ENT Flashcards
(151 cards)
1
Q
Fundoscopic exam with ACCG would show
A
cupping of optic disk
2
Q
Multiple sclerosis and eye presentation
A
- new or intermittent loss of vision in one eye
- possible nystagmus
- other neuro symptoms present
- refer to neurologist
3
Q
Retinal detachment patient complaints
A
- sudden onset floaters
- “looking through a curtain”
- sudden flashes of light (photopsia)
- ED referral
4
Q
Cholesteatoma presentation
A
- “cauliflower-like growth”
- foul-smelling ear discharge
- hearing loss on affectedear
- no TM or ossicles visible
- hx of chronic OM
5
Q
Cholesteatoma can cause damage to which nerve if not treated
A
CN VII
6
Q
Urine dipstick will be positive for what with CSF leak
A
glucose
7
Q
Peritonsillar abscess presentation
A
- severe sore throat
- difficulty talking
- odynophagia (pain on swallowing)
- “hot potato” voice
- trismus (jaw muscle spasm making it difficult to open mouth)
8
Q
Diptheria presentation
A
- sore throat
- fever
- “bull’s neck”
- throat covered with gray to yellow pseudomembrane
- contact prophylaxis required
- refer to ED
9
Q
Age related visul change
A
Presbyopia
10
Q
Presbyopia occurs due to what
A
decreased ability of the eye to accommodate stiffening of the lenses
-difficulty reading small print at close range
11
Q
Leukoplakia
A
- white to light gray patch on tongue, floor of mouth, or inside cheek
- rule out oral cancer
- chewing tobacco and alcohol use increases risk
12
Q
Aphthous stomatitis
A
- painful shallow ulcers on soft tissue
- treat with magic mouthwash
13
Q
Plan for avulsed tooth
A
-store in cool milk or saline and see dentist
14
Q
Vermillion border
A
edges of lips
15
Q
Oral commissure
A
corners of lips
16
Q
Sialolithiasis
A
blocked salivary gland with a stone
17
Q
Geographic tongue
A
- map like appearance
- complain of soreness with acidic and spicy foods
18
Q
Torus Palanitus
A
- painless bony prominence midline on hard palate
- may be asymmetrical
- benign
19
Q
Fishtail or split uvula
A
- may be a sign of occult cleft palate
- rare
20
Q
Physiological gaze-evoked nystagmus
A
-with prolonged extreme lateral gaze, a few beats of nystamgus that resolves when back at midline is normal
21
Q
Hypertensive retinopathy fundoscopic exam findings
A
- retinal hemorrhages
- Copper silver wire arterioles
- AV nicking
22
Q
Diabetic retinopathy fundoscopic exam findings
A
- cotton wool spots
- hard exudates
- flame hemorrhages
- microaneurysms
- neovascularization
23
Q
Nasal polyps have an increased risk for what
A
ASA sensitivity or allergy
24
Q
Hairy leukoplakia
A
- elongated papilla on lateral aspects of tongue
- pathognomonic for HIV infection
25
What is hairy leukoplakia caused by
EBV
26
Oral leukoplakia of oral mucosa/tongue
- bright white plaque caused by chronic irritation
| - r/o oral cancer
27
Cheilosis
- painful skin fissures and maceration at corners of mouth due to excessive moisture
- 2ndary infection with Candida or Staph
28
Cheilosis treatment
- check B12 to r/o pernicious anemia
- remove underlying cause
- if yeast: topical azole ointment (clotrimazole)
- staph: topical mupirocin
- once cleared: used barrier cream or petroleum jelly
29
Palpebral conjunctiva
mucosal lining inside eyelids
30
Bulbar conjunctiva
mucosal lining covering eyes
31
Hyperopia
farsight
| -near vision blurry
32
Myopia
- near sight
| - far vision blurry
33
What chart to use if patient is illiterate
Tumbling E
34
Right eye
OD
35
Left eye
OS
36
Both eyes
OU
37
Testing peripheral vision
confrontation
38
Test for color blindness
Ishihara chart
39
Legal blindness
Best corrected vision of 20/200
| or visual field less than 20 degrees (tunnel vision)
40
If child's vision is not 20/20 by what age should they be referred to ophtho
-6 years
41
Normal Weber test
no lateralization
42
Weber test: lateralization to "good ear"
Sensorineural loss
- Meniere's
- Presbycusis
43
Weber test: lateralization to bad ear
-conductive loss
| OM, SOM, ceruminosis, TM perforation
44
Normal Rinne test
AC > BC
45
AC > BC with Rinne test can indicate what
normal or sensorineural hearing loss
46
BC > AC with Rinne test can indicate what
conductive hearing loss
47
Weber test method
place tuning fork midline on forehead
48
Rinne test method
- place tuning fork first on mastoid, then in front of ear
| - time each one
49
Presbycusis
age-related hearing loss
50
Ototoxic medications
- aminoglycosides
- erythromycin
- tetracyclines
- high dose ASA
- sildenafil, etc
51
Herpes keratitis black lamp presentation
-fern-like lines on corneal surface
52
Contact lens related keratitis
-abrasions usually in center and round
53
Contact lens related keratitis treatment
- check pupils
- Flush with sterile NS to remove foreign body
- remove FB if possible, refer if you can't
- Topical antibiotic with pseudomonal coverage (Cipro, ofloxacin, Polytrim)
- do not patch
- F/u 24 hours, ED or optho if no improvement
- Topical pain meds: Acular 1 gtts QID
54
Topical antibiotic for contact lens related keratitis
- need pseudomonal coverage
| - (Cipro, ofloxacin, Polytrim)
55
Hordeolum
- abscess of hair follicle and sebaceous gland in upper or lower eyelid
- may have history of blepharitis
56
Hordeolum treatment
- hot compress
- if spreading to preseptal cellulitis: dicloxacillin or erythromycin
- refer to ophto for I&D
57
Chalazion
- chronic inflam of meibomian gland of eyelids
| - resolve in 2-8 weeks
58
Chalazion treatment
- self-resolving
| - refer to optho if interfering with vision
59
Pinguecula
- raised yellow to white growth in bulbar conjunctiva
| - chronic sun exposure
60
Pterygium
- yellow triangular thickening of conjunctiva
- can spread across cornea on nasal side
- chronic sun exposure
- can be red or inflamed
61
Pinguecula and pterygium treatment
- if inflamed --> ophtho
- sunglasses
- surgery if covering cornea
62
Normal IOP
8-21
63
What IOP is considered very high
>30
64
POAG medications
- timilol
| - Latanoprost (prostoglandin, increase aqueous outflow)
65
POAG complication
- blindness due to ischemic damage to retina
| - CN II
66
PACG presentation
- fixed and mid-dilated cloudy pupil
- looks more oval than round
- pupil reacts slowly to light
- conjunctival injection with increased lacrimation
67
Anterior uveitis (Iritis) may be a complication of
- RA
- lupus
- ankylosing spondylitis
- sarcoidosis
- syphilis
- etc
68
Anterior uveitis presentation
- insidious onset of eye pain
- conjunctival injection
- no purulent drainage
- refer ASAP
69
Age related macular degeneration cause
- gradual damage to pigment of macula (area of central vision)
- severe visual loss to blindness
70
Dry form of AMD
more common
| -less severe
71
Wet form of AMD
- less common
| - responsible for 80% of vision loss (choroidal neovascularization)
72
AMD is more common in
smokers
73
AMD treatment
- refer to ophtho
- Amsler grid
- ocular vitamins: leutein, zeaxanthin, zinc
74
Amsler grid
- focus eye on center dot and view grid 12 inches from eyes
| - check daily to weekly
75
Sjogren's syndrome presentation
- daily symptoms of dry eyes and moth
- >3 months
- many dental caries
- swollen and inflamed salivary glands
76
Sjogren's syndrome treatment
- OTC tear substitute
| - refer to ophtho, dental, rheumatology
77
Blepharitis
inflammation of eyelids
| -lid may be colonized by staph
78
blepharitis presentation
- itching
- irritation
- gritty sensation
- eye redness
- crusting
79
Blepharitis treatment
- baby shampoo with warm water
- consider erythromycin eye drops
- warm compress
80
Allergic rhinitis first line treatment
- topical nasal sprays
- Fluticasone (Flonase) BID, triamcinolone (Nasacort Allergy) one to two sprays once a day
- Consider oral antihistamine
- eliminate environmental allergens
81
Rhinitis medicamentosa
-prolonged use of topical nasal decongestants (>3 days) can cause severe rebound
82
Afrin generic name
Oxymetazoline
83
What type of nose bleed is milder and more common
anterior
84
Anterior nose bleeds can be a result of bleeding from where
Kiesselbach's plexus
85
Posterior nasal bleeds can lead to what
severe hemorrhage
86
Epistaxis treatment
- direct pressure for several minutes
- Afrin can help to shrink tissue
- apply triple antibiotic or Vasoline for a few days
87
Strep pharyngitis caused by
GABHS
88
Viral causes of pharyngitis
- Rhinovirus
- adenovirus
- RSV
89
When to suspect viral pharyngitis
- cough
- stuffy nose
- rhinitis with clear mucus
- water eyes
90
Centor criteria for strep pharyngitis
- tonsillar exudate
- tender anterior cervical adenopathy
- history of fever
- absent cough
91
First line treatment for strep pharyngitis
- Oral PCN V 500 mg to TID x 10 days
alt: amoxicillin
- PCN allergy: Z-pak
92
Who to do test of cure for strep pharyngitis
-history of MVP or heart valve surgery
93
Strep pharyngitis complications
- scarlet fever
- acute rheumatic fever
- peritonsillar abscess
- poststreptococcal GN
94
Scarlet fever presentation
- sandpaper pink rash
- sore throat
- strawberry tongue
- rash starts on head and spreads down
- skin desquamatizes
95
Acute rheumatic fever presentation
-inflam reaction to strep infection that may affect the heart and vales, joints, and brain
96
Poststreptococcal GN presentation
- abrupt onset of proteinuria
- hematuria
- dark colored urine
- HTN
- edema
- RBC casts
97
AOM organisms
- S.pneumoniae
- H. infleunzae
- M. catarrhalis
98
Bullous Myringitis
- type of AOM
- more painful due to blisters on TM
- conductive hearing loss
- same treatment as AOM
99
AOM findings
- Weber: lateralization to bad ear
- Rinne: BC>AC
- bulging or retracted TM, displaced light reflex, erythema
100
First line treatment AOM
- amoxicillin
- mild to mod: 5-7 days
- severe; 10 days
- if no response in 48 hours, switch to augmentin
101
Middle ear effusion can persist for how long after treatment of AOM
8 weeks
102
Acute bacterial rhinosinusitis presentation
```
-upper teeth pain
nasal congestion >10 days
-purulent nasal and/or postnasal drip
-pain on face or forehead
-hyposmia (loss of smell)
```
103
Acute rhinosinusitis treatment
- symptomatic treatment without antibiotics in healthy individuals --> F/u in 10 days, if worse, start abx
- start abx is severe or IC patient
- Augmentin
104
Acute rhinosinusitis symptomatic treatment
- oral decongestant: Sudafed, Mucinex D
- Topical decongestant: Afrin
- Saline nasal spray: Ocean spray
- Steroid nasal spray: Flonase if allergy based
- Mucolytic: guaifenesin
- cough: dextromethorphan, benzonatate, increase fluids
105
Recurrent sinusitis treatment
refer to otolaryngologist
106
Mastoiditis
- red and swollen mastoid that is tender to palpation
| - ED referral
107
Cavernous sinus thrombosis
- acute headache
- abnormal neuro exam
- confused
- febrile
- STAT ED
108
What can OME be caused by
- previous AOM
| - chronic AR
109
OME presentation
- ear pressure
- popping noises
- muffled hearing in ear
110
OME findings
- Tm may bulge or retract
- TM should not be red
- fluid level and/or bubbles may be visible
111
OME treatment
- oral decongestants
- steroid nasal spray
- saline nasal spray
- LA oral antihistamine (Zyrtec)
112
Otitis externa organisms
- pseudomonas
| - Staph
113
Otitis externa treatment
- Polymyxin B-neomycin, hydrocortisone (Cortisporin 4 gtts QID x 7 days)
- prophylaxis: Otic Domeboro or alcohol and vinegar
114
Mono classic triad
- fever
- pharyngitis
- lymphadenopathy
-fatigue
115
Mono labs
- CBC: atypical lymphs, lymphocytosis
- repeat CBC until it resolves
- LFTS elevated for several weeks
- Large cerivcal nodes
- erythematous throat
- inflamed tonsils with off-white color coating
- hepatosplenomegaly
- sometimes a generalized maculopapular rash
116
Mono treatment
- acute: limit physical activity
- abdominal US if hepatosplenomegaly is present
- repeat in 4-6 weeks if abnormal to document resolution
117
What medication to avoid with mono
Amoxicillin and PCN type medications
118
How long to stay out of sports with mono
at least 4 weeks, until US results show resolution
119
Weber and Rinne test which nerve
CN VIII
120
Most common OTC treatment for ceruminosis
```
Carbamide peroxide (Debrox)
similar to hydrogen peroxide
```
121
GABHS aka
strep pyogenes
122
Strep and mono coinfection treatment
cephalexin
123
PANDAS syndrome
- psychiatric symptoms after a strep infection
| - debilitating OCD
124
What percentage of patients have hepatosplenomegaly with mono?
50%
125
Normal cup to disk ratio of optic disk
<0.5
126
Veins or arteries in fundus are pulsatile
veins
127
Cotton wool spot causes
- HTN
- DM
- MODERATE
128
Flame hemorrhages
- HTN
- DM
- MOderate
129
Blot and dot hemorrhages
moderate
130
Hard exudates
moderate
131
MIcroaneurysms
moderate
132
AV nicking
- HTN
| - mild
133
Patients presenting with macular degeneration complain of
central vision loss
134
Abnormal cupping
Cup diameter >50% of vertical disc diameter
135
Earliest sign of hearing loss
tinnitus
136
Presbycusis common complaints
- difficulty understanding speech in large crowds
- difficulty hearing high-pitched tones
- tinnitus
137
Symptoms associated with acute angle closure glaucoma
- N/V
- HA
- halos around lights
138
Photopsia may indicate what
- retinal detachment
| - flashes of lights
139
Starting what age can patients take oral decongestants
12 years old
140
Oral decongestants should not be used in patients with
- on metformin
- uncontrolled hypertension
- closed angle glaucoma
- severe heart disease
- enlarged prostate
- overactive thyroid
141
Menieres triad
-episodic vertigo
tinnitus
sensorineural hearing loss (low frequency)
-may have ear fullness
142
What part of eye is responsible for color vision
cones
143
What part of eye is responsible for sharpest vision 20/20
fovea of macula
144
What are the only receptors in the fovea
cones
145
What is the macula responsible for
central vision
146
What does the macula and fovea look like
dark spot
| fovea is the central clearer part
147
OE with ruptured tympanic membrane
-Ofloxacin ear drops
148
Which ear drops are ototoxic
-aminoglycosides (gentamycin, tobramycin, neomycin)
149
Labrynthitis aka
vestibular neuritis
150
What causes labrynthitis
- viral or postviral inflammation that affects the vestibular portion of CN VIII
- usually self limiting
- dizziness and vertigo
151
Labrynthitis treatment
- corticosteroids
- antivirals
- antihistamines
