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Emergency Medicine > ENT/Ophthalmology > Flashcards

ENT/Ophthalmology Flashcards

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1
Q

What is Blepharitis

A

Inflammation of both eyelids

Common in patients with Down’s Syndrome and Eczema

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2
Q

Sx of Blepharitis

A

Eye irrtation/itching

Burning, erythema with crusting, scaling, red-rimming of eyelid and eyelash flaking

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3
Q

Tx of Blepharitis

A

Anterior: Eyelid hygiene: warm compresses, eyelid scrubbing, baby shampoo
Posterior: Eyelid massage/expression of Meibomian gland regularly

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4
Q

What is a Hordeolum (Stye)

A

Local abscess of eyelid margin

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5
Q

What is the most common pathogen in Hordeolum

A

Staph. Aureus

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6
Q

Sx of Hordeolum

A

Focal Abscess: Painful, warm, swollen red lump on eyelid

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7
Q

Tx of Hordeolum

A

Warm Compresses, Topical Abx (Erythromycin, Bacitracin), I&D if no drainage after 48 hours

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8
Q

What is a Chalazion

A

Painless granuloma of internal meibomian sebaceous gland

Leads to focal eyelid swelling

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9
Q

Sx of Chalazion

A

Hard, non-tender eyelid swelling on conjunctival surface of eyelid

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10
Q

Tx of Chalazion

A

Eyelid Hygiene, Warm Compresses

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11
Q

What is Dacrocystitis

A

Infection of the lacrimal gland

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12
Q

What are the common pathogens associated with Dacrocystitis

A

S. Aureus, GABHS, S. Epidermis, H.Flue, S. Pneumoniae

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13
Q

Sx of Dacrocystitis

A

Tenderness, edema and redness to nasal side of lower lid

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14
Q

Tx of Dacrocystitis

A

Oral abx: Clindamycin + 3rd Gen Cephalosporin

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15
Q

What is a Pterygium

A

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

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16
Q

Tx ot Pterygium

A

Observation in most cases (Artificial tears), Removal if growth affects vision

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17
Q

What is a Pinguecula

A

Yellow, Elevated nodule on nasal side of eye

It does not grow

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18
Q

What is an Orbital Floor “blowout” Fracture

A

Fractures to the orbital floor (maxillary, zygomatic, palatine)

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19
Q

Sx of Orbital Floor Fracture

A

Decreased visual acuity, Enophthalmos (sunken eye)
Diplopia especially with upward gaze
Orbital Emphysema
Epistaxis, Dyesthesias, Hyperalgesia

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20
Q

Dx of Orbital Floor Fracture

A

CT Scan

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21
Q

Tx of Orbital Floor Fracture

A 
Nasal Decongestants
Avoid blowing nose
Prednisone
Abx (Unasyn or Clindamycin)
Surgical Repair
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22
Q

What is a Globe Rupture

A

The outer membranes of eye disrupted by blunt or penetrating trauma
This is an emergency

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23
Q

Sx of Globe Rupture

A

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

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24
Q

Tx of Globe Rupture

A

Rigid Eye Shield, Immediate Ophtho Consult

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25
Q

what is Macular Degeneration

A

Most common cause of legal blindness and visual loss in the elderly
Macula is responsible for central vision (detail and color)

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26
Q

What is Dry Macular Degeneration

A

Gradual breakdown of the macula, gradual blurring of central vision
See Drusen: Small, round, yellow-white spots on outer retina

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27
Q

What is Wet Macular Degeneration

A

New, abnormal vessels grow under central retinal which leak and bleed
Leads to retinal scarring

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28
Q

Dx of Wet Macular Degeneration

A

Fluorescein Angiography

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29
Q

Sx of Macular Degeneration

A

Bilateral blurred or loss of Central Vision
Scotomas (blind spots, shadows)
Metamorphopsia (straight lines appear bent)
Micropsia

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30
Q

Tx of Macular Degenration

A

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)

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31
Q

What is Papilledema

A

Optic nerve (disc) swelling secondary to increased intracranial pressure

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32
Q

What leads to Papilledema

A

Idiopathic intracranial HTN
Space-Occupying Lesion (tumor, abscess)
Increased CSF production
Cerebral Edema, Severe HTN

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33
Q

Sx of Papilledema

A

Headache, N/V, Vision usually preserved

Usually bilateral

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34
Q

Dx of Papilledema

A

Swollen optic disc with blurred margins

MRI or CT to r/o mass

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35
Q

Tx of Papilledema

A

Diuretics (Acetazolamide)

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36
Q

What is Retinal Detachment

A

Retinal tear leads to retinal inner layer detaching from choroid plexus

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37
Q

Sx of Retinal Detachment

A

Photopisa (Flashing Lights) with detachment
Floaters
Progressive unilateral vision loss: Shadow in peripheral field then central visual field TUNNEL VISION
No Pain or Redness

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38
Q

Dx of Retinal Detachment

A

Fundoscopy: Retina is seen hanging in vitreous

Positive Schaffer’s Sign (clumping of pigment cells in anterior vitreious)

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39
Q

Tx of Retinal Detachment

A

Optho Emergency: Laser, Cryotherapy Ocular Surgery

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40
Q

What are Sx of a Foreign Body or Corneal Abrasion

A

Foreign body sensation in eye, tearing, red and painful eye

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41
Q

Dx of Corneal Abrasion

A

Pain relieved with ophthalmic analgesic drops

Fluorescein staining for epithelial defects

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42
Q

Tx of Corneal Abrasion

A

Check visual acuity first
Remove foreign body with sterile irrigation or moist sterile cotton swab
Topical Abx (Fq for contacts to cover Pseudomonas)

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43
Q

What is Orbital (post septal) Cellulitis

A

Usually secondary to sinus infections

44
Q

What pathogens are associated with Orbital Cellulitis

A

s. Pneumo, GABHS, H. Influenza, S. Aureus

45
Q

Sx of Orbital Cellulitis

A

Decreased vision
Pain with ocular movement
Proptosis

46
Q

Dx of Orbital Cellulitis

A

CT: Infection of fat and ocular muscles

47
Q

Tx of Orbital Cellulitis

A

IV Abx (Vancomycin, Clindamycin, Cefotaxime)

48
Q

What is Periorbital Cellulitis

A

Preseptal Cellulitis

Infection of eyelid and periocular tissue

49
Q

Sx of Periorbital Cellulitis

A

No visual changes

No pain with ocular movement

50
Q

What is Acute Narrow-Angle Closure Glaucoma

A

Glaucoma: Increased Intraocular Pressure, Leads to optic nerve damage (decreased visual acuity)
Decreased drainage of aqueous humor via trabecular meshwork and canal of Schlemm

51
Q

Sx of Acute Narrow-Angle Closure Glaucoma

A 
Severe unilateral ocular pain
N/V
Headache
Intermittent blurry vision
Halos around lights
Tunnel Vision
Steamy Cornea
Eye feels hard to palpation
52
Q

Dx of Acute Narrow-Angle Closure Glaucoma

A

Increased intraocular pressure measured by tonometry

Cupping of optic nerve

53
Q

Tx of Acute Narrow-Angle Closure Glaucoma

A

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

54
Q

What is the most common pathogen in Viral Conjunctivitis

A

Adenovirus
Usually in swimming pools
Very Contageious

55
Q

Sx of Viral Conjunctivitis

A

Preauricular lymphadenopathy
Copious water discharge
Scanty mucoid discharge
Often Bilatera

56
Q

Tx of Viral Conjunctivitis

A

Cool Compresses
Artificial Tears
Atihistamines for itching/redness

57
Q

What are the common pathogens involved in Bacterial Conjunctivitis

A

Staph/Strep, H. Influenza, Moraxella

58
Q

Sx of Bacterial Conjunctivitis

A

Purulent discharge, lid crusting, no visual changes

59
Q

Tx of Bacterial Conjunctivitis

A 
Topical Abx (Erythromycin)
If contacts: FQ for pseudomonas coverage
60
Q

What is Keratitis

A

Corneal Ulcer/Inflammation
Due to bacteria, viruses, fungi
Associated with rapid progression and sight-threatening

61
Q

Sx of Keratitis

A

Pain, Photophobia, Reduced Vision, Tearing
Corneal ulceration on slit lamp exam
Hazy Cornea in Bacterial
Dendritic Lesions in HSV

62
Q

Tx of Bacterial Keratitis

A

FQ (Moxifloxacin)
Don’t patch the eye
Topical Steroids

63
Q

Tx of HSV Keratitis

A

Trifluridine, Vidarabine, Acyclovir ointment

Oral Acyclovir

64
Q

What is Optic Neuritis

A

Inflammation of Optic Nerve (CN II)

65
Q

Sx of Optic Neuritis

A

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

66
Q

Tx of Optic Neuritis

A

IV Methylprednisolone followed by oral steroids

67
Q

What is Central Retinal Vein Occlusion

A

The central retinal vein thrombus leads to fluid backup in the retina which in turn leads to acute, sudden monocular vision loss

68
Q

What are risk factors for central retinal vein occlusion

A

HTN, DM, Glaucoma, Hypercoagulable State

69
Q

Dx of Central Retinal Vein Occlusion

A

Fundoscopy: Extensive retinal hemorrhages (blood and thunder appearance)
Retinal vein dilation
Macular edema

70
Q

Tx of Central Retinal Vein Occlusion

A

Anti-Inflammatories
Steroids
Plasmapheresis
Laser

71
Q

What is Otitis Externa

A

Swimmers Ear

Bacterial overgrowth, usually Pseudomonas

72
Q

Sx of Otitis Externa

A

Ear pain, Pruritis, Auricular Discharge
Pain on traction of ear canal/tragus
Erythema, Edema, Debris

73
Q

Tx of Otitis Externa

A

Isopropyl Alcohol and Acetic Acid to dry ear

Cipro/Dexamethason

74
Q

What is Acute Otitis Media

A

Infection of middle ear, temporal bone and mastoid air cells

Usually preceded by UIR

75
Q

What are the most common pathogens with Acute Otitis Media

A

S. Pneumo, H. Influenza, Moraxella, Strep Pyogens

76
Q

Sx of Acute Otitis Media

A

Fevers, Otalgia, Ear tugging in infants, conductive hearing loss
TM may be perforated: rapid relief of pain + Otorrhea
See bulging, erythematous TM with effusions

77
Q

Tx of Acute Otitis Media

A

Amoxicillin

If PCN Allergy: Erythromcyin-Sulfisoxazole, Azithromycin

78
Q

What is Mastoiditis

A

Inflammation of mastoid air cells of temporal bone

79
Q

Sx of Mastoiditis

A

Deep ear pain, usually worse at night

Mastoid tenderness

80
Q

Tx of Mastoiditis

A

IV abx with myringotomy (Ampicillin, Cefuroxime)

If refractory: Mastoidectomy

81
Q

What is Labyrinthitis

A

Vestibular Neuritis + Hearing Loss/Tinnitus

82
Q

Sx of Labyrinthitis

A

Vestibular Sx: Peripheral vertigo, dizziness, N/V, gait disturbances
Cochlear sx: Hearing loss

83
Q

Tx of Labyrinthitis

A

Corticosteroids are 1st line

Antihistamines if sx

84
Q

What is Acute Sinusitis

A

URI leads to edema which blocks drainage of the sinuses, leads to fluid buildup and bacterial colonization

85
Q

What are the most common pathogens seen with Acute Sinusitis

A

Strep. Pneumo, GABHS, H.Flu, M. Catarrhalis

SAME AS ACUTE OTITIS MEDIA

86
Q

Sx of Acute Sinusitis

A

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

87
Q

Dx of Acute Sinusitis

A

Clinic
CT scan is diagnostic
Xray: Water’s View

88
Q

Tx of Acute Sinusitis

A

Amoxicillin, Doxycyclince, Bactrim

89
Q

What is Chronic Sinusitis

A

Sinusitis that lastsa 8 weeks or more

90
Q

What is the most common pathogen associated with Chronic Sinusitis

A

Staph Aureus, Psuedomonas, Aspergillus

91
Q

Sx of Acute Rhinitis

A

Sneezing, nasal congestion/itching, clear rhinorrhea
If allergic type: Pale, Boggy Turbinates, Nasal Polyps with cobblestone mucosa
If Vrial: Erythematous Turbinates

92
Q

Tx of Acute Rhinitis

A

Oral Antihistamines
Decongestants like Pseudoephedrine
Intranasal Steroids for allergic rhinitis especially with nasal polyps

93
Q

What is Epistaxis

A

Bleeding from the nose

94
Q

What is the most common source of Anterior Epistaxis

A

Kiesselbach’s Plexus

95
Q

What is the most common source for Posterior Epistaxis

A

Palatine Artery

96
Q

Tx of Epistaxis

A

Direct Pressure for 10 minutes
Short acting Topical decongestants (Afrin)
Cauterization or Nasal Packing

97
Q

What is a Peritonsillar Abscess

A

Starts as tonsillitis, followed by cellulitis, followed by abscess formation

98
Q

What is the most common pathogen with Peritonsillar Abscess

A

Strep Pyogens, Staph Aureus, Polymicrobial

99
Q

Sx of Peritonsillar Abscess

A

Dysphagia, Pharyngitis, muffled “hot potato voice” difficultly handling oral secretions, trismus, uvula deviation to contralateral side

100
Q

Dx of Peritonsillar Abscess

A

CT Scan

101
Q

Tx of Peritonsillar Abscess

A

Drainage and Abx (Unasyn or Clindamycin)

Steroids for edema

102
Q

What is Epiglottitis

A

Inflammation of epiglotis

103
Q

What are the most common pathogens associated with Epiglottitis

A

H. Influenza type B, S. Pneumo

104
Q

Sx of Epiglottitis

A

ABrupt onset of fever, droolwing, dysphagia and distress (tripod position)

105
Q

Dx of Epiglottitis

A

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

106
Q

Tx of Epiglottitis

A

Secure airway, IV abx (Ceftriaxone), IV Corticosteroids and IV fluids

Emergency Medicine (6 decks)

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