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Emergency Medicine > ENT/Ophthalmology > Flashcards

ENT/Ophthalmology Flashcards

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1
Q

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

A

“Blood and thunder”/”Ketchup” Fundus

*Can lead to a sudden, complete loss of vision or blurred/cloudy vision

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2
Q

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

A

Pale retina/cherry red spot

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3
Q

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

A

Optic neuritis

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4
Q

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 ______.

A

Giant cell arteritis

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5
Q

______ 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.

A

Cataracts

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6
Q

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

A

TIAs

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7
Q

Early symptoms including floaters, blurriness, dark areas of vision, and difficulty perceiving colors (blindness can occur) are associated with what chronic condition?

A

Diabetes (Diabetic retinopathy)

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8
Q

The 5 types of peripheral vertigo are:

A
  1. BPPV (MC!!!)- episodic vertigo, no hearing loss
  2. Meniere- episodic vertigo with hearing loss
  3. Vestibular Neuritis- continuous vertigo, no hearing loss
  4. Labyrinthitis- continuous vertigo with hearing loss
  5. Cholesteatoma
    a. Clinical Manifestations- Horizontal Nystagmus , fatigable
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9
Q

Central vertigo may be caused by:

A
  1. Cerebellopontine tumors
  2. Migraine
  3. Cerebral Vascular Dz
  4. MS
  5. Vestibular Neuroma
    a. Clinical Manifestations- Vertical Nystagmus, non-fatigable, gait problems more severe, gradual onset, positive CNS signs
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10
Q

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

A

Antihistamines, Meclizine

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11
Q

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

A

Benadryl

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12
Q

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

A

Motion sickness

*Watch out for anticholinergic toxidrome!

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13
Q

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

A

BPPV

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14
Q

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

A

10-60 seconds

Provoked by sudden changes in head positioning

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15
Q

The _____ test can be used to check for BPPV.

A

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.

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16
Q

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

A

Epley; antihistamines

*Meds usually not needed. Usually resolves over time.

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17
Q

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

A

Labyrinthitis

*Sx usually resolve in weeks

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18
Q

1st line medication used to treat labyrinthitis is:

A

Corticosteroids

*If symptomatic use Meclizine

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19
Q

______ disease is associated with increased pressure in the inner ear due to excess fluid. It can lead to hearing and balance disorders characterized by:

  1. Episodic Vertigo (mins-hours)
  2. Tinnitus
  3. Ear fullness
  4. Fluctuating hearing loss
A

Meniere’s

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20
Q

Symptomatic Meniere’s can be treated with ____ (med).

A

Meclizine or Benzos

  • Decompression with PE tube if refractory or severe
  • *Preventative: Diuretics; Avoid: salt, caffeine, chocolate, and ETOH
  • **Meniere’s DISEASE is idiopathic
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21
Q

Acute sinusitis lasts ____ (time frame) and is caused by _____ (organisms).

A

S pneumo, H flu, GABHS, M catarrhalis

  • Same orgs that cause AOM
  • *Often occurs with concurrent rhinitis or follows viral URI
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22
Q

The main symptoms of acute sinusitis are:

A

HA, purulent sputum or nasal discharge

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23
Q

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

A

CT scan

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24
Q

If symptoms of acute sinusitis are present for >10-14 days then antibiotics can be used. The drug of choice is:

A

Amoxicillin

2nd line: Doxy or Bactrim

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25
Q

Inflammation of both eyelids is known as ______. It is common in people with Down syndrome & eczema.

A

Blepharitis

*Treated with eyelid hygiene, warm compresses, and possibly Azithromycin

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26
Q

_____ (viral/bacterial) conjunctivitis is more often unilateral with no pain.

A

Bacterial

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27
Q

Abx typically given for bacterial conjunctivitis:

A

Erythromycin, Fluoroquinolones

*If CONTACT LENS wearer you need to cover PSEUDOMONAS- Fluoroquinolone or Aminoglycoside

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28
Q

Preauricular lymphadenopathy is associated with what eye condition?

A

Viral conjunctivitis

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29
Q

Diplopia, especially with an upward gaze, following a trauma is associated with a ______. CT is the scan of choice.

A

Blow-out fracture

*Treatment- nasal decongestants, avoid blowing nose, abx (Unasyn or Clinda)

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30
Q

____ is associated with a loss of the epithelial layer of the cornea and is EXTREMELY PAINFUL! It is often a result of trauma.

A

Corneal abrasion

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31
Q

Corneal abrasions are diagnosed by _____.

A

Fluorescein stain

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32
Q

Corneal abrasions are treated with:

A

Anesthetic drops

Abx ointment (Erythromycin)

*Resolves in 1-2 days

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33
Q

Corneal ulcers are often due to Pseudomonas. Some risk factors include:

A
  1. Contact lens wearers
  2. Swimming in lake
  3. Trauma
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34
Q

Treatment of corneal ulcers requires frequent abx use!!!

A

Treat every 1-2 hours with fluoroquinolone (Cipro or Moxifloxacin)

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35
Q

Corneal ulcer sx include:

A

Pain, photophobia, increased tearing, reduced vision

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36
Q

Inflammation/Infxn of lacrimal gland is known as ______. Often a result of mumps, EBV, Staph, gonococcus.

A

Dacryoadenitis

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37
Q

You want to check visual acuity first in the case of an ocular foreign body!!!

A

*BEWARE of patching an eye with a corneal abrasion for longer than 24 hours. DO NOT PATCH eye of CONTACT LENS wearer

38
Q

If you have ear pain, drainage, and conductive hearing loss in a child (< 6y) you want to check for a _____.

A

Foreign body in the ear!

39
Q

If you have mucopurulent nasal discharge, a foul odor, and epistaxis in a child you want to check for a ______.

A

Foreign body in the nose!

40
Q

Increased IOP due to decreased drainage of aqueous humor which can lead to optic nerve damage and decreased visual acuity is known as: _____.

A

Acute angle closure glaucoma

*IOP > 21 mmHg

41
Q

Pupillary dilation (mydriasis) further closes the angle in acute angle closure glaucoma. So dim lights, sympathomimetics, and anticholinergics are all precipitating factors.

A

fyi

42
Q

Severe, sudden onset of unilateral ocular pain with halos around lights and tunnel vision is associated with ____.

A

Acute angle closure glaucoma

43
Q

Treating acute angle closure glaucoma involves using ___ (medication) to decrease IOP of decreasing aqueous humor production.

A

Acetazolamide

  • Can also use topical beta blocker and cholinergics
  • *Peripheral iridotomy is the definitive treatment!
44
Q

Blood in the anterior chamber of the eye leading to loss of vision is known as ____. Usually associated with trauma.

A

Hyphema

*Steroid eye drops and dilating drops can help minimize the pain

45
Q

______ is the MC cause of permanent legal blindness and visual loss in the elderly (≥ 75y).

A

Macular degeneration

46
Q

Drusen (small, round, yellow-white spots on the outer retina) can be seen on a fundoscopic exam of a person who has _____.

A

Macular degeneration (dry)

*New, abnormal vessels are seen with wet macular degeneration–> diagnosed by fluorescein angiography

47
Q

Bilateral blurred or loss of CENTRAL VISION (including detailed and colored vision) is associated with ______.

A

Macular degeneration

48
Q

What are the treatments for Dry and Wet Macular Degeneration?

A
  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
49
Q

Acute inflammatory demyelination of the optic nerves that is MC seen in individuals with multiple sclerosis is known as ______.

A

Optic Neuritis

50
Q

Symptoms of optic neuritis include:

A
  1. Loss of color vision
  2. Blind spot
  3. Unilateral loss of vision over several days
51
Q

Optic neuritis is treated with:

A

IV methylprednisone (Solumedrol) followed by oral corticosteroids

52
Q

_____ is defined by optic nerve (disc) swelling secondary to increased intracranial pressure. It is usually bilateral.

A

Papilledema

53
Q

How is papilledema managed?

A

Acetazolamide–> decreases aqueous humor production

54
Q

_____ 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).

A

Orbital cellulitis

55
Q

How is orbital cellulitis diagnosed?

A

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.

56
Q

How is orbital cellulitis treated?

A

IV abx like Vancomycin, Clindamycin, Unasyn

57
Q

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 ______.

A

Retinal detachment

*NO pain/redness

58
Q

A positive Shafer’s sign is associated with what disorder of the eye?

A

Retinal detachment

*clumping of brown-colored pigment cells in the anterior vitreous humor resembling “tobacco dust”

59
Q

Retinal detachment is an eye emergency!! Treated with laser, cryotherapy, and ocular surgery.

A

fyi

60
Q

The most common cause of otitis externa is _____.

A

Pseudomonas

61
Q

Abx that are often used for the treatment of otitis externa include:

A

Cipro/Dexamethasone (Ofloxacin if there is a TM perf)

*Aminoglycosides can be used if TM not perforated

62
Q

Prolonged or inadequately treated otitis media can lead to _____ which is associated with deep ear pain, fever, and mastoid tenderness.

A

Mastoiditis

63
Q

1st line for diagnosing mastoiditis is a _____.

A

CT scan

64
Q

Mastoiditis is treated with ____ and _____.

A

IV abx (same as used to treat AOM) and middle ear drainage

65
Q

______ is most commonly associated with S. pneumo and preceded by a viral URI. The peak age to have this condition is 6-18 months.

A

AOM

66
Q

Treatment of choice for AOM is:

A

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

67
Q

Barotrauma is managed by:

A
  • Autoinsufflation (swallowing, yawning).

- Decongestants or antihistamines

68
Q

_____ (Anterior/Posterior) is MC location of epistaxis.

A

Anterior

*Kiesselbach’s plexus is the MC site!

69
Q

Treatments for epistaxis include:

A
  1. Direct pressure (1st line)
  2. Topical decongestants/vasoconstrictors- Afrin, cocaine
  3. Cauterization
  4. Nasal packing
70
Q

Bloody otorrhea with tinnitus & vertigo can sometimes be seen with:

A

TM perforation

71
Q

What should you avoid if you have a perforated TM?

A

Water, moisture, and topical aminoglycosides!

*Most perforated TMs will heal spontaneously

72
Q

_____ is the MC overall cause of acute pharyngitis/tonsillitis.

A

A Virus (Adenovirus, Rhinovirus, EBV, RSV, Influenza, etc.)

73
Q

The MC bacterial cause of pharyngitis is ______.

A

GABHS

74
Q

The Centor Criteria is used to diagnose _____. Its 4 key components are:

A

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
75
Q

The DEFINITIVE diagnosis for strep is:

A

Throat culture

*Rapid strep test is useful if positive because it is specific but it is only 55-90% sensitive

76
Q

Treatment of Strep throat includes:

A

Penicillin, Amoxil, Augmentin

*Macrolides if PCN allergic

77
Q

Rheumatic fever, Glomerulonephritis, and peritonsillar abscess are all complications of:

A

Strep throat

78
Q

A muffled voice, trismus (lockjaw), and uvula deviation are associated with what condition?

A

Peritonsillar abscess

79
Q

1st line test for the diagnosis of a peritonsillar abscess is:

A

CT scan

80
Q

Antibiotics such as Clindamycin and Unasyn + an aspiration or I & D are the treatment choices for a _____.

A

Periotonsillar abscess

81
Q

How are dental abscesses managed?

A
  • Small abscesses resolve with penicillin VK or clindamycin, analgesics, and short term chlorhexidine mouth rinses (to avoid tooth discoloration)
  • Larger abscesses require I&D
82
Q

Hoarseness and aphonia are hallmark symptoms of _____.

A

Laryngitis

*Treatment- supportive

83
Q

The most common cause of epiglottitis is:

A

Hib

84
Q

The 3 D’s of epiglottitis are:

A
  1. Dysphagia
  2. Drooling
  3. Distress
    * MC seen in kids 3 months- 6 years, Males 2x MC.
85
Q

How is epiglottitis diagnosed?

A
  1. Definitive- laryngoscopy (cherry red epiglottis with swelling)
  2. Lateral cervical x-ray- THUMBPRINT sign
86
Q

How is epiglottitis managed?

A
  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
87
Q

_______ 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.

A

Allergic Rhinitis

88
Q

_____ is the most effective treatment for allergic rhinitis (especially with nasal polyps).

A

Intranasal steroids

*Budesonide (Rhinocort), Fluticasone (Flonase)

89
Q

Don’t use ______ for more than 3-5 days because it can lead to rebound congestion.

A

Intranasal decongestants (Phenylephrine).

90
Q

Know p. 244 PPP

A

Review!

Emergency Medicine (11 decks)

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