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Pance Prep Pearls > Opthalmology and Otorhinolaryngology (HEENT) > Flashcards

Opthalmology and Otorhinolaryngology (HEENT) Flashcards

1
Q

Blepharitis vs hordeolum definition

A

Inflammation of the eyelid margin vs localized abscess of the eyelid margin, both are painful

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2
Q

Steps of management of a globe rupture (3)

A

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

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3
Q

Antibiotics to give in the case of an orbital floor blow out fracture

A

augmentin or clindamycin

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4
Q

Retinoblastoma definition

A

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

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5
Q

Most common cause of permanent legal blindness and vision loss in older adults

A

Macular degeneration

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6
Q

2 types of macular degeneration

A

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

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7
Q

Side effect of PDE5 inhibitors such as sildenafil

A

Blue tinted vision

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8
Q

Macular degeneration diagnosis

A

Fundoscopy, fluorescin angiography, amsler grid

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9
Q

Most common cause of new permanent vision loss in 20-74 year olds

A

Diabetic retinoapthy

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10
Q

Diabetic retinopathy preventative screeing

A

Annual eye exam in diabetics

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11
Q

Management of retinal detachment

A

Keep patient supine with head turned toward side of detachment and immediately consult opthalmology

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12
Q

Causes of neonatal conjunctivitis based on timeline and management of each respective form

A

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)

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13
Q

Treatment for contact wearer conjunctivits or corneal abrasion

A

Topical cipro or ofloxacin drops (cover pseudomonas)

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14
Q

First line management of ocular chemical burns

A

Copious irrigation till a neutral pH is achieved with lactated ringers or normal saline

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15
Q

Strabismus definition and first line treatment

A

Misalignment of one or both eyes either esotropic (convergent) or exotropic (divergent), first line treatment is occlusive patch therapy

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16
Q

What distinguishes periorbital cellulitis from orbital cellulitis

A

Absence of proptosis, ocular pain with EOM

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17
Q

Clinical manifestations of uveitis and how is it managed?

A

Unilateral severe ocular pain and photophobia, eye redness, tearing, blurred or decreased vision, constricted pupil
Managed with topical glucocorticoids

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18
Q

Most common cause of blindness in the world

A

Cataracts

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19
Q

Papilledema diagnosis and management

A

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

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20
Q

Side effect of ethambutol

A

Optic neuritis

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21
Q

Optic neuritis maangement

A

IV methylprednisolone followed by oral corticosteroids

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22
Q

Marcus gunn pupil definition

A

Affected eye pupils appear to dilate during swinging flashlight test

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23
Q

Treatment of acute narrow angle closure glaucoma

A

Timolol, pilocarpine, PO or IV acetazolamide

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24
Q

How does glaucoma vision loss present (either acute or chronic)

A

Peripheral vision loss (tunnel vision) initially. Acute is very painful while chronic is painless

25
Q

Management of chronic open angle glaucoma

A

Prostaglandin analogs like latanoprost, timolol, acetazolamide

26
Q

Treatment of otitis externa

A

Cipro or ofloxacin topical drops

27
Q

Most common cause of otitis externa, most common cause of malignant necrotizing otitis externa

A

Pseudomonas in both cases

28
Q

Treatment of malignant necrotizing otitis externa

A

Admission plus IV ciprofloxacin

29
Q

Chronic otitis media definition

A

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

30
Q

Most common cause of acute otitis media

A

Strep pneumoniae

31
Q

Treatment of acute otitis media

A

Amoxicillin drug of choice, alternatives include augmentin, azithromycin

32
Q

Serous otitis media with effusion definition

A

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

33
Q

Caloric testing

A

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.

34
Q

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

A

Normal, normal (AC>BC), affected ear, abnormal (BC>AC)

35
Q

Most common cause of conductive hearing loss, most common cause of sensorineural

A

Cerumen impaction, presbycusis

36
Q

What drug class should be absolutely avoided when there is a TM rupture

A

Topical aminoglycosides as they are notoriously ototoxic

37
Q

Cholesteatoma presentation

A

Painless otorrhea, may perforate TM, brought on by abnormal keratinized collection of epithelium in middle ear, surgical excision is treatment

38
Q

Peripheral vs central vertigo signs

A

Peripheral has horizontal nystagmus that is fatigable, central has vertical that is nonfatigable and positive other CNS signs

39
Q

Differences between benign positional vertigo, meniere, vestibular neuritis, and labrynthitis

A

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

40
Q

BPPV diagnosis and treatment

A

Dix halpike producing fatigable horizontal nystagmus, treated with epley maneuver

41
Q

Vestibular neuritis and labrynthitis treatment

A

Glucocorticoids and symptomatic relief such as antihistamines (meclizine)

42
Q

Meniere’s disease treatment

A

Initial is dietery modifications, if no relief, antihistamines like meclizine, anticholinergics such as scopolamine, or diuretics such as HCTZ

43
Q

Unilateral sensorineural hearing loss is ___ until proven otherwise, how is that diagnosed (2)?

A

acoustic neuroma (benign tumor), MRI imaging and audiometry lab testing

44
Q

Antibiotic of choice for acute rhinosinusitis

A

Augmentin

45
Q

Fungal infection of the sinuses (most often seen in DM or immunocompromised patients) treatment

A

IV amphotericin B and surgical debridement 1st line

46
Q

Most common cause of infectious rhinitis

A

Rhinovirus

47
Q

Treatment of nasal polyps that are often caused by allergic rhinitis

A

Intranasal glucocorticoids

48
Q

Most common source of anterior epistaxis and most common source of posterior

A

Kiesselbach plexus, sphenopalatine artery brancehs and woodruff’s plexus

49
Q

Management of anterior epistaxis

A
  • Direct pressure, leaning forward
  • cauterization or silver nitrate
  • nasal packing
50
Q

Management of posterior epistaxis

A

-Balloon catheters

51
Q

Most common bacterial source of acute pharyngitis, what is the most common overall cause of pharyngitis

A

Group A strep, viral

52
Q

Anterior cervical lymphadenopathy is more suggestive of ___, while posterior is more suggestive of ___

A

strep pharyngitis, mono

53
Q

1st and 2nd line medications for strep throat

A

PCN, if allergic then macrolides

54
Q

Oral lichen planus definition

A

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

55
Q

Ludwig’s angina description

A

Tender, symmetric swelling woody induration and erythema of the upper neck and chin

56
Q

Ludwig angina initial test of choice for diagnosis

A

CT scan

57
Q

Painless erythematous soft velvety patch in the oral cavity might be erythroplakia, what is that?

A

Uncommon oral lesion with high risk of malignancy, 90% are cancerous, biopsy required to rule out squamous cell carcinoma

58
Q

Most common agent causing acute bacterialsialadenitis

A

S Aureus

59
Q

Oral hairy leukoplakia definition

A

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

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