ENT Flashcards
With chemical ophthalmic burns, what is the initial management?
sterile (if possible) irrigation for at least 30 minutes
What physical exam finding is most concerning for a blow out orbital fracture?
inability of the patient to look up due to an entrapment of the infraorbital nerve and musculature
What diagnosis is associated with a curtain being drawn over the eye from top to bottom?
Retinal detachment
what is the prognosis for retinal detachment?
80% will recover spontaneously, 15% require treatment, 5% will never recover
What is the major worrisome side effect of long term or high dose chloroquine use?
Macular degeneration
What is the leading cause of irreversible central visual loss?
Macular degeneration
What is the biggest risk factor for macular degeneration?
Age > 50
Patient presents with a gradual loss of central vision with wavy distorted remaining vision, unilaterally. Diagnosis?
Macular degeneration
How do you differentiate central retinal artery occlusion from giant cell arteritis?
GCA: fever, HA, jaw claudication
What is associated with unilateral visual loss/blurriness and a “blood and thunder” retina on fundoscopic exam?
Central retinal vein occlusion
What is the leading cause of blindness in the US?
diabetic retinopathy
Differentiate Macular degeneration from cataracts
Cataracts: usually bilateral, intact peripheral vision, non distorted
Describe a typical patient with open-angle glaucoma
African American with diabetes < 40 years old
What type of glaucoma is most common?
open-angle glaucoma
Patient presents with circumlimbal injection, seamy cornea, fixed mid-dilated pupil, decreased visual acuity and tearing. Patient has vomited once. Diagnosis? Treatment?
angle-closure glaucoma - anhydrase inhibitor (acetazolamide) + topical B-blocker + systemic diuresis (mannitol)
What are the typical pathogens in orbital cellulitis?
S. pneumoniae, S Aureus, H. Flu and Gram-negatives
9 yo F p/w ptosis, eyelid edema, exophthalmos, purulent conjunctivitis and fever. She has decreased EOM and sluggish pupil. She reports having had cold symptoms for the 2 previous weeks. Work up? Likely Dx? Tx?
CT for extent of infection, Orbital Cellulitis, IV abx for total 2-3 week course, initially nafcillin + flagyl or clinda
Conjunctivities with intracellular gram-negative diplococci seen on smear. What is the organism?
N. Gonorrhea
Blue sclera
osteogenesis imperfecta
Weber: lateralization to affected ear, Rinne: Bone>Air on affected side - What type of hearing loss?
Conductive
Weber: lateralization to the unaffected ear (better hearing), Rinne: air > bone in both ears - what type of hearing loss?
sensorineural
What is the most common etiology of sensorineural hearing loss?
Presbycusis - gradual impairment of higher sound frequencies occurring with increasing age
Pt presents with episodic vertigo over the past week, lasting several minutes, unilateral hearing loss and tinnitus. On exam caloric testing reveals loss of nystagmus on the side with hearing impairment. Diagnosis?
Meniere disease
What is the primary treatment of Meniere’s disease?
diuretics (acetazolamide) and low-sodium diet
What are the most common ototoxic medications?
Aminoglycoside abx (mycins), lasix, chemotherapy
Child with h/o ear infections p/w painless ear discharge - what is the diagnosis? Likely PE findings? Tx?
Likely chronic otits media, perforated TM, will need abx drops/tubes
What is the differential of antibiotics for acute sinusitis?
10-14 days of symptoms - Amox or for PCN all Macrolides/Bactrim/Doxy -> Amp -> fq
What are the diagnostic criteria for strep throat? (4)
Fever > 100.4, tender anterior cervical lymphadenopathy, lack of cough, pharyngotonsillar exudate
Patient presents with painless white oral plaques, next step?
biopsy - likely leukoplakia 5% risk of SCC
Differentiate epiglottitis from peritonsilar abscess
No physically identifiable swelling or intra oral erythema in epiglottitis - just difficulty swallowing and/or breathing
What medication should be avoided in patients with allergic rhinitis, nasal polyps and asthma?
aspirin can cause bronchospasm
