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Foundations 2 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Cerumen Impaction

A

Hearing loss, earache/fullness, itchiness, reflex cough

Treated with irrigation, mechanical removal, drops

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2
Q

Foreign Body

A

Asymptomatic

Urgent if: button batteries, live insects, penetrating TM

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3
Q

Otitis Externa

A

“swimmers ear”
Inflammation of external canal; allergic, dermatologic or infection (pseudomonas 38%) or fungi

Pain, pruritus, purulent discharge (black with fungal), hearing loss, fullness

Treated with topical amino glycoside or fluoroquinolone antibx (if no risk of perforated TM)

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4
Q

Ramsay Hunt Syndrome

A

AKA herpes zoster oticus
Herpes simplex of ear (vesicles on outer canal)
Causes facial paralysis, pain

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5
Q

Hematoma of External Ear

A

Traumatic auricular hematoma
Treated with drainage w/in 48hours
If not treated causes cauliflower ear

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6
Q

Acute otitis media

A

Bacterial infection of middle ear, usually after URI
Most common bacteria-strep pneumoniae/haemophilus influenza
Most common in 4-24 months
Pain, pressure, hearing loss, fever, URI symptoms, immobile TM
Treated with 80-90 mg/kg/day amoxicillin divided twice daily (cephalosporin, doxycycline, macrolide if PCN allergic)

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7
Q

When can you observe otitis media

A

6 months-2 years w/ unilateral AOM and mild symptoms, >2 unilateral or bilat if not severe

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8
Q

When to give immediate antibx for AOM

A

under 6 months

<24 months if severe (mod-severe pain, pain >48 hours, temp >102*, bilat)

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9
Q

Chronic Otitis Media

A

Recurrent AOM
Perforated TM, conductive hearing loss
Treatment-removal of infected debris, earplugs, topical/oral antibx, surgery

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10
Q

Serous otitis media

A

Blocked Eustachian tube>negative pressure in middle ear
More common in kids
Conductive hearing loss, fullness
Treated w/ decongestants, antihistamines, nasal steroids, ventilating tubes

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11
Q

Cholesteatoma

A

Chronic OM w/ neg pressure creating sac lined with squamous epithelium producing keratin
Assymptomtic or hearing loss, chronic infection>drainage
Treated with antibx drops, sx removal

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12
Q

Eustachian Tube Dysfunction

A

Edema of tube lining, causing neg pressure; viral URI or allergies
Fullness, fluctuating hearing, pain with pressure change, popping/crackling
Retracted TM, decreased TM mobility
Treated with decongestants, auto inflation, intranasal steroids, sx

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13
Q

Otic Barotrauma

A

Inability to equalize pressure in middle ear during air travel, rapid altitude change, and underwater diving
Poor Eustachian tube function is precursor
Presents with pain
Treated with decongestants, yam, auto-inflation

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14
Q

TM Perforation

A

Small (<25%) will close on their own, large require sx

avoid water or ear drops until rupture is closed

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15
Q

Conductive hearing loss

A

External/middle ear
Obstruction, mass effect (fluid), stiffness, TM perforation
Caused by cerumen, OM, OE, trauma

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16
Q

Sensorineural hearing loss

A

Inner ear, more often sensory (cochlea)

Most often due to aging, loud noise, Menieres disease, head trauma, MS

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17
Q

Tinnitus

A

Mild-high pitched sounds (ringing, buzzing, hissing); continuous or intermittent
Usually sensory hearing loss
Can be pulsatile (hearing heartbeat-vascular abnormality) or staccato (rapid series of pops or clicks-middle ear spasm)
Treatment: underlying conditions, behavioral therapy, masking

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18
Q

Vertigo

A

Sense of motion without motion (spinning, tumbling, falling fwd or backward)
Vestibular neuritis/labrynthitis, meunière disease, benign positional vertigo
Rule out seizures, MS, wernicke encephalitis
Peripheral: sudden onset, N/V, tinnitus, horizontal nystagmus, hearing loss, eye motion in response to head turning

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19
Q

Benign Paroxysmal Positional Vertigo

A

Sediment in semicircular canals
Provoked by changes in head position, brief recurrent episodes
Treatment: Epley maneuver, PT or OT referral

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20
Q

Labyrinthitis/Vestibular neuritis

A

Inflamed vestibular portion of CN 8, occurs post URI
Acute onset vertigo, hearing loss, tinnitus, gait, N/V
MRI-dont miss cerebellar heme or infarction!
Treatment: antibx, vestibular suppressants

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21
Q

Meniere Disease

A

Vertigo syndrome due to peripheral lesion
Episodic vertigo 20 mins-hours, fluctuating hearing loss, tinnitus, unilateral ear pressure
Treatment: diuretics, lowsalt diet

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22
Q

Vestibular schwannoma

A

Common intracranial tumors
Benign tumor of CN 8, begins in auditory canal, unilateral
Unilat hearing loss, continuous disequilibrium, tinnitus

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23
Q

Red eye possibilities

A

Blepharitis, chalazion, cellulitis, conjunctivitis, dacryoadenitis, corneal ulcer, uveitis, subconj heme, corneal abrasion, foreign body, hyphema, glaucoma, tumor

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24
Q

Blepharitis

A

Red eyes, gritty/burning sensation, excessive tearing, crusty lashes, light sensitivity, plugged glands
Treatment: warm compress, lid massage/hygiene, topical antibx, omega 3 for prevention

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25
Q

Cellulitis

A

Periorbital: Infection of soft tissues around eye (eyelids)-more common, eye pain, lid swelling/red, no vision change/fever/proptosis; treatment: amoxicillin if no MRSa, otherwise bactrim

Orbital: infection of fat/muscles around globe (serious), caused by extension of infection in sinuses; eye pain, lid swelling/red, vision change, fever, proptosis, conjunctivitis; treatment: IV broad spectrum antibx, hospitalization

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26
Q

Conjunctivitis

A 
Inflammation of conjunctiva
Most common eye disease
Normally viral-adenovirus
symptoms of cold 
Treatment: cold compress
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27
Q

Bacterial conjunctivitis

A

S. pneumoniae, H flu and pseudomonas
“eyes matted shut”
Treatment: erythromycin ointment, fluoroquinolone drops

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28
Q

Allergic conjunctivitis

A

Bilateral, seasonal
Itchiness, injection/chemosis
Treatment: cold compress, topical/oral antihistamines

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29
Q

Dacryocystitis

A 
Lacrimal sac infection
Agressive antibx (clindamycin, vanc), may require sx
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30
Q

Entropion

A

Inward turned eyelids, can cause corneal abrasion

Treat w/ lubrication, will grow out of it

31
Q

Ectropion

A

Outward turned eyelids, usually due to age

May require sx if excessive tearing or keratitis

32
Q

Pingueculum

A

Yellow nodule on nasal conjunctiva, doesn’t grow or require tx

33
Q

Pterygium

A

Triangular groth on conjunctiva, grows, can threaten visual axis
Wind, sun, dust exposure can cause
drops/anti-inflammatories, may require excision

34
Q

Chemical conjunctivitis

A

Acute pain/burning, blurry vision
Decreased VA, corneal abrasion, red/pink/white
Treatment: irrigation, drops, antibx, optometrist referral

35
Q

Sunconj heme

A

Vessel rupture causing blood under conj.
Vision unaffected, stops at limbus
Treatment-reassurance

36
Q

Hyphema

A

Ant chamber injury disrupts vasculature supporting iris/ciliary body (blunt trauma)
Acute onset pain, photophobia, tearing, N/V/IOP rise, can cause VA decrease, heme in ant chamber
Ophtho referral same day, supine bed rest; IOP control (diuretics), topical steroid, cyclo

37
Q

Foreign Body

A

Pain, can’t open eye, attempted irrigation, vision unaffected, tearing, injection, fluorescein staining if abrasion
MUST evert eyelid, removal with qtip, lubricant/antibx drops

38
Q

Perforated globe

A

Penetrating trauma
Ant chamber shallow, misshapen pupil, vitreous leakage
Emergency referral, avoid manipulation

39
Q

Corneal Abrasion

A

Trauma to eye, acute onset pain, foreign body sensation, tearing, photophobia, can’t open, fluorescein staining
antibx drops, topical lubricant f/u 1-2 days
NEVER send home with anesthetic drops

40
Q

Corneal ulcer/keratitis

A

Due to infection (bacterial/viral/fungal/amebic) or contact abuse
Eye pain, photophobia, tearing, decreased VA, injection, cloudy/hazy cornea
Ophtho referral, moxifloxacin if bx, acyclovir if HSV

41
Q

Uveitis/Iritis

A

Inflammation of uvea (iris, ciliary body, choroid)
Immunologic (herpes, IBD) or trauma
Pain, redness, photophobia, headache, tearing, decreased VA, limbal injection, constricted pupil, cells/flare, low IOP
Ophtho referral, steroids, cyclo

42
Q

Blow-out fracture

A

Compressive force to globe
Pain, diplopia, restricted movement, decreased sensation, enophthalmos
CT, can do Xray
Emergent referral, antibx started ASAP

43
Q

Glaucoma (acute angle)

A

Emergent, rare
Pre-existing narrow angle, outflow obstructed building pressure at ciliary body
Pain, headache, photophobia, blurry/light halos, N/V, decreased VA, red eye, fixed/dilated pupil, crescent shadow, increased IOP
IV acetazolamide>oral, timolol, mitotic drops (constrictor), hourly IOP check until ophtho
Iridotomy

44
Q

Chronic Open angle Glaucoma

A

Progressive nerve damage (cupping) resulting in constricted visual field, increased IOP
Typically asymptomatic/bilateral
Consistent/reproducible optic disc/visual field/IOP abnormalities
Topical hypertensives (timolol/dorzolamide), laser trabeculoplasty, sx trabeculectomy

45
Q

URI/Common Cold

A

Most frequent acute illness
Most commonly rhinovirus (30-50%), respiratory syncytial in kids, adenovirus causes throat pain
Lasts 7-10 days w/ 2-3 day incubation
Nasal edema/congestion, red throat, clear lungs
Treatment: supportive care/education, zinc, nasal saline, decongestants, etc

46
Q

Acute Rhinosinusitis

A

Viral (rhino, influenza, parainfluenza), can be bacterial
Nasal congestion/obstruction, purulent nasal discharge, facial pain/pressure, maxillary tooth discomfort
Red flags: fever 102 w/ headache, abnormal vision, change in mental status, neck stiffness, periorbital edema/redness
Bacterial if longer than 10 days with no improvement
Treatment: supportive care, if bacterial-amoxicillin-clavulanate/cephalosporin if pcn allergic

47
Q

Chronic rhinosinusitis

A

sinusitis lasting 12 weeks or more
reduction of smell, purulent drainage/mucus, CT showing opacification of sinuses
Management: nasal irrigation, glucocorticoids, antimicrobials, antileukotriene agents

48
Q

Allergic rhinitis

A

Intermittent <4 days/week or <4 weeks
Persistent >4 days/week and >4 weeks
moderate-severe: sleep disturbance, impaired work performance/daily activities, troublesome symptoms
“allergic shiners”, “allergic salute”, pale blue nasal mucosa, clear rhinorrhea, pharynx cobblestoning, TM retraction

Meds: glucocorticoid nasal spray, oral/nasal antihistamines, mast cell stabilizer

49
Q

Chronic nonallergic rhinitis/vasomotor rhinitis

A

Triggers: temp changes, spicy food, odors/chemicals, alcohol use
Nasal congestion/drainage, edematous turbinates (only nasal symptoms)
Treat w/ topical glucocorticoids and antihistamines

50
Q

Epistaxis

A

95% anterior bleed, but don’t miss posterior bleed
treatment: Continuous occlusion 10-15 min, lean forward, cold compress; or cautery or nasal packing (tampon, gauze, balloon); if persistent pack bilaterally

51
Q

Nasal Polyps

A

Could be cystic fibrosis in kids, benign in adults
Avoid aspirin if asthma also
Nasal obstruction, anosmia, rhinorrhea, post nasal drip, pale swollen mucus covered mass
Treat w/ topical corticosteroids or sx (high recurrence)

52
Q

Malignant neoplasms

A 
Rare in nose
squamous cellor adenocarcinoma
male>female
Diagnose w/ biopsy
Treatment: sx, radiation, oncology
53
Q

Acute Pharyngitis

A

Group A strep 5-15% or viral (50%)
Redness, tonsillar hypertrophy, purulent exudate, tender/enlarged nodes
Rule out: epiglottis, peritonsilar abbess, Ludwig’s angina, HIV, strep
Supportive treatment, reassess 5-7 days

54
Q

Group A Strep

A

Centor criteria: tonsillar exudate, tender cervical adenitis, fever, cough absent (don’t test if 1 or 4)
Rapid test sensitivity 70-90, specificity 90-100-culture for negs
Treatment: Penicillin 500g 2-3/day for 10 days (or amoxicillin BID), macrolide if allergic
Can cause rheumatic fever, glomerulonephritis, scarlet fever…
Refer if 7x in 1 year

55
Q

Peritonsillar Abcess

A

Most common deep neck infection
Strep pyogenes (group A)
Severe sore throat, fever, “hot potato” voice, drooling; swollen tonsil w/ uvula deviation
Drainage, amoxicillin x14 days, supportive care

56
Q

Acute Laryngitis

A

Respiratory viruses or bacterial (strep sp., H flu, s. aureus)
Noninfectious causes (vocal abuse, toxic exposure, GERD, polyps)
Hoarseness, URI symptoms
Treatment: treat underlying, humidification, voice rest, hydration; resolves 1-3 weeks-if longer could be cancer

57
Q

Epiglottis

A

Viral or bacterial (haemophilus influenza type B most common)
VACCINATION
Could be immunodeficiency
Fever 101-104, tripod position, drooling, distress, dysphagia stridor
Caution with examination-normally normal
Xray before other tests
Send to ER, IV antibx, airway protection

58
Q

HSV

A

Type 1
Coldsores; 10-15 days initial, 5 days recurrent
Triggers: sunlight, fever, menstruation, stress, trauma
treatment: antivirals, analgesics, fluids
gingivostomatitis-primary infection, more severe

59
Q

Coxsackie Virus

A

Hand/foot/mouth
Low grade fever, malaise, abdominal pain, URI symptoms, lesions in mouth/feet/hands/buttocks
Resolves in 2-3 days

60
Q

Aphthous Ulcers

A

Canker sore
HHV6, IBD, HIV or celiac disease
on gums, tongue, lips, palate, mucosa, usually single lesion, recurrent painful shallow gray base w/ red halo
Trigger: stress
Treatment: topical corticosteroids/analgesics

61
Q

Bechets

A

Inflammatory disorder
Recurrent oral anogenital lesions >3x/year
Refer to rheumatologist

62
Q

Oral candidiasis

A

Thrush
Candida albicans
poor oral hygiene, dentures, DM, steroid use (inhalers), antibx use, HIV
Painful creamy-white curd-like patches on mucosa, “thrush will brush”, cotton mouth, loss of taste, pain eating/swallowing
KOH wet prep/culture/biopsy for dx
treatment: antifungals

63
Q

Oral Lichen Planus

A

Autoimmune disease
White plaques (won’t brush off) or mucosal erythema or ulcers (cancer risk) or hyperkeratotic plaques; painless or painful
dx with biopsy
Treatment: pain management, steroids, cyclosporines

64
Q

Oral leukoplakia

A 
Hyperplasia of squamous epithelium
Precancerous
Can be associated with HPV
White lesion that doesn't scrape off
Irritants: smoking, dentures, lichen planus
BIOPSY
Pt education, can be SCC
65
Q

Erythroplakia

A

Red, velvety plaque-like lesion
>90% are cancerous, common w/ tobacco/alcohol
MUST be biopsied
Refer to ENT

66
Q

Hairy Leukoplakia

A

Epstein Barr virus, almost exclusively w/ HIV
White painless plaque on lateral tongue that doesn’t come off
Tx not necessary, can use antivirals

67
Q

Mucoceles

A

Fluid filled cavities w/ mucus glands lining epithelium
Oral truma
May rupture, remove with cryotherapy or excision

68
Q

Amalgam Tattoo

A

Benign

adjacent to fillings

69
Q

Torus Palatinus

A

Benign bony lesion on hard palate, doesn’t grow

70
Q

Dental Carries (cavities)

A

Strep mutans
Heat/cold intolerance
refer to dentist

71
Q

Sialolithiasis/Sialadenitis

A

Stone w/ or w/out inflammation
Uncertain etiology (reduced salivary flow?)
Risk factors: dehydration, trauma, gout, smoking, periodontal disease
Most occur in whartons duct
Pain/swelling of gland when activated, episodic or persistent
Treatment: “milk” duct, sialagogues, discontinue aggravating meds, monitor for infection (s aureus), IV or oral antibx

72
Q

Suppurative parotitis

A

Infection of parotid gland (viral or bacterial)
Back-flow of saliva w/ oral flora into gland
Sudden onset of firm red swelling areas around ear into mandible, severe pain/tenderness, difficulty opening mouth/swallowing, fever, chills
Labs-elevated amylase
Treatment: IV antibx, hydration, sx I&D if no improvement in 48hours

73
Q

Ludwig’s Angina

A

Most common Neck space infection
Cellulitis of sublingual/submaxillary spaces
Edema, erythema, induration of upper neck/floor of mouth, fever, fatigue, pain, difficulty swallowing, elevated tongue
Check for airway compromise-CT scan
Treatment: secure airway, hospitalize, IV antibx

74
Q

Squamous Cell Carcinoma

A

90% of all oral cancer
Tobacco/alcohol up tp 80% of cases
Papules, plaques, erosions, ulcers that don’t heal
ENT referral-biopsy

Foundations 2 (4 decks)

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