EENT Review Flashcards

Health Care
Terms Definitions
odynophagia
painful swallowing
best tx hyphema
surgery
Keratitis
inflammation of cornea
Esotropia
medial eye deviation
aphthous stomatitis
Canker sores
Parotitis
Pain with salivation
pain with auricular movement
OE
CNHC
Chodrodermatitis nodularis helices chronicus. "Hurts my ear when I sleep"
Watery eye discharge
Viral conjunctivitis/Keratitis
granulomatous inflammation of the meibomian gland. hard, non-tender swelling on the LOWER lid.
chalazion
most common complication of inadequately treated OM
mastoiditis
What is keratoconjunctivitis sicca?
Dry eyes
Photophobia
Sensitivity to light (corneal inflammation, iritis)
Acute dacryocystitis
Staph aureus, beta-hemolytic streptococci
Corneal arcus
Moon shaped whitish area
Firm Thyroid
Hashimoto's thyroiditis: autoimmune hypothyroidism
Ultraviolet keratitis
aka diffuse punctate keratopathy/welder's flash. Sx agonizing pain severe photophobia. Diffuse punctate lesions. Rx: cyclopentolate.
Flare
Inflammatory cells and proteins escaping from dilated vessels. Ant chamber appears gray/milky. IRITIS
tympanocentesis
surgical puncture of the tympanic membrane for removal of fluid from the middle ear.
inflamed eyelid and conjunctiva, mucopurulent drainage , foreign body sensation, eye pain and blurred vision.
Corneal ulceration
abx class contraindicated in peds(suffix)
quinolones(-floxacin, -quin)
abx with potential cross-reactivity in PCN allergic pts
cephalosorins
Define Pterygium.
Triangular, yellow/opaque patch of hypertrophied bulbar sunconjunctival tissue, extending from the medial angle of the eye to the border of the cornea and beyond
11. What organisms cause acute bacterial conjunctivitis?
• Staph aureus-Adults• Hib-children• Pseudomonas aeruginosa-contact wearers
Retinal Detachment
Most common site detachment=superior temporal retinal area. Sx: New onset of floaters, flashing light. Pt sees shadow or curtain. Rx: cryosurgery or laser. pt should remain supine /w head turned ipsilateral to detachment.
Myxedema
Severe hypothyroidism. PANCE: loss of lateral 1/3 eyebrows
Shotty nodes
Small, mobile, discrete, nontender lymph nodes. Healthy
Fordyce spots
Normal variant. Ectopic sebaceous glands in mouth, orange dots
Uveitis
Any combination of iritis, cyclitis, or choroiditis.Rx: topical cycloplegics, corticosteroids
Optic neuritis
Inflammation usually retro bulbar.Sx: Sudden monocular loss of vision. Pain c eye movements and palpitation of globe. Central scotoma, loss color vision. Rx: IV steroids
Nystagmus
fine rhythmic oscillations of the eyes
Trichiasis
Rubbing of eyelashes against cornea (foreign body sensation)
Hordeolum
Stye, typically caused by Staph. aureus. Acute onset of pain and edema of eyelid.
retinal artery occlusion, Fundoscopy =
ischemic, opaque retina
tx labyrinthitis
- relief of symptoms. - antivertiginous: (eg, meclizine, scopolamine, ephedrine, dimenhydrinate, diazepam)- others are antiemetics (eg, promethazine, prochlorperazine). - Meclizine, Dimenhydrinate, Scopolamine, Diazepam, Promethazine
blurred vision, deep aching eye pain, photophobia and varying erythema.
Uveitis
pathogens associated with sinusitis(drug of choice for sinusitis?)
- streptococcus- Haemophilus influenza- Moraxella catarrhalis(amoxicillin)
sudden loss of vision, floaters, bleeding within the eye.
vitreous hemorrhage
hyphema
hemorrhage in the anterior chamber of the eye
exotropia
strabismus in which there is permanent deviation of the visual axis of one eye away from that of the other, resulting in diplopia;

(WALLEYE)
Should the cornea be clear in conjunctivitis?
Yes
What is the most common eye disorder?
Conjunctivitis
21. What is the treatment for Inclusion Conjunctivitis
• “cline”—tetracycline, doxycycline• Erythromycin and azithromycin
19. Which type of conjunctivitis is considered an STD?
inclusion conjuctivitis
14. What type of conjunctivitis is an ophthalmic emergency?
hyperacute
Leukocoria
White light, abnormal for red reflex. Possibly retinoblastoma, tumor in eye found most often in children
Bacterial conjunctivitis
Staph aureus, Strep pneumoniae. Acute onset of copious, purulent, sticky discharge from both eyes worse upon wakening. Dx: H+P. Rx: sulfonamide
Atopic keratoconjunctivitis
Chronic allergic eye. Fine papillary conjunctivitis w/fibrosis, entropion and trichiasis.Rx:Antihistimines
Ectropion
Outward turning of lower lid (palsy assoc)
Fungal keratitis
Plant material, indolent, loss in middle layer of cornea.
Amblyopia
Lazy eye, poor vision development in one eye
Amaurosis Fugax
Cause: retinal emboli from ipsilateral carotid disease. Sx: curtain effect on vision.
orbital cellulitis
Sx fever, proptosis, ocular signs. Sinusitis usually underlying cause. Rx: IV antibiotics, broad spectrum.
CRAO
Sx: sudden painless unilateral loss of vision. Pale retina w/cherry red spot. Rx: lay pt flat, high conc O2, topical beta blocker, ocular massage. DDx: temporal arteritis
20 month old, moderate fever, tachypnea, neck in hyperextended, hx URI
retropharyngeal space abscess
modified Epley maneuver
- modified Epley maneuver. (for BPV)

-- Turns pt's head 45 degrees horizontally toward the affected ear. Hold the pt's arms for support. Tilt the pt backward to a horizontal position with your head kept in place at a 45-degree turn, hanging. An attack of vertigo is likely as the debris moves toward the apex of the canal. Hold in this position until the vertigo stops, usually within a minute. Turn the pt's head 90 degrees toward the unaffected ear. Roll the pt to the side of the unaffected ear, so they are now looking at the floor. The debris should move in the canal again, possibly provoking another attack of vertigo. You should remain in this position until the vertigo subsides, usually within a minute. Help pt back to a seated position. Then tilt the pt's head down 30 degrees, which allows the debris to fall into the utricle of the canal where it will not cause vertigo.
inclusion conjuctivitis
- caused by an organism (Chlamydia trachomatis) - it affects primarily newborn infants, beginning as an acute purulent conjunctivitis that leads to papillary hypertrophy of the palpebral conjunctiva.
Define pinguecula.
A yellowish spot of proliferation in the bulbar conjunctiva near the sclerocorneal junction
Definition of Conjunctivitis
Inflammation of the bulbar and/or palpebral conjunctiva < 4wks duration
Describe seasonal allergic conjunctivitis.
Predictable, chronic course that corresponds to specific pollen seasons
44. What is the important cause of keratitis in contact lens wearers?
acanthomeoba keratitis
which is painful to the pt, hordeolum or chalazion?
hordeolum
Vitreous hemorrhage
Sx: inability to see fundal details. Pt sudden visual loss, floaters.
Chemical conjunctivitis
Dx: nitrazine paper. Rx: irrigation w/ LR. 1 ltr acid, 2 ltrs if alkaline. Prophylactic topical antibiotics
Diabetic Retinopathy: nonproliferative
Leading cause new blindness 20-65, NIDDM Sx: any of dilation of veins, capillary microaneurysms, flame, splinter/dot/blot hemorrhages, retinal edema, hard exudates. Rx: treat blood glucose and any hypertension
Aniscoria greater in dim light
Issue w/sympathetic nervous supply
Herpes labialis
Cold sore on vermilllion border of lip
Papilledema
Swelling of optic disc and bulging of physiologic cup due to IOP. Flame hemorrhages, cotton wool
acute angle-closure glaucoma
unilateral eye pain, N/V, halo around lights, red eye, pupil is nonreactive and steamy cornea.
slight cupping of the optic disk or changes in retinal nerve fiber layer.
open-angle glaucoma
abx route for orbital cellulitis or abscess.
IV (NOT PO)
What is considered the "gold standard" for diagnosis of neonatal conjunctivitis?
Isolation by culture
What portion of conjunctivitis cases are bacterial versus viral?
Bacterial - 5%
Viral 95%
39. Bacterial Keratitis is caused by
A. Direct corneal traumaB. Tear film abnormalitiesC. Hypoxic trauma from contact lens wearD. Microbial invasion
18. What is the treatment for trachoma?
• Azithromycin oral or ophthalmic• Surgery to correct eyelid deformities• Transplant of cornea
Glands of Moll
apocrine sweat glands in dermis of eyelids
Imaging for retropharyngeal space abscess and what are you looking for?
- lateral neck films- widened retropharyngeal space (wider then C4 vertebral body)
general antibiotic choice against pseudomonas aeruginosa
Two-drug combination therapy, such as an antipseudomonal beta-lactam with an aminoglycoside.
- glaucoma caused by closure of the anterior angle by contact between the iris and the inner surface of the trabecular meshwork
angle-closure (closed) glaucoma
sx acute angle-closure glaucoma
unilateral eye pain, N/V, halo around lights, red eye, pupil is nonreactive and steamy cornea.
Inability to gaze downward and inward with the right eye.
Right fourth cranial nerve
What is the etiology of pinguecula?
Common in persons > 35
What is the etiology of subconjunctival hemorrhage?
violent coughing, powerful sneezing, heavy lifting, vomiting
Describe the pathophysiology of acute bacterial conjunctivitis.
- Bacteria induces antigen-antibody immune rxn and inflammation. 
- Defenses: bacteriostatic lysozymes and immunoglbulins in tear film, shearing force of blink and colonozed non-pathogenic bacteria
- This causes self-eradication or infection
Explain the disease progression of trachoma.
- Repeated follicular inflammation leads to eyelid scarring
- Eyelid scarring leads to entropion and subsequent trichiasis
- Eyelash abrasion leads to corneal opacification and blindness
What is used to treat neonatal conjunctivitis caused by gram (-) bacteria (others)?
Gentamicin or tobramycin ointments
What are differential diagnoses for bacterial conjunctivitis?
Uveitis, acute glaucoma, ocular trauma, keratitis, corneal ulcers/foreign body, dacryocystitis
Describe the pathophysiology of allergic conjunctivitis.
- Classic Type I IgE-mediated hypersensitivity
- Mast cells interact w/ allergens and release chemical mediators (degranulation)
- Histamine (vasodilation, vascular permeability, itching, mucus secretion) - early phase, neutral proteases (inflammatory mediators), arachidonic acid
26. How does the presentation of EKC differ from PCF?
• EKC may have:o pseudo membraneo Swollen lidso Decreased visual acuityo Severe FB sensationo Keratitis with corneal infiltrates that degrade acuity• PCF may haveo Tarsal conjunctiva may become bumpyo May have viral prodrome (adenopathy, fever, pharyngitis and malaise)o Palpable preauricular lymphadenopathy
38. What is a complication of a corneal ulcer?
corneal scaring; obscured vision
Herpes Zoster Ophthalmicus
2ndry to activation of zoster virus in ophthalmic division tirgeminal. Hutchinson's sign, lesion on tip of nose poses higher risk. Dx Fluoresceine stain (dendritic lesions).Dx: acyclovir
inability to gaze laterally with the right eye. (What nerve and what is it called?)
Right sixth cranial nerve(maximal esotropia with rightward gaze)
inability to gaze laterally with the left eye. (What nerve and what is it called?)
Left sixth cranial nerve(maximal esotropia with leftward gaze)
- unresolved OE after appropriate therapy, not immunocompromised. - Suspect?
Squamous cell carcinoma or other neoplasm.
differences in presenting sx of optic neuritis vs central retinal artery occlusion.
- central retinal artery occlusionACUTE VISION LOSS- optic neuritisPROGRESSIVE VISION LOSS- central retinal artery occlusionCOMPLETELY PAINLESS- optic neuritisPAIN WITH EYE MOVEMENT
Optic neuritis (define and sx)
- inflammation of the optic nerve.- assumed autoimmune- associated with MS-- Acute loss of vision in one eye-- Loss of color vision-- Pain on movement of the eye-- Changes in the pupil's reactions to bright light.
Define neonatal conjunctivitis.  What is another name for it?
- Conjunctivitis in the first 4 wks of life
- Ophthalmia Neonatorum
What is the etiology for neonatal conjunctivitis that occurs 2-5 days post partum? 3-15 days?
- Bacteria (Staph, Strep, Haemophilus)
- Virus (HSV types 1 & 2)
What is the pathophysiology of pterygium?
- Degeneration of conjunctival stroma replaced by thickened, tortuous elastic fibers
- Fibroblasts invade and fragment Bowman's layer
- Resembles actinic degeneration of the skin
What is the etiology of chlamydial conjunctivitis outside of the US?
Inclusion conjunctivitis - Chlamydia trachomatis serotypes D-K
47. A 35 year old patient presents to your office with a yellow band of opacity around the periphery of his cornea. What two disease processes would you further investigate?
• CAD and CV disease
abx for orbital cellulitis or abscess.
- ceftriaxone (rochephin) IV. - broad spectrum 3rd gen Cephalosporin
Why is glaucoma bad?
Leads to damage to the optic nerve & vision loss/blindness.
In which of the following conditions, conjunctivitis, iritis, acute glaucoma, or keratitis, would marked photophobia be present?
Iritis, slight photophobia is present in glaucoma and keratitis
What can happen in severe cases of dry eyes?
marked discomfort, photophobia, difficulty in moving the eyelids, and excessive mucus secretion
How would you educate a patient about pinguecula?
- Prevention
- Wear sunglasses (don't help once its already there)
43. What is the presentation hallmark of Herpes Zoster Ophthalmicus?
• A vesicular rash that involves the first division of CN5 that presents in a dermatomal distribution and respects the midline
What is postural drainage and when is it no longer recommended?
Not recommended for foreign body airway obstruction because it may cause the FB to become dislodged and obstruct a central airway.
eye exams for DM2 pts occur when?
At dx, annually and with any fundoscopic changes.
What are risk factors for bacterial conjunctivitis?
Spread by direct contact or on fomites.  Daycare or schools.  Contact lens use.
What is the prognosis for conjunctivitis?
- resolves in 10-14 days if untreated and in 2-3 days if treated
What are the 2 main types of viral conjunctivitis?
- Pharyngoconjunctival fever (PCF)
- Epidemic keratoconjunctivitis (EKC)
What are red flags when a pt present with red eye?
Vision change, diploplia, photophobia, severe pain, nausea, contact lenses, trauma, chemical in eye, limitation of eye movement, change in corneal clarity, hyphema, hypophon, sluggish or displaced pupil, altered fundus reflex
amaurosis fugax (define and give cause)
- a clot of plaque in the carotid artery breaking off and traveling to the retinal artery in the eye. - This blocks the artery for a time and causes loss of vision in that eye for as long as its blood supply is cut off.- Atherosclerosis of the carotid arteries (in the neck) is the main risk factor for this condition.
Does fam hx matter in dx of cataracts?- contact lense use?- acquired rubella?
- No, fam hx indicates no sig increase risk.- Not contact lense use.- Not ACQUIRED rubella, but congenital rubella does.
What do you do if any of these red flags are present?
Re-evaluate in 24-48 hrs and refer if no improvement in that time
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