ENT Flashcards
Conjunctivitis
-generally acute, inflammation with or without infection of the conjunctiva, but not involving the cornea or deeper structures of the eye
-Spread by direct inoculation via fingers or droplets
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Bacterial causes-Conjunctivitis
S aureus
Pseudomonas
H influenzae
S. pneumoniae
Morexella
GC / Chlamydia
-unilateral – purulent drainage, eye stuck shut in the AM, rarely any other associated sx.
Viral Conjunctivitis
-Adenovirus
-Herpes Virus (life threatening)
-starts unilateral and spreads bilateral 48 hours, more watery discharge, usually have other sx of viral URI.
Conjunctivitis assessment
-Conjunctiva appears “injected”
-Eyelid may be red, swollen
-Discharge
-Visual acuity, EOMs, reflexes remain normal
-Eye should NOT be painful
—May report a grainy, foreign body feeling
-Chemosis
Quality of conjunctivitis drainage
-Purulent=bacterial
-Watery=viral
-Stringy/Rope like =allergy
Bacterial/Viral Conjunctivitis management
-Erythromycin oint, ½ in. q6hrs 5-7 days
-Trimethoprim-polymyxin B 1-2 drops q6hrs 5-7 days
-Azithromycin drops (expensive) 1 drop BID 2 days then 1 drop daily for 5 days
Corneal abrasion
-Disruption of the epithelium of the cornea
-intense pain
-feeling of foreign body
-decreased visual acuity, photophobia
Treatment of corneal abrasion
-Topical antibiotics
-Steroids are contraindicated
-Delay healing
-Topical NSAIDs controversial
—May delay healing
—If use - short term 24-48 hours
-Cycloplegics
-Oral Narcotics for short term 24-48 hours.
-Refer to ophthalmologist if healing has not occurred in 24-48 hours
-NO PATCHING
Retinal Detachment
-Separation of the neural retina from the choroid
-Causes: trauma, hemorrhage, increased intraocular pressure, or transudation of fluid, surgery
-painless, sudden visual changes
-curtain in field of vision
Central Retinal Artery Occlusion
-Abrupt blockage of the central retinal artery causing sudden vision loss or loss of visual fields
-Causes: Embolism, thrombosis, or arteritis after surgery.
-Sudden vision loss – painless and unilateral
-Retinal exam – pale and may have bloodless arteries
Glaucoma
-Increased intraocular pressure that leads to partial or complete blindness
-Epidemiology: Advancing age, heredity, myopia,
-*African American ethnicity
Two types:
-Chronic, wide, or open-angle
-Acute, narrow, or closed-angle
Chronic, wide, open-angle glaucoma
-Cause: age, nearsightedness, diabetes, ethnicity
-S/s: gradual, painless loss of visual fields, vision halos
-PE: Elevated intraocular pressure (normal 10-20mmHg)
-Tx: Improve flow or reduce aqueous; beta-blockers & prostaglandin analogs first line therapy
Acute, Narrow, closed-angle glaucoma
-cause: anatomic abnormalities, acute blockage of flow
-s/s: severe pain, headache, blurry vision, halos around objects, vomiting
-PE: Decreased visual acuity, injection, edematous and cloudy cornea, firm globe, marked elevation of IOP
-Tx: Immediate referral:
Drug of choice for otitis media
-Amoxicillin
If pcn allergy:
-Cefdinir 300 BID for 7-10 days
-Ceftriaxone 2gm IM once
Otitis Media assessment
-Throbbing pain, hearing loss, vertigo, otorrhea (if ruptured)
-P/E: Red, dull, bulging tympanic membrane; air-fluid levels, obscured bony landmarks
Serous Otitis Media
-Caused by eustachian tube dysfunction
-Tx: Valsalva to clear ears
-Oral antihistamines
Sinusitis Management
-Treatment if >10 days of sx or acutely ill
-CT scan if needed
-Tx: pathogens- S.pneumoniae, H.Influenzae & M. catarrhalis
-Amoxicillin-clavulanate
-Alternatives-levofloxacin, doxycycline, cefdinir, +/- nasal steroids
Epistaxis tx
-blow out blood clots
-pressure 20-30 min
-afrin/lido w/ epi spray/soaked cotton ball
-TXA soaked nasal tampon
-Definitive tx:
—Lido 4% solution pack
–Silver nitrate cautery
–Anterior packing
–Posterior packing-ENT referral and admit
Pharyngitis common viral causes
1.Influenza A and influenza B
2.Adenovirus
3.Epstein-Barr virus/CMV
4.Enterovirus
Pharyngitis
Inflammation of the tonsils, pharynx and larynx
Common bacterial causes of pharynx
1.Group A beta-hemolytic streptococcus
2.Haemophilus influenzae
3.Neisseria gonorrhoeae
4.Chlamydia trachomatis
5.Mycoplasma
Bacterial pharyngitis findings
-Sore throat, dysphagia, myalgias, fever, chills, malaise
-Bright red, edematous pharyngeal mucosa
-White or yellow exudate
Viral pharyngitis findings
-Sore throat, dysphagia, myalgias, fever, chills, malaise
-Edema of lymphoid tissue in the posterior oropharyngeal wall—elevated oval islands
-Pale, boggy mucosae of the posterior pharynx
-Painful ulcers/blistering in oral cavity/pharynx
Pharyngitis management
-Rapid antigen detection test, +/- culture, WBC, monospot
-Viral – rest, fluids, symptom management
Tx of pharyngitis due to group A streptococcus
-Oral penicillin V
-IM penicillin
-Amoxicillin
-Cephalexin
—-Allergies to beta-lactams
-Clarithromycin
-clindamycin
-azithromycin
Epiglottitis Assessment
-Inflammation of the mucous membrane of the epiglottis
-H. influenzae type b, streptococcus pneumoniae, staphylococcus aureus, beta-hemolytic streptococci: group A, B, C, F, G
-change in voice, dyspnea, dysphagia, sore throat, tripod positioning
-High fever, stridor, drooling, anxious, retraction
Epiglottitis Management
-xray, cbc, ABGs
-maintain airway
-Antimicrobial agents:
—3rd gen. cephalosporin & antistaphylococcal agent active against MRSA (vanco, clindamycin etc..)
-Steroids
-Typically resolves in 2-3 days
