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ACR 1 Screening/HEENT > Acne, Red Eye, Ear Pain, Sore Throat, Cough > Flashcards

Acne, Red Eye, Ear Pain, Sore Throat, Cough Flashcards

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1
Q

How is Mild acne described?

A

Small blemishes

Blackheads (open comedones)/whiteheads (closed comedones)

No inflammation

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2
Q

How is Moderate acne described?

A

Numerous blackheads & whiteheads

Papules and pustules

Inflammation

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3
Q

How is Severe acne described

A

Severe inflammation

Large papules and pustules

Cystic nodules

Scarring & hyperpigmentation; if acne is difficult to control, cystic or scarring, hyperpigmented post-resolution

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4
Q

What DDx may you consider in a women with acne?

A

PCOS

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5
Q

What is 1st line tx for mild acne?

A 
Benzoyl Peroxide (BP)
or
Topical Retinoid
or 
Combo therapy
- BP + Abx
- Retinoid +BP
- Retinoid + BP + Abx
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6
Q

What is 1st line tx for moderate acne?

A

Topical combo therapy

  • BP + Abx
  • Retinoid +BP
  • Retinoid + BP + Abx

or

oral Abx + topical retinoid + BP + topical abx

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7
Q

What are some alternative txs for moderate and severe acne?

A

Add OCP or oral sprionolactone

Consider oral isotretinoin

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8
Q

What is 1st line tx for severe acne?

A

Oral abx + Topical combo therapy

or

Isotretinoin

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9
Q

2 most common causes of red eye?

A

viral and allergic conjunctivitis

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10
Q

Most common virus that is responsible for viral conjunctivitis?

A

Adenovirus

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11
Q

Examples of eye emergencies (8)

A
  • Angle closure glaucoma
  • Orbital cellulitis
  • Bacterial Keratitis
  • HSV (dendritic lesions)
  • Hyphema (globe laceration)
  • Hyperacute conjunctivitis
  • Temporal arteritis
  • Foreign body
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12
Q

What is the dx of the following sxs;

Acute onset pain, HA, N/V, decreased vision and halos, rapid rise in IOP

A

Angle closure glaucoma

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13
Q

What is the dx of the following sxs;

Eye bulging forward, Fever, double vision/decreased vision, Pain on eye movement, Limited eye movement

A

Orbital cellulitis

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14
Q

What is the dx of the following sxs;
Unilateral skin lesions on face and scalp
Pain in eye and skin – can be severe and chronic
Photosensitivity
Blurry vision
Watery discharge

A

Herpetic Conjunctivitis (HZV)

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15
Q 
What is the dx of the following sxs; 
Foreign body sensation
Redness
Photosensitivity
Mild blurriness
fluorescein staining w/ blue light reveals dendritic/branching pattern
A

HSV (dendritic lesions)

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16
Q

What is the dx of the following sxs;
Trauma causes blood to enter anterior segment.
Blood in the Anterior Chamber of Eye, Pain, Blurry vision

A

Hyphema

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17
Q

What is the dx of the following sxs;
Associated with Pseudomonas or acanthamoeba, trauma and contact lens wear

pain, photo-phobia, reduced vision,
Corneal ulcers

A

Bacterial Keratitis

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18
Q

What is the dx of the following sxs;

Painful drainage w/ erythema, difficulty openign eye, gritty feeling.

A

Foreign body

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19
Q

S/S of an eye emergency

A 
Visual changes
Severe pain
photosensitive
pain with eye movement 
HA
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20
Q

Common causes of red eye

A

Conjunctivitis (bacterial, viral, allergic)
Keratoconjunctivitis sicca
Blephritis

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21
Q

PE you must perform w/ every eye complaint

A

Visual acuity
EOM
Inspection (pattern of erythema)
pupilary response

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22
Q

Important questions to ask pt with eye complaints

A
  • Sick contacts/ occupation
  • Do they wear contacts
  • unilateral/bilateral
  • duration of sx & amount of discharge
  • visual changes
  • severity of pain
  • photophobia
  • previous treatment
  • allergies or systemic dz
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23
Q

What are clinical manifestations of viral conjunctivitis? (4)

What are PE signs of viral conjunctivitis? (3)

A

foreign body sensation
erythema
itching
accompanying viral sxs

Preauricular lymphadenopathy
copious watery discharge
bilateral

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24
Q

What is the Tx for viral conjunctivitis

A

supportive (cool compress, eye drops)

antihistamines or the itching/redness

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25
What are clinical manifestations of allergic conjunctivitis? What are PE signs of allergic conjunctivitis?
erythema and other allergic sxs ``` cobblestone mucosa (throat and inner eye) itching tearing (stinging discharge) erythema bilateral ```
26
What is the Tx for allergic conjunctivitis
antihistamines (possibly NSAIDS and corticosteroids)
27
What are clinical manifestations of bacterial conjunctivitis?
purulent discharge lid crusting mild pain
28
Common bacterial etiologies for bacterial conjunctivitis
S. aureus (adults) strep, pneumoniae (children) H. influenzae (children)
29
What is the Tx for bacterial conjunctivitis
Trimethoprim/polymyxin B (Polytrim) erythrmoycin (good option for peds) Stay home until discharge subsides, school = 24hr tx with drops
30
Common ear complaints (5)
Otalgia, Otorrhea, Hearing Loss, Dizziness/Vertigo, Tinnitus
31
What Dx is described by the description below? - Dysfxn of Eustachian Tube - Retraction of membrane - Decreased mobility on pneumatic otoscopy. What is the tx?
Serous otitis media ``` Nasal steroids (decongestants) Myringotomy if hearing is impacted ```
32
What are clinical manifestations of Acute Otitis Media PE signs of AOM?
Fever tugging at affected ear (pain) erythema TM with effusion and bulging (loss of landmarks) decreased membrane mobility on pneumatic otoscopy
33
Common etiologies for AOM (3)
Strep pn Hemophilus inf Moraxella cat.
34
Tx for AOM
Amoxicillin 80-90mg/kg BID x 10days (comes in 400mg/5ml suspension) Pain relief (tylenol) Macrolides for Pen allergic pts
35
What are clinical manifestations of chronic Otitis Media
perforated TM persistent/recurrent purulent otorrhea pain conductive hearing loss
36
Tx for chronic Otitis Media
``` topical abx (oflaxacin, ciprofloxacin) Possible TM repair ```
37
Most common causes of chronic otitis media?
pseudomonas staph strep
38
What are common etiologies of Otitis externa?
swimming | Pseudomonas
39
What are clinical manifestations of Otitis externa? PE signs of Otitis externa
ear pain pruritis auricular discharge tragus pain canal erythema edema, debris
40
Tx for otitis externa
cortisporin | ciprofloxacin/dexamethasone
41
____ is a collection of squamous debris in middle ear - “skin where it doesn’t belong” with Crusting on tympanic membrane which can lead to a ______
Cholesteatoma TM perforation
42
Potential causes of hearing loss?
Trauma (TM perforation, Temporal bone fracture) Infections (viral and bacterial) Temporary process (cerumen impaction, foreign body, fluid in middle ear)
43
_____ is a complication of acute Otitis Media. fever, otalgia, postauricular tenderness, erythema, and swelling, displacement of the auricle
Mastoiditis
44
Common cause of mastoiditis is _____
S. pneumoniae
45
Tx of mastoiditis
Vancomycin is used first line until cultures return. Middle ear/mastoid draining Mastoidectomy might be indicated in those with complications.
46
Gold standard dx tool for mastoiditis
CT
47
Causes of Peripheral vertigo? (5)
``` Benign positional vertigo Meniere Vestibular neuritis Labyrinthitis Cholesteatoma ```
48
Causes of central vertigo? (5)
``` cerebellopontine tumor migraine Cerebral vascular dz MS Vestibular neuroma ```
49
Signs of peripheral vertigo?
HORIZONTAL Nystagmus that is fatigable | Sudden onset of tinnitus & hearing loss
50
Signs of Central vertigo?
VERTICAL nystagmus that is non-fatigable gait problems gradual onset + CNS signs
51
1st line tx for vertigo
Antihistamines
52
____ is the most common cause of vertigo and is caused by displaces otoliths
Benign paroxysmal positional vertigo
53
Clinical manifestations of Benign paroxysmal positional vertigo? How long does the vertigo last?
Sudden, episodic peripheral vertigo provoked with changes of head positioning vertigo lasts: 10-60 seconds
54
How is the Dix-Hallpike test performed?
place pt in supine position with head 30 degrees lower than body Quickly turn head 90 degrees to one side to elicit delayed fatigable horizontal nystagmus
55
What is the mainstay of tx for BPPV?
Epley maneuver for canalith repositioning
56
_____ is Post-viral inflammatory disorder affecting the eight cranial nerve. Vertigo is severe and lasts a couple of days. what is the Tx?
Vestibular neuritis/labyrinthitis corticosteroids & antihistamines
57
______ is Increased endolymphatic fluid. Episodes of vertigo lasts minutes to hours
Meniere's Dz
58
What is the Meniere's triad?
Recurrent vertigo attacks roaring tinnitus worsening hearing
59
What tool can be used to dx meniere's dz, and what will it show?
Audiogram which shows low frequency hearing loss
60
Tx for Meniere's dz?
Na++ restriction [can resolve it] Diuretic therapy [reduce fluid pressure in ear] Anti-emetics for episodes
61
_____ is a schmannoma on CN VIII
Vestibular Neuroma
62
Sx of Vestibular Neuroma (4)
Unilateral sensorineural hearing loss tinnitus dizziness facial numbness.
63
Dx test that should be performed for a vestibular neuroma
Audiometry | MRI w/ contrast
64
Tx for vestibular neuroma
Surgery | Radiation
65
Most common cause of infective pharyngitis?
Viral (Adenovirus, EBV, RSV)
66
Most common bacterial cause of pharyngitis
GABH strep
67
What 4 S/S are used in the Centor criteria?
fever exudates anterior cervical lymphadenopathy absence of cough petechiae - very indicative of strep! not included in criteria
68
Centor criteria 0-1 interpretation
no abx or cx
69
Centor criteria 2-3 interpretation
cx throat
70
Centor criteria 4-5 interpretation | pt added if <15 y,o. pt subtracted if >44 y.o
give abx
71
Dx tools for GABH strep
Rapid antigen detection test (very specific, not very sensitive --> if negative with clinical suspicion obtain a cx for 5-15 y.o.) Throat cx (gold standard)
72
Tx for GABH strep
First line: penicillin. | Penicillin allergic: cephalosporins or macrolides
73
Complications of untreated GABH strep
Non-Suppurative: Rheumatic fever, Glomerulonephritis Suppurative: peritonsillar abscess, cellulitis
74
Non-pharm txs for GABH strep (good FYI)
Oral/IV hydration (if severe dehydration) Rest Tonsillectomy Sipping warm beverages Salt water gargle Lozenges w/ menthol Eating cold or frozen desserts (ice cream, popsicles)
75
Clinical manifestations of EBV
``` fever sore throat posterior cervical lymphadenopathy malaise myalgia splenomegaly petechial rash (esp if given ampicillin) ```
76
Dx tools for EBV
Mono spot test (+ w/i 4 weeks) CBC w/ diff (>10% atypical lymphocytes, >4,000 lymphocytes)
77
Tx for EBV
Supportive care: rest, no physical contact sports (1 month), stay hydrated, refrain from intimate contact or sharing drinks, educate on worsening sx. Tylenol (fever, pain) Glucocorticoids, acyclovir → if fear of losing airway
78
Wha are the 3 stages of Pertussis & description of each stage
Catarrhal - URI symptoms Paroxysmal - Progression of cough severity with an inspiratory whoop. Rapidly increases in frequency, then stabilization of cough. Post-tussive emesis might be present. Convalescent - Gradual improvement of cough until resolution.
79
What are the dx tools for pertussis
Cx nasal secretions (gold standard) CBC w/ diff (>60,000 leukocytes, >10,000 lymphocytes) CXR : to rule out other causes of cough
80
S/S of Pertussis
coughing spells with cyanosis a-febrile normal PE between spells
81
Tx for pertussis
azithromycin for 1 mo old erythromycin can cause pyloric stenosis in <1 mo olds
82
S/S of respiratory distress in an infant (7)
``` cyanosis grunting poor feeding retractions nasal flaring tachypnea head bobbing ```
83
Most common cause of hyperacute conjunctivitis
N. gonorrhoeae
84
When should an Eye Cx be performed?
``` severe cases immune compromised contact lens wearers neonates initial tx fails ```
85
What does the weber hearing test determine?
distinguish bt conductive hearing loss (CHL) and sensorineural hearing loss (SNHL)
86
What does the Rinne hearing test determine?
conductive hearing loss (CHL) only
87
how is the weber test performed?
hitting the tuning fork and holding it inplace midline on the pts forehead
88
What are normal results of a Weber test?
when the vibration is heard equally in both ears
89
if the sound is louder in one ear during the weber test, it is indicative of ____ in that ear or _____ in the opposite ear.
conductive hearing loss (CHL) sensorineural hearing loss (SNHL)
90
If the sound is quieter in one ear during the weber test, it is indicative of ___ in that ear or ___ in the opposite ear
SNHL CHL
91
The bone conduction is a measure of ___, while the air conduction is a measure of ___.
SNHL CHL
92
How is the rinne test performed?
hit the tuning fork place it on pt's mastoid process time how long it takes before the pt can no longer hear the vibration, move the fork just outside the external auditory meatus and time how long beofor they are unable to hear the sound
93
What are normal results of the rinne test?
If the sound is able to be heard after fork is moved, it is a normal result AC > BC
94
What is a negative sign of the rinne test?
The sound cannot be heard once fork its moved BC > AC If there is no air conduction, then CHL must be present.

ACR 1 Screening/HEENT (3 decks)

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