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PNCB2 > Eye, Ear, Nose, and Throat Issues and Disorders > Flashcards

Eye, Ear, Nose, and Throat Issues and Disorders Flashcards

1
Q

What is blepharitis?

A

inflammation of eye lid (usually where eye lashes are)

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2
Q

What is dacryocystitis?

A

infection of lacrimal sac

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3
Q

What is a hordeolum?

A

stye–a common staph abscess on the upper or lower eyelid

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4
Q

What are the symptoms of a hordeolum?

A

abrupt onset
localized pain and edema
pain proportional to the amount of edema

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5
Q

What is the management of a hordeolum?

A

warm compresses
topical bacitracin or erythromycin ointment
refer to ophthalmologist for possible incision and drainage if doesn’t resolve in 48 hours

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6
Q

What is a chalazion?

A

a beady nodule on the eyelid–infection or retention cyst of meibomian gland

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7
Q

What are the signs and symptoms of a chalazion?

A

Differs from hordeolum in that it is usually PAINLESS
red conjuctiva
itching
visual distortion if cyst is large enough and can lead to astigmatisim
eyelid swelling
light sensitivity
increased tearing

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8
Q

What is the managment of a chalazion?

A

warm compresses

refer for surgical removal

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9
Q

When in a culture recommended for conjunctivitis

A

when gonococcal is suspected

in infants

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10
Q

What does the discharge look like and what is the management of allergic conjunctivitis?

A

stringy and increased tearing
oral antihistamines
referral to allergist or ophthalmologist
**steroids not ordered because of increased intraocular pressure and activation of herpes simplex virus

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11
Q

What does the discharge look like and what is the management of herpetic conjunctivitis?

A

bright red and irritated

Refer to ophthalmologist

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12
Q

What does the discharge look like and what is the management of viral conjunctivitis?

A

watery
symptomatic care:
1. mild: saline drops (refrigerated cool is best)
2. moderate: decongestents/antihistamines and NSAIDs
3. sulfacetamide 10% opthalmic solution for bacterial prophylaxis

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13
Q

What does the discharge look like and what is the management of chlamydia conjunctivitis?

A

erythromycin opthalmic ointment

oral: tetracycline, erythromycin, azithromycin, doxycycline, clarithromycin

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14
Q

What does the discharge look like and what is the management of gonococcal conjunctivitis?

A

THIS IS AN OPHTHALMIC EMERGENCY!
copious, purulent drainage
IV Pen G or ceftriaxone IM

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15
Q

What does the discharge look like and what is the management of bacterial conjunctivitis?

A

purulent drainage
Erythromycin 0.5% ophthalmic ointment
tetracycline 1%
polymyxin B ophthalmic solution or ointment

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16
Q

What does the discharge look like and what is the management of chemical conjunctivitis?

A

this is self-limiting

flush with normal saline

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17
Q

What are cataracts and what populations are they normally seen in?

A

abnormal, uniform, progressive opacity of the eye seen in children with down syndrome, diabetes, Marfan syndrome, and atopic dermatitis

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18
Q

What are causes of cataracts?

A 
congential
certain disorders
prolonged steroid use
infection
injury
radiation
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19
Q

What are symptoms of cataracts?

A 
painless
decreased vision acuity
clouded, blurred, dim vision
white fundus reflex
poor visual fixation
photophobia
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20
Q

What is the management of cataracts?

A

surgical removal

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21
Q

What is strabismus?

A

ocular misalignment as a result of uncoordinated ocular muscles
**If occurs after 6 months of age, then usually related to an underlying problem

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22
Q

Esotropia

A

eyes deviate inward

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23
Q

Exotropia

A

eyes deviate outward (exit)

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24
Q

hypertropia

A

eyes deviate upward (hyper=up)

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25
Q

Hypotropia

A

eyes deviate downward (hypo= down)

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26
Q

How could you diagnose strabismus?

A

hirschberg papillary light reflex is unequal

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27
Q

What is the management of stabismus?

A

Refer to ophthalmology:
if fixed or continuous at 6 months or more
immediately for hypertropia or hypotropia
signs of underlying cause

28
Q

What is otitis externa?

A

inflammation of the external auditory meatus (also known as swimmers ear)

29
Q

What are signs/symptoms of otitis externa?

A

otalgia (ear pain)
pruritus (itching
purulent discharge

30
Q

What are the physical exam findings of otitis externa?

A

erythema of the ear canal
edema of the ear canal
purulent exudate (sometimes with odor)
pain upon manipulation of auricle
lateral surface of tympanic membrane may be erythematous
**TYMPANIC MEMBRANE IS NORMAL–with normal mobility

31
Q

What is the management of otitis externa?

A

remove purulent debris
keep from moisture/injury

Bacterial, topical ear medication:
acetic acid with/without hydrocortisone
cortisporin (neomycin, polymyxin B)

Fungal:
antifungal drops such as clotrimazole 1% solution

32
Q

What is acute otitis media and what are the typical causes?

A

bacterial infection of the mucosally lined air-containing spaces of the temporal bone, most commonly caused by s. pneumoniae (30%) and h. influenzae (20%)

33
Q

What are signs/symptoms of acute otitis media?

A 
decreased hearing
otalgia
fever
aural presure
vertigo
nausea/vomiting
34
Q

What are the exam findings of acute otitis media?

A 
erythematous (not diagnostic)
edematous 
purulent exudate!!!
tympanic membrane rarely bulges
**impaired mobility of TM
35
Q

What is the management of acute otitis media?

A

**Watchful waiting for 48-72 hours in healthy, asymptomatic children
tylenol, benzocaine otic drops
amoxicillin 80-90 mg/kg/day 2x daily x10 days

TO prevent: Hib, PCV13, annual flu vaccines; avoid second hand smoke (those exposed with have 4x more often than peers)

36
Q

What is serous otitis media/otitis media with effusion?

A

presence of fluid in middle ear without s/sx of acute otitis media

37
Q

What are the signs/symptoms and exam findings of serous otitis media?

A

hearing loss, popping sensation when pressure altered, fullness in ear

air bubbles behind TM, decreased mobility, weber/rinne tests suggestive of conductive hearing loss

38
Q

What is the management of serous otitis media?

A

watchful monitoring- 3 months
reevaluate in 3-6 months
**antibiotics and antihistamines/decongestants are not effective

39
Q

Weber test

A

strike tuning fork and place in middle of head and state where sound is coming from (L, R, or both)

  • “W” looks like bow on top of head so W=weber

determines whether there is conductive or sensorineural hearing loss

40
Q

What are normal findings of a weber test?

A

should be heard equally in both ears and not laterlize

41
Q

Rinne test

A

strike tuning fork and put near base of mastoid bone (bone); then when no longer can hear move fork near ear canal (air) and state when you can no longer hear. Then compare the time.

determines bone and air conduction hearing

42
Q

What are normal findings of a rinne test?

A

air conduction should last twice as long as bone conduction

43
Q

What are causes of conductive hearing loss?

A 
something is blocking ear
cerumen impaction/foreign body
hematoma
otitis media
perforated tympanic membrane
44
Q

What are causes of sensorineural hearing loss?

A

Impaired transmission of sound through the nervous system from diseases ex) meningitis (treated with ototoxic meds-gent/vanc, causing more problems)

acoustic neuroma
syphilis
central nervous system disease
medication toxicity

45
Q

Diagnosis of conductive hearing loss

A

Weber test: hearing better in affected ear

Rinne test: abnormal in affected ear (bone conduction is heard better than air conduction)

46
Q

Diagnosis of sensorineural hearing loss

A

Rinne test is is normal

Weber test: hear better in normal ear

47
Q

Labs/diagnostic tests of hearing loss

A 
Rinne/weber
otoscopic exam
neurologic exam 
audiometric screening
CT scan if neurologic condition is suspected
serum blood tests as needed
48
Q

Management of hearing loss

A

remove foreign body/ear wax
refer for audiogram
refer for further eval/hearing aid

49
Q

When can you give OTC cold preparation such as decongestants/antihistamines/antitussives etc.?

A

Do not give until age of 6

50
Q

How to manage epistaxis?

A

to manage nosebleeds–put pressure at kiesselbach’s triangle (where nose goes from hard to soft).
Hold for 10 minutes and apply ice

51
Q

What clinical features are must suggestive of group A beta-hemolytic streptococci (GABHS)?

A 
FLEA:
F: fever (100.4+/38)
L: lack of cough
E: exudate of pharyngo-tonsillar 
A: anterior cervical adenopathy   
OR
F: fever
L: lymph node swelling
E: exudate
A: absent cough

**Strep test is recommended for 1 or more of these

52
Q

Management of strep infection:

A

supportive cares
antibiotics:
Penicillin VK 250 mg orally 3x/day x10 days
If allergic to penicillin–erythromycin 250 mg 4 x daily x 10 days

53
Q

What are the most common pathogens that cause epiglottitis?

A

streptococci, pneumococci, and h. influenzae

**Bacterial infection

54
Q

When is the peak incidence of epiglottitis?

A

between ages 6 and 10

55
Q

What are s/sx of epiglottitis?

A 
sudden onset high fever
drooling
choking sensation
restless, fearful
hyperextension of the neck
rapidly progressive signs of resp distress
56
Q

What diagnostic sign is indicative of epiglottitis?

A

thumb sign (thumb shaped patch, appearing on radiograph of neck)

57
Q

What is the management of epiglottitis?

A 
immediate hospitalization
DO NOT PERFORM PHARYNGEAL EXAM
keep child calm
intubation capabilities ASAP
IV third generation cephalosporin until pathogen identified
58
Q

Who does croup most commonly affect?

A

3 month year olds to six years olds
more common in males
most common occurrence in fall or winter

59
Q

What are s/sx of croup?

A 
symptoms of URI
barky cough
low grade fever
vital signs consistent with infection
dyspnea
stridor if severe
clear lung sounds
60
Q

What diagnostic tests help confirm croup?

A

pulse oximetry will show hypoxia in severe croup

radiograph will show a steeple sign (narrowing of trachea) of the neck

61
Q

What is the management of croup?

A

mild: supportive care
moderate: hospitalize for resp support/IV fluids and possible racemic epi
Short course of corticosteroids

62
Q

Who does sinusitis affect and what is it caused by?

A

Occurs in those 9 years of age and older most commonly in the maxillary and ethmoid sinuses
Caused by same organisms of otitis media: s. pneumoniae, h. flu, m. catarrhalis

63
Q

What is the treatment of sinusitis?

A

augmentin for 10 days–change to levaquin if no improvement in 3 days
*decongestants and antihistamines are not useful in acute sinusitis, but possibly work in chronic sinusitis

Chronic sinusitis can be referred to oto

64
Q

Signs/symptoms of mono?

A

posterior cervical lymphadenophathy and generalized lymphadenopathy
White exudate on tonsils
splenomegaly
maculopapular or petechial rash

65
Q

Laboratory tests indicative of mono?

A

lymphocytic leukocytosis, neutropenia
positive heterophil and monospot
early rise in IgM EBV
permanent rise in IgG

PNCB2 (18 decks)

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