Eyes, Ears, Nose, and Throat Flashcards
What condition typically precedes sinusitis?
URI
What S/S are associated with sinusitis?
Purulent nasal discharge, nasal obstruction, fever, pain to palpation over sinuses.
What is the recommended treatment for the initial presentation of sinusitis?
NSAIDs for pain, saline washes, steam, oral/nasal decongestents
When are abx indicated for the treatment of sinusitis?
Extended duration (10-14 days) or severe symptoms.
What abx are indicated for use in sinusitis?
Amoxicillin or doxycycline 1st line
Augmentin if refractory to amoxicillin
Fluoroquinolones if recent abx use or treatment failure
What are the S/S of allergic rhinitis?
Cyanosis below the eyes, rhinorrhea, itchy or watery eyes, sneezing, nasal congestion, dry cough, pale/boggy/bluish mucosa
Define and describe aphthous ulcers.
Painful, round ulcers with yellow-gray centers and red halos that occur on buccal or labial areas and are usually recurrent –> thought to be caused by HSV 6.
What is used in the management of aphthous ulcers?
Corticosteroids for pain relief
Cimetidine for maintenance
Define blepharitis.
Chronic inflammation of eyelid margins caused by seborrhea, staph, or strep
What are the S/S associated with blepharitis?
Red rims, adherent eyelashes, dandruff like deposits (scurf) and fibrous scales (collarettes), thick cloudy discharge visible when Meibomian glands obstructed (posterior blepharitis)
Describe the treatment of blepharitis.
Lid scrubs with diluted baby shampoo on cotton tipped swabs –> topical abx if infection suspected
Define cholesteatoma.
Squamous epithelium trapped within the skull base that can erode structures within the temporal bone.
What S/S are associated with cholestatoma?
Painless ear drainage, conductive hearing loss, dizziness.
What are the most common pathogens associated with viral and bacterial conjunctivitis?
Viral: adenovirus
Bacterial: Strep pneumo and staph aureus (G/C rare)
What are S/S associated with viral conjunctivitis?
Unilateral or bilateral erythema of conjunctiva, copious watery discharge, tender pre-auricular lymphadenopathy
What is used in the treatment of viral conjunctivitis?
NS eye lavage, antihistamine drops, warm then cool compress
What are the S/S associated with bacterial conjunctivitis?
Purulent discharge from both eyes –> “glued” shut in the morning
What is the treatment for bacterial conjunctivitis?
Topical abx (drops) –> sulfonamides, quinolones, aminoglycosides
When are PO abx indicated for bacterial conjunctivitis?
Only for rare pathogens
What is the most common cause of a corneal abrasion?
Minor trauma
What are S/S associated with corneal abrasion and how is it diagnosed?
S/S: pain, foreign body sensation, photophobia, tearing, injection, blepharospasm, blurred vision
Dx: slit lamp with fluorescein –> clear cornea with epithelial defect
Describe the appropriate use of topical anesthetics for corneal abrasions.
For diagnosis only –> do not prescribe
Describe the treatment for corneal abrasions.
NS irrigation, abx ointment (gentamicin or sulfactamide), APAP for pain, patch for no more than 24 hours if large abrasion (5-10 mm)
Define dacrocystitis.
Inflammation of the lacrimal sac caused by obstruction
Describe the S/S and treatment for dacrocystitis.
S/S; pain, swelling, tenderness, redness, tearing, may have purulent discharge
Tx: systemic abx and warm compresses
Differentiate entropion from extroption.
En: lid and lashes are turned in
Ect: edge of eyelid everts
What is the treatment of entropion and ectropion?
Surgical repair if trauma, excessive tearing, expousure keratitis, cosmetic distress
What is the most common source of anterior and posterior epistaxis?
Ant: kiesselbach plexus
Post: woodruff plexus
What are risk factors for epistaxis?
Trauma, dryness, HTN, cocaine, ETOH
Describe the treatment for epistaxis.
Ant: direct pressure, lean forward, topical anesthetics and decongestants, packing
Post: admit and refer
Define glaucoma.
increased IOP with optic nerve damage s/p impediment to the flow of aqueous humor through trabecular meshwork
Describe the S/S of angle closure glaucoma.
painful loss of vision, N/V, diaphoresis, circumlimbal injection, steamy cornea, fixed mid-dilated pupil, decreased visual acuity, tearing, anterior chamber narrowed, IOP acutely elevated
What is the treatment for angle closure glaucoma?
Refer, IV carbonic anhydrase inhibitor, diuresis, topical BB
What medication is contraindicated in angle closure glaucoma?
Mydriatics (pupil dilators)
What are the S/S associated with open angle glaucoma?
Increased IOP, defects in peripheral visual field, increased cup to disc ratio –> asymptomatic until late in disease.
Describe the pharmacological treatment for open angle glaucoma.
Dec aqueous production: topical BBs and CAIs
Inc outflow: PGs, cholinergics, alpha agonists, epi
Define hordeolum.
AKA stye –> small, mildly painful nodule or pustule within gland of upper/lower eyelid
Differentiate between internal and external hordeolum.
Int: infection/inflammation of Meibomian gland
Ext: glands of Moll or Zeis
What is the most common cause of hordeolum?
Staph Aureus
What is the hallmark S/S of hordeolum?
Painful, indurated area of eyelid
State the treatment for hordeolum including when I&D is indicated.
Warm compress –> I&D if no resolution in 48 hours
Define hyphema.
Blood inside the anterior chamber of the eye
T/F: Hyphema is always noted on inspection of the eye.
False: May not be visible if small.
What is the treatment of hyphema?
Steroid drops, patch, bed rest, limited eye movement, check eye pressure daily
What are the clinical features of labyrinthitis?
Acute severe vertigo, hearing loss –> Vertigo progressively improves but hearing loss may not resolve.
What is the treatment of labyrinthitis?
Abx if fever
Lorazepam/clonazepam (vestibular suppressants)
What condition typically precedes laryngitis?
URI
What is the hallmark S/S of laryngitis?
Hoarseness
What is the treatment for laryngitis?
Supportive, eryhtromycin or augmentin if bacterial cause suspected, steroids may speed recovery.
Differentiate between wet and dry macular degeneration.
Wet: neovascular degeneration –> hemorrhage and fibrosis
Dry: Drusen deposits –> degenerative atrophy
What is the key clinical feature of macular degeneration?
Gradual loss of central vision
How is macular degeneration diagnosed?
Amsler grid –> wavy or distorted vision (metamorphosia)
Define and list another name for Meniere Disease.
Endolymphatic hydrops –> distension of inner ear’s endolymphatic compartment
What are the common S/S of Meniere Disease?
Vertigo, lower range haering loss, tinnitus, one sided aural pressure, nystagmus on impaired side.
What is the treatment for Meniere Disease?
1st line: diuretics and low Na diet
If refractory: intratympanic corticosteroid therapy, surgery
What is the Samter triad?
AKS asthma triad –> Asthma with nasal polyps = do not take ASA
What is the treatment for nasal polyps?
1st line: 3 months topical corticosteroid
2nd line: PO steroids, surgery
What is the medical term for swimmer’s ear?
otitis externa
What is the recommended treatment for otitis externa?
abx drops (aminoglycoside or quinolone) +/- steroid and avoid moisture
What is the risk of otitis externa in DM or immunocompromised patients?
malignant otits externa –> nectrotizing infection –> hospitalization with IV abx
WHat patients typically get otitis media and what are the most common causative pathogens?
Infants –> strep pneumo, h flu, Moraxella, strep
pyogenes
What are the first line abx for otitis media?
amoxicillin, cephalosporin, bactrim, z-pack
What is the treatment of recurrent otitis media?
tympanostomy, tymapnocentesis, myringotomy
What is the treatment for chronic otitis media?
Removal of infected debris, avoid water exposure, topical abx drops; surgery (TM repair)
What are common causes of papilledema and what is seen on physical exam?
Cause: increased ICP
PE: swollen disc, blurred margins, obliteration of vessels
Differentiate between bacterial and viral parotitis.
Bacterial: caused by staph aureus and anaerobes and seen in post-op eldery patients or those with poor oral hygiene.
Viral: caused by paramyxovirus (mumps), EBV, flu A, coxsackievirus,
What is the typical presentation of parotitis?
Recurrent (every few months) unilateral parotid swelling with fever, malaise, and pain lasting days to weeks with each episode.
What is the treatment for parotitis?
Supportive unless acute bacterial infection –> abx after blood culture, usually cefazolin or other anti-staph abx. May require surgical drainage.
Define peritonsillar abscess.
Penetration of infection through tonsillar capsule to involve neighboring tissue
What is the hallmark sign of peritonsillar abscess?
Deviation of uvula/soft palate.
What is the treatment of peritonsillar abscess?
Emergent I&D, IV abx
What S/S indicate pharyngitis is likely caused by group A strep?
fever, tender anterior cervical adenopathy, pharyngotonsilar exudate, absence of cough. Presence of at least 3 = 90% likelihood of strep.
What S/S of pharyngitis make strep less likely?
Cough, hoarseness, coryza (inflammation of nasal mucus membranes with discharge)
How is strep pharyngitis diagnosed?
Rapid test 90-99% sensitive –> if negative but strep still suspected, throat culture is confirmatory.
What are the potential complications of untreated strep pharyngitis?
Scarlet fever, glomerulonephritis, acute rheumatic fever, abscess formation
What is the treatment for strep pharyngitis?
PCN –> erythromycin if allergic
Define Pterygium.
Slow growing thickening of the bulbar conjunctiva
What are the clinical features of a pterygium and how is it treated?
Highly vascular, triangular mass growing form nasal side toward cornea
Tx: surgical excision if interferes with vision.
Define and describe retinal detachment.
Separation of retina from pigmented epithelial layer.
Most commonly begins at the superior temporal area.
State the common causes of retina detachment.
Spontaneous, trauma, extreme myopia (nearsighted), inflammatory changes in the vitreous, retina, or choroid.
Describe S/S associated with retinal detachment.
Acute painless loss of vision that progresses over hours, curtain vision, floaters/flashers, normal or dec IOP, relative afferent pupillary defect (RAPD - eyes reacting differently to light)
What is the treatment for retinal detachment?
Refer, remain supine with head turned toward affected eye, surgery needed in 20% of cases.
What are the S/S associated with retinal artery occlusion?
Sudden painless loss of vision - complete unilateral vision loss.
What condition is critical to differentiate from when considering retinal artery occlusion and what S/S indicate this decision?
Giant cell arteritis (ischemia s/p inflammation of arteries) - vision loss, fever, HA, scalp tenderness, jaw claudication (pain and tenderness s/p chewing).
What indications on fundoscopic exam indicate retinal artery occlusion and what signs indicate blindness?
Pale retina, arteriolar narrowing, cherry red spot.
Blindness –> optic atrophy + pale retina
What is the treatment for retinal artery occlusion?
Refer and place in recumbent position.
What are risk factors for retinal vein occlusion?
DM, hyperlipidemia, glaucoma, polycythemia, leukemia
What are the S/S of retinal vein occlusion?
Sudden, painless blurred or complete vision loss.
Fundoscopic - optic disc swelling, blood and thunder retina (dilated veins, hemorrhages, edema, exudates)
What is the treatment for retinal vein occlusion?
Will at least partially resolve spontaneously. May administer intravitreal injection of VEGF inhibitors.
What is the leading cause of blindness in the US?
DM Retinopathy
What are the two primary causes of retinopathy?
HTN and DM
What are the findings on fundoscopic exam that indicate retinopathy?
AV nicking, arteriolar narrowing, copper wiring
Differentiate between proliferative and non-proliferative DM retinopathy.
Pro: neovascularization, vitreous hemorrhage
Non-pro: venous dilation, microaneurysms, retinal hemorrhage, retinal edema, hard exudates
What is the treatment for retinopathy?
Control GLC and BP, laser photocoagulation, vitrectomy
Define sialedinitis.
Infection of the salivary glands
What patients are most commonly affected by sialedinitis and what glands are most often affected?
Pts: elderly and chronically ill with dry mouth or dehydration.
Glands: parotid and submandibular
Describe S/S of sialedinitis.
Pain, redness, and gradual, localized swelling.
What is the purpose of imaging in the assessment of sialedinitis?
Dx is clinical bu CT/MRI/US may be used to r/o abscess or look for a stone.
Describe the treatment of sialedinitis.
1st line: supportive –> gland massage, warm compress, inc fluid intake, maintain oral hygiene
2nd line: abx for staph –> dicloxacillin, clindamycin, cephalexin
List 4 medication classes that are ototoxic and may cause tinnitus.
NSAIDs –> ASA
Abx –> aminoglycosides, erythromycin, vancomycin
Quinine
Chemotherapy agents
What condition typicall occurs with tinnitus and must be assessed for when tinnitus is present?
Depression
List 7 non-pharmacologic causes of tinnitus.
Accoustic Neuroma --> CN VIII Meniere disease Ramsay Hunt Syndrome Labyrinthitis Head Trauma Electrical Injury Diving Injury
What are the hallmark S/S of Ramsay Hunt Syndrome?
Facial paralysis, zoster lesions, tinnitus
Differentiate vertigo associated with Meniere disease from that of labyrinthitis.
Men: recurrent vertigo
Lab: sudden onset, non-recurrent vertigo
What medications have been shown to be helpful in treating tinnitus?
Nortriptyline - 50mg at bedtime –> best drug
Paroxatine - 10mg at bedtime
Sertraline - 50mg per day
What are the two primary causes of tympanic membrane perforation?
Infection –> otitis media
Trauma –> barotrauma, direct impact
What are the treatment options for tympanic membrane perforation?
Observation & monitoring –> often resolves on its own
Surgical repair –> if persistent hearing loss
Prevent moisture from getting in ear
