ENT Opt Flashcards
what are the weber and rinne tests used for
to differentiate between senory and conductive hearing loss
medical prevention of barotrauma
decongestants, antihistamines
classic radical neck dissection removes what
internal jugular
SCM
CN XI
infectious vs non infectious causes of conjunctivitis
infectious (bacterial, viral)
noninfectious (allergic, nonallergic0
typical presentation of viral conjunctivitis
adenopathy
fever
pharyngitis
URI
mucous like drainage
profuse tearing
follicular tarsal conjunctiva
describe ´Topical glucocorticoid preparations in treating allergic conjuntivitis
used for patients with refractory symptoms
can suppress late phase reaction to alllergies
should be used for short therapy for patients who failed other Rx
complications associate with acute mastroidits
osteomylitis
epidural, subdural, brain abscess
meningitis
carotid artery involvement
Mrs. P is a 65 year old female who has become acutely ill in the waiting room. An ophthalmologic assistant had dilated her eyes in preparation for examination. She is now complaining of nausea, diaphoresis and pain in her right eye, which is now red and swollen.
probable Dx
closed angle glaucoma
central scotoma
a symptom of macular degeneration where the middle part of the visual field looks black
treatment for thyroid carcinoma
most require total thyroid
radioactive iodine
synthyroid
occasionally external beam
Acoustic Neuroma (Vestibular Schwannoma)
slow growing benigh tumor usually at the cerebelo-pontine angle
chronic rhinosinusitis defined
12 weeks or more with
mucopurulent drainage, nasal obstruction, facial pain/pressure, decreased sense of smell AND inflammation documented
treatment for traumatic, foreign body, or reccurrent erosion corneal abrasins
remove foreign body if needed
topical ABx with erythromycin or sulfacetamine
can use a patch
no topical steroids
no follow up needed unless the abrasion is >1/4 the corneal surface
late post operative complications for cataract surgery
endopthalmitis
retina dtachment
cystioud macular edema
lens displacement
persisting astigmatism
secondary glaucoma
posterior capsule opacification
anterior capusle phimosis
what causes Unilateral Vocal Cord Paralysis
unilateral RLN injury from malignancy, iatrogenic injury, ET tubes, trauma, degenerative disorders
Unilateral Vocal Cord Paralysis signs
weak, breathy voice
risk for aspiration
describe seasonal allergic conjunctivitis
less dramatic onset that is typically caused by outdoor airborne allergens and takes weeks to develop and produces a predicatable course based on the allergen
conjunctivitis visual acuity
pen light
fundoscopy
should be normal, if its not REFER
pupil reaction should normal (REFER)
pinpoint pupil (REFER)
white or spotty cornea (REFER)
fundoscopy is not very useful but it should be normal
blepharitis Dx
clinical, no labs
pink/irritated eyelid edges
crusting of the lashes or lid margins might be present
chronic inflammation may result in structural changes (entropon, ectropion)
accumulation of mucous around teh cricoid cartilage may cause what
stenosis
describe posterior subscapular cataracts
secondary causes
classically involves what age
opactities that appear in the posterior aspect of the lens that often causes flare and difficulty reading
diabetes, steroids, inflammation
occurs in patients under 50
talking points for patients about diabetic eye disease
most damage is assymptomatic
control is of the ut must importance
encourage them to take charge
DMII can be managed with diet and exercise
is Malignant (Necrotizing) (MOE) potenially fatal
yes, it can spread to the bones, nerves, and cranial contents
what is considered a normal IOP
between 10 and 20
what should be used to kill life insects in the ear
ethanol, mineral oil, lidocaine
indications for biopsy of a neck mass
- Progressively enlarging nodes
- Single, asymmetric nodal mass
- Persistent nodal mass, Esp. if no prior signs of infection
- Active infection not responding to conventional antibiotics with routine cultures indeterminate
what is the treatment for nasopharyngel carcinoma
chemo
inflammatory neck masses
lymphadenopathy, abscess
drainage from an ear tube during an active infect is normal TF
they can always be treated with topical ABX TF
true
true
Central Dizziness clinical presentation
sudden on set more consistent with vascular event such as stroke or infarct
progressive when paired with headache over weeks and months is indicative of a space occupying tumor
otosclerosis
process in which the stapes loses mobility by excessive bone growth at the oval window
Allergic rhinitis clinical presentation
paroxysms of sneezing, rhinorrhea, nasal itching, obstruction
post nasal drip, cough, fatigue
descrive viral conjunctivitis
a highly contagious form of conjunctivitis that incubates for 5 -12days, usually bilateral
characteristics of Meniere’s Disease
(Endolymphatic hydrops)
episodic vertigo that lasts several hours
sudden unilateral hearing decrease
fluctuating hearing loss
tinnitius (roaring)
unilateral aural fullness
Perilymph Fistula clinical presentation
vertigo
motion intolerance
N/V
sudden hearing loss or fluctuating hearing loss
aural fullness
tinnitis
Perilymph Fistula Dx
surgery?
treatment
no diagnosis bur fistual test is helpful
surgical exploration is not accepted
bed rest with feet up, avoid straninig, surgical pataching
SS macular degeneration
metamorphosia
central scotoma
Vestibular schwannoma (acoustic neuroma) presentation
diagnostic studies
treatment
unilateral SNHL accompanied by tinnitus
MRI is the standard for diagnosis
surgery, radiation, observation
what is the treatment of diabetic macular edema
advantages
focal laser
painless, mild side effects, reduces severe vision loss by half
neoplastic neck masses
benign (paraganglioma, schwannoma, hemangioma, lipoma)
malignant (lymphoma, sailvary, thyroid)
metastatic
treatment of mastoiditis
IV ABx directed against staph pneumo, h flu, strep pyo
myringotomy (incsion of the TM to drain fluid)
mastoid ectome if medical therapy fails
imaging for orbital fracture
coronal ct because plain Xray is not sensitive enough
Otomycosis Fungal Otitis externa treatment
frequent cleaning and debridement
alcohol and vinegar soluton
nystain
lotrim
betadine
gentian violet
stay away from water
T/F viral conjuncivitis is a chronic condition that requires treatment
treatment
false, it is self limiting and thre is no specific anti viral
antihistamines
warm or cool compreses
Otomycosis Fungal Otitis externa symptoms
itching, ear fullness, local irritation, otorrhea, pain
T/F macular degeneration is painless
true
management of an orbita fracture
protetion of the globe
elevation of the head
IV fluids
treat NV
pain control
augmentin or azithromycin
add corticosteroids for EOM entrapment
what is needed for treatment of Malignant (Necrotizing) (MOE)
oral/IV therapy based on culture and sensivities
what causes gonococcal conjunctivitis
gonorrhea from the genetialita to the hands then eyes often has an active STI
pars plana vitrectomy
surgical removal of part of the vitreous
treatment for EAC foreign object
presentation
what types of objects require immediate action
hearing loss, otalgia, otorrhea
penetrating foreign bodies, batteries, live insects
describe the use of ´Antihistamines with mast cell-stabilizing properties in treating allergic conjunctivits
Rx include: olopatadine (Patanol, Pataday), bepotastine (Bepreve)
antihistamines blocks degranulation
usually does BID or once daily
usuually takes effect immediately
Acute suppurative sialadenitis treatment
correct predisposing factors
warm compress
sour lozenges
ABx (augmentin)
parotiditis usuallly needs IV Abx
: Chondrodermatitis Nodularis Helicis indcidence and perinent HP
most are men
spontaneous onset
usually enlarges to a size then stays stable
why do you need to differentiate between simple and complicated eyelid lacerations
complicated lacerations will need surgical repair
complications from cerumen impaction
TM perforation
infection
abrasion
test for vertebro-bassilar insufficiency
tiltiong head back cause dizziness
staphylococcus anterior blepharitis
colonaization of the eye lids by staph that leads to fibrinous scales and crusts around the eyelashes
what are lymph node stages used for in head and neck surgery
certain primary cancers are know to spread to certain lymph nodes so those nodes can be targeted and removed
chronic laryngitis
laryngitis that lasts longer than 3 weeks
DDx of +2cm congenital neck mass in an adult
branchial cleft cyst, thyroglossal duct cyst
what is the use of fine needle aspiriation in the Dx of neck masses
- Differentiates benign from malignant
- Carcinoma vs. Lymphoid
- Avoids open biopsy
- Standard work-up for thyroid nodule
- Can be used for culture
Otomycosis Fungal Otitis externa risk factors
moisture, prior use of topical ABx
cholestatatoma
a cystic mass of squamous epithelium in the middle ear or in the temporal bone that causes bondy destruction of the mastoid bon and ossicles
the unknown primary
cancer in a cervical node with no detectable primary tumor
usually a squamous, undifferentiated tumor
History clues that can help Dx a neck mass
congenital (age, duration)
inflammatory (infection, pain, fever)
neoplastic (rapid growth, associated symptoms, risk factors, location)
treatment of bacterial keratitis
do not patch
being topical fluroquinolone
emergent evaluation by opthamalogist with close follow up
treatment for contact lens corneal abrasion
rule out infiltrate or opacity (refer if present)
topical ABx with cipro
no patch
no topical steroids
daily follow up
nasal foreign body dx
history or visualized foreign body
what will the swinging flashlight test look like
the consensual pupillary reflex will be diminshed in the good eye when the light is shined in the affected eye
lyre sign
a splayed appearance of the internal and external carotids indicative of carotid body tumor
Laryngopharyngeal Reflux symptoms
–dysphonia/hoarseness
–globus pharyngeus
–mild dysphagia
–chronic cough
–nonproductive throat clearing
vascular lesions associated with head and neck surgery
hemangioma, lymphangioma, vascular malformations
describe the use of mast cell stabilizers in treating allergic conjunctivitis
Rx includes cromolyn sodium (generic, Opticrom), nedocromil (Alocril)
full efficacy of therapy is reached 5-14 days
not useful for acumy symptoms
usually dose 4x daily
typical clincal course of viral conjunctivitis
symptoms get worse foe 3-5 days, very gradual resolution over 1-2w wth full recovery after 2-3 weeks
physical exam indications of an open eye injury
decreased visual acuity
affernyl pupillary defect
eccentric or teardrop pupul
increased anterior chamber depth
extrusion of vitrous
360 hemorrhage
how is a substernal goiter removed
transcerivcally, sometimes by sternotomy
Acoustic Neuroma (Vestibular Schwannoma) treatment
ecision or radiation
epistaxis diagnosis
HP with airway and CV assessment
work up for anemia and coagulopathy
clinical presentation of preseptal vs post septal cellulitis
eye pain/tenderness
pre: maybe
psost: yes, may cause deep eye pain
what levels of the spine will refer pain to the ear
C3-4
what will cause sensorineural hearing loss
dysfunction of the cochlea or neural components of the auditory system
causes of afferent pupillary defect
retinal detachment (total)
optic nerve damage
clinical presentation is tongue cancer
leukoplakia
erythroplasia
mass
ulceration
ill fitting dentures
pain
otalgia
neck mass
Presbycusis treatment
hearing aids
assistive listening devices
cochlear implants if hearing aids are ineffective
clinical presentation of preseptal vs post septal cellulitis
opthalmoplagia with diplopia
pre no
pro yes
ranula
a mucocele found on the floor of the mouth
acute mastoiditis is not a referal situation
false, it is
T/F Bilateral Vocal Cord Paralysis leaves the voice intact but has impaired respiratory function ranging from moderate stridor to respiratory distress
treu
benign paroxysmal positional vertigo treatment
particle reposition with the epley manuver
DDx for tinnitus: autoimmune
RA, SLE
complications of ETD
acute OM
OM with effusion
tympanic membrane retraction
conductive hearing loss
ear pressure and fullness
patulous estachian tubes
what is the most common type of glaucoma
open angle
Otitis media with effusion
presence of the fluid in the middle ear with/without SS of acute ear infection that can cauase conductive hearing loss
ciloretinal artery
a branch of the retinal artery that has left the optic nerve and found a different way into the retina
when in adenoidectomy indicated
children over the age of 4 with Hx of OME and nasal obstruction
pneumatic retinopexy
repair of a retinal tear on the superior portion of the retina tha tuses are an air bubble in teh vitreous chamber to tamp down the tear why whe pigemented retinal cells pump out eh vitreous
T/F Sudden Sensorineural Hearing Loss is a medical emergency
true
Central Vertigo
and Balance Disorders
central dizziness
vestibular equivalent migraine
vertebro-basilar insufficiency
stroke
space occupying lesion
hyper ventiallation
DM
MS
PE considerations for : Chondrodermatitis Nodularis Helicis
nodules are firm, tender, well demarcated, round to oval, central crust or ulcer
limited discoloration
commonly found on the right mre than the left
differentiate preseptal vs post septal cellulitis
severity
pre: generally mild
post: may cause vision loss or death
common cold etiology
rhinovirus
patient presents with a trauma that lacerates the retina
what might be sequela from this
some visual field lost from retinal artery occlusion
differentiate preseptal vs post septal cellulitis
location of infection
pre: anterior portion of the eyelid not involving the orbit
post: involves the content of the orbit but not the globe
when is immunotherapy used in allergic rhinitis
typically for refractory or severe cases
DDx of a +2cm congenital neck mass in kids
brachial cleft cyst, thyroglossal duct cyst
congenital neck masses
thyroglossal duct cyst, brachial cleft cyst, dermoid, laryngocele, thymic masses
vitrectomy
scope operation that fixes retinal detachment by draining the vitreous from behind the retina then putting an air bubble in the vitreous chamber to tamp down the retina
typical causes of conductive hearing loss in the outer ear
wax
otitis externa
trauma
exostosis
osteoma
squamous cell carcinoma
samters triad
asthma, aspirin sensitivity, nasal poyps
treatment of a corneal laceration with open globe injury
leave the object
place eye shield over affective eye
bed rest
avoid eye solutions
nacotics (no NSAIDs)
sedation if needed
emergent OP refereal with CT, IV vanco+ceph, NPO, tetanus booster
common clinical presentation of Cholesteatoma
hearing loss caused by pseudomonas
what can help decide whether or not to operate on a cataract
what degree of vision the person needs
most likely cause of Vestibular Neuritis
viral (herpes, epstein bar, flu, CMV)
Malignant (Necrotizing) (MOE) hallmark sign
infected granulated tissue on the flor of the cartilaginous each cannal near the bony junction that may have formed a defect under the skin
clinical presentation of oropharyngeal cancer
referred otalgia, trismus, throat pain, dysphagia, odynophagia
describe acute allergic conjunctivitis
how long to resolve
clinical presentation
sudden onset (within 30 mins) to hypersentitivty reaction cause by a known allergen
symptoms usually resolve within 24 hours after the allergen is removed
itching, hyperemia, tearing, chemosis, eyelid edema
how does HPV cause metastatic head and neck cancer
HPV causes occult tonsil cancer or base of tongue cancer
virus dies, but the tumor still grows
subdivisions of the larynx
supraglottis, glottis, subglottis
glaucoma
optic neuropathy that is the leading cause of irreversible blindness worldwide typically caused by increased inrtraocular pressure
when would augmentin be prescribed for treatment of Acute bacterial rhinosinusitis (ABRS)
what if they are cilin allegeric
likely ABx resistance (ABx use in the last month)
moderate to severe infection
presence of comorbidities (Diabetes)
use doxyclyclin
hordeolum
an accure purulent inflammation of the eyelid most commonly caused by staph
glaucoma treatment that will decrease aqueous pressure
beta blockers levobunolol, timolol, carteolol
alpha 2 adrenergic agonists apraclonidine, brimonidine
carbonic anhydrase inbitors acetazolmide, dorzolamide
Superior Canal Dehiscence Syndrome
a lesion in the superior semicircular canal
causes of SNHL
prebycusis
ototoxic drugs
meniere disease
acoustic neuroma
MS
autoimmune
what causes macular degeneration
vascular overgrowth in the retinal pigmented epithelium precipitated by an defect
arnolds nerve
what will it trigger
a branch of cranial nerve X in the ear that when stimulated causes a cough
pertinent HP and SS Exostosis
Hx of aquatic activty
more commn in males
usually assymtpomatic unless that are large enough to cause obstruction
what is the most common conjunctivtis in adults
what is the typical cause
viral conjunctivitis
adenovirus (cold)
describe ischemic optic neuropathy
usually optic nerve swelling
usually irrerverislbe
artheritic or non arteritic, both usually in the eldery
types of carotid body tumor
chemodectoma
paraganglioma
presentation of chlamydial conjunctivitis
unilateral, somtimes bilateral, follicular conjunctivitis that typucally affects the tarsal conjunctiva more so than the bulbar conjunctiva
clinical presentaiton of Ototoxicity
bilateral loss of cochelar funtion resulting in unstable gait and oscillopsia
can lead to senory hearing loss
what type of thyroid cancer has the best prognosis
papillary, it also is the most common
how does mastoiditis present on CT scan
loss of mastoid air cells and local bone destruction
describe the composition and location of the true vocal cords
bands of msucle, ligaments, mucosa that run from the arytenoids posterior to the midline of the thyroid cartilage posterior
pars plana
the area of the eye that can be incised without damaging other structures to allow access to the vitreous and retina
structures in the supraglottis
structures above the true vocal cords
epiglottis, false vocal cords, arytenoglottal folds, arytenoids
Meniere’s Disease (Endolymphatic hydrops) causes
mostly idiopathic but can associated with trauma and auto immune disease
causes of infectious uveitis
both herpes can cause this, usually unilateral
CMV can also do this with concurrent HIV infection
Superior Canal Dehiscence Syndrome clinical presentation
vertigo and oscilopsia in response to loud noise, vibration, changes in middle ear pressure
can also include conductive hearing loss
typical visual field defect in open angle glaucoma
down the to the right
how is bacterial conjunctivitis spread
pathogens in adults
pathogens in children
direct contact with secretions or contaminated surfaces
staph aureus, MRSA
strep pneumoniae, haemophilus influenze, moraaella cotarrhalis
Meniere’s Disease (Endolymphatic hydrops) treatment
low sodium
diuretic
endolymphatic trunk
labrynthecomy
gentamycin (ototaxic)
Allergic rhinitis treatment
intranasal glucocorticoids
oral antihistamines
antihistamine sprays
decongestant/antihistamine combo
intranasal cromolyn sodium
montelukast
immunotherapy
curvature of the cornea will cause what
astigmatism if its not spherical
sequela from Malignant (Necrotizing) (MOE)
spread to temporal bone and cause osteomylitis, leading to cranila nerve damange, brain abscess, meningitis
what movement is detected by the urtricle
saccule
horizontal movement
vertical movement
hollenhort plaque
a piece of cholesterol or calcium from the carotid or heart valves that has lodged in a retinal artery
correlated with high risk of stroke
T.F maculopathy from plaquenil is reversible
false
DDx for tinnitus: ototoxic meds
aminoglycosides, cisplatin, aspirin, loop diuretics
what percent of parotid cancers are benign
what percent of submandubular cancer are benign
80% parotid
50% submandibular
PE considerations for conjunctivitis
the conjuntiva will be pink or red instead of clear
you can see injection (blood vessels)
can become opacified (look white, yellow, or fleshy)
affects both the palpebral and bulbar conjuctiva
modified neck dissection spares what
Type I
Type II
Type III
Type I CN XI
type II IJV and XI
Type III IVJ, SCM, XI
metamorphosia
a symptom of macular degeneration where a grid of straightlines will appear wavy and some parts of the grid will look black
first line treatment for nasal polyps
intranasal corticosteroids
Perilymph Fistula causes
barotrauma (common)
heas trauma
complications from middle ear surgery
excessive straining
what movements are detectted by the semicircular canals
pitch (yes), yaw (no), roll (side to side
what causes Benign Paroxysmal Positional Vertigo
a mechanical dysfunction caused by an otolith becoming dislodged and flating around the semicircular canals, most common the posterior
T/F fine needle biopsy is a last resort for aneck mass
false, open biopsy is a last resort
uveits
inflammation of the uvea (the middle portion of the eye)
can be atnerior (iris and cilliary body) or posterior (choroid)
Recurrent acute rhinosinusitis defined
4+ episodes of acute bacterial rhinosinusitis per year without signs or symptoms of rhinosinusitis between episodes
describe a brachial cleft cyst
- Lateral neck
- Increase in size with URI
- Second cleft most common
- First associated with parotid
- Third may be associated with thyroiditis
what is the risk for the use of ´Vasoconstrictor/antihistamine combinations for longer than 2 weeks
it can cause rebound hyperemia
clinical presentation of an orbital fracture
periocular ecchymosis
tenderness
crepitus
diplopia
decreased sensation
NV
bradycardia
disconjugate gaze
what afferent pupillary defect look like
what does it mean
thee affected pupil doesn’t constrict symetrically when a light is moved from one eye to the other
to parts of the cupula
utricle
saccule
Vestibular Neuritis treatment
rest, antiemetics, vestibular suppresson, steroids, antivirals, PT
treament for lichenification OE
anti inflammatory (elocon, dexamethasone)
can need canalplasty sometimes
origins of vertigo
vestibular issues
CNS (stroke, brain tumor, multiple sclerosis)
orthostatic hypotension
anxieity
hyperventilation
ortho issues
visual
Alpha-2 Adrenergic Agonists [apraclonidine, brimonidine] for glaucoma
mechanisms
admin
side effects
decreases production of aqueous humor
drops
lethargy, fatigue, dry mouth
complications of acute chronic OM
hearing loss
ossicular disconinuety/fixation
labrynthitis
skull or brain abscess
meningitis
TM perforation
cholestatoma
tympanosclerosis
mastoiditis
facial paralysus
T/F Suspected perforation of the pars flaccida (TM attic) is a cholesteatoma until proven otherwise.
true
typical pathogenesis of Acute Otitis Externa
overgrowth of bacteria caused by skin breakdown caused by excessive ear cleaning, scratching, ear phones, moisture
issues that would cause chronic recurrant otitis externa
treament
bacteria, fungal, inflamatory
treated with dandruff shampoo and topical corticosteroids
when should bacterial conjunctivitis be cultured
can ABx be reduced in treatment
what if symptoms don’t get better
when it is severe, recurrent, or deals with a resistant strain
it can be reduced after 4 days with improvement
try another Dx, ABx, or refer
etiology of cataracts
age
trauma
medication toxicity (steroids, anticholinesterase, etc)
inflammation
radiation
systemic disase (DM, hypocalcemia, wilsons disease)
when to not irrigate an ear
Hx of chronic ear disease
HX of TM perforation
ear tubes
only hearing ear
Malignant otitis externa (Necrotizing) (MOE)
an aggressive, invasive, destructuve inflammatory process found in diabetics or the immunocompromised
DDx of +2cm inflammatory neck mass in an adult
HIV, TB
Dx of chlymdial conjuctivitis
confirmed with direct fluorescent antibody staiing of conjuctival smears or culture
orbital cellulitis treatment
admit for OP or ENT
begin IV vancomycin plus ceftiaxone
structures of the inner ear
cochlea, semicircular canal, internal auditory canals
treatments for PDR
laser
surgery
VEGF injections/steroids
common Ototoxic drugs
aminoglycosides (amikacin, gentamycin, vancomycin)
loop diuretics
chemo
high dose aspririn
how long does acute laryngitis last
what is it usually associared with
3 weeks (self-limiting)
usually a URI (rhinorrhea, cough, sore throat) or acute vocal strain
future treatments of DME
surgery
steroids
VEGF inhibitor
oral meds
montelukast
how it it used in treating allergic rhinitis
selective leukotriene receptor antagonist, less effecive than intranasal glucocorticoids
sometimes used for people with allegies and asthma or nasal polyps
sudden SNHL = ?
refer
what is the goal of the scleral buckle
to fix retinal detachment by indenting the posterior eye to remove traction on the retina from the vitreous
algorhythm for corneal abrasion down to subtype
rule out penetrating injury
exam with fluorescein consistent with corneal abrasion
Hx suggesting subtype
presbyopia
diminished power of accodation due to loss of elasticity of the lens, usualy starts after 40
Acute rhinosinusitis (ARS) defined
inflammation of the nasal passages and paranasal sinuses lasting up to four weeks combined with purulent nasal discharge, nasal obstruction, sinus pain and pressure
Vestibular schwannoma (acoustic neuroma) defined
Schwann cell-derived tumors-commonly originating from the vestibular potion of cranial nerve VIII
commonly associated immune mediated uveitis condtions
ankylosing spondyloarthritis
reactive arthritis
sarcoidosis
behcets deiease
psoriatic arthritis
IBS
immediate treatment for ocular chemical burns
remove the offending agent with irrigation
promote surface healing with artificial tears and topical ABx
elimating inflammation
preventing infection
controlling IOP
labyrinthitis etiology
unknown, maybe viral infection
Sialolithiasis treatment
hydration, warm compress, treat underlying infection
refer if treatment is ineffective or have severe symtpoms
VEGF inhibition
vascular enthothelial growth factor inhibition, treatment for macular degeneration
treatment of TM perforation
treat causative factor
most heal on their own, refere for surgical correction
what is the major risk of epiglottis
infection that will cause swelling and eventually result in airway obstruction
T/F quinolones are firstline therapy for bacterial conjunctivitis
exception?
false, they are expensive and there is a concern about resistance
contact wears get first line treatment because of high incidence of pseudomonas
Acoustic Neuroma (Vestibular Schwannoma) clinical presentation
unilatearl sensory hearing loss
tinnitus
vestibular hypofunction
dysequilibrium
clinical presntation of allergic conjunctivitis
ocular pruitis is the most common symptom
blurred vision
redness
eyelid edema
usual bilateral symptoms
watery, non purulent discharge
NO eye pain
causes of senorineural hearing loss
presbycusis
noise exposure
epistaxis etiology
trauma
neoplasm
hereditary hemorrhagic telangectasia (osler-weber-rendu)
wegeners
coagulopathy
blood thiners
infection
how many episodes of acute OM indicate the placement of tympanostomy tubes
6 or more in one yera
clinical presentation of conjunctivitis
gritty feeling in the eye
itching/burning
excessive tearing
clear or yellow discharge
morning crust
swollen eyelids
increased sensitivity to light
signs of an upper respiratory infection
sialadenitis bacterial cause
viral
infection of the salivary glands cuased by staph, strep, h flu though to be caused by retrograde contamination from the oral cavity
mumps
DDx for tinnitus: neurologic
MS, Tumor
midline head and neck cancers
thyroglossal duct cyst
level I lymph nodes
dermoids
thyroid masses
level IV pathology
allergic cascade that causes allergic conjunctivitis
mast cell is exposed and sensitized to an allergen
subsequent exposure to the allergen causes massive degranulation
degranulation releases histamine which causes the majority of the symptoms
Otomycosis Fungal Otitis externa Dx
direct visualization or ear culture
typical symptoms of open angle glaucoma
progressive loss of vision from the periphery to center
disc cupping due to retinal cell death
open anterior angle chamber
assymptomatic with IOP >21mmHG
DDx of a +2cm neoplastic neck mass in kids
lymphoma, thyroid, sacroma
location and structures in the glottis of the larynx
true vocal cords and the area adjecent extending 1 cm below
benign paroxysmal positional vertigo etiology
most commonly associated with calcium debris of the posterior semicircular canal (canalthiasis)
Eustachian tube dysfunction
etiology
presentation
commonly associated with edema of the URT (viral URI or allegery)
earfullness, popping or cracking when swallowing, mild to moderate hearing loss, retraction or decreased mobility on pneumatic otoscopt
Exostosis
a benign, slowly growing, dome shaped area of bony hypertrophy that comes from the medial surface of teh temporal bone
signs of background diabetic retinopathy
dot/blot hemorrhages
hard exudate
cotton wool spots
intraretinal microvascular abnormalities
diseases that cause fibrosis or fixation of teh cricoarytenoid cartilage
RA, trauma
treamtne of dacryocysitis
mst be fast
get blood culture and drainage
begin emipiric ABx therapy
central RVO
central retinal vein occulsion that can cause blindness of varying severity with no real treatment
caused by compression around teh optic nerve
Branch retinal artery occusion
blockage of the artery associated with carotid/cardiac dieases
may be considered emergent
DDx of a +2cm inflammatory neck mass in children
atypical TB, lymphadenitis
meniere disease presentation
episodic vertigo
SNHL that fluctuates and typically affects lower frequencies
tinnitis
aural fullness
complication of nasoethmoid fracture
disruption of the medial canthal ligament and lacrimal duct system
can trap medial rectus
Acute Otitis Externa furuncle
a staph abcess that come from a hair follicle (usually called a boil) that only happen in the outer part of the ear where hair is present
Vestibular Neuritis Dx
calorics that will show hypofunction on the affected side
fakuda stepping
posterior uvetitis
most likely to be apinless and may result in nonspecific visual changes such as floats or reduced acuity
redness of the eye is not a prominent feature unless there is anterior uveitis
you can see posterior inflammmation and or WBCs in the vitreous
structure of the inner ear (periperal vestibular system) that can cause vertigo
semi circullar canals
cupulas of the semi circular canal
otolith structures
factors associatd with chronic laryngitis
referral?
inhaled irritants (smoke, GERD, alcohol)
yes, requires laryngoscopy
acute otitis media
inflammation of the middle ear that causes pain, hearing loss, red and bulging TM most common between 4 months and 4 years old
reccomendations for allergic conjunctivits
dont rub eyes (exacerbates mast cell degranulation)
cool compresses can help
refridgerated articial tears are useful
stop contact lens use while symptomatic
limit exposure to allergens
nasal polyps
pale, edematous, mucosa covered masses that form in the nasal cavity or paranasal sinuses
Allergic rhinitis treatment with oral antihistamines
issues with first generation (benedryl)
issues with second (claritin)
lots of side effects (drowsiness)
cause less sedation and useful with patients who need relief from intermittent symptoms
DDx for tinnitus; infection
rubella, neurosyphylis, lymdisease
what is the function of the eustachian tube
regulates pressure
drains mucus
aerates the middle ear
blepharitis treatment
warm compress
lid massage
lid washing
classifications of allergic rhinitis
temporal pattern (seasonal)
perennial
episodic
determined by frequency and severity of symptoms
T/F HTN is a direct cause of vision loss
false, it can cause many eye issues indirectly
otitis externa lichenification
thickened, leathery epidermis caused over time by scratching, rubbbing that can lead to obsruction
Laryngopharyngeal Reflux reccomendation
avoid foods that strip mucous from the esophagus (coffee, tea, peppermit(
avoid acidic foods
no smoking
eat smaller meals
avoid exercise for 2 hours after eating
meniere disease acute treatment
vestivbular suppressants and antiemetics
Perilymph Fistula
abnormal communication beween the inner and middle ear
risk factors for developmental difficulties for children with OME
permanent hearing loss
suspected or confirmed speech and language delay
ASD and othe developmental disorders
down syndrome
craniofacial disordesr
blindness or uncorrectable visual impairment
cleft palate
developmental delay
Allergic rhinitis treatment with Intranasal glucocorticoids
onset of action
continuous vs intermittent use?
adverse drug reactions
3-5 to 36 hours after first dose
continuous is better than intermittent
headache, throat irriation, epistaxis, nasal dryness
common cause of blindness related to HIV
CMV retinitis
what will happen in a rinne test with normal hearing
CHL
SNHL
air condicution will be better than bone
bone conduction will be equal or better than air
ac conduction will be better than bone
function of the vocal chords
phonation
airway patency
valsalva
ramsay huny syndrome (herpes zoster oticus)
definition
presentation
an otologic complication of the herpes zoster virus
ipsilateral face paralysis, ear pain, vesicles in the auditoy canal and auricle
dacryocystitis
an infection of the nasolacrimal system
Otomycosis Fungal Otitis externa PE
lumen will have cotton whie growth or debris wtih creamy white exudate
whatis the function of the arytenoid cartilage
allow for attachment of intrinsic muscles of the neck that perfrom complex movements of the larynx
T/F squamous cell parotid tumors require nothing post op
false, they need aggressive surgical managment and post operative radiation
typical cause of barotrauma
usually flying or scuba diving, in conjuction with an ET dysfunction that prevents equalization
Post op care for cataract surgery
steroid drops
topcical mydriatics
IOP reducers
refraction testing
use glasses
two types of astigmaism
regular (light is always bent the same way)
irregular (distorted images caused by warps surfaces)
what causes retinal detachment
tears that allow the vitreous humor to escape the posterior chamber and flow behind the retina
lab test for corneal lesions, foreign bodies, abrasions
fluorscein staining on he corneal epithelium that will turn defects bright green
mastoiditis defined
presentation
common complication of acute otitis media that is associated with mastoid bone destruction
fever, post auricular erythema/tenderness, ear proptosis, acute otitis media on otoscopy
Mal De Barquement Syndrome
spontaneous rocking sensation that comes with spending a lot of time on a boat that usually resolves in a few days
in central retinal artery occulsion, why would the fovea be red
causes
treatment
because the fovea doesn’t get much blood from the arteries of the eye
thrombosis, embolism
usually untreatable
etiology of : Chondrodermatitis Nodularis Helicis
dermal inflammation, edema, necrosis, pressure probably intiatie the disease
may be assocaited with CTD, autoimmune, thyrod issues, SLE, scleroderma
clinical presentation of bacterial keratitis
pain in the eye usually sudden
unusual eye redness
reduce visual acuity
photophobia
excessive tearing
corneal opacity of infiltrate
discharge
can present with hypopyn
types of cataracts
nuclear sclerosis
cortical
posterior subscapular
drugs that increase aqueous flow
Nonspecific Adrenergic Agonists [epinephrine, dipivefrin]
Parasympathomimetics [pilocarpine, carbachol, echothiophate]
Prostaglandins [latanoprost, lumigan, travatan]
Sudden Sensorineural Hearing Loss chance of restorng hearing in the first 2 weeks
50%
Bilateral Vocal Cord Paralysis caauses what
why
stridor
beccause the non functrional vocal cords cause glottal stenosis
labs for severe epistaxsis
CBC for anemia and thrombocytosis
coagulation (PT, INR, PTT)
blood type
typical causes of bacterial keratitis
pseudamonas, staph a, strep
uvetitis diagnoses and treatment
refereral to OP
topical, intravitral or system corticosteroids
systemic immunosuppression
anti microbial therapy
when is urgent removeal for a nasal foreign body required
treatment
when to refer
button batteries or paired magnets
positive pressure or direct instrumentation
when the object is posteriorly located, impacted, or penetrating
T/F bacterial conjunctivitis needs treatment
false, it typically is self limiting but ABx will decrease the clinical course if given before day 6
PDR laser treatment
considerations
a more extensive laser treatment
more extensive, treats peripheral retina, can be painful, reduces side/night vision
Acoustic Neuroma (Vestibular Schwannoma) Dx
MRI-IAC with contrst
DDx for tinnitus
SNHL (most common)
neuro
ototoxic meds
infection
metabolic disorders
autoimmune
vascular disorders
DDx of +2cm neoplastic neck mass in an adult
SCCA, thyroid, salivary gland, lymphoma
what is the most common of periodontal disease
it is a precursor to what
how can it be reversed
gingivits
periodontitis
can be reversed withgood dental hygiene
differentiate preseptal vs post septal cellulitis
blood work
pre: bactricemia is rare
post: blood cultures are more often positive in children than adults
laryngopharyngeal reflux
retrograde movemnt of gastric contents into the laryngopharnyx
Ototoxicity
ingestion or exposure to an ototoxic subsance that kills the hair cells in the cochlea
prevention an education for conjunctivitis
practive good hygeine
dont touch your eyes with your hands
wash your hands often
change towels and wash cloths
return to sport, school, work after 24 hours of treatment and drainage as resolved
what is the larynx suspended from
the hyoid bone
typical causative organisms of dacryocystitis
alpha hemolytic strep
staph epi
staph a
treatment for otitis externa
are ABx always nessasry
Aural toliet
topical therapy with steroids
analgesics
no ABx unless there is an extenstion out side the ear canal or comorbities that raise concern (diabetes, immune deficiency
types of imaging used for neck masses
US
CT
MRI
PET
nuc med
cause closed angle glaucoma
apposition of the iris and the trabecular meshwork
increases risk with age due to increase in lens volume
can be brought on by parasympatholytics (pupilary dilation)
clinical presentation of oral cavity cancer
non-healing ulcer, dysarthria, bleeding, pain, loose teeth
eye length
myopia
hyperopia
myopia long
hyper short
History for unknow primary cancer
- Risk Factors
- Prior Malignancy
- Prior Surgery (including skin or neck)
- Head and Neck Symptoms
- Oromandibular and Dental
- Dysphagia/Odynophagia/Voice complaints
- Epistaxis, Nasal Congestion/obstruction
- Otalgia, Hearing Loss
- Weight Loss
- Fever, Chills, Sweats
describe cortical cataracts
radial or spoke like opacities in the lens perphery that expand to involve the anterior and posterior lens (often asymptomatic until the defect is centrally involved)
if epistaxis doesn’t stop with convervative measures
if that doesn;t work then what
if that doesn’t work then what
nasal packing with ABx
ENT consult, pack the oppostive nasal cavity
consider posterior source
retinal side effect of plaquenil
screening
toxicity that can cause bullseye maculopathy
need to have eye exam yearly
clinical presentation of Acute localized otitis external
Furuncle
severe pain that is agrrevated by movement of the pinna, pressure on the tragus, chewing
hearing loss is present if the ear canal is occluded
typical presentation of an Overly patent eustachian tube (a.k.a. patulous eustachian tube)
treatment
autophony (exaggerated ability to hear ones breathing and voice)
directed at treating an underlying condition
Parasympathomimetics [pilocarpine, carbachol, echothiophate] for glaucoma
mechanism
admin
side effects
increases contractile force of the ciliary body muscle to increase out flow of aqueous
topical drops or gel
headache, myopia
leukoplakia often indicates what
how often will it progress to carcinoma
when should it be biopsied
hyperkeratosis from chronic infection
1-20% within 10 yrs
indurated or enlarged lesions
clinical presentation of preseptal vs post septal cellulitis
pain with eye movements
pre no
post yes
differentiate preseptal vs post septal cellulitis
agents
staph, strep, anaerobes
post: strep anginosus, staph a, strep pyo
SS cerumen impaction
tinnitis
conductive hearing loss
feeling plugged
Rx considerations for bacterial conjunctivitis
ointment is prefered for children, those with poor compliance, or people who are hard to administer drops to because the ointement stays on the eye longer
what is the goal of imaging studies in diagnosing orbital cellulitis
when is a CT recommended
look for an abcess or complication that needs surgery
proptosis, limitation of movement or pain, double vision, vision loss, edema beyound the eyelish, signs og CNS involvement
T/F HPV positve oropharyngeal cancers have a worse prognosis than those who have cancer realted to tobacco
false, HPV has a better prognosis
treatment of Sudden Sensorineural Hearing Loss
high dose steroids
intratympanic steroid injetions
antiviral med
HTN related signs of poor retinal health
arterial narrowing
AV nicking
exudate
optic nerve swelling
why is afferent pupillary defect diagnostically valuable
because you can assess the function of the afferent and efferent nerves in both eyes from one
globus
feeling like there is something in the throat
chronic rhinosinusitis ways to document inflammation
purulent mucus and edema in the middle meatus or anterior ethmoid
polyps in the nasal cavity or middle meatus
radiographs showing inflamation of the sinuses
elements to include during exam of a corneal abrasion
measure visula acuity
exclsusion of open globe and hyphema
fluorescein
lid eversion to asses conjunctival foreign body
typical presentation of gonococcal conjunctivitis
profuse discharge within 12 hours of innoculation that rapidly progresses to irritation, redness, tenderness
has prearicular adenopathy
T/F christmas tree cataracts are typically congenital
true
auricular hematoma
presentation
treatment
complications
tender, fluctuant collection of blood floowling a blunt trauma
drainage, pressure to keep the hematoma from forming, ABx
infection, recurrance, hematoma, cauliflower ear
symptoms of retinal detachment
new floaters
flashing lights (photopsia)
visual field loss
what type of neck masses are most common in children
young adults
adults
inflammatory
congenital or inflammatory
neoplasia
secondary sources of ear pain
C spine
TMJ
temporal arteritis
GERD
neuralgia
poor dentition
tonsilitis
gonococcal conjuctivitis lab test
treatment
referal
can be gramstained G- diplococci
ceftriaxone IM + azithromycin oral + topical
admit for monitoring, treatment
most common pathogens for acute OM
strep pneumo
Haemophilus
moraxella catarrhalis
group A strep
clinical presentation ocular chemical burns
decrease vision
moderate of severe eye pain
blepharospasm (inability to open eyes)
conjuctival redness
photophobia
alkaline burns turn the eye white
when should hoarseness be refered to ENT
when there are no URI symptoms, lasts more than 2 weeks
accompanied by risk factors for head and neck cancer, severe cough, hemoptysis, unlateral ear or throat pain, dysphagia, unexplained weight loss
Acute bacterial rhinosinusitis (ABRS) complications
orbital cellulitis and abcess
osteomyelitis
intracranial extension
cavernous sinus thrombosis
benign paroxysmal positional vertigo presentation
recurrent episodes of vertigo lasting one minute or less provoked by sudden head movement
positive dix hallpike manuver with characteristic nystagmus
causes of refractive errors
eye length
curvature of the cornea
curvature of the lens
barotrauma
presentation
prevention
referral?
ear pressure, hearing loss, otalgia, tinnitus
avoid activities that might cause injury
if there is SNHL or dizziness, but most will heal on their own
what will happen during the weber test if there is CHL
SNHL
normal
CH - sound lateralizes to the bad ear
SNHL - sound lateralizes to the good ear
normal hearing - sound hear equally in both ears
atrophoic glossitis
causes
inflammation of the tonhe that makes the tongue look glossy
iron, b12, folic acid deficient
low protein diet
infection
sjogrens
celiac
presentation of otosclerosis
treatment
slowly progressive conductive hearing loss that is usually bilateral and assymetric
tinnitus, SNHL
refer to ENT for hearing amplification or surgery
describe allergic conjunctivitis
inflammation caused by airborne allergens in the eye that is comonly associated with other allergic disease (asthma, allergic rhinitis, atopic dermatitis)
corneal abrasion Hx subtypes
tramuatic
foreign body
recurrent erosion
contact lens
Intranasal cromolyn sodium
how effective of a treatment is it for allergic rhinitis
mast cell stabilizer that inhibits mast cell degranulation
frequently less effective than intranasal glucocorticoids or 2nd gen antihistamine
T/F there are many things that can present as a cyst, so it is important to not assume things are a cystic
true
pleiomorphic adenoma
a benign tumor of the parotid gland that can convert into a more serious issue if allowed to grown
factors that are cocerning for proliferative diabetic retinopathy
can cause true blindness, esp in DM I
important to look for uncontrolled DMI as teens
causes of acute vision loss
macular disease
retinal detachments
vein occlusions
arterial onclusions
vitreous hemorrhage
optic nerve trauma
“functional vision loss”
proliferative diabetic retinopathy
neovascularization of the retina that causes the secretion of VEGF and infiltration of the vitreous
seborrheic anterior blepharitis
dandruff like skin changes around the base of the eyelids, resulting in greasy scalse around teh eye lashes
what causes vision loss in background diabetic retinopathy
macular edema
hyopyon
layer of white cells in the anterior chamber of the eye assocated with fulminiant cases of bacterial keratitis
T/F sublingula tumors are rare
true
treatment for Laryngopharyngeal Reflux
full strength PPI for 3 months
what age is most likely to present with a foreign body in the EAC
6
Beta-Blockers [levobunolol, timolol, carteolol, betaxolol] for glaucoma
mechanism
adminstration
three side effects
acts on the ciliary body to decrease production fo aqueous humor
topical drops to minimize side effects
bradycardia, syncope, bronchonconstrction
Vestibular Neuritis
sudden onset of vertigo without an associated auditory symptoms, lasts more than 24 hours, postural instability, and nystagmus
Otomycosis Fungal Otitis externa defined
superficail fungal infection of the ear
mild dacryocystitis should be treated with what
severe
oral clindamycin
IV vancomycin with cephalosporin
referal
etiology of Otomycosis Fungal Otitis externa
identification based on discharge
aspergilis, candida are common
aspergilus: black, yellow, gery
candida white
what does a head and neck oncologist do
management of cerival lymph nodes, salivary glands, thyroid malignancy, otologic maliganancy, paranasal sinus malignancy, cranial base malignancy
what is the most common eye exam in kids
conjunctivitis
what is detected by the otoliths
movements where the head stay in the same positon but the body moves as awhole
clinical presentation of cancer below the pharynx
dysphagia, odynophagia, hoarseness, otalgia, neck mass, sore throat
causes of Sudden Sensorineural Hearing Loss
idiopathic
viral
meniere disease
trauma
stroke DM
treatment methods for glaucoma
lower IOP by decreasing production aqueous humor or increasing out flow of aqueous humor
DDx of lymphadenopathic neck masses
infection (bacterial, abscess)
caseating granuloma
reactive
sarcoidosis
what is the only definitive therapy for closed angle glaucoma
trabeculectomy
intact confrontational visual fields with poor vision is indicative of what
central scotoma from macular degeneration
dix hallpike manuever
turn patient head to the right, lay them down fast, look of rotary nystagmus and dizziness
if the right side doesnt work try the left
the side that has a positive test is the location of the dysfunction
T/F Cholesteatoma should be refered
true
treatment for cerumen impaction
wax removal kits
irrigation with warm water and alcohol
SS optic neuritis
gender bias
imaging
MS
pain with eye movement
APD
usually makes a complete recovery
more young women
MRI is advisable
diagnostic categories of neck masses
inflammatory
congenital
neiplastic
traumatic
what would cause a bitempral visual field defect
lesion at the optic chiasma
four types of refractive errors
myopia
hyperopia
astigmatism
presbyopia
Common Cold presentation
rhinitis, congestion, sore throat, cough, sometimes conjunctivitis
typically NOT fever
structures of the outer ear
auricle and ear canal
topical treatment for allergic conjunctivitis
antihistamine/vasoconstrictor product
anti histamines with mast cell stabilizing properties
mast cells stabilizers
NSAIDs
topical glucocortcoids
describe arteritic ION
elderly women
related to PMR (tender scalp, headache, fever, jaw pain)
can progress to giant cell arteritis
why is nasopharyngeal cancer unique
EBV is the carcinogen
Acute Otitis Externa defined
inflammtion of the skin of the outer ear
unilateral purulent discharge in a young patient suggests what
a foreign body of organic nature
less familiar with signs of acquired cataracts
retina appears indistinct on fundoscopy
dim red reflex
increased myopia that previously noted
cataract does not cause an afferent pupil defect
evaulation for vertigo
- History, History, History
- Physical Exam with Orthostatic blood pressures
- Audiogram
- ENG (electrovestibular nystamogram) or VNG
- Labs
- Imaging studies
labyrinthitis presentation
vertigo lasting for several days to a week accompanied by hearing loss
what is the primary risk factor for head and neck cancer
tobacco use
T/F eye ointment doesn’t affect vision
false, it will cause blurred vision for 20 minutes
Acute Otitis Externa typical bacterial agents
pseudomonas
staph
what gets treated first, eye lid laceration or globe injury
globe
describe the use of ´Vasoconstrictor/antihistamine combinations in treatment of allergic conjuctivitis
OTC drugs (naphazoline, phenariamine)
dosing up to four times daily for accute symptoms
reversibly blocks histamine
vasoconstricts (alpha-adrenergic agonist)
appropriate for short term use
Acute bacterial rhinosinusitis (ABRS) must fit one of what three presentations
acute rhinosinusitis lasting for 10 days after the onset of URI
acute rhinosinusitis worsening within 10 days after initial improvement
onset of sever symptoms of signs of high fever (+102F), purulent discharge or facial pain, lasting for at least 3-4 days at the beginning of illness
meniere disease etiology
possible fluid in the ear due to abnormal ion homeostasis
where is the arytenoid cartilage
on the upper border of the posterior cricoid cartilage
middle ear causes of conductive hearing loss
otitis media
cholesteatoma
otosclerosis
TM perforation
Eustachian tube issue
middle ear barotrauma
: Chondrodermatitis Nodularis Helicis
common, benign, painful condition of the helix or anti helix
risks of a deep lobe tumor in the parotid gland
more likely to have a facial nerve insult that causes facial paralysis
clinical presentation of nasopharyngeal cancer
epistaxis, nasal obstruction, unlateral hearing loss, SOm, Neck mass, cranial nerve palse
caution for vestibular suppresants in Vestibular Neuritis treatment
meclizine can cause decreased central compensation
positive fakuda stepping for Vestibular Neuritis
marching in place for 100 steps causes movement greater than 1m or rotate more than 45deg
Exostosis PE
usualy multiple nodules
circumscribed or diffuse
small hard, shiny, sometimes penduculated
overlying skin is sometimes more pale an thin
can be differentiated from a foreign body on palpation
Prostaglandins [latanoprost, lumigan, travatan] for glaucoma
mechanism
adminstration
side effects
may increase uveoscleral outflow by relaxing ciliary body
topical
iris color change
patient presents with hard exudate but no DM or HTN
what might be the cause
hyper lipidemia
what causes open angle glaucoma
obstruction of trabecular meshwork that allows the flow of fluid between the intermediate and anterior chambers of the eye
T/F pediatric epiglottitis can be confirmed with a through oral exam
false, adults can be examined but children can gag and completely close their glottis
clinical presentation of preseptal vs post septal cellulitis
proptosis
pre no
post usually may be subtle
euphimisms for dizzy
spinny
unsteady
staggering
lightheaded
disequilbirum
disoriented
woozy
floatin
Carbonic Anhydrase Inhibitors [acetazolmide, dorzolamide] for glaucoma
mechanism
admin
side effects
blocks enzyme that produce HCO3 that carry osmotic water, therby decreaseing the production of aqueous humor
oral or topical
malaise, kidney stones, aplastic anemia
symptoms of acquired cataracts
slowly progressive visual loss or blurring
glare
reduced color perception
hall mark presentaton of prebycusis
other symptoms
progressive, systemic loss of hearing over many years (SNHL)
tinnitus, vertigo
Allergic rhinitis treatment with Oral antihistamine/decongestant combinations
why use them?
adverse drug reactions
nonsedating antihistamines combined with pseduoephedrine provide better relief than antihistamine alone
limit us, include HTN, insomnia, irritability, headache
what is the only complete ring of cartilage in the larynx
the cricoid cartilage, below the thyroid cartilage
clinical presentation of preseptal vs post septal cellulitis
vision impairment
pre no
post maybe
what usually causes corneal abrasion
trauma or foreign body
how does HTN affect the eye
worsens DR
vein/artery occlusions
aneurysyms
optic nerve issues
macular degeneration
Acute suppurative sialadenitis presentation
pain and swelling of the affected gland
induration, edema, tenderness
possible expression of pus
Acute bacterial rhinosinusitis (ABRS) treatment
ABx (amoxicillin or augmentin)
NSAIDs and tylenol
intranasal saline irrigation
intranasal corticosteroids
erythroplakia
is this more or less indicative of malignancy compared to leukoplakia
red mucosal plaques
more likely to be malignant, should be biopsied
DDx for tinnitus: metabolic disorders
thyroid, chronic renal failure
what determines the presentaion of hearing loss with TM perforation
depends on the size and location of the perforation
Meniere’s Disease (Endolymphatic hydrops) dx
usually clinical
audometric evaluatation for low frequency sensory loss
vestibular evaluation with nystagmus toward the hypofunctioning side
calorics will usually be hypofunctioning on the affected side
more common in women bewteen 30and 60
practice guidlines for OME
screen at risk kids
discourage antihistamines and intranasal steroids
fluld present for 3 months warrants tubes
observation of children without risk for development disability for 3-6 months
if hearing loss is >20dbs put in tubes
Meniere’s Disease (Endolymphatic hydrops) hearing loss
early stage only has low frequency loss
as the disease progresses the heaing loss will flatten
usually results in poor word recongition
what is often the presenting symptom of spondyloarthropthy
uveitis
descrive perennial allergies
mild, chronic, waxing and waning related to environmental exposure to year round indoor allergens (dust mites, animals, molds)
conditions related to nasal polyps in adults
in kids
chronic sinusitis, ashtma, aspirin sensitivty
cystic fibrosis
Acute localized otitis external Furuncle on physical exam
a extremely tender, erhytmatous, localized swellling on the out ear
adenopathy between the mandible and mastoud
pain
how would a lesion in the optic tract behind the optic chiasm manifest
contralateral homogogenous hemianopsia (vision lost on the nasal ipsilateral and the temporal contralateral side)
epiglottis
Infectious epiglottitis is a cellulitis of the epiglottis and adjacent tissues that can result from bacteremia and/or direct invasion of the epithelial layer by the pathogen
Acute localized otitis external Furuncle treatment
I&D
oral Abx (keflex, clindamycin, bactim)
topical ABx
warm compress
indications for removal of a substernal goiter
airway obstruction or dysphagia
Central Dizziness
dizziness causd by a lesion in the cerebellum, brain stem or central vestiblar pathway
patient education associated with blepharitis
it is a chronic condition with no definitive cure
good lid hygiene is important
have reasonable expectation
early post opp complications of cataract
endopthalmitis
uveitis
retained lens matter
corneal edema
hyphema
astigmatism
exacerbation of diabetic retinopathy
clinical presentation of laryngeal cancer
muffled voice, hoarseness, sore throat, otaligia, airway obstruction
diabetic screening for retinal health
DM I, yearly dilated exams starting a puberty or within 5 years of diagnosis
DM II, at diagnosis and yearly after
Gestational: in the first trimester, each trimester as indicated
types of thyroid carcinoma
- Papillary
- Follicular
- Medullary
- Anaplastic
- Lymphoma
- Metastatic (melanoma, renal and others rarely)
what must be done when lymphoma is suspected
fine needle biopsy to exclude carcinoma
what is a common presentation of uveitis relating to behcet disease
wide spread intraretinal hemorrhage that is secondary to retinal vasculitis
hyperopia
corrected by
far sighted ness caused by light rays focused behing the retina because the cornea/lens is too flat or the eye is too short
corrected by a convex lens to converge light
what is one tool that can help localize the location of a stroke
central visual field defect
strucutres of the middle ear
tympanic membrane, ossicles, middle ear space
causative factors for TM perforation
barotrauma, foreign body injury, infection
blood under the retina is indicative of what
macular degeneration
common causes for otitis externa
what bacteria are the most common vectors in otitis externa
infection, allergy, dermatological reasons
pseudmonas and staphylococcus
causes of eustachain tube diysfunction
youth
URI
chronic sinusitis
allergic rhinitis
adenoid hypertrophy
tobacco smoke
reflux
radiation
DDx for tinnitus
when to suspect a vascular cause
lab studies?
when the tinnitus is pulsatile
contrast CT, MRI, and angiography
T/F Laryngeal Growths tend to be bilateral
false, they tend to be unilateral with a contralateral friction lesion, though some “screamer nodes” can occur that are bilateral
differentiate between a hordeolum and a stye
an internal hordeolum is an inflammed meibomian gland under the conjuctival side of the lid
a stye is an external hordoleum that comes from an eyelash or a lid margin gland
etiology of uvetis
systemic infections
inflammatory disease
immune conditions
anterior blepharitis
a less common form that involves inflamtion of the base of eye lashes
usually seen in youner women
can be staphylcoccal or seborhheic
describe chlamydial conjuctivitis
a chronic case of conjunvtivitis that usually concurrent with GU infection
what happens during panendoscopy
- Palpation of the base of tongue facilitated
- Evaluation of the pyriform sinuses
- Biopsy of inaccessible regions
- Telescopic Mapping
- Screening for multiple primaries
Lip-Splitting Incisions
Straight
Curved around mental sulcus and chin
“Z” and “V”
Stepped approaches
what is the most important part of evaluating a patient with uveitis
you need to ask questions about underlying causes
spondyloarthrtis (LBP before age 45)
joint pain or swelling
FHx of spondyloarthritis
risk fators for HIV
Exostosis Dx and treatment
usually clinical
no unless obstructive
T/F the otoliths house the cupulas
false, the cupulas house the otoliths
treatment for hordelum/stye
warm compresses on off for about 10-15 minutes
ABx has little evidence
if treatment doesn;t reduce size in 2 weeks or a chlazion forms, refer for incision and curretage
Unusual Presentations of Head and Neck Cancer and Sinonasal and Skull Base Tumors
- Trismus
- Proptosis (unilateral)
- Cheek swelling
- Facial numbness
- Facial Pain
- Intermittent epistaxis
- Facial nerve paralysis
- Nasal obstruction
chalazion clinical presentation
firm, pea sied swelling that can happen after internal hordeolum
usually one at a time
usually no signs of inflammation externally
minimal pain
best treatment for carotid body tumor
surgical removal, but conservative can be used in ellderly patient
problems assocaited with laryngeal dysfunction
hoarseness (often with weakness, fatigue, strained voice)
stridor
Benign Paroxysmal Positional Vertigo dx
dix hallpike manuver
SS acute OM
otaliga
hearing loss
fussy
poor sleep
nausea
fever
red bulging TM
what percent of neck masses in kids are benign vs malignant
what about adults
80% benign, 20% malignany
8-% maliganant, 20% benign
typical causes of hoarseness
acute/chronic laryngitis
benign vocla cord lesion
maliganacy
neuro dysfunction
systemic condition
what is the most common cause of epiglottis in kids
H flu, but also associated with strep, staph, mrsa
describe blepharitis
chronic eye condition that is characterized by inflammation of the eye lid with intermittent exacerbation
clinical presentation of corneal abrasion
severe pain
photophobia
foreign body senstation
T/F presence of a fovea reflex indicates diabetic macular edema
false, it indicates good retainal health
two categories of causes leading to vertigo
peripheral (benign paroxsysmal positional vertigo)
central (MS)
clinical presentation of otitis externa
otalgia, itching, ear fullness, possible hearing loss
tenderness at the tragus or pinna
diffuse ear canal edema, erythema
purulent otorrhea
what do cotton wool spots indicate in terms of progression in diabetic retinal edema
very davanced disease
what nerve innervates all the intrinsic muscles of the larynx
the reccurrent laryngeal nerve
corneal vs lenticular astimatism
abnormal cornea vs abnormal lens
what is the most common cause of epiglottis in adults
viruses, but can be bacterial, fungal, or a combination
Acute rhinosinusitis (ARS) presentation
drainage, clogged nose, sinus pain or pressure, fever, fatigue, cough, ear pressure
calorics
pouring cold water into the ear to cause dizziness
typical presentation of dacryocystitis
erythema, swelling, warm, tender lacrimal sac with/without discharge
typically associated with congenital NLD obstruction
Benign Paroxysmal Positional Vertigo
a fatiguable spinning senation that lasts less than one minute often triggered by laying down, rolling in bed, tilting the head back
describe thyroglossal duct remnants
- Midline
- Move with swallowing, tongue protrusion
DDx difuse Acute Otitis Externa
necrotizing otitis externa
furunculosis
trauma
carcioma
atopic dermatttis
foreign body
impaction
nasopharyngeal carcinoma is related to what virus
epstein bar
considerations when prescribing for glaucoma
most drugs require several agents deliveryed frequently
slow release delivery devices are useful
laser treatment and surgical treatment is an option
treatment is focused on decreasing IOP but issues can exist without IOP
Acute Otitis Externa treatment
clean or debride ears
topical cleaner (alcohol, vinegar, boric acid)
ABx ear drops (otafloxacin, cipro, vasocidin)
when are mast cell stabilizers most often used
when patients don’t tolerate other medications and can anticipate their onset
three typical orbital fractures
zygomatic
nasoethmoid
orbital floor
T/F vertigo is a diagnosis
false vertigo is a symptom and the trigger of the vertigo might lead to Dx
three types of allergic conjunctivitis
acute
seasonal
perennial
labyrinthitis treatment
vestibular suppressants
anti emetics
corticosteroids
critical sign of acquired cataract
opacification of the normal clear lens
treatment for herpes keratitis
DON’T use topicla glucocorticoids
if there is vision loss, refer
topical antivirals
consideration of treatment for cerumen impaction
treat symptomatic patients
keep in mind you don’t know what is behind the wax
sometimes a patient cannot adequately express their symptoms
treatment of chlamydial conjunctivitis
azithromycin 1g po once
or doxycyline 100 mg bid or erythromycin 500mg po gid for 7b days
useful empiric ABx for bacterial conjunctivitis
erythromycin ointment
azithromycin drops
ciprofloxacin drops (prefered for contact wearers)
typically presentation of herpes simplex keratitis
infection of the superfical layer of the cornea with a puncate or diffuse branching lesion in the epithelium
usually fom viral latency rather than primary infection
usually unilateral
anterior nose bleeds most typically comes from what
posterior comes from what
up to 90% area of kiesselbach’s plexus
originate most cmmonly from the posterolateral branches of the sphenopalatine artery
branch retinal occulsion
ischemia in the retina related to HTN caused by a blockage int he retinal veins that releases VEGF`
T/F labyrinthtis will recover completely with with time
false, patients my have sporadic vertigo and might never regain hearing
where are the false vocal cords
what separates them from the true vocal cords
above the true vocal cords
the laryngeal ventricle, that contains mucous producing glands that produce lubrication for the true vocal cords
T/F blood cultures are often useful in diagnosing preseptal cellulitis
who should be admitted
who should be outpatietn
false, since the sight of infection is hard to get to
adults and children over 1 with mild symptoms and no toxicity
children under on who cannot cooprerate or who are severly il
T/F cataracts are almost always unresponsive to medical treatment except when due to a correctable cause like DM, steroid use
true
causes of conductive hearing loss
AOM
OME
otosclerosis
ETD
what type of cancerous cells are found in parotid tumors
are they primary or mets
squamous cell carcinoma.
usually mets from a cutaneous lesion, but rarely is a primary lesion
management and treatment of epiglottis
intubation
epiglottal culture
ABx
causes of Bilateral Vocal Cord Paralysis
iatrogenic
ALS, diabetic neuropathy, myasthenia gravis, organophosphate pesticide toxicity, stroke, head injury
what is the goal of laser treatment of diabetic edema
but
it coagulate microaneurysms
only 1 in 7 will regain vision
what is considered head and neck cancer
what type of cell is usually effected
generally cancer of the upper aerodigestive tract
usually squamous cells
Superior Canal Dehiscence Syndrome treatment and Dx
CT without contrast
surgical plugging
common side effects of ´Antihistamines with mast cell-stabilizing properties
stinging and burning
headache
increased occular dryness
Laryngeal Growths are manifestations fo what
irritation caused by smoking, reflux, muscle tension, trauma
T/F no single medication can be used to treat glaucoma in all patients
true
Allergic rhinitis diagnosis
HP consistent with allegic cause
nasal congestion, rhinorrhea, itchy nose, sneezing
Nonspecific Adrenergic Agonists [epinephrine, dipivefrin] for glaucoma
mechanism
admmin
side effects
increase uveoscleral out flow
topical
can precipitate acute attacks in patients with narrow angle, head aches, tachycardia
epiglottis in immunocompromised hosts can be caused by wha
pseudomonas aeruginosa or candida
complication of the orbital floor fracture
entrapment of the inferior rectus
what CN innervates the laryngopharynx
the vagus
curvature of the lens
myopia
hyperopia
too steep, myopia
too flat, hyper
vestbular ocular reflex
reflexive eye movement in response to head movement that allows for stable gaze while the head is moving
Acute rhinosinusitis (ARS) common cause
viral etiology along with URI or common cold
common cold treatment
symptomatic therapy
periodonitis
gingival inflammation that leads to loss of connective tissue and alvolar bone that causes tooth loss
T/F inorganic foreing bodies cause more severe symptoms
false, they are typically assymptomatic
meniere disease long term therapy
avoid triggers (high salt, caffiene, alcohol, stress)
diuretics with lifestyle control is ineffective
vestibular rehab with hearingaids
most common cause of orbital fracture
because of this, what will need to do
assault, MVA, sports
30% will have globe injury
evaluate for CNS injury (epidural hemtoma, subdural, subarachnooid)
typical vectors that can cause acute laryngitis
treatment
M cat, H flue, strep pneumo
usually resolves with conservative treatment
ABx not needed
sterds can be given if there is a pressing need to use their voice
etiology of exostosis
cold water exposure in susceptible individuals
what is the most common kind of vertigo
benign proxysmal positional vertigo
epistaxis treatment
ABC’s
conservative (squeeze your nose, bend at the waist
2 sprays of oxymetazoline
chemical or electrocautery for anteriot nose bleed
if the bleeding stops and no source is visualized, observe for recurrance
thumb sign
a radiographic sign of epiglottis where it is so inflammed it looks like a thumb in the neck
common presentation of unknown primary cancer
painless unilateral mass, typically in a non smoking white male
describe ´Nonsteroidal anti-inflammatory drugs (NSAIDs) for allergic conjunctivitis
block prostaglandin formation
less effective than topical antihistamines but are clincally efficacious compared to placebo
how does anterior uvetits present
redness around the limbus
cillary flush
no discharge
constricted pupil with pain
have have WBC int he anterior chamber
a haze/flare can be seen on slit lamp that indicated protein accumulation
chalazion
an inflammatory granular lesion that forms around obstructed meibomian glands that can be sequla to internal hordeolum
Mr. S presents to you with diminished peripheral vision. He complains that he feels like the world is closing in on him. He also notes that he has trouble looking at lights as they all appear to be surrounded by halos.
probable Dx?
open angle glaucoma
T/F most people are aware of Laryngopharyngeal Reflux and easy to diagnose
false, they are often assymptomatic so all other conditions must be ruled out then confirmed with laryngoscopy
PE for Acute Otitis Externa
flaking, infammation, erythema, edema, discharge, granulation, narrowing of the external meatus
describe the drainage caused by bacterial conjunctivitis
thick, white/yellow/green, continally produced and respawns quickyl when wiped
describe nuclear sclerosis
yellow or brown discoloration of the central part of the lens that tends to blur distance more than near vision
common clinical presentation Acute Otitis Externa
itching
pain
hearing loss
swelling
dranage
Sialolithiasis
salivary stones, presents with pain and swelling exacerbated by eating
can be imaged if suspected but PE doesn’t reveal an obvious probelm
when should an eye lid laceration be refered
if there is fat in the lac
it goes throug the margin of the eyelid
involves the tear ducts
poor alignment or avulsion
baterial keratitis
a bacterial infection of the cornea
T/F Unilateral otitis media in an adult, without a preceding URI or a URI that fails to resolve, is a nasopharyngeal carcinoma until proven otherwise.
true
posterior blepharitis
more common form that involves inflammation of the inner eye lid at the level of the meibomian glands (also know as meibomian gland dysfunction)
can be associated with rosacea or seborrheic dermatitis
treatment for acute OM
amoxicilin
augmentin
omnicef
if allergic use quinolones (levo, mexo, cipro)
differentiate preseptal vs post septal cellulitis
source of infection
pre: local trauma, insect bites, dacryocytitis, sinusitis
post: paranasal sinuses
complications associated with glucocortocoid treatment of allergic conjunctivitis
cataracts, elevated intraocular pressure, glaucoma, secondary infection
Benign Paroxysmal Positional Vertigo treatment
canalith repositioning manuver (epley), need referal to PT
clinical findings associated with epiglottis in kids
respiratory distress (stridor, tachypnea, tripod breathing)
sore throat
dysphasia
muffled voice
retractions
what will cause conductive hearing loss
dysfunction of the EAC, TM, or ossicles
types of head and neck neoplasia
- Carcinoma
- Salivary Gland
- Lymphoma
- Thyroid
- Carotid Body
- Sarcoma
- Melanoma
typical prsentaion of closed angle glaucoma
acute onset of headache, nausea, malaise that requires immediate treatment
location and structures of the subglottis
the region of the larynx extending from the inferior edge of the glottis down to the inferior edge of the cricoid cartilage
clinical presentation of preseptal vs post septal cellulitis
eye lid swelling with or without erhthema
yes to both
what causes myopia
corrected by
light rays focused in front of the retina caused by an eye that is too long, or the cornea/lens are too steep
coorrected by a concave lens to divergle light
differentiate preseptal vs post septal cellulitis
incidence
pre: much more cmmon
post: much less common
ABx treatment of preseptal cellulitis
oral clinday mycin
oral sulfa + amoxicillin
describe the course of the reccurrent laryngeal nerve
on the left it passes under the aortic arch, on the right it passes under the subclavian, then it reenters the ekc at the thoracic inlet
types of hearing loss
conductive, sensorineural, mixed
treatment for arteritic ION
stat esr, CRP
immediate referral
start high dose steroids
schedule biopsy
what causes sunflower catartact
wilsons disease
describe non arteritic ION
No GCA symptoms
small disc cup
other involved 25-50%
might be related to nocturnal hypotension
two major types of glaucoma
open angle and closed angle
vestibular sedeatives
Meclizine (Antivert)
Promethazine (Phenergan)
Dimenhydrinate (Dramamine)
Diphenhydramine (Benadryl)
Anticholinergics (Scopolamine)
