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EOR Exam - Family Medicine > Eyes, Ears, Nose, and Throat > Flashcards

Eyes, Ears, Nose, and Throat Flashcards

1
Q

What condition typically precedes sinusitis?

A

URI

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2
Q

What S/S are associated with sinusitis?

A

Purulent nasal discharge, nasal obstruction, fever, pain to palpation over sinuses.

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3
Q

What is the recommended treatment for the initial presentation of sinusitis?

A

NSAIDs for pain, saline washes, steam, oral/nasal decongestents

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4
Q

When are abx indicated for the treatment of sinusitis?

A

Extended duration (10-14 days) or severe symptoms.

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5
Q

What abx are indicated for use in sinusitis?

A

Amoxicillin or doxycycline 1st line
Augmentin if refractory to amoxicillin
Fluoroquinolones if recent abx use or treatment failure

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6
Q

What are the S/S of allergic rhinitis?

A

Cyanosis below the eyes, rhinorrhea, itchy or watery eyes, sneezing, nasal congestion, dry cough, pale/boggy/bluish mucosa

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7
Q

Define and describe aphthous ulcers.

A

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.

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8
Q

What is used in the management of aphthous ulcers?

A

Corticosteroids for pain relief

Cimetidine for maintenance

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9
Q

Define blepharitis.

A

Chronic inflammation of eyelid margins caused by seborrhea, staph, or strep

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10
Q

What are the S/S associated with blepharitis?

A

Red rims, adherent eyelashes, dandruff like deposits (scurf) and fibrous scales (collarettes), thick cloudy discharge visible when Meibomian glands obstructed (posterior blepharitis)

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11
Q

Describe the treatment of blepharitis.

A

Lid scrubs with diluted baby shampoo on cotton tipped swabs –> topical abx if infection suspected

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12
Q

Define cholesteatoma.

A

Squamous epithelium trapped within the skull base that can erode structures within the temporal bone.

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13
Q

What S/S are associated with cholestatoma?

A

Painless ear drainage, conductive hearing loss, dizziness.

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14
Q

What are the most common pathogens associated with viral and bacterial conjunctivitis?

A

Viral: adenovirus
Bacterial: Strep pneumo and staph aureus (G/C rare)

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15
Q

What are S/S associated with viral conjunctivitis?

A

Unilateral or bilateral erythema of conjunctiva, copious watery discharge, tender pre-auricular lymphadenopathy

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16
Q

What is used in the treatment of viral conjunctivitis?

A

NS eye lavage, antihistamine drops, warm then cool compress

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17
Q

What are the S/S associated with bacterial conjunctivitis?

A

Purulent discharge from both eyes –> “glued” shut in the morning

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18
Q

What is the treatment for bacterial conjunctivitis?

A

Topical abx (drops) –> sulfonamides, quinolones, aminoglycosides

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19
Q

When are PO abx indicated for bacterial conjunctivitis?

A

Only for rare pathogens

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20
Q

What is the most common cause of a corneal abrasion?

A

Minor trauma

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21
Q

What are S/S associated with corneal abrasion and how is it diagnosed?

A

S/S: pain, foreign body sensation, photophobia, tearing, injection, blepharospasm, blurred vision
Dx: slit lamp with fluorescein –> clear cornea with epithelial defect

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22
Q

Describe the appropriate use of topical anesthetics for corneal abrasions.

A

For diagnosis only –> do not prescribe

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23
Q

Describe the treatment for corneal abrasions.

A

NS irrigation, abx ointment (gentamicin or sulfactamide), APAP for pain, patch for no more than 24 hours if large abrasion (5-10 mm)

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24
Q

Define dacrocystitis.

A

Inflammation of the lacrimal sac caused by obstruction

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25
Q

Describe the S/S and treatment for dacrocystitis.

A

S/S; pain, swelling, tenderness, redness, tearing, may have purulent discharge
Tx: systemic abx and warm compresses

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26
Q

Differentiate entropion from extroption.

A

En: lid and lashes are turned in
Ect: edge of eyelid everts

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27
Q

What is the treatment of entropion and ectropion?

A

Surgical repair if trauma, excessive tearing, expousure keratitis, cosmetic distress

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28
Q

What is the most common source of anterior and posterior epistaxis?

A

Ant: kiesselbach plexus
Post: woodruff plexus

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29
Q

What are risk factors for epistaxis?

A

Trauma, dryness, HTN, cocaine, ETOH

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30
Q

Describe the treatment for epistaxis.

A

Ant: direct pressure, lean forward, topical anesthetics and decongestants, packing
Post: admit and refer

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31
Q

Define glaucoma.

A

increased IOP with optic nerve damage s/p impediment to the flow of aqueous humor through trabecular meshwork

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32
Q

Describe the S/S of angle closure glaucoma.

A

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

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33
Q

What is the treatment for angle closure glaucoma?

A

Refer, IV carbonic anhydrase inhibitor, diuresis, topical BB

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34
Q

What medication is contraindicated in angle closure glaucoma?

A

Mydriatics (pupil dilators)

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35
Q

What are the S/S associated with open angle glaucoma?

A

Increased IOP, defects in peripheral visual field, increased cup to disc ratio –> asymptomatic until late in disease.

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36
Q

Describe the pharmacological treatment for open angle glaucoma.

A

Dec aqueous production: topical BBs and CAIs

Inc outflow: PGs, cholinergics, alpha agonists, epi

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37
Q

Define hordeolum.

A

AKA stye –> small, mildly painful nodule or pustule within gland of upper/lower eyelid

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38
Q

Differentiate between internal and external hordeolum.

A

Int: infection/inflammation of Meibomian gland
Ext: glands of Moll or Zeis

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39
Q

What is the most common cause of hordeolum?

A

Staph Aureus

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40
Q

What is the hallmark S/S of hordeolum?

A

Painful, indurated area of eyelid

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41
Q

State the treatment for hordeolum including when I&D is indicated.

A

Warm compress –> I&D if no resolution in 48 hours

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42
Q

Define hyphema.

A

Blood inside the anterior chamber of the eye

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43
Q

T/F: Hyphema is always noted on inspection of the eye.

A

False: May not be visible if small.

44
Q

What is the treatment of hyphema?

A

Steroid drops, patch, bed rest, limited eye movement, check eye pressure daily

45
Q

What are the clinical features of labyrinthitis?

A

Acute severe vertigo, hearing loss –> Vertigo progressively improves but hearing loss may not resolve.

46
Q

What is the treatment of labyrinthitis?

A

Abx if fever

Lorazepam/clonazepam (vestibular suppressants)

47
Q

What condition typically precedes laryngitis?

A

URI

48
Q

What is the hallmark S/S of laryngitis?

A

Hoarseness

49
Q

What is the treatment for laryngitis?

A

Supportive, eryhtromycin or augmentin if bacterial cause suspected, steroids may speed recovery.

50
Q

Differentiate between wet and dry macular degeneration.

A

Wet: neovascular degeneration –> hemorrhage and fibrosis
Dry: Drusen deposits –> degenerative atrophy

51
Q

What is the key clinical feature of macular degeneration?

A

Gradual loss of central vision

52
Q

How is macular degeneration diagnosed?

A

Amsler grid –> wavy or distorted vision (metamorphosia)

53
Q

Define and list another name for Meniere Disease.

A

Endolymphatic hydrops –> distension of inner ear’s endolymphatic compartment

54
Q

What are the common S/S of Meniere Disease?

A

Vertigo, lower range haering loss, tinnitus, one sided aural pressure, nystagmus on impaired side.

55
Q

What is the treatment for Meniere Disease?

A

1st line: diuretics and low Na diet

If refractory: intratympanic corticosteroid therapy, surgery

56
Q

What is the Samter triad?

A

AKS asthma triad –> Asthma with nasal polyps = do not take ASA

57
Q

What is the treatment for nasal polyps?

A

1st line: 3 months topical corticosteroid

2nd line: PO steroids, surgery

58
Q

What is the medical term for swimmer’s ear?

A

otitis externa

59
Q

What is the recommended treatment for otitis externa?

A

abx drops (aminoglycoside or quinolone) +/- steroid and avoid moisture

60
Q

What is the risk of otitis externa in DM or immunocompromised patients?

A

malignant otits externa –> nectrotizing infection –> hospitalization with IV abx

61
Q

WHat patients typically get otitis media and what are the most common causative pathogens?

A

Infants –> strep pneumo, h flu, Moraxella, strep

pyogenes

62
Q

What are the first line abx for otitis media?

A

amoxicillin, cephalosporin, bactrim, z-pack

63
Q

What is the treatment of recurrent otitis media?

A

tympanostomy, tymapnocentesis, myringotomy

64
Q

What is the treatment for chronic otitis media?

A

Removal of infected debris, avoid water exposure, topical abx drops; surgery (TM repair)

65
Q

What are common causes of papilledema and what is seen on physical exam?

A

Cause: increased ICP
PE: swollen disc, blurred margins, obliteration of vessels

66
Q

Differentiate between bacterial and viral parotitis.

A

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,

67
Q

What is the typical presentation of parotitis?

A

Recurrent (every few months) unilateral parotid swelling with fever, malaise, and pain lasting days to weeks with each episode.

68
Q

What is the treatment for parotitis?

A

Supportive unless acute bacterial infection –> abx after blood culture, usually cefazolin or other anti-staph abx. May require surgical drainage.

69
Q

Define peritonsillar abscess.

A

Penetration of infection through tonsillar capsule to involve neighboring tissue

70
Q

What is the hallmark sign of peritonsillar abscess?

A

Deviation of uvula/soft palate.

71
Q

What is the treatment of peritonsillar abscess?

A

Emergent I&D, IV abx

72
Q

What S/S indicate pharyngitis is likely caused by group A strep?

A

fever, tender anterior cervical adenopathy, pharyngotonsilar exudate, absence of cough. Presence of at least 3 = 90% likelihood of strep.

73
Q

What S/S of pharyngitis make strep less likely?

A

Cough, hoarseness, coryza (inflammation of nasal mucus membranes with discharge)

74
Q

How is strep pharyngitis diagnosed?

A

Rapid test 90-99% sensitive –> if negative but strep still suspected, throat culture is confirmatory.

75
Q

What are the potential complications of untreated strep pharyngitis?

A

Scarlet fever, glomerulonephritis, acute rheumatic fever, abscess formation

76
Q

What is the treatment for strep pharyngitis?

A

PCN –> erythromycin if allergic

77
Q

Define Pterygium.

A

Slow growing thickening of the bulbar conjunctiva

78
Q

What are the clinical features of a pterygium and how is it treated?

A

Highly vascular, triangular mass growing form nasal side toward cornea
Tx: surgical excision if interferes with vision.

79
Q

Define and describe retinal detachment.

A

Separation of retina from pigmented epithelial layer.

Most commonly begins at the superior temporal area.

80
Q

State the common causes of retina detachment.

A

Spontaneous, trauma, extreme myopia (nearsighted), inflammatory changes in the vitreous, retina, or choroid.

81
Q

Describe S/S associated with retinal detachment.

A

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)

82
Q

What is the treatment for retinal detachment?

A

Refer, remain supine with head turned toward affected eye, surgery needed in 20% of cases.

83
Q

What are the S/S associated with retinal artery occlusion?

A

Sudden painless loss of vision - complete unilateral vision loss.

84
Q

What condition is critical to differentiate from when considering retinal artery occlusion and what S/S indicate this decision?

A

Giant cell arteritis (ischemia s/p inflammation of arteries) - vision loss, fever, HA, scalp tenderness, jaw claudication (pain and tenderness s/p chewing).

85
Q

What indications on fundoscopic exam indicate retinal artery occlusion and what signs indicate blindness?

A

Pale retina, arteriolar narrowing, cherry red spot.

Blindness –> optic atrophy + pale retina

86
Q

What is the treatment for retinal artery occlusion?

A

Refer and place in recumbent position.

87
Q

What are risk factors for retinal vein occlusion?

A

DM, hyperlipidemia, glaucoma, polycythemia, leukemia

88
Q

What are the S/S of retinal vein occlusion?

A

Sudden, painless blurred or complete vision loss.

Fundoscopic - optic disc swelling, blood and thunder retina (dilated veins, hemorrhages, edema, exudates)

89
Q

What is the treatment for retinal vein occlusion?

A

Will at least partially resolve spontaneously. May administer intravitreal injection of VEGF inhibitors.

90
Q

What is the leading cause of blindness in the US?

A

DM Retinopathy

91
Q

What are the two primary causes of retinopathy?

A

HTN and DM

92
Q

What are the findings on fundoscopic exam that indicate retinopathy?

A

AV nicking, arteriolar narrowing, copper wiring

93
Q

Differentiate between proliferative and non-proliferative DM retinopathy.

A

Pro: neovascularization, vitreous hemorrhage

Non-pro: venous dilation, microaneurysms, retinal hemorrhage, retinal edema, hard exudates

94
Q

What is the treatment for retinopathy?

A

Control GLC and BP, laser photocoagulation, vitrectomy

95
Q

Define sialedinitis.

A

Infection of the salivary glands

96
Q

What patients are most commonly affected by sialedinitis and what glands are most often affected?

A

Pts: elderly and chronically ill with dry mouth or dehydration.
Glands: parotid and submandibular

97
Q

Describe S/S of sialedinitis.

A

Pain, redness, and gradual, localized swelling.

98
Q

What is the purpose of imaging in the assessment of sialedinitis?

A

Dx is clinical bu CT/MRI/US may be used to r/o abscess or look for a stone.

99
Q

Describe the treatment of sialedinitis.

A

1st line: supportive –> gland massage, warm compress, inc fluid intake, maintain oral hygiene
2nd line: abx for staph –> dicloxacillin, clindamycin, cephalexin

100
Q

List 4 medication classes that are ototoxic and may cause tinnitus.

A

NSAIDs –> ASA
Abx –> aminoglycosides, erythromycin, vancomycin
Quinine
Chemotherapy agents

101
Q

What condition typicall occurs with tinnitus and must be assessed for when tinnitus is present?

A

Depression

102
Q

List 7 non-pharmacologic causes of tinnitus.

A 
Accoustic Neuroma --> CN VIII
Meniere disease
Ramsay Hunt Syndrome
Labyrinthitis
Head Trauma
Electrical Injury
Diving Injury
103
Q

What are the hallmark S/S of Ramsay Hunt Syndrome?

A

Facial paralysis, zoster lesions, tinnitus

104
Q

Differentiate vertigo associated with Meniere disease from that of labyrinthitis.

A

Men: recurrent vertigo
Lab: sudden onset, non-recurrent vertigo

105
Q

What medications have been shown to be helpful in treating tinnitus?

A

Nortriptyline - 50mg at bedtime –> best drug
Paroxatine - 10mg at bedtime
Sertraline - 50mg per day

106
Q

What are the two primary causes of tympanic membrane perforation?

A

Infection –> otitis media

Trauma –> barotrauma, direct impact

107
Q

What are the treatment options for tympanic membrane perforation?

A

Observation & monitoring –> often resolves on its own
Surgical repair –> if persistent hearing loss
Prevent moisture from getting in ear

EOR Exam - Family Medicine (15 decks)

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