ENT Flashcards
Blepharitis
Inflammation of both eyelids
Anterior: Staph Aureus most common or Seborrheic
Posterior: Dysfunction of Meibomian gland
Sx: Eye irritation/tiching, burning, erythema with CRUSTING, SCALING, RED RIMMING, EYELASH FLAKING
Tx: Anterior - Heigene, warm compress, eyelid scrub with baby shampoo
Posterior - Eyelid massage, expression of Meibomian gland regularly
Hordeolum (Stye)
Local abscess of EYELID MARGIN
Staph Aureus
Sx: Painful, warm, swollen red lump on eyelid
Tx: Warm compress
Chalazion
Painless granuoma of internal meibomian sebaceous gland leads to focal eyelid swelling
Sx: Hard, non-tender eyelid swelling
Tx: Hygiene, warm compress
Dacrocystitis
Infection of lacrimal gland
S. Auerus, Group A Beta-Hemolytic Strep
Sx: Tenderness, edema, redness to nasal side of lower lid
Tx: Systemic abx like Clindamycin + 3rd gen Cephalosporin
Pterygium
Elevated superficial fleshy TRIANGULAR SHAPED GROWING FIBROVASCULAR MASS
Usually on nasal side of eye
Associated with UV exposure, sand, wind, dust
Tx: Observation, removal if vision affected
Pinguecula
Yellow, elevated nodule on nasal side of eye, usually fat and protein deposit, it doesn’t grow
Orbital Floor Blowout Fracture
Maxillary, Zygomatic, Palatine bones
Sx: Decreased visiaul acuity, Enophthalmos
Diplopia, especially with upward gaze
Orbital emphysema (eyelid swelling)
Dx: CT scan
Tx: Nasal decongestants to reduce pain, avoid blowing nose, prednise, surgery
Globe Rupture
Outer membrane of eye disrupted by blunt or penetrating trauma
Sx: Ocular pain, diplopia
Misshaped eye with prolapse of ocular tisue, reduced acuity, Enophthalmos
Severe conjunctival hemorrhage
Positive Seidel’s test
Teardrop or irregularly shaped pupil
Tx: RIGID EYELID SHILED
Macular Degeneration
Most common cause of PERMANENT legal blindneess and visual loss in ELDERLY
Macula responsible for CENTRAL VISION (DETAIL AND COLOR)
Dry: gradual breakdown of macula, see DRUSEN (small, round, yellow white spots on outer retina
Wet: Neovascular or Exudative, new abnormal vessels grow under central retina
Dx of wet is Fluorescein angiography
Sx: BILATERAL blurred or loss of CENTRAL VISION, scotomas, metamorphopsia
Tx: Dry amsler Grid at home, Vitamin A, C, E and zinc slows progression
Wet anti-angiogeniecs (bevacizumab) VEGF inhibitior
Diabetic Retinopathy
Most common cause of PERMANENT blindness in young
Damage to retinal blood vessels that leads to retinal ischemia
Non-proliferative: Microaneurysms, flame shaped hemorrahges, cotton-wool spots, hard excudates, not associated with vision loss
Proliferative: Neovascularization, Tx with VEGF inhibitors (Bevacizumab)
Maculopathy: Macular edema or excudates, blurred vision, central vision loss
Hypertensive Retinopathy
Damage to retinal blood vessels from longstanding high blood pressure
Tx: Control HTN
Increasing severity
I: Arterial Narrowing: abnormal light reflexes on dilated tortuous arteriole, copper wiring, silver wiring
II: AV Nicking: Venous compression at junction due to increased arterial pressure
III: Flame shaped hemorrhages, Cotton Wool Spots
IV: Papilledema (MALIGNANT HTN)
Papilledema
Optic Nerve, Disc swelling due to increased intracranial pressure
Due to Idiopathic Intracranial HTN, space-occupying lesion, Increased CSF production, Cerebra ledema
Sx: Headache, N/V, VISION USUALLY WELL PRESERVED
Dx: MRI or CT to r/u mass effect, Lumbar Puncture shows increased CSF pressure
Tx: Diuretics (acetazolamide)
Retinal Detachment
Retinal tear that lads to retinal inner lyaer detachment from choroid plexus
Sx: Photopsia (flashing lights), Floaters, Progressive UNILATERAL vision loss, CURTAIN in peripheral with eventual central visiaul field. No pain or redness
Dx: Fundoscopy, Positive Schaffer’s Sign (Clumping of pgiment cells in atnerior vitreous)
Tx: Laser, Cryotherapy ocular srugery
Corneal Abrasion
Foreign body sensation, tearing, red and painful eye
Dx: Pain relieved with ophthalmic analgesic drops
Fluorescein staining for epithelial defects
Tx: Remove foreign body with sterile irrigation or moist sterile cotton swab
Topical abx, Rust ring
Orbital Cellulitis
Postseptal
Secondary to SINUS INFECTION: S. Pneumo, GABHS, H.Flu, S. Aureus
Sx: Decreased vision, PAIN WITH MOVEMENT, proptosis
Dx: CT shows infection of fat and ocular muscles
Tx: IV abx (Vancomycin, Clindamycin, Cefotaxime)
Preseptal Cellulitis
Infection of eyelid and periocular tissue
No visual changes no pain with ocular movement
Acute Narrow Angle Closure Glaucoma
Glaucoma is increased intraocular pressure that can lead to optic nerve damage
Due to decreased drainiage of aqueous humor
Sx: Severe unilateral ocular PAIN, N/V, headache, intermittent blurry vision, HALOS AROUND LIGHTS, PERIPHERAL LOSS OF VISION (TUNNEL VISION)
Steamy Cornea, Nonreactive pupil, eye feels hard to palpation
Dx: Increased IOP by tonometry, Cupping of optic nerve
Tx: Acetazolamide IV is 1st line to decrease IOP
Topical Beta Blocker (Timolol) reduces IOP
Miotics/Cholinergics (Pilocarpine, Carbachol)
Chronic Open Angle Glaucoma
Slow progressive BILATERAL peripheral vision loss
sx: TUNNEL VISION
Tx: Prostaglandins (Latenoprost), Timolol
Viral Conjunctivitis
Adenovirus
Swimming pools is comon source
Very contagious
Sx: Preaurical lymphadenopathy, copious WATERY DISCHARGE, bilateral
Tx: Cool compress, artificial tears, antihistamines for itching/redness
Allergic Conjuncitivitis
Red eyes, viral sx (rhinorrhea, fever, malaise, pharyngitis)
Sx: Cobblestone Mucosa, itching tearing
Tx: Topical Antihistamines (Olopatadine)
Bacterial Conjuncitivits
Staph and Strep
Sx: Purulent discharge, lid crusing, no visual changes
Absence of ciliary injection
Tx: Topica Abx (Erythromycin)
If wear contacts cover for pseudomonas with FQ
Optic Neuritis
Acute inflammatory demylenation of optic nerve
Seen in multiple sclerosis, and meds like ethambutol
Sx: Loss of color vision, visiaul field defects, ocular pain worse with eye movement
Marcus Gunn Pupil (afferent pupillary defect)
Tx: IV Methylprednisolone)
Uveitis
Inflammation of IRis or ciliary body
Usually seen with LA-B27
Sx: Unilateral ocular pain/redness/photophobia
Ciliary injection, consensual photophobia
Tx: Topical Steroids or systemic if posterior
Central Retinal Artery Occlusion
Retinal artery thrombus or embolus
Usually due to atherosclerotic disease
Sx: Acute, sudden monocular vision loss, usually preceeded by Amaurosis Fugax (temorary monocular vision loss that lasts few a minutes with complete recovery)
Dx: Fundoscopy shows pale retina with cherry red macula (RED SPOT), VEins show Box car appearance
Tx: Decrease IOP (acetazolamide), Lay patient flat on back, massage orbit to dislodge clot
Central Retinal VEIN Occlusion
Usually due to vein thrombus that leads to fluid bakcup and acute sudden monocular vision loss
HTN, DM, gluacoma are risk factors
Dx: Fundoscopy shows extensive retinal hemorrhages (BLOOD AND THUNDER APPEARANCE)
Tx: Anti-Inflammatories, steroids, plasphaeresis
Cataracts
Lens Opacification due to protein preceiptation in lens
RF: Smoking, Corticosteroids, Aging
Sx: Blurred/loss of vision over months, years, halos around lights, absent red reflex
Tx: Remove cataract
Otitis Externa
Pseudomonas
Swimmers Ear
Sx: Ear pain, pruritus, auricular discharge, pressure/fullness
Pain on traction of ear canal/tragus, Erythema, edema, debris
Tx: Cipro/Dexamethasone
Drying agents like Isopropyl alcohol and aceitic acid
Aminoglycoside antibiotics
Acute Otitis Media
Strep Pneumo, H. Influenza, Moraxella, Group A Beta-Hemolytic strep (S.Pyogens) (SAME AS FOR BRONCHITIS AND SINUSITIS)
Sx: Ear tugging in infants, fevers, otalgia, conductive hearing loss
If TM perforated there will be rapid relief of pain and otorrhea
Bulging, erythematous TM with effusion and decreased TM mobility
Tx: Amoxicillin for 10-14 days, Cefixime in children, Augmentin is 2nd line
If PCN allergy use Erythromycin-Sulfisoxazole, Azithromycin, Bactrim
Mastoiditis
Inflammation of mastoid air cells
Sx: Deep ear pain, mastoid tenderness
Tx: IV abx with Myringotomy (Ampicillin, Cefuroxime)
IF refractory, mastoidectomy
Acoustin Neruoma
CN 8 Schwannoma, benign tumor of Schwann cels
Sx: Unilateral hearing loss is acoustic neuroma until proven otherwise, tinnitus, headache, facial numbness
Dx: MRI or CT
Tx: Surgery
Cerumen Impaction
Wax impacted in external auditory canal
Tx: Hydrogen Peroxide, Carbamide Peroxide
Vertigo
False sene of motion
Peripheral: Location is Labyrinth or vestibular Nerve, have horizontal nystagmus, fatigue, sudden onset of tinnitus and hearing loss
Central: Brainstem or cerebellar location, have verticle nystagmus, continuous, gait abnormalities, positive CNS isgns
Tx: Antihistamines are 1st line with Meclizine, Cyclizine, Dimenhydrinate
Dopamine blockers (Metoclopramide, prochlorperazine)
Anticholinergics (scopolamine)
Benzodiazepines with Lorazepam, Diazepam
Benign Paroxysmal Positional Vertigo
Caused by displaced otoliths
Sx: Episodic peripheral vertigo provoked with changes of head position, usually lasts 10-60 seconds
Dix-Hallpike Test Positive (causes fatiguable horizontal nystagmus
Tx: Epley Maneuver: CAnalith reposition
Antihistamines (Meclizine)
Labyrinthitis
Vestibular neuritis WITH hearing loss/tinnitus
Sx: Peripheral vertigo, usually continuous, dizziness, N/V, gait issues, hearing loss
Tx: Corticosteroids
Antihistamines (meclizine)
Vestibular Neuritis
Inflammation of vestibular portion of CN 8 of inner ear
Usually after viral infection
Sx: Peripheral vertigle, dizziness, N/V, gait issues
Tx: Corticosteroids
Antihistamines (Meclizine)
Meniere’s Disease
Distention of endolymphatic compartemnt of inner ear by excess fluid
Sx: Episodic peripheral vertigo lasting 1-8 hours with horizatonal nystagmus, N/V
Ear fullness
Dx: Dix-Hallpike Position test
Tx: Antiemetics with Meclizine, Benzodiazepines
Preventative use diuretics (HCTZ) to reduce presure, avoid salt/caffeine/chocolate/alochol
Cholesteatoma
Abnromal growth of aquamous epithelium that leads to mastoid bony erosion
Sx: Painless otorrhea (brown/yellow/dischrage with strong odor)
Tx: Surgical excision and reconstruction of ossicles
Weber Test vs. Rinne Test
Weber: Top of head, no lateralization is normal
Rinne: Mastoid by ear, Normal is Air conducution > Bone Conduction
Sensorinueral hearing loss
Inner ear disroders
SensoriNueral laterizes to NORMAL ear + NORMAL Rinne
N=Neural
Due to inner ear disroders (labarynthitis, menieres)
Conductive hearing loss
Lateraizest to AFFECTED ear, Bone Conduction>Air Conduction
Due to external or middle ear disroders
Acute Sinusitis
Strep. Pneumo, GABHS (Strep.Pyogens), H. Flu, Moraxella (same as Acute Otitis Media)
Often occurs with rhinitis or follows URI
Sx: Sinus pain/pressure, worse with bending down and leaning forward, ehadache, purulent sputum or nasal drainage
Maxillary is most common affected
Sinus tenderness on palpation, opacification with trans illumination
Dx: CT is 1st choice
Xray: WAter’s View
Tx: Amoxicillin 10-14 days, Doxycycline, Bactrim
Chronic Sinusitis
Sinusitis for more than 8 weeks
Staph. Aureus is most common, Pseudomonas, anareobes
Rhinitis
Allergic is most common, IgE mediated mast cell histamine release
Infectious is due to Rhinovirus (common cold), GABHS
Sx: Sneezing, nasal congestion/itching, clear rhinorrhea
Sx: Allergic will have pale/violaceous, boggy turbinates, nasal polyps with cobblestone mucosa
Viral will have erythematous turbinates
Tx: Oral Antihistamines
Decongestants like pseudoephedrine
Intranasal Steroids for allergic with nasal polyps
Epistaxis
Anterior is most common, Kiesselbach’s Plexus
Posterior is due to Palatine artery
Tx: Direct pressure for 10 minutes, leaning forweard while seated
Short acting topical decongestants like cocaine, phenyephrine, oxymetazoline nasal (AFrin)
Cauterization or nasal packing if all else fails
Sialadenitis
BActerial infection of parotid or submandibular salivary gland
Sx: Acute swelling of glands after meals, tenderness at ductal opening
Tx: Increase salivery flow, Lemon Drops
Sialolithiasis
Saliveary stones due to Submandibular (Wharton’s duct) or Stenson’s (Parotid gland)
Sx: Post prandial salivary gland pain and swelling
Oral Lichen Planus
Idiopathic cell mediated autoimmune response
More common in HCV infections
Sx: LACY LEUKOPLAKIA LESIONS OF ORAL MUCOSA
Tx: Steroids
Oral Leukoplakia
Precancerous hyperkeratosis due to chronic irritation
Smoking, alcohol, dentures are risk factors
Sx: WHITE PATCHY LESIOSNT HAT CAN’T BE RUBBED OFF, PAINLESS
Tx: Cryotherapy, laser ablation
Erythroplakia
Precancerous lesions similar to leukoplakia but with erythema, most are dysplastic or evident of Squamous Cell Carcinoma
Oral Hairy Leukoplakia
EPSTEIN BARR VIRUS (HHV-4)
Seen in HIV patients
Sx: Non painful white plaque along LATERAL TONGUE BORDERS or BUCCAL mucosa, smooth or irregular hairy orfeature
Tx: Antiretrovial or nothing
Oral CAndidaias
Candida Albicans
Sx: White curd-like plaques, leave behind erythema/bleed if scraped
Dx: KOH smear see budding yeast/hyphae
Tx: Nystatin, Fluconazole
Aphthous Ulcers (Canker Sore)
Painful ulcers with erythematous halos
Tx: Topical analgesics, topical oral steroids
Peritonsillar Abscess
GABHS, Staph. Aureus, Polymirobial
Sx: Muffled, hot potato voice, difficultly handling oral secretions, uvula deviation to contralateral side
Dx: CT scan
Tx: Drainage and Antibiotics (Unasyn or Clindamycin), steroids for edema
Epiglottitis
H. Influenza
Sx: Abrupt onset of fevers, drooling, dysphagia and distress (Tripod position)
Dx: NO DIRECT VISUALATION, can cause laryngospasms
Lateral cervica film shows THUMB SIGN
Laryngoscope is DEFINITIVE in adults see cherry-red epiglots
Tx: Secure airway first, IV abx (Ceftriaxone + clindamycin)
