Quiz 3 Flashcards
Dx: Gonococall pharyngitis
DNA probe
Gonococcal pharyngitis is an important source of ___.
gonococcemia
What is the MC deep neck infection in children and young adults?
peritonsillar abscess
Which glands, when infected, become the source of infection in Peritonsillar abscess?
Weber’s glands
Risk factors: Peritonsillar abscess
Acute tonsillitis, pharyngitis, periodontal disease, smoking
There is a strong association between Peritonsillar abscess and which medication?
NSAIDs
SSx: Peritonsillar abscess
Appears ill, trismus, drooling, unable to swallow, hot potato voice, unilateral tonsil hypertrophy w/ contralateral displaced uvula
PE: Peritonsillar abscess
CxLA on ipsilateral side, palpate for fluctuance (abscess)
Complications: Peritonsillar abscess
Airway obstruction, meningitis, septicemia, aspiration pneumonia, GABHS sequelae, carotid artery rupture, Lemierre Syndrome
DX: Peritonsillar abscess
Needle aspiration (gold standard), U/S, CT
What is Lemierre Syndrome?
Internal jugular vein thrombophlebitis and sepsis
Complication of Peritonsillar abscess
Tx: Peritonsillar abscess
Refer for I and D
Etiology: Peritonsillar abscess
Polymicrobial
GABHS, Strep pyogenes, Staph A, respiratory anaerobes
Etiology: Diphtheria
Corynebacterium diphtheriae
SSx: Diphtheria
Blue/white membrane adhered to posterior pharynx
SSx: Retropharyngeal abscess
Dyspnea, stridor, hot potato voice, stiff neck, pain referred to post. neck
Etiology: Retropharyngeal abscess
2’ to dental infx, foreign body insult, trauma
PE: Retropharyngeal abscess
High fever, ant. bulging in post. pharynx
Location: Ludwig’s angina
Submental space infx
SSx: Ludwig’s angina
Severe trismus, drooling, airway compromise
PE: Ludwig’s angina
Collar of brawny edema (neck), elevation of tongue, possible airway obstruction
Etiology: Necrotizing fasciitis
Complication of Strep
Population: Epiglottitis
2-5 yo (MC)
Etiology: Epiglottitis
HiB (MC)
SSx: Epiglottitis
Sore throat, high fever, weak voice, hot potato voice, drooling, tripod position, stridor
PE: Epiglottitis
Trismus, swollen uvula
What part of the PE for epiglottitis is contraindicated in children?
Visualization of the supraglottic area
Dx: Epiglottitis
Lateral X-ray (thumbprint sign)
Condition: sore throat < AM, > hot drinks
Post-nasal drip
Which vitamin can improve the integrity of esophageal epithelium?
Vitamin A
DDx: Chronic sore throat
Malignancy, Chronic cough, Vocal abuse, Sick House Syndrome, Smoking, Solvent use, Post-nasal drip, Reflux pharyngitis, Post-nasal drip, Infectious (esp. Mono)
Kawasaki Disease
Acute, self-limited vasculitis that occurs in children of all ages
SSx: Kawasaki Disease
Conjunctivits (non-exudative) Rash (polymorphous non-vesicular) Edema (or erythema of hands/feet) Adenopathy (cervical) Mucosal involvement (erythema, fissures, crusting)
Low-pitch hoarseness is suggestive of ___
hypothyroidism
Red flags: hoarseness d/t malignancy
Hx of smoking, heavy EtOH use, weight loss, stridor
DDx (Neuro): Hoarseness
Parkinson’s, MS, myasthenia gravis
Most vocal cord paralysis is (unilateral/bilateral) and is caused by damage to the ___.
unilateral
recurrent laryngeal nerve
Bilateral vocal chord paralysis is MC d/t ___.
complication from thyroid surgery
Etiology: Hoarseness d/t chronic vocal laryngitis
Smoking, vocal abuse, laryngopharyngeal reflux, allergies, inhaled glucocorticoids
When hoarseness lasts longer than 2 weeks w/o a clear benign cause, ___. An exception to this rule is ___.
do a direct or indirect laryngoscopy
patients w/ asthma on inhaled corticosteroids
Etiology: Globus
GERD (MC), abnormal UES, psychological and psychiatric d/o, stress, inflammatory dz, thyroid dz
Red flags: Globus
Dysphagia, pain, wt loss, hoarseness, neck mass
Conditions associated with globus
Cervical osteophyte, TMJ d/o, salivary hypofunction
Tx: Globus
Mg, homeopathy, acupuncture
Etiology (endocrine): Hoarseness
Hypothyroid, acromegaly
SSx: OSA
Overweight, snore loudly, chronic daytime sleepiness
Tx: Mild OSA
Abstaining from alcohol and sedatives, losing weight, avoiding supine position during sleep
Tx: Severe OSA
CPAP, palatal surgery, jaw surgery, tracheotomy
How is severity of OSA measured?
Apnea-hypopnea index (number of sleep events per hour)
Long-term mortality increases in pts treated for OSA with a apnea-hypopnea index > ___.
20 events per hour
Morbidities associated with OSA
Metabolic syndrome, IHD, HTN, CHF, arrhythmias, cerebral vascular dz, pulmonary vascular dz, memory deficit, inc. risk for accidents/CV events
Bulbar conjunctiva
corner of eye
Palpebral conjunctiva
under surface of lids
Innervation: cornea
CN V
Mydriasis
dilation of pupil
Myosis
constriction of pupil
What produces aqueous humour?
ciliary body
What provides the major blood supply to the eye?
Choroid
Differentiate rods vs. cones
Both are light receptors
Rods are sensitive to light, insensitive to color, important for night vision and dim light
Cones are sensitive to color
What is the name of the yellow spot in the center of the retina, 2 cm lateral to optic disk?
Macula lutea
Where is the highest concentration of cones?
Fovea centralis
DDx: Acute vision loss (media problems)
Keratitis, hyphema, cataract, vitreous hemorrhage, uveitis
DDx: Acute vision loss (retinal problems)
Vascular occlusion, retinal detachment, acute maculopathy
DDx: Acute vision loss (neural visual pathway problems)
Optic nerve, optic chiasm, retrociasmal (occipital lobe)
Bilateral vision loss suggests ____.
occipital involvement
DDx: sharp superficial eye pain
Keratitis
DDx: deep brow pain w/ N/V
acute glaucoma, uveitis (no N/V)
DDx: eye pain < movement
optic neuritis
DDx: vision loss w/ eye pain
Keratitis, acute gluacoma, uveitis, optic neuritis
DDx: vision loss w/ red eye
Keratitis, acute glaucoma, uveitis
Nearsighted eyes increase risk for ___.
retinal tears -> retinal detachment
Wearing contact lenses increases risk for ___.
bacterial keratitis
What is Fluorescein dye used for?
corneal ulcers and abrasions
DDx: Unilateral, painless vision loss
Lens dislocation, vitreous hemorrhage, acute maculopathy, retinal detachment, retinal vein/artery occlusion, ischemic optic neuropathy
DDx: Unilateral, painful vision loss
Corneal abrasion, keratitis, acute glaucoma, hyphema, iritis/uveitis
DDx: Bilateral, painless vision loss
Pseudo-tumor cerebri, metabolic or toxic, homonymous field loss
DDx: Bilateral, painful vision loss
Bacterial keratitis
Which conditions of the eye require immediate attention?
Acute central retinal artery occlusion, acute glaucoma, infectious keratitis, iritis/uveitis, hyphema, retinal detachment
Hyphema
Blood in anterior chamber
Hyphema can spontaneously occur in what population?
Diabetics
What is a sign of significant vitreous hemorrhage?
Decreased red reflex
PE: Central retinal artery occlusion
vascular narrowing, pale retina, CHERRY-RED SPOT (macula), afferent pupillary defect
What is a cause of CRAO in older patients?
Giant cell (temporal) arteritis
Onset: CRAO vs. CRVO
CRAO - acute
CRVO - subacute
PE: Central retinal vein occlusion
“Blood and thunder” fundus
SSx: Retinal detachment
Sudden onset of new floaters and black dots, photopsias, dec. red reflex, afferent pupillary defect (if macular involvement)
Etiology: acute maculopathy
severe age-related macular degeneration, diabetic retinopathy
SSx: Acute maculopathy
Central blind spot, blurred vision w/ visual distortion
Optic neuritis is associated with what other condition?
MS
SSx: Optic neuritis
Eye pain < movement, reduced visual acuity, washed-out color vision, afferent pupillary defect, normal/swollen optic disc
SSx: Papilledema
B/L optic nerve swelling w/o afferent nerve defect
Chiasmal visual field defects involve what visual fields?
Temporal
DDx: Painful red eye
corneal abrasion, foreign body, ulcer, infection, keratitis, scleritis, acute angle closure glaucoma, iritis/uveitis
DDx: Painless red eye
Subjunctival hemorrhage, conjunctivitis
Significant eye pain suggests involvement of ___
Cornea/iris b/c they are well-innervated
DDx: Red eye w/ impaired vision
Allergic, acute glaucoma, iritis, corneal dz
DDx: Abrupt onset of red eye
Trauma
Foreign body
Chemical/UV exposure
Gonococcal conjunctivitis
DDx: Subacute onset of red eye
Non-gonococcal conjunctivitis
DDx: Chronic/Persistent onset of red eye
Infection (Staph, Chlamydia, Moraxella)
DDx: Recurrent red eye
Allergic conjunctivitis, reactive arthritis
Eye discharge is suggestive of ___.
conjunctivitis
DDx: Red eye w/ photophobia
Iritis, corneal dz, acute angle closure glaucoma