ENT/Ophthalmology Flashcards by Lucy Skeen

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

How well did you know this?

Not at all

Perfectly

There is no pain with central retinal artery occlusion and the onset is sudden! The fundoscopic findings are _____.

Pale retina/cherry red spot

How well did you know this?

Not at all

Perfectly

Gradual onset of eye pain in a young female patient with associated papilledema and painful EOM is seen with ______.

Optic neuritis

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

______ 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

How well did you know this?

Not at all

Perfectly

____ (neuro event) can lead to sudden, transient binocular vision loss.

TIAs

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

____ (class of drugs) are most commonly used in patients with vertigo. _____ (specific drug) is a good first line.

Antihistamines, Meclizine

How well did you know this?

Not at all

Perfectly

Dopamine blockers (Reglan, Compazine, Phenergan) are often given to treat severe N/V. ______ is often given with these to prevent dystonic/dyskinesias reactions.

Benadryl

How well did you know this?

Not at all

Perfectly

Anticholinergics may also be used in patients with vertigo. They are especially good a treating patients with _______.

Motion sickness

*Watch out for anticholinergic toxidrome!

How well did you know this?

Not at all

Perfectly

_____ is the MC cause of vertigo. It is caused by displaced otoliths.

BPPV

How well did you know this?

Not at all

Perfectly

Episodes of BPPV usually last ____ (time) and are provoked by ____.

10-60 seconds

Provoked by sudden changes in head positioning

How well did you know this?

Not at all

Perfectly

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.

How well did you know this?

Not at all

Perfectly

____ maneuver is a mainstay of BPPV treatment. Can also treat with ____ (type of med).

Epley; antihistamines

*Meds usually not needed. Usually resolves over time.

How well did you know this?

Not at all

Perfectly

Continuous peripheral vertigo, dizziness, N/V, and gait disturbances with hearing loss is associated with ____.

Labyrinthitis

*Sx usually resolve in weeks

How well did you know this?

Not at all

Perfectly

1st line medication used to treat labyrinthitis is:

Corticosteroids

*If symptomatic use Meclizine

How well did you know this?

Not at all

Perfectly

______ 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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

The main symptoms of acute sinusitis are:

HA, purulent sputum or nasal discharge

How well did you know this?

Not at all

Perfectly

Although acute sinusitis is mainly diagnosed clinically. ____ (test) is the diagnostic test of choice.

CT scan

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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:

1. Contact lens wearers 2. Swimming in lake 3. 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?

1. Dry: Zinc, Vitamins A, C, & E may slow progression. Amsler grid at home to monitor stability. 2. 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:

1. Loss of color vision 2. Blind spot 3. 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:

1. Direct pressure (1st line) 2. Topical decongestants/vasoconstrictors- Afrin, cocaine 3. Cauterization 4. 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 1. Fever > 38 C/ 100.4 F 2. Pharyngotonsillar exudates 3. Tender anterior cervical LAD 4. 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:

1. Dysphagia 2. Drooling 3. Distress * MC seen in kids 3 months- 6 years, Males 2x MC.

How is epiglottitis diagnosed?

1. Definitive- laryngoscopy (cherry red epiglottis with swelling) 2. Lateral cervical x-ray- THUMBPRINT sign

How is epiglottitis managed?

1. Maintaining airway and supportive management is the mainstay of treatment!! (Dexamethasone to reduce airway edema and tracheal intubation in severe cases). 2. 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!