PANCE_EENT 7% Flashcards
(RR)
symptomatic relief for viral pharyngitis
IBUPROFEN po
NSAIDs provide most symptomatic relief
(CME)
entropion
inward turning of eyelid (usually lower)
(CME)
ectropion
outward turning of lower lid
common in elderly
(CME)
what is anterior blepharitis? How do you treat it?
common chronic bilat inflammation of lid margins, commonly scales on lashes
tx: remove w/ baby shampoo, add antistaph abx eye ointment
(CME)
what is posterior blepharitis? How do you treat it?
inflammation of eyelids 2/2 dysfxn of meibomian glands, strongly assoc’d w/ acne rosacea
tx: low dose systemic abx (doxy, macrolide) and short term topical steroids
(CME)
differences b/w hordeolum and chalazion
hordeolum hurts!
hordeolum is bac infection of oil gland in eyelid (can be upper or lower)
chalazion is nontender
chalazion is granulomatous inflammation of meibomian gland (can be upper or lower)
(CME)
similarities in tx of hordeolum and chalazion
both can be treated with
warm compresses
abx (hordeolum topical, chalazion po)
(CME)
MC eye disease
conjunctivitis
viral or bac
(CME)
Presentation and tx differences b/w viral and bac conjunctivitis
viral: bilateral, copious water, preauricular adenopathy, treated w/ cool compress
bac: purulent drainage (yellow), treated with abx gtts (polymyxin B/ trimethoprim)
(CME)
why is gonococcal conjunctivitis an ophthalmologic emergency?
because of possible corneal perforation
(RR)
how do you recognize subconjunctival hemorrhage?
painless reddened eye w/o visual changes, and bleeding does not cross the limbus
(pt sneezed or coughed a small capillary rupture)
(RR)
three symptoms or PE exam findings common to glaucoma (open-angle glaucoma, which is 90% of all cases)
GRADUAL LOSS OF PERIPHERAL VISION
ENLARGED CUP-TO-DISK RATIO
DIMINISHED VISUAL FIELDS
(RR)
top two leading causes of blindness in US
1 - diabetic retinopathy
2 - open-angle glaucoma
(RR)
top three causes of otitis media in children
Strep pneumo, 15 - 25% of cases
2nd - Haemophilus influenzae
3rd - Moraxella catarrhalis, 15% of cases
(RR)
what imaging is done for suspected orbital cellulitis, even for children
CT scan of the orbit and sinuses
what is chemosis?
swelling of the conjunctiva that looks like a big blister, so big you can’t close your eyelid (visioncenter.org)
(RR)
“Which CN is involved if a pt is having difficulty moving her eye laterally?”
CN VI
(abducens)
(RR)
tx of orbital cellulitis
ophthalmology eval
broad spectrum abx
(RR)
“A previously healthy 55-year-old woman presents to your office with a complaint of vertigo that occurs with positional changes of her head. [What] structure is most likely to be involved?”
“POSTERIOR SEMICIRCULAR CANAL”
(RR)
What do you do for a pt w/ suspected malignant otitis externa?
CT scan of head w/ IV contrast
(CME)
RF for malignant external otitis
diabetics
immunocompromised pts
(CME)
Pathogenic etiology of malignant otitis externa
Pseudomonas aeruginosa
therefore, Tx = prolonged antipseudomonal abx (IV), +/- surgical debridement
(RR)
management of necrotizing (malignant) otitis externa
ciprofloxacin monotherapy
or
ciprofloxacin + antipseudomonal beta-lactam
(RR)
“Which CN is MC involved in malignant otitis externa?”
CN VII
(RR)
treatment of a perforated TM w/ minimal hearing loss and no vestibular symptoms
ofloxacin otic drops
(RR)
When do we f/u on perforated TM?
4 weeks later to assess hearing loss and TM healing
(RR)
TM perforation - what is the usual course?
90% heal in a few months
(RR)
What is true regarding treatment of Group A Strep pharyngitis and acute rheumatic fever and post-strep glomerulonephritis?
“Treatment prevents acute rheumatic fever but not post-streptococcal glomerulonephritis”
(RR)
What drugs can cause reversible sensorineural hearing loss?
salicylates (ASA)
“hearing loss related to salicylates, such as aspirin, is typically reversible once the agent is discontinued”
(RR)
pt shows signs of epiglottitis but lateral CT or lateral soft tissue neck radiograph does not show a thumbprint sign
retropharyngeal abscess
(prob not on PANCE?)
(RR)
untreated contact lens infection/conjunctivitis complication
bacterial keratitis
(“an infection of the cornea for which contact lens use is the greatest risk factor”)
(RR)
what is uveitis
“an inflammatory condition involving the uveal tract of the eye…commonly assoc’d w/ autoimmune conditions”
(RR)
how do you treat contact lens conjunctivitis?
topically -
- erythromycin ointment
- trimethoprim-polymyxin B drops
- ofloxacin drops
PO -
- FQs 2/2 increased risk of P. aeruginosa infection
(RR)
“which pathogen is commonly assoc’d w/ hyperacute conjunctivitis?”
Neisseria gonorrhoeae
(RR)
first line therapy for glaucoma
ophthalmic preparations of prostaglandin analogs such as LATANOPROST
(even w/ tx, 1 in 7 pts experience blindness in at least one eye w/in 20 yrs of diagnosis)
(RR)
“What is a nml intraocular pressure?”
12-22 mmHg
(CME)
s/s of acute angle-closure glaucoma
rapid onset
extreme pain
blurred vision w/ halos around lights
n/v
hard eye (tonometry >22 mmHg)
(CME)
Tx for acute angle-closure glaucoma
IV acetazolamide
IV mannitol
gtts beta blocker
miotic agent pilocarpine
(CME)
describe chronic open-angle glaucoma
90% of all glaucoma
slow bilat increase in IOP
slow loss of peripheral vision –> tunnel vision
cupping of the optic discs
(CME)
tx for chronic open-angle glaucoma
prostaglandin analogues (latanoprost)
beta blocking gtts (timolol)
pilocarpine
laser trabeculoplasty
(RR)
MC cause of cholesteatoma formation
prolonged eustachian tube dysfunction
(a squamous epithelium-filled sac of desquamated keratin forms)
(RR)
danger of cholesteatoma
erosion through the mastoid bone and destroy the ossicular chain (along w/ inner ear and facial n.)
(RR)
tx of cholesteatoma
refer to ENT for surgical marsupialization of the sac or its complete removal
(RR)
common hx of acquired cholesteatoma and s/s and PE
hx of chronic ear infections or tympanostomy tubes
painless otorrhea
PE - yellow or white mass BEHIND the TM
(RR)
why is a pt with inferior orbital wall fx unable to gaze upward?
entrapment of the extraocular m., specifically the inf rectus m.
(CME)
MC location for stone formation in sialolithiasis
and 2nd MC location
WHARTON’S DUCT = MC
2nd = STENSEN’S DUCT (parotid gland)
(RR)
how do you distinguish sialadenitis from sialolithiasis?
sialolithiasis DOES NOT usually include purulent ductal discharge
or
trismus
(RR)
both sialadenitis and sialolithiasis —>
both include local swelling, postprandial pain
both are a RF of Sjogren’s
(RR)
MC pathogenic cause of sialadenitis
S. aureus
(RR)
tx of sialadenitis
warm compress
gland massage
abx
sialogogs (like lemon drops)
(NCCPA practice exam)
a pt has a 6-mo hx of persistent dizziness, and abruptly turning his head worsens the dizziness. PE shows ataxic gait and vertical nystagmus. What is the most appropriate next step in management?
a) carotid doppler studies
b) EEG
c) electronystagmography
d) evoked response audiometry
e) MRI of the head
C) electronystagmography
(?? I think this is the right answer??)
(RR)
what is the most common finding on funduscopic exam of central retinal vein occlusion?
tortuous and dilated retinal v.v.
(RR)
central retinal vein occlusion hx and presentation
hx of HTN or DM
varying degree of sudden, painless monocular vision loss
(RR)
if a pt presents with dacryocystitis pain and swelling around the eye, and EOM are intact, vision is normal, what do you do next?
oral antibiotics
- clindamycin for mild cases
- vanc, 3rd gen cephalosporin for severe cases
(no CT scan is needed unless deeper infection is suspected)
(RR)
a 48 y/o M takes a softball to the eye and c/o visual changes floaters, light flashes, reduced brightness, mild pain. EOM intact in all directions. What is most likely diagnosis?
RETINAL DETACHMENT
can be observed after blunt eye injury
(vision change may be described as curtain-lowering sensation)
(RR)
what is first line therapy for allergic rhinitis (an IgE mediated illness)?
what if that doesn’t work?
intranasal corticosteroids
intranasal irrigation, decongestants, intranasal or oral antihistamines, such as azelastine, cromolyn or leukotriene receptor antagonists
(2nd gen antihistamines like azelastine are better than 1st gen like hydroxyzine)
(RR)
acute viral parotid gland infection is called ______ or _____
parotitis
or
mumps
(RR)
bilateral facial enlargement and fever, generalized warmth and tenderness just anterior to the ears near the temporomandibular joints, no vaccinations in childhood….think….
paramyxovirus mumps
classified by NONPROGRESSIVE PAROTID GLAND PAIN
(RR)
“A 55 y/o M presents w/ sudden onset of decreased vision and pain in his right eye. He reports vomiting twice prior to presentation. Examination reveals normal extraocular motions and a mid position pupil that does not react to light. What management should be pursued?”
TIMOLOL DROPS
these are s/s concerning for acute angle closure glaucoma
treat immediately w/ topical BB like timolol
(RR)
“What are the common findings found on fundoscopy in central retinal artery occlusion?”
“retinal edema w/ a pale appearance and a cherry-red spot representing the fovea”
(RR)
A 34 y/o M pt presents with a pale mass of granulation tissue near the pars flaccida. What is next step in management?
refer to otolaryngoloist
(RR)
“45 y/o M c/o ringing in his R ear w/ decreased hearing on the R side. He does not recall any trauma. On exam there is no cerumen impaction or carotid bruits. Audiographic evaluation confirms right-sided hearing loss only. What is the next step in evaluation and treatment?”
MRI of internal auditory canal
need to r/o acoustic neuroma
(RR)
“A 44 y/o F c/o dizziness, stating the room spins to the right every time she turns her head quickly. These episodes last three to five seconds and resolve on their own. Which of the following additional findings is most likely to be present in this patient?
a) horizontal nystagmus w/ Dix-Hallpike
b) low frequency hearing loss
c) reproduction of vertigo wtih tragal pressure
d) resolution of symptoms w/ Epley maneuver”
D) RESOLUTION OF SYMPTOMS W/ EPLEY MANEUVER
(Dix-Hallpike elicits rotational and vertical nystagmus, not horizontal nystagmus)
(CME)
herpes simplex keratitis - what tx is contraindicated?
NEVER USE TOPICAL CORTICOSTEROIDS
(you’ll suppress the immune system and the virus wins)
(CME)
RF for acute angle-closure glaucoma
elderly
Asian
hyperopia (far-sightedness)
