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ENT Flashcards

1
Q

Eyelid/lashes turned outward 2T relaxation of orbicularis Oculi muscle: MC in elderly: BL:

irritation, ocular dryness and sagging of eyelid: Tx:

A

Ectropion (Inward Entropion)

Tx: Lubricating eye drops–> Sx

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2
Q

infection of lacrimal sac: MC S. Aureus: Redness to medial canthal side of lower lid: Tx?

A

Dacrocystitis

Tx: ABx- Clindamycin (Vancomycin + Ceftriaxone)

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3
Q

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:

A

Blepharitis

Tx: Baby shampoo scrub (Abx erythromycin)

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4
Q

Local abcess of eyelild: External=Sebaceous Internal=Meibomian: painful, warm swollen red lump Tx:

A

Hordeolum

Tx: Warm compress (>48hrs = I and D

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5
Q

elevated superficial fleshy triangular shape growing fibrovascular mass: MC inner corner (Nasal):

2T sun/dust/wind exposure: Tx

A

Pterygium (Nasal) and Pinguecula (Lateral-no growth)

Tx: observe (removal if affects vision)

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6
Q

Chalazion highlights

A
  • painless granuloma
  • internal Meibomian sebaceous gland
  • Tx= eye lid hygiene and warm compress (No abx)
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7
Q

eye trauma –> diplopia especially with upward gaze, orbital emphysema post-blowing of nose.

Dx: TX:

A

Orbital floor Blow-out fracture

Dx: Ct “teardrop sign”
Tx: Decongestant/ No nose blowing
Sx if severe or persistent diploplia

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8
Q

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:

A

Globe Rupture

Tx: Rigid Eye shield (Immediate Ophtho consult)
“ Emergency”

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9
Q

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

A

Macular Degeneration

Dx: Fluorescein Angiography
Tx: Bevacizumab (Anti-neovascular
Amsler grid monitors progession/stability

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10
Q

Wet macular degeneration specific pathophysiology

A
  • abnormal/new vessel leaks–> scarring

- Progresses more rapidly

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11
Q

Dry macular degeneration specific pathophysiology

A

-Drusen (acummulation of waste products from retinal pigment epithelium) small round yellow/white spots

MC

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12
Q

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:

A

Retinal Detachment

Tx: “Ophtho emergency” keep patient supine
No myotic drops

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13
Q

Corneal abrasion treatment?

A
  • > 5mm patch (Not longer than 24 hours)
  • 24 hour Ophtho follw up
  • Rust ring removal at 24 hours
  • Abx Erythromycin/Cipro
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14
Q

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:?

A

Viral conjunctivitis

Tx: cool compress, artificial tears, antihistamines (Olapatadine)

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15
Q

Cobblestone mucosa: conjunctival swelling (Chemosis) erythema, itching, tearing redness, stringy discharge:

Tx:

A

Allergic Conjunctivitis

Tx: Topical Antihistamines (Olapatadine), Ketorolac

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16
Q

MCC and 2nd MCC of Bacterial conjunctivitis

A

MCC= S. Aureus (2nd MCC Strep Pneumoniae)

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17
Q

Bacterial conjunctivitis manifestations

A
  • Purulent DC (lid crusting)
  • absence of ciliary injection
  • Fluorescein to R/O abrasion or Keratitis
  • mild pain
  • Tx: Erythromycin (Pseudomonas- Cipro/Moxi)
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18
Q

Treatment for Chlamydia or Gonorrhea Bacterial conjunctivitis?

A

May admit for IV or topical Abx

Gonorrhea=IV Ceftriaxone chlamydia= Azithromycin

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19
Q

Chemical burns to the eyes Tx:

A
  1. irrigate 30 min. or 2L
  2. pH between 7.0-7.3
  3. Antibiotics (Moxifloxacin)
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20
Q

usually secondary to sinus infection Ethmoid 90%: Aureus or pneumoniae: Decreased vision, proptosis,

eyelid erythema and edema, decreased vision, ocular movement pain. Dx: Tx:

A

Orbital (Septal cellulitis)

Dx: Ct scan (fat/muscle infection)
Tx: IV Abx (Clindamycin/vancomycin/cefotaxime)

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21
Q

misalignment of the eyes: Eso/Exotropia: Diplopia or amblyopia (Dec. visiual acuity) symptoms. Dx: Tx:

A

Strabismus

Dx: Hirshcberg (Light reflex)
Tx: Patch (Normal eye) Sx

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22
Q

MCC pseudomonas/acanthamoeba: pain, photophobia, reduced vision, tearing, conjunctival erythema:

Slit lamp corneal defect, Ciliary injection (Limbic Flush- red ring around limbus). Dx: Tx:

A

Keratitis (Corneal Ulcer)

Dx: slit lamp Tx; Moxifloxacin/Gatifloxacin
“Trifluradine or Vidarabine”- HSV Dendritic

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23
Q

usually occurs after blunt trauma: CMV infections: UL pain, redness, photophobia: Limbic Flush:

Tx:

A

Uveitis (Iritis)

Tx: Topical steroids
Cyclopentolate (Cycloplegic relieves m. spasm pain)

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24
Q

Risk factors of aging >60, smoking, Corticosteroid use:

Absent red reflex opaque lens

A

Cataract

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25
Q

headache, NV, vision is well preserved, swollen optic disc with blurred margins? Tx:?

A

Papilledema

Tx: Diuretics and Acetazolamide (CT R/O mass)

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26
Q

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:?

A

Optic Neuritis

Tx: IV methylprednisolone

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27
Q

Pupil constricts on accommodation but does not react to bright light. “ Prostitute- accommodates but not reacts”

MCC?

A

Argyll-Robertson Pupil

MCC= Neurosyphilis

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28
Q

Swinging of light from unaffected eye to affected eye–> pupils appear to dilate?

MCC?

A

Marcus Gun Pupil

MCC= Optic Neuritis

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29
Q

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

A

Acute narrow Angle-closure Glaucoma

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30
Q

Acute narrow Angle-closure Glaucoma Dx: Tx:

A

Dx: Tonometry >21mmHg
Tx: 1. Acetazolamide, Timolol, Pilocarpine (Cholinergics), Alpha 2 agonists- Apraclonidine

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31
Q

Slow progressive and painless BL, peripheral vision loss: Increased cup to disc ratio:

Reduced aqueous drainage from Trabeculum: Tx:

A

Chronic (Open Angle) Glaucoma

Tx: Latanoprost (Prostaglandin analog), BBs, Bromodine Acetazolamide,

32
Q

Temporary monocular vision loss: “curtain” lasting minutes with complete recovery usually within 1 hour:

TIA or Giant cell arteritis

A

Amaurosis Fugax

33
Q

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:

A

Central Retinal Vein Occlusion (CRVO)

34
Q

Central Retinal Artery occlusion highlights X5 :

A
  • MC 50-80 yo
  • MCC Thrombus
  • Pale retina + cherry red macula (Red spot)
  • “Box car” appearance
  • Tx: Acetazolamide, orbital massage in supine position
35
Q

1-2 day of ear pain/pruritus, auricular discharge, pressure or fullness: pain w pinna traction or tragus

A

Otitis Externa

Cipro+ dexamethasone
aminoglycoside- Meomycin/polytrim- B w cortisone–> ototoxicity

36
Q

MCC of otitis externa

A

Pseudomonas

37
Q

MC seen in Diabetics or immunocompromised: –> osteomyelitis at skull base.

IV Abx and admission required

A

Malignant Otitis Media

38
Q

Mastoiditis highlights and treatment

A
  • complication of Otitis media
  • Mastoid and deep ear tenderness
  • CT Diagnostic 1st line
  • IV Abx (Admit)
39
Q

bluging erythematous TM with effusion, loss of landmarks and mobility: MCC strep pneumoniae

Tx:

A

Acute Otitis Media

Tx: Amoxicillin 10-14 days     (Cefixime child)
2nd line (Augmentin or Cefaclor)
40
Q

If a bullae presents on a suspected AOM, suspect ?

A

Mycoplasma Pneumoniae

41
Q

PCN allergy treatment for AOM?

A

Erythromycin-Sulfisoxazole, Azithromycin, Septra

42
Q

Chronic Otitis media MC pathogen and treatment?

A

MC pathogen- Pseudomonas/S Aureus

Ofloxacin/ Ciprofloxacin

43
Q

Intermittent sharp ear pain, disequilibrium, ear fullness, CHL, tinnitus: Ear exam normal: Fluid behind TM:

Follows URI or allergic rhinitis- Tx

A

Eustachian Tube Dysfunction

Tx: 1. Pseudoephedrine, Phenylephrine, Oxymetazoline nasal spray 2. Auto-insufflation 3. INCS

44
Q

Tuning fork placed on top of head?

A

Weber

45
Q

BC>AC: Weber lateralizes to affected ear:

A

Conductive Hearing Loss

46
Q

AC>BC (Normal): Weber lateralizes to normal ear

A

Sensorineural HL

47
Q

MCC of conductive hearing loss (CHL)

A

Cerumen Impaction

48
Q

MCC of sensorineural hearing loss (SHL)

A

Presbycusis

49
Q

Cerumen Impaction Treatment?

A

Tx: Hydrogen Peroxidase Carbamide Peroxide

50
Q

MC anatomic position where membrane perforation occurs?

A

Pars Tensa

51
Q

granulation tissue that eroded the ossicles overtime–> CHL:

A

Cholesteatoma

52
Q

Abnormal bony growth: Slowly progressive CHL w tinnitus Tx:

A

Osteosclerosis

Tx: Stapedectomy w prosthesis

53
Q

Central vertigo highlights

A
  • Gradual onset
  • Positive CNS signs
  • Vertical Nystagmus
  • Migraine or Multiple sclerosis
54
Q

Peripheral Vertigo highlights

A
  • Sudden onset
  • no CNS signs
  • horizontal nystagmus
  • BPV (MC), Menieres
55
Q

sudden episodic vertigo lasting 10-60 seconds: Preceded or caused by _______

Tx:

A

Benign Paroxysmal Positional Vertigo (head movement)

Tx: Apley’s maneuver (Antihistamines)

56
Q

episodic peripheral vertigo lasting 1-8 hours: Horizontal nystagmus, NV, tinnitus, ear-fullness, Hearing loss:

2T Increased endolymphatic fluid Tx:

A

Meniere’s Disease

Tx: Meclizine Prophylaxis: diuretics avoid caffeine/salt chocolate/ETOH

57
Q

continuous vertigo, dizziness NV, gait disturbances, inflammation of CN post viral infection: lasts weeks ?

Rotary horizontal nystagmus away from affected side:

A

Vestibular Neuritis (CNIII)

58
Q

continuous vertigo, dizziness NV, gait disturbances, inflammation of CN post viral infection lasts weeks?

with hearing loss and tinnitus: Tx:

A

Labyrinthitis

Tx: 1st line corticosteroids (CS) Meclizine

59
Q

Unilateral sensorineural hearing loss with tinnitus: facial numbness, vertigo: Dx: Tx:

A

Acoustic Vestibular CNIII Neuroma

Dx: CT scan (Assoc. w NF II) Tx: Surgery

60
Q

symptoms of sinus pressure worse with bending down and leaning forward: purulent sputum or nasal discharge

CN VI palsy with frontal: Dx: TOC TX:

A

Acute sinusitis

Dx: CT scan Tx: Sx >10-14 days= Amoxicillin DOC 10-14
2nd line is Doxy/Septra

61
Q

Refractory acute sinusitis Tx

A

Augmentin or Cipro/Moxi

62
Q

Chronic sinusitis >12 consecutive weeks: Mucormycotic or aspergillus Tx:

A

Amphotericin B (or Posaconazole)

63
Q

Rhinitis viral MC pathogen

A

Rhinovirus

64
Q

Allergic rhinitis findings?

Tx

A
  • Clear rhinorrhea
  • pale violaceous turbinate (Viral-Erythematous)
  • cobblestone mucosa
  • Intranasal steroids most effective Tx (Polyps)
65
Q

Oxymetazoline, Phenylephrine or Naphazoline 3-5 days –> to what?

A

rhinitis medicamentosa

66
Q

Samster’s triad consists of what?

A

Asthma, Aspirin, and Polyps (INCS TOC)

67
Q

MC site of bleeding of anterior epistaxis?

A

Kiesselbach’s Plexus

68
Q

Sequential Epistaxis treatment?

A
  1. Direct pressure (10-15 min. seated forward)
  2. Topical decongestants (Oxymetazoline, Phenylephrine, cocaine)
  3. Cauterization
  4. Nasal Packing (Admit)
69
Q

Mucopurulent discharge with foul odor?

A

Nasal Foreign Body

70
Q

Viral MC overall cause of pharyngitis/tonsillitis?

A

Adeno virus/ Rhino virus

71
Q

MC bacterial pathogen of pharyngitis/tonsillitis?

Tx:

A

GABHS S pyogenes

Tx: PCN or PCN allergy Erythromycin/clindamycin
Macrolide

72
Q

what is the Centor criteria?

A

Fever (FACE)
Age (<15 yo +1) (>44 -1)
Cough absent/Cervical LAD
Exudates

73
Q

Rapid antigen detection test is more ___ than _____?

A

Specific than sensitive (most useful if positive)

Culture is definitive

74
Q

muffled hot potato voice, difficulty handling oral secretions, uvula deviation to CL side, C-LAD, dysphagia

DX: Tx:

A

Peritonsillar Abscess (Quinsy)

Dx: CT DOC Tx: Ampicillin+sulbactam or Clindamycin and Iand D

75
Q

Hoarseness, aphonia, pharyngitis, and rhinitis?

A

Laryngitis

76
Q

Oral candidiasis Treatment of choice?

A

Nystatin Liquid TOC (2nd Clotrimazole PO fluconazole_

PANCE (13 decks)

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