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AANP Study Cards > EENT > Flashcards

EENT Flashcards

1
Q

What is the presentation with corneal ulcers

A
  • severe eye pain
  • foreign body sensation
  • tearing
  • photophobia
  • whitish lesion on the cornea
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2
Q

What is the presentation of herpes keratitis

A
  • acute onset
  • severe eye pain
  • photophobia
  • tearing
  • blurred vision in one eye
  • fern like lines in the corneal surface on black lamp with fluorescein dye
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3
Q

The complication of herpes keratitis is that

A

it damages corneal epithelium that results in corneal blindess

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4
Q

What is the presentation of acute angle-closure glaucoma

A
  • acute onset
  • severe eye pain
  • headache
  • N/V
  • halos around lights
  • lacrimation
  • decreased vision
  • mid-dilated pupil
  • cornea appears cloudy
  • fundoscopic exam reveals cupping of the optic nerve
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5
Q

What condition may present with loss of visual acuity over hours to days, color vision is affected, there is a central scotom as well as other neuro symptoms such as (aphasia, paresthesias, abnormal gaity), fatigue

A

MS

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6
Q

What is the presentation of orbital cellulitis

A
  • acute onset of erythematous swollen eye lid with proptosis and pain
  • unable to perform full ROM of the eyes
  • Hx of recent rhinosinusitis or URI
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7
Q

Sudden onset of floaters associated with “looking through the curtain” with sudden flashes of light (photopsia)

A

Retinal detachment

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8
Q

What is an auricular hematoma

A

-direct blunt trauma to the ear that causes bleeding in the auricular cartilage

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9
Q

What is the result if an auricular hematoma is not properly drained

A

cauliflower ear

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10
Q

What is the presentation of an acoustic neuroma

A
  • unilateral hearing loss
  • tinnitus
  • unsteadiness when walking
  • episodes of verring or tilting that fluctuates in severity
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11
Q

A cauliflower like mass behind the tympanic membrane

A

Cholesteatoma

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12
Q

When you have a basilar skull fracture these signs are often present

A
  • Racoon eyes
  • brusing behind the ear (mastoid area)
  • clear or golden serous discharge from the ear or nose
  • hemothympanum (blue or purple color of the TM)
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13
Q

If a permanent tooth is avulsed what should you do

A
  • avoid touching the root
  • rinse tooth with normal saline
  • irrigate socket with normal saline and reimplant tooth
  • have patient bite down on gauze and refer to dentist ASAP
  • if unable to replant store in cool mil, saline or inside cheek
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14
Q

What is the presentation of a peritonsillar abscess

A
  • severe sore throat
  • difficulty swallowing
  • odynophagia
  • trismus
  • hot potato voice
  • unilateral swelling of the peritonsillar area and soft palate
  • displaced uvula
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15
Q

What is the presentation of diptheria

A
  • sore throat
  • fever
  • marked swelling of the neck
  • hoarseness
  • dysphagia
  • grey to yellow pseudomembrane that is hard to displace covers the pharynx, tonsils, uvula and soft palate
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16
Q

What is virchow’s node or troisier’s sign

A

an enlarged and hard left sided supraventricular node

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17
Q

What is the significance of Virchow’s node or troisier’s sign

A

-associated with malignancy

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18
Q

In the eye the ____ are larger than the _____

A

veins are larger than the arteries

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19
Q

Cones are for ____ vision while rods are for ____ vision

A
  • cones: color

- rods: low light vision and peripheral vision

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20
Q

The ____ is responsible for central vision

A

macula

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21
Q

What is presbyopia

A

-age related change due to a decreased ability of the eye to accommodate and focus due to stiffening of the lenses usually starting at age 40

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22
Q

What is blepharitis

A

-inflammation of the edges of the eyelids where the eyelashes grow
r/t tiny oil glands at the base of the eyelashes become clogged

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23
Q

The bones of the ear are the

A
  • mallus
  • incus
  • stapes (smallest bone in the body)
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24
Q

What is a tympanogram

A

-the most objective measure to test for the presence pf fluid inside the middle ear

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25
Q

What is kisselbach’s plexus

A

-an area on the anterior-inferior aspect of the nose and is the most common place for anterior nosebleeds

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26
Q

There are 4 sinuses:

A
  • Ethmoid (present at birth)
  • Maxillary (present at birth)
  • Front (present at 5 years)
  • Sphenoid (present by 12 years)
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27
Q

What is a white to light gray patch that appears on the tongue, floor of the mouth or inside cheek and what does it make you concerned for?

A

Leukoplakia

-oral cancer

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28
Q

Painful shallow ulcers on soft tissue of the mouth that usually heal within 7-10 days

A

Aphthous stomatitis

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29
Q

There are 3 salivary glands:

A

parotid, submandibular and sublingual

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30
Q

What is the presentation of mumps

A
  • acute onset
  • fever
  • headache
  • fatigue
  • myalgia
  • anorexia
  • within 48 hrs parotid gland becomes swollen and tender
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31
Q

What are the complications of mumps

A

-orchitis, meningitis, encephalitits, deafness

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32
Q

Painless bony protuberance midline on the hard palate

A

torus palatinus

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33
Q

Uvula that is split into 2 sections and resembles a fish tail

A

Fishtail or split uvula

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34
Q

On prolonged, extreme lateral gaze a few beats of nystagmus that resolves when the eye moves back towards midline in healthy patients is _____

A

normal; physiologic caze evoked nystagmus

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35
Q

Optic disc swelling with blurred edges due to increased ICP secondary to bleeding, brain tumor, abscess, pseudotumor cerebri is

A

Papilledema

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36
Q

Disc cupping is when ___ and is associated with ____

A

An abnormal cup to disc ratio and is associated with glaucoma

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37
Q

What are the hypertensive retinopathies?

A
  • AC nicking
  • retinal hemorrhages
  • copper and silver wire arterioles
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38
Q

What are the diabetic retinopathies

A
  • microaneurysms
  • cotton wool spots
  • neovascularizations
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39
Q

What are cataracts

A

-opacities of the lens of the eye

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40
Q

What are sx of cataracts

A
  • difficulty with glare
  • halos around lights
  • blurred vision
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41
Q

Clusters of small red papules with white centers inside the cheeks by the lower cheeks are ____ which are pathognomonic for _____

A
  • Koplik spots

- Measles (Rubeola)

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42
Q

What is the 1st line treatment for nasal polyps

A

-intranasal glucocorticoids

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43
Q

What are elongated papilla on the lateral aspect of the tongue and what is this pathognomonic fo

A
  • Hair leukoplakia

- HIV

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44
Q

Painful skin fissures and macerations at the corner of the mouth are called

A

Cheilosis or angular cheilitis

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45
Q

What is the management of cheilosis

A
  • Check B12 level
  • Remove underlying cause of excess moisture
  • use barrier creams with zinc or petroleum jelly at night
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46
Q

Hyperopia is

A

farsightedness; distance vision is intact but near vision is blurry

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47
Q

Myopia

A

Nearsightedness; near vision is intact but distance is blurry

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48
Q

The ______ chart is used to evaluate color blindness

A

Ishihara chart

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49
Q

In evaluating the results of snellen testing the

A
  • top number is the distance in feet at which the patient stands from the snell chart
  • The bottom number is the number of feet at which the patient can see compared with a patient with normal vision.
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50
Q

At what age should a child have normal visual acuity

A

6 years

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51
Q

Weber test

A
  • tuning fork is placed midline on the forehead

- abnormal is lateralization:

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52
Q

Rinne test

A
  • tuning fork on mastoid then in front of the ear time eat

- Normal is: AC > BC

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53
Q

If a weber and rinne are performed and lateralization is to the “normal ear” and AC > BC this suggests

A

-sensorineural hearing loss

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54
Q

If a weber and rinne are performed and lateralization is to the “bad ear and BC > AC this suggests

A

-conductive hearing loss

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55
Q

What is the presentation of a corneal abraison

A
  • acute onset of eye pain

- feeling of foreign body sensation on eye surface

56
Q

What is the management plan for keratitis

A
  • check visual acuity
  • pupils
  • if infection suspected get C&S of discharge
  • Use topical ophthalmic antibiotic with pseudomonal coverage such as Cipro, ofloxacin, trimethoprim-polyxicin B x 3-5 days
57
Q

What is a Hordeolum

A

-an external abscess of a hair follicle and sebaceous gland in the upper or lower eyelid

58
Q

What are symptoms of hordeolum

A

-acute onset of swollen, red and warm abscess on the upper or lower lid

59
Q

What is the management of a hordeolum

A

-hot compresses

60
Q

What is a chalazion

A

chronic inflammation of the meibomian gland of the eye lid

61
Q

What is the presentation of chalazion

A
  • gradual onset

- small superficial nodul of the upper eyelid that feels like a bead, is discrete and movable

62
Q

What is the treatment for chalazion

A

I&D, or steroid injections so refer

63
Q

What is a pinguecula

A

-a raised, yellow white, small round growth in the bulbar conjunctiva next to the cornea caused by chronic sun exposure

64
Q

What is a pterygium

A

-a yellow triangular thickening of the conjunctiva that extends across the cornea is the result of chronic sun exposure

65
Q

What is the management of pinguecula or pterygium

A
  • during inflammatory periods: steroid eye drops
  • sunglasses with UVA UVB coverage
  • Surgical removal if encroaches on pupil
66
Q

What are common risk factors for subconjunctival hemorrhage

A
  • coughing
  • sneezing
  • heavy lifting
  • vomiting
  • local trauma
  • spontaneously can occur
67
Q

What is primary open angle glaucoma

A

-gradual onset of increased IOP >22mmHg r/t blockage of the drainage of aqueous humor inside the eye

68
Q

What is the management of primary open angle glaucoma

A

-check IOP with tonometer
if >30 requires urgent referral
-Beta blocker eye drops (timolol; decrease aqueous production)
-Latanoprost: increase outflow

69
Q

What is normal IOP

A

8-21

70
Q

What are CI to timolol

A
  • asthma
  • 2nd or 3rd-degree heart block
  • COPD
  • Emphysema
  • Heart failure
71
Q

What is the presentation of anterior uveitis

A
  • insidious onset of eye pain with conjunctival injection
  • is a complication of autoimmune disorders, sarcoidosis, syphilis
  • no purulent discharge
72
Q

What is the management of anterior uveitis

A

Refer to opthalmologist as can result in blindness

73
Q

What is the leading cause of blindness in the elderly

A

macular degeneration

74
Q

Gradual or sudden and painless loss of central vision in one or both eyes.

  • Describes straight lines as appearing distorted or curved
  • peripheral vision is intact
A

Macular degeration

75
Q

What is the test used to check on macular degeneration

A

Amsler grid

76
Q

What is sjogren syndrome

A

-chronic autoimmune disorder characterized by decreased function of the lacrimal and salivary glands

77
Q

What is the presentation of sjogren’s syndrome

A
  • daily sx of

- dry eyes and dry mouth for > 3 months

78
Q

What is the management of blepharititis

A

-use johnson’s baby shampoo until it resolves

79
Q

An ______ is when the eyelid is turned inwards which causes the eyelashes to continuously rub resulting in irritation, watery eyes, redness, pain and foreign body sensation

A

Entropion

80
Q

An ____ is when the eyelid is turned outwards and sags

A

Ectropion

81
Q

Allergic rhinitis is

A

inflammatory changes of the nasal mucosa due to alleries

82
Q

What is the presentation of allergic rhinitis

A
  • chronic or seasonal nasal congestion with clear mucus
  • rhinorrhea
  • post nasal drip that worsens when supine
  • nasal itch
  • frequent sneezing
  • click to clear mucus
  • blue tinged, pale and boggy nasal turbinates
  • undereye circles
  • posterior pharynx shows cobblestoning
83
Q

What is 1st line treatment of allergic rhinitis

A

-Topical nasal steroid sprays

84
Q

The prolonged use of a topical nasal decongestant >3 days causes rebound effects that result in severe and chronic nasal congestion called

A

rhinintis medicamentosa

85
Q

What are common causes of septal perforation

A
  • Cocaine use
  • snoring
  • trauma
  • prior septal surgery
  • untreated septal hematoma
86
Q

What is first line treatment for strep throat

A

Penicillin V 500mg BID-TID x 10 days

-If pen allergicy Z-Pak x 5 days

87
Q

What are complications of untreated strep throat

A
  • scarlet fever
  • acute rheumatic fever
  • pertionsillar abscess
  • poststrep glomerulonephritis
88
Q

What is the presentation of OM

A
  • ear pain
  • popping noises
  • muffled hearing
  • recent hx of cold or flare of allergic rhinitis
89
Q

What is bullous myringitis

A

-Type of AOM infection that is more painful due to the presence of blisters on a reddened and bulging TM

90
Q

What are objective findings of an OM

A
  • weber lateralizes to bad ear
  • rinne shows BC > AC
  • TM may be bulging or retractions with dispalced light reflex, decreased TM mobility
  • if TM is ruptured then draining purulent discharge
91
Q

First line treatment for OM is

A

-Amoxicillin

92
Q

What is the presentation of acute bacterial rhinosinusitis

A
  • unilateral facial pain or upper molar pain
  • nasal congestion for 10 days or longer
  • purulent nasal and or postnasal discharge
  • hyposmia
93
Q

First line antibiotic treatment for acute bacterial rhinosinusitis

A

Augmentin 1000/62.5

94
Q

What is the management of ABRS

A
  • in mild uncomplicated cases: expectant mgmt

- in mod to sever cases or sx worsen after 10 days then treat with Augmentin (Levofloxacin if pen allergic)

95
Q

What is the treatment of OM with effusion

A

Oral decongestants

Steroid nasal spray or saline spray

96
Q

What is the presentation of OE

A
  • external ear pain
  • swelling
  • discharge
  • pruritus
  • hearing loss
  • purulent green discharge
  • red/swollen ear canal
97
Q

What is the management of OE

A
  • Polymyxin B-neomycin hydrocortisone suspension 4gtt QID x 7 days
  • Ofloxacin or ciprofloxacin otic ear drops BID x 7days
  • In immunocompromised pts treat with topical and systemic ABx
  • keep ear out of water during tx
  • if recurrent episodes then Boric acid, or vinegar is prophylactic
98
Q

What is the classic triad of mono

A
  • fever
  • pharyngitis
  • lymphadenopathy
99
Q

What is the classic presentation of mono

A
  • sore throat
  • enlarge posterior cervical nodes
  • symmetric lymphadenopathy
  • tonsillar exudate
  • fatigue
  • hepatosplenomegaly
100
Q

What tests are done in mono

A
  • CBC (atypical lymphocytes and lymphocytosis)
  • LFTs
  • Monospot (heterophile antibody test)
  • U/S if spleno/hepatomegaly present and repeat in 4-6 weeks to document resolution
101
Q

What is the treatment plan in mono

A

-limit physical activity x 4 weeks to reduce risk of splenic rupture

102
Q

What is the gold standard test for BPPV

A

Dix-Hallpike

103
Q

New onset urticaria consider

A

Benadryl or Zyrtec

Benadryl is more sedating

104
Q

Acute or reactivated ___ can present at generalized maculopapular rash, enlarged tonsils with cryptic exudate, sore throat or enlarged cervical nodes

A

Mono

105
Q

Treatment for OE is

A

Cortisporin drops (Antibiotic + Steroid)

106
Q

Weber and Rinne test what cranial nerve?

A

VIII

107
Q

______ is one of the most common OTC tx for ceruminosis

A

Carbamide

108
Q

If a corneal abrasion or keratitis is suspected you should use _____

A

Fluorescein strips

109
Q

Fundoscopic exam findings

A
  • red reflex should be present
  • optic disc should be sharply outlined
  • cup to disc ratio should be <0.5
  • veins pulsate in the eyes
110
Q

What is the first sign of macular degeneration

A

scotoma

or central blind spot

111
Q

A 70 year old patient presents to clinic with eye pain, conjunctival redness, and a pupil that reacts poorly to light what could be the cause?

  1. viral conjunctivitis
  2. angle closure glaucoma
  3. open angle glaucoma
  4. ocular foreign body
A

-angle closure glacuoma

112
Q

What are xanthelasmas and what does this often indicate

A
  • yellowish plaques on the inner canthus; cholesterol deposits
  • elevated lipids
113
Q

4 step assessment of all eye complaints

A
  1. Always start by assessing visual acuity and document for both eyes
  2. Examine with slit lamp or binocular loupe or penlight
  3. Lid eversion
  4. Fluorescein staining (will show corneal defect)
114
Q

Red eye and change in vision warrants

A

Opthalmology referral

115
Q

Red eye with photophobia warrants

A

Opthalmology referral

116
Q

Red Eye with sensitivity and inability to keep eye open warrants

A

Opthalmology referral

117
Q

What is a cataract

A

An opacity in the lens of the eye which decreases visual acuity

118
Q

What are complications from Group A strep

A
  • sinusitis
  • retropharyngeal and peritonsillar abscesses
  • acute rheumatic fever
  • acute glomerulonephritis
119
Q

MCENTOR

A
  • Must be 3
  • Cough absent
  • Exudative tonsils
  • Nodes present; anterior
  • Temp >100.4
  • Often young 3-14
  • Rarely old -1
120
Q

If the centor score is

  • 2
  • 3+
A

2- consider rapid strep

3+ likely strep rapid strep treat empircally

121
Q

A 13 year old presents with fatigue, sore throat, enlarged and tender anterior and posterior cervical nodes . She has a + rapid strep test how should this be handled

  1. Rx penicillin
  2. Addition lab testing
  3. Order a CXR
  4. Rx azithromycin
A

-she should have additional lab testing

122
Q

What is the screening test for mono

A

Monospot: Screening of heterophil antibodies

123
Q

What is epiglottitis

A

-a life threatening infection of the epiglottis and surrounding tissues which can cause sudden and critical narrowing of the airway

124
Q

What is presentation of epiglottitis

A
  • sore throat
  • fever
  • muffled voice
  • drooling
  • stridor
  • hoarseness
  • thumb sign
125
Q

How can you manage epistaxis

A
  • if mild: pinch nose tightly for 10 minutes
  • cautery: silver nitrate stick
  • nasal packing balloon if cautery unsuccessful
126
Q

A 30 year old patient has been diagnosed with rhinitis medicamentosa what drug has she been overusing

1) An antihistamine
2) A decongestant
3) A topical nasal steroid
4) A topical vasoconstrictor

A

4) A topical vasoconstrictor

127
Q

A common side effect of topical nasal steroids is

A

Epistaxis

128
Q 
A patient takes cetirizine for allergic rhinitis what side effects are common?
select all that apply
1. Adrenal suppression
2. Epistaxis
3. Sedation
4. Rebound stuffiness
5. Increased BP
6. Dry Mucous Membranes
A
  1. Sedation

6. Dry mucous membranes

129
Q

A 78 year old with hearing aids complains of itching in both ears what is a likely diagnosis

A

Otitis externa

130
Q

Presbycusis is

A

Hearing loss in aging

-lose the ability to hear high pitched tones

131
Q

Conductive hearing loss involves the

A

External canal or middle ear
Weber: Lateralization to bad ear
Rinne: Bad Ear BC>AC

132
Q

Sensorineural Hearin loss

A

involves the inner ear or CNIII
Weber: Lateralization to good ear
Rinne: Normal

133
Q

What are examples of conductive hearing loss

A
  • cerumen impaction
  • ear plugs
  • fluid in the middle ear
134
Q

What are examples of sensorineural hearing loss

A
  • hereditary hearing loss
  • presbycusbis
  • noise exposure
  • meniere’s
  • acoustic tumors
  • trauma
135
Q

A 78 year old has been diagnosed with presbycusis what are likely findings. Select all

  1. Hearing loss is symmetrical
  2. Sudden hearing loss
  3. Hearing deficits are worse with background noise
  4. Sensitivity to loud sounds
  5. Tinnitus present
  6. Audigoram shows loss of high pitched tones
  7. Most common beginning in the 6th decade
A
  1. Hearing loss is symmetrical
  2. Hearing deficits are worse with background noise
  3. Sensitivity to loud sounds
  4. Tinnitus present
  5. Audiogram shows loss of high pitched tones
  6. Most common beginning in the 6th decade

AANP Study Cards (20 decks)

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