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EENT Flashcards

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1
Q

Blepharitis

A

Eyelid acne dt blockage of memobian gland
Sx: itching, burning, crusting eyes, no pus
Mgmt
Warm compress + baby shampoo
Optic abx to dec bacterial load but it’s not a true infection

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2
Q

Cataract

A

1 cause of blindness worldwide dt natural clouding of lens

Sx: painless gradual loss, reduced visual acuity, reduced red reflex
Mgmt
Tx indicated if vision 20/40 or worse or affects QOL
Outpt- phacoemulsification

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3
Q

Chalazion

A

Internal eyelid
Slow developing chronic blockage of oil gland

Mgmt
Aggressive warm compress
1-2wk no improvement - steroid injection or I/d
Resolve spontaneously

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4
Q

Corneal abrasion

A 
Irritability in an infant 
Sx:
Pain worse w blinking
Photophobia
FB sensation
Conjunctival injection

Dx: evert lid, flourescein stain w Woods lamp

Tx:
Topical anesthetic (if it’s iritis, pain won’t be reduced)
Remove FB
Tetanus prophylaxis
Erythromycin or gentamicin gtt… FQ if contacts or freshwater exposure
Ophtho f/u 1-2d

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5
Q

Dacryoadenitis

A

Mc in infants
Sx: red, swollen inferior/medial canthus; mucopurulent dc w lid crusting

Tx: warm compress w massage
Refer acute lacrimal infection for dx confirmation and abx

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6
Q

Ectropion

A

Older pt w eyelid turned out
Dryness*
Tx: lubrication

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7
Q

Entropion

A

Older pt w eyelid turned in
Irritation*

Tx: lubrication

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8
Q

Hordeolum (Stye)

A

Acute inflammation of memobian gland
Painful

Mgmt
Aggressive warm compress -4x per day for 20min
I&d if persisting more than 1-2wk
Spontaneous resolution

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9
Q

Pterygium

A

Dt chronic sun exposure
White vascular growth on nasal or temporal cornea
Concern for dry eye

Tx: artificial tears
Inflammation = ophtho for steroid or excision

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10
Q

Acoustic neuroma (“Vestibular Schwannoma” - CN 8)

A

Almost all unilateral; one of the MC intracranial tumors
A/w NF 1 (bilateral = NF 2)
Sx
- auditory: unilateral SNHL (gradual or sudden)
- vestibular: tinnitus, vertigo (continuous)

Dx: enhanced MRI
Tx: radiotherapy* - prevents further growth, does not shrink
- may require surgical excision if larger

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11
Q

Barotrauma

A

Inability to equalize barometric stress on middle ear during flight/dive

Sx: tinnitus, vertigo, NV, hearing loss

Middle ear: pressure decreases with descent; if the eustachian tube does not open, fluid fills middle ear space and may rupture TM

Inner ear: difficulty equalizing inner ear pressure suddenly able to open the eustachian tube, the rush of air can cause oval or round window rupture

Tx: refer, bed rest, antivertigo meds, steroid taper, avoid Valsalva

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12
Q

Cholesteatoma

A

Et: ETD, recurrent AOM, chronic OM –> epidermal structure replaces middle ear mucosa and resorbs underlying bone

Sx: recurrent/persistent otorrhea, hearing loss, tinnitus

Tx: surgery

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13
Q

Conductive hearing impairment

A

MC cause: cerumen impaction, ETD a/w URI
Dysfunction of external or middle ear

Tx:

  • AOM = abx
  • cerumen removal, TM repair, ear tubes, ossicular reconstruction, hearing aids
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14
Q

Sensory hearing impairment

A

MC cause: age (presbycusis) d/t loss of hair cell function
- autoimmune: Lupus, GPA, Cogan

Sxs:

  • presbycusis: high frequency loss
  • sudden sensory hearing loss: unilateral, peaks in 5th decade, idiopathic (no middle ear path = refer)
  • autoimmune: bilateral wax and wane; may have vestibular/balance issues

Dx: MRI if suspecting acoustic neuroma

Mgmt:

  • prevent further loss, hearing aids for amplification, cochlear implants
  • steroids for disease specific
  • SSHL - improved odds of full recovery with quick admin of steroids
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15
Q

Neural hearing impairment

A

D/t lesions affecting CN 8

E.g. acoustic neuroma, MS, auditory neuropathy

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16
Q

Labyrinthitis

A

Inner ear inflammation d/t viral
Sxs: continuous vertigo (days-wks), hearing loss, tinnitus
- no hearing loss = vestibular neuritis

Dx:

  • serous: coexisiting or recent URI/ear infection, may have hearing loss, nontoxic, may have mild fever
  • bacterial: coexisting OM, severe sx, hearing loss, fever, toxic [only peripheral cause warranting admission]

Tx:

  • febrile: abx
  • supportive care; vertigo - meclizine
  • may take several weeks to resolve, hearing may or may not return
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17
Q

Meniere’s disease

A

Idiopathic disorder of inner ear

Sx: spontaneous, recurrent attacks of episodic vertigo lasting hours; tinnitus; aural fullness; fluctuating SNHL
- w/out hearing loss = vestibular migraine

Dx: audiometric confirmation; r/o syphilis

Tx:

  • acute: meclizine or short burst of steroids*
  • 1st line: salt restriction, diuretics
  • ablation - aminoglycosides
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18
Q

Tinnitus

A

Ddx: Meniere’s; acoustic neuroma; otosclerosis; otitis media; MS; salicylate OD; chronic; cerebrovascular disease

D/t: h/o noise exposure, episodic sounds, hearing loss; persistence indicates SNHL

Dx: audiology screening*

  • labs, imaging, med history
  • pulsatile: MRI & venography to r/o aneurysm or vascular tumor

Tx: refer to audiology*

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19
Q

TM Perf

Study These Flashcards
A

Trauma - slap injury, foreign body
Infection - complication of otitis media

Dx: audiology eval

Tx: refer for tympanoplasty if hearing loss persists
- infection = abx

20
Q

Vertigo

Study These Flashcards
A

Sensation of disorientation in space w/sensation of motion/spinning

Central - MS, vestibular schwannoma
Peripheral - labyrinthitis/vestibular neuritis, Meniere’s, BPPV, inner ear barotrauma
Seconds: no HL - BPPV; HL - cholesteatoma
Minutes: no HL - migraines
Hours: HL - Meniere’s
Days: no HL - vestibular neuritis; HL - labyrinthitis
Weeks: no HL - Lyme, MS, central NS; HL - acoustic neuroma, psychogenic, autoimmune

21
Q

Central vertigo

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A 
RF: older male vasculopath
Sx: 
- gradual, progressive, constant; presents later in course; mild/mod intensity 
- vertical nystagmus**
- mild nausea, HA, not affected by mvmt

Dx:

  • Head CT: r/o hemorrhage
  • MRI**
22
Q

Peripheral vertigo

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A

Usually not emergent
Sx:
- acute, intermittent, brief; presents early in course; severe intensity
- nystagmus always present: unidirectional, fatigable, horizontal, or rotary* (never vertical)
- intense NV; provoked by mvmt; +/- hearing loss

23
Q

Peripheral vertigo DDx

Study These Flashcards
A
  • BPPV
  • Labyrinthitis
  • Vestibular neuronitis
  • Meniere’s
  • Acoustic neuroma
24
Q

BPPV

Study These Flashcards
A

Positional vertigo d/t calcium debris w/in posterior semicircular canal
MC older females

Sx:

  • recurrent vertigo lasting 1 min or less provoked by specific head movements; episodes for wks-mos
  • +/- NV w/out other neuro complaints

Dx: Dix-Hallpike Maneuver
Tx: Epley Maneuver

25
Acute sinusitis
Duration <4wk Starts URI --> edema --> ostial blockage, mucus stasis, bacterial proliferation MC: S. pneumo, H. flu, S. pyogenes ** Sxs: - URI > 10d w/no improvement - severe sxs w/high fever w/purulent nasal d/c or facial pain (3-4d) - worsening sxs w/new onset HA, fever, INC nasal d/c following URI w/initial improvement Tx: Amoxicillin*, Augmentin*, Doxycycline* or Resp FQ - nasal saline for irrigation, nasal steroids, antihistamines
26
Chronic sinusitis
>12wk d/t impaired mucociliary clearance, abnormal sinus ventilation, or immune deficiency - nasal polyps + chronic sinusitis = CF - different bugs: Staph, Pseudomonas, anaerobes Dx: consider CT sinuses Tx: ENT referral; FQ culture-directed therapy for 3-6wk - steroids dec inflammation
27
Allergic rhinitis
Early phase: 10-15min histamine - sneezing, rhinorrhea, itching [antihistamines - loratadine, fexofenadine, cetirizine] Late phase: 4-6hr cytokines/leukotrienes - inflammation, nasal congestion, postnatal drip [nasal steroid - triamcinolone, fluticasone, mometasone] Seasonal: worse in AM and dry/windy conditions* Perennial: pet dander, dust mite, worse PM* Sxs: edematous, bluish/boggy turbinates - kids: allergic shiners, mouth breathing, salute Montelukast (Singulair): allergies + asthma
28
Epistaxis
90% anterior - Kesselbach's Plexus MC d/t URI Posterior source - heavy, brisk, may compromise airway and be life threatening Dx: H/H (prolonged bleed) / INR (warfarin) Mgmt: Anterior: - oxymetazoline (Afrin) 3 spray + hold pressure 15 min - continued bleed - lubricated nasal tampon - d/c w/48hr f/u w/abx for TSS (clindamycin, augmentin) - abx ointment to spot for 1wk Posterior: - double balloon device OR pass foley cath thru nose and inflate balloon - admit w/ENT consult
29
Nasal polyp
Child w/allergic rhinitis Nasal polyp + chronic sinusitis = CF Sx: pale edematous, smooth masses arising from middle meatus Small - nasal steroid Large - surgical removal
30
Acute pharyngitis
Normal oropharynx colonization: staph, non-hemolytic strep, lactobacillus, Bacteroides Peds - 80-90% viral infection Sxs: - sore throat, erythema w/out exudate a/w other URI sxs (rhinorrhea, coryza, cough) - if oral ulcers or hoarseness, almost always viral (no need to swab) Mgmt: self limiting
31
Strep throat
MC: group A beta-hemolytic strep Sxs: - sudden onset* sore throat; age 5-15 - fever, HA, NV, abdominal pain, pharyngeal inflammation, palatal petechiae, anterior cervical LAD - winter/early spring Dx: - culture negative rapid strep in children to verify Modified Centor Criteria* - absence of cough - swollen, tender anterior cervical nodes - T > 100.4 - tonsillar exudates/swelling - 3-14yo - 45+ = -1pt Mgmt: - 4: abx [Penicillin, amoxicillin, cefdinir, azithro] - 2-3: swab - 0-1: unlikely to swab No improvement after 48hr - cefuroxime or augmentin
32
Strep Complication: Scarlet Fever
Erythrogenic exotoxin produced by strep * diffuse sandpaper rash, facial flushing - petechiae in body folds (groin), strawberry tongue, desquamation
33
Strep Complication: Acute Rheumatic Fever
Inflammatory disease caused by ab cross-reactivity presenting 1-6wk after infection; sudden onset - fever, arthralgia, carditis *Jones Criteria: 2 Major OR 1 Major and 2 minor + evidence of strep infection Major: carditis, migratory polyarthritis, erythema marginatum, subcutaneous nodules, chorea Minor: fever, arthralgia, previous RF or RHD, leukocytosis, elevated ESR/CRP, prolonged PR on ECG Tx: treat strep, sxs treatment - continue for 5y w/out carditis; 10y w/carditis [Benzathine PCN shot q month]
34
Strep Complication: Post-strep glomerulonephritis
Acute nephrotic syndrome, 10d after strep infection Protein in urine Swelling of eyes/face
35
Strep Complication: PANDAS
Pediatric autoimmune neuropsychiatric diagnosis associated with strep New onset OCD sxs w/in a few weeks - tics, fears, anxiety, ritual Tx: SSRI, CBT, plasmapheresis
36
Strep Complication: Peritonsillar Abscess
Strep infection invading beyond tonsil Strep infection initial improvement w/meds, then abscess develops - severe odynophagia - trismus - malaise - hot potato voice Mgmt: IV abx, I/D, quinsy tonsillectomy
37
Apthous ulcers
Et: stress, acid, hormone, trauma, genetic Sxs: painful, swallow, yellow-grey ulcer w/red halo on non-keratinized mucosa (lips, gums) - lasts 7-10d Dx: - magic mouthwash: benadryl + maalox - occlusive: orabase - anesthetics: benzocaine - cleansing agents, antiseptics Mgmt: - avoid trigger - Rx: viscous lidocaine - other: topical steroid, cimetidine, tetracycline - chemical cautery (silver nitrate)
38
Necrotizing Ulcerative Gingivitis ("Trench Mouth")
Bacterial infection d/t overgrowth of mouth bacteria [bacteroides, fusobacterium, spirochetes] - young adults; I/C Sxs: gingival inflammation/necrosis - "punched out" interdental papillae - bleeding, pain, halitosis, fever, cervical LAD Mgmt: - salt water, peroxide rinse - augmentin, penicillin - oral hygiene, pain control, refer
39
Oral candidiasis
Candida albicans on oral mucosa and tongue RF: dentures, debilitated, DM, anemia, radiation, corticosteroids or abx Sxs: - creamy white curd-like patches overlying erythematous mucosa, mouth pain - CAN rub off - angular cheilitis: another manifestation; dry cracking in corners of mouth Tx: PO Fluconazole (Diflucan) - clotrimazole troches - nystatin suspension, swish and spit
40
Oral leukoplakia
May progress to dysplasia or early invasive SCC Hyperkeratosis of mucosa in response to irritant (tobacco) Sx: buccal mucosa or tongue; does NOT scrape off Tx: referral if bx cancerous
41
Laryngitis
MC cause of hoarseness - hoarseness may persist a week or two after sx of URI resolve Mgmt: - pt should avoid singing and shouting until voice returns to normal; persistent use may lead to polyps, nodules, cysts Longer than 3 weeks = chronic. Requires ENT eval.
42
Herpetic stomatitis
Possible presentation for 1st time oral HSV outbreak (kids) Sx: lesions on gums, tongue, oral mucosa, lips - vesicles rupture, become ulcers - a/w high fever, mouth pain, swollen bleeding gums, irritability, anorexia Tx: 7-10d PO acyclovir - pain control w/magic mouthwash, liquid/soft diet
43
Herpes labialis
Recurrent HSV d/t UV light, stress, fatigue, menses Sx: itching, burning, tingling - 1-2d later a vesicle forms on red base, ruptures, crusts and heals Tx: PO or topical acyclovir ASAP when feel sensation or lesion coming on
44
Parotitis
Parotid gland - Stenson's duct Submandibular gland - Wharton's duct Mumps - bilateral swelling of parotid glands - fever, malaise, pain, tenderness, erythema, trismus, kids 4-6yo Sx: tender glands
45
Sialadenitis
MC cause: staph aureus - predisposing factor: dehydration - bacterial infection of salivary gland Sx: acute unilateral swelling, erythema, pain, tenderness, trismus, purulent ductal discharge, induration, fever Tx: IV abx, rehydration, sialogogues, oral hygiene - no improvement in 48hr: refer to I/D to investigate potential abscess

Family Medicine (17 decks)

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