H P/EENT Still Flashcards

Health Care
Terms Definitions
Erythema
Redness
Verrucae
Nose warts
swimmers ear
otitis externa
Exotropia
lateral eye deviation
Pilar cysts
Scalp masses
Miosis
constriction of pupils
tx acoustic neuroma
surgical removal
Myopia
Nearsightedness: Unaccommodated eye brings into focus images of objects closer than infinity. Correct w/concave lenses
Emmetropia
Normal state of refractive/accomodation
Cushing's syndrome: PANCE
Moon facies
Acoustic Neuroma is AKA...
Vestibular Schwannoma
chronic vertigo, progressive unilateral hearing loss.
acoustic neuroma
3. Hordeolum, Scarring of eyelid margin, Misdirection of eyelashes, and corneal irritation/ulcer are complications of what disease process?
blepharitis
Tearing, ropy eye discharge
Allergic conjunctivitis
Drusen
Undigested cellular debris assoc w/macular degeneration
Chalazion
Painless, more internal protrusion nodule on eyelid. Granulomatous inflammation of meibomian gland
Corneal abrasion
Sx: tearing, photophobia, blepharospasm. Dx fluorescein- Seidel's test. Rx: cycloplegic to reduce spasm, topical antibiotic drops.
schiotz tonometry
An instrument that registers intraocular pressure by direct application to the cornea.
cheek pain and pressure, discolored nasal discharge.
sinusitis
bilat inflammation of conjunctiva, excessive tearing,
viral conjunctivitis
a localized, purulent, inflammatory staphylococcal infection of one or more sebaceous glands (meibomian or zeisian) of the eyelids. - AKA?
hordeolumAKA: stye
sore throat, odynophagia, muffled voice, soft palate deviation, peritonsillar fold.
peritonsillar abscess
Define subconjunctival hemorrhage?
Bleeding underneath the conjunctiva
45. The treatment for Hyphema includes all of the following except?
aspirin
Keloid
Growth on helix associated w/ear piercings
Trichotillomania
Pulling out own hair. Asymmetric irregularity
Macular degeneration
Sx Drusen (hard or soft).
Chronic dacryocystitis
Staph epidermidis, anerobic strep., candida albicans
Sjogren's disease
Scratching and burning signifying deficiency of tear film components
Internal Hordeolum
Meibomian gland abscess (on margin)
Chemosis
Swelling of bulbar conjunctiva, occurs w/allergic eye
Semont maneuver
- Semont maneuver (for BPV)

--Turn head 45 degrees horizontally toward the unaffected ear.Tilts pt 105 degrees so pt is lying on the side of the affected ear with your head hanging and your nose pointed upward. You remain in this position for 3 minutes. The debris should move to the apex of the canal. Then moves the pt quickly through the seated position, holding your head in place, until you are lying on the side of the affected ear with your nose pointed to the ground. You remain in this position for 3 minutes. The debris should move toward the exit of the canal. Then slowly move the pt back to the seated position. The debris should fall into the utricle of the canal, where it will not cause vertigo.
flashing lights, large number of floaters and a 'shade' over the vision in one eye.
retinal detachment
hallmark of age related macular degeneration
retinal drusen
esotropia
strabismus in which there is manifest deviation of the visual axis of an eye toward that of the other eye, resulting in diplopia. (CROSS-EYED)
conjunctival dendritic plaques(tx with?)
Herpetic keratosis.- oral acylovir
What causes mucin deficiency?
malnutrition, infection, burns, or drugs
What can hyperacute conjunctivitis lead to if not treated promptly?
Perforation and/or blindness
20. When diagnosing inclusion conjunctivitis what important presentation symptom should be considered when diagnosing?
• Concurrent asymptomatic urogenital infection
28. What is a common conjunctival disorder in elderly women?
keratoconjuctivitis sicca
Glands of Zeis
Modified sebaceous glands, secretions flow to edge of eyelid into follicles of eyelashes
Dacryocystitis
Infection of lacrimal sac due to obstruction of nasolacrimal. Infants/age over 40, unilateral.
Vernal keratoconjunctivitis
COBBLESTONE PAPILLAE (PANCE). More aggressive allergic eye occurs bilaterally. Rx: Antihistimines
how do you remove an airway obstruction from a foreign body?
rigid bronchoscopy
Meniere's disease (describe)
Meniere's disease involves a swelling of part of the (endolymphatic sac). The endolymphic sac controls the filtration and excretion of the fluid in the semicircular canals.
clear nasal drainage triggered by cold and emotions.
vasomotor rhinitis
What should be done for irregular pupil?
Emergent referral
22. What is the “gold standard” for diagnosis of Newborn conjunctivitis?
isolation by culture
6. What is the most common cause of tearing in children
dacryostenosis
Induration
Hardening of a normally soft tissue or organ due to inflammation, infiltration of a neoplasm, or an accumulation of blood
Chlamydial conjunctivitis
Cause of blindness wolrd wide. Dx: Giemsa. Rx: anitbiotics
Angular chelitis
Cracked corners of lips. AKA perleche, commissural cheilitis, angular stomatitis
HSV Keratitis
Most common cause corneal ulcers. HSV lives in trigeminal ganglion. Present: blepharitis w/vesicles. Dx: fluor. terminal bulbs. Rx: topical antivirals
Actinic cheilitis
"chapped lips all the time". Precursor of squamous cell carcinoma.
Anisocoria greater in bright light
Issue w/parasympathetic nervous supply
tx dacryocystitis
- The treatment of choice is a dacryocystorhinostomy whether the patient is symptomatic or not.- Purulent infection of the lacrimal sac and skin should be treated similarly with oral antibiotics (Augmentin)- Cultures of the lacrimal fluid should be obtained.
clinical presentation of cataracts
- decreased visualization of the retina- obscure or absent red reflex
Weber's test(describe and explain results)
- for differentiating between conduction deafness and sensorineural deafness. - the stem of a vibrating tuning fork is placed on the vertex or midline of the forehead- if the sound is heard best in the affected ear, the deafness is probably of the conductive type- if heard best in the normal ear, it is probably of the sensorineural type.
an inflammation of part or all of the uvea, commonly involving the other tunics of the eye (sclera, cornea, and retina).
uveitis
Similarities and differences between retinal vein occlusion and hypertensive retinopathy.
Similar: both present with intraretinal hemmorages, and cotton-wool spots. Difference: HTN retinopathy has progressive visual loss, retinal vein occlusion has acute, unilateral visual loss.
suspect gonococcal conjunctivitis, what is your abx of choice and why?
- IV ceftriaxone (3rd gen, cephalosporin)- (+/- topical erythromycin) - for PCN-restssistant gonococcus.
What is the clinical presentation of trachoma?
Majority are asymptomatic
What is the etiology for neonatal conjunctivitis that occurs in the first 1-36 hrs of life?
 
Silver nitrate (chemical)
30. If a patient presents with red, itchy, burning, tearing, and watery discharge and has known allergies of mold, what type of conjunctivitis would the patient be most likely diagnosed with?
perrennial allergic conjuctivitis
8. What is the chief characterization of conjunctivitis?
• All conjunctivitis is characterized by red eye….but not all red eye is conjunctivitis
25. What are the two types of Viral Conjunctivitis
• PCF-pharyngoconjunctival fever-most commonly caused by Adenovirus type 3• EKC-Epidemic Keratoconjunctivitis –caused by Adenovirus type 8, 19, 29, and 37
Arcus senilis
thin gray/white arc on edge of cornea caused by lipid deposits
dyspnea, inspiratory stridor and unilateral wheezing.
airway obstruction of a foreign body.
- inflammation of the lacrimal sac- presentation?
dacryocystitis- pain, swelling, tenderness, and redness of tear sac area.
Inability to gaze downward and inward with the left eye.
Left fourth cranial nerve
Describe the pathophysiology of pinguecula.
Caused by chronic solar radiation which alters collagen and elastic tissues of conjunctival stroma
What are complications of dry eyes?
erosions and scarring of cornea
27. What are the treatments for EKC or PCF
• Cold compresses• Typically resolve without treatment in 1-3 weeks• With EKC consider referral for confirmation of diagnosis and possible steroids to prevent scarring
34. Without pathogenesis the cornea is a vascular surface?
False - cornea is avascular
Cytomegalovirus retinitis
In Aids pt whn CD4 counts down. Sx: cotton wool, retinal hemorrhages, microaneurysms. Pt floaters, scintillating scotoma, metamorphopsia. "Pizza pie, cheese and ketchup". Rx: Ganciclovir, foscarnet, cidofovir.
cerebellopontine angle(Why do I care?)
Space that an acoustic neuroma can occupy.
Difference between closed and open glaucoma
- closure of the anterior angle

angle-closure glaucoma - closed angle with apposition of the iris and trabecular meshwork.

- open-angle glaucoma - angle of the anterior chamber remains open, but filtration is gradually diminished because of the tissues of the angle
pathogen of OE in immunocmpromised pts (such as with diabetes.) What is a name for this type of inf?
- pseudomonas aeruginosa- malignant external otitis
Describe the clinical presentation of EKC.
- Injection, watery or mucoid discharge, swollen lids and burning sensation
- May have severe foreign body sensation
- Keratitis w/ corneal infiltrates that degrade acuity
- May have pseudo membrane
What are the most common bacteria that infects children in conjunctivitis?
Streptococci pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, and Moraxella catarrhalis
What is the etiology of pterygium?
Exposure to irritants (wind, dirt, dust, pollution, chemicals, allergens)
7. What is the definition of Conjunctivitis?
• Inflammation of the bulbar and/or palpebral conjunctiva for less than four weeks
32. Pinguecula occurs 90% of the time on the nasal side of the bulbar conjunctiva?
• False-Pterygium occurs on the nasal side
35. What is the most critical sign for a foreign body?
• Finding the particulate matter
Possible entrapments from an orbital fx
- "soft tissue" - extraocular muscles- orbital fatPOSSIBLE BLOWOUT FX
Minor infections at the opening of the nose may result from folliculitis. (pathogen & tx?)
- nasal vestibulitis- Staphylococcus- Bacitracin ointment
- initial tx of peritonsillar abscess- followed by...
- incision and drainage or aspiration.- oral abx tx (PCN or E-mycin for PCN allergic)
4 yo, acute fever, erythematous TM. (suspect? confirmed by?)
- OM- confirmed by pneumatic otoscopty/insufflation to inspect TM mobility.
What is the etiology of viral conjunctivitis?
- PCF: Adenovirus type 3
- EKC: Adenovirus 8, 19, 29 and 37
What causes hypofunction of lacrimal glands?
- Loss of aqueous component of tears
- Occurs w/ aging
- Hereditary disorders, systemic disease, or systemic and topical drugs
What are others methods used to diagnose neonatal conjunctivitis?
Gram stain, nucleic acid amplification tests, antigen detection, smear, and monoclonal antibody immunoassays
What is the clinical presentation of inclusion conjunctivitis?
- Acute or chronic
- Usually unilateral
- Redness, discharge, irritation
- Preauricular lymphadenopathy
- Swollen lids
- Concurrent aysmptomatic urogenital infection
 
In which of the following conditions, conjunctivitis, iritis, acute glaucoma, or keratitis, is visual acuity reduced?
Iritis and glaucoma, visual acuity varies in keratitis according to the site of the lesion
Who is at greatest risk for hypertensive retinopathy?
those who undergo acute abrupt BP elevations such as pheochromocytoma, malignant HTN, acute renal failure or pre-eclampsia.
Tx goal for closed angle glaucoma
- Decrease IOP until iridotomy can be completed.
What is the clinical presentation of hyperacute conjunctivitis?
- Copious purulent discharge w/i 12 hrs of inoculation
- Rapidly progressive
- Includes redness, irritation, tenderness, lid swelling, and tender preauricular adenopathy
What is the treatment for viral conjunctivitis and what is its prognosis?
- Symptomatic tx: cold compresses to soothe
- MOst reseolve spontaneously w/i 1-3 wks (avg. 10 days)
Caloric stimulation (What is it and why do I care?)
- A test which uses differences in temperature to diagnose ear nerve damage.- Positive = meniere's dz- This test stimulates the inner ear and nearby nerves by delivering cold and warm water to the ear canal at different times. - cold water enters the ear, it should cause nystagmus. The eyes should move away from the cold water and slowly back.- Warm water is placed into the ear. The eyes should now move towards the warm water then slowly away.- electrodes, placed around the eyes, detect the movements. A computer records all the results.
What is the epidemiology for viral conjunctivitis?
- Extremely common in the US
- Occurs equally in men and women
- Highly contagious
How is seasonal and perennial allergic conjunctivitis treated?
- Initiate tx 2 wks before onset of sx if possible
- 1st line agent: topical antihistamine/mast cell stabilizer (Patanol, Pataday, Optiver, Alocril, Elestat)
- 2nd line: add oral antihistamine (Allegra, Claritin, Clarinex, Zyrtec)
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