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ENOT Flashcards

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1
Q

Acute Laryngitis

A

Inflammation of Larynx - usu Viral following URI or change in voice

  • Consider Squamous Cell Caricinoma if hoarseness > 2wks + hx of ETOH and smoking
  • consider GERD if no viral eti
  • M. Cat or H. flu

Sxs

  • no pain or sore throat

Dx - clinical, laryngoscopy if sx > 3wk

  • Deviation of soft palate -> abscess

Tx

  • Symptomatic - cough suppressant, voice rest, steam inhalant
  • Viral - self limited, oral or IM steroids for vocal performers
  • Bacterial - erythromycin, cefuroxime, or augmentin
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2
Q

Acute Otitis Media

A

Infx of middle ear

MC preceded by viral infx

MC bacterial - S. pneump, H. influ

Sxs:

  • Otalgia
  • fever
  • middle ear effusion
  • Erythematous TM
  • acute < 3 wks
  • chronic > 3 mos
  • Recurrent 3 eps in 6 mo or 4 in 12 w/ clearning in btwn

Dx: otoscopic

  • bulging of TM
  • acute sxs of inflammation (above)
  • limited mobility of TM with pneumotoscopy

Tx

Amoxicillin 80-90 mg/kg

  • <2yo for 10 days
  • > 2yo 5-7 days

Augmentin 2nd line

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3
Q

Mastoiditis

A

Complication of AOM - Suppurative infx of mastoid air cells

MC S. pneumo, H. influ, M. cat, S. aureus, S. pyogenes

Sxs:

  • Fever
  • otalgia
  • pain
  • Erythema posterior to ear and fwd displacement of external ear

Dx

  • Clinical
  • CT scan temporal bone w/ contrast for complicated - toxic appearing

Tx

  • Simple - PO or IV Ceftriaxone
  • ENT referral in more complicated
  • Drainage of middle ear fluid
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4
Q

Otitis Externa

A

Swimmer’s ear

infx of auditory canal 2/2 trauma or consistently moist env

MCC - Pseudomonas, S aureus

malignant OE in DM - MC aspergillus

Sxs:

  • Ear pain w/ tragus or auricle movement
  • purulent cheesy white dc
  • erythematous canal

Dx

  • clinical
  • tuning form - bone conduction > air conduction

Tx

  • Ofloxacin 0.3% solution 10 drops QD x 7d
  • if perforated or chance of - ciprofloxacin 0.3% and dexamethasone 0.1% 4 drops BID x 7 days
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5
Q

Hyphema

A

Trauma causing blood acc in anterior chamber of eye (btwn cornea and iris)

Dx:

  • orbital CT + ophthal consult

Tx

  • blood reabsorbed over days/wks
  • ele head 30d at night
  • NSAID c/i
  • patch/shield
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6
Q

Labyrinthitis

A

Preceded by viral respiratory illness

Sxs:

  • Acute Severe vertigo, hearing loss (days to a week)
    • vertigo can resolve but not hearing loss
  • Tinnitius
  • Imbalance

Dx - clinical, no neuro deficit

  • Vestibular Sx - peripheral vertigo can have rotary or horizontal nystagmus (away from affected side)

Tx - Vestibular suppresants - meclizine or diazepam

Resolves in 3-6 wks

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7
Q

Acute Pharyngitis (Viral)

A

Less likely exudative (CMV, EBV, adenovirus)

Mononucleosis - EBV, rash w/ penicillin

Dx

  • atypical lymphocytes
    • Heterophile agglutination tests (monospot)
  • Splenomegaly - splenic rupture
    • non contact sports - 3 wks after sxs onset
    • contact sport - 4 wks

Tx supportive

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8
Q

Acute Pharyngitis (Bacterial)

A

Usu GAS

Centor Criteria - if +3/4, get rapid strep test

  • Fever > 100.4 or 38C
  • Absence of cough
  • Pharyntonsillar Exudate
  • Tender anterior cervical lymphadenopathy

Dx - throat culture - gold std

Tx

  • Symptomatic - fluids, NSAIDs, saline gargles, CS
  • Bacterial - Penicillin or Amoxicillin
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9
Q

Macular Degeneration (Wet)

A

Gradual loss of central vision

advanced form of dry age-related macular degeneration

new blood vessel growth beneath retina (neovascularization) leak blood and fluid -> damage retinal cells

  • rapid and severe vision loss

Dx

  • dilated funduscopic findings are diagnositic
  • distortion on Amsler grid

Tx -

  • VEGF Inhibitors - bevacizumab
  • photodynamic therapy
  • Zinc and antioxidant vitamin
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10
Q

Acute Sinusitis

A

Often follows URI - viral or bacterial (S. pneumo, H. influ, M. catar)

RF - cig smoking, hx of trauma, presence of foreign body

Sxs

  • purulent nasal dc
  • facial pain and pressure
  • nasal obstruction
  • fever
  • tenderness to palp on affected sinus

Dx - clinical, bacterial more likely in IMC pts

Tx

  • Self limited for viral, lasts < 10 days
    • NSAIDs, saline washes, steam, PO/nasal decongestants
  • Abx for symptoms > 10d
    • Amoxicillin 500 mg TID
    • Augmentin 500 mg TID
    • Doxy 100 mg PO BID if pcn allergic
    • NOT REC’d macrolides
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11
Q

Allergic Rhinitis

A

Eti - fam hx of atopy, IgE mediated mast cell histamine release

Sxs:

  • clear nasal dc
  • rhinorrhea
  • itchy, watery eyes
  • allergic shiners - blue discoloration under eye
  • Transverse nasal crease

Tx

  • Avoid allergens
  • nasal CS - beclomethasone, mometasone
  • Intranasal decongestants dont use more than 3-5 days –> causes rhinitis medicamentosa
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12
Q

Barotrauma

A

Tissue damage d/t pressure related change in body gas volume

Sxs:

  • ear pain
  • hearing loss persist after inciting event
    • sinus pain
    • epitaxis
    • abd pain/dyspnea
    • LOC

Dx - clinical.0 may bneed imaging

Tx

  • Supportive - anti inflammatories
  • Pseudoephedrine for prophy - for divers
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13
Q

Optic Neuritis

A

Acute inflammation and demyelination of optic n. leading to acute monocular vision loss/blurriness and pain on EOM

a/w Multiple Sclerosis - MCC and initial presenting Sxs

eti - ethambutol (TB drug)

Dx - fundoscopy - inflammation of optic disc, confirmed by MRI

Tx - Corticosteroids - methylpredinsolone IV

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14
Q

Blepharitis

A

Chronic infl of lid margins - seborrhea, staph or strep - dysfx of Meibomian agents

Anterior

  • eyelid skin, eyelashes
  • ulcerative (S aureus) or seborrheic

Posterior

  • infl of Meibomian agents

Sxs:

  • Crusting, scaling
  • Red-rimmed eyelid
  • eyelash flanking

Dx - slit lamp examination

Tx - warm compressions, daily lid wash w/ baby shampoo

topica abx - azithro solution or erythro ointment

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15
Q

Orbital Cellulitis

A

Infx of orbital muscles and fat behind eye

MC in children 7-12yo

Sxs:

  • decreased EOM
  • pain w/ mvmt of eye
  • Proptosis
  • Signs of infx
  • a/w with sinusitis

dx - CT scans of orbits - confirmatory

tx - hospitalization with IV broad spectrum abx - Vanco

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16
Q

Blowout Fracture

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A

Hx of blunt trauma, muscle entrapment, eyelid swelling

  • gaze restriction
  • double vision
  • decrease VA
  • pain with EOM
  • Racoon eyes - ecchymosis*
  • Anesthesia or paresthesia in gums, upper lips and cheek = infraorbital n damage

Tx - opthalmic referral = surgery

abx for infx

17
Q

Viral Conjunctivitis

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A

MCC Adenovirus, more common than bacterial

highly contagious - direct contact or swimming pool

  • Acute onset unilateral or bilateral erythema of conjunctiva
  • copious watery discharge

Tx - eye lavage w/ normal saline BID 7-14d

antihistamine drops

warm to cool compresses

18
Q

Bacterial Conjunctivitis

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A

MCC - S aureus, S pneumo

M. Cat and Gonoccocal - copious purulent dc not responding to conventional tx

Chlamydia - newborn, Giemsa stain - inclusion body, scant mucopurulent dc

sxs:

  • purulent dc from both eyes - glued shut
  • crusting - worse in AM

Tx

  • 0.5 in of ointment in lower lid or 1-2 drops instilled QID 5-7 days
  • Gentamicin/tobramycin - aminoglycoside abx for G neg coverage
  • Erythromycin - chlamydia for newborns
  • Trimethoprim and polymixin B - ocular infx
  • Contact lense user - pseudomonas - tx with FQ/Cipro
19
Q

Allergic Conjunctivitis

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A

Red eyes, itiching and tearing, bilateral

cobblestone mucosa

Tx

  • systemic antihistamines and topic AHs
    • Naphcon A
20
Q

Papilledema

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A

Optic disc swlling d/t increased ICP - bilateral & occurs over period of hrs to wks

Eti - malignant HTN, brain tumor/abscess, meningitis, pseudotumor cerebri, encephalitis

asymptomatic or present with transient visual alterations (seconds)

Dx - neuroimaging to r/o lesions, CSF analysis

Tx underlying cause

21
Q

Corneal Abrasion

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A

Usu from minor trauma - finger nail, contact lens, eyelash, small foreign body

Sudden onset of

  • Eye pain
  • photophobia
  • tearing
  • foreign body sensation

Dx - fluorescein dye - incr abs in devoid area

Tx

  • topic anesthestic for dx
  • saline irrigation
  • abx ointmen t- gentamicin or sulfacetamide
  • Tylenol for pain
  • NO PATCHING
22
Q

Peritonsillar Abscess

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A

Penetration of infx through tonsillar capsule-> tonsillitis -> cellulitis -> abscess formation

MC GABHS, S aureus

  • Hot potato/muffled voice
  • medial deviation of soft palate
  • Uvula deviation to contralat side
  • Dysphagia
  • trismus

Dx - CT to diff btwn cellulitis and abscess

Tx

  • I&D
  • IV abx - amoxicilling, Amox-Sulbactam (Unasyn), Clinda
  • Tonsillectomy
23
Q

Dacryoadenitis

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A

Inflammation of lacrimal (tear-producing) glands - usu bacteria or virus

MCC mumps, EBV, staph, gonococcus

Sxs:

  • unilateral severe pain, swelling, redness, tearing drainage

Dx - clinical or CT orbits if chronic

Tx

  • if Viral eti - rest and warm compresses
  • Tx cause
24
Q

Retinal Detachment

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A

Separation of retina from pigmented epithelial layer

Sxs:

  • acute onset painless blurred or blackened vision
  • monoccular blindness
  • vertical curtain coming down
  • Floaters and flashes

Dx:

  • Fundoscopic - asymmetric red reflex
  • IOP is normal or reduced

Tx

  • Stay supine - lying face upward - head turned towards detached retina
  • Pneumatic retinopexy - air bubbles in vitreous
25
Dental Abscess
Dental caries destroys hard surface of tooth --\> dental pulp --\> abscess formation * Pain * swelling * Fever Dx w/ CT scan Tx - Ceftriaxone, followed by PO amox
26
Epiglottis
Supraglottic inflammation & obstruction of airway d/t infx w/ H. influ **Med EMERGENCY** Sxs: * Stridor, restlessness, fever, cough, dyspnea * **Sniffing dog posture** * 3 D's * Drooling * Dysphagia * Respiratory Distress Dx * Secure airway - culture for H. influ * Lateral neck film - **thumbprint sign** Tx * intubation * supportive care * **ceftriaxone**
27
Retinal Arterial Occlusion
Central **retinal artery** occlusion eti - atherosclerotic thrombosis, embolism on same side/ipsilateral carotid artery, or giant cell arteritis _Sxs:_ * Sudden, painless, unilat, and severe vision loss - **Amaurosis fugax** _Dx:_ * Fundoscopy - **perifoveal atrophy - Cherry red spots** * pale opaque fundus + red fovea + arterial attenuation * R/o carotid artery stenosis w/ carotid US _Tx:_ * EMERGENT OPTHAL consult - immediate tx if occlusion \<24 hrs * Reduce IOP w/ ocular hypotensive drugs - **topical timolol 0.5% & acetazolamide 500 mg IV or PO** * Intermittent digital massage over closed eyelid * irreversible damage to retina if \> 90 mins
28
Retinal Vein Occlusion
**Blood and thunder fundus** MC \>50yo, HTN, DM, primary open angle glaucoma, HLD, hyperviscosity (polycythemia and leukemia) Occurs 2/2 to thrombotic event Sxs: * Sudden, painles, unilat vision loss * blurred vision or complete loss of vision Dx: * Fundoscopy - **retinal hemorrhages in all quadrants** * optic disc swelling * blood and thunder retina Tx: * vision resolves with time * tx neovascularization w. intravitreal injections of VEGF inhibitors
29
Sore Throat
Viral \> bacterial - adenovirus MC Eti: * Mononucleosis * EBV, fever, sore throat, lymphadenopathy * atypical lymphocytes * + Heterophile agglutination test/ monospot * Gonorrhea pharyngitis for recent sexual encounters or **non resolving pharyngitis** * Fungal in pts **Inhaled steroids** ​​**GABHS** * Fever, tender anterior cervical adenopathy, no cough, pharyngo tonsillar exudate * 3/4 Centor - rapid strep test, only 1/4 Centor - not likely strep Dx * Rapid strep - if negative * Throat culture is confirmatory Tx * IM PCN if pt incompliance * PO PCN/ Cefuroxime * Erythromycin if pcn allergy
30
Epistaxis
Eti - nasal trauma, dryness, HTN, cocaine, etoh **Kiesselbach's Plexus** MC site for anterior bleeds **Woodruff's plexus** - MC site for posterior - less common Tx: * Anterior - stop with pressure - leaning forward for 10-15 mins * Short acting topical decongestants - Afrin, phenylephrine, cocaine * **Anterior nasal packing -** tx w/ abx/Cephalosporin for TSS * Cauterize * **Posterior balloon packing for posterior bleeds** * high risk of complications If recurrent nosebleeds - r/o HTN or clotting disorder
31
Tympanic Membrane Perforation
ETi - infx (AOM) or trauma (barotrauma, direct impact, or explosions) Sxs: * pain * otorrhea * hearing loss/reduction Tx * Resolves on own, surgery if persistent hearing loss * keep dry -\> water 2ry to infx * Floxin drops * Surgery if \> 2mos
32
Foreign Body - Occular
Metallic foreign body - Rust ring - refer to opthal if can't remove Dx - slit lamp - XR or CT Tx - irrigation after topical anesthetic - visualized and extra
33
Foregin body - Ear
Sxs - pain, decrease earing, fullness dx - visualization tx - removal w/ warm irrigation w/ syringe or alligator forcep Insects - drown with mineral oil or viscous lidocaine before trying to remove
34
Foreign Body - Nasal
Persistent, foul smelling, unilateral nasal dc Tx - oxymetazoline to shrink mucous membrane, then remove
35
Glaucoma - Acute Angle Closure
Increased IOP w/ optic n damage - a**queous humor blockage t**hrough trabecular meshwork **Canal of Schlemm** - increasing pressure in anterior chamber Open angle more common, \> 40yo, AA + fam hx Sxs: * **Opthalmic EMERGENCY** * Triad * Injected conjunctiva * Fixed dilated pupil * Steamy cornea * painful eye/loss of vision, tearing, N/V, diaphoresis Tx: * REFER to ophthal * start MEDS * IV Carbonic anhydrase inhibitor (acetazolamide) * topical B blocker - timolol * osmotic diuresis * **laser/surgical iridotomy** * **mydriatics - dilate pupils - do not administered**
36
Glaucoma - Open Angle
Chronic, asymptomatic, insidious Sxs: * Increased IPO * defects in periph visual field * incr cup to disc ratio * asymptomatic until late - **loss of peripheral vision** = main symptoms Dx: * elevated IOP w/o optic disc damage or * optic n damage w/o increased IOP Tx * Refer to opthalmologist * **Prostaglandin analogs - latanoprost** * **B blocker timolol** * carbonic anhydrase Inhibitor to decr production * Laser or surgical treatment
37
Vertigo
Sensation of Movement in the absence of movement **_Peripheral_ -** Inner ear --\> labyrinthitis, BPPV, Meniere, vestibular neuritis, head injury -\> sudden onset, n/v, tinnitus, hearing loss, **horizontal nystagmus** **_Central_** - brainstem vascular dz, AVM, tumor, MS -\> gradual onset/**vertical nystagmus**, no auditory symptoms (vertigo+symptom = vertebrobasilar insufficiency ) **_BBPV_ -** positional, **no hearing loss**, tinnitus, ataxia * dx - Dix Hallpike, tx with Epley's manuveur **Vestibular Neuritis:** not positional, no hearing loss/tinnitus **Labyrinthitis:** acute, self-resolving episode; vertigo, hearing loss, tinnitus * tx - meclizine + steroids **Meniere's Disease:** chronic, relapsing, remitting; vertigo + **hearing loss** + tinnitus * tx - diuretics, salt restriction, CN VIII ablation for severe cases **Perilymph fistula:** a history of trauma; vertigo from trauma * tx - fix damage surgically **Acoustic neuroma:** ataxia, neurofibromatosis type II, MRI findings. Hearing loss, tinnitus, and ataxia; * tx - surgery

Emergency Medicine (13 decks)

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