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1
Q

What is a HORDEOLUM?
EYE

A

“Style”
Acute inflammation (local infection)
Cause is staph

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2
Q

Assessment of HORDEOLUM (6)

A

Tender
Pain
Swelling
Redness
-Meibomian gland (sticks-in)
-sebaceous or sweat gland (faces out)

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3
Q

Treatment of HORDEOLUM (6)

A

Warm moist soaks q1hour
Antibiotic ointment-erythromycin
REFER if no resolution in 48 hours
Throw away makeup every 6 months
Wash pillow cases
If worse refer to ENT

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4
Q

CHALAZION

A

granulomatous inflammation
May follow a HORDEOLUM
Assessment-
Obstruction of gland
Hard NON-tender bump
Conjunctiva-red and elevated
Large press on eyeball/vision distortion
Treatment
-small usually disappears
Warm compress
Refer for incision

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5
Q

CONJUNCTIVITIS

A

Four types. Bacterial chlamydial viral and allergic.
Inflammation of the conjunctivae
Cornea involved Dash Corrado conjunctivitis
CAUSE-bacterial, virus, chemical, irritant, staph, H. Influenza, chlamydia, HSV, allergies.
Mode of transmission – fingers, towels

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6
Q

Bacterial conjunctivitis

A

Starts in one eye, and spreads to the other
Mild discomfort
No blurring or vision changes
Matted eyelashes – when you wake up, you have junk in your eye
Palpebral conjunctiva more inflamed than bulbar(front of eye)
Self-limiting – 10 to 14 days
Antibiotics, decrease time by two days duration

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7
Q

Chlamydial conjunctivitis

A

18 to 34 years old
** mucoid, thin
Photophobia
** Enlarged tender, pre-auricular nodes
Sexually transmitted
Persist 3 to 12 months
If not treated blindness

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8
Q

Allergic conjunctivitis

A

Itching
*** bilateral
Tearing
Redness
Stringy discharge
Photophobia
Cobblestone appearance of eyelids

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9
Q

Treatment for a bacterial conjunctivitis

A

Warm compresses
Antibiotic ointment
—> first line is quinolones, which are Cipro Levaquin ofloxacin. Or you could do azithromycin, gentamicin, tobramycin drops
Refer if no improvement within 48 to 72 hours

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10
Q

Treatment for chlamydia conjunctivitis

A

Treat the sexual partner
First line antibiotics, quinolone, which are Cipro, Levaquin ofloxacin

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11
Q

Treatment for viral conjunctivitis

A

Warm compresses
Antibiotics
First line quinolones, which are Cipro Levaquin ofloxacin

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12
Q

Treatment for allergic conjunctivitis

A

Systemic anti-histamines
Patanol 1-2 gtts BID

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13
Q

Always with viral conjunctivitis you do what?

A

Symptom management

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14
Q

How do you administer eyedrops?

A

Two drops in affected eye every two hours for one day

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15
Q

When can a child go back to school after being on antibiotics with conjunctivitis?

A

24 hours

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16
Q

Teaching for conjunctivitis

A

Call or return 24 to 48 hours
Report moderate to severe pain
I secretions are contagious 24 to 48 hours
Avoid transmission to the other eye

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17
Q

Glaucoma, definition

A

Characterized by damage to the optic nerve and visual field loss
Normal IOP 15-16 mmHg
Correlation between increased, intraocular, pressure and visual loss

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18
Q

Risk factors for glaucoma

A

40 years or older
Family history
African-American
Hypertension
Nearsighted

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19
Q

Two types of glaucoma

A

Open angle= chronic
-Blockage of aqueous outflow
Closed angle = acute
-fluid can no longer flow forward through the pupil.
Happens quickly

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20
Q

Open angle glaucoma

A

No symptoms early
Loss, mid peripheral vision, then tunnel vision
Blurred vision is late
HALOS
Increased cup to disk ratio

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21
Q

Closed angle glaucoma

A

Sudden onset
Pupillary, dilation – if darkened room and out in the sun
Extremely painful
Blurred vision
Red eyes
Cornea is steamy looking
Pallor
Pupils moderately dilated, or non-reactive
Nausea and vomiting
No treatment
Loss of sight in 2 to 3 days

22
Q

Treatment for open angled, enclosed, angled glaucoma

A

Refer to ophthalmologist
Emergency is sudden loss
Miotics
Beta blockers
Diamox-prevents aqueous humor
Surgery

23
Q

Otitis externa definition

A

Also known as Swimmers. Ear.
Diffuse infection
Cause is swimming or trauma
Organism is pseudomonas aeruginosa fungi

24
Q

Otitis externa assessment

A

Pain
Erythema
Edema of canal
Conductive hearing loss
NML TM
No middle ear fluid
No mastoid pain or swelling right behind the ear

25
Otitis externa treatment
Warm moist packs Clean ear canal with gentle normal saline irrigation * bacterial-Cortisporin eardrops (polymyxin B) * fungal-vasol otic solution(acetic acid) Keep moisture out of the air for 4 to 6 weeks Increased swelling – make a cotton Wick Earplugs Follow up in one week or two
26
Acute, otitis media definition
Information of the middle ear Dysfunction of the eustachian tube 5 to 7 days after a cold Cause is a bacterial infection #1 Streptococcus, pneumonia, H. Flu. M. Cat (use prescription against B lactamase.) Infection/allergy causes edema Fluid collections promote pathogen growth Otitis media = Serous
27
Assessment of otitis media
Ear pain Otorhea Hearing loss Vertigo * full bulging TM * retracted TM Redness Absent mobility of TM Must differentiate between acute otitis media and otitis media external
28
Otitis media treatment
#1 amoxicillin Augmentin – 7 to 14 days Cefuroxime (Ceftin, Keflex) or zpack Ceftriaxone (rocephin) IM TYLENOL OR MOTRIN TOPICAL NASAL STEROIDS Consult -recurrent
29
Ménière’s disease
Chronic condition Vertigo and hearing loss Happens in middle aged adults Referral if suspected Will sometimes use hydrochlorothiazide or an anti-histamine, which will dry extra fluid from the air canal
30
Definition Allergic rhinitis
An IgG E, medicated, inflammatory disease. Involves nasal mucosa Seasonal- treating normal seasonal things Perennial -dust, mites, animal allergens Irritants Viral rhinitis, or the common cold
31
Assessment of allergic rhinitis
Nose is congested Sneezing Clear, thin, watery rhinorrhea May have cough sore throat Look in nose, may look pale Enlarge nasal turbinates Allergic shiners Transverse nasal crease Allergic salute RAST test=allergy testing
32
Allergic rhinitis differential diagnosis
Nasal polyps Cold Deviated septum Flu Rhinitis Medicamentosa- if they do topical decongestions after three days so I can get this until off meds
33
Treatment for allergic rhinitis
Avoidance of the allergen Oral anti-histamines Decongestants Nasal corticosteroids spray
34
Sinusitis definition
ABRS Acute, subacute, or chronic inflammation Acute – follows an upper respiratory infection Deviated septum Maxillary sinus most frequently affected
35
Sinusitis assessment
Purulent nasal discharge Sore throat Pain/pressure over paranasal sinuses Headache Bilateral or a unilateral nasal obstruction Maxillary toothache Hyperemic turbinates
36
Differential diagnosis of sinusitis
Allergic rhinitis Acute/chronic sinusitis Rhinitis medicimentosa deviated, nasal septum
37
Treatment for sinusitis
Amoxicillin 1 g twice a day for 7 to 10 days Switch therapy if first anabiotic choice not effective 3 to 4 weeks treatment Topical steroids NO ANTIHISTAMINES ORAL DECONGESTANT HUMIDIFIED AIR Refer Can mimic tooth pain
38
Throat/pharyngitis
“ gateway to the body” Inflammation of the pharynx Cause – virus Infectious mononucleosis Complications- scarlet fever, rheumatic fever, glomerular nephritis
39
Viral pharyngitis
Low-grade fever Headach Malaise Sore throat *** rhinorrhea and coughing Tonsils enlarged Most common after upper respiratory infection
40
Group A B- hemolytic strep/ pharyngitis symptoms
Rapid onset Higher fever Headache Sore throat Dysphasia Erythema of tonsils WHITE OR YELLOW EXUDATE ON TONSILS TENDER ENLARGED ANTERIOR CERVICAL LYMPH NODES + rapid, strep, test + throat cultures -Monospot **White blood cell elevation
41
Differential diagnosis of pharyngitis
URI Strep throat Mono Sinusitis
42
Infectious, mononucleosis, definition
Acute viral syndrome Transmitted by exchange of saliva Found in the pharynx up to 18 months 4 to 6 weeks Most likely around ages 15 to 24 years old
43
Assessment of infectious mononucleosis
Fever Sore throat Malaise Post cervical lymphadenopathy Pharyngeal exudate Petechiae on palate Insidious onset + hepatomegaly + splenomegaly Skin rash WBC 10,000 to 20,000 Presence of heterophile AB
44
Differential diagnosis of infectious mononucleosis
Streptococcal pharyngitis Hepatitis Cytomegalovirus Acute symptoms of HIV
45
Treatment for infectious mononucleosis
Supportive treatment Rest Treat, concomitant strep, infection AVOID AMPICILLIN Monitor LFTs
46
Apthous Stomatitis definition
Canker sore Painful, small well circumscribed Round to oval, white ulcerative lesion Oral mucosa, lips, cheeks, tongue Erythematous edge —yellow grey base Painful swallow
47
Cause of Apthous Stomatitis
Allergic stimuli -Walnuts, peanuts, food, etc. Herpetiform -least common
48
Treatment for Apthous stomatitis
Topical- anti inflammatory(corticosteroid) Immunomodulatory agents(retinoid, cyclosporin) Renters to decrease bacterial loads, which also reduces inflammation and shortens the healing Systemic treatment includes Colchicine .6 mg TID Prednisone 20 to 80 mg daily Azaqthriopine 50 mg daily
49
Herpangina definition
Tonsillar and/or palatal Principle causes CVA -coxsackievirus a Viral to adenovirus and other entero virus, coxsackievirus b ENANTHEM - gray-white minute papulovesicular -1-2mm diameter - erthamatous halo surrounding Progresses to shallow ulcer covered by fibrin
50
Treatment for herpangina
Self-limiting and usually resolves 5 to 10 days Tonsils, uvula, soft palate Anterior Pullaes of tonsillar fauces

EENT (2 decks)

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