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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

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
Q

What are clinical manifestations of allergic conjunctivitis?

What are PE signs of allergic conjunctivitis?

A

erythema and other allergic sxs

cobblestone mucosa (throat and inner eye) 
itching
tearing (stinging discharge) 
erythema 
bilateral
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26
Q

What is the Tx for allergic conjunctivitis

A

antihistamines (possibly NSAIDS and corticosteroids)

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27
Q

What are clinical manifestations of bacterial conjunctivitis?

A

purulent discharge
lid crusting
mild pain

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28
Q

Common bacterial etiologies for bacterial conjunctivitis

A

S. aureus (adults)
strep, pneumoniae (children)
H. influenzae (children)

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29
Q

What is the Tx for bacterial conjunctivitis

A

Trimethoprim/polymyxin B (Polytrim)
erythrmoycin (good option for peds)

Stay home until discharge subsides, school = 24hr tx with drops

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30
Q

Common ear complaints (5)

A

Otalgia, Otorrhea, Hearing Loss, Dizziness/Vertigo, Tinnitus

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31
Q

What Dx is described by the description below?

  • Dysfxn of Eustachian Tube
  • Retraction of membrane
  • Decreased mobility on pneumatic otoscopy.

What is the tx?

A

Serous otitis media

Nasal steroids (decongestants)
Myringotomy if hearing is impacted
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32
Q

What are clinical manifestations of Acute Otitis Media

PE signs of AOM?

A

Fever
tugging at affected ear (pain)

erythema
TM with effusion and bulging (loss of landmarks)
decreased membrane mobility on pneumatic otoscopy

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33
Q

Common etiologies for AOM (3)

A

Strep pn
Hemophilus inf
Moraxella cat.

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34
Q

Tx for AOM

A

Amoxicillin 80-90mg/kg BID x 10days
(comes in 400mg/5ml suspension)
Pain relief (tylenol)

Macrolides for Pen allergic pts

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35
Q

What are clinical manifestations of chronic Otitis Media

A

perforated TM
persistent/recurrent purulent otorrhea
pain
conductive hearing loss

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36
Q

Tx for chronic Otitis Media

A 
topical abx (oflaxacin, ciprofloxacin) 
Possible TM repair
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37
Q

Most common causes of chronic otitis media?

A

pseudomonas
staph
strep

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38
Q

What are common etiologies of Otitis externa?

A

swimming

Pseudomonas

39
Q

What are clinical manifestations of Otitis externa?

PE signs of Otitis externa

A

ear pain
pruritis
auricular discharge

tragus pain
canal erythema
edema, debris

40
Q

Tx for otitis externa

A

cortisporin

ciprofloxacin/dexamethasone

41
Q

____ 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 ______

A

Cholesteatoma

TM perforation

42
Q

Potential causes of hearing loss?

A

Trauma (TM perforation, Temporal bone fracture)

Infections (viral and bacterial)

Temporary process (cerumen impaction, foreign body, fluid in middle ear)

43
Q

_____ is a complication of acute Otitis Media.

fever, otalgia, postauricular tenderness, erythema, and swelling, displacement of the auricle

A

Mastoiditis

44
Q

Common cause of mastoiditis is _____

A

S. pneumoniae

45
Q

Tx of mastoiditis

A

Vancomycin is used first line until cultures return.

Middle ear/mastoid draining

Mastoidectomy might be indicated in those with complications.

46
Q

Gold standard dx tool for mastoiditis

A

CT

47
Q

Causes of Peripheral vertigo? (5)

A 
Benign positional vertigo
Meniere
Vestibular neuritis 
Labyrinthitis 
Cholesteatoma
48
Q

Causes of central vertigo? (5)

A 
cerebellopontine tumor
migraine
Cerebral vascular dz
MS
Vestibular neuroma
49
Q

Signs of peripheral vertigo?

A

HORIZONTAL Nystagmus that is fatigable

Sudden onset of tinnitus & hearing loss

50
Q

Signs of Central vertigo?

A

VERTICAL nystagmus that is non-fatigable
gait problems
gradual onset
+ CNS signs

51
Q

1st line tx for vertigo

A

Antihistamines

52
Q

____ is the most common cause of vertigo and is caused by displaces otoliths

A

Benign paroxysmal positional vertigo

53
Q

Clinical manifestations of Benign paroxysmal positional vertigo?

How long does the vertigo last?

A

Sudden, episodic peripheral vertigo provoked with changes of head positioning

vertigo lasts: 10-60 seconds

54
Q

How is the Dix-Hallpike test performed?

A

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
Q

What is the mainstay of tx for BPPV?

A

Epley maneuver for canalith repositioning

56
Q

_____ is Post-viral inflammatory disorder affecting the eight cranial nerve. Vertigo is severe and lasts a couple of days.

what is the Tx?

A

Vestibular neuritis/labyrinthitis

corticosteroids & antihistamines

57
Q

______ is Increased endolymphatic fluid. Episodes of vertigo lasts minutes to hours

A

Meniere’s Dz

58
Q

What is the Meniere’s triad?

A

Recurrent vertigo attacks
roaring tinnitus
worsening hearing

59
Q

What tool can be used to dx meniere’s dz, and what will it show?

A

Audiogram which shows low frequency hearing loss

60
Q

Tx for Meniere’s dz?

A

Na++ restriction [can resolve it]
Diuretic therapy [reduce fluid pressure in ear]
Anti-emetics for episodes

61
Q

_____ is a schmannoma on CN VIII

A

Vestibular Neuroma

62
Q

Sx of Vestibular Neuroma (4)

A

Unilateral sensorineural hearing loss
tinnitus
dizziness
facial numbness.

63
Q

Dx test that should be performed for a vestibular neuroma

A

Audiometry

MRI w/ contrast

64
Q

Tx for vestibular neuroma

A

Surgery

Radiation

65
Q

Most common cause of infective pharyngitis?

A

Viral (Adenovirus, EBV, RSV)

66
Q

Most common bacterial cause of pharyngitis

A

GABH strep

67
Q

What 4 S/S are used in the Centor criteria?

A

fever
exudates
anterior cervical lymphadenopathy
absence of cough

petechiae - very indicative of strep! not included in criteria

68
Q

Centor criteria 0-1 interpretation

A

no abx or cx

69
Q

Centor criteria 2-3 interpretation

A

cx throat

70
Q

Centor criteria 4-5 interpretation

pt added if <15 y,o. pt subtracted if >44 y.o

A

give abx

71
Q

Dx tools for GABH strep

A

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
Q

Tx for GABH strep

A

First line: penicillin.

Penicillin allergic: cephalosporins or macrolides

73
Q

Complications of untreated GABH strep

A

Non-Suppurative: Rheumatic fever, Glomerulonephritis

Suppurative: peritonsillar abscess, cellulitis

74
Q

Non-pharm txs for GABH strep (good FYI)

A

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
Q

Clinical manifestations of EBV

A 
fever
sore throat
posterior cervical lymphadenopathy 
malaise
myalgia
splenomegaly 
petechial rash (esp if given ampicillin)
76
Q

Dx tools for EBV

A

Mono spot test (+ w/i 4 weeks)

CBC w/ diff (>10% atypical lymphocytes, >4,000 lymphocytes)

77
Q

Tx for EBV

A

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
Q

Wha are the 3 stages of Pertussis & description of each stage

A

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
Q

What are the dx tools for pertussis

A

Cx nasal secretions (gold standard)

CBC w/ diff (>60,000 leukocytes, >10,000 lymphocytes)

CXR : to rule out other causes of cough

80
Q

S/S of Pertussis

A

coughing spells with cyanosis
a-febrile
normal PE between spells

81
Q

Tx for pertussis

A

azithromycin for 1 mo old

erythromycin can cause pyloric stenosis in <1 mo olds

82
Q

S/S of respiratory distress in an infant (7)

A 
cyanosis
grunting 
poor feeding
retractions
nasal flaring
tachypnea
head bobbing
83
Q

Most common cause of hyperacute conjunctivitis

A

N. gonorrhoeae

84
Q

When should an Eye Cx be performed?

A 
severe cases
immune compromised
contact lens wearers
neonates
initial tx fails
85
Q

What does the weber hearing test determine?

A

distinguish bt conductive hearing loss (CHL) and sensorineural hearing loss (SNHL)

86
Q

What does the Rinne hearing test determine?

A

conductive hearing loss (CHL) only

87
Q

how is the weber test performed?

A

hitting the tuning fork and holding it inplace midline on the pts forehead

88
Q

What are normal results of a Weber test?

A

when the vibration is heard equally in both ears

89
Q

if the sound is louder in one ear during the weber test, it is indicative of ____ in that ear or _____ in the opposite ear.

A

conductive hearing loss (CHL)

sensorineural hearing loss (SNHL)

90
Q

If the sound is quieter in one ear during the weber test, it is indicative of ___ in that ear or ___ in the opposite ear

A

SNHL

CHL

91
Q

The bone conduction is a measure of ___, while the air conduction is a measure of ___.

A

SNHL

CHL

92
Q

How is the rinne test performed?

A

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
Q

What are normal results of the rinne test?

A

If the sound is able to be heard after fork is moved, it is a normal result AC > BC

94
Q

What is a negative sign of the rinne test?

A

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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