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PPP ROSH- EENT Flashcards

1
Q

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

A

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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2
Q

MC Sxs for Retinal Detachment

What is the recommended method of evaluation

What procedures may be performed to correct this

A

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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3
Q

Retinal detachment from ? location has a poor prognosis

MC location for epistaxis

Steps for stopping bleeds from this location

A

Macula

A: Kiesselbach plexus, P: sphenopalantine

Pressure x 10min
Oxymetazoline/Phenylephrine gauze pressure
Coke/Lidocaine application
Silver nitrate cautery

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4
Q

What arteries supply nose w/ blood supply

Acute mastoiditis is a complication from ?

How does infection spread from this infection to develop into mastoiditis

A

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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5
Q

Acute mastoiditis progresses into ? MC

What is the MC microbe to cause mastoiditis

First step in working up suspected mastoiditis

A

Acute mastoid steitis

Strep pneumo

CT

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6
Q

Define the Gradenigo Syndrome

When is the HIB vaccine series started

How does Orbital Cellulitis present

A

Supurative OM
Ipsilateral orbit pain
Palsy, abducens nerve palsy (CN6)

2mon

Restricted, painful movement
Inc IOP
Proptosis
Loss of vision

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7
Q

What are the MC microbes causing orbital cellulitis

MCC of Otitis Externa

How are mild/mod/sev cases Tx

A

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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8
Q

MCC of Chalazions

What causes these to develop

How are these different than Hordeolums

A

Obstructed meibomian/zeis gland

Above upper eye lid lashes

Near eye lash follicle d/t bacterial infection

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9
Q

Define Periapical Abscess

What ABX are used

These abscess are usually d/t ?

A

Infection of alveolar bone adjacent to tooth apex causing pain w/ percussion

Clinda/PCN VK

Dental carries

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10
Q

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

A

Maxillary sinus

Inferior alveolar- numbs all mandibular teeth to midline

Dec TM mobility

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11
Q

Three MC microbes causing AOM

How does a central vein occlusion present

What is the MC fundoscopic findings for Dx

A

Strep HFlu Moraxella

Sudden, painless vision loss

Torturous, dilated veins (blood and thunder) and retinal hemorrhages

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12
Q

How are Central Vein Occlusions Tx

How are Central Retinal Artery Occlusions identified on PE

Define Sialadenitis

A

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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13
Q

Sialadenitis is usually caused by ?

Define Sialolithiasis

What causes Mumps

A

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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14
Q

How would bacterial parotitis be differed from viral origin

Retained insects in EAC are immobilized w/?

When is saline syringe methods be avoided

A

Viral: non-progressive/short course in younger, healthy adult

Mineral oil/Lidocaine

Organic matter- risk of swelling

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15
Q

What causes Hereditary Angioedema

What will this look like on PE

How are Pts Tx

A

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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16
Q

MCC of Dacryocystitis

These infections are usually 2/2 ?

How are Pts Tx

A

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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17
Q

How is Thrush differed on PE from Hairy Leukoplakia

PO Candidiasis suggests CD4 levels below ?

How are Thrush Pts Tx

A

Hairy- can’t be scraped off

<100

Clotrimazole, Nystatin suspension
Refractory/Recurrent: Amphotericin, PO Fluconazole

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18
Q

? virus is associated w/ Kaposi Sarcomas

What causes corneal ulcers in Pts wearing contacts

What causes BPPV

A

HHV-8

Pseudomonas

Ca debris/Otoliths in posterior semi-circular canal

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19
Q

Triad for Menieres Dz

What causes clicking tinnitus

Define Oral Leukoplakia

A

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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20
Q

Define Hairy Leukoplakia

How do Schwannomas present

What underlying condition can cause Pts to present w/ bilateral schwannomas

A

Non-precancerous lesion d/t EBV in HIV Pts

SNHL Tinnitus Disequilibrium

NF-2

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21
Q

MCC of blindness in older Americans

What will be seen on PE

Diabetic retinopathy PE finding key terms

A

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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22
Q

What ABX are used during Tx of orbital cellulitis

Two MCCs of blindness in US

How does the 2nd MC present

A

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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23
Q

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

A

Iris and Cornea

Trabeculoplasty/ectomy

6-12hrs post tanning/snow blind/welder w/ pain, tearing, photophobia and foreign sensation

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24
Q

Define Pterygium

Define Pinguecula

Normal IOP ranges and ? measurement is considered elevated

A

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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25
Q

BPPV Sxs

Menieres Sxs

Vestibular Neuritis Sxs

Neuroma Sxs

Labyrinthitis Sxs

A

Short, positional

HL, Tinnitus

Vertigo for days, no auditory Sxs

Vertigo, HL, Tinnitus

HL, Tinnitus, Toxicity

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26
Q

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

A

Dilation of pupils- will prevent fluid from entering anterior chamber

Halos around lights

Steamy cornea, red eye, non-reactive pupil

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27
Q

How is acute angle closure glaucoma Tx empirically

How is this Tx systemically

A

Timolol- topical BB
Apraclonidine- topical A-agonist
Pilocarpine- miotic after IOP decreased

Acetazolamide- carbonic anhydrase inhibitor
Mannitol- osmotic diuretic

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28
Q

Bacterial conjunctivitis

Viral conjunctivitis

Allergic conjunctivitis

A

Acute, minimal pain/pruritus w/ d/c and chemosis (boggy conjunctiva)

Watery d/c w/ pruritus

Cobble stoning w/ redness and pruritus

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29
Q

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

A

Burows solution

Fluoroquinolones :Ciprocloxacin

Bacitracin-Polymyxin B
Erythromycin
TMP-Polymyxin B
Sufacetamide

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30
Q

How does Iritis present

How does Keratitis present

First line med for Tx of epiglottitis

A

Ciliary flush, Blurred vision, Clear cornea

Reactive pupil, not dilated like AACG

Ceftriaxone d/t Hflu or Anti-Staph to target MRSA

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31
Q

What will be seen on PE during Retinopathy

How is this Tx

Define Mucormycosis

A

Microaneurysms- earliest, Hypervascularization

Laser surgery- vitrectomy

Invasive infection of face by Rhizopus

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32
Q

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

A

Massage
Dec IOP: Acetazolamide, Mannitol
Dilators; Pentoxifylline Isosorbide Nitro
Anterior paracentesis

Coins

Trach: side/narrow view
Esophagus: frontal/broad view

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33
Q

? sinus cavity bordering the orbit is MC route of infection into the orbit

How does CMV retinitis present

What will be seen on fundoscopy

A

Ethmoid

CD4 <50w/ dec acuity, field defects, spots, floaters and photophobia

White, fluffy retinal lesion w/ necrosis

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34
Q

What meds would be given IV for Pts w/ CMV retinitis

How would HSV keratitis present

What causes HFM Dz

A

Ganciclovir* Valganciclovir Foscarnet

Foreign sensation, Photophobia, Pain w/ dendritic stain on cornea

Coxsackie A16

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35
Q

? vitamin supplementation can help reduce/slow macular degeneration

What at home test can Pts use

What PE finding suggests a globe puncture

A

A, C, E Zinc Copper

Amsler grid

Hyphema

36
Q

What are the 4 grades of hyphemas

What is the earliest sign of papilledema on fundoscopy

MCC of acute laryngitis

A

1: <1/3
2: 1/3-1/2
3: >1/2
4: “eight ball” hyphema

Loss of venous pulsations

Viral etiology

37
Q

? MedHx Dx increases the risk for developing a chalazion

How are blepharitis exacerbations Tx w/ ABX

What is added for severe exacerbations

A

Anterior blepharitis

Bacitracin, Erythromycin

Prednisolone

38
Q

MC complication of anterior blepharitis

Define Adie Pupil

How does bacterial tracheitis present

A

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

39
Q

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

A

Non-tender cyst anterior to SCM border

Lack of Neuro Sxs

Central: vertical
Peripheral: unidirectional/fatiguable

40
Q

Define Juvenile Nasopharyngeal Angiofibroma

Gram Pos cocci in clusters

Gram Pos bacilli

A

Adolescent boy w/ recurrent epistaxis and nasal obstructions

Staph

Corynebacterium Clostridium Listeria Bacillus

41
Q

Gram Neg bacilli

Gram Neg diplococci

What PE finding suggests a Dx of MS

A

Klebsiella Haemophilus EColi Pseudomonas

Neisseria Morexella Acinetobacter Brucella

Monocular loss of color vision (red) w/ afferent defect, normal/swollen disc

42
Q

Define Uhthoff Phenomenon

How are Aphthous Ulcers Tx

What DDx is considered if ulcers are persistent and non-healing

A

Transient worsening of vision w/ incresed body temp during MS

Tetracycline, Minocycline, Lidocaine, Triamcinolone

SCC

43
Q

How do retropharyngeal abscesses present

How are these Dx

What type of image is used

A

Drooling, Fever, Muffles voice, dec ROM w/ hyperextension

Preferred: CT w/ contrast
X-ray w/ prevertebral thick C2-4 >7mm

Neck extension, end inspiration

44
Q

Papilledema is AKA and defined as

What diuretic can be used in the Tx of Menieres Dz

Where are auditory receptors located

A

Optic disk edema; Inc ICP preserving vision and bilateral findings

Hydrochlorothiazide

Cochlea

45
Q

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

A

Vestibular labyrinthitis- prednisolone, benzos

Horizontal nystagmus, Pos head thrust

Ramsay Hunt Syndrome, Tx: Acyclovir

46
Q

How does Malignant Otitis Externa present

How is this Dx

Pts are kept on ABX until ?

A

Persistant, malodorous odor w/ granulation
CN 6, 7, 9-12 defects (CN7 first)

CT of auditory canal

Gallium scan shows dec inflammation

47
Q

MOA of Timolol and Betaxolol

MOA of Pilocarpine

Define Alvolar Osteitis

A

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

48
Q

How are Alveolar Abscesses Tx

What ABX can be used

What ABX are used for PTAs to cover ? MCC

A

Pack w/ iodoform gauze and eugenol oil- cloves

PCN VK, Clinda, Erythromycin, Doxy

Augmentin- strep pyogens

49
Q

First Generation Cephalosporins

Second generations

Third generation

Fourth generation

Fifth generation

A

Fa/Pha

Everything else

One/Ten/Me

Pi

Rol

50
Q

MCC of PTAs

MCC of chronic retropharyngeal abscesses

Define Dacryoadenitis

A

GAS

TB

Unilateral viral infection w/ supratemporal pain/swelling d/ lacrimal swelling

51
Q

What PE finding helps idffer Dacryocystitis from Dacryoadenitis

What two microbes cause NUG

How are Pts Tx

A

Cyst- epiphora: excessive tear overflow

Fusobacterium, Spriochetes (Borellia)

PCN, Clinda, Metro w/ H2O2 or Chlorhexidine

52
Q

What criteria makes AOM as severe

How does ophthalmia neonatorum present

How is this prevented

A

Mod/Sev otalgia
Otalgia >48hrs
Temp >102.2

Day 3 of life MC from chlamydia

Topical 0.5% erythromycin

53
Q

Two causes of blepharitis

How are avulsed permanent teeth Tx

How are these Tx if extraoral time involved

A

Meibomian dysfunction, Staph overgrowth

Reimplant immediatley

<60min: rinse and reimplant
>60min: citric acid/fluoride, consult OMFS

54
Q

Monospot test AKA ?

How can parotitis be differed from sialolithiasis

MC type of retinal detachment

A

Heterophile Ab test

Parotitis- pain is constant, irrelevant of eating

Rhegmatogenous

55
Q

? autosomal dominant condition has epistaxis as the predominant presenting c/c

Leading cause of blindness worldwide

How are these Tx

A

Osler Weber Rendu Dz (Hereditary Hemorrhagic Telangiectasia)

Cataracts

Phacoemulsification w/ artificial lens impants

56
Q

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

A-1 antagonists: Tamsulosin

Adenovirus- pre-auricular adenopathy

Choroid and retinal pigment layer

57
Q

What does a positive Seidel’s Sign mean

What pupil finding would be seen

What two maneuvers can help Tx BPPV along w/ Epleys

A

Globe perforation

Tear drop

Semont, Cawthorne

58
Q

MOA of cycloplegics

What type of nerve block is used for upper central incisor work

MCC of AOM

A

Relax ciliary muscles to prevent contractions/reduce photo response

Inferior orbital block

HFlu

59
Q

How does Wet Macular Degeneration cause visual impairment

How is this Tx

How long after removal of metal foreign bodies are rust rings removed

A

Neovascularizatiion and blood accumulation between choroid and retina

Bevacizumab, Ranibizumab

24-48hrs

60
Q

Why do PTAs present w/ trismus

How are infected piercings Tx

How are corneal ulcers Tx w/ ABX

A

Irritation induced spasm of internal pterygoid muscle

Levofloxacin

Topical fluoroquinolone

61
Q

What causes dendritic stain pattern of the eye

What other med can be used for Tx besides Acyclovir

What causes Herpes Opthalmicu

A

Herpes keratitis- trigeminal colonization by viraus

Trifluridine

Varicella zoster

62
Q

Labyrinthitis Sxs

How is this Tx

Primary ABX of choice to Tx GAS and alternatives for allergies

A

Unilateral HL Vertigo Instability N/V

Pred/Benzos for acute vertigo

PCN, Amox, 1st Gen Cephalosporins;
Azithro/Clinda-mycin

63
Q

S/e of posterior nasal packing

How are they best managed

What part of the ear are primary acquired cholesteatomas MC found

A

Bradycardia, Bronchoconstriction

Telemetry monitoring admission

Pars flaccida- superior aspect of TM

64
Q

How are tooth Fxs classified

? derm condition can cause recurrent hordeolums

How are TM perfs Tx

A

Ellis Class:

1: enamel only
2: enamel and dentin
3: pulp exposure

Rosacea

Non-conaminated environment: observe
Contaminated: Ofloxacin drops

65
Q

Loratadine

A

2nd gen antihisamine that selectively antagonizes peripheral H1 receptors

MC used to Tx mild/mod allergic rhinits and urticaria

MC s/e: HA

66
Q

First step in Tx of otitis externa

How are retropharyngeal abscesses Tx w/ ABX

Define parulis/gumboil

A

Debridement of EAC for topical ABX

3rd Gen Cephalosporin +Amp/Sulbactam or Clinda

Lesion from periapical abscess tracking to alveolar periosteum/gingival surface

67
Q

Atruamtic hyphema can indicate ? Dxs

What is used to Tx rhinosinusitis in PCN allergic PTs

Define Strabismus and the two types

A

Retinoblastoma, Melanoma

Doxy

Misalignment of visual axis:
Esotropia: convergent axis
Exotropia: divergent axis

68
Q

Define Amblyopia

? is the gold standard method to dx acute angle closure glaucoma

? non-cyclovir med can be used for HSV Tx

A

Dec visual acuity d/t visual deprivation

Gonioscopy

Docosanol- inhibits viral fusion w/ host cells

69
Q

? antiviral has the least frequent dosing schedule

MCC otitis media in Peds

MOA of Olopatadine

A

Valacyclovir

HFlu

Mast cell stabilizer and antihistamine for allergic conjunctivitis

70
Q

Define Otomycosis

What will Pts present w/ as c/c

How are they Tx

A

Primary fungal infection after Pt is Tx for bacterial infection

Ear pruritus w/ d/c and fullness

Clotrimazole or vinegar:water mixture

71
Q

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

A: eustachain P: mastoid air cells

Tongue w/ SCC

Cholesteatoma

72
Q

Weber test

Rinne test

A

Normal: no lateralization
Unilateral CHL: lats to affected side
Unilateral SNHL: lats to normal side

Normal AC>BC
CHL; BC>AC

73
Q

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

A

HSV-6

Pregnant

Phenytoin Cyclosporin Phenobarbital CCBs

74
Q

MCC of suppurative parotitis

What is used for Tx

What medication is used for Tx HSV keratitis

A

Staph A (psuedomonas if hospitalized)

Nafcillin w/ Metronidazole/Clinda
Amp-Sulbactam

Trifluridine

75
Q

What needs to be avoided when Tx conjunctivitis

MCC of orbital cellulitis

MC species to cause fungal otitis externa

A

Eye patching, CCS

Rhinosinusitis from Staph/Strep

Aspergillus

76
Q

Too much acetazolamide can lead to ? metabolic disturbance

? bacteria causes dental carries

Posterior nose packings need ? prophylaxis ABX

A

Metabolic acidosis

Strep mutans

Augmentin

77
Q

? 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

A

1st degree block

Peripheral vestibular nystagmus lesion on left side of body

Visual evoked potential test

78
Q

Define Pulfrich phenomenon

Define Pott Puffy Tumor

Define Blowout Fx

A

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

79
Q

What PE findings suggest blowout Fx

What radiographic sign may be seen

? type of nystagmus is seen w/ BPPV

A

Upward gaze diplopia, Dec EOM d/t inferior rectus entrapment

Tear drop: herniated tissue/muscle

Rotational and vertical

80
Q

Painful causes of vision loss

Painless vision loss

A 
Corneal abrasion/ulcer
Optic neuritis
Acute ACG
Temporal arteritis
Anterior uveitis
Iritis
Endopthalmitis
CRAO/CRVO
Detached retina
Vitreous hemorrhage
Amaurosis fugax
Macular degeneration
CVA
81
Q

Define Tullio Sign

Contact w/ ? side of the battery leads to perforation

Samter triad

A

Vertigo d/t loud noises from superior canal dehiscence

Negative pole

Polyps Asthma NSAID/ASA allergy

82
Q

Define Ectropion

CRAO needs to have ? possibility r/o for future issues

Define Lemierre Syndrome

A

Outward turning of lower lid d/t age

EKG- Afib induced emboli

Thrombophlebitis of internal jugular 2/2 oropharyngeal inflammation

83
Q

Define Endophthalmitis

What would be seen on PE

Cataracts present w/ ? color change

A

Inflammation/infection of intraocular cavities

Hypopyon- dependent pocket of pus in anterior chamber

Yellow tinted vision

84
Q

MCC of lens opacity during cataracts

MC complication from retropharyngeal abscesses

Target pH after chemical burn to eyes

A

Nuclear sclerosis cataract

Mediastinitis

7-7.4

85
Q

Epiglottitis will cause ? breathing noise to be heard on PE

Peds pneumonia w/ “shaggy heart” border

Normal caloric test results w/ normal vestibular function

A

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
86
Q

Define Doll’s Head Phenomenon

Two MCC of neonatal hearing loss

MC intracranial complication from AOM

A

Conjugate eye movement in opposite direction of head movement; absence means vestibular cause of nystagmus

Rubella, CMV

Meningitis

87
Q

How are Peds Tx for AOM who have past Amoxicillin rashes

A

Cefdinir

IPAP (212 decks)

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