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Family Medicine EOR > ENOT/Opthalmology > Flashcards

ENOT/Opthalmology Flashcards

1
Q

what is the MC location for acute bacterial sinusitis

A

maxillary sinus

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2
Q

what is the MC pathogens for bacterial sinusitis

A
  1. strep pnuemo (MC)
  2. H flu
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3
Q

what are s/s of acute bacterial sinusitis

A
  • nasal congestion
  • tooth pain
  • purulent nasal discharge
  • fever

preceeded by a URI (better and then worse again or 10 days straight)

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4
Q

what is the treatment for acute bacterial sinusitis

A
  • augmentin
  • doxy, levo or z pack for PCN allergy

can use clinda

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5
Q

what is considered chronic bacterial sinusitis

A

symptoms for >12 weeks

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6
Q

how do you diagnose chronic bacterial sinusitis

A

CT face/sinuses

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7
Q

what is the treatment for chronic bacterial sinusitis

A
  • treat emperically w augmentin or clinda
  • nasal secretion culture
  • abx based on culture
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8
Q

what is the treatment of allergic rhinitis

A
  • daily intranasal glucocorticoids
  • Antihistamines
  • decongestants
  • montelukast
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9
Q

what is the MC location for epistaxis

A

Anterior: Kiesselbach’s plexus

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10
Q

how do you manage anterior epistaxis

A
  1. pressure for 15 min
  2. sit, lean forward
  3. phenylephrine
  4. if still bleeding topical lidocaine or cocaine
  5. then if still, silver nitrate
  6. then if still nasal packing
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11
Q

how do you manage posterior epistaxis

A
  • ENT consult
  • packing
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12
Q

what is the abx management for nasal packing

A

augmentin, clinda, or keflex

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13
Q

what are the common underlying cuases of nasal polyps

A
  • allergic rhinitis
  • cystic fibrosis
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14
Q

what is the treatment for nasal polyps

A
  • topical nasal steroids for 1-3 months
  • if still, short course of oral steroids
  • surgical removal if remain
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15
Q

what is the major predisposing factor for aphthous ulcers

A

stress

some association with herpes 6

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16
Q

what is the presentation of an aphthous ulcer

A
  • small round ulceration with yellow gray center surrounded by red halos
  • painful
  • lasts 1-3 weeks
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17
Q

what is the treatment for aphthous ulcers

A

symptomatic:
- viscous lidocaine
- topical steroid
- magic mouthwash (lidocaine, nystatin, diphenhydramine)

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18
Q

what is the treatment for herpes gingivostomatitis

A

antivirals within 24-48 hours
viscous lidocaine

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19
Q

presentation of mono (EBV)

A
  • pharyngitis w/wo exudate
  • fever
  • posterior cerv LAD
  • splenomegaly
  • rash w amoxicillin
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20
Q

diagnosis for mono

A

monospot

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21
Q

treatment for mono

A
  • no contact sports 4 weeks

supportive

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22
Q

Presentation of strep throat

A

fever
sore throat
N/V
anterior cerv LAD
palatal petechiae

NO COUGH

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23
Q

testing for strep

A
  • swab
  • culutre
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24
Q

treatment for strep throat

A
  • penicillin
  • amox
  • azithro for allergy

change toothbrush

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25
Q

What lab value will be elevated after recent strep infections

A

ASO titer

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25
Q

Complications of strep throat

A
  • otitis media
  • rheumatic fever/valvular heart disease
  • poststreptococcal glomerulonephritis
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26
Q

presentation of a peritonsillar abscess

A
  • severe sore throat (unilateral)
  • fever
  • muffled voice
  • neck swelling/pain
  • deviation of uvula to opposite side
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27
Q

how do you confirm a peritonsillar abscess

A

cut into that thing and aspirate pus

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28
Q

treatment for peritonsillar abscess

A
  • I&D
  • IV Unasyn or clinda
  • followed by oral augmentin or clinda
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29
Q

what is a retropharyngeal abscess

A

abscess of the deep neck structures

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30
Q

presentation of retropharyngeal abscess

A
  • neck swelling/LAD
  • fever
  • odynophagia
  • dysphagia
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31
Q

how do you confirm retropharyngeal abscess

A

CT neck with contrast

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32
Q

what is the management of a retropharyngeal abscess

A
  • IV Abx: unasyn, rocephin + metro, or clinda + levo
  • surgical drainage
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33
Q

presnetation of acute laryngitis

A
  • hoarseness
  • preceeded by URI
  • if bacterial: exudative tonsills, fever and ant cerv LAD
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34
Q

what is the treatment for acute laryngitis

consider viral, bacterial, and vocal strain

A
  • viral - supportive
  • bacterial - PCN, erythromycin
    strain - steroids and/or surgical
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35
Q

Presentation of croup

A
  • seal like cough
  • inspiratory stridor
  • fever

parainfluenza is the cause

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36
Q

what would you see on Xray of croup

A

steeple sign

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37
Q

Treatment of croup

A
  • dexamethasone or prednisone + neb epi
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38
Q

presentation of epiglottitis

A
  • tripod position
  • dysphagia, drooling and distress
  • high fever
  • toxic appearance
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39
Q

treatment of epiglottitis

A
  • airway maintenance
  • Rocephin + Vanc
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40
Q

Presentation of bacterial conjunctivitis

A
  • purulent discharge
  • discomfort
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41
Q

MC organism for bacterial conjunctivitis

A
  • Staph Aureus
  • strep pneumo

psuedomonas for contact wearers

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42
Q

treatment for bacterial conjunctivitis

A
  • topical erythromycin
  • trimethoprim-polymyxin B
  • severe or pseudomonas = topical FQ
  • gonococcal - rocephin
  • chlamydial - azithromycin
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43
Q

presentation of viral conjunctivitis

A
  • watery discharge
  • associated pharyngitis, fever, malaise, and preauricular adenopathhy
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44
Q

treatment of viral conjunctivitis

A

supportive

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45
Q

presentation of allergic conjunctivitis

A
  • itching, redness, tearing
  • stringy discharge
  • cobblestone papillae on exam
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46
Q

treatment of allergic conjunctivitis

A
  • topical antihistamines (alaway, patanol, olopatadine)
  • topical NSAIDs
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47
Q

presentation of dacryoadenitis and dacryocystitis

A
  • dacryoadenitis: swelling/pain at lacrimal gland
  • dacryocystitis: pain/swelling in tear sac area
48
Q

What is the treatment of dacryoadenitis

A
  • autoimmune: steroids
  • viral: supportive
  • bacterial: antibiotics (I&D if necessary)
49
Q

how do you treat dacryocystitis

A

Acute: lacrimal massage + augmentin if erythema/swelling
Chronic: topical tobramycin or moxifloxacin

50
Q

Presentation of blepharitis (Anterior and posterior)

A

Anterior: red rimmed eyes w scales in lashes
Posterior: Hyperemic lid margins with telangiectasia, inflamed meibomian glands, frothy/greasy tears

51
Q

treatment of anterior and posterior blepharitis

A
  • anterior: cleanliness/topical bacitracin or erythromycin
  • posterior: hot wash cloth, doxy + topical steroids if severe
52
Q

what is a hordeolum

A

acute staph infection/abscess of the eyelid

53
Q

presentation of hordeolum

A

localized swollen, red, tender area on the upper or lower eyelid

can be internal or external

54
Q

treatment of hordeolum

A
  • warm compress
  • I&D if not resolved after 1 week
55
Q

what is a chalazion

A

inflammation of the meibomian gland

56
Q

What is the presentation of a chalazion

A

hard, NON TENDER, localized swelling of the eye

57
Q

treatment of chalazion

A
  • self resolving
  • warm compress/massage
58
Q

what is the presentation of orbital cellulitis

A
  • fever
  • pain
  • eyelid swelling
  • erythema
  • ptosis
  • pain/limitation of EOM
  • inflammatory proptosis
59
Q

Presentation of preseptal cellulitis

A
  • no fever, proptosis, EOM limitation or vision impairement
  • eyelid swelling/erythema
60
Q

What is the treatment of preseptal and periorbital cellulitis

A

augmentin + Bactrim

or: cefdinir + clinda

61
Q

What is a corneal ulcer

A

bacterial, viral or fungal infection of the cornea secondary to a defective epithelium

62
Q

what is the presentation of a corneal ulcer secondary to pseudomonas

A
  • grey/yellow infiltrate
  • severe pain
  • ciliary flush
63
Q

presentation of corneal ulcer 2/2 strep or staph

A
  • no big identifying features
  • large hypopyon
  • ciliary flush
64
Q

treatment for corneal ulcers

A
  • FQ eyedrops
  • amphotericin B for fungal
  • acyclovir for viral
65
Q

presentation of corneal ulcers secondary to fungus

A
  • gray infiltrate with irregular edges
  • superficial ulceration
  • satellite lesions
66
Q

what is the presentation of corneal ulcers secondary to HSV

A
  • dendritic ulcer in corneal epithelium
  • branching linear pattern w feather edges
67
Q

Presentation of corneal abrasion

A

significant discomfort, tearing, foreign body sensation, ciliary flush.

68
Q

treatment for corneal abrasion

A
  • evert lid to rule out foreign body
  • topical bacitracin-polymyxin B drops
  • Diclofenac eye drop
69
Q

what is ectropion

A

outward turning of the lower lid

70
Q

treatment for ectropion

A
  • surgery indicated if excessive tearing, exposure keratisis or cosmetic
71
Q

what is entropion

A

Inward turning of the lower eyelid

72
Q

what is the treatment of entropion

A
  • botulinum toxin injections
  • surgery if lashes rub on cornea
73
Q

narrow angle glaucoma presentation

acute glaucoma

A
  • cupping of optic disc
  • halos around lights
  • severe eye pain (N/V)
  • red, steamy cornea
  • poor pupillary reaction to light
  • hard eye to palpation (>50mmg IOP)
74
Q

how do you diagnose narrow angle glaucoma

A

gonioscopy

75
Q

Treatment of narrow angle glaucoma

A
  • emergent ophthalmologic referral
  • place patient supine
  • acetazolamide
  • pilocarpine AFTER IOP drops
  • Laser peripheral iridotomy (definitive)
76
Q

presentation of open angle glaucoma

A
  • progressive peripheral vision loss that leads to central vision loss
  • cupping of optic disc
77
Q

what is the treatment for open angle glaucoma

A
  • topical prostaglandins (latanoprost, tafluprost, bimatoprost)
  • topical BB (Timolol)
  • Apraclonidine
  • Pilocarpine
  • laser iridotomy definitive
78
Q

what is the presentation of macular degeneration

A

bilateral loss of central vision

79
Q

What is the treatment for macular degeneration

A

VEGF inhibitors

80
Q

what is the presentation of pterygium

A

fleshy, triangular encroachment of the conjunctiva on the nasal side of the cornea.

can be caused by prolonged wind, sun, sand and dust

81
Q

what is the treatment for pterygium

A
  • artificial tears
  • NSAIDs or weak corticosteroids
82
Q

What is a hyphema

A

injury causing hemorrhage to the anterior chamber of the eye.

83
Q

Presentation of hyphema

A
  • blood in anterior chamber
  • pain
  • photophobia/blurred vision
  • NV could mean increased IOP
84
Q

what is the treatment for hyphema

A
  • supine at 45 degrees
  • hard eye shield
  • pain meds/antiemetics but NO ASPIRIN OR NSAIDS

EMERGENT opthalmology consult

85
Q

What is papilledema

A

optic disc swelling usually due to increased IOP

86
Q

what is the exam findings for papilledema

A
  • flame hemorrhages
  • disc margin blurring
  • engorged retinal veins
87
Q

what is retinal detachement

A

detachment of the posterior retina

88
Q

what is the presentation of retinal detachment

A
  • sudden monocular vision loss
  • curtain/veil across vision field
  • photopsia (flashing lights)
  • floaters
  • eye pain
89
Q

what is the treatment for retinal detachment

A

consult ophthalmology for surgery

90
Q

what is central retinal arterial occlusion (CRAO)

A

stroke of the central retinal artery

91
Q

what is the presentation of CRAO

A
  • sudden, painless, monocular vision loss
  • cherry red spot at fovea
  • Afferent pupillary defect (RAPD)
  • box car segmentation in vessels
92
Q

what should you consider as underlyig cause in CRAO

A
  • giant cell arteritis
  • DM, HTN, HLD
93
Q

what is the treatment for CRAO

A
  • lie supine
  • oxygen
  • Acetazolamide or mannitol
  • nitro

EMERGENT ophth consult

94
Q

Central Retinal Vein Occlusion

A

blockage/stroke in central retinal vein

95
Q

presentation of CRVO

A
  • sudden PAINLESS monocular vision loss
  • often upon wakening
  • retinal vein dilation/tortuosity
  • cotton wool spots
96
Q

treatment for CRVO

A
  • consult
  • anti-VEGF
97
Q

what are the MCC of retinopathy

98
Q

what are the findings for retinopathy

A
  • cotton wool spots
  • AV nicking
  • copper/silver wiring
  • Flame hemorrhages and hard exudates
  • neovascularization
99
Q

what is cholesteatoma

A

Abnormal growth of squamous epithelium in middle ear and mastoid cause by prolonged eustachian tube dysfunction

100
Q

Presentation of cholesteatoma

A
  • white mass behind TM
  • ear drainage for >2 weeks despite treatment
  • conductive hearing loss
101
Q

treatment of cholesteatoma

A

surgical removal

102
Q

what is labyrinthitis

aka vestibular neuritis

A

A viral/post viral inflammatory response that effects CN VIII

vestib neuritis = vestibular branch. Labyrinthitis. =vest and cochlear

103
Q

what is the presentation of labyrinthitis/vestibular neuritis

A
  • sudden onset, persistent vertigo. even when sitting still.
  • nystagmus away from affected side
  • unsteady gait, nausea, vomiting
104
Q

treatment for labyrinthitis/vestibular neuritis

A

corticosteroids
supportive: meclizine/zofran/benzos

105
Q

what is menieres disease

A

excess fluid in middle ear causing swelling and impaired sensations of balance

106
Q

what is the presentation of menieres disease

A
  • Classic triad: vertigo, unilateral hearing impairement, tinnitus
  • episodes lasting 20+ minutes
  • Normal head impulse test or very little nystagmus on test
107
Q

treatment of menieres disease

A
  • low salt diet (control BP)
  • restrict caffiene
  • Acute: meclizine, zofran
  • chronic: HCTZ, acetazolamide
108
Q

what is the MCC of otitis externa

A

psuedomonas (swimming pools)

109
Q

what is the presentation of otitis externa

A
  • itching/pain
  • fullness
  • drainage
  • tragus or auricle pain to palpation
  • difficulty visualizing TM
110
Q

treatment for otitis externa

A

ofloxacin or cipro otic drops
ear wick

111
Q

what are the MCC of otitis media

A
  • Strep pneumo
  • M. cat
  • H flu
112
Q

what is the clinical presentation of otitis media

A
  • ear pain
  • Buldging TM
  • fever (sometimes)
  • other URI symptoms
113
Q

treatment for otitis media

A
  • amoxicillin
  • rocephin or azith or doxy for PCN allergy
114
Q

what is the presentation of TM rupture

A
  • sudden betterment of pain followed by ear drainage
  • perfd TM on exam
115
Q

treatment of Perforated TM

A
  • oral abx (amoxicillin)
  • topical abx (oflox, cipro)
  • ear plugs
  • spontaneous resolution
116
Q

what is parotitis

A

inflammation of the parotid gland

117
Q

presentation of parotitis

A
  • unilateral swelling of gland
  • firm, erythematous skin
  • dysphagia and trismus
  • pus from stensons gland w massage
  • leukocytosis and fever
118
Q

treatment for parotitis

A
  • IV abx FIRST (nafcillin, vanc if MRSA)
  • then oral (augmentin)
  • surgical I&D if no response to abx in 48 hours

Family Medicine EOR (17 decks)

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