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Clin Med- Misc
HEENT
129
Medical
Graduate
09/16/2018

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Term
Lemierre's syndrome
Definition
infectious thrombophlebitis of the internal jugular vein.
most often develops as a complication of a bacterial sore throat infection in young, otherwise healthy adults.
Term
Behcet's syndrome
Definition
The cause of Behçet's disease is unknown, but it may be the body's immune system attacking healthy cells (autoimmune disorder).
Symptoms include mouth and genital sores, inflamed eyes, and rashes.
Term
Herpangina
Definition
Common illness in children; similar to hand foot mouth
Caused by Coxsackie type A
Term
PFAPA
Definition
Periodic fever w/ aphthous stomatitis, pharyngitis, and adenitis
Term
How often does a patient need to get tonsillitis to be a candidate for tonsillectomy?
Definition
More than 7 times in 1 year
More than 5/year for 2 years
More than 3/year for 3 years
Term
Treatment for croup?
Definition
Recover in 3 days with home supportive therapy; if severe, dexamethasone and/or epi neb
Term
Tx for bacterial pharyngitis?
Definition
Ampicillin-sulbactam or 2nd/3rd gen ceph
Term
Tx for epiglottitis?
Definition
Ceftriaxone or cefotaxime +/- vanco
Term
What disease is associated w/ "strawberry tongue"?
Definition
Kawasaki
Term
Kawasaki disease
Definition
Mucocutaneous, inflammation of medium-sized muscular arteries
Term
Kawasaki labs/tx?
Definition
CRP/ESR, LFTs
IV Immunoglobulin
Term
What type of virus is RSV?
Definition
RNA
Paramyxoviridae
Term
What is trismus?
Definition
Lockjaw
Term
How wide does the jaw normally open?
Definition
40mm
Term
Retropharyngeal abscess tx?
Definition
Clindamycin, cefoxitin, timentin, zosyn, or unasyn
Term
Vaccination schedule for HiB?
Definition
1st dose- 2 months
2nd dose- 4 months
3rd dose- 6 months
4th dose- 12-15 months
Term
Topical tx for otitis externa?
Definition
Ofloxacin
Term
In what part of the mouth does hairy leukoplakia most often present?
Definition
Lateral surface of tongue
Term
What diseases can trigger hairy leukoplakia?
Definition
EBV and HIV
Term
Treatment of choice for recurrent bacterial sinusitis?
Definition
Amoxicillin-clavulanate (Augmentin)
Term
Gold standard for sinus imaging?
Definition
CT scan of the sinuses
Term
Ludwig angina
Definition
bacterial infection that occurs in the floor of the mouth, under the tongue. It often develops after an infection of the roots of the teeth (such as tooth abscess) or a mouth injury.
Term
MC organisms in acute otitis media?
Definition
Strep pneumoniae, H. influenza, strep pyogenes
Term
Mastoiditis tx?
Definition
IV antibiotics- ceftriaxone/vanco
Term
What is our major concern following strep throat infection?
Definition
rheumatic fever
Term
Coryza
Definition
aka rhinitis
Irritation and swelling of the mucous membrane in the nose.
Term
What causes the stereotypical "barking cough" of croup?
Definition
Swelling of vocal cords
Term
What is the classic X ray sign in croup?
Definition
Steeple sign
Term
What is the indication for dextromethorphan?
Definition
Cough suppressant
Term
What disease entity presents w/ "Hot potato voice" (muffled)
Definition
peritonsillar abscess
Term
Quinsy triad?
Definition
For peritonsillar abscess
1) trismus (abscess pushes on muscles that open jaw)
2) uvula deviation to contralateral side
3) dysphonia
Term
Kawasaki disease diagnostic criteria
Definition
fever >/= 5 days plus 4 of the 5 following:
1) bilateral bulbar conjunctivitis
2) Oral mucous membrane changes
3) Peripheral extremity changes, such as erythema of palms/soles, periungual desquamation
4) polymorphous rash
5) cervical lymphadenopathy
Term
Tx for KD?
Definition
IVIG
Term
What is the indication for the Dix-Hallpike maneuver?
Definition
To diagnose posterior canal Benign Paroxysmal Positional Vertigo (BPPV)
Term
Etiology of BPPV?
Definition
Otoconia shift from utricle to semicircular canals
Term
Meniere's disease symptoms
Definition
recurrent episodes of vertigo, hearing loss and tinnitus; episodes may be accompanied by a headache and a feeling of fullness in the ears
Term
Etiology of Meniere's
Definition
Distended endolymph- in vestibule, causes vertigo, in cochlea, causes tinnitus and hearing loss
Term
Episodic vertigo w/ hearing loss makes you think of _____
Definition
Meniere's disease
Term
Episodic vertigo w/o hearing loss makes you think of ______
Definition
BPPV
Term
Continuous vertigo w/ hearing loss makes you think of ______
Definition
Labyrinthitis
Term
Continuous vertigo w/o hearing loss makes you think of ______
Definition
Vestibular neuritis
Term
dysdiadochokinesia
Definition
impaired ability to perform rapid, alternating movements (associated w/ cerebellar dysfunction)
Term
Causes of peripheral vertigo?
Definition
BPPV, Meniere's, AOM, labyrinthitis, vestibular neuritis, trauma
Term
Causes of central vertigo?
Definition
Meningitis, encephalitis, vertebral basilar insufficiency, cerebellar hemorrhage, temporal lobe epilepsy, tumors
Term
Indication for supine head roll test?
Definition
Dx of lateral/horizontal canal BPPV
Term
Epley maneuver indication?
Definition
Tx for vertigo
Term
Indication for tympanostomy tubes in children?
Definition
≥3 distinct and well-documented episodes of AOM within six months or ≥4 episodes within 12 months
Term
What will the Halo test performed on nasal or ear drainage indicate?
Definition
CSF leak
Term
Hyperacusis
Definition
highly debilitating hearing disorder characterized by an increased sensitivity to certain frequencies and volume ranges of sound
Term
Signs of basilar skull fracture?
Definition
Battle's sign (postauricular hematoma)
Raccoon eyes (periorbital hematoma)
Hemotympanum
Term
What should be our biggest concern with unilateral hearing loss?
Definition
Acoustic neuroma (MRI to confirm)
Term
For which age group should we always treat AOM w/ abx?
Definition
<6months
Term
MOA of oseltamavir and zanamivir?
Definition
Neuraminidase inhibitors
Used to tx flu
Term
MOA of ribavirin?
Definition
Inhibits viral RNA polymerase
Term
Hordeolum
Definition
aka stye
A red, painful lump near the edge of the eyelid that may look like a boil or pimple.
Term
chalazion
Definition
benign, painless bump or nodule inside the upper or lower eyelid. Chalazia (plural for chalazion) result from healed internal styes that no longer are infectious.
Term
Dacrocystitis
Definition
Inflammation of the lacrimal sac
Term
Dx: red, burning, crusting, scaling, red-rimming eyelid w/ eyelash flaking
Definition
Blepharitis
Term
Blepharitis tx?
Definition
Eyelid hygiene (warm compresses)
Abx: azithromycin
Term
Ways to distinguish chalazion from hordeolum?
Definition
Hordeolum = painful, @ lid margin
Chalazion = painless granuloma of internal Meibomian gland
Term
Pinguecula
Definition
Yellow, elevated nodule on nasal side of sclera
Term
Trauma plus the following lead to what dx:
-decreased visual acuity
-diplopia especially w/ upward gaze
-orbital emphysema
Definition
Orbital floor blowout fracture
Term
Imaging of choice in blowout fractures?
Definition
CT
Term
MC cause of blindness/vision loss in elderly? (>75)
Definition
macular degeneration
Term
What are Drusen spots?
Definition
Small, round, yellow-white spots on outer retina
Seen in Macular degeneration
Term
What is "wet" MD?
Definition
neovascular
Term
metamorphopsia
Definition
straight lines appear bent
Term
Tx of dry MD?
Definition
Amsler grid at home to monitor stability
Term
Tx of wet MD?
Definition
Intravitreal anti-angiogenics e.g. bevacizumab
Term
MC cause of new permanent vision loss in 25-74y.o.?
Definition
Diabetic retinopathy
Term
MOA of bevacizumab?
Definition
VEGF inhibitor
Term
Funduscopic exam in diabetic retinopathy?
Definition
Cotton wool spots
Flame hemorrhages
Hard exudates
Term
Arterial narrowing is what grade of HTN retinopathy?
Definition
I
Copper wiring- moderate, silver-wiring- severe
Term
A-V nicking is what grade of HTN ret.?
Definition
II
Term
Flame hemorrhages, cotton wool spots = what grade of HTN ret?
Definition
III
Term
Papilledema is what grade of HTN ret?
Definition
IV (malignant HTN)
Term
Is retinal detachment painful?
Definition
No
Term
Sxs of retinal detachment?
Definition
Photopsia, floaters, progressive unilateral vision loss
NO PAIN
Term
What is Shafer's sign?
Definition
Clumping of brown-colored pigment cells in anterior vitreous humor resembling "tobacco dust"
Can indicate retinal detachment
Term
MC cause of viral conjunctivitis?
Definition
Adenovirus
Term
Olopatadine
Definition
Optic antihistamine/mast cell stabilizer for redness/itching
Term
What solution should you use to flush eyes in case of chemical burns?
Definition
Lactated ringers
Term
Which is more damaging to the eye: alkali burns or acidic?
Definition
Alkali
Term
Distinction b/w septal and preseptal cellulitis?
Definition
Septal = infection of the fat & ocular muscles. CT imaging. Usually follows sinus infection. Pain w/ ocular movement, decreased vision, proptosis (bulging eye)
Preseptal: infection of eyelid & periocular tissue. NO PAIN WITH OCULAR MOVEMENT OR VISION CHANGE
Term
Strabismus
Definition
Misalignment of the eyes ("lazy eye")
Term
Esotropia vs. exotropia
Definition
Types of strabismus.
Eso = convergent- deviated inward (cross eyed)
Exo = divergent- deviated outward
Term
What is the cover-uncover test used to dx?
Definition
Strabismus
Term
Screening test for strabismus?
Definition
Hirschberg corneal light reflex test
Term
Corneal injection/limbic flush should lead you toward what dx?
Definition
Keratitis
Term
Sxs of bacterial keratitis?
Definition
Hazy cornea, hypopyon
Term
Signs of HSV keratitis?
Definition
Dendritic lesions (branching seen w/ fluorescein stain)
Term
Cataract
Definition
Lens opacification (thickening)
Term
What is our biggest concern in babies w/ absent red reflex + white pupil?
Definition
Retinoblastoma
Term
Acetazolamide MOA?
Definition
Carbonic anhydrase inhibitor
Decreases aqueous humor production
Term
Halos around light should make you think of what?
Definition
Glaucoma
Term
Marcus Gunn test
Definition
Swinging flashlight test- positive if affected eye constricts less to light
Relative afferent pupillary defect
Term
MC cause of optic neuritis?
Definition
MS
Term
What drugs can cause optic neuritis?
Definition
Ethambutol (anti-tuberculosis), chloramphenicol (interferes with ribosome 50S)
Term
Is optic neuritis painful?
Definition
Yes- ocular pain worse w/ eye movement
Term
Tx for optic neuritis?
Definition
Corticosteroids (methylprednisolone)
Term
Etiology of optic neuritis
Definition
Acute inflammatory demyelination of optic nerve
Term
Argyll-Robertson pupil
Definition
Pupil constricts to accommodation but not to bright light
Term
MC cause of Argyll-Robertson pupil?
Definition
Neurosyphilis
Term
Does mydriasis precipitate or relieve glaucoma?
Definition
Precipitate- dilation closes the angle
Term
Mid-dilated, fixed, nonreactive pupil
Definition
Acute glaucoma
Term
MC microbe in otitis externa?
Definition
Pseudomonas
Term
MC organism in AOM?
Definition
Strep pneumoniae
Term
Tx of eustachian tube dysfunction?
Definition
Decongestants to lower ET edema: pseudoephedrine, phenylephrine, oxymetazoline nasal spray
Term
Cholesteatoma
Definition
Abnormal keratinized collection of desquamated squamous epithelium
Term
Is horizontal, fatigable nystagmus associated w/ peripheral or central vertigo?
Definition
Peripheral
Term
Tx for N/V with vertigo?
Definition
1) antihistamines (meclizine)
2) dopamine blockers (metoclopramide, prochlorperazine, promethazine)
3) anticholinergics (scopolamine)
4) benzos (lorazepam, diazepam)
Term
What type of cells are involved in acoustic neuroma
Definition
Schwann cells of CN VIII
Term
Bilateral sudden sensorineural hearing loss- think what?
Definition
Neurofibromatosis type II
Term
What foods should be avoided in pts w/ Meniere's?
Definition
Salt, chocolate, coffee, EtOH (increase endolymphatic pressure)
Term
MC cause of chronic bacterial sinusitis?
Definition
S. aureus
Term
MC cause of chronic fungal sinusitis?
Definition
Aspergillus
Term
Mucormycosis
Definition
Fungi invade the sinuses & may enter CNS
Seen in immunocompromised pts
Term
Tx for mucormycosis?
Definition
Amphtericin B (binds irreversibly to ergosterol)
Term
Nasal polyps and pale, boggy turbinates associated w/ what type of rhinitis?
Definition
Allergic (IgE-mediated)
Term
MC vascular sites of bleeding in anterior and posterior epistaxis?
Definition
Anterior- Kiesselbach's plexus
Posterior- palatine artery
Term
Centor criteria for strep throat?
Definition
Def give abx if 4-5 out of 5:
1) Fever over 100.4
2) Pharyngotonsillar exudates
3) Absence of cough
4) Anterior cervical lymphadenopathy
+1 if <15yrs, -1 if >44 yrs
Term
Tx for thrush?
Definition
Nystatin liquid
Term
Painful white patchy lesion that can be scraped off and leave behind erythema or bleeding in mouth?
Definition
Thrush (candida albicans)
Term
Painless white patchy lesion that cannot be scraped off tongue?
Definition
Oral leukoplakia- premalignant lesion
Term
Cause of oral hairy leukoplakia?
Definition
EBV (HHV-4)
Term
Sialolithiasis
Definition
Salivary gland stones
Term
Lacy leukoplakia/Wickham striae of oral mucosa associated w/?
Definition
Oral lichen planus
Term
Oral lichen planus tx?
Definition
Corticosteroids
Term
Ludwig's angina- signs & tx?
Definition
Swelling & erythema of upper neck & chin; pus on floor of mouth
Ampicillin/sulbactam
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