ENT/Ophthalmology Flashcards
1
Q
What is required for the clinical diagnosis of acute otitis media?
A
1) bulging of the tympanic membrane
2) other signs of acute inflammation (marked erythema of the tympanic membrane, fever, ear pain) and middle ear effusion
2
Q
What are the most common bugs to cause acute otitis media?
A
- S. pneumoniae
- H. influenzae
- M. catarrhalis
3
Q
How long does acute otitis media last?
A
last less than 3 weeks
4
Q
What is chronic otitis media?
A
> 3 months, 3 episodes in 6 months or 4 in 12 with clearing between
-clear serous fluid in the middle ear without symptoms of ear infection (may have hearing loss/asymptomatic) - no abx
5
Q
How do you dx acute otitis media?
A
otoscopic - bulging, loss of landmarks, redness, TM injection
-a key finding is limited mobility of the TM with pneumotoscopy
6
Q
What is the tx of acute otitis media?
A
-first-line amoxicillin, augmentin = 2nd line (PCN allergy = azithromycin, erythromycin, Bactrim)
-treat for <2 years for 10 days
and >2 years for 5-7 days
7
Q
What are the complications of acute otitis media?
A
mastoiditis and bullous myringitis
8
Q
What is the most common cause of viral acute pharyngotonsillitis?
A
adenovirus
9
Q
What are the characteristics of mononucleosis?
A
Epstien Barr virus, fever, sore throat, lymphadenopathy, splenomegaly, atypical lymphocytes and heterophiles agglutination test (monospot)
10
Q
When should you consider gonorrhea pharyngitis?
A
patients with recent sexual encounters or with non-resolving pharyngitis
11
Q
When is it fungal pharyngotonsillitis?
A
in patients using inhaled steroids
12
Q
What is strep pharyngitis caused by?
A
Group A B-hemolytic streptococci (GABHS)
13
Q
What is the centor criteria?
A
- Absence of cough
- exudates
- fever (>100.4)
- cervical lymphadenopathy
14
Q
What is not suggestive of strep?
A
coryza, hoarseness, and cough
15
Q
What does the centor score need to meet to get a rapid streptococcal test?
A
3 out of 4 (sensitivity >90%)
16
Q
What do you do if you have a negative rapid streptococcal test?
A
throat culture is the gold standard
17
Q
What is the treatment for Group A Strep?
A
penicillin is first line, azithromycin if penicillin-allergic
18
Q
What is the complications of Group A strep?
A
rheumatic fever and post-strep glomerulonephritis
19
Q
What is the treatment of viral acute pharyngotonsillitis?
A
supportive
20
Q
What is the treatment for mononucleosis?
A
symptomatic and avoid contact sports, antibiotics such as amoxicillin or ampicillin may cause a rash
- for athletes planning to resume non-contact sports three weeks from symptoms onset
- for strenuous contact sports 4 weeks after illness onset
21
Q
What is the treatment for funga pharyngitis l?
A
clotrimazole, miconazole, or nystatin
22
Q
What is the treatment of gonorrhea pharyngitis?
A
IM ceftriaxone and azithromycin
23
Q
What are the symptoms of allergic rhinitis?
A
clear nasal drainage, rhinorrhea, itchy, watery eyes, sneezing nasal congestion, pale, bluish, boggy mucosa
- allergic shiners (blue discoloration below eyes), transverse nasal crease
- IgE mediated mast cell histamine release
24
Q
What is the tx of allergic rhinitis?
A
avoid any known allergens and use antihistamines, cromolyn sodium, nasal or systemic corticosteroids, nasal saline drops or washes, and immunotherapy
25
Intranasal decongestants should not be used more then 3-5 days because it can cause what?
rhinitis medicamentosa
26
What is viral conjunctivitis?
acute onset unilateral or bilateral erythema o conjunctiva. copious watery discharge, tender preauricular lymphadenopathy, scant mucoid discharge
27
What is the MC of viral conjunctivitis?
adenovirus
| -highly contagious
28
How is viral conjunctivitis transmitted?
direct contact or swimming pools
29
What is bacterial conjunctivitis?
will present with purulent (yellow) discharge from both eyes ("glued shut"), crusting, usually worse in the morning
-may be unilateral
30
What are the most common causes of bacterial conjunctivitis?
S. pneumonia and S. aureus
31
What are the signs and symptoms of M. catarrhalis and gonococcal?
copious purulent discharge, in a patient who is not responding to conventional treatment
32
What are the signs and symptoms of chlamydia (bacterial conjunctivitis)?
newborn, Giemsa stain - inclusion body, scant mucopurulent discharge
33
What are the signs and symptoms of allergic conjunctivitis?
red eyes, itching, and tearing, usually bilateral, cobblestone mucosa on the inner/upper eyelid
34
What is the tx of allergic conjunctivitis?
hand washing, avoid contamination
35
What is the treatment of bacterial conjunctivitis?
- gentamicin/tobramycin
- erythromycin ointment (chlamydia for newborns)
- trimethoprim and polymyxin B
- ciprofloxacin
36
What do you use for bacterial conjunctivitis with those that wear contact lenses?
pseudomonas treatment = fluoroquinolone (ciprofloxacin/ciloxan drops)
37
What is used for treatment of Neisseria conjunctivitis?
warrants prompt referral and topical + systemic antibiotics
38
What is the treatment for chlamydial conjunctivitis?
systemic tetracycline or erythromycin x 3 weeks, topical ointments as well, assess for STD or child abuse
39
What is the treatment for viral conjunctivitis?
eye lavage with normal saline BID 7-14 days, antihistamine drops, warm to cool compresses
40
What is the treatment for allergic conjunctivitis?
systemic antihistamines and topical antihistamines or mast cell stabilizers (Naphcon-A, Ocuhist, generics)
- epinatine
- azalastine
- emedatine difumarate
- levocabastine
41
What is epiglottis?
supraglottic inflammation and obstruction of airway due to infection with Haemophilus influenza type b (Hib)
-medical emergency
42
Who does epiglottis usually occur to?
usually unvaccinated children or underserved area
43
What are the signs and symptoms of epiglottis?
stridor, restlessness, cough, dyspnea, fever, dysphagia, drooling, respiratory distress (tripod/"sniffing dog" posture - neck extended)
44
What are the 3 D's of epiglottis?
- dsyphagia
- drooling
- respiratory distress
45
What is the dx of epiglottis?
secure airway then culture for H. flu
| -the classic finding is thumbprint sign on x-ray lateral neck from swelling
46
What is the tx of epiglottis?
intubating if necessary, supportive care, ceftriaxone, may treat as an outpatient if stable
47
What are the causes of epistaxis?
nasal traume, dryness, hypertension, nasal cocaine, alcohol
48
What is the most common site for anterior bleeds?
kiesselbach's plexus or little's are
49
Where do posterior bleeds occur?
woodruff plexus (less frequent)
50
What is the tx of epistaxis?
- most nosebleeds are anterior and stop with direct pressure
- apply direct pressure at least 10-15 minutes, seated leaning forward
- short-acting topical decongestants (Afrin, phenylephrine, cocaine)
51
What is involved in anterior nasal packing?
patients with nasal packing must be treated with antibiotics (cephalosporin) to prevent toxic shock syndrome and the patient has to return to take the packing out
- if there is no packing in the nose, place a small amount of petroleum jelly or antibiotic ointment inside the nostril 2 times a day for 4-5 days
- cauterize if able to visualize bleeding source
52
What is used to treat posterior epistaxis?
posterior balloon packing
-high-risk for complications: specialist eval and inpatient monitoring; nasal arterial supply ligation via surgery in some cases
53
What do you need to rule out when their are recurrent epistaxis?
hypertension of hyper coagulable disorder
54
What can hearing loss be classified as?
- conductive
- sensorinerual
- both (mixed loss)
55
What is the weber test?
tuning fork is place on the center of the head to see if sound lateralizes - sound lateralizes to affected ear in conductive hearing loss, sound lateralizes to unaffected ear in sensorineural hearing loss
56
What is the Rhinne test?
tuning fork placed on mastoid and then up to the ear (should continue to hear) conductive hearing loss if bone>air, sensorineural hearing loss if air>bone
57
What are the findings for conductive loss?
Weber: hear in bad ear
Rhinne: bone>air
58
What is the most common cause of otitis media?
conductive loss
59
What are the findings of sensorineural loss?
Weber: hear in good ear
Rhinne: air >bone
60
What is the most common cause of sensorineural hearing loss?
presbycusis
61
What is prebycusis?
gradual, symmetric hearing loss associated with aging - the most common cause of diminished hearing in elderly patients - degeneration of sensory cells and nerve fibers at the base of the cochlea
62
What causes sensorineural hearing loss
noise-induced, infection, drug-induced, congenital, meunière disease, CNS lesions
63
What causes conductive hearing loss?
- cerumen impaction, otitis externa, exostoses (bony outgrowths of external auditory canal related to exposure to cold water)
- tympanic membrane perforation
- otitis media, otosclerosis, neoplasms
64
What is the treatment of hearing impairment?
treat the underlying cause, hearing aids, surgery, cochlear implants
65
What is mastoiditis?
supportive infection of mastoid air cell - usually a complication of acute otitis media
66
What is the organisms that that cause mastoiditis?
S. pneumonia, H. influenzas, M. catarrhalis, S. aureus, S. pyogenes
67
How is mastoiditis dx?
clinical, CT scan temporal bone with contrast for complicated/toxic appearing
68
What is the treatment of mastoiditis?
simple = oral antibiotics, IV antibiotics (ceftriaxone)
- ENT referral in more serious cases or pt with unreliable follow up
- drainage of middle ear fluid
69
What is oral candidiasis?
oral thrush is an infection in which the fungus (candida albicans) accumulates in the mouth
70
What are the signs and symptoms of oral candidiasis?
mouth pain and white plaques that bleed when scraped
71
What is the dx of oral candidiasis?
KOH smear reveals budding yeast and psudohyphae
72
What is the tx of oral candidiasis?
nystatin, oral fluconazole
73
What is orbital cellulitis?
infection of orbital muscles and fat behind the eye (periorbital = infection only of skin)
74
What are the signs and symptoms of orbital cellulitis?
decreased extraocular movement, pain with movement of the eye, and apoptosis, signs of infection
75
What is orbital cellulitis often associated with?
sinusitis
76
Who does orbital cellulitis most often occur in
children ages 7-12 y/o
77
What is a rare manifestation of orbital cellulitis?
decreased vision
78
How is orbital cellulitis dx?
Ct scan of orbits (confirmatory)
- focused assessment on extra ocular muscles
- CBC and blood cultures in some settings
79
What is the tx of orbital cellulitis?
hospitalization and IV broad-spectrum antibiotics (vancomycin)
80
What is bacterial otitis externl?
"swimmer's ear"
-ear pain (especially with movement of tragus or auricle), pain with eating, purulent cheesy white discharge, palpation of tragus is painful
81
What are the findings of tuning fork with bacterial otitis externl?
bone conduction > air conduction
82
What is the most common cause of bacterial otitis externa?
Pseudomonoas aeruginosa (swimmer's ear), S. aureus (digital trauma)
83
Who is malignant otitis externa commonly seen in?
diabetics
84
What is the tx for bacterial otitis externa?
antibiotic drops - (amino glycoside or fluoroquinolone +/- corticosteroids) + avoid moisture
85
What is the tx for perforate or chance of perforation with bacterial otitis externa?
ciprofloxacin 0.3% and dexamethasone 0.1% suspension: 4 drops BID x 7 days or ofloxacin 0.3% solution 10 drops once a day x 7 days
86
What is the tx for for bacterial otitis externa for a diabetic/immunocomprised patient?
necrotizing infection = hospitalization with IV abx (caused by aspergillus)
87
What is fungal otitis externa?
- pruitis, weeping, pain, hearing loss
| - swollen, moist, wet appearance
88
What are the causes of fungal otitis externa?
- aspergillus niger (black)
- A. flavus (yellow)
- A. fumigates (gray)
- Candida albicans
89
What is the tx for fungal otitis externa?
topical therapy, anti-yeast for Candida or yeast: 2% acetic acid 3-4 drops QID, clotrimazole 1% solution, itraconazole oral
90
What does peritonsillar abscess result from?
penetration of infection through tonsillar capsule and involvement of neighboring tissue
91
What is the presentation of peritonsillar abscess?
presents with a hot potato (muffled) voice, severe sore throat, lateral uvula displacement, bulging tonsillar pillar
92
What is the cause of peritonsillar abscess?
streptococcus pyogenes
93
What is the tx of peritonsillar abscess?
aspiration, incision and drainage and/or antibiotics
| -tonsillectomy may also be considered in about 10% of patients
94
What antibiotics are used to tx peritonsillar abscess?
amoxicillin, amoxicillin-sulbactam, and clindamycin
| -in less sever cases, oral antibiotics can be used for 7-10 days
95
What is strabismus?
any form of ocular misalignment
96
What is exotropia?
out-turning of eyes
97
What is esotropia?
in-turning of eyes
98
What is the dx of strabismus?
```
the cover/uncover test
-cover: cover one, observe other
-(+) uncovered eye shifts to re-fixate
Cover/uncover
-(+) deviated affected eye
```
99
What is the tx of strabismus?
referral if constant anytime or intermittent >6 mo
| -patch exercised, if untreated after age two, amblyopia results
100
How does a tympanic membrane perforation present?
with pain, otorrhea, and hearing loss/reduction
101
What can a tympanic membrane perforation occur from?
infection (acute otitis media) or trauma (barotrauma, direct impact, explosions)
102
What is the tx of tympanic membrane perforation?
usually, resolve on own, surgical repair may be necessary with persistent hearing loss
- keep dry - water/moisture to the ear should be avoided to prevent secondary infection that impedes closure
- the only class of antibiotics that are non-ototoxic are the floxin drops and should be used if you are going to be prescribing drops with a perforated TM
- surgery if persists past 2 months
