ENT Flashcards
Eyelid/lashes turned outward 2T relaxation of orbicularis Oculi muscle: MC in elderly: BL:
irritation, ocular dryness and sagging of eyelid: Tx:
Ectropion (Inward Entropion)
Tx: Lubricating eye drops–> Sx
infection of lacrimal sac: MC S. Aureus: Redness to medial canthal side of lower lid: Tx?
Dacrocystitis
Tx: ABx- Clindamycin (Vancomycin + Ceftriaxone)
inflammation of both eyelids: MC in trisomy 21 and Eczema: Anterior= infectious or seborrheic:
Posterior= Meibomian gland dysfunction: crusting, red-rimming, scaling of eyelid: eyelash flaking Tx:
Blepharitis
Tx: Baby shampoo scrub (Abx erythromycin)
Local abcess of eyelild: External=Sebaceous Internal=Meibomian: painful, warm swollen red lump Tx:
Hordeolum
Tx: Warm compress (>48hrs = I and D
elevated superficial fleshy triangular shape growing fibrovascular mass: MC inner corner (Nasal):
2T sun/dust/wind exposure: Tx
Pterygium (Nasal) and Pinguecula (Lateral-no growth)
Tx: observe (removal if affects vision)
Chalazion highlights
- painless granuloma
- internal Meibomian sebaceous gland
- Tx= eye lid hygiene and warm compress (No abx)
eye trauma –> diplopia especially with upward gaze, orbital emphysema post-blowing of nose.
Dx: TX:
Orbital floor Blow-out fracture
Dx: Ct “teardrop sign”
Tx: Decongestant/ No nose blowing
Sx if severe or persistent diploplia
outer membrane of eye is disrupted by trauma or penetration. Diplopia w ocular pain: Tear-drop pupil:
Prolapse of the iris through the cornea (+) Seidel’s test: Obscure red reflex: Tx:
Globe Rupture
Tx: Rigid Eye shield (Immediate Ophtho consult)
“ Emergency”
occurs > 50 yo: “MCC of permanent blindness and visual loss in elderly”:
BL blurred or central vision loss (detailed/color vision): blindspots/shadows or lines bent: Dx : Tx
Macular Degeneration
Dx: Fluorescein Angiography
Tx: Bevacizumab (Anti-neovascular
Amsler grid monitors progession/stability
Wet macular degeneration specific pathophysiology
- abnormal/new vessel leaks–> scarring
- Progresses more rapidly
Dry macular degeneration specific pathophysiology
-Drusen (acummulation of waste products from retinal pigment epithelium) small round yellow/white spots
MC
Progressive UL vision loss: Floaters, shadow/curtain coming down” peripherally initially, loss of central vision
Causes: DM retinopathy, sickle cell, Trauma:
Rhegmatogenous MC type Tx:
Retinal Detachment
Tx: “Ophtho emergency” keep patient supine
No myotic drops
Corneal abrasion treatment?
- > 5mm patch (Not longer than 24 hours)
- 24 hour Ophtho follw up
- Rust ring removal at 24 hours
- Abx Erythromycin/Cipro
Preauricular LAD: copious watery eye discharge: scant mucoid DC swimming pool MC source: MC in children:
punctate staining on slit lamp exam: often BL: TX:?
Viral conjunctivitis
Tx: cool compress, artificial tears, antihistamines (Olapatadine)
Cobblestone mucosa: conjunctival swelling (Chemosis) erythema, itching, tearing redness, stringy discharge:
Tx:
Allergic Conjunctivitis
Tx: Topical Antihistamines (Olapatadine), Ketorolac
MCC and 2nd MCC of Bacterial conjunctivitis
MCC= S. Aureus (2nd MCC Strep Pneumoniae)
Bacterial conjunctivitis manifestations
- Purulent DC (lid crusting)
- absence of ciliary injection
- Fluorescein to R/O abrasion or Keratitis
- mild pain
- Tx: Erythromycin (Pseudomonas- Cipro/Moxi)
Treatment for Chlamydia or Gonorrhea Bacterial conjunctivitis?
May admit for IV or topical Abx
Gonorrhea=IV Ceftriaxone chlamydia= Azithromycin
Chemical burns to the eyes Tx:
- irrigate 30 min. or 2L
- pH between 7.0-7.3
- Antibiotics (Moxifloxacin)
usually secondary to sinus infection Ethmoid 90%: Aureus or pneumoniae: Decreased vision, proptosis,
eyelid erythema and edema, decreased vision, ocular movement pain. Dx: Tx:
Orbital (Septal cellulitis)
Dx: Ct scan (fat/muscle infection)
Tx: IV Abx (Clindamycin/vancomycin/cefotaxime)
misalignment of the eyes: Eso/Exotropia: Diplopia or amblyopia (Dec. visiual acuity) symptoms. Dx: Tx:
Strabismus
Dx: Hirshcberg (Light reflex)
Tx: Patch (Normal eye) Sx
MCC pseudomonas/acanthamoeba: pain, photophobia, reduced vision, tearing, conjunctival erythema:
Slit lamp corneal defect, Ciliary injection (Limbic Flush- red ring around limbus). Dx: Tx:
Keratitis (Corneal Ulcer)
Dx: slit lamp Tx; Moxifloxacin/Gatifloxacin
“Trifluradine or Vidarabine”- HSV Dendritic
usually occurs after blunt trauma: CMV infections: UL pain, redness, photophobia: Limbic Flush:
Tx:
Uveitis (Iritis)
Tx: Topical steroids
Cyclopentolate (Cycloplegic relieves m. spasm pain)
Risk factors of aging >60, smoking, Corticosteroid use:
Absent red reflex opaque lens
Cataract
headache, NV, vision is well preserved, swollen optic disc with blurred margins? Tx:?
Papilledema
Tx: Diuretics and Acetazolamide (CT R/O mass)
MC seen in multiple sclerosis or Ethambutol Rx: loss of color vision/central vision over a few days:
Associated with ocular pain that is worse with eye movement. Marcus-Gunn Pupil; Blurred disc-cup: Tx:?
Optic Neuritis
Tx: IV methylprednisolone
Pupil constricts on accommodation but does not react to bright light. “ Prostitute- accommodates but not reacts”
MCC?
Argyll-Robertson Pupil
MCC= Neurosyphilis
Swinging of light from unaffected eye to affected eye–> pupils appear to dilate?
MCC?
Marcus Gun Pupil
MCC= Optic Neuritis
Sudden onset of UL ocular pain, NV, headache, halos around lights, peripheral vision loss:
Mid dilated fixed non-reactive pupil: precipitated from bright into dark, sympathomimetics or anticholinergics
Acute narrow Angle-closure Glaucoma
Acute narrow Angle-closure Glaucoma Dx: Tx:
Dx: Tonometry >21mmHg
Tx: 1. Acetazolamide, Timolol, Pilocarpine (Cholinergics), Alpha 2 agonists- Apraclonidine
Slow progressive and painless BL, peripheral vision loss: Increased cup to disc ratio:
Reduced aqueous drainage from Trabeculum: Tx:
Chronic (Open Angle) Glaucoma
Tx: Latanoprost (Prostaglandin analog), BBs, Bromodine Acetazolamide,
Temporary monocular vision loss: “curtain” lasting minutes with complete recovery usually within 1 hour:
TIA or Giant cell arteritis
Amaurosis Fugax
Acute sudden monocular vision loss, extensive retinal hemorrhages “blood and thunder: fluid back up
optic disc swelling, macular edema: RF-HTN, DM, Glaucoma or hypercoagulable states Tx:
Central Retinal Vein Occlusion (CRVO)
Central Retinal Artery occlusion highlights X5 :
- MC 50-80 yo
- MCC Thrombus
- Pale retina + cherry red macula (Red spot)
- “Box car” appearance
- Tx: Acetazolamide, orbital massage in supine position
1-2 day of ear pain/pruritus, auricular discharge, pressure or fullness: pain w pinna traction or tragus
Otitis Externa
Cipro+ dexamethasone
aminoglycoside- Meomycin/polytrim- B w cortisone–> ototoxicity
MCC of otitis externa
Pseudomonas
MC seen in Diabetics or immunocompromised: –> osteomyelitis at skull base.
IV Abx and admission required
Malignant Otitis Media
Mastoiditis highlights and treatment
- complication of Otitis media
- Mastoid and deep ear tenderness
- CT Diagnostic 1st line
- IV Abx (Admit)
bluging erythematous TM with effusion, loss of landmarks and mobility: MCC strep pneumoniae
Tx:
Acute Otitis Media
Tx: Amoxicillin 10-14 days (Cefixime child) 2nd line (Augmentin or Cefaclor)
If a bullae presents on a suspected AOM, suspect ?
Mycoplasma Pneumoniae
PCN allergy treatment for AOM?
Erythromycin-Sulfisoxazole, Azithromycin, Septra
Chronic Otitis media MC pathogen and treatment?
MC pathogen- Pseudomonas/S Aureus
Ofloxacin/ Ciprofloxacin
Intermittent sharp ear pain, disequilibrium, ear fullness, CHL, tinnitus: Ear exam normal: Fluid behind TM:
Follows URI or allergic rhinitis- Tx
Eustachian Tube Dysfunction
Tx: 1. Pseudoephedrine, Phenylephrine, Oxymetazoline nasal spray 2. Auto-insufflation 3. INCS
Tuning fork placed on top of head?
Weber
BC>AC: Weber lateralizes to affected ear:
Conductive Hearing Loss
AC>BC (Normal): Weber lateralizes to normal ear
Sensorineural HL
MCC of conductive hearing loss (CHL)
Cerumen Impaction
MCC of sensorineural hearing loss (SHL)
Presbycusis
Cerumen Impaction Treatment?
Tx: Hydrogen Peroxidase Carbamide Peroxide
MC anatomic position where membrane perforation occurs?
Pars Tensa
granulation tissue that eroded the ossicles overtime–> CHL:
Cholesteatoma
Abnormal bony growth: Slowly progressive CHL w tinnitus Tx:
Osteosclerosis
Tx: Stapedectomy w prosthesis
Central vertigo highlights
- Gradual onset
- Positive CNS signs
- Vertical Nystagmus
- Migraine or Multiple sclerosis
Peripheral Vertigo highlights
- Sudden onset
- no CNS signs
- horizontal nystagmus
- BPV (MC), Menieres
sudden episodic vertigo lasting 10-60 seconds: Preceded or caused by _______
Tx:
Benign Paroxysmal Positional Vertigo (head movement)
Tx: Apley’s maneuver (Antihistamines)
episodic peripheral vertigo lasting 1-8 hours: Horizontal nystagmus, NV, tinnitus, ear-fullness, Hearing loss:
2T Increased endolymphatic fluid Tx:
Meniere’s Disease
Tx: Meclizine Prophylaxis: diuretics avoid caffeine/salt chocolate/ETOH
continuous vertigo, dizziness NV, gait disturbances, inflammation of CN post viral infection: lasts weeks ?
Rotary horizontal nystagmus away from affected side:
Vestibular Neuritis (CNIII)
continuous vertigo, dizziness NV, gait disturbances, inflammation of CN post viral infection lasts weeks?
with hearing loss and tinnitus: Tx:
Labyrinthitis
Tx: 1st line corticosteroids (CS) Meclizine
Unilateral sensorineural hearing loss with tinnitus: facial numbness, vertigo: Dx: Tx:
Acoustic Vestibular CNIII Neuroma
Dx: CT scan (Assoc. w NF II) Tx: Surgery
symptoms of sinus pressure worse with bending down and leaning forward: purulent sputum or nasal discharge
CN VI palsy with frontal: Dx: TOC TX:
Acute sinusitis
Dx: CT scan Tx: Sx >10-14 days= Amoxicillin DOC 10-14
2nd line is Doxy/Septra
Refractory acute sinusitis Tx
Augmentin or Cipro/Moxi
Chronic sinusitis >12 consecutive weeks: Mucormycotic or aspergillus Tx:
Amphotericin B (or Posaconazole)
Rhinitis viral MC pathogen
Rhinovirus
Allergic rhinitis findings?
Tx
- Clear rhinorrhea
- pale violaceous turbinate (Viral-Erythematous)
- cobblestone mucosa
- Intranasal steroids most effective Tx (Polyps)
Oxymetazoline, Phenylephrine or Naphazoline 3-5 days –> to what?
rhinitis medicamentosa
Samster’s triad consists of what?
Asthma, Aspirin, and Polyps (INCS TOC)
MC site of bleeding of anterior epistaxis?
Kiesselbach’s Plexus
Sequential Epistaxis treatment?
- Direct pressure (10-15 min. seated forward)
- Topical decongestants (Oxymetazoline, Phenylephrine, cocaine)
- Cauterization
- Nasal Packing (Admit)
Mucopurulent discharge with foul odor?
Nasal Foreign Body
Viral MC overall cause of pharyngitis/tonsillitis?
Adeno virus/ Rhino virus
MC bacterial pathogen of pharyngitis/tonsillitis?
Tx:
GABHS S pyogenes
Tx: PCN or PCN allergy Erythromycin/clindamycin
Macrolide
what is the Centor criteria?
Fever (FACE)
Age (<15 yo +1) (>44 -1)
Cough absent/Cervical LAD
Exudates
Rapid antigen detection test is more ___ than _____?
Specific than sensitive (most useful if positive)
Culture is definitive
muffled hot potato voice, difficulty handling oral secretions, uvula deviation to CL side, C-LAD, dysphagia
DX: Tx:
Peritonsillar Abscess (Quinsy)
Dx: CT DOC Tx: Ampicillin+sulbactam or Clindamycin and Iand D
Hoarseness, aphonia, pharyngitis, and rhinitis?
Laryngitis
Oral candidiasis Treatment of choice?
Nystatin Liquid TOC (2nd Clotrimazole PO fluconazole_