EENT Flashcards
how long should an eye be patched following corneal abrasion?
no longer than 24 hours. daily follow up on all abrasions
orbital floor is composed of …
maxillary, palatine, and zygomatic bones
why don’t you give patient’s topical anesthetic for corneal abrasion?
retards healing
what type of antibiotic ointment is used in corneal abrasion
gentamicin, sulfacetamide
how is a corneal ulcer described?
dense corneal infiltrate with overlying epithelial defect
all corneal ulcer go to the ….
ophthalmologist
patients with retinal detachment should be placed in what position?
supine, with head turned to the side of the detachment while emergency consult to ophtham is confirmed
will the intraocular pressure be affected with retinal detachment?
no
Leading cause of IRREVERSIBLE central visual loss
macular degeneration
gradual loss of central vision, drusen deposits are found in Bruch membrane, and neovascular degeneration is seen on exam. Name the disorder.
Macular degeneration
Tx macular degeneration
laser therapy, injections of monoclonal antibody and vitamins
ganglionic death leads to optic atrophy and pale retina, but the perifoveal atrophy is bright red
central retinal artery occlusion
Retinal artery occlusion is an emergency, what measures can be done, while waiting for ophtham to arrive?
place patent is recumbent position and do ocular massage
chloroquine and phenothiazine are known to cause what optic disorder?
Macular degeneration
Central retinal vein occlusion usually occurs secondary to what other medical disorders?
DM, hyperlipidemia, glaucoma
Central retinal vein occlusion is painless blurred vision or vision loss, similar to central retinal artery occlusion and retinal detachment. What is the buzz word associated with exam?
afferent pupillary detect, optic disc swelling and blood/thunder retina (due to dilated veins, hemorrhage and edema)
CRVO and CRAO are usually caused by a
embolic or thrombotic event
cataracts can form due to age and what other conditions
steroid use, trauma, dm, sun exposure and statins
what type of glaucoma is an emergency? Angle-closure glaucoma or open angle glaucoma
Angle-closure glaucoma.
painful eye, loss of vision, steamy cornea, and fixed mid dilated pupil and tear. This is most likely?
Angle-closure glaucoma
what visual fields are affected in open angle glaucoma?
peripheral visual fields and increased cup to disc ratio
Is IOP increased in both open and closed glaucoma
yes
Treatment for emergent angle-closure glaucoma
refer, start IV (carbonic anhydrase inhibitor) acetazolamide, topical beta blocker and osmotic diuresis (mannitol)
tx for open angle glaucoma
this is a chronic condition, use topical meds to decease IOP by decreasing aqueous production (b-blocker or acetazolamide and prostaglandin like med to increase outflow.
prostaglandin like medications that help outflow of aqueous humor?
cholinergic agents, epinephrine, alpha agonist
what disorder is orbital cellulitis primary associated with?
sinusitis, but dental infections and trauma can also be part of the etiology
Bacteria responsible for orbital cellulitis?
same as otitis media…strep pneumo, staph aureus, h flu and gram negative bacteria
tx for orbital cellulitis?
medical emergency requiring hospitalization and IV antibiotics
Difference between internal and external hordeolum?
internal is pustule within the meibomian gland and external is an infection of the glands of Moll or Zeis located near the palpebral margin
Viral conjunctivitis is usually caused by?
adenovirus 3, 8, and 19
Common pathogens that cause bacterial conjunctivitis?
strep pneumo, staph aureus, h.flu
Complication of conjunctivitis?
keratits - permanent visual impairment
What will gram stain show for conjunctivitis caused by chlamydia and gonorrhea?
polymorphonuclear cells. Chlamydia (no organism) Gonorrhea (gram negative diplococci)
tx bacterial conjunctivitis
sulfonamides, fluroquinolone, use systemic antibiotics for atypical bacteria
optic disc appears swollen and the margins are blurred, with obliteration of vessels.
Papilledema
marcus gunn pupil
use swinging flash light directed in the affected eye will cause only mild constriction of both pupils (due to decreased response to light from the afferent defect), while light in the unaffected eye will cause a normal constriction of both pupils (due to an intact efferent path, and an intact consensual pupillary reflex).
location of a lesion along the optic pathway will affect vision differently. What changes are present if the lesion is anterior to optic chiasm? at the optic chiasm? and posterior to the chiasm?
Anterior: will only affect one eye
At the chiasm: will affect both eyes partially
Posterior: will either affect the left visual field of both eyes or the right visual field of both eyes
transient vision loss, tender temporal artery, fever and increase sed rate? what autoimmune disease is this associated with?
giant cell arteritis. associated autoimmune dz? polymyalgia rheumatic
sensorineural hearing loss
damage/impairment of the inner ear (cochlea) or neural pathway. weber lateralization to the better ear and Rinne= air>bone
Meniere’s disease
distention of the inner’s ear’s endolymphatic compartment
symptoms of meniere’s disease
recurrent vertigo, low range hearing loss, tinnitus and one sided aural pressure
Tx of meniere’s dz
low salt diet, diuretics, unresponsive cases may need surgery
Acoustic neuroma (vestibular schwannoma) affects what cranial nerve?
8th.
unilateral progressive one sided hearing loss with impaired speech with continuous vertigo
Acoustic neuroma,
If question describes severe vertigo and hearing loss =Labyrinthtits
Best modality to dx acoustic neuroma?
MRI
you said aminoglycosides, loop diuretics and anticancer drugs?
what i can’t hear you, b/c these drugs are ototoxic
bacteria responsible for chronic otitis media?
pseudomonas, s aureus, proteus
otitis externa is usually caused by pseudomonas or proteus what is the treatment
antibiotic otic drops aminoglycoside or fluoroquinolone + or - corticosteroid
Causes of central vertigo
tumor, brainstem vascular dz, AV malformation and MS
treatment for severe vertigo associated with Labyrinthitis?
vestibular suppressant (meclizine) and antibiotics if associated with fever
physical exam component that differentiates sinusitis from allergic or viral rhinitis?
inflammation of the osteomeatal complex is a sinusitis finding.
first line antibiotic for sinus infections
amoxicillin. secondary: TMP-SMX or doxycycline. Augmentin or quinolines if failed tx or chronic
triad of atopic disease
allergic rhinitis, asthma, & eczema/atopic dermatitis
medication in nasal decongestant that causes rhinitis medicamentosa?
oxymetazoline or phenylephrine
are coryza (irritation & swelling of mucous), hoarseness and cough symptoms of GABHS
nope. fever, tender anterior cervical adenopathy and lack of a cough.
Tx for strep if allergic to penicillin
erthyromycin or another macrolide
inadequate tx of GABHS can lead to what four complications?
scarlet fever, glomerulonephritis, rheumatic fever and abscess formation
what antibiotic would you use if laryngitis is bacterial in origin
erythromycin or augmentin
A patient presents with a round ulcer in her mouth that is yellow-grey and has a red halo. It is on the buccal mucosa and it is painful. what is the dx
apthous ulcers
medication that can be used as maintenance therapy in recurrent cases of aphthous ulcers
Cimetidine (H2 blocker)
what are erythematous appearing plaques that are associated with Leukoplakia dangerous?
higher risk of cancer =90%
ERYTHROPLAKIA
what % of leukoplakia lesions are dyplastic or squamous cell carcinoma
5%
treatment epiglottis
IV antibiotics (ceftizoxime or cefuroxime) and IV corticosteroids
posterior epistaxis is associated with which medical conditions?
hypertension and atherosclerosis.
medical treatment for epistaxis
topical cocaine, oxymetazoline and lidocaine
Samter triad
Most commonly the first symptom is rhinitis, which can manifest as sneezing, runny nose, or congestion. The disorder typically progresses to asthma, then nasal polyposis, with aspirin sensitivity coming last.
Initial treatment for nasal polyps?
3 month course of nasal corticosteroid, oral steroids are helpful to shrink size of larger polyps. May need surgery
17 year old has left ear pain, tender tragus, and normal TM without bulging or retraction do you prescribed a. amoxicillin b. ofloxacin solution c. carbide solution (debrox) or d. pseudoephedrine
B. antibiotic ear drops the treatment of choice for otitis extern. solutions containing aminoglycoside (neomycin, polymyxin) or fluoroquinlone
is congenital or acquired rubella associated with developing cataracts?
congenital
Sialadenitis is
inflammation of salivary gland
27 yo female presents with progressive unilateral loss in vision, mild eye pain that worsens with extra ocular movements. Exam reveals loss in color vision and afferent pupillary defect. Most likely dx? Hint: she also has MS.
optic neuritis
how does uveitis present?
blurred vision, deep aching pain, photophobia and varying erythema
What is optic neuritis? Name the other terms associated with optic neuritis.
Inflammation of the optic nerve. It is also called papillitis or retrobulbar neuritis, depending on the location of the inflammation
most common etiology of optic neuritis
MS (Inflammation of the optic nerve causes loss of vision, usually because of the swelling and destruction of the myelin sheath covering the optic nerve)
pt presents with inflamed, painful eye, exam reveals swallow dendritic ulcer in the center of the cornea?
Trifluridine (viroptic)- antiherpetic/antiviral drug. Refer to ophtham
pt with DM presents with decreased visual acuity and presence of micro aneurysms and small hemorrhages. What is the best next step refer or do visual field testing?
refer
what is the definitive treatment for adults with dacryocystitis
relief of the obstruction is the only cure=dacryocystorhinostomy.
Dx of a 63 yo with sudden onset of painful red eye, throbbing frontal HA, blurred vision with halo, nausea, ciliary flush and cloudy cornea?
acute angle glaucoma
Pt presents complaining of floaters, flashing lights and scotomata in the peripheral visual field after being hit in the eye with a tennis ball. Dx?
retinal detachment
What is normal intraocular pressure?
10-21mm Hg by tonometry
Trismus (hot potato voice should make you think of…..
peritonsillar abscess
what is ramsay hunt syndrome?
herpes zoster oticus ( acute peripheral facial palsy associated with otalgia/varicella like lesions
tx for ramsay hunt syndrome?
steroids, antivirals and pain meds
Concern about the infant’s hearing since birth. Physical examination reveals no apparent response to a sudden loud sound. What is the most appropriate diagnostic evaluation?
Brainstem auditory-evoked potentials evaluate the sensory pathway and identify the site of any anatomical
disruption. The test does not require any active response from the patient and is useful in the evaluation of an infant.
Hit to the right eye, resulting is ptosis, diplopia, and limitation of upward gaze. What is most likely fractured?
Prolapse of orbital soft tissue, including inferior rectus muscle, inferior oblique muscle, orbital fat, and
connective tissue due to an the orbital floor fracture
Small grayish vesicles and punched-out ulcers in the posterior pharynx in a child with pharyngitis is representative of which organism?
Coxsackievirus
Proliferative retinopathy, as evidenced by neovascularization, is associated with an increased risk of?
vitreous hemorrhage. think DM patients
Use of systemic corticosteroids can cause which of the following adverse effects in the eye? A. Cortical blindness B. Optic atrophy C. Glaucoma D. Papilledema
Glaucoma
Dental caries are caused by which of the following organisms? A. Streptococcus mutans B. Streptococcus pyogenes C. Staphylococcus epidermidis D. Staphylococcus aureus
A. Streptococcus Mutans
conservative treatment for TMJ
Lorazepam, teeth guards, physical therapy referral, muscle relaxants
What is the most common causative organism of meningitis in neonates?
Group B streptococcus
This is a physical exam finding consistent with the suspected diagnosis of chronic dry eye.
Poor tear film with punctate epithelial erosions
Lisch nodules found on the iris
neurofibromatosis
what can can precipitate cluster headaches?
Alcohol consumption, smoking and nitroglycerin
A patient presents with bilateral cheek pain and fever. On physical exam you note bilateral edema of the mandibular region which crosses the angle of the jaw with preauricular tenderness to palpation. Which of the following is the most likely diagnosis?
Parotitis
You notice during a prekindergarten exam that your patient doesn’t appear to have binocular fixation. What is the most appropriate physical exam test to perform next?
Corneal light reflexion, next step to confirm the presence of strabismus.
A 67 year old female, who has been recovering from an upper respiratory tract infection, presents today complaining of acutely feeling “the room spinning”. She admits having trouble walking at times and has stumbled, but not fallen yet. She denies having hearing loss or tinnitus. On physical exam you note a horizontal nystagmus with moderate amplitude and frequency. Which of the following is the most likely diagnosis?
vestibular neuronitis
Vertigo that presents after an upper respiratory illness is either vestibular neuronitis and/or labrynthitis. Pure vestibular neuronitis is distinguished from labyrnthitis in that vestibular neuronitis is acute vertigo with preserved auditory function, while labrynthitis is acute vertigo with loss of hearing.
A 5 year old female is brought to your office by her mother who has noticed a rash on the palms of her hands and soles of her feet. She also reports that her daughter has had a fever of 100.5 F (38.1 C) and significantly decreased appetite for the past 3 days. What physical exam findings would you suspect in this patient?
Painful, small gray lesions on an erythematous base seen on the oral mucosa. This describes the aphthous ulcers commonly seen in Hand, foot, mouth disease caused by Coxsackie virus A16.
the risk of malignant otitis externa (osteomyelitis of the skull base) is high, and treatment should begin immediately with
IV anti-pseudomonal antibiotics.
history of relapsing-remitting Multiple Sclerosis, presents complaining of a lancinating pain from the corner of her mouth to her ear on the right side.
Trigeminal neuralgia commonly presents with the lancinating pain described, and is often a symptom of those with MS.
The retina will be pallor and have arteriolar narrowing, box-carring, edema and perifoval atrophy (cherry red spot)
central retinal artery occlusion
in patient with sensorineural hearing loss what will be the results of the weber test?
the patient will hear the sound louder in the unaffected ear
three possible treatments for peritonsillar abscess
needle aspiration, I&D, or tonsilectomy
what virus causes the mumps
paramyxovirus
is watchful waiting ok with a dx of acoustic neuroma?
Yes, very slow growing
a patient with a hx of smoking presents with a new onset hoareness. what is the dx
laryngeal squamous cell carcinoma
child has erythematous sandpaper rash, you should think
scarlet fever, due to strep infection
timeframe for chronic sinusitis
> 3mo
are topical or systemic antivirals first line for oral herpes
topical
what is the difference between vestibular neuritis and labyrnthitis?
Pure vestibular neuronitis is distinguished from labyrnthitis in that vestibular neuronitis is acute vertigo with preserved auditory function, while labrynthitis is acute vertigo with loss of hearing.
