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EOR Family med > ENT > Flashcards

ENT Flashcards

1
Q

MC cause bacterial sinusitis

A

streptococcus pneumoniae
haemophilus influenza (2nd)

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2
Q

oral decongestants should be limited to how many days

A

3 days

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3
Q

oral decongestants should be avoided in

A

ppl w cardiovascular dz
HTN
angle-closure glaucoma
bladder neck obstruction

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4
Q

tx bacterial sinusitis

A

amoxicillin or augmentin
doxy if allergy to PCN

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5
Q

MC cause of chronic bacterial sinusitis (> 12 weeks)

A

staph aureus

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6
Q

turbinates in allergic rhinitis

A

pale and boggy

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7
Q

tx allergic rhinitis

A

intranasal corticosteroid sprays (fluticasone, budesonide, beclomethasome)
second generation antihistamines (loratidine, fexofenidine, cetirizine)

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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

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9
Q

simple aphthous stomatitis

A

MC
sporadic episodes throughout year
limited to oral mucosa
3-5 mm
heal within 1-2 weeks

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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

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11
Q

pts w recurrent oral and genital ulcers should be evaluated for

A

Behcet syndrome (using a pathergy test)

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12
Q

what toothpaste can you recommend to ppl w aphthous stomatitis

A

sodium laurel sulfate-containing toothpaste

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13
Q

topical anesthetics for aphthous stomatitis

A

2% viscous lidocaine
diphenhydramine liquid
dyclonine lozenges

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14
Q

topical steroids for aphthous stomatitis

A

dexamethasone elixir

oral prednisone if inadequate (usually for complex) - 4-7 days

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15
Q

MC cause aphthous ulcers

A

human herpes virus 6

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16
Q

inflammation of the eyelid margin

A

blepharitis

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17
Q

posterior blepharitis

A

MC
meibomian gland dysfunction

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18
Q

anterior blepharitis

A

involves lid skin and base of eyelashes
2 types - infectious (staph aureus) and seborrheic

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19
Q

sx blepharitis

A

crusting
scaling
red-rimming of eyelid
flaking on lashes or lid margins

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20
Q

tx blepharitis

A

eyelid hygiene
if refractory/severe - topical abx (Azithromycin, Erythromycin, Bacitracin)

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21
Q

sx corneal abrasion or ocular foreign body

A

foreign body sensation
tearing
red and painful eye
photophobia
blepharospasms (hard to open eye)

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22
Q

dx corneal abrasion

A

fluorescein stain – ice rink/linear abrasions
make sure to use wood lamp

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23
Q

tx corneal abrasions for non-contact lens wearers

A

erythromycin ointment

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24
Q

tx corneal abrasions for contact lens wearers

A

pseudomonas coverage - fluoroquinolones (ciprofloxacin or oxfloxacin) or aminoglycoside (tobramycin or gentamicin)

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25
Q

when is patching the eye contraindicated for corneal abrasion

A

if foreign body cannot be removed
pt is a contact lens wearer

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26
Q

topical anesthetic for corneal abrasion

A

proparacaine

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27
Q

anesthetic for severe pain/large corneal abrasions

A

cycloplegic drops (cyclopentolate) + short course of oral opioids

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28
Q

indications for urgent referral corneal abrasion

A

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!!!

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29
Q

bacterial conjunctivitis is commonly due to

A

staphylococcus aureus
streptococcus pneumoniae
H influenzae
M catarrhalis

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30
Q

sx bacterial conjunctivitis

A

painless
mucopurulent discharge
lid crusting (stuck shut in the morning)
normal vision

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31
Q

tx for bacterial conjunctivitis

A

topical antibiotics - erythromycin ointment
for contact lens wearers (pseudomonas coverage) - topical ciprofloxacin or Ofloxacin

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32
Q

MC cause viral conjunctivitis

A

adenovirus

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33
Q

MC source of outbreaks of viral conjunctivitis

A

swimming pool

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34
Q

sx viral conjunctivitis

A

foreign body or gritty sensation
ocular erythema
tearing
itching
normal vision

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35
Q

PE viral conjunctivitis

A

ipsilateral enlarged and tender pre auricular lymphadenopathy
copious watery tearing

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36
Q

tx viral conjunctivitis

A

supportive

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37
Q

sx allergic conjunctivitis

A

allergic sx (MARKED PRURITUS)
bilateral eye redness
normal vision
watery discharge

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38
Q

PE for allergic conjunctivitis

A

cobblestone mucosa
watery or mucoid stringy discharge
chemises (conjunctival edema)

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39
Q

tx allergic conjunctivitis

A

supportive
topical antihistamine - olopatadine and pheniramine-naphazoline

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40
Q

corneal ulcers are also called

A

keratitis (bacterial vs herpes keratitis)

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41
Q

increased risk of corneal ulcer

A

contact wearer and improper wear – pseudomonas

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42
Q

sx corneal ulcer

A

OCULAR PAIN
photophobia
eye redness
vision changes (threatens sight)
watery discharge/tearing
foreign body sensation

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43
Q

PE corneal ulcer

A

conjunctival erythema
ciliary injection (limbal flush)
hazy cornea (corneal opacification and ulceration)
increased fluorescein uptake on slit lamp (deeper than corneal abrasion)

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44
Q

tx corneal ulcer

A

fluoroquinolone topical (Moxifloxacin, Gatifloxacin)
DO NOT PATCH EYE

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45
Q

what nerve is affected in herpes keratitis

A

trigeminal ganglion

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46
Q

dx herpes keratitis

A

dendritic (branching) corneal ulceration w fluorescein staining hallmark

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47
Q

tx for herpes keratitis

A

antiviral - acyclovir or ganciclovir ointment

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48
Q

is keratitis/corneal ulcer an ophthalmologic emergency

A

YES –> referral

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49
Q

dacrocystitis

A

infection of lacrimal sac due to obstruction of nasolacrimal duct

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50
Q

sx dacrocystitis

A

tearing and signs of infx - tenderness, erythema, warmth to the inferior medial cantonal (nasal) side/lower lid area
may have purulent discharge

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51
Q

acute tx dacrocystitis

A

warm compress + systemic abx (Clindamycin, Vancomycin + Ceftriaxone)

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52
Q

chronic or severe tx dacrocystitis

A

dacryocystorhinostomy
abx prior to surgery

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53
Q

tx for posterior epistaxis

A

balloon catheter

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54
Q

sx acute narrow angle closure glaucoma

A

sudden onset of severe, unilateral ocular pain
vision changes - haloes around lights and peripheral vision loss (tunnel vision)

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55
Q

PE acute narrow angle closure glaucoma

A

conjunctival erythema
cloudy “steamy” cornea
mid-dilated fixed pupil (reacts poorly to light)

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56
Q

what will you see on funduscopy for acute narrow angle closure glaucoma

A

optic disc blurring or cupping (HALLMARK) of optic nerve (thinning of outer rim of optic nerve head)

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57
Q

cup to disk ratio and asymmetry of __ indicates glaucoma

A

cup to disc ratio of > 0.5 or asymmetry of > 0.2

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58
Q

what will tonometry show for glaucoma

A

increased intraocular pressure > 21 mmHg

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59
Q

what is the standard to diagnose acute narrow angle closure glaucoma

A

gonioscopy - allows for observation of narrow chamber angle

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60
Q

topical agent to reduce intraocular pressure in glaucoma

A

topical BB - timolol
or alpha 2 agonist - Apraclonidine, brimonidine

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61
Q

topical prostaglandin for acute narrow angle closure glaucoma

A

lantanoprost

62
Q

agent to induce miosis in glaucoma

A

Pilocarpine
Carbachol

63
Q

systemic agent to lower intraocular pressure in acute narrow angle closure glaucoma

A

IV acetazolamide or IV mannitol

64
Q

definitive tx acute narrow angle closure glaucoma

A

iridotomy

65
Q

sx chronic open angle glaucoma

A

ask until later
slow, progressive painless b/l peripheral vision loss (tunnel vision)

66
Q

MC cause hordeolum

A

staph aureus

67
Q

sx hordeolum

A

localized, erythematous, painful, warm, tender nodule or pustule on the eyelid

68
Q

tx hordeollum

A

warm compress

69
Q

hyphema

A

visible layering of blood in the anterior chamber of the eye

70
Q

MC cause hyphema

A

blunt or penetrating injury to eye

71
Q

what should you order if globe rupture suspected

A

CT scan of eye

72
Q

tx hyphema

A

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
Q

sx labyrinthitis

A

vestibular sx - continuous peripheral vertigo, dizziness, N/V, gait disturbance
nystagmus is usually horizontal and rotary
hearing loss

74
Q

tx labyrinthitis

A

glucocorticoids

75
Q

how is nystagmus suppressed in labyrinthitis

A

visual fixation

76
Q

MC cause laryngitis

A

viral upper respiratory tract infection (MC)
vocal strain

77
Q

sx laryngitis

A

hoarseness hallmark
aphonia

78
Q

tx laryngitis

A

supportive

79
Q

MC cause of permanent legal blindness and vision loss in older adults in the US

A

macular degeneration

80
Q

dry macular degeneration

A

MC
progressive (over decades)

81
Q

PE dry macular degeneration

A

druse bodies hallmark - small, round, yellow-white spots on the outer retina

82
Q

wet macular degeneration

A

more aggressive
choroidal neovascularization

83
Q

PE wet macular degeneration

A

new, abnormal choral vessels

84
Q

sx macular degeneration

A

bilateral, progressive central vision loss
metamorphopsia (straight lines appear bent)

85
Q

dx macular degeneration

A

funduscopy
fluorescein angiography
amsler grid (shows metamorphopsia)

86
Q

tx dry macular degeneration

A

zinc and vitamins C and E to slow progression

87
Q

tx wet macular degeneration

A

VEGF inhibitors - Bevacizumab, Ranibizumab, Aflibercept - decrease new vessel formation

88
Q

sx menieres dz

A

episodic peripheral hearing loss
unilateral fluctuating sensorineural hearing loss
tinnitus
ear fullness
horizontal nystagmus
N/V

89
Q

what should you rule out when someone presents w sx of Menieres dz

A

syphilis (FTA-ABS)

90
Q

tx menieres dz

A

sodium, caffeine, nicotine, chocolate, alcohol restriction
antihistamines (Meclizine)
diuretics (hydrochlorothiazide)

91
Q

cholesteatoma

A

abnormal keratinized collection of desquamated squamous epithelium in the middle ear or mastoid that can lead to bony erosion of the mastoid

92
Q

MC causes of cholesteatoma

A

chronic middle ear dz
Eustachian tube dysfunction

93
Q

sx cholesteatoma

A

painless otorrhea - brown or yellow discharge w a strong odor
hearing loss

94
Q

PE cholesteatoma

A

otoscope - granulation tissue (cellular debris)
conductive hearing loss - weber - heard in affected ear; rinne - BC > AC in affected ear

95
Q

tx cholesteatoma

A

surgical excision of debris (tympanoplasty and reconstruction of ossicular chain)

96
Q

MC cause nasal polyps

A

allergic rhinitis

97
Q

tx nasal polyps

A

intranasal corticosteroids

98
Q

MC cause otitis externa

A

pseudomonas aeruginosa

99
Q

sx otitis externa

A

ear pain and erythema
pruritus in ear canal

100
Q

PE otitis externa

A

edema and pain on traction of ear canal or trigs, purulent auricular discharge

101
Q

dx otitis externa

A

edema of external auditory canal on otoscope

102
Q

tx otitis externa

A

ciprofloxacin-dexamethasone, Ofloxacin

103
Q

peak age acute otitis media

A

6-24 mos

104
Q

causes acute otitis media

A

s pneumonia
h influenza
m catarrhalis
MC proceeded by virus

105
Q

PE acute otitis media

A

bulging and inflamed TM w effusion, loss of landmarks
decreased TM mobility (most sensitive)

106
Q

tx acute otitis media

A

amoxicillin

107
Q

papilledema

A

optic nerve (disc) swelling secondary to increased intracranial pressure (usually b/l)

108
Q

funduscopy papilledema

A

swollen optic disc w blurred margins

109
Q

tx papilledema

A

acetazolamide

110
Q

parotitis

A

acute infxn of parotid gland (bacterial or viral)

111
Q

MC cause parotitis

A

staph aureus

112
Q

RF parotitis

A

dehydration
poor oral hygiene

113
Q

sx bacterial parotitis

A

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
Q

should patients be admitted for acute bacterial parotitis

A

yes

115
Q

tx community acquired bacterial parotitis

A

ampicillin-sulbactam or cefuroxime and metronidazole
add Vancomycin or Linezolid if MRSA

116
Q

tx hospital acquired bacterial parotitis or immunocompromised

A

vancomycin or linezolid and either cefepime and metronidazole, imipenem, meropenem, or piperacillin-tazobactam

117
Q

duration abx tx parotitis

A

10-14 days

118
Q

when is I and D considered for parotitis

A

no improvement within 2-3 days

119
Q

peritonsillar abscess is also called

A

quinsy

120
Q

peritonsillar abscess is often

A

polymicrobial

121
Q

sx peritonsillar abscess

A

ill appearing
severe unilateral pharyngitis
dysphagia
odynophagia
high fever
malaise
ear pain
muffled hot potato voice
drooling
trismus (lockjaw)

122
Q

PE peritonsillar abscess

A

swollen or fluctuant tonsil, causing usual deviation to the contralateral side

123
Q

tx peritonsillar abscess

A

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
Q

MC overall cause of pharyngitis

A

viral

125
Q

MC bacterial cause pharyngitis

A

Group A strep

126
Q

PE streptococcal pharyngitis

A

enlarged tender anterior cervical lymphadenopathy

127
Q

tx streptococcal pharyngitis

A

pcn

128
Q

complication of streptococcal pharyngitis

A

rheumatic fever

129
Q

pterygium vs pinguecula

A

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
Q

RF pterygium

A

UV light exposure in sunny climates (tropics)
snad, wind, dust exposure

131
Q

sx pterygium

A

elevated, superficial fleshy, triangular-shaped growing fibrovascular mass that usually starts medially (nasal side of the eye) and extends laterally

132
Q

tx pterygium

A

obsevation
surgical removal if it affects vision

133
Q

sx retinal detachment

A

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
Q

funduscopy retinal detachment

A

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
Q

is retinal detachment an emergency

A

YES
keep pt supine while awaiting for ophthalmology consult w the head turned toward the side of the detachment

no miotic drops

136
Q

sx retinal artery occlusion

A

sudden, painless, unilateral acute visual loss usually attributed to ischemia or thrombus
small unilateral pupil on affected side

137
Q

retinal artery occlusion causes

A

embolism from Afib
atherosclerosis
ruptured plague from same side carotid

138
Q

funduscopy central retinal artery occlusion

A

cloudy, pale retina
cherry red spot in fovea
attenuation of vessels

139
Q

tx central retinal artery occlusion

A

ophthalmology referral
ocular massage to affected eye

140
Q

sx retinal vein occlusion

A

sudden acute monocular vision loss
CV risk factors - DM, HTN, polycythemia vera

141
Q

funduscopic exam retinal vein occlusion

A

optic disc swelling
retinal hemorrhages**
dilated/tortuous veins –> blood and thunder appearance

142
Q

tx retinal vein occlusion

A

laser therapy
VEGF

143
Q

retinopathy

A

causes decreased/blurred vision

144
Q

findings for nonproliferative diabetic retinopathy

A

micro aneurysms (visible as red dots)
cotton wool spots (fluffy white patches on retina)
hemorrhages
hard exudates

145
Q

findings for proliferative diabetic retinopathy

A

micro aneurysms
cotton wool spots
hemorrhages
hard exudates
neovascularization!!!!

146
Q

findings for hypertensive retinopathy

A

AV nicking
silver wiring

147
Q

tx non proliferative diabetic retinopathy

A

glucose control

148
Q

tx proliferative diabetic retinopathy

A

anti VEGF (Ranibizumab, Bevacizumab)
peripheral retinal photocoagulation
surgery

149
Q

tx hypertensive retinopathy

A

blood pressure and lipid control
laser therapy

150
Q

tympanic membrane perforation may lead to

A

cholesteatoma

151
Q

sx tympanic membrane perforation

A

sudden pain relief w bloody otorrhea

152
Q

tx tympanic membrane perf

A

observation
ofloxacin in some
avoid water and topical aminoglycosides

EOR Family med (25 decks)

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