ENT Flashcards

1
Q

Conjunctivitis

A

-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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2
Q

Bacterial causes-Conjunctivitis

A

S aureus
Pseudomonas
H influenzae
S. pneumoniae
Morexella
GC / Chlamydia
-unilateral – purulent drainage, eye stuck shut in the AM, rarely any other associated sx.

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3
Q

Viral Conjunctivitis

A

-Adenovirus
-Herpes Virus (life threatening)
-starts unilateral and spreads bilateral 48 hours, more watery discharge, usually have other sx of viral URI.

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4
Q

Conjunctivitis assessment

A

-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

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5
Q

Quality of conjunctivitis drainage

A

-Purulent=bacterial
-Watery=viral
-Stringy/Rope like =allergy

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6
Q

Bacterial/Viral Conjunctivitis management

A

-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

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7
Q

Corneal abrasion

A

-Disruption of the epithelium of the cornea
-intense pain
-feeling of foreign body
-decreased visual acuity, photophobia

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8
Q

Treatment of corneal abrasion

A

-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

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9
Q

Retinal Detachment

A

-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

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10
Q

Central Retinal Artery Occlusion

A

-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

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11
Q

Glaucoma

A

-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

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12
Q

Chronic, wide, open-angle glaucoma

A

-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

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13
Q

Acute, Narrow, closed-angle glaucoma

A

-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:

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14
Q

Drug of choice for otitis media

A

-Amoxicillin
If pcn allergy:
-Cefdinir 300 BID for 7-10 days
-Ceftriaxone 2gm IM once

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15
Q

Otitis Media assessment

A

-Throbbing pain, hearing loss, vertigo, otorrhea (if ruptured)
-P/E: Red, dull, bulging tympanic membrane; air-fluid levels, obscured bony landmarks

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16
Q

Serous Otitis Media

A

-Caused by eustachian tube dysfunction
-Tx: Valsalva to clear ears
-Oral antihistamines

17
Q

Sinusitis Management

A

-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

18
Q

Epistaxis tx

A

-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

19
Q

Pharyngitis common viral causes

A

1.Influenza A and influenza B
2.Adenovirus
3.Epstein-Barr virus/CMV
4.Enterovirus

20
Q

Pharyngitis

A

Inflammation of the tonsils, pharynx and larynx

21
Q

Common bacterial causes of pharynx

A

1.Group A beta-hemolytic streptococcus
2.Haemophilus influenzae
3.Neisseria gonorrhoeae
4.Chlamydia trachomatis
5.Mycoplasma

22
Q

Bacterial pharyngitis findings

A

-Sore throat, dysphagia, myalgias, fever, chills, malaise
-Bright red, edematous pharyngeal mucosa
-White or yellow exudate

23
Q

Viral pharyngitis findings

A

-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

24
Q

Pharyngitis management

A

-Rapid antigen detection test, +/- culture, WBC, monospot
-Viral – rest, fluids, symptom management

25
Q

Tx of pharyngitis due to group A streptococcus

A

-Oral penicillin V
-IM penicillin
-Amoxicillin
-Cephalexin
—-Allergies to beta-lactams
-Clarithromycin
-clindamycin
-azithromycin

26
Q

Epiglottitis Assessment

A

-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

27
Q

Epiglottitis Management

A

-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