ENT Flashcards
herpes keratitis
SEVERE eye pain, photophobia, blurred vision
fernlike lines in corneal surface (using black lamp)
EMERGENCY=blindness
acute angle closure glaucoma
elderly, severe eye pain, n/v, “halos”. exam: dilated oval shaped pupil, cloudy cornea, “cupping”. EMERGENCY
cholesteatoma
cauliflower like growth with foul smelling ear discharge
hearing loss
hx of otitis media, not concerous by may effect CN 7
refer
battle sign
bruise behind the ear (mastoid) area after recent trauma
indicates skull fracture
look for clear golden discharge
Emergency
clear fluid from nose or ear
sign of skull fracture
test fluid with urine dipstick=glucose (CSF)
emergency
cavernous sinus thrombosis
hx of sinus injection with SEVERE headache/fever,
peritonsillar absess
severe sore throat, odonophagia (painful swallowing), truisms (jaw tightening), “hot potato”, uvula displaced, fever.
Refer to ED fro incision and drainage
diptheria
swollen “bulls neck”
posterior pharynx coated with gray/yellow psudomembrane, very contagious. ED
normal eye findings
veins larger than arteries
leukoplakia
on the tongue, may be cancerous, high risk in tobacco users
apthous stomatitis ( canker sores)
painful shallow ulcers of soft tissue
geographic tongue
map like appearance on tongue
patches may move
soreness with acidic/spicy foods
benign
torus palatinus
benign
bony protuberance midline on the hard palate
fishtail or split uvula
benign
may be a sign of occult cleft lip
nystagmus
few beats on extreme lateral gaze that resolves when back to midline .
VERTICAL nystagmus is ALWAYS abnormal
papilledema
swollen optic disc
secondary to bleeding, brain tumor, abscess, pseudo tumor cerebri
hypertensive retinopathy
silver/copper wire arterioles
diabetic retinopathy
microaneurysms caused by neovascularization (new arteries in the retina fragile)
On funduscopic exam, cotton wool spots, flame hemorrhages (similar lesions are also caused by the alpha-toxin of Clostridium novyi), and dot-blot hemorrhages.
cataracts
opacity of the cornea
chronic steroid can cause
allergic rhinitis
blue tinged or pale/swollen boggy nasal turbinates
koplik spots
measles
small red papules with blue/white centers inside the cheeks by the lower molars
hairy leukoplakia
elongated papilla on the lateral tongue, HIV injection caused by EBV
leukoplakia of the tongue
bright white plaque caused by chewing tobacco or chronic infection ( rule out cancer)
nystagmus
horizonal is normal, vertical his not
rule out strabismus
abnormal vision test
2 line difference between each eye
test for color blindess
ishihara chart
vision test if illiterate
tumbling E chart
legal blindess
20/200 or visual field
normal rinne test
air conduction > bone conduction ( can hear longer in front of the ear than on mastoid bone)
herpes keratitis
look for herpetic rash not eh side of the temple/tip of the nose (rule out shingles) of CN 5
The trigeminal nerve (the fifth cranial nerve, or simply CN V) is a nerve responsible for sensation in the face and certain motor functions such as biting and chewing. It is the largest of the cranial nerves.
corneal abrasions
appear linear line on back lamp ( fernlike for herpes keratitis)
flush out with saline, if unable to remove refer
if corneal abrasion, use topical antibiotic (erythro, plytrim). do NOT patch eye. f/u in 24 hours
hordeolum (stye)
painful bacterial infection of a hair follicle of the eyelid antibiotic drops (sulfa or erythromycin gtts), warm packs
chalazion
chronic inflammation of the meibomian gland (sweat gland) of the eyelids
“PAINLESS” nodule to the upper eyelid, benign
tx: if nodule enlarges or does not resolve in a few weeks, biopsy to r/u squamous cell cancer.
pinguecula
yellow triangular thickening of the bulbar conjunctiva caused by UV damage
A pinguecula (above) is a yellowish patch or bump on the conjunctiva, near the cornea. It most often appears on the side of the eye closest to the nose. It is a change in the normal tissue that results in a deposit of protein, fat and/or calcium. It is similar to a callus on the skin.
pterygium
yellow triangular thickening of the conjunctiva that extends to the cornea on the nasal or temporal cornea du to UV.
A pterygium (also known as surfer’s eye or farmer’s eye) is a triangular-shaped growth of fleshy tissue on the white of the eye that eventually extends over the cornea. This growth may remain small or grow large enough to interfere with vision. A pterygium can often develop from a pinguecula.
subconjuctival hermorrhage
blood trapped under conjunctiva and sclera, resolves within 1-3 wks.
watchful waiting
primary open angle glaucoma
gradual >IOP, >22mm hg dt lbokcage of the drainage of aqueous humor. CN2 can be permanently damaged (glaucoma, 60-70%)
most common in elderly, AA
gradual change in peripheral first. if shoes “cupping”- refer
tx:
BB gtts Betimol (timolol)
side effects: fatigue/depression, bradycardia
contraind: heart block, heart failure, copy/astham/emphysema
closed angel glaucoma
SUDDEN blockage, increase IOP causing ischemia and permanent CN 2 damage
ie: elder with sudden headache and eye pain, sees halos, n/v
objective: fixed, mid dilated cloudy pupil. oval shaped. REFER ED
anterior uveitis (iritis)
inflammation of the iris
refer to opthamalogist
higher risk with autoimmune; RA, lupus, anklosing spodylitis, etc.
complains of red sore eyes, no discharge
age related macular degeneration
higher risk in smokers
gradual damage to the macula
treatment: refer
pt is given AMSLER grid (focus on central dot and view grad 12” from eye). check daily or weekly
“areds” formula ocular vitamins (Antioxidents and zinc)
sjorgrens syndrome
autoimmune. 3 months, gritty eyes (keratoconjuntivitis sicca). swollen salivatory glands
OTC tear substitute eye gtts, refer
belpharitis
chronic condition, inflammation of base of eyelashes, redness, crusting
tx: baby shampoo until resolved. or erythromycin gtts
allergic rhinitis
chronic nasal congestion, clear mucus post nasal drip, cough worse in supine.
objective: blue tinged or pale boggy nasal turbinates
mucus clear
tx: flonase, decongestants, zyrtec, avoid dust mite allergies
complications: acute sinusitis
acute otitis media
rhinitis medicamentosa
prolonged use of topical nasal decongestants (>3 days) causes rebound.
epistaxis
tilt head forward and apply pressure, use afrin prn, nasal packing, antibiotic prophylaxis for staph/strep prn.
posterior nose bleeds refer to ED
strep throat
acute infection of the pharynx
B. streptocuccus gram + group A
classic example: acute onset of pain on swallowing, mild submandibular nodes, no rhinitis, pharynx pink/red, afebrile, tonsillar exudate, pettechiae on the palate
Tx: throat culture and sensitivity (C&S) or rapid strep test
first line: PCN QID x 10 days
salt water gargles, throat lozenges
repeat culture if high risk: hx of mitral valve or valve surgery
pcn allergy:
azithromyzin ( zpack) x 5 days
levo x 10 days ( contraindicated if
acute otitis media
acute infection middle ear
organisms: S. pneumoniae, h. influenza, m. catarrhalis
classic ex: ear pain (otalgia), popping nose, hx of cold/allergies.
bullous myringitis
AOM but causes more PAIN
blisters (or bulla) on tempanic membrane, hearing closs
tx for AOM
amoxicillin gold standard for all age groups
or 2nd line augmenting, ceftin, cefzil
(use 2nd line if antibiotic use in past 3 mos, no response to amoxicillin, or severe AOM (high fever, severe pain).
if allergic to PCN:
azithro, bacterium, levo (>18 yo dt risk of tendinitis/achilles tendon rupture
complications:
meningitis ( positive brudzinski or kerning sign)
otitis externa ( swimmers ear)
bacterial infection of the skin of the external ear canal
p. aeruginosa
s. aureus
external ear pain, swelling, green discharge
“ear pain with tragus”.
tx: cortisporin otic suspension qid x 7 days. keep water out of ear. if recurrent, prophylaxis is otic domeboro (boric) or alcohol and vinegar (vosol)
mono
EPV 15-24yo triad; fatigue, pharyngitis, lymphadenopathy stomach pain ( dt splenomegaly) objective: cbc (>50% lymphocytes) Positive mono spot tender cervical nodes, tonsils inflamed
Tx: abdomen US if splenomegaly
no contact sports 4-6 wks
avoid amoxicillin if patient has strep throat
** keep checking lymphocytes until normal**
cheilosis
skin fissures corner of the mouth
apply topical antibiotic
tx for otitis externa
corisporin otic drops
otitis externa = pseudomonas
if pt has used antibiotics in the past 3 months
do nOT use amox
use augmenting of ceftin
PCN allergy
use macrolides, sulfa (avoid cephalosporins if true PCN allergy)
weber and rinne test which CN
8 (acoustic)
most common cerumen tx
carbamide peroxide
