- painless granuloma - internal Meibomian sebaceous gland - Tx= eye lid hygiene and warm compress (No abx)

ENT Flashcards by Rodrigo N

Eyelid/lashes turned outward 2T relaxation of orbicularis Oculi muscle: MC in elderly: BL:

irritation, ocular dryness and sagging of eyelid: Tx:

Ectropion (Inward Entropion)

Tx: Lubricating eye drops–> Sx

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infection of lacrimal sac: MC S. Aureus: Redness to medial canthal side of lower lid: Tx?

Dacrocystitis

Tx: ABx- Clindamycin (Vancomycin + Ceftriaxone)

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inflammation of both eyelids: MC in trisomy 21 and Eczema: Anterior= infectious or seborrheic:

Posterior= Meibomian gland dysfunction: crusting, red-rimming, scaling of eyelid: eyelash flaking Tx:

Blepharitis

Tx: Baby shampoo scrub (Abx erythromycin)

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Local abcess of eyelild: External=Sebaceous Internal=Meibomian: painful, warm swollen red lump Tx:

Hordeolum

Tx: Warm compress (>48hrs = I and D

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elevated superficial fleshy triangular shape growing fibrovascular mass: MC inner corner (Nasal):

2T sun/dust/wind exposure: Tx

Pterygium (Nasal) and Pinguecula (Lateral-no growth)

Tx: observe (removal if affects vision)

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Chalazion highlights

painless granuloma
internal Meibomian sebaceous gland
Tx= eye lid hygiene and warm compress (No abx)

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eye trauma –> diplopia especially with upward gaze, orbital emphysema post-blowing of nose.

Dx: TX:

Orbital floor Blow-out fracture

Dx: Ct “teardrop sign”
Tx: Decongestant/ No nose blowing
Sx if severe or persistent diploplia

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outer membrane of eye is disrupted by trauma or penetration. Diplopia w ocular pain: Tear-drop pupil:

Prolapse of the iris through the cornea (+) Seidel’s test: Obscure red reflex: Tx:

Globe Rupture

Tx: Rigid Eye shield (Immediate Ophtho consult)
“ Emergency”

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occurs > 50 yo: “MCC of permanent blindness and visual loss in elderly”:

BL blurred or central vision loss (detailed/color vision): blindspots/shadows or lines bent: Dx : Tx

Macular Degeneration

Dx: Fluorescein Angiography
Tx: Bevacizumab (Anti-neovascular
Amsler grid monitors progession/stability

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Wet macular degeneration specific pathophysiology

abnormal/new vessel leaks–> scarring

- Progresses more rapidly

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Dry macular degeneration specific pathophysiology

-Drusen (acummulation of waste products from retinal pigment epithelium) small round yellow/white spots

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Progressive UL vision loss: Floaters, shadow/curtain coming down” peripherally initially, loss of central vision

Causes: DM retinopathy, sickle cell, Trauma:
Rhegmatogenous MC type Tx:

Retinal Detachment

Tx: “Ophtho emergency” keep patient supine
No myotic drops

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Corneal abrasion treatment?

> 5mm patch (Not longer than 24 hours)
24 hour Ophtho follw up
Rust ring removal at 24 hours
Abx Erythromycin/Cipro

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Preauricular LAD: copious watery eye discharge: scant mucoid DC swimming pool MC source: MC in children:

punctate staining on slit lamp exam: often BL: TX:?

Viral conjunctivitis

Tx: cool compress, artificial tears, antihistamines (Olapatadine)

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Cobblestone mucosa: conjunctival swelling (Chemosis) erythema, itching, tearing redness, stringy discharge:

Tx:

Allergic Conjunctivitis

Tx: Topical Antihistamines (Olapatadine), Ketorolac

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MCC and 2nd MCC of Bacterial conjunctivitis

MCC= S. Aureus (2nd MCC Strep Pneumoniae)

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Bacterial conjunctivitis manifestations

Purulent DC (lid crusting)
absence of ciliary injection
Fluorescein to R/O abrasion or Keratitis
mild pain
Tx: Erythromycin (Pseudomonas- Cipro/Moxi)

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Treatment for Chlamydia or Gonorrhea Bacterial conjunctivitis?

May admit for IV or topical Abx

Gonorrhea=IV Ceftriaxone chlamydia= Azithromycin

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Chemical burns to the eyes Tx:

irrigate 30 min. or 2L
pH between 7.0-7.3
Antibiotics (Moxifloxacin)

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usually secondary to sinus infection Ethmoid 90%: Aureus or pneumoniae: Decreased vision, proptosis,

eyelid erythema and edema, decreased vision, ocular movement pain. Dx: Tx:

Orbital (Septal cellulitis)

Dx: Ct scan (fat/muscle infection)
Tx: IV Abx (Clindamycin/vancomycin/cefotaxime)

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misalignment of the eyes: Eso/Exotropia: Diplopia or amblyopia (Dec. visiual acuity) symptoms. Dx: Tx:

Strabismus

Dx: Hirshcberg (Light reflex)
Tx: Patch (Normal eye) Sx

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MCC pseudomonas/acanthamoeba: pain, photophobia, reduced vision, tearing, conjunctival erythema:

Slit lamp corneal defect, Ciliary injection (Limbic Flush- red ring around limbus). Dx: Tx:

Keratitis (Corneal Ulcer)

Dx: slit lamp Tx; Moxifloxacin/Gatifloxacin
“Trifluradine or Vidarabine”- HSV Dendritic

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usually occurs after blunt trauma: CMV infections: UL pain, redness, photophobia: Limbic Flush:

Tx:

Uveitis (Iritis)

Tx: Topical steroids
Cyclopentolate (Cycloplegic relieves m. spasm pain)

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Risk factors of aging >60, smoking, Corticosteroid use:

Absent red reflex opaque lens

Cataract

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headache, NV, vision is well preserved, swollen optic disc with blurred margins? Tx:?

Papilledema Tx: Diuretics and Acetazolamide (CT R/O mass)

MC seen in multiple sclerosis or Ethambutol Rx: loss of color vision/central vision over a few days: Associated with ocular pain that is worse with eye movement. Marcus-Gunn Pupil; Blurred disc-cup: Tx:?

Optic Neuritis Tx: IV methylprednisolone

Pupil constricts on accommodation but does not react to bright light. " Prostitute- accommodates but not reacts" MCC?

Argyll-Robertson Pupil MCC= Neurosyphilis

Swinging of light from unaffected eye to affected eye--> pupils appear to dilate? MCC?

Marcus Gun Pupil MCC= Optic Neuritis

Sudden onset of UL ocular pain, NV, headache, halos around lights, peripheral vision loss: Mid dilated fixed non-reactive pupil: precipitated from bright into dark, sympathomimetics or anticholinergics

Acute narrow Angle-closure Glaucoma

Acute narrow Angle-closure Glaucoma Dx: Tx:

Dx: Tonometry >21mmHg Tx: 1. Acetazolamide, Timolol, Pilocarpine (Cholinergics), Alpha 2 agonists- Apraclonidine

Slow progressive and painless BL, peripheral vision loss: Increased cup to disc ratio: Reduced aqueous drainage from Trabeculum: Tx:

Chronic (Open Angle) Glaucoma Tx: Latanoprost (Prostaglandin analog), BBs, Bromodine Acetazolamide,

Temporary monocular vision loss: "curtain" lasting minutes with complete recovery usually within 1 hour: TIA or Giant cell arteritis

Amaurosis Fugax

Acute sudden monocular vision loss, extensive retinal hemorrhages "blood and thunder: fluid back up optic disc swelling, macular edema: RF-HTN, DM, Glaucoma or hypercoagulable states Tx:

Central Retinal Vein Occlusion (CRVO)

Central Retinal Artery occlusion highlights X5 :

- MC 50-80 yo - MCC Thrombus - Pale retina + cherry red macula (Red spot) - "Box car" appearance - Tx: Acetazolamide, orbital massage in supine position

1-2 day of ear pain/pruritus, auricular discharge, pressure or fullness: pain w pinna traction or tragus

Otitis Externa | Cipro+ dexamethasone aminoglycoside- Meomycin/polytrim- B w cortisone--> ototoxicity

MCC of otitis externa

Pseudomonas

MC seen in Diabetics or immunocompromised: --> osteomyelitis at skull base. IV Abx and admission required

Malignant Otitis Media

Mastoiditis highlights and treatment

- complication of Otitis media - Mastoid and deep ear tenderness - CT Diagnostic 1st line - IV Abx (Admit)

bluging erythematous TM with effusion, loss of landmarks and mobility: MCC strep pneumoniae Tx:

Acute Otitis Media ``` Tx: Amoxicillin 10-14 days (Cefixime child) 2nd line (Augmentin or Cefaclor) ```

If a bullae presents on a suspected AOM, suspect ?

Mycoplasma Pneumoniae

PCN allergy treatment for AOM?

Erythromycin-Sulfisoxazole, Azithromycin, Septra

Chronic Otitis media MC pathogen and treatment?

MC pathogen- Pseudomonas/S Aureus Ofloxacin/ Ciprofloxacin

Intermittent sharp ear pain, disequilibrium, ear fullness, CHL, tinnitus: Ear exam normal: Fluid behind TM: Follows URI or allergic rhinitis- Tx

Eustachian Tube Dysfunction Tx: 1. Pseudoephedrine, Phenylephrine, Oxymetazoline nasal spray 2. Auto-insufflation 3. INCS

Tuning fork placed on top of head?

Weber

BC>AC: Weber lateralizes to affected ear:

Conductive Hearing Loss

AC>BC (Normal): Weber lateralizes to normal ear

Sensorineural HL

MCC of conductive hearing loss (CHL)

Cerumen Impaction

MCC of sensorineural hearing loss (SHL)

Presbycusis

Cerumen Impaction Treatment?

Tx: Hydrogen Peroxidase Carbamide Peroxide

MC anatomic position where membrane perforation occurs?

Pars Tensa

granulation tissue that eroded the ossicles overtime--> CHL:

Cholesteatoma

Abnormal bony growth: Slowly progressive CHL w tinnitus Tx:

Osteosclerosis Tx: Stapedectomy w prosthesis

Central vertigo highlights

- Gradual onset - Positive CNS signs - Vertical Nystagmus - Migraine or Multiple sclerosis

Peripheral Vertigo highlights

- Sudden onset - no CNS signs - horizontal nystagmus - BPV (MC), Menieres

sudden episodic vertigo lasting 10-60 seconds: Preceded or caused by _______ Tx:

Benign Paroxysmal Positional Vertigo (head movement) Tx: Apley's maneuver (Antihistamines)

episodic peripheral vertigo lasting 1-8 hours: Horizontal nystagmus, NV, tinnitus, ear-fullness, Hearing loss: 2T Increased endolymphatic fluid Tx:

Meniere's Disease Tx: Meclizine Prophylaxis: diuretics avoid caffeine/salt chocolate/ETOH

continuous vertigo, dizziness NV, gait disturbances, inflammation of CN post viral infection: lasts weeks ? Rotary horizontal nystagmus away from affected side:

Vestibular Neuritis (CNIII)

continuous vertigo, dizziness NV, gait disturbances, inflammation of CN post viral infection lasts weeks? with hearing loss and tinnitus: Tx:

Labyrinthitis Tx: 1st line corticosteroids (CS) Meclizine

Unilateral sensorineural hearing loss with tinnitus: facial numbness, vertigo: Dx: Tx:

Acoustic Vestibular CNIII Neuroma Dx: CT scan (Assoc. w NF II) Tx: Surgery

symptoms of sinus pressure worse with bending down and leaning forward: purulent sputum or nasal discharge CN VI palsy with frontal: Dx: TOC TX:

Acute sinusitis Dx: CT scan Tx: Sx >10-14 days= Amoxicillin DOC 10-14 2nd line is Doxy/Septra

Refractory acute sinusitis Tx

Augmentin or Cipro/Moxi

Chronic sinusitis >12 consecutive weeks: Mucormycotic or aspergillus Tx:

Amphotericin B (or Posaconazole)

Rhinitis viral MC pathogen

Rhinovirus

Allergic rhinitis findings? Tx

- Clear rhinorrhea - pale violaceous turbinate (Viral-Erythematous) - cobblestone mucosa - Intranasal steroids most effective Tx (Polyps)

Oxymetazoline, Phenylephrine or Naphazoline 3-5 days --> to what?

rhinitis medicamentosa

Samster's triad consists of what?

Asthma, Aspirin, and Polyps (INCS TOC)

MC site of bleeding of anterior epistaxis?

Kiesselbach's Plexus

Sequential Epistaxis treatment?

1. Direct pressure (10-15 min. seated forward) 2. Topical decongestants (Oxymetazoline, Phenylephrine, cocaine) 3. Cauterization 4. Nasal Packing (Admit)

Mucopurulent discharge with foul odor?

Nasal Foreign Body

Viral MC overall cause of pharyngitis/tonsillitis?

Adeno virus/ Rhino virus

MC bacterial pathogen of pharyngitis/tonsillitis? Tx:

GABHS S pyogenes | Tx: PCN or PCN allergy Erythromycin/clindamycin Macrolide

what is the Centor criteria?

Fever (FACE) Age (<15 yo +1) (>44 -1) Cough absent/Cervical LAD Exudates

Rapid antigen detection test is more ___ than _____?

Specific than sensitive (most useful if positive) | Culture is definitive

muffled hot potato voice, difficulty handling oral secretions, uvula deviation to CL side, C-LAD, dysphagia DX: Tx:

Peritonsillar Abscess (Quinsy) Dx: CT DOC Tx: Ampicillin+sulbactam or Clindamycin and Iand D

Hoarseness, aphonia, pharyngitis, and rhinitis?

Laryngitis

Oral candidiasis Treatment of choice?

Nystatin Liquid TOC (2nd Clotrimazole PO fluconazole_

ENT Flashcards

(76 cards)