Opthalmology and Otorhinolaryngology (HEENT) Flashcards
Blepharitis vs hordeolum definition
Inflammation of the eyelid margin vs localized abscess of the eyelid margin, both are painful
Steps of management of a globe rupture (3)
1) rigid eye shield to protect eye from applied pressure, impaled objects should be left undisturbed
2) IV antibioitics and tentanus prophylaxis if needed
3) Emergent opthalmology consult
Antibiotics to give in the case of an orbital floor blow out fracture
augmentin or clindamycin
Retinoblastoma definition
Most common primary intraocular malignancy in childhood, most diagnosed before 3 years of age almost found exclusively in children, presents with leukocoria (presence of abnormal white reflex instead of normal red reflex), may develop strabismus or nystagmus, fatal if untreated by 95% survive if treated properly
Most common cause of permanent legal blindness and vision loss in older adults
Macular degeneration
2 types of macular degeneration
Dry (atrophic) - most common type, progressive over decades, drusen bodies (small white yellow spots on outer retina representing localized deposits)
Wet (neovascular or exudative) - less common but much more aggressive within months new abnormal vessels causing retinal hemorrhage and scarring
Side effect of PDE5 inhibitors such as sildenafil
Blue tinted vision
Macular degeneration diagnosis
Fundoscopy, fluorescin angiography, amsler grid
Most common cause of new permanent vision loss in 20-74 year olds
Diabetic retinoapthy
Diabetic retinopathy preventative screeing
Annual eye exam in diabetics
Management of retinal detachment
Keep patient supine with head turned toward side of detachment and immediately consult opthalmology
Causes of neonatal conjunctivitis based on timeline and management of each respective form
Day 1 - chemical conjunctivits (artificial tears)
Day 2-5 - Gonococcal (IM or IV ceftriaxone once infection as occurred, topical erythromycin drops are used prophylactically to prevent)
Day 5-7 - Chlamydia (oral erythromycin)
Treatment for contact wearer conjunctivits or corneal abrasion
Topical cipro or ofloxacin drops (cover pseudomonas)
First line management of ocular chemical burns
Copious irrigation till a neutral pH is achieved with lactated ringers or normal saline
Strabismus definition and first line treatment
Misalignment of one or both eyes either esotropic (convergent) or exotropic (divergent), first line treatment is occlusive patch therapy
What distinguishes periorbital cellulitis from orbital cellulitis
Absence of proptosis, ocular pain with EOM
Clinical manifestations of uveitis and how is it managed?
Unilateral severe ocular pain and photophobia, eye redness, tearing, blurred or decreased vision, constricted pupil
Managed with topical glucocorticoids
Most common cause of blindness in the world
Cataracts
Papilledema diagnosis and management
Fundoscopy followed by MRI or CT to rule out mass effect followed by LP
Managed with acetazolamide to decrease CSF production, and treating underlying causes
Side effect of ethambutol
Optic neuritis
Optic neuritis maangement
IV methylprednisolone followed by oral corticosteroids
Marcus gunn pupil definition
Affected eye pupils appear to dilate during swinging flashlight test
Treatment of acute narrow angle closure glaucoma
Timolol, pilocarpine, PO or IV acetazolamide
How does glaucoma vision loss present (either acute or chronic)
Peripheral vision loss (tunnel vision) initially. Acute is very painful while chronic is painless
Management of chronic open angle glaucoma
Prostaglandin analogs like latanoprost, timolol, acetazolamide
Treatment of otitis externa
Cipro or ofloxacin topical drops
Most common cause of otitis externa, most common cause of malignant necrotizing otitis externa
Pseudomonas in both cases
Treatment of malignant necrotizing otitis externa
Admission plus IV ciprofloxacin
Chronic otitis media definition
Recurrent or persistent infection of the middle ear in the presence of tympanic membrane perforation >6 weeks, most often pseudomonas, sees persistent or recurrent purulent otorrhea, may have a cholesteatoma, requires topical antibiotic drops first line like ofloxacin or cipro
Most common cause of acute otitis media
Strep pneumoniae
Treatment of acute otitis media
Amoxicillin drug of choice, alternatives include augmentin, azithromycin
Serous otitis media with effusion definition
Middle ear fluid with no signs or symptoms of inflammation like fever ear pain or erythema or bulging of TM, may see after resolution of acute otitis media or in patients with eustachian tube dysfunction, TM is retracted or flat and has hypomobilitiy with insufflation, observation is required in most cases
Caloric testing
Cold water causes the eyes to look toward the side of the drop, beats of nystagmus therefore occur opposite. Warm water causes eyes to look away the side of the drop, beats of nystagmus therefore occur same side.
Sensorineural hearing loss will lateralize to the __ ear and have a ____ rinne result, while conductive will lateralize to the ___ ear and have a ____ rinne result
Normal, normal (AC>BC), affected ear, abnormal (BC>AC)
Most common cause of conductive hearing loss, most common cause of sensorineural
Cerumen impaction, presbycusis
What drug class should be absolutely avoided when there is a TM rupture
Topical aminoglycosides as they are notoriously ototoxic
Cholesteatoma presentation
Painless otorrhea, may perforate TM, brought on by abnormal keratinized collection of epithelium in middle ear, surgical excision is treatment
Peripheral vs central vertigo signs
Peripheral has horizontal nystagmus that is fatigable, central has vertical that is nonfatigable and positive other CNS signs
Differences between benign positional vertigo, meniere, vestibular neuritis, and labrynthitis
BPPV - episodic vertigo no hearing loss
Meniere’s - episodic vertigo plus hearing loss
Vestibular neuritis - continuous vertigo, no hearing loss
Labyrinthitis - continuous vertigo and hearing loss
BPPV diagnosis and treatment
Dix halpike producing fatigable horizontal nystagmus, treated with epley maneuver
Vestibular neuritis and labrynthitis treatment
Glucocorticoids and symptomatic relief such as antihistamines (meclizine)
Meniere’s disease treatment
Initial is dietery modifications, if no relief, antihistamines like meclizine, anticholinergics such as scopolamine, or diuretics such as HCTZ
Unilateral sensorineural hearing loss is ___ until proven otherwise, how is that diagnosed (2)?
acoustic neuroma (benign tumor), MRI imaging and audiometry lab testing
Antibiotic of choice for acute rhinosinusitis
Augmentin
Fungal infection of the sinuses (most often seen in DM or immunocompromised patients) treatment
IV amphotericin B and surgical debridement 1st line
Most common cause of infectious rhinitis
Rhinovirus
Treatment of nasal polyps that are often caused by allergic rhinitis
Intranasal glucocorticoids
Most common source of anterior epistaxis and most common source of posterior
Kiesselbach plexus, sphenopalatine artery brancehs and woodruff’s plexus
Management of anterior epistaxis
- Direct pressure, leaning forward
- cauterization or silver nitrate
- nasal packing
Management of posterior epistaxis
-Balloon catheters
Most common bacterial source of acute pharyngitis, what is the most common overall cause of pharyngitis
Group A strep, viral
Anterior cervical lymphadenopathy is more suggestive of ___, while posterior is more suggestive of ___
strep pharyngitis, mono
1st and 2nd line medications for strep throat
PCN, if allergic then macrolides
Oral lichen planus definition
Idiopathic autoimmune response affecting skin and mucus membranes, reticular leukoplakia of oral mucosa most common form, diagnosed mainly clinical but biopsy can be performed to rule out malignancy, treated with local glucocorticoids
Ludwig’s angina description
Tender, symmetric swelling woody induration and erythema of the upper neck and chin
Ludwig angina initial test of choice for diagnosis
CT scan
Painless erythematous soft velvety patch in the oral cavity might be erythroplakia, what is that?
Uncommon oral lesion with high risk of malignancy, 90% are cancerous, biopsy required to rule out squamous cell carcinoma
Most common agent causing acute bacterialsialadenitis
S Aureus
Oral hairy leukoplakia definition
Mucocutaneous manifestation of epstein barr virus seen in HIV infected patients or other severe immunocompromised states, have painless, white, smooth hairy plaque on the lateral tongue border or buccal mucosa that cannot be scraped off, may resolve on its own and doesn’t need specific treatment
