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EENT Flashcards

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1
Q

ectropion

A

eyelid + lashes turned outward (relaxed orbicularis oculi)

-mc bilateral elderly, but can be congenital, infx or CN7 palsy

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2
Q

entropion

A

eyelid + lashes turned inward (spasms of orbicularis oculi)

-mc in elderly

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3
Q

dacrocystitis

A

infx of lacrimal sac

  • mc s. aureus, strep
  • redness to medial canthal (nasal side) of lower lid
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4
Q

blepharitis

A

inflam of both eyelids - common in down’s + eczema

  • anterior (skin + base of eyelashes) - infx or seborrheic
  • posterior - meibomian gland dysfunction (rosacea or allergic derm)
  • tx - eyelid hygiene, compress, massage (posterior), abx if unresponsive
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5
Q

chalazion

A

painless lipogranuloma of either a meibomian gland or a Zeis gland

  • eyelid lump/swelling, nontender
  • hygiene, compress, abx not necessary, cortico injection or incision if large/affecting vision
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6
Q

pterygium

A

triangular-shaped, “growing”, fibrovascular mass - nasal side of eye

  • assoc w/ inc UV exposure, sand, wind, dust
  • observe, remove if vision affected
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7
Q

pinguecula

A

yellow, elevated nodule on nasal side of sclera (fat/protein)

  • doesnt grow!
  • observe, cosmetic removal
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8
Q

orbital floor “blowout” fracture

A
  • decreased vision, diplopia esp w/ upward gaze (if inferior rectus entrapped), epistaxis, dyesthesias, hyperalgesia or anesthesia to cheek (due to infraorbital nerve)
  • nasal decongestant (dec pain), abx, corticosteriords, surgical repair
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9
Q

macular degeneration

A

rf: >50yo, caucasian, F, smoker
- mc cause of permanent legal blindness in elderly >75yo
- macula responsible for central vision and detail/color

-MC dry (atrophic) type: gradual breakdown; DRUSEN = small, round, yellow-white spots on outer retina (accum of waste products)
-wet (neovascular or exudative): new, abnormal vessels grow under central retina and leak blood –> scars
(rare and faster progression)

-sx: bilateral blurred or loss of central vision (detail/color), scotomoas (blind spots), metamorphosia (straight lines appear bent), micropsia (objects look smaller)

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10
Q

diabetic retinopathy

A
  • mc cause of new, permanent vision loss/blind 25-74yo
  • glycosylation of collagen of BV –> capillary wall breakdown–> ischemia, edema

Nonproliferative (background): microaneurysms (cotton wool spots, hard exudates, blot + dot hemorrhages)
-tx: panlaser tx, strict glucose control

Proliferative: neovascularization (new BV), vitreous hemorrhage
-tx: VEGF inhibitors (bevacizumab), laser photocoag tx, glucose control

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11
Q

hypertensive retinopathy grades

A

I: arterial narrowing –> copper wiring (mod), silver wiring (sev)
II: AV nicking - venous compression at arterial-venous jx by increased arterial pressure
III: flame-shaped hemorrhages, cotton wool spots
IV: papilledema (malignant HTN)

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12
Q

retinal detachment

A

Rhegmatogenous MC type: retinal tear –> retinal inner sensory layer detaches from choroid plexus

  • mc predisposing factors: myopia + cataracts
  • sx: photopsia (flashing lights) –> floaters –> progressive unilateral vision loss (curtain coming down) in periphery initially –> central vision loss
  • dx: fundoscopy = retinal tear, +shafer’s sign (clumping of brown pigment cells in anterior vitreous humor (“tobacco dust”)
  • OPTHO EMER - keep supine, no drops –> laser, cryotherapy, ocular sx
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13
Q

chemical burns (eye)

A

OPTHO EMER - immediate irrigation

  • alkali worse than acid (liquefactive necrosis vs. coagulative necrosis)
  • irrigate w/ lactated ringers or normal saline; LR ph higher and closer to tears (pH 7.1) x30 min, at least 2L
  • check pH and visual acuity after irrigation
  • abx like moxifloxacin + 0.25% atropine drops (cycloplegic agent), optho f/u
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14
Q

periorbital cellulitis

A
  • usually 2ry to sinus infx, ethmoid mc
  • mc children
  • DECREASED VISION, pain w/ eye movement, proptosis (eye bulge), erythema + edema
  • dx - CT scan
  • tx - IV abx - cover for STAPH/MRSA - vanc, clinda, cefotaxime, amp/sulbactam

preseptal cellulitis - infx of eyelid and periocular tissue, pain/swell but NO VISUAL CHANGE and NO PAIN w/ MOVEMENT
-tx- amox/clav

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15
Q

keratitis (corneal ulcer/inflam)

A
  • bacterial mc, pseudomonas, acanthamoeba (contacts)
  • sx: pain, photophobia, reduced vision, red, tearing
  • bacterial: hazy cornea, ulcer –> FQ drops, no patch!
  • HSV: dendritic lesions (branching w/ fluoro stain) –> topical antivirals
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16
Q

anterior uveitis (iritis)

A

inflam of iris or ciliary body (cyclitis)

  • systemic inflam dz (esp if reocurrs) or infectious
  • unilateral pain/red/photophobia, usually after trauma
  • ciliary injection (limbic flush), consensual photopohobia, inflammatory cells and flare w/in aq humor

-tx- topical corticosteroids, scopolamine, topical cycloplegics to relieve pain

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17
Q

posterior uveitis

A

choroid inflammation

  • blurred/decreased vision, floaters, no pain, no sx of anterior involvement
  • ciliary injection (limbic flush), consensual photopohobia, inflammatory cells and flare w/in aq humor

-tx- systemic corticosteroids

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18
Q

RF for cataracts

A

aging (mc >60), smoker, corticosteroids
DM, UV light, malnutrition, trauma

-congenital: ToRCH syndrome (toxoplasmosis, rubella, CMV, HSV)

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19
Q

papilledema

A

optic nerve (disc) swelling 2ry to increased intracranial pressure (bilat)

  • mc idiopathic intracranial HTN
  • space-occupying lesion, inc CSF, cerebral edema, malignant/sev HTN
  • sx- HA, N/V, vision preserved but maybe changes
  • exam- swollen optic disc, blurred margins
  • MRI/CT to r/o mass effect; LP for inc CSF
  • tx- diuretics (acetazolamide - dec production of aq humor and CSF)
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20
Q

optic neuritis (optic nerve CN2 inflam)

Study These Flashcards
A

acute inflam demylination of optic nerve

  • mc young 20-40yo
  • MULTIPLE SCLEROSIS mc, meds - ethambutol, chloramphenicol
  • loss of color vision, central scotoma/blind spot, usually unilateral, loss of vision over a few days
  • ocular pain that is worse w/ movement

MARCUS-GUNN PUPIL (positive)

-tx: IV methylprednisolone, followed by oral corticosteroids

21
Q

acute narrow angle-closure glaucoma

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A

decreased drainage of aqueous humor in pt w/ preexisting narrow angle or large lens (elderly, far-sighted, asians)

  • preciptating factor = mydriasis (pupil dilation futher closes angle) like dim lights, sympathomimetics and anticholinergics
  • sx - severe, sudden, UNILATERAL ocular pain, vision changes, halos around lights, tunnel vision
  • exam - conjunctival erythema, steamy cornea, mid-dilated, fixed, nonreactive pupil, cupping of optic nerve via fundo
  • tx- lower IOP (acetazolamide) and open angle (cholinergics), topical BB
22
Q

chronic (open angle) glaucoma

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A

slow, progressive BILATERAL vision loss

  • normal anterior chamber and angle, reduced aqueous drainage through trabeculum
  • RF: AA, >40yo, fam hx, DM
  • sx- painless, tunnel vision –> central loss
  • exam- cupping of optic discs (inc ratio)
  • tx- prostaglandin analogs 1st line, BB, a-2 agonists; laser tx if fails
23
Q

central retinal artery occlusion (CRAO)

Study These Flashcards
A

retinal artery thrombus or embolus

  • mc 50-80yo w/ atherosclerotic disease; OPTHO ER
  • sx- acute, sudden monocular vision loss, often preceded by amaurosis fugax
  • dx- pale retina w/ cherry-red macula (red spot) due to obstx; “box car” appearance of retinal vessels
  • tx- decrease IOP, revascularize by laying supine and orpital massage to dislodge clot
24
Q

central retinal vein occlusion (CRVO)

Study These Flashcards
A

central retinal vein thrombus –> fluid backup in retina

  • RF: HTN, DM, glaucoma, hypercoagulable
  • sx- acute, sudden, monocular vision loss
  • exam- extensive retinal hemorrhages (blood + thunder appearance), macular edema, optic disc swelling
  • tx- +/- antiinflammatories, steroids, laser photocoag
25
mastoiditis
usually complication of prolonged/untreated otitis media - sx- deep ear pain (worse at night), F, mastoid tenderness - complications- hearing loss, vertigo, CN7 paralysis, abscess - dx- CT scan - tx- IV abx + middle ear/mastoid drainage (myringotomy)
26
etiologies of conductive hearing loss
CERUMEN IMPACTION MC external or middle ear - defect in sound conduction (obstx of object or cerumen), damage to ossicles (otosclerosis, cholesteatoma), mastoiditis, OM
27
etiologies of sensorineural hearing loss
``` PRESBYACUSIS MC (natural aging) internal ear disorders - presbyacusis, chronic loud noise exposure, CNS lesions (acoustic neuroma), labyrinthitis, Meniere's syndrome ```
28
TM perforation
mc due to penetrating or noise trauma (mc occurs at pars tensa), otitis media -may lead to cholesteatoma devo +/-conductive hearing loss -most heal spontaneously -avoid water/moisture, no topical aminoglycosides
29
cholesteatoma
abnormal keratinized collection of desquamated squamous epithelium --> mastoid bony erosion - granulation tissue that erodes the ossicles over time --> conductive hearing loss - sx- painless otorrhea (brown/yellow w/ strong odor) +/- vertigo/dizzy - dx- granulation tissue/cellular debris +/- perf of TM, vertigo, conductive hearing loss - tx- surgical excision and reconstruction of ossicles
30
otosclerosis
abnormal bony overgrowth of stapes --> conductive loss - sx- slowly progressive hearing loss, tinnitus - tx- stapedectomy w/ prosthesis
31
benign paroxysmal positional vertigo
sudden, episodic, provoked by change of head position - usually lasts 10-60 seconds - pos DIX-HALLPIKE TEST/NYLAN BARANY --> fatigable, horizontal nystagmus - tx- EPLEY maneuver; antihistamines
32
vestibular neuritis
inflam of the vestibular portion of CN8 - MC after viral infx - sx- peripheral vertigo (continuous), dizzy, N/V, gait disturbances; +/- horizontal nystagmus, away from affected side - tx- CORTICOSTEROIDS, antihistamines for symptoms
33
labyrinthitis
vestibular neuritis + hearing loss/tinnitus - sx- cochlear involvement so hearing loss + continuous peripheral vertigo, dizzy, N/V, gait disturb, horiz nystagmus - tx- CORTICOSTEROIDS
34
meniere's disease (idiopathic endolymphatic hydrops)
idiopathic distention of endolymphatic compartment of inner ear by excess fluid --> increased pressure --> hearing and balance disorders - sx- episodic vertigo lasting min-hours, tinnitus, ear fullness, fluctuating hearing loss - dx- transtympanic electrocochleography during active - tx- symptomatic - antihistamines, anticholinergics, benzos; decompress if refractory or severe - prevent- diuretics reduce endolymph pressure, avoid salt/caffeine/chocolate/ETOH (bc inc endolymph pressure) *meniere syndrome due to identifiable cause, meniere disease is idiopathic
35
acoustic (vestibular) neuroma
CN8 / schwannoma - benign tumor of schwann cells - sx- gradual hearing loss unilateral, tinnitus, balance disturbance (not episodic) - dx- MRI
36
sinusitis area frequency
maxillary > ethmoid > frontal > sphenoid
37
peritonsillar abscess
tonsillitis --> cellulitis --> abscess formation - mc strep (then staph, polymicrobial) - sx- muffled "hot potato voice", diffulty w/ oral secretions, trismus, UVULA DEVIATES to CONTRALATERAL SIDE - dx- CT scan differentiate cellulitis vs abscess - tx- abx + aspiration or I+D (ampicilin/sulbactam) - tx clinically if not worried about deep neck involvement
38
oral leukoplakia
precancerous hyperkeratosis due to chronic irritation (tobacco, smoking, ETOH, dentures) - sx- painless, white patches can't be scraped off - tx- cryotherapy, laser ablation, biopsy for cancer risk
39
erythroplakia
precancerous lesions similar to leukoplakia but w/ erythematous appearance *90% is either dysplastic or evident of SCC
40
oral hairy leukoplakia
caused by EBV (human herpes virus 4) - mc in immunocompromised - painless, white plaque along lateral tongue or buccal mucosa +/- smooth or irregular "hairy" lesions, can't be scraped off, may change appearance daily - tx- no tx required, may spont resolve, antiretroviral tx
41
sialothiasis
mc in wharton's duct (submandibular); stensen's duct - postpranidal salivary gland pain/swell - tx- sialogogues, increased fluids, massage; avoid anticholinergics --> lithotripsy
42
acute bacterial sialadenitis (suppurative sialadenitis)
bacterial infx of parotid or submanibular salivar glands - STAPH MC, dehydration, chronic illness - sx- pain, swell, erythema near gland esp w/ meals, tenderness at opening, +/- puss if massaged - dx- CT SCAN (for associated abscess/extent) - tx- sialogogues, abx (dicloxacillin or nafcillin)
43
oral lichen planus
idopathic cell-medicated autoimmune response (inc in pt w/ HCV infx) - sx- lacy leukoplakia of oral mucosa (wickham striae) - tx- local or systemic corticosteroids
44
acute herpetic gingivostomatitis
primary manifestation of HSV-1 in children (mc 6mo-5y) -sx- sudden onset F, anorexia --> gingivitis vessicles on oral mucosa (gray/yellow lesions) -tx- usually self-limiting, acyclovir if severe
45
actue herpetic pharyngotonsillitis
primary manifestation of HSV-1 in adults - sx- F, malaise, HA, sore throat, vesicles that rupture --> ulcerative lesions w/ grayish exudates in post pharynx - tx- oral hygiene, resolve 1-2 wks
46
ludwig's angina
cellulitis of sublingual and submaxillary spaces in neck - MC 2ry to dental infx (anaerobes) - sx- swelling/erythema of upper neck and chin w/ PUS ON FLOOR OF MOUTH - dx- CT SCAN - tx- AMP/SULBACTAM (unasyn) or PCN + metro or clinda
47
tinnitus
Evaluation should include a review of the patients blood pressure, allergies, serum lipids and thyroid function. Since most cases are due to presbycusis (age-related, cumulative hearing damage and loss), effective therapies are limited. Medication management involves trials of diuretics, antihistamines, anticonvulsants, tricyclic antidepressants and benzodiazepines. Acoustic neuroma: CN VIII, hearing loss + tinnitus + disequilibrium Ménière disease: recurrent vertigo + tinnitus + hearing loss ​Ramsay Hunt syndrome: facial paralysis, zoster lesions, tinnitus Labyrinthitis: sudden severe vertigo, hearing loss, tinnitus, not recurrent Head trauma Electrical injury Diving Ototoxic agents: Salicylates: respiratory alkalosis + anion gap metabolic acidosis + tinnitus NSAIDs Quinine ABX (aminoglycosides, erythromycin, vancomycin) Chemotherapeutic agents
48
sinusitis classification / duration
< 4 weeks - acute subacute >12 weeks - chronic
49
Retropharyngeal Abscess
Patient will be a toxic-appearing child 3–5 years-old w/ hx of trauma or URI - sx- fever, sore throat, dysphagia, trismus, stridor, nuchal rigidity, muffled voice, cri du canard (duck "quack") - neck X-ray will show widened retropharyngeal space twice the size of the vertebral body - dx- CT scan - MC S. aureus, group A streptococcus, anaerobes, foreign body - tx- intravenous antibiotics, +/- I+D

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