ENT Flashcards
s/s of herpes keratitis
sever eye pain, photophobia, and blurred vision in one eye
herpes keratitis is diagnosed with
fernlike lines on corneal surface using flourescein dye
complication of herpes keratitis
corneal blindness
exam with acute angle-closure glaucoma reveals
mid-dilated pupil that’s oval shaped, cloudy cornea
treatment for acute angle-closure glaucoma
medical emergency
s/s of acute vision loss
sudden onset of floaters or black dots, scotoma (retinal detachment), blurred vision, eye pain
s/s of cholesteatoma
“cauliflower-like” growth with foul-smelling discharge to ear; hearing loss
those with cholesteatoma often have a hx of
chronic otitis media infections
complication of cholesteatoma
can damage CN VII (facial)
treatment for cholesteatoma
atbx and surgical debridement, refer to ENT
acute onset of bruise behind ear over the mastoid area after recent trauma
Battle’s sign
Battle’s sign indicates
fracture of basilar skull
s/s of basilar skull fracture
Battle’s sign, clear golden fluid discharge from ear or nose (CSF)
rare complication where a patient with a hx of sinus or facial infection will present with severe headache and high fever
cavernous sinus thrombosis
s/s of peritonsillar abscess
severe sore throat, difficulty swallowing, trismus, “hot- potato” voice, fever, one-sided swelling with uvula displaced
trx for peritonsillar abscess
refer to ED for I&D
sore throat, fever, swollen neck “bull neck”, hoarsness, dysphagia with gray-yellow colored pharynx
diphtheria
the macula is responsible for
central vision
the area of the eye that determines 20/20 vision
fovea
cobblestoning inner conjunctiva can be seen in patients with
atopy, allergic rhinitis, allergic conjunctivitis
age-related vision change that causes difficulty focusing and ability to read print at close range
presbyopia
thickened, white patches inside of mouth that may be cancerous
leukoplakia
management for avulsed tooth
store in cool milk see refer to dentist ASAP
this kind of nystagmus is always abnormal
vertical
optic disc swelling with blurred edges d/t increased ICP
papilledema
finding with hypertensive retinopathy
copper and silver wire arterioles
finding with diabetic retinopathy
microaneurysms caused by neovascularization
chronic steroid use can cause
cataracts
“grain of salt” papules in the buccal mucosa
Koplik spots, appear with measles
mucosal lining inside eyelids
palpebral conjunctiva
mucosal lining covering the eyes
bulbar conjunctiva
farsightedness
hyperopia
nearsightedness
myopia
abnormal Snellen chart result
two-line difference between each eye; less than 4 out of 6 letters correct
interpretation of 20/60
a person can see at 20 feet what the patient can see at 60 feet
legal blindness is characterized as
20/200
Weber test
placed on forehead, sound should not lateralize
Rinne test
placed on mastoid process, then front of ear. Normal is AC> BC
fluorescein dye with corneal abrasion
linear lines on cornea
s/s of corneal abrasian
severe eye pain with tearing; will keep affected eye shut.
treatment for corneal abrasion
check vision, flush with NS, if unable to remove, refer. Treat with erythromycin or polytrim x3-5 days.
Do not do this for corneal abrasion
do NOT patch eye
F/U for corneal abrasion in
24 hours, if not improved, refer
painful acute bacterial infection of hair follicle on eyelid
hordeolum (stye)
trx of stye
sulfa or erythromycin drops, warm compress bid-tid
chronic inflammation of the meibomian gland
chalazion
different between hordoleum (stye) and chalazion
hordoleum is painful and itchy; chalazion is not painful
yellow triangular thickening of bulbar conjunctiva caused by UV damage
pinguecula and pterygium
difference between pinguecula and pterygium
pinguecula will not cover the cornea; pterygium can cover cornea and affect vision
treatment for pinguecula and pterygium
weak steroid eye drops, sunglasses, surgery if pterygium starts affecting vision
subconjunctival hemorrhage can be caused by
coughing, sneezing, heavy lifting, vomiting, on ASA or anticoagulants
subconjunctival hemorrhage usually resolve within
1-3 weeks
normal intraocular pressure
8-21 mmHg
risk factors for primary open-angle glaucoma
elderly, African Americans, diabetes
In primary open-angle glaucoma, gradual changes occur in ____ first, then ____
peripheral vision; central
caused by gradual onset on increased intraocular pressure
open angle glaucoma
treatment for open angle glaucoma
Betimol beta blocker eye drops
contraindications for betimol beta-blocker eye drops for open angle glaucoma
asthma, COPD, heart block, heart failure
sudden blockage of aqueous humor causing increased intraocular pressure
primary angle closure glaucoma
s/s of primary angle closure glaucoma
acute onset of severe frontal headache with eye pain, decreased vision, halos around lights N/V
high risk of anterior uveitis in those with
autoimmune disease
s/s of anterior uveitis
red sore eyes with increased tearing
which form of macular degeneration is most common and less severe?
atrophic (dry form)
The exudative (wet form) of macular degeneration is responsible for
vision loss
s/s of macular degeneration
painless central vision loss; peripheral vision not affected
Treatment for macular degeneration
refer to opthalmologist, Amsler grid (focus eye on center dot daily).
chronic autoimmune disorder where there is decreased function of the lacrimal and salivary glands
Sjogren’s syndrome
s/s of Sjogren’s syndrome
dry eyes and dry mouth for > 3 months
trx for Sjogren’s syndrome
artificial tear gtts, check ESR/CRP, refer to ophthalmologist and rheumatologist.
chronic red inflammation to eyelids that causes itching
blepharitis
trx for blepharitis
johnson’s baby shampoo with warm water scrub eyelids;
Treatment for allergic rhinitis
nasal steroid sprays, decongestants, antihistamine
prolonged use of nasal decongestants for more than 3 days causing rebound nasal congestion
rhinitis medicamentosa
First line trx for strep throat
penicillin; Zpack if allergic to PCn
An acute type of AOM that causes more pain; presence of blisters on red/bulging TM.
bullous myringitis
AOM will lead to this kind of hearing loss
conductive
If AOM does not start resolving in 48-72 hours then,
switch to either Augmentin or (cefuroxime) Ceftin
first line trx for AOM
amoxicillin 875 mg x 10-14 days
first line trx for AOM if allergic to PCN
Zpack x 5 days, Bactrim DS
s/s of otitis media with effusion
bulging TM with fluid level
trx for otitis media with effusion
oral decongestants, steroid nasal spray
organisms that cause otitis externa
Pseudomonas aeruginosa (-), Staph aureus (+)
s/s of otitis externa
ear pain, swelling, green purulent discharge
trx for otitis externa
cortisporin otic QID x 7 days; or ciprofloxacin + hydrocortisone bid x 7 days
triad of mononucleosis
fatigue, pharyngitis, posterior cervical lymphadenopathy
avoid this drug if allergic to PCN
cephalosporins
difference b/t stye and chalazion
stye is painful, chalazion is not painful
medication for angular cheilitis
topical nystatin
common cause of angular cheilitis
C. albicans
first line trx for acute bacterial rhinosinusitis (ABRS)
augmentin
a characteristic of H. influenza is
may have some antimicrobial resistance to beta-lactamase
when sound gets better in a noisy enviornment
conductive hearing loss
Rinne test in conductive hearing loss
BC>AC
Weber test in conductive hearing loss
lateralizes to impaired ear
when hearing worsens in noisy enviornment
sensorineural hearing loss
Rinne test in sensorineural hearing loss
AC> BC
Weber test in sensorineural hearing loss
sound lateralizes to good ear
diphenhydramine is cautiously given in those with
BPH, COPD, glaucoma
most common cause of epiglottiitis
H influenza type b
s/s of epiglottitis
sore throat, stridor, sniffing posture, drooling, fever
Do not attempt to visualize pharynx if this is suspected
epiglottitis
rotavirus is given at
2 and 4 months
PCV13 is given at
2, 4, 6, 12-15 months
MMR is given at
12-15 months, 4-6 years
Hib is given at
2, 4, 12-15 months
DTap is given at
2, 4, 5, 15-18 months, 4-6 years
TdaP is given at
11-12 years, college freshmen, booster ever 10 years
varicella vaccine is given at
12-15 months, 4-6 years
s/s of acute rhinosinusitis
purulent nasal discharge, nasal congestion, tooth discomfort, facial pressure (esp when bending forward)
s/s suggestive of bacterial sinusitis
fever, purulent drainage; symptoms for more than 10 days
trx for rhinosinusitis
promote drainage
trx for bacterial sinusitis if allergic to PCN
doxycycline or quinolone
how long to trx for bacterial sinusitis
5-7 days
when should noticeable improvement occur after atbx for ABRS
3-5 days
complication of ABRS
periorbital cellulitis
diagnostic for periorbital cellulitis
CT with contrast
complications of GABHS
peritonsillar abscess, rheumatic fever, glomerulonephritis
Centor criteria for GABHS
absence of cough, fever greater than 100.4F, anterior lymphadenopathy, tonsillar exudate and swelling, age 3-14
RADT if greater than 2 points
If GABHS is not treated within 24-48 hours, then
symptoms will spontaneously resolve in 2-5 days. Can sequelae into rheumatic fever, glomerulonephritis.
Mononucleosis is caused by
Epstein-barr virus
s/s of mono
fever, pharyngitis, fatigue, posterior adenopathy, splenomegaly
diagnostic for mono
monospot (likely to be positive on 2-3rd week); EBV titers, CBC shows atypical lymphocytes
how long those with mono need to avoid direct contact sports
3-4 weeks
treatment for rhinitis medicamentosa
nasal steroid
first choice trx for allergic rhinitis
nasal steroid: diminishes allergic response overtime
4 step assessment of all eye complaints
- assess visual acuity
- examine with lamp or penlight
- fluourescein staining
- lid eversion
if patient only c/o scratchy and gritty sensation in eyes without visual changes, then suspect
viral conjunctivitis
best predicting s/s of AOM
cloudy, bulging TM with impaired mobility
causes of AOM in children
viral, streptococcus pneumonia
AOM in those less than 6 months old
always treat with atbx
f/u with AOM
in 48-72 hours
