer immediately, topical meds (BB, alpha agonist, carbonica anhydrase inhib) to decrease production, prostaglandin analogue, cholinergics, or epi to increase outflow, laser or surgical tx
25
Q

hyphema

A
  • blood in the anterior chamber resulting from a rupture of one or more iris stromal vessels, MC in children (70%)
  • RF: sickle cell dz or trait, AA, ASA use
  • tx: rest, elevation of head, topical steroids, avoid ASA and NSAIDs
  • Complications: 4 S’s - Staining of cornea, Synechiae (iris adheres to cornea or lens), Secondary rebleed on days 2-5, Significantly increased IOP
  • Prognosis: poor prognostic factors = hyphema in greater 1/3 of anterior chamber, tx after 24h, high IOP, prior low visual acuity
26
Q

papilledema

A
  • bilateral edema of head of optic nerve dt increased ICP → disc margins blurred, cup diminished or gone, nerve head elevated w/ vasc congestion, flame-shaped hemorrhages seen on or adjacent to nerve head
  • causes: malignant HTN, hemorrhagic stoke, acute subdural hematoma, pseudotumor cerebri
  • sxs: asx or transient visual alterations (seconds), bilateral, develops over hours to weeks
  • dx: disc appears swollen, ICP increased
  • tx: tx underlying cause
27
Q

pterygium

A
  • “surfer’s eye”, commonly grows from nasal side of conjunctiva, small raised nodule at temporal or nasal limbus
  • sxs: slowly growing thickening of bulbar conjunctiva, unilateral or bilateral, interferes with vision if reaches cornea
  • tx: excision, recurrence is commone, may be more aggressive
28
Q

retinopathy

A
  • systemic disorders including DM, HTN, preeclamp/eclamp, blood dyscrasia, and HIV
  • Prolonged hyperglyc causes basement membrane thickening, decreased pericytes, microaneurysms, neovasc; leading cause of blindness in adults
  • tx: if diabetic, get yearly ophthal exams, optimize glucose control, regulate BP, laser photocoag, vitrectomy
  • diabetic proliferative retinopathy: neovascularization breaks through inner limiting membrane leading to tractional retinal detachment, vitreous hemorrhage
  • nonproliferative retinopathy: microaneurysms, hard exudates, retinal hemorrhages, venous dilation
29
Q

retinal detachment

A
  • separation of retina from pigmented ep layer, can occur spontaneously or 2ary to trauma or extreme myopia
  • sxs: curtain of darkness with periph flashes, preceding post vitreous detachment (flashes of light, floaters, feeling of heaviness in eye, acute onset, painless vision loss (peripheral to central loss), blurred or blackened vision over several hours, partial or complete monocular blindness
  • dx: detached retinal flapping in vitreous humor
  • tx: emergent ophthal consult, remain supine w/ head turned to side of detachment, laser surg or cryosurg
  • Prognosis: 80% recover w/ no recurrenc, 15% require retreatment, 5% will never reattach
30
Q

Central . retinal artery occlusion

A
  • Cherry red spot, ischemic retina
  • flow through CRA occluded, atherosclerotic thrombosis, embolus, giant cell arteritis
  • sxs: sudden painless unilateral vision loss
  • PE: pale grey retina, cherry dot
  • dx: fundoscopy - arteriolar narrowing, separation of arterial flow, retinal edema, perifoveal atrphy (cherry red spot), ganglionic death leads to optic atrophy and pale retina
  • tx: emergent ophthal consult (dec IOP, arterial dilation, paracentesis), workup and management of atherosclerotic dz, irreversible damage to retina after 90mins (poor prog)
31
Q

central retinal vein occlusion

A
  • blood and thunder fundus
  • 50+, MC associated with HTN, POAG, occurs secondary to thrombotic event
  • sxs: sudden, painless unilateral vision loss, blurred or complete loss
  • PE: retinal hemorrhages in all quadrants
  • dx: fundoscopy - dilated veins, macular edema, cotton wool spot, massive superficial/deep hemorrhage with vitreous involvement
  • tx: spontaneously resolves over time, workup for thrombosis
32
Q

macular degeneration

A
  • RF: long hx of smoking, metabolic syndrome, FHx, F, white, >50yo, drugs (chloroquine, phenothiazine), leading cause of irreversible central vision loss
  • sxs: insidious onset, gradual loss of central vision clarity (metamorphopsia - wavy or distorted vision, measure with Amsler grid)
  • dx: drusen formation, mottling, serous leaks, hemorrhages on retina
  • tx: no effective tx, laser tx, anti VEGF intravitreal injecitons of monoclonal antibody drugs: slows progression, vitamins and antioxidants slow progression
33
Q

allergic rhinitis

A
  • IgE-mediated reactivity to airborne Ags (pollen, molds, danders, dust)
  • RF: FHx, atopic triad (asthma, eczema, allergic rhinitis)
  • sxs: similar to common cold, allergic shiners, rhinorrhea, itchy watery eyes, sneezing, nasal congestion, dry cough
  • signs: pale, boggy, bluish mucosa, clear, watey dc
  • dx: clinical dx
  • tx: avoid known allergens and use antihistamines, cromolyn sodium, nasal or systemic corticosteroids, nasal saline drops or washes, immunotx
34
Q

anterior epistaxis

A
  • kiesselbach plexus
  • RF: nose picking, dry nasal mucosa, HTN, cocaine, ETOH, more than 90% of bleeds
  • sxs: typically unilateral and easily visualized
  • dx: clinical dx
  • tx: direct pressure at site of bleed (sit, leaning forward, compress nares 15min)
    • topical cocaine used as anesthetic and vasoconstrictor, or other topical decongestatnts (oxymetazoline) and anesthetics (lidocaine)
35
Q

posterior epistaxis

A
  • posterior is less common occuring in Woodruff plexus
  • RF: HTN, atherosclerosis
  • sxs: typically bilateral or from posterior pharynx, if placement of ant pack doesnt stop bleeding and bleeding noted in post pharynx
  • dx: clinical dx
  • tx: posterior packing is difficult and high risk of complications, consult with inpt monitoring (balloon packing)
  • prognosis: greater risk of airway compromise, aspiration of blood, and more difficult to control bleeding
36
Q

nasal polyps

A
  • associated: allergic rhinitis, hx of nasal polyps and asthma
  • sxs: pale, boggy masses on the nasal mucosa, chronic congestion, decreased sense of smell
  • tx: 3 mo course topical nasal corticosteroid (first line) for small polyps, oral steroids with 6d taper to reduce size, surgical removal
  • Note: ASA contrainidicated, possibility of severe bronchospasm
37
Q

strep pharyngitis and tonsilitis and exudative pharyngitis

A
  • Group A B-hemolytic Strep - treat to prevent complications
  • viral >>> bacterial
  • sxs: rapid onset high fever, sore throat, lack of cough (not suggestive of strep = coryza, hoarseness, cough)
  • signs: beefy-red uvula, tender anterior cervical adenopathy, palatal petechiae, gray furry tongue, pharyngotonsillar exudate
    • CENTOR CRITERIA: presents of 1-4 suggests GABHS
  • dx: if 3/4 criteria met → rapid strep test, if neg → throat cx (confirms, GOLD STANDARD)
  • tx: IM PCN, oral PCN, if PCN allergy give macrolide (erythromycin)
  • complications: scarlet fever, glomerulonephritis, abscess formation
38
Q

peritonsillar abscess

A
  • penetration of infxn through tonsillar capsule
  • sxs: sore throat, pain with swallowing (odynophagia), trismus, deviation of soft palate or uvula, muffled “hot potato” voice
  • signs: deviation of soft palate, asymmetric risk of uvula, erythematous and edematous tonsil
  • dx: neck CT
    tx: needle aspiration, incision and drainage +/- abx (IV amox, unasyn, and clinda), tonsillectomy
39
Q

aphthous ulcers

A
  • canker sores, ulcerative stomatitis
  • unclear etiology, may be associated with HHV-6
  • sxs: single or multiple painful, round ulcers with yellow-gray centers and red halos, occur on nonkeratinized mucosa, usually recurrent
  • tx: OTC topical anesthetics, nonspecific topical tx (steroids) provide sx relief, 1 wk oral prednisone taper, cimetidine (maintenance) in recurrent cases
40
Q

laryngitis

A
  • viral >>> bacterial (M. cat, H. flu)
  • follows URI: hoarseness, cough, absence of pain or sore throat
  • tx: supportive care (vocal rest, avoidance of singing, shouting), if bacterial → erythromycin, cefuroxime or agumentin, oral or IM steroids for faster recovery but requires vocal fold eval
  • complications: vocal fold hemorrhage, polyp or cyst formation
41
Q

Mumps parotitis

A
  • Develops in 70-90% sxatic infxns w/in 24hrs of prodromal sx onset but can begin as long as a week after
  • First most common complication/manifestation of mumps
  • MCC: paramyxovirus, but also caused by influenza, parainfluenza, coxsackie, echovirus, HIV
  • MC: children <15
  • transmission: airborne droplets
  • sxs: lo fever, malaise, myalgia, arthralgias, HA, anorexia, acute onset unilat or bilat swelling of parotid or salivary glands lasting >2d, tenderness and obliteration of space between earlobe and angle of mandible, earache and difficulty swallowing, eating, or talking
  • signs: gland is tense, painful, erythema and warmth absent, no pus expressed from stensen duct
  • dx: clinical, CT
  • tx: supportive (self-limiting)
    • children shouldnt return to school for 9 days after onset of swelling
42
Q

suppurative parotitis

A
  • newborns and debilitated elderly, bact infxn of parotic gland in pts w/ compromised salivary flow, caused by retrograde flow of oral bacteria into salivary ducts and parenchyma
  • MCC: S. aureus
  • RF: recent anesthesia, dehydration, prematurity, advanced age, sialolithiasis, oral CA, salivary druct strictures, tracheostomy, ductal foreign bodies; medications; chronic illness
  • sxs: rapid onset swollen parotid gland, TTP and erythema, usually unilateral, drainage of purulent material from Stenson duct, fever
  • signs: gland is tense and painful, erythema and warmth, pus, fever, trismus
  • dx: clinical, culture dc, CBC (leukocytosis)
  • tx: hydration w/ fluids, massage, stimulate salivation, dc drugs that cause dry mouth, PO abx (augmentin, clinda, cephalexin w/ flagyl), IV abx (nafcillin, unasyn, vanco + flagyl), neonates = gent + antistaphylococcal abx
43
Q

sialadenitis

A
  • affects parotid or submandib gland, occurs w/ dehydration of chronic illness (Sjogren syndrome0, ductal obst.
  • MC bug: S. aureus
  • sxs: acute swelling of gland, increased pain and swelling with eating, TTP, erythema, pus
  • dx: US or CT to dx
  • tx: IV abx (nafcillin), hydration, warm compress, sialagogues, massage gland, oral abx, resolves 2-3wks
  • complications: abscess, ductal stricture, stone, tumor

R2 - Family Medicine (14 decks)

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