EOR primary care - EENT Flashcards
“it was like a curtain over my vision for a few seconds/minutes” - dx? cause?
amaurosis fugax: MC cause from lack of blood flow: plaque or clot send from ipsilateral carotid artery. (also temporal arteritis, vasospasm)
treatment for amaurosis fugax ?
txt underlying cause + prevent stroke - blood thinners, endarterectomy, BP meds
functional reduction in visual acuity caused by abnormal visual development early in life. Dx?
amblyopia
what are the 3 kinds of amblyopia?
Strabismic: abnormal alignment of eyes
Refractive: unequal focus between eyes
Deprivational: caused by structural abnormalities of the eye obscuring incoming images
aside from obvious anatomic abnormalities on exam, what 2 things would prompt you to refer to optho for possible amblyopia?
Visual acuity worse than 20/40 in a child 3 to 5 years of age or worse than 20/30 in a child ≥6 years
Visual acuity difference of ≥2 lines between eyes
what is blepharitis and who is it most common in?
inflammation of BOTH eyelids. MC pts w/ down syndrome + eczema.
anterior vs posterior blepharitis?
Anterior: skin + base of eyelids. Can be infectious (staph aureus, strep epidermis, viral) or seborrheic
Posterior: (MC) meibomian gland dysfxn (assoc. With rosacea + allergic dermatitis)
symptoms of blepharitis
eye irritation/itching, eyelid burning, crusty, scaling, red-rimming. Eyelash flaking. +/- entropion/ectropion (more w/ posterior).
abx options for anterior blepharitis?
(azithromycin topical, erythromycin or bacitracin topical)
txt for posterior blepharitis?
eyelid hygiene, regular massage/expression of meibomian gland. +/- systemic abx if severe
possible blowout fx, pain with movement of the eye indicates what?
injury to extraocular muscles
possible blowout fx of eye, what things would prompt a CT needed?
Decreased visual acuity, widened intercanthal distance (damage to medial intercanthal ligament), evidence orbital compartment syndrome (“rock hard eye, irreducible), open globe, severe vagal symptoms (N/V/ bradycardia assoc. w/ extraocular muscle entrapment)
orbital hematoma may cause what?
proptosis
signs of ruptured globe
Extrusion of intraocular contents, severe conjunctival hemorrhage, and/or a tear-shaped pupil
Orbital dystopia (loss of horizontal alignment of the eyes) and/or enophthalmos (eye receding into the orbit): these indicate what dx?
orbital floor fracture
opacity of eye lens is what?
cataracts
risk factors for cataracts
old age, smoking, alcohol, sunlight exposure, DM, steroid use.
Dx? :MC bilat, trouble w/ night driving, reading road signs, fine print. Myopia. Painless progressive decline in vision
cataracts
how is a chalazion different from a stye?
these are larger, firmer, slower growing, less painful. dont need Abx.
txt for a chalazion that is affecting vision?
Injection of corticosteroid or I+curretage if affecting vision.
Dx of cataracts
fundoscopy = incr lens opacity. loss of red reflex (mature)
bacterial vs viral conjunctivitis
Bacterial = thick, purulent discharge that continues throughout the day. Viral = serous fluid, burning, gritty feeling +/- systemic illness, second eye involved w/in 24-48hrs.
txt for conjunctivitis
abx NOT needed for bacterial - usually self-limited. Erythromycin ointment to shorten duration (or TMP-polymixin drops)
how long before most corneal abrasions heal?
24-72hrs
txt options for corneal abrasion? abx for contact wearer vs no contacts. who needs a patch?
Analgesic - pilocarpine drops
Abx contact lens wearer: cover for pseudomonas (cipro, gentamycin or tobramycin)+ NO pressure patch
Abx no contact lenses: erythromycin ointment
Patch only for large abrasion (>50% eye) + cycloplegic drops
FB with rust, what do you do about a rust ring?
remove, while it will likely reabsorb on its own, you dont want to miss scarring and vision loss.
what is dacroadenitis/dacrocystitis? MC pathogen?
inflammation of lacrimal gland (adenitis) +/- lacrimal system (cystitis).= tearing, tender, edema, redness to upper lid or medial canthal of lower lid.
MC Staph Aureus.
txt for dacroadentitis/dacrocytitis?
Abx (clindamycin, vanco+ceftriaxone) → dacrocystorhinostomy
entropion/ectropion- involves what muscle? what pt population is it most common in? txt?
orbicularis oculi muscles (relaxation or spasm)
elderly
lubricating drops
what is glaucoma?
elevated IOP (>21mmHg) and damage to optic nerve.
S+S glaucoma: open vs closed
Open: MC asymptomatic. Peripheral vision loss → central vision loss. “Cupping” (over 50% of disc)
Closed: painful red eye
Dx of glaucoma (2 ways)
measure IOP via tanometry, pachymetry to measure corneal thickness (US)
txt for glaucoma: open vs closed
open: meds: prostoglandin analogs (-oprost). Laser txt, Sx.
Closed: emergent recovery in 24hrs to prevent permanent blindness. Drugs to promote miosis (dilation = pain) + Sx
screening for glaucoma?
age >40yo (fundoscopy or measure of IOP via tonometry)
Dx?:misshapen eye w/ prolapse ocular tissue from sclera or corneal opening. Markedly reduced visual acuity, enopthalmos (recession of globe into orbit) or exopthalmos, Severe conjuntival hemorrhage (360 bulbar), prolapse of iris through cornea. Obscured red reflex, teardrop/irregular shaped pupil, hyphema.
globe rupture
what is a positive siedel’s test for globe rupture?
+ Seidel’s test: parting of fluorescien dye by clear stream of aqueous humor from anterior chamber.
txt for globe rupture?
Rigid eye shield + impaled object left undisturbed. IMMEDIATE OPTHO CONSULT. Avoid topical eye solutions.
Hyphema- place at 45 degrees (keeps RBCs from staining the cornea)
internal vs external hordeolum (stye)
External: infection of lash follicle or sebaceous gland (near lid margin)
Internal: meibomian gland
txt for hordeolum
eyelid hygiene (warm compress), +/- abx (topical erythromycin or bacitracin). +/- I+D if not draining spontaneously w/in 48hrs.
what is a hyphema? what can it lead to? MC cause?
pooling of blood in anterior chamber (between cornea + iris), covers iris/pupil. Can lead to permanent vision loss. MC cause- eye trauma,
dx of hyphema
clinical, slit lamp, tanometry, CT (if trauma)
txt for hyphema
mild - heals spontaneously in one week +/- steroid or dilating drops, patch, bed rest (head of bed @ 40 degrees), limits on reading (eye movement). Severe increased IOP = Sx
pterygium vs pinguicula
Pterygium: fleshy, triangle, “growing” fibrovascular mass. MC medial side of eye. Assoc. w/ UV exposure + sand,wind,dust.
Pinguicula: yellow, elevated nodule on medial sideo sclera (fat/protein), does NOT GROW.
Dx?: sclera swollen, red, tender, blurry vision, tearing, photophia. Pain w/ movement of eye.
infectious (or rheumatic) scleritis
txt of scleritis
steroids, NSAIDs, immunosuppressive drugs, eyedrops, abx (if infective)
what is keratitis and what causes it?
inflammation of cornea. Causes- infection (bacterial, viral, fungal), injury, prolonged wearing of contact lenses, FB. +/- nodules, ulcers
S+S keratitis?
redness, pain, tearing, discharge, blurry/decreased vision, photophobia, FB sensation.
AMD: what are the two types? risk factors?
leading cause of blindness in industrialized countries. Dry (atrophic/nonexudative) or wet (neovascular or exudative) Risks: age, smoking.
S+S dry vs wet AMD?
dry: gradual loss of central vision. Wet: acute visual distortion or loss subretinal hemorrhage or fluid accumulation. Distortion of straight lines - early sign of wet.
dilated fundoscopy of dry vs wet AMD
Dry: drusen
Wet: subretinal fluid or hemorrhage.
txt for dry vs wet AMD
dry- daily oral eye vitamen supplement.
wet = anti-VEGF +/- urgent ophthalmology consult.
what is optic neuritis and the MC causes?
swelling (inflammation) damages -demyelination- the optic nerve. Cause unknown but MC in viral + autoimmune d/o. Common with MS.
S+S optic neuritis?
MC monocular. pain w/ eye movement, temporary vision loss/blurry vision. Worse with exercise or heat.
txt for optic neuritis?
resolves spontaneously over weeks-1year. IV methylprednisone
Dx of optic neuritis?
clinical +/- fundoscopy (cupping)
what is papilledema? S+S?
optic disc swelling from increased intracranial pressure.
asymptomatic to HA (worse w/ lying down or in morning), N/V, diplopia
retinal detachment- what are the causes? what are the two types ? which is more common?
old age or trauma. EMERGENCY
MC - “Rhegmatogenous”: result of a retinal hole or retinal tear. Posterior vitreous detachment from old age.
“Nonrhegmatogenous”: due to traction or an exudative process.
painless loss of vision + symptoms PVD - floaters, flashes of light.
retinal detachment
txt for retinal detachment
Sx: laser, retinopexy, pneumatic retinopexy
retinal vascular occlusion - from clot/plaque - can cause what symptoms?
causes vision loss through macular edema, neovascularization + leakage, neovascular glaucoma
txt for retinal vasc occlusion
injection of anti-VEGF, steroids, laser therapy, pan-retinal photocoag therapy.
how does DM retinopathy occur?
high blood sugar damages vessels. changes within the retinal vessels, namely abnormal permeability and vascular occlusion with ischemia and subsequent neovascularization
what are the two types of DM retinopathy
Proliferative (later, new vessels)
Nonproflierative (early)
Dx and Txt of DM retinopathy
Dx: history + fundoscopy = multiple hemorrhages, edema, exudates, AV nicking
Txt: txt underlying condition + anti-VEGF.
Dx and txt of HTN retinopathy
Dx: clinical + fundoscopy = cotton wool spots, flame hemorrhages. AV nicking
Txt: txt underlying cause
subconjunctival hemorrhage- what is it? S+S?
Blood vessels in conjuntiva break and leak between it and the sclera. Causes- cough,strain,trauma.
S+S: one or more blood spots on the white of the eye (sclera).
Weber test - normal, sensorineural, conductive
Normal = no lateralization, sensorineural loss (inner ear) = laterizes to NORMAL ear, conductive loss (ext/middle ear) = lateralizes to affected ear
Rinne test- normal, sensorineural, conductive
Normal = no lateralization, sensorineural loss (inner ear) = laterizes to NORMAL ear, conductive loss (ext/middle ear) = lateralizes to affected ear
txt options for cerumen impaction
soften cerumen with hydrogen peroxide, carbamide peroxide (debrox). Aural toilet (irrigation, currette, suction). Irrigation - water at body temp to prevent vertigo + NONE if perf expected.
otitis externa cause and MC pathogens?
swimming, excessive cleaning/local trauma = change in pH of the ear = bacteria overgrowth. MC pseudomonas.
also.. Staph aureus, staph epidermis. Fungal after bacterial infection
otitis externa txt: mild, moderate, severe, fungal
protect ear against moisture (drying agent like isopropyl alcohol + acetic acid)
Mild (mild discomfort): topical acetic acid/glucocorticoid.
Moderate (pain): abx/steroid (cipro/dexamethasone, cipro HC, cortisporin or ofloxacin if ™ perforation).
Severe (intense pain,fully occluded canal): add wick. If infection past ear canal = oral cipro
*fungal = amphotericin B
why cant you use aminoglycosides if there is a perfed TM?
ototoxic
what pathogens MC cause acute vs chronic otitis media?
acute: Strep pneumo, Mcatt, Hflu, Strep pyogenes.
Chronic= Staph aureus + pseudomonas
pathophys of viral URI -> bacterial otitis media?
URI = eustachian tube edema → negative pressure → transudate fluid/mucus → 2ry colonization of bacteria + flora.
1st and 2nd line txt for otitis media? PCN allergic?
Amoxicillin 10-14 days. 2nd line = Augmentin.
PCN allergic = Cefdinir or clindamycin + TMP/SMX
chronic otitis media txt?
ciprofloxacin +/- Tubes
patho: BPPV vs meneires?
BPPV: displaced otoliths = episodic vertigo
Meniere: distension of endolymphatic compartment of inner ear by excess fluid → increased pressure. episodic + hearing loss, + tinnitus
patho: vestibular neuritis vs labrynthitis
Vestibular neuritis: inflammation of vestibular portion of CN 8, MC after viral infection. continuous vertigo
Labrynthitis: vestibular neuritis + hearing loss/tinnitus: continuous vertigo + hearing loss.
txt options for peripheral vertigo (4)
- Antihistamines (meclizine, diphenhydramine aka benadryl)
- Dopamine antagonists (metoclopramide, prochlorpherazine, IV promethazine aka phenergan. Give w/ benadryl to prevent dystonic rxns.
- Anticholinergics: scolpolamine
- Benzodiazepines (lorazepam, diazepam if refractory) - potentiates GABA.
prevention of meneires
diuretics, avoid salt/caffeine/chocolate/ETOH.
vestibular neuritis/labrynthitis txt?
corticosteroids
Dx and Txt of mastoiditis
Dx: CT head
Txt: IV abx (amox, cefixime, FQs) + middle ear/mastoid drainage (myringotomy) +/- tubes. refractory/complicated = mastoidectomy.
oral CA, MC type and MC areas where it occurs
MC squamous cell. MC occurs in areas of abnormal mucosa (leukoplakia, erythroplakia, lichen planus).
MC location- lateral tongue
Dx of oral CA
Lesion >3wks duration → RULE for clinical prediction of oral CA = Bx
Red or red/white lesion, Ulcer, Lump, Especially in combination or indurated (firm)
Dx HSV
PCR (best), tzank smear = multinucleated giant cells + inclusion bodies
MC cause periodontitis/gingivitis
MC bacterial-biofilm induced. MC polymicrobial - Strep strains.
txt periodontitis/gingivitis
debridement, oral hygiene, chlorhexidine rinse. +/- topical abx (doxycycline), Sx
mouth/throat pain. White curd-like plaques, bleed if scraped +/- leave behind erythema.
thrush (oral candidida)
Dx and Txt of oral thrush
Dx: clinical + KOH smear = budding yeast/pseudohyphae
Txt: 1st line- nystatin liquid. also clotrimazole or oral fluconazole.
sialadenitis: what is it? MC cause? pathogen?
bacterial infection of parotid or submandibular parotid glands. +/- from dehydration, chronic illness. MC staph aureus.
Dx + Txt of sialadenitis
CT for abscess/tissue involvement.
sialogogues (hard candy to increase salivary flow), Abx - antistaph (Dicloxacillin or Nafcillin) + metronidazole or clindamycin if severe.
leukoplakia
precancerous hyperkeratosis due to chronic irritation (e.g. tobacco/smoking, ETOH, dentures).
painless, white patchy lesions that CAN’T be scraped off.
leukoplakia
txt for leukoplakia
cryotherapy, laser ablation. Bx for CA risk
what is oral hairy leukoplakia? txt?
caused by EBV, MC immunocomprimised. = painless white plaque on lateral tongue border or buccal mucosa. +/- smooth or “hairy”/ “feathery” - lesions with prominent folds or projections. CAN’T be scraped.
- no txt needed, resolve spontaneously.
what sinus is MC affected in sinusitis?
maxillary (then ethmoid)
acute vs chronic sinusitis: duration + pathogens
Acute: 1-4wks. Strep pneumo, H flu, GABHS, M catt.
Chronic: >12wks. Bacterial - MC Staph Aureus, Wegner’s (necrotic), fungal - MC aspergillus
chronic sinusitis: mucormycosis -what is it? txt?
Mucormycosis: Fungi invade sinuses and could enter CNS. MC immunocomprimised. +/- black eschar on palate/face.
Txt: IV amphotericin B
when would you add abx for sinusitis txt? which abx?
if symptoms <7days. + Abx (if symptoms >10-14 days) Amoxicillin, 2. doxycycline , TMP/SMX
3 types of rhinitis, which is MC?
MC- Allergic: IgE-mediated mast-cell histamine release
Infectious: MC rhinovirus
Vasomotor: dilation blood vessels (i.e. temp change)
what causes anterior vs posterior epistaxis?
MC anterior, Risk- dry, hot climate, ETOH, blood thinners. Posterior MC with HTN, atherosclerosis - palantine artery
what indicates a posterior (vs anterior) epistaxis?
bilateral or posterior pharynx bleeding.
step-up txt for epistaxis?
- Direct pressure (10-15min, leaning forward), topical decongestants/vasoconstrictors (phenylephrine, oxymetazoline, cocaine)
IF above failed… cauterize, nasal packing +/- abx to avoid toxic shock.
what can a septal hematoma progress to?
loss of cartilage if hematoma not removed
what is samter’s triad?
asthma, polyps, ASA/NSAID sensitive/allergies.
how does a peritonsillar abscess form and what are the MC pathogens?
tonsillitis → cellulitis → abscess formation. MC strep pyogenes (GABHS), staph aureus, polymicrobial.
txt for peritonsillar abscess?
Abx (amp/sulbactam, clindamycin, PCN G +metronidazole) + aspiration or I&D. Tonsillectomy if recurrent
MC causes of pharyngitis? complications?
MC overall = viral. MC bacterial = GABHS/Strep pyogenes. Complications = rheumatic fever, glomerulonephritis, peritonsillar abscess.
txt for pharyngitis
viral = symptoms, bacterial = PCN G (amox or augmentin), macrolides if PCN allergic.
MC cause of epiglottitis
MC Hib. nonHib MC for adults (w/ DM).
high suspicion of epiglottitis, what do you NOT want to do for kids?
do NOT attempt to visualize with tongue depressor in kids (vagal response).
Dx: dysphagia, drooling, distress. Odynophagia, inspiratory stridor, tripoding. Rapidly developing.
epiglottitis
txt for epiglottitis
airway mgmt + supportive. Abx ceftriaxone or cefotaxime.
