ENT disorders Flashcards by Emily Newman

What percentage of URIs are viral in nature?

98%

*<2% of URIs are complicated by ABRS

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Acute rhinosinusitis definition?

Inflammation of the mucosal lining of nasal passages & paranasal sinuses lasting up to 4 weeks caused by allergens, environmental irritants, and/or infection

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Acute bacterial rhinosinusitis (ABRS) definition?

Secondary bacterial infection of paranasal sinuses, usually following viral URIs

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Causative pathogens in ABRS (by order rank)?

S. pneumoniae (gram +)
H. influenzae (gram - )
M. catarrhalis (gram - )

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S. pneumonia & H. influenzae common causes (Hint: COMPS pneumonic)

Conjunctivitis
Otitis media
Meningititis
Pneumonia
Sinusitis

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Majority of antibiotic treatment regimen for ABRS lasts for __ to __ days?

5-7 days

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“Double sickening” can be indicative of ABRS (true/false)?

True
*“Double sickening” –> initial symptom improvement and then worsening of symptoms

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Fever & symptom duration of more than __ days may be indicative of ABRS?

10 days

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True/False: Give the highest dose for shortest amount of time when considering antimicrobial therapy?

True
*Need drug to be able to concentrate med enough to optimize treatment success & minimize development of resistant pathogens

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Most common risk factors for antibiotic resistance?

Age <2 or >65 yrs, daycare attendance
Prior systemic antibiotics within PAST MONTH
Hospitalization within past 5 days
Comorbidities
Immunocompromised

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Biggest risk with fluroquinolones (ex: -floxacin)?

Tendon rupture

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First line treatment for ABRS?

Amoxicillin
or
Amoxicillin-clavulanate (Augmentin)
*may be more effective against ABRS due to H. influenzae & M. catarrhalis coverage

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Second line treatment if beta-lactam allergy for ABRS?

If no anaphylaxis hx: Cefdinir, Cefpodoxime, or Cefuroxime

If anaphylaxis history: Levofloxacin, moxifloxacin, or doxycycline (category D pregnancy risk)

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Substrate, Inhibitor, or Inducer: A medication that is metabolized/biotransformed by the isoenzyme, utilizing this enzyme in order to be modified so it can reach the drug site of action and/or be eliminated?

Substrate (CYP450)
Ex: Statins, OCP, benzos, sildenafil

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Substrate, Inhibitor, or Inducer: A drug or other substance that blocks that activity of the isoenzyme, limiting substrate excretion (increased risk of toxicity)
(hint: doesn’t allow medication to leave the body)

Inhibitor
Ex: grapefruit juice, clarithromycin
clarithromycin + simvastatin = statin-induced rhabdo risk

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Substrate, Inhibitor, or Inducer: accelerates the activity of the isoenzyme (pushes med out of body, resulting in decreased effectiveness of med)
(Hint: “jet pack”)

Inducer
Ex: St. John’s wort
St. John’s wort + COC = potential contraceptive failure

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What is presbyopia?

Age-related visual change (hardening of lens); near vision is affected (decreased ability to read small print at close range)

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What is blepharitis?

Inflammation of the edges of the eyelids where eyelashes grow

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Kiesselbach’s plexus location?

Anterior inferior aspect of nose (lower one-third)

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Color and appearance of nasal turbinates seen in allergic rhinitis?

Bluish, pale, and/or boggy

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White-to-light gray patch that appears on tongue, floor of mouth, inside cheek.

Leukoplakia

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Aphthous stomatitis

Canker sore

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Geographic tongue

Tongue surface has maplike appearance; benign

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Torus palatinus

Painless bony protuberance midline on hard palate; benign

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Optic nerve cupping is associated with ____?

Glaucoma

HTN or DM: Copper & silver wire arterioles?

Hypertensive retinopathy

HTN or DM: Arteriovenous nicking

Hypertensive retinopathy

HTN or DM: Cotton-wool spots

Diabetic retinopathy

Clusters of small red papules with white centers inside cheeks by lower molars (Hint: pathognomonic for measles (rubeola)

Koplik's spots

First line treatment for nasal polyps?

Intranasal glucocorticoids (ex: fluticasone or budesonide BID)

Condition of tongue caused by Epstein-Barr virus (EBV)

Hairy leukoplakia

Excessive constriction of the pupil

Miosis

Drooping of upper eyelid

Ptosis

Legal blindness vision (Snellen test result)

20/200 (ex: patient can see at 20 feet what a person with normal vision can see at 200 feet)

Vision chart used to measure distance (eye sight)

Snellen chart *Numerator never changes (20/X)

Tuning fork midline on forehead

Weber test *Normal = no lateralization. *Abnormal = lateralization/louder in one ear

Tuning fork on mastoid process

Rinne test *Normal = air conduction lasts longer than bone conduction (ex: can hear longer in front of ear than on mastoid bone)

Types of sensorineural hearing loss (Inner ear)

Aging, damage Ex: Presbycusis, Meniere's disease

Types of conductive hearing loss (Outer/middle ear)

Obstruction Ex: Otitis media, ceruminosis, perforation of tympanic membrane

Sensorineural or conductive hearing loss: Rinne AC>BC

Sensorineural

Sensorineural or conductive hearing loss: Rinne BC>AC

Conductive

True/False: Use topical opthalmic abx with pseudomonal coverage if patient is contact lens user

True Ex: ciprofloxacin, ofloxacin, trimethoprim-polymyxin B

Abscess of a hair follicle and sebaceous gland in upper or lower eyelid

Hordeolum (stye)

Gradual onset of increased IOP >22 mmHg due to blockage of the drainage of aqueous humor inside eye

Primary open-angle glaucoma

Sudden blockage of aqueous humor with elevated IOP, resulting in ischemia & permanent damage to optic nerve

Primary angle-closure glaucoma

Gradual damage to pigment of macula (area of central vision) that results in severe visual loss or blindness (hint: leading cause of blindness in elderly)

Age-related macular degeneration

Amsler grid is used to test vision for central vision loss commonly seen in _______ _________?

Macular degeneration

First-line treatment for allergic rhinitis?

Topical nasal sprays (ex: Fluticasone, Nasacort)

Tonsillar exudate, tender anterior cervical adenopathy, hx of fever, absence of cough

Strep throat symptoms

First-line treatment for strep throat?

Oral penicillin V (500 mg 2-3x/day x10 days) or Amoxicillin BID x 10 days

Strep treatment if penicillin or beta-lactam allergy?

Azithromycin (Z-Pak) x5 days

First-line treatment for acute otitis media (AOM) for any age group?

Amoxicillin

Second-line treatment for AOM (if no response to initial treatment in 48-72 hrs)?

Amoxicillin-clavulanate (Augmentin), cefdinir or cefprozil, or levofloxacin or moxifloxacin

First-line treatment for acute bacterial rhinosinusitis (ABRS)?

Amoxicillin-clavulanate (Augmentin)

Acute onset of severe headache that interferes with sleep, abnormal neuro exam, confusion, febrile. Life threatening emergency with high mortality (Hint: serious complication of AOM and rhinosinusitis).

Cavernous sinus thrombosis

Infectious mononucleosis is caused by what virus?

EBV

Classic triad of mono symptoms?

Fever, pharyngitis, lymphadenopathy (<50% of cases)

Diagnostic test to confirm mono?

Monospot

Type of vertigo caused by disorders of the vestibular apparatus of the inner ear or by inflammation of CN VIII?

Peripheral vertigo

Type of vertigo associated with stroke (cerebellar or brainstem bleeding), MS, infections, or tumor (Hint: can be life-threatening)

Central vertigo

Gold-stand clinical test for benign paroxysmal positional vertigo disease (BPPV)

Dix-Hallpike maneuver

Type of vertigo: abrupt onset w/ brief episodes (<1 min) induced by sudden head movements. Due to calcium carbonate crystals trapped in semicircular canals

BPPV

Diagnostic tool to check for corneal abrasion and keratitis?

Fluorescein strip

Reliever therapy for allergic rhinitis?

2nd generation oral antihistamines (ex: loratidine/Claritin, cetirizine/Zyrtec)

"Rope-like" eye discharge most consistent with?

Allergic conjunctivitis

Most common type of oral cancer? (Hint: can be related to HPV 16)

Squamous cell carcinoma

Potent risk factors for oral squamous cell carcinoma?

Longstanding HPV infection (HPV 16), tobacco use, alcohol misuse Other risk factors: male gender, advancing age (>55 yrs)

True/False: Retinal veins are always wider than arteries

True

Myopia

Nearsightedness

Tonometry reading tests for which vision disorder?

Glaucoma

Gradual onset blurring of near vision?

Presbyopia (normative age-related finding in eye, lens becomes less flexible)

Gradual peripheral vision loss?

Glaucoma Risk factors: older, African ancestry, DM2

Central vision loss?

Macular degeneration *most problematic, no cure *Risk factors: >50, smoking, HTN *Dry (develops slowly); Wet (develops quickly)

Presbycusis?

Age-related hearing loss; loss of CN VIII sensitivity

Eye condition with following risk factors: tobacco use, poor nutrition, sun exposure, systemic corticosteroid therapy

Senile cataracts (lens clouding) *progressive vision dimming, distance vision problems

Common pathogens for suppurative conjunctivitis (non-gonococcal, non-chlamydial)

S. aureus, S. pneumoniae, H. influenzae

First-line treatment for suppurative conjunctivitis?

Opthalmic cipro ocular solution or polymyxin B with trimethoprim opthalmic solution

Viral conjunctivitis ("pink-eye") typically caused by _____ ?

Adenovirus

1:2 mixture of white vinegar/rubbing alcohol eardrops can help decrease reinfection of _____?

Otitis externa (Swimmer's ear)

Common pathogen for otitis externa?

Pseudomonas, S. aureus

True/False: Otitis media with effusion (serous otitis) typically needs antimicrobial therapy

False; usually resolves in 1-3 weeks without intervention

ENT disorders Flashcards

(81 cards)