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5. EENT Flashcards

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1
Q

Bacterial Conjunctivitis

Pathogen/SX/PE/TX/Lens wearer

A
  • Pathogen: Staph A
  • Sx: Crusting, worst in the morning, discharge
  • PE: Purulent yellow
  • Tx: Erythromycin
  • Lens wearer for long time: Psudomonas, Tx: Cipro
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2
Q

Allergic conjuctivitis

SX/PE/TX/Lens wearer

A
  • Sx: itch
  • PE: Cobblestone
  • Tx: olopatadine
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3
Q

Viral conjunctivitis

Pathogen/Sx/PE/Tx

A
  • Pathogen: adenovirus
  • Sx: bilateral pink eye
  • PE: copious watery discharge, scant mucoid
  • Tx: Supportive (cool compress, itch for antihistamine)
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4
Q

Chlamydia/Gonorrhea conjunctivitis

Pathogen/Patient/PE/Dx/Tx

A
  • Pathogen: chlamydia
  • Patient: Neonate (5-14D old), 0-5D old - gonorrhea
  • PE: eye swelling, mucopurent discharge
  • Dx: culture
  • Tx: Oral erythromycin
  • Tx for gonorrhea: Oint erythromycin
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5
Q

Bacterial vs Iritis vs keratitis vs acute close glaucoma

A

Bacterial: Normal vision, discharge

Iritis: blurred vision, pupil constrict, pain

Keratitis: Blurred vision, severe pain

Acute-closure glaucoma: Coudy, dilated pupil

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6
Q

Cataract

Patient/Sx/PE/Tx/Comment

A

Patient: Old

Sx: gradual blurred vision

PE: Cloudy lens

Tx: Remove and replace lens

Comment: MC blindness in elders

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7
Q

Corneal Ulcer

Pathogen/Hx/PE/Dx/Tx

A
  • Pathogen: Staphy, Lens wearer - Pseudomona
  • Hx - trauma, lens
  • PE: Ragged edge
  • Dx: Flurescein stain
  • Tx: ER consult
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8
Q

Ultraviolet keratitis

Patient/Sx/PE/Tx

A
  • Patient: Welder, Skier
  • Sx: bilateral vision acuity decrease
  • PE: mutiple punctate lesion
  • Dx: Fluoresein stain
  • Tx: NSAID
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9
Q

Herpe simplex Keratitis

Pathogen/Clonize/PE/Tx

A
  • Pathogen: HSV
  • Colonize: trigeminal ganglion (V1)
  • PE: Slit lamp (dedrite)
  • Tx: Acyclovir
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10
Q

Pterygium

Hx/PE/Tx

Pinguecula

PE

A
  • Hx: Sunlight, sandy, windy, dusty
  • PE: triangular shape cornea involve
  • Tx: Observe
  • Yellow fleshy mass on conjuntiva but do no involve cornea
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11
Q

Dacryocytitis vs Dacryoadenitis

Cause/Location/Sx/Complication/Tx

A
  • Cause: infection of lacrimal gland
  • Location: Supratemporal (adenitis), inframedial (cyctitis)
  • Sx: Pain, swelling
  • Complication: preseptal, orbital cellulitis
  • Tx: Mild - clinda, Severe - vancomycin
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12
Q

Blepharitis

Cause/Sx/PE/Dx/Tx

A
  • Cause: dyfunction of meibomian gland
  • PE: Scaling, red-rimming
  • Dx: Slit-lamp exam
  • Tx: Warm compress, abx for flare up: erythromycin
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13
Q

Hordeolum vs Chalazion

Cause/Sx/Location/Tx

A

Hordeolum

  • Cause: MC bacterial infection
  • Sx: Painful
  • Location: near foliicle
  • Tx: Warm compress + I&D

Chalazion

  • Cause: MC
  • Sx: Painless
  • Location: upper lid
  • Tx: Warm compress (if prolonged I&D)
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14
Q

Ectropion vs Entropion

PE/Tx

A
  • Entropion: inward, surgical fix
  • Ectropion: outward, surgical fix
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15
Q

Nystagmus

Up/down, horizontal, gaze-evoke

A
  • Down/up: CNS dysfunction
  • Horizontal: labyrinth or vestibular
  • Gaze-evoke: MC and often benign
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16
Q

Optic neuritis

Cause/Related Dx/Medication/Sx/PE/Dx/Tx

A
  • Cause: demyelinating inflammation of the optic nerve
  • Related dz: MS (multiple sclerosis)
  • Medication: ethambutal
  • Sx: pain with movement + Mono vision loss (red color)
  • PE: Marcus-gunn pupil
  • Dx: MRI
  • Tx: Methyprednisone (return to normal if tx)
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17
Q

Papilledema

Cause/Sx/PE/Tx

A
  • Casue: ICP high
  • Sx: Sudden HA, blurred vision
  • PE: optic disk swelling
  • Tx: Acetazolamide
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18
Q

Orbital cellulitis

Cause/PE/Dx/Tx/Preseptic difference

A
  • Cause: infection by bacterial rhinosinusitis
  • PE: Pain with move
  • Dx: CT scan
  • Tx: IV vanco + ceftx
  • Preseptic: Normal vision, No pain
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19
Q

Macular degeneration

2type/Onset/Risk factor/Sx/PE/Dx/Tx

A
  • 2 type: dry and wet
    • Dry - drugen (waste pile up)
    • Wet - abnormal vessel
  • Onset
    • Dry - gradual
    • Wet - sudden
  • Risk factor: age< 50
  • Sx: Center vision loss, wavy or bent vision
  • Dx: Amsler grid (dry), Fluorescein angio (wet)
  • Tx: Dry - Zinc ACE vitamin, Wet - zumab meds
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20
Q

Retinal detachment

Cause/Sx/Dx/Tx/Avoid/Other confuse dz

A
  • Cause: Retinal tear
  • Sx: Painless Curtain down vision loss, flash, floater
  • Dx: Fundoscpy - white folds
  • Tx: Optho ER
  • Avoid: No miotic drop
  • Confused dz: amaurosis fugax - curtain lift up
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21
Q

Diabetic retinopathy

Hx/Sx/PE/Tx

A
  • Hx: DM
  • Sx: Progressive vision loss
  • PE: Microaneurysms
  • Tx: DM control, laser surgery or vitrectomy
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22
Q

Retinoblastoma

Cause/PE/Comment

A
  • Cause: loss of retinoblastoma gene
  • PE: white pupil (leukocoria) + no red reflex
  • Comment: MC eye tumor in children
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23
Q

Orbital floor fx

Cause/Muscle trapped/MC site/Sx/Dx/Tx/Avoid

A
  • Cause: Trauma
  • Muscle trapped: inferior rectus
  • MC site: Maxillary
  • Sx: limited upward gaze
  • Dx: CT scan
  • Tx: Nasal decon, corticosteriod, abx, surgery
  • Avoid: Do not blow nose,
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24
Q

Corneal Abrasion

Cause/Sx/Dx/Tx

A
  • Cause: Trauma
  • Sx: Foreign body sensation, pain
  • Dx: Slit exam (dye)
  • Tx
    • if lens wearer - Cipro
    • abrasion - abx, if more than 5 mm use patch for 24hr only
    • Rust ring - wait 24 hour to remove
    • just foregin body - remove
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25
Globe Rupture Cause/PE/Dx/Tx/Avoid
* Cause: Trauma * PE: teardrop pupil, hyphema * Dx: CT * Tx: Emergency * Avoid: IOP meansure
26
Hyphema Cause/PE/Tx
* Cause: Trauma * PE: blood in the anterior chamber * Tx: eye protection + head of bed at 30-45 degree
27
CRAO vs CRVO Cause/sx/Dx/Tx
CRAO * Cause: atherosclerotic dz (OPTHALMO ER) * Sx: sudden mono vision loss, NO pain * Dx: fundoscopy (cherry red spot) * Tx: Immediate ophthalmology consult + Lower IOP CRVO * Cause: hx of HTN, DM * Sx: sudden mono vision loss, NO pain * Dx: Fundoscopy (thunder and blood), tort * Tx: Ophtalmology consult
28
Amaurosis fugax Cause/Sx
* Cause: Embolism * Sx: curtain lift up or vertical curtain coming down
29
Glaucoma (open vs close) Cause/Sx/PE/Dx/Tx
Open * Cause: slow bloackage of drainage canal * Sx: slow painless peripheral vision loss (tunnel) * PE: Cupping of optic disk * Tx: Prostaglandin (if med fail laser surgery) Close * Cause: Fast blockage of drainage canal * Sx: Sudden painful vision loss * PE: fixed pupil, cloudy cornea * Dx: Tonometry (IOP \>21) * Tx: Timolol (reduce IOP 1st)
30
Strabismus Cause/4 type/Dx/Tx
* Cause: muscle misalignment * Type * Esotropia - in * Exotropia - out * Hypertropia - up * Hypotropia - down * Dx: Cover/Uncover test (hirshberg) * Tx: Patchy, surgical
31
Chemical burn Type/Tx
* Ophtho Emergency * Type * Alkali burn - worse than acid, denature protein * Acid burn - coagulative necrosis * Tx * Irrigation with Lactaed ringers or Normal saline * PH & visual acuity after irrigation * ABX - moxifloxacin
32
Scleritis Casue/hx/Dx/Tx
* Cause: inflammation (may vision loss) * Hx: Autoimmune dz (RA, SLE) * Sx: Deep eye pain, hyperemic (blood vessel shows), necrotizing if severe * Dx: Slit exam * Tx: Prednisone Oral
33
Amblyopia Cause/Risk/Sx/Dx/Tx
* Cause: Brain favors one of eye, (if dont tx, brain start ignored bad eye blurred vision which lead to vision impairtment) * Risk: child * Sx: One eye blurred, one eye vision clear * Dx: Eye exam * Tx: Patchy therapy, atropine drop to good eye * Concept is try to use blurre vision only
34
Cerumen impaction Cause/Tx
* Cause: conductive hearing * Tx: carbamide peroxide, irrigation, manual removal
35
Otitis externa Cause/Hx/Sx/PE/Tx/Complication
* Cause: Infection Pseudomonas * Hx: swimming * Sx: Malodorous discharge * PE: tenderness pinna or tragus * Tx: Cipro * Complication Nacrotizing OE * Immunosupressant pt * Tx: IV piperacilin or ceftazidime + FQ
36
Auricular hematoma Cause/PE/Tx
* Cause: Blunt trauma * PE: Cartilage thicken (cauliflower ear) * Tx: I&D if less than 7 days + cephalexin * More than 7 days ENT f/u
37
Acoustic neruroma (vestibular schwannoma) Cause/Sx/Dx/Tx
* Cause: Tumor in CN 8 * Sx: Gradual hearing loss (sensorineural hearing) * Dx: MRI * Tx: Surgery
38
Barotitis Cause/Hx/Tx
* Cause: Rapid pressure change, ET can't equalize * Hx: flying or diver * Tx: Autoinsufflation (swallowing, yawning), decongestant
39
Vertigo 4type/Cause/Dx/Tx
1. BBPV * Cause: displaced otolith * Sx: Episodic Dizz + No hearing loss * Dx: Dix Hallpike (30 -\>90 spinned head, check delayed nystagmus (POSITIVE) * Tx: Epley Maneuver 2. Meniere * Cause: Inner ear distended by Excessive fluid * Sx: Episodic Dizz + hearing loss + tinnitus * Tx: Vestibular rehap (main) + remove fluid (Low salt diet and diuretic) + Meclizine (dizz) 3. Vestibular Neuronitis * Cause: Inflammation of vestibular by virus * Sx: Continue Dizz + No hearing loss * Tx: Corticosteriod + Meclizine 4. Labyrinthitis * Cause: infection, recent URI at cochlear * Sx: Continue Dizz + Hearing loss + Tinnitus * Tx: Corticosteriod + Meclizine
40
Difference Central vs Peripheral vertigo Onset/Head position/Nystagmus/Neuro Finding
Central * Gradual * Minimal effect by head position * Bidirection of nystagmus * Neurologic finding Peripheral * Sudden * Worsen by head position * Unidirection of nystagmus (never vertical) * No neruologic finding
41
Cholesteatoma Cause/Sx/PE/Tx
* Cause: chronic ET * Sx: painless otorrhea and conductive hearing loss * Dx: mass behind TM by otoscopy * Tx: TM surgery
42
Dysfunction of ET Cause/Sx/Dx/Tx
* Cause: URI or allergy * Sx: Ear poping or fullness * Dx: Otoscopy (normal) * Tx: Decongestant
43
Acute Otitis Media Cause/Sx/Dx/Tx/PCN allergy/can't afford
* Cause: infection (Staphy Pneumo, H flu, Morax cat, Strep pyo) * Sx: Ear pain * Dx: Otoscopy (red bulging TM) * Tx: Amox (1st) -\> PCN allergy (Cefixime, cefidinir) * Persistant (augmentin) -\> Clinda + Cefixrme or cefidinir * If anyone can't afford abx -\> acetic drop
44
Chronic OM Cause/Hx/Tx
* Cause: Pseudomona, Staph A * Hx: Persistant OM several times * Tx: Ofloxacin * Perforated TM: keep clean, no aminoglycoside
45
TM perforation Sx/Tx
* Sx: sudden pain with hearing loss * Tx: Most heal its own, if need Ofloxacin
46
Conductive hearing vs Sensorineural hearing loss Explain/Example
Conductive * Webber test (lateralization (hearing louder) to affected ear) * Rhinne test (BC \>AC) * Example: Cerumen impaction MC Sensorineura * Webber test (lateralization Equal or Non Affected ear) * Rhinne test (AC\>BC, normal) * Example: Presbyacusis(Aging) MC
47
Mastoiditis Hx/Sx/PE/Dx/Tx
* hx: hx of OM * Sx: Swelling behing ear, fever * PE: displaced ear due to swelling and tender * Dx: CT scan * Tx: IV abx + addmission + drainage * Refractory: Mastoidectomy
48
Foreign body(bug) in ear Risk/Tx
* Risk: 6y\> * Tx: kill the bug with mineral oil or lidocain then remove
49
Tinnitus Sx/Tx
* MC cause: cerumen impact, presbyacusis * Sx: high pitch ringing sound * Dx: otoscopy * Tx: underlying cause
50
Epistaxis Cause/Location/Tx
* Cause: Truma * Location * Anterior - kiesselbach * Posterior - sphenopalatine * Tx * Anterior - gauze packing, direct pressure leaning forward * Posteior - gauze packing, if continue admission for monitor hypoxia
51
Allergic rhinitis Cause/Triad/Sx/PE/Dx/Tx
* Cause * Allergic - IgE mediated mast cell histamin release * Viral - rinovirus * Triad (Atopy) Samter - asthma, nasal polyp, allerigy (NSAID + ASA) * PE * Allergy - cobblestone, nasal crease, orbital edema * Viral - erythmatous terbinate * Dx: IgE high * Tx: Flonase(1st), Azeletine (2nd) * Nasal decongestant (Not use for monotherapy) * 3-5 days use no more than 5 days due to rebound congestion
52
Nasal Polyps Cause/Triad/Tx
* Cause: Allergy MC * Triad: Samter - Allergy (NSAID + ASA) + asthma + nasal polyp (atopy) * Tx: Flonase
53
Nasal foreign body Risk/Sx/Dx/Tx
* Risk: Children * Sx: Malodorous smell * Dx: Rigid or flexible fiberoptic endoscopy * Tx: Remove
54
Gingivitis 3 type/Cause/Tx/Special counsel for both
Linear gingival erythema * Cause: HIV * Sx: bleed easy and painful * PE: bright inflamed * Tx: Oral hygiene, Not responsive - debridement + abx Gingival hyperperplasia * Cause: drug induced (phenytoin) * Sx: thicken gum may block teetch * PE: large gum * Tx: Stop medication Acute Necrotizing Ulcerative gingicitis (Trench mouth) * Cause: immunosupressant and smokers * Sx: painful, Foul smell pesudomembrane formation * PE: bacterial plaque * Tx: PCN VK or Clinda Special counsel: increased risk of CV event
55
Other gum teeth 1. Dental periapical abscess * Cause/PE 2. Dental abscess * Cause/Tx
1. Cause: dental cary, PE: pain with tapping tooth (percussing) 2. Cause: poor dental health, Tx: IM Amox, Ceftx
56
Strep throat Cause/4 sx/Criteria interpretation/Dx/Tx/Complication
* Cause: GAS * Strep throat 4 sx * Fever (101.5) * Lymadenopathy (neck) * No cough * Exudate * Criteria interpretation * 0-1 point - No abx No culture * 2 - Rapid test(1st) if Neg do culture * 3-4 - Rapid test(1st) and culture + Abx * Dx * Rapid strep test (1st screening) if negative should do culture * Culture (Definitive) * Tx * PCN * Macrolide if PCN allergy * Complication: Glomerulonephritis, Rheumatic fever
57
Quinsy (peritonsillar abscess) Cause/Sx/Dx/Tx
* Cause: GAS * Sx: Muffle voice * PE: Uvula deviated * Dx: CT * Tx: I & D(aspiration) + Augmentin
58
Laryngitis Cause/Sx/Hx/Tx
* Cause: inflammation of the larynx (Viral MC) * Sx: Horseness * Hx: singling, screamming * Tx: supportive
59
Oral Candidiasis (thrush) Cause/Sx/Hx/Dx/Tx
* Cause: Candida albican * Sx: White curled like plaque, able to scrap off and bleed * Hx: DM (check glucose) * Dx: KOH (Pseudohyphae) * Tx: Fluconazole, Nystatin
60
Retropharyngeal abscess Cause/Sx/PE/Dx/Tx
* Cause: Staph A, GAS * Sx: Fever, throat pain * PE: muffle voice, trsimus, pain when neck extend * Dx: Lateral X-ray (widened retropharyngeal space twice the size of the vertebral body in C2-4) * Tx: IV abx then I&D **(SECURE AIRWAY)**
61
Leukoplakia 2 type/PE/Dx/Tx
Luekoplakia (precancerous) * Sx: white patch can't scraped off * Dx: bx * Tx: Cryotherapy, laser surgery Hairy Leukoplakia (HIV, epstein-barr) * Sx: White plaque along tongue (hairy looking) * Tx: No tx, Acyclovir
62
Aphthous ulcers (Canker sore, ulcerative stomatitis) Sx/PE/Tx
* Sx: Painful * PE: Small ulcer, yellow centered surrounded by red halo * Tx: viscous lidocain 2-5%
63
Sialadenitis vs Sialolthiasis Cause/Sx/Tx
Sialadenitis * Cause: Staph A infection * Sx: **Trismus, Ductal discharge, Gland swelling** * Involve duct: Submandibluar or parotid * Dx: CT * Tx * Sialogogues (Tart hard candies or lemon drop) * IV dicloxacillin or nafcillin + Metronidazole or Clindamycin if severe Sialolthiasis * Cause: stone blocks salivary gland cause inflammation * Sx: **NO Trismus, No ductral disharge, Gland swelling pain after meal** * Involve duct: Submandibluar or parotid * Dx: Clinical * Tx: Sialogogues (Tart hard candies or lemon drop)
64
Oral lichen planus Cause/Sx/Tx
* Cause: Hep C * PE: Wickham striae, lacy luekoplakia * Tx: Corticosteriod
65
Hepetic mouth dz Cause/Risk/Tx
* Cause: HSV oral * Patient: MC children * Sx: Painful, fever * PE: Vesicle, gum swelling, bleeding * Tx: Supporitve, oral hygine (self limited)
66
Ludwig's angina Cause/Sx/Dx/Tx
* Cause: Cellulitis (submandible, submaxilla) * Sx: Swelling upper neck * PE: tongue position displaced, Pus on the floor of mouth * Dx: CT * Tx: AMP/sulbactam
67
Pariotitis Cause/Sx/Hx/Tx
* Cause: Staph A * Sx: Swelling angle of mandible * Hx: recent intubation, dehyration * Tx: IV Abx
68
1. Shine on unaffected eye both constrict but shine on affected eye both dilate = Name/MC cause 2. Accomodation but does not react to light = Name/MC cause 3. Bitemporal heteronymous hemianopsia = MC cause 4. Vision curtain lift up usually within 1 hour called as?
1. Marcus gunn pupil - MC Optic neuritis (MS) 2. argyll-robertson pupil - MC neurosyphilis 3. Pituitary adenoma 4. Amaurosis fugax
69
Torus palatine Cause/Sx/Dx/Tx
* Cause: genetic * Sx: painless mass top of palatine * Dx: CT to rule out cancer * Tx: Obeserve, if sx, interfere airway, or eating then surgical remove

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