Acne, Red Eye, Ear Pain, Sore Throat, Cough Flashcards
How is Mild acne described?
Small blemishes
Blackheads (open comedones)/whiteheads (closed comedones)
No inflammation
How is Moderate acne described?
Numerous blackheads & whiteheads
Papules and pustules
Inflammation
How is Severe acne described
Severe inflammation
Large papules and pustules
Cystic nodules
Scarring & hyperpigmentation; if acne is difficult to control, cystic or scarring, hyperpigmented post-resolution
What DDx may you consider in a women with acne?
PCOS
What is 1st line tx for mild acne?
Benzoyl Peroxide (BP) or Topical Retinoid or Combo therapy - BP + Abx - Retinoid +BP - Retinoid + BP + Abx
What is 1st line tx for moderate acne?
Topical combo therapy
- BP + Abx
- Retinoid +BP
- Retinoid + BP + Abx
or
oral Abx + topical retinoid + BP + topical abx
What are some alternative txs for moderate and severe acne?
Add OCP or oral sprionolactone
Consider oral isotretinoin
What is 1st line tx for severe acne?
Oral abx + Topical combo therapy
or
Isotretinoin
2 most common causes of red eye?
viral and allergic conjunctivitis
Most common virus that is responsible for viral conjunctivitis?
Adenovirus
Examples of eye emergencies (8)
- Angle closure glaucoma
- Orbital cellulitis
- Bacterial Keratitis
- HSV (dendritic lesions)
- Hyphema (globe laceration)
- Hyperacute conjunctivitis
- Temporal arteritis
- Foreign body
What is the dx of the following sxs;
Acute onset pain, HA, N/V, decreased vision and halos, rapid rise in IOP
Angle closure glaucoma
What is the dx of the following sxs;
Eye bulging forward, Fever, double vision/decreased vision, Pain on eye movement, Limited eye movement
Orbital cellulitis
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
Herpetic Conjunctivitis (HZV)
What is the dx of the following sxs; Foreign body sensation Redness Photosensitivity Mild blurriness fluorescein staining w/ blue light reveals dendritic/branching pattern
HSV (dendritic lesions)
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
Hyphema
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
Bacterial Keratitis
What is the dx of the following sxs;
Painful drainage w/ erythema, difficulty openign eye, gritty feeling.
Foreign body
S/S of an eye emergency
Visual changes Severe pain photosensitive pain with eye movement HA
Common causes of red eye
Conjunctivitis (bacterial, viral, allergic)
Keratoconjunctivitis sicca
Blephritis
PE you must perform w/ every eye complaint
Visual acuity
EOM
Inspection (pattern of erythema)
pupilary response
Important questions to ask pt with eye complaints
- 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
What are clinical manifestations of viral conjunctivitis? (4)
What are PE signs of viral conjunctivitis? (3)
foreign body sensation
erythema
itching
accompanying viral sxs
Preauricular lymphadenopathy
copious watery discharge
bilateral
What is the Tx for viral conjunctivitis
supportive (cool compress, eye drops)
antihistamines or the itching/redness
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
What is the Tx for allergic conjunctivitis
antihistamines (possibly NSAIDS and corticosteroids)
What are clinical manifestations of bacterial conjunctivitis?
purulent discharge
lid crusting
mild pain
Common bacterial etiologies for bacterial conjunctivitis
S. aureus (adults)
strep, pneumoniae (children)
H. influenzae (children)
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
Common ear complaints (5)
Otalgia, Otorrhea, Hearing Loss, Dizziness/Vertigo, Tinnitus
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
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
Common etiologies for AOM (3)
Strep pn
Hemophilus inf
Moraxella cat.
Tx for AOM
Amoxicillin 80-90mg/kg BID x 10days
(comes in 400mg/5ml suspension)
Pain relief (tylenol)
Macrolides for Pen allergic pts
What are clinical manifestations of chronic Otitis Media
perforated TM
persistent/recurrent purulent otorrhea
pain
conductive hearing loss
Tx for chronic Otitis Media
topical abx (oflaxacin, ciprofloxacin) Possible TM repair
Most common causes of chronic otitis media?
pseudomonas
staph
strep
What are common etiologies of Otitis externa?
swimming
Pseudomonas
What are clinical manifestations of Otitis externa?
PE signs of Otitis externa
ear pain
pruritis
auricular discharge
tragus pain
canal erythema
edema, debris
Tx for otitis externa
cortisporin
ciprofloxacin/dexamethasone
____ 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
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)
_____ is a complication of acute Otitis Media.
fever, otalgia, postauricular tenderness, erythema, and swelling, displacement of the auricle
Mastoiditis
Common cause of mastoiditis is _____
S. pneumoniae
Tx of mastoiditis
Vancomycin is used first line until cultures return.
Middle ear/mastoid draining
Mastoidectomy might be indicated in those with complications.
Gold standard dx tool for mastoiditis
CT
Causes of Peripheral vertigo? (5)
Benign positional vertigo Meniere Vestibular neuritis Labyrinthitis Cholesteatoma
Causes of central vertigo? (5)
cerebellopontine tumor migraine Cerebral vascular dz MS Vestibular neuroma
Signs of peripheral vertigo?
HORIZONTAL Nystagmus that is fatigable
Sudden onset of tinnitus & hearing loss
Signs of Central vertigo?
VERTICAL nystagmus that is non-fatigable
gait problems
gradual onset
+ CNS signs
1st line tx for vertigo
Antihistamines
____ is the most common cause of vertigo and is caused by displaces otoliths
Benign paroxysmal positional vertigo
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
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
What is the mainstay of tx for BPPV?
Epley maneuver for canalith repositioning
_____ 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
______ is Increased endolymphatic fluid. Episodes of vertigo lasts minutes to hours
Meniere’s Dz
What is the Meniere’s triad?
Recurrent vertigo attacks
roaring tinnitus
worsening hearing
What tool can be used to dx meniere’s dz, and what will it show?
Audiogram which shows low frequency hearing loss
Tx for Meniere’s dz?
Na++ restriction [can resolve it]
Diuretic therapy [reduce fluid pressure in ear]
Anti-emetics for episodes
_____ is a schmannoma on CN VIII
Vestibular Neuroma
Sx of Vestibular Neuroma (4)
Unilateral sensorineural hearing loss
tinnitus
dizziness
facial numbness.
Dx test that should be performed for a vestibular neuroma
Audiometry
MRI w/ contrast
Tx for vestibular neuroma
Surgery
Radiation
Most common cause of infective pharyngitis?
Viral (Adenovirus, EBV, RSV)
Most common bacterial cause of pharyngitis
GABH strep
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
Centor criteria 0-1 interpretation
no abx or cx
Centor criteria 2-3 interpretation
cx throat
Centor criteria 4-5 interpretation
pt added if <15 y,o. pt subtracted if >44 y.o
give abx
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)
Tx for GABH strep
First line: penicillin.
Penicillin allergic: cephalosporins or macrolides
Complications of untreated GABH strep
Non-Suppurative: Rheumatic fever, Glomerulonephritis
Suppurative: peritonsillar abscess, cellulitis
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)
Clinical manifestations of EBV
fever sore throat posterior cervical lymphadenopathy malaise myalgia splenomegaly petechial rash (esp if given ampicillin)
Dx tools for EBV
Mono spot test (+ w/i 4 weeks)
CBC w/ diff (>10% atypical lymphocytes, >4,000 lymphocytes)
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
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.
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
S/S of Pertussis
coughing spells with cyanosis
a-febrile
normal PE between spells
Tx for pertussis
azithromycin for 1 mo old
erythromycin can cause pyloric stenosis in <1 mo olds
S/S of respiratory distress in an infant (7)
cyanosis grunting poor feeding retractions nasal flaring tachypnea head bobbing
Most common cause of hyperacute conjunctivitis
N. gonorrhoeae
When should an Eye Cx be performed?
severe cases immune compromised contact lens wearers neonates initial tx fails
What does the weber hearing test determine?
distinguish bt conductive hearing loss (CHL) and sensorineural hearing loss (SNHL)
What does the Rinne hearing test determine?
conductive hearing loss (CHL) only
how is the weber test performed?
hitting the tuning fork and holding it inplace midline on the pts forehead
What are normal results of a Weber test?
when the vibration is heard equally in both ears
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)
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
The bone conduction is a measure of ___, while the air conduction is a measure of ___.
SNHL
CHL
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
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
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.
