Ophtho/ENT/GU/MSK Flashcards
Define Hordeolum
How are these Tx
Systemic ABX such as ? are used if ? Dx is present
Painful, hot stye d/t infected eye lid gland
Warm compress
Topical ABX
Cellulitis;
Doxy, Erythromycin
Define Chalazion
Where are these MC found
How are these Tx
Painless lesions d/t noninfected obstruction of meibomian gland
Upper eyelid
Warm compress
Incision/curettage
CCX
Defie Blepharitis
What two Dx are commonly assoicated w/ blepharitis’
What do Pts present complaining of
Inflammation of eyelids d/t dysfunctional meibomian gland or Staph infection
Seborrhea
Rosacea
Crusty eyelids in AM
How is Blepharitis Dx
How are these Tx
? is the MC Ophtho c/c in ER
Slit lamp exam
Warm compress
Eyelid hygiene
Topical ABX
Corneal abrasion
How are corneal abrasions Dx
How are these Tx
What are the 3 MCC of hearing loss
Fluorescein staining
Topical ABX: Cipro Ofloxacin Polymyxin Gentamicin Erythromycin Tobramycin
Presbycusis
Impaction
Eustacian dysfunction
Define Conductive Hearing Loss
Define Sensorineural HL
Neural hearing loss is MC d/t ?
Lesions in EAC/TM/Mid ear preventing sound conduction
Lesion in inner eary/CN8
Cerebellopontine angle tumor
Weber Test results
Rinne test results
All children under 7y/o have some form of ? ear issue
Lateralizes to affected ear w/ CHL;
Lateralizes to unaffected ear w/ SHL
CHL= bone > air SNHL= air > bone
ET dysfunction
How does Eustachian Tube Dysfunction present
This is a primary cause of ? two issues
How is this Dx
Ear fullness/popping w/ intermittent pain/tinnitus
AOM, OME
Tympanogram
How is Eustachian Tube Dysfunction Tx
3 MC microbes causing AOM
Time frames for acute, chronic and recurrent
Pseudophedrine
Ibuprofen
Nasal steroids
Surgery- medical failure
Strep pneumo
H influenza
Moraxella catarrhalis
Acute: <3wks
Chronic: >3mon
Recurrent: 3 episodes in 6mon; 4 episodes in 12mon
Time frame for COM
What will be seen in PE
What is a key finding for Dx
> 3mon
Clear serous fluid in middle ear w/out S/Sxs of infection
Limited mobility of TM w/ pneumotoscopy
How is AOM Tx
What is used for 2nd line Tx
What is used for Pts w/ PCN allergy
Amox
Cefixime for PEds
Augmentin
Bactrim Azith Erythromycin
How is COM Tx
How does Otitis Externa present on PE
What would tuning fork results look like
Myringotomy
Itching, Pain w/ manipulation
Weber lateralizes to blocked canal
3 MC microbes causing Otitis Externa
? variant will DMs have
Fungal OM is caused by ?
Pseudomonas
Staph A
Proteus
Malignant OE
Aspergillus
How is bacterial OE Tx if there’s a chance of perf
How is Fungal OE Tx
? is the MCC of CHL
Cipro and Dexameth
Ofloxacin
2% acetic acid
Clotrimazole
PO Itraconazole
Cerumen impaction
What will Weber/Rinne look like during impaction
How can this be softened for removal
How long are Sxs needed for sinusitis Dx
W to affected side
R: A > B conduction
Carbamide peroxide
Trithanolamine
Worsen over 5-7d,
Fail to improve >10d
How are adults w/ sinusitis Tx
How is this Tx in Pts w/ PCN allergy
What is done for second line therapy in Pts that fail to improve in 7d
Amoxicillin
Augmentin
Doxycycline
Cephalosporin w/ Clinda
Augmentin
Levo/Moxi-flox
How is Chronic Sinusitis Tx
MC site for anterior nose bleeds to come from
Where do posterior bleeds come from
Augmentin
PCN-all: Clinda
Kiesselbachs/Little’s area
Woodruffs plexus: Shenopalatine artery
How are nose bleeds Tx
What types of bleeds are admitted
Define Leukoplakia
Pressure x 15min leaning fwd
Afrin x 2
Anterior packing w/ cephalosporin
Posterior w/ balloon packing
White patches on buccal surfaces that can’t be wiped off
Leukoplakia itself is benign but can lead to ?
? type of leukoplakia has a higher risk for dysplasia and Ca
? form of leukoplakia is not premalignant
SCC
Erythroplakis
Hairy leukoplakia from EBV in HIV Pts
How is Leukoplakia Dx
How is it Tx
How is PO Hairy Leukoplakis Tx
Biopsy
Excision
Cryosurgery
Zidovudine
Ganciclovir
Topical podophyllin or Isotretinoin
Difference between Leukoplakia and Hairy Leukoplakia
When do aphthous ulcers need to be considered for biopsy
What topical anesthetics can be used
Hairy won’t progress into SCC
Lasting >3wks
Mg hydroxide
Dphenhydramine hydrochloride
Bacterial pharyngitis is MCC by ?
What criteria is used for Dx//ABX
Gold standard for Dx
GAStrep
Centor: Fever >100.4 Anterior adenopathy Cough, no Exudate 3 of 4= rapid
Rapid then Culture
Why are ABX used in the Tx of bacterial pharyngitis
MCC of viral pharyngitis
How is this form Dx
PCN, Macrolide
Adenovirus
Atypical lymphocytes; monospot test
How is fungal pharngitis Tx
How is this Dx Tx in Pts w/ HIV
How long after sickness can Pts w/ Mono return to sports
Clotrimazole troches
Miconazole
Nystatin
Fluconazole
3wks from Sx onset
How is ghonorrhea pharyngitis Tx
What two PE findings are highly suggestive of tonsilar abscesses
These are AKA ? abscess
Ceftriaxone
Deviated palate
Asymmetric uvula rise
Quincy’s
? are the MC aerobic and anaerobic microbes causing tonsilar abscesses
How are these Tx non-surgically
Infections of upper airway/epiglottitis is MC from ?
Staph, Strep
Bacteroides
Augmentin, Clindamycin
H Influenza b
What will be seen on PE of epiglottitis
What position do Pts adopt
How is it Dx
Drooling Dysphagia Distress
Sniffing dog- neck hyperextended, chin protrusion
Xray- thumbprint sign
What ABX are used for epiglottitis after admission
When is throat Ca a DDx from pharyngitis
If PO/IM steroids are going to be used for Tx, what must be done first
IV Ceftriax and Clinda
Hoarse >2wks w/ Hx of ETOh/Tobacco
Vocal cord eval prior to start
Renal artery stenosis is MCC by ?
What presentation signals this Dx
What imaging is used for Dx
How is this Tx
Atherosclerosis,
Fibromuscluar dyplasia
Pt Tx w/ ACEI and develops kidney failure
First: US
GS: renal ateriography
Percutaneous transluminal angiography
What causes Syphilis
After 3wk incubation, what are the three phases
What is seen if acquired congenitally
Treponema pellidum (spirochette)
Primary: painless chancre
Secondary: erythematous rash, condyloma lata
Tertiary: latent; systemic, mucosal growth- gummas
Hutchinson teeth
Saddle nose deformity
ToRCH syndrome
How is syphilis Dx
How isneurosyphilis Dx
? conditions can cause a false pos result
Monospot w/ reactive treponemal test
Lumbar puncture
Lyme Malaria Pregnancy TB
How is syphilis Tx
What is usd for PTs w/ allergy to mainstay Tx
What is the hallmark PE finding for trichomonas vaginitis
PCN G:
Primary/Secondary: IM
Congenital/late: IV
Doxy or Tetracycline
Strawberry cervix
Mobile, pear shaped protozoa w/ flagella on wet mount
How is Trichomonas Vaginitis Tx
What causes condyloma acuminate
How are these prevented
How are they Tx
Metronidazole
HPV 6, 11
Gardasil- protects from 6, 11 and two most Ca types: 16, 18
Podofilox, Cryo
How does HSV present on PE
Where do these reside in for life
What are HHV 3-8 names
Grouped vesicles on erythematous base, all in same stages of development
Trigeminal, Sacral ganglia
3: Varicella Zoster
4: EBV
5: CMV
6: Roseolovirus, 6th dz
7: similar to 6
8: rhadinovirus called Kaposi sarcoma associated HSV
? is the MC virus passed from mother to unborn baby
How are HSV cases Dx
How are they Tx
CMV
Tzanck prep- multinucleated gian cells
FAV-cyclovir
What kind/shape is N gonorrhoeae
? biliary-hepatic dz can gonorrhea mimic
How is it Dx
Gram neg diplococci
Fitz-Hugh-Curtis syndrome
NAAT:
women: vaginal swab
men: first catch UA
Persistent after ABX= culture
How is gonorrhea Tx
What is used for PTs allergic to mainstay Tx
? is the MC STI
Ceftriaxone, + doxy for chlamydia
Gentamicin + Azith
Chlamydia
Gold standard to Dx chlamydia
How is chlamydia Tx
How is gonorrhea Tx
How is chlamydia Tx during pregnancy
NAAT
Azithromycin,
Doxy
Ceftriaxone
Azith, Amox
Define Chancroid
What microbe causes this
How is it Dx
How is it Tx
STD w/ painful ulcers and inguinal adenpoathy/bulbo
Haemophilus ducreyi: gram neg rod
Serologic testing
Gram stain, culture
Ceftriax or Axithromycin
AIDS is defined as a ? three criteria?
How is this Dx made
What is used to monitor infectivity and Tx effectiveness
CD4 <200
Opportunistic infections
Malignancies
Immunoassay
ELISA (screen) and Western Blot (confirm)
HIV RNA viral load
When is HAART therapy initiated for HIV
What are the HAART regiments for naive Pts
CD4 <350 or
Viral load >55K
NNRTI + 2 NRTIs or
PI + 2 NRTI or
INSTI+2 NRTI
Opportunistic infections at CD4 count of <250
Opportunistic infections at CD4 count of <200
Opportunistic infections at CD4 count of <150
Opportunistic infections at CD4 count of <100
Opportunistic infections at CD4 count of <50
Coccidiomycosis
Pneumocystis
Histoplasmosis
Toxoplasmosis/Crypto
Mycobacterium avium complex
Post-HIV exposure prophylaxis needs to be started w/in ?hrs of exposure
How can this infection be passed to infants
<72hrs
Breast milk
