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EOR - Emergency Medicine > ENT/Ophthalmology > Flashcards

ENT/Ophthalmology Flashcards

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1
Q

when should you suspect squamous cell carcinoma in a pt w. acute laryngitis

A

hoarseness persists > 2 weeks
hx etoh/smoking

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2
Q

2 mc causes of acute laryngitis

A

virus
overuse

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3
Q

consider _ if pt has acute laryngitis w. no viral etiology

A

GERD

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4
Q

2 pathogens mc associated w. acute laryngitis

A

m.cat
h.flu

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5
Q

order laryngoscopy if sx of acute laryngitis persist _

A

> 3 weeks

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6
Q

laryngitis + deviation of soft palate makes you think

A

absess

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7
Q

tx for viral laryngitis to hasten recovery (ex for vocal performers)

A

oral AND IM steroids

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8
Q

3 abx for bacterial laryngitis

A

erythromycin
cefuroxime
augmentin

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9
Q

what is this showing

A

hyphema
blood in anterior chamber of eye

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10
Q

t/f: with hyphema, blood may cover the iris, pupil, and block vision

A

t!

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11
Q

mc cause of hyphema

A

blunt/penetrating trauma

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12
Q

dx for hyphema

A

orbital CT if indicated
ophthalmology consult

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13
Q

tx for hyphema

A

blood reabsorbs over days/weeks
elevate head 30 degrees at night
APAP
eye patch/shield
bb or acetazolamide
+/- surgery

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14
Q

pharm contraindicated for hyphema

A

NSAIDs

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15
Q

clinical dx criteria for AOM

A
  1. bulging tympanic membrane
  2. other signs of acute inflammation: TM erythema, fever, ear pain, middle ear effusion
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16
Q

top 3 pathogens associatd w. AOM

A
  1. strep pneumo
  2. h.flu
  3. m. cat
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17
Q

classifications of AOM

A

acute: < 3 weeks
chronic: > 3 mo
recurrent: 3 episodes x 6 mo OR 4 in 12 w.o full remission
chronic: > 3 mo clear serous fluid in middle ear w.o sx of ear infxn

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18
Q

should you use abx to treat chronic AOM

A

no

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19
Q

hallmark PE finding of AOM

A

limited mobility of TM w. pneumotoscopy

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20
Q

1st and 2nd line tx for AOM

A
  1. amoxicillin
  2. augmentin

pcn allergy: macrolides vs bactrim

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21
Q

abx duration:
<2 yo
< 2 yo

A

< 2 yo: 10 days
< 2 yo: 5-7 days

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22
Q

tx for recurrent AOM (3)

A

tympanostomy
tympanocentesis
myringotomy

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23
Q

2 complications of AOM

A

mastoiditis
bullous myringitis

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24
Q

acute severe vertigo
hearing loss
tinnitus
hx viral respiratory illness

A

labyrinthitis

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25
Q

what sx may not resolve w. labyrinthitis

A

hearing loss

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26
Q

dx and tx for labyrinthitis

A

dx: clinical - no neuro deficits

tx:
-meclizine
- +/- abx
- benzos for acute

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27
Q

bacterial pharyngitis is mc caused by

A

GAS

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28
Q

centor criteria

A

3/4 = strep test
sensitivity 90%

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29
Q

gs dx for pharyngitis

A

throat culture

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30
Q

2 complications of strep pharyngitis

A

rheumatic fever
glomerulonephritis

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31
Q

tx for strep pharyngitis

A

PCN

allergy: erythromycin

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32
Q

3 viral pathologies of pharyngitis

A

CMV
EBV
adenovirus

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33
Q

rash w. PCNs

A

EBV

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34
Q

dx for viral pharyngitis

A

atypical lymphocytes
+
heterophile agglutination test (monospot)

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35
Q

hallmark PE finding of EBV

A

splenomegaly

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36
Q

when can athletes w. splenomegaly return to contact sports

A

3 weeks after sx onset
4 weeks for strenuous contact sports

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37
Q

2 common cause of fungal pharyngitis

A

inhaled steroids
HIV pt’s

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38
Q

tx for fungal pharyngitis

A

clotrimazole troches
miconazole
nystatin swish
fluconazole

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39
Q

2 types of macular degeneration

A

wet
dry

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40
Q

gradual painless loss of central vision:
gradual loss of painless peripheral vision:

A

central: wet macular degeneration
peripheral: glaucoma

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41
Q

what is this showing

A

drusen spots: yellow retinal deposits -> dry macular degeneration

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42
Q

advanced form of dry macular degeneration characterized by rapid/severe vision loss

A

wet macular degeneration

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43
Q

what is this showing

A

neovascularization -> leaking bv/damaged retinal cells

wet macular degeneration

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44
Q

dx for macular degeneration

A

dilated fundoscopy:
-hemorrhage or fluid in subretina
-macular grayish-green discoloration

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45
Q

what is this showing

A

distortion of amsler grid -> macular degeneration

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46
Q

tx for macular degeneration: wet vs dry

A

dry: zinc, copper, vitamins C/E, lutein
wet: bevacizumab (VEGF inhibitor), photodynamic therapy, supplements used for dry

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47
Q

3 mc bacteria associated w. acute sinusitis

A
  1. strep pneumo
  2. h.flu
  3. m.cat
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48
Q

3 rf for acute sinusitis

A

cigs
trauma
foreign body

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49
Q

2 PE findings of acute sinusitis

A

-ttp of sinuses
-decreased transmission w. transillumination

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50
Q

indications for abx for sinusitis

A

sx > 10 days w.o improvement

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51
Q

duration of abx for acute sinusitis

A

5-7 days

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52
Q

abx for acute sinusitis

A

amoxicillin
augmentin
pcn allergy: doxy
peds: amoxicillin

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53
Q

suppurative infxn of mastoid air cell
usually complication of AOM

A

mastoiditis

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54
Q

pathogens associated w. mastoiditis

A

strep pneumo
h.flu
m.cat
s.aureus
s.pyogenes

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55
Q

2 PE findings of mastoiditis

A

erythema posterior to ear
forward displacement of external ear

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56
Q

mastoiditis is a clinical dx, but what is the gs imaging for complicated/toxic appearing pt’s

A

CT w. contrast

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57
Q

tx for mastoiditis

A

vanco
ceftriaxone

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58
Q

what is this showing

A

allergic shiners -> allergic rhinitis

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59
Q

what is this showing

A

allergic salute -> allergic rhinitis

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60
Q

what is this showing

A

transverse nasal crease -> allergic rhinitis

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61
Q

4 PE findings of allergic rhinitis

A

pale, bluish, boggy mucosa
allergic shiners
transverese nasal crease
alleric salute

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62
Q

allergic rhinitis involves _ mediated _ release

A

IgE mediated
mast cell/histamine release

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63
Q

risk of using intransal decongestants (pseudoephedrine, afrin) > 3-5 days

A

rhinitis medicamentosa (rebound congestion)

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64
Q

pharm for allergic rhinitis

A

antihistamines
cromolyn sodium
nasal/systemic steroids
saline drops/washes

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65
Q

tissue injury -> pressure-related change in body compartment gas volume -> disruption of air containing areas

A

barotrauma

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66
Q

areas affected by barotrauma

A

ears
lungs
sinuses
GI tract
airspaces in teeth

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67
Q

sx of barotrauma

A

-ear pain/hearing loss persisting past inciting event
-sinus pain
-epistaxis
-abdominal pain
-dyspnea
-LOC

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68
Q

tx for barotrauma

A

supportive
NSAIDs

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69
Q

acute (hr’s - days) inflammation/demyelination of optic nerve -> acute monocular vision loss, pain w. extraocular movements

A

optic neuritis

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70
Q

mc cause of optic neuritis

A

MS

also ethambutol

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71
Q

dx for optic neuritis

A
  1. fundoscopy
  2. MRI
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72
Q

fundoscopy finding of optic neuritis

A

inflammation of optic disc

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73
Q

tx for optic neuritis

A

IV methylprednisone
neuro referral

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74
Q

chronic inflammation of lid margins -> dysfxn of meibomian glands

A

blepharitis

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75
Q

3 causes of blepharitis

A

seborrhea
staph
strep

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76
Q

2 types of blepharitis

A

anterior
posterior

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77
Q

anterior blepharitis involves inflammation of _ (2)
and is caused by _ (2)

A

eyelid skin, eyelashes
seborrhea, s.aureus

78
Q

posterior blepharitis involves inflammation of the _
and is caused by _

A

meibomian glands
s.aureus, gland infxn

79
Q

what is this showing

A

-crusting, scaling, red-rimming of the eyelid
-eyelash flaking
-hyperemic lid margins
-dandruff like deposits/fibrous scales

blepharitis

80
Q

what does scurf and colarettes make you think of

A

blepharitis

81
Q

dx for blepharitis

A

slit lamp exam

82
Q

tx for blepharitis

A

warm compress
wash w. diluted baby shampoo
gland expression
+/- topical abx

83
Q

what is this showing

A

infxn of orbital muscles AND fat behind the eye

**orbital cellulitis **

84
Q

what is this showing

A

infxn of eye skin only

periorbital cellulitis

85
Q

sx of orbital cellulitis

A

-decreased extraocular movement
-pain w. eye movements
-proptosis

86
Q

orbital cellulitis is mc a complication of

A

sinusitis

87
Q

_ is not commonly associated w. orbital cellulitis

A

vision loss

88
Q

gs dx for orbital cellulitis

A

orbital CT

89
Q

tx for orbital cellulitis

A

admit
vanco

90
Q

blunt trauma -> muscle entrapment
eyelid swelling, gaze restriction

A

blowout fx

91
Q

2 hallmark PE findings of blowout fx

A

enophthalmos (shrunken eye)
raccoon eyes

92
Q

what sx make you concerned for damage to the infraorbital nerve (ex w. blowout fx)

A

anesthesia/paresthesia in gums, upper lips, cheek

93
Q

tx for blowout fx

A

ophthalmic referral asap
abx

94
Q

pain. movement of tragus or auricle
cheesy white discharge
swimmer’s ear

A

otitis externa

95
Q

tuning fork findings of otitis externa

A

bc > ac

96
Q

pathogens associated w. otitis externa: swimmer’s ear vs digital trauma

A

swimmer’s ear: pseudo
digital trauma: s.aureus

97
Q

type of otitis externa mc seen in diabetics

A

malignant otitis externa

98
Q

tx for otitis externa

A

-abx drops: aminoglycosides vs fluoroquinolones
-avoid moisture
+/- steroids

99
Q

abx choice for otitis externa if you suspect perforation

A

cipro PLUS dexamethasone
OR
ofloxacin

100
Q

tx for malignant otitis externa

A

admit
IV abx

101
Q

2 pathogens associated w. malignant otitis externa

A

aspergillus
candida

102
Q

tx for fungal otitis externa

A

acetic acid drops
clotrimazole drops
PO itraconazole

103
Q

3 types of conjunctivitis

A

viral
bacterial
allergic

104
Q

pathogens mc associated w. conjunctivitis:
viral:
bacterial:

A

viral: adenovirus
bacterial: s.aureus, strep pneumo, m.cat, gonococcal, chlamydia

105
Q

2 pathogens associated. acute mucopurulent bacterial conjunctivitis

A

s.aureus - mc
strep pneumo

106
Q

pathogen associated w. bacterial conjunctivitis w. copious purulent d.c - not responding to conventional tx

A

m.cat

107
Q

newborn bacterial conjunctivitis makes you think of what pathogen

A

chlamydia

108
Q

dx for clamydia conjunctivitis

A

giemsa stain showing inclusion body

109
Q

-acute onset unilateral vs bilateral erythema of conjunctiva
-copious watery d.c, tender periauricular LAD, scant mucoid d.c

A

viral conjunctivitis

110
Q

-purulent d.c mc from both eyes (can be unilateral) -> glued shut appearance
-crusting worse in the AM

A

bacterial conjunctivitis

111
Q

red eyes bilaterally
itching/tearing
cobblestoning mucosa on inner/upper eyelid

A

allergic conjunctivitis

112
Q

tx for bacterial conjunctivitis based on pathogen

A

gram negative: gentamicin/tobramycin (tobrex)
chlamydia: erythromycin (E-Mycin) vs tetracycline

trimethoprim and polymyxin B (polytrim)

113
Q

pathogen associated w. conjunctivitis in contact lens wearers plus treatment

A

pseudo
fluoroquinolone drops

114
Q

tx for viral conjunctivitis

A

-eye lavage w. normal saline bid x 7-14 days
-antihistamine drops

115
Q

pharm for allergic conjunctivitis

A

topical vs systemic antihistamines
naphcon-A/ocuhist
azelastine

116
Q

bilateral optic disc swelling from increased intracranial pressure - lasting hours-weeks

A

papilledema

117
Q

6 causes of papilledema

A

malignant HTN
malignancy
abscess
meningitis
cerebral hemorrhage
pseudotumor cerebri

118
Q

3 fundoscopy findings of pseudotumor cerebri

A

swollen disc
blurred margins
obliteration of vessels

119
Q

management of papilledema

A
  1. imaging asap
  2. LP
120
Q

sudden onset of eye pain, photophobia, tearing, foreign body sensation, blurred vision

A

corneal abrasion/ulcer

121
Q

mc cause of corneal abrasion/ulcer

A

trauma

122
Q

dx for corneal abrasion/ulcer

A

slit lamp w. fluroscein dye -> increased absorption in devoid area

123
Q

management of corneal abrasion/ulcer

A

topical anesthetic
irrigation
gentamicin vs sulfacetamide
APAP

124
Q

what med can be used for to aid in dx of corneal abrasion/ulcer, but can delay healing if used longterm

A

topical anesthetics

125
Q

_ is contraindicated for corneal abrasion/ulcer

A

eye patching

increased risk for infxn

126
Q

penetration of infxn through the tonsilar capsule into neighboring tissue

A

peritonsillar abscess

127
Q

4 PE findings of peritonsillar abscess

A

hot potato voice
severe sore throat
uvula displacement
bulging tonsillar pillar

128
Q

pathogen mc associated w. peritonsillar abscess

A

strep pyogenes

129
Q

managment of peritonsillar abscess

A

ASA
I&D
PO vs IV abx (aminoglycocides vs amoxicillin/augmentin)
+/- tonsillectomy

130
Q

what is this showing

A

inflammation of lacrimal glands -> dacryoadenitis

131
Q

mc causes of dacryoadenitis (4)

A

mumps
EBV
staph
gonococcus

132
Q

gs imaging for chronic dacryoadenitis

A

CT orbits

133
Q

acute onset of unilateral painless (extreme myopia), blurred or blackened vision that occurs over several minutes to hr -> progresses to complete or partial monocular blindness

A

retinal detachment

134
Q

how might a pt describe retinal detachment (3)

A

curtain over field of vision
floaters/flashes
painless

135
Q

what is this showing

A

detached retina

136
Q

PE finding of retinal detachment

A

asymmetric red reflex
normal vs decreased IOP

137
Q

management of retinal detachment

A

-stay supine w. head towards side of detachment
-ophtho consult
-pneumatic retinopexy
-injxn of air bubble into vitreous

138
Q

tx for dental abscess

A

ceftriaxone IM
followed by PO amoxicillin

139
Q

what is this showing

A

cherry red spot -> central retinal artery occlusion (CRAO)

140
Q

3 causes of CRAO

A

atherosclerotic thrombosis
ipsilateral embolism
giant cell arteritis

141
Q

describe pain w. CRAO

A

sudden
painless
unilateral
amaurosis fugax

142
Q

3 fundoscopic findings of CRAO

A

perifoveal atrophy
pale opaque fundus w. red fovea -> cherry red spot
areterial attenuation

143
Q

imaging for CRAO

A

carotid US to r.o carotid artery stenosis

144
Q

management of CRAO

A

-emergent ophtho consult -> emergent carotid/opthalmic artery catheterization w. thrombolytic drugs if occlusion is w.in 24 hr of sx
-topical timolol vs acetazolamide
-digital massage
-anterior chamber paracentesis

145
Q

w. CRAO, irreversible damage to the retina occurs after _ min of sx onset

A

90 min

146
Q

what is this showing

A

blood and thunder fundus -> central retinal vein occlusion (CRVO)

147
Q

describe pain w. CRVO

A

sudden
painless
unilateral vision loss

148
Q

6 rf for CRVO

A

> 50 yo
HTN
primary open angle glaucoma
DM
HLD
hyperviscosity: polycythemia, leukemia

149
Q

mc cause of CRVO

A

thrombotic event

150
Q

fundoscopy findings of CRVO

A

-retinal hemorrhages in all quadrants
-optic disc swelling
-dilated veins/hemorrhages/edema/exudates -> blood and thunder

151
Q

management of CRVO (3)

A

vision self resovles - partial vs full
work up for thrombosis
bevacizumab (VGEF inhibitor)

152
Q

4 types of external ear trauma

A

hematoma
laceration
avulsion
fx

153
Q

what is this

A

subperichondrial hematoma (cauliflower ear)

avascular necrosis of cartilage

154
Q

managemet of cauliflower ear

A

immediate ENT referral for I&D
cefalexin

155
Q

external ear wounds < _ can be closed

A

12 hr

156
Q

laceration of what part of the external ear should be sutured whenever possible

A

pinna

157
Q

management of ear avulsion

A

otolaryngologist/plastics referral

158
Q

5 rf for epistaxis

A

nasal trauma
dryness
HTN
cocaine
etoh

159
Q

mc site for anterior vs posterior epistaxis

A

anterior: kiesselbach’splexus/little’s area
posterior woodruff plexus

160
Q

arteries of kiesselbach’s plexus

A

anterior ethmoid
superior labial
sphenopalatine
greater palatine

161
Q

arteries associated w. woodruff’s plexus

A

posterior ethmoid
sphenopalatine

162
Q

management of anterior epistaxis

A

-direct pressure at least 10-15 sec leaning forward
-afrin/phenylephrine
-+/- anterior nasal packing
-petroleum jelly + topical abx if no packing available
-cauterize if bleeding source visible

163
Q

if you pack a nose for epistaxis, you must order

A

cephalosporin

to avoid toxic shock syndrome
pt must come back for packing removal

164
Q

mnagement of posterior epistaxis

A

admit/consult
posterior balloon packing
+/- surgical ligation

165
Q

w. recurrent epistaxis, you must rule out (2)

A

HTN
hypercoagulable d.o

166
Q

pain, otorrhea, hearing loss/reduction

A

TM perforation

167
Q

causes of TM perforation (2)

A

infxn
trauma

168
Q

management of TM perforation (3)

A

-self resolve vs surgery if sx > 2 mo
-keep dry
-floxin drops

169
Q

what are the only non-ototoxic drops

A

floxin

170
Q

what is this showing

A

rust ring -> foreign body

171
Q

dx for eye foreign body

A

slit lamp vs XR/CT

172
Q

management of eye foreign body

A
  1. topical anesthetics
  2. irrigation
  3. extract vs ophtho consult
  4. +/- abx
173
Q

what pathogen are you concerned about if an eye foreign body came from soil/vegetation

A

bacillus cereus

174
Q

management of ear foreign body

A

removal via irrigation or alligator forceps
insects: mineral oil vs lidocaine -> removal

175
Q

persistent, foul smelling, unilateral nasal discharge

A

nasal foreign body

176
Q

management of nasal foreign body

A

oxymetazoline drops (shrinks mucus membrane) -> remove

177
Q

3 indications for otolaryngology referral for nasal foreign body

A

non visualized posterior
impacted
unsuccessful initial removal attempts

178
Q

2 types of glaucoma

A

acute angle closure
open angle

179
Q

73 yo M w. severe unilateral eye pain and loss of vision x 1 hr with vomiting - meds include HCTZ and tamsulosin - ophthalmic exam shows conjunctival injxn and a hazy cornea w. elevated intraocular pressure

A

acute angle-closure glaucoma

180
Q

increased IOP is caused by impediment to the flow of aqueous humor through _

A

canal of schlemm -> anterior chamber

181
Q

which type of glaucoma is a medical emergency

A

acute angle closure

182
Q

triad for acute angle closure glaucoma

A

injected conjunctiva
steamy cornea
fixed/dilated pupil

183
Q

what pt pop do you think of with open angle glaucoma (3)

A

AA
fam hx
> 40 yo

184
Q

management of acute angle closure glaucoma (5)

A

ophtho referral asap
IV acetazolamide (CAH inhibitor)
topical timolol
diuresis
laser/surgical iridotomy

185
Q

what tx is absolutel contraindicated for acute angle closure glaucoma

A

mydriatics to dilate pupil

186
Q

chronic, asyomptomatic peripheral vision loss

A

open angle glaucoma

187
Q

fundoscopy findings of open angle glaucoma

A

increased cup to disc ratio

188
Q

t/f: optic disk damage can occur w. or w.o increased IOP

A

t!

189
Q

management of open angle glaucoma

A

-ophtho referral
-latanoprost (PG analog)
-timolol
-acetazolamide (CAH inhibitor)
-+/- surgery

190
Q

6 causes of painful vision loss

A

trauma
acute closed angle glaucoma
uveitis
corneal ulcer
temporal arteritis
optic neuritis

191
Q

causes of painless vision loss

A

amaurosis fugax
TIA
CRAO/CRVO
vitreous hemorrhage
retinal detachment
lens dislocation
HTN encephalopathy
pituitary tumors
macular disorders
toxic ingestion

EOR - Emergency Medicine (13 decks)

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