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Family Medicine EOR > ENOT/Opthalmology > Flashcards

ENOT/Opthalmology Flashcards

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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
What lab value will be elevated after recent strep infections
ASO titer
25
Complications of strep throat
* otitis media * rheumatic fever/valvular heart disease * poststreptococcal glomerulonephritis
26
presentation of a peritonsillar abscess
* severe sore throat (unilateral) * fever * muffled voice * neck swelling/pain * deviation of uvula to opposite side
27
how do you confirm a peritonsillar abscess
cut into that thing and aspirate pus
28
treatment for peritonsillar abscess
* I&D * IV Unasyn or clinda * followed by oral augmentin or clinda
29
what is a retropharyngeal abscess
abscess of the deep neck structures
30
presentation of retropharyngeal abscess
* neck swelling/LAD * fever * odynophagia * dysphagia
31
how do you confirm retropharyngeal abscess
CT neck with contrast
32
what is the management of a retropharyngeal abscess
* IV Abx: unasyn, rocephin + metro, or clinda + levo * surgical drainage
33
presnetation of acute laryngitis
* hoarseness * preceeded by URI * if bacterial: exudative tonsills, fever and ant cerv LAD
34
what is the treatment for acute laryngitis | consider viral, bacterial, and vocal strain
* viral - supportive * bacterial - PCN, erythromycin strain - steroids and/or surgical
35
Presentation of croup
* seal like cough * inspiratory stridor * fever | parainfluenza is the cause
36
what would you see on Xray of croup
steeple sign
37
Treatment of croup
* dexamethasone or prednisone + neb epi
38
presentation of epiglottitis
* tripod position * dysphagia, drooling and distress * high fever * toxic appearance
39
treatment of epiglottitis
* airway maintenance * Rocephin + Vanc
40
Presentation of bacterial conjunctivitis
* purulent discharge * discomfort
41
MC organism for bacterial conjunctivitis
* Staph Aureus * strep pneumo | psuedomonas for contact wearers
42
treatment for bacterial conjunctivitis
* topical erythromycin * trimethoprim-polymyxin B * severe or pseudomonas = topical FQ * gonococcal - rocephin * chlamydial - azithromycin
43
presentation of viral conjunctivitis
* watery discharge * associated pharyngitis, fever, malaise, and preauricular adenopathhy
44
treatment of viral conjunctivitis
supportive
45
presentation of allergic conjunctivitis
* itching, redness, tearing * stringy discharge * cobblestone papillae on exam
46
treatment of allergic conjunctivitis
* topical antihistamines (alaway, patanol, olopatadine) * topical NSAIDs
47
presentation of dacryoadenitis and dacryocystitis
* dacryoadenitis: swelling/pain at lacrimal gland * dacryocystitis: pain/swelling in tear sac area
48
What is the treatment of dacryoadenitis
* autoimmune: steroids * viral: supportive * bacterial: antibiotics (I&D if necessary)
49
how do you treat dacryocystitis
Acute: lacrimal massage + augmentin if erythema/swelling Chronic: topical tobramycin or moxifloxacin
50
Presentation of blepharitis (Anterior and posterior)
Anterior: red rimmed eyes w scales in lashes Posterior: Hyperemic lid margins with telangiectasia, inflamed meibomian glands, frothy/greasy tears
51
treatment of anterior and posterior blepharitis
* anterior: cleanliness/topical bacitracin or erythromycin * posterior: hot wash cloth, doxy + topical steroids if severe
52
what is a hordeolum
acute staph infection/abscess of the eyelid
53
presentation of hordeolum
localized swollen, red, tender area on the upper or lower eyelid | can be internal or external
54
treatment of hordeolum
* warm compress * I&D if not resolved after 1 week
55
what is a chalazion
inflammation of the meibomian gland
56
What is the presentation of a chalazion
hard, NON TENDER, localized swelling of the eye
57
treatment of chalazion
* self resolving * warm compress/massage
58
what is the presentation of orbital cellulitis
* fever * pain * eyelid swelling * erythema * ptosis * pain/limitation of EOM * inflammatory proptosis
59
Presentation of preseptal cellulitis
* no fever, proptosis, EOM limitation or vision impairement * eyelid swelling/erythema
60
What is the treatment of preseptal and periorbital cellulitis
augmentin + Bactrim | or: cefdinir + clinda
61
What is a corneal ulcer
bacterial, viral or fungal infection of the cornea secondary to a defective epithelium
62
what is the presentation of a corneal ulcer secondary to pseudomonas
* grey/yellow infiltrate * severe pain * ciliary flush
63
presentation of corneal ulcer 2/2 strep or staph
* no big identifying features * large hypopyon * ciliary flush
64
treatment for corneal ulcers
* FQ eyedrops * amphotericin B for fungal * acyclovir for viral
65
presentation of corneal ulcers secondary to fungus
* gray infiltrate with irregular edges * superficial ulceration * satellite lesions
66
what is the presentation of corneal ulcers secondary to HSV
* dendritic ulcer in corneal epithelium * branching linear pattern w feather edges
67
Presentation of corneal abrasion
significant discomfort, tearing, foreign body sensation, ciliary flush.
68
treatment for corneal abrasion
* evert lid to rule out foreign body * topical bacitracin-polymyxin B drops * Diclofenac eye drop
69
what is ectropion
outward turning of the lower lid
70
treatment for ectropion
* surgery indicated if excessive tearing, exposure keratisis or cosmetic
71
what is entropion
Inward turning of the lower eyelid
72
what is the treatment of entropion
* botulinum toxin injections * surgery if lashes rub on cornea
73
narrow angle glaucoma presentation | acute glaucoma
* 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
how do you diagnose narrow angle glaucoma
gonioscopy
75
Treatment of narrow angle glaucoma
* emergent ophthalmologic referral * place patient supine * acetazolamide * pilocarpine AFTER IOP drops * Laser peripheral iridotomy (definitive)
76
presentation of open angle glaucoma
* progressive peripheral vision loss that leads to central vision loss * cupping of optic disc
77
what is the treatment for open angle glaucoma
* topical prostaglandins (latanoprost, tafluprost, bimatoprost) * topical BB (Timolol) * Apraclonidine * Pilocarpine * laser iridotomy definitive
78
what is the presentation of macular degeneration
bilateral loss of central vision
79
What is the treatment for macular degeneration
VEGF inhibitors
80
what is the presentation of pterygium
fleshy, triangular encroachment of the conjunctiva on the nasal side of the cornea. | can be caused by prolonged wind, sun, sand and dust
81
what is the treatment for pterygium
* artificial tears * NSAIDs or weak corticosteroids
82
What is a hyphema
injury causing hemorrhage to the anterior chamber of the eye.
83
Presentation of hyphema
* blood in anterior chamber * pain * photophobia/blurred vision * NV could mean increased IOP
84
what is the treatment for hyphema
* supine at 45 degrees * hard eye shield * pain meds/antiemetics but NO ASPIRIN OR NSAIDS | EMERGENT opthalmology consult
85
What is papilledema
optic disc swelling usually due to increased IOP
86
what is the exam findings for papilledema
* flame hemorrhages * disc margin blurring * engorged retinal veins
87
what is retinal detachement
detachment of the posterior retina
88
what is the presentation of retinal detachment
* sudden monocular vision loss * curtain/veil across vision field * photopsia (flashing lights) * floaters * eye pain
89
what is the treatment for retinal detachment
consult ophthalmology for surgery
90
what is central retinal arterial occlusion (CRAO)
stroke of the central retinal artery
91
what is the presentation of CRAO
* sudden, painless, monocular vision loss * cherry red spot at fovea * Afferent pupillary defect (RAPD) * box car segmentation in vessels
92
what should you consider as underlyig cause in CRAO
* giant cell arteritis * DM, HTN, HLD
93
what is the treatment for CRAO
* lie supine * oxygen * Acetazolamide or mannitol * nitro | EMERGENT ophth consult
94
Central Retinal Vein Occlusion
blockage/stroke in central retinal vein
95
presentation of CRVO
* sudden PAINLESS monocular vision loss * often upon wakening * retinal vein dilation/tortuosity * cotton wool spots
96
treatment for CRVO
* consult * anti-VEGF
97
what are the MCC of retinopathy
* DM * HTN
98
what are the findings for retinopathy
* cotton wool spots * AV nicking * copper/silver wiring * Flame hemorrhages and hard exudates * neovascularization
99
what is cholesteatoma
Abnormal growth of squamous epithelium in middle ear and mastoid cause by prolonged eustachian tube dysfunction
100
Presentation of cholesteatoma
* white mass behind TM * ear drainage for >2 weeks despite treatment * conductive hearing loss
101
treatment of cholesteatoma
surgical removal
102
what is labyrinthitis | aka vestibular neuritis
A viral/post viral inflammatory response that effects CN VIII | vestib neuritis = vestibular branch. Labyrinthitis. =vest and cochlear
103
what is the presentation of labyrinthitis/vestibular neuritis
* sudden onset, persistent vertigo. even when sitting still. * nystagmus away from affected side * unsteady gait, nausea, vomiting
104
treatment for labyrinthitis/vestibular neuritis
corticosteroids supportive: meclizine/zofran/benzos
105
what is menieres disease
excess fluid in middle ear causing swelling and impaired sensations of balance
106
what is the presentation of menieres disease
* Classic triad: vertigo, unilateral hearing impairement, tinnitus * episodes lasting 20+ minutes * Normal head impulse test or very little nystagmus on test
107
treatment of menieres disease
* low salt diet (control BP) * restrict caffiene * Acute: meclizine, zofran * chronic: HCTZ, acetazolamide
108
what is the MCC of otitis externa
psuedomonas (swimming pools)
109
what is the presentation of otitis externa
* itching/pain * fullness * drainage * tragus or auricle pain to palpation * difficulty visualizing TM
110
treatment for otitis externa
ofloxacin or cipro otic drops ear wick
111
what are the MCC of otitis media
* Strep pneumo * M. cat * H flu
112
what is the clinical presentation of otitis media
* ear pain * Buldging TM * fever (sometimes) * other URI symptoms
113
treatment for otitis media
* amoxicillin * rocephin or azith or doxy for PCN allergy
114
what is the presentation of TM rupture
* sudden betterment of pain followed by ear drainage * perfd TM on exam
115
treatment of Perforated TM
* oral abx (amoxicillin) * topical abx (oflox, cipro) * ear plugs * spontaneous resolution
116
what is parotitis
inflammation of the parotid gland
117
presentation of parotitis
* unilateral swelling of gland * firm, erythematous skin * dysphagia and trismus * pus from stensons gland w massage * leukocytosis and fever
118
treatment for parotitis
* 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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