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Review > ENT > Flashcards

ENT Flashcards

1
Q

Fundoscopic exam with ACCG would show

A

cupping of optic disk

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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
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3
Q

Retinal detachment patient complaints

A
  • sudden onset floaters
  • “looking through a curtain”
  • sudden flashes of light (photopsia)
  • ED referral
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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
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5
Q

Cholesteatoma can cause damage to which nerve if not treated

A

CN VII

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6
Q

Urine dipstick will be positive for what with CSF leak

A

glucose

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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)
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8
Q

Diptheria presentation

A
  • sore throat
  • fever
  • “bull’s neck”
  • throat covered with gray to yellow pseudomembrane
  • contact prophylaxis required
  • refer to ED
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9
Q

Age related visul change

A

Presbyopia

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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

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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
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12
Q

Aphthous stomatitis

A
  • painful shallow ulcers on soft tissue

- treat with magic mouthwash

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13
Q

Plan for avulsed tooth

A

-store in cool milk or saline and see dentist

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14
Q

Vermillion border

A

edges of lips

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15
Q

Oral commissure

A

corners of lips

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16
Q

Sialolithiasis

A

blocked salivary gland with a stone

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17
Q

Geographic tongue

A
  • map like appearance

- complain of soreness with acidic and spicy foods

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18
Q

Torus Palanitus

A
  • painless bony prominence midline on hard palate
  • may be asymmetrical
  • benign
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19
Q

Fishtail or split uvula

A
  • may be a sign of occult cleft palate

- rare

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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

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21
Q

Hypertensive retinopathy fundoscopic exam findings

A
  • retinal hemorrhages
  • Copper silver wire arterioles
  • AV nicking
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22
Q

Diabetic retinopathy fundoscopic exam findings

A
  • cotton wool spots
  • hard exudates
  • flame hemorrhages
  • microaneurysms
  • neovascularization
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23
Q

Nasal polyps have an increased risk for what

A

ASA sensitivity or allergy

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24
Q

Hairy leukoplakia

A
  • elongated papilla on lateral aspects of tongue

- pathognomonic for HIV infection

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25
Q

What is hairy leukoplakia caused by

A

EBV

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26
Q

Oral leukoplakia of oral mucosa/tongue

A
  • bright white plaque caused by chronic irritation

- r/o oral cancer

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27
Q

Cheilosis

A
  • painful skin fissures and maceration at corners of mouth due to excessive moisture
  • 2ndary infection with Candida or Staph
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28
Q

Cheilosis treatment

A
  • 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
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29
Q

Palpebral conjunctiva

A

mucosal lining inside eyelids

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30
Q

Bulbar conjunctiva

A

mucosal lining covering eyes

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31
Q

Hyperopia

A

farsight

-near vision blurry

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32
Q

Myopia

A
  • near sight

- far vision blurry

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33
Q

What chart to use if patient is illiterate

A

Tumbling E

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34
Q

Right eye

A

OD

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35
Q

Left eye

A

OS

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36
Q

Both eyes

A

OU

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37
Q

Testing peripheral vision

A

confrontation

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38
Q

Test for color blindness

A

Ishihara chart

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39
Q

Legal blindness

A

Best corrected vision of 20/200

or visual field less than 20 degrees (tunnel vision)

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40
Q

If child’s vision is not 20/20 by what age should they be referred to ophtho

A

-6 years

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41
Q

Normal Weber test

A

no lateralization

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42
Q

Weber test: lateralization to “good ear”

A

Sensorineural loss

  • Meniere’s
  • Presbycusis
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43
Q

Weber test: lateralization to bad ear

A

-conductive loss

OM, SOM, ceruminosis, TM perforation

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44
Q

Normal Rinne test

A

AC > BC

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45
Q

AC > BC with Rinne test can indicate what

A

normal or sensorineural hearing loss

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46
Q

BC > AC with Rinne test can indicate what

A

conductive hearing loss

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47
Q

Weber test method

A

place tuning fork midline on forehead

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48
Q

Rinne test method

A
  • place tuning fork first on mastoid, then in front of ear

- time each one

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49
Q

Presbycusis

A

age-related hearing loss

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50
Q

Ototoxic medications

A
  • aminoglycosides
  • erythromycin
  • tetracyclines
  • high dose ASA
  • sildenafil, etc
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51
Q

Herpes keratitis black lamp presentation

A

-fern-like lines on corneal surface

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52
Q

Contact lens related keratitis

A

-abrasions usually in center and round

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53
Q

Contact lens related keratitis treatment

A
  • 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
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54
Q

Topical antibiotic for contact lens related keratitis

A
  • need pseudomonal coverage

- (Cipro, ofloxacin, Polytrim)

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55
Q

Hordeolum

A
  • abscess of hair follicle and sebaceous gland in upper or lower eyelid
  • may have history of blepharitis
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56
Q

Hordeolum treatment

A
  • hot compress
  • if spreading to preseptal cellulitis: dicloxacillin or erythromycin
  • refer to ophto for I&D
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57
Q

Chalazion

A
  • chronic inflam of meibomian gland of eyelids

- resolve in 2-8 weeks

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58
Q

Chalazion treatment

A
  • self-resolving

- refer to optho if interfering with vision

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59
Q

Pinguecula

A
  • raised yellow to white growth in bulbar conjunctiva

- chronic sun exposure

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60
Q

Pterygium

A
  • yellow triangular thickening of conjunctiva
  • can spread across cornea on nasal side
  • chronic sun exposure
  • can be red or inflamed
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61
Q

Pinguecula and pterygium treatment

A
  • if inflamed –> ophtho
  • sunglasses
  • surgery if covering cornea
62
Q

Normal IOP

A

8-21

63
Q

What IOP is considered very high

A

> 30

64
Q

POAG medications

A
  • timilol

- Latanoprost (prostoglandin, increase aqueous outflow)

65
Q

POAG complication

A
  • blindness due to ischemic damage to retina

- CN II

66
Q

PACG presentation

A
  • fixed and mid-dilated cloudy pupil
  • looks more oval than round
  • pupil reacts slowly to light
  • conjunctival injection with increased lacrimation
67
Q

Anterior uveitis (Iritis) may be a complication of

A
  • RA
  • lupus
  • ankylosing spondylitis
  • sarcoidosis
  • syphilis
  • etc
68
Q

Anterior uveitis presentation

A
  • insidious onset of eye pain
  • conjunctival injection
  • no purulent drainage
  • refer ASAP
69
Q

Age related macular degeneration cause

A
  • gradual damage to pigment of macula (area of central vision)
  • severe visual loss to blindness
70
Q

Dry form of AMD

A

more common

-less severe

71
Q

Wet form of AMD

A
  • less common

- responsible for 80% of vision loss (choroidal neovascularization)

72
Q

AMD is more common in

A

smokers

73
Q

AMD treatment

A
  • refer to ophtho
  • Amsler grid
  • ocular vitamins: leutein, zeaxanthin, zinc
74
Q

Amsler grid

A
  • focus eye on center dot and view grid 12 inches from eyes

- check daily to weekly

75
Q

Sjogren’s syndrome presentation

A
  • daily symptoms of dry eyes and moth
  • > 3 months
  • many dental caries
  • swollen and inflamed salivary glands
76
Q

Sjogren’s syndrome treatment

A
  • OTC tear substitute

- refer to ophtho, dental, rheumatology

77
Q

Blepharitis

A

inflammation of eyelids

-lid may be colonized by staph

78
Q

blepharitis presentation

A
  • itching
  • irritation
  • gritty sensation
  • eye redness
  • crusting
79
Q

Blepharitis treatment

A
  • baby shampoo with warm water
  • consider erythromycin eye drops
  • warm compress
80
Q

Allergic rhinitis first line treatment

A
  • topical nasal sprays
  • Fluticasone (Flonase) BID, triamcinolone (Nasacort Allergy) one to two sprays once a day
  • Consider oral antihistamine
  • eliminate environmental allergens
81
Q

Rhinitis medicamentosa

A

-prolonged use of topical nasal decongestants (>3 days) can cause severe rebound

82
Q

Afrin generic name

A

Oxymetazoline

83
Q

What type of nose bleed is milder and more common

A

anterior

84
Q

Anterior nose bleeds can be a result of bleeding from where

A

Kiesselbach’s plexus

85
Q

Posterior nasal bleeds can lead to what

A

severe hemorrhage

86
Q

Epistaxis treatment

A
  • direct pressure for several minutes
  • Afrin can help to shrink tissue
  • apply triple antibiotic or Vasoline for a few days
87
Q

Strep pharyngitis caused by

A

GABHS

88
Q

Viral causes of pharyngitis

A
  • Rhinovirus
  • adenovirus
  • RSV
89
Q

When to suspect viral pharyngitis

A
  • cough
  • stuffy nose
  • rhinitis with clear mucus
  • water eyes
90
Q

Centor criteria for strep pharyngitis

A
  • tonsillar exudate
  • tender anterior cervical adenopathy
  • history of fever
  • absent cough
91
Q

First line treatment for strep pharyngitis

A
  • Oral PCN V 500 mg to TID x 10 days
    alt: amoxicillin
  • PCN allergy: Z-pak
92
Q

Who to do test of cure for strep pharyngitis

A

-history of MVP or heart valve surgery

93
Q

Strep pharyngitis complications

A
  • scarlet fever
  • acute rheumatic fever
  • peritonsillar abscess
  • poststreptococcal GN
94
Q

Scarlet fever presentation

A
  • sandpaper pink rash
  • sore throat
  • strawberry tongue
  • rash starts on head and spreads down
  • skin desquamatizes
95
Q

Acute rheumatic fever presentation

A

-inflam reaction to strep infection that may affect the heart and vales, joints, and brain

96
Q

Poststreptococcal GN presentation

A
  • abrupt onset of proteinuria
  • hematuria
  • dark colored urine
  • HTN
  • edema
  • RBC casts
97
Q

AOM organisms

A
  • S.pneumoniae
  • H. infleunzae
  • M. catarrhalis
98
Q

Bullous Myringitis

A
  • type of AOM
  • more painful due to blisters on TM
  • conductive hearing loss
  • same treatment as AOM
99
Q

AOM findings

A
  • Weber: lateralization to bad ear
  • Rinne: BC>AC
  • bulging or retracted TM, displaced light reflex, erythema
100
Q

First line treatment AOM

A
  • amoxicillin
  • mild to mod: 5-7 days
  • severe; 10 days
  • if no response in 48 hours, switch to augmentin
101
Q

Middle ear effusion can persist for how long after treatment of AOM

A

8 weeks

102
Q

Acute bacterial rhinosinusitis presentation

A 
-upper teeth pain
nasal congestion >10 days 
-purulent nasal and/or postnasal drip
-pain on face or forehead
-hyposmia (loss of smell)
103
Q

Acute rhinosinusitis treatment

A
  • 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
Q

Acute rhinosinusitis symptomatic treatment

A
  • 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
Q

Recurrent sinusitis treatment

A

refer to otolaryngologist

106
Q

Mastoiditis

A
  • red and swollen mastoid that is tender to palpation

- ED referral

107
Q

Cavernous sinus thrombosis

A
  • acute headache
  • abnormal neuro exam
  • confused
  • febrile
  • STAT ED
108
Q

What can OME be caused by

A
  • previous AOM

- chronic AR

109
Q

OME presentation

A
  • ear pressure
  • popping noises
  • muffled hearing in ear
110
Q

OME findings

A
  • Tm may bulge or retract
  • TM should not be red
  • fluid level and/or bubbles may be visible
111
Q

OME treatment

A
  • oral decongestants
  • steroid nasal spray
  • saline nasal spray
  • LA oral antihistamine (Zyrtec)
112
Q

Otitis externa organisms

A
  • pseudomonas

- Staph

113
Q

Otitis externa treatment

A
  • Polymyxin B-neomycin, hydrocortisone (Cortisporin 4 gtts QID x 7 days)
  • prophylaxis: Otic Domeboro or alcohol and vinegar
114
Q

Mono classic triad

A
  • fever
  • pharyngitis
  • lymphadenopathy

-fatigue

115
Q

Mono labs

A
  • 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
Q

Mono treatment

A
  • acute: limit physical activity
  • abdominal US if hepatosplenomegaly is present
  • repeat in 4-6 weeks if abnormal to document resolution
117
Q

What medication to avoid with mono

A

Amoxicillin and PCN type medications

118
Q

How long to stay out of sports with mono

A

at least 4 weeks, until US results show resolution

119
Q

Weber and Rinne test which nerve

A

CN VIII

120
Q

Most common OTC treatment for ceruminosis

A 
Carbamide peroxide (Debrox)
similar to hydrogen peroxide
121
Q

GABHS aka

A

strep pyogenes

122
Q

Strep and mono coinfection treatment

A

cephalexin

123
Q

PANDAS syndrome

A
  • psychiatric symptoms after a strep infection

- debilitating OCD

124
Q

What percentage of patients have hepatosplenomegaly with mono?

A

50%

125
Q

Normal cup to disk ratio of optic disk

A

<0.5

126
Q

Veins or arteries in fundus are pulsatile

A

veins

127
Q

Cotton wool spot causes

A
  • HTN
  • DM
  • MODERATE
128
Q

Flame hemorrhages

A
  • HTN
  • DM
  • MOderate
129
Q

Blot and dot hemorrhages

A

moderate

130
Q

Hard exudates

A

moderate

131
Q

MIcroaneurysms

A

moderate

132
Q

AV nicking

A
  • HTN

- mild

133
Q

Patients presenting with macular degeneration complain of

A

central vision loss

134
Q

Abnormal cupping

A

Cup diameter >50% of vertical disc diameter

135
Q

Earliest sign of hearing loss

A

tinnitus

136
Q

Presbycusis common complaints

A
  • difficulty understanding speech in large crowds
  • difficulty hearing high-pitched tones
  • tinnitus
137
Q

Symptoms associated with acute angle closure glaucoma

A
  • N/V
  • HA
  • halos around lights
138
Q

Photopsia may indicate what

A
  • retinal detachment

- flashes of lights

139
Q

Starting what age can patients take oral decongestants

A

12 years old

140
Q

Oral decongestants should not be used in patients with

A
  • on metformin
  • uncontrolled hypertension
  • closed angle glaucoma
  • severe heart disease
  • enlarged prostate
  • overactive thyroid
141
Q

Menieres triad

A

-episodic vertigo
tinnitus
sensorineural hearing loss (low frequency)
-may have ear fullness

142
Q

What part of eye is responsible for color vision

A

cones

143
Q

What part of eye is responsible for sharpest vision 20/20

A

fovea of macula

144
Q

What are the only receptors in the fovea

A

cones

145
Q

What is the macula responsible for

A

central vision

146
Q

What does the macula and fovea look like

A

dark spot

fovea is the central clearer part

147
Q

OE with ruptured tympanic membrane

A

-Ofloxacin ear drops

148
Q

Which ear drops are ototoxic

A

-aminoglycosides (gentamycin, tobramycin, neomycin)

149
Q

Labrynthitis aka

A

vestibular neuritis

150
Q

What causes labrynthitis

A
  • viral or postviral inflammation that affects the vestibular portion of CN VIII
  • usually self limiting
  • dizziness and vertigo
151
Q

Labrynthitis treatment

A
  • corticosteroids
  • antivirals
  • antihistamines

Review (24 decks)

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