eyes, ears, nose and throat pathophysiology

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Questions and Answers

What is a common infectious cause of keratitis?

Contact lens wear

Trauma

Corneal burn

Bacterial infection (correct)

Which symptom is least likely associated with keratitis?

Blurred vision

Persistent pain

Severe headache (correct)

Photophobia

What is indicated by a positive fluorescein stain in the context of keratitis?

Non-infectious injury

Damaged epithelium (correct)

Normal epithelium

Presence of hypopyon

What characteristic finding might you see during a slit lamp exam for HSV-1 related keratitis?

Dendritic ulcers with terminal bulbs Signup and view all the answers

Which of the following is a non-infectious cause of keratitis?

Trauma Signup and view all the answers

What is the recommended action if a patient is suspected to have keratitis?

Refer to an ophthalmologist immediately Signup and view all the answers

What recurrence rate is associated with HSV-1 keratitis?

25% Signup and view all the answers

Which symptom may indicate a more severe case of keratitis?

Severe persistent pain Signup and view all the answers

What is the potential consequence of a perforated nasal septum?

Nasal stuffiness and chronic infections Signup and view all the answers

Which sinus is typically the last to fully develop?

Frontal sinus Signup and view all the answers

What leads to blockage of the middle meatus?

Chronic sinusitis or treatment-resistant sinusitis Signup and view all the answers

What is a common characteristic of most viral upper respiratory infections (URIs)?

They involve both the nose and sinuses Signup and view all the answers

Which of the following conditions is associated with nasal septum deviation due to trauma?

Chronic nasal obstruction Signup and view all the answers

What is a major concern regarding abscess formation near the nasal septum?

Its proximity to the brain makes it potentially dangerous Signup and view all the answers

What percentage of acute bacterial sinusitis cases is associated with viral upper respiratory infections?

80% Signup and view all the answers

What might cause a nasal septum perforation?

Chronic infections or cocaine use Signup and view all the answers

Which condition can commonly present with thick and purulent nasal discharge?

Acute sinusitis Signup and view all the answers

At what age are the frontal sinuses typically developed?

Early adolescence Signup and view all the answers

Which virus is primarily associated with Hand-Foot-Mouth Disease?

Coxsackie virus A-16 Signup and view all the answers

What is a common characteristic of Sialadenitis?

Acute inflammation of a salivary gland Signup and view all the answers

What is the most common type of oral cancer?

Squamous cell carcinoma Signup and view all the answers

Which symptom is characteristic of strep pharyngitis?

Strawberry tongue and circumoral pallor Signup and view all the answers

Which statement correctly describes Rheumatic Fever?

Jones criteria is used for its diagnosis. Signup and view all the answers

Which statement is true regarding herpes zoster involvement in the ophthalmic division?

It can lead to loss of extraocular movements. Signup and view all the answers

What is a characteristic symptom of anterior uveitis?

A unilateral presentation in most cases. Signup and view all the answers

What distinguishes nongranulomatous anterior uveitis from granulomatous?

Granulomatous has a higher incidence of systemic diseases. Signup and view all the answers

Which feature is associated with the clinical presentation of dendrites in herpes zoster?

They exhibit tapered ends. Signup and view all the answers

Which factor is NOT a part of the pathophysiology of anterior uveitis?

Extravasation of fusion proteins. Signup and view all the answers

What symptom is NOT commonly associated with anterior uveitis?

Bilateral blurred vision. Signup and view all the answers

In herpes zoster cases involving the eye, which symptom can develop as the condition progresses?

Necrosis leading to permanent vision loss. Signup and view all the answers

What is a potential danger sign in the examination of a patient suspected of anterior uveitis?

Severe pain with light accommodation. Signup and view all the answers

Which statement best describes the nature of visual acuity in patients with anterior uveitis?

Visual acuity may significantly decrease. Signup and view all the answers

Which of the following descriptions is inaccurate regarding the symptoms of herpes zoster ophthalmicus?

Visual disturbances are typically bilateral. Signup and view all the answers

What defines chronic sinusitis in terms of duration of symptoms?

Infection lasting more than 90 days Signup and view all the answers

What is the primary symptom indicating a potential secondary bacterial sinusitis in a viral URI?

Persistence of symptoms without improvement Signup and view all the answers

Which organism is most associated with viral upper respiratory infections leading to sinusitis?

H influenzae Signup and view all the answers

In which condition can acute bacterial sinusitis occur after an existing chronic condition?

Acute bacterial sinusitis superimposed on chronic sinusitis Signup and view all the answers

What is a significant finding that could indicate a severe condition in a sinusitis case?

Periorbital swelling or proptosis Signup and view all the answers

When should imaging studies be considered in adults with suspected chronic or recurrent sinusitis?

If chronic or recurrent episodes are suspected Signup and view all the answers

What is a common characteristic of recurrent acute bacterial sinusitis?

Episodes lasting less than 30 days, separated by 10 days Signup and view all the answers

Which treatment is indicated for patients when bacteria are sensitive to the prescribed antibiotic?

Gradual improvement over 72 hours Signup and view all the answers

Which management approach is not effective for non-allergic patients with sinusitis?

H1 antihistamine use Signup and view all the answers

What distinguishes subacute sinusitis from acute sinusitis?

Symptoms last between 30 and 90 days Signup and view all the answers

Which throat disorder is primarily characterized by inflammation of the larynx that can cause voice changes?

Laryngitis Signup and view all the answers

Which disorder is characterized by swollen tonsils and often follows a viral or bacterial infection?

Tonsillitis Signup and view all the answers

Which of the following is NOT a typical symptom of Gastroesophageal Reflux Disease (GERD)?

Frequent diarrhea Signup and view all the answers

Which condition is known to result in painful, shallow ulcers within the mouth, known as canker sores?

Aphthous Stomatitis Signup and view all the answers

What is a common characteristic of Meniere’s Disease?

Episodes of vertigo Signup and view all the answers

Which of the following conditions typically presents with redness, itching, and discharge of the conjunctiva?

Conjunctivitis Signup and view all the answers

Which type of hearing loss is caused by damage to the inner ear or auditory nerve?

Sensorineural hearing loss Signup and view all the answers

Which ear disorder is characterized by the accumulation of earwax obstructing the ear canal?

Cerumen Impaction Signup and view all the answers

Which type of oral cancer is associated primarily with tobacco and alcohol use?

Oral Squamous Cell Carcinoma Signup and view all the answers

Which symptom is commonly associated with both pharyngitis and tonsillitis?

Difficulty swallowing Signup and view all the answers

Study Notes

Keratitis

Keratitis is inflammation of the cornea.
Infectious causes include bacterial, viral, and fungal infections.
Herpes simplex and zoster are common viral causes.
Non-infectious causes include contact lens wear, trauma, and corneal burns.
Symptoms include pain, photophobia, blurred vision, and minimal discharge.
Fluorescein stain can be used to identify damaged epithelium.
Hypopyon, pus in the anterior chamber, may be present.
Refer to an ophthalmologist immediately for suspected keratitis.

Herpetic Eye Diseases

Herpetic eye diseases are caused by the herpes simplex virus (HSV).
HSV-1 typically starts on the cornea with keratitis.
Slit-lamp examination reveals dendritic ulcers with terminal bulbs in HSV-1 infections.
Recurrence is possible in 25% of HSV-1 cases.
HSV-1 symptoms may include pain, decreased visual acuity.
Herpes zoster is a reactivation of varicella in the ophthalmic division of the trigeminal nerve.
Herpes zoster may present with a dermatomal rash, loss of extraocular muscle function, and dendrites with tapered ends instead of bulbs.
Keratitis can progress to retinitis with necrosis in severe cases of herpes zoster.

Anterior Uveitis

Anterior uveitis is inflammation of the iris.
Inflammation can also involve the ciliary body, termed iridocyclitis.
Anterior uveitis can be classified as nongranulomatous or granulomatous.
The breakdown of the blood-ocular barrier leads to the extravasation of WBCs and protein into the aqueous humor.
Symptoms include pain, photophobia, blurred vision, redness with increased tearing, and no discharge.
Most cases are unilateral.

Nasal Septum

The nasal septum should be examined for deviation or perforation.
Deviation can be due to trauma and may present with nasal stuffiness or a feeling of constant colds.
Perforation can be caused by chronic infection, cocaine use, crusting from atrophic rhinitis, previous nasal surgery, tuberculosis, or syphilis.
Nasal septum abscesses are rare but dangerous due to proximity to the brain.

Sinusitis

Sinuses are not fully developed until about 18 years of age.
It is difficult to differentiate between simple URI and acute sinusitis.
Viral URI’s typically involve both the nose and sinuses.
Bacteria infections of the sinuses do not involve the nose.
Purulent discharge is likely coming from the sinuses via the nose.
80% of acute bacterial sinusitis follows viral URI.
20% of acute bacterial sinusitis are associated with allergic rhinitis.
Acute bacterial otitis media and sinusitis are common sequelae of viral URI.
Acute bacterial sinusitis lasts less than 30 days with resolution of symptoms.
Subacute sinusitis lasts between 30 and 90 days with resolution of symptoms.
Recurrent acute bacterial sinusitis involves episodes lasting less than 30 days separated by at least 10 days.
Chronic sinusitis involves symptoms lasting more than 90 days.
Acute bacterial sinusitis superimposed on chronic sinusitis involves new respiratory symptoms that resolve with therapy but the underlying residual symptoms persist.
Uncomplicated viral URIs typically last 5-7 days.
Persistent symptoms without improvement suggest secondary bacterial infection.
Fever and purulent discharge for 3-4 days may suggest bacterial sinusitis.
Nasal mucosa is swollen in sinusitis.
Pain or tenderness over the sinuses or behind the orbit can occur, though not necessarily bacterial.
Periorbital swelling or proptosis (eyeball bulging) is an alarming finding.
Cough is present in subacute and chronic sinusitis and may be worse at night.

Diagnosis & Treatment of Sinusitis

CT scan of the sinuses is recommended for chronic or recurrent sinusitis.
Conventional treatment includes antibiotics.
Ampicillin may not be effective against causative organisms.
Most patients should respond to treatment within 72 hours if the bacteria is sensitive.

Hand-Foot-Mouth Disease

Caused by Coxsackie virus A-16.
Common in young children during spring and summer.
Presents with vesicles and small ulcers.
Lesions can occur on the lips, buccal mucosa, soles, and palms.
Transient macular rash can occur on the trunk or extremities.
Mild systemic symptoms like low-grade fever may be present.

Sialadenitis

Sialadenitis is acute inflammation of the parotid or salivary gland.
Typically due to infection.
Presents with swollen and tender glands.
Probing the ducts may reveal a plug or stenosis.

Oral Cancer

The tongue is the most common site of oral cancer.
Over 90% of oral cancers are squamous cell cancers.
Increased risk factors include alcohol and tobacco use.
The 5-year survival rate for oral cancer is 50%.

Pharyngitis / Tonsillitis

Pharyngitis and tonsillitis are usually caused by viruses.
Exudate, pus pockets on the tonsils, may be present.
Exudate is more liquid-like and may be bacterial or viral.
Pharyngitis may or may not have lymphadenopathy.
Strep throat and infectious mononucleosis should be ruled out.
Carditis can occur with strep throat.
Splenomegaly can occur with mononucleosis, therefore contact sports should be avoided.
Scarlet fever is strep pharyngitis with a rash.
Scarlet fever rash features a sandpaper feeling and red papules.
Throat cultures can distinguish strep throat infections.

Signs and Symptoms of Strep Pharyngitis

Strawberry tongue: red, swollen tongue with white coating.
Circumoral pallor: white or pale skin around the mouth.
Pastia's lines: horizontal, linear rash in the antecubital fossa.
Sandpapery rash: occurs when endotoxins are released from bacteria as they are destroyed.
Hot potato voice: change in voice while talking to avoid rubbing together of throat structures.

Rheumatic Fever

Rheumatic fever is a possible sequela of strep pharyngitis.
Peak age for rheumatic fever is 5-15 years old.
Diagnosis requires fulfilling the Jones criteria.

Throat Disorders

Pharyngitis is inflammation of the pharynx, often caused by viral or bacterial infections. Symptoms include a sore throat, fever, and difficulty swallowing.
Laryngitis is inflammation of the larynx, resulting in hoarseness or loss of voice. It can be caused by overuse, infections, or irritants.
Tonsillitis is inflammation of the tonsils, typically occurring after a viral or bacterial infection. Symptoms include swollen tonsils, a sore throat, and trouble swallowing.
Sleep Apnea is a disorder characterized by repeated interruptions in breathing during sleep. It can lead to loud snoring and daytime fatigue.
Gastroesophageal Reflux Disease (GERD) is a condition where acid reflux can irritate the throat, causing a chronic cough, sore throat, and hoarseness.

Mouth Disorders

Oral Candidiasis, also known as thrush, is a fungal infection that presents as white patches in the mouth. It is often observed in immunocompromised individuals.
Periodontal Disease involves inflammation and infection of the gums and surrounding tissues, potentially leading to tooth loss.
Aphthous Stomatitis is characterized by painful, shallow ulcers within the mouth, commonly referred to as canker sores. The causes are often unknown.
Oral Squamous Cell Carcinoma is a malignant tumor of the oral cavity. Risk factors include tobacco and alcohol use.
Temporomandibular Joint Disorders (TMJ) cause pain and dysfunction of the jaw joint and muscles, often resulting in jaw clicking or locking.

Ear Disorders

Otitis Media, a middle ear infection, is common in children and is associated with ear pain, fever, and irritability. It can lead to hearing loss if recurrent.
Tinnitus is the perception of noise or ringing in the ears without any external sound. It is often related to exposure to loud noises or ear injury.
Hearing Loss can be conductive, stemming from problems in the outer or middle ear, or sensorineural, resulting from damage to the inner ear or auditory nerve.
Meniere’s Disease is an inner ear disorder that causes vertigo, tinnitus, hearing loss, and aural fullness. Episodes can last for several hours.
Cerumen Impaction is the accumulation of earwax that can obstruct the ear canal, leading to discomfort and hearing impairment.

Eye Disorders

Conjunctivitis, also known as pink eye, is inflammation of the conjunctiva, presenting with redness, itching, and discharge. It can be viral, bacterial, or allergic.
Cataracts are a clouding of the eye’s natural lens, leading to decreased vision. They are commonly associated with aging, diabetes, and certain medications.
Glaucoma is a group of eye conditions that damage the optic nerve, often associated with increased intraocular pressure. It can lead to vision loss if left untreated.
Age-related Macular Degeneration (AMD) is a progressive disorder affecting the macula, leading to a loss of central vision, particularly in the elderly.
Diabetic Retinopathy is a complication of diabetes that leads to damage of retinal blood vessels, potentially causing vision impairment or blindness.

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