ENT Flashcards
1
Q
MC cause bacterial sinusitis
A
streptococcus pneumoniae
haemophilus influenza (2nd)
2
Q
oral decongestants should be limited to how many days
A
3 days
3
Q
oral decongestants should be avoided in
A
ppl w cardiovascular dz
HTN
angle-closure glaucoma
bladder neck obstruction
4
Q
tx bacterial sinusitis
A
amoxicillin or augmentin
doxy if allergy to PCN
5
Q
MC cause of chronic bacterial sinusitis (> 12 weeks)
A
staph aureus
6
Q
turbinates in allergic rhinitis
A
pale and boggy
7
Q
tx allergic rhinitis
A
intranasal corticosteroid sprays (fluticasone, budesonide, beclomethasome)
second generation antihistamines (loratidine, fexofenidine, cetirizine)
8
Q
aphthous stomatitis (canker sore)
A
small, painful, round to oval ulcers that typically heal within 1-2 weeks
peripheral rim of erythema surrounding a yellowish, central exudate
9
Q
simple aphthous stomatitis
A
MC
sporadic episodes throughout year
limited to oral mucosa
3-5 mm
heal within 1-2 weeks
10
Q
complex aphthous stomatitis
A
ulcers on both oral and genital mucosa
> 1 cm
more painful
can take up to 6 weeks to heal
11
Q
pts w recurrent oral and genital ulcers should be evaluated for
A
Behcet syndrome (using a pathergy test)
12
Q
what toothpaste can you recommend to ppl w aphthous stomatitis
A
sodium laurel sulfate-containing toothpaste
13
Q
topical anesthetics for aphthous stomatitis
A
2% viscous lidocaine
diphenhydramine liquid
dyclonine lozenges
14
Q
topical steroids for aphthous stomatitis
A
dexamethasone elixir
oral prednisone if inadequate (usually for complex) - 4-7 days
15
Q
MC cause aphthous ulcers
A
human herpes virus 6
16
Q
inflammation of the eyelid margin
A
blepharitis
17
Q
posterior blepharitis
A
MC
meibomian gland dysfunction
18
Q
anterior blepharitis
A
involves lid skin and base of eyelashes
2 types - infectious (staph aureus) and seborrheic
19
Q
sx blepharitis
A
crusting
scaling
red-rimming of eyelid
flaking on lashes or lid margins
20
Q
tx blepharitis
A
eyelid hygiene
if refractory/severe - topical abx (Azithromycin, Erythromycin, Bacitracin)
21
Q
sx corneal abrasion or ocular foreign body
A
foreign body sensation
tearing
red and painful eye
photophobia
blepharospasms (hard to open eye)
22
Q
dx corneal abrasion
A
fluorescein stain – ice rink/linear abrasions
make sure to use wood lamp
23
Q
tx corneal abrasions for non-contact lens wearers
A
erythromycin ointment
24
Q
tx corneal abrasions for contact lens wearers
A
pseudomonas coverage - fluoroquinolones (ciprofloxacin or oxfloxacin) or aminoglycoside (tobramycin or gentamicin)
25
when is patching the eye contraindicated for corneal abrasion
if foreign body cannot be removed
pt is a contact lens wearer
26
topical anesthetic for corneal abrasion
proparacaine
27
anesthetic for severe pain/large corneal abrasions
cycloplegic drops (cyclopentolate) + short course of oral opioids
28
indications for urgent referral corneal abrasion
large epithelial defect
purulent discharge
drop in visual acuity of more than 2 lines in snellen chart
corneal abrasion that has not healed within 72 hours!!!
29
bacterial conjunctivitis is commonly due to
staphylococcus aureus
streptococcus pneumoniae
H influenzae
M catarrhalis
30
sx bacterial conjunctivitis
painless
mucopurulent discharge
lid crusting (stuck shut in the morning)
normal vision
31
tx for bacterial conjunctivitis
topical antibiotics - erythromycin ointment
for contact lens wearers (pseudomonas coverage) - topical ciprofloxacin or Ofloxacin
32
MC cause viral conjunctivitis
adenovirus
33
MC source of outbreaks of viral conjunctivitis
swimming pool
34
sx viral conjunctivitis
foreign body or gritty sensation
ocular erythema
tearing
itching
normal vision
35
PE viral conjunctivitis
ipsilateral enlarged and tender pre auricular lymphadenopathy
copious watery tearing
36
tx viral conjunctivitis
supportive
37
sx allergic conjunctivitis
allergic sx (MARKED PRURITUS)
bilateral eye redness
normal vision
watery discharge
38
PE for allergic conjunctivitis
cobblestone mucosa
watery or mucoid stringy discharge
chemises (conjunctival edema)
39
tx allergic conjunctivitis
supportive
topical antihistamine - olopatadine and pheniramine-naphazoline
40
corneal ulcers are also called
keratitis (bacterial vs herpes keratitis)
41
increased risk of corneal ulcer
contact wearer and improper wear -- pseudomonas
42
sx corneal ulcer
OCULAR PAIN
photophobia
eye redness
vision changes (threatens sight)
watery discharge/tearing
foreign body sensation
43
PE corneal ulcer
conjunctival erythema
ciliary injection (limbal flush)
hazy cornea (corneal opacification and ulceration)
increased fluorescein uptake on slit lamp (deeper than corneal abrasion)
44
tx corneal ulcer
fluoroquinolone topical (Moxifloxacin, Gatifloxacin)
DO NOT PATCH EYE
45
what nerve is affected in herpes keratitis
trigeminal ganglion
46
dx herpes keratitis
dendritic (branching) corneal ulceration w fluorescein staining hallmark
47
tx for herpes keratitis
antiviral - acyclovir or ganciclovir ointment
48
is keratitis/corneal ulcer an ophthalmologic emergency
YES --> referral
49
dacrocystitis
infection of lacrimal sac due to obstruction of nasolacrimal duct
50
sx dacrocystitis
tearing and signs of infx - tenderness, erythema, warmth to the inferior medial cantonal (nasal) side/lower lid area
may have purulent discharge
51
acute tx dacrocystitis
warm compress + systemic abx (Clindamycin, Vancomycin + Ceftriaxone)
52
chronic or severe tx dacrocystitis
dacryocystorhinostomy
abx prior to surgery
53
tx for posterior epistaxis
balloon catheter
54
sx acute narrow angle closure glaucoma
sudden onset of severe, unilateral ocular pain
vision changes - haloes around lights and peripheral vision loss (tunnel vision)
55
PE acute narrow angle closure glaucoma
conjunctival erythema
cloudy "steamy" cornea
mid-dilated fixed pupil (reacts poorly to light)
56
what will you see on funduscopy for acute narrow angle closure glaucoma
optic disc blurring or cupping (HALLMARK) of optic nerve (thinning of outer rim of optic nerve head)
57
cup to disk ratio and asymmetry of __ indicates glaucoma
cup to disc ratio of > 0.5 or asymmetry of > 0.2
58
what will tonometry show for glaucoma
increased intraocular pressure > 21 mmHg
59
what is the standard to diagnose acute narrow angle closure glaucoma
gonioscopy - allows for observation of narrow chamber angle
60
topical agent to reduce intraocular pressure in glaucoma
topical BB - timolol
or alpha 2 agonist - Apraclonidine, brimonidine
61
topical prostaglandin for acute narrow angle closure glaucoma
lantanoprost
62
agent to induce miosis in glaucoma
Pilocarpine
Carbachol
63
systemic agent to lower intraocular pressure in acute narrow angle closure glaucoma
IV acetazolamide or IV mannitol
64
definitive tx acute narrow angle closure glaucoma
iridotomy
65
sx chronic open angle glaucoma
ask until later
slow, progressive painless b/l peripheral vision loss (tunnel vision)
66
MC cause hordeolum
staph aureus
67
sx hordeolum
localized, erythematous, painful, warm, tender nodule or pustule on the eyelid
68
tx hordeollum
warm compress
69
hyphema
visible layering of blood in the anterior chamber of the eye
70
MC cause hyphema
blunt or penetrating injury to eye
71
what should you order if globe rupture suspected
CT scan of eye
72
tx hyphema
eye shield, bed rest, dim lighting
elevation of head to at least 30 degrees
topical tetracaine for pain and topical glucocorticoids to reduce bleeding
73
sx labyrinthitis
vestibular sx - continuous peripheral vertigo, dizziness, N/V, gait disturbance
nystagmus is usually horizontal and rotary
hearing loss
74
tx labyrinthitis
glucocorticoids
75
how is nystagmus suppressed in labyrinthitis
visual fixation
76
MC cause laryngitis
viral upper respiratory tract infection (MC)
vocal strain
77
sx laryngitis
hoarseness hallmark
aphonia
78
tx laryngitis
supportive
79
MC cause of permanent legal blindness and vision loss in older adults in the US
macular degeneration
80
dry macular degeneration
MC
progressive (over decades)
81
PE dry macular degeneration
druse bodies hallmark - small, round, yellow-white spots on the outer retina
82
wet macular degeneration
more aggressive
choroidal neovascularization
83
PE wet macular degeneration
new, abnormal choral vessels
84
sx macular degeneration
bilateral, progressive central vision loss
metamorphopsia (straight lines appear bent)
85
dx macular degeneration
funduscopy
fluorescein angiography
amsler grid (shows metamorphopsia)
86
tx dry macular degeneration
zinc and vitamins C and E to slow progression
87
tx wet macular degeneration
VEGF inhibitors - Bevacizumab, Ranibizumab, Aflibercept - decrease new vessel formation
88
sx menieres dz
episodic peripheral hearing loss
unilateral fluctuating sensorineural hearing loss
tinnitus
ear fullness
horizontal nystagmus
N/V
89
what should you rule out when someone presents w sx of Menieres dz
syphilis (FTA-ABS)
90
tx menieres dz
sodium, caffeine, nicotine, chocolate, alcohol restriction
antihistamines (Meclizine)
diuretics (hydrochlorothiazide)
91
cholesteatoma
abnormal keratinized collection of desquamated squamous epithelium in the middle ear or mastoid that can lead to bony erosion of the mastoid
92
MC causes of cholesteatoma
chronic middle ear dz
Eustachian tube dysfunction
93
sx cholesteatoma
painless otorrhea - brown or yellow discharge w a strong odor
hearing loss
94
PE cholesteatoma
otoscope - granulation tissue (cellular debris)
conductive hearing loss - weber - heard in affected ear; rinne - BC > AC in affected ear
95
tx cholesteatoma
surgical excision of debris (tympanoplasty and reconstruction of ossicular chain)
96
MC cause nasal polyps
allergic rhinitis
97
tx nasal polyps
intranasal corticosteroids
98
MC cause otitis externa
pseudomonas aeruginosa
99
sx otitis externa
ear pain and erythema
pruritus in ear canal
100
PE otitis externa
edema and pain on traction of ear canal or trigs, purulent auricular discharge
101
dx otitis externa
edema of external auditory canal on otoscope
102
tx otitis externa
ciprofloxacin-dexamethasone, Ofloxacin
103
peak age acute otitis media
6-24 mos
104
causes acute otitis media
s pneumonia
h influenza
m catarrhalis
MC proceeded by virus
105
PE acute otitis media
bulging and inflamed TM w effusion, loss of landmarks
decreased TM mobility (most sensitive)
106
tx acute otitis media
amoxicillin
107
papilledema
optic nerve (disc) swelling secondary to increased intracranial pressure (usually b/l)
108
funduscopy papilledema
swollen optic disc w blurred margins
109
tx papilledema
acetazolamide
110
parotitis
acute infxn of parotid gland (bacterial or viral)
111
MC cause parotitis
staph aureus
112
RF parotitis
dehydration
poor oral hygiene
113
sx bacterial parotitis
abrupt onset of unilateral, firm, erythematous, painful swelling from the pre auricular area to the angle of the mandible
purulent drainage from Stenson gland on exam
114
should patients be admitted for acute bacterial parotitis
yes
115
tx community acquired bacterial parotitis
ampicillin-sulbactam or cefuroxime and metronidazole
add Vancomycin or Linezolid if MRSA
116
tx hospital acquired bacterial parotitis or immunocompromised
vancomycin or linezolid and either cefepime and metronidazole, imipenem, meropenem, or piperacillin-tazobactam
117
duration abx tx parotitis
10-14 days
118
when is I and D considered for parotitis
no improvement within 2-3 days
119
peritonsillar abscess is also called
quinsy
120
peritonsillar abscess is often
polymicrobial
121
sx peritonsillar abscess
ill appearing
severe unilateral pharyngitis
dysphagia
odynophagia
high fever
malaise
ear pain
muffled hot potato voice
drooling
trismus (lockjaw)
122
PE peritonsillar abscess
swollen or fluctuant tonsil, causing usual deviation to the contralateral side
123
tx peritonsillar abscess
needle aspiration preferred or I and D
abx - oral augmenting or clindamycin; parenteral ampicillin-sulbactam or clindamycin
tonsillectomy if fail to respond to drainage
124
MC overall cause of pharyngitis
viral
125
MC bacterial cause pharyngitis
Group A strep
126
PE streptococcal pharyngitis
enlarged tender anterior cervical lymphadenopathy
127
tx streptococcal pharyngitis
pcn
128
complication of streptococcal pharyngitis
rheumatic fever
129
pterygium vs pinguecula
pterygium - slow growing thickening of the bulbar conjunctiva that may extend onto the corneal surface
pinguecula - slow growing thickening of the bulbar conjunctiva that remains confined to the conjunctiva
130
RF pterygium
UV light exposure in sunny climates (tropics)
snad, wind, dust exposure
131
sx pterygium
elevated, superficial fleshy, triangular-shaped growing fibrovascular mass that usually starts medially (nasal side of the eye) and extends laterally
132
tx pterygium
obsevation
surgical removal if it affects vision
133
sx retinal detachment
photopsia (flashing lights) w detachment followed by floaters (spots in visual fields) followed by progressive UNILATERAL PERIPHERAL vision loss: shadow or "curtain coming down"
no pain/redness
134
funduscopy retinal detachment
retinal tear - detached tissue flapping in vitreous humor
positive shakers sign - clumping of brown-colored pigment vitreous cells in the anterior vitreous humor resembling tobacco dust
135
is retinal detachment an emergency
YES
keep pt supine while awaiting for ophthalmology consult w the head turned toward the side of the detachment
no miotic drops
136
sx retinal artery occlusion
sudden, painless, unilateral acute visual loss usually attributed to ischemia or thrombus
small unilateral pupil on affected side
137
retinal artery occlusion causes
embolism from Afib
atherosclerosis
ruptured plague from same side carotid
138
funduscopy central retinal artery occlusion
cloudy, pale retina
cherry red spot in fovea
attenuation of vessels
139
tx central retinal artery occlusion
ophthalmology referral
ocular massage to affected eye
140
sx retinal vein occlusion
sudden acute monocular vision loss
CV risk factors - DM, HTN, polycythemia vera
141
funduscopic exam retinal vein occlusion
optic disc swelling
retinal hemorrhages**
dilated/tortuous veins --> blood and thunder appearance
142
tx retinal vein occlusion
laser therapy
VEGF
143
retinopathy
causes decreased/blurred vision
144
findings for nonproliferative diabetic retinopathy
micro aneurysms (visible as red dots)
cotton wool spots (fluffy white patches on retina)
hemorrhages
hard exudates
145
findings for proliferative diabetic retinopathy
micro aneurysms
cotton wool spots
hemorrhages
hard exudates
neovascularization!!!!
146
findings for hypertensive retinopathy
AV nicking
silver wiring
147
tx non proliferative diabetic retinopathy
glucose control
148
tx proliferative diabetic retinopathy
anti VEGF (Ranibizumab, Bevacizumab)
peripheral retinal photocoagulation
surgery
149
tx hypertensive retinopathy
blood pressure and lipid control
laser therapy
150
tympanic membrane perforation may lead to
cholesteatoma
151
sx tympanic membrane perforation
sudden pain relief w bloody otorrhea
152
tx tympanic membrane perf
observation
ofloxacin in some
avoid water and topical aminoglycosides
