ENT Flashcards
Fundoscopic exam with ACCG would show
cupping of optic disk
Multiple sclerosis and eye presentation
- new or intermittent loss of vision in one eye
- possible nystagmus
- other neuro symptoms present
- refer to neurologist
Retinal detachment patient complaints
- sudden onset floaters
- “looking through a curtain”
- sudden flashes of light (photopsia)
- ED referral
Cholesteatoma presentation
- “cauliflower-like growth”
- foul-smelling ear discharge
- hearing loss on affectedear
- no TM or ossicles visible
- hx of chronic OM
Cholesteatoma can cause damage to which nerve if not treated
CN VII
Urine dipstick will be positive for what with CSF leak
glucose
Peritonsillar abscess presentation
- severe sore throat
- difficulty talking
- odynophagia (pain on swallowing)
- “hot potato” voice
- trismus (jaw muscle spasm making it difficult to open mouth)
Diptheria presentation
- sore throat
- fever
- “bull’s neck”
- throat covered with gray to yellow pseudomembrane
- contact prophylaxis required
- refer to ED
Age related visul change
Presbyopia
Presbyopia occurs due to what
decreased ability of the eye to accommodate stiffening of the lenses
-difficulty reading small print at close range
Leukoplakia
- white to light gray patch on tongue, floor of mouth, or inside cheek
- rule out oral cancer
- chewing tobacco and alcohol use increases risk
Aphthous stomatitis
- painful shallow ulcers on soft tissue
- treat with magic mouthwash
Plan for avulsed tooth
-store in cool milk or saline and see dentist
Vermillion border
edges of lips
Oral commissure
corners of lips
Sialolithiasis
blocked salivary gland with a stone
Geographic tongue
- map like appearance
- complain of soreness with acidic and spicy foods
Torus Palanitus
- painless bony prominence midline on hard palate
- may be asymmetrical
- benign
Fishtail or split uvula
- may be a sign of occult cleft palate
- rare
Physiological gaze-evoked nystagmus
-with prolonged extreme lateral gaze, a few beats of nystamgus that resolves when back at midline is normal
Hypertensive retinopathy fundoscopic exam findings
- retinal hemorrhages
- Copper silver wire arterioles
- AV nicking
Diabetic retinopathy fundoscopic exam findings
- cotton wool spots
- hard exudates
- flame hemorrhages
- microaneurysms
- neovascularization
Nasal polyps have an increased risk for what
ASA sensitivity or allergy
Hairy leukoplakia
- elongated papilla on lateral aspects of tongue
- pathognomonic for HIV infection
What is hairy leukoplakia caused by
EBV
Oral leukoplakia of oral mucosa/tongue
- bright white plaque caused by chronic irritation
- r/o oral cancer
Cheilosis
- painful skin fissures and maceration at corners of mouth due to excessive moisture
- 2ndary infection with Candida or Staph
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
Palpebral conjunctiva
mucosal lining inside eyelids
Bulbar conjunctiva
mucosal lining covering eyes
Hyperopia
farsight
-near vision blurry
Myopia
- near sight
- far vision blurry
What chart to use if patient is illiterate
Tumbling E
Right eye
OD
Left eye
OS
Both eyes
OU
Testing peripheral vision
confrontation
Test for color blindness
Ishihara chart
Legal blindness
Best corrected vision of 20/200
or visual field less than 20 degrees (tunnel vision)
If child’s vision is not 20/20 by what age should they be referred to ophtho
-6 years
Normal Weber test
no lateralization
Weber test: lateralization to “good ear”
Sensorineural loss
- Meniere’s
- Presbycusis
Weber test: lateralization to bad ear
-conductive loss
OM, SOM, ceruminosis, TM perforation
Normal Rinne test
AC > BC
AC > BC with Rinne test can indicate what
normal or sensorineural hearing loss
BC > AC with Rinne test can indicate what
conductive hearing loss
Weber test method
place tuning fork midline on forehead
Rinne test method
- place tuning fork first on mastoid, then in front of ear
- time each one
Presbycusis
age-related hearing loss
Ototoxic medications
- aminoglycosides
- erythromycin
- tetracyclines
- high dose ASA
- sildenafil, etc
Herpes keratitis black lamp presentation
-fern-like lines on corneal surface
Contact lens related keratitis
-abrasions usually in center and round
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
Topical antibiotic for contact lens related keratitis
- need pseudomonal coverage
- (Cipro, ofloxacin, Polytrim)
Hordeolum
- abscess of hair follicle and sebaceous gland in upper or lower eyelid
- may have history of blepharitis
Hordeolum treatment
- hot compress
- if spreading to preseptal cellulitis: dicloxacillin or erythromycin
- refer to ophto for I&D
Chalazion
- chronic inflam of meibomian gland of eyelids
- resolve in 2-8 weeks
Chalazion treatment
- self-resolving
- refer to optho if interfering with vision
Pinguecula
- raised yellow to white growth in bulbar conjunctiva
- chronic sun exposure
Pterygium
- yellow triangular thickening of conjunctiva
- can spread across cornea on nasal side
- chronic sun exposure
- can be red or inflamed
Pinguecula and pterygium treatment
- if inflamed –> ophtho
- sunglasses
- surgery if covering cornea
Normal IOP
8-21
What IOP is considered very high
> 30
POAG medications
- timilol
- Latanoprost (prostoglandin, increase aqueous outflow)
POAG complication
- blindness due to ischemic damage to retina
- CN II
PACG presentation
- fixed and mid-dilated cloudy pupil
- looks more oval than round
- pupil reacts slowly to light
- conjunctival injection with increased lacrimation
Anterior uveitis (Iritis) may be a complication of
- RA
- lupus
- ankylosing spondylitis
- sarcoidosis
- syphilis
- etc
Anterior uveitis presentation
- insidious onset of eye pain
- conjunctival injection
- no purulent drainage
- refer ASAP
Age related macular degeneration cause
- gradual damage to pigment of macula (area of central vision)
- severe visual loss to blindness
Dry form of AMD
more common
-less severe
Wet form of AMD
- less common
- responsible for 80% of vision loss (choroidal neovascularization)
AMD is more common in
smokers
AMD treatment
- refer to ophtho
- Amsler grid
- ocular vitamins: leutein, zeaxanthin, zinc
Amsler grid
- focus eye on center dot and view grid 12 inches from eyes
- check daily to weekly
Sjogren’s syndrome presentation
- daily symptoms of dry eyes and moth
- > 3 months
- many dental caries
- swollen and inflamed salivary glands
Sjogren’s syndrome treatment
- OTC tear substitute
- refer to ophtho, dental, rheumatology
Blepharitis
inflammation of eyelids
-lid may be colonized by staph
blepharitis presentation
- itching
- irritation
- gritty sensation
- eye redness
- crusting
Blepharitis treatment
- baby shampoo with warm water
- consider erythromycin eye drops
- warm compress
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
Rhinitis medicamentosa
-prolonged use of topical nasal decongestants (>3 days) can cause severe rebound
Afrin generic name
Oxymetazoline
What type of nose bleed is milder and more common
anterior
Anterior nose bleeds can be a result of bleeding from where
Kiesselbach’s plexus
Posterior nasal bleeds can lead to what
severe hemorrhage
Epistaxis treatment
- direct pressure for several minutes
- Afrin can help to shrink tissue
- apply triple antibiotic or Vasoline for a few days
Strep pharyngitis caused by
GABHS
Viral causes of pharyngitis
- Rhinovirus
- adenovirus
- RSV
When to suspect viral pharyngitis
- cough
- stuffy nose
- rhinitis with clear mucus
- water eyes
Centor criteria for strep pharyngitis
- tonsillar exudate
- tender anterior cervical adenopathy
- history of fever
- absent cough
First line treatment for strep pharyngitis
- Oral PCN V 500 mg to TID x 10 days
alt: amoxicillin - PCN allergy: Z-pak
Who to do test of cure for strep pharyngitis
-history of MVP or heart valve surgery
Strep pharyngitis complications
- scarlet fever
- acute rheumatic fever
- peritonsillar abscess
- poststreptococcal GN
Scarlet fever presentation
- sandpaper pink rash
- sore throat
- strawberry tongue
- rash starts on head and spreads down
- skin desquamatizes
Acute rheumatic fever presentation
-inflam reaction to strep infection that may affect the heart and vales, joints, and brain
Poststreptococcal GN presentation
- abrupt onset of proteinuria
- hematuria
- dark colored urine
- HTN
- edema
- RBC casts
AOM organisms
- S.pneumoniae
- H. infleunzae
- M. catarrhalis
Bullous Myringitis
- type of AOM
- more painful due to blisters on TM
- conductive hearing loss
- same treatment as AOM
AOM findings
- Weber: lateralization to bad ear
- Rinne: BC>AC
- bulging or retracted TM, displaced light reflex, erythema
First line treatment AOM
- amoxicillin
- mild to mod: 5-7 days
- severe; 10 days
- if no response in 48 hours, switch to augmentin
Middle ear effusion can persist for how long after treatment of AOM
8 weeks
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)
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
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
Recurrent sinusitis treatment
refer to otolaryngologist
Mastoiditis
- red and swollen mastoid that is tender to palpation
- ED referral
Cavernous sinus thrombosis
- acute headache
- abnormal neuro exam
- confused
- febrile
- STAT ED
What can OME be caused by
- previous AOM
- chronic AR
OME presentation
- ear pressure
- popping noises
- muffled hearing in ear
OME findings
- Tm may bulge or retract
- TM should not be red
- fluid level and/or bubbles may be visible
OME treatment
- oral decongestants
- steroid nasal spray
- saline nasal spray
- LA oral antihistamine (Zyrtec)
Otitis externa organisms
- pseudomonas
- Staph
Otitis externa treatment
- Polymyxin B-neomycin, hydrocortisone (Cortisporin 4 gtts QID x 7 days)
- prophylaxis: Otic Domeboro or alcohol and vinegar
Mono classic triad
- fever
- pharyngitis
- lymphadenopathy
-fatigue
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
Mono treatment
- acute: limit physical activity
- abdominal US if hepatosplenomegaly is present
- repeat in 4-6 weeks if abnormal to document resolution
What medication to avoid with mono
Amoxicillin and PCN type medications
How long to stay out of sports with mono
at least 4 weeks, until US results show resolution
Weber and Rinne test which nerve
CN VIII
Most common OTC treatment for ceruminosis
Carbamide peroxide (Debrox) similar to hydrogen peroxide
GABHS aka
strep pyogenes
Strep and mono coinfection treatment
cephalexin
PANDAS syndrome
- psychiatric symptoms after a strep infection
- debilitating OCD
What percentage of patients have hepatosplenomegaly with mono?
50%
Normal cup to disk ratio of optic disk
<0.5
Veins or arteries in fundus are pulsatile
veins
Cotton wool spot causes
- HTN
- DM
- MODERATE
Flame hemorrhages
- HTN
- DM
- MOderate
Blot and dot hemorrhages
moderate
Hard exudates
moderate
MIcroaneurysms
moderate
AV nicking
- HTN
- mild
Patients presenting with macular degeneration complain of
central vision loss
Abnormal cupping
Cup diameter >50% of vertical disc diameter
Earliest sign of hearing loss
tinnitus
Presbycusis common complaints
- difficulty understanding speech in large crowds
- difficulty hearing high-pitched tones
- tinnitus
Symptoms associated with acute angle closure glaucoma
- N/V
- HA
- halos around lights
Photopsia may indicate what
- retinal detachment
- flashes of lights
Starting what age can patients take oral decongestants
12 years old
Oral decongestants should not be used in patients with
- on metformin
- uncontrolled hypertension
- closed angle glaucoma
- severe heart disease
- enlarged prostate
- overactive thyroid
Menieres triad
-episodic vertigo
tinnitus
sensorineural hearing loss (low frequency)
-may have ear fullness
What part of eye is responsible for color vision
cones
What part of eye is responsible for sharpest vision 20/20
fovea of macula
What are the only receptors in the fovea
cones
What is the macula responsible for
central vision
What does the macula and fovea look like
dark spot
fovea is the central clearer part
OE with ruptured tympanic membrane
-Ofloxacin ear drops
Which ear drops are ototoxic
-aminoglycosides (gentamycin, tobramycin, neomycin)
Labrynthitis aka
vestibular neuritis
What causes labrynthitis
- viral or postviral inflammation that affects the vestibular portion of CN VIII
- usually self limiting
- dizziness and vertigo
Labrynthitis treatment
- corticosteroids
- antivirals
- antihistamines
