ENOT/Ophthalmology Flashcards
1
Q
tympanic membrane 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
2
Q
otitis externa - bacterial
A
- “swimmers ear”; MCC = pseudomonas, proteus, fungi
- malignant OE caused by pseudomonas in immunocompromised ppl and DM
- 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, no fever
- 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
3
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
4
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
5
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
6
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
7
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
8
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
9
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)
10
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
11
Q
tonsilitis and pharyngitis
A
- viral >>> bacterial
- Group A B-hemolytic Strep = MCC bacterial cause - treat to prevent complications
- 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
12
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
13
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
14
Q
mastoiditis
A
- evolve following several weeks of inadequately treated AOM
- postauricular pain and erythema, spiking fever
- CT scan = coalescence of mastoid air cells dt destruction of bony septa
- initiatl tx = IV abx (cefazolin) and myringotomy for cx and drainage
- failure of med tx indicates need for surg drainage (mastoidectomy)
15
Q
Neonatal or hyperacute conjunctivitis
A
- etiology: C. trachomatis and N. gonorrhoeae; suspect in newborns who may be exposed during vaginal delivery
- sxs: preauricular lymphadenopathy
- signs: copious purulence, severe injection, chemosis, severe eyelid edema
- dx: bacterial cx on Thayer-Martin agar, chocolate agar, and Gram strain; Giemsa stain helpful to screen for intracellular inclusion bodies of chlamydia
- tx: chalmydia (PO erythromycin for neonates; treat mom and at-risk contacts with doxy), gonorrhea (IV PCN G, mother and at-risk contacts get single-dose IM ceftriaxone and doxy
- prophylaxis against ophthalmia neonatorum → 1% silver nitrate soln, 1% tetracycline or erythromycin ointment
