ENT

Question 1

MCC AOM

Answer 1

strep pneumo
H flu
m catarrhalis

Question 2

tx AOM

Answer 2

amoxicillin/augmentin
azithromycin if allergy

Question 3

MCC bacterial pharyngitis

Answer 3

viral MC overall
strep pyogenes (GAS) mc bacterial

Question 4

tx bacterial pharyngitis

Answer 4

PCN (IM or oral)

Question 5

MCC sinusitis

Answer 5

s pneumo, h flu

Question 6

tx sinusitis

Answer 6

amoxicillin/augmentin
(same as AOM bc same organisms)

Question 7

tx allergic rhinitis

Answer 7

intranasal steroids (Flonase)

Question 8

sx blepharitis

Answer 8

inflammation of eyelids WITHOUT significant pain

crusting, scaling, red-rimming of the eyelid

Question 9

tx blepharitis

Answer 9

eyelid hygiene!!!!

if refractory - azithromycin solution or ointment

Question 10

MCC viral conjuncitivits

Answer 10

adenovirus –> pre auricular lymph node

Question 11

MCC bacterial conjunctivitis

Answer 11

staph aureus –> eye glued shut

Question 12

tx for corneal abrasion

Answer 12

non contact lens wearer - erythromycin ointment
contact lens wearer - topical ciprofloxacin or ofloxacin

Question 13

sx with orbital floor blowout fracture

Answer 13

decreased visual acuity
diplopia (double vision) especially with upward gaze due to inferior rectus muscle entrapment

eyelid swelling (orbital emphysema) due to air from maxillary sinus

numbness to the anteromedial cheek from stretching of the infraorbital nerve

Question 14

dx orbital floor blowout fx

Answer 14

CT scan - tear drop sign - inferior herniation of the orbital fat inferiorly

Question 15

tx epiglottitis

Answer 15

second or third generation cephalosporin + vancomycin

Question 16

what is acute narrow angle-closure glaucoma

Answer 16

increased intraocular pressure leading to damage of the optic nerve

Question 17

sx acute narrow angle-closure glaucoma

Answer 17

sudden onset of severe, unilateral ocular pain

vision changes - halos around lights and peripheral vision loss (tunnel vision)

Question 18

PE acute narrow angle-closure glaucoma

Answer 18

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

funduscopy - optic disc blurring or cupping of the optic nerve

Question 19

tx acute narrow angle-closure glaucoma

Answer 19

topical agent to reduce intraocular pressure (timolol, apraclonidine)

agent to induce miosis (pilocarpine)

systemic agent to lower intraocular pressure (PO or IV acetazolamide or mannitol)

Question 20

dx acute narrow angle-closure glaucoma

Answer 20

tonometry - increased intraocular pressure > 21

gonioscopy - criterion standard - allows one to observe a narrow chamber angle

Question 21

sx chronic open angle glaucoma

Answer 21

asx
slow, progressive painless bilateral peripheral vision loss (tunnel vision)

Question 22

PE chronic open angle glaucoma

Answer 22

cupping of optic discs

Question 23

tx chronic open angle glaucoma

Answer 23

prostaglandin analogs are first line (latanoprost)

laser therapy if medical tx fails

Question 24

what meds should you avoid if hyphema

Answer 24

NSAIDs

Question 25

tx hyphema

Answer 25

shield, elevate head, topical steroid if trauma

Question 26

what is labyrinthitis

Answer 26

inflammation of the vestibular and cochlear portion of CN8

Question 27

what usually causes labyrinthitis

Answer 27

associated with viral or post viral inflammation

Question 28

sx labyrinthitis

Answer 28

continuous peripheral vertigo nystagmus is horizontal or rotary hearing loss

Question 29

dx labyrinthitis

Answer 29

usually clinical MRI to rule out alternative causes

Question 30

tx labyrinthitis

Answer 30

steroids first line symptomatic relief (Meclizine)

Question 31

sx menieres

Answer 31

episodic peripheral vertigo (minutes --> hours) unilateral fluctuating sensorineural hearing loss tinnitus ear fullness horizontal nystagmus

Question 32

dx menieres

Answer 32

dx of exclusion rule out syphilis

Question 33

tx meneires

Answer 33

sodium, caffeine, nicotine, chocolate, alcohol restriction meclizine and HCTZ

Question 34

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

Answer 34

macular degeneration

Question 35

sx macular degeneration

Answer 35

bilateral, progression central vision loss (including detailed and colored vision) metamorphosis - straight lines appear bent

Question 36

PE macular degeneration (wet)

Answer 36

new abnormal choroidal vessels

Question 37

dx macular degeneration

Answer 37

fundoscopy fluorescein angiography ambler grid shows metamorphopsia (line distortion)

Question 38

tx wet macular degeneration

Answer 38

VEGF inhibitors (Bevacizumab, Ranibizumab, Aflibercept)

Question 39

mastoiditis is usually a complication of

Answer 39

AOM!!!

Question 40

sx mastoiditis

Answer 40

deep ear pain (usually worse at night)

Question 41

PE mastoiditis

Answer 41

otalgia fever mastoid tenderness, edema, erythema protrusion of the auricle

Question 42

dx mastoiditis

Answer 42

CT with contrast MRI

Question 43

tx mastoiditis

Answer 43

IV abx + middle ear drainage (myringotomy) with or without tube placement abx - Vancomycin + cef or piperacillin-tazobactam if refractory - mastoidectomy

Question 44

what is optic neuritis

Answer 44

acute inflammatory demyelination of the optic nerve

Question 45

2 important causes of optic neuritis

Answer 45

MS ethambutol

Question 46

sx optic neuritis

Answer 46

painful MONOCULAR vision loss decrease in color vision visual field defects - central scotoma (blind spot)

Question 47

PE optic neuritis

Answer 47

ocular pain w eye movement Marcus-Gunn pupil - from unaffected eye to affected eye, the pupils dilate

Question 48

dx optic neuritis

Answer 48

MRI of brain and orbits

Question 49

tx optic neuritis

Answer 49

IV methylprednisolone

Question 50

orbital cellulitis is MC due to

Answer 50

sinus infection

Question 51

dx orbital cellulitis

Answer 51

CT

Question 52

tx orbital cellulitis

Answer 52

admit IV vancomycin + cef or ampicillin-sulbactam

Question 53

MCC otitis externa

Answer 53

pseudomonas

Question 54

tx otitis externa

Answer 54

topical abx + topical steroid ciprofloxacin-dexamethasone

Question 55

what is papilledema

Answer 55

optic nerve (disc) swelling secondary to increased ICP (usually bilateral)

Question 56

sx papilledema

Answer 56

HA N/V transient visual changes following abrupt shifts in posture or may happen spontaneously

Question 57

dx papilledema

Answer 57

funduscopy - swollen optic disc with blurred margins

Question 58

tx papilledema

Answer 58

acetazolamide

Question 59

sx retinal detachment

Answer 59

photopsia (flashing lights) followed by floaters followed by progressive unilateral peripheral vision loss NO PAIN

Question 60

dx retinal detachment

Answer 60

funduscopy - detached tissue flapping in vitreous humor

Question 61

tx retinal detachment

Answer 61

EMERGENCY - keep patient supine while awaiting eye doc -- turn head TOWARD side of detachment

Question 62

sx retinal vein occlusion

Answer 62

sudden painless unilateral vision loss due to thrombosis

Question 63

dx retinal vein occlusion

Answer 63

retinal hemorrhages on funduscopy

Question 64

tx retinal vein occlusion

Answer 64

VEGF inhibitors