ENT/Ophthalmology Flashcards
There is no pain with central retinal vein occlusion and the onset is sudden! The fundoscopic findings are _____.
“Blood and thunder”/”Ketchup” Fundus
*Can lead to a sudden, complete loss of vision or blurred/cloudy vision
There is no pain with central retinal artery occlusion and the onset is sudden! The fundoscopic findings are _____.
Pale retina/cherry red spot
Gradual onset of eye pain in a young female patient with associated papilledema and painful EOM is seen with ______.
Optic neuritis
A gradual onset of HAs (especially retro-orbital) and myalgias often seen in older women that is associated with and inflamed temporal artery is known as ______.
Giant cell arteritis
______ are seen in older individuals. They are associated with a gradual onset, no eye pain, and an opacity in the lens which causes cloudiness. They are the MC cause of vision loss in pts > 40y.
Cataracts
____ (neuro event) can lead to sudden, transient binocular vision loss.
TIAs
Early symptoms including floaters, blurriness, dark areas of vision, and difficulty perceiving colors (blindness can occur) are associated with what chronic condition?
Diabetes (Diabetic retinopathy)
The 5 types of peripheral vertigo are:
- BPPV (MC!!!)- episodic vertigo, no hearing loss
- Meniere- episodic vertigo with hearing loss
- Vestibular Neuritis- continuous vertigo, no hearing loss
- Labyrinthitis- continuous vertigo with hearing loss
- Cholesteatoma
a. Clinical Manifestations- Horizontal Nystagmus , fatigable
Central vertigo may be caused by:
- Cerebellopontine tumors
- Migraine
- Cerebral Vascular Dz
- MS
- Vestibular Neuroma
a. Clinical Manifestations- Vertical Nystagmus, non-fatigable, gait problems more severe, gradual onset, positive CNS signs
____ (class of drugs) are most commonly used in patients with vertigo. _____ (specific drug) is a good first line.
Antihistamines, Meclizine
Dopamine blockers (Reglan, Compazine, Phenergan) are often given to treat severe N/V. ______ is often given with these to prevent dystonic/dyskinesias reactions.
Benadryl
Anticholinergics may also be used in patients with vertigo. They are especially good a treating patients with _______.
Motion sickness
*Watch out for anticholinergic toxidrome!
_____ is the MC cause of vertigo. It is caused by displaced otoliths.
BPPV
Episodes of BPPV usually last ____ (time) and are provoked by ____.
10-60 seconds
Provoked by sudden changes in head positioning
The _____ test can be used to check for BPPV.
Dix-Hallpike
*Patient placed in supine position with head 30 degrees lower than body. Head quickly turned 90 degrees to one side–> look for delayed, fatigable horizontal nystagmus.
____ maneuver is a mainstay of BPPV treatment. Can also treat with ____ (type of med).
Epley; antihistamines
*Meds usually not needed. Usually resolves over time.
Continuous peripheral vertigo, dizziness, N/V, and gait disturbances with hearing loss is associated with ____.
Labyrinthitis
*Sx usually resolve in weeks
1st line medication used to treat labyrinthitis is:
Corticosteroids
*If symptomatic use Meclizine
______ disease is associated with increased pressure in the inner ear due to excess fluid. It can lead to hearing and balance disorders characterized by:
- Episodic Vertigo (mins-hours)
- Tinnitus
- Ear fullness
- Fluctuating hearing loss
Meniere’s
Symptomatic Meniere’s can be treated with ____ (med).
Meclizine or Benzos
- Decompression with PE tube if refractory or severe
- *Preventative: Diuretics; Avoid: salt, caffeine, chocolate, and ETOH
- **Meniere’s DISEASE is idiopathic
Acute sinusitis lasts ____ (time frame) and is caused by _____ (organisms).
S pneumo, H flu, GABHS, M catarrhalis
- Same orgs that cause AOM
- *Often occurs with concurrent rhinitis or follows viral URI
The main symptoms of acute sinusitis are:
HA, purulent sputum or nasal discharge
Although acute sinusitis is mainly diagnosed clinically. ____ (test) is the diagnostic test of choice.
CT scan
If symptoms of acute sinusitis are present for >10-14 days then antibiotics can be used. The drug of choice is:
Amoxicillin
2nd line: Doxy or Bactrim
Inflammation of both eyelids is known as ______. It is common in people with Down syndrome & eczema.
Blepharitis
*Treated with eyelid hygiene, warm compresses, and possibly Azithromycin
_____ (viral/bacterial) conjunctivitis is more often unilateral with no pain.
Bacterial
Abx typically given for bacterial conjunctivitis:
Erythromycin, Fluoroquinolones
*If CONTACT LENS wearer you need to cover PSEUDOMONAS- Fluoroquinolone or Aminoglycoside
Preauricular lymphadenopathy is associated with what eye condition?
Viral conjunctivitis
Diplopia, especially with an upward gaze, following a trauma is associated with a ______. CT is the scan of choice.
Blow-out fracture
*Treatment- nasal decongestants, avoid blowing nose, abx (Unasyn or Clinda)
____ is associated with a loss of the epithelial layer of the cornea and is EXTREMELY PAINFUL! It is often a result of trauma.
Corneal abrasion
Corneal abrasions are diagnosed by _____.
Fluorescein stain
Corneal abrasions are treated with:
Anesthetic drops
Abx ointment (Erythromycin)
*Resolves in 1-2 days
Corneal ulcers are often due to Pseudomonas. Some risk factors include:
- Contact lens wearers
- Swimming in lake
- Trauma
Treatment of corneal ulcers requires frequent abx use!!!
Treat every 1-2 hours with fluoroquinolone (Cipro or Moxifloxacin)
Corneal ulcer sx include:
Pain, photophobia, increased tearing, reduced vision
Inflammation/Infxn of lacrimal gland is known as ______. Often a result of mumps, EBV, Staph, gonococcus.
Dacryoadenitis
You want to check visual acuity first in the case of an ocular foreign body!!!
*BEWARE of patching an eye with a corneal abrasion for longer than 24 hours. DO NOT PATCH eye of CONTACT LENS wearer
If you have ear pain, drainage, and conductive hearing loss in a child (< 6y) you want to check for a _____.
Foreign body in the ear!
If you have mucopurulent nasal discharge, a foul odor, and epistaxis in a child you want to check for a ______.
Foreign body in the nose!
Increased IOP due to decreased drainage of aqueous humor which can lead to optic nerve damage and decreased visual acuity is known as: _____.
Acute angle closure glaucoma
*IOP > 21 mmHg
Pupillary dilation (mydriasis) further closes the angle in acute angle closure glaucoma. So dim lights, sympathomimetics, and anticholinergics are all precipitating factors.
fyi
Severe, sudden onset of unilateral ocular pain with halos around lights and tunnel vision is associated with ____.
Acute angle closure glaucoma
Treating acute angle closure glaucoma involves using ___ (medication) to decrease IOP of decreasing aqueous humor production.
Acetazolamide
- Can also use topical beta blocker and cholinergics
- *Peripheral iridotomy is the definitive treatment!
Blood in the anterior chamber of the eye leading to loss of vision is known as ____. Usually associated with trauma.
Hyphema
*Steroid eye drops and dilating drops can help minimize the pain
______ is the MC cause of permanent legal blindness and visual loss in the elderly (≥ 75y).
Macular degeneration
Drusen (small, round, yellow-white spots on the outer retina) can be seen on a fundoscopic exam of a person who has _____.
Macular degeneration (dry)
*New, abnormal vessels are seen with wet macular degeneration–> diagnosed by fluorescein angiography
Bilateral blurred or loss of CENTRAL VISION (including detailed and colored vision) is associated with ______.
Macular degeneration
What are the treatments for Dry and Wet Macular Degeneration?
- Dry: Zinc, Vitamins A, C, & E may slow progression. Amsler grid at home to monitor stability.
- Wet: Intravitreal anti-angiogenics (Bevacizumab)–> VEGF inhibitor
Acute inflammatory demyelination of the optic nerves that is MC seen in individuals with multiple sclerosis is known as ______.
Optic Neuritis
Symptoms of optic neuritis include:
- Loss of color vision
- Blind spot
- Unilateral loss of vision over several days
Optic neuritis is treated with:
IV methylprednisone (Solumedrol) followed by oral corticosteroids
_____ is defined by optic nerve (disc) swelling secondary to increased intracranial pressure. It is usually bilateral.
Papilledema
How is papilledema managed?
Acetazolamide–> decreases aqueous humor production
_____ is usually secondary to sinus infections (ethmoid 90%) and MC occurs in children 7-12 y. Sx include decreased vision, pain with ocular movement, and proptosis (bulging eye).
Orbital cellulitis
How is orbital cellulitis diagnosed?
High resolution CT scan or MRI
*Differentiate between PRESEPTAL CELLULITIS which is an infxn of the eyelid and periocular tissue with NO visual changes and NO pain with EOMs.
How is orbital cellulitis treated?
IV abx like Vancomycin, Clindamycin, Unasyn
Photopsia (flashing lights), floaters, progressive unilateral vision loss with a shadow “curtain coming down” in periphery initially followed by loss of central visual field is seen with ______.
Retinal detachment
*NO pain/redness
A positive Shafer’s sign is associated with what disorder of the eye?
Retinal detachment
*clumping of brown-colored pigment cells in the anterior vitreous humor resembling “tobacco dust”
Retinal detachment is an eye emergency!! Treated with laser, cryotherapy, and ocular surgery.
fyi
The most common cause of otitis externa is _____.
Pseudomonas
Abx that are often used for the treatment of otitis externa include:
Cipro/Dexamethasone (Ofloxacin if there is a TM perf)
*Aminoglycosides can be used if TM not perforated
Prolonged or inadequately treated otitis media can lead to _____ which is associated with deep ear pain, fever, and mastoid tenderness.
Mastoiditis
1st line for diagnosing mastoiditis is a _____.
CT scan
Mastoiditis is treated with ____ and _____.
IV abx (same as used to treat AOM) and middle ear drainage
______ is most commonly associated with S. pneumo and preceded by a viral URI. The peak age to have this condition is 6-18 months.
AOM
Treatment of choice for AOM is:
Amoxicillin (10-14d) or Cefixime.
(Augmentin is 2nd line)
*In kids with recurrent otitis media get an iron deficiency anemia workup and a CT scan
Barotrauma is managed by:
- Autoinsufflation (swallowing, yawning).
- Decongestants or antihistamines
_____ (Anterior/Posterior) is MC location of epistaxis.
Anterior
*Kiesselbach’s plexus is the MC site!
Treatments for epistaxis include:
- Direct pressure (1st line)
- Topical decongestants/vasoconstrictors- Afrin, cocaine
- Cauterization
- Nasal packing
Bloody otorrhea with tinnitus & vertigo can sometimes be seen with:
TM perforation
What should you avoid if you have a perforated TM?
Water, moisture, and topical aminoglycosides!
*Most perforated TMs will heal spontaneously
_____ is the MC overall cause of acute pharyngitis/tonsillitis.
A Virus (Adenovirus, Rhinovirus, EBV, RSV, Influenza, etc.)
The MC bacterial cause of pharyngitis is ______.
GABHS
The Centor Criteria is used to diagnose _____. Its 4 key components are:
Strep throat
- Fever > 38 C/ 100.4 F
- Pharyngotonsillar exudates
- Tender anterior cervical LAD
- Absence of cough
- Each is assigned 1 pt.
- *If b/w 5-15 y throat cultures should be sent in all cases
The DEFINITIVE diagnosis for strep is:
Throat culture
*Rapid strep test is useful if positive because it is specific but it is only 55-90% sensitive
Treatment of Strep throat includes:
Penicillin, Amoxil, Augmentin
*Macrolides if PCN allergic
Rheumatic fever, Glomerulonephritis, and peritonsillar abscess are all complications of:
Strep throat
A muffled voice, trismus (lockjaw), and uvula deviation are associated with what condition?
Peritonsillar abscess
1st line test for the diagnosis of a peritonsillar abscess is:
CT scan
Antibiotics such as Clindamycin and Unasyn + an aspiration or I & D are the treatment choices for a _____.
Periotonsillar abscess
How are dental abscesses managed?
- Small abscesses resolve with penicillin VK or clindamycin, analgesics, and short term chlorhexidine mouth rinses (to avoid tooth discoloration)
- Larger abscesses require I&D
Hoarseness and aphonia are hallmark symptoms of _____.
Laryngitis
*Treatment- supportive
The most common cause of epiglottitis is:
Hib
The 3 D’s of epiglottitis are:
- Dysphagia
- Drooling
- Distress
* MC seen in kids 3 months- 6 years, Males 2x MC.
How is epiglottitis diagnosed?
- Definitive- laryngoscopy (cherry red epiglottis with swelling)
- Lateral cervical x-ray- THUMBPRINT sign
How is epiglottitis managed?
- Maintaining airway and supportive management is the mainstay of treatment!! (Dexamethasone to reduce airway edema and tracheal intubation in severe cases).
- Abx- Ceftriaxone +/- a penicillin for anti-staph coverage
_______ is associated with nasal polyps and tends to be worse in the AM. It is the MC type of this condition. Sx include pale, boggy turbinates with cobblestone mucosa of the conjunctiva.
Allergic Rhinitis
_____ is the most effective treatment for allergic rhinitis (especially with nasal polyps).
Intranasal steroids
*Budesonide (Rhinocort), Fluticasone (Flonase)
Don’t use ______ for more than 3-5 days because it can lead to rebound congestion.
Intranasal decongestants (Phenylephrine).
Know p. 244 PPP
Review!
