PPP ROSH- EENT Flashcards by brandon lovin

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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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? 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

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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

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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

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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

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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

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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

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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

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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