Eye, ear, nose and throat issues and disorders Flashcards
A common staphylococcal abscess on the upper or lower eyelid
Hordeolum (Stye)
Cause of this eye condition/ Hordeolum (Stye):
1) _______________
2) Extremely common
1) Staphylococcus
Differential diagnosis of Hordeolum ( Stye):
a) Conjunctivitis
b) __________
c) Blepharitis
d) Dacryocystitis
Chalazion
Signs and symptoms of Hordeolum
1) _____ onset
2) Localized pain (acutely tender) and edema
3) Pain proportional to the amount of edema
Abrupt
Management of Hordeolum is:
a) Warm compresses
b) Topical ______ or erythromycin ophthalmic ointment may be considered
c) Refer to an ophthalmologist for possible incision and drainage (I & D) if there are no resolution within ___ hours
b) bacitracin
c) 48 hours
A granulomatous (beady nodule) on the eyelid; infection or retention cyst of the meibomian gland
Chalazion
Note: A Chalazion is a hard, non-tender cyst; it differs from styes (Hordeola) in that this is usually ______?
Painless
Signs and symptoms associated with Chalazion include:
a) __________
b) Red conjunctiva
c) itching
d) Visual distortion if the cyst is large enough to impress cornea; may cause astigmatism (blurred vision) due to pressure on the cornea
e) Eyelid swelling
f) Light sensitivity
g) Increased tearing
Asymptomatic
Management of Chalazion include:
1) ____ ____
2) Referral for surgical removal
1) Warm compresses
The most common eye disorder; an inflammation/infection of the conjunctiva (“pink eye”) resulting from a variety of causes including allergies, chemical irritation. or infection (bacterial, viral, gonococcal/chlamydial)
Conjunctivitis
Signs and symptoms of conjunctivitis:
a) Inflammation, redness, irritation
b) itching, burning
c) increased tears
d) ____ _____ possible
e) eyelid swelling
f) foreign body sensation
g) eyelids may be crusty and sticky with mucopurulent discharge
blurred vision
Laboratory/Diagnostics for conjunctivitis commonly are gram stain and cuture when indicated (e.g. if _____ is suspected)
gonococcal
______ conjunctivitis is treated by:
1) Self-limiting
2) FLushing with normal saline
Chemical
______ conjunctivitis discharge is purulent
bacterial
Bacterial conjunctivitis is treated by:
1) _________ 0.5% ophthalmic oitment
2) Tetracycline 1%
3) Polymyxin B ophthalmic solution or ointment
1) Erythromycin
_______ (ophthalmic emergency) discharge is purulent
Gonococcal
Treatment for Gonococcal conjunctivitis is?
IV Pen G or ceftriaxone IM
_______ conjunctivitis is treated with
1) Erythromycin ophthalmic ointment
2) Oral: Tetracycline, erythromycin, clarithromycin, azithromycin, doxycycline
Chlamydia
______ conjunctivitis discharge is stringy, increased tearing
Allergic
_______ conjunctivitis is treated with
1) Oral antihistamines
2) Refer to allergist/ ophthalmologist
a) Steroids are not ordered in primary care because of increased intraocular pressure and activation of herpes simplex virus
Allergic
_____ conjunctivitis discharge is watery
Viral
Treatment for this ____ conjunctivitis:
Symptomatic care
1) Mild: Sline gtt/ artificial tears (refrigerated, cool is best)
2) Moderate: Decongestants/ antihistamines, mast cell stabilizers, NSAIDs
3) Sulfacetamide 10% ophthalmic solution for bacterial (secondary) prophylaxis
Viral
______ conjunctivitis discharge is bright red and irritated
Herpetic
______ conjunctivitis refers to ophthalmologists with this virus
Herpetic
An abnormal, uniform, progressive opacity of the eye seen in children with the co-morbid syndrome (e.g., Down syndrome, diabetes mellitus, Marfan syndrome, and atopic dermatitis)
Cataracts
Cause/ incidence of _______
a) Congenital
b) Prolonged steroid use
c) Infection
d) Injury
e) Radiation
Cataracts
One of the main causes of cataracts is this. It naturally occurs from this because of _____.
Age
Signs and symptoms of cataracts:
a) Hallmark is ______
b) decreased visual acuity
c) clouded, blurred, dim vision
d) white fundus reflex
e) poor visual fixation
f) photophobia
a) painless
Laboratory/ diagnostics for cataracts include?
None indicated
Management of cataracts include?
Refer for surgical removal
1) Ocular misalignment as a result of uncoordinated ocular muscles
2) If acquired after six months of age, it is usually related to an underlying problem
Strabismus
Signs and symptoms of Strabismus:
a) Squinting
b) _____ visual acuity
c) Head tilt
d) Face turning
e) Esotropia
f) Exotropia
g) Hypertropia
h) Hypotropia
i) Hirschberg papillary light reflex is unequal
b) decreased
Eyes deviate inward
Esotropia
Eyes deviate outward
Exotropia
Eyes deviate upward
Hypertropia
Eyes deviate downward
Hypotropia
Management Strabismus:
1) Refer to ophthalmology
a) If fixed or continuous at ___ months of age or more
b) Immedicatley for hypertropia and hypotropia
c) Signs of underlying cause present
six months
Inflammation of the external auditory meatus
Otitis Externa ( Swimmer’s Ear)
Cause/ Incidence of Otitis External include
1) Infection
a) ______ ( usually gram-negative)
b) Fungal
c) Viral
2) Recent history of water exposure
3) History of mechanical trauma, foreign body, or excess cerumen may be present
a) Bacterial
Signs/ symptoms of Otitis Externa include:
a) Otalgia
b) ______
c) Purulent discharge
b) Pruritus
Physical examination of Otitis Externa is found:
a) _____ of the ear canal
b) Edema of the ear canal
c) Purulent exudate (something with odor)
d) Pain upon manipulation of the auricle
e) The lateral surface of the tympanic membrane may be erythematous
f) Tympanic membrane is _______
a) Erythema
f) Normal
Laboratory/ diagnostics for Otitis Externa?
a) Pneumatic otoscopy should demonstrate _______
Mobility
Management of Otitis Externa include
1) Remove ____ debris
2) Protect from moisture or injury
3) Topical ear medications
1) Purulent
Bacterial management of Otitis Externa:
a) ____ ____ with or without hydrocortisone
b) Cortisporin ( Neomycin, polymyxin B, HC)
Acetic acid
Fungal management of Otitis Externa:
a) Antifungal drops (e.g. ________ 1% solution)
Clotrimazole
_____ is a bacterial infection of the mucosally lined air- containing spaces of the temporal bone. ___ _______ is responsible for about 30% and __ ______ for about 20% of AOM cases.
S. Pneumoniae
H. Influenzae
Signs and symptoms of Acute Otitis Media (AOM)
a) _______ hearing
b) Otalgia
c) Fever
d) Aural pressure
e) vertigo
f) nausea/vomiting
a) decreased hearing
Physical exam findings for AOM include:
a) Tympanic membrane
1) _________
2) Edematous
b) Purulent exudate
c) Tympanic membrane rarely bulges
1) Erythematous
Laboratory/ Diagnostics of AOM include:
1) Impaired mobility of tympanic _____ with pneumatic otoscopy
1) membrane
Management of the AOM include:
1) Pain management: ________, benzocaine otic drops
2) The observation period for healthy children: “Watchful waiting “ for __ to ___ hours
3) Medications
4) Prevention with immunization and avoidance of ___ hand smoke
1) Acetaminophen
2) 48 to 72 hours
4) Second-hand smoke
Medications commonly used for AOM include?
Amoxicillin 80 to 90mg/kg/day, twice daily orally x 10 days
Common vaccinations for AOM include?
Hib, PCV13, annual flu
The presence of fluid in the middle ears without the signs or symptoms of AOM; also known as chronic otitis media with effusion?
Serous Otitis Media/ otitis Media with Effusion (OME)
Cause/ incidence of Serous Otitis Media/ otitis Media with effusion (OME) include:
1) Blocked _______ tube; inability to equalize pressure
2) Allergy, barotrauma influence
1) eustachian tubes
Signs and symptoms of Serous Otitis Media/ Otitis Media with effusion (OME)
1) Hearing loss
2) _____ sensation when pressure altered
3) Fullness in ears
2) Popping sensation
Physical exam findings of Serous Otitis Media/ Otitis Media with Effusion (OME):
1) ___ ____ behind the tympanic membrane
2) Decreased membrane mobility
3) ____ and ____ test suggestive of conductive hearing loss
1) Air bubbles
3) Weber and Rinne tests
Laboratory/ diagnostics for Serous Otitis Media/ Otitis Media with Effusion (OME):
1) Decreased _____ via audiometry
1) hearing
Management of Serous Otitis Media/ Otitis Media with Effusion (OME):
1) Watchful monitoring: ____ months
2) Antibiotic therapy: No long- term efficacy
3) Antihistamines/ decongestants: Ineffective
4) Re-evaluate in ___ to six months
1) three
4) three
Any degree of impairment in the ability to apprehend sound
Hearing Loss
Hearing loss may be ______ or sensorineural
conductive
Conductive hearing loss may be caused by:
a) Decreased ability to conduct sound from external to the inner ear
1) ______ inpaction/ foreign body ( most treatable)
2) Hematoma
3) Otitis Media
4) Perforated tympanic membrane
1) Cerumen
Sensorineural hearing loss is associated with the impaired transmission of sound through the _____ system.
nervous system
Cause of the hearing loss include:
a) acoustic _________
b) syphilis
c) Central nervous system disease
d) Medication toxicity
a) Neuroma
The signs and symptoms of hearing loss include:
a) Understanding ___ and _____ test
Weber and Rinner Tests
Normal findings for ____ test: Sound should be heard equally in both ears and not lateralize
Weber test
Normal findings for ____ test: Air conduction (AC) is greater than bone conduction (BC)
Rinne test
Findings with hearing loss:
1) Conductive hearing loss
a) _____ test: Sound lateralizes to the affected ear
a) Weber test
Findings with hearing loss:
1) Conductive hearing loss
b) ____ test: Abnormal in the affected ear (i.e. AC greater
than BC)
b) Rinne test
Findings with hearing loss:
2) Sensorineural hearing loss
a) ____ test: Sound lateralized to the unaffected ear
Weber test
Findings with hearing loss:
2) Sensorineural hearing loss
a) ____ test: sound lateralized to the unaffected ear
Weber test
Findings with hearing loss:
2) Sensorineural hearing loss
b) _____ test: Normal in the affected ear
Rinne test
Laboratory/ diagnostics for hearing loss:
1) _______ exam: inspect canal and tympanic membrane
2) General neurological exam
3) Audiometric testing
4) ___ scan if a neurological condition is suspected
5) Serum blood tests as needed
1) Otoscopic
4) CT
Management of hearing loss include:
a) Remove _____ body/ cerumen
b) Refer for audiogram
c) Refer for further evalutation / hearing aid
foreign
Viral rhinitis, a self-limited upper respiratory tract infection
Common cold
Signs and symptoms of Common cold include:
a) headache
b) watery ________
c) sneezing
d) Cough
e) Sore throat
f) Malaise
b) rhinorrhea
Management of the common cold:
1) Rest and hydration
2) ____ ____ ___, humidifier
3) No OTC cold preparations (e.g. decongestants, antihistamines, antitussives, expectorants)
4) No antibiotics
Nasal saline drops
Signs and symptoms:
1) Bleeding usually only from one nostril
2) Upset stomach because of blood dropping from the back of the throat into the stomach
Epistaxis ( Nosebleed)
Management of Epistaxis:
1) Sit upright
2) Pressure at ________ ____: Anterior inferior aspect of the nasal septum (end of body ridge) x 10 minutes
3) Apply ice
Kiesselbach’s Triangle
Inflammation of the pharynx or tonsils
Pharyngitis/ Tonsillitis
Cause/ Incidence of Pharyngitis/ Tonsillitis:
a) Viruses (RSV, influenza A; B, Epstein Barr Virus)
b) Group ___ ___- hemolytic streptococci
c) Neisseria Gonorrhoeae
d) Mycoplasma
e) Chlamydia trachomatis
f) Corynebacterium Species
A and B
Signs and symptoms of pharyngitis/ tonsillitis:
a) Erythematous pharynx
b) _______; cough
c) Malaise
d) Phinorrhea (viral)
e) Fever ( more pronounced in ____ infections)
f) Anterior cervical adenophathy (______)
g) Painful throat
h) exudate
i) _____ fever (strep infection) with sandpaper like rash
b) dysphagia
e) bacteria
f) bacteria
i) Scarlet
Centor Criteria Clinical features most suggestive of group \_\_\_\_ beta-hemolytic streptococci (GABHS) include FLEA: F L E A
F–Fever
L– Lack of cough
E– Pharyngo- tonsillar Exudate
A– Anterior cervical Adenopathy
Laboratory/ diagnostics of Pharyngitis/ Tonsillitis include:
1) ____ routine testing
2) Consider throat culture only if suspicious of strep
1) No
Management of Pharyngitis/ Tonsillitis
1) Supportive Care
a) Fluids/ hydration
b) Warm _____ water gargles
c) Antipyretics (acetaminophen)
2) Anbitioitis only for streptococcal infection
salt
Antibiotics for Pharyngitis/ Tonsillitis include
a) _____ ___ 250 mg orally three times daily x 10 days
b) if allergic to PCN give _______ 250 mg four times dialy x 10 days
a) Penicillin VK
b) Erythromycin
Sudden, severe swelling of the epiglottis that occurs as a result of bacterial infection; can produce respiratory compromise in a matter of hours
Epiglottis
Epiglottis:
- Common pathogens include _______, Pneumococci, and H. influenza
- Peak incidence occurs between the ages of 6 to 10
1) Streptococci
Signs/ Symptoms of Epiglottis:
1) Sudden onset ____ fever
2) Drooling
3) Choking sensation
4) Restless, fearful
5) Hyperextension of the neck
6) Rapidly progressive signs of respiratory distress
high
Laboratory/ Diagnosis of Epiglottis:
1) Blood and tracheal ______ for the causative organism
2) “ ___ _____,” and thumb-shaped patch, appearing on a radiograph of the neck
2) “Thumb sign”
Management of Epiglottitis:
1) Immediate ________
2) Do not perform a pharyngeal exam
3) Keep child calm
4) Intubation capabilities as soon as possible
5) IV third generation _______ until pathogen identified
1) hospitalization
Parainfluenza viral infection of the larynx
Croup
This is seen with croup:
1) Severity can range from ___ to quite severe
2) Peak incidence is from ____ months to six-year of age
3) Affects ____ more often than females
4) Most common in fall and winter
1) mild
2) three
3) males
Signs and symptoms of Croup:
1) Recent symptoms of a ___ ____ ___ (__ )
2) Bark- like cough
3) Low-grade fever
4) Vital signs consistent with infection
5) Dyspnea
6) Stridor if severe
7) Lungs typically clear
1) Upper respiratory infection (URI)
Laboratory/ Diagnostics:
1) Pulse oximetry: Show hypoxic in sever forms
2) The appearance of a “____” shaped narrowing of the trachea on a frontal radiograph of the neck
2) steeple
Management of croup includes:
1) ____disease: Outpatient supportive care
1) Mild
Management of croup includes:
2) _____ disease: Hospitalize for respiratory support: IV fluids
2) Moderate
Management of croup includes:
3) May require nebulized racemic _________
3) epinephrine
Management of croup includes:
4) Short course of __________
corticosteroids
________
a) bacterial infection
b) supraglottic structure
c) six to 10 years of age
d) high fever drooling
e) x-ray; thumb sign
Epiglottitis
_______
a) viral infection, bacteria rare
b) Larynx
c) Three months to six years of age
d) Low fever, “barky cough”
e) x-ray: Steeple sign
Croup
An acute infectious disease dire to the Epstein-Bar virus, usually occurring over the age of 10
Infectious Mononucleosis
Infectious Mononucleosis:
a) Mode of transmission is _______
saliva
The incubation period of Infectious Mononucleosis is?
One to two months
Usually, Infectious Mononucleosis is ______ limited, but malaise and fatigue may last months
self
Signs and symptoms of Mononucleosis are?
a) Fever
b) Pharyngitis ( most severe)
c) Malaise, anorexia, mylagia
Physical examination of Infectious Mononucleosis is?
a) __________ cervical lymphadenopathy
b) Generalized lymphadenopathy
c) _______ exudate on tonsils
d) Splenomegaly
e) Macolpapular or petechial rash
a) Posterior
c) White
Laboratory/ Diagnosis: Mononucleosis
a) Lymphocytic Leukocytosis: _________
Neutropenia
Laboratory/ Diagnosis: Mononucleosis
b) Positive _______ and monospot
heterophil
Laboratory/ Diagnosis: Mononucleosis
Early rise in Immunoglobulin ____ (Ig___) EBV
M (IgM)
Laboratory/ Diagnosis: Mononucleosis
Permanent rise in Immunoglobulin ___ (Ig__) EBV
G (IgG)
Management of Mononucleosis:
a) Supportive ( ______ ____ , warm saline grargels)
non-steroids
Management of Mononucleosis:
b) Oral ________ when enlarged lymph tissue threatens airway obstruction
corticosteroids
Management of Mononucleosis:
c) Avoidance of _____ _____ (three weeks to several months) to avoid splenic rupture (even without clinically detectable splenomegaly)
c) contact sports
Occurs when an undrained collection of pus accumulates in one or more of the paranasal sinuses in children 9 years of age or older
Sinusitis (Rhinosinusitis)
The _____ and ethmoid sinus are the most commonly affected
Sinusitis (Rhinosinusitis)
Typical pathogens are the same as those of acute otitis media with Sinusitis (Rhinosinusitis) what are they?
S. Pneumoniae, H. Influenzae, and M. catarrhalis
Signs and symptoms of Sinusitis (Rhinosinusitis):
a) Pain and _____ over the cheek
b) Headache
c) DIscolored nasal discharge, halitosis
d) Postnasal drip and cough (usually during the day and maybe worse at night)
e) Dull, throbbing pain worsening when headed is _______
a) pressure
e) dependent
Laboratory/ Diagnostics: Sinusitis (Rhinosinusitis)
1) Diagnosis is often made on clinical presentation
2) Radiological studies are not needed in uncomplicated presentations
a) CT scan preferred over standard x-rays because it is
more sensitive and no more expensive; only for more
complicated sinusitis
b) May culture purulent nasal discharge
c) Children under the age of nine have poorly differentiated sinus cavities (________)
c) honeycomb
Management: Sinusitis (Rhinosinusitis)
1) Uncomplicated with mild symptoms treat as an outpatient
a) ______-______ for 10 days; change to ______ if no
improvement in 3 days
b) Decongestants, antihistamines are not useful in acute sinusitis; maybe in chronic sinusitis
c) Pain management with acetaminophen
d) Nighttime humidification to reduce mucosal drying
e) Supportive care
2) Chronic, refractory or recurrent sinusitis: Refer to an otolaryngologist
a) Amoxicillin- Clavulanate
Levaquin
