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ENT Disorders Flashcards

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1
Q

What is blepharitis?

A

Inflammation of both eyelids

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2
Q

Blepharitis is common in which patient population?

A

Those with down syndrome and eczema

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3
Q

What is this?

A

Anterior blepharitis

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4
Q

What is this?

A

Posterior blepharitis

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5
Q

Hordeolum (Stye): Treatment (2)

A
  1. Warm compresses are the mainstay of treatment +/- add topical abx ointment (erythromycin, bacitracin) if actively draining
  2. +/- I&D if no drainage within 48 hours
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6
Q

What is a chalazion?

A

Painless granuloma of the internal meibomian sebaceous gland–>focal eyelid swelling

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7
Q

What is dacrocystitis?

A

Infection of the lacrimal gland

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8
Q

Dacrocystitis treatment (2)

A
  1. Systemic antibiotics: Clindamycin + 3rd gen. cephalosporin
  2. Dacrocstorhinoscopy
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9
Q

What is this?

A

Pterygium (fleshy, triangular-shaped “growing” fibrovascular mass)

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10
Q

Where are pterygiums most commonly located at?

A

Inner corner/nasal side of eye and extends laterally

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11
Q

What is this?

A

Pinguecula (yellow, elevated nodule on the nasal side of the eye that does not grow)

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12
Q

Orbital floor “Blowout” fractures: Clinical manifestations (4)

A
  1. Decreased visual acuity; Enophthalmos
  2. Diplopia especially with upward gaze
  3. Orbital emphsema
  4. Epistaxis, dysesthesias, hyperalgesia, anesthesia to anteriomedial cheek
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13
Q

Blowout fractures: Diagnosis

A

CT scan

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14
Q

Orbital floor “blowout” fractures: Treatment

A
  1. Initial: Nasal decongestants, avoid blowing nose, prednisone, antibiotics (usu. ampicillin/sulbactam or clindamycin)
  2. Surgical repair
  3. Ophtho referral
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15
Q

With a globe rupture, what may be seen on PE in the orbits?

A

Enophthalmos, foreign body may be present, may have exopthalmos. Severe conjunctival hemorrhage

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16
Q

With a global rupture, what may be seen on PE with corneal/sclera?

A

Prolapse of the iris thorugh the cornea, (+) Seidel’s test, teardrop or irregularly-shaped pupil, hymphema

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17
Q

Global rupture: Management

A
  1. Rigid eye shield*, immediate ophtho consult. IV abx. Avoid topical eye solutions
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18
Q

What is the MC cause of permanent legal blindness and visual loss in the elderly (>75 years old)?

A

Macular degeneration

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19
Q

Dry (Atrophic) Macular Degeneration

A
  1. Gradual breakdown of the macula –>gradual blurring of the central vision.
  2. Presence of Drusen
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20
Q

What are Drusen’s spots?

A

Small, round, yellow-white spots on the outer retina (scattered, diffuse). They are an accumulation of waste products from retinal pigment epithelium.

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21
Q

Wet (neovascular or exudative) macular degeneration?

A

New, abnormal vessels that grow under the central retina that leak and bleed –> retinal scarring. Rarer than dry (but progresses more rapidly)

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22
Q

Wet MD: Diagnosis

A

Fluorescein angiography

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23
Q

Dry MD: Treatment (2)

A
  1. Amsler grid @ home to monitor stability
  2. Vitamin A, C, E, and zinc may slow progression
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24
Q

Wet MD: treatment (2)

A
  1. Anti-angiogenics in wet (ex: bevacizumab)
  2. Optical tomography done to monitor treatment response
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25
What is the MC cause of new, permanent vision loss/blindness in 25-74 year olds?
Diabetic retinopathy
26
Nonproliferative diabetic retinopathy: General
1. Microaneurysms --\> blot and dot hemorrhages, flame-shaped hemorrhages, cotton wool spots, hard exudates 2. **Not associated with vision loss**
27
Nonproliferative diabetic retinopathy: Treatment (2)
1. Glucose control 2. Panlaser treatment
28
Proliferative Diabetic Retinopathy: General
1. Neovascularization
29
Proliferative Diabetic Retinopathy: Treatment
VEGF inhibiors (ex: Bevacizumab), laser photocoagulation tx, tight glucose control
30
Maculopathy: General (3)
1. Macular edema or exudates 2. Blurred vision 3. Central vision loss
31
Hypertensive Retinopathy: I
1. **_Arterial narrowing_** 1. **_​_****_Copper wiring_**: Moderate 2. **_Silver wiring_**​: Severe
32
Hypertensive Retinopathy: II
AV nicking
33
Hypertensive Retinopathy: III
Flame-shaped hemorrhages, cotton wool spots
34
Hypertensive Retinopathy: IV
Papilledema (malignant HTN)
35
Papilledema: Etiologies (4)
1. Idiopathic intracranial HTN (pseudotumor cerebri) 2. Space-occupying lesion (ex: cerebral tumor, abscess) 3. Increased CSF production 4. Cerebral edema, sever (malignant) HTN
36
Papilledema: Treatment
Diuretics (ex: acetazolamide)
37
What is the most common type of retinal detachment?
Rhegmatogenous
38
Retinal Detachment: Treatment
1. **Ophtho emergency!**: Laser, cryotherapy, ocular surgery 2. Keep patient supine 3. Miotics are CI
39
Acute Narrow-Angle Closure Glaucoma: Precipitating Factors
1. Mydriasis (ex: Dim lights, anticholinergics, sympathomimetics) 2. Increased incidence in AA and DM patients
40
Acute Narrow-Angle Closure Glaucoma: Clinical Maniefstations (6)
1. Severe **unilateral ocular pain** 2. N/V 3. HA 4. Peripheral loss of vision (tunnel vision) 5. Intermittent blurry vision 6. Halos around lights
41
Acute Narrow-Angle Closure Glaucoma: PE (4)
1. Conjunctival erythema 2. "Steamy cornea" 3. Mid-dilated nonreactive pupil 4. Eye feels hard to palpation (increased IOP)
42
Acute Narrow-Angle Closure Glaucoma: Management (5)
1. Acetazolamide IV: **first-line agent**! 2. Topical beta blocker (ex: timolol) 3. Miotics/cholinergics (ex: pilocarpine, carbachol): Usu. started once IOP has been reduced 4. Peripheral iridotomy definitive treatment\* (Avoid anticholinergic, sympathomimetics) 5. Alpha-2 agonists (ex: apraclonidine, brimonidine)
43
Chronic Open-Angle Glaucoma: Treatment (2)
1. Prostaglanding analogs are first line (ex: lantanoprost), Timolol 2. Trabeculoplasty --\> trabeculostomy
44
Viral conjunctivitis: 1. MC organism 2. MC source 3. MC patient population
1. Adenovirus 2. Swimming pool 3. Children
45
Neonaturum Bacterial Conjunctivitis
1. Day 1 --\> Silver Nitrate 2. Day 2-5--\>Gonococcal 3. Day 5-7 --\> Chlamydia 4. Day 7-11 --\> HSV
46
Keratitis: Physical Exam (4)
1. Conuncitival erythema/injection 2. **_Limbic flush_** (ciliary injection) 3. **_Corneal ulceration_** on slit lamp exam 4. Purulent or watery discharge
47
Bacterial Keratitis: PE (4)
1. *hazy cornea* 2. Ulcer 3. Stromal abscess 4. +/- hypopyon
48
Bacterial Keratitis: Management
Fluoroquinolone (ex: Moxifloxacin). DO NOT PATCH EYE! Topical steroids may be used by ophtho
49
HSV Keratitis: PE Findings
**_Dendritic Lesions_**
50
HSV Keratitis: Management
Trifluridine, vidarabine, acyclovir ointment. PO acyclovir
51
What is optic neuritis?
Inflammation of optic nerve CN II
52
Optic Neuritis: Etiologies (3)
1. Multiple Sclerosis MC\*\* 2. Meds (ethambutol, chloramphenicol) 3. Autoimmune
53
Optic neuritis: Clinical Manifestations (4)
1. Loss of color vision 2. Visual field defects (ex: _central scotoma_/blind spot) 3. Unilateral vision loss 4. Ocular pain that is worse with eye movement
54
Optic Neuritis: Physical Exam
1. **_Marcus Gunn pupil_** 2. Fundoscopy: 2/3 normal (retrobulbar neuritis) or 1/3 with optic disc swelling/blurring (papillitis)
55
Optic neuritis: Management
1. IV methylprednisolone followed by PO steroids
56
Anterior uveitis (iritis): Clinical manifestations (3)
1. **unilateral ocular pain/redness/photophobia** 2. Excessive tearing (no discharge) 3. Anterior usually occurs after blunt trauma
57
Posterior uveitis: Clinical manifestations (4)
1. Blurred/_decreased_ vision 2. Floaters 3. Absenct symptom of anterior involvement 4. No pain
58
Uveitis (iritis): Physical exam (4)
1. Ciliary injection (_limbic flush_)\*\* 2. Consensual photophobia 3. +/- visual changes 4. _Inflammatory cells and flare\*\* within aqueous_
59
Uveitis (iritis): Treatment
1. Topical **steroids** for anterior, *Homatropine* (anticholinergic) 2. Systemic **corticosteroids** for posterior
60
Central Retinal Artery Occlusion (CRAO): Clinical Manifestations
1. Acute, sudden **monocular** vision loss\*, usually preceded by **amaurosis fugax\***
61
CRAO: Diagnosis (2)
1. Fundoscopy: **_pale retina with cherry-red macula_** (red spot)\*. Veins may show segmentation ("*box car appearance*") 2. Workupt to see if artherosclerosis is present
62
CRAO Treatment (4)
1. Decrease IOP to prevent anterior chamber involvement (acetazolamide) 2. No treatment has been shown effective 3. Lay patient flat on back, massage orbit to dislodge clot 4. Vessel dilation may be used
63
Central Retinal Vein Occlusion (CRVO): Diagnosis
Fundoscopic: **Extensive retinal hemorrhages (_"Blood and thunder"_** apearance)\*\*, retinal vein dilation, macular edema (disc swelling)
64
Central Retinal Vein Occlusion: Treatment (2)
1. No known effective treatment 2. Anti-inflammatories, steroids, plasmapheresis, laser
65
Cataracts: Risk factors in adults (6)
1. Cigarette smoking 2. Corticosteroids 3. UV light 4. DM 5. Malnutrition 6. Aging (MC\>60 years)
66
Cataracts: Risk factors in neonates (4)
TORCH syndrome ## Footnote 1. Taxoplasmosis 2. Rubella 3. CMV 4. HSV
67
What is the most common organism found in otitis externa?
Pseudomonas
68
Otitis Externa: Management (3)
1. Ciprofloxacin/dexamethasone (ofloxacin safe if there is an assoc. TM perforation) 2. Aminoglycoside abx combination: neomycin/polytrim-B/hydrocortisone otic (not used if TIM perforation is suspected) 3. Amphotericin B if fungal
69
What are the MC organisms of Acute Otitis Media (AOM)? (4)
1. S. pneumo (MC)\* 2. H. influenza 3. Moraxella catarrhalis 4. Strep pyogenes
70
AOM: Management (4)
1. Amoxicillin x 10-14 days DOC. Cefixime in children, Augmentin 2nd line 2. If PCN allergic--\>**Erythromycin-Sulfisoxazole**, Azithromycin; Bactrim 3. Myringotomy (surgical drainage) if severe otalgia or if severe mastoiditis 4. Tympanostomy if recurrent or persistent l
71
Mastoiditis: Treatment (2)
1. IV abx with myringotomy (Ampicillin, cefuroxime), oral abx 2. Refractory --\> mastoidectomy
72
Eustachian Tube Dysfunction: Treatment (3)
1. Decongestants: Pseudoephedrine, phenylephrine, oxymetazoline nasal spray 2. Auto-insufflation (swallow, yawn) 3. Nasal steroids
73
Acoustic (Vestibular) CN VIII Neuroma: Clinical Manifestations (5)
1. Unilateral hearing loss is acoustic neuroma until proven otherwise 2. Tinnitus 3. HA 4. Facial numbness 5 Continuous disequilibrium
74
Antihistamines used in vertigo
1. 1st line 2. Ex: **Meclizine**, cyclizine, dimenhydrinate, diphenhydramine
75
Dopamine blockers used in vertigo (3)
1. **Metoclopramide, prochlorperazine** (Compazine) IM/rectal; **IV promethazine (Phenergan)** 2. MOA: Antagonized dopamine D2 receptors 3. Often given with benadryl to prevent dystonic reactions
76
Anticholinergics used for vertigo
Scopolamine
77
What is vestibular neuritis?
Inflammation of the vestibular portion of CN 8 in the inner ear
78
What is labyrinthitis?
Vestibular neuritis + hearing loss/tinnitus\*
79
Vestibular neuritis and labyrinthitis: Management (2)
1. Corticosteroids 1st line 2. If symptomatic: antihistamines (ex: meclizine), benzos
80
Meniere's disease: characteristics (4)
1. Episodic vertigo 2. Fluctuating hearing loss 3. Tinnitus 4. Ear fullness
81
Treatment regimens used in acute sinusitis
Amoxicillin DOC 10-14 days, doxycycline, bactrium
82
What is mucomycosis? (4)
1. Fungi that invades the sinuses that may enter the CNS 2. Seen in immunocompromised patients 3. Affects the orbits, lungs, and CNS 4. May cause black eschar on the face
83
Mucormycosis treatment
Lipid amphotericin B, posaconazole
84
Sialadenitis: Treatment
1. Increase salivary flow: **sialogogues** (ex: lemon drops) 2. IV Nafcillin if severe
85
Where is sialolithiasis most commonly found?
Wharton's Duct
86
What is oral hairy leukoplakia caused by?
Epstein Barr Virus (HHV-4)
87
What can be given for recurrent aphthous ulcers?
Cimetidine
88
MC organisms found in peritonsillar abscess
Strep pyogenes, S. aureus, polymicrobial
89
Peritonsillar abscess: Management (2)
1. Drainage + Abx (Ampicillin/sulbactam or clindamycin) 2. Steroids (for edema)
90
Tonsillectomy indications (3)
1. Recurrent strep infections 2. Recurrent peritonsillar infections 3. Chronic tonsillitis
91
What will show on a lateral cervical film with epiglotitis?
Thumb sign
92
What abx are given in epiglottitis?
Ceftriaxone +/- clindamycin
93
What is the prophylactic treatment for epiglottitis?
Rifampin
94
Ludwig's Angina: Clinical Manifestations
Swelling and erythema of the upper neck and chin with pus on the floor of the mouth
95
Ludwig's Angina: Management
Penicillin + Metronidazole, Clindamycin, Ampicillin/sulbactam (Unasyn)

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