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Flashcards in EENT Deck (110):
1

how long should an eye be patched following corneal abrasion?

no longer than 24 hours. daily follow up on all abrasions

2

orbital floor is composed of ...

maxillary, palatine, and zygomatic bones

3

why don't you give patient's topical anesthetic for corneal abrasion?

retards healing

4

what type of antibiotic ointment is used in corneal abrasion

gentamicin, sulfacetamide

5

how is a corneal ulcer described?

dense corneal infiltrate with overlying epithelial defect

6

all corneal ulcer go to the ....

ophthalmologist

7

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

8

will the intraocular pressure be affected with retinal detachment?

no

9

Leading cause of IRREVERSIBLE central visual loss

macular degeneration

10

gradual loss of central vision, drusen deposits are found in Bruch membrane, and neovascular degeneration is seen on exam. Name the disorder.

Macular degeneration

11

Tx macular degeneration

laser therapy, injections of monoclonal antibody and vitamins

12

ganglionic death leads to optic atrophy and pale retina, but the perifoveal atrophy is bright red

central retinal artery occlusion

13

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

14

chloroquine and phenothiazine are known to cause what optic disorder?

Macular degeneration

15

Central retinal vein occlusion usually occurs secondary to what other medical disorders?

DM, hyperlipidemia, glaucoma

16

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)

17

CRVO and CRAO are usually caused by a

embolic or thrombotic event

18

cataracts can form due to age and what other conditions

steroid use, trauma, dm, sun exposure and statins

19

what type of glaucoma is an emergency? Angle-closure glaucoma or open angle glaucoma

Angle-closure glaucoma.

20

painful eye, loss of vision, steamy cornea, and fixed mid dilated pupil and tear. This is most likely?

Angle-closure glaucoma

21

what visual fields are affected in open angle glaucoma?

peripheral visual fields and increased cup to disc ratio

22

Is IOP increased in both open and closed glaucoma

yes

23

Treatment for emergent angle-closure glaucoma

refer, start IV (carbonic anhydrase inhibitor) acetazolamide, topical beta blocker and osmotic diuresis (mannitol)

24

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.

25

prostaglandin like medications that help outflow of aqueous humor?

cholinergic agents, epinephrine, alpha agonist

26

what disorder is orbital cellulitis primary associated with?

sinusitis, but dental infections and trauma can also be part of the etiology

27

Bacteria responsible for orbital cellulitis?

same as otitis media...strep pneumo, staph aureus, h flu and gram negative bacteria

28

tx for orbital cellulitis?

medical emergency requiring hospitalization and IV antibiotics

29

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

30

Viral conjunctivitis is usually caused by?

adenovirus 3, 8, and 19

31

Common pathogens that cause bacterial conjunctivitis?

strep pneumo, staph aureus, h.flu

32

Complication of conjunctivitis?

keratits - permanent visual impairment

33

What will gram stain show for conjunctivitis caused by chlamydia and gonorrhea?

polymorphonuclear cells. Chlamydia (no organism) Gonorrhea (gram negative diplococci)

34

tx bacterial conjunctivitis

sulfonamides, fluroquinolone, use systemic antibiotics for atypical bacteria

35

optic disc appears swollen and the margins are blurred, with obliteration of vessels.

Papilledema

36

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).

37

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

38

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

39

sensorineural hearing loss

damage/impairment of the inner ear (cochlea) or neural pathway. weber lateralization to the better ear and Rinne= air>bone

40

Meniere's disease

distention of the inner's ear's endolymphatic compartment

41

symptoms of meniere's disease

recurrent vertigo, low range hearing loss, tinnitus and one sided aural pressure

42

Tx of meniere's dz

low salt diet, diuretics, unresponsive cases may need surgery

43

Acoustic neuroma (vestibular schwannoma) affects what cranial nerve?

8th.

44

unilateral progressive one sided hearing loss with impaired speech with continuous vertigo

Acoustic neuroma,
If question describes severe vertigo and hearing loss =Labyrinthtits

45

Best modality to dx acoustic neuroma?

MRI

46

you said aminoglycosides, loop diuretics and anticancer drugs?

what i can't hear you, b/c these drugs are ototoxic

47

bacteria responsible for chronic otitis media?

pseudomonas, s aureus, proteus

48

otitis externa is usually caused by pseudomonas or proteus what is the treatment

antibiotic otic drops aminoglycoside or fluoroquinolone + or - corticosteroid

49

Causes of central vertigo

tumor, brainstem vascular dz, AV malformation and MS

50

treatment for severe vertigo associated with Labyrinthitis?

vestibular suppressant (meclizine) and antibiotics if associated with fever

51

physical exam component that differentiates sinusitis from allergic or viral rhinitis?

inflammation of the osteomeatal complex is a sinusitis finding.

52

first line antibiotic for sinus infections

amoxicillin. secondary: TMP-SMX or doxycycline. Augmentin or quinolines if failed tx or chronic

53

triad of atopic disease

allergic rhinitis, asthma, & eczema/atopic dermatitis

54

medication in nasal decongestant that causes rhinitis medicamentosa?

oxymetazoline or phenylephrine

55

are coryza (irritation & swelling of mucous), hoarseness and cough symptoms of GABHS

nope. fever, tender anterior cervical adenopathy and lack of a cough.

56

Tx for strep if allergic to penicillin

erthyromycin or another macrolide

57

inadequate tx of GABHS can lead to what four complications?

scarlet fever, glomerulonephritis, rheumatic fever and abscess formation

58

what antibiotic would you use if laryngitis is bacterial in origin

erythromycin or augmentin

59

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

60

medication that can be used as maintenance therapy in recurrent cases of aphthous ulcers

Cimetidine (H2 blocker)

61

what are erythematous appearing plaques that are associated with Leukoplakia dangerous?

higher risk of cancer =90%
ERYTHROPLAKIA

62

what % of leukoplakia lesions are dyplastic or squamous cell carcinoma

5%

63

treatment epiglottis

IV antibiotics (ceftizoxime or cefuroxime) and IV corticosteroids

64

posterior epistaxis is associated with which medical conditions?

hypertension and atherosclerosis.

65

medical treatment for epistaxis

topical cocaine, oxymetazoline and lidocaine

66

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.

67

Initial treatment for nasal polyps?

3 month course of nasal corticosteroid, oral steroids are helpful to shrink size of larger polyps. May need surgery

68

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

69

is congenital or acquired rubella associated with developing cataracts?

congenital

70

Sialadenitis is

inflammation of salivary gland

71

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

72

how does uveitis present?

blurred vision, deep aching pain, photophobia and varying erythema

73

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

74

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)

75

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

76

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

77

what is the definitive treatment for adults with dacryocystitis

relief of the obstruction is the only cure=dacryocystorhinostomy.

78

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

79

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

80

What is normal intraocular pressure?

10-21mm Hg by tonometry

81

Trismus (hot potato voice should make you think of.....

peritonsillar abscess

82

what is ramsay hunt syndrome?

herpes zoster oticus ( acute peripheral facial palsy associated with otalgia/varicella like lesions

83

tx for ramsay hunt syndrome?

steroids, antivirals and pain meds

84

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.

85

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

86

Small grayish vesicles and punched-out ulcers in the posterior pharynx in a child with pharyngitis is representative of which organism?

Coxsackievirus

87

Proliferative retinopathy, as evidenced by neovascularization, is associated with an increased risk of?

vitreous hemorrhage. think DM patients

88

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

89

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

90

conservative treatment for TMJ

Lorazepam, teeth guards, physical therapy referral, muscle relaxants

91

What is the most common causative organism of meningitis in neonates?

Group B streptococcus

92

This is a physical exam finding consistent with the suspected diagnosis of chronic dry eye.

Poor tear film with punctate epithelial erosions

93

Lisch nodules found on the iris

neurofibromatosis

94

what can can precipitate cluster headaches?

Alcohol consumption, smoking and nitroglycerin

95

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

96

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.

97

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.

98

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.

99

the risk of malignant otitis externa (osteomyelitis of the skull base) is high, and treatment should begin immediately with

IV anti-pseudomonal antibiotics.

100

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.

101

The retina will be pallor and have arteriolar narrowing, box-carring, edema and perifoval atrophy (cherry red spot)

central retinal artery occlusion

102

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

103

three possible treatments for peritonsillar abscess

needle aspiration, I&D, or tonsilectomy

104

what virus causes the mumps

paramyxovirus

105

is watchful waiting ok with a dx of acoustic neuroma?

Yes, very slow growing

106

a patient with a hx of smoking presents with a new onset hoareness. what is the dx

laryngeal squamous cell carcinoma

107

child has erythematous sandpaper rash, you should think

scarlet fever, due to strep infection

108

timeframe for chronic sinusitis

>3mo

109

are topical or systemic antivirals first line for oral herpes

topical

110

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.