Eyes, Ears, Nose and Throat

Question 1

most common eye complaints

Answer 1

red eyes, most often caused by conjunctivitis (viral, allergic or bacterial

Question 2

Opthalmologic red flags

Answer 2

painless sudden decreased vision pain with light, movement or accompanied by N/V trauma - hyphema, orbital fracture Corneal abrasion uveitis periorbital cellulitis assoc. neurological deficits

Question 3

sudden loss of vision

Answer 3

can be unilateral or bilateral, think glaucoma, central retinal vessel occlusion, stroke, trauma, , iritis, retinal detachment

Question 4

gradual loss of vision

Answer 4

cataract, macular degeneration, glaucoma

Question 5

signs of retinal detachement

Answer 5

“curtain over vision” flashing lights, no pain

Question 6

routine opthalmology evals

Answer 6

age > 40 to screen for glaucoma, all with HTN and DM,

Question 7

AREDS

Answer 7

age related eye diseases - cataracts, diabetic retinopathy, macular degeneration, glaucoma

Question 8

cataracts

Answer 8

lens opacity leads to decreased visual acuity and blindness, leading cause of blindness in the US, usually bilateral, c/o blurry vision, rings around objects, gradual decrease in acuity, glare with bright lights, distance vision les than near vision

Question 9

cataract causes

Answer 9

age, congenital, galactosemia, hypocalcemia, Wilson dz, statins,

Question 10

Age related macular degeneration

Answer 10

dim central vision due to aging macule, leading cause of irreversibly vision loss, risk factors include europeans with fair skin, female, +FH, smoking, poor exercise and diet.

Question 11

macular degeneration exam

Answer 11

drusen visible in macular region, central vision is limited

Question 12

dry age related macular degeneration

Answer 12

non-neovascular (leaky vessel), more common (90%) with less severe effect on vision, can progress to wet

Question 13

wet AMD or excitative age related macular degeneration

Answer 13

neovascularization occurs, these are leaky vessels, harder to treat

Question 14

glaucoma

Answer 14

2nd leading cause of blindness in US. damage to ocular nerve caused by high intraocular pressure >21mm HG, loss of visual field, can be primary open-angle and angel-closure types, or secondary to trauma and inflammation,

Question 15

glaucoma exam findings

Answer 15

>21 mm HG pressure, loss of round regular contour of optic disc, notch on superior or inferior temporal rim, increase depth and with, pallor and disc hemorrhage.

Question 16

glaucoma risk

Answer 16

primary open angle common in blacks, whits and hispanics, closed angle in Chines, S. Indian Risk increases with age

Question 17

symptoms of open angle glaucoma

Answer 17

asymptomatic elevation of IOP, called the silent blinder

Question 18

symptoms of angle closure glaucoma

Answer 18

painful red eye, decreased visual acuity, nausea and vomiting. requires emergency treatment, on exam will have corneal cloudiness, diffuse red eye and slow pupillary response

Question 19

agents to treat glaucoma

Answer 19

pilocarpine (cholinergic), timolol (beta blocker), anthicholinesterases, prostaglandins, alpha agonists, laser surgery if meds fail,

Question 20

diabetic retinopathy

Answer 20

leading cause of blindness in ppl <65, assoc. with diabetes, poor glycemic control, smoking, renal dz, HTN and pregnancy. symptoms include floaters and vision loss

Question 21

diabetic retinopathy on fundoscopic exam

Answer 21

retinal “cotton wool spots” hemorrhages

Question 22

screening for diabetic retinopathy

Answer 22

DM 1 - annually for the first 5 yrs of dx DM 2 - at dx and then annually

Question 23

dry eyes

Answer 23

“keratitis sicca” decreased tear production, increased evaporation, abnormal composition or spreading, assoc .with autoimmune do, meds and aging, meds including diuretics, antihistamines, accutaine and anticholinergics

Question 24

exam dry eyes

Answer 24

neuro, signs of trauma or infection, rosacea, eye appears dry above lower lid, dull cornea

Question 25

treatment of dry eyes

Answer 25

avoid irritants, avoid sun, hot compresses, OTC artificial tears, lubricants, restasis for chronic (refer to opthal),

Question 26

conjunctivitis

Answer 26

inflammation of the bulbar conjunctiva giving the appearance of red eyes, caused by bacteria, virus or allergy

Question 27

bacterial causes of conjunctiviti

Answer 27

staph aureas - most common strep pneumoccoccus - colder weather haemophilus - warmer moraxella lacunata, E coli, Proteus Pseudomonas - contact lens weareres

Question 28

viral causes of conjunctivitis

Answer 28

adenovirus, enterovirus, coxsackie, HSV

Question 29

inclusion conjunctivitis

Answer 29

chlamydia trachoma

Question 30

hyperacute bacterial conjunctivitis cause

Answer 30

neisseria gonorrhea, chlamydia

Question 31

s/s bacterial conjuctivitis

Answer 31

pink eye, mucopuruluent discharge, lids stick together, unilateral at first, heremia of conjunctiva, normal vision without photophobia or pain. very contagious

Question 32

treatment for bacterial conjunctivitis

Answer 32

polytrim (trimethoprim & polymyxinB) Erythromycin (ilotycin) bacitracin sulfacetamide sodium 10% (sulamyd, Blep-10) Fluroquinolones (ofloxacin, ciprofloxacin) warm compresses andjohnsons baby shampoo . Treat for 5 days. Tobrex is for severe infection

Question 33

s/s viral conjunct

Answer 33

abrupt onset and unilateral then bilateral distribution within 2 days mucoid watery discharge, often with pre auricular lymphadenopathy, no pain or vision loss, diffuse conjunctival erythema, often A/W URI sx, if A/W HSV refer

Question 34

fundoscopic exam finding with ocular HSV

Answer 34

dendritic branching

Question 36

S/S allergic conjunctivitis

Answer 36

History of atopy, allergic rhinitis

watery, itchy, bilateral

mild erythema and edem of lids and conjuctiva

no pain or vision problems,

treat with Cool compresses, oral antihistamines

topical treatment with NSAIDS (aculair), antihistamines/mast cell stabilizers (patanol, claritis), anthistamine/vasocontrictor (naphcon-a), or nasalcrom (cromolyn)

Question 37

Chlamydia conjunctivitis

Answer 37

inclusion conjunctivitis, abrupt onset of ocular discomfort, diffuse erythema, scant to no mucopurulent discharge, follicles on lower palpebral conjunctiva

can progress to keratitis if not treated

A/W urethritis or cervicitis

treat with systemic TCN, Emycin, or bactrim for 21 days, and refer! for monitorin gto prefent corneal uceration and systeic spread, visiual deficit andblindness are possible

Question 38

hyperacute bacterial conjunctiviti Neisseria

Answer 38

usually transmitted from the GU tract, will have copious purulent discharge, surrounding structures will be involved, red and painful!

must promptly refer to opthal

can also cause visiual deficit if not treated

Question 39

Uveitis/iritis

Answer 39

uveitis is iflammation of the anterior and posterior uveal structures including the iris, ciliary body, and choroid.

Iritis is inflammation of the iris (anterior tract). finding includes a small and non-reactive pupil

S/S include perilimbal or ciliary flush (redness around cornea), can be unilateral or bilateral

can be iodipathic or r/t systemic dz (ankylosing spondylitis, JRA, sarcoidosis, TB)

refer to opthalm for eval and steroid treatment

Question 40

corneal injury

Answer 40

abrasion, foreign body, erosion, tear and ulcers are all corneal injuries

cc: pain, can also have tearing, blurred vision, redness

dx with fluorescein - will turn green with UV light,

if the corneal surface is white or opaque it is ulcertaed

refer for corneal ulcer ,erosion or trauma,

corneal abrasion, don’t patch! use ABX tobrex, ilotycin or sulamyd

FU with opthal in 1-2 days

Question 41

bleeding the eye

Answer 41

Subconjunctival hemorrhage

• Bleeding under conjunctiva:
• Occurs spontaneously or with coughing, sneezing, minor trauma, Deep, flat, bright red hemorrhage
• No pain or visual deficit
• Complete eye exam to r/o conjunctivitis or trauma
• Reassurance–clears in 2-3 weeks

Hyphema

• Accumulation of blood in anterior chamber due to trauma
• Painless, poor pupil reaction,
• Immediate referral

Question 42

hordeolum

Answer 42

AKA stye

Acute localized painful mass, internal or external

evert the eyelid over a cottn swab to see internal masses

treat with warm compresses and antibiotic ointment if inflamed

stop wearing contacts, change eye makeup

can be caused by staph

Question 43

chalazion

Answer 43

painless chronic granulomatous nodule, treated by surgical excision, can become acutely inflamed

Question 44

blepharitis

Answer 44

acute or chronic infection/inflammation of the lid margin,

associated with seborrhea

crusty, erythematous, missing eyelashes, inflamed

daily wash, antibiotic ointment at bedtime for 3 weeks, if chronic refer to opth

Question 45

congestion and rhinorrhea causes

Answer 45

allergies

URI

sinusitis

obstruction from polyps, tumors, deviated septum

vasomotor - idopathic (no itch or sneeze) in response to env. trigger, stress, exercise, food (do not use antihistamines, decons work)

drugs - alpha adrenergic blockers, cocaine

hormones, - pregnancy, hypothyroid

Wegeners granulomatosis, immune mediated dz, sarcoidosis, midline granuloma

Question 46

allegic rhinitis

Answer 46

seasonal - pollens usuall y in spring or fall

perential - dust mites, mold, animals, indoor source

swelling leads to obstruction leads to mucous secretions which can then harbor bacteria (predisposing to sinusitis)

S/x cong. rhinoorhea, boggy pale and endematous mucosa, clear discharge

topical steroids are preventatitve, saline sprays work well, singulair oral also effective, antihistamines, immunotherapy

Question 47

URI

Answer 47

caused by rhinovirus, coronavirus, adenovirus, and RSV.

hallmark absence of fever, purulent discharge, faical pain, signficant respirtory syptoms, self limiting last about a week ,

treat with analgesics, steam, humidifier, decongestants, neti pot,