Ear Disorders and Treatments
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Questions and Answers

What is the appropriate treatment for excessive cerumen in the ear canal?

  • Use a cotton swab for removal
  • Remove with a plastic curette or warm water (correct)
  • Remove with a metal spoon
  • Leave it untreated

    • Which condition is NOT associated with fluid in the middle ear space?

  • Acute Otitis Media
  • Otitis Media Effusion
  • Cholesteatoma
  • Barotrauma (correct)

    • What is the correct treatment for a hordeolum?

  • Antibiotic ointment
  • Surgical excision immediately
  • Oral antibiotics
  • Warm compress for at least 48 hours (correct)

    • Which medication is commonly associated with causing dizziness in vestibular conditions?

    <p>Meclizine</p> Signup and view all the answers

    Which of the following statements about tympanic membrane perforation is accurate?

    <p>Observation is necessary as it should heal in approximately 3 months.</p> Signup and view all the answers

    What is a common complication of acute otitis media?

    <p>Mastoiditis</p> Signup and view all the answers

    What is the primary cause of benign paroxysmal positional vertigo?

    <p>Canalithiasis</p> Signup and view all the answers

    What is a key characteristic of Meniere's disease?

    <p>Vertigo, ear pressure/fullness, tinnitus</p> Signup and view all the answers

    What is the most common type of nasopharyngeal cancer?

    <p>Nasopharyngeal carcinoma</p> Signup and view all the answers

    What is a risk factor associated with adenocarcinoma in sinonasal tumors?

    <p>Exposure to wood dust</p> Signup and view all the answers

    What is the recommended treatment for juvenile angiofibroma?

    <p>Surgical removal</p> Signup and view all the answers

    Which symptom is least likely associated with malignant tumors in the nasal region?

    <p>Severe headaches</p> Signup and view all the answers

    What factor contributes to lower cure rates in nasal malignancies?

    <p>Involvement of the base of the skull</p> Signup and view all the answers

    What is the primary cause of presbyopia?

    <p>Loss of accommodation due to aging</p> Signup and view all the answers

    What symptom is NOT typically associated with retinal detachment?

    <p>Eye redness</p> Signup and view all the answers

    Which of the following conditions is recognized as the leading cause of world blindness?

    <p>Cataracts</p> Signup and view all the answers

    In cases of acute iritis, what symptom is commonly observed?

    <p>Ciliary flush</p> Signup and view all the answers

    What is the primary treatment for uveitis posterior?

    <p>Systemic corticosteroids</p> Signup and view all the answers

    What is a characteristic symptom of scleritis?

    <p>Photophobia</p> Signup and view all the answers

    Which condition is most commonly associated with extended contact lens wearers?

    <p>Corneal Ulcers</p> Signup and view all the answers

    What is the typical duration of vision loss in amaurosis fugax?

    <p>A few minutes</p> Signup and view all the answers

    What is the main visual distortion associated with wet Age-Related Macular Degeneration?

    <p>Straight lines appearing crooked</p> Signup and view all the answers

    What does the term 'hypopyon' refer to in the context of eye conditions?

    <p>Layering of leukocytes in the anterior chamber</p> Signup and view all the answers

    What is a common treatment for Thyroid Eye Disease?

    <p>Protection and corticosteroids</p> Signup and view all the answers

    Which organism is most commonly associated with Preseptal Cellulitis?

    <p>Staphylococcus</p> Signup and view all the answers

    What symptom is associated with lens dislocation?

    <p>Iris may quiver</p> Signup and view all the answers

    What is the treatment for a corneal abrasion?

    <p>Removing the foreign body</p> Signup and view all the answers

    What treatment is recommended for Necrotizing Ulcerative Gingivitis?

    <p>Antibiotics like penicillin</p> Signup and view all the answers

    What is the most common first sign of demineralized enamel?

    <p>White lines or spots</p> Signup and view all the answers

    Which condition is characterized by erythematous, smooth, lobulated masses that bleed when touched?

    <p>Pyogenic granuloma</p> Signup and view all the answers

    What is the necessary approach for treating an avulsed primary tooth?

    <p>Refer immediately to a dentist</p> Signup and view all the answers

    What is a significant complication of hyphema?

    <p>Permanent vision loss from glaucoma</p> Signup and view all the answers

    Which of these conditions is characterized by a burning sensation and may lead to vesicle rupture in the mouth?

    <p>Herpetic stomatitis</p> Signup and view all the answers

    What is a common symptom of nasal polyps?

    <p>Anosmia</p> Signup and view all the answers

    Which treatment is recommended for nasal polyps?

    <p>Nasal saline irrigations with budesonide</p> Signup and view all the answers

    What is the most common area for anterior epistaxis?

    <p>Kiesselback’s plexus</p> Signup and view all the answers

    What should be done prior to performing cauterization for epistaxis?

    <p>Apply a local anesthetic with decongestant</p> Signup and view all the answers

    In patients with nasal polyps and asthma, which medication should be avoided?

    <p>Aspirin</p> Signup and view all the answers

    What is a typical characteristic of nasal polyps as noted in a physical exam?

    <p>Pale, edematous masses</p> Signup and view all the answers

    What type of epistaxis is likely more difficult to control?

    <p>Posterior epistaxis</p> Signup and view all the answers

    Which condition in children is associated with the presence of nasal polyps?

    <p>Cystic fibrosis</p> Signup and view all the answers

    What is often a cause of local epistaxis in adults?

    <p>Trauma</p> Signup and view all the answers

    What is a common treatment method for controlling anterior epistaxis?

    <p>Observation and anterior pressure</p> Signup and view all the answers

    What is the primary treatment for juvenile angiofibroma?

    <p>Surgical removal</p> Signup and view all the answers

    Which symptom is commonly associated with nasopharyngeal malignant tumors?

    <p>Malar hypesthesia</p> Signup and view all the answers

    Which factor is NOT a risk factor for adenocarcinoma in sinonasal tumors?

    <p>Epstein-Barr Virus</p> Signup and view all the answers

    What is the most common type of nasopharyngeal carcinoma?

    <p>Squamous cell carcinoma</p> Signup and view all the answers

    What surgical procedure is primarily used for treating unilateral nasal obstruction due to benign conditions?

    <p>Medial maxillectomy</p> Signup and view all the answers

    Which symptom is most commonly associated with Otitis Externa?

    <p>Ear pain</p> Signup and view all the answers

    What is a common treatment option for Meniere's disease?

    <p>Lipoflavonoid and diuretics</p> Signup and view all the answers

    What condition is characterized by painless drainage and hearing loss?

    <p>Cholesteatoma</p> Signup and view all the answers

    Which factor may lead to Eustachian tube dysfunction?

    <p>Negative pressure in the middle ear</p> Signup and view all the answers

    What is a primary treatment recommendation for acute otitis media with purulence?

    <p>Amoxicillin high dose</p> Signup and view all the answers

    What condition involves an abnormal growth of bone within the ear canal?

    <p>Exostoses</p> Signup and view all the answers

    Which treatment is NOT recommended for tympanic membrane perforation?

    <p>Immediate surgical repair</p> Signup and view all the answers

    What condition presents with symptoms of vertigo, a sense of ear fullness, and fluctuating hearing loss?

    <p>Meniere's disease</p> Signup and view all the answers

    What is the primary treatment for bacterial Gonococcus infection of the eye?

    <p>IM Ceftriaxone</p> Signup and view all the answers

    Which condition is indicated by cobblestone papillae and treated with topical antihistamines?

    <p>Allergic conjunctivitis</p> Signup and view all the answers

    What symptom is commonly associated with dry eyes due to inadequate tear production?

    <p>Eye strain</p> Signup and view all the answers

    What is the most common infectious cause of blindness?

    <p>Chlamydia Trachomatis</p> Signup and view all the answers

    Which treatment is indicated for herpes simplex keratitis?

    <p>Antivirals</p> Signup and view all the answers

    What is a defining characteristic of a pterygium?

    <p>Fleshy triangular growth</p> Signup and view all the answers

    Which test is used to measure the production rate of the aqueous component of tears?

    <p>Schirmer test</p> Signup and view all the answers

    What symptom is most likely associated with infectious keratitis?

    <p>Eye pain</p> Signup and view all the answers

    Which type of treatment is required for infectious keratitis?

    <p>High concentration topical antibiotic drops</p> Signup and view all the answers

    What is a key symptom of allergic conjunctivitis, specifically the vernal form?

    <p>Cobblestone papillae</p> Signup and view all the answers

    What condition is characterized by inflammation of the lacrimal gland and often presents with an ‘S’ shaped lid deformity?

    <p>Dacryoadenitis</p> Signup and view all the answers

    Which treatment is typically recommended for nasolacrimal duct obstruction in infants?

    <p>Gentle downward massage</p> Signup and view all the answers

    What is a common symptom associated with acute angle closure glaucoma?

    <p>Extreme pain</p> Signup and view all the answers

    What type of keratitis is associated with contact with fresh water and hot tubs?

    <p>Acanthamoeba Keratitis</p> Signup and view all the answers

    Which statement accurately describes chronic glaucoma?

    <p>It is characterized by irreversible cupping of the optic disc.</p> Signup and view all the answers

    What is a common treatment approach for amblyopia?

    <p>Patching the stronger eye</p> Signup and view all the answers

    What is a symptom most commonly associated with dacryocystitis?

    <p>Inflamed lacrimal sac</p> Signup and view all the answers

    Which of the following is a risk factor for developing chronic glaucoma?

    <p>Being African American</p> Signup and view all the answers

    What typically causes the characteristic features of strabismus?

    <p>Misalignment of the eyes</p> Signup and view all the answers

    Which treatment is preferred for managing intraocular pressure in chronic glaucoma?

    <p>Prostaglandins</p> Signup and view all the answers

    What is a common treatment for nasal septal hematoma?

    <p>Drainage within 24 hours</p> Signup and view all the answers

    Which symptom is associated with septal perforation?

    <p>Nasal dryness</p> Signup and view all the answers

    What is the most critical factor for the urgent removal of a nasal foreign body?

    <p>Location of the foreign body</p> Signup and view all the answers

    What is a key preventative measure for patients on Warfarin?

    <p>Avoid digital trauma</p> Signup and view all the answers

    Inverted papilloma is typically characterized by which signs?

    <p>Unilateral and flesh-colored</p> Signup and view all the answers

    What common materials can be found in nasal foreign bodies in children?

    <p>Paper, duct tape, and beads</p> Signup and view all the answers

    What is one of the risks associated with untreated nasal septal hematoma?

    <p>Cartilage death</p> Signup and view all the answers

    Which treatment method is advised for later removal of a foreign body?

    <p>ENT consultation and antibiotics</p> Signup and view all the answers

    What should be monitored to prevent complications in a patient with a septal perforation?

    <p>Nasal moisture levels</p> Signup and view all the answers

    What could be a systemic disease consideration for children with nasal issues?

    <p>Cystic fibrosis</p> Signup and view all the answers

    What is the primary symptom of presbyopia?

    <p>Blurry vision while reading</p> Signup and view all the answers

    Which condition is characterized by inflammation of the iris?

    <p>Iritis</p> Signup and view all the answers

    What is a common symptom of cataracts?

    <p>Ghosting images</p> Signup and view all the answers

    What condition is known as the leading cause of permanent vision loss in the elderly?

    <p>Age-Related Macular Degeneration</p> Signup and view all the answers

    Which symptoms are commonly associated with scleritis?

    <p>Deep boring pain</p> Signup and view all the answers

    What is a common risk factor associated with nasopharyngeal carcinoma?

    <p>Asian descent</p> Signup and view all the answers

    Which treatment is recommended for paranasal sinus malignant tumors without base of skull involvement?

    <p>Surgical excision</p> Signup and view all the answers

    What immediate treatment is recommended for retinal detachment?

    <p>Refer to an ophthalmologist</p> Signup and view all the answers

    Which of the following describes the treatment for uveitis posterior?

    <p>Systemic corticosteroids</p> Signup and view all the answers

    What condition is characterized by unilateral nasal obstruction and is mostly benign?

    <p>Nasal polyp</p> Signup and view all the answers

    What is a key symptom of vitreous hemorrhage?

    <p>Sudden vision loss</p> Signup and view all the answers

    Which type of lymphoma is most commonly associated with nasal malignancies?

    <p>T-cell lymphoma</p> Signup and view all the answers

    What is the typical treatment approach for juvenile angiofibroma?

    <p>Surgical removal</p> Signup and view all the answers

    What is the primary treatment for orbital cellulitis caused by a Streptococcus infection?

    <p>High dose broad spectrum IV antibiotics</p> Signup and view all the answers

    Which symptom is commonly associated with thyroid eye disease?

    <p>Eyelid retraction</p> Signup and view all the answers

    What condition is characterized by smooth, lobulated masses that bleed upon contact?

    <p>Pyogenic granuloma</p> Signup and view all the answers

    What treatment is recommended for a patient with irreversible pulpitis?

    <p>Root canal or tooth extraction</p> Signup and view all the answers

    What is the recommended first-line treatment for oral pain?

    <p>NSAIDs</p> Signup and view all the answers

    Which of the following is a common symptom of a corneal abrasion?

    <p>Foreign body sensation</p> Signup and view all the answers

    Which medication is primarily associated with causing gingival hyperplasia?

    <p>Anticonvulsants</p> Signup and view all the answers

    What is the treatment for hyphema in the anterior chamber of the eye?

    <p>Bed rest and eye shield</p> Signup and view all the answers

    What common oral condition involves tender, swollen, and bleeding gums?

    <p>Gingivitis</p> Signup and view all the answers

    What condition commonly requires tonsillectomy due to recurrent infections?

    <p>Tonsillitis</p> Signup and view all the answers

    Which symptom is associated with lens dislocation?

    <p>Iris quivering</p> Signup and view all the answers

    What is a significant symptom of adenoiditis?

    <p>Nasal congestion</p> Signup and view all the answers

    What is a key intervention for the treatment of geographic tongue?

    <p>No treatment needed</p> Signup and view all the answers

    Which of the following is a common treatment for angioedema due to hypersensitivity?

    <p>Epinephrine</p> Signup and view all the answers

    What is a defined characteristic of periodontal abscess?

    <p>Tooth loseness and sensitivity</p> Signup and view all the answers

    Which drug class is known to cause osteonecrosis?

    <p>Bisphosphonates</p> Signup and view all the answers

    Which condition typically presents with symptoms including fever, malaise, and dysphagia?

    <p>Tonsillitis</p> Signup and view all the answers

    In treating Group A Beta-Hemolytic Streptococcus (GABHS), which complication is primarily prevented?

    <p>Rheumatic fever</p> Signup and view all the answers

    What is a common cause of dental caries?

    <p>Sugar preparations</p> Signup and view all the answers

    What is an indication of requiring tonsillectomy?

    <p>7 episodes of tonsillitis per year</p> Signup and view all the answers

    What is a significant risk associated with untreated nasal septal hematoma?

    <p>Cartilage death</p> Signup and view all the answers

    Which treatment modality is recommended for nasal foreign bodies that are not removed urgently?

    <p>ENT consultation</p> Signup and view all the answers

    What common symptom is indicative of a septal perforation?

    <p>Increased nasal dryness</p> Signup and view all the answers

    Which population is most at risk for nasal foreign bodies?

    <p>Young children and disabled adults</p> Signup and view all the answers

    What is a common component of prevention measures for nasal complications?

    <p>Humidification measures</p> Signup and view all the answers

    Which characteristic is associated with inverted papilloma?

    <p>Flesh-colored and unilateral growths</p> Signup and view all the answers

    What drainage characteristic is expected with organic material as a nasal foreign body?

    <p>Foul smelling and purulent</p> Signup and view all the answers

    Which treatment method is a last resort for nasal foreign bodies after initial attempts fail?

    <p>Surgical extraction</p> Signup and view all the answers

    What systemic condition might necessitate consideration when diagnosing a septal perforation in children?

    <p>Systemic lupus erythematosus</p> Signup and view all the answers

    What treatment is typically used for nasal septal hematoma within the first 24 hours?

    <p>Immediate drainage</p> Signup and view all the answers

    What is the primary treatment for nasal septal hematoma?

    <p>Draining the hematoma within 24 hours</p> Signup and view all the answers

    Which of the following is a common symptom of nasal foreign body obstruction in children?

    <p>Foul-smelling unilateral drainage</p> Signup and view all the answers

    What risk is associated with untreated nasal septal hematoma?

    <p>Cartilage death</p> Signup and view all the answers

    Which treatment is appropriate for an inorganic foreign body found deep in the nasal cavity?

    <p>ENT consultation for possible surgical intervention</p> Signup and view all the answers

    What preventive measure can help manage nasal complications related to moisture?

    <p>Saline mist application</p> Signup and view all the answers

    What does a positive Weber Test indicate in cases of conductive hearing loss?

    <p>Sound is heard better in the bad ear</p> Signup and view all the answers

    Which condition is characterized by the loss of mobility in the stapes due to excessive bony growth?

    <p>Otosclerosis</p> Signup and view all the answers

    What is the recommended treatment for sudden sensory-neural hearing loss?

    <p>High dose oral steroids</p> Signup and view all the answers

    What distinguishes mixed hearing loss from other types of hearing loss?

    <p>It involves a combination of conductive and sensory factors</p> Signup and view all the answers

    In the context of acoustic neuroma, which symptom is most likely to be observed?

    <p>Unilateral sensorineural hearing loss</p> Signup and view all the answers

    Which of the following conditions is most commonly associated with aging and leads to sensorineural hearing loss?

    <p>Presbycusis</p> Signup and view all the answers

    What type of dermatitis commonly affects the external ear and may lead to cellulitis?

    <p>Seborrheic dermatitis</p> Signup and view all the answers

    Which treatment is recommended for a patient suffering from hyperacusis?

    <p>Hearing aids amplification</p> Signup and view all the answers

    Which condition is characterized by inflammation of the iris and may present with unilateral eye pain?

    <p>Iritis (anterior uveitis)</p> Signup and view all the answers

    What is the primary symptom of age-related macular degeneration in its wet form?

    <p>Visual distortion where straight lines appear crooked</p> Signup and view all the answers

    What treatment is typically indicated for retinal detachment?

    <p>Refer to ophthalmologist</p> Signup and view all the answers

    Which of the following symptoms is NOT typically associated with cataracts?

    <p>Redness of the eye</p> Signup and view all the answers

    What symptom might indicate the presence of scleritis?

    <p>Deep boring pain, worse at night</p> Signup and view all the answers

    What is a common risk factor contributing to corneal ulcers?

    <p>Extended contact lens wear</p> Signup and view all the answers

    What is the first-line treatment for oral pain?

    <p>NSAIDs</p> Signup and view all the answers

    What is the main characteristic of the vision loss associated with central and branch retinal arterial occlusion?

    <p>Painless monocular vision loss</p> Signup and view all the answers

    What condition is associated with avulsion of permanent teeth?

    <p>Is a dental emergency</p> Signup and view all the answers

    Which statement accurately describes the symptoms of age-related macular degeneration?

    <p>It can lead to both atrophic and neovascular changes.</p> Signup and view all the answers

    What is a characteristic sign of vitreous hemorrhage?

    <p>Decreased red reflex</p> Signup and view all the answers

    Which medication is linked to gingival hyperplasia?

    <p>Anticonvulsants</p> Signup and view all the answers

    What is typically the first noticeable symptom of central and branch retinal vein occlusions?

    <p>Painless vision loss upon waking</p> Signup and view all the answers

    Which of the following symptoms is associated with angioedema?

    <p>Soft swelling</p> Signup and view all the answers

    In cases of tonsillitis, what is a common indication for tonsillectomy?

    <p>Seven or more episodes per year</p> Signup and view all the answers

    What is a common sign of adenoiditis?

    <p>Difficulty breathing through the nose</p> Signup and view all the answers

    Which condition is primarily viral and more prevalent in winter for children aged 4-7?

    <p>Pharyngitis</p> Signup and view all the answers

    What treatment is recommended for Group A Beta-Hemolytic Streptococcus (GABHS) infections?

    <p>Antibiotics to prevent sequelae</p> Signup and view all the answers

    Which medication is associated with dental erosion?

    <p>Progesterone</p> Signup and view all the answers

    What is an incorrect statement regarding antibiotic prophylaxis for patients?

    <p>Most patients need it before dental procedures.</p> Signup and view all the answers

    Which symptom is commonly associated with allergic rhinitis?

    <p>Nasal congestion</p> Signup and view all the answers

    What is a common underlying mechanism for the symptoms in allergic rhinitis?

    <p>Mast cell degranulation</p> Signup and view all the answers

    When diagnosing allergic rhinitis, which test would be appropriate?

    <p>Skin testing</p> Signup and view all the answers

    What is the primary treatment recommended for perennial allergic rhinitis?

    <p>Corticosteroid nasal sprays</p> Signup and view all the answers

    Which symptom indicates the presence of vasomotor rhinitis?

    <p>Nasal congestion without allergens</p> Signup and view all the answers

    What is a common characteristic of salivary gland tumors?

    <p>Typically benign but require evaluation</p> Signup and view all the answers

    What is the treatment recommendation for rhinitis medicamentosa?

    <p>Discontinue nasal spray use and consider steroids</p> Signup and view all the answers

    Which condition is characterized by an inability to detect odors?

    <p>Anosmia</p> Signup and view all the answers

    Which of the following is a risk factor for developing allergic rhinitis?

    <p>Family history of allergies</p> Signup and view all the answers

    What is the effect of pregnancy on the sense of smell?

    <p>Increased sensitivity to smells</p> Signup and view all the answers

    What is the treatment for bacterial gonococcal conjunctivitis?

    <p>IM Ceftriaxone</p> Signup and view all the answers

    Which condition is primarily caused by inadequate tear production?

    <p>Dry eyes (Keratoconjunctivitis Sicca)</p> Signup and view all the answers

    What symptom is commonly associated with herpes simplex keratitis?

    <p>Dendritic branching</p> Signup and view all the answers

    What indicates the need for removal in a pterygium?

    <p>Vision impairment</p> Signup and view all the answers

    Which of the following is a symptom of infectious keratitis?

    <p>Eye pain</p> Signup and view all the answers

    What is the primary treatment for allergic conjunctivitis?

    <p>Topical antihistamines</p> Signup and view all the answers

    Which organism is associated with the most common infectious cause of blindness?

    <p>Chlamydia trachomatis</p> Signup and view all the answers

    What condition presents with copious discharge and is considered an emergency?

    <p>Bacterial gonococcal conjunctivitis</p> Signup and view all the answers

    What characteristic appearance do nasal polyps have during a physical examination?

    <p>Pale, edematous, mucosally covered masses resembling peeled grapes</p> Signup and view all the answers

    In the management of nasal polyps, which treatment is least effective alone?

    <p>Antihistamines</p> Signup and view all the answers

    Which of the following is a common cause of local epistaxis in adults?

    <p>Nose picking or blowing</p> Signup and view all the answers

    What is the primary difference between anterior and posterior epistaxis?

    <p>Anterior epistaxis originates from Kiesselback’s plexus, while posterior originates from Woodruff’s plexus.</p> Signup and view all the answers

    Which of the following patients is most likely to experience a recurrence of nasal polyps?

    <p>An adult with chronic sinusitis</p> Signup and view all the answers

    What is the main cause of presbyopia?

    <p>Loss of elasticity in the lens</p> Signup and view all the answers

    Which type of uveitis primarily affects the vitreous cavity?

    <p>Intermediate uveitis</p> Signup and view all the answers

    What symptom is most commonly associated with cataracts?

    <p>Blurry or ghosting images</p> Signup and view all the answers

    What is the appropriate initial treatment for a retinal detachment?

    <p>Refer to ophthalmologist urgently</p> Signup and view all the answers

    What is a common feature associated with dry Age-Related Macular Degeneration?

    <p>Drusen</p> Signup and view all the answers

    What condition is characterized by unilateral eye pain and redness?

    <p>Scleritis</p> Signup and view all the answers

    Which symptom is often NOT associated with vitreous hemorrhage?

    <p>Severe eye pain</p> Signup and view all the answers

    What is the leading cause of permanent vision loss in the elderly?

    <p>Age-Related Macular Degeneration</p> Signup and view all the answers

    Which condition is known to have cotton wool spots as a symptom?

    <p>Central retinal vein occlusion</p> Signup and view all the answers

    What symptom might a person experience during an episode of amaurosis fugax?

    <p>Sudden onset, monocular vision loss lasting a few minutes</p> Signup and view all the answers

    What is the primary treatment for Thyroid Eye Disease?

    <p>Corticosteroids</p> Signup and view all the answers

    Which symptom is characteristic of Orbital Cellulitis?

    <p>Swelling, tenderness, and warmth</p> Signup and view all the answers

    What common issue occurs with a corneal abrasion?

    <p>Severe pain and tearing</p> Signup and view all the answers

    Which condition involves anterior chamber hemorrhage?

    <p>Hyphema</p> Signup and view all the answers

    Which symptom does NOT commonly present with Preseptal Cellulitis?

    <p>Decreased ocular motility</p> Signup and view all the answers

    What is the most typical treatment for a dental abscess?

    <p>Urgent dental referral</p> Signup and view all the answers

    Which treatment is most appropriate for Gingivitis?

    <p>Effective brushing and flossing</p> Signup and view all the answers

    Which condition indicates the presence of smooth, glassy teeth due to dental erosion?

    <p>Dental erosion</p> Signup and view all the answers

    Which symptom is commonly seen in patients with Xerostomia?

    <p>Dry mouth and burning sensation</p> Signup and view all the answers

    What is the most common treatment for Herpetic Stomatitis?

    <p>Antiviral medications</p> Signup and view all the answers

    Which medication is most commonly associated with gingival hyperplasia?

    <p>Cyclosporine</p> Signup and view all the answers

    What is the primary first-line treatment for oral pain?

    <p>NSAIDs</p> Signup and view all the answers

    Which condition is characterized by soft, non-itchy swelling of the mouth and lips?

    <p>Angioedema</p> Signup and view all the answers

    What is a common indication for a tonsillectomy?

    <p>Recurrent infections</p> Signup and view all the answers

    Which medications may lead to dental erosion?

    <p>Nitrates</p> Signup and view all the answers

    Which of the following is NOT a symptom of pharyngitis?

    <p>Nasal congestion</p> Signup and view all the answers

    What is typically NOT required by most patients regarding antibiotic prophylaxis?

    <p>For chronic sinus infections</p> Signup and view all the answers

    What condition is characterized by a 'junky' nose feeling and mouth breathing?

    <p>Adenoiditis</p> Signup and view all the answers

    What is the recommended treatment for GABHS to prevent sequelae?

    <p>Antibiotics</p> Signup and view all the answers

    Which factor is associated with osteonecrosis?

    <p>Bisphosphonates</p> Signup and view all the answers

    Which symptom is associated with nasopharyngeal malignant tumors?

    <p>Chronic rhinitis or sinusitis</p> Signup and view all the answers

    What is the main treatment approach for most malignant tumors of the nasopharynx?

    <p>Chemotherapy and radiation</p> Signup and view all the answers

    Which factor is a recognized risk for the development of nasopharyngeal carcinoma?

    <p>EBV exposure</p> Signup and view all the answers

    What surgical procedure is typically performed to treat unilateral nasal obstruction due to benign tumors?

    <p>Medial maxillectomy</p> Signup and view all the answers

    What is the most common type of cancer associated with malignant sinonasal tumors?

    <p>Squamous cell carcinoma</p> Signup and view all the answers

    Which treatment is essential for managing a nasal septal hematoma effectively?

    <p>Immediate surgical drainage within 24 hours</p> Signup and view all the answers

    What is a common symptom of a nasal foreign body in children?

    <p>Unilateral foul-smelling drainage</p> Signup and view all the answers

    Which method is NOT a recommended treatment for nasal foreign bodies?

    <p>Application of saline nasal spray</p> Signup and view all the answers

    What is a potential risk associated with untreated nasal septal hematoma?

    <p>Cartilage death</p> Signup and view all the answers

    What symptom could indicate a septal perforation?

    <p>Nasal dryness and increased nasal sound</p> Signup and view all the answers

    Which condition is most likely to be indicated by unilateral flesh-colored nasal lesions?

    <p>Inverted papilloma</p> Signup and view all the answers

    Which method of treatment is recommended for a nasal foreign body that is a button battery?

    <p>Immediate removal by health care provider</p> Signup and view all the answers

    What should be monitored when a patient is taking Warfarin?

    <p>INR levels</p> Signup and view all the answers

    Which complication is most concerning after treating a nasal septal hematoma?

    <p>Sepsis</p> Signup and view all the answers

    Which method is suggested for increasing nasal moisture in cases of septal perforation?

    <p>Using saline nasal spray frequently</p> Signup and view all the answers

    What is the first-line treatment for Bacterial Gonococcus conjunctivitis?

    <p>IM Ceftriaxone</p> Signup and view all the answers

    Which condition is characterized by inadequate tear production or accelerated tear evaporation?

    <p>Keratoconjunctivitis Sicca</p> Signup and view all the answers

    Which of the following is a symptom of Herpes Simplex Keratitis?

    <p>Dendritic branching</p> Signup and view all the answers

    Which treatment is indicated for Allergic Conjunctivitis?

    <p>Topical antihistamines</p> Signup and view all the answers

    What is a common characteristic feature of Pterygium?

    <p>Fleshy triangular growth</p> Signup and view all the answers

    What is a key sign of infectious keratitis?

    <p>Eye redness and pain</p> Signup and view all the answers

    Which test is used to measure the rate of production of aqueous component in dry eyes?

    <p>Schirmer test</p> Signup and view all the answers

    What is the potential consequence of untreated Bacterial Chlamydia: Trachomatis infection?

    <p>Blindness</p> Signup and view all the answers

    Which of the following is NOT a characteristic sign of nasal polyps?

    <p>Nasal disfigurement</p> Signup and view all the answers

    What is the most common site for anterior epistaxis?

    <p>Kiesselback’s plexus</p> Signup and view all the answers

    What is a common treatment for managing chronic nasal congestion caused by nasal polyps?

    <p>Nasal saline irrigations with budesonide</p> Signup and view all the answers

    Which of the following conditions is commonly associated with the development of nasal polyps in children?

    <p>Cystic fibrosis</p> Signup and view all the answers

    What is the primary treatment for orbital cellulitis?

    <p>High dose broad spectrum IV antibiotics</p> Signup and view all the answers

    What is a typical approach to treating anterior epistaxis?

    <p>Anterior pressure and oxymetazoline</p> Signup and view all the answers

    Which of the following conditions is characterized by symptoms of exophthalmos and lid retraction?

    <p>Thyroid Eye Disease</p> Signup and view all the answers

    Which statement regarding posterior epistaxis is true?

    <p>It may present with bleeding from both nostrils and clots.</p> Signup and view all the answers

    Which treatment is indicated for managing hyphema?

    <p>Bed rest and eye shield</p> Signup and view all the answers

    What is the correct management for a corneal abrasion?

    <p>Removal of the foreign object and eye patching</p> Signup and view all the answers

    What potential complication can arise from bilateral cauterization for epistaxis?

    <p>Septal perforation</p> Signup and view all the answers

    In a patient with asthma and nasal polyps, which medication should be avoided?

    <p>Ibuprofen</p> Signup and view all the answers

    Which condition is characterized by a nonpainful, lobulated mass that bleeds when touched?

    <p>Pyogenic granuloma</p> Signup and view all the answers

    Which of the following is a common cause of local epistaxis in adults?

    <p>Nose picking or blowing</p> Signup and view all the answers

    What is a common symptom of periodontitis?

    <p>Redness and bleeding of gums</p> Signup and view all the answers

    Which form of treatment is appropriate for dental erosion?

    <p>Rinsing with water after reflux/vomiting</p> Signup and view all the answers

    What procedure should be done prior to nasal cauterization to ensure effective treatment for epistaxis?

    <p>Administering local anesthesia</p> Signup and view all the answers

    Which treatment is indicated for irreversible pulpitis?

    <p>Root canal or extraction</p> Signup and view all the answers

    What distinguishes herpes labialis from herpetic stomatitis?

    <p>Location of lesions</p> Signup and view all the answers

    Which oral condition is often associated with a burning mouth syndrome?

    <p>Glossodynia</p> Signup and view all the answers

    What is the recommended first line of treatment for managing nasal polyps?

    <p>Intranasal corticosteroids</p> Signup and view all the answers

    Which statement accurately describes a typical physical examination finding for nasal polyps?

    <p>Pale, edematous, mucosally covered masses</p> Signup and view all the answers

    What is a common local cause of epistaxis?

    <p>Nose picking</p> Signup and view all the answers

    In patients with nasal polyps who also have asthma, what medication should be avoided?

    <p>Aspirin</p> Signup and view all the answers

    Which method is typically NOT a part of the treatment protocol for anterior epistaxis?

    <p>Surgical intervention</p> Signup and view all the answers

    What causes conductive hearing loss in atresia?

    <p>Absence of the ear canal</p> Signup and view all the answers

    Which is a common symptom of Meniere's disease?

    <p>Fluctuant hearing loss</p> Signup and view all the answers

    What is the main treatment for tympanic membrane perforation?

    <p>Observation with strict water precautions</p> Signup and view all the answers

    What complication is associated with untreated acute otitis media?

    <p>Mastoiditis</p> Signup and view all the answers

    How is benign paroxysmal positional vertigo primarily treated?

    <p>Canalith repositioning maneuvers</p> Signup and view all the answers

    What is the typical management approach for otitis media effusion?

    <p>Monitoring for up to 3 months</p> Signup and view all the answers

    Which condition is characterized by painless drainage and hearing loss?

    <p>Cholesteatoma</p> Signup and view all the answers

    What is a characteristic feature of vestibular neuronitis?

    <p>Not associated with sensorineural hearing loss</p> Signup and view all the answers

    Which condition is characterized by unilateral eye pain and redness?

    <p>Iritis</p> Signup and view all the answers

    In which condition do patients commonly experience blurry or ghosting images, especially during night driving?

    <p>Cataracts</p> Signup and view all the answers

    What is the primary symptom of vitreous hemorrhage?

    <p>Sudden vision loss</p> Signup and view all the answers

    Which type of Age-Related Macular Degeneration is progressive and characterized by BIL atrophy and drusen?

    <p>Dry AMD</p> Signup and view all the answers

    What is the medical term for sudden monochromatic vision loss that lasts only a few minutes?

    <p>Amaurosis fugax</p> Signup and view all the answers

    What is the primary treatment for bilateral floaters and blurred vision associated with intermediate uveitis?

    <p>Systemic corticosteroids</p> Signup and view all the answers

    Which condition is associated with deep boring pain and photophobia, worsening at night?

    <p>Scleritis</p> Signup and view all the answers

    What is typically the first sign of central retinal artery occlusion?

    <p>Painless vision loss</p> Signup and view all the answers

    Which treatment is commonly recommended for corneal ulcers?

    <p>Antibiotic drops</p> Signup and view all the answers

    What is a typical risk factor for cataracts?

    <p>Aging</p> Signup and view all the answers

    What is the most common treatment for diabetic retinopathy?

    <p>Optimizing disease control</p> Signup and view all the answers

    Which symptom is indicative of optic neuritis?

    <p>Abrupt vision loss</p> Signup and view all the answers

    What sign is associated with hypertensive retinopathy?

    <p>Arteriovenous nicking</p> Signup and view all the answers

    What can worsen diabetic retinopathy during pregnancy?

    <p>Impaired blood glucose control</p> Signup and view all the answers

    In which condition is drusen most commonly associated?

    <p>Farsightedness</p> Signup and view all the answers

    What is a common symptom of oculomotor palsies?

    <p>Pain on eye movement</p> Signup and view all the answers

    What condition is strongly associated with optic neuritis?

    <p>Multiple Sclerosis</p> Signup and view all the answers

    Which treatment is recommended for papilledema?

    <p>Surgical intervention</p> Signup and view all the answers

    What is the appropriate treatment for a patient diagnosed with orbital cellulitis?

    <p>High dose broad spectrum IV antibiotics</p> Signup and view all the answers

    What visual symptom might present with proliferative diabetic retinopathy?

    <p>Black spots or floaters</p> Signup and view all the answers

    Which condition is associated with a burning sensation in the mouth and requires antiviral treatment?

    <p>Herpes labialis</p> Signup and view all the answers

    Which of the following is a common characteristic of congenital nystagmus?

    <p>Dancing eyes</p> Signup and view all the answers

    What is the main treatment approach for managing hyphema?

    <p>Eye shield and bed rest</p> Signup and view all the answers

    What is the characteristic finding in a patient with lens dislocation?

    <p>Iris quivering and off-center lens</p> Signup and view all the answers

    Which of the following is a symptom of conjunctival and corneal foreign bodies?

    <p>Severe pain and tearing</p> Signup and view all the answers

    Which statement about dental caries is accurate?

    <p>Demineralization is accelerated with frequent sugar consumption.</p> Signup and view all the answers

    What is a common cause of xerostomia?

    <p>Medications such as antihistamines</p> Signup and view all the answers

    Which treatment is indicated for an individual with necrotizing ulcerative gingivitis?

    <p>Penicillin for 10 days</p> Signup and view all the answers

    What is the key symptom of periodontal abscess?

    <p>Localized pain and loose tooth</p> Signup and view all the answers

    What is the likely consequence of untreated gingivitis?

    <p>Development of periodontal disease</p> Signup and view all the answers

    Which medication is known to cause gingival hyperplasia?

    <p>Anticonvulsants</p> Signup and view all the answers

    What is the primary first-line treatment for oral pain?

    <p>NSAIDs</p> Signup and view all the answers

    Which of the following symptoms is characteristic of angioedema?

    <p>Soft, non-itchy swelling</p> Signup and view all the answers

    Which indication is NOT a reason for performing a tonsillectomy?

    <p>Acute pharyngitis</p> Signup and view all the answers

    Which factor is commonly associated with adenoiditis?

    <p>Difficulty breathing through the nose</p> Signup and view all the answers

    What is the treatment for Bacterial Gonococcus infection in the eye?

    <p>IM Ceftriaxone</p> Signup and view all the answers

    Which symptoms are associated with Dry Eyes (Keratoconjunctivitis Sicca)?

    <p>Dryness, gritty/sandy sensation, and eye strain</p> Signup and view all the answers

    What is the primary treatment for allergic conjunctivitis?

    <p>Topical antihistamines</p> Signup and view all the answers

    Which condition is characterized by a flesh-colored triangular growth on the eye?

    <p>Pterygium</p> Signup and view all the answers

    What indicates a need for high concentration topical antibiotic drops in eye treatment?

    <p>Infectious keratitis</p> Signup and view all the answers

    What is the most common infectious cause of blindness?

    <p>Bacterial Chlamydia Trachomatis</p> Signup and view all the answers

    What is a common symptom of Herpes Simplex Keratitis?

    <p>Dendritic branching</p> Signup and view all the answers

    What diagnostic test is used to measure the rate of tear production?

    <p>Schirmer test</p> Signup and view all the answers

    What is a characteristic symptom of acute angle closure glaucoma?

    <p>Halos around lights</p> Signup and view all the answers

    What is the most appropriate treatment for dacryostenosis in infants?

    <p>Downward massage</p> Signup and view all the answers

    Which condition is associated with an 'S' shaped lid deformity?

    <p>Dacryoadenitis</p> Signup and view all the answers

    What is a common cause of dacryocystitis?

    <p>Bacterial obstruction</p> Signup and view all the answers

    What is a typical sign of chronic glaucoma?

    <p>Tunnel vision</p> Signup and view all the answers

    What is the primary treatment option for fungal keratitis?

    <p>Oral antivirals</p> Signup and view all the answers

    Which treatment method is preferred for chronic glaucoma to lower intraocular pressure?

    <p>Prostaglandins</p> Signup and view all the answers

    What symptom indicates the presence of acanthamoeba keratitis?

    <p>Ring infiltrates</p> Signup and view all the answers

    In which demographic is dacryoadenitis most common?

    <p>Children</p> Signup and view all the answers

    What treatment is typically used for treating amblyopia?

    <p>Patching and corrective lenses</p> Signup and view all the answers

    What condition is characterized by multiple focal points in vision?

    <p>Astigmatism</p> Signup and view all the answers

    Which symptom is typically associated with age-related macular degeneration?

    <p>Blurry images</p> Signup and view all the answers

    How is uveitis posterior primarily treated?

    <p>Systemic corticosteroids</p> Signup and view all the answers

    What is a common consequence of untreated corneal ulcers?

    <p>Corneal scarring</p> Signup and view all the answers

    Which condition is considered a medical emergency related to sudden vision loss?

    <p>Central retinal arterial occlusion</p> Signup and view all the answers

    What visual phenomenon is often reported with retinal detachment?

    <p>Shadow or curtain coming down</p> Signup and view all the answers

    What is the leading cause of permanent vision loss in the elderly?

    <p>Age-Related Macular Degeneration</p> Signup and view all the answers

    Which symptom is indicative of iritis?

    <p>Unilateral eye pain</p> Signup and view all the answers

    What condition is primarily treated with oral antioxidants?

    <p>Dry Age-Related Macular Degeneration</p> Signup and view all the answers

    Which of the following is NOT a symptom of scleritis?

    <p>Shadow or curtain coming down</p> Signup and view all the answers

    What is the primary treatment for optic neuritis?

    <p>Corticosteroids</p> Signup and view all the answers

    Which type of diabetic retinopathy is characterized by neovascularization?

    <p>Proliferative</p> Signup and view all the answers

    What is a sign commonly associated with hypertensive retinopathy?

    <p>Arteriovenous nicking</p> Signup and view all the answers

    What is the appropriate treatment for managing diabetic retinopathy?

    <p>Optimize control of disease</p> Signup and view all the answers

    Which condition is characterized by the presence of double vision and eye movement pain?

    <p>Oculomotor palsies</p> Signup and view all the answers

    What is a common risk factor for hypertensive retinopathy?

    <p>Smoking</p> Signup and view all the answers

    What symptom is typically associated with optic disc swelling?

    <p>Bilateral vision loss</p> Signup and view all the answers

    What sign is characteristic of nonproliferative diabetic retinopathy?

    <p>Cotton wool spots</p> Signup and view all the answers

    Which type of retinopathy involves microaneurysms and retinal capillary closure?

    <p>Diabetic retinopathy</p> Signup and view all the answers

    What are common symptoms of nystagmus?

    <p>Limited vision and rapid eye movements</p> Signup and view all the answers

    What is the first-line treatment for bacterial gonococcal conjunctivitis?

    <p>IM Ceftriaxone</p> Signup and view all the answers

    Which condition is characterized by inadequate tear production or accelerated tear evaporation?

    <p>Dry eyes (Keratoconjunctivitis Sicca)</p> Signup and view all the answers

    What symptom is most commonly associated with allergic conjunctivitis?

    <p>Itchiness</p> Signup and view all the answers

    What is a characteristic feature of herpes simplex keratitis?

    <p>Dendritic branching</p> Signup and view all the answers

    Which of the following is a typical treatment for pterygium?

    <p>Surgical removal</p> Signup and view all the answers

    Which test is used to measure the rate of tear production in dry eyes?

    <p>Schirmer test</p> Signup and view all the answers

    What treatment is indicated for infectious keratitis?

    <p>High concentration topical antibiotic drops</p> Signup and view all the answers

    Which of the following conditions is the most common infectious cause of blindness?

    <p>Bacterial chlamydia</p> Signup and view all the answers

    What is the treatment method for unilateral nasal obstruction caused by benign tumors?

    <p>Surgical excision (medial maxillectomy)</p> Signup and view all the answers

    Which symptom is most commonly associated with nasopharyngeal carcinoma?

    <p>Unilateral ear pain</p> Signup and view all the answers

    What is the primary risk factor for nasopharyngeal carcinoma?

    <p>Race and EBV exposure</p> Signup and view all the answers

    What is a common treatment approach for malignant tumors of the nasal and paranasal region?

    <p>Chemotherapy and radiation as per tumor type</p> Signup and view all the answers

    What distinguishes juvenile angiofibroma in terms of demographic?

    <p>Frequently diagnosed in young boys</p> Signup and view all the answers

    What is the first line treatment for oral pain?

    <p>NSAIDs</p> Signup and view all the answers

    Which condition requires immediate airway management with epinephrine?

    <p>Angioedema</p> Signup and view all the answers

    Which medication is known to cause gingival hyperplasia?

    <p>Anticonvulsants</p> Signup and view all the answers

    What should not be done when dealing with an avulsed permanent tooth?

    <p>Touch the root of the tooth</p> Signup and view all the answers

    Which is a common symptom associated with adenoiditis?

    <p>Mouth breathing</p> Signup and view all the answers

    What is a typical indication for tonsillectomy?

    <p>Recurrent infections</p> Signup and view all the answers

    Which of the following is NOT a common cause of dental caries?

    <p>Nitrates</p> Signup and view all the answers

    What age range is more prevalent for viral pharyngitis?

    <p>4-7 years</p> Signup and view all the answers

    What is one of the symptoms of streptococcal pharyngitis?

    <p>Dysphagia</p> Signup and view all the answers

    What dental medication is associated with causing osteonecrosis?

    <p>Bisphosphonates</p> Signup and view all the answers

    Which characteristic symptom is associated with acute angle closure glaucoma?

    <p>Dilated and nonreactive pupil</p> Signup and view all the answers

    What is the primary treatment for dacryocystitis?

    <p>Systemic antibiotics</p> Signup and view all the answers

    Which condition is characterized by inflammation of the lacrimal gland and is most commonly seen in children?

    <p>Dacryoadenitis</p> Signup and view all the answers

    What is the primary cause of presbyopia?

    <p>Loss of elasticity in the lens</p> Signup and view all the answers

    What type of glaucoma is most commonly associated with irreversible cupping of the optic disc?

    <p>Chronic open angle glaucoma</p> Signup and view all the answers

    What is the key symptom of uveitis intermediate?

    <p>Bilateral floaters and blurred vision</p> Signup and view all the answers

    In treating amblyopia, which method is commonly used?

    <p>Patching the dominant eye</p> Signup and view all the answers

    What treatment is commonly used for scleritis?

    <p>Systemic corticosteroids</p> Signup and view all the answers

    What is a common sign of dacryostenosis in newborns?

    <p>Excessive tearing without signs of infection</p> Signup and view all the answers

    What common risk factor is associated with retinal detachment?

    <p>Previous eye surgery</p> Signup and view all the answers

    Which treatment is recommended for managing chronic glaucoma?

    <p>Medication to lower intraocular pressure</p> Signup and view all the answers

    Which condition primarily leads to the accumulation of drusen in the eye?

    <p>Age-related macular degeneration</p> Signup and view all the answers

    What is a key distinguishing feature of Acanthamoeba keratitis?

    <p>Contact with fresh water</p> Signup and view all the answers

    What eye condition is characterized by misalignment of the eyes?

    <p>Strabismus</p> Signup and view all the answers

    Which symptom is most commonly associated with corneal ulcers?

    <p>Photophobia</p> Signup and view all the answers

    Which treatment is effective for fungal keratitis caused by contact with plants?

    <p>Oral antifungals</p> Signup and view all the answers

    What visual distortion is characteristic of wet age-related macular degeneration?

    <p>Crooked straight lines</p> Signup and view all the answers

    What is the typical treatment for a vitreous hemorrhage?

    <p>Observation and referral to an ophthalmologist</p> Signup and view all the answers

    What is the most common method for treating cataracts?

    <p>Surgery</p> Signup and view all the answers

    Which condition features sudden, painless, profound vision loss and is classified as a medical emergency?

    <p>Central retinal arterial occlusion</p> Signup and view all the answers

    What is the expected outcome of the Weber test in a patient with conductive hearing loss?

    <p>Sound is heard more in the bad ear</p> Signup and view all the answers

    Which statement is true regarding the treatment of otosclerosis?

    <p>Sodium fluoride and bisphosphonates may be used</p> Signup and view all the answers

    What characterizes sudden sensory-neural hearing loss?

    <p>Rapid onset within 72 hours</p> Signup and view all the answers

    What is a common sign of acoustic neuroma?

    <p>Unilateral sensory-neural hearing loss</p> Signup and view all the answers

    Which condition is characterized by excessive bone growth at the oval window?

    <p>Otosclerosis</p> Signup and view all the answers

    What is the treatment recommendation for autoimmune sensory-neural hearing loss?

    <p>High dose oral steroids</p> Signup and view all the answers

    What symptom is most commonly associated with presbycusis?

    <p>Loss in high frequencies</p> Signup and view all the answers

    Which type of dermatitis is most likely linked to nickel in earrings?

    <p>Contact dermatitis</p> Signup and view all the answers

    What is the common treatment for nasal obstructions caused by benign tumors?

    <p>Surgical excision</p> Signup and view all the answers

    What is the primary demographic at risk for juvenile angiofibroma?

    <p>Young boys</p> Signup and view all the answers

    What risk factor is associated with nasopharyngeal carcinoma?

    <p>Exposure to Epstein-Barr Virus</p> Signup and view all the answers

    Which of the following best describes the treatment approach for malignant nasal tumors?

    <p>Combination of chemotherapy and radiation</p> Signup and view all the answers

    What symptom is a common indicator of advanced malignancies in the nasal region?

    <p>Severe malar hypesthesia</p> Signup and view all the answers

    What is the recommended first-line medication for oral pain management?

    <p>Ibuprofen</p> Signup and view all the answers

    Which condition is treated with epinephrine due to its rapid onset?

    <p>Angioedema</p> Signup and view all the answers

    Which medication is associated with causing gingival hyperplasia?

    <p>Methotrexate</p> Signup and view all the answers

    What is a common symptom indicating the need for a tonsillectomy in children?

    <p>One tonsil larger than the other</p> Signup and view all the answers

    When is antibiotic prophylaxis generally required for patients?

    <p>Most patients do not require it</p> Signup and view all the answers

    Which condition is characterized by being unable to breathe through the nose and may indicate adenoiditis?

    <p>Stuffed up nose</p> Signup and view all the answers

    What is the recommended treatment for Group A beta-hemolytic streptococcal (GABHS) to prevent complications?

    <p>Antibiotics</p> Signup and view all the answers

    Which type of dental erosion is associated with the use of nitrates?

    <p>Chemical erosion</p> Signup and view all the answers

    Which of the following symptoms is most commonly associated with tonsillitis?

    <p>Sore throat</p> Signup and view all the answers

    What is a key characteristic symptom of pharyngitis and its prevalence?

    <p>More prevalent in winter, ages 4-7</p> Signup and view all the answers

    What is the primary treatment for bacterial Gonococcus conjunctivitis?

    <p>IM Ceftriaxone</p> Signup and view all the answers

    Which condition is characterized by eye pain, discharge, and redness?

    <p>Infectious keratitis</p> Signup and view all the answers

    What symptom is primarily associated with allergic conjunctivitis?

    <p>Itchiness</p> Signup and view all the answers

    What is the most common infectious cause of blindness?

    <p>Bacterial Chlamydia Trachomatis</p> Signup and view all the answers

    Which treatment is appropriate for dry eyes (Keratoconjunctivitis Sicca)?

    <p>Artificial tears</p> Signup and view all the answers

    What is a characteristic feature of Pterygium?

    <p>Fleshy triangular growth</p> Signup and view all the answers

    What test is used to measure the rate of production of the aqueous component in tears?

    <p>Schirmer test</p> Signup and view all the answers

    Which of the following is a symptom of Herpes Zoster Ophthalmicus?

    <p>Malaise and fever</p> Signup and view all the answers

    What is usually the treatment for allergies causing conjunctivitis?

    <p>Topical antihistamines</p> Signup and view all the answers

    Which condition may lead to a need for surgical removal due to its growth characteristics?

    <p>Pterygium</p> Signup and view all the answers

    What is a potential complication of hyphema?

    <p>Decreased visual acuity</p> Signup and view all the answers

    Which organism is primarily associated with orbital cellulitis?

    <p>Streptococcus</p> Signup and view all the answers

    What symptom is commonly experienced with conjunctival and corneal foreign bodies?

    <p>Tearing</p> Signup and view all the answers

    What is the first sign of dental caries in children?

    <p>White lines or spots on teeth</p> Signup and view all the answers

    Which treatment is recommended for irreversible pulpitis?

    <p>Root canal or tooth extraction</p> Signup and view all the answers

    What is the primary risk factor associated with oral cancers?

    <p>Tobacco and alcohol use</p> Signup and view all the answers

    How should a periapical abscess be treated?

    <p>Urgent dental referral</p> Signup and view all the answers

    Which condition is characterized by a burning sensation in the mouth and is typically treated with clonazepam?

    <p>Glossodynia</p> Signup and view all the answers

    What is the treatment for a pyogenic granuloma?

    <p>Conservative surgical excision</p> Signup and view all the answers

    What is a common symptom of pericoronitis?

    <p>Localized swelling and pain</p> Signup and view all the answers

    Study Notes

    Ear (External)

    • Antonia refers to the absence of an external ear.
    • Microtia describes a small external ear.
    • Atresia signifies the absence of the ear canal, leading to conductive hearing loss.
    • Clean excessive cerumen in the ear canal using a plastic curette or warm water.
    • Do not flush organic material from the ear canal. If an insect is present, use lidocaine first.
    • Otitis Externa, commonly known as swimmer's ear, presents with ear pain, itching, and sometimes drainage.
    • Treatment for Otitis Externa involves clearing the external ear canal and administering antibiotics if needed.
    • Exostoses, abnormal bone growth within the ear canal, is often referred to as "surfer's ear."
    • Refer patients with exostoses to rule out cholesteatoma.

    Ear (Middle)

    • Eustachian tube dysfunction can cause negative pressure in the middle ear, resulting in a feeling of fullness, popping, or cracking in the ear.
    • Treatment for Eustachian Tube Dysfunction may involve nasal steroids and decongestants.
    • Rule out sudden hearing loss when evaluating Eustachian tube dysfunction.
    • Barotrauma, a consequence of poor eustachian tube function, can occur during airplane descent, rapid altitude changes, or diving.
    • Treatment for Barotrauma includes prophylactic topical decongestants.
    • Acute Otitis Media is an infection of the middle ear space, commonly affecting young children.
    • Viral causes of acute otitis media include RSV, influenza, and adenovirus.
    • Bacterial causes of acute otitis media are primarily S. pneumonia.
    • Diagnosis of acute otitis media requires the presence of purulence.
    • Treatment for Acute Otitis Media involves high-dose amoxicillin.
    • Complications of Acute Otitis Media include perforation, leading to increased pressure in the middle ear, and mastoiditis, where the infection spreads from the middle ear to the mastoid.
    • Otitis Media Effusion refers to fluid in the middle ear space.
    • Fluid in the middle ear space is considered normal for up to 3 months.
    • Tympanostomy tubes may be necessary for Otitis Media Effusion.
    • Acute Otitis Media Effusion treatment may involve tympanocentesis for pressure relief, but this is seldom used.
    • Chronic Otitis Media Effusion is managed with tympanostomy tubes, which spontaneously extrude.
    • Ear drainage indicates proper tube function.
    • Ear pain without drainage suggests tube blockage.
    • Tympanic membrane perforation is typically managed with observation and water precautions. Healing usually occurs within 3 months.
    • Cholesteatoma involves an accumulation of squamous cells in the middle ear.
    • Symptoms of Cholesteatoma include painless drainage and hearing loss.
    • Treatment of Cholesteatoma involves referral for hearing testing.

    Ear (Vestibular)

    • Meclizine is a medication commonly associated with dizziness.
    • Vertigo is an abnormal sensation of movement when none exists.
    • Vestibular neuronitis does not involve sensorineural hearing loss (SNHL).
    • Labyrinthitis is associated with SNHL.
    • Treatment for Vertigo involves benzodiazepines and anticholinergics for two weeks.
    • Meniere's disease presents with vertigo, ear pressure or fullness, tinnitus, and fluctuating hearing loss.
    • Treatment for Meniere's disease includes lipoflavonoid and diuretics.
    • Benign Paroxysmal Positional Vertigo (BPPV) is characterized by transient episodic vertigo.
    • BPPV is caused by canalithiasis, most commonly affecting the posterior semicircular canal.
    • Treatment for BPPV involves canalith repositioning maneuvers.
    • Nystagmus refers to involuntary rhythmic eye movement.
    • Oscillopsia describes the illusion of subtle movement or shimmering.
    • Cupulolithiasis occurs when otolithic debris adheres to the cupula, resulting in persistent and episodic vertigo.
    • Canalithiasis involves clumping of otolithic debris in the endolymph, leading to transient and episodic vertigo.
    • Avoid loud noises in patients with superior semicircular canal dehiscence.

    Eye

    • Hordeolum, commonly known as a stye, is a localized infection or inflammation.
    • External hordeolum affects the eyelid and eyelashes.
    • Internal hordeolum involves the meibomian gland.
    • Staphylococcus aureus is the most common causative organism for hordeolum.
    • Presentation of hordeolum includes eyelid redness, pain, and swelling.
    • Warm compresses are the primary treatment for hordeolum; incision and drainage (I&D) may be needed after 48 hours.
    • Chalazion is a noninfectious obstruction of the meibomian gland.
    • Symptoms of chalazion include a painless, small nodule and a deep cyst inside the lid.
    • Treatment for chalazion involves warm compresses.
    • Blepharitis is an inflammation of the eyelid margins.
    • Blepharitis can be associated with rosacea or seborrheic dermatitis.
    • Staphylococcus blepharitis presents with red-rimmed eyelids, dry scales, and pain.
    • Seborrheic blepharitis is characterized by greasy scales and pruritus.
    • Treatment for blepharitis involves warm compresses.
    • Entropion refers to an inward turning of the lower lid.
    • Entropion can cause corneal excoriation.
    • Treatment for entropion includes lubricants and botox.
    • Ectropion describes an outward turning of the lower lid.
    • Etiology of ectropion includes cranial nerve VII palsy and age-related tissue relaxation.
    • Treatment for ectropion is symptomatic.
    • Most lid tumors are benign.
    • Basal cell carcinoma is the most common malignant lid tumor.
    • Conjunctivitis, the most common eye disease, is more frequently caused by viruses than bacteria.
    • Bacterial conjunctivitis is more common in younger individuals, while viral conjunctivitis is more prevalent in older individuals.
    • Viral conjunctivitis is typically caused by adenovirus, is bilateral, and presents with watery discharge.
    • Treatment for viral conjunctivitis is symptomatic.
    • Herpes simplex virus (HSV) conjunctivitis is unilateral and often associated with lid vesicles.
    • Treatment for HSV conjunctivitis includes antivirals.
    • Bacterial conjunctivitis is often caused by Staphylococcus and presents with purulent discharge, initially unilateral and progressing to bilateral.
    • Presbyopia, a loss of accommodation due to aging, affects the ability to focus on near objects.
    • Myopia or nearsightedness causes focusing in front of the retina.
    • Hyperopia or farsightedness causes focusing behind the retina.
    • Astigmatism results in multiple focal points.
    • Iritis, also known as anterior uveitis, involves inflammation of the iris.
    • Symptoms of iritis include unilateral eye pain, redness, hypopyon (layering of leukocytes), and a ciliary flush.
    • Treatment for iritis requires referral to an ophthalmologist.
    • Intermediate uveitis affects the vitreous cavity.
    • Symptoms of intermediate uveitis include bilateral floaters, blurred vision, and "snowballs."
    • Treatment for intermediate uveitis involves systemic corticosteroids.
    • Posterior uveitis affects the choroid, retina, and vitreous.
    • Symptoms of posterior uveitis include floaters and cells in the vitreous humor.
    • Treatment for posterior uveitis involves systemic corticosteroids.
    • Scleritis is an inflammation of the sclera.
    • Symptoms of scleritis include deep, boring pain, worsened at night, photophobia, and increased pain with ocular movements.
    • Treatment for scleritis varies based on the specific cause.
    • Cataracts, the leading cause of blindness worldwide, are most commonly age-related.
    • Risk factors for cataracts include aging and smoking.
    • Symptoms of cataracts include blurry or ghosting images, and problems with night driving.
    • Congenital cataracts are typically asymptomatic and may involve leukoria (requiring investigation for a tumor).
    • Treatment for cataracts involves surgery.
    • Corneal ulcers are commonly caused by infection.
    • Risk factors for corneal ulcers include prolonged contact lens wear.
    • Symptoms of corneal ulcers include pain, photophobia, tearing, and blurry vision.
    • Treatment for corneal ulcers varies depending on the underlying cause; consider it an emergency.
    • Retinal detachment presents with a sudden onset of unilateral flashes of light, a shower of floaters, a shadow or curtain coming down, and no pain or redness.
    • Treatment for retinal detachment requires urgent referral to an ophthalmologist.
    • Vitreous hemorrhage involves leakage of blood into the vitreous humor.
    • Symptoms of vitreous hemorrhage include sudden vision loss and bleeding within the eye.
    • The eye is not red or painful in cases of vitreous hemorrhage, and the condition is more common unilaterally.
    • Treatment for vitreous hemorrhage requires referral to an ophthalmologist.
    • Age-related macular degeneration (AMD) is the leading cause of permanent vision loss in older adults.
    • AMD is non-reversible and typically affects both eyes.
    • Dry AMD, also known as atrophic or geographic, is the initial stage for all AMD.
    • Dry AMD involves slow, bilateral atrophy, drusen formation, and is treated with oral antioxidants.
    • Wet AMD, also known as neovascular or exudative, consists of new, leaky vessel growth.
    • Symptoms of wet AMD include visual distortions (straight lines appear crooked), gray or green discoloration, and is treated with laser photocoagulation.
    • Central and branch retinal vein occlusions cause painless vision loss, often first noticed upon awakening, and are unilateral.
    • Signs of central and branch retinal vein occlusions include blood and thunder, cotton wool spots, and optic disc swelling.
    • Treatment for central and branch retinal vein occlusions involves referral.
    • Neovascularization is a potential complication of retinal vein occlusions.
    • Central and branch retinal arterial occlusion is a medical emergency.
    • Symptoms of central and branch retinal arterial occlusion include sudden, painless, profound monocular vision loss.
    • Signs of central and branch retinal arterial occlusion include a red fovea ("cherry red spot"), box-car segmentation, and relative afferent pupillary defect (RAPD).
    • Treatment for central and branch retinal arterial occlusion requires referral for assessment, potentially for a stroke.
    • Amaurosis fugax refers to a transient ischemic attack (TIA) affecting the eye.
    • Symptoms of amaurosis fugax include sudden onset of monocular vision loss lasting a few minutes with complete recovery.
    • Thyroid eye disease is associated with hyperthyroidism.
    • Thyroid eye disease involves the accumulation of mucopolysaccharides in extraocular muscles.
    • Symptoms of thyroid eye disease include exophthalmos, lid retraction, and lag.
    • Treatment for thyroid eye disease involves protection and corticosteroids.
    • Orbital cellulitis is an infection of the orbital tissues, typically caused by Streptococcus.
    • Symptoms of orbital cellulitis include tenderness, swelling, and warmth.
    • Treatment for orbital cellulitis involves high-dose broad-spectrum intravenous antibiotics.
    • Preseptal cellulitis is an infection of the eyelid skin.
    • Preseptal cellulitis is usually caused by Staphylococcus.
    • Symptoms of preseptal cellulitis include swelling, decreased ocular motility, pain with eye movements, and proptosis.
    • Treatment for preseptal cellulitis involves antibiotics.
    • Conjunctival and corneal foreign bodies (something in the eye) require a visual acuity test for evaluation.
    • Metabolic corneal foreign bodies, particularly iron, can cause rust rings and should be referred to an ophthalmologist.
    • Treatment for conjunctival and corneal foreign bodies involves removal with a damp cotton-tipped swab or needle.
    • Intraocular foreign bodies require emergency treatment, especially those resulting from grinding equipment.
    • Corneal abrasion follows trauma to the eye.
    • Symptoms of corneal abrasion include severe pain, tearing, a foreign body sensation, and blurry vision.
    • Treatment for corneal abrasion involves the identification of a potential foreign body and eversion of the upper lid.
    • Contusions, also known as closed globe injury, can lead to eyelid ecchymosis ("black eye").
    • Treatment for contusions includes ice packs and hot packs.
    • Globe trauma is a more severe injury involving massive lid edema or laceration.
    • Globe trauma usually requires immediate eye surgery.
    • Hyphema refers to anterior chamber hemorrhage.
    • Hyphema can lead to glaucoma and permanent vision loss.
    • Treatment for hyphema involves bed rest and an eye shield.
    • Subconjunctival hemorrhage is bleeding under the conjunctiva.
    • Causes of subconjunctival hemorrhage include surgery, straining, and vomiting.
    • No treatment is required for subconjunctival hemorrhage.
    • Lens dislocation can result from trauma or some hereditary conditions.
    • Symptoms of lens dislocation include an iris that may quiver and a lens that appears off-center during an eye exam.
    • Treatment for lens dislocation is permanent, involving glasses.
    • Orbital fracture occurs when blunt trauma forces orbital contents through the orbital floor.
    • Symptoms of orbital fracture include diplopia, posterior displacement of the eye, and inferiorly displaced globe.
    • Treatment for orbital fracture requires referral.

    Teeth/Mouth

    • Dental caries are the most common chronic disease of childhood.
    • Dental caries are most prevalent in adolescents aged 12-19.
    • Bacteria metabolize sugars into acid which demineralizes tooth enamel.
    • Saliva buffers acid, promoting remineralization.
    • More frequent sugar consumption reduces remineralization time.
    • Higher cavity risk areas include newly erupted teeth.
    • White lines or spots are the initial sign of demineralized enamel.
    • Dark enamel indicates later stages of demineralization, potentially affecting dentin.
    • Prevention of dental caries involves brushing twice daily and flossing once daily.
    • Fluoride guidelines emphasize topical application.
    • Children under 3 years of age should receive a rice-grain-sized amount of fluoride.
    • Children over 3 years of age should receive a pea-sized amount of fluoride.
    • Periodontitis is most common in adults.
    • Periodontitis is associated with diabetes.
    • HIV-16 DNA is involved in oral cancers.
    • Xerostomia, or dry mouth, is caused by decreased salivary flow.
    • Causes of xerostomia include steroids, antihistamines, diuretics, and opioids.
    • Signs of xerostomia include dry mouth, a burning sensation, changes in taste, and difficulty swallowing.
    • Treatment for xerostomia involves encouraging water intake and avoiding caffeine and sugary drinks.
    • Oral exams should be conducted at each well-child visit.
    • Gingivitis presents with tenderness, mild gum swelling, redness, and bleeding gums.
    • Treatment for gingivitis involves effective brushing and flossing.
    • Periodontitis involves destruction of the periodontal ligament, which can be halted but not reversed.
    • Treatment for periodontitis involves brushing and flossing.
    • Gingival hyperplasia is gingival enlargement, making it challenging to clean teeth.
    • Treatment for gingival hyperplasia includes oral hygiene and regular cleaning.
    • Dental erosion leaves teeth smooth and glassy, exposing the pulp and causing heat or cold sensitivity; it is often associated with reflux or vomiting.
    • Treatment for dental erosion involves rinsing with water after reflux/vomiting and avoiding immediate brushing.
    • Herpes labialis presents with burning, itching, and crusting.
    • Treatment for herpes labialis involves topical or oral antiviral agents.
    • Pyogenic granuloma is an erythematous, non-painful, smooth, lobulated mass that bleeds when touched.
    • Treatment for pyogenic granuloma involves conservative surgical excision.
    • Oral ulcerations are most common in aphthous minor.
    • Symptoms of oral ulcerations include recurring painful ulcers with an erythematous halo.
    • Treatment for oral ulcerations is with a "magic mouthwash."
    • Herpetic stomatitis presents with a burning sensation followed by vesicle rupture on the buccal mucosa (inside the mouth).
    • Treatment for herpetic stomatitis includes antivirals.
    • Necrotizing ulcerative gingivitis is characterized by bleeding and halitosis.
    • Treatment for necrotizing ulcerative gingivitis involves penicillin for 10 days.
    • Geographic tongue is a normal variant.
    • Symptoms of geographic tongue include spicy food sensitivity and waxing and waning of appearance.
    • No treatment is required for geographic tongue.
    • Hairy tongue is asymptomatic and often associated with tobacco use.
    • Glossitis, or a smooth tongue, is linked to nutritional deficiencies, such as iron, B12, and folate.
    • Treatment for glossitis addresses the underlying cause.
    • Glossodynia, also known as burning mouth syndrome, is treated with clonazepam.
    • Fissured tongue is a normal variant and is asymptomatic.
    • Bony tori are benign growths arising from the cortical plate.
    • Treatment for bony tori may involve surgery if needed.
    • Candidiasis is a fungal infection; pseudomembranous candidiasis (thrush) is the most common type.
    • Symptoms of candidiasis include a burning sensation and white or curd patches over red mucosa that can be rubbed off.
    • Treatment for candidiasis involves topical antifungal agents.
    • In adult patients, a workup for HIV should be considered.
    • Lichen planus presents with reticular, white, lacy striations.
    • Treatment for lichen planus includes corticosteroid gels or mouthrinses.
    • Oral hairy leukoplakia, a common early HIV sign, presents as hairy tongue on the lateral sides.
    • Leukoplakia and erythroplakia are premalignant conditions characterized by subtle white patches that progress to ulceration and cannot be rubbed off.
    • Treatment for leukoplakia and erythroplakia involves biopsy after more than 14 days, as they can be cancerous or dysplastic.
    • Oral cancer is usually squamous cell carcinoma.
    • Risk factors for oral cancer include tobacco and alcohol use, as well as HPV infection.
    • Treatment for oral cancer requires biopsy after more than 14 days.
    • Reversible pulpitis causes pain with hot, cold, or sweet stimuli, which resolves after the stimulus is removed.
    • Treatment for reversible pulpitis involves a dental filling.
    • Irreversible pulpitis is associated with severe, persistent pain, sensitive to percussion.
    • Treatment for irreversible pulpitis includes root canal therapy or tooth extraction.
    • Periapical abscess, a purulent form of periapical periodontitis, presents with well-localized pain and drainage from the abscess.
    • Periapical abscess can cause cellulitis.
    • Treatment for periapical abscess involves urgent dental referral.
    • Pericoronitis is an infection of the gum flap overlying partially erupted molars.
    • Treatment for pericoronitis involves irrigation.
    • Periodontal abscess is a deep infection of tooth support structures.
    • Symptoms of periodontal abscess include tooth looseness and sensitivity to touch
    • Treatment for periodontal abscess includes analgesics.
    • Alveolar bone fracture presents with localized tenderness and step-offs in the occlusion of teeth.
    • Treatment for alveolar bone fracture includes imaging with CT and referral to a dentist.
    • Condylar fracture is associated with preauricular swelling and limited ability to open the mouth.
    • Treatment for condylar fracture involves referral.
    • Intrusion of primary teeth should not be removed.
    • Treatment for intrusion of primary teeth involves referral.
    • Luxation is a lateral displacement of a tooth, still within the socket.
    • Treatment for luxation involves dental referral as needed.
    • Avulsion of primary teeth, where the tooth is completely knocked out of the socket, requires referral as needed.
    • Fractures of primary teeth can be classified as follows:
      • Simple crown fracture affects enamel and dentin.
      • Crown fracture with pulp involvement affects enamel, dentin, and pulp, requiring urgent attention.
      • Root fracture requires immediate referral and is often difficult to detect.
    • Intrusion of permanent teeth should not be removed.
    • Treatment for intrusion of permanent teeth requires immediate referral.

    Nose

    • Nasal polyps are benign lesions arising from the middle meatus.
    • Symptoms of nasal polyps include anosmia, soft and painless masses, chronic nasal congestion, and pale, edematous, mucosally covered masses resembling peeled grapes.
    • Nasal polyps arise from chronically inflamed sinonasal mucosa, often affecting the ethmoid sinuses.
    • Children with nasal polyps should be evaluated for cystic fibrosis.
    • Treatment for nasal polyps includes nasal saline irrigations (with added budesonide), intranasal corticosteroids, surgery, and allergy evaluation.
    • Patients with nasal polyps and asthma should avoid aspirin.
    • Referral to an ENT specialist with maxillofacial CT is necessary.
    • Nasal polyps frequently recur.
    • Epistaxis or nosebleeds require airway assessment and cardiovascular stability evaluation.
    • Etiology for epistaxis includes local causes (trauma, nose picking/blowing, surgery, dry air, irritants) and systemic causes (bleeding disorders, hereditary hemorrhagic telangiectasia, drugs, hypertension).
    • The nasal pyramid is the most frequently fractured bone in the body.
    • Anterior epistaxis originates from Kiesselback's plexus or Little's area.
    • Treatment for anterior epistaxis includes observation, anterior pressure, oxymetazoline, packing, and cauterization.
    • Spray anesthetic with decongestant (Afrin) can be used for anterior epistaxis.
    • Cauterization should be performed from outside in.
    • Bilateral cauterization may lead to septal perforation.
    • Nasal packing can involve absorbable gelfoam, vaseline gauze, or Surgicel.
    • Pack only the bleeding side, not both sides.
    • Packing creates a tight seal to hold pressure. Lubricate the packing.
    • Add moisture to expanded packing once placed.
    • Rhino-rocket is inserted horizontally and inflated with air after adding liquid.
    • Anterior epistaxis often results in less frequent and less severe nosebleeds.
    • Posterior epistaxis originates from Woodruff's plexus (venous) or the sphenopalatine artery (more common).
    • Posterior epistaxis is more frequent in older individuals with underlying pathology.
    • Symptoms of posterior epistaxis include bleeding from both nostrils, coughing up clots, and blood in the throat.
    • Posterior epistaxis is more difficult to control and often points to an underlying cause, requiring emergency services.
    • Sinonasal tumors can cause unilateral nasal obstruction, facial pressure, and headache, similar to nasal polyps.
    • Most sinonasal tumors are benign, with 5% to 15% being squamous cell carcinoma.
    • Treatment of sinonasal tumors involves surgical excision (medial maxillectomy).
    • Recurrence rates for sinonasal tumors are high.
    • Juvenile angiofibroma is a slow-growing tumor in young boys, rarely affecting girls, possibly linked to gonadal dysgenesis.
    • Juvenile angiofibroma arises in the posterior nasal cavity and grows into the nasopharynx.
    • Treatment for juvenile angiofibroma involves removal.
    • Malignant tumors of the nose and sinuses are uncommon.
    • Symptoms of malignant tumors include chronic rhinitis/sinusitis, unilateral ear pain, and hearing loss.
    • Nasopharyngeal malignant tumors include:
      • Nasopharyngeal carcinoma (squamous cell) is the most common type of nasopharyngeal cancer.
      • Risk factors for nasopharyngeal carcinoma include adult age, Asian race, and EBV exposure.
      • Adenocarcinoma and adenoid cystic carcinoma are less common types of nasopharyngeal tumors.
      • Risk factors for sinonasal tumors include exposure to wood dust, leather dust, and asbestos.
      • Sinonasal tumors most commonly arise from the ethmoid sinuses.
      • Lymphoma (often T-cell lymphoma) is another type of nasopharyngeal tumor, known as "lethal midline granuloma".
      • Lymphoma presents with significant bleeding and is linked to Epstein-Barr Virus (EBV).
      • Overall cure rates for nasopharyngeal tumors are high.
    • Paranasal sinuses and nasal malignancies include:
      • Squamous cell carcinoma often originates in the maxillary antrum.
      • Other paranasal sinus and nasal malignancies include lymphoma.
      • Advanced symptoms of paranasal sinus and nasal malignancies include proptosis, expansion of the cheek, ill-fitting maxillary dentures, severe pain, and malar hypesthesia (involving the infraorbital nerve).
      • Smoking is a risk factor for paranasal sinus and nasal malignancies.
      • Lower cure rates are associated with involvement of the base of the skull.
    • Diagnostics for nasopharyngeal tumors include CT and MRI.
    • Treatment for nasopharyngeal tumors depends on the tumor type and extent and may involve chemotherapy or radiation.

    Ear

    • Antonia: Absent external ear
    • Microtia: Small external ear
    • Atresia: Agenesis of the ear canal leading to conductive hearing loss
    • Ear Canal:
      • Excessive Cerumen: Removal with plastic curette or warm water
      • Foreign Bodies: Do not flush organic material, use Lidocaine for insects
    • Otitis Externa (Swimmer's Ear):
      • Ear pain, itching, and sometimes drainage
      • Treat: Clear the external ear canal and administer antibiotics if needed
    • Exostoses (Surfers Ear): Abnormal growth of bone within the ear canal
      • Refer to rule out cholesteatoma

    Middle Ear

    • Eustachian Tube Dysfunction: May result in negative pressure in the middle ear
      • Sense of fullness in the ear, "popping" or "cracking" sounds
      • Treat: Consider nasal steroids and decongestants
      • Rule out sudden hearing loss
    • Barotrauma: Consequence of poor eustachian tube function
      • Occurs during airplane descent, rapid altitude changes, and diving
      • Treat: Topical decongestants prophylactically
    • Acute Otitis Media: Infection of the middle ear space
      • Most common in young children
      • Viral infections: RSV, influenza, adenovirus
      • Bacterial infection: S. pneumonia
      • Requires purulence for diagnosis
      • Treat: Amoxicillin in high doses
      • Complications:
        • Perforation: Increased pressure in the middle ear
        • Mastoiditis: Infection spreads from the middle ear to the mastoid bone
    • Otitis Media Effusion: Fluid in the middle ear space
      • Normal for up to 3 months
      • Consider tubes if needed
      • Treat:
        • Acute: Tympanocentesis may relieve pressure but is rarely used
        • Chronic: Tympanostomy tubes are inserted and spontaneously extrude. Ear drainage is a good sign. Ear pain without drainage suggests blockage
    • Tympanic Membrane Perforation: Observation is usually sufficient, should heal within 3 months
      • Strict water precautions
    • Cholesteatoma: Accumulation of squamous cells in the middle ear
      • Painless drainage and hearing loss are common
      • Treat: Hearing test and referral

    Vestibular Ear

    • Meclizine: A medication often causing dizziness
    • Vertigo: Abnormal sensation of movement when none exists
      • Vestibular Neuronitis: Not associated with sensorineural hearing loss (SNHL)
      • Labyrinthitis: Associated with SNHL
      • Treat: Benzodiazepines and anticholinergics for 2 weeks
    • Meniere's Disease:
      • Vertigo, ear pressure/fullness, tinnitus, and fluctuant hearing loss
      • Treat: Lipoflavonoids and diuretics
    • Benign Paroxysmal Positional Vertigo (BPPV): Transient episodic vertigo
      • Caused by canalithiasis, most commonly in the posterior semicircular canal
      • Treat: Canalith repositioning maneuvers
    • Nystagmus: Involuntary rhythmic eye movement
    • Oscillopsia: Illusion of subtle movement or shimmering
    • Cupulolithiasis: Otolithic debris adheres to the cupula
      • Persistent and episodic vertigo
    • Canalithiasis: Clumping of otolithic debris in the endolymph
      • Transient and episodic vertigo
    • Superior Semicircular Canal Dehiscence: Avoid loud noises

    Eye

    • Hordeolum (Stye): Localized infection/inflammation
      • External: Eyelid/eyelashes
      • Internal: Meibomian gland
      • Most common cause: Staphylococcus aureus
      • Presentation: Eyelid redness, pain, and swelling
      • Treat: Warm compress. If symptoms persist for over 48 hours, consider incision and drainage (I&D)
    • Chalazion: Noninfectious obstruction of the meibomian gland
      • Painless, small nodule, deep cyst inside the eyelid
      • Treat: Warm compress
    • Blepharitis: Inflammation of the eyelid margins
      • Associated with rosacea or seborrheic dermatitis
      • Staph: Red-rimmed/dry scales, painful
      • Seborrhea: Greasy scales and pruritic
      • Treatment: Warm compress
    • Entropion: Inward turning of the lower eyelid → corneal excoriation
      • Treat: Lubricants and Botox
    • Ectropion: Outward turning of the lower eyelid
      • Etiology: Cranial nerve VII palsy and age-related tissue relaxation
      • Treat: Symptomatically
    • Lid Tumors: Most are benign
      • Basal cell carcinoma is the most common malignant tumor
    • Conjunctivitis: Most common eye disease
      • Viral is more common than bacterial
        • Younger patients: More likely to have bacterial conjunctivitis
        • Older patients: More likely to have viral conjunctivitis
      • Viral: Adenovirus, bilateral disease, watery discharge
        • Treat: Symptomatically
        • Consider Herpes Simplex Virus (HSV): Unilateral with lid vesicles; treat with antivirals
      • Bacterial: Staphylococcus aureus most commonly, purulent discharge, starts unilateral then bilateral. Eye is stuck shut
        • Treat: Antibiotics if needed, usually self-limited
        • Gonococcal conjunctivitis: Copious discharge, usually from genital secretions - EMERGENCY - Treat: IM Ceftriaxone
        • Chlamydial conjunctivitis (Trachomatis): Most common infectious cause of blindness. Treat: Oral antibiotics
    • Allergic Conjunctivitis: Itchiness
      • Vernal conjunctivitis: Cobblestone papilla
      • Treat: Topical antihistamines
    • Dry Eyes (Keratoconjunctivitis Sicca): Inadequate tear production or accelerated tear evaporation
      • Symptoms: Bilateral dryness, gritty/sandy sensation, and eye strain
      • Schirmer Test: Measures the rate of aqueous component production
      • Treat: Artificial Tears
    • Pinguecula: Raised yellowish white mass, rarely needs to be removed
    • Pterygium: Fleshy triangular growth, removal is often indicated
    • Infectious Keratitis: Infection of the cornea
      • Signs: Eye pain, discharge, and eye redness
      • Treat: High concentration topical antibiotic drops, ER referral
      • Herpes Simplex Keratitis: Corneal ulceration, dendritic branching
        • Treat: Antivirals
      • Herpes Zoster Ophthalmicus: Involves the trigeminal nerve
        • Malaise, fever, Hutchinson's sign
        • Treat: Oral antivirals
      • Fungal Keratitis: Contact with plants. Presents with satellite lesions
      • Acanthamoeba Keratitis: Fresh water and hot tubs
        • Perineural and ring infiltrates
        • Treat: Long-term intensive topical biguanide/diamidine therapy
    • Dacryoadenitis: Inflammation of the lacrimal gland
      • Usually occurs in children due to viral infection
      • “S” Shaped lid deformity
      • Treat: Symptomatically
    • Dacryostenosis: Nasolacrimal duct obstruction
      • Common in newborns and infants
      • Lack signs of infection
      • Treat: Gently massage downward
    • Dacryocystitis: Inflammation of the lacrimal sac
      • Commonly caused by obstruction
      • Usually due to Streptococcus or Staphylococcus
      • Treat: Systemic antibiotics
      • Adults: Commonly occurs in postmenopausal women
    • Glaucoma: Damage to the optic nerve due to high intraocular pressure
      • Acute Angle Closure Glaucoma: Physically obstructed anterior chamber
        • Primary: Preexisting
        • Secondary: No preexisting condition
        • Symptoms: Rapid onset, extreme pain, halos and lights, nausea, vomiting
        • Exam: Hard eye, dilated and nonreactive pupil
        • Treat: Immediate ophthalmology referral to reduce IOP
          • IV acetazolamide
      • Chronic Glaucoma: Irreversible cupping of the optic disc
        • Risk factors: Black race, older age, nearsightedness, diabetes
          • Chronic open angle glaucoma: Most common
          • Chronic angle closure glaucoma: Flow of fluid into the anterior chamber is obstructed
        • Signs: Tunnel vision
        • Treat: Medications to lower IOP
          • Prostaglandins are preferred
    • Strabismus: Misalignment of eyes "cross eyes"
      • Tropia: Constant misalignment
      • Phoria: Intermittent misalignment
      • Pseudostrabismus: NORMAL in children
      • Treat: Patching and contact lenses/eyeglasses
    • Amblyopia: Lazy eye
      • Preventable if treated
      • The eye does not match the brain, so the brain suppresses the image from one eye to prevent double vision. Surgery is often required to correct this condition.

    Nose

    • Nasal Septal Hematoma: Uncommon, secondary to nasal or septal fracture
      • Treat: Drainage within 24 hours, nasal packing if needed
      • Risks: Infection, sepsis, and cartilage death
    • Nasal Foreign Body: Common in young children and disabled adults
      • Most are inorganic (paper, duct tape, beads)
      • Inorganic/Porous/Organic material causes unilateral, purulent, and foul-smelling drainage with an inflamed nasal vestibule
      • Treat: Removal of FB
        • Urgent: Removal of button batteries and paired magnets across the septum
        • ENT consultation for deep, impacted, or penetrating FB
        • Early and inorganic: Positive pressure, curved hook, balloon extractor
        • Later: ENT consultation with or without oral antibiotics
    • Septal Perforation: Consider past drug use (cocaine), consider rhinitis medicamentosa
      • Systemic disease may be a consideration in children. Ask patients "Have you ever taken drugs through your nose?"
      • Symptoms: Increased nasal sound, nasal dryness, and epistaxis
      • Treatment: Increasing nasal moisture, nasal button, reconstruction with limited success
    • Inverted Papilloma (Schneiderian Papilloma):
      • Signs: Unilateral and flesh-colored, typically located on the lateral nasal wall and middle meatus
      • Very uncommon, likely caused by HPV virus
      • Findings: Unilateral nasal obstruction, facial pressure, headache, similar to nasal polyps
      • Mostly benign: 5-15% are squamous cell carcinoma
      • Treat: Surgical excision (medial maxillectomy)
      • High recurrence rates
    • Juvenile Angiofibroma: Slow-growing tumor in young boys, uncommon
      • Posterior nasal cavity, growing into the nasopharynx
      • In girls, it may indicate gonadal dysgenesis
      • Treat: Removal

    Malignant Tumors

    • VERY RARE
    • Symptoms: Chronic rhinitis/sinusitis, unilateral ear pain, and hearing loss
    • Nasopharyngeal Malignant Tumors
      • Nasopharyngeal Carcinoma (Squamous Cell): Most common cancer of the nasopharynx
        • Risk factors: Adult, race (Asians), EBV exposure
      • Adenocarcinoma/Adenoid Cystic Carcinoma: Less common
        • Sinonasal tumors
        • Risk factors: Wood dust, leather dust, asbestos
          • Most commonly from ethmoid sinuses
      • Lymphoma ("Lethal Midline Granuloma"): Most commonly T-cell lymphoma
        • Bleeds quite a bit, associated with Epstein-Barr Virus
      • Overall high cure rates
    • Paranasal Sinuses and Nasal Malignancies
      • Squamous Cell Carcinoma: Maxillary Antrum (epicenter)
      • Lymphoma
      • Symptoms (Advanced): Proptosis, expansion of the cheek, ill-fitting maxillary dentures, severe pain, malar hypesthesia (infraorbital nerve is involved).
      • Risk Factor: Smoking
        • Treatment has a higher success rate if the base of the skull is NOT involved
        • Lower cure rates
    • Diagnostics: CT and MRI
    • Treatment: Depends on tumor type and extent (chemotherapy/radiation therapy)

    Eye Conditions

    • Presbyopia: Age-related loss of accommodation, making it difficult to focus on near objects.
    • Myopia: Nearsightedness; light focuses in front of the retina.
    • Hyperopia: Farsightedness; light focuses behind the retina.
    • Astigmatism: Multiple focal points, resulting in blurred vision at all distances.
    • Iritis (anterior uveitis): Inflammation of the iris, characterized by unilateral eye pain, redness, and potential hypopyon (layering of leukocytes). Treatment requires referral to an ophthalmologist.
    • Uveitis Intermediate: Inflammation of the vitreous cavity, resulting in bilateral floaters and blurred vision. Treatment involves systemic corticosteroids.
    • Uveitis Posterior: Inflammation of the choroid, retina, and vitreous, manifesting as floaters and cells in the vitreous humor. Systemic corticosteroids are indicated for treatment.
    • Scleritis: Inflammation of the sclera, causing deep boring pain, worsened at night, and photophobia. Pain increases with ocular movements. Treatment varies depending on the cause.
    • Cataracts: Leading cause of blindness worldwide, most commonly age-related. Risk factors include aging and smoking. Symptoms include blurry vision, ghosting images, and difficulty with night driving. Treatment involves surgery.
    • Corneal Ulcers: Often caused by infection, particularly in extended contact lens wearers. Symptoms include pain, photophobia, tearing, and blurry vision. Treatment varies depending on the cause but requires emergency attention.
    • Retinal Detachment: Sudden onset of flashes of light, a shower of floaters, a shadow or curtain descending, and no pain or redness. Urgent referral to an ophthalmologist is crucial.
    • Vitreous Hemorrhage: Leakage of blood into the vitreous humor, resulting in sudden vision loss and bleeding within the eye. The eye is typically not red or painful, and the red reflex is diminished or absent. Referral to an ophthalmologist is necessary.
    • Age-Related Macular Degeneration (AMD): Leading cause of permanent vision loss in the elderly.
      • Dry AMD: Atrophic/geographic degeneration that progresses bilaterally.
        • Characterized by drusen (yellow deposits) and gradual vision loss.
        • Treatment: oral antioxidants.
      • Wet AMD: Neovascular/exudative degeneration, characterized by new leaky vessel growth. Manifests as visual distortion (straight lines appear crooked), gray/green discoloration, and rapid vision loss.
        • Treatment: Laser photocoagulation.
    • Central and Branch Retinal Vein Occlusions: Painless vision loss, often noticed upon waking.
      • Characterized by blood and thunder appearances (haemorrhages), cotton wool spots, and optic disc swelling.
      • Treatment involves referral to an ophthalmologist, as neovascularization is a potential complication.
    • Central and Branch Retinal Artery Occlusions: MEDICAL EMERGENCY! Sudden painless, profound monocular vision loss.
      • Characterized by a red fovea (cherry red spot), box-car segmentation, and relative afferent pupillary defect (RAPD).
      • Diagnostic tools include Doppler ultrasonography.
      • Treatment requires immediate referral to assess for a stroke.
    • Amaurosis Fugax: Transient ischemic attack of the eye resulting in sudden monocular vision loss that typically lasts a few minutes. Full recovery occurs.
      • May be treated with glasses, surgery, or medication for underlying disorders.
    • Thyroid Eye Disease: Caused by hyperthyroidism, resulting in mucopolysaccharide buildup in the extraocular muscles.
      • Symptoms include exophthalmos (protruding eyes), lid retraction, and lag.
      • Treatment focuses on protection and corticosteroids.
    • Orbital Cellulitis: Infection of the orbital tissues, commonly caused by Streptococcus bacteria.
      • Manifests as tenderness, swelling, warmth, and potential proptosis (protruding eye).
      • Requires high-dose broad-spectrum intravenous antibiotics.
    • Preseptal Cellulitis: Infection of the eyelid surrounding skin, usually caused by Staphylococcus bacteria.
      • Characterized by swelling, decreased ocular motility, pain with eye movements, and possible proptosis.
      • Treated with antibiotics.
    • Conjunctival & Corneal Foreign Bodies: Objects in the eye.
      • Assessment includes visual acuity testing.
      • Metabolic foreign bodies, particularly iron, can cause a rust ring and require referral to an ophthalmologist.
      • Treatment involves removal using a damp, cotton-tipped swab or needle.
    • Intraocular Foreign Body: Foreign object embedded within the eye. Requires emergency treatment.
    • Corneal Abrasion: Caused by trauma to the eye.
      • Symptoms include severe pain, tearing, foreign body sensation, and blurry vision.
      • Examination involves everting the upper eyelid to look for a foreign body.
    • Contusions: Closed globe injury.
      • Characterized by eyelid ecchymosis (black eye).
      • Treat with ice packs and hot packs.
    • Globe Trauma: Massive eyelid edema or laceration, often requiring immediate eye surgery.
    • Hyphema: Anterior chamber hemorrhage.
      • May lead to glaucoma and permanent vision loss.
      • Treatment: bed rest and an eye shield.
    • Subconjunctival Hemorrhage: Bleeding under the conjunctiva, often caused by surgery, straining, or vomiting.
      • Treatment is typically not required.
    • Lens Dislocation: Caused by trauma or certain hereditary conditions.
      • Symptoms: iris may quiver, lens appears off-center on exam.
      • Treatment: permanent corrective lenses (glasses).
    • Orbital Fracture: Blunt trauma forces orbital contents through the orbital floor.
      • Symptoms include diplopia (double vision), posterior displacement of the eye, and inferiorly displaced globe.
      • Treatment involves referral to a specialist.

    Teeth/Mouth

    • Dental Caries
      • Most common chronic disease of childhood, particularly in adolescents ages 12-19.
      • Bacteria metabolize sugars, producing acid that demineralizes tooth enamel.
      • Remineralization occurs when saliva buffers the acid; frequent sugar consumption limits remineralization time.
      • Higher cavity risk areas include newly erupted teeth.
      • First signs of demineralized enamel include white lines or spots, typically affecting upper front teeth.
      • Dark dentin indicates later stages of demineralization.
      • Prevention includes twice-daily brushing, once-daily flossing, and fluoride use:
        • Less than age 3: rice-grain sized amount of fluoride toothpaste
        • Older than age 3: pea-sized amount of fluoride toothpaste
    • Periodontitis:
      • More common in adults.
      • Associated with diabetes.
      • Destruction of the periodontal ligament, but can be halted with proper treatment.
    • HIV 16 DNA: Implicated in oral cancers.
    • Xerostomia: Dry mouth due to decreased saliva flow.
      • Can be caused by medications such as steroids, antihistamines, diuretics, and opioids.
      • Symptoms include dry mouth, burning sensation, changes in taste, and difficulty swallowing.
      • Treatment involves encouraging water consumption and avoiding caffeine and sugary drinks.
    • Oral Exams: Should be performed at every well-child visit.
    • Gingivitis: Tenderness, mild gum swelling, redness, and bleeding gums.
      • Treatment involves effective brushing and flossing.
    • Periodontitis: Destruction of the periodontal ligament.
      • Cannot be reversed but can be halted with proper treatment.
      • Treatment includes brushing, flossing, and other measures.
    • Gingival Hyperplasia: Gingival enlargement, making teeth difficult to clean.
      • Treatment involves oral hygiene and regular cleanings.
    • Dental Erosion: Smooth, glassy teeth with pulp exposure, causing heat/cold sensitivity.
      • Treatment includes rinsing with water after reflux/vomiting and avoiding immediate brushing after these events.
    • Herpes Labialis: Burning, itching, and crusting around the mouth.
      • Treated with topical or oral antiviral agents.
    • Pyogenic Granuloma: Erythematous, non-painful, smooth, lobulated mass that bleeds when touched.
      • Treatment: conservative surgical excision.
    • Oral Ulcerations: Most common is aphthous minor, characterized by recurring painful ulcers with an erythematous halo.
      • Treatment: Magic mouthwash.
    • Herpetic Stomatitis: Initial burning sensation followed by vesicle rupture on buccal mucosa (inside mouth).
      • Treatment: antivirals.
    • Necrotizing Ulcerative Gingivitis: Bleeding and halitosis.
      • Treatment: penicillin for 10 days.
    • Geographic Tongue: Normal variant, characterized by spicy food sensitivities.
      • Waxes and wanes.
      • No treatment needed.
    • Hairy Tongue: Asymptomatic and often associated with tobacco use.
    • Glossitis: Smooth tongue.
      • Can be caused by nutritional deficiencies such as iron, B12, and folate.
      • Treatment involves addressing the underlying cause.
    • Glossodynia: Burning mouth syndrome.
      • Treatment: clonazepam.
    • Fissured Tongue: Normal variant, asymptomatic.
    • Bony Tori: Benign growth arising from the cortical plate.
      • Treatment: surgery if necessary.
    • Candidiasis: Fungal infection, often pseudomembranous candidiasis (thrush), characterized by burning sensation and white/curd patches over red mucosa.
      • Treatment: topical antifungal agents.
        • In adults, workup for HIV is indicated.
    • Lichen Planus: Reticular white lacy striations.
      • Treatment: corticosteroid gels or mouth rinses.
    • Oral Hairy Leukoplakia: Hairy tongue appearance on the lateral sides.
      • Common early sign of HIV infection.
    • Leukoplakia and Erythroplakia: Premalignant conditions characterized by subtle white patches that progress to ulcers.
      • Cannot be rubbed off.
      • Treatment: biopsy after 14 days as they can be carcinoma or dysplasia.
    • Oral Cancer: Typically squamous cell carcinoma.
      • Risk factors include tobacco and alcohol use, and HPV infection.
      • Treatment involves biopsy after 14 days.
    • Reversible Pulpitis: Pain with hot, cold, or sweet stimuli that resolves once the stimulus is removed."
      • Treatment: dental filling.
    • Irreversible Pulpitis: Severe and persistent pain, sensitive to percussion, that does not resolve with removal of stimulus.
      • Treatment: root canal or tooth extraction.
    • Periapical Abscess: Purulent form of periapical periodontitis, characterized by localized pain and drainage.
      • Can cause cellulitis.
      • Treatment: urgent dental referral.
    • Pericoronitis: Infection of the gum flap overlying partially erupted molars.
      • Treatment: irrigation.
    • Periodontal Abscess: Deep infection of tooth support structures.
      • Tooth is loose and sensitive to touch.
      • Treatment focuses on pain relief.
    • Alveolar Bone Fracture: Localized tenderness and step-offs in teeth occlusion.
      • Treatment: CT imaging and referral to a dentist.
    • Condylar Fracture: Preauricular swelling and limited ability to open the mouth.
      • Treatment: referral to a specialist.
    • Intrusion of Primary Teeth: Do not remove the tooth.
      • Treatment: referral to a specialist.
    • Luxation: Lateral displacement of a tooth still in the socket.
      • Treatment: dental referral as needed.
    • Avulsion of Primary Teeth: Tooth is completely knocked out of the socket.
      • Treatment: referral as needed.
    • Fractures of Primary Teeth:
      • Simple crown fracture: Enamel and dentin involvement.
      • Crown fracture with pulp involvement: Enamel, dentin, and pulp involvement. Urgent referral needed.
      • Root fracture: Referral to a specialist (often difficult to detect).
    • Intrusion of Permanent Teeth: Do not attempt to remove the tooth.
      • Treatment: immediate referral to a specialist.
    • Avulsion of Permanent Teeth: Tooth is completely knocked out of the socket.
      • TRUE DENTAL EMERGENCY! Do not touch the root of the tooth.
    • Medication Effects:
      • Gingival hyperplasia: Can be caused by anticonvulsants, methotrexate, and cyclosporine.
      • Dental erosion: Can be caused by progesterone and nitrates.
      • Osteonecrosis: Can be caused by bisphosphonates.
      • Dental caries: Can be caused by sugary preparations.
    • Antibiotic Prophylaxis: Most patients do not require this.
    • Oral Pain: First-line treatment is NSAIDs.

    Throat

    • Tonsillitis: Bacterial infection of the tonsils, causing congestion.
      • Indications for tonsillectomy:
        • Recurrent infections (more than 7 episodes per year)
        • Sleep apnea
        • Gagging
        • One tonsil significantly larger than the other
        • Bad breath
    • Adenoiditis: Inflammation of the adenoids, leading to a "junky nose" sensation.
      • Symptoms include inability to breathe through the nose, feeling or appearing unwell, and cervical lymphadenopathy.
      • Physical signs include a long face, gummy smile, dry lower lip, and mouth breathing.
      • Indications for adenoidectomy:
        • Recurrent adenoiditis
        • Sinusitis
        • Persistent middle ear fluid
        • Sleep apnea
    • Pharyngitis: Inflammation of the pharynx, more common in winter and in children ages 4-7. Viral causes are more common than bacterial.
      • Possible causes include:
        • Streptococcal bacteria
        • Herpes/coxsackievirus
        • Oral Candida
        • Group A Beta-hemolytic Streptococcus (GABHS)
      • Treatment of GABHS is indicated to prevent sequelae.
      • Symptoms include sore throat, dysphagia (difficulty swallowing), fever, malaise (general feeling of discomfort), headache, and vomiting (particularly in children).
      • Differentiate from upper respiratory tract infection (URI) symptoms.
    • Nasal Septal Hematoma: Uncommon and usually secondary to nasal/septal fracture.
      • Requires drainage within 24 hours and potentially nasal packing.
      • Risks of untreated hematoma include infection, sepsis, and cartilage death.
    • Nasal Foreign Body: Common in young children and disabled adults.
      • Most are inorganic (paper, duct tape, beads, etc).
      • Inorganic, porous, or organic material can cause unilateral, purulent, foul-smelling drainage.
      • Treatment involves removal of the foreign body.
      • Urgent removal is required for button batteries and paired magnets across the septum.
      • Deep, impacted, or penetrating foreign bodies require ENT consultation.
      • Early removal (inorganic materials) can be attempted with positive pressure, a curved hook, or balloon extractor.
      • Removal in later stages may involve ENT consultation with or without oral antibiotics.
    • Septal Perforation: Can be caused by drug use (cocaine), rhinitis medicamentosa, or systemic disease (in children).
      • Symptoms: increased nasal sound, nasal dryness, and epistaxis.
      • Treatment: increase nasal moisture, nasal button, or limited reconstruction.
    • Inverted Papilloma (Schneiderian Papilloma):
      • Uncommon and often HPV associated.
      • Signs: Unilateral, flesh-colored, typically located on the lateral nasal wall and middle meatus.
      • Symptoms: Unilateral nasal obstruction, facial pressure, headache, and are similar to a nasal polyp.
      • Mostly benign, but 5-15% are squamous cell carcinoma.
      • Treatment: Surgical excision (medial maxillectomy).
      • High recurrence rates.
    • Juvenile Angiofibroma: Slow-growing tumor in young boys.
      • Uncommon.
      • Location: Posterior nasal cavity, often extending into the nasopharynx.
      • In girls: may be associated with gonadal dysgenesis.
      • Treatment: removal.
    • Malignant Tumors: Very rare.
      • Symptoms: Chronic rhinitis or sinusitis, unilateral ear pain, and hearing loss.
      • Nasopharyngeal Malignant Tumors:
        • Nasopharyngeal Carcinoma (squamous cell):
          • Most common cancer of the nasopharynx.
          • Risk factors include being an adult, Asian race, and EBV exposure.
        • Adenocarcinoma/Adenoid Cystic Carcinoma (less common):
          • Sinonasal tumors.
          • Risk factors: wood dust, leather dust, asbestos.
          • Most likely to originate in the ethmoid sinuses.
        • Lymphoma ("Lethal Midline Granuloma"):
          • Most commonly, T-cell lymphoma.
          • Heavy bleeding occurs, associated with Epstein-Barr Virus.
      • Overall, nasopharyngeal malignant tumors have high cure rates.
      • Paranasal Sinuses and Nasal Malignancies:
        • Squamous cell carcinoma: Most common in the maxillary antrum.
        • Lymphoma.
        • Symptoms in advanced stages:
          • Proptosis (protruding eye)
          • Expansion of the cheek
          • Ill-fitting maxillary dentures
          • Severe pain
          • Malar hypesthesia (infraorbital nerve involvement)
        • Risk Factors: Smoking.
        • Treatment: higher cure rates if the base of the skull is not involved. Lower cure rates if the base is involved.
      • Diagnostics: CT and MRI.
      • Treatment: Dependent on the tumor type and extent. Includes chemotherapy and radiation therapy.

    Ear (Hearing)

    • Conductive Hearing Loss: Dysfunction of the external auditory canal, ossicles, or tympanic membrane
    • Sensory-Neural Hearing Loss: Dysfunction of the cochlea or neural components
    • Mixed Hearing Loss: Both conductive and sensory-neural hearing loss
    • Weber Test: Tuning fork on the center of the forehead
      • Normal: Sound is heard equally in both ears
      • Conductive Hearing Loss: Sound is louder in the affected ear
      • Sensory-Neural Hearing Loss: Sound is louder in the unaffected ear
    • Rinne Test: Tuning fork on the mastoid bone, then moved to the shoulder
      • Normal: Air conduction is greater than bone conduction (AC>BC)
      • Conductive Hearing Loss: Air conduction is equal to or less than bone conduction (AC=BC or BC>AC)
      • Sensory-Neural Hearing Loss: Air conduction is greater than bone conduction (AC>BC)
    • Middle Ear Effusions and Conductive Hearing Loss
      • Tympanic membrane is non-mobile
      • Treatment: Observation for 3 months, antihistamines and oral steroids are not effective
    • Otosclerosis: Stapes loses mobility due to excessive bony growth at the oval window
      • Cause: Increased osteoblastic and osteoclastic activity with vascular proliferation
      • Location: Anterior stapes footplate
      • Presentation: Progressive, bilateral conductive hearing loss
      • Treatment: Refer to ENT
        • Medications: Sodium fluoride and bisphosphonates
    • Sudden Sensory-Neural Hearing Loss: Rapid onset within 72 hours, typically involves one ear
      • Risk factors: Viral infection and environmental allergies
      • Treatment: Refer ASAP, prescribe high dose oral steroids
    • Acoustic Neuroma: Schwann cell derived tumors of the vestibular portion of CN VIII (vestibulocochlear nerve)
      • Risk factors: Neurofibromatosis
      • Signs: Unilateral sensory-neural hearing loss, tinnitus, balance problems
      • Examination: CN VII asymmetry in large tumors
      • Treatment: Observation, high dose oral steroids, surgical resection
    • Hereditary SNHL: Unknown origin
      • Syndromic findings: Typically symmetric SNHL
      • Non-syndromic findings: Cookie-bite and U-shaped configurations on audiogram
      • Treatment: Amplification
    • Autoimmune SNHL: Associated with rheumatoid arthritis and systemic lupus erythematosus (SLE)
      • Presentation: Often bilateral and progressive
      • Treatment: Refer to ENT, corticosteroids
    • Presbycusis: Age-related sensory-neural hearing loss
      • Cause: Loss of hair cells at the basal turn of the cochlea
      • Treatment: Amplification
    • Acoustic Noise Trauma: Second most common cause of sensory-neural hearing loss
      • Presentation: Loss typically begins in high frequencies
      • Treatment: Noise and hearing protection
    • Tinnitus: Ringing, buzzing, or roaring noises
    • Hyperacusis: Excessive sound sensitivity
      • Worsened by stress, anxiety, fatigue, caffeine, aspirin, and ibuprofen
      • Treatment: Amplification, antidepressants

    Ear (External)

    • Seborrheic Dermatitis: Scaling and erythema, usually affecting the auricular fold
      • Risk: May predispose to cellulitis
    • Psoriasis: Scaly silver plaques
    • Atopic Dermatitis: Prominent excoriation
    • Contact Dermatitis: Due to irritants (e.g., nickel in earrings)
    • Skin Cancer: Squamous cell carcinoma most common
      • Lack of subcutaneous tissue in the pinna should be considered
    • Cellulitis: Infection of the pinna, most commonly caused by staphylococcus
    • Perichondritis: Inflammation of the perichondrium, most commonly caused by Pseudomonas
    • Relapsing Polychondritis: Rheumatologic disorder affecting the tracheobronchial tree
      • Treatment: Steroids
    • Epidermoid Cyst: Proliferation of epidermal cells, usually benign
    • External Ear Trauma: Common in wrestlers
      • Prompt drainage required to prevent cauliflower ear
        • Needle drainage within 6 hours
        • Incision up to 7 days
    • Congenital Malformations: Referral early is essential

    Eye

    • Presbyopia: Loss of accommodation due to aging
    • Myopia: Nearsightedness, focusing in front of the retina
    • Hyperopia: Farsightedness, focusing behind the retina
    • Astigmatism: Multiple focal points
    • Iritis (Anterior Uveitis): Inflammation of the iris
      • Presentation: Unilateral eye pain, redness
        • Hypopyon: Layering of leukocytes
        • Ciliary flush
      • Treatment: Refer to ophthalmologist
    • Uveitis Intermediate: Inflammation of the vitreous cavity
      • Presentation: Bilateral, bilateral floaters, blurred vision, "snowballs"
      • Treatment: Systemic corticosteroids
    • Uveitis Posterior: Inflammation of the choroid, retina, and vitreous
      • Presentation: Floaters, cells in the vitreous humor
      • Treatment: Systemic corticosteroids
    • Scleritis: Inflammation of the sclera
      • Presentation: Deep boring pain, worse at night, photophobia, increased pain with ocular movements
      • Treatment: Varies
    • Cataracts: Leading cause of world blindness
      • Most common cause: Age-related
      • Risk factors: Aging, smoking
      • Presentation: Blurry vision, ghosting images, image problems with night driving
        • Congenital cataracts: Asymptomatic, leukocoria (rule out tumor)
      • Treatment: Surgery
    • Corneal Ulcers: Most commonly caused by infection
      • Risk factor: Extended contact lens wear
      • Presentation: Pain, photophobia, tearing
      • Treatment: Varies based on cause, EMERGENCY
    • Retinal Detachment: Separation of the retina from the underlying choroid
      • Presentation: Unilateral, sudden flashes of light, shower of floaters, shadow or curtain coming down (no pain or redness)
      • Treatment: Urgent referral to ophthalmologist
    • Vitreous Hemorrhage: Leakage of blood into the vitreous humor
      • Presentation: Sudden vision loss, bleeding within the eye (eye is not red/painful, unilateral is more common, red reflex diminished or absent)
      • Treatment: Refer to ophthalmologist
    • Age-Related Macular Degeneration: Leading cause of permanent vision loss in the elderly
      • Non-reversible, bilateral
        • Dry AMD: Atrophic/geographic (all AMD starts as dry)
          • Presentation: Progressive, bilateral atrophy, drusen
          • Treatment: Oral antioxidants
        • Wet AMD: Neovascular/exudative
          • Presentation: New leaky vessel growth, visual distortion (straight lines appear crooked), gray/green discoloration
          • Treatment: Laser photocoagulation
    • Central and Branch Retinal Vein Occlusions:
      • Presentation: Painless vision loss (first noticed upon waking), unilateral, "blood and thunder" appearance, cotton wool spots, optic disc swelling
      • Treatment: Refer, complication is neovascularization
    • Central and Branch Retinal Artery Occlusions: MEDICAL EMERGENCY
      • Presentation: Sudden, painless profound monocular vision loss, red fovea (cherry red spot), box-car segmentation, relative afferent pupillary defect (RAPD)
      • Treatment: Refer, Doppler ultrasonography to assess for stroke

    Mouth

    • Avulsion of Permanent Teeth: TRUE DENTAL EMERGENCY
      • DO NOT touch root of tooth
    • Medication Effects
      • Gingival hyperplasia: Anticonvulsants, methotrexate, cyclosporine
      • Dental erosion: Progesterone, nitrates
      • Osteonecrosis: Bisphosphonates
      • Dental caries: Sugar preparations
    • Most patients do not require antibiotic prophylaxis
    • Oral Pain: First line treatment is NSAIDs
    • Angioedema: Hypersensitivity reaction, soft, non-itchy swelling of the mouth/lips, tongue, or cheeks
      • Rapid onset
      • Treatment: Airway management (epinephrine)

    Throat

    • Tonsillitis: Congestion with bacteria in the tonsils
      • Tonsillectomy indications: Recurrent infections, sleep apnea, gagging, one tonsil larger than the other, bad breath (more than 7 episodes/year)
    • Adenoiditis: Junky nose, always feeling stuffed up
      • Presentation: Unable to breathe through nose, ill feeling/appearing, cervical lymphadenopathy, long face, gummy smile, dry lower lip, mouth breathing
      • Adenoidectomy indications: Recurrent adenoiditis, sinusitis, persistent middle ear fluid, sleep apnea
    • Pharyngitis: Viral > bacterial, more prevalent in winter, ages 4-7
      • Common organisms: Streptococcal, herpes/coxsackievirus, oral candida, Group A beta-hemolytic streptococcus (GABHS)
        • Treatment for GABHS to prevent sequelae
      • Presentation: Sore throat, dysphagia, fever, malaise, headache, vomiting (kids!), absence of other upper respiratory infection symptoms
    • Streptococcal Pharyngitis: Types include non-hemolytic and hemolytic
      • Symptoms: Sore throat, dysphagia, fever, malaise, headache, vomiting (kids!), absence of other upper respiratory infection symptoms
    • Rapid Strep Antigen Test (RST) Screening:
      • Center Criteria for considering RST:
        • Fever or elevated temperature
        • Absence of cough
        • Tender anterior cervical lymph nodes
        • Tonsillar swelling or exudates
        • Age 2 mm or doesn’t resolve
    • Salivary Gland Tumors: Often benign but need to be evaluated
      • Parotid gland: Most likely to be benign and most common
      • Submandibular and sublingual glands: More rare and more likely to be malignant
      • Presentation: Painless swelling, gradual onset
      • Imaging: MRI
      • Treatment: Refer to ENT

    Nose

    • Allergic Rhinitis: Typically presents at younger ages
      • Risk factors: Family history
      • Perennial allergic rhinitis increases the risk for sleep disorder
      • IgE-mediated, Type I hypersensitivity
      • Sensitization to allergen → IgE production → Mast cell activation → Mediator release → Clinical signs
      • Perennial: Dust, mites, indoor molds, animal dander
      • Seasonal: Tree, grass, weed pollens
      • Occupational: Latex, chemicals, farm animals
      • Presentation: Nasal congestion, rhinorrhea (clear/watery), pruritus, sneezing
      • Examination:
        • Eyes: Conjunctiva, watering, shining
        • Nose: Boggy turbinates, wet, swollen nasal mucosa, itching
      • Increased occurrence during pregnancy
      • Diagnosis: Skin testing, CBC shows increased eosinophils
        • Nasal swab for eosinophils
      • Prevention: Avoid irritants
      • Treatment: Corticosteroid nasal sprays
        • Avoid first-generation antihistamines (sedating)
        • Second-generation antihistamines preferred
        • Mast cell stabilizers: Must be started prior to onset of symptoms, weeks for effect
        • Leukotriene antagonists: Add-on therapy
        • Saline irrigation: NEVER use unboiled tap water
    • Oral Allergy Syndrome: Raw fruits, vegetables, and tree nuts
      • Presentation: Itchy mouth/throat, swollen lips/tongue/throat
        • Example: An individual can eat blueberry muffins but NOT raw blueberries
    • Rhinitis Medicamentosa: Rebound effect with continued use of topical decongestants (e.g., Afrin)
      • Mechanism: Overuse (> 3 days) leads to the body compensating by creating more blood vessels
        • Can lead to atrophy of nasal mucosa
      • Treatment: Stop nasal spray, use nasal steroids/oral steroids/IM steroids
    • Vasomotor and Gustatory Rhinitis: Difficult to treat
    • Olfactory Dysfunction: Altered sense of smell
      • CN I (olfactory nerve) passes through the cribriform plate
      • Sense of smell and taste are closely related
      • Sense of smell decreases with age
      • Hyposmia: Reduced ability to detect odors
      • Anosmia: Inability to detect odors
      • Dysosmia: Change in normal odor perception
      • Phantosmia: Sensation of odor when none is present
      • Treatment for transport loss: Treat underlying issue
      • Treatment for sensorineural loss: No effective treatment
      • Safety counseling: Smoke detectors
      • Hyperosmia: Smell more than usual (pregnancy)
      • Normosmia: Normal sense of smell
      • Complications: Increased risk of food poisoning, environmental exposure, diminished satisfaction, social isolation
    • Nasal Septal Hematoma: Uncommon, secondary to nasal or septal fracture
      • Treatment: Drainage within 24 hours, nasal packing if needed
        • Risks: Infection, sepsis, cartilage death
    • Nasal Foreign Body: Common in young children and disabled adults
      • Most are inorganic (e.g., paper, duct tape, beads)
      • Inorganic, porous, or organic material: Unilateral, purulent, foul-smelling drainage, inflamed nasal vestibule
      • Treatment: Removal of foreign body
        • Urgent removal of button batteries and paired magnets across the septum
        • ENT consultation for deep, impacted, penetrating foreign bodies
        • Early removal of inorganic foreign bodies: Positive pressure, curved hook, balloon extractor
        • Later removal: ENT with/without oral antibiotics
    • Septal Perforation: Consider past drug use (cocaine) and rhinitis medicamentosa
      • Systemic disease may be a consideration in children
      • Presentation: Increased nasal sound, nasal dryness, epistaxis
      • Treatment: Increase nasal moisture, a nasal button, reconstruction limited
    • Inverted Papilloma (Schneiderian Papilloma):
      • Presentation: Unilateral, flesh-colored, typically located on the lateral nasal wall and middle meatus
      • Very uncommon, possible association with HPV virus
      • Treatment: Surgical removal
    • Epistaxis: Nosebleed
      • Causes: Trauma, dry air, high blood pressure, medications like aspirin, cocaine use
      • Treatment:
        • Direct pressure
        • If pressure doesn’t work
          • Apply topical vasoconstrictor (Afrin)
          • Control high blood pressure
          • Vitamin K
          • Posterior packing
          • Endoscopic cauterization
      • Prevention:
        • Humidification measures
        • Control blood pressure
        • Saline mist (especially for itchiness, do not overuse)
        • Monitor warfarin/INR
        • Avoid digital/foreign body trauma

    Eyelid Disorders

    • Eyelid stuck shut is usually self-limiting
    • Bacterial Gonococcus is the most dangerous. It can cause copious discharge from the eye. This usually occurs due to genital secretions. Treat with IM Ceftriaxone.
    • Bacterial Chlamydia is the most common infectious cause of blindness. This is caused by Trachomatis and is treated with oral antibiotics.
    • Allergic Conjunctivitis causes itching and cobblestone papillae. This is treated with topical antihistamines.
    • Dry Eyes (Keratoconjunctivitis Sicca) is due to inadequate tear production or accelerated tear evaporation. Symptoms include blurry vision, dryness, gritty/sandy feeling, and eye strain.
    • Pinguecula is a raised yellowish-white mass that rarely needs to be removed.
    • Pterygium is a fleshy triangular growth and removal is often indicated.
    • Infectious Keratitis is an infection of the cornea.
      • Signs include eye pain, discharge, and redness.
      • Treatment includes high concentration topical antibiotic drops and ER referral.
    • Herpes Simplex Keratitis causes corneal ulceration and dendritic branching. It is treated with antivirals.
    • Herpes Zoster Ophthalmicus is caused by the trigeminal nerve. Symptoms include malaise, fever, and Hutchinson's sign.

    Eye Disorders

    • Presbyopia is the loss of accommodation due to aging.
    • Myopia (nearsightedness) causes light to focus in front of the retina.
    • Hyperopia (farsightedness) causes light to focus behind the retina.
    • Astigmatism causes multiple focal points.
    • Iritis (anterior uveitis) is inflammation of the iris. This causes unilateral eye pain and redness and may have hypopyon from layering of leukocytes/ciliary flush. Treat by referral to ophthalmologist.
    • Uveitis Intermediate affects the vitreous cavity causing bilateral floaters and blurred vision. This is treated with systemic corticosteroids.
    • Uveitis Posterior affects the choroid, retina, and vitreous causing floaters, cells in vitreous humor, and is treated with systemic corticosteroids.
    • Scleritis is inflammation of the sclera. Symptoms include deep boring pain, worse at night, photophobia, and increased pain with ocular movements. The treatment varies.
    • Cataracts are the leading cause of world blindness.
      • Most common cause is age-related.
      • Risk factors include aging and smoking.
      • Symptoms include blurry/ghosting images, image problems with night driving, and asymptomatic leukoria (rule out tumor) in congenital cataracts.
      • Treatment includes surgery.
    • Corneal Ulcers are most commonly caused by infection.
      • Risk factors include extended contact lens wear.
      • Symptoms include pain, photophobia, tearing.
      • Treatment varies with the cause. This is an EMERGENCY.
    • Retinal Detachment is a sudden unilateral event that can result in flashes of light, a shower of floaters, a shadow or curtain coming down, and no pain or redness. This requires urgent referral to an ophthalmologist.
    • Vitreous Hemorrhage is the leakage of blood into the vitreous humor.
      • Symptoms include sudden vision loss, bleeding within the eye.
      • The eye is not red or painful and the red reflex is diminished or absent.
      • This requires referral to an ophthalmologist.
    • Age-Related Macular Degeneration is the leading cause of permanent vision loss in the elderly.
      • This is non-reversible and bilateral.
      • Dry form of AMD is atrophic/geographic. It causes progressive, bilateral atrophy, drusen. The treatment includes oral antioxidants.
      • Wet form of AMD is neovascular/exudative. It causes new leaky vessel growth. Symptoms include visual distortion where straight lines appear crooked. There may also be gray/green discoloration. The treatment includes laser photocoagulation.
    • Central & Branch Retinal Vein Occlusion causes painless vision loss, most noticeable upon waking and is often unilateral. It may cause blood and thunder and cotton wool spots. Optic disc swelling is also common. Treat by referral.
      • Complication: Neovascularization.
    • Central & Branch Retinal Arterial Occlusion is a MEDICAL EMERGENCY resulting in sudden, painless, profound monocular vision loss. The fovea may have a cherry red spot, box-car segmentation, and RAPD. Treatment includes referral to assess for a stroke.
    • Amaurosis Fugax is a transient ischemic attack (TIA) that causes sudden onset, monocular loss of vision usually lasting a few minutes with complete recovery.
    • Thyroid Eye Disease, caused by hyperthyroidism, results from mucopolysaccharides in extraocular muscles. Symptoms include exophthalmos, lid retraction, and lag. Treatment includes protection and corticosteroids.
    • Orbital Cellulitis is an infection of orbital tissues.
      • Organism: Strep.
      • Symptoms: Tender, swelling, warm.
      • Treatment: High dose broad spectrum IV antibiotics.
    • Preseptal Cellulitis is an infection of the eyelid surrounding skin.
      • Organism: Staph.
      • Symptoms: Swelling, decreased ocular motility, pain with eye movements, proptosis.
      • Treatment: Antibiotics.
    • Conjunctival & Corneal Foreign Bodies is when something is in the eye.
      • Exam: Visual acuity test. Metabolic iron may cause a rust ring that requires referral to ophthalmology.
      • Treatment: Removal with damp, cotton-tipped swab, or needle.
    • Intraocular Foreign Body requires emergency treatment.
    • Corneal Abrasion is a history of trauma to the eye with severe pain, tearing, foreign body sensation, and blurry vision. Look for foreign body by everting the upper eyelid.
    • Contusions are a closed globe injury.
      • Eyelid ecchymosis (black eye).
      • Treat: Ice packs, then hot packs.
    • Globe Trauma is a massive lid edema or laceration that usually needs immediate eye surgery.
    • Hyphema, an anterior chamber hemorrhage, may cause glaucoma with permanent vision loss.
      • Treat: Bed rest and eye shield.
    • Subconjunctival Hemorrhage, bleeding under the conjunctiva, occurs due to surgery, straining, or vomiting. No treatment is needed.
    • Lens Dislocation may be caused by trauma or hereditary conditions.
      • Symptoms: Iris may quiver, lens appears off center on eye exam.
      • Treatment: Permanent glasses.
    • Orbital Fracture is a blunt trauma that forces contents through the orbital floor.
      • Symptoms: Diplopia, posterior displacement of the eye, inferiorly displaced globe.
      • Treat: Referral.

    Teeth and Mouth

    • Dental Caries are the most common chronic disease of childhood.
      • Most common in adolescents aged 12-19.
      • Bacteria metabolize sugars into acid, demineralizing tooth enamel.
      • Remineralization occurs when the acid is buffered by saliva.
      • Higher cavity risk areas: Newly erupted teeth.
      • White lines/spots are the first sign of demineralized enamel.
        • Usually affecting upper front teeth.
        • Dentin may be dark in later stages.
      • Prevention: Brushing 2x/day and flossing 1x/day.
        • Fluoride guidelines: Main effect is topical.
          • Less than 3 years old: Grain of rice.
          • Older than 3 years old: Pea-sized.
    • Periodontitis is most common in adults and is associated with diabetes.
    • HIV 16 DNA is involved in oral cancers.
    • Xerostomia is dry mouth due to decreased salivary flow.
      • Causes: Steroids, antihistamines, diuretics, opioids.
      • Signs: Dry mouth, burning sensation, changes in taste, difficulty swallowing.
      • Treat: Encourage drinking water, avoid caffeine/sugary drinks.
    • Oral exams should be performed at each well-child visit.
    • Gingivitis causes tenderness, mild gum swelling, redness, and bleeding gums.
      • Treat: Effective brushing and flossing.
    • Periodontitis causes destruction of the periodontal ligament.
      • It can be halted but not reversed.
      • Treat: Brushing and flossing.
    • Gingival Hyperplasia causes gingival enlargement and makes it hard to clean teeth.
      • Treat: Oral hygiene and regular cleaning.
    • Dental Erosion causes smooth/glassy teeth and pulp exposure leading to heat/cold sensitivity.
      • Treat: Rinse with water after reflux/vomiting, don't immediately brush.
    • Herpes Labialis(cold sore) causes burning, itching, and crusting.
      • Treat: Topical or oral antiviral agents.
    • Pyogenic Granuloma is a nonpainful smooth, lobulated mass that bleeds easily.
      • Treat: Conservative surgical excision.
    • Oral Ulcerations are most common in aphthous minor.
      • Symptoms: Recurring painful ulcers with an erythematous halo.
      • Treat: Magic mouthwash.
    • Herpetic Stomatitis causes a burning sensation and vesicle rupture on the buccal mucosa (inside mouth).
      • Treat: Antivirals.
    • Necrotizing Ulcerative Gingivitis causes bleeding and halitosis.
      • Treat: Penicillin for 10 days.
    • Geographic Tongue is a normal variant, with spicy foods, waxes, and wanes.
      • Treat: None needed.
    • Hairy Tongue is asymptomatic and often associated with tobacco use.
    • Glossitis, a smooth tongue, is often caused by nutritional deficiencies in iron, B12, and folate.
      • Treat: Underlying problem.
    • Glossodynia, burning mouth syndrome, is treated with clonazepam.
    • Fissured Tongue is a normal, asymptomatic variant.
    • Bony Tori are benign growths arising from the cortical plate.
      • Treat: Surgery if needed.
    • Candidiasis is a fungal infection. Pseudomembranous candidiasis (thrush) causes burning, white/curd patches that can be rubbed off.
      • Treat: Topical antifungal agents.
        • Adult patients should be worked up for HIV.
    • Lichen Planus causes reticular white lacy striations.
      • Treat: Corticosteroid gels or mouthrinses.
    • Oral Hairy Leukoplakia is a hairy tongue on the lateral sides. It is a common early sign of HIV.
    • Leukoplakia and Erythroplakia are subtle white patches that progress to ulcerate. They cannot be rubbed off.
      • Treat: Biopsy if present for 14+ days as they can be carcinoma or dysplasia.
    • Oral Cancer, usually squamous cell carcinoma, is a risk factor for tobacco and alcohol usage as well as HPV.
      • Treat: Biopsy if present for 14+ days.
    • Reversible Pulpitis causes pain with hot/cold/sweet but resolves once removed.
      • Treat: Dental filling.
    • Irreversible Pulpitis results in severe, persistent pain, sensitive to percussion.
      • Treatment: Root canal/tooth extraction.
    • Periapical Abscess is a purulent form of periapical periodontitis.
      • Pain is well localized and the abscess may drain.
        • This may lead to cellulitis.
        • Treatment: Urgent dental referral.
    • Pericoronitis is an infection of the gum flap overlying a partially erupted molar.
      • Treatment: Irrigation.
    • Periodontal Abscess is a deep infection of the tooth support structures.
      • Tooth is loose and sensitive to touch.
      • Treat: Analgesics.
    • Alveolar Bone Fracture results in localized tenderness and step-offs in occlusion of teeth.
      • Treat: CT imaging, dentist referral.
    • Condylar Fracture causes preauricular swelling and limited ability to open mouth.
      • Treat: Referral.
    • Intrusion of Primary Teeth should not be removed and require a referral.
    • Luxation, lateral displacement though still in socket, requires dental referral as needed.
    • Avulsion of Primary Teeth, completely knocked out of socket, requires referral as needed.
    • Fractures of Primary Teeth:
      • Simple Crown Fracture: Enamel and dentin.
      • Crown Fracture with Pulp Involvement: Enamel, dentin, and pulp. This is urgent.
      • Root Fracture: Routing referral, not very detectable.
    • Intrusion of Permanent Teeth should not be removed, require an immediate referral.
    • Avulsion of Permanent Teeth is a TRUE DENTAL EMERGENCY. DO NOT touch the root of the tooth.
    • Medication Effects:
      • Gingival Hyperplasia: Anticonvulsants, methotrexate, cyclosporine.
      • Dental Erosion: Progesterone, nitrates.
      • Osteonecrosis: Bisphosphonates.
      • Dental Caries: Sugar preparations.
    • Most patients do not require antibiotic prophylaxis.
    • Oral pain: First line is NSAIDs.
    • Angioedema is a hypersensitivity reaction that causes soft, non-itchy swelling of mouth/lips, tongue, or cheeks.
      • Rapid onset.
      • Treat: Airway management (epinephrine).

    Throat

    • Tonsillitis is congestion with bacteria in the tonsils
    • Tonsillectomy indications: Recurrent infections, sleep apnea, gagging, one tonsil larger than other, bad breath, and >7 episodes/year.
    • Adenoiditis causes a junky nose with a feeling of being constantly stuffed up, unable to breathe through the nose, an ill-feeling/appearance, and cervical lymphadenopathy.
      • The patient may have a long face, gummy smile, dry lower lip, and mouth breathing.
    • Adenoidectomy indications: Recurrent adenoiditis, sinusitis, persistent middle-ear fluid, and sleep apnea.
    • Pharyngitis is more prevalent in winter among ages 4-7. Viral causes are more common than bacterial.
      • Bugs: Streptococcal, herpes/coxsackievirus, oral candida, GABHS. GABHS is treated to prevent sequelae.
      • Symptoms: Sore throat, dysphagia, fever, malaise, headache, vomiting (kids!), absence of other upper respiratory infection symptoms.
      • Streptococcal types include:
        • Non-hemolytic.
        • Hemolytic.
    • Nasal Polyps are benign lesions from the middle meatus.
      • Signs: Anosmia, soft, painless, benign (typically), chronic nasal congestion.
      • Physical exam: Pale, edematous, mucosally covered masses peeled grapes.
      • Arise from chronically inflamed sinonasal mucosa (ethmoid sinuses).
      • Children: Cystic fibrosis.
      • Treat: Nasal saline irrigations (add budesonide), intranasal corticosteroids, surgery, allergy evaluation.
        • ENT referral WITH maxillofacial CT.
        • Polyps frequently come back.
      • Nasal polyps + Asthma = NO ASPIRIN.
    • Epistaxis:
      • Assess airway and cardiovascular stability.
      • Etiology:
        • Local (A): Trauma, nose picking/blowing, surgery, dry air/irritants.
          • Nasal pyramid is the most frequently fractured bone in the body.
        • Systemic (P): Bleeding disorders, hereditary hemorrhagic, drugs, Hypertension.
      • Anterior: Kiesselback’s plexus or Little’s area.
        • Treat: Observation, anterior pressure, oxymetazoline, packing.
          • Spray anesthetic with decongestant (Afrin).
          • Cauterization: Start from the outside in. Bilateral cauterization may result in septal perforation.
          • Nasal Packing: Absorbable gelfoam, vaseline gauze, surgicel. Usually pack only the side of the bleed.
            • Packing: Form a tight seal to hold pressure, lubricate. Add moisture to expand ONCE placed.
            • Rhino-rocket: Add liquid prior to inserting. Insert horizontally, inflate with air.
        • Expectations: Less frequent and less severe nosebleeds.
      • Posterior: Woodruff’s plexus (venous), Sphenopalatine artery (more common).
        • Often elderly with underlying pathology.
        • Bleeding from both nostrils, coughing up clots, blood in the throat.
        • Posterior bleeds are more difficult to control, requiring attention to underlying etiology.
        • EMERGENCY SERVICES!!!

    Eye Conditions

    • Eyelid Edema can be caused by allergic conjunctivitis, conjunctival & corneal foreign bodies, corneal abrasion, contusions, globe trauma
    • Discharge from eye can be caused by bacterial gonococcus, bacterial chlamydia, allergic conjunctivitis, infectious keratitis
    • Pain in eye can be caused by infectious keratitis, corneal abrasion, orbital cellulitis, preseptal cellulitis, intraocular foreign body,
    • Redness in eye can be caused by allergic conjunctivitis, infectious keratitis, orbital cellulitis, preseptal cellulitis
    • Blurred vision can be caused by corneal abrasion, lens dislocation
    • Exophthalmos (bulging eyes) can be caused by thyroid eye disease
    • Lid retraction can be caused by thyroid eye disease
    • Orbital cellulitis is an infection of the orbital tissues
    • Preseptal Cellulitis is an infection of the eyelid surrounding skin
    • Conjunctival & Corneal foreign bodies are foreign objects embedded in the eye
    • Intraocular Foreign body is a foreign object embedded in the eye
    • Corneal Abrasion is a scratch on the cornea
    • Contusions are closed globe injuries of the eye
    • Globe Trauma is massive lid edema or laceration of the eye
    • Hyphema is a hemorrhage in the anterior chamber of the eye
    • Subconjunctival Hemorrhage is bleeding under the conjunctiva
    • Lens Dislocation can be caused by trauma, some hereditary conditions
    • Orbital fracture is caused by blunt trauma forcing the eye contents through the orbital floor
    • Bacterial Conjunctivitis is an infection of the conjunctiva that can be caused by bacteria like Gonococcus and Chlamydia
    • Allergic Conjunctivitis is an allergic reaction that causes itchy eyes
    • Dry Eyes (Keratoconjunctivitis Sicca) is caused by inadequate tear production or accelerated tear evaporation
    • Pinguecula is a raised yellowish white mass on the conjunctiva
    • Pterygium is a fleshy triangular growth that can be removed in some cases
    • Infectious Keratitis is an infection of the cornea
    • Herpes Simplex Keratitis is a corneal ulceration caused by the herpes simplex virus
    • Herpes Zoster Ophthalmicus is an infection of the trigeminal nerve that can cause eye pain, malaise, fever, and Hutchinson's sign
    • Thyroid Eye Disease is a condition caused by hyperthyroidism that affects the eye muscles
    • Bacterial Gonococcus is a common cause of infectious conjunctivitis and can lead to blindness
    • Bacterial Chlamydia is a common cause of infectious conjunctivitis and can lead to blindness
    • Treatment for Bacterial Gonoccocal Conjunctivitis is IM Ceftriaxone
    • Treatment for Bacterial Chlamydial Conjunctivitis is oral antibiotics
    • Treatment for Allergic Conjunctivitis is topical antihistamines
    • Treatment for Dry Eyes is artificial tears
    • Treatment for Infectious Keratitis is high concentration topical antibiotic drops and ER referral
    • Treatment for Herpes Simplex Keratitis is antivirals
    • Treatment for Herpes Zoster Ophthalmicus is glasses, surgery, and treating the underlying disorder
    • Treatment for Thyroid Eye Disease is protection, corticosteroids

    Dental Conditions

    • Dental Caries are the most common chronic disease of childhood
    • Prevalance of Dental Caries is highest during adolescence, ages 12-19
    • White lines or spots on teeth are the first sign of demineralized enamel
    • Peridontitis is most common in adults
    • Xerostomia is dry mouth due to decreased salivary flow
    • Gingivitis is inflammation of the gums
    • Periodontitis is destruction of the periodontal ligament
    • Gingival Hyperplasia is gingival enlargement
    • Dental Erosion is a smooth/glassy appearance of teeth caused by acid exposure
    • Herpes Labialis is a common cold sore that causes burning, itching, and crusting
    • Pyogenic Granuloma is a red, non-painful mass on the gums that bleeds when touched
    • Oral Ulcerations are painful sores in the mouth
    • Herpetic Stomatitis causes burning mouth and vesicle rupture in the buccal mucosa
    • Necrotizing Ulcerative Gingivitis is a bacterial infection of the gums causing bleeding and halitosis
    • Geographic Tongue is a normal variant of the tongue
    • Hairy Tongue is an asymptomatic condition
    • Glossitis is a smooth tongue associated with nutritional deficiencies
    • Glossodynia is burning mouth syndrome
    • Fissured Tongue is a normal variant of the tongue
    • Bony Tori are benign growths on the bone
    • Candidiasis is a fungal infection of the mouth
    • Lichen Planus is a condition that causes lacy white lines on the gums
    • Oral Hairy Leukoplakia is a condition that causes "hairy" tongue on the lateral sides associated with HIV
    • Leukoplakia and Erythroplakia are precancerous lesions on the gums
    • Oral Cancer is typically squamous cell carcinoma
    • Reversible Pulpitis is pain in the tooth that resolves when the stimulus is removed
    • Irreversible Pulpitis is pain in the tooth that is severe and persistent
    • Periapical Abscess is a localized pocket of pus near the root of a tooth
    • Pericoronitis is an infection of the gum flap over a partially erupted molar
    • Periodontal Abscess is a deep infection of the tooth support structures
    • Alveolar Bone Fracture is a fracture of the jaw bone
    • Condylar Fracture is fracture of the jaw bone
    • Intrusion is a tooth being pushed into the gum
    • Luxation is a tooth being displaced but still in the socket
    • Avulsion is a tooth being completely knocked out
    • Fractures of Primary Teeth include Simple Crown Fracture, Crown Fracture with Pulp Involvement, and Root Fracture
    • Intrusion of Permanent Teeth is when a tooth is pushed into the gum
    • Treatment for Dental Caries is brushing twice a day and flossing once a day
    • Treatment for Peridontitis is brushing and flossing
    • Treatment for Xerostomia is encouraging drinking water
    • Treatment for Gingivitis is effective brushing and flossing
    • Treatment for Periodontitis is brushing and flossing, although it cannot be reversed
    • Treatment for Gingival Hyperplasia is oral hygiene and regular cleanings
    • Treatment for Dental Erosion is rinsing with water after reflux/vomiting and not brushing immediately
    • Treatment for Herpes Labialis is antiviral agents (topical or oral)
    • Treatment for Pyogenic Granuloma is conservative surgical excision
    • Treatment for Oral Ulcerations is "magic mouthwash"
    • Treatment for Herpetic Stomatitis is antivirals
    • Treatment for Necrotizing Ulcerative Gingivitis is penicillin for 10 days
    • Treatment for Geographic Tongue is none, as it is a normal variant
    • Treatment for Hairy Tongue is none, as it is asymptomatic
    • Treatment for Glossitis is to treat the underlying problem
    • Treatment for Glossodynia is clonazepam
    • Treatment for Fissured Tongue is none, as it is a normal variant
    • Treatment for Bony Tori is surgery if needed
    • Treatment for Candidiasis is topical antifungal agents
    • Treatment for Lichen Planus is corticosteroid gels or mouthrinses
    • Treatment for Oral Hairy Leukoplakia is treating the underlying HIV infection
    • Treatment for Leukoplakia and Erythroplakia is biopsy to rule out carcinoma or dysplasia
    • Treatment for Oral Cancer is biopsy and referral to specialist
    • Treatment for Reversible Pulpitis is dental filling
    • Treatment for Irreversible Pulpitis is root canal, tooth extraction
    • Treatment for Periapical Abscess is urgent referral to a dentist
    • Treatment for Pericoronitis is irrigation
    • Treatment for Periodontal Abscess is analgesics
    • Treatment for Alveolar Bone Fracture is CT imaging and referral to a dentist
    • Treatment for Condylar Fracture is referral to a specialist
    • Treatment for Intrusion of Primary Teeth is referral to a dentist
    • Treatment for Luxation is referral to a dentist
    • Treatment for Avulsion of Primary Teeth is referral to a dentist
    • Treatment for Intrusion of Permanent Teeth is immediate referral to a specialist

    Nasal Conditions

    • Nasal Polyps are benign growths in the ethmoid sinuses that cause anosmia, nasal congestion, and facial pressure
    • Causes of Nasal Polyps include chronic sinonasal mucosal inflammation, cystic fibrosis
    • Treatment for Nasal Polyps includes nasal saline irrigations, intranasal corticosteroids, surgery, allergy evaluation
    • Epistaxis refers to nosebleed
    • Causes of Anterior Epistaxis include trauma, dry air, irritants, nose picking/blowing, surgery
    • Causes of Posterior Epistaxis include bleeding disorders, medications, hypertension
    • Treatment for Anterior Epistaxis includes pressure, ice packs
    • Treatment for Posterior Epistaxis includes immediate medical attention, packing
    • Nasal Septal Hematoma is a collection of blood in the septum
    • Causes of Nasal Septal Hematoma include nasal fracture
    • Treatment for Nasal Septal Hematoma includes drainage within 24 hours
    • Nasal Foreign Body is a foreign object in the nose
    • Causes of Nasal Foreign Body are common in young children and disabled adults
    • Treatment for Nasal Foreign Body is removal
    • Septal Perforation a hole in the septum
    • Causes of Septal Perforation include past drug use, rhinitis medicamentosa
    • Treatment for Septal Perforation increased nasal moisture
    • Inverted Papilloma (Schneiderian Papilloma) benign tumor of the nasal cavity
    • Causes of Inverted Papilloma HPV virus
    • Treatment for Inverted Papilloma surgical excision
    • Juvenile Angiofibroma is a slow growing tumor in young boys
    • Causes of Juvenile Angiofibroma unknown, but may be related to gonadal dysgenesis in girls
    • Treatment for Juvenile Angiofibroma is surgical removal
    • Malignant Tumors are very rare in the nasal cavity
    • Symptoms of Nasal Malignant Tumors include chronic rhinitis/sinusitis, unilateral ear pain, hearing loss
    • Types of Nasal Malignant Tumors include nasopharyngeal carcinoma, adenocarcinoma, adeno cystic carcinoma, lymphoma
    • Risk Factors for Nasopharyngeal Carcinoma include race (Asians), EBV exposure
    • Risk Factors for Adenocarcinoma/Adenoid Cystic Carcinoma wood dust, leather dust, asbestos
    • Risk Factors for Lymphoma Epstein Barr Virus exposure
    • Symptoms of Paranasal Sinus tumors include proptosis, expansion of cheek, ill fitting dentures, severe pain, malar hypesthesia
    • Treatment for Nasal Malignant Tumors depends on tumor type and extent

    Ears

    • External ear

      • Antonia: Absent external ear
      • Microtia: Small external ear
      • Atresia: Agenesis of the ear canal, resulting in conductive hearing loss
      • Excessive cerumen: Remove with plastic curette or warm water
      • Foreign bodies: Do not flush organic material. Insects = Lidocaine first.
      • Otitis Externa: Swimmers ear
        • Symptoms: Ear pain, itching, sometimes drainage
        • Treatment: Clear external ear canal and antibiotic as needed
      • Exostoses: Abnormal growth of bone within ear canal "surfers ear"
        • Referral needed to rule out cholesteatoma

    • Middle ear

      • Eustachian tube dysfunction: May result in negative pressure in middle ear
        • Symptoms: Sense of fullness in the ear "popping" "cracking"
        • Treatment: Consider nasal steroids, decongestants. Rule out sudden hearing loss.
      • Barotrauma: Consequence of poor eustachian tube function
        • Occurs with airplane descent, rapid altitude change, diving
        • Treatment: Topical decongestants prophylactically
      • Acute Otitis Media: Infection of middle ear space
        • Most common in young children
        • Viral causes: RSV, influenza, adenovirus
        • Bacterial causes: S. pneumonia
        • Diagnosis requires purulence
        • Treatment: Amoxicillin high dose
        • Complications: Perforation, Mastoiditis
      • Otitis Media Effusion: Fluid in middle ear space
        • Up to 3 months is normal
        • Tympanostomy tubes may be needed
        • Treatment:
          • Acute: Tympanocentesis (seldom used)
          • Chronic: Tympanostomy tubes (spontaneously extrude)
            • Ear drainage = good
            • Ear pain without drainage = blockage
      • Tympanic membrane perforation: Observation, should heal in 3 months
        • Strict water precautions
      • Cholesteatoma: Accumulation of squamous cells in middle ear
        • Symptoms: Painless drainage, hearing loss
        • Treatment: Refer for hearing test

    • Vestibular ear

      • Meclizine: Medication often causing dizziness
      • Vertigo: Abnormal sensation of movement when none exists
        • Vestibular neuronitis: Not associated with SNHL
        • Labyrinthitis: Associated with SNHL
        • Treatment: Benzodiazepines and anticholinergics for two weeks
      • Meniere's disease:
        • Symptoms: Vertigo, ear pressure/fullness, tinnitus, fluctuant hearing loss
        • Treatment: Lipoflavonoid, diuretics
      • Benign Paroxysmal Positional Vertigo: Transient episodic vertigo
        • Caused by canalithiasis
          • Posterior semicircular canal most commonly
        • Treatment: Canalith repositioning maneuvers
      • Nystagmus: Involuntary rhythmic eye movement
      • Oscillopsia: Illusion of subtle movement or shimmering
      • Cupulolithiasis: Otolithic debris adhere to cupula
        • Vertigo is persistent and episodic
      • Canalithiasis: Clumping of otolithic debris in endolymph
        • Vertigo is transient and episodic
      • Superior semicircular canal dehiscence: Avoid loud noises

    Eyes

    • Hordeolum: Stye
      • Localized infection/inflammation
        • External: Eyelid/eyelashes
        • Internal: Meibomian gland
      • Most common: Staph aureus
      • Presentation: Eyelid redness, pain, swelling
      • Treatment: Warm compress (>48 hours = I&D)
    • Chalazion: Noninfectious obstruction of meibomian gland
      • Painless, small nodule, deep cyst inside lid
      • Treatment: Warm compress
    • Blepharitis: Inflammation of eyelid margins
      • Associated with rosacea or seborrheic dermatitis
      • Staph: Red rimmed/dry scales → Painful
      • Seborrhea: Greasy scales/pruritic
      • Treatment: Warm compress
    • Entropion: Inward turning of lower lid → corneal excoriation
      • Treatment: Lubricant, botox
    • Ectropion: Outward turning of lower lid
      • Etiology: Cranial nerve VII palsy, age tissue relaxation
      • Treatment: Symptomatic
    • Lid tumors: Most benign
      • Basal cell is most common malignant
    • Conjunctivitis: Most common eye disease
      • Viral more common than bacterial
        • Younger = Bacterial
        • Older = Viral
      • Viral: Adenovirus, bilateral disease, watery discharge
        • Treatment: Symptomatically. Consider HSV: Unilateral with lid vesicles → Antivirals
      • Bacterial: Staph most commonly, purulent discharge, starts unilateral then bilateral
    • Presbyopia: Loss of accommodation due to aging
    • Myopia: Nearsightedness, focuses in front of retina
    • Hyperopia: Farsightedness, focuses behind retina
    • Astigmatism: Multiple focal points
    • Iritis (anterior uveitis): Inflammation of the iris
      • Unilateral eye pain, redness
        • May have hypopyon from layering of leukocytes/ ciliary flush
      • Treatment: Refer to ophthalmologist
    • Uveitis Intermediate: Vitreous cavity
      • BIL, bilateral floaters and blurred vision "snowballs"
      • Treatment: Systemic corticosteroids
    • Uveitis Posterior: Choroid, retina, vitreous
      • Floaters, cells in vitreous humor
      • Treatment: Systemic corticosteroids
    • Scleritis: Inflammation of sclera
      • Symptoms: Deep boring pain, worse at night, photophobia. Increased pain with ocular movements.
      • Treatment: Varies
    • Cataracts: LEADING CAUSE OF WORLD BLINDNESS
      • Age related most common
      • Risk factor: Aging, smoking
      • Symptoms: Blurry/ghosting images, image problems with night driving. Congenital: Asymptomatic, leukoria (rule out tumor)
      • Treatment: Surgery
    • Corneal Ulcers: Most commonly infection
      • Risk factor: Extended contact lens wearers
      • Symptoms: Pain, photophobia, tearing
      • Treatment: Varies with cause EMERGENCY
    • Retinal Detachment:
      • Symptoms: Unilateral sudden flashes of lights, shower of floaters, shadow or curtain coming down, no pain or redness
      • Treatment: Urgent referral to ophthalmologist
    • Vitreous Hemorrhage: Leakage of blood into vitreous humor
      • Symptoms: Sudden vision loss, bleeding within the eye
        • Eye NOT red/painful, unilateral more common
        • Red reflex diminished or absent
      • Treatment: Refer to ophthalmologist
    • Age-Related Macular Degeneration: Leading cause of permanent vision loss in elderly
      • Non-reversible, bilateral
        • Dry: Atrophic/geographic (ALL AMD starts as dry)
          • Progressive, BIL atrophy
          • Drusen
          • Treatment: Oral antioxidants
        • Wet: Neovascular/exudative
          • New leaky vessel growth
          • Visual distortion straight lines appear crooked
          • Gray/green discoloration
          • Treatment: Laser photocoagulation
    • Central and branch retinal vein occlusions:
      • Painless vision loss, first noticed upon waking, unilateral
      • Blood and thunder, cotton wool spots, optic disc swelling
      • Treatment: Refer
        • Complication: Neovascularization
    • Central and branch retinal arterial occlusion: MEDICAL EMERGENCY
      • Sudden painless, profound monocular vision loss
      • Red fovea (Cherry red spot), box-car segmentation, RAPD
      • Doppler ultrasonography
      • Treatment: Refer to assess for a stroke
    • Amaurosis fugax: Transient ischemic attack
      • Sudden onset, monocular loss of vision usually lasting a few minutes with complete recovery. "Curtain passing vertically"
      • Treatment: Aspirin → look for cardiac returns
      • Refer for all
    • Diabetic Retinopathy: Noninflammatory retinal disorder retinal capillary closure and microaneurysms
      • Type 1 is most common
      • Pregnancy can impair blood glucose and worsen retinopathy
      • Nonproliferative: Develops first
        • Signs: Vision loss, blurriness
        • Treatment: Optimize control of disease
      • Proliferative: More severe vision loss, neovascularization
        • Signs: Black spots/floaters, dot and blot, cotton wool spots
        • Treatment: Optimize control of disease
    • Hypertensive retinopathy/choroidopathy:
      • Arteriovenous nicking (Copper/silver wiring), blurry vision, visual field defects, superficial flame-shaped hemorrhages, yellow hard exudates, optic disc edema. Risk factors: Smoking, DM
      • Treatment: Aggressive BP control
    • Optic Neuritis: Inflammation of optic nerve
      • Strongly associated with demyelinating disease (MS)
      • Signs: Abrupt vision loss, periorbital pain, brow ache
      • Papillitis, flame-shaped hemorrhage, temporal disc pallor
      • Treatment: Corticosteroids
    • Optic Disc Swelling: Drusen associated with farsightedness
    • Papilledema: Swelling due to raised IOP, usually BIL
    • Oculomotor Palsies: Cranial nerves III, IV, VI innervate extraocular muscles
      • Symptoms: Double vision, pain on eye movement
      • Exam: Ptosis, pupil abnormalities
        • 3rd: Eye down and out
        • 4th: Vertical hypertropia
        • 6th: Lateral movement
    • Nystagmus: Dancing eyes, limited vision
      • Congenital: Presents between 6 weeks and 6 months
      • Acquired: Medical conditions
      • Symptoms: Rapid eye movements, sensitivity to light
      • Treatment: Glasses, surgery, treat underlying disorder
    • Thyroid Eye Disease: Hyperthyroidism
      • Mucopolysaccharides in extraocular muscles
      • Symptoms: Exophthalmos, lid retraction and lag
      • Treatment: Protection, corticosteroids
    • Orbital Cellulitis: Infection of orbital tissues
      • Organism: Strep
      • Symptoms: Tender, swelling, warm
      • Treatment: High dose broad spectrum IV antibiotics
    • Preseptal Cellulitis: Infection of the eyelid surrounding skin
      • Organism: Staph
      • Symptoms: Swelling, decreased ocular motility, pain with eye movements, proptosis
      • Treatment: Antibiotics
    • Conjunctival & Corneal foreign bodies: "Something in my eye"
      • Exam: Visual acuity test. Metabolic → Iron → Rust ring → Ophthalmology
      • Treatment: Removal with damp, cotton tipped swab, or needle
    • Intraocular foreign body: Requires emergency treatment
      • Grinding equipment
    • Corneal Abrasion: History of trauma to the eye
      • Symptoms: Severe pain, tearing, foreign body sensation, blurry vision
      • Look for foreign body → Evert upper lid
    • Contusions: Closed globe injury
      • Eyelid ecchymosis → Black eye
      • Treatment: Ice Packs, hot packs
    • Globe Trauma: Massive lid edema or laceration
      • Usually need immediate eye surgery
    • Hyphema: Anterior chamber hemorrhage
      • May cause glaucoma with permanent vision loss
      • Treatment: Bed rest and eye shield
    • Subconjunctival Hemorrhage: Bleeding under conjunctiva
      • Etiology: Surgery, straining, vomiting
      • Treatment: None required
    • Lens Dislocation: Trauma, some hereditary conditions
      • Symptoms: Iris may quiver, lens appears off center on eye exam
      • Treatment: Permanent, glasses
    • Orbital fracture: Blunt trauma forces contents through orbital floor
      • Symptoms: Diplopia, posterior displacement of the eye, inferiorly displaced globe
      • Treatment: Referral

    Teeth & Mouth

    • Dental caries: Most common chronic disease of childhood
      • Most common in adolescents ages 12-19
      • Bacteria metabolize sugars into acid which demineralize tooth enamel
        • Remineralization occurs when acid is buffered by saliva
        • Increased frequency of sugar consumption decreases remineralization time
      • Higher cavity risk areas: Newly erupted teeth
      • White lines/spots = first sign of demineralized enamel
        • Usually affecting upper front teeth
        • Dentin is in later stages and may be dark
      • Prevention: Brushing 2x/day and flossing 1x/day
        • Fluoride guidelines: Main effect is topical mechanism
          • Less than 3 = grain of rice
          • Older than 3 = pea sized
    • Periodontitis: Most common in adults
      • Associated with diabetes
    • HIV 16 DNA: Involved in oral cancers
    • Xerostomia: Dry mouth due to decreased salivary flow
      • Causes: Steroids, antihistamines, diuretics, opioids
      • Symptoms: Dry mouth, burning sensation, changes in taste, difficulty swallowing
      • Treatment: Encourage drinking water, avoid caffeine/sugary drinks
    • Oral exams: Should be performed at each well child visit
    • Gingivitis: Tenderness, mild gum swelling, redness, bleeding gums
      • Treatment: Effective brushing and flossing
    • Periodontitis: Destruction of periodontal ligament
      • Can be halted but not reversed
      • Treatment: Brushing and flossing
    • Gingival hyperplasia: Gingival enlargement, teeth are hard to clean
      • Treatment: Oral hygiene and regular cleaning
    • Dental erosion: Teeth are smooth/glassy, pulp exposure causes heat/cold sensitivity
      • Treatment: Rinse with water after reflux/vomiting, don't immediately brush
    • Herpes Labialis: Burning, itching, crusting
      • Treatment: Antiviral agents topical or oral
    • Pyogenic Granuloma: Erythematous, nonpainful, smooth, lobulated mass
      • Bleeds when touched
      • Treatment: Conservative surgical excision
    • Oral ulcerations: Most common in aphthous minor
      • Symptoms: Recurring painful ulcers with erythematous halo
      • Treatment: Magic mouthwash
    • Herpetic Stomatitis: Burning sensation then vesicle rupture buccal mucosa (inside mouth)
      • Treatment: Antivirals
    • Necrotizing ulcerative gingivitis: Bleeding, halitosis
      • Treatment: Penicillin x 10 days
    • Geographic tongue: Normal variant
      • Spicy foods, waxes and wanes
      • Treatment: None needed
    • Hairy tongue: Asymptomatic, associated with tobacco use
    • Glossitis: Smooth tongue
      • Nutritional deficiencies: Iron, B12, folate
      • Treatment: Underlying problem
    • Glossodynia: Burning mouth syndrome
      • Treatment: Clonazepam
    • Fissured tongue: Normal variant, asymptomatic
    • Bony Tori: Benign arising from cortical plate
      • Treatment: Surgery if needed
    • Candidiasis: Fungal infection oftenly pseudomembranous candidiasis (thrush)
      • Burning sensation, white/curd patches over red mucosa that CAN be rubbed off
      • Treatment: Topical antifungal agents
        • Adult patient: Workup for HIV
    • Lichen Planus: Reticular white lacy striations
      • Treatment: Corticosteroid gels or mouthrinses
    • Oral Hairy Leukoplakia: Hairy tongue on lateral sides
      • Common early HIV sign
    • Leukoplakia and erythroplakia: Premalignant, subtle white patch that progresses to ulcerate
      • Cannot be rubbed off
      • Treatment: >14 days should be biopsied as they can be carcinoma or dysplastic
    • Oral Cancer: Usually squamous cell carcinoma
      • Risk factor: Tobacco and alcohol usage as well as HPV
      • Treatment: Biopsy >14 days
    • Reversible pulpitis: Pain with hot/cold/sweet but resolves once removed
      • Treatment: Dental filling
    • Irreversible pulpitis: Pain is severe and persistent, sensitive to percussion
      • Treatment: Root canal/tooth extraction
    • Periapical abscess: Purulent form for periapical periodontitis
      • Pain is well localized, abscess is draining
        • May cause cellulitis
        • Treatment: Urgent dental referral
    • Pericoronitis: Infection of a gum flap overlying partially erupted molars
      • Treatment: Irrigation
    • Periodontal abscess: Deep infection of tooth support structures
      • Tooth is loose and sensitive to touch
      • Treatment: Analgesics
    • Alveolar bone fracture: Localized tenderness, step-offs in occlusion of teeth
      • Treatment: Image with CT, dentist
    • Condylar fracture: Preauricular swelling, limited ability to open mouth
      • Treatment: Refer
    • Intrusion of primary teeth: Do not remove tooth
      • Treatment: Refer
    • Luxation: Lateral displacement though still in socket
      • Treatment: Dental referral as needed
    • Avulsion of primary teeth: Completely knocked out of socket
      • Treatment: Referral as needed
    • Fractures of primary teeth:
      • Simple crown fracture: Enamel and dentin
      • Crown fracture with pulp involvement: Enamel, dentin, and pulp - Urgent
      • Root fracture: Routing referral - not very detectable
    • Intrusion of permanent teeth: Do not attempt to remove tooth
      • Treatment: Refer immediately!

    Nose

    • Nasal Polyps: Benign lesions from middle meatus
      • Signs: Anosmia, soft, painless, benign (typically), chronic nasal congestion
      • Physical exam: Pale, edematous, mucosally covered masses "peeled grapes"
      • Arise from chronically inflamed sinonasal mucosa (ethmoid sinuses)
      • Children: Cystic fibrosis
      • Treatment: Nasal saline irrigations (add budesonide), intranasal corticosteroids, surgery, allergy evaluation
        • ENT referral WITH maxillofacial CT
        • Polyps frequently come back
      • Nasal polyps + Asthma = NO ASPIRIN
    • Epistaxis:
      • Airway assessment and cardiovascular stability
      • Etiology:
        • Local (A): Trauma, nose picking/blowing, surgery, dry air/irritants
          • Nasal pyramid is most frequently fractured bone in body
        • Systemic (P): Bleeding disorders, hereditary hemorrhagic, drugs, HTN
      • Anterior: Kiesselback’s plexus or Little’s area
        • Treatment: Observation, anterior pressure, oxymetazoline, packing
          • Spray anesthetic with decongestant (Afrin)
          • Cauterization: Start from outside in
            • Bilateral cauterization may result in septal perforation
          • Nasal Packing: Absorbable gelfoam, vaseline gauze, surgicel
            • Usually just pack the side the bleeding is on (not both )
            • Packing: Form a tight seal to hold pressure → Lubricate! Add moisture to expand ONCE placed
            • Rhino-rocket: Add liquid prior to inserting. Insert horizontally → inflate with air
        • Expectations: Less frequent and less severe nosebleeds
      • Posterior: Woodruff’s plexus (venous), Sphenopalatine artery (more common)
        • Often elderly with underlying pathology
        • Bleeding from both nostrils, coughing up clots, blood in throat
        • Posterior are more difficult to control → underlying etiology
        • EMERGENCY SERVICES!!!

    Eye Conditions

    • Bacterial Conjunctivitis
      • Gonococcal: Copious discharge, usually due to genital secretions
      • Chlamydial: Trachomatis, most common infectious cause of blindness
    • Allergic Conjunctivitis: Itchiness
      • Vernal: Cobblestone papilla
    • Dry Eyes (Keratoconjunctivitis Sicca): Inadequate tear production or accelerated tear evaporation
      • Symptoms: Burning, dryness, gritty sensation, eye strain
      • Schirmer Test: Measures tear production rate
    • Pinguecula: Raised yellowish-white mass, rarely needs removal
    • Pterygium: Fleshy triangular growth, removal is often indicated
    • Infectious Keratitis: Infection of the cornea
      • Symptoms: Eye pain, discharge, redness
      • Herpes Simplex Keratitis: Corneal ulceration, dendritic branching
      • Herpes Zoster Ophthalmicus: Trigeminal nerve involvement, malaise, fever, Hutchinson's sign
      • Fungal Keratitis: Contact with plants, satellite lesions
      • Acanthamoeba Keratitis: Fresh water and hot tubs, perineural and ring infiltrates
    • Dacryoadenitis: Inflammation of the lacrimal gland
      • Usually in children due to viral infection
      • "S" shaped lid deformity
    • Dacryostenosis: Nasolacrimal duct obstruction
      • Common in newborns and infants
      • Lack of signs of infection
    • Dacryocystitis: Inflammation of the lacrimal sac
      • Often due to obstruction
      • Usually caused by Staph or Strep
      • More common in postmenopausal women
    • Glaucoma: Damage to optic nerve due to high intraocular pressure
      • Acute Angle Closure Glaucoma: Physically obstructed anterior chamber
        • Primary: Preexisting
        • Secondary: No preexisting
        • Symptoms: Rapid onset, extreme pain, halos around lights, nausea, vomiting
        • Exam: Hard eye, dilated and nonreactive pupil
      • Chronic Glaucoma: Irreversible cupping of the optic disc
        • Risk Factors: Black, older, nearsighted, diabetic
        • Chronic Open Angle: Most common
        • Chronic Angle Closure: Flow of fluid into anterior chamber
        • Symptoms: Tunnel vision
    • Strabismus: Misalignment of the eyes
      • Tropia: Constant misalignment
      • Phoria: Intermittent misalignment
      • Pseudostrabismus: Normal in children
    • Amblyopia: Lazy eye
      • Preventable if treated
    • Presbyopia: Loss of accommodation due to aging
    • Myopia: Nearsightedness, focuses in front of the retina
    • Hyperopia: Farsightedness, focuses behind the retina
    • Astigmatism: Multiple focal points
    • Iritis (Anterior Uveitis): Inflammation of the iris
      • Unilateral eye pain, redness
      • May have hypopyon (layering of leukocytes) and ciliary flush
    • Uveitis Intermediate: Vitreous cavity
      • Bilateral, bilateral floaters and blurred vision
      • Snowballs
    • Uveitis Posterior: Choroid, retina, vitreous
      • Floaters, cells in vitreous humor
    • Scleritis: Inflammation of the sclera
      • Symptoms: Deep boring pain, worse at night, photophobia
      • Increased pain with ocular movements
    • Cataracts: Leading cause of world blindness
      • Age related is most common
      • Risk Factors: Aging, smoking
      • Symptoms: Blurry/ghosting images, problems with night driving
      • Congenital: Asymptomatic, leukoria (rule out tumor)
    • Corneal Ulcers: Most commonly infection
      • Risk factor: Extended contact lens wearers
      • Symptoms: Pain, photophobia, tearing
    • Retinal Detachment:
      • Symptoms: Unilateral sudden flashes of lights, shower of floaters, shadow or curtain coming down, no pain or redness
    • Vitreous Hemorrhage: Leakage of blood into vitreous humor
      • Symptoms: Sudden vision loss, bleeding within the eye, reduced or absent red reflex
    • Age-Related Macular Degeneration Leading cause of permanent vision loss in the elderly
      • Non-reversible, bilateral
        • Dry: Atrophic/geographic (all AMD starts as dry)
          • Progressive, bilateral atrophy
          • Drusen
        • Wet: Neovascular/exudative
          • New leaky vessel growth
          • Visual distortion (straight lines appear crooked)
          • Gray/green discoloration
    • Central and Branch Retinal Vein Occlusions:
      • Painless vision loss, first noticed upon waking, unilateral
      • Blood and thunder, cotton wool spots, optic disc swelling
    • Central and Branch Retinal Artery Occlusion: MEDICAL EMERGENCY
      • Sudden painless, profound monocular vision loss
      • Red fovea (Cherry red spot), box-car segmentation, RAPD
    • Amaurosis Fugax: Transient ischemic attack
      • Sudden onset, monocular loss of vision, usually lasting a few minutes, complete recovery
      • Curtain passing vertically
    • Diabetic Retinopathy: Noninflammatory retinal disorder, retinal capillary closure and microaneurysms
      • Type 1 is most common
      • Pregnancy can worsen retinopathy
        • Nonproliferative: Develops first
          • Symptoms: Vision loss, blurriness
        • Proliferative: More severe vision loss, neovascularization
          • Signs: Black spots/floaters, dot and blot, cotton wool spots
    • Hypertensive Retinopathy/Choroidopathy:
      • Risk Factors: Smoking, diabetes
      • Symptoms: Arteriovenous nicking, blurry vision, visual field defects
    • Optic Neuritis: Inflammation of the optic nerve
      • Strongly associated with demyelinating disease (MS)
      • Symptoms: Abrupt vision loss, periorbital pain, brow ache
    • Optic Disc Swelling
      • Drusen associated with farsightedness
    • Papilledema: Swelling of the optic nerve due to raised intracranial pressure, usually bilateral
    • Oculomotor Palsies: Cranial nerves III, IV, VI innervate extraocular muscles
      • Symptoms: Double vision, pain on eye movement
      • Exam: Ptosis, pupil abnormalities
    • Nystagmus: Dancing eyes, limited vision

    Teeth Conditions

    • Avulsion of Permanent Teeth: True dental emergency, DO NOT touch the root of the tooth
    • Medication Effects:
      • Gingival Hyperplasia: Anticonvulsants, methotrexate, cyclosporine
      • Dental Erosion: Progesterone, nitrates
      • Osteonecrosis: Bisphosphonates
      • Dental Caries: Sugar preparations

    Oral Conditions

    • Oral Pain: First-line treatment is NSAIDS
    • Angioedema: Hypersensitivity reaction, soft, non-itchy swelling of mouth/lips, tongue or cheeks
      • Rapid onset
      • Treatment: Airway management (epinephrine)

    Throat Conditions

    • Tonsillitis: Congestion with bacteria in the tonsils
      • Tonsillectomy Indications: Recurrent infections, sleep apnea, gagging, one tonsil larger than the other, bad breath.
    • Adenoiditis: Junky nose, always feeling stuffed up
      • Adenoidectomy Indications: Recurrent adenoiditis, sinusitis, persistent middle ear fluid, sleep apnea
    • Pharyngitis: Viral > bacterial, more prevalent in winter, ages 4-7
      • Bugs: Streptococcal, herpes/coxsackievirus, oral candida, GABHS
      • Treatment: Treat GABHS to prevent sequelae
      • Symptoms: Sore throat, dysphagia, fever, malaise, headache, vomiting (kids!), absence of other upper respiratory infection symptoms

    Eye Conditions

    • Eyelid Issue - Eyelid stuck shut - Often resolves itself, but may be caused by bacterial infection - If caused by Gonorrhea, this is an emergency and must be treated with IM Ceftriaxone.
    • Conjunctivitis
      • Bacterial - Most common cause of blindness - Treated with oral antibiotics.
      • Allergic - Itchiness, may appear like cobblestone papilla - Treated with topical antihistamines.
    • Dry Eyes - Insufficient tear production or accelerated tear evaporation - May cause blurriness, dryness, eye strain, gritty feeling - Treated with artificial tears.
    • Pinguecula - Raised yellowish-white mass on conjunctiva, rarely needs to be removed.
    • Pterygium - Fleshy triangular growth on conjunctiva, often requires removal.
    • Infectious Keratitis - Infection of the cornea - Can cause pain, discharge, redness, and blurry vision - High concentration topical antibiotic drops are crucial - May require emergency treatment.
      • Herpes Simplex Keratitis - Corneal ulceration and dendritic branching - Treated with antivirals.
      • Herpes Zoster Ophthalmicus- Affects the trigeminal nerve, causing malaise, fever and Hutchinson's sign - Treated with oral antivirals.
      • Fungal Keratitis - Caused by contact with plants - May present with satellite lesions.
      • Acanthamoeba Keratitis - Caused by contact with fresh water or hot tubs - May present with perineural and ring infiltrates - Treated with long-term, intensive topical biguanide/diamidine.
    • Dacryoadenitis - Inflammation of the lacrimal gland - Commonly caused by viral infection in children - Can cause "S" shaped eyelid deformity.
    • Dacryostenosis - Nasolacrimal duct obstruction - Common in newborns and infants - Usually no signs of infection - Treatment involves gentle, downward massage.
    • Dacryocystitis - Inflammation of the lacrimal sac - Commonly caused by obstruction, leading to infection - Usually caused by Strep or Staph - Treated with systemic antibiotics.
    • Glaucoma
      • Damage to the optic nerve caused by high intraocular pressure.
      • Acute Angle Closure Glaucoma
        • Anterior chamber is physically obstructed - May be primary (preexisting) or secondary (not preexisting).
        • Rapid onset of symptoms - Extreme pain, halos around lights, nausea, vomiting, hard eye, dilated and nonreactive pupil.
        • Treat immediately with ophthalmology referral.
        • Reduce IOP with IV acetazolamide.
      • Chronic Glaucoma
        • Irreversible cupping of the optic disc.
        • Risk factors: Older age, blackness, nearsightedness, diabetes.
        • Chronic Open Angle Glaucoma - The most common type.
        • Chronic Angle Closure Glaucoma - Flow of fluid into the anterior chamber is impaired.
        • Symptoms - Tunnel vision.
        • Treatment - Medication to lower IOP, prostaglandins preferred.

    Eye Conditions: Other

    • Strabismus - Misalignment of the eyes - Can be constant (tropia) or intermittent (phoria) - Treat with patching, contact lenses, or eyeglasses.
    • Amblyopia - Lazy eye - Preventable if treated early - One eye is suppressed to prevent double vision - Treatment includes patching or visual therapy.
    • Presbyopia - Loss of accommodation due to aging.
    • Myopia - Nearsightedness - Light focuses in front of the retina.
    • Hyperopia - Farsightedness - Light focuses behind the retina.
    • Astigmatism - Multiple focal points.
    • Iritis (Anterior Uveitis) - Inflammation of the iris - Unilateral eye pain, redness - May have hypopyon (layering of leukocytes) or ciliary flush - Refer to ophthalmologist.
    • Uveitis Intermediate - Inflammation of the vitreous cavity - Bilateral, with floaters and blurred vision - May appear as "snowballs" - Treated with systemic corticosteroids.
    • Uveitis Posterior - Inflammation of the choroid, retina, and vitreous - Floaters, cells in vitreous humor - Treated with systemic corticosteroids.
    • Scleritis - Inflammation of the sclera - Deep, boring pain, worse at night, photophobia - Pain intensifies with eye movements - Treatment varies.
    • Cataracts - Leading cause of blindness worldwide - Commonly caused by aging or smoking - Symptoms include blurry or ghosting images, difficulty driving at night.
      • Congenital Cataracts - Asymptomatic - Leukocoria (whitish reflex) requires investigation to rule out a tumor.
    • Corneal Ulcers - Commonly caused by infection - Pain, photophobia, and tearing are common - Treatment depends on the cause - EMERGENCY
    • Retinal Detachment - Unilateral flashes of light, shower of floaters, curtain coming down - No pain or redness - Urgent ophthalmology referral is required.
    • Vitreous Hemorrhage - Leakage of blood into the vitreous humor - Sudden vision loss, bleeding within the eye - Eye is not red or painful - Unilateral symptoms are more common - Red reflex is diminished or absent - Treatment: Referral to an ophthalmologist.
    • Age-Related Macular Degeneration - Leading cause of permanent vision loss in the elderly - Non-reversible - Bilateral.
      • Dry AMD - Atrophic/geographic - All AMD initially presents as dry.
        • Progressive, bilateral atrophy
        • Drusen (yellow deposits) are common.
        • Treated with oral antioxidants.
      • Wet AMD - Neovascular/exudative - New leaky blood vessel growth.
        • Visual distortions - Straight lines may appear crooked.
        • Gray or green discoloration.
        • Treat with laser photocoagulation.
    • Central and Branch Retinal Vein Occlusion - Painless vision loss, often noticed upon waking - Unilateral - Blood and thunder, cotton wool spots, and optic disc swelling.
      • Treated with referral - May lead to neovascularization as a complication.
    • Central and Branch Retinal Artery Occlusion - Acute medical emergency - Sudden, painless, profound monocular vision loss.
      • Red fovea (Cherry red spot), box-car segmentation of the retina, RAPD (relative afferent pupillary defect).
      • Doppler ultrasonography is used for diagnosis.
      • **Treatment involves immediate referral - Assess for stroke. **
    • Amaurosis Fugax - Transient ischemic attack (TIA) - Sudden, monocular vision loss lasting a few minutes with complete recovery.

    Dental Emergencies

    • Avulsion of Permanent Teeth: DO NOT touch the tooth root - True dental emergency - See a dentist immediately.
    • Medication Side Effects
      • Gingival hyperplasia - Anticonvulsants, methotrexate, cyclosporine.
      • Dental erosion - Progesterone, nitrates.
      • Osteonecrosis - Bisphosphonates.
      • Dental caries - Sugar preparations.

    Oral Health: Other

    • Most patients do not require antibiotic prophylaxis.
    • Oral pain - First line treatment is NSAIDs.
    • Angioedema - Hypersensitivity reaction - Rapid onset of soft, non-itchy swelling of the mouth, lips, tongue, or cheeks - Treat with airway management, including epinephrine.

    Throat and Nasal Conditions

    • Tonsillitis - Congestion of tonsils with bacteria.
      • Tonsillectomy indications: Recurrent infections, sleep apnea, gagging, one tonsil larger than the other, bad breath, seven or more episodes yearly.
    • Adenoiditis - Feeling of constant nasal congestion - Inability to breathe through the nose - Poor appearance and feeling ill - Cervical lymphadenopathy.
      • Symptoms: Long face, gummy smile, dry lower lip, mouth breathing.
      • Adenoidectomy indications: Recurrent adenoiditis, sinusitis, persistent middle ear fluid, sleep apnea.
    • Pharyngitis - Viral > bacterial, more prevalent in winter -Ages 4 -7 - Most commonly caused by Streptococcus, Herpes/Coxsackievirus, oral Candida, GABHS.
      • Symptoms: Sore throat, dysphagia, fever, malaise, headache, vomiting (in children), absence of other upper respiratory infection symptoms.
      • Treatment: Treat GABHS to prevent sequelae.
    • Nasal Polyps - Unilateral nasal obstruction, facial pressure, headache - Similar to nasal polyps - Mostly benign, 5-15% are squamous cell carcinoma.
      • Treatment: Surgical excision (medial maxillectomy) - High recurrence rates.
    • Juvenile Angiofibroma - Slow growing tumor in young boys (uncommon) - Grows in the posterior nasal cavity and extends into the nasopharynx - In girls, may indicate gonadal dysgenesis. - Treatment: Removal.

    Nasal and Paranasal Sinus Tumors

    • Malignant Tumors - VERY RARE - May present as chronic rhinitis/sinusitis, unilateral ear pain, hearing loss.
      • Nasopharyngeal Malignant Tumors
        • Nasopharyngeal Carcinoma (squamous cell) - Most common cancer of the nasopharynx - Risk factors: Adult, Asian race, EBV exposure.
        • Adenocarcinoma/Adenoid Cystic Carcinoma (less common) - Sinonasal tumors - Risk factors: Wood dust, leather dust, asbestos - Most commonly originate in the ethmoid sinuses.
        • Lymphoma ("Lethal midline granuloma") - Most commonly T-cell lymphoma - May cause bleeding - Associated with Epstein-Barr virus.
        • Overall high cure rates
      • Paranasal Sinuses and Nasal Malignancies
        • Squamous cell carcinoma - Maxillary Antrum (epicenter).
        • Lymphoma.
        • Symptoms: Advanced - Proptosis, expansion of the cheek, ill-fitting maxillary dentures, severe pain, malar hypesthesia (infraorbital nerve involvement).
      • Risk Factors: Smoking - Cure rates are lower if the base of the skull is involved.
      • Diagnosis: CT and MRI.
      • Treatment: Chemotherapy/radiation - Varies depending on tumor type and extent.

    Ear (Hearing)

    • Conductive Hearing Loss: External auditory canal, ossicles, or tympanic membrane dysfunction
    • Sensory-Neural Hearing Loss: Cochlea or neural component dysfunction
    • Mixed Hearing Loss: Includes both conductive and sensory components
    • Weber Test: Tuning fork placed on center of forehead
      • Normal: Sound heard equally in both ears
      • Conductive Hearing Loss: Sound heard louder in affected ear
      • Sensory-Neural Hearing Loss: Sound heard louder in unaffected ear
    • Rinne Test: Tuning fork placed on mastoid then shoulder
      • Normal: Air conduction (AC) is greater than bone conduction (BC)
      • Conductive Hearing Loss: AC equal to BC or BC greater than AC
      • Sensory-Neural Hearing Loss: AC greater than BC
    • Middle Ear Effusions and Conductive Hearing Loss:
      • Non-mobile tympanic membrane - Treat: Observe for 3 months - Antihistamines and oral steroids are not effective
    • Otosclerosis: Stapes loses mobility due to excessive bony growth at the oval window
      • Increased osteoblastic and osteoclastic activity and vascular proliferation
      • Most common location: Anterior stapes footplate
      • Presents as progressive bilateral conductive hearing loss
      • Treat: Refer to ENT - Medications: Sodium fluoride and bisphosphonates
    • Sudden Sensory-Neural Hearing Loss: Rapid onset within 72 hours, typically one ear
      • Risk factor: Viral infection/environmental allergies
      • Treat: Refer ASAP, prescribe high dose oral steroids
    • Acoustic Neuroma: Schwann cell derived tumors- vestibular portion of CN VIII
      • Risk factors: Neurofibromatosis
      • Signs: Unilateral sensory-neural hearing loss and tinnitus, balance problems
      • Exam: CN VII asymmetry in large tumors
      • Treat: Observation, high dose oral steroids, surgical resection
    • Hereditary SNHL: Unknown origin
      • Syndromic exam findings: SNHL typically symmetric
      • Non-syndromic exam findings: Cookie bite, U-shaped
      • Treatment: Amplification
    • Autoimmune SNHL: Rheumatoid arthritis, SLE
      • Often bilateral and progressive
      • Treat: Refer to ENT, corticosteroids
    • Presbycusis: Age related SNHL
      • Loss of hair cells at basal turn of cochlea
      • Treatment: Amplification
    • Acoustic Noise Trauma: Second most common cause of sensorineural hearing loss
      • Loss typically begins in high frequencies
      • Treatment: Noise/hearing protection
    • Tinnitus: Ringing/buzzing/roaring noises
    • Hyperacusis: Excessive sound sensitivity
      • Symptoms worse with stress, anxiety, fatigue, caffeine, ASA/Ibuprofen
      • Treat: Amplification, antidepressants

    Ear (External)

    • Seborrheic dermatitis: Scaling and erythema usually affecting auricular fold
      • Can predispose cellulitis
    • Psoriasis: Scaly silver plaques
    • Atopic dermatitis: Prominent excoriation
    • Contact Dermatitis: Due to irritant→ Nickel in earrings
    • Skin cancer: Squamous cell most commonly
      • Lack subcutaneous tissue→ consider when treating
    • Cellulitis: Infection of the pinna, staph most common
    • Perichondritis: Pseudomonas most common
    • Relapsing polychondritis: Rheumatologic disorder affecting tracheobronchial tree
      • Treat: Steroids
    • Epidermoid cyst: Proliferation of epidermal cells, usually benign
    • External Ear trauma: Common in wrestlers
      • Drained promptly→ Cauliflower ear
        • Needle within 6 hours
        • Incision up to 7 days
    • Congenital malformations: Treat by referring early!

    Eye

    • Conjunctivitis:
      • Bacterial Conjunctivitis: Viral or bacterial, more prevalent in winter, ages 4-7, can be caused by strep, herpes/coxsackievirus, oral candida, GABHS
        • Treat: Antibiotics to prevent sequelae
        • Bacterial Gonococcus: Copious discharge, usually due to genital secretions, EMERGENCY - Treat: IM Ceftriaxone
        • Bacterial Chlamydia: Trachomatis, Most common infectious cause of blindness - Treat: Oral antibiotics
      • Allergic Conjunctivitis: Itchiness - Vernal→ cobblestone papilla - Treat: Topical antihistamines
    • Dry eyes (Keratoconjunctivitis Sicca):
      • Inadequate tear production or accelerated tear evaporation
      • Symptoms: Bilateral, dryness, gritty/sandy, eye strain
      • Schirmer test→ Measure rate of production of aqueous component
      • Treat: Artificial tears
    • Pinguecula: Raised yellowish white mass, rarely needs to be removed
    • Pterygium: Fleshy triangular growth, removal is often indicated
    • Infectious keratitis: Infection of the cornea
      • Signs: Eye pain, discharge, eye redness - Treatment: High concentration topical antibiotic drops, ER
      • Herpes Simplex Keratitis: Corneal ulceration, dendritic branching - Treat: Antivirals
      • Herpes Zoster Ophthalmicus: Trigeminal nerve - Malaise, fever, Hutchinson's sign - Treatment: Glasses, surgery, treat underlying disorder
    • Thyroid Eye Disease: Hyperthyroidism
      • Mucopolysaccharides in extraocular muscles
      • Symptoms: Exophthalmos, lid retraction and lag
      • Treatment: protection, corticosteroids
    • Orbital Cellulitis: Infection of orbital tissues
      • Organism: Strep
      • Symptoms: Tender, swelling, warm
      • Treat: High dose broad spectrum IV antibiotics
    • Preseptal Cellulitis: Infection of the eyelid surrounding skin
      • Organism: Staph
      • Symptoms: Swelling, decreased ocular motility, pain with eye movements, proptosis
      • Treat: Antibiotics
    • Conjunctival & Corneal foreign bodies: Something in my eye
      • Exam: Visual acuity test
      • Metabolic→ Iron → Rust ring→ Ophthalmology
      • Treat: Removal with damp, cotton tipped swab, or needle
    • Intraocular foreign body: Requires emergency treatment
      • Grinding equipment
    • Corneal Abrasion: History of trauma to the eye
      • Symptoms: Severe pain, tearing, foreign body sensation, blurry vision
      • Look for foreign body→ Evert upper lid
    • Contusions: Closed globe injury
      • Eyelid ecchymosis→ Black eye
      • Treat: Ice Packs, hot packs
    • Globe Trauma: Massive lid edema or laceration
      • Usually need immediate eye surgery
    • Hyphema: Anterior chamber hemorrhage
      • May cause glaucoma with permanent vision loss
      • Treat: bed rest and eye shield
    • Subconjunctival Hemorrhage: Bleeding under conjunctiva
      • Etiology: Surgery, straining, vomiting
      • Treatment: None required
    • Lens Dislocation: Trauma, some hereditary conditions
      • Symptoms: Iris may quiver, lens appears off center on eye exam
      • Treatment: Permanent, glasses
    • Orbital fracture: Blunt trauma forces contents through orbital floor
      • Symptoms: Diplopia, posterior displacement of the eye, inferiorly displaced globe
      • Treat: Referral

    Teeth/Mouth

    • Dental caries are the most common chronic disease of childhood
      • Most commonly in adolescents ages 12-19
      • Bacteria metabolize sugars into acid which demineralize tooth enamel
        • Remineralization occurs when acid is buffered by saliva
        • The more frequent the consumption the decreased time for remineralization
      • Higher cavity risk areas: Newly erupted teeth
      • White lines/spots = first sign of demineralized enamel
        • Usually affecting upper front teeth
        • Dentin is in later stages and may be dark
      • Prevention: Brushin 2x/day and floss 1x/day
        • Fluoride guidelines: Main effect is topical mechanism
          • Less than 3 years old = grain of rice
          • Older than 3 years old = pea sized
    • Peridontitis is most common in adults
      • Associated with diabetes
    • HIV 16 DNA is involved in oral cancers
    • Xerostomia: Dry mouth due to decreased salivary flow
      • Steroids, antihistamines, diuretics, opioids
      • Signs: Dry mouth, burning sensation, changes in taste, difficulty swallowing
      • Treat: Encourage drinking water, avoid caffeine/sugary drinks
    • Oral exams should be performed at each well child visit
    • Gingivitis: Tenderness, mild gum swelling, redness, bleeding gums
      • Treat: Effective brushing and flossing
    • Periodontitis: Destruction of periodontal ligament
      • Can be halted but not reversed
      • Treat: Brushing and flossing
    • Gingival hyperplasia: Gingival enlargement, teeth are hard to clean
      • Treat: Oral hygiene and regular cleaning
    • Dental erosion: Teeth are smooth/glassy, pulp exposure caused heat/cold sensitivity
      • Treat: Rinse with water after reflux/vomiting, don’t immediately brush
    • Herpes Labialis: Burning, itching, crusting
      • Treat: Antiviral agents topical or oral
    • Pyogenic Granuloma: Erythematous, nonpainful, smooth, lobulated mass
      • Bleeds when touched
      • Treat: Conservative surgical excision
    • Oral ulcerations: Most common in aphthous minor
      • Symptoms: Recurring painful ulcers with erythematous halo
      • Treat: Magic mouthwash
    • Herpetic Stomatitis: Burning sensation then vesicle rupture buccal mucosa (inside mouth)
      • Treat: Antivirals
    • Necrotizing ulcerative gingivitis: Bleeding, halitosis
      • Treat: Penicillin x 10 days
    • Geographic tongue: Normal variant
      • Spicy foods, waxes and wanes
      • Treat: None needed
    • Hairy tongue: Asymptomatic, associated with tobacco use
    • Glossitis: Smooth tongue
      • Nutritional deficiencies: Iron, B12, folate
      • Treat: Underlying problem
    • Glossodynia: Burning mouth syndrome
      • Treat: Clonazepam
    • Fissured tongue: Normal variant, asymptomatic
    • Bony Tori: Benign arising from cortical plate
      • Treat: Surgery if needed
    • Candidiasis: Fungal infection oftenly pseudomembranous candidiasis (thrush)
      • Burning sensation, white/curd patches over red mucosa that CAN be rubbed off
      • Treat: Topical antifungal agents
        • Adult patient: Workup for HIV
    • Lichen Planus: Reticular white lacy striations
      • Treat: Corticosteroid gels or mouthrinses
    • Oral Hairy Leukoplakia: Hairy tongue on lateral sides
      • Common early HIV sign
    • Leukoplakia and erythroplakia: Premalignant, subtle white patch that progresses to ulcerate
      • Cannot be rubbed off
      • Treat: >14 days should be biopsied as they can be carcinoma or dysplastic
    • Oral Cancer: Usually squamous cell carcinoma
      • Risk factor: Tobacco and alcohol usage as well as HPV
      • Treat: Biopsy >14 days
    • Reversible pulpitis: Pain with hot/cold/sweet but resolves once removed
      • Treat: Dental filling
    • Irreversible pulpitis: Pain is severe and persistent, sensitive to percussion
      • Treatment: Root canal/tooth extraction
    • Periapical abscess: Purulent form for periapical periodontitis
      • Pain is well localized, abscess is draining
        • May cause cellulitis
        • Treatment: Urgent dental referral
    • Pericoronitis: Infection of a gum flap overlying partially erupted molars
      • Treatment: Irrigation
    • Periodontal abscess: Deep infection of tooth support structures
      • Tooth is loose and sensitive to touch
      • Treat: Analgesics
    • Alveolar bone fracture: Localized tenderness, step-offs in occlusion of teeth
      • Treat: Image with CT, dentist
    • Condylar fracture: Preauricular swelling, limited ability to open mouth
      • Treat: Refer
    • Intrusion of primary teeth: Do not remove tooth
      • Treat: Refer
    • Luxation: Lateral displacement though still in socket
      • Treat: Dental referral as needed
    • Avulsion of primary teeth: Completely knocked out of socket
      • Treat: Referral as needed
    • Fractures of primary teeth:
      • Simple crown fracture: Enamel and dentin
      • Crown fracture with pulp involvement: Enamel, dentin, and pulp- Urgent
      • Root fracture: Routing referral- not very detectable
    • Intrusion of permanent teeth: Do not attempt to remove tooth
      • Treat: Refer immediately!
    • Avulsion of permanent teeth: DO NOT touch root of tooth
      • TRUE DENTAL EMERGENCY
    • Medication effects:
      • Gingival hyperplasia: Anticonvulsants, methotrexate, cyclosporine
      • Dental erosion: Progesterone, nitrates
      • Osteonecrosis: Bisphosphonates
      • Dental caries: Sugar preparations
    • Most patient do not require antibiotic prophylaxis
    • Oral Pain: First line is NSAIDS
    • Angioedema: Hypersensitivity reaction: soft, non-itchy swelling of mouth/lips, tongue or cheeks
      • Rapid onset
      • Treat: Airway management (epinephrine)

    Throat

    • Tonsillitis: Congestion with bacteria in the tonsils
      • Tonsillectomy indications: Recurrent infections, sleep apnea, gagging, one tonsil larger than other, bad breath - 7 episodes/year
    • Adenoiditis: Junky nose- always feeling stuffed up
      • Unable to breath through nose, ill feeling/appearing, cervical lymphadenopathy
        • Long face, gummy smile, dry lower lip, mouth breathing
      • Adenoidectomy indications: Recurrent adenoiditis, sinusitis, persistent middle ear fluid, sleep apnea
    • Pharyngitis: Viral > bacterial, more prevalent in winter, ages 4-7
      • Bugs: Streptococcal, herpes/coxsackievirus, oral candida, GABHS
        • We treat GABHS to prevent sequelae!
        • Streptococcal further: Types include non-hemolytic and hemolytic
          • Symptoms: Sore throat, dysphagia, fever, malaise, headache, vomiting (kids!), absence of other upper respiratory infection symptoms

    Nose

    • Nasal polyps: Unilateral nasal obstruction, facial pressure, headache, similar to nasal polyp
      • Mostly benign: 5-15% are squamous cell carcinoma
      • Treat: Surgical excision (medial maxillectomy)
        • Recurrence rates are high
    • Juvenile Angiofibroma: Slow growing tumor in young boys (Uncommon!)
      • Posterior nasal cavity growing into nasopharynx
        • Girls= Gonadal dysgenesis
        • Treatment: Removal
    • Malignant Tumors: VERY RARE
      • Symptoms: Chronic rhinitis/sinusitis, unilateral ear pain, hearing loss
      • Nasopharyngeal malignant tumors
        • Nasopharyngeal carcinoma (squamous cell)
          • Most common cancer of nasopharyngeal cancer
          • Risk factors: Adult, race (Asians), EBV exposure
        • Adenocarcinoma/Adenoid cystic carcinoma (less common)
          • Sinonasal tumors
          • Risk factors: Wood dust, leather dust, asbestos
            • Most commonly from ethmoid sinuses
        • Lymphoma “Lethal midline granuloma”
          • Most commonly T-cell lymphoma
          • Bleeds quite a bit associated with Epstein-Barr Virus
          • Overall high cure rates
      • Paranasal sinuses and nasal malignancies
        • Squamous cell carcinoma- Maxillary Antrum (epicenter)
        • Lymphoma
        • Symptoms: Advanced: Proptosis, expansion of cheek, ill fitting maxillary dentures, severe pain, malar hypesthesia (infraorbital nerve is involved)
          • Risk Factor: Smoking
          • Treatment is higher if base of skull is NOT involved
            • Lower cure rates
      • Diagnostics: CT and MRI
      • Treatment: Depends on tumor type and extent (chemotherapy/radiation)

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    This quiz covers various external and middle ear conditions, including microtia, atresia, and otitis externa. Test your knowledge on symptoms, treatments, and diagnostic procedures related to ear health. Perfect for medical students and healthcare professionals.

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