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Year 2 - DERM and HEENT

Terms in this set (392)

Risk factors for skin cancer?
-Family history
-Prolonged sun exposure
-Fair skin
-Sun burns
-Red hair
-Blue eyes
-Multiple freckles
Junctional Nevi:
-Appearance?
-Location?
-Associated symptoms?
-Benign, flat, hyperpigmented (brown-tan), small macule (uniform color and shape)
-Located: anywhere
-Appear in childhood (disappear as patient ages)
Compound Nevi:
-Appearance?
-Location?
-Associated symptoms?
-Benign, raised, small, hyperpigmented papules (uniform color and shape)
-Lose color as you age
Intradermal Nevi:
-Appearance?
-Location?
-Associated symptoms?
-Benign, raised, fleshy
-Course dark hairs may grow from it
Halo Nevi:
-Appearance?
-Location?
-Associated symptoms?
-Benign nevus with ring of hyperpigmentation around it
-Nevus disappears over time, just leaving hypopigmented patch
Which nevus is associated with an increased risk of developing vitiligo?
Halo nevus
What is the most common form of melanoma?
superficial melanoma
Superficial Melanoma:
-Appearance?
-Location?
-Associated symptoms?
-Malignant, flat, asymmetric, varying in color
-Stays in horizontal growth for 10 years (low risk of metastisis)
Tx for Melanomas?
-Complete excision
-Lymph node biopsy (for staging)
-Refer to derm
Nodular Melanoma:
-Appearance?
-Location?
-Associated symptoms?
-Malignant, raised, charcoal/black papules
-May bleed
-Grows rapidly (often metastisized)
Lentigo Maligna Melanoma:
-Appearance?
-Location?
-Associated symptoms?
-Malignant, flat, brown/black, large, with irregular borders
-Slowly growing
-Appears more often in elderly
Acral-Lengtiginous Melanoma:
-Appearance?
-Location?
-Associated symptoms?
-Palms, soles, and nails of Black person
-Malignant, abnormal pigmentation, flat, irregular borders
-Slowly growing
What is the most common melanoma in Blacks?
Acral-lengtiginous melanoma
Actinic Keratosis - risk factors?
-Years of UV radiation
-Age > 40
Actinic Keratosis:
-Appearance?
-Location?
-Associated symptoms?
-Rough, adherent yellow scales on red base
-Located on face, head, neck

(may turn into Squamous Cell carcinoma)
Tx for Actinic Keratosis?
-5FU (topical 5-fluorouracil)
-Liquid nitrogen (cryotherapy)
-Sunscreen
-Biopsy if recurrent or bleeding
What is the most common malignancy of the skin?
Basal Cell Carcinoma
Most common type of basal cell carcinoma?
Nodular
Basal Cell Carcinoma:
-Appearance?
-Location?
-Associated symptoms?
-Malignant, translucent pearly/red nodule with telangiectasia
-May bleed
-Head and neck

(rarely metasticizes)
Tx for Basal Cell Carcinoma?
-Mohs surgery referral
Squamous Cell Carcinoma:
-Appearance?
-Location?
-Associated symptoms?
-Ulcerated, friable, hyperkeratotic pink/red nodule
-Adherent white/yellow scales
-Crusted center
Tx for Squamous Cell Carcinoma?
-Mohs surgery
How can you increase the potency of a topic steroid?
-Use ointment form (instead of cream)
-Using occlusive dressing
What are the ultra high potency steroids?
-Betamethasone
-Clobetasol propionate
-Halobetasol propionate
-Flurandrenolinde
Atopic Dermatitis:
-Appearance?
-Location?
-Associated symptoms?
-Severe pruritis
-Rough red plaques with scales and lichenification
-Located in flexors (popliteal, anticubital), face, and trunk
-Rash caused by scratching dry skin
-Young age of onset
-Elevated IgE and eosinophilia
What are the 3 conditions of atopy?
-Asthma
-Eczema/Dermatitis
-Allergic rhinitis
Tx for Atopic Dermatitis?
-Avoid drying soaps and too much bathing
-Emollients for hydration (after bathing)
-Topical steroids (triamcinolone)
-Immune modulators (tacrolimus, pimecrolimus)
-Antihistamines (benadryl)
Pityriasis Rosea:
-Appearance?
-Location?
-Associated symptoms?
-Rough, oval, pink/purple, plaque with collarette scales inside border (cigarette paper appearance)
-Herald patch 1-2 weeks earlier
-Christmas tree distribution (following lines of cleavage on trunk)
-NOT on palms/soles
-Mild pruritis
Tx for Pityriasis Rosea?
-None (resolve in 6 weeks)
-Steroids if itchy
Labs for Pityriasis Rosea?
-Rule out syphilis with RPR
Seborrheic Dermatitis:
-Appearance?
-Location?
-Associated symptoms?
-Erythema with yellow-orange and scaley plaques
-Scales like dandruff
-Nose, eyelashes, eyebrowns, scalp, beard
Tx for Seborrheic Dermatitis?
-Mild corticosteroid (hydrocortisone)
-Antifungal cream (ketoconazole)
-Selenium and ketoconazole shampoos (since it is due to yeast)

No cure (it will reoccur)
Tinea versicolor:
-Appearance?
-Location?
-Associated symptoms?
-Hypopigmented spots on upper trunk (uneven tanning)
Labs for Tinea Versicolor?
-KOH (shows spaghetti and meatballs hyphae and spores of yeast)
Tx for Tinea Versicolor?
-Selenium sulfide lotion
-Ketoconazole po before exercise/sweating
-Pigment will take months to come back
Risk factors for Tinea Capitis?
-Low SES (crowded living allows spread via contact)
-Children
Tinea Capitis:
-Appearance?
-Location?
-Associated symptoms?
Inflamed type:
-Boggy tender pustules on head
-Hair loss

Black-dot type:
-Black dots (ends of broken hairs) on head in areas of hair loss
-Scaly scalp

Seborrheic type:
-Patchy, fine, scales on head
-Hair loss
Labs for Tinea Capitis?
-KOH
-Culture (best)
-DTM (dermatophyte test media turns pink if infected)
-Black light (some dermatophytes fluoresce)
Tx for Tinea Capitis?
-Oral antifungal (Griseofulvin, Itraconazole, Terbinafine, Ketoconazole)
-Oral steroids if inflammatory
Tinea Corporis:
-Appearance?
-Location?
-Associated symptoms?
-Ring worm
-Annular (ring-shaped) papules with raised, red, scaly border with clear center
Labs for Tinea Corporis?
-KOH
-Culture (best)
-DTM (dermatophyte test media turns pink if infected)
Tx for Tinea Corporis?
-Topical antifungal (Clotrimazole or Miconazole creams)
-Oral antifungal if extensive involvement
Tinea Cruris:
-Appearance?
-Location?
-Associated symptoms?
-Jock itch
-Half-moon shaped plaques with scaly, raised borders
-Located on upper-medial thighs (spares scrotum)
-Usually itchy
Tx for Tinea Cruris?
-Topical antifungal (Clotrimazole, Miconazole)
-Drying powders
Tinea Manuum:
-Appearance?
-Location?
-Associated symptoms?
-Scaly, dry lesions on hands (usually associated with tinea pedis in 1-2 fashion)
-Itching, burning, or stinging
Tx for Tinea Manuum?
Oral antifungal (ketoconazole)
Tinea Pedis:
-Appearance?
-Location?
-Associated symptoms?
-Dry, scaly, fissured areas
-Webs of toes (4th and 5th usually), plantar aspect of feet, mocassin form
-Itching, burning, stinging
Tx for Tinea Pedis?
-Antifungal cream (miconazole, clotrimazole)
-Oral antifungal if recurrent
-Drying powder
-Change socks frequently
Tinea Unguium (Onychomycosis):
-Appearance?
-Location?
-Associated symptoms?
-Thickened, yellow nail separating from underlying nail bed
Tx for Tinea Unguium (Onychomycosis)?
-Oral Itraconazole (preferred) x 3 months
-Oral Griseoulvin x 6 months
What is a complication of oral antifungals?
Hepatotoxicity
Furuncle:
-Appearance?
-Location?
-Associated symptoms?
-Red, swollen, tender mass around hair follicle (i.e., Boil)
-Eventually points and drains
-Located in thighs, armpits, chest, waist
Tx for Furuncle?
-Warm, moist compresses
-Topical abx (Bactroban)
-I&D if large and fluctuant
Carbuncle:
-Appearance?
-Location?
-Associated symptoms?
-Large, red, swollen, tender mass spread into multiple follicles
-Draining from multiple sites
-Malaise and fever
-Located in thighs, armpits, chest, waist
Tx for Carbuncle?
-I&D
-Anti-staph abx (cephalexin, bactrim, clindamycin)
Impetigo:
-Appearance?
-Location?
-Associated symptoms?
-Thin roofed bullae with clear/cloudy fluid
-Bullae collapse to produce thin, flat honey-colored crust
-Vesicles that rupture and expose red base and honey crust
-Usually on face
Tx for Impetigo?
-Topical abx (bacitracin or mupirocin)
-Cephalexin (if widespread)
Herpes Simplex:
-Appearance?
-Location?
-Associated symptoms?
-Grouped vesicles on erythematous base that burn/sting and crust
-Prodrome of headache, malaise, fever, myalgia, localized pain
-May be provoked by stress
Labs for Herpes Simplex?
-Tzanck smear (dire fluroescent antibody test)
-Viral culture
-Serology antibody tests
Tx for Herpes Simplex?
-Oral or topical antivirals (acyclovir, valacyclovir, famciclovir) x 7-10 days
Herpes Zoster:
-Appearance?
-Location?
-Associated symptoms?
-Dewdrops on a rose pedal
-Grouped vesicles on erythematous base that turn into crusting pustules
-Located on unilateral dermatome
-Prodrome of localized pain and fever
Tx for Herpes Zoster?
-Vaccine if > 60 years old (even if had zoster previously)
-Acyclovir within 72 hours
-Oral steroids
Pediculosis Capitus:
-Appearance?
-Location?
-Associated symptoms?
-Pruritis
-Small red papules
-Usually at base of neck
-Small white dots firmly held to hairshaft
Tx for Pediculosis?
-Permethrin tx now and repeated in 1 week
-Wash everything
-Shaving (if badly infected)
Pediculosis Corporis:
-Appearance?
-Location?
-Associated symptoms?
-Small red papules and urticaria
-Small white dots on seams of clothing
-Spread via "aerosolization" of disease
-Located all over body
Which type of lice spreads disease?
Body lice (pediculosis corporis)
Pediculosis Pubis:
-Appearance?
-Location?
-Associated symptoms?
-Pruritus
-Small white dots firmly head to hairshafts on inner thighs, pubic, anus
What is the most contagious STD?
Pubic lice (crabs)
Scabies:
-Appearance?
-Location?
-Associated symptoms?
-Itching worse at night
-Linear or curved burrows in webs of hands, wrists, genitals
Labs for Scabies?
-Skin scraping with oil, KOH, or saline (shows the mite)
Tx for Scabies?
-Topical permethrin over entire body, repeated in 1 week

Note: itching will continue for several weeks even after mites are dead
Bedbugs (Cimex Lectularius):
-Appearance?
-Location?
-Associated symptoms?
-Lines of bites
-Papular urticaria
Bedbugs:
-Appearance?
-Location?
-Associated symptoms?
-Lines of bites
-Papular urticaria
Seborrheic Keratosis:
-Appearance?
-Location?
-Associated symptoms?
-Benign, oval, verrucous (wart-like), velvety, greasy, brown/black plaque
-Defined edges
-Stuck on appearance
-Common in elderly
Tx for Seborrheic Keratosis?
None unless irritating
Lichen Simplex Chronicus:
-Appearance?
-Location?
-Associated symptoms?
-Sharply demarcated, dry, leathery, red violet plaque with scales
-Lichenification
-Exaggerated skin lines
-Located on wrists, ankles, neck, genitals, anus
-Chronic itching and scratching (which perpetuates the rash)
Tx for Lichen Simplex Chronicus?
-Stop scratching the area (this is the cause of the rash)
-High potency topical steroids
-Hydrocolloid dressing to occlude area
Plaque Psoriasis:
-Appearance?
-Location?
-Associated symptoms?
-Red, sharply defined, papules/plaques with silver scales all over
-Auspitz sign (scale bleed when removed)
-Located on elbows, knees, scalp, sacrum, intergluteal folds
-Arthritis
-Pitting nails
Tx for Psoriasis?
-UV phototherapy
-Topical corticosteroids (high potency)
-Vitamin D ointment (calcipotriene)
-Coal tar shampoo
-Weight loss (obesity can exacerbate effects)
-If severe - methotrexate, cyclosporin
Cause of Guttate Psoriasis?
Strep pharyngitis
Dyshidrosis (Pompholyx):
-Appearance?
-Location?
-Associated symptoms?
-Abrupt eruption of small vesicles with clear fluid
-Vesicles erupt and peel into erythematous base with scales and cracked skin
-Located on palms, fingers, soles
-Severe itching
-Associated with atopy
Tx for Dyshidrosis (Pompholyx)?
-Topical steroids (high potency)
-Avoid irritants (e.g., wear gloves when washing dishes)
Irritant Contact Dermatitis:
-Appearance?
-Location?
-Associated symptoms?
-Red, scaley macules
-Dry, cracking fissures
-Burning
-Usually on hands (in response to irritating cleansers, heat, friction)
Allergic Contact Dermatitis:
-Appearance?
-Location?
-Associated symptoms?
-Red, swollen area mimicking shape of contact (e.g., linear streaks in poison ivy)
-Tiny vesicles and weeping
-Itching, burning
Tx for Irritant Contact Dermatitis?
-Avoid irritant
-Topical steroids
Tx for Allergic Contact Dermatitis?
-Wet dressing for weeping lesions
-Topical corticosteroids
Acne Vulgaris:
-Appearance?
-Location?
-Associated symptoms?
-Open (blackheads) and closed (white heads) comedones
-Papules and pustules
-Nodules and cysts (if severe)
-Located on face, neck, upper chest, back
Tx for Acne Vulgaris?
-Low glycemic diet
-Gentle cleansing of skin (avoid irritation)
-Benzoyl peroxide
-Tretinoin (retinoid) - contraindicated in pregnancy
-Topical erythromycin or clindamycin
-Oral tetracycline or doxycycline
Rosacea:
-Appearance?
-Location?
-Associated symptoms?
-Beefy red nose (rhinophyma)
-Telangiectasia
-Flushing and blushing
-Located on nose, cheeks, forehead
-Exacerbated by temperature changes, spicy food, sunlight, alcohol, exercise
-May have ophthalmic diseases
Tx for Rosacea?
-Sunscreen
-Avoid triggers (alcohol, heat, sunlight)
-Metronidazole (topical)
-Tetracycline (oral)
-Laser therapy

(No cure - just symptomatic tx)
Mucocutaneous Candidiasis:
-Appearance?
-Location?
-Associated symptoms?
-Burning/itching
-Beefy red, denuded areas with cigarette paper-like scaling
-Satellite lesions (pustules/papules spreading out)
-Located in skin folds (under breasts, vulva, anus)
Labs for Mucocutaneous Candidiasis?
KOH (shows pseudohyphae)
Risk factors for Mucocutaneous Candidiasis?
-Immunocompromised (HIV)
-Steroid use
-Obese individuals
-DM
-Pregnancy
Tx for Mucocutaneous Candidiasis?
-Keep area dry and exposed to air
-Nystatin ointment or Clotrimazole cream
Tx for Urticaria?
-H1 antihistamines (Hydroxyzine)
Erythema Multiforme:
-Appearance?
-Location?
-Associated symptoms?
-Target lesions (clear center and concentric erythematous rings)
-Vesicles and bullae
-Burns/itches
-Located symmetrically on hands, feet, arms, legs
What is the most common cause of Erythema Multiforme?
Herpes simplex
Tx for Erythema Multiforme?
-Resolves on its own in 2-6 weeks
-Oral acyclovir for prophylaxis
Stevens-Johnson Syndrome (SJS)?
-Appearance?
-Location?
-Associated symptoms?
-Raised, target lesions with central blister and purpura on trunk
-Bullae and erosions in mouth
-Pain in locations of bullae
-Less than 10% BSA skin loss
Toxix Epidermal Necrolysis (TEN):
-Appearance?
-Location?
-Associated symptoms?
-Raised, target lesions with central blister and purpura on trunk
-Bullae and erosions in mouth
-Pain in locations of bullae
-Sloughing of skin (Nikolsky's)
-Greater than 30% BSA skin loss
What are the most common causes of SJS and TEN?
-Sulfonamides
-NSAIDS
-Allopurinol
-Anticonvulsants
Tx for SJS and TEN?
-Stop offending medication
-Fluid and nutrition support
-IVIG
Erysipelas:
-Appearance?
-Location?
-Associated symptoms?
-Hot, sharply demarcated, erythematous, swollen area that rapidly spreads
-Located usually on central face (e.g., cheek)
-Prodrome of malaise and fever
-Leukocytosis
Most common cause of Erysipelas?
Beta hemolytic strep
Tx for Erysipelas?
-Bed rest with HOB elevated
-Penicillin
Cellulitis:
-Appearance?
-Location?
-Associated symptoms?
-Expanding, red, swollen plaque
-Located usually on lower leg
-Painful to touch
-Fever (possibly)
Most common causes of Cellulitis?
-GABH strep
-Staph aureus
Tx for Cellulitis?
-Vancomycin, Clindamycin, or Bactrim + Cephalexin
Bullous Pemphigoid:
-Appearance?
-Location?
-Associated symptoms?
-Itchy urticaria for months followed by Tense blisters that come and go for 5-6 years
-Located in Flexural areas
-Mostly in elderly men
Labs for Bullous Pemphigoid?
-Skin biopsy
-Immunofluorescence (shows IgG and C3)
Tx for Bullous Pemphigoid?
-Prednisone
-Tetracycline + Nicotinamide
What causes warts?
HPV
Verruca Vulgaris:
-Appearance?
-Location?
-Associated symptoms?
-Rough, thick, dome-shaped papule with black dots
-Interrupts normal skin lines
-Located on hands, feet, knees, elbows
Verruca Plana:
-Appearance?
-Location?
-Associated symptoms?
-Slightly elevated light-pink papules grouped together
-Located on face, hands, legs
Verruca Plantaris:
-Appearance?
-Location?
-Associated symptoms?
-Rough papule with punctate black dots
-Located on heels and toes
-Can be painful with pressure
Condyloma Acuminata:
-Appearance?
-Location?
-Associated symptoms?
-Genital warts
-Smooth, velvety, moist surface
-Cauliflower-like mass
-Pale-pink color
-Located on genitals
Tx for Verruca Vulgaris?
-Liquid nitrogen (to remove)
-Salicylic acid (keratolytic agent)
Tx for Condyloma Acuminata?
-Podophyllum resin (podofilox) topical
-Imiquimod cream
-Snip biopsy
-CO2 laser therapy
Tx for Verruca Plantaris?
-Blunt dissection
-Paring and then salicyclic acid
-CO2 laser therapy
Molluscum Contagiosum:
-Appearance?
-Location?
-Associated symptoms?
-White/pink, shiny, dome-shaped papule with central umbilication
-Located on face, abdomen, genitals
-Become softer and more white over time
Cause of Molluscum Contagiosum?
Pox-virus (spread via direct contact)
Tx for Molluscum Contagiosum?
-Curettage
-Liquid nitrogen
-Resolves on their own in months
Lichen Planus:
-Appearance?
-Location?
-Associated symptoms?
-Pruritis
-Purple, Planar (flat-topped), Polygonal Papules
-Wickham's striae (lacy reticulated white lines through papule)
-Located on flexor surfaces and trunk and mucosal membranes
Tx for Lichen Planus?
-Topical steroids (high potency)
-Oral steroids (if severe)
Kaposi Sarcoma:
-Appearance?
-Location?
-Associated symptoms?
-Red/Purple plaque on cutaneous and mucosal surfaces
-Fever (if systemic)
Cause of Kaposi Sarcoma?
HSV 8
Labs for Kaposi Sarcoma?
-HIV test and CD4
-Fecal occult blood test (often positive)
-Bronchoscopy (if pulmonary problems)
Tx for Kaposi Sarcoma?
-Intralesional chemotherapy or radiation (Vinblastine)
Epidermal Inclusion Cyst:
-Appearance?
-Location?
-Associated symptoms?
-Benign, firm dermal papule or nodule overlying a black comedone (punctum)
-Contains foul-smelling cheesy (but sterile) material
-Located on face and trunk
Tx for Epidermal Inclusion Cyst?
-No tx needed if asymptomatic
-I&D if inflamed
-Excision if large
Multiple epidermal inclusion cysts are indicative of...
Gardner syndrome
Vitiligo:
-Appearance?
-Location?
-Associated symptoms?
-White macules with well-defined borders and no caling
-Located on face, hands, body folds
Melasma:
-Appearance?
-Location?
-Associated symptoms?
-Brown hyperpigmentation of the face
-Exacerbated by sun exposure
-Usually in women (during pregnancy or taking estrogen contraceptives)
Tx for Vitiligo?
-Tacrolimus topical (immunosuppresant)
-Topical steroid (high potency)
-Concealer cosmetic
-Sunscreen
Tx for Melasma?
-Hydroquinone cream
-Tretinoin cream
-Sunscreen and minimize sun exposure
Causes of Alopecia?
-Trauma
-Scleroderma
-Lupus
-Bacterial or fungal infection
-Radiation
-Hyper/hypothyroidism
-Iron deficiency anemia
-Pituitary insufficiency
-Androgenetic (MC form)
-Alopecia areata
-Trichotillomania
Tx for Androgenetic Alopecia?
-Minoxidil
-Finasteride (only in males)
Alopecia Areata:
-Appearance?
-Location?
-Associated symptoms?
-Sudden loss of hair in 1-4 cm areas in a patchy distribution
-Can include eyelashes and facial hair
Tx for Alopecia Areata?
-Corticosteroids (intradermal injection)
-Self-limiting (most grow back)
Paronychia:
-Appearance?
-Location?
-Associated symptoms?
-Bacterial infection of nail folds
-Erythema and swelling of proximal and lateral nail folds
-Cuticle disappears
Tx for Paronychia?
-Drain pus
-Anti-staph abx for infection
Drug Eruption (Dermatitis Medicamentosa):
-Appearance?
-Location?
-Associated symptoms?
-Abrupt onset of widespread, symmetric erythema
-Starts 2-3 weeks after taking drug

If complex:
-Systemic symptoms (fever, malaise)
-Eosinophilia
Most common causes of Drug Eruptions?
-Amoxicillin
-Penicillin
-Fluoroquinolones
-Bactrim
-Anticonvulsants
Tx for Drug Eruptions?
-Antihistamines
-EPI (in emergency)
-Oral corticosteroid
Varicella (Chickenpox):
-Appearance?
-Location?
-Associated symptoms?
-Pruritis
-Macules, papules, vesicles, pustules with crusts at different stages
-Pitted scars
-Starts on head and trunk and moves to extremities
Labs for Varicella-Zoster?
-Tzanck smear (shows large multinucleated cells)
Tx for Varicella (Chickenpox)?
-Isolation until crusts disappear
-Bed rest until afebrile
-Antihistamines
-Calamine lotion
-Acyclovir within 24 hours
-Varicella vaccine for prevention
Acanthosis Nigracans:
-Appearance?
-Location?
-Associated symptoms?
-Hyperpigmentation and hyperkeratosis
-Located in neck, axilla, groin

(Associated with DM)
Hidradenitis Suppurativa:
-Appearance?
-Location?
-Associated symptoms?
-Multiple, recurrent, painful, tender, sterile abscesses
-Abscesses for sinus tracts and scars
-"Double comedone" (blackhead openings)
-Located in axillae, groin, buttocks, breasts
Tx for Hidradenitis Suppurativa?
-I&D
-Tetracycline long-term
Pilonidal disease:
-Appearance?
-Location?
-Associated symptoms?
-Warm, tender, fluctuant nodule over the sacrum
-Sinus tracts around the anus
Tx for Pilonidal disease?
-I&D of abscess over sacrum
-Warm sitz baths
-Remove hair from the area
Pressure Ulcer stages?
1 = non-blanchable hyperemia
2 = extension through epidermis
3 = full thickness skin loss
4 = full thickness with extension into muscle and bone
Unstageable = if eschar or slough overlies wound
Suspected deep tissue injury = area of discoloration or blistering that is boggy and warm
Risk factors for Pressure Ulcer?
-Immobility
-Reduced sensation
-Moisture
-Poor nutrition
-Friction
Tx for Pressure Ulcer?
-Remove necrotic debris (except do NOT remove eschar on heel)
-Maintain moist wound bed (foam dressing, hydrocolloid wafer, polyurethane film)
-Pressure reducing devices
Rule of nines for burns?
-Head = 9
-Each arm = 9
-Each leg = 18
-Front torso = 18
-Back torso = 18
Depth classification for burns?
1st degree = good capillary refill, no blisters
2nd degree = blistering
3rd degree = smooth, gray skin; no hair or sweat glands
Tx for burns?
-Airway (intubation)
-Breathing (oxygen)
-Circulation (crystalloids)
-Disability assessment
-Tetanus immunization
-Debride minor wounds + apply topical abx
Entropion - symptoms? complications?
Symptoms:
-Inward turning of lower eyelid
-FB sensation in eye
-Tearing
-Burning
-Redness of conjunctiva

Complications:
-Corneal abrasions (from eyelashes)
Entropion - tx?
-Lid eversion (taping lid in place)
-Botox and surgery (if severe)
Ectropion - symptoms?
-Outward turning of lower eyelid
-Excessive tearing (Epiphora)
-Dry eye syndrome
Ectropion - tx?
-Lubricants (if only mild)
-Surgery (if severe)
What is the most common cause of persistent tearing in infants?
Nasolacrimal duct obstruction (dacryostenosis)
Dacryostenosis - symptoms?
-Obstructed nasolacrimal duct
-Epiphora (tearing) = MC symptom
-Mucoid discharge in morning
Dacryostenosis - tx?
-Massage tear ducts downward along nose 2-3 x per day
-Should improve as child gets older
-Surgery (if no improvement)
Dacryocystitis - symptoms?
-Inflammation of lacrimal sac (usually unilateral)
-Pain, swelling, tenderness between eye and nose
-Pus drainage (possibly)
Bacteria that causes Dacrycystitis?
-Staph aureus (MC)
-Beta hemolytic strep
-Staph epidermidis
Dacryocystitis - tx?
-Oral abx
-Warm compresses
-Surgery (if chronic)
Anterior Blepharitis - symptoms?
-"red rimmed" eyes
-Burning and itching of eyes
-Crusting around eyes upon waking
-Scales or granulations on lashes

Greasy scales = seborrheic type
Dry scales + loss of lashes = staph type
Anterior Blepharitis - tx?
-Scrub eyelids with baby shampoo
-Abx eye drops/ointment (erythromycin, bacitracin)
-Warm compresses
Posterior Blepharitis - symptoms?
-Hyperemic lid margins with telangiectasias
-Inflamed, swollen meibomiam glands
-Mild entropion (inward lid turning)
-Frothy, greasy tears
Posterior Blepharitis - tx?
-Regular meibomiam gland expression
-Tetracycline oral (if severe)
Hordeolum (stye) - symptoms?
-Localized, red, swollen, tender area of external eyelid
-May come to a point
Hordeolum (stye) - tx?
-Staph infection of meibomian gland
-Warm compresses (to drain pus)
-Incision (if does not drain in 48 hours)
-Bacitracin or Erythromycin ointment
Chalazion - symptoms?
-Granulomatous inflammation of meibomian gland
-Hard, non-tender, swelling of internal eyelid
Chalazion - tx?
-Surgery (incision and curettage)
Pinguecula - symptoms? causes?
Caused by:
-Wind, UV, dust

Symptoms:
-Yellow, elevated conjunctival nodule
-Bilateral, nasal side (usually)
Pinguecula - tx?
-No tx unless inflamed
-Keep eyes lubricated and wear sunglasses
-Anti-inflammatory eye drops (prednisolone) if inflamed
Pterygium - symptoms? causes?
Caused by:
-Wind, UV, dust

Symptoms:
-Fleshy, triangular encroachment onto cornea from nasal side
Pterygium - tx?
-Keep eye lubricated and wear sunglasses
-Surgery when it starts encroaching on cornea
What imaging technique should be performed for suspected ruptured globe of the eye?
CT
Corneal FB - symptoms?
-Pain with lid movement
-Circumcorneal redness
-Photophobia (possibly)
-Rust ring (if steel FB)
Labs for Corneal FB?
-Visual acuity (before and after)
-Evert both upper and lower eye lid
-Fluorecein stain
Corneal FB - tx?
-Local anesthetic (proparacaine)
-Cotton tip applicator or hypodermic needle to remove FB
-Bacitracin ointment abx
-NO patching of the eye
-Refer if rust ring
Orbital Cellulitis - symptoms?
-Abrupt onset of fever
-Proptosis
-Restricted EOMs
-Swelling and redness of eyelids
Orbital Cellulitis - causes?
-Sinus infection (Strep pneumonia = MC)
-Dacrocystitis
-Tooth abscess
-Trauma
Orbital Cellulitis - complications?
-Blindness
-Cavernous Venous Sinus Thrombosis
-Meningitis
Orbital Cellulitis - tx?
-Emergent IV abx to cover suspected cause
Bacterial conjunctivitis - organisms?
-Staph aureus
-Strep pneumonia
-H. flu
-Pseudomonas
-Moraxella
Bacterial conjunctivitis - symptoms?
-Purulent discharge
-Mild discomfort in the eyes
-NO blurring of vision
-Hyperemia (redness) of conjunctiva
Bacterial conjunctivitis - tx?
-Topical sulfonamide (trimethoprim with polymixin B) or Gentamicin or Erythromycin ointment
Viral conjunctivitis - organisms?
Adenovirus (MC cause) types 3, 4, 7, 11
Viral conjunctivitis - symptoms?
-Prodrome of URI (pharyngitis, fever)
-Preauricular LAD
-Copious watery discharged
-FB sensation
-NO vision impairment
-Hyperemia (redness) of conjunctiva
Viral conjunctivitis - tx?
-Self limiting (lasts 10 days)
-Cold compresses
Gonococcal Conjunctivitis - symptoms?
-Copious, runny purulent discharge
-No/mild pain
-Hyperemia of conjunctiva
Gonococcal Conjunctivitis - cause?
Contact with infected genital secretions
Labs for Gonococcal Conjunctivitis?
-Stained smear
-Culture of discharge
Gonococcal Conjunctivitis - tx?
-Ophthalmologic emergency
-Ceftriaxone 1 gram IM
-Check for other STDs
What is the leading infectious cause of blindness worldwide?
Trachoma (chlamydial keratoconjunctivitis)

(Note: NOT sexually transmitted. Transmitted via finger/fomites)
Trachoma Chlamydial Keratoconjunctivitis - symptoms?
-Bilateral conjunctivitis
-Corneal vascularization (vessels at edge of cornea)
-Entropion
-Corneal scarring
-Hazy/cloudy cornea
Trachoma Chlamydial Keratoconjunctivitis - tx?
-Azithromycin oral
-Surgery for scarring
Inclusion Conjunctivitis - causes?
-Chlamydia (transmitted from genital tract into eye)
Inclusion Conjunctivitis - symptoms?
-Redness, discharge, and irritation
-Follicular conjunctivitis
-Mild keratitis
-Non-tender preauricular LAD
Inclusion Conjunctivitis - tx?
-Azithromycin 1 g oral
-STD tests
Epidemic Keratoconjunctivitis - causes?
-Adenovirus types 8, 9, 37

(type of viral conjunctivitis)
Epidemic Keratoconjunctivitis - symptoms?
-Conjunctivitis
-Vision loss (due to subepithelial infiltrates)
Epidemic Keratoconjunctivitis - tx?
-Self-limiting (2 weeks)
-Topical steroids (after ophtho consult)
-Topical abx (to prevent bacterial involvement)
Keratoconjunctivitis Sicca - causes?
Dry eyes due to:
-Aging
-Drugs
-Autoimmune disorders
Keratoconjunctivitis Sicca - symptoms?
-Dry eyes
-Red eyes
-FB sensation in eyes
-Photophobia
Keratoconjunctivitis Sicca - tx?
-Artificial tears
-Cyclosporine (if severe)
Allergic conjunctivitis - symptoms?
-Redness of eyes
-NO vision impairment
-Chemosis (edema of conjunctiva)
-Itchy eyes
-Occurs seasonally
-Cobblestone papillae
-Associated asthma and atopic dermatitis
Allergic conjunctivitis - tx?
-Antihistamines
-Mast cell stabilizer (Cromolyn sodium)
-Topical corticoteroids (refer for this)
What is the leading cause of blindness worldwide?
Cataracts
What is the most common type of cataracts?
-Age-related
Cataracts - symptoms?
-Progressive blurring of vision over years
-Needing increased light to see clearly
-Decreased night vision
-NO pain or rednes
-Poorly visualized fundus on exam (lost red reflex)
Cataracts - tx?
-Avoid smoking and control glucose
-Glasses/contacts (helpful early)
-Surgery (when everyday activities affected by visual impairment)
Arcus Senilis - symptoms?
Gray ring around iris of eye

(may be an indication of hyperlipidemia but not always; may also occur in old age)
Bacterial Keratitis - organisms?
-Pseudomonas (usually do to prolonged contact wearing)
-Pneumococcus
-Moraxella
-Staph
-MRSA
Bacterial Keratitis - symptoms?
-Hazy cornea
-Central ulcer on cornea with stromal abscess
-Hypopyon (pus in anterior chamber)
Bacterial Keratitis - tx?
-Culture scrapings from ulcer
-Fluoroquinolone oral
-Vacomycin (if MRSA)
Corneal Ulcer - symptoms?
-Severe Pain
-Tearing
-Photophobia
-Reduced vision
-Red eye
-Circumcorneal injection
Corneal Ulcer - tx?
Urgent referral to ophthamology
Herpes Simplex Keratitis - symptoms?
-Dendritic branching ulcer (seen on fluorescein stain)
-Severe pain
-Epiphora (tearing)
Herpes Simplex Keratitis - tx?
-Acyclovir (topical or oral)
Herpes Zoster Ophthalmicus - symptoms?
-Malaise
-Fever
-Periorbital burning
-Vesicular rash with crusting around eye
-Conjunctivitis
Herpes Zoster Ophthalmicus - cause?
Herpes zoster infection of opthalmic division of trigeminal nerve
Herpes Zoster Ophthalmicus - tx?
-High dose oral acyclovir 800 mg
Acute Angle-Closure Glaucoma - risk factors?
-Asians
-Elderly
-Recent dilation (dark room)
-Far sighted (hyperopia)
-Family hx
Acute Angle-Closure Glaucoma - symptoms?
-Extreme pain
-Blurred vision
-Halos around lights
-Red eye
-Cloudy cornea
-Dilated, non-reactive pupil
-IOP > 50 (hard eye)
-Enlarged cup to disc (>.5)
Acute Angle-Closure Glaucoma - tx?
-Acetazolamide IV 500 mg (carbonic anhydrase inhibitor)
-Mannitol
-Diuretics
-Pilocarpine every 15 minutes (miotic)
-Emergent referral for surgery/laser iridotomy (definitive tx)
Chronic Open-Angle Glaucoma - symptoms?
-Gradual increase in cup-to-disc (>.5)
-Pale optic disk
-Bilateral, vision loss (starting in periphery) to tunnel vision
-Increased IOP >21
-NO pain
Chronic Open-Angle Glaucoma - risk factors?
-Family hx
-DM
-Blacks
Chronic Open-Angle Glaucoma - tx?
-Topical prostaglandins (bimatoprost) = 1st line
-Topical beta agonists (timolol)
-Topical alpha-2 agonist (brimonidine)
-Topical carbonic anyhdrase inhibitors (dorzolamide)
-Trabeculectomy (if can't control via meds)
Retinal Detachment - causes?
-Rhegmatogenous = spontaneous retinal tear (MC)
-Tractional = pre-retinal fibrosis
-Serous = accumulation of fluid behing retina
Retinal Detachment - risk factors?
Rhegmatogenous:
-Nearsightedness
-Cataract surgery

Tractional:
-DM retinopathy
-Vein occlusion

Serous:
-Wet AMD
-Choroid tumor
Retinal detachment - symptoms?
-"Curtain spreading across visual field" in one eye
-Photopsia (flashing lights)
-Floaters
-NO redness
-NO pain
-Retain hangs in vitreous on opthalmoscopic exam
Retinal detachment - tx?
-Emergent referral for pneumatic retinopathy (gas pressure) and cryotherapy
-Position head so that retina falls back in place
Retinal Artery Occlusion - causes?
-Giant cell arteritis
-Emboli (cardiac problems)
Central Retinal Artery Occlusion - symptoms?
-Sudden, painless vision loss in one eye (counting fingers or worse)
-Vision may only include small island in temporal field
-Cherry-red fovea/macula
-Box-car segmentation of veins
-Pale optic disc
Branch Retinal Artery Occlusion - symptoms?
-Sudden, painless vision loss in one eye (counting fingers or worse)
-Vision loss is primarily in PERIPHERAL fields
-Cotton-wool spots only in one quadrant of retina
Retinal Artery Occlusion - labs?
-Screen for DM and hyperlipidemia
-ESR and CRP (for giant cell arteritis)
-Check for cardiac problems (EG, US of carotid arteries)
Retinal Artery Occlusion - tx?
-Emergent referral
-Lay pt flat
-Ocular massage
-High concentrations of O2
-IV acetazolamide
-Anterior chamber paracentesis
-High dose steroids (if giant cell arteritis)
Central Retinal Vein Occlusion - causes?
-Artherosclerosis
-Thrombosis
Central Retinal Vein Occlusion - symptoms?
-Blurry vision upon waking
-Retinal hemorrhages in all quadrants
-Retinal vein dilation and torutosity
-Cotton-wool spots
-Optic disk swelling
Branch Retinal Vein Occlusion - symptoms?
-Blurry vision
-Retinal hemorrhage in one quadrant
-Macular edema
Retinal Vein Occlusion - tx?
-Urgent referral
-VEGF inhibitor (bevacizumab)
-Laser photocoagulation
What is the leading cause of new blindness among adults 20-65 yrs old?
DM retinopathy
Non-proliferative DM retinopathy - symptoms?
-Microaneurysms
-Retinal hemorrhages
-Hard exudates
-Macular edema
What is the most common cause of blindness in type 2 DM?
Non-proliferative maculopathy
Proliferative DM retinopathy - symptoms?
-Neovascularization in optic disc
-Vitreous hemorrhages
DM retinopathy - tx?
-Annual opthalmologic exams for DM
-Control DM, BP, lipids
-Laser photocoagulation
-VEGF inhibitors
Hypertensive Retinopathy - symptoms?
-Silver/Copper wiring
-AV nicking
-Cotton wool spots
-Retinal hemorrhages
-Hard exudates
-Macular star/stellate appearance
Hypertensive Retinopathy - tx?
-Emergent referral
Anterior Uveitis - cause?
-Autoimmune diseases (arthritis, Crohns)
-Infections in immunocompromised (toxoplasmosis, tb, syphilis)
Anterior Uveitis - symptoms?
-Pain
-Red eye
-Blurred vision
-Floaters
-Hypopyon
-Small, irregular pupil
-Flare and inflammatory cells in aqueous humor
Anterior Uveitis - tx?
Topical corticoteroids (refer for this)
Neovascular Wet AMD - symptoms?
-Loss of central vision bilaterally
-NO pain or redness
-Large, pale, soft drusen in area of macule
-Vitreous hemorrhage
What is the leading cause of permanent vision loss in the older population of developed countries?
Age-related Macular Degeneration (AMD)
AMD - risk factors?
-White
-Elderly
-Female
-Smoking
-Family hx
Neovascular Wet AMD - tx?
-Vitamins and antioxidants
-Laser photocoagulation (for drusen)
-VEGF inhibitors (bevacizumab)
Atrophic Dry AMD - symptoms?
-Small loss of central vision bilaterally
-NO pain or redness
-Large, pale, soft drusen in area of macula
-NO vitreous hemorrhage
Atrophic Dry AMD - tx?
-No known tx
-Refer
Optic neuritis - symptoms?
-Central vision loss in one eye
-Retro-orbital pain (pain behind eye)
-Defect in pupillary response
-Pale, puffy optic disc
Optic neuritis - tx?
-IV corticosteroids
-Refer to neurology for evaluation of Multiple Sclerosis
Papilledema - symptoms?
-Bilateral enlargement of blind spot
-Swollen optic disc (due to increased intracranial pressure)
Papilledema - tx?
-CT scan to look for intracranial mass
-CSF shunt (for intracranial pressure)
Corneal abrasion - symptoms?
-Severe pain
-Photophobia
-Hx of trauma to the eye
-Deep green stain with fluorescein
Corneal abrasion - tx?
-Bacitracin-polymyxin ointment
-Cyclopentolate
-NSAIDs for pain
Blowout Fracture - symptoms?
-Severe eye pain with attempted eye movement
-EOMs are not intact
-N/V
-Orbital edema
-Double vision
-Hx of eye trauma
Blowout Fracture - tx?
Emergent surgery referral
Hyphema - definition?
Blood in anterior chamber (may indicate ruptured globe)
Esotropia - symptoms?
Strabismus of eye toward nose

(can be related to sixth nerve palsy)
Exotropia - symptoms?
Strabismus of eye toward temporal side
How do you remove a cerumen impaction?
-Irrigation with water at body temperature (only if no TM perforation) and then isopropyl alcohol to dry
-Mechanical removal
Otitis Externa - risk factors?
-Eczema
-Seborrheic dermatitis
-Furuncles
-Moist environments (Swimmer's ear)
-Mechanical trauma (qtips)
Otitis Externa - symptoms?
-Otalgia (ear pain) exacerbated by moving pinna/tragus
-Erythema and edema of ear canal
-Pruritis
-Ear discharge
-Normal pneumatic otoscopy
Otitis Externa - organisms?
-Gram negative rods (Pseudomonas, Proteus)
-Fungus (Aspergillus)
Malignant Otitis Externa - risk factors?
-DM
-Immunocompromised
Malignant Otitis Externa - symptoms?
-Otalgia (ear pain) exacerbated by moving pinna/tragus
-Erythema and edema of ear canal
-Persistent foul discharge
-Granulation tissue in ear canal
-Cranial Nerve palsies
Malignant Otitis Exertna - what is it?
Osteomyelitis of skull bone due to spread of otitis externa (Pseudomona = MC) in immunocompromised person
Malignant Otitis Externa - labs?
-CT (shows osseous erosion)
Otitis Externa - tx?
-Ear plugs when swimming
-Dry out ears with 50/50 mix of isopropyl alcohol/white vinegar
-Abx drops (aminoglycoside, fluoroquinolone)
Malignant Otitis Externa - tx?
-Refer to ENT
-Cipro (oral) for several months
Acute Otitis Media - risk factors?
-Recent URI
-Allergic rhinitis
Acute Otitis Media - organisms?
-Strep pneumoniae
-H flu
-Strep pyogenes
Acute Otitis Media - symptoms?
-Otalgia
-Ear pressure
-Fever
-Decreased hearing
-Erythema of TM
-Hypomobility of TM
-Bulging TM
Acute Otitis Media - tx?
-Amoxicillin (80-90 mg/kg/day divided BID) + Sulfonamide x 10 days
Complications of Otitis Media?
-Rupture of TM
-Mastoiditis
-Facial paralysis
-Osteomyelitis
-Sinus Thrombosis
-Meningitis
-Intracranial abscess
-Cholesteatoma
Chronic Otitis Media - organisms?
-Pseudomonas
-Proteus
-Staph aureus
-Anarerobes
Chronic Otitis Media - symptoms?
-Purulent discharge from ear (hallmark)
-Not much pain
-Conductive hearing loss
-TM perforation
Chronic Otitis Media - tx?
-Ear plugs when in water
-Topical abx (cipro)
-Surgery (possibly to repair TM)
Cholesteatoma - what is it? cause?
Subtype of chronic otitis media in which keratin cells grow within middle ears

Caused by prolonged eustachian tube dysfunction which causes negative pressure to retract TM
Cholesteatoma - symptoms?
-Purulent discharge
-Conductive hearing loss
-Pearly white discoloration behind TM
-Epitympanic retraction pocket
-TM perforation with granulation tissue

If complicated:
-Facial nerve palsies
-Mastoid and inner ear bone erosion
Cholesteatoma - tx?
-Surgical marsupialization
Mastoiditis - cause?
Otitis media on-going for several weeks that was not treated properly (so spread to mastoid)
Mastoiditis - symptoms?
-Post-auricular pain, edema, erythema
-High fever
-Ear sticks out and turns anteriorly (due to swelling behind it)
Mastoiditis - labs?
CT scan (shows destruction of bony septa)
Mastoiditis - tx?
-Admit
-IV cefazolin
-Myringotomy for culture and drainage
-Mastoidectomy (possibly)
TM perforation - tx?
-Usually heal on own
-Ear plugs for water
-Surgery if not healed after 3-6 months or if >30 db hearing loss for > 3 months

If due to AOM:
-Otic abx (cipro) x 10-14 days
-Refer to ENT in 2-3 weeks
Hear loss classifications:
-Normal
-Mild
-Moderate
-Severe
-Profound
Normal = soft whisper, 0-20 db
Mild = soft spoken voice, 20-40 db
Moderate = normal voice, 40-60 db
Severe = loud spoken voice, 60-80 db
Profound = shout, >80 db
Conductive hearing loss:
-Weber results
-Rinne results
Weber = louder in affected ear
Rinne = BC > AC
Sensorineural hearing loss:
-Weber results
-Rinne results
Weber = louder in non-affected (good) ear
Rinne = AC > BC
Conductive hearing loss - causes?
-Cerumen impaction (MC) or other obstruction
-Eustachian tube dysruption (due to URI)
-Middle ear effusion
-Otosclerosis
-Ossicular disruption
-Chronic ear infection
Sensorineural hearing loss - causes?
-Presbyacusis (MC)
-Excessive noise exposure (> 85 db is damaging)
-Head trauma
-Ototoxic drugs (aminoglycosides, loop diuretics, cisplatin)
-Autoimmune diseases
-Acoustic neuroma
-Multiple Sclerosis
-Auditory neuropathy
How should you remove ear FBs?
-Use loop or hook for firm material
-Do NOT use water irrigation if organic (e.g., food, insect)
-Fill ear with lidocaine if living insect
-If battery - emergent referral
Eustachian tube dysfunction - risk factors?
-Recent URI
-Allergies
Eustachian tube dysfunction - what is it?
-Tube connecting middler ear to nasopharynx is swollen, trapping air in middle ear and causing negative pressure
Eustachian tube dysfunction - symptoms?
-Ear fullness
-Slight decrease in hearing
-Popping/crackling when swallowing/yawning (if partially blocked)
-Retracted TM
-TM with decreased mobility
Eustachian tube dysfunction - tx?
-Decongestants
-Autoinflation (closed nostrils and breathing out)
-Intranasal corticosteroids (if allergies)
-Avoid altitude changes (flying, diving)
Tinnitus - causes?
-Normal = mild, high pitch lasting seconds
-Persistent tonal = Sensory hearing loss
-Vascular abnormality = pulsatile/heartbeat like
-Clicking/popping = middle ear muscle spasm
Tinnitus - tx?
-Avoidance of excessive noise and ototoxic agents
-Masking with music
-Antidepressants (nortriptyline)
Peripheral Vertigo vs Central Vertigo?
Peripheral:
-Sudden onset
-Fatiguable horizontal nystagmus

Central:
-Develops gradually, getting more severe over time
-Non-fatiguable vertical nystagmus (or no nystagmus)
-Loss of consciousness
Peripheral Vertigo - causes?
Lesions in ear and vestibular nerve

-BPPV (MC)
-Meniere Disease
-Labrynthitis
-Vestibular neuronitis
-Ethanol intoxication
-Barotrauma
-Ototoxic drugs
Central Vertigo - causes?
Lesions in CNS

-Acoustic Neuroma
-Seizures/Epilepsy
-Multiple Sclerosis
-Wernicke Encephalopathy
-Chiari malformation
-Migraine
-Stroke
-Cardiovascular insufficiency
BPPV - symptoms?
-Recurrent vertigo, lasting seconds/minutes, provoked by changes in head position (e.g., turning in bed)
-NO hearing problems or tinnitus
-Positive dix-hallpike
BPPV - tx?
Physical therapy (Eply maneuver) to move free-floating otoconia back in place in semicircular canal
Labyrinthitis (AKA Vestibular Neuronitis) - symptoms?
-Recent URI (virus)
-Sudden onset of vertigo lasting days
-Spontaneous nystagmus
-Sensorineural hearing loss
-Tinnitus
Labyrinthitis (AKA Vestibular Neuronitis) - tx?
-Diazepam or Meclizine (vestibular suppressants) during attack
-Vertigo improves over weeks
-Hearing loss may or may not improve
Meniere's Disease - cause?
Distention of endolymphatic compartment of inner ear due to:
-Idiopathic (unknown)
-Syphilis
-Head trauma
Meniere's Disease - symptoms?
-Episodic vertigo, lasting hours
-Low-frequency sensorineural hearing loss
-Tinnitus ("blowing" in quality)
-Unilateral ear pressure
Meniere's Disease - tx?
Reduce fluid retention via:
-Low salt diet
-Diuretics (acetazolamide)
Acoustic Neuroma - what is it?
8th CN tumor
What is the most common intracranial tumor?
Acoustic neuroma
Acoustic Neuroma - symptoms?
-Unilateral sensorineural hearing loss
-Vertigo that is continuous, for months
Acoustic Neuroma - labs?
MRI with contrast
Acoustic Neuroma - tx?
-Neuro referral for observation
-Excision
-Radiotherapy
-Bevacizumab (VEGF inhibitor) if neurofibromatosis type 2
Barotrauma - what is it?
Inability to equalize air pressure in middle ear during altitude changes (due to narrowed eustachian tube)
Barotrauma - symptoms?
-Mild hearing loss
-Autophony (hearing yourself in head)
-Popping/cracking in ears when swallowing/yawning
Barotrauma - tx?
-Swallow, yawn, autoinflate during airplane descent
-Oral decongestants (take hours before descent)
-Ventilating tubes (if chronic)
-Avoid diving/air travel with URI or nasal allergy or TM perforation
Auricular Hematoma - causes? tx? complications?
Cause:
-Trauma

Tx:
-I&D

Complications if not drained:
-Cauliflower ear (cosmetic deformity)
-Ear canal blockage
Viral Rhinosinusitis - symptoms?
-Clear, watery rhinorrhea
-Nasal congestion
-Erythema and edema of turbinates
-Sore throat
-Cough
-Low fever
-Headache
Rhinosinusitis: acute vs subacute vs chronic vs recurrent acute?
Acute < 4 weeks
Subacute: 4-12 weeks
Chronic: >12 weeks
Recurrent acute: 4 or more episodes per year of 10 days-4 weeks
Viral Rhinosinusitis - tx?
-Hypertonic saline nasal irrigation
-Decongestants (pseudophedrine)
-Nasal decongestants (no longer than 3 days, or will cause rhinits medicamentosa)
-NSAIDs
-Zinc acetate
Viral Rhinosinusitis - organisms?
-Adenovirus
-Rhinovirus
Bacterial Rhinosinusitis (AKA Sinusitis) - causes? organisms?
-Obstruction of ostia (sinus pores) preventing mucus clearance

-Strep pneumoniae
-H flu
-Staph aureus
-Moraxella
Bacterial Rhinosinusitis (AKA Sinusitis) - symptoms?
-Purulent yellow-green nasal discharge
-Facial pain/pressure over sinuses (exacerbated by leaning forward)
-Nasal congestion
-Cough
-Malaise
-Fever
-Headache
-Red, erythematous turbinates
-Halitosis
-Symptoms persist > 10 days
MC sinus involved in bacterial rhinosinusitis?
Maxillary
Bacterial Rhinosinusitis (AKA Sinusitis) - tx?
-NSAIDs
-Decongestants (pseudophedrine)
-Intranasal corticosteroids
-Abx (amoxicillin) if severe, lasts > 14 days, or immunodeficient
Allergic Rhinits (Hay Fever) - symptoms?
-Pruritis of nose, eyes, ears
-Watery rhinorrhea
-Sneezing
-Pale/Violet turbinates
-Nasal polyps (yellow, boggy masses)
-Nasal salute crease
-NO fever

-Symptoms are of Childhood onset and seasonal
-May have asthma or eczema
Non-Allergic (Vasomotor) Rhinitis - symptoms?
-Watery rhinorrhea
-Sneezing
-Pruritis of nose

-Symptoms are of Adult onset and start in response to smoke, odors, light, change in air temperature
Allergic Rhinits (Hay Fever) - tx?
-Intranasal corticosteroids (beclomethasone; flunisolide)
-Antihistamines (loratadine)
-Leukotriene inhibitors (Montelukast)
-Mast cell stabilizers (Cromolyn)
-Avoid allergens
Non-Allergic (Vasomotor) Rhinitis - tx?
-Anticholinergics (Ipratropum nasal sprays)
-Avoid irritants
Nasal Polyps - what are they?
-Pale, gray soft masses, non-tender to palpation (Note: turbinates are firm, not soft)
Nasal Polyps - causes?
-Allergies
-Cystic fibrosis (if in children)
-Idiopathic
What medication should be avoided in a patient with nasal polyps?
Aspirin (can induce "Triad Asthma" bronchospasms)
Nasal polyps - tx?
-Intranasal corticosteroids
-Surgery (if massive)
Epistaxis - causes?
-Trauma (nose picking, FB, forceful nose blowing)
-Low humidity (dry nasal mucosa)
-Cocaine use
-HTN
-Atheroscleoritc disease
-Blood thinners
Epistaxis - most common locations?
Keisselbach plexus (of anterior septum)
Epistaxis - tx?
-Direct compression of nares for 15 minutes (1st line)
-Topical nasal decongestent (phenylephrine)
-Topical cocaine
-Anterior packing/Nasal tamponade
-Cauterize with silver nitrate

Follow-up measures:
-Anti-staph abx (to prevent toxic shock syndrome)
-Keep packing lubricated
-Increase home humidity
-Avoid hot/spicy foods
-Avoid tobacco
-Avoid vigorous exercise
When to refer a patient with Epistaxis?
-Large volume
-On-going bleeding beyond 15 minutes
-Posterior bleed
-Bilateral bleed
Nasal Foreign Body - symptoms?
-Foul smelling, unilateral discharge
-Halitosis
-Bleeding
-Nasal obstruction
Nasal Foreign Body - tx?
-Vigorous nose blowing
-Alligator forceps
-Refer if unable to visualize or can't get it out or battery
Centor Criteria for GABHS pharyngitis? what it suggests?
-Fever > 100.4
-Anterior cervical lymphadenopathy
-Exudates
-NO cough

1 symptom = no abx, no tests
2-3 symptoms = culture or rapid strep
4 symptoms = abx without tests
Mononucleosis - organism?
Epstein Barr Virus
Mononucleosis - symptoms?
-Enlarged tonsils
-Shaggy white-purple exudate
-Sore throat
-Fever
-Posterior Cervical LAD
-Extreme fatigue
-Palpable spleen
-Lymphocyte count high
GABHS pharyngitis - tx?
-Penicillin V x 10 days
-Erythromycin if allergic to penicillin
Mononucleosis - tx?
-Rest
-No contact sports
-No ampicillin
Peri-Tonsillar Abscess (Quinsy) - symptoms?
-Severe sore throat
-Odynophagia
-Trismus
-Deviated palate and uvula
-Unilateral swelling of tonsil
-Hot-potatoe voice (raspy)
Peri-Tonsillar Abscess (Quinsy) - tx?
-Amoxicillin (IV if unable to swallow)
-I&D
-Tonsillectomy (possibly)
Tonsillectomy - indications?
-Airway obstruction (due to large tonsils)
-Sleep apnea
-Cor pulmonale
-Peri-Tonsillar abscess
-Recurrent tonsillitis
Sialadenitis - causes?
Inflammation of salivary gland due:
-Dehydration
-Duct obstrution (e.g., sialolithiasis)
-Staph aureus infection
-Sjogren syndrome
Parotitis - causes?
-Mumps
-Parainfluenza
-EBV
Sialadenitis - symptoms?
-Swollen gland (usually parotid)
-Increased pain and swelling with meals
-Erythema
-Pus massaged from duct
Sialadenitis - tx?
-Nafcillin (IV if can't swallow)
-Hydration
-Warm compreses
-Sialagogues (lemon drops)
-Massage of gland
Laryngitis - causes?
-URI
-Vigorous use of voice
-Smoking
-Reflux (GERD)
Laryngitis - symptoms?
-Hoarseness
-Sore throat
-Cough
What is the most common cause of hoarseness?
Viral laryngitis
Laryngitis - tx?
-Voice rest (no singing, shouting)
-Symptomatic tx for any URI symptoms
-Refer if > 2 weeks
Parotid Gland Tumor - symptoms?
-Non-tender, mass in superficial part of gland
-Facial nerve palsy
Laryngeal Cancer - risk factors?
-Smoking
-HPV 16 and 18 (in non-smokers)
-Men 50-70 yrs old
Laryngeal Cancer - most common type?
Squamous cell carcinoma
Laryngeal Cancer - symptoms?
-Dysphonia (hoarseness or stridor) > 2 weeks
-Odynophagia
-Weight loss
-Otalgia (ear pain)
-Hemoptysis
Epiglottitis - organisms?
-H flu
-Neisseria meningitidies
-Strep
Epiglottitis - symptoms?
-Sudden onset of high fever
-Dysphagia
-Drooling
-Muffled voice
-Inspiratory retractions
-Cyanois
-Soft stridor
-Sniffing dog position (neck hyperextended)
Epiglottitis - labs?
-Lateral neck X-ray (thumbprint sign)
Epiglottitis - tx?
-Endotracheal intubation
-Cetriaxone IV
Dental abscess - symptoms?
-Swollen, tender gums (if periodontal)
-Tooth sensitivity (if apical)
-Localized erythema
-Otalgia (ear pain)
Leukoplakia - symptoms?
-Adherent, white patch on the mucosa (cannot be removed with rubbing) inside mouth
Leukoplakia and Erythroplakia - what is it?
-Hyperkeratosis in response to chronic irritation (dentures, tobacco use)
-Can be premalignant squamous cell (especially if on floor of mouth or posterior lateral tongue)
-90% of erythroplakia is oral cancer
Oral cancer - risk factors?
-Alcohol
-Smoking
-Age > 45
Hairy Leukoplakia - symptoms?
-Slightly raised white area on lateral border of tongue with a corrugated surface
-Vertical parallel lines with projections ("hairy")

(common early finding in HIV infection)
Oral Candidiasis (Thrush) - Symptoms?
-Creamy-white, curd-like patches on top of erythematous mucosa
-Can be easily scraped off
-Pain and burning sensations
-Angular cheilitis (red sores at junction of upper/lower junction of lips)
Oral Candidiasis (Thrush) - Risk Factors?
-Dentures
-Poor oral hygiene
-DM
-Anemia
-Chemotherapy
-Systemic steroids
-HIV
Oral Candidiasis (Thrush) - tx?
-Fluconazole or Nystatin
-Chlorehexidine mouth rinses
-Test for HIV, DM, or Anemia
Aphthous Ulcer - symptoms?
-Small round ulcerations with yellow-gray centers on red-halo
-Usually on buccal and labial mucosa (but can occur anywhere in GI tract)
-Painful
Aphthous Ulcer - tx?
-Avoid trigger foods (spicy, sour)
-Topical corticosteroid (Orabase) for pain
-Cimetidine H2-blocker (if recurrent)
-Triamcinolone intralesional injection (if severe)
Herpes Stomatitis - symptoms?
-Prodrome of burning
-Small vesicles that rupture and form scabs
-Usually on inner and outer lip (but can be anywhere)
Herpes Stomatitis - risk factors?
The following can reactivate the virus:
-stress
-GI upset
-menses
-solar radiation
-change in weather
-infections
Herpes Stomatitis - tx?
-Acyclovir (shortens course and reduces pain)
Necrotizing Ulcerative Gingivitis - cause? risk factors?
Caused by infection (not due to form hygiene)

Risk factors:
-Young adults
-Stress
Necrotizing Ulcerative Gingivitis - symptoms?
-Painful, gingival inflammation
-Halitosis
-Gingival necrosis (black tissue of gums)
-LAD
-Fever
Necrotizing Ulcerative Gingivitis - tx?
-50/50 hydrogen peroxide and water rinses
-Oral penicillin
-Refer to dentist for curettage
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