PPP ROSH- EENT Flashcards
What is a classic ABX reaction that indicates an illness etiology d/t EBV
First/Second line therapy for allergic rhinitis
MCC of Cholesteatoma formations
Pruritic, maculopapular exanthem after starting Ampicillin/Amox/Cephalosporins (B-lactams)
1st- Fluticasone/2nd Gen- Cetirizine, Fexofenadine, Loratadine
2nd: PO antihistamine: Azelastine, Cromolyn, Leukotriene antagonist
Prolonged ET dysfunction
MC Sxs for Retinal Detachment
What is the recommended method of evaluation
What procedures may be performed to correct this
Painless central vision loss w/ floaters and peripheral photopsia (flashers)
Fundoscopic exam w/ photography
Pneumatic retinopexy
Cryo/Laser photocoagulation
Vitrectomy
Scleral buckle
Retinal detachment from ? location has a poor prognosis
MC location for epistaxis
Steps for stopping bleeds from this location
Macula
A: Kiesselbach plexus, P: sphenopalantine
Pressure x 10min
Oxymetazoline/Phenylephrine gauze pressure
Coke/Lidocaine application
Silver nitrate cautery
What arteries supply nose w/ blood supply
Acute mastoiditis is a complication from ?
How does infection spread from this infection to develop into mastoiditis
Internal carotid ethmoid branch
External carotid facial/maxillary branches
AOM d/t Strep pneumo
Aditus, Antrum- connection between middle ear and mastoid air cells
Acute mastoiditis progresses into ? MC
What is the MC microbe to cause mastoiditis
First step in working up suspected mastoiditis
Acute mastoid steitis
Strep pneumo
CT
Define the Gradenigo Syndrome
When is the HIB vaccine series started
How does Orbital Cellulitis present
Supurative OM
Ipsilateral orbit pain
Palsy, abducens nerve palsy (CN6)
2mon
Restricted, painful movement
Inc IOP
Proptosis
Loss of vision
What are the MC microbes causing orbital cellulitis
MCC of Otitis Externa
How are mild/mod/sev cases Tx
Staph, Strep pneumo
Pseudomonas > Strep epidermis
1st line: Neomycin/Polymyxin
Mild: Acetic acid/hydrocortisone
Mod: Cipro/hydrocortisone
Sev: Cipro/Hydro w/ wick placement
MCC of Chalazions
What causes these to develop
How are these different than Hordeolums
Obstructed meibomian/zeis gland
Above upper eye lid lashes
Near eye lash follicle d/t bacterial infection
Define Periapical Abscess
What ABX are used
These abscess are usually d/t ?
Infection of alveolar bone adjacent to tooth apex causing pain w/ percussion
Clinda/PCN VK
Dental carries
Untreated periapical abscess can lead to invasion into ? structure
What nerve is blocked for mandibular Tx
What PE finding has the strongest likelihood of an AOM Dx
Maxillary sinus
Inferior alveolar- numbs all mandibular teeth to midline
Dec TM mobility
Three MC microbes causing AOM
How does a central vein occlusion present
What is the MC fundoscopic findings for Dx
Strep HFlu Moraxella
Sudden, painless vision loss
Torturous, dilated veins (blood and thunder) and retinal hemorrhages
How are Central Vein Occlusions Tx
How are Central Retinal Artery Occlusions identified on PE
Define Sialadenitis
Triancinolone
Anti-vascular endothelial growth factor
Dexamethasone
Cherry red spot on fovea w/ afferent defect
Painful parotid/submandibular swelling after meals, pus expressed w/ massage
Sialadenitis is usually caused by ?
Define Sialolithiasis
What causes Mumps
Staph A infections
Calculus (MC Wharton) presents similar to sialadenitis but w/ palpable stone, less likely to express pus w/ massaging
Paramyxovirus via oral secretions
How would bacterial parotitis be differed from viral origin
Retained insects in EAC are immobilized w/?
When is saline syringe methods be avoided
Viral: non-progressive/short course in younger, healthy adult
Mineral oil/Lidocaine
Organic matter- risk of swelling
What causes Hereditary Angioedema
What will this look like on PE
How are Pts Tx
C1 esterase inhibitor deficiency leading to increased bradykinin production
Deeper tissue swells w/out superficial skin color changes or pruritus
FFPlasma- contains C1 inhibitor
MCC of Dacryocystitis
These infections are usually 2/2 ?
How are Pts Tx
Staph A- pain, swelling, warmth around lacrimal sac w/ drainage expressed from duct
Ocstructed nasolacrimal system
Mild: Clinda
Sev: Vanc, 3rd Gen Cephalosporin
How is Thrush differed on PE from Hairy Leukoplakia
PO Candidiasis suggests CD4 levels below ?
How are Thrush Pts Tx
Hairy- can’t be scraped off
<100
Clotrimazole, Nystatin suspension
Refractory/Recurrent: Amphotericin, PO Fluconazole
? virus is associated w/ Kaposi Sarcomas
What causes corneal ulcers in Pts wearing contacts
What causes BPPV
HHV-8
Pseudomonas
Ca debris/Otoliths in posterior semi-circular canal
Triad for Menieres Dz
What causes clicking tinnitus
Define Oral Leukoplakia
SNHL Tinnitus Vertigo (Aural fullness) lasting ≥20min
Palatal myoclonus
Pre-malignant, non-removeable d/t tobacco; cases persisting >2wks need biopsy
Define Hairy Leukoplakia
How do Schwannomas present
What underlying condition can cause Pts to present w/ bilateral schwannomas
Non-precancerous lesion d/t EBV in HIV Pts
SNHL Tinnitus Disequilibrium
NF-2
MCC of blindness in older Americans
What will be seen on PE
Diabetic retinopathy PE finding key terms
ARMD- distorted, wavy central vision w/ difficult night vision and reading faces, preserved peripheral vision
Drusens: yellow sub-retinal deposits
Cotton Wool Spots, Flame hemorrhages
What ABX are used during Tx of orbital cellulitis
Two MCCs of blindness in US
How does the 2nd MC present
Vanc and Ceft/Amp:
Vanc- MRSA coverage
Ceftriax- anti-Staph/Strep
Amp-Sulbactam- no Staph/Strep concern
Diabetic retinopathy > Open angle glaucoma
Peripheral field loss, enlarged cup-disc ratio, inc IOP
Closed Angle Glaucoma is d/t dec drainage between ? two structures
What procedure is used for Open Angle when medical Tx fails
How does UV keratitis present
Iris and Cornea
Trabeculoplasty/ectomy
6-12hrs post tanning/snow blind/welder w/ pain, tearing, photophobia and foreign sensation
Define Pterygium
Define Pinguecula
Normal IOP ranges and ? measurement is considered elevated
Triangluar wedge extending medially into cornea d/t sun exposure
Yellow, raised lesion w/out progression onto cornea
8-21mmHg, >30mm
BPPV Sxs
Menieres Sxs
Vestibular Neuritis Sxs
Neuroma Sxs
Labyrinthitis Sxs
Short, positional
HL, Tinnitus
Vertigo for days, no auditory Sxs
Vertigo, HL, Tinnitus
HL, Tinnitus, Toxicity
What PE test is c/i in acute closed angle glaucoma
Pts will present w/ sudden onset of pain and report ?
What will be seen on PE
Dilation of pupils- will prevent fluid from entering anterior chamber
Halos around lights
Steamy cornea, red eye, non-reactive pupil
How is acute angle closure glaucoma Tx empirically
How is this Tx systemically
Timolol- topical BB
Apraclonidine- topical A-agonist
Pilocarpine- miotic after IOP decreased
Acetazolamide- carbonic anhydrase inhibitor
Mannitol- osmotic diuretic
Bacterial conjunctivitis
Viral conjunctivitis
Allergic conjunctivitis
Acute, minimal pain/pruritus w/ d/c and chemosis (boggy conjunctiva)
Watery d/c w/ pruritus
Cobble stoning w/ redness and pruritus
What solution contains aluminum acetate and dec inflammation d/t otits externa
Bacterial conjunctivitis d/t Pseudo is Tx w/ ?
How is bacterial conjunctivitis w/out contact wear Tx
Burows solution
Fluoroquinolones :Ciprocloxacin
Bacitracin-Polymyxin B
Erythromycin
TMP-Polymyxin B
Sufacetamide
How does Iritis present
How does Keratitis present
First line med for Tx of epiglottitis
Ciliary flush, Blurred vision, Clear cornea
Reactive pupil, not dilated like AACG
Ceftriaxone d/t Hflu or Anti-Staph to target MRSA
What will be seen on PE during Retinopathy
How is this Tx
Define Mucormycosis
Microaneurysms- earliest, Hypervascularization
Laser surgery- vitrectomy
Invasive infection of face by Rhizopus
How can central artery occlusions be Tx
MC foreign body ingestion of Peds
How can images tell if item is caught in trachea or esophagus
Massage
Dec IOP: Acetazolamide, Mannitol
Dilators; Pentoxifylline Isosorbide Nitro
Anterior paracentesis
Coins
Trach: side/narrow view
Esophagus: frontal/broad view
? sinus cavity bordering the orbit is MC route of infection into the orbit
How does CMV retinitis present
What will be seen on fundoscopy
Ethmoid
CD4 <50w/ dec acuity, field defects, spots, floaters and photophobia
White, fluffy retinal lesion w/ necrosis
What meds would be given IV for Pts w/ CMV retinitis
How would HSV keratitis present
What causes HFM Dz
Ganciclovir* Valganciclovir Foscarnet
Foreign sensation, Photophobia, Pain w/ dendritic stain on cornea
Coxsackie A16
? vitamin supplementation can help reduce/slow macular degeneration
What at home test can Pts use
What PE finding suggests a globe puncture
A, C, E Zinc Copper
Amsler grid
Hyphema
What are the 4 grades of hyphemas
What is the earliest sign of papilledema on fundoscopy
MCC of acute laryngitis
1: <1/3
2: 1/3-1/2
3: >1/2
4: “eight ball” hyphema
Loss of venous pulsations
Viral etiology
? MedHx Dx increases the risk for developing a chalazion
How are blepharitis exacerbations Tx w/ ABX
What is added for severe exacerbations
Anterior blepharitis
Bacitracin, Erythromycin
Prednisolone
MC complication of anterior blepharitis
Define Adie Pupil
How does bacterial tracheitis present
Recurrent conjunctivitis
PNS denervation causing poor constriction to light, reacts to accomodation
Croup-like prodrome d/t Staph A w/ Pt rapidly becoming sicker/toxic appearing
Define Brachial Cleft Cyst
What PE findings is most indicative of a BPPV Dx
? type of nystagmus is seen w/ central/peripheral etiologies of vertigo
Non-tender cyst anterior to SCM border
Lack of Neuro Sxs
Central: vertical
Peripheral: unidirectional/fatiguable
Define Juvenile Nasopharyngeal Angiofibroma
Gram Pos cocci in clusters
Gram Pos bacilli
Adolescent boy w/ recurrent epistaxis and nasal obstructions
Staph
Corynebacterium Clostridium Listeria Bacillus
Gram Neg bacilli
Gram Neg diplococci
What PE finding suggests a Dx of MS
Klebsiella Haemophilus EColi Pseudomonas
Neisseria Morexella Acinetobacter Brucella
Monocular loss of color vision (red) w/ afferent defect, normal/swollen disc
Define Uhthoff Phenomenon
How are Aphthous Ulcers Tx
What DDx is considered if ulcers are persistent and non-healing
Transient worsening of vision w/ incresed body temp during MS
Tetracycline, Minocycline, Lidocaine, Triamcinolone
SCC
How do retropharyngeal abscesses present
How are these Dx
What type of image is used
Drooling, Fever, Muffles voice, dec ROM w/ hyperextension
Preferred: CT w/ contrast
X-ray w/ prevertebral thick C2-4 >7mm
Neck extension, end inspiration
Papilledema is AKA and defined as
What diuretic can be used in the Tx of Menieres Dz
Where are auditory receptors located
Optic disk edema; Inc ICP preserving vision and bilateral findings
Hydrochlorothiazide
Cochlea
Vertigo and Tinnitus after URI indicates ? Dx and how is it Tx
What two PE findings aid w/ Dx
Vertigo w/ vesicles on/in EAC suggest ? Dx
Vestibular labyrinthitis- prednisolone, benzos
Horizontal nystagmus, Pos head thrust
Ramsay Hunt Syndrome, Tx: Acyclovir
How does Malignant Otitis Externa present
How is this Dx
Pts are kept on ABX until ?
Persistant, malodorous odor w/ granulation
CN 6, 7, 9-12 defects (CN7 first)
CT of auditory canal
Gallium scan shows dec inflammation
MOA of Timolol and Betaxolol
MOA of Pilocarpine
Define Alvolar Osteitis
Non-sel B-antagonists to dec aqueous humor production
Cholinergic- miosis, inc aqueous drainage
Dry socket: day 3-4 post-dental extraction d/t premature loss of blood clot
How are Alveolar Abscesses Tx
What ABX can be used
What ABX are used for PTAs to cover ? MCC
Pack w/ iodoform gauze and eugenol oil- cloves
PCN VK, Clinda, Erythromycin, Doxy
Augmentin- strep pyogens
First Generation Cephalosporins
Second generations
Third generation
Fourth generation
Fifth generation
Fa/Pha
Everything else
One/Ten/Me
Pi
Rol
MCC of PTAs
MCC of chronic retropharyngeal abscesses
Define Dacryoadenitis
GAS
TB
Unilateral viral infection w/ supratemporal pain/swelling d/ lacrimal swelling
What PE finding helps idffer Dacryocystitis from Dacryoadenitis
What two microbes cause NUG
How are Pts Tx
Cyst- epiphora: excessive tear overflow
Fusobacterium, Spriochetes (Borellia)
PCN, Clinda, Metro w/ H2O2 or Chlorhexidine
What criteria makes AOM as severe
How does ophthalmia neonatorum present
How is this prevented
Mod/Sev otalgia
Otalgia >48hrs
Temp >102.2
Day 3 of life MC from chlamydia
Topical 0.5% erythromycin
Two causes of blepharitis
How are avulsed permanent teeth Tx
How are these Tx if extraoral time involved
Meibomian dysfunction, Staph overgrowth
Reimplant immediatley
<60min: rinse and reimplant
>60min: citric acid/fluoride, consult OMFS
Monospot test AKA ?
How can parotitis be differed from sialolithiasis
MC type of retinal detachment
Heterophile Ab test
Parotitis- pain is constant, irrelevant of eating
Rhegmatogenous
? autosomal dominant condition has epistaxis as the predominant presenting c/c
Leading cause of blindness worldwide
How are these Tx
Osler Weber Rendu Dz (Hereditary Hemorrhagic Telangiectasia)
Cataracts
Phacoemulsification w/ artificial lens impants
What medication increases risk for floppy iris syndrome during cataract surgery
MCC of conjunctivitis in adults and what PE finding supports
Retina attaches to ?
A-1 antagonists: Tamsulosin
Adenovirus- pre-auricular adenopathy
Choroid and retinal pigment layer
What does a positive Seidel’s Sign mean
What pupil finding would be seen
What two maneuvers can help Tx BPPV along w/ Epleys
Globe perforation
Tear drop
Semont, Cawthorne
MOA of cycloplegics
What type of nerve block is used for upper central incisor work
MCC of AOM
Relax ciliary muscles to prevent contractions/reduce photo response
Inferior orbital block
HFlu
How does Wet Macular Degeneration cause visual impairment
How is this Tx
How long after removal of metal foreign bodies are rust rings removed
Neovascularizatiion and blood accumulation between choroid and retina
Bevacizumab, Ranibizumab
24-48hrs
Why do PTAs present w/ trismus
How are infected piercings Tx
How are corneal ulcers Tx w/ ABX
Irritation induced spasm of internal pterygoid muscle
Levofloxacin
Topical fluoroquinolone
What causes dendritic stain pattern of the eye
What other med can be used for Tx besides Acyclovir
What causes Herpes Opthalmicu
Herpes keratitis- trigeminal colonization by viraus
Trifluridine
Varicella zoster
Labyrinthitis Sxs
How is this Tx
Primary ABX of choice to Tx GAS and alternatives for allergies
Unilateral HL Vertigo Instability N/V
Pred/Benzos for acute vertigo
PCN, Amox, 1st Gen Cephalosporins;
Azithro/Clinda-mycin
S/e of posterior nasal packing
How are they best managed
What part of the ear are primary acquired cholesteatomas MC found
Bradycardia, Bronchoconstriction
Telemetry monitoring admission
Pars flaccida- superior aspect of TM
How are tooth Fxs classified
? derm condition can cause recurrent hordeolums
How are TM perfs Tx
Ellis Class:
1: enamel only
2: enamel and dentin
3: pulp exposure
Rosacea
Non-conaminated environment: observe
Contaminated: Ofloxacin drops
Loratadine
2nd gen antihisamine that selectively antagonizes peripheral H1 receptors
MC used to Tx mild/mod allergic rhinits and urticaria
MC s/e: HA
First step in Tx of otitis externa
How are retropharyngeal abscesses Tx w/ ABX
Define parulis/gumboil
Debridement of EAC for topical ABX
3rd Gen Cephalosporin +Amp/Sulbactam or Clinda
Lesion from periapical abscess tracking to alveolar periosteum/gingival surface
Atruamtic hyphema can indicate ? Dxs
What is used to Tx rhinosinusitis in PCN allergic PTs
Define Strabismus and the two types
Retinoblastoma, Melanoma
Doxy
Misalignment of visual axis:
Esotropia: convergent axis
Exotropia: divergent axis
Define Amblyopia
? is the gold standard method to dx acute angle closure glaucoma
? non-cyclovir med can be used for HSV Tx
Dec visual acuity d/t visual deprivation
Gonioscopy
Docosanol- inhibits viral fusion w/ host cells
? antiviral has the least frequent dosing schedule
MCC otitis media in Peds
MOA of Olopatadine
Valacyclovir
HFlu
Mast cell stabilizer and antihistamine for allergic conjunctivitis
Define Otomycosis
What will Pts present w/ as c/c
How are they Tx
Primary fungal infection after Pt is Tx for bacterial infection
Ear pruritus w/ d/c and fullness
Clotrimazole or vinegar:water mixture
Middle ear communicates anteriorly via ? and posteriorly via ?
MC location for the MC type of oral cancer to be found
What Dx is considered when Pt is Dx and evaluated for AOM, retreated w/ higher ABX for AOM and is still Sxs
A: eustachain P: mastoid air cells
Tongue w/ SCC
Cholesteatoma
Weber test
Rinne test
Normal: no lateralization
Unilateral CHL: lats to affected side
Unilateral SNHL: lats to normal side
Normal AC>BC
CHL; BC>AC
Aphthous ulcer/Canker sores are commonly d/t ? virus
When would thalidomide be inappropriate for these Pts Tx
? meds have been known to cause gingival hyperplasia
HSV-6
Pregnant
Phenytoin Cyclosporin Phenobarbital CCBs
MCC of suppurative parotitis
What is used for Tx
What medication is used for Tx HSV keratitis
Staph A (psuedomonas if hospitalized)
Nafcillin w/ Metronidazole/Clinda
Amp-Sulbactam
Trifluridine
What needs to be avoided when Tx conjunctivitis
MCC of orbital cellulitis
MC species to cause fungal otitis externa
Eye patching, CCS
Rhinosinusitis from Staph/Strep
Aspergillus
Too much acetazolamide can lead to ? metabolic disturbance
? bacteria causes dental carries
Posterior nose packings need ? prophylaxis ABX
Metabolic acidosis
Strep mutans
Augmentin
? type of heart block is consistent w/ acute rheumatic fever
Unidirectional nystagmus w/ fast phase directed to the right side means ?
How is optic neuritis viewed w/ imaging
1st degree block
Peripheral vestibular nystagmus lesion on left side of body
Visual evoked potential test
Define Pulfrich phenomenon
Define Pott Puffy Tumor
Define Blowout Fx
Optic neuritis Sx when objects moving in straight line appear to be moving along curved trajectory
Osteomyelitis of frontal bone d/t complication from sinusitis
Maxillary bone Fx of inferior orbital wall MC from direct, blunt trauma
What PE findings suggest blowout Fx
What radiographic sign may be seen
? type of nystagmus is seen w/ BPPV
Upward gaze diplopia, Dec EOM d/t inferior rectus entrapment
Tear drop: herniated tissue/muscle
Rotational and vertical
Painful causes of vision loss
Painless vision loss
Corneal abrasion/ulcer Optic neuritis Acute ACG Temporal arteritis Anterior uveitis Iritis Endopthalmitis
CRAO/CRVO Detached retina Vitreous hemorrhage Amaurosis fugax Macular degeneration CVA
Define Tullio Sign
Contact w/ ? side of the battery leads to perforation
Samter triad
Vertigo d/t loud noises from superior canal dehiscence
Negative pole
Polyps Asthma NSAID/ASA allergy
Define Ectropion
CRAO needs to have ? possibility r/o for future issues
Define Lemierre Syndrome
Outward turning of lower lid d/t age
EKG- Afib induced emboli
Thrombophlebitis of internal jugular 2/2 oropharyngeal inflammation
Define Endophthalmitis
What would be seen on PE
Cataracts present w/ ? color change
Inflammation/infection of intraocular cavities
Hypopyon- dependent pocket of pus in anterior chamber
Yellow tinted vision
MCC of lens opacity during cataracts
MC complication from retropharyngeal abscesses
Target pH after chemical burn to eyes
Nuclear sclerosis cataract
Mediastinitis
7-7.4
Epiglottitis will cause ? breathing noise to be heard on PE
Peds pneumonia w/ “shaggy heart” border
Normal caloric test results w/ normal vestibular function
Inspiratory stridor
Pertussis pneumonia
COWS: cold opposite, warm same Cold water R ear= nystagmus to left Cold: mimics head turn to opposite side Warm: mimics hear turn to same side Abnormal results= dysfunction to side tested
Define Doll’s Head Phenomenon
Two MCC of neonatal hearing loss
MC intracranial complication from AOM
Conjugate eye movement in opposite direction of head movement; absence means vestibular cause of nystagmus
Rubella, CMV
Meningitis
How are Peds Tx for AOM who have past Amoxicillin rashes
Cefdinir
