HEENT

Question 1

Otitis externa defintion, MCC, sx, dx, tx

Answer 1

▪︎inflammation of the external auditory canal (EAC)

MCC: Pseudomonas aeruginosa (associated w/ swimming

S/SXS: ear pain worse at night, otorrhea, intense itching, conductive hearing loss

PE: tenderness on palpation of tragus, pain w/ ear canal traction (pulling up & back), crusting

DX: clinical ⇢ otoscope exam
▪︎erythematous/edematous EAC
▪︎otorrhea or debris
▪︎TM may be red but should not bulge

onservative: avoid swimming, keep ears dry, avoid cotton swabs & scratching ear canal

ABX drops + steroids:
▪︎Ciprodex (ciprofloxacin/dexamethasone)
▪︎Neomycin/polymyxin B/hydrocortisone

Question 2

Malignant Otitis Externa defintion, sx, dx, tx

Answer 2

MOE: severe variant of acute otitis externa; necrotizing inflammation of EAC

MCC: P. aeruginosa

S/SXS: severe, persistent ear &/or jaw pain, conductive hearing loss, red/swollen EAC, otorrhea
Otoscope: granulation tissue at cartilage-bone junction of EAC
Extension ⇢ headache & fever (CNS), facial (VII) nerve
palsy (skull base osteomyelitis)

dx
CT w/ contrast ⇢ bone erosion, soft tissue involvement, intracranial extension, abscess
MRI: better for soft tissue/intracranial

TX: ADMIT + ABX x6-8wks

ABX: ciprofloxacin + one of the following:
▪︎ceftazidime, piperacillin/tazobactam, cefepime

Question 3

Acute Otitis Media definition, MCC, sx, dx, tx

Answer 3

AOM: middle ear infection commonly following viral URI
▪︎highest incidence 6-24mo, most often combined bacterial/viral
RF: second-hand smoke, daycare, bottles/pacifiers, supine feeds

MCC: S. pneumoniae, H. flu, M. catarrhalis, GABS (older kids)
Viral: RSV, parainfluenza, influenza, rhinovirus

S/SXS: otalgia/earache (throbbing pain), conductive hearing loss, fever
Infants: ear tugging, irritability, refusal to feed

TM rupture ⇢ pain relief, otorrhea

Otoscope exam:
▪︎bulging/erythematous TM, loss of landmarks
▪︎opacification, loss of light reflex
▪︎⇣ TM mobility (pneumatic otoscopy)

DX: clinical ⇢ otoscope exam

TX: amoxicillin or amoxicillin/clavulanate
▪︎PCN allergy: azithromycin or clarithromycin

Question 4

Mastoiditis definition, MCC, sx, dx, tx

Answer 4

inflammation of the mastoid air cells; MC in children <2yo

Organisms: S. pneumoniae, H. flu, M. catarrhalis, S. aureus, S. pyogenes

S/SXS: begin days to weeks after onset of AOM
▪︎fever, otalgia, mastoid tenderness, erythema, & edema
▪︎external ear displaced forward

Otoscope: +/- AOM findings

DX: mostly clinical

Complicated/toxic-appearing:
▪︎CT scan of temporal bone w/ contrast

TX: IV ceftriaxone for ≥2wks

Early infection: myringotomy & tympanostomy tube insertion to facilitate drainage
Severe/refractory: mastoidectomy

Question 5

Barotrauma definition, MCC, sx, dx, tx

Answer 5

Ear barotrauma: injury caused by rapid change in ambient pressure w/o adequate equalization of the pressure between the middle/inner ear & external environment
▪MCC: flying & diving

S/SXS: acute onset of symptoms
» Middle ear: ear pain, conductive hearing loss, TM rupture
» Inner ear: persistent vertigo/ataxia, sensorineural hearing
loss, tinnitus, N/V

DX: clinical

Possible supportive findings
▪︎otoscope: hemotympanum, ruptured TM

TX: supportive, most heal spontaneously

Question 6

TM Perforation sx, dx, tx

Answer 6

TM perforation: breach in membrane between middle ear & ear canal
Etiology: infection, barotrauma (scuba diving, blast injuries), mechanical trauma (cotton swabs)

S/SXS: pain, hearing loss, tinnitus, otorrhea

DX: clinical ⇢ otoscope exam

TX: most heal spontaneously, f/u to ensure resolution
▪︎persists ≥2mo ⇢ surgery

Question 7

External Ear Trauma, Hematoma: definition, sx, dx, tx

Answer 7

Auricular hematoma: a collection of blood within the cartilaginous auricle
Mechanism: direct blows to the ear (e.g., boxing, wrestling, rugby)

▪︎S/SXS: tender, tense, fluctuant collection of blood; erythema or ecchymosis
Cauliflower ear: permanent deformity d/t fibrocartilage overgrowth that occurs when an auricular hematoma is not fully drained, recurs, or is left untreated

dx
Auricular hematoma: clinical DX
Head trauma: temporal bone CT w/o contrast

tx:
Auricular hematoma: prompt evacuation of the clot
▪︎cephalexin 500mg TID x5d to prevent infection

Question 8

Acute Laryngitis definition, MCC, sx, dx, tx

Answer 8

Acute inflammation of the mucosa of the larynx
Etiologies:
*viral URI MC – adenovirus, rhinovirus, influenza, RSV, parainfluenza
*bacterial: M. catarrhalis, mycoplasma
*vocal strain, irritants (acid – GERD), polyps, laryngeal cancer

sx
Hoarseness, aphonia; dry or scratchy throat
+/- URI sxs (rhinorrhea, cough, sore throat)

dx: clinical

tx: supportive; hydration, humidification, vocal rest, warm saline gargles, anesthetics

Question 9

Acute Pharyngitis/Tonsillitis causes, sx, dx, tx

Answer 9

Etiologies: usually viral; adenovirus MC

sx
Sore throat, pain
Viral: cough, hoarseness, coryza, conjunctivitis, diarrhea

dx: clinical

tx: Symptomatic therapy – fluids, warm saline gargles, topical anesthetics

Question 10

Streptococcal Pharyngitis “strep throat”: MCC, sx, dx, tx

Answer 10

Group A streptococcus (S. pyogenes)

sx
Dysphagia, fever
Not usually associated w/ sxs of viral infection

PE:
*pharyngeal edema or exudate, tonsillar exudate &/or petechiae
*anterior cervical LAD

dx:
Centor Criteria:
(1) absence of cough
(2) exudates
(3) fever (>100.4F)
(4) cervical LAD
3/4 🡪 rapid antigen detection test
(+): treat strep
(-): throat culture: gold standard

tx: Penicillin first line

Question 11

Rhinosinusitis acute vs chronic

Answer 11

Acute rhinosinusitis (ARS): symptomatic inflammation of the nasal cavity & paranasal sinuses lasting <4wks
» Acute viral rhinosinusitis (AVRS): MC type, rhinovirus, influenza, & parainfluenza viruses
» Acute bacterial rhinosinusitis (ABRS): S. pneumo, H. influenzae, M. catarrhalis; often follows viral URI

sx
ARS S/SXS: nasal congestion, rhinorrhea, purulent nasal, discharge, facial pain/pressure worse leaning forward, fever, atigue, cough, hyposmia/anosmia, HA, ear pressure/fullness, ➁ nasal obstruction/congestion
halitosis (bad breath)

PE: TTP over affected sinuses, mucosal edema, narrowing of the middle meatus, inferior turbinate hypertrophy

dx: clinical, CT when needed

tx: usually self-limiting

Chronic rhinosinusitis (CRS): inflammatory condition involving paranasal sinuses & nasal passage linings lasting ≥12wks
Invasive fungal sinusitis: immunocompromised*

sx
➀ anterior/posterior nasal mucopurulent drainage
➁ nasal obstruction/congestion
➂ facial pain
➃ hyposmia/anosmia

dx
CRS DX: 2/4 cardinal SXS + evidence of inflammation
▪︎1+ findings on nasal endoscopy &/or CT:
➀ purulent mucus/edema in middle meatus/ethmoid
➁ polys in nasal cavity/middle meatus
➂ mucosal thickening or paranasal sinus opacification

tx: amoxicillin or Augmentin

Question 12

Rhinitis definition, sx, dx, tx

Answer 12

Rhinitis: irritation & swelling of nasal mucous membrane

▪︎Allergic Rhinitis: type I hypersensitivity reaction (IgE)
▪︎Vasomotor Rhinitis: nonallergic, ⇡ blood flow to nasal mucosa

S/SXS: recurrent episodes of sneezing, congestion, rhinorrhea, & postnasal drip; itchy nose/throat
▪︎pale, boggy nasal mucosa w/ hypertrophic turbinates
▪︎cobblestone appearance of posterior pharyngeal wall
▪︎allergic shiners: dark discoloration under eyes
▪︎allergic salute: habit of wiping nose upwards
» allergic nasal crease: transverse crease from upwards wiping

dx: allergy testing

tx: X: intranasal steroids (e.g., fluticasone, mometasone)

Question 13

Epistaxis posterior vs anterior

Answer 13

posterior
location: Woodruffs plexus

sx: hematemesis from swallowing

tx: Posterior: posterior nasal packing (e.g., balloon catheter)

anterior
location: Kiesselbach’s venous plexus or sphenopalatine artery

sx: small volume
MCC nose picking

tx: Anterior: apply direct pressure at least x10-15min, head tilted forward

Question 14

Blepharitis definition, MCC, sx, dx, tx

Answer 14

▪︎inflammation w/ scaling of eyelid margins
▪︎MCC: staphylococci

S/SXS: red, swollen eyelids w/ crusting/scaling on eyelid margin & eyelashes
▪︎eye irritation (e.g., pain, itching, FB sensation, watering)

dx: clinical

TX: eyelid hygiene (e.g., warm compress, washing w/ baby shampoo, avoid contacts/makeup)

Severe/refractory: topical ABX
▪︎bacitracin, erythromycin, polymyxin B

Question 15

Anterior vs posterior blepharitis

Answer 15

Anterior: inflammation of the anterior eyelid margins involving skin, eyelashes, & follicles

Posterior: inflammation of the posterior eyelid margins associated w/ meibomian gland dysfunction

Question 16

Orbital Floor “Blowout” Fracture defintion, locations, sx, dx, tx

Answer 16

▪︎fractures to the orbital floor as a result of blunt trauma; may lead ⇢ trapping of eye structures
▪︎orbital floor: zygomatic, palatine, maxillary bones

sx
Eyes: ⇣ visual acuity, orbital emphysema
▪︎diplopia esp. w/ upward gaze
*inferior rectus muscle entrapment

Facial: epistaxis, dysesthesias
▪︎hyperalgesia or anesthesia to the anteromedial cheek
*d/t stretching of the infraorbital nerve

dx
CT scan – localizes the fracture
*Teardrop sign: inferior herniation of the orbital fat inferiorly

tx
*nasal decongestants (decreases pain)
*avoid blowing nose or sneezing
*corticosteroids
*abx (ampicillin-sulbactam or clindamycin)

Question 17

viral conjunctivitis MCC, sx, dx, tx

Answer 17

▪︎MC form of infectious conjunctivitis, mostly adults
▪︎MCC: adenoviruses (highly contagious)

Transmission: direct contact
▪︎contamination via water (e.g., swimming pools)

S/SXS: often starts unilateral ⇢ bilateral
▪︎conjunctival injection; clear, watery discharge
▪︎⇡ lacrimation (epiphora), itchy eyes, preauricular LAD

Dx: clinical

tx: self limiting

Question 18

Bacterial Conjunctivitis MCC, sx, dx, tx

Answer 18

▪︎MC form of conjunctivitis in children
▪︎MCC (adults): S. aureus
▪︎MCC (children): S. pneumoniae & H. influenzae
▪︎contact lens wearers: Pseudomonas, M. catarrhalis

S/SXS: typically unilateral
▪︎conjunctival injection; thick, mucopurulent discharge
▪︎crusting, difficulty opening eyes in the morning (stuck shut)

dx: clinical

TX: symptomatic + ABX drops
▪︎macrolides (e.g., erythromycin), trimethoprim/polymyxin B
▪︎aminoglycosides (e.g., tobramycin)
▪︎contact lens: ciprofloxacin

Question 19

Allergic Conjunctivitis MCC, sx, dx, tx

Answer 19

▪︎IgE-mediated hypersensitivity reaction (type I)

S/SXS: bilateral itching**
▪︎conjunctival injection, watery or stringy discharge
▪︎chemosis (conjunctival edema)

dx: clinical

TX: avoid exposure to known allergens, eye hygiene
▪︎topical naphazoline/pheniramine
▪︎H1 antagonist (e.g., azelastine)

Question 20

Corneal Abrasion defintion, sx, dx, tx

Answer 20

Corneal abrasion: scrape/scratch injury on corneal epithelium; MC eye injury

S/SXS: FB sensation, eye pain, watering, blurred vision, photophobia (pain w/ exposure to bright light), erythema

DX: fluorescein staining

TX: removal of any retained FB, NSAIDs for pain
▪︎ABX drops ⇢ erythromycin
» contact lens: ciprofloxacin (anti-pseudomonal)
▪︎patching for abrasions >5mm (≤24h)

Question 21

Corneal Ulcer definition, sx, dx, tx

Answer 21

▪︎serious infection involving multiple layers of the cornea

RF: contact lens wearers (Pseudomonas), incomplete lid closure (Bell’s palsy), trauma

S/SXS: eye pain, conjunctival injection, FB sensation, photophobia, lacrimation

PE: round or irregular ulcer w/ white, hazy base

DX: slit-lamp w/ fluorescein staining
▪︎corneal infiltrate w/ ⇡ fluorescein uptake

TX: topical FQs (e.g., ciprofloxacin), cycloplegic drops (e.g., cyclopentolate) for pain, emergent ophthalmology referral
▪︎NO PATCHING**

Question 22

Dacryocystitis acute vs chronic defintion, sx, dx, tx

Answer 22

acute or chronic inflammation of the lacrimal sac

▪︎acute: streptococci, staphylococci
▪︎chronic: pneumococci, H. influenzae, Pseudomonas

S/SXS (acute): erythema, edema, warmth, & pain below the medial canthus of the eye, watering, purulent discharge

S/SXS (chronic): persistent watering, mucopurulent discharge, no signs of acute inflammation*

DX: clinical, pus culture

DCG (dacryocystography): contrast imaging of lacrimal sac & nasolacrimal duct

X (acute): warm compress, NSAIDs, I&D (abscess)
▪︎ABX (e.g., clindamycin, Augmentin, vancomycin)
▪︎DCR (dacryocystorhinostomy)

TX (chronic): DCR to prevent reoccurrence, ABX

Question 23

Dacryoadenitis acute vs chronic definition, sx, dx, tx

Answer 23

▪︎acute or chronic inflammation of lacrimal gland
» dacryo-A-denitis is Above eye

▪︎acute: viral (e.g., mumps, EBV), bacterial (e.g., S. aureus)
▪︎chronic: inflammatory/granulomatous MCC (e.g.,
sarcoidosis, granulomatosis w/ polyangiitis),
autoimmune (e.g., Sjogren, Graves’ disease), neoplastic

S/SXS (acute): rapid onset unilateral painful swelling/erythema over lacrimal gland (lateral upper eyelid)

S/SXS (chronic): insidious onset unilateral or bilateral painless swelling over lacrimal gland

DX: eye swabs if discharge

CT: rule out orbital cellulitis (acute) or malignancy (chronic)

TX (acute): viral is usually self-limiting, broad-spectrum ABX for bacterial

TX (chronic): treat underlying disease

Question 24

Nasal Foreign Body sx, dx, tx

Answer 24

sx
*persistent foul-smelling purulent unilateral nasal discharge in a young child
*absence of other respiratory sxs

dx
Visualization through PE
Sometimes 🡪 rigid or flexible fiberoptic endoscopy
Plain radiographs (button batteries, magnets)

tx
Removal w/ nasal speculum & Hartmann nasal forceps
*oxymetazoline prior to removal – shirks mucous membrane

Question 25

Ocular Foreign Body definition, sx, dx, tx

Answer 25

Any object embedded in or adhering to the conjunctiva or cornea

sx
Metallic FB 🡪 rust ring
Trapped under lid 🡪 corneal abrasions (worsen w/ blinking)

dx
*slit-lamp exam w/ fluorescein staining w/ cobalt light illumination

Globe penetration 🡪 x-ray or CT

tx
*first 🡪 install topical anesthetic
*then 🡪 removal attempt w/ irrigation
*can attempt to remove w/ swab after visual

Intraocular FB 🡪 immediate surgical removal by ophthalmologist
*systemic & topical abx indicated

Rust ring 🡪 treat as corneal abrasion
*ring will resorb gradually on its own

Question 26

Angle-Closure Glaucoma defintion, sx, dx, tx

Answer 26

Angle-closure glaucoma: closure of the anterior angle chamber at the junction of the iris & cornea (iridocorneal angle) physically blocks drainage of aqueous, elevating IOP which damages the optic nerve
➀ Acute angle-closure glaucoma (AACG): sudden angle obstruction causes rapid, acutely-symptomatic, vision-threatening
IOP elevation
Acute angle-closure glaucoma (AACG):

▪︎S/SXS: sudden onset severe, unilateral ocular pain, blurry vision, halos around lights, HA, N/V

▪︎PE: unilateral conjunctival erythema, cloudy cornea, mid-dilated fixed pupil, eye hard on palpation

dx
▪︎tonometry: ⇡ IOP >30mmHg
▪︎slit-lamp/gonioscopy: narrowing/closure of
iridocorneal angle

tx
TX (acute): emergency ophthalmology consult, place patient supine
➀ Topical drops:
▪︎pilocarpine (cholinergic/miotic) +
▪︎apraclonidine (⍺2 agonist) +
▪︎timolol (BB) plus
➁ PO acetazolamide (CAI)

Definitive: laser peripheral iridotomy (LPI) within 24-48h after attack resolution

Question 27

Labyrinthitis, Vestibular Neuritis definition, sx, dx, tx

Answer 27

Vestibular Neuritis: inflammation of the vestibular portion of CN 8
Labyrinthitis: inflammation of the vestibular & cochlear portion of CN 8
*Etiologies: idiopathic – may be associated w/ viral or post-viral inflammation

sx
Vestibular sxs (both): continuous peripheral vertigo, dizziness, N/V, gait disturbances
*nystagmus – usually horizontal & rotary

Cochlear sxs (labyrinthitis only): unilateral hearing loss, tinnitus

dx: clinical

tx: Glucocorticoids first line

Question 28

Optic Neuritis (Optic Nerve/CN II Inflammation) defintion, sx, dx, tx

Answer 28

acute inflammatory demyelination of the optic nerve

sx
*painful loss of vision
*decrease in color vision (desaturation)
*visual field defects (scotoma – blind spot) over hrs-days
*unilateral

PE:
*ocular pain worse w/ eye movement
*Marcus-Gunn pupil: eye dilates when light enters

dx
Fundoscopy: optic disc swelling/blurring (papillitis)

tx
IV methylprednisolone

Question 29

Orbital Cellulitis defintion, sx, dx, tx

Answer 29

Infection of the orbit (fat & ocular muscles) posterior to the orbital system

Polymicrobial: S. aureus, streptococci, GABHS, H. flu

sx
*ocular pain esp. w/ eye movements
*ophthalmoplegia (extraocular muscle weakness)
*proptosis (bulging)
*eyelid edema & erythema

dx: clinical
CT – confirmatory

tx: ADMIT + IV abx (vancomycin + ceftriaxone/cefotaxim

Question 30

Peritonsillar Abscess definition, sx, dx, tx

Answer 30

Abscess between the palatine tonsil & the pharyngeal muscles resulting from a complication of tonsillitis or pharyngitis – MC in adolescent & young adults 15-30yrs

Dysphagia, severe unilateral pharyngitis, high fever

Muffled “hot potato” voice, drooling, trismus

PE:
*swollen or fluctuant tonsil causing uvula deviation to the contralateral side
*bulging of the posterior soft palate
*anterior cervical LAD

dx
Primarily clinical; U/S

CT imaging of choice to differentiate between abscess and cellulitis

tx
Drainage (aspiration or I&D) + abx
*drainage: needle aspiration preferred
*abx: PO Augmentin, clindamycin

Tonsillectomy – reserved for pts who fail to respond to drainage, complications, recurrent, or severe

Question 31

Retropharyngeal Abscess definition, sx, dx, tx

Answer 31

*deep neck space infection located behind the posterior pharyngeal wall
*MC in children 2-4yrs

sx
Neck:
*torticollis (unwilling to move the neck secondary to pain & spasms)
*neck stiffness esp. w/ extension

*fever, drooling, dysphagia, odynophagia, chest pain, trismus
*muffled “hot potato” voice

PE:
*midline or unilateral posterior pharyngeal wall edema (MC)
*anterior cervical LAD, lateral neck mass or swelling

dx
Lateral neck x-ray: *low suspicion
*increased prevertebral space >50% of the width of adjacent vertebral body

CT w/ contrast *preferred if high suspicion

tx
*surgical incision & drainage w/ abx for large & mature abscesses in the OR
-ampicillin-sulbactam or clindamycin
*abscess <2.5cm2 may be observed for 24-48hrs w/ antibiotic therapy

Question 32

Retinal Detachment non-Rhegmatogenous vs Rhegmatogenous

Answer 32

Rhegmatogenous (MC): retinal tears cause fluid to seep into
subretinal space
▪︎RF: prior eye surgery, posterior vitreous detachment, myopia
Non-Rhegmatogenous:
➀ Tractional: formation of vitreoretinal bands
▪︎RF: proliferative diabetic retinopathy, sickle cell
➁ Exudative: subretinal fluid accumulation
▪︎RF: HTN, central serous retinopathy

Question 33

Retinal Detachment sx, dx, tx

Answer 33

Prodromal: floaters, flashes of light (photopsia)
S/SXS: sudden onset unilateral, painless visual loss, “curtain coming down”
⊕relative afferent pupillary defect (RAPD), also called Marcus Gunn pupil
» defect in consensual light reflex i.e., affected eye constricts less

Fundoscopy: retinal tear (dark red), detached tissue floats freely/moves w/ eye movements
⊕Shafer’s sign: pigment cells in vitreous

tx
TX: keep patient supine w/ head turned towards side of detachment, emergency ophthalmology consult
▪︎laser photocoagulation, cryoretinopexy

Question 34

Central Retinal Artery Occlusion (CRAO) definition, MCC, sx, dx, tx

Answer 34

CRAO: retinal artery thrombus or embolus causing ischemia
▪︎onset >60yo, more common in males
MCC: embolus resulting from carotid artery atherosclerosis
▪︎cardiogenic emboli (e.g., AFIB), temporal arteritis (rare)

S/SXS: sudden onset unilateral, painless vision loss; may be preceded by amaurosis fugax
⊕RAPD

Fundoscopy: pale, opaque fundus (retina) w/ cherry-red spot (fovea/macula); attenuated arteries (boxcar appearance)

TX: ⇣ IOP; immediate TX indicated if onset within 24h*
▪︎ocular massage, anterior chamber paracentesis
▪︎ocular hypotensive drugs (timolol 0.5%, acetazolamide)
▪︎catheterization, thrombolytics
**irreversible retinal damage after 90m

Question 35

Central Retinal Vein Occlusion (CRVO) definition, sx, dx, tx

Answer 35

CRVO: non-ischemic (venous stasis retinopathy) or ischemic (hemorrhagic retinopathy) vein occlusion causing ischemia
▪︎onset >80yo, exact cause known

SXS: sudden onset unilateral, painless vision loss; ⊕RAPD
Fundoscopy: blood & thunder retina (i.e., dilated, tortuous veins; hemorrhages; cotton wool spots)
▪︎macular edema, papilledema (optic disc swelling)

DX: fluorescein angiography (differentiates ischemic vs non-ischemic)
▪︎optical coherence tomography: determines degree of macular edema & its response to TX

TX: panretinal photocoagulation (minimizes neovascularization)

Macular edema: intravitreal anti-VEGF injection

Question 36

Epstein-Barr Virus (Mononucleosis) – HHV4 definition, sx, dx, tx

Answer 36

Infection due to EBV characterized by fever, LAD, & tonsillar pharyngitis

PATHO: EBV infects B cells

Transmission: saliva (known as the kissing disease) esp. ages 15-25

sx
*fever, LAD (esp. posterior cervical)
*tonsillar pharyngitis (may be exudative)
+/- petechiae on hard palate
+/- fatigue, HA, malaise

PE:
*splenomegaly
*rash – seen in ~5% esp. if given ampicillin

dx
Heterophile antibody (Monospot)
Rapid viral capsid antigen test; ↑ LFTs
Peripheral smear: lymphocytosis >5% w/ >10% atypical lymphocytes

tx
Supportive
- rest
- analgesics (acetaminophen, NSAIDs)
- antipyretics

Steroids ONLY if:
- airway obstruction d/t LAD
- hemolytic anemia
- severe thrombocytopenia

AVOID TRAUMA & CONTACT SPORTS 3-4WKS IF SPLENOMEGALY TO PREVENT RUPTURE

Question 37

Subperichondrial Hematoma (Cauliflower Ear) defintion, sx, dx, tx

Answer 37

*blunt trauma to the pinna may cause a subperichondrial hematoma & accumulation of large amounts of blood between the perichondrium & cartilage
*this can interrupt the blood supply to the cartilage & render all or part of the pinna a shapeless, reddish-purple mass
*avascular necrosis of the cartilage may follow
*characteristic “cauliflower ear” of wrestlers/boxers

dx
Cauliflower ear: clinical appearance + hx of blunt trauma to the auricle

tx
Cauliflower ear:
*immediate referral for I&D by an ENT specialist
*PO abx effective against staph (cephalexin 500mg TID) x5d

Question 38

Hyphema defintion, sx, dx, tx

Answer 38

Collection of blood inside the anterior chamber of the eye (the space between the cornea and the iris); blood may cover most or all of iris/pupil, blocking vision partially or completely; usually painful.
▪︎MCC: trauma

S/SXS: visible blood in front of eye, photophobia, pain, blurry/clouded vision

dx: clinical

tx: monitor IOP, limit activity, eye shield
▪︎cycloplegic drops (cyclopentolate, scopolamine)
▪︎steroid drops (prednisolone, dexamethasone)

Question 39

Papilledema definition, sx, dx, tx

Answer 39

Optic nerve (disc) swelling 2° to ⇡ ICP (usually bilateral)

S/SXS: HA, N/V
*vision is often preserved
Fundoscopy: swollen optic disc w/ blurred margins

DX: MRI/CT (r/o mass effect) ⇢ LP (⇡ CSF pressure)

TX: acetazolamide, treat the underlying cause

Question 40

Macular Degeneration dry vs wet: definition, sx, dx, tx

Answer 40

MC cause of permanent legal blindness & vision loss in older adults (esp. >75)

Types:
*dry (atrophic): MC type; progressive (over decades)
*wet (neovascular or exudative): more aggressive (within months)

sx
Bilateral, progressive central vision loss (including detailed & colored vision)
*central scotomas
*metamorphopsia (strait lines appear bent)
*micropsia (objects seem smaller in affected eye)
Wet occurs more rapidly & is more severe

dx
Fundoscopic exam:
- dry: drusen bodies – small, round, yellow-white spots on the outer retina (represent local deposits of extracellular material)
- wet: new, abnormal vessels that can cause retinal hemorrhaging & scarring
Fluorescein staining, Amsler grid

tx
Dry:
*zinc + antioxidant vitamins (C, E) may slow progression but do not reverse changes
*amsler grid at home to monitor stability

Wet:
*intravitreal VEGF inhibitors (bevacizumab) ↓ new, abnormal vessel formation
*laser photocoagulation