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PANCE Prep Pearls > ENT Disorders > Flashcards

ENT Disorders Flashcards

1
Q

What is blepharitis?

A

Inflammation of both eyelids

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2
Q

Blepharitis is common in which patient population?

A

Those with down syndrome and eczema

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3
Q

What is this?

A

Anterior blepharitis

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4
Q

What is this?

A

Posterior blepharitis

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5
Q

Hordeolum (Stye): Treatment (2)

A
  1. Warm compresses are the mainstay of treatment +/- add topical abx ointment (erythromycin, bacitracin) if actively draining
  2. +/- I&D if no drainage within 48 hours
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6
Q

What is a chalazion?

A

Painless granuloma of the internal meibomian sebaceous gland–>focal eyelid swelling

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7
Q

What is dacrocystitis?

A

Infection of the lacrimal gland

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8
Q

Dacrocystitis treatment (2)

A
  1. Systemic antibiotics: Clindamycin + 3rd gen. cephalosporin
  2. Dacrocstorhinoscopy
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9
Q

What is this?

A

Pterygium (fleshy, triangular-shaped “growing” fibrovascular mass)

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10
Q

Where are pterygiums most commonly located at?

A

Inner corner/nasal side of eye and extends laterally

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11
Q

What is this?

A

Pinguecula (yellow, elevated nodule on the nasal side of the eye that does not grow)

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12
Q

Orbital floor “Blowout” fractures: Clinical manifestations (4)

A
  1. Decreased visual acuity; Enophthalmos
  2. Diplopia especially with upward gaze
  3. Orbital emphsema
  4. Epistaxis, dysesthesias, hyperalgesia, anesthesia to anteriomedial cheek
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13
Q

Blowout fractures: Diagnosis

A

CT scan

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14
Q

Orbital floor “blowout” fractures: Treatment

A
  1. Initial: Nasal decongestants, avoid blowing nose, prednisone, antibiotics (usu. ampicillin/sulbactam or clindamycin)
  2. Surgical repair
  3. Ophtho referral
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15
Q

With a globe rupture, what may be seen on PE in the orbits?

A

Enophthalmos, foreign body may be present, may have exopthalmos. Severe conjunctival hemorrhage

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16
Q

With a global rupture, what may be seen on PE with corneal/sclera?

A

Prolapse of the iris thorugh the cornea, (+) Seidel’s test, teardrop or irregularly-shaped pupil, hymphema

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17
Q

Global rupture: Management

A
  1. Rigid eye shield*, immediate ophtho consult. IV abx. Avoid topical eye solutions
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18
Q

What is the MC cause of permanent legal blindness and visual loss in the elderly (>75 years old)?

A

Macular degeneration

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19
Q

Dry (Atrophic) Macular Degeneration

A
  1. Gradual breakdown of the macula –>gradual blurring of the central vision.
  2. Presence of Drusen
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20
Q

What are Drusen’s spots?

A

Small, round, yellow-white spots on the outer retina (scattered, diffuse). They are an accumulation of waste products from retinal pigment epithelium.

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21
Q

Wet (neovascular or exudative) macular degeneration?

A

New, abnormal vessels that grow under the central retina that leak and bleed –> retinal scarring. Rarer than dry (but progresses more rapidly)

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22
Q

Wet MD: Diagnosis

A

Fluorescein angiography

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23
Q

Dry MD: Treatment (2)

A
  1. Amsler grid @ home to monitor stability
  2. Vitamin A, C, E, and zinc may slow progression
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24
Q

Wet MD: treatment (2)

A
  1. Anti-angiogenics in wet (ex: bevacizumab)
  2. Optical tomography done to monitor treatment response
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25
Q

What is the MC cause of new, permanent vision loss/blindness in 25-74 year olds?

A

Diabetic retinopathy

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26
Q

Nonproliferative diabetic retinopathy: General

A
  1. Microaneurysms –> blot and dot hemorrhages, flame-shaped hemorrhages, cotton wool spots, hard exudates
  2. Not associated with vision loss
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27
Q

Nonproliferative diabetic retinopathy: Treatment (2)

A
  1. Glucose control
  2. Panlaser treatment
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28
Q

Proliferative Diabetic Retinopathy: General

A
  1. Neovascularization
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29
Q

Proliferative Diabetic Retinopathy: Treatment

A

VEGF inhibiors (ex: Bevacizumab), laser photocoagulation tx, tight glucose control

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30
Q

Maculopathy: General (3)

A
  1. Macular edema or exudates
  2. Blurred vision
  3. Central vision loss
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31
Q

Hypertensive Retinopathy: I

A
  1. Arterial narrowing
    1. ​Copper wiring: Moderate
    2. Silver wiring​: Severe
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32
Q

Hypertensive Retinopathy: II

A

AV nicking

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33
Q

Hypertensive Retinopathy: III

A

Flame-shaped hemorrhages, cotton wool spots

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34
Q

Hypertensive Retinopathy: IV

A

Papilledema (malignant HTN)

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35
Q

Papilledema: Etiologies (4)

A
  1. Idiopathic intracranial HTN (pseudotumor cerebri)
  2. Space-occupying lesion (ex: cerebral tumor, abscess)
  3. Increased CSF production
  4. Cerebral edema, sever (malignant) HTN
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36
Q

Papilledema: Treatment

A

Diuretics (ex: acetazolamide)

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37
Q

What is the most common type of retinal detachment?

A

Rhegmatogenous

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38
Q

Retinal Detachment: Treatment

A
  1. Ophtho emergency!: Laser, cryotherapy, ocular surgery
  2. Keep patient supine
  3. Miotics are CI
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39
Q

Acute Narrow-Angle Closure Glaucoma: Precipitating Factors

A
  1. Mydriasis (ex: Dim lights, anticholinergics, sympathomimetics)
  2. Increased incidence in AA and DM patients
40
Q

Acute Narrow-Angle Closure Glaucoma: Clinical Maniefstations (6)

A
  1. Severe unilateral ocular pain
  2. N/V
  3. HA
  4. Peripheral loss of vision (tunnel vision)
  5. Intermittent blurry vision
  6. Halos around lights
41
Q

Acute Narrow-Angle Closure Glaucoma: PE (4)

A
  1. Conjunctival erythema
  2. “Steamy cornea”
  3. Mid-dilated nonreactive pupil
  4. Eye feels hard to palpation (increased IOP)
42
Q

Acute Narrow-Angle Closure Glaucoma: Management (5)

A
  1. Acetazolamide IV: first-line agent!
  2. Topical beta blocker (ex: timolol)
  3. Miotics/cholinergics (ex: pilocarpine, carbachol): Usu. started once IOP has been reduced
  4. Peripheral iridotomy definitive treatment* (Avoid anticholinergic, sympathomimetics)
  5. Alpha-2 agonists (ex: apraclonidine, brimonidine)
43
Q

Chronic Open-Angle Glaucoma: Treatment (2)

A
  1. Prostaglanding analogs are first line (ex: lantanoprost), Timolol
  2. Trabeculoplasty –> trabeculostomy
44
Q

Viral conjunctivitis:

  1. MC organism
  2. MC source
  3. MC patient population
A
  1. Adenovirus
  2. Swimming pool
  3. Children
45
Q

Neonaturum Bacterial Conjunctivitis

A
  1. Day 1 –> Silver Nitrate
  2. Day 2-5–>Gonococcal
  3. Day 5-7 –> Chlamydia
  4. Day 7-11 –> HSV
46
Q

Keratitis: Physical Exam (4)

A
  1. Conuncitival erythema/injection
  2. Limbic flush (ciliary injection)
  3. Corneal ulceration on slit lamp exam
  4. Purulent or watery discharge
47
Q

Bacterial Keratitis: PE (4)

A
  1. hazy cornea
  2. Ulcer
  3. Stromal abscess
  4. +/- hypopyon
48
Q

Bacterial Keratitis: Management

A

Fluoroquinolone (ex: Moxifloxacin). DO NOT PATCH EYE! Topical steroids may be used by ophtho

49
Q

HSV Keratitis: PE Findings

A

Dendritic Lesions

50
Q

HSV Keratitis: Management

A

Trifluridine, vidarabine, acyclovir ointment. PO acyclovir

51
Q

What is optic neuritis?

A

Inflammation of optic nerve CN II

52
Q

Optic Neuritis: Etiologies (3)

A
  1. Multiple Sclerosis MC**
  2. Meds (ethambutol, chloramphenicol)
  3. Autoimmune
53
Q

Optic neuritis: Clinical Manifestations (4)

A
  1. Loss of color vision
  2. Visual field defects (ex: central scotoma/blind spot)
  3. Unilateral vision loss
  4. Ocular pain that is worse with eye movement
54
Q

Optic Neuritis: Physical Exam

A
  1. Marcus Gunn pupil
  2. Fundoscopy: 2/3 normal (retrobulbar neuritis) or 1/3 with optic disc swelling/blurring (papillitis)
55
Q

Optic neuritis: Management

A
  1. IV methylprednisolone followed by PO steroids
56
Q

Anterior uveitis (iritis): Clinical manifestations (3)

A
  1. unilateral ocular pain/redness/photophobia
  2. Excessive tearing (no discharge)
  3. Anterior usually occurs after blunt trauma
57
Q

Posterior uveitis: Clinical manifestations (4)

A
  1. Blurred/decreased vision
  2. Floaters
  3. Absenct symptom of anterior involvement
  4. No pain
58
Q

Uveitis (iritis): Physical exam (4)

A
  1. Ciliary injection (limbic flush)**
  2. Consensual photophobia
  3. +/- visual changes
  4. Inflammatory cells and flare** within aqueous
59
Q

Uveitis (iritis): Treatment

A
  1. Topical steroids for anterior, Homatropine (anticholinergic)
  2. Systemic corticosteroids for posterior
60
Q

Central Retinal Artery Occlusion (CRAO): Clinical Manifestations

A
  1. Acute, sudden monocular vision loss*, usually preceded by amaurosis fugax*
61
Q

CRAO: Diagnosis (2)

A
  1. Fundoscopy: pale retina with cherry-red macula (red spot)*. Veins may show segmentation (“box car appearance”)
  2. Workupt to see if artherosclerosis is present
62
Q

CRAO Treatment (4)

A
  1. Decrease IOP to prevent anterior chamber involvement (acetazolamide)
  2. No treatment has been shown effective
  3. Lay patient flat on back, massage orbit to dislodge clot
  4. Vessel dilation may be used
63
Q

Central Retinal Vein Occlusion (CRVO): Diagnosis

A

Fundoscopic: Extensive retinal hemorrhages (“Blood and thunder” apearance)**, retinal vein dilation, macular edema (disc swelling)

64
Q

Central Retinal Vein Occlusion: Treatment (2)

A
  1. No known effective treatment
  2. Anti-inflammatories, steroids, plasmapheresis, laser
65
Q

Cataracts: Risk factors in adults (6)

A
  1. Cigarette smoking
  2. Corticosteroids
  3. UV light
  4. DM
  5. Malnutrition
  6. Aging (MC>60 years)
66
Q

Cataracts: Risk factors in neonates (4)

A

TORCH syndrome

  1. Taxoplasmosis
  2. Rubella
  3. CMV
  4. HSV
67
Q

What is the most common organism found in otitis externa?

A

Pseudomonas

68
Q

Otitis Externa: Management (3)

A
  1. Ciprofloxacin/dexamethasone (ofloxacin safe if there is an assoc. TM perforation)
  2. Aminoglycoside abx combination: neomycin/polytrim-B/hydrocortisone otic (not used if TIM perforation is suspected)
  3. Amphotericin B if fungal
69
Q

What are the MC organisms of Acute Otitis Media (AOM)? (4)

A
  1. S. pneumo (MC)*
  2. H. influenza
  3. Moraxella catarrhalis
  4. Strep pyogenes
70
Q

AOM: Management (4)

A
  1. Amoxicillin x 10-14 days DOC. Cefixime in children, Augmentin 2nd line
  2. If PCN allergic–>Erythromycin-Sulfisoxazole, Azithromycin; Bactrim
  3. Myringotomy (surgical drainage) if severe otalgia or if severe mastoiditis
  4. Tympanostomy if recurrent or persistent l
71
Q

Mastoiditis: Treatment (2)

A
  1. IV abx with myringotomy (Ampicillin, cefuroxime), oral abx
  2. Refractory –> mastoidectomy
72
Q

Eustachian Tube Dysfunction: Treatment (3)

A
  1. Decongestants: Pseudoephedrine, phenylephrine, oxymetazoline nasal spray
  2. Auto-insufflation (swallow, yawn)
  3. Nasal steroids
73
Q

Acoustic (Vestibular) CN VIII Neuroma: Clinical Manifestations (5)

A
  1. Unilateral hearing loss is acoustic neuroma until proven otherwise
  2. Tinnitus
  3. HA
  4. Facial numbness

5 Continuous disequilibrium

74
Q

Antihistamines used in vertigo

A
  1. 1st line
  2. Ex: Meclizine, cyclizine, dimenhydrinate, diphenhydramine
75
Q

Dopamine blockers used in vertigo (3)

A
  1. Metoclopramide, prochlorperazine (Compazine) IM/rectal; IV promethazine (Phenergan)
  2. MOA: Antagonized dopamine D2 receptors
  3. Often given with benadryl to prevent dystonic reactions
76
Q

Anticholinergics used for vertigo

A

Scopolamine

77
Q

What is vestibular neuritis?

A

Inflammation of the vestibular portion of CN 8 in the inner ear

78
Q

What is labyrinthitis?

A

Vestibular neuritis + hearing loss/tinnitus*

79
Q

Vestibular neuritis and labyrinthitis: Management (2)

A
  1. Corticosteroids 1st line
  2. If symptomatic: antihistamines (ex: meclizine), benzos
80
Q

Meniere’s disease: characteristics (4)

A
  1. Episodic vertigo
  2. Fluctuating hearing loss
  3. Tinnitus
  4. Ear fullness
81
Q

Treatment regimens used in acute sinusitis

A

Amoxicillin DOC 10-14 days, doxycycline, bactrium

82
Q

What is mucomycosis? (4)

A
  1. Fungi that invades the sinuses that may enter the CNS
  2. Seen in immunocompromised patients
  3. Affects the orbits, lungs, and CNS
  4. May cause black eschar on the face
83
Q

Mucormycosis treatment

A

Lipid amphotericin B, posaconazole

84
Q

Sialadenitis: Treatment

A
  1. Increase salivary flow: sialogogues (ex: lemon drops)
  2. IV Nafcillin if severe
85
Q

Where is sialolithiasis most commonly found?

A

Wharton’s Duct

86
Q

What is oral hairy leukoplakia caused by?

A

Epstein Barr Virus (HHV-4)

87
Q

What can be given for recurrent aphthous ulcers?

A

Cimetidine

88
Q

MC organisms found in peritonsillar abscess

A

Strep pyogenes, S. aureus, polymicrobial

89
Q

Peritonsillar abscess: Management (2)

A
  1. Drainage + Abx (Ampicillin/sulbactam or clindamycin)
  2. Steroids (for edema)
90
Q

Tonsillectomy indications (3)

A
  1. Recurrent strep infections
  2. Recurrent peritonsillar infections
  3. Chronic tonsillitis
91
Q

What will show on a lateral cervical film with epiglotitis?

A

Thumb sign

92
Q

What abx are given in epiglottitis?

A

Ceftriaxone +/- clindamycin

93
Q

What is the prophylactic treatment for epiglottitis?

94
Q

Ludwig’s Angina: Clinical Manifestations

A

Swelling and erythema of the upper neck and chin with pus on the floor of the mouth

95
Q

Ludwig’s Angina: Management

A

Penicillin + Metronidazole, Clindamycin, Ampicillin/sulbactam (Unasyn)

PANCE Prep Pearls (7 decks)

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