Eye, Ear, Nose, and Throat Issues and Disorders Flashcards
What is blepharitis?
inflammation of eye lid (usually where eye lashes are)
What is dacryocystitis?
infection of lacrimal sac
What is a hordeolum?
stye–a common staph abscess on the upper or lower eyelid
What are the symptoms of a hordeolum?
abrupt onset
localized pain and edema
pain proportional to the amount of edema
What is the management of a hordeolum?
warm compresses
topical bacitracin or erythromycin ointment
refer to ophthalmologist for possible incision and drainage if doesn’t resolve in 48 hours
What is a chalazion?
a beady nodule on the eyelid–infection or retention cyst of meibomian gland
What are the signs and symptoms of a chalazion?
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
What is the managment of a chalazion?
warm compresses
refer for surgical removal
When in a culture recommended for conjunctivitis
when gonococcal is suspected
in infants
What does the discharge look like and what is the management of allergic conjunctivitis?
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
What does the discharge look like and what is the management of herpetic conjunctivitis?
bright red and irritated
Refer to ophthalmologist
What does the discharge look like and what is the management of viral conjunctivitis?
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
What does the discharge look like and what is the management of chlamydia conjunctivitis?
erythromycin opthalmic ointment
oral: tetracycline, erythromycin, azithromycin, doxycycline, clarithromycin
What does the discharge look like and what is the management of gonococcal conjunctivitis?
THIS IS AN OPHTHALMIC EMERGENCY!
copious, purulent drainage
IV Pen G or ceftriaxone IM
What does the discharge look like and what is the management of bacterial conjunctivitis?
purulent drainage
Erythromycin 0.5% ophthalmic ointment
tetracycline 1%
polymyxin B ophthalmic solution or ointment
What does the discharge look like and what is the management of chemical conjunctivitis?
this is self-limiting
flush with normal saline
What are cataracts and what populations are they normally seen in?
abnormal, uniform, progressive opacity of the eye seen in children with down syndrome, diabetes, Marfan syndrome, and atopic dermatitis
What are causes of cataracts?
congential certain disorders prolonged steroid use infection injury radiation
What are symptoms of cataracts?
painless decreased vision acuity clouded, blurred, dim vision white fundus reflex poor visual fixation photophobia
What is the management of cataracts?
surgical removal
What is strabismus?
ocular misalignment as a result of uncoordinated ocular muscles
**If occurs after 6 months of age, then usually related to an underlying problem
Esotropia
eyes deviate inward
Exotropia
eyes deviate outward (exit)
hypertropia
eyes deviate upward (hyper=up)
Hypotropia
eyes deviate downward (hypo= down)
How could you diagnose strabismus?
hirschberg papillary light reflex is unequal
What is the management of stabismus?
Refer to ophthalmology:
if fixed or continuous at 6 months or more
immediately for hypertropia or hypotropia
signs of underlying cause
What is otitis externa?
inflammation of the external auditory meatus (also known as swimmers ear)
What are signs/symptoms of otitis externa?
otalgia (ear pain)
pruritus (itching
purulent discharge
What are the physical exam findings of otitis externa?
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
What is the management of otitis externa?
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
What is acute otitis media and what are the typical causes?
bacterial infection of the mucosally lined air-containing spaces of the temporal bone, most commonly caused by s. pneumoniae (30%) and h. influenzae (20%)
What are signs/symptoms of acute otitis media?
decreased hearing otalgia fever aural presure vertigo nausea/vomiting
What are the exam findings of acute otitis media?
erythematous (not diagnostic) edematous purulent exudate!!! tympanic membrane rarely bulges **impaired mobility of TM
What is the management of acute otitis media?
**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)
What is serous otitis media/otitis media with effusion?
presence of fluid in middle ear without s/sx of acute otitis media
What are the signs/symptoms and exam findings of serous otitis media?
hearing loss, popping sensation when pressure altered, fullness in ear
air bubbles behind TM, decreased mobility, weber/rinne tests suggestive of conductive hearing loss
What is the management of serous otitis media?
watchful monitoring- 3 months
reevaluate in 3-6 months
**antibiotics and antihistamines/decongestants are not effective
Weber test
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
What are normal findings of a weber test?
should be heard equally in both ears and not laterlize
Rinne test
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
What are normal findings of a rinne test?
air conduction should last twice as long as bone conduction
What are causes of conductive hearing loss?
something is blocking ear cerumen impaction/foreign body hematoma otitis media perforated tympanic membrane
What are causes of sensorineural hearing loss?
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
Diagnosis of conductive hearing loss
Weber test: hearing better in affected ear
Rinne test: abnormal in affected ear (bone conduction is heard better than air conduction)
Diagnosis of sensorineural hearing loss
Rinne test is is normal
Weber test: hear better in normal ear
Labs/diagnostic tests of hearing loss
Rinne/weber otoscopic exam neurologic exam audiometric screening CT scan if neurologic condition is suspected serum blood tests as needed
Management of hearing loss
remove foreign body/ear wax
refer for audiogram
refer for further eval/hearing aid
When can you give OTC cold preparation such as decongestants/antihistamines/antitussives etc.?
Do not give until age of 6
How to manage epistaxis?
to manage nosebleeds–put pressure at kiesselbach’s triangle (where nose goes from hard to soft).
Hold for 10 minutes and apply ice
What clinical features are must suggestive of group A beta-hemolytic streptococci (GABHS)?
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
Management of strep infection:
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
What are the most common pathogens that cause epiglottitis?
streptococci, pneumococci, and h. influenzae
**Bacterial infection
When is the peak incidence of epiglottitis?
between ages 6 and 10
What are s/sx of epiglottitis?
sudden onset high fever drooling choking sensation restless, fearful hyperextension of the neck rapidly progressive signs of resp distress
What diagnostic sign is indicative of epiglottitis?
thumb sign (thumb shaped patch, appearing on radiograph of neck)
What is the management of epiglottitis?
immediate hospitalization DO NOT PERFORM PHARYNGEAL EXAM keep child calm intubation capabilities ASAP IV third generation cephalosporin until pathogen identified
Who does croup most commonly affect?
3 month year olds to six years olds
more common in males
most common occurrence in fall or winter
What are s/sx of croup?
symptoms of URI barky cough low grade fever vital signs consistent with infection dyspnea stridor if severe clear lung sounds
What diagnostic tests help confirm croup?
pulse oximetry will show hypoxia in severe croup
radiograph will show a steeple sign (narrowing of trachea) of the neck
What is the management of croup?
mild: supportive care
moderate: hospitalize for resp support/IV fluids and possible racemic epi
Short course of corticosteroids
Who does sinusitis affect and what is it caused by?
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
What is the treatment of sinusitis?
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
Signs/symptoms of mono?
posterior cervical lymphadenophathy and generalized lymphadenopathy
White exudate on tonsils
splenomegaly
maculopapular or petechial rash
Laboratory tests indicative of mono?
lymphocytic leukocytosis, neutropenia
positive heterophil and monospot
early rise in IgM EBV
permanent rise in IgG
