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MEGAQUIZ Flashcards

1
Q

SAH

A

-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)

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2
Q

giant cell arteritis (temporal arteritis)

A

-redness
-visual loss
-jaw claudication
-fever, wt loss
-ESR > 50
-polymyalgia rheumatica
-temporal artery bx- skip lesions
-high dose steroid prednisone

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3
Q

meningitis

A

-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

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4
Q

COVID-19 headache

A

-worsens with bending over
-flu symptoms
-dominates entire head

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5
Q

intracranial lesions

A

-posterior fossa- vomiting proceeds headaches
-systemic symptoms indicate malignant- wt loss
-worse with recumbency

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6
Q

activity headache

A

-treated with LP

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7
Q

other causes of facial pain

A

-postherpetic neuralgia (shingles)- treatment is acyclovir
-glossopharyngeal neuralgia
-TMJ joint dysfunction- worsening pain, continuing pain f undiagnosed cause, surgical treatment -> refer to dentist

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7
Q

glaucoma

A

-facial and ocular pain
-unilateral blurring of vision
-fixed dilated pupil
-acetazolamide
-beta blocker (timolol)
-pilocarpine

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7
Q

trigeminal neuralgia

A

-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

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8
Q

when to refer headache

A

-acute onset
-increasing headache unresponsive to simple measure
-hx of trauma, hypertension, fever, visual changes
-presence of neurologic signs or of scalp tenderness
-thunderclap

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9
Q

when to admit

A

-suspected subarachnoid hemorrhage
-structural intracranial lesion

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10
Q

cluster prevention

A

-lithium
-pills

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11
Q

basilar migraine

A

-brain stem
-visual aura
-ataxia
-vertigo
-tinnitus
-diplopia
-nystagmus
-dysarthria

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12
Q

ophthalmologic migraine

A

-acute 3rd CN w/ dilated pupil and unilateral eye pain

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13
Q

allergic rhinitis

A

->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

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14
Q

wegener’s granulomatosis:

A

-inflammation of blood vessels (unknown etiology)
-bloodstained, crusts and friable mucosa
-biopsy- necrotizing granulomas and vasculitis
-allergic rhinitis differential

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15
Q

sarcoidosis

A

enlarged lymph nodes

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16
Q

vasomotor rhinitis

A

-nonallergic
-not itchy
-anosmia
-negative family hx
-negative skin test

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17
Q

olfactory nerve dysfunction

A

CN 1
-hyposmia or anosmia
-anatomical blockage of nasal cavity -> polyps septal deformities
-CNS tumors
-head trauma

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18
Q

epistaxis

A

-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

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19
Q

Samter triad

A

-allergic rhinitis
-asthma
-nasal polyp
-hypersensitivity to aspirin

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20
Q

foreign body complications

A

-unilateral sinusitis
-periorbital cellulitis
-do not irrigate a foreign body if TM is ruptured

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21
Q

Kartagener’s Syndrome

A

-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

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22
Q

upper respiratory tract infection

A

-clear, no purulence
-erythematous- engorged nasal mucosa
-can develop into viral sinus infection
-<4 weeks and typically <10 days

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23
VRS
-watery -reddened mucous -tender over sinus -dark circles -self limited -NSAIDS, acetaminophen, intranasal corticosteroids, decongestants
24
rhinitis medicamentosa
-oxymetazoline or phenylephrine -decongestant overuse -vasoconstrictor -beefy red
25
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)
25
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)
26
sinus drainage
-maxillary drainage via antral lavage -frontal sinuses via trephination
27
ethmoidectomy
-removes infected tissue and bone in the ethmoid sinus that blocks natural drainage
28
chronic sinusitis
-facial edema, tenderness, mucosal edema, septal perforation -mucopurulent -fever usually not present -CT
29
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
30
fungal sinusitis
-MRI (also for tumors) -aspergillosis -biopsy and culture -dark greasy material
31
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
32
pre-septal orbital cellulitis
-lid edema -red -spreading into eye -tender -absence of proptosis -absence of extraocular muscle restriction -absence of fever
33
post septal/orbital cellulitis
-emergency -infection traversing orbital septum -IV antibiotic -surgery
34
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
35
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
36
intracranial sinus infection
-subdural abscess, intracranial abscess, meningitis -nuchal rigidity -neurosurgery to manage ICP -> surgical drainage
37
delayed motor development
-vestibular deficit -sensorineural hearing loss
38
ototoxic drug
-gentamicin -glycosides
39
insufflation
-bulb on the end that blows air -negative for insufflation- abnormal -positive is normal
40
cranial nerve 7 and 8
-7 rhamsey -8 central auditory pathway
41
conductive hearing
-deficit of loud -maintain normal voice -low frequency -hearing aids for uncorrectable
42
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
43
related hearing loss
cochlear otosclerosis -unrelated (NIHL plus TM rupture)
44
non-organic hearing loss
-non-organic- voluntary (malingering) or involuntary (psychological)
45
vestibular schwannoma
-acoustic neuroma -8th cranial nerve -benign tumor of axon coverings -MRI -pure tones
46
plain films
-Exceptions : confirmation of air fluid levels in acute sinusitis; evaluating size and integrity of sinuses
47
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
48
bullous myingitis
-sudden pain -sometimes hx of herpes -blebs on tympanic membrane -herpetic lesions adjacent to tragus -mycoplasma pneumoniae
49
temporomandibular joint disorder
-trismus- lock jaw -ear ache
50
auricular hematoma/cauliflower ear
-auricular hematoma- can cause periostitis -cauliflower ear- fibrocartilage overgrowth
51
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
52
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
53
hemotympanum
-blood in tympanic cavity of middle ear -result of basilar skull fracture
54
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
55
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
56
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
57
peripheral vertigo
-secondary to disorders of inner ear or 8th cranial nerve -acute and transient -> Severe vertigo
58
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
59
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
60
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*
61
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
62
nystagmus
-sustained and demonstrable- true -horizontal- peripheral and central -pendular nystagmus- to and fro movement -ocular causes- long standing visual impairment -congenital -BBPV
63
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
64
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
65
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
66
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
67
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
68
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
69
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
70
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
71
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
72
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
73
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
74
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

HEENT (18 decks)

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