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HEENT > FINAL > Flashcards

FINAL Flashcards

1
Q

blepharitis / anterior

A

-chronic inflammation
-tearing, dry eyes, burning, itching, photophobia
-staphylococcal anterior- sty may form -> baby shampoo, erythromycin, bacitracin, sulfa, azith solution, steroid for ulcer

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2
Q

posterior blepharitis

A

-hyperemic with telangiectasis- blood spots
-commonly seen in pts with acne rosacea OR seborrheic dermatitis
-treatment:
-warm compresses
-lid scrubs
-bacitracin or erythromycin eye ointment
-oral tetracycline and/or short term topical corticosteroids

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3
Q

hordeolum

A

-purulent
-angry red
-localized
-staphylococcus aureus - usually
-abscess
-may lead to cellulitis of lid
-anterior or posterior glands

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4
Q

preseptal cellulitis treatment

A

-dicloxacillin or augmentin
-less than 4- hospitalize

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5
Q

orbital cellulitis

A

-decreased visual acuity
-hours-days
-WBC, conjunctival cultures, blood cultures
-CT
-referral
-IV ampicillin/sulbactam
-cephalosporins
-MRSA- clindamycin/vancomycin
-proptosis -> afferent pupillary defect

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6
Q

dacroadenitis

A

-infection of the lacrimal sac due to obstruction
-malformation of tear duct, injury, eye infection, trauma
-affects infants and persons > 40 years
-epiphora and discharge
-tenderness, redness, swelling
-acute- staphylococcus aureus, B-hemolytic strep -> antibiotics
-chronic- staphylococcus epidermidis -> relief of obstruction is only cure
-anaerobic species- candida albicans
-dacryocystorhinostomy- take out sac so doesn’t reoccur

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7
Q

-polymyxin-bacitracin ophthalmic ointment

A

-foreign body
-ocular trauma/abrasion

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8
Q

corneal laceration

A

-c/o intense pain initially but diminish due to corneal desensitization
-photophobia and profuse lacrimation
-significant uveitis
-intraocular pressure- ranges from 2-6 mmHg (normal- 10-21 mm Hg)
-bubbles within the anterior chamber- key finding**
-visual acuity significantly reduced-> test*
-lens dislocation, iridodialysis, and hyphema
-NPO, pain medication, CT, x-ray

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9
Q

blow out fracture

A

-test visual acuity
-double vision
-some ignore treatment at first (elderly)-> may not be swollen on presentation
-enophthalmos (sunken in) after swelling down
-motility restriction, upgaze
-orbital crepitus (subcutaneous emphysema)- air in bone
-hypoesthesia -entrapment of the infraorbital nerve in foramen
-orbital edema initially surrounds and displaces the globe
-eye appears proptotic
-associated traumatic uveitis and/or hyphema
-CT
-floor fracture, diplopia, gaze up/down down, significant enophthalmos -> surgery 10-14 days

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10
Q

cataracts

A

-late sign- swell occluding drainage-> secondary closed-angle glaucoma and pain (rare)
-surgery- maximally corrected vision < 20/40 (<6/12), limiting vision

Dx: best w/ pupil dilated
-examination of red reflex through dilated pupil discloses subtle opacities
-small cataracts 🡪 stand out as dark defects in red reflex (won’t see back of eye choroid plexus)
-Absent Red reflex: vessels all the way at back on choroid, won’t see
-large cataract 🡪 may obliterate red reflex
-slit lamp examination more detail about character, location, extent of opacity

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11
Q

retinal detachment

A

-Posterior vitreous detachment -With AGE, the vitreous gel collapses and detaches from the retina
-vitreous membrane pulls on and creates a tear in the retina
-Vitreous fluid seeps into or underneath the retina
-Detachment occurs from the pigmented epithelium underneath
-Shower of floaters- blood cells from a tiny broken blood vessel
-Descent of a “web” or “veil” in front of the eye or in the periphery
-Permanent vision loss can result
-Detachment needs to be repaired as soon as possible- Argon laser or “cryotherapy”
-can occur due to injury
-painless

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12
Q

age-related macular disease (ARMD)

A

-leading cause of irreversible blindness
-persistent blurred vision*
-debris from light absorbent molecules accumulates in cells in back of eye
-central part of retina damaged
-“Dry” macular degeneration - thinning of macula layers, GRADUAL vision loss -> drusen
-“Wet” macular degeneration:
-Tiny, fragile blood vessels develop under macula
-blood vessels hemorrhage -> destroy macular tissue
-Vision loss can be RAPID—over months or even weeks

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13
Q

age related macular degeneration dx and treatment

A

-Amsler grid:
-see wavy lines, straight become crooked
-screening tool
-visualize retina w/ lamp slit
-detect central field abnormality due to macular disease

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14
Q

proliferative diabetic retinopathy

A

-neovascularization retina, optic nerve, or iris
-vitreous hemorrhage
-vitreous blood vessel proliferation can lead to retinal detachment
-creates new vessels due to lack of O2
-VEGF-A, photocoagulation

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15
Q

hypertensive retinopathy

A

-obliterative- total vascular occlusion
-edema*
-wall changes (hyperplasia)- copper wiring (moderate) + silver wiring (severe)
-arteriovenous nicking
-flame shaped hemorrhages
-cotton wool spots
-yellow hard exudates (lipid)
-papilledema- optic disc swelling
-control BP

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16
Q

central retinal artery occlusion

A

-blockage by embolism usually
-sudden
-poor pupil response in bad eye but normal in good
-pain
-cherry red spot- pale fundus, red fovea
-retina is pale
-cause- embolism from atherosclerotic plaques, endocarditis, fat emboli, atrial myxoma, thrombosis of a retinal artery; Temporal arteritis**
- ESR (temporal arteritis), diabetes, hyperlipidemia
-infarct -> permanent blindness

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17
Q

central retinal artery occlusion treatment

A

-ocular massage
-lay flat
-high concentration inhaled oxygen
-IV acetazolamide
-anterior chamber paracentesis
-early thrombolysis
-RULE OUT STROKE- carotid, temporal arteritis
-<24- immediate treatment
->72- lost cause

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18
Q

central retinal vein occlusion

A

-by thrombus
-painless
-multiple hemorrhages, congested**, blue tint
-vision loss sudden or gradual
-neovascularization of retina or iris (rubeosis iridis) with secondary (neovascular) glaucoma can occur weeks to months after occlusion
-vitreous hemorrhage may develop with neovascularization
-distended, tortuous, blurry
-optic disc swelling
-cotton wool spots
-vision can be saved with quick reperfusion

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19
Q

amaurosis fugax

A

-fleeting blindness- resolves quick
-retinal emboli
-mostly unilateral
-choroidal/retinal vascular spasm
-curtain passing vertically across visual field
-duplex u/s / MRA -> find where it stems from
-echocardiogram - embolism from heart?
-carotid endarterectomy; angioplasty** -> source can be carotid -> take out the plaques
-sudden- similar to TIA

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20
Q

retinitis pigmentosa

A

-night blindness
-hereditary
-degeneration of rods
-tunnel vision
-peripheral vision lost
-UV glasses to slow progression
-no cute

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21
Q

conjunctivitis

A

-dx- generally not needed 🡪 Dx w/ H+P
-swabs taken if no improvement in 2-3 d
-take swabs in all and immunosuppressed or when N. gonorrhoeae suspected
-swabs taken from lower conjuctival fornix
-gram stain & giemsa stain
-Tx: antimicrobials and Sx therapy recommended for all pt initially
-Supportive: artificial tears help discomfort of keratitis and photophobia
-cold compress
-Antibiotic drops help prevent secondary bacterial infx
-Topical corticosteroids – CAUTION
-exclude HSV infx
-best to reverse use by ophthalmologist
-numerous topical antimicrobial agents used
- broad spectrum antibiotics
- instill drops every 2 hr
- ointment used at night or every 4-6 hr
throughout day
Prevention: hand washing, towels, pillows separate

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22
Q

Conjunctivitis: adenovirus, chlamydia, HSV

A

-Associations:
-1. follicular conjunctivitis
-2. preauricular adenopathy
-3. superficial keratitis

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23
Q

viral conjunctivitis

A

-preauricular lymphnode present sometimes
-pharyngoconjunctival fever
-epidemic keratoconjunctivitis (EKC)- adenovirus
-visual loss complication*
-cold compress / sulfa 2ndary
-occasional severe photophobia
-treat STD high risk pts empirically
-NO blurring

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24
Q

gonococcal conjunctivitis

A

-can be invasive and lead to rapid corneal perforation

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25
Q

allergic conjunctivitis

A

-no pain
-stringy discharge
-hyperemia and edema (chemosis)
-antimicrobial drops- 2 hours
-topical corticosteroid- 4-6 hours -> caution cataracts, glaucoma, HSV
-topical histamine H1 receptor blocker
-antihistamines
-broad spectrum antibiotics

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26
Q

dry eye syndrome

A

-poor quality:
-meibomian gland- acne rosacea
-lid related
-vitamin A deficiency
-poor quantity:
-keratoconjunctivitis sicca (KCS)
-lacrimal disease
-paralytics facial nerve

-lacrimal disease 🡪 Sarcoidosis
-paralytic 🡪 VII CN palsy
-eyelids don’t close 🡪 dry out 🡪 tears wont lubricate

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27
Q

episcleritis/scleritis

A

-scleritis:
-collagen vascular disease (RA, ankylosing spondylitis (AS), SLE, Wegener, PAN)
-Tx: systemic w/ NSAID or prednisone if severe
-zoster, sarcoidosis
-dull pain that wakes up
-episcleritis- collagen vascular disease (RA), no pain

28
Q

uveitis

A

-anterior (iritis)- recurrent/acute/chronic, photophobia, red, decreased vision, systemic association* ->
-seronegative arthropathies: AS, IBD, psoriatic arthritis, Reiter’s
Autoimmune: sarcoidosis, Behcet’s
Infx: Shingles, toxoplasmosis, TB, syphilis, TB

-posterior- blurred, decreased vision, floaters -> vitritis, retinal vasculitis, retinitis, choroiditis

29
Q

glaucoma

A

-optic disc damage most common feature
-bitemporal hemianopsia : outer 2 areas blacked out
-CN 4,6
-raised IOP most important risk
-halo/glare

-open angle/chronic- IOP > 21, asymptomatic, hyperopia -> beta blockers (timolol), alpha 1 and prostaglandin agonist
-tx- timolol BID, brimonidine (Alphagan)🡪 alpha 2 adrenergic agonist, prostaglandin agonist latanoprost

-acute angle/closure- facial pain, 20/80 >, vision threatened
-narrow canal of Schlemm 🡪 aqueous humor can’t drain because of blockage
-don’t give dilating eye drops
-tx- iridotomy, Acetazolamide, Pilocarpine, Prednisone acetate

30
Q

salivary mass

A

-parotid- stensen’s duct
-sublingual and submandibular- whartons duct
-viral sialadenitis (parotitis)- mumps, pain
-acute bacterial sialadenitis (suppurative)- pain, stone or no stone
-tumor- painless
-benign- pleomorphic adenoma
-malignant- mucoepidermoid carcinoma and adenoid cystic carcinoma

31
Q

corneal ulcer

A

-fern like pattern- dendritic
-positive flouricen test
-break in the corneal epithelium
-Pseudomonas, strep pneumonia, herpes, and fungus must be considered as possible causes
-ED: saline water, anesthetic, continuous washing, antibiotic ointment, referral
-steroids make it worse
-conjunctival: topical antibiotic
-Bacterial: adnexal infx, lid malposition, dry eye, CL
-Viral: HSV (dendritic ulcer), H. zoster oticus (shingles, maxillary cranial nerve has ophthalmic branch that gets shingles 🡪 pain and vesicles 🡪 can get blind and can spread)
-Fungal
-Protozoan: acanthamoeba in contact lens wearer (swim in water)
-chemical: alkali injuries worse than acid 🡪 wash out ASAP

32
Q

cystic mass

A

-mobile- mostly congenital
-in adults- can be metastases from HPV related oropharyngeal squamous cell carcinoma (OPSCC)
-age is important for cystic mass*

33
Q

neck mass characteristics

A

-moves side to side but not up and down- involvement with carotid sheath (tumor) or vagal shwannoma
-pulsatile- vascular lesion
-immobile, elevates with swallowing- thyroid source
-rapid expansion- infection or lymphoma

34
Q

cat scratch

A

-young
-rochalimaea henselae
-painful
-persistent lymphadenopathy
-hanger-rose skin test
-excisional bx
-titers
-28 day antibiotics- ampicillin, cephalosporin, cephalosporin

35
Q

congenital mass

A

-thyroglossal duct cyst- MC, FNA
-branchial cleft cyst or fistula- failure of obliteration of 2nd brachial cleft, anterior to sternomastoid
-dermoid cyst- entrapment of epithelium, submental, surgery
-lymphangioma- surgery, laser
-congenital torticollis
-teratoma- arises from pluripotential cells, 3 germ layers
-thymic mass- implantation of thymic tissue, surgery if problematic

36
Q

metabolic mass

A

-rare
-gout
-sarcoidosis- lymph nodes enlarge
-kimura’s disease- uncommon chronic inflammatory condition involving subcutaneous tissue
-castleman’s disease- benign lymphoproliferative disorder that most frequently involves the mediastinal lymph nodes

37
Q

lymphoma

A

-painless
-B-symptoms- fever, night sweat. weight loss (either) -> stages
-Hodgkins- young, neck, axilla, chest, reed sternberg cell- identical cells on both sides, abnormal
-non-Hodgkins- 60+, anywhere

38
Q

angioedema

A

-no scaling usually
-painful

39
Q

pinguecula and pterygium

A

-Pinguecula- inflammed, > 35,does not grow
-Both- artificial tears beneficial
-short course of NSAIDs or weak steroid

40
Q

foreign body/trauma steps

A

-VA recorded (shadows, fingers for base level)
-local anesthetic
-Fluorescein
-examine eye
-sterile wet cotton-tipped applicator (invert top lid)
-Polymyxin-bacitracin ophthalmic ointment
-Follow up/refer!
-irrigate chemical irritants before VA

41
Q

leading cause of monocular blindness in young adult men in U.S

A

corneal abrasion

42
Q

hyphema

A

-lay down 🡪 blood won’t show up
-stand up to see
-must elevate head when laying down

43
Q

never do MRI for

A

suspected metal foreign body
-globe rupture
-laceration

44
Q

nuclear cataract

A

-central lens nucleus
-myopia may develop in early stages, pt may be temporarily able to read without glasses (Second sight)

45
Q

posterior subcapsular cataract

A

-cataract beneath posterior lens capsule
-reduces visual acuity more when the pupil constricts (in bright light or during reading)
-most likely to produce glare
-loss of contrast

46
Q

leading cause of new blindness 20-65

A

diabetic retinopathy

47
Q

photophobia

A

-Ocular trauma- abrasions and lacerations
-Conjunctivitis: Viral (can be severe), gonococcal, allergic (occasional)
-Anterior uveitis
-Acute angle-closure glaucoma
-Blepharitis
-meningitis

48
Q

pharyngitis

A

-Often coated with a yellow or thin white non-confluent membrane
-Peels away without bleeding* (different from diphtheria)*
-edematous, blistered, or have painful ulcers
-CHRONIC tonsillitis- White particulate matter in tonsillar crypts (pockets) **
-Cervical lymph nodes may be swollen, enlarged, or tender
-Dry mucous membranes- mouth breathers

49
Q

tonsillectomy or adenotonsillectomy treatment

A

-Absolute indications -> Upper airway obstruction, severe dysphagia, sleep disorders, or cardiopulmonary complications; Peri-tonsillar abscess OR Tonsillitis resulting in febrile convulsions
-Relative indications:
-3 or more tonsil infections per year
-Streptococcal carrier not responding to treatment
-CI: Bleeding diathesis; Poor anesthetic risk or comorbidities

50
Q

other ways strep can present

A

-scarlet fever
-impetigo- blisters around mouth

51
Q

peritonsillar abscess

A

-Quinsy
-beware of examining oropharynx in children -> tongue depressor in airway obstruction can cause respiratory distress
-peritonsillar cellulitis -> peritonsillar abscess

52
Q

retropharyngeal abscess

A

-early stages are indistinguishable from pharyngitis
-chest pain -> can spread to mediastinum
-stridor, tachypnea, distress
-I&D -> beware of carotid

53
Q

acute necrotizing gingivitis (ANUG) S/S + treatment

A

-vincents angina / trench mouth
-Prevotella intermedia, Alpha-hemolytic streptococci, Actinomyces species
-bleeding, halitosis, fever
-lymphadenopathy
-ulcerative
-systemic:
-coronary artery disease (CAD) -> CVA -> bacteria sits on valves
-periodontal disease in pregnancy -> preterm
-tx- debridment and penicillin + metronidazole w/ clindamycin
-erythromycin alternative
-chlorhexidine mouth wash

54
Q

ludwigs angina treatment

A

-ampicillin-sulbactam OR
-penicillin G + metronidazole OR
-clindamycin

55
Q

leukoplakia

A

-squamous carcinoma often -> malignant
-often on floor of mouth
-erythroplakias- premalignant
-recurrence is common
-may do antifungal and corrective dental

56
Q

aphthous ulcers treatment / HH_

A

-HH6
-topical steroids
-magic mouthwash -> diphenhydramine, viscous lidocaine, maalox
-swish and swallow
-bx for consistent

57
Q

epiglottitis

A

-supraglottitis -> stridor
-sniffing position- children
-tripod position- adults
-hypoxia, cyanosis, toxic looking
-cough is rare
-ADULTS- rapidly developing sore throat***
-tender larynx

58
Q

epiglottitis treatment

A

-secure airway first
-IV ceftriaxone/cefuroxime -> switch to oral course for 10 days
-dexamethasone -> IV bolus then infusion -> taper steroids; oral antibiotics
-Hib vaccine prophylaxis
-rifampin prophylaxis for pt in contact with no vaccine or increased risk

59
Q

epiglottitis imaging/labs

A

-non specific
-WBC 15,000-45,000
-Hib blood culture -> + in half of cases
-thumbprint sign
-dilation of hypopharynx
-thickened aryepiglottic folds
-imaging to rule out other cause always

60
Q

croup

A

-low grade fever and URTI prodrome
-cough, rhinorrhea, non toxic
-tachycardia, tachypnea
-retraction of accessory muscles
-no change in stridor with positioning
-nontender larynx**
-pallor/cyanosis
-PA view x-ray- steeple sign in subglottis (narrowing below epiglottis)
-lateral view- distended hypopharynx

61
Q

croup treatment

A

-simple- reassurance/education, cool mist (may loosen secretions), oxygen, frequent monitoring, hydration
-mild-moderate- glucocorticoids -> dexamethasone, prednisone, budesonide
-mod-severe- nebulized epinephrine observe 3-4 hrs, discharge with steroids and consider antibiotics

62
Q

laryngeal disease

A

-hoarseness- abnormal vibration of vocal folds -> unilateral vocal fold paralysis / mass
-above vocal folds -> inspiratory stridor
-below vocal fold -> expiratory of biphasic stridor
-acute- URTI, viral, voice abuse -> rest/humidity
-chronic- irritants, benign lesions

63
Q

cavernous sinus thrombosis complications

A

-High mortality rate
-cavernous sinus infection
-Usually from retrograde transmission through valveless veins leading to the cavernous sinus
-Heralded by bilateral orbital involvement
-progressive chemosis- Temp: 105F
-Treat with drainage, IV antibiotics
-Heparin is controversial
-> abscess

64
Q

cholesteatoma

A

-may be congenital, acute or chronic
-precipitating factors- chronic infection, trauma, Eustachian tube dysfunction
-VERTIGO
-extends from tympanic membrane into middle ear, possibly into bone
-co-morbidities- chronic middle ear infection, eustachian tube dysfunction
-intermittent drainage with signs/symptoms of infection and hearing loss
-if untreated -> bone destruction, deafness, facial nerve paralysis, dizziness, abscess, systemic infection, death
-dx- audiogram- conductive (possible sensorineural) hearing loss
-CT- measures extend of spread
-treatment- antibiotics, ear cleaning, ear drops, surgery

65
Q

menieres disease

A

-episodic attacks:
-vertigo*
-tinnitus*
-sensation of aural fullness*
-hearing loss*
-^ three often manifest as a prodrome to vertigo attacks
-due to fluid in semicanal -> DIURETIC FUREOSEMIDE -> decrease fluid
-initial attacks usually more severe, frequent, longer in duration, and may be disabling
-hearing loss temporary during early attacks
-later becomes permanent starting in lower frequency
-attacks usually becomes less frequency and often less severe after 5 years, occurring every few months or years
-once hearing loss sets in usually vertigo goes away

66
Q

Ramsay Hunt

A

-facial paralysis
-herpetic blisters
-cranial nerve (CN 7)
-VZV- varicella zoster virus
-paroxysmal pain deep within ear
-constant, diffuse, and dull background pain
-vertigo
-ipsilateral hearing loss
-tinnitus
-rash or blisters -> can lead to cellulitis
-corticosteroids and oral acyclovir
-vestibular suppressants

HEENT (18 decks)

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