ENT/Resp basics Flashcards
Ambylopia is?
Central vision loss due to bad development
Types of Ambylopia?
Strabismus
Refractory
Deprivation
Ambylopia due to Strabismus attributes?
Misalignment - brain ignores input from bad eye
Ambylopia due to Refractory attributes?
Vision blurry
- Myopic - near-sighted
- Hyperopic - far sighted
Ambylopia due to Deprivation attributes?
Vision obstructed
- Retinopathy of prematurity
- Congenital cataracts/glaucoma
- Retinoblastoma (w/ leukocoria)
When is complete ophthalmologic exam is necessary?
Premature birth
Hx cerebral palsy/downs
Poor school performance
Reasons to refer to Ophthalmology?
Any - Nystagmus, Strabismus, Acuity >20/40 either eye after 3yo or 2 line difference on eye chart.
ABNL Red reflex
Torticollis that is unexplained
MC cause of conjunctivitis per timing of onset in neonate?
Day 1-3 - Chemical 2-7 - Staph/Strep, Pseudomonas, E. Coli 3-21 - HSV 4-19 - C. Trachomatis
Types of conjunctivitis?
Neonatal
Infectious
Allergic
Chemical
Dx of HSV neonatal conjunctivitis?
Dendritic lesions on cornea
N. Gono infection Prevention?
Prph silver nitrate
OR
Erythromycin - Tetracycline ointment after birth
TXT of C. Trachomatis conjunctivitis?
(po) Erythromycin x14d
TXT of Gonorrhea conjunctivitis?
Ceftriaxone (IV) or (IM) once and ADMIT
TXT of HSV conjunctivitis?
Acyclovir + refer
TXT of S.A conjunctivitis?
(Top) Abx - Erythromycin or Polysporin
TXT of Pseudomonas conjunctivitis?
(Top) FQ - moxifloxacin or ciprofloxacin
Indications of viral conjunctivitis?
Pre-auricular node
Watery eye unilateral > bilateral
MC organism of viral conjunctivitis?
Adenovirus (Pink eye)
TXT of viral conjunctivitis?
Supportive/hand wash and cool compress
How to distinguish Bacterial from Viral conjunctivitis?
Bacterial - Purulent Discharge - Wipes frequently
TXT of HIB, S. Pneumo, M. Catarrhalis conjunctivitis?
(Top) Abx - Erythromycin, polymyxin, b-trimethoprim
What should be initial TXT of any conjunctivitis?
Gentle massage w/ warm moist washcloth
Polytrim ABX for conjunctivitis is? Form? Rx?
Ophth drops OF - Polymyxin B and Trimethoprim
Erythromycin for conjunctivitis is? Form?
Ointment
(PO erythromycin is used for what type of conjunctivitis?
C. trachomatis
Allergic conjunctivitis presents as?
Bilateral
- Pruritus
- Watery DC
- Cobble-stoning eyelid edema
- Blebs
TXT of allergic conjunctivitis?
(Top) V-con, NSAIDs, AH Blepharitisor (Top) Cromolyn or (PO) AH
How far does erythema/injection extend w/ conjunctivitis?
Stops before limbus
Blepharitis is?
Eyelid margin inflammation due to bacteria or dysfx of seborrhea/Meibomian glans
TXT of Blepharitis is?
Gentle cleanse (Johnson baby shampoo) and warm compress
OR
(Top) Abx - Bacitracin - Erythromycin
MC bacteria causing Blepharitis?
S.A.
Dacrocystitis is classified as?
Acute - complete block
Chronic - Partial blk (dacryostenosis)
Dacrocystitis is usually due to what organism?
S.A or coag = staph
TXT of Acute Dacrocystitis?
(PO) systemic Abx
TXT of Chronic Dacrocystitis?
Warm compress AND (Top) ABx
Complication of Dacrocystitis?
Orbital cellulitis
Hordeolum is?
External (Stye)- infected Zeis glands of eye lash follicle
Internal (Stye)- infected Meibomian gland
- Painful and RED
Hordeolum (Stye) MC organism?
Staph (TTP and RED)
TXT of Hordeolum?
Warm compress freq
NSAIDs
Refer - 1-2w if no resolution
Chalazion is?
Meibomian gland obstruction
- NOT painful or RED
Meibomian gland difference between Hordeolum and Chalazion?
Hordeolum - Internal stye = Infected Meibomian gland
Chalazion - Obstructed Meibomian gland
TXT of Chalazion?
SML - warm compress - SL wk-mo
No resolution or symptomatic - Refer CCS Inj or surgery
What is a serious complication of Sinusitis?
Orbital cellulitis
Orbital cellulitis is?
Bacteria spreading into orbit through infected sinus wall
Organisms ass/w Orbital cellulitis?
S.A, Strep pneumo, HIB
Which is a true emergency Orbital cellulitis or preseptal (periorbital) cellulitis?
Orbital cellulitis
TXT of Orbital cellulitis?
Admit - Blood cx - CT (surgery) IV Abx - Cefazolin OR Clindamycin OR - Cefuroxime + metronidazole OR - MRSA - Vanc + cefotaxime + clindamycin
RED flags of Orbital cellulitis?
Fever Painful extraocular motion LROM of eyes Exophthalmos Vision changes Chemosis
Complications of Orbital cellulitis?
Cavernous sinus thrombosis
Subperiosteal abscess
Vision loss
Preseptal (periorbital) cellulitis MC occurs in what pop?
<3yo
Which cellulitis of eye has pain/exophthalmos?
Orbital cellulitis - NOT preseptal cellulitis
Preseptal (periorbital) cellulitis is ass/w what MOI?
Skin lesion or trauma
MC organism of Preseptal (periorbital) cellulitis?
S.A or GAS
TXT of Preseptal (periorbital) cellulitis?
Outpt TXT w/ daily f/u
- Augmentin or Cephalexin or Clindamycin
- MRSA - TMP-SMX or Clindamycin
Congenital anomalies ass/w AOM?
Cleft palate, Downs, HIV PEDs
Pathogens MC to AOM
Bacteria - S. Pneumo, HIB, M. Catarrhalis, GAS
Viral - Rhinovirus, Influenza, RSV
AOM Dx requires what 3 things?
Acute onset S?S
Mid Ear Effusion
Mid Ear Inflammation
Other S/S of AOM?
Bulging TM - opaque or hyperemia
Decreased mobility of TM
TM air-fluid level
Uncertain AOM can use what to help Dx?
Tympanometry - good seal/technique
What is OME?
Effusion w/ otitis media - but w/out acute S/S
- common in 1st 2yr of life
MC freq sequela of AOM?
OME
TXT of AOM?
Abx
1L - Amoxicillin
2L - Augmentin
3L - Ceftriaxone (IM) - Cefdinir, Cefuroxime axetil
AOM complications?
Unresolved after months Conductive hearing loss - Speech delay Mastoiditis Cholesteatoma Petrositis Intracranial invasion
When is pressure equalization tubes considered for AOM?
PEDs w/ developmental risks
or
Recurrent AOM + 3mo persistent effusion w/ bilateral hearing loss.
Mastoiditis S/S?
Posterior auricular TTP, edema, red + AOM
Pinna is displaced down/out
Mastoiditis TXT?
Systemic Abx and ENT to I/D
Cholesteatoma is?
Mass like keratinized epithelial growth
ENT refer
Recurrent OM in <1mo requires?
Abx change
Recurrent OM over >1mo requires?
Can use same Abx
Prph Abx considered in Recurrent OM if?
> 3 episodes in 6mo
or
4 episodes in 12mo
Prph Abx used for Recurrent OM?
Amoxicillin Q/d at night
Sulfisoxazole Q/d at night
Indication for ENT referral concerning Recurrent OM?
Recurrence while on PRPH Abx
>3mo effusion
Speech/hearing delay
- >3 AOM episodes w/in 6mo OR >4 AOM episodes 12mo
When are tympanostomy tubes inserted?
Recurrent OM
- >3 AOM epsiodes w/in 6mo
or
- >4 AOM episodes w/in 12mo
Otitis Externa is AKA?
Swimmers Ear
Otitis Externa is?
External auditory canal inflammation w/ exudate
MC organisms ass/w Otitis Externa?
P. aeruginosa - (ass/w swimming) or S.A. or Tubes - expands potential organisms
Otitis Externa presents as?
Ear pain, TTP, discharge
Pinna/Tragus TTP (esp. if chewing)
Canal - red/edema
TM- usually NL
Otitis Externa TXT?
(Top) - antimicrobial + CCS otic agent
- Ofloxacin or Ciprofloxacin + Hydrocortisone or Dexamethasone
- Polymyxin B - Hydrocortisone
PVT of Otitis Externa?
Avoid vigorous cleaning of canal
Dry ears after swimming/showering - Acetic acid/diluted rubbing ETOH/ burrow solution
MC attributes of Epistaxis?
6-10yo - Late fall or Winter
Epistaxis pathology?
Dry friable mucosa at KIESSELBACH Plexus
Epistaxis causes?
MC - Digital trauma URI/AR FOB Bleeding d/o Dry air
Initial TXT of Epistaxis?
Sit pt up - direct pressure pinching x10m
Persistant Epistaxis w/ identifiable source TXT?
Cauterize w/ silver nitrate or aluminum chloride
Persistant Epistaxis w/ NO source TXT?
Afrin spray
or
Afrin ointment soaked gauze, phenylephrine, lidocaine PACK!
Severely persistant Epistaxis and all TXT failed?
Anterior nasal packing in place 2-3d
and
Prph Abx - Augmentin OR TMP-SMX
When is ENT referral considered for Epistaxis?
Persistant bleeding or located posteriorly
Complication of Epistaxis packing?
Septal necrosis
PVT of Epistaxis?
Avoid trauma
Humidifer, Vaseline around nares
TXT underlying conditions
Common Cold etiology?
MC - Rhinovirus
- Coronavirus > RSV > Flu > Paraflu > Adenovirus
Common cold resolves when?
7-10d
Complications of common cold?
OM or Bacterial sinusitis
Common presents as?
Nasal congestion/rhinorrhea
Sore/Scratchy throat
+- non-productive cough
TXT of common cold?
Symptomatic
Antipyretics - fever
NO - AH, decongestants <6yo Or NO Abx, cough suppressants and expectorants
Sinuses present at birth?
Maxillary and Ethmoid
When does other sinuses develop?
Sphenoid - 5yo
Frontal - 7yo > Adolescence
What are ostia?
Narrow Openings 1-3mm that drain sinuses into middle meatus (AKA. Ostiomeatal complex)
Are sinuses a sterile environment?
YES
Sinusitis is?
Obstruction of mucociliary flow impeding drainage allowing for bacterial infection
Pathogens ass/w acute Sinusitis?
S.A. - GAS - S. Pneumo
M. Catarrhalis
HIB
Pathogens ass/w SUB-acute Sinusitis?
Anaerobes
Common Sinusitis manifestations?
Lasts >10-14d w/out improvement
Mucopurulent rhinorrhea
Nasal stuffiness
Cough at night
Other Sinusitis S/S possibly present?
Voice is nasal
Bad breath
Facial swelling/TTP
HA
Most accurate Dx of Sinusitis?
Sinus aspiration - not necessary usually
- CT/MRI
TXT of Sinusitis?
1L - Augmentin 14d
- high dose therapy if -
1. had ABX last 3mo
2. <2yo,
3. resistant patterns in area
2L - Levofloxacin (Type 1 HSN rxn to PCN)
or
2L - Clindamycin + Cefixime or Cefpodoxime
(Non-type 1 HSN rxn to PCN)
Allergic rhinitis is AKA?
Hay fever
Allergic rhinitis S/S?
Sneeze
Itch
Nasal congestion/Drainage
Types of Allergic rhinitis?
Seasonal - pollen
Perennial - Indoor allergens
Episodic - Only if exposed to that environment
Allergic rhinitis is what type of rxn?
IgE mediated allergic response
Allergic rhinitis pathophys occurs how?
Early phase
- Mast cells degranulate > histamine, PG, leukotrienes
Late phase (4-8h later)
- EOS, BASO, CD4, Mono, SEGs >
- Mediators released >
- Nasal inflammation and PLT activating factor
Allergic rhinitis is ass/w what other conditions?
Atopic triad
- Eczema
- Asthma
- Allergic rhinits
Stand out findings w/ Allergic rhinitis?
Pruritis
Cobble stoning
Allergic shiners
Transverse nasal crease
Rhinitis medicamentosa is?
Overuse of (top) nasal decongestants
TXT of Allergic rhinits?
- (IN) CCS - Fluticasone or Mometasone
- (PO) AH - 1st gen (Benadryl/hydroxyzine)
or (MC) - 2nd gen (Cetirizine, loratadine, fexofenadine) - (Top) AH - Azelastine or Olopatadine
- Cromolyn or Neocromodil (QID dosing)
- (2-3L) Montelukast (Leukotriene Recep antag)
- Immunotherapy
Most potent Rx TXT for any Rhinitis?
(IN) CCS - Fluticasone or Mometasone
Decongestants used for Allergic rhinitis?
Pseudoephedrine or Phenylephrine
Rx specifically for non-allergic rhinitis OR rhinits ass/w viral URI?
(Top) Ipratropium Bromide nasal spray
Pharyngitis/Tonsillitis pathogens?
Viral - rhino, corona, adeno, HSV, flu, etc
Bacterial - GAS, Group C strep
Pharyngitis/Tonsillitis presents as?
Prominent sore throat
Fever
No URI S/S
Pharyngitis/Tonsillitis is uncommon in what population?
Before 2-3yo
Centor criteria?
1pt each -
- No cough
- TTP/Swollen Anterior cervical LAD
- Fever
- Swollen or exudative Tonsils
- 3-14yo
Results
- 1-3 - Rapid/Cx > Abx IF positive
- 4-5 - Rapid/Cx > Start empiric Abx
Gold standard for Strep Pharyngitis/Tonsillitis?
Strep Culture
If mononucleosis is part of DDx include what in eval?
Monospot AND CBC
TXT of Pharyngitis/Tonsillitis strep?
(PO) PCN V x10d
(IM) PCN G Benz once
- cephalexin, cefadroxil, clindamycin x10d - PCN allergy
- Erythromycin x10d -or- Azuthromycin x5d - B-Lactam allergy
Why is Strep Pharyngitis/Tonsillitis TXT?
Shortens illness 12-24h PVTs complications (ENT, Acute RF)
What is not PVT during TXT of Pharyngitis/Tonsillitis?
PSGN
Local complications of Pharyngitis/Tonsillitis?
AOM, Sinusitis, Peritonsillar abscess
Systemic complications of Pharyngitis/Tonsillitis?
Toxic shock syndrome Scarlet fever PSGN RF - PANDAS - basal ganglia autoimmune inflammation causing OCD/tics (motor/vocal)