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Flashcards in EENT Deck (74):
1

Proper way to conduct an eye exam

right hand, right eye, right eye
start with wheel at 0
start 12' away
move in to 1-2" away
after red reflex, then exam from the optic disc and end with the fovea of each eye

2

what is the shape of the optic disc

Doughnut-like with an orange/pink neuroretinal rim and a central white depression (physiologic cup)

3

What should the cup/disc ratio be?

cup should not be more than 1/2 the size of the disc diameter

4

consider________ if the cup is more than 1/2 the size of the disc diameter

glaucoma

5

describe retinal vessels

arteries are brighter red and narrower than veins
A:V ratio 2:3 or 4:5

6

Where is the macula located

centered 2-2.5 disc diameters temoral to the optic disc and is avascular

7

What are the characteristics of the fovea centralis

2.5mm diameter reflective area that looks slightly darker and lies in the center of the macula region

8

have the patient look______ if the macula is difficult to visualize

directly into the light

9

What is hyperopia

Farsightedness, gero patient

10

What is myopia

Nearsightedness, younger patients

11

What is presbyopia

lessing of the crystalline lens and weakening of the ciliary muscles which controls the lens focusing leading to greater difficulty maintaining a clear focus at a near distance. Common after age 40

12

At what snellen do you refer a patient

20/30

13

What is arcus senilis

cloudy appearance of the cornea with a gray/ white arc or circle around the limbus due to the disposition of LIPID material. No affect on vision

14

S/SX of a hordeolum (stye)

abrupt onset, pain, erythema
localized tender mass developing in the eyelid

15

management of the hordeolum

warm compresses to bring to a head
Topical bacitracin or erythromycin opthalmic ointment
Refer to ophthla if no resolution in 2 days

16

Chalazion definition

beady nodule on the eye lid, infection or retention cyst of a meibomian gland, usually on the upper eyelid

17

What differentiates a hordeolum and a chalazion

hordeolum hurts

18

S/SX of chalazion

swelling on the eyelid
eyelid tenderness
sensitivity to light
increased tearing
if large: can cause astigmatism due to pressure on the cornea

19

Management of chalazion

warm compresses, refer for surgery

20

define blepharitis

staph or seborrheic dermatitis of the lid edge

21

s/sx of blepharitis

red, scaly, greedy flakes
Thickened crusted lid margins
Burning
itching
tearing

22

management of blepharitis

Hot compresses
Topical antibiotics, bacitracin or erythromycin
vigourous scrub

23

What should conjunctivitis not include in s/sx

pain

24

type of discharge with bacterial conjunctivitis

purulent

25

type of discharge with gonococcal or chlamydial conjunctivitis

copious purulent

26

Treatment for bacterial conjunctivitis

self limiting
Antibiotics drops: Levo, ofloxacin, cipro, tobra, gent

27

type of discharge with allergic conjunctivitis

stringy, increased tearing

28

Discharge for viral conjunctivitis

watery

29

management of allergic conjunctivitis

oral antihistamines, not gtt because can worsen glaucoma

30

What is the pathology of glaucoma

Increased intraocular pressure
Open angle- chronic
Closed angle- acute

31

s/sx of open angle glaucoma

chronic
asymptomatic
elevated IOP
cupping of the disc
Constriction of the visual fields

32

s/sx of closed angle glaucoma

acute
Extreme pain
blurred vision
halos around lights
Pupil fixed or dilated

33

diagnostics of glaucoma

tonometry, screening nationally recommended by age 40

34

Management of open angle glaucoma

Alpha 2-adrenergic agonists- brimonidine, alphagan
Beta-adrenergic blockers- timolol
Miotic agents- pilocarpine

35

Pathology of cataracts

Clouding and opacification of the normally clear lens of the eye

36

s/sx of cataracts

Painless, clouded blurred or dim vision
Halos around lights, NOT PAINFUL
Difficulty with vision at night
Sensitivity to light and glare
fading/ yellowing of colors
diplopia (2x vision) in a single eye
The need for brighter light for reading
NO RED REFLEX
Opacity of the lens

37

s/sx of retinal detachment

Flashes of light (photopsia) especially in peripheral vision
FLOATERS IN THE EYE
blurred vision
shadow or blindness in a part of the visual field of one eye

38

Management of otitis externa

Cleansing and debridement of the ear
Topical otic drops: Cortisporin otic, others
Pain control: NSAIDS, topical corticosteroids

39

What is streptococcus pneumoniae the key bacterial pathogen of?

Otitis media,
Sinusitis
Meningitis
CAP

40

What is the most common source of otitis media in adults

viral

41

What are the 3 phases of otitis media and what does it entail?

Local inflammation: erythema with diminished light reflex, fluid in the middle ear
Exudative phase: middle ear serous excudate
Suppurartive phase (serous)- purulent excudates; retraction and poor motility of the ™. Membrane becomes bulging and convex (IS SUPPOSED TO BE CRESENT). membrane may rupture

42

Management of otitis media in the adult

uncomplicated will resolve itself
hydration
avoid irritants
topical or oral decongestants
cool mist
antibiotic if suspected: AMOX

43

Define Cholesteatoma

Type of chronic otitis media consisting of peeling layers of scaly or keratinized epithelium; if untreated may erode the middle ear causing nerve damage and deafness

44

define vertigo

sensation of motion of either of the the person or the environment

45

define benign paroxysmal positional vertigo

most common form of vertigo- characterized by the sensation of motion initiated by sudden head movements

46

Causes of vertigo

brain tumors
medications
otitis media or labrinthitis
Meniere's disease
Acoustic neuroma
Head trauma or neck injury
Migraines
Cerebellar hemorrhage

47

Labs/ diagnostics of vertigo

CT scan
VDRL/RPR
serum medication levels
hearing exam
Blood glucose and ECG may be helpful

48

Management of vertigo

Diazepam
Meclizine hydrochloride
diphenhydramine
scopolamine patch
antiemetics

49

What are some of the medications that cause sensorineural hearing loss?

OTOTOXIC DRUGS:
Aminoglycosides
diuretics
salicylates
NSAIDS
Antineoplastics

50

What are some infections that cause sensorineural hearing loss?

Mumps, measles, herpes zoster, syphilis, meningitis

51

What are the 3 components of meniers disease?

sensorineural hearing loss, tinnitus, vertigo

52

What do the weber and rinne test show in conductive hearing loss?

weber: sound lateralizes to the affected ear
Rinne test: Abnormal in the affected ear (AC

53

What will the weber and rinne test show in sensorineural hearing loss?

Weber: Sound lateralized to the unaffected ear
Rinne: Normal in the affected ear

54

define the common cold

Viral rhinitis: self-limiting (5-10 days) caused by any 1 or more of the 200 viruses (Rhinovirus, coronavirus, RSV, adenovirus…)

55

What is the Centor Criteria?

clinical features most suggestive of group A B-hemolytic strep pharyngitis (FLEA)
Fever >38C or 100.4F
Lack of cough
Exudate
Anterior cervical adenopathy
If 2 or 3- rapid strep test

56

management of pharyngitis

Fluids/ hydration
salt water gargles
asa/ tylenol
ANX for strep- PCN V, erythromycin)
Ceftriaxone for gonococcal infection

57

Lab/diagnostic for pharyngitis

rapid streptococcal antigen test
Monospot
CBC with diff

58

labs/ diagnostic for influenza

virus isolation from nasal or throat swab or sputum specimen (most rapid)

59

When would you RX a antibiotic in influenza

if bacterial infection is suspected or patient is asthma, COPD, or immune compromised

60

What are neuraminidase inhibitors and what do they do?

Shorten the duration of symptoms by 2 days, effective for both influenza A and B. Must give within 48 hours or exposed
Zanamivir
Osteltamivir (tamiflu)

61

What virus causes mononucleosis

epstein-barr virus

62

What age group is most common for mono?

15-24 yo

63

What kind of adenopathy is seen with mononucleosis

posterior cervical region

64

What is the most severe symptom of mono?

pharyngitis, white tonsillar excavates

65

What occurs usually during the 2nd week of mono illness?

Spelnomegaly

66

What are the labs/ diagnostics of mono

Monospot positive
Increased WBC and relative lymphocytosis and neutropenia

67

What are the indications of a bacterial rhino sinusitis

purulent nasal drainage
fever

68

How long is mono incubation?

1-2 months, usually self limited, but malaise and fatigue may last months

69

What is the management of rhinosinusitis

Hyrdation
Oral decongestants (sudafed, mucinex)
Analgesics
Antibiotics only if bacterial is suspected- AMOX+CLAV= Augmentin, or clarithromycin (Biaxin)
supportive care

70

What is the most frequent location of nose bleeds

anterior spetum

71

What might uncontrolled nose bleeds be an indication of?

posterior septum nose bleed- more complicated, artery in the back of the nose.

72

If no resolution of nosebleed after____ minutes, refer to ENT

10

73

what kind of eye drops are used in the management of open angle glaucoma

miotic agents to produce miosis which symptomatically lowers IOP (pilocarpine)

74

what teeth erupt by 12.5 years

all teeth except the third molar
the second molar erupts by 11.9 (lower) and upper by 12.25