EENT Flashcards
(150 cards)
1
Q
subconjunctival hemorrhage
A
red around the eye, benign
2
Q
uveitis
A
inflammatory autoimmune - use steroids to treat
3
Q
when to never use steroids in the eye
A
HSV infection- causes blindness
4
Q
symptoms of glaucoma
A
orbital swelling, corneal clouding, decreased vision, fixed/dilated pupil
5
Q
blepharitis
A
eyelid infection or inflammation
6
Q
dacrocystitis
A
lacrimal sac inflammation
7
Q
keratitis
A
cornea inflammation
8
Q
cellulitis
A
inflammation of the skin to the subdermal tissues
9
Q
symptoms of conjuctivitis
A
tearing, burning, erythema, discharge, crusting
10
Q
what should be on the differential for possible conjunctivitis if blurry vision is present
A
uveitis, scleritis, glaucoma
11
Q
most common cause of viral conjunctivitis
A
adenovirus (but consider HSV, HZV, and EBV)
12
Q
is MORNING crusting more common with viral or bacterial conjunctivitis
A
viral
13
Q
most common corneal infection in the US
A
HSV keratitis
14
Q
what cranial nerve is affected with HSV keratitis
A
CN 5
15
Q
what drugs treat HSV keratitis
A
acyclovir and valacyclovir
16
Q
what indicates eye involvement in an HZV reactivation
A
lesion at the tip of the nose- Hutchinson sign
17
Q
what cranial nerve is affected with chorioretinitis
A
CN 2
18
Q
most common causes of chorioretinitis
A
CMV and toxoplasmosis
19
Q
characteristic sign of chorioretinitis on exam
A
flame hemorrhages and patches
20
Q
which STIs cause bacterial conjunctivitis- need referral
A
N. ghonorrhea, Chlamydia trachomatis
21
Q
most common bacteria that cause bacterial conjunctivits
A
S. pneumo, S. aureus, M. catarrhalis, H. influ.
22
Q
is bacterial conjunctivitis most commonly unilateral or bilateral
A
unilateral initially, spreads to second eye within 24-48 hours
23
Q
when does bacterial conjunctivitis present with photophobia?
A
chlamydia
24
Q
what is the treatment for bacterial conjunctivitis
A
topical antibiotics- TMP/polymixin B drops and erythromycin ointment
25
when is a stat opthamology referral required for bacterial conjunctivitis?
If suspected gonorrhea or chlamydia
26
what treatment should be given for chlamydia or gonorrhea resulting in bacterial conjuctivitis?
ceftriaxone AND azithromycin
27
common causes of orbital cellulitis
staph, strep, H. flu, anaerobes, and pseudomonas.In diabetics, often fungal- mucor or aspergillus
28
symptoms of orbital cellulitis
proptosis, opthalmoplegia, edema, erythema, headache, and fever
29
preseptal cellulitis
anterior to orbital septum, usually associated with trauma, no proptosis
30
Define Dacryoadenitis
Inflammation of the lacrimal gland.
31
Dacryoadenitis - DX
acute - unilateral, swollen lid and lacrimal system, severe pain and pressure in the supratemporal area of the orbit. no vision changes presents in hours to days
chronic - more common form. Can Present bilaterally with painless enlargement of the lacrimal gland. no vision changes Note: infectious causes are rare, but when they occur, bacterial gram +ve
32
Dacryoadenitis - Treatment and Management
Viral (MC) - self-limiting, supportive measures (warm compress, NSAIDS)Bacterial - initiate with 1st gen cephalosporins (Keflex) until culturefungal or protozoan - treat accordinglyinflammatory - steroids and investigate for systemtic etiology
33
Dacryoadenitis - DDX
* dacrocystitis
* viral conjunctivitis
* bacterial conjunctivitis
34
Dacrocystitis - Definition
lacrimal sac is inflammation of the lacrimal sac. Usually accompanied by blockage of the lacrimal duct
35
Dacrocystitis - Dx
Diagnosis is based on clinical presentation
36
Dacrocystitis - Treatment
* Distended and erythematous with discharge and tenderness: I&D Non-tender without discharge:
* massage in infants
* irrigation in adults
* midly tender with discharge: warm compresses and antibiotics (depends on culture), but first line is Augmentin
37
Dacrocystitis - Clinical Presentation
* lacrimal sac is frequently blocked, with tears draining out of eye
* palpable and visible mass over lacrimal sac, which is located just inferior to the medial canthus
* in acute, sometimes with erythema, tenderness and discharge (indicative of infection as complication)
* can be chronic, then manage surgically by opening blocked duct
* can also be congenital
38
Thyroid Eye Disease (TED)Definition
* Autoimmune disorder often, but not always in hyperthyroid patients
* e.g., Hashimotos thyroiditis
* leads to characteristic changes in the eye
39
TED - Epidemiology
* Women more likely than men
But, men more likely to develop SEVERE TED
* Smoking linked to TED and progression (dose-response dependent based on cigarette #)
* RAI (treatment for thyroid) may worsen TED
40
TED - Management and Prevention (Get Euthyroid first)
* Mild -
* Most cases and mild and will improve spontaneously
* 74% in study needed no Rx or supportive therapy only
* artificial tears
* establish euthyroid status
* selenium - slowed progression
2. Moderate/Severe -
* IV methylprednisolone pulse, PO steriods later with taper (effective, but hard to do outside Europe)
* orbital radiation
* Rituximab (Mab) - Note that this treatment is still experimental. can have bad side effects like serum sickness and infusion reaction. Also $$ Surgical -
* Emergent - immediate decompression when CON unresponsive to IV steriods or severe proptosis with exposure Elective - delay until pt. is euthyroid and stable for 6-9 months Sequenced approach:
* decompression
* extraocular muscle surgery
* lid retraction surgery
* dermatochalasis (fat protrusion)
41
What is the common name for Keratoconjunctivities Sicca?
Dry Eye
42
Dry Eye (KS) - Epidemiology
* very common (5-30%)
* Elderly
* Female
43
Dry Eye (KS) - Treatment/Management
Non-pharmacologic
* blink more often
* avoid ac/heating
* use humidifier (esp. at night)
* moisture chamber glasses/goggles
* Artificial Tears - Mainstay (OTC)
* Restasis (topical cyclosporine) - prescription with immunosuppressive char. Must fail OTC artificial tears. Doesn't work for everyone and really expensive (donut hole)
44
Dry Eye - Diagnosis and Tests
* tear break-up time (E)
* Schirmer's tear test - (LP)
* corneal sensation (LP) - low sensitivity
* tear hyperosmolarity (non-specific)
* ocular surface inflammatio (non-specific) Questionnaires (non-specific)
* ocular surface disease index (OSDI)
* impact of dry eye on everyday life (IDEEL)
* Salisbury eye evaluation questionnaire (SEE)
(E) = evaporative(LP) = low production
45
Dry Eye - Clinical Presentation SymptomsSigns
Symptoms:
* irritation
* feeling of grittiness or sand
* redness
* photophobia
* burning
* blurry vision
* Signs:
* conjunctival injection
* loss of luster
* mebomian gland dysfunction
* punctate epithelial lesions
* neovascularization
* corneal scarring
46
Dry Eye - Decreased Tear ProductionPathophysiology
* Sjogren Syndrome - autoimmune disease that cuases decreased fluid secretion
* Age-related duct obstruction
* infiltrative disease (attacks lacrimal gland) - sarcoidosis, lymphoma, graft-vs-host
* contact lens use (reflexive decrease in tears)
* DM
Decreased tear production-->hyperosmolar tear film-->inflammation of ocular surface cells on cornea
47
Dry Eye - Increased Evaporative LossEtiology/Pathophys
* meibomian gland dysfunction (aka posterior blepharitis) - decreased lipid in tears, so they evaporate faster
* decreased blinking - staring at a computer screen
* decreased eyelid integrity (TED, entropian)
48
Allergic Eye Disease - Definition and subtypes
Allergic conjunctivitis acute allergic conjunctivitis
* exposure to allergen
* rapid (less than one hour) onset
seasonal allergic conjunctivitis (Hay Fever)Outdoor environmental allergen
* spring = tree pollens
* summer = grass pollens
* late summer/early fall = weed pollens
* slow onset, constant through season
perennial allergic conjunctivitis - year-round symptoms to ubiquitous allergens (mold, dust mites, etc.)
49
Allergic Eye Disease - Epi
* 20% of the population
* more common in young
* decreasing prevalence with age commonly co-occurs with other allergic disorders
* allergic rhinitis
* atopic dermatitis
* asthma
50
Allergic Eye Disease - Pathophys.
IgE mediated hypersensitivity reaction Mast cells cause histamine release which in turn, causes vasodilation, vasopermeability, itchingattracts, eosinophils, basophils and neutrophilsthen monocytes and lymphocytes
51
Allergic Eye Disease - Clinical Presentation
* itchy
* burning
* red
bilateral
52
Allergic Eye Disease - DDX
* dry eye
* viral conjunctivitis
* keratitis (esp. if unilateral)
* blepharitis
* toxic exposure
* acute angle closure glaucoma
* episcleritis - layer on top of sclera inflammed (if eye pain)
53
Allergic Eye Disease - Management and Treatment
* don't rub eyes
* cool compresses
* artificial tears
* discontinue contact lens use
* allergen avoidance antihistamines/mast cell stabilizers (goal is vasoconstriction)
* visine-A (antihistamine/vasoconstric)
* alaway - (antihistamine/mast cell stab.)
54
Age-Related Macular Degeneration (AMD)Definition
* degeneration of the macula resulting in central vision loss
* normal part of aging
* can be accelerated by certain risk factors
55
AMD - Epi
* Age - 40% of 75+ have some form
* white>Asian>Hispanic>Black
* F>M
* Genetics - Ask about FH Disease-related factors
* High BMI
* CV Disease
* inflammatory conditions
* Smoking (2x more likely) - progress from dry to wet faster
56
AMD - Clinical Presentation
Symptoms - gradual onset of blurred central vision in one or both eyesSigns - Drusen body accumulation around the macula (dist. from hard exudates). Amsler grid distortion
57
AMD - Pathophysiology
Vascular Endothelial Growth Factor (VGEF) - produced in excess in eye promotes neovascularization but the vessels do not reach maturity. They are friable and bleed and leak. Leaking vessels is more prominent in wet, which is advanced form. Most are dry (80%) and stay dry.
58
AMD - Treatment and Management
* quit smoking
* vitamin and mineral supplements (lutein in particular)
* Advanced disease - injectable VEGF inhibitors (4-8 weeks)
* photodynamic therapy
59
Primary Open-Angle Glaucoma (POAG)Definition
Progressive degeneration of the optic nerve with cupping of the optic disc and visual field defects. NB: CAN OCCUR WITH NORMAL IOP
60
POAG - Pathophysiology
* poor drainage of aqueous humor at trabecular mesh network
* increases anterior chamber pressure
* translation of pressure to rest of globe
* nerve damage due to IOP increase
but, there's issues with this model (because IOP can be normal)
61
POAG - Epi
* 1/2 of people aware they have disease
* cited as second leading cause of irreversible blindness
* 2.25 over 40 in U.S. have POAG
62
POAG - Clinical Presentation
hx of eye pain or redness halos around lights (rainbows) diminshed peripheral vision headache (elevated IOP) previous ocular disease
63
POAG - Diagnosis (Testing)
usually found on routine eye exam (most are covered every 2 years)
* normal IOP is 12-22 mmHg
* ocular hypertension >22 mmHg with no evidence of glaucoma
* Increasing cup:disk ratio (greater than 0.5)
* Photograph retina to tell extent of nerve damage
* Perimetry - available in ophtho.
64
POAG - Rx and Prevention
* Regular screening of IOP and peripheral vision
* medications (topical protaglandins increase uveoscleral outflow) - the "prosts" (Bimatoprost/Lumigan; Travoprost/Travatan; Latanoprost/Xalatan)
* topical Beta Blockers (decrease aqueous humor production) - Timolol (Timoptic)
* Laser trabeculoplasty surgical trabulectomy
* last two focus on improving drainage
65
Cataracts - Definition
* opacification of the lens
66
Cataracts - Clinical Presentation
* People complain of decline in vision, but it is really color vision and sharpness that goes
* glare - daytime glare/night driving
* second sight (aka myopic shift) - presbyopia disappears because of "tired" lens changing shape
* cloudiness on the lens during exam
67
Cataract - Treatment
* sunglasses for glare
* avoid night driving
* surgical replacement with artificial lens
68
Diabetic Retinopathy - Definition
Disease of the retina from persistent hyperglycemia. Leads to destruction of the retina and blindness.
69
Diabetic Retinopathy - Epidemiology
Type I - 3-5 years after onset of systemic disease
Type II - DR usually present at the time of diagnosis of DM
Can occur with GD Risk factors: chronic hyperglycemia hypertension hypercholesterolemia smoking
70
Diabetic Retinopathy - Clinical Presntation
```
Fundoscopic Exam:Non-Proliferative
* Dot and Blot hemmorrhages
* hard exudates (lipid deposition)
* microaneurysms
* cotton wool spots
* flame hemorrhages - within superficial nerve fiber layer
Proliferative
* neovascularization
* vitreous hemorrhage (due to new blood vessels that are friable permeating into humor)
```
71
Diabetic Retinopathy - Rx
* Treat DM Then, for non-proliferative DR:
* Anti-VEGFs
* intravitreal corticosteriod implants
* focal photocoagulation therapy
* vitrectomy For proliferative
* panretinal laser photocoagulation
72
Papilledema - Definition
swelling of the optic nerve and disc
73
Papilldema - Causes
* tumors
* space-occupying lesions of the CNS
* subarachnoid hemorrhage
74
Papilledema (Clinical Presentation)
```
Early
* blurred disc margins
* disc hyperemia
* small peripapillary hemorrhages
* loss of venous pulsation
Late
* very blurry disc margins
* elevation of disc
* venous congestion with small hemorrhages, exudates, cotton wool spots
```
75
Hypertensive Retinopathy - Clinical Pres.
* arterial narrowing
* AV nicking
* copper or silver wiring
* flame shaped hemorrhages
* cotton wool spots
* hard exudates
76
Hypertensive Retinopathy - RX
* Treat the underlying HTN Then:
* laser therapy
* intravitreal corticosteriod injection
* anti-VEGF
77
define serous otitis media
transudation of fluid due to prolonged eustachian tube dysfunction with resultant negative middle ear pressure
78
when does serous otitis media occur in adults
after a URI, barotrauma, or chronic allergic rhinitis
79
must not miss dx for persistent unilateral serous otitis media
nasopharyngeal carcinoma
80
appearance of tympanic membrane in serous otitis media
dull, hypomobile, retraction, and sometimes air bubbles
81
does serous otitis media cause sensorineuro or conductive hearing loss?
conductive
82
treatment of serous otitis media
oral steroids vs oral abxif failed response- ventilation tubes
83
define tympanosclerosis
calcification of the TM and middle ear structures from inflammation
84
define myringosclerosis
calcification of the TM only
85
does tympanosclerosis or myringosclerosis cause hearing loss?
tympanosclerosis
86
what is a retraction pocket?
chronic inflammation and negative pressure causes invagination of the pars tensa or pars flaccida.produces atrophy and atelectasis
87
what does chronic retraction and inflammation result in?
adhesive otitis- predisposes to formation of cholesteatoma or fixation and erosion of the ossicles
88
define cholesteatoma
greasy or pearly white mass in a retraction pocket or perforation- causes destruction of temporal boneHallmark is painless otorrhea
89
symptoms of cholesteatoma
persistent, recurrent, foul smelling otorrhea
90
treatment of TM perforation due to AOM
ototopical abx for 10-14 days. refer for hearing evaluation. if it doesn't heal on it's own, surgery can correct.
91
etiology of chronic suppurative otitis media
persistent otorrhea with tympanostomy tubes or TM perforation. has ongoing purulent ear drainage. may be associated with cholesteatomachronic infection with mucosal edema, ulceration, granulation tissue, and polyp formation
92
bacteria associated with chronic suppurative otitis media
P aeruginosa, S aureus, Proteus, Klebsiella pneumoniae, and diphtheroids
93
if chronic suppurative otitis media fails culture directed treatment, what is the ddx?
foreign body, neoplasm, langerhan's cell histiocytosis, tuberculosis, granulomatosis, fungal infection, or petrositis
94
treatment of chronic suppurative otitis media
culture drainage and treat with appropriate abx
95
pathogenesis of mastoiditis
infection from middle ear spreads to the mastoid portion of temporal bone into air-filled spaces
96
most common affected age group for mastoiditis
60% younger than 2
97
symptoms of mastoiditis
postauricular pain, fever, outwardly displaced pinnamastoid is indurated and red, swollen, and fluctuantmastoid is tenderAOM almost always present
98
imaging for mastoiditis
CT- initially looks like AOM
| progression of disease shows coalescence of mastoid air cells
99
pathogens of mastoiditis
S pneumo, H influenzae, and S pyogenes
100
ddx of mastoiditis
lymphadenitis, parotitis, trauma, tumor, histiocytosis, OE, furuncle
101
major complication of mastoiditis
meningitis or brain abscess
102
treatment of mastoiditis
IV abx- depends on culture, must cross blood-brain barrierif no improvement in 24-48 hours requires sugery- tympanostomy tube and culture vs I and D vs cortical mastoidectomy
103
prognosis for mastoiditis
good. typically full recovery
104
symptoms of AOM
otalgia, aural pressure, decreased hearing, and fever
105
treatment of AOM
abx- amoxicillin and nasal decongestants can use cefaclor or augmentin for resistant cases
106
chronic otitis media essentials of dx
chronic otorrhea, TM perforation with conductive hearing loss
107
most common bacteria causing chronic otitis media
P aeruginosa, Proteus, S aureus, and mixed anaerobes
108
define cholesteatoma
variety of chronic otitis media, most commonly due to eustachian tube dysfunctioninward migration of tympanic membrane creating a squamous epithelium-lined sac- fills with desquamated keratin and becomes infected. Can erode bone, destroy ossicular chain, erode inner ear, effect the facial nerve and spread intercranially
109
define otosclerosis
lesions of footplate of the stapes impede passage of sound, causing conductive hearing losslesions can impede on the cochlea causing sensory hearing loss
110
middle ear neoplasia
rarepresents with pulsatile tinnitus and hearing loss
111
nerves involved with middle ear neoplasia
VII, IX, X, XI, and XII
112
treatment of middle ear neoplasia
surgery, radiotherapy or both
113
ototoxic medication
aminoglycosides, loop diuretics, antineoplastic agents
114
Describe pinna hematoma- location, etiology, major complication
Between perichondrium and cartilageCauliflower appearance if untreatedCaused by trauma
115
How to treat pinna hematoma
Pressure dressing after lancing within 2 days (use abx prophylaxis)- cannot for chronic injury due to coagulation
116
When should you never irrigate the ear
TM perforation, if there is a foreign body which absorbs water, or if foreign body is a battery
117
Symptoms of cerumen impaction
pain, pressure, vertigo, hearing loss
118
Most common age group for foreign body
less than 8
119
most common tools used for foreign body removal
alligator forceps, suction, cerumen loop, balloon catheter, right angle hook
120
3 causes of otitis externa
trauma, bacteria, fungi
121
most common etiology of otitis externa
recent swimming
122
common symptoms of otitis externa
tragus and pinna tenderness, erythema, epithelial edema, TM can be mildly inflammed
123
most common causes of chronic otitis externa
hearing aids and foreign bodieslasts longer than 6 weeks
124
When to order a CT for otitis externa
mastoiditis
125
mortality rate of mastoiditis or malignant otitis externa
50%
126
major sign of physical abuse in ears
bilateral atraumatic tympanic membrane perforation
127
etiology of TM perforations
foreign body, iatrogenic, forceful irrigation, otitis media, or barotrauma
128
for TM perforation does sound lateralize toward or away from affected ear during the weber test
toward
129
TM perforation treatment if infectious
keep dry, surgery usually not necessary abx drops + oral abx controversial need audiology referral, then ENT
130
treatment for middle ear hematoma
watchful waiting hearing returns 6-8 weeks, can refer to ENT for audiometry
131
What is the most common cause of bacterial AOM in infants less than three months?
E. coli
| S. aureus
132
What is the most common cause of bacterial AOM in kids 3 months-14 years?
S. pneumo
H. influenza
M. catarrhalis
133
What's the most common cause of bacterial AOM in those older than 14?
S pneumo
GAS
S aureus
134
Weber test
Lateralizes to affected ear in conductive
| Lateralizes to the normal ear in sensorineural
135
Rinne Test
AC>BC in sensorineural and normal
| BC>AC in conductive
136
Which frequencies are lost first in SNL hearing loss?
high frequencies (front of cochlea and less protected)
137
What's a characteristic finding of noise induced hearing loss?
a notch at 4k on audiogram
138
What test should you always do with unilateral sensorineural hearing loss?
MRI of the cerebellopontine angle (CPA) with gadolinium. (looking for neuroma)
139
Which type of vertigo has horizontal nystagmus that suppresses with fixation?
peripheral
140
Which type of vertigo has vertical nystagmus that does not suppress with fixation?
central
141
cold water calorics causes the fast phase of the nystagmus to beat where?
to the opposite side of the stimulus (COWS)
142
What disease is marked by tinnitus, vertigo and hearing loss?
Meniere's Disease
143
What is an indication in a neuro PE of acoustic neuroma?
Romberg +ve for drift towards affected side
144
What is first-line and 2nd line pharmacotherapy in POAG?
1. Latanoprost drops
| 2. Timolol drops
145
Orbital Cellulitis treatment
IV Vancomycin and Cephalosporins or Amp/Sub and Piper/Tazo or fluroquinolones if PenCeph allergy
146
What is the RX for viral Conjunctivitis
Topical antihistamines/decongestants (Naphcon-A or Ocuhist)
147
What is the Rx for bacterial conjunctivitis
Cipro drops
148
What is the Rx for HSV keratitis?
trifluridine eye drops
149
what is the rx for dacrocystitis that is mild tenderness with discharge?
Amoxicillin-clavunate (PO)
150
What is an Rx to bridge to surgery for Entropion?
Botox
