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Test 4 ENT Flashcards

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1
Q

Anterior blepharitis

A

Inflammation of the eyelid
S. aureus or epidermidis
Seborrheic

From direct bacterial infection & response against bacterial toxins
Delayed hypersensitivity rxns to bacterial antigens

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2
Q

Posterior blepharitis

A

Inflammation of eyelids

Dysfunction of meibomian glands

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3
Q

S/S blepharitis

A
  1. Burning
  2. Itching
  3. Foreign body senstaion
  4. Crusting of the eye lashes
  5. Erythematous lid margins
  6. Scaling lids
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4
Q

Risk factors of blepharitis

A
  1. Rosacea
  2. Eczema
  3. Prior lid injury
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5
Q

What would you see with slit lamp exam of blepharitis?

A

Usually bilateral may be asymmetric

  1. Lid erythema
  2. Lid telangiectasia
  3. Oily collerettes base of lashes
  4. Papules
  5. Pustules w/ rosacea
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6
Q

Tx blepharitis

A
  1. Warm compresses 2x/day
  2. Eyelid scrubs after compresses
  3. Anterior - Topical abx if infected (erythromicin/bacitracin)
    Posterior - oral doxycyline
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7
Q

What is the most common orbital Fx?

A

Blowout Fx

Occurs with blunt force trauma to globe or orbital rim

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8
Q

What is the weakest area for orbital Fx?

A

Medial wall & orbital floor

-lamina papyracea

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9
Q

S/S Blowout Fx

A

Blunt trauma

  1. Diplopia on upgaze
  2. Periorbital ecchymosis & edema
  3. Anesthesia of maxillary teeth & upper lip
  4. Step off deformity over infraorbital ridge
  5. Orbital crepitus
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10
Q

How to Dx blowout Fx?

A
  1. Plain skull XR w/ Waters & Caldwell views
  2. Teardrop sign
    CT scan needed to Dx & determine extent of damage (coronal & sagittal views)
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11
Q

Tx blowout Fx

A

Surgery for persistent diplopia & endopthalmitis

Refer

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12
Q

MCC of cataracts & other causes ?

A

Aging

  1. Trauma
  2. Metabolic disorders
  3. Infections (rubella)
  4. Medications
  5. Congenital problems
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13
Q

What is the MCC of blindness in the world?

A

cataracts

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14
Q

What causes cataracts?

A

Changes in the lens protein affects how the lens refracts light, reducing clarity & visual acuity
May cause color to turn yellow, green, brown or white

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15
Q

S/S cataracts

A
  1. Painless blurry vision or vision loss
  2. Glare
  3. Myopia
  4. Monocular diplopia
  5. Absent red reflex
  6. Leukoria
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16
Q

How to Tx cataracts?

A
  1. Surgery w/ intraocular lens implant
    May just remove it w/o implant
    Refer
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17
Q

What is a chalazion?

A

Idiopathic, sterile chronic granulomatous inflammation of the meibomian gland caused by a foreign body reaction to sebum

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18
Q

What causes chalazion?

A
  1. Chronic process of that results from an inflammatory foreign body reaction to sebum
  2. Blockage of normal drainage glands, especially at at the eyelid margin
  3. Blepharitis, acne rosacea or hordeolum may contribute to development
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19
Q

Dx chalazion

A
  1. Nontender, palpable localized swelling
  2. Swelling points to the conjunctival surface
  3. No signs of inflammation
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20
Q

Tx chalazion

A
  1. Warm compresses and lid scrubs

If recurrent - refer for incision & curettage

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21
Q

What is the MCC of acute conjunctivitis, & others?

A

Adenovirus

1. Bacterial
Streptococcus pneumoniae
Haemophilus influenza
Staphloccus aureus
Neisseria gonorrhea
Chlamydia trachomatis
2. Viral
Herpes simplex virus type 1 and 2
Picornaviruses
3. Allergies
4. Chemical
5. Irritative
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22
Q

Who more commonly gets bacterial conjunctivitis?

A

Kids

Adults usually get viral

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23
Q

S/S Conjuncitivits

A
  1. Foreign body sensation
  2. Burning
  3. Itching
  4. Photophobia
  5. URI
  6. Family member with same symptoms
  7. Tearing
  8. H/o cold sores
  9. Crusting
  10. Lids stuck shut in the morning
  11. Hyperemia
  12. Pseudoptosis
  13. Preauricular LAD
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24
Q

Dx conjuncitivitis

A
  1. Rapid adenovirus immunoassay kit

2. Bacterial or viral culture

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25
Tx of bacterial conjuncitivits
Self limiting 10-14 days If Tx - 1-3 days Broad specturm topical abx
26
Tx of chlamydial conjuncitivitis
Oral tetracylcine, doxycylcine, erythromicin or azithromycin Topical ointments of drops used
27
Tx of viral conjuncivitis
1. Artificial tears 2. Cool compresses Acyclovir if herpes
28
Tx of allergic conjunctivitis
1. Topical antihistamines | 2. Short course of topical steroids
29
Good sign for bacterial conjunctivitis
Lid stuck shut in morning Less itching
30
Good signs for viral conjuncitivitis
1. Preauricular LAD 2. Subconjunctival hemorrhage 3. Punctate keratopathy 4. Photophobia
31
Good signs for allergic conjuncitivitis
1. Intense itching 2. Chemosis 3. Thick stringy mucus 4. Conjunctival papilla
32
S/S corneal abrasion
1. Sudden onset 2. Foreign body sensation 3. Photophobia 4. Excessive tearing 5. Blepharospasm 6. Blurry vision 7. Pain worse with eye movement
33
Tx corneal abrasion
1. Remove foreign body 2. Anesthetic eye drop 3. Topical abx (Tobramycin) 4. NSAID No patching, no contacts
34
What ulcers can contacts cause?
P. aeruginosa
35
Risk factors for corneal ulcers
1. Contact lenses 2. HIV 3. Trauma 4. Ocular surface disease 5. Ocular surgery 6. Age 7. Gender 8. Smoking 9. Low socioeconomic class, poor hygiene
36
Common causes of corneal ulcers
1. Staphylococcus sp, Pseudomonas 2. Fungi - Fusarium 3. Amoeba - Acanthamoeba 4. Herpes simplex, Varicella-Zoster 5. Idiopathic 6. Neurotrophic keratitis 7. Exposure keratitis 8. Severe dry eyes 9. Severe allergic disease
37
S/S corneal ulcer
1. Pain 2. Photophobia 3. Tearing 4. Decreased/blurred vision 5. Erythema of eyelid and conjunctiva 6. Circum-corneal injection 7. Purulent or watery discharge 8. Foreign body sensation
38
Tx of corneal ulcer
1. Broad spectrum abx - usually cipro If contact lens wearer - fluoroquinolone 2. Cycloplegic eye drops Refer
39
Dacryoadenitis & when is it commonly seen in kids?
``` Inflammation of lacrimal gland May be primary inflammatory condition of secondary 1. Mumps 2. Measles 3. Influenza ```
40
Causes of dacryoadenitis
1. Autoimmune diseases - Sjorgen syndrome, Sarcoidosis, Tumor 2. Rare caused by staphyloccus, aures, Nesseria gonorrhea or streptococci 3. Mumps, mononucleosis, influenza and herpes zoster
41
S/S dacryoadenitis
1. Unilateral eye pain 2. Redness 3. Swelling over lateral 1/3 upper eyelid 4. Tearing or discharge
42
Tx of dacryoadenitis
1. Inflammatory - Refer to ophthalmologist for treatment pseudo tumor cerebri 2. Viral - Cool compresses to swelling, NSAIDs PRN 3. Bacterial or infectious mild to moderate amoxicillin/clavulanate or cephalexin Moderate to severe Hospitalize treat according to causative organism
43
What is ectropion caused by?
Eversion of lower eyelid | Relaxation of the orbicularis oculi muscle or degeneration of the lid fascia
44
S/S ectropion
1. Previous surgery, trauma, chemical burn or seventh nerve palsy 2. Excessive tearing 3. Corneal abrasion from eyelashes 4. Foreign body sensation
45
Tx of ectropion
1. Artificial tears & lubricant 2. Bacitracin/erythromycin 3. Warm compress 4. Tape lid into place Refer for surgery
46
What is entropion caused by?
Onward turning of the lower eyelid 1. Due to age related laxity of the lower eyelid muscles and degeneration of the lid fascia 2. Can also be caused by birth defect (Down’s Syndrome), facial palsy & scar tissue of conjunctiva and tarsus
47
S/S entropion
1. Eye irritation 2. Foreign body sensation 3. Tearing redness 4. Conjunctival injection 5. Blepharospasm
48
Tx of entropion
1. Artificial tears & lubricants | 2. Surgical repair
49
What can happen w/ corneal foreign body?
1. Small particles lodge in the corneal epithelium or stroma 2. Foreign body may start inflammatory cascade dilation of vessels, eyelid edema, conjunctiva and cornea 3. WBC’s may be released resulting in anterior chamber causing inflammation and/or corneal infiltration
50
S/S corneal foreign body
1. Pain, worse with eye movement (significant relief with topical anesthetic) 2. Foreign body sensation (relieved by topical anesthetic) 3. Photophobia 4. Tearing 5. Redness
51
Tx corneal foreign body
1. Topical anesthetic 2. Remove FB 3. If rust ring is present must completely removed 4. Tx w/ abx Pts w/ intraocular foreign body need immediate referral
52
What is the 2nd leading cause of blindness?
Glaucoma
53
Cause of glaucoma
Inc. intraocular pressure causing optic nerve damage Open- angle: Neurodegenerative condition from dysfunction of aqueous humor Angle closure: restricted flow of aqueous humor
54
S/S open angle glaucoma
1. Usually asymptomatic early 2. FH diabetes or glaucoma 3. Halos around lights
55
S/S closed angle glaucoma
1. Halos around lights 2. Aching eye/brow pain 3. HA 4. N&V 5. Dec. vision 6. Eye redness 7. Use of sulfa based drugs
56
Dx open angle glaucoma
1. IOP >21 2. Loss of rim tissue on optic disc 3. Enlarged cup to disc ratio or asymmetric cup to disc
57
Dx closed angle glaucoma
1. Reduced visual acuity 2. Hyperemia 3. Elevated IOP 4. Corneal edema 5. Dilated fixed pupil 6. Shallow anterior chamber
58
Tx of open angle glaucoma
1. Reduction of aqueous production beta-adrenergic drops timolol or levobunolol contraindicated in asthma and cardiac conduction defects. Alpha-adrenergic agonists apraclonidine and brimonidine. 2. Laser trabeculectomy
59
Tx closed angle glaucoma
Medical Emergency!!! 1. Reduce IOP and break the angle closure Beta-adrenergic drops Topical Streoids drops Prednisilone acetate 1% Alpha-adrenergic agonists Carbonic anhydrase inhibitor acetazolamide 500 mg 2. Hyperosmotic agents when pressures are very high 3. Laser peripheral iridotomy used to relieve pressure in iris
60
Tx glaucoma caused by Topiramate or sulfonamide
``` Angle closure 1. Cycloplegia (atropine 1% BID to TID 2. IV hyperosmotic agents 3. IV steroids (methylprednisione250 mg QID) Refer - emergency ```
61
What bacteria causes Hordeolum & what is infected?
S. aureus Meibomian gland Tx w/ warm compress
62
Who is at inc. risk of Hordeolum?
Adults 1. Diabetes 2. Blepharitis 3. Seborrhea 4. High serum lipids
63
S/S hordeolum
1. Acute pain or tenderness eyelid 2. Erythematous eyelid 3. Pustule on eyelid 4. Hyperemia 5. Eyelid bump 6. Eyelid swelling 7. Previous eye surgery or eyelid surgery 8. Rosacea or blepharitis
64
Dx hordeolum
1. Palpate lid for eyelid nodule 2. Visual examination for blocked meibomian gland 3. Eyelid swelling 4. Localized eyelid tenderness
65
What should you consider if there is periorbital erythema & warm edema?
preseptal cellulitis | Tx w/ cephalexin & refer
66
Tx hordeolum
1. Warm compresses 10 minutes QID with lid massage over nodule 2. Eyelid scrubs 3. Abx maybe If no improvement after 3-4 weeks refer to an ophthalmologist curettage and drainage
67
Hyphema
Post injury accumulation of blood in the aqueous humor of the anterior chamber Inc. intraocular pressures REFER - Medical Emergency
68
What is the most common site of bleeding w/ hyphema?
anterior aspect of ciliary body
69
S/S hyphema
1. Blunt or penetrating trauma, intraocular surgery 2. Vision loss 3. Eye pain 4. N&V 5. Blurry vision 6. Vision loss (is it changing over time?) 7. Medications w/ anticoagulation properties
70
Dx hyphema
1. Blood/clot in anterior chamber 2. R/O ruptured globe 3. Measure IOP Screen black & mediterranean Pts for sickle cell
71
Tx of hyphema
1. Avoid ASA & NSAIDS 2. Bedrest or limited activity 3. Elevate head of head to allow blood to settle 4. Eye shield either metal or plastic (do not patch) 5. Atropine 1% BID to TID 6. Acetaminophen only
72
What is the leading cause of blindness in industrialized nations?
Macular Degeneration
73
Risk Factors of Macular Degeneration
1. Age 2. FH 3. Smoking 4. Previous cataract surgery 5. ARMS2/HTRA1
74
S/S non-exudative macular degeneration
1. Gradual loss of central vision 2. Drusen's 3. Macular retinal pigment epithelial changes 4. Variable vision loss 5. Amsler Grid changes
75
S/S exudative macular degeneration
1. Severe vision loss 2. Choroidal neovascularization noted on fundus examination 3. Drusen and subretinal fluid or retinal pigment epithelium detachment 4. Disciform scar
76
Tx non-exudativee macular degeneration
1. AREDS formula vitamins 2. Monitor with Amsler Grid 3. Smoking cessation
77
Tx exudative macular degeneration
1. Laser photocoagulation | 2. Intraocular injections of anti-vegf drug
78
Nystagmus
Fast uncontrollable mvmts of the eye Can be in one or both eyes Acquired/Congenital Usually asymptomatic unless developed after 8y/o
79
Causes of congenital nystagmus
1. Idiopathic 2. Albinoism 3. Aniridia 4. Leber congenital amaurosis
80
Causes of acquired nystagmus
1. Vision loss 2. Toxic or metabolic causes 3. CNS disorders 4. Non-physiologic 5. Trauma 6. Labyrinth's/Meniere's disease 7. Thiamine/Vit B12 deficiency 8. Drugs/alcohol 9. Vertigo 10. MS
81
Tx congenital nystagmus
1. Maximize vision by refraction 2. Treat amblyopia 3. Prism glasses maybe 4. Muscle surgery maybe
82
Tx acquired nystagmus
1. Treat underlying etiology | 2. Periodic alternating nystagmus treat baclofen (not for use in children)
83
Optic neuritis & Causes
``` Inflammation of the optic nerve 1. Epstein-barr Virus Other viruses - demyelinating disease 2. Autoimmune SLE, Sarcoidosis, Sjogren, Behcet & MS ```
84
S/S Optic Neuritis
1. Monocular periorbital pain/retro-ocular pain 2. Eye pain worse w/ eye mvmt 3. Loss of visual acuity w/ scotoma 4. Color desaturation/loss of color vision 5. Relative afferent papillary defect 6. Uhthoff phenomenon 7. Pulfrich phenomenon 8. Phosphenes (see light with sight being present)
85
What is Uhthoff phenomenon?
Worsening of symtoms w/ inc. in body temps Seen w/ Optic neuritis
86
What is Pulfrich phenomenon?
Altered depth perception of moving objects Seen w/ optic neuritis
87
Dx optic neuritis
1. Visual acuity 2. Optic disc swelling 3. Color perception 4. Contrast sensitivity 5. Visual field - APD (90% pts) 6. Optic disc pallor (optic atrophy from previous ON) 7. MRI brain/orbits 8. Labs -CBC, RPR, FTA-ABS, ESR & CRP
88
Tx optic neuritis
1. MRI w/ 1 demyelinating lesion - steoids for 14 days 2. Antiulcer meds - ranitidine 150 mg BID 3. MRI w/ >3 demyelinating lesions - steroids then refer for interferon Tx
89
Why is periorbital cellulitis concerning in kids?
Could be underlying bacterial sinusitis
90
Orbital cellulitis
Infective process occurring in the eyelid tissues superficial to the orbital septum Affects muscles & fat w/in orbit but not the globe Commonly spread & causes other infections
91
Causes of orbital cellulitis
1. Superficial inoculation - insect bite, chalazion, epidermal inclusion cyst, folliculitis 2. Local spread from respiratory tract 3. Orbital injury, Tx, dacryocystitis, endophthalmitis, dental infections
92
What organisms commonly cause cellulitis?
1. S. aureus 2. S. epidermidis 3. Strep & anaerobes 4. Fingal seen in immunosuppressed/diabetics...very aggressive
93
S/S orbital cellulitis
1. Ocular pain 2. Proptosis 3. Ophthaloplegia (paralysis of extraocular muscles) 4. Eyelid edema 5. Vision loss 6. Chemosis 7. Eyelid erythema 8. Elevated intraocular pressure 9. HA 10. Decreased eye motility 11. N&V
94
Dx orbital cellulitis
1. Complete dilated eye examination with visual acuity 2. Head and neck examination 3. Oral examination (tissue necrosis and black eschar) 4. Check for +APD 5. CT scan
95
Tx orbital cellulitis
1. Empiric oral or IV antibiotics 2. Incision and drainage of abscess 3. Culture for causative organism 4. Antifungal therapy with amphoteracin-B (for immunosuppressed or ketoacidosis pts)
96
Papilledema
Optic disc swelling that is secondary to elevated intracranial pressure No dec. vision*** Usually bilat Caused by infection, infiltration or inflammation
97
Causes of papilledema
1. Primary and metastatic intracranial tumors 2. Hydrocephalus 3. Pseudotumor cerebri 4. Subdural and epidural hematomas 5. Subarchnoid hemorrhage 6. Arteriovenous malformation 7. Brain abscess 8. Meningitis 9. Encephalitis 10. Cerebral venous sinus thrombosis
98
S/S papilledema
1. HA (worse on awakening, exacerbated by coughing or other types of Valsalva maneuver) 2. N&V 3. LOC, pupillary dilation and death 4. Pulsatile tinnitus 5. Blurry vision, constriction visual field & decreased color vision 6. Diplopia (6th nerve palsy) No visual disturbances
99
Dx papilledema
1. Full dilated eye examination 2. Automated visual field test (detect blind spot or constriction of field) 3. Color vision testing 4. Optic disc photos 5. BP 6. MRI head with gadolinium and MRV head 7. Lumbar puncture with CSF analysis and opening pressure msmt
100
Tx papilledema
Fix cause 1. Diuretics-carbonic anhydrase inhibitors (idiopathic intracranial hypertension) 2. Weight reduction (idiopathic intracranial hypertension) 3. Corticosteroids (inflammatory disorders)
101
Pterygium & Risk factors
Fleshy, fibrovascular overgrowth from the conjunctiva onto the corneal surface 1. UV 2. Irritation from wind 3. Genetics
102
S/S Pterygium
1. Ocular irritation and burning 2. Redness 3. Tearing 4. Blurred vision 5. Diplopia 6. Altered ocular cosmesis
103
Dx Pterygium
1. Wing shaped, vascular, conjunctival overgrowth | 2. Increased tear lakes
104
Tx Pterygium
1. Protect eyes from direct sun and wind 2. Topical steroid drop to reduce irritation 3. Refer to ophthalmologist for surgical excision if overgrowth encroaches into the pupillary area
105
Retinal Detachment
Acute or progressive condition where the neuroretina separates from the retinal pigment epithelium with accumulation of subretinal fluid and loss of visual function
106
S/S Retinal Detachment
1. Flashes of light 2. Floaters 3. A curtain or shadow moving over the field of vision 4. Peripheral or central vision loss
107
Causes of Retinal Detachment
Traction 1. Diabetes 2. Trauma 3. Previous surgery
108
Dx retinal detachment
1. Full dilated eye examination 2. Confrontational fields 3. Indirect ophthalmoscopy with scleral depression 4. B-scan (ultrasound) is used if media problem
109
Tx Retinal Detachment
1. Pneumatic retinopexy | 2. Surgical-vitrectomy and/or scleral buckle
110
Causes of Retinal Artery Occlusion
Embolus 1. Cholesterol - Hollenhorst plaque from carotid artery bifurcation 2. Calcium - from heart valves 3. Fibrin - from atheromas in carotids 4. Thrombosis 5. Giant cell arteritis 6. Collagen-vascular disease 7. Hypercoag. disorders
111
S/S Retinal Artery Occlusion
1. Acute persistent vision loss 2. Visual acuity finger count to light perception 3. H/O HA, weight loss, jaw claudication, scalp tenderness, fever, proximal joint pain 4. H/O atrial fibrillation, endocarditis, coagulopathies, atherosclerotic disease 5. Direct pressure to the globe or drug induced stupor
112
Dx Retinal Artery Occlusion
1. Whitening of the retina on the posterior pole 2. Cherry red spot macula 3. + APD 4. Narrowed retinal arterioles 5. Boxcaring or segmentation of the blood columns in the arterioles
113
Tx Retinal Artery Occlusion
Tx underlying medical problems
114
Retinal Vein Occlusion
Non-ischemic - milder | Ischemic
115
Causes of retinal vein occlusion
1. Atherosclerosis of the adjacent central retinal artery causing thrombosis 2. HTN 3. Optic disc edema 4. Glaucoma 5. Optic disc drusen 6. Hypercoagulable states 7. Vasculitis 8. Drugs
116
S/S Retinal Vein Occlusion
1. Unilateral painless vision loss
117
Dx Retinal Vein Occlusion
1. Diffuse retinal hemorrhages, dilated, tortuous retinal veins 2. Cotton-wool patches, disc edema, retinal hemorrhages, retinal edema, optociliary shunt vessels on the disc, neovascularization of the optic disc, retina and/or angle 3. Intravenous fluorescein angiography 4. Labs-FBS, HgbA1c, CBC with diff, platelets, PT/PTT, ESR, lipid profile, homocystine, ANA, FTA-ABS 5. Medical eval CV disease and hypercoagulability
118
Tx Central Retinal Vein Occlusion
1. Chronic macular edema-focal laser or anti-VEGF intraocular injections 2. Retinal neovascularization-panretinalphotocoagulation laser
119
S/S Diabetic Retinopathy
``` Non-proliferative 1. Venous dilation 2. Microaneurysms 3. Retinal hemorrhages 4. Edema 5. Hard exudates 6. Cotton-wool patches Proliferative 7. Neovascularization 8. Hemorrhage in the vitreous body 9. May lead to retinal detachment 10. Fibrosis ```
120
Dx Diabetic Retinopathy
1. Based on history and funduscopic examination 2. Optical coherence tomography scanning of the macula 3. Fluorescein angiography
121
Tx Diabetic Retinopathy
1. Management of blood glucose, BP & lipids 2. Yearly dilated eye examination 3. Neovascularization of the retina and disc is treated with panphotocoagulation laser 4. Neovascularization of the angle is treated with PRP laser, cryotherapy and/or topical glaucoma medications 5. Macular edema use intraocular injectable
122
Strabismus
Deviation from perfect ocular alignment | Congenital or defective nerves
123
S/S Strabismus
1. Diplopia 2. Scotoma 3. Amblyopia 4. Abnormal eye movements 5. Visual confusion 6. Asthenopia (weakness or fatigue of the eyes with headache) 7. Intermittent closure of the eye 8. Cranial nerve palsy
124
Dx Strabismus
1. Full dilated eye examination with cycloplegics 2. Cover test 3. Forced duction testing 4. MRI of bra if needed to r/o mass lesion 5. CT chest if needed to r/o possible thyoma 6. CT or MRI orbit if needed to orbital fracture, entrapment of extraocular muscle or tissue or Graves disease
125
Tx Strabismus
Primary and secondary strabismus 1. Correct refraction 2. Treat amblyopia or diplopia 3. Extraocular muscle surgery 4. Chemodenerviation 5. Over-minus prescription or occlusion Paralytic and restrictive strabismus 1.Botulinum toxin injections
126
What type of glaucoma is a medical emergency?
Acute Closure
127
When is a cherry red spot macula seen?
Retinal Artery Occlusion
128
Common organisms w/ otitis externa & sinusitis
aka swimmer's ear 1. Pseudomonas Sp. 2. Enterobacteriaceae 3. Proteus Sp 4. Fungi sometimes or contact dermatitis
129
S/S otitis externa
1. Pain in ear 2. Tenderness w/ palpation of tragus/auricle 3. Grayish discharge in canal
130
What is otomycosis?
Fungal infection due to excessive use of abx greenish drainage
131
Tx otitis externa
1. Abx drops - Quinolone 2. Keep canal clean & dry Maybe steroid & acetic acid
132
Cause of otitis media
1. Poor drainage from eustachian tubes 2. Inflammation & edema 3. Congenital deformity (Down's) Most common in 4-24 months
133
Organisms w/ otitis media
1. S pneumoniae 2. H. influenzae 3. Moraxella catarrhais 4. Strep pyogenes 5. S. aureus
134
S/S otitis media
1. Fever (rare) 2. Pressure 3. Pain 4. Hearing loss 5. Immobile, erythematous, bulging TM
135
Complications w/ otitis media
1. TM rupture - otorrhea & dec. pain | 2. Mastoiditis - spiking fevers, postauricular pain, erythema
136
Tx otitis media
>2 y/o or 6mo-2y/o w/o middle ear effusion - watch & wait for 48-72 hrs If effusion/more severe Sx - Amoxicillin If fever + otalgia - Amoxicillin + Clavulanate
137
Choleseatoma Sx & Tx
Destruction & expanding growth of keratinizing squamous epithelium in the middle ear &/or mastoid process Sx - discharge & hearing loss Tx - Surgery
138
What is barotrauma & cause?
inability to equalize barometric stress on the middle ear causing pain Caused by auditory tube dysfunction from congenital narrowing or acquired mucosal edema TM may rupture if not equalized
139
Causes of conductive hearing loss
1. Cerumen impaction 2. Acute otitis externa 3. Otosclerosis 4. Otitis media
140
What is the MCC of sensorineural hearing loss?
Presbycusis High frequency hearing loss May be assoc. w/ tinnitus Tx - hearing aids
141
Causes of vertigo
1. Labyrinthitis 2. Meniere's disease 3. Vestibular neuritis 4. Obstructing anatomic abnormalities 5. Brain stem vascular disease 6. Arteriovenous malformations 7. Tumors of the brain stem or cerebellum 8. MS 9. Vertebrobasilar migraine syndrome
142
Benign Paroxysmal Position Vertigo Dx & Tx
Predicted type of vertigo in certain positions Dx - Dix-Halpike maneuver Tx - Epley maneuver
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Vestibular Neuritis Labyrinthitis Cause S/S & Tx
Viral/post-viral affecting the vestibular portion of the 8th nerve Need thorough neuro exam Worse w/ rolling over in bed & quick head turning 1. Severe persistent vertigo 2. N&V 3. Gait instability Dx - Hallpike maneuver Tx - Meclizine
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What should you consider in an old person w/ labryinthitis?
Cerebellar/posterior stroke
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Who gets malignant otitis externa & what do you need to get?
elderly/immunocompromised Get CT to rule out osteomyelitis
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Herpes Zoster Oticus S/S
aka Ramsay Hunt Syndrome CN VII 1. Acute vertigo & hearing loss 2. Facial paralysis 3. Ear pain 4. Vesicules in the auditory canal
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If a Pt has vertigo, what must you document?
1. Chronic hearing loss 2. Tinnitus 3. Dizziness/vertigo If yes to all 3 = Meniere's
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Meniere's disease S/S & Tx
Excess endolymphatic fluid pressure 1. Hearing loss 2. Tinnitus 3. Vertigo 4. N&V Tx - diuretics & salt restriction
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Acoustic neuroma & Dx
aka vestibular shwannoma More common in females 1. Unilateral hearing loss 2. Tinnitus 3. Vertigo 4. Ataxia 5. Brain stem dysfunction Dx - CT/MRI TX- Surgery
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TM Perforation
Traumatic or w/ OM Small ones heal in 4-6 wks Large may need surgery
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Mastoiditis
Rare but serious Tender in mastoid area FEVER
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What it the most common nosebleed?
Anterior From Keisselbach's plexus Causes: 1. Trauma 2. Irritation 3. Low moisture 4. Infection, allergy 5. Foreign body
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Tx of posterior epistaxis
From Woodruff's plexus 1. Packing 2. Surgery 3. Embolization
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Tx of allergic rhinitis
Pale stringy mucus 1. Antihistamine (Beclomethasone-spray, or benadryl) 2. Steroid 3. Avoid exposure 4. Allergy testing
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Viruses assoc. w/ sinusitis
Usually follows a URI - usually viral 1. Rhinovirus 2. Parainfluenza virus 3. Influenza
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S/S acute sinusitis
1. Nasal drainage & congestion 2. Facial pain or pressure worse w/ bending over 3. HA 4. Thick, purulent or discolored nasal discharge 5. Cough 6. Sneezing 7. Fever Tooth pain & halitosis may be bacterial
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When do you get a CT scan w/ sinusitis?
persistent, recurrent, or chronic sinusitis
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Tx of acute sinusitis
If 10 days, facial pain or fever = amoxicillin Symptom Tx
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Complications of sinusitis
1. Fungal in immunocompromised 2 . Osteomyelitis 3. Cavernous sinus thrombosis 4. Orbital cellulitis
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Centor Criteria
For Dx acute pharyngitis 1. Fever 2. Tonsillar exudates 3. NO cough 4. Tender anterior cervcal chain LAN 0-1 = low possibility of strep - no abx 2 or + = RST but only Tx positive Pts 4 = Tx
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Organisms of pharyngitis
Viral more common - supportive Tx 1. Rhinovirus 2. Coronavirus 3. Influenza 4. Parainfluenza 5. Adenovirus 6. Herpes, Coxsackie, CMV, EBV 7. S. pyogenes 8. Group A Strep
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S/S pharyngitis
1. Sore throat 2. Difficulty swallowing 3. Fever 4. Erthema of tonsils & posterior pharynx 5. LAD 6. Rhinitis 7. Cough
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Tx Strep
Penicillin/erythromicin
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When is strep most common?
Nov-Dec April-May Incubation 2-5 days Once on abx for 24 hours, risk of transmission greatly dec.
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Secondary disorders from EBV
1. HIV-related lymphomas 2. Nasopharyngeal carcinoma 3. Burkitt lymphoma 4. Oral hairy leukoplakia 5. Posttransplant lymphoproliferative disorder
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S/S mono
1. Fever, sore throat 2. Malaise, anorexia, myalgia 3. LAD 4. Transient bilateral upper-lid edema (Hoagland sign) 5. Splenomegaly 6. Maculopapular rash uncommon (15%), except in patients receiving ampicillin (90%) 7. Exudative pharyngitis, uvular edema, tonsillitis, or gingivitis may occur and soft palatal petechiae may be noted
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Who commonly gets mono?
Age 10-35
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What is the common triad w/ nasal polyps?
1. Nasal polyps 2. Asthma 3. ASA sensitivity
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Organisms of epiglottitis
1. Group A strep 2. Pneumococci 3. Staph 4. H. influenza
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S/S epiglottitis
Abrupt onset 1. High fever 2. Difficulty swallowing 3. Sore throat 4. Drooling 5. Sitting in tripod/sniffing position in kids 6. Stridor 7. Hoarseness 8. Neck tenderness
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Dx & Tx epiglottitis
Thumb sign X-ray, intubation NO tongue depressor IV fluids & abx, steroids Prophylactic rifampin
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Peritonsillar abscess S/S & Tx
These areRED FLAGS for no sore throat 1. Fever >39.4 2. Severe unilateral pain 3. Trismus 4. Drooling 5. Muffled "hot potato" voice Tx - surgical drainage
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Laryngitis causes
Usually viral - sometimes bacterial Chronic 1. GERD 2. Chronic sinusitis vocal strain 3. EtOH 4. Smoking
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Laryngitis S/S & Tx
Hoarseness, cough maybe Voice rest & Tx underlying cause
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Sialadenitis Causes, S/S & Tx
Inflammation of salivary glands Causes - Dehydration, poor oral hygiene S - Painful welling redness, fever, purulent exudate Tx - hydration, analgesics, abx
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Sialolithiasis
Calculi in salivary gland ducts More common in Wharton duct Must clamp duct so it doesn't go back into gland Shock wave therapy
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Parotitis Causes
1. Mumps 2. EBV 3. CMV 4. Influenza 5. S. aureus 6. Mixed oral flora Bilateral firm, erythematous swelling Elevated amylase but not lipase Symptomatic Tx
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Aphthous ulcers
May be caused by HHV6 Topical steroids provide Sx relief
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Necrotizing gingivitis causes S/S & Tx
1. Spirochetes 2. Fusiform bacilli 1. Acute gingival inflammation & necrosis 2. Bleeding 3. Halitosis 4. Fever 5. Cervical LAD warm peroxide rinses & penicillin
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Leukoplakia
A white lesion that cannot be removed by rubbing the mucosal surface
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Erythroplakia
Similar to leukoplakia except that it has a definite erythematous component
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Oral Lichen Planus
Most commonly presents as lacy leukoplakia but may be erosive; definitive diagnosis requires biopsy
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Hairy leukoplakia
occurs on the lateral border of the tongue and is a common early finding in HIV infection
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Oral Cancer
SCC Early lesions appear as leukoplakia or erythroplakia; more advanced lesions will be larger, with invasion into tongue such that a mass lesion is palpable. Ulceration may be present.
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What is a DDx of oral herpes simplex?
Hand, foot & mouth disease
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Oral candidiasis Risk Factors & Tx
aka thrush Usually painful and looks like creamy-white curd-like patches overlying erythematous mucosa Can be scraped off 1. Dentures 2. Debilitated & have poor oral hygiene 3. Diabetics 4. Anemics 5. Pts doing chemo or radiation 6. corticosteroids or broad-spectrum abx Tx = fluconazole
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What is angular cheilitis & when is it seen?
Form of candidiasis seen w/ nutritional deficiencies
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S/S laryngeal CA
1. New & persistent hoarseness in a smoker 2. Persistent throat or ear pain, especially with swallowing 3. Neck mass 4. Hemoptysis 5. Stridor or other symptoms of a compromised airway

Clinical Medicine (11 decks)

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