ENT/Ophthalmology Flashcards
What is Blepharitis
Inflammation of both eyelids
Common in patients with Down’s Syndrome and Eczema
Sx of Blepharitis
Eye irrtation/itching
Burning, erythema with crusting, scaling, red-rimming of eyelid and eyelash flaking
Tx of Blepharitis
Anterior: Eyelid hygiene: warm compresses, eyelid scrubbing, baby shampoo
Posterior: Eyelid massage/expression of Meibomian gland regularly
What is a Hordeolum (Stye)
Local abscess of eyelid margin
What is the most common pathogen in Hordeolum
Staph. Aureus
Sx of Hordeolum
Focal Abscess: Painful, warm, swollen red lump on eyelid
Tx of Hordeolum
Warm Compresses, Topical Abx (Erythromycin, Bacitracin), I&D if no drainage after 48 hours
What is a Chalazion
Painless granuloma of internal meibomian sebaceous gland
Leads to focal eyelid swelling
Sx of Chalazion
Hard, non-tender eyelid swelling on conjunctival surface of eyelid
Tx of Chalazion
Eyelid Hygiene, Warm Compresses
What is Dacrocystitis
Infection of the lacrimal gland
What are the common pathogens associated with Dacrocystitis
S. Aureus, GABHS, S. Epidermis, H.Flue, S. Pneumoniae
Sx of Dacrocystitis
Tenderness, edema and redness to nasal side of lower lid
Tx of Dacrocystitis
Oral abx: Clindamycin + 3rd Gen Cephalosporin
What is a Pterygium
Elevated, superficial fleshy, triangle shaped growing fibrovascular mass on the nasal side of the eye and extends laterally
Associated with increased UV exposure in sunny climates, sand, wind, dust
Tx ot Pterygium
Observation in most cases (Artificial tears), Removal if growth affects vision
What is a Pinguecula
Yellow, Elevated nodule on nasal side of eye
It does not grow
What is an Orbital Floor “blowout” Fracture
Fractures to the orbital floor (maxillary, zygomatic, palatine)
Sx of Orbital Floor Fracture
Decreased visual acuity, Enophthalmos (sunken eye)
Diplopia especially with upward gaze
Orbital Emphysema
Epistaxis, Dyesthesias, Hyperalgesia
Dx of Orbital Floor Fracture
CT Scan
Tx of Orbital Floor Fracture
Nasal Decongestants Avoid blowing nose Prednisone Abx (Unasyn or Clindamycin) Surgical Repair
What is a Globe Rupture
The outer membranes of eye disrupted by blunt or penetrating trauma
This is an emergency
Sx of Globe Rupture
Ocular Pain, Diplopia
Misshaped eye with prolapse of ocular tissue from sclera or corneal opening
Enophthalmos (sunken eye), Severe conjunctival hemorrhage
Teardrop or irregularly shaped pupil
Tx of Globe Rupture
Rigid Eye Shield, Immediate Ophtho Consult
what is Macular Degeneration
Most common cause of legal blindness and visual loss in the elderly
Macula is responsible for central vision (detail and color)
What is Dry Macular Degeneration
Gradual breakdown of the macula, gradual blurring of central vision
See Drusen: Small, round, yellow-white spots on outer retina
What is Wet Macular Degeneration
New, abnormal vessels grow under central retinal which leak and bleed
Leads to retinal scarring
Dx of Wet Macular Degeneration
Fluorescein Angiography
Sx of Macular Degeneration
Bilateral blurred or loss of Central Vision
Scotomas (blind spots, shadows)
Metamorphopsia (straight lines appear bent)
Micropsia
Tx of Macular Degenration
Dry: Amsler Grid at home to monitor stability, Vit. A, B, E, Zing to slow progression
Wet: Anti-Angiogenics (Bevacizumab which inhibits vascular endothelial growth factor)
What is Papilledema
Optic nerve (disc) swelling secondary to increased intracranial pressure
What leads to Papilledema
Idiopathic intracranial HTN
Space-Occupying Lesion (tumor, abscess)
Increased CSF production
Cerebral Edema, Severe HTN
Sx of Papilledema
Headache, N/V, Vision usually preserved
Usually bilateral
Dx of Papilledema
Swollen optic disc with blurred margins
MRI or CT to r/o mass
Tx of Papilledema
Diuretics (Acetazolamide)
What is Retinal Detachment
Retinal tear leads to retinal inner layer detaching from choroid plexus
Sx of Retinal Detachment
Photopisa (Flashing Lights) with detachment
Floaters
Progressive unilateral vision loss: Shadow in peripheral field then central visual field TUNNEL VISION
No Pain or Redness
Dx of Retinal Detachment
Fundoscopy: Retina is seen hanging in vitreous
Positive Schaffer’s Sign (clumping of pigment cells in anterior vitreious)
Tx of Retinal Detachment
Optho Emergency: Laser, Cryotherapy Ocular Surgery
What are Sx of a Foreign Body or Corneal Abrasion
Foreign body sensation in eye, tearing, red and painful eye
Dx of Corneal Abrasion
Pain relieved with ophthalmic analgesic drops
Fluorescein staining for epithelial defects
Tx of Corneal Abrasion
Check visual acuity first
Remove foreign body with sterile irrigation or moist sterile cotton swab
Topical Abx (Fq for contacts to cover Pseudomonas)
What is Orbital (post septal) Cellulitis
Usually secondary to sinus infections
What pathogens are associated with Orbital Cellulitis
s. Pneumo, GABHS, H. Influenza, S. Aureus
Sx of Orbital Cellulitis
Decreased vision
Pain with ocular movement
Proptosis
Dx of Orbital Cellulitis
CT: Infection of fat and ocular muscles
Tx of Orbital Cellulitis
IV Abx (Vancomycin, Clindamycin, Cefotaxime)
What is Periorbital Cellulitis
Preseptal Cellulitis
Infection of eyelid and periocular tissue
Sx of Periorbital Cellulitis
No visual changes
No pain with ocular movement
What is Acute Narrow-Angle Closure Glaucoma
Glaucoma: Increased Intraocular Pressure, Leads to optic nerve damage (decreased visual acuity)
Decreased drainage of aqueous humor via trabecular meshwork and canal of Schlemm
Sx of Acute Narrow-Angle Closure Glaucoma
Severe unilateral ocular pain N/V Headache Intermittent blurry vision Halos around lights Tunnel Vision Steamy Cornea Eye feels hard to palpation
Dx of Acute Narrow-Angle Closure Glaucoma
Increased intraocular pressure measured by tonometry
Cupping of optic nerve
Tx of Acute Narrow-Angle Closure Glaucoma
Lower Intra Ocular Pressure first then Open the angle
Acetazolamide IV is 1st line (decreased IOP by decreased aqueous humor production)
Topical Beta-Blocker reduces IOP
Miotics/Cholinergics
What is the most common pathogen in Viral Conjunctivitis
Adenovirus
Usually in swimming pools
Very Contageious
Sx of Viral Conjunctivitis
Preauricular lymphadenopathy
Copious water discharge
Scanty mucoid discharge
Often Bilatera
Tx of Viral Conjunctivitis
Cool Compresses
Artificial Tears
Atihistamines for itching/redness
What are the common pathogens involved in Bacterial Conjunctivitis
Staph/Strep, H. Influenza, Moraxella
Sx of Bacterial Conjunctivitis
Purulent discharge, lid crusting, no visual changes
Tx of Bacterial Conjunctivitis
Topical Abx (Erythromycin) If contacts: FQ for pseudomonas coverage
What is Keratitis
Corneal Ulcer/Inflammation
Due to bacteria, viruses, fungi
Associated with rapid progression and sight-threatening
Sx of Keratitis
Pain, Photophobia, Reduced Vision, Tearing
Corneal ulceration on slit lamp exam
Hazy Cornea in Bacterial
Dendritic Lesions in HSV
Tx of Bacterial Keratitis
FQ (Moxifloxacin)
Don’t patch the eye
Topical Steroids
Tx of HSV Keratitis
Trifluridine, Vidarabine, Acyclovir ointment
Oral Acyclovir
What is Optic Neuritis
Inflammation of Optic Nerve (CN II)
Sx of Optic Neuritis
Loss of color vision
Visual field defects (central scotoma/blind spot)
Unilateral vision loss
Ocular pain that is worse with eye movement
Marcus Gunn Pupil: When light shone into eye, it dilates rather than constricts
Tx of Optic Neuritis
IV Methylprednisolone followed by oral steroids
What is Central Retinal Vein Occlusion
The central retinal vein thrombus leads to fluid backup in the retina which in turn leads to acute, sudden monocular vision loss
What are risk factors for central retinal vein occlusion
HTN, DM, Glaucoma, Hypercoagulable State
Dx of Central Retinal Vein Occlusion
Fundoscopy: Extensive retinal hemorrhages (blood and thunder appearance)
Retinal vein dilation
Macular edema
Tx of Central Retinal Vein Occlusion
Anti-Inflammatories
Steroids
Plasmapheresis
Laser
What is Otitis Externa
Swimmers Ear
Bacterial overgrowth, usually Pseudomonas
Sx of Otitis Externa
Ear pain, Pruritis, Auricular Discharge
Pain on traction of ear canal/tragus
Erythema, Edema, Debris
Tx of Otitis Externa
Isopropyl Alcohol and Acetic Acid to dry ear
Cipro/Dexamethason
What is Acute Otitis Media
Infection of middle ear, temporal bone and mastoid air cells
Usually preceded by UIR
What are the most common pathogens with Acute Otitis Media
S. Pneumo, H. Influenza, Moraxella, Strep Pyogens
Sx of Acute Otitis Media
Fevers, Otalgia, Ear tugging in infants, conductive hearing loss
TM may be perforated: rapid relief of pain + Otorrhea
See bulging, erythematous TM with effusions
Tx of Acute Otitis Media
Amoxicillin
If PCN Allergy: Erythromcyin-Sulfisoxazole, Azithromycin
What is Mastoiditis
Inflammation of mastoid air cells of temporal bone
Sx of Mastoiditis
Deep ear pain, usually worse at night
Mastoid tenderness
Tx of Mastoiditis
IV abx with myringotomy (Ampicillin, Cefuroxime)
If refractory: Mastoidectomy
What is Labyrinthitis
Vestibular Neuritis + Hearing Loss/Tinnitus
Sx of Labyrinthitis
Vestibular Sx: Peripheral vertigo, dizziness, N/V, gait disturbances
Cochlear sx: Hearing loss
Tx of Labyrinthitis
Corticosteroids are 1st line
Antihistamines if sx
What is Acute Sinusitis
URI leads to edema which blocks drainage of the sinuses, leads to fluid buildup and bacterial colonization
What are the most common pathogens seen with Acute Sinusitis
Strep. Pneumo, GABHS, H.Flu, M. Catarrhalis
SAME AS ACUTE OTITIS MEDIA
Sx of Acute Sinusitis
Sinus pain/pressure, worse with bending forward, headache, malaise, purulent sputum or nasal discharge
Cheek pain/pressure
Tenderness to high lateral wall of nose
Sinus tenderness on palpation, opacifications with trans illumincation
Dx of Acute Sinusitis
Clinic
CT scan is diagnostic
Xray: Water’s View
Tx of Acute Sinusitis
Amoxicillin, Doxycyclince, Bactrim
What is Chronic Sinusitis
Sinusitis that lastsa 8 weeks or more
What is the most common pathogen associated with Chronic Sinusitis
Staph Aureus, Psuedomonas, Aspergillus
Sx of Acute Rhinitis
Sneezing, nasal congestion/itching, clear rhinorrhea
If allergic type: Pale, Boggy Turbinates, Nasal Polyps with cobblestone mucosa
If Vrial: Erythematous Turbinates
Tx of Acute Rhinitis
Oral Antihistamines
Decongestants like Pseudoephedrine
Intranasal Steroids for allergic rhinitis especially with nasal polyps
What is Epistaxis
Bleeding from the nose
What is the most common source of Anterior Epistaxis
Kiesselbach’s Plexus
What is the most common source for Posterior Epistaxis
Palatine Artery
Tx of Epistaxis
Direct Pressure for 10 minutes
Short acting Topical decongestants (Afrin)
Cauterization or Nasal Packing
What is a Peritonsillar Abscess
Starts as tonsillitis, followed by cellulitis, followed by abscess formation
What is the most common pathogen with Peritonsillar Abscess
Strep Pyogens, Staph Aureus, Polymicrobial
Sx of Peritonsillar Abscess
Dysphagia, Pharyngitis, muffled “hot potato voice” difficultly handling oral secretions, trismus, uvula deviation to contralateral side
Dx of Peritonsillar Abscess
CT Scan
Tx of Peritonsillar Abscess
Drainage and Abx (Unasyn or Clindamycin)
Steroids for edema
What is Epiglottitis
Inflammation of epiglotis
What are the most common pathogens associated with Epiglottitis
H. Influenza type B, S. Pneumo
Sx of Epiglottitis
ABrupt onset of fever, droolwing, dysphagia and distress (tripod position)
Dx of Epiglottitis
Tongue blade not used, it will cause a laryngospasm
Lateral Cervical Film: See Thumb Sign
Laryngoscop is definitive, only in adults, see cherry-red epiglottis
Tx of Epiglottitis
Secure airway, IV abx (Ceftriaxone), IV Corticosteroids and IV fluids
