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PANCE REVIEW > HEENT > Flashcards

HEENT Flashcards

1
Q

ectropion vs entropion

A

ectropion: eyelid and lashed turned outwards
* MC in elderly due to relaxation of orbicular oculi muscle
entropion: eyelid and lashed turned inwards
* Mc due to orbicularis oculi spasm

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2
Q

what is dacrocystitis, and what is the MC organism?

A

-lacrimal gland infection MC due to S. Aureus

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3
Q

Treatment for dacrocystitis

A

-Clindamycin,

OR vancomycin + ceftriaxone

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4
Q

Causes of anterior blepharitis

A

Where skin and eyelid meet:

1) Infection (staph MC)
2) Seborrheic

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5
Q

Causes of Posterior Blepharitis

A

Caused by a Meibomian gland dysfunction

*associated with rosacea, allergic dermatitis

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6
Q

What is blepharitis?

A

Inflammation of both eyelids

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7
Q

Patients with blephritis commonly have what other conditions?

A

1) down syndrome

2) eczema

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8
Q

Blephritis treatment

A

-Eyelid hygiene, warm compress, meibomian gland expression if a posterior cause, azithromycin solution

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9
Q

What is a hordeolum and what organism MC causes it?

A

Local access of the eyelid margin (stye)

MC caused by staph aureus

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10
Q

What is the treatment of a hordeolum ?

A
  • Warm compress is the mainstay
  • topical erythromycin or bacitracin ointments

**if it does not spontaneously drain in 48 hrs, I&D may be indicated!

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11
Q

What is a chalazion?

A

PAINLESS granuloma of the meibomian gland

-presents as non-tender eyelid swelling that heals with warm compress

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12
Q

What is a Pterygium?

A

Fleshy, triangle shaped GROWING fibrovascular mass growing into eye, BEGINNING AT NASAL SIDE OF EYE

-associated with UV exposure, sand, wind, dust,

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13
Q

What is a pinguecula?

A

Yellow nodule on the NASAL SIDE OF SCLERA,

-DOES NOT GROW

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14
Q

What part of vision is the macula responsible for?

A

Central Vision

Color Vision

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15
Q

What is the MC cause of macular degeneration?

A

Age

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16
Q

Two types of macular degeneration

A

1) DRY: caused by atrophy of the macula, blurring of central vision with DRUSEN spots found on physical exam
2) WET: caused by neovascularization or exudates, new abnormal vessels grow under retina which leak and bleed leading to retinal scaring , diagnose with fluorescein angiography

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17
Q

Vision changes in a patient with macular degeneration

A

Central vision loss, scotomas, metamorphopsia (straight lines appear bent)

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18
Q

Treatment of dry macular degeneration

A
  • Amsler grid to monitor (grid of lines to see if metamorphopsia is present)
  • Zinc, Vit A, C, E can slow progression
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19
Q

Treatment of wet macular degeneration

A

Intravitreal anti-angiogenics: (VEGF inhibitors) such as Bevacizumab, these inhibit neovascularization

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20
Q

Pathophysiology of diabetic retinopathy

A

excess sugar attaches to the cologne of retinal blood vessels leading to ischemia and breakdown

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21
Q

3 types of diabetic retinopathy

A

1) Nonproliferative: microaneurysm;
- cotton wool spots (soft exudates)
- Hard exudates from lipid deposits
- Blot & dot hemorrhages
* NO VISION CHANGE

2) Proliferative: neovascularization
* VITREOUS HEMORRHAGE CAUSES BLOTTED VISON

3) Maculopathy: macular edema or exudates, blurred CENTRAL VISION LOSS

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22
Q

3 types of retinal detachment

A

1) Rhegmatogenous (MC type): direct tear of the retinal inner sensory layer from choroid plexus
2) Traction: adhesions separate retina from base
3) Exudative: serous fluid collects beneath the retina

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23
Q

MC predisposing factors to a phegmatogenous retinal detachment

A
  • myopia (nearsighted)

- cataracts

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24
Q

Clinical Manifestations

A
  • Photopsia (flashing lights)
  • Floaters
  • Progressive unilateral vision loss of central vision field
  • Curtain coming down from periphery (amaurosis fugax will resolve, this will not)
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25
Q

What is Shafer’s sign?

A

On fundoscopy:

Clumping of brown-colored pigment cells in the anterior vitreous humor, “tobacco dust” appearance; found in retinal detachment

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26
Q

Treatment of a retinal detachment

A

OPTHO emergency; NO MIOTIC DROPS

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27
Q

Steps to treating a corneal abrasion

A

1) Check visual acuity
2) Fluorescein staining to look for abrasion of foreign body (“ice rink abrasions”)
3) May patch the eye if larger than 5mm, for 24 hours
4) antibiotic drops (erythromycin, or ciprofloxacin)

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28
Q

Contraindications to giving a patient an eye patch

A
  • contact lens wearer

- pseudomonas infection

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29
Q

Which topical antibiotics cover pseudomonas?

A

Floroquinolones

Aminoglycosides

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30
Q

Hallmarks of viral conjunctivitis

A

Red itchy eye, pre auricular lymphadenopathy, WATERY discharge; often bilateral

  • Punctate staining on slit lamp
  • Treat with supportive treatment
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31
Q

Hallmarks of allergic conjunctivitis

A

Red eyes with other allergy s/s

-COBBLESTONE mucosa on inner eyelid; often bilateral

-Treat with topical antihistamines:
Olopatdine, Naohcon A

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32
Q

Hallmarks of bacterial conjunctivitis

A

Purulent discharge with LID CRUST, absence of colliery injection; often unilateral

-Treat with topical antibiotics

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33
Q

Which type of chemical burn is worse on the eye, alkali or acid?

A

Alkali is worse! (these cause denaturing and liquefactive necrosis)

-Acid burns cause coagulative necrosis

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34
Q

Management of chemical burns to the eye

A

1) IRRIGATION: use lactated ringers as these have a similar pH to tears (7.1)
- irrigate at least 30 minutes with at least 2 Liters
2) Check pH and visual acuity after irrigation
3) Moxifloxacin antibiotics

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35
Q

What is the MC virus causing conjunctivitis?

A

Adenovirus; often caught by children in swimming pools

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36
Q

Hallmarks of Orbital (septal) cellulitis

A
  • usual 2ry to an ethmoid sinus infection
  • Decreased vision, pain with ocular movements, proptosis
  • High resolution CT
  • IV antibiotics (vancomycin, clindamycin)
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37
Q

Preseptal cellulitis

A

infection of the eyelid and periocular tissue , NO vision loss or pain with ocular movement

-treat with IV amoxicillin

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38
Q

Esotropia

A

convergent strabismus (deviated inward)

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39
Q

Exotropia

A

divergent strabismus (deviated outward)

40
Q

What is cilliary injection

A

Redness concentrated right around the cornea; found in keratitis, or a corneal ulcer

41
Q

What is the most common cause of keratitis?`

A

Bacteria (pseudomonas or acanthamoeba) in contact wearers

42
Q

Physical exam findings of bacterial vs HSV keratitis

A

BACTERIAL: hazy cornea, give fluoroquinolone drops and do not patch eye

HSV: dendritic lesions on flurescein stain

43
Q

What are the two MC risk factors for cataract development?

A

Smoking, corticosteroids

Cataract= progressive lens thickening

44
Q

Pathophysiology of papilledema

A

swelling of the OPTIC NERVE (disc) 2ry to increased intracranial pressure

45
Q

Management of papilledema

A

decrease intracranial pressure with acetazolamide (decreased production of aqueous humor & CSF)

46
Q

demyelination of the optic nerve is called

A

optic neuritis

47
Q

What medication causes optic neuritis

A

Ethambutol

48
Q

Physical exam findings in optic neuritis

A
  • Loss of color vision
  • central scotoma/blind spots
  • ocular pain worse with eye movements
  • Marcus-Gunn pupil
49
Q

What is a Marcus-Gunn pupil?

A
  • relative afferent pupillary defect; when the light is swung into the affected eye the pupil dilates instead of constricts.
  • delayed response of the optic nerve seen in optic neuritis
50
Q

What is a Argyll-Robertson Pupil?

A

Pupil constricts on accommodation, but does not react to bright light

-causes by neurosyphilis MC, midbrain lesions, or diabetic neuropathy

51
Q

What are precipitating factors to acute angle closure glaucoma?

A

Mydriasis (pupillary dilation)

-dim lights, sympathomimetics, anticholinergics

52
Q

Clinical manifestations of acute angle closure glaucoma

A
  • Acute unilateral painful PERIPHERAL vision loss with halos
  • tunnel vision +/- n/v, headache
  • steamy cornea, mid-dilated, fixed, non-restive pupil
53
Q

What is the treatment for acute angle closure glaucoma?

A

Acetazolamide to decrease aqueous humor production
Timolol to decrease IOP
Avoid sympathomimetics and anticholinergics

54
Q

What causes an acute angle closure glaucoma?

A

Decreased drainage of aqueous humor

55
Q

Chronic, open angle, glaucoma hallmarks

A
  • Gradual, Bilateral, Painless, Peripheral vision loss (tunnel vision)
  • Due to chronic reduced aqueous humor drainage
  • Cupping of optic disc on exam
  • Prostaglandin analogs 1st line tx (Latanoprost)
56
Q

Hallmarks of a central retinal artery occlusion

A
  • Often have atherosclerosis
  • acute, sudden, monocular vision loss often proceed my amaurosis fugal
  • PALE RETINA, CHERY RED MACULA
  • acetazolamide tx
57
Q

Hallmarks of central retinal vein occlusion

A
  • fluid backup to due occlusion
  • acute sudden monocular vision loss
  • extensive retinal hemorrhages with “BLOOD AND THUNDER” APPEARANCE
  • no tx
58
Q

MC organism causing otitis externa

A

Pseudomonas,

*AKA swimmers ear, often the increased water exposure weakens the ears normal acidic pH allowing for bacterial overgrowth

59
Q

Presentation of otitis externa

A

Pain, pruritus, discharge, fullness, hearing usually preserved.

60
Q

Treatment of otitis externa

A
  • Cipofloxacin/dexamethazone topical agents

- You can use aminoglycosides as long as there is no TM perforation as they are ototoxic

61
Q

What is malignant otitis externa?

A

Osteomyelitis at skull base 2ry to Pseudomonas

  • Often seen in DM, or immunocompromised patients
  • Tx with IV antipseudomonal
62
Q

Mc organisms causing acute otitis media

A

1) S. pneumo
2) H. Flu
3) Moroxella catarrhalis
4) Strep Pyogenes
5) If Bullae on TM = mycoplasma pneumonia

**MC proceeded by viral URI

63
Q

Pathophysiology of acute otitis media

A

URI causes edema of eustachian tube (or congenital tube dysfunction) which leads to transudation of fluid & mucus in the middle ear, leading to bacterial colonization

64
Q

Clinical manifestations of acute otitis media

A

bulging Tm with erythema, otalgia, ear tugging in infants,

-Pain with DECREASE with TM rupture, and otorrhea will begin (2 days to heal)

65
Q

Treatment of acute otitis media

A

Amoxicillin x10-14 days

Cefixime in children

*erythromycin-sulfisoxazole if allergic

66
Q

Hallmarks of chronic otitis media

A

Complication of actor otitis media

  • MC pseudomonas, S. aureus
  • Perforated TM + persistant recurrent purulent otorrhea

_Topical antibiotic treatment with oflaxacin or cipro

67
Q

What is a cholesteatoma?

A

Abnormal keratinized collection of squamous epithelium that erodes the ossicles and mastoid bone over time

-Leads to a conductive hearing loss

68
Q

Clinical manifestions/PE of cholesteatoma

A
  • Painless otorrhea (brown/yellow discharge with odor)
  • Granulation tissue with conductive hearing loss
  • Treat with surgical excision
69
Q

Hallmarks of Benign positional vertigo

A
  • Episodic, peripheral vertigo with changes to head positioning.
  • DX with DIX-Hallpike : lay patient with head 30 degrees lower than body, watch for delayed horizontal nystagmus when head is quickly tuned.
  • Treat with Epley maneuver: canalith reposition, no medical treatment needed
70
Q

What is the labyrinth and what is it made up of?

A

The bony & membranous part of the inner ear that is made up of:

1) Cochlea: converts impulses to allow for HEARING
2) Vestibular system: 3 semicircle canals responsible for BALANCE

71
Q

What is the difference between vestibular neuritis & Labyrinthitis?

A

Vestibular neuritis: inflammation of the vestibular nerve (CN 8); this will present as continuous dizziness with gait/balance disturbances, NO HEARING LOSS

Labyrinthitis: Inflammation of vestibular nerve PLUS the cochlea; this will present as vestibular s/s PLUS hearing loss continuously

**treatment is with steroids

72
Q

What cranial nerve is responsible for balance?

A

CN VIII (vestibular nerve)

73
Q

What is Meniere’s Disease?

A

IDIOPATHIC dissension of the inner ear by excess fluid

74
Q

Presentation of Meniere’s Disease

A

1) episodic vertigo for minutes to hours
2) tinnitus
3) ear fullness
4) fluctuating hearing loss
5) nystagmus, n/v

75
Q

Treatment of Meniere’s disease

A

Treat nausea s/s with antiemetics

  • Prevent with diuretics (HCTZ)
  • Avoid salt, caffeine, chocolate, ETOH
76
Q

What is an acoustic neuroma and how does it present?

A

Tumor of the schwann cells that make up the myelin sheath of CN VIII

-It will present as UNILATERAL hearing loss with tinnitus

77
Q

What is the MC location of acute sinusitis

A

maxillary>ethmoid>frontal>sphenoid

78
Q

Clinical manifestations of acute sinusitis

A

Acute = 1-4 weeks
Sinus pressure, headache, purulent sputum, nasal discharge

*sinus transillumination on physical exam

79
Q

Treatment of acute sinusitis

A

Amoxicillin *symptoms must be present for at least 1-14 days before you give antibiotics to rule out viral causes !!!

-2nd line is doxy or bactrim

80
Q

Definition and common organisms causing chronic sinusitis

A

At least 12 weeks

  • S. Aureus MC bacteria
  • Aspergillus MC fungal cause
  • Mucormycosis 2nd MC fungal cause
81
Q

What does chronic sinusitis caused by mucormycosis present like?

A
  • Often immunocompromised patient
  • black eschar on palate or face
  • IV amphotercin B for treatment
82
Q

What are the 3 types of rhinitis?

A

1) Allergic (MC)
2) Viral: rhinovirus (common cold)
3) Vasomotor (blood vessel dilation from temp change)

83
Q

Clinical manifestations of allergic rhinitis

A

-pale, violet boggy turbinates; clear rhinorrhea, nasal polyps*****, cobblestone mucosa of conjunctiva, worse in the morning

**treat with intranasal corticosteroids

84
Q

Clinical manifestations of viral rhinitis

A

erythematous turbinates

85
Q

What is Samter’s triad?

A

1) asthma
2) nasal polyps
3) ASA allergy

86
Q

Where is the bleed coming from in anterior vs. posterior epistaxis?

A

Anterior: Kiesselbach’s plexus , one nostril

Posterior: Palantine artery, bleed from both nostrils (HTN and atherosclerosis predispose)

87
Q

What is MC cause of pharyngitis?

A

Viral!

-If bacterial… GABHS

88
Q

What is Centor Criteria ?

A

For the diagnosis of Bacterial (Strep) Throat

1) Fever
2) Anterior cervical lymphadenopathy
3) Pharyngotonsillar exudates
4) absence of cough
5) add a point if younger than 15

**if O-1; no culture needed

2-3; culture

4-5; go straight to antibiotics

89
Q

What is the treatment for strep pharyngitis?

A

Pen G or VK

Macrolides if pen allergic

90
Q

Signs of a peritonsilar access (Quincy)

A
  • Uvula deviation
  • Hot potato voice
  • difficulty handling secretions
91
Q

Diagnosis and treatment of a peritonsilar abcess

A

Dx: CT scan

Tx: I&D plus antibiotics

  • Unasyn
  • Pen G + Metronidazole
92
Q

How does laryngitis present?

A
  • It is inflammation of the larynx (vocal chords) :
  • Hoarseness, aphonia
  • MC viral cause so give supportive treatment
93
Q

Presentation of oral leukoplakia

A
  • White painless patchy lesions that cannot be scared off

* *precurser to cancer

94
Q

Aphthous Ulcers (canker sore)

A

Painful ulcers with ulceration and erythematous ulcers,

-Associated with human herpes virus 6

95
Q

What are the two salary gland ducts of the mouth?

A

Wharton’s duct-submandibular (MC place for stones)

Stensen’s duct (parotid gland duct)

96
Q

Sialolithiasis

A

Salivary gland stones!
-MC in wharton’s duct

  • Postparandial salivary gland pain and swelling
  • fluids and sialogogues (tart hard candies)
97
Q

Sialadenitis

A

salivary gland stones:

  • INFECTION of salivary glands MC S. Aureus
  • Pain, swelling, trismus, duct tenderness and drainage
  • Give antibiotics (dicloxacillin or Nafcillin)

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