ENT Flashcards
MCC AOM
strep pneumo
H flu
m catarrhalis
tx AOM
amoxicillin/augmentin
azithromycin if allergy
MCC bacterial pharyngitis
viral MC overall
strep pyogenes (GAS) mc bacterial
tx bacterial pharyngitis
PCN (IM or oral)
MCC sinusitis
s pneumo, h flu
tx sinusitis
amoxicillin/augmentin
(same as AOM bc same organisms)
tx allergic rhinitis
intranasal steroids (Flonase)
sx blepharitis
inflammation of eyelids WITHOUT significant pain
crusting, scaling, red-rimming of the eyelid
tx blepharitis
eyelid hygiene!!!!
if refractory - azithromycin solution or ointment
MCC viral conjuncitivits
adenovirus –> pre auricular lymph node
MCC bacterial conjunctivitis
staph aureus –> eye glued shut
tx for corneal abrasion
non contact lens wearer - erythromycin ointment
contact lens wearer - topical ciprofloxacin or ofloxacin
sx with orbital floor blowout fracture
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
dx orbital floor blowout fx
CT scan - tear drop sign - inferior herniation of the orbital fat inferiorly
tx epiglottitis
second or third generation cephalosporin + vancomycin
what is acute narrow angle-closure glaucoma
increased intraocular pressure leading to damage of the optic nerve
sx acute narrow angle-closure glaucoma
sudden onset of severe, unilateral ocular pain
vision changes - halos around lights and peripheral vision loss (tunnel vision)
PE acute narrow angle-closure glaucoma
conjunctival erythema
cloudy, steamy cornea
mid-dilated fixed pupil (reacts poorly to light)
funduscopy - optic disc blurring or cupping of the optic nerve
tx acute narrow angle-closure glaucoma
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)
dx acute narrow angle-closure glaucoma
tonometry - increased intraocular pressure > 21
gonioscopy - criterion standard - allows one to observe a narrow chamber angle
sx chronic open angle glaucoma
asx
slow, progressive painless bilateral peripheral vision loss (tunnel vision)
PE chronic open angle glaucoma
cupping of optic discs
tx chronic open angle glaucoma
prostaglandin analogs are first line (latanoprost)
laser therapy if medical tx fails
what meds should you avoid if hyphema
NSAIDs
tx hyphema
shield, elevate head, topical steroid if trauma
what is labyrinthitis
inflammation of the vestibular and cochlear portion of CN8
what usually causes labyrinthitis
associated with viral or post viral inflammation
sx labyrinthitis
continuous peripheral vertigo
nystagmus is horizontal or rotary
hearing loss
dx labyrinthitis
usually clinical
MRI to rule out alternative causes
tx labyrinthitis
steroids first line
symptomatic relief (Meclizine)
sx menieres
episodic peripheral vertigo (minutes –> hours)
unilateral fluctuating sensorineural hearing loss
tinnitus
ear fullness
horizontal nystagmus
dx menieres
dx of exclusion
rule out syphilis
tx meneires
sodium, caffeine, nicotine, chocolate, alcohol restriction
meclizine and HCTZ
MCC of permanent legal blindness and vision loss in older adults in the US
macular degeneration
sx macular degeneration
bilateral, progression central vision loss (including detailed and colored vision)
metamorphosis - straight lines appear bent
PE macular degeneration (wet)
new abnormal choroidal vessels
dx macular degeneration
fundoscopy
fluorescein angiography
ambler grid shows metamorphopsia (line distortion)
tx wet macular degeneration
VEGF inhibitors (Bevacizumab, Ranibizumab, Aflibercept)
mastoiditis is usually a complication of
AOM!!!
sx mastoiditis
deep ear pain (usually worse at night)
PE mastoiditis
otalgia
fever
mastoid tenderness, edema, erythema
protrusion of the auricle
dx mastoiditis
CT with contrast
MRI
tx mastoiditis
IV abx + middle ear drainage (myringotomy) with or without tube placement
abx - Vancomycin + cef or piperacillin-tazobactam
if refractory - mastoidectomy
what is optic neuritis
acute inflammatory demyelination of the optic nerve
2 important causes of optic neuritis
MS
ethambutol
sx optic neuritis
painful MONOCULAR vision loss
decrease in color vision
visual field defects - central scotoma (blind spot)
PE optic neuritis
ocular pain w eye movement
Marcus-Gunn pupil - from unaffected eye to affected eye, the pupils dilate
dx optic neuritis
MRI of brain and orbits
tx optic neuritis
IV methylprednisolone
orbital cellulitis is MC due to
sinus infection
dx orbital cellulitis
CT
tx orbital cellulitis
admit
IV vancomycin + cef or ampicillin-sulbactam
MCC otitis externa
pseudomonas
tx otitis externa
topical abx + topical steroid
ciprofloxacin-dexamethasone
what is papilledema
optic nerve (disc) swelling secondary to increased ICP (usually bilateral)
sx papilledema
HA
N/V
transient visual changes following abrupt shifts in posture or may happen spontaneously
dx papilledema
funduscopy - swollen optic disc with blurred margins
tx papilledema
acetazolamide
sx retinal detachment
photopsia (flashing lights) followed by floaters followed by progressive unilateral peripheral vision loss
NO PAIN
dx retinal detachment
funduscopy - detached tissue flapping in vitreous humor
tx retinal detachment
EMERGENCY - keep patient supine while awaiting eye doc – turn head TOWARD side of detachment
sx retinal vein occlusion
sudden painless unilateral vision loss due to thrombosis
dx retinal vein occlusion
retinal hemorrhages on funduscopy
tx retinal vein occlusion
VEGF inhibitors
