MEGAQUIZ Flashcards
SAH
-CT and/or LP
-meningismus
-cerebral arteriography is CT or LP is +
-sentinel bleed
-cardiac arrhythmias and pulmonary edema
-concerns- re-bleed and development of hydrocephalus
-ruptured aneurysm needs to be secured (clipping/coiling)
giant cell arteritis (temporal arteritis)
-redness
-visual loss
-jaw claudication
-fever, wt loss
-ESR > 50
-polymyalgia rheumatica
-temporal artery bx- skip lesions
-high dose steroid prednisone
meningitis
-CT and/or LP (low glucose high protein)
-meningoencephalitis- meninges and brain parenchyma are infected
-classic triad- fever, headache, nuchal rigidity
-photophobia
-kernigs sign in older children- supine, knees bent, try to extend legs, pain in hamstrings or inability -> +
-brudzinskis sign- neck flexion -> knees/hips flex up
-purpuric lesion on the skin (gunmetal or slate gray)
-empiric antibiotics
-acute bacterial- high neutrophil
-aseptic- high lymphocyte
COVID-19 headache
-worsens with bending over
-flu symptoms
-dominates entire head
intracranial lesions
-posterior fossa- vomiting proceeds headaches
-systemic symptoms indicate malignant- wt loss
-worse with recumbency
activity headache
-treated with LP
other causes of facial pain
-postherpetic neuralgia (shingles)- treatment is acyclovir
-glossopharyngeal neuralgia
-TMJ joint dysfunction- worsening pain, continuing pain f undiagnosed cause, surgical treatment -> refer to dentist
glaucoma
-facial and ocular pain
-unilateral blurring of vision
-fixed dilated pupil
-acetazolamide
-beta blocker (timolol)
-pilocarpine
trigeminal neuralgia
-tic douloureux
-CN 5
-unilateral
-multiple sclerosis
-facial pain
-maxillary and mandibular divisions of CN V
-women > men
-mid to later life
-antiseizures:
-oxcarbazepine
-carbamazepine
when to refer headache
-acute onset
-increasing headache unresponsive to simple measure
-hx of trauma, hypertension, fever, visual changes
-presence of neurologic signs or of scalp tenderness
-thunderclap
when to admit
-suspected subarachnoid hemorrhage
-structural intracranial lesion
cluster prevention
-lithium
-pills
basilar migraine
-brain stem
-visual aura
-ataxia
-vertigo
-tinnitus
-diplopia
-nystagmus
-dysarthria
ophthalmologic migraine
-acute 3rd CN w/ dilated pupil and unilateral eye pain
allergic rhinitis
->2 hrs per day for > 9 months
->10 days
-atopy- family hx
-edematous, blanched (pale)* or violaceous (blueish)* nasal mucosa
-nasal polyps- hypertrophy
-asthma, eczema, otitis media, rhinosinusitis
-confirmed by positive skin prick test or RAST (serum IgE) -> shows you what allergen to avoid
-can cause eustachian tube dysfunction and serous otitis media
-CT of sinus
-intranasal corticosteroids (can take weeks but most effective)
-antihistamine- loratadine, cetirizine
-decongestant
-adjunct treatment: (asthma)
-ipratropium
-cromolyn
-Montelukast
-immunotherapy
wegener’s granulomatosis:
-inflammation of blood vessels (unknown etiology)
-bloodstained, crusts and friable mucosa
-biopsy- necrotizing granulomas and vasculitis
-allergic rhinitis differential
sarcoidosis
enlarged lymph nodes
vasomotor rhinitis
-nonallergic
-not itchy
-anosmia
-negative family hx
-negative skin test
olfactory nerve dysfunction
CN 1
-hyposmia or anosmia
-anatomical blockage of nasal cavity -> polyps septal deformities
-CNS tumors
-head trauma
epistaxis
-can be caused by corticosteroids or antihistamines
-posterior- plexus in the back
-anterior- kiesselbach plexus
-merocel packing- horizontal
-balloons/catheters for posterior bleeds
-antibiotics for posterior foreign body insertion
-admit for certain causes of bleed
-can cause sinusitis, septal hematoma, aspiration
Samter triad
-allergic rhinitis
-asthma
-nasal polyp
-hypersensitivity to aspirin
foreign body complications
-unilateral sinusitis
-periorbital cellulitis
-do not irrigate a foreign body if TM is ruptured
Kartagener’s Syndrome
-immotile cilia
-Situs inversus- rare disease when organs on the right side are on left (vice versa)
-bronchiectasis- destroyed architecture of bronchi - widened and tram like + mucus
-defect in the formation of cilia -> particles will get past and infect
-Autosomal recessive pattern
upper respiratory tract infection
-clear, no purulence
-erythematous- engorged nasal mucosa
-can develop into viral sinus infection
-<4 weeks and typically <10 days
VRS
-watery
-reddened mucous
-tender over sinus
-dark circles
-self limited
-NSAIDS, acetaminophen, intranasal corticosteroids, decongestants
rhinitis medicamentosa
-oxymetazoline or phenylephrine
-decongestant overuse
-vasoconstrictor
-beefy red
ABRS
-drainage, decongestants, antihistamines for pts with mild pain, no recent antibiotic use, temp < 101 and follow up)
-DRAINAGE AND ANTIBIOTICS- cornerstone (especially recurrent and chronic)
sinus infection antibiotics
-first line- amoxicillin + clavulanate (augmentin)
-PCN allergy- clindamycin
-second line- clindamycin, trimethoprim, sulfa, levofloxacin, azithromycin
-if no response in 3-4 weeks -> metronidazole or clindamycin is added (anaerobic coverage)
sinus drainage
-maxillary drainage via antral lavage
-frontal sinuses via trephination
ethmoidectomy
-removes infected tissue and bone in the ethmoid sinus that blocks natural drainage
chronic sinusitis
-facial edema, tenderness, mucosal edema, septal perforation
-mucopurulent
-fever usually not present
-CT
paranasal sinus biopsy
-diagnostic tool
-can detect allergic rhinitis, nonallergic rhinitis with eosinophilia syndrome, nasal polyposis
-dx chronic sinusitis*
-bx of lesions
-fungal disease
-granulomatous diseases
fungal sinusitis
-MRI (also for tumors)
-aspergillosis
-biopsy and culture
-dark greasy material
orbital involvement
-orbit and ethmoids separated by thin lamina papyracea
-First indication - inflammatory edema of eyelids -> progresses to cellulitis, proptosis, chemosis (collection of fluid in the eye) and ophthalmoplegia (paralysis of eye)
-osteomyelitis- frontal sinus -> POTTS PUFFY TUMOR
-IV antibiotics with or without sinus drainage
-abscess- surgical drainage and IV antibiotic
pre-septal orbital cellulitis
-lid edema
-red
-spreading into eye
-tender
-absence of proptosis
-absence of extraocular muscle restriction
-absence of fever
post septal/orbital cellulitis
-emergency
-infection traversing orbital septum
-IV antibiotic
-surgery
mucormycoses
-enters through respiratory tract
-invades vascular channels
-hemorrhagic ischemia and necrosis
-fungal
-deadly
-thrives in acidic environment- ketoacidosis
-engorgement of turbinate’s -> ischemia and necrosis
-loss of vision
-treatment:
-radical surgical debridement (drainage)
-amphotericin B
-underlying immunosuppression treatment
cavernous sinus thrombosis
-deadly
-infection
-cellulitis
-transmission from valveless veins leading to cavernous sinus
-bilateral orbital involvement
-fever
-treatment:
-drainage
-IV antibiotics
-heparin is controversial
intracranial sinus infection
-subdural abscess, intracranial abscess, meningitis
-nuchal rigidity
-neurosurgery to manage ICP -> surgical drainage
delayed motor development
-vestibular deficit
-sensorineural hearing loss
ototoxic drug
-gentamicin
-glycosides
insufflation
-bulb on the end that blows air
-negative for insufflation- abnormal
-positive is normal
cranial nerve 7 and 8
-7 rhamsey
-8 central auditory pathway
conductive hearing
-deficit of loud
-maintain normal voice
-low frequency
-hearing aids for uncorrectable
sensory neural
-loudness deficit and distorted hearing
-loud voice compensation
-tinnitus
-high frequency loss
-background noise makes hearing harder
-hearing aids
-genetics/congenital
-disease- mumps, measles, meningitis, CMV
-ototoxic drugs
-head trauma
-presbycusis- old age
-meniere’s disease- vertigo, tinnitus
-acoustic neuroma- central hearing loss
-noise exposure- prolonged exposure to hazardous noise causes hearing loss by physical destruction of hair cells in cochlea
related hearing loss
cochlear otosclerosis
-unrelated (NIHL plus TM rupture)
non-organic hearing loss
-non-organic- voluntary (malingering) or involuntary (psychological)
vestibular schwannoma
-acoustic neuroma
-8th cranial nerve
-benign tumor of axon coverings
-MRI
-pure tones
plain films
-Exceptions : confirmation of air fluid levels in acute sinusitis; evaluating size and integrity of sinuses
malignant external otitis
-persistent otitis media
-osteomyelitis
-foul smelling discharge
-granulations, deep otalgia, CN palsies (6,7,79,10,11,12)
-CT scan- osseous erosion
-antipseudomonal IV
bullous myingitis
-sudden pain
-sometimes hx of herpes
-blebs on tympanic membrane
-herpetic lesions adjacent to tragus
-mycoplasma pneumoniae
temporomandibular joint disorder
-trismus- lock jaw
-ear ache
auricular hematoma/cauliflower ear
-auricular hematoma- can cause periostitis
-cauliflower ear- fibrocartilage overgrowth
non-traumatic tympanic membrane rupture
-otorrhea follows rupture
-precipitating factors- severe acute otitis media
-dx- otoscopy and audiometry (conductive hearing loss)
-spontaneous repair for small perforation
traumatic tympanic membrane
-foreign body insertion / irrigation into ear can cause
-head trauma with or without basilar skull fracture
-barotrauma
-sudden severe pain
-hearing loss*
-tinnitus*
-vertigo*
-dx- otoscopy
-suction blood
-avoid- irrigation and pneumatic otoscopy
-antibiotics if contaminants have entered otherwise no treatment
hemotympanum
-blood in tympanic cavity of middle ear
-result of basilar skull fracture
cholesteatoma
-can be congenital, acute, chronic
-precipitating factors- chronic infection, trauma, eustachian tube dysfunction
-intermittent drainage if infection suspected
-untreated-> bone destruction, deadness, facial paralysis, dizzy, abscess, systemic infection, death
-hearing loss**
-painless otorrhea
-dx- audiogram- conductive (possible sensorineural) hearing loss
-CT
-antibiotics, ear cleaning, ear drops, surgery
mastoiditis
-complication of acute otitis media
-infection of mastoid air cells
-pneumococcus
-fever, postauricular pain, otorrhea
-downward or lateral pinna displacement
-edema
-destruction of bony septa- air cells coalesce on x-ray
-dx- clinical, CT rarely necessary
-IV ceftriaxone
-myringotomy
-mastoidectomy
mastoiditis complications
-infection may decompress through perforation in tympanic membrane
-can extend through the lateral mastoid cortex forming postauricular subperiosteal abscess
-rarely extend centrally causing temporal lobe abscess or septic thrombosis of the lateral sinus
peripheral vertigo
-secondary to disorders of inner ear or 8th cranial nerve
-acute and transient -> Severe vertigo
central vertigo
-secondary to disorder of vestibular nuclei and their pathways in the brain stem and cerebellum
-vertical nystagmus -> central lesion
-long term -> weeks, months or more
vertigo
-rotary sensation
-can be acute and severe- vomiting, nausea -> episodically
-disturbance of 8th vestibular nerve, brainstem, or rarely cortical function
-accompanying deafness and tinnitus origin from ear or CN13
-treatment- antihistamines, prochlorperazine, scopolamine
causes of vertigo
-drugs- aminoglycosides, chloroquine, furosemide
-tumors- acoustic neuroma and cerebellopontine angle tumor
-vascular- autoimmune ear disease and cholesteatoma
-herpes zoster oticus
-otitis media
-Meniere’s disease*
benign postural or positional vertigo
-common cause of relapsing vertigo
-triggered by changing position
-<60 seconds- acute episode
-dx- clinical, dix hallpike maneuver
-treatment- canalith repositioning, meclizine, benzo, epley’s maneuver
nystagmus
-sustained and demonstrable- true
-horizontal- peripheral and central
-pendular nystagmus- to and fro movement
-ocular causes- long standing visual impairment
-congenital
-BBPV
menieres disease
-episodic
-vertigo
-tinnitus
-hearing loss- temporary at first than becomes permanent starting in lower frequency
-aural fullness
-due to fluid in semicanal
-once you loose your hearing vertigo usually goes away -> relief
-initial attack are more severe, longer, disabling -> less bad after 5 years usually
-furosemide -> diuretic -> decrease fluid
-antiemetic, antinausea, antivertigo
-low sodium, restrict coffee, alcohol
-antianxiety and vertigo treatment
-surgery
eustachian tube dysfunction
-ventilation and drainage for middle ear cleft
-closed generally
-preceded by viral URI or allergic component
-aural fullness
-discomfort with pressure change -> dont fly, dive, hike
-at risk for serous titis media
-fluctuating hearing
-decreased mobility on pneumatic otoscopy
-treatment- decongestants, auto-inflation by forced exhalation against closed nostrils, balloon dilation
ramsay hunt syndrome
-acute facial paralysis
-vertigo
-tinnitus
-ipsilateral* hearing loss
-associated with herpetic blisters of skin of ear canal, auricle, or both
-herpes zoster oticus
-geniculate neuralgia
-nervus intermedius neuralgia
-pathology- located in geniculate ganglion of 7th cranial nerve -> hearing and balance
-VZV
-deep ear pain that radiates outward to pinna
-constant, diffuse, dull
-always after breakout
-anterior 2/3rd of tongue- rash and loss of taste
-rashes can lead to cellulitis
ramsay hunt dx and treatment
-WBC count
-ESR
-viral study
-VZV- culture, vesicle fluid, serology
-corticosteroids, acyclovir
-vestibular suppressants
-treatment to prevent corneal irritation
-carbamazepine for idiopathic geniculate neuralgia
otitis media causes
-newborns- gram negative enteric bacilli -> e coli and staph aureus
-children/adults- streptococcus pneumoniae*******
-second hand smoke
-craniofacial abnormalities (cleft)
-pacifier
-eustachian tube angle is more horizontal
-bottle fed laying down
-first episode under 6 month, native american, innuit, down syndrome - recurrent AOM
acute otitis media
-6-18mo is peak age
-purulent otorrhea, erythematous
-fever, nausea, vomiting, diarrhea, perforation, headache, confusion, neurological signs
-decreased hearing
-less common symptoms: vertigo, nystagmus, tinnitus, facial paralysis
-TRIAD- rapid onset, MEE, middle ear inflammation
-bulging TM- pneumatic otoscopy
-acoustic reflectometry- sound waves detect middle ear fluids
acute otitis media treatment
-analgesics, decongestants, antihistamines, topical agents, narcotic analgesia
-myringotomy/tympanostomy
-observation if appropriate -> mild symptoms (little pain and fever <39), no risk factors, and follow up ensured
-< 6 months - treat STAT
-6month-2 years can observe but must have no risks, symptoms, etc.
-pt with tube or perforation may be given nontoxic drop (cipro or olfloxacin) with oral antibiotics
-5 days therapy for children > 2 and uncomplicated AOM
-<2 with perforation - 10 days
AOM antibiotics
- > 2, no day care, no antibiotic in past 3 months->
-amoxicillin- 80-100 mg/kg/day 5 days - high risk, < 2, day care, antibiotics used in last 3 months ->
-Augmentin- 80-100mg/kg/day 10 days
Second Line or Allergies:
-amoxicillin clavulanate (> 3 mo) -> augmentin
-cefdinir (> 6 mo)
-macrolides - azithromycin (> 6mo)
-clindamycin
-cefpodoxime, cefuroxime, intramuscular ceftriaxone
recurrent acute OM
-3 or more in 6 months
-4 or more in a year
-elicited from hx
-antibiotic prophylaxis
-amoxicillin (20mg QD) 1-3 months
otitis media follow up
-recheck all < 5 years
-recheck > 5 if risk factors present
-within 3-4 weeks or next well child visit if within next 4-6
chronic otitis media
-conductive hearing loss
-otorrhea
-usually no pain
-cholesteatoma common
-clinical dx
-drainage -> culture
-CT or MRI- intratemporal/intracranial processes
-treatment- irrigation, granulation tissue removal, antibiotics, tympanoplasty, ear plugs, myringotomy, mastoidectomy, TM repair
-oral cipro- good against pseudomonas -> helps dry
-ear drops- ofloxacin or cipro
otitis media with effusion
-no signs of acute ear infection
-serous or mucoid
-opaque or yellow
-dull cloudy TM
-decreased mobility
-spontaneous OR from inflammatory response following AOM
-common for 6 mo- 4 year
-in older pts common with URTI, barotrauma, chronic allergic rhinitis
-consider nasopharyngeal carcinoma
-results from untreated AOM
-hearing loss
-air fluid level or air bubbles in middle ear*
-tympanometry or acoustic reflectometry
-treatment:
-corticosteroids
-decongestants
-antibiotics
-antihistamines
-tympanostomy tube insertion preferred initial procedure
-myringotomy for persistent cases
