ENT/Ophthalmology Flashcards
(191 cards)
1
Q
when should you suspect squamous cell carcinoma in a pt w. acute laryngitis
A
hoarseness persists > 2 weeks
hx etoh/smoking
2
Q
2 mc causes of acute laryngitis
A
virus
overuse
3
Q
consider _ if pt has acute laryngitis w. no viral etiology
A
GERD
4
Q
2 pathogens mc associated w. acute laryngitis
A
m.cat
h.flu
5
Q
order laryngoscopy if sx of acute laryngitis persist _
A
> 3 weeks
6
Q
laryngitis + deviation of soft palate makes you think
A
absess
7
Q
tx for viral laryngitis to hasten recovery (ex for vocal performers)
A
oral AND IM steroids
8
Q
3 abx for bacterial laryngitis
A
erythromycin
cefuroxime
augmentin
9
Q
what is this showing
A
hyphema
blood in anterior chamber of eye
10
Q
t/f: with hyphema, blood may cover the iris, pupil, and block vision
A
t!
11
Q
mc cause of hyphema
A
blunt/penetrating trauma
12
Q
dx for hyphema
A
orbital CT if indicated
ophthalmology consult
13
Q
tx for hyphema
A
blood reabsorbs over days/weeks
elevate head 30 degrees at night
APAP
eye patch/shield
bb or acetazolamide
+/- surgery
14
Q
pharm contraindicated for hyphema
A
NSAIDs
15
Q
clinical dx criteria for AOM
A
- bulging tympanic membrane
- other signs of acute inflammation: TM erythema, fever, ear pain, middle ear effusion
16
Q
top 3 pathogens associatd w. AOM
A
- strep pneumo
- h.flu
- m. cat
17
Q
classifications of AOM
A
acute: < 3 weeks
chronic: > 3 mo
recurrent: 3 episodes x 6 mo OR 4 in 12 w.o full remission
chronic: > 3 mo clear serous fluid in middle ear w.o sx of ear infxn
18
Q
should you use abx to treat chronic AOM
A
no
19
Q
hallmark PE finding of AOM
A
limited mobility of TM w. pneumotoscopy
20
Q
1st and 2nd line tx for AOM
A
- amoxicillin
- augmentin
pcn allergy: macrolides vs bactrim
21
Q
abx duration:
<2 yo
< 2 yo
A
< 2 yo: 10 days
< 2 yo: 5-7 days
22
Q
tx for recurrent AOM (3)
A
tympanostomy
tympanocentesis
myringotomy
23
Q
2 complications of AOM
A
mastoiditis
bullous myringitis
24
Q
acute severe vertigo
hearing loss
tinnitus
hx viral respiratory illness
A
labyrinthitis
25
what sx may not resolve w. labyrinthitis
hearing loss
26
dx and tx for labyrinthitis
dx: clinical - no neuro deficits
tx:
-meclizine
- +/- abx
- benzos for acute
27
bacterial pharyngitis is mc caused by
GAS
28
centor criteria
3/4 = strep test
*sensitivity 90%*
29
gs dx for pharyngitis
throat culture
30
2 complications of strep pharyngitis
rheumatic fever
glomerulonephritis
31
tx for strep pharyngitis
PCN
allergy: erythromycin
32
3 viral pathologies of pharyngitis
CMV
EBV
adenovirus
33
rash w. PCNs
EBV
34
dx for viral pharyngitis
atypical lymphocytes
+
heterophile agglutination test (monospot)
35
hallmark PE finding of EBV
splenomegaly
36
when can athletes w. splenomegaly return to contact sports
3 weeks after sx onset
4 weeks for strenuous contact sports
37
2 common cause of fungal pharyngitis
inhaled steroids
HIV pt's
38
tx for fungal pharyngitis
clotrimazole troches
miconazole
nystatin swish
fluconazole
39
2 types of macular degeneration
wet
dry
40
gradual painless loss of central vision:
gradual loss of painless peripheral vision:
central: wet macular degeneration
peripheral: glaucoma
41
what is this showing
**d**rusen spots: yellow retinal deposits -> **d**ry macular degeneration
42
advanced form of dry macular degeneration characterized by rapid/severe vision loss
wet macular degeneration
43
what is this showing
neovascularization -> leaking bv/damaged retinal cells
**wet macular degeneration**
44
dx for macular degeneration
**dilated fundoscopy:**
-hemorrhage or fluid in subretina
-macular grayish-green discoloration
45
what is this showing
distortion of amsler grid -> macular degeneration
46
tx for macular degeneration: wet vs dry
**dry:** zinc, copper, vitamins C/E, lutein
**wet:** bevacizumab (VEGF inhibitor), photodynamic therapy, supplements used for dry
47
3 mc bacteria associated w. acute sinusitis
1. strep pneumo
2. h.flu
3. m.cat
48
3 rf for acute sinusitis
cigs
trauma
foreign body
49
2 PE findings of acute sinusitis
-ttp of sinuses
-decreased transmission w. transillumination
50
indications for abx for sinusitis
sx > 10 days w.o improvement
51
duration of abx for acute sinusitis
5-7 days
52
abx for acute sinusitis
amoxicillin
augmentin
pcn allergy: doxy
peds: amoxicillin
53
suppurative infxn of mastoid air cell
usually complication of AOM
mastoiditis
54
pathogens associated w. mastoiditis
strep pneumo
h.flu
m.cat
s.aureus
s.pyogenes
55
2 PE findings of mastoiditis
erythema posterior to ear
forward displacement of external ear
56
mastoiditis is a clinical dx, but what is the gs imaging for complicated/toxic appearing pt's
CT w. contrast
57
tx for mastoiditis
vanco
ceftriaxone
58
what is this showing
allergic shiners -> allergic rhinitis
59
what is this showing
allergic salute -> allergic rhinitis
60
what is this showing
transverse nasal crease -> allergic rhinitis
61
4 PE findings of allergic rhinitis
pale, bluish, boggy mucosa
allergic shiners
transverese nasal crease
alleric salute
62
allergic rhinitis involves _ mediated _ release
IgE mediated
mast cell/histamine release
63
risk of using intransal decongestants (pseudoephedrine, afrin) > 3-5 days
rhinitis medicamentosa (rebound congestion)
64
pharm for allergic rhinitis
antihistamines
cromolyn sodium
nasal/systemic steroids
saline drops/washes
65
tissue injury -> pressure-related change in body compartment gas volume -> disruption of air containing areas
barotrauma
66
areas affected by barotrauma
ears
lungs
sinuses
GI tract
airspaces in teeth
67
sx of barotrauma
-ear pain/hearing loss persisting past inciting event
-sinus pain
-epistaxis
-abdominal pain
-dyspnea
-LOC
68
tx for barotrauma
supportive
NSAIDs
69
acute (hr's - days) inflammation/demyelination of optic nerve -> acute monocular vision loss, pain w. extraocular movements
optic neuritis
70
mc cause of optic neuritis
**MS**
*also ethambutol*
71
dx for optic neuritis
1. fundoscopy
2. MRI
72
fundoscopy finding of optic neuritis
inflammation of optic disc
73
tx for optic neuritis
IV methylprednisone
neuro referral
74
chronic inflammation of lid margins -> dysfxn of meibomian glands
blepharitis
75
3 causes of blepharitis
seborrhea
staph
strep
76
2 types of blepharitis
anterior
posterior
77
anterior blepharitis involves inflammation of _ (2)
and is caused by _ (2)
eyelid skin, eyelashes
seborrhea, s.aureus
78
posterior blepharitis involves inflammation of the _
and is caused by _
meibomian glands
s.aureus, gland infxn
79
what is this showing
-crusting, scaling, red-rimming of the eyelid
-eyelash flaking
-hyperemic lid margins
-dandruff like deposits/fibrous scales
**blepharitis**
80
what does scurf and colarettes make you think of
blepharitis
81
dx for blepharitis
slit lamp exam
82
tx for blepharitis
warm compress
wash w. diluted baby shampoo
gland expression
+/- topical abx
83
what is this showing
infxn of orbital muscles AND fat behind the eye
**orbital cellulitis **
84
what is this showing
infxn of eye skin only
**periorbital cellulitis**
85
sx of orbital cellulitis
-decreased extraocular movement
-pain w. eye movements
-proptosis
86
orbital cellulitis is mc a complication of
sinusitis
87
_ is not commonly associated w. orbital cellulitis
vision loss
88
gs dx for orbital cellulitis
orbital CT
89
tx for orbital cellulitis
admit
vanco
90
blunt trauma -> muscle entrapment
eyelid swelling, gaze restriction
blowout fx
91
2 hallmark PE findings of blowout fx
enophthalmos (shrunken eye)
raccoon eyes
92
what sx make you concerned for damage to the infraorbital nerve (ex w. blowout fx)
anesthesia/paresthesia in gums, upper lips, cheek
93
tx for blowout fx
ophthalmic referral asap
abx
94
pain. movement of tragus or auricle
cheesy white discharge
swimmer's ear
otitis externa
95
tuning fork findings of otitis externa
bc > ac
96
pathogens associated w. otitis externa: swimmer's ear vs digital trauma
swimmer's ear: pseudo
digital trauma: s.aureus
97
type of otitis externa mc seen in diabetics
malignant otitis externa
98
tx for otitis externa
-abx drops: aminoglycosides vs fluoroquinolones
-avoid moisture
+/- steroids
99
abx choice for otitis externa if you suspect perforation
cipro PLUS dexamethasone
OR
ofloxacin
100
tx for malignant otitis externa
admit
IV abx
101
2 pathogens associated w. malignant otitis externa
aspergillus
candida
102
tx for fungal otitis externa
acetic acid drops
clotrimazole drops
PO itraconazole
103
3 types of conjunctivitis
viral
bacterial
allergic
104
pathogens mc associated w. conjunctivitis:
viral:
bacterial:
viral: adenovirus
bacterial: **s.aureus,** strep pneumo, m.cat, gonococcal, chlamydia
105
2 pathogens associated. acute mucopurulent bacterial conjunctivitis
**s.aureus - mc**
strep pneumo
106
pathogen associated w. bacterial conjunctivitis w. copious purulent d.c - not responding to conventional tx
m.cat
107
newborn bacterial conjunctivitis makes you think of what pathogen
chlamydia
108
dx for clamydia conjunctivitis
giemsa stain showing inclusion body
109
-acute onset unilateral vs bilateral erythema of conjunctiva
-copious watery d.c, tender periauricular LAD, scant mucoid d.c
viral conjunctivitis
110
-purulent d.c mc from both eyes (can be unilateral) -> glued shut appearance
-crusting worse in the AM
bacterial conjunctivitis
111
red eyes bilaterally
itching/tearing
cobblestoning mucosa on inner/upper eyelid
allergic conjunctivitis
112
tx for bacterial conjunctivitis based on pathogen
gram negative: gentamicin/tobramycin (tobrex)
chlamydia: erythromycin (E-Mycin) vs tetracycline
trimethoprim and polymyxin B (polytrim)
113
pathogen associated w. conjunctivitis in contact lens wearers plus treatment
pseudo
fluoroquinolone drops
114
tx for viral conjunctivitis
-eye lavage w. normal saline bid x 7-14 days
-antihistamine drops
115
pharm for allergic conjunctivitis
topical vs systemic antihistamines
naphcon-A/ocuhist
azelastine
116
bilateral optic disc swelling from increased intracranial pressure - lasting hours-weeks
papilledema
117
6 causes of papilledema
malignant HTN
malignancy
abscess
meningitis
cerebral hemorrhage
pseudotumor cerebri
118
3 fundoscopy findings of pseudotumor cerebri
swollen disc
blurred margins
obliteration of vessels
119
management of papilledema
1. imaging asap
2. LP
120
sudden onset of eye pain, photophobia, tearing, foreign body sensation, blurred vision
corneal abrasion/ulcer
121
mc cause of corneal abrasion/ulcer
trauma
122
dx for corneal abrasion/ulcer
slit lamp w. fluroscein dye -> increased absorption in devoid area
123
management of corneal abrasion/ulcer
topical anesthetic
irrigation
gentamicin vs sulfacetamide
APAP
124
what med can be used for to aid in dx of corneal abrasion/ulcer, but can delay healing if used longterm
topical anesthetics
125
_ is contraindicated for corneal abrasion/ulcer
eye patching
*increased risk for infxn*
126
penetration of infxn through the tonsilar capsule into neighboring tissue
peritonsillar abscess
127
4 PE findings of peritonsillar abscess
hot potato voice
severe sore throat
uvula displacement
bulging tonsillar pillar
128
pathogen mc associated w. peritonsillar abscess
strep pyogenes
129
managment of peritonsillar abscess
ASA
I&D
PO vs IV abx (aminoglycocides vs amoxicillin/augmentin)
+/- tonsillectomy
130
what is this showing
inflammation of lacrimal glands -> **dacryoadenitis**
131
mc causes of dacryoadenitis (4)
**mumps**
EBV
staph
gonococcus
132
gs imaging for chronic dacryoadenitis
CT orbits
133
acute onset of unilateral painless (extreme myopia), blurred or blackened vision that occurs over several minutes to hr -> progresses to complete or partial monocular blindness
retinal detachment
134
how might a pt describe retinal detachment (3)
curtain over field of vision
floaters/flashes
painless
135
what is this showing
detached retina
136
PE finding of retinal detachment
asymmetric red reflex
normal vs decreased IOP
137
management of retinal detachment
-stay supine w. head towards side of detachment
-ophtho consult
-pneumatic retinopexy
-injxn of air bubble into vitreous
138
tx for dental abscess
ceftriaxone IM
followed by PO amoxicillin
139
what is this showing
cherry red spot -> central retinal artery occlusion (CRAO)
140
3 causes of CRAO
atherosclerotic thrombosis
ipsilateral embolism
giant cell arteritis
141
describe pain w. CRAO
sudden
painless
unilateral
**amaurosis fugax**
142
3 fundoscopic findings of CRAO
perifoveal atrophy
pale opaque fundus w. red fovea -> cherry red spot
areterial attenuation
143
imaging for CRAO
carotid US to r.o carotid artery stenosis
144
management of CRAO
-emergent ophtho consult -> emergent carotid/opthalmic artery catheterization w. thrombolytic drugs if occlusion is w.in 24 hr of sx
-topical timolol vs acetazolamide
-digital massage
-anterior chamber paracentesis
145
w. CRAO, irreversible damage to the retina occurs after _ min of sx onset
90 min
146
what is this showing
blood and thunder fundus -> central retinal vein occlusion (CRVO)
147
describe pain w. CRVO
sudden
painless
unilateral vision loss
148
6 rf for CRVO
> 50 yo
HTN
primary open angle glaucoma
DM
HLD
hyperviscosity: polycythemia, leukemia
149
mc cause of CRVO
thrombotic event
150
fundoscopy findings of CRVO
-retinal hemorrhages in all quadrants
-optic disc swelling
-dilated veins/hemorrhages/edema/exudates -> blood and thunder
151
management of CRVO (3)
vision self resovles - partial vs full
work up for thrombosis
bevacizumab (VGEF inhibitor)
152
4 types of external ear trauma
hematoma
laceration
avulsion
fx
153
what is this
subperichondrial hematoma (cauliflower ear)
*avascular necrosis of cartilage*
154
managemet of cauliflower ear
immediate ENT referral for I&D
cefalexin
155
external ear wounds < _ can be closed
12 hr
156
laceration of what part of the external ear should be sutured whenever possible
pinna
157
management of ear avulsion
otolaryngologist/plastics referral
158
5 rf for epistaxis
nasal trauma
dryness
HTN
cocaine
etoh
159
mc site for anterior vs posterior epistaxis
anterior: kiesselbach'splexus/little's area
posterior woodruff plexus
160
arteries of kiesselbach's plexus
anterior ethmoid
superior labial
sphenopalatine
greater palatine
161
arteries associated w. woodruff's plexus
posterior ethmoid
sphenopalatine
162
management of anterior epistaxis
-direct pressure at least 10-15 sec leaning forward
-afrin/phenylephrine
-+/- anterior nasal packing
-petroleum jelly + topical abx if no packing available
-cauterize if bleeding source visible
163
if you pack a nose for epistaxis, you must order
cephalosporin
*to avoid toxic shock syndrome*
*pt must come back for packing removal*
164
mnagement of posterior epistaxis
admit/consult
posterior balloon packing
+/- surgical ligation
165
w. recurrent epistaxis, you must rule out (2)
HTN
hypercoagulable d.o
166
pain, otorrhea, hearing loss/reduction
TM perforation
167
causes of TM perforation (2)
infxn
trauma
168
management of TM perforation (3)
-self resolve vs surgery if sx > 2 mo
-keep dry
-floxin drops
169
what are the only non-ototoxic drops
floxin
170
what is this showing
rust ring -> foreign body
171
dx for eye foreign body
slit lamp vs XR/CT
172
management of eye foreign body
1. topical anesthetics
2. irrigation
3. extract vs ophtho consult
4. +/- abx
173
what pathogen are you concerned about if an eye foreign body came from soil/vegetation
bacillus cereus
174
management of ear foreign body
removal via irrigation or alligator forceps
insects: mineral oil vs lidocaine -> removal
175
persistent, foul smelling, unilateral nasal discharge
nasal foreign body
176
management of nasal foreign body
oxymetazoline drops (shrinks mucus membrane) -> remove
177
3 indications for otolaryngology referral for nasal foreign body
non visualized posterior
impacted
unsuccessful initial removal attempts
178
2 types of glaucoma
acute angle closure
open angle
179
73 yo M w. severe unilateral eye pain and loss of vision x 1 hr with vomiting - meds include HCTZ and tamsulosin - ophthalmic exam shows conjunctival injxn and a hazy cornea w. elevated intraocular pressure
acute angle-closure glaucoma
180
increased IOP is caused by impediment to the flow of aqueous humor through _
canal of schlemm -> anterior chamber
181
which type of glaucoma is a medical emergency
acute angle closure
182
triad for acute angle closure glaucoma
injected conjunctiva
steamy cornea
fixed/dilated pupil
183
what pt pop do you think of with open angle glaucoma (3)
AA
fam hx
> 40 yo
184
management of acute angle closure glaucoma (5)
ophtho referral asap
IV acetazolamide (CAH inhibitor)
topical timolol
diuresis
laser/surgical iridotomy
185
what tx is absolutel contraindicated for acute angle closure glaucoma
mydriatics to dilate pupil
186
chronic, asyomptomatic peripheral vision loss
open angle glaucoma
187
fundoscopy findings of open angle glaucoma
increased cup to disc ratio
188
t/f: optic disk damage can occur w. or w.o increased IOP
t!
189
management of open angle glaucoma
-ophtho referral
-latanoprost (PG analog)
-timolol
-acetazolamide (CAH inhibitor)
-+/- surgery
190
6 causes of painful vision loss
trauma
acute closed angle glaucoma
uveitis
corneal ulcer
temporal arteritis
optic neuritis
191
causes of painless vision loss
amaurosis fugax
TIA
CRAO/CRVO
vitreous hemorrhage
retinal detachment
lens dislocation
HTN encephalopathy
pituitary tumors
macular disorders
toxic ingestion
