HEENT 1 Flashcards
what is inflammation of the lid margins may be associated with conjunctivitis
blepharitis
what has symptoms of burning and irritated eyes, photophobia
blepharitis
what is caused by most often a staph infection, can be meibomian gland dysfunction, and seborrhea
blepharitis
how do you treat blepharitis?
Local steroid and antibiotic ointment applied at night (depending on cause). This may be needed long term as the condition tends to recur
what is a hordeolum?
Stye
what is a hordeolum caused by?
Staph infection
External - glands of Zeis in lid
Internal – meibomian glands , can lead to Chalazion
what is a painful and red bump on the eyelid?
hordeolum
how do you treat a hordeolum? 4
Often Self-limiting
Drainage
Warm compresses
Local antibiotics to prevent recurrence.
what is Obstruction / Inflammation in a Meibomian gland.
chalazion (meibomian cyst)
what may develop acute suppuration infection–> A lump is seen over the tarsal plate
chalazion
how do you treat a chalazion? acute and chronic?
If acutely inflamed , warm compresses and antibiotics to reduce cellulitis.
Chronic cysts – incise and curette.
what is Normal canalisation of the nasolacrimal ducts may nor occur until 4-6 months of age.
nasolacrimal duct obs
what may cause Tear overflow and secondary infection
nasolacrimal duct obs
what has clinical findings of watery, discharging eyes in first few months of life- can be mucoid
+/- conjunctival redness
Erythema of lids
nasolacrimal duct obs
when infection caused, what bug causes nasolacrimal duct obs
strep and staph
how do you tx nasolacrimal duct obs?
Massage over lacrimal sac
Local antibiotic drops – for secondary infection
Surgical treatment = probing . Successful 80% of the time
Most clear spontaneously in 1st year of life.
what is the most common cause of viral conjuctivitis?
adenovirus
what are 2 other less freq viruses that cause conjunctivitis?
coxackievirus and enteroviruses
what presents with Frequently unilateral initially, spread to other eye 1-3 days later Red eye, dryness/burning sensation Watery discharge Tender preauricular lymph node Can present with pharyngitis, cold sxs
viral conjunctivitis
how do you tx viral conjunctivitis
support
what lymph node may present tender in viral conjunctivitis
preauricular
what is the most common cause of bacterial conjunctivitis?
S.aureus
what is the 2nd most common cause of bacterial conjunctivitis?
S. pneumo
what is the 3rd most common cause of bacterial conjunctivitis?
h.flu
what kind of bacteria should you suspect in ppl who wear contacts in bacterial conjunctivitis?
N. gonn and pseudmonas
how do you treat bacterial conjunctivitis? 4
Topical erythromicin, polymixin-bacitracin, sulfacetamide, fluoroquinolones
what is opthalmia neonatorum? and what could it cause if untreated? what is it caused by?
Neonatal conj
could lead to permanent eye damage unless it is treated immediately (Erythromycin)
Organisms from birth canal = Chlamydia or gonorrhea ,E coli , HSV
in what conjunctivitis should you get gram stain and cultures?
neonates
what presents with Itchy eye, Rubbing of eyes
Watery discharge
No injection
Often lid edema, nasal congestion/sneezing present
Cobblestone papillae on tarsal conjunctiva
allergic conjunctivitis
in allergic conjunctivitis what does photophobia and reduced vision mean?
corneal involvement and possible serious loss of vision!
what has Eosinophils in conjunctival scraping
allergic conjunctivitis
how do you treat allergic conjunctivitis?
Topical solutions combining antihistamine and mast cell stabilizers,
Antihistamine plus vasoconstrictors- Naphcon A,
what is Inflammation of the cornea?
keratitis
what may cause keratitis
HSV, N gonn, Adenovirus
how do you treat herpetic keratosis
acular acyclovir
what can lead to corneal scarring
iritis and deep keratitis
recurrence of keratitis
what is contraindicated in keratitis
Corticosteroids are contraindicated for they cause rapid progression and can lead to corneal perforation
what is always the wrong answer for treatment in eyes
CORTICOSTERIODS
what causes a corneal abrasion?
Trauma or FB
what is corneal abrasion?
physical scratch over cornea
what has symptoms of pain, blurred vision, photophobia and may use fluorescein exam to reveal
corneal abrasion
how do you treat corneal abrasion
Abx gtts to avoid secondary infection (common)
Patching for comfort if sxs severe
what is related to rheumatologic dz (RA, sjogren, SLE, polyarteritis nodosa
corneal ulcer
how do you treat corneal ulcer
Tx underlying Dz, usually by rheumatology
what is Blood in anterior chamber
hyphema
when you see hyphema what should you think? 3
trauma, glaucoma, vascular abn
how do you treat hyphema?
Treatment underlying dz if applicable, pain mgmt.
may need surgery if no resolution
what is primary glaucoma?
present at birth
what is secondary glaucoma?
d/t genetic or other congenital syndromes, prenatal infection, etc
what is marked by Increased IOP creating pain, damage to eye structures resulting in progressive vision loss
glaucoma
how do you treat glaucoma?
Tx medical or surgical depending on severity, usually by ophtho
Can be medical emergency if acute presentation
what is opacity of the lens that may be bilateral or unilateral
catarct
what may be AD AR or xlinked?
cataract
what may be caused by Intrauterine Rubella, CMV, congenital varicella
cataract
what has symptoms of Leukocoria, strabismus, nystagmus, poor fixation
cataract
what has Altered red reflex on ophthalmoscopic examination.
cataract
how do you treat cataract
surgical
what is a decrease in the child’s vision that can happen even when there is no problem with the structure of the eye.
amblyopia
what are the 3 types of amblyopia
Strabismic amblyopia,
deprivation amblyopia
refractive amblyopia
how do you treat amblyopia
patch unaffected eye
what is any misalignment of the eyes
strabismus
what is esotropia, exotropia, hypotropia, and hypertropia
strabismus
when strabismus involves cranial N what is it?
3rd nerve palsy, superior oblique palsy
what is d/t an abnormality of the poorly understood neuromuscular (including brain) control of eye movement.
strabismus
disorders that affect the brain such as cerebral palsy, Down syndrome, hydrocephalus and brain tumor are more likely to develop what eye condition?
strabismus
how do you treat strabismus? 4
eye glasses, eye exercises, prism, and/ or eye muscle surgery
what is Oscillatory movement of eyes, may be horizontal, vertical or torsional/rotational
nystagmus
what are 4 congenital causes of nystagmus
Idiopathic
Neurologic dysfunction
Decreased visual acuity
Rarely glioma
what are 4 acquired causes of nystagmus
Vestibular lesions/inflammation/infection
Brain lesions/malformations
Muscle spasm
medications
what is Neovascularization of immature vasculature seen in preemies (< 1500g)
retinopathy of preemie
what can be induced by excess O2 supplementation, hypoxemia, illness
retinopathy
what results in retinal detachment and vision loss
retinopathy
how do you treat retinopathy?
medical or surgical ablation vessels by ophtho
what is Inflammation of skin lining in the ear canal
otitis externa
what are risk factors of otitis externa? 2
Water trapped “swimmers ear”
Trauma to canal from q tip
what is the most common pathogen of otitis externa? 2nd?
Pseudomonas Aeuruginosa
Staph aureus
what has Pain and itching, +/- purulent discharge, pain elicited with traction on pinna or tragus
otitis externa
how do you treat otitis externa
Topical –2% acetic acid to restore ph …. Or antibiotic / corticosteroid drops . Cipro HC
what do you never use for ear infections
aminoglycosides –>ototox
what has Grey TM Air fluid levels Bubbles Little to no movement of TM TM may be retracted
Otitis Media with Effusion (OME)
what is either mucoid or serous
effusion
what has Hx hearing loss, fullness of ear, maybe vertigo
OME
when OME has no pain or fever..
acute
what has Potential contributing factors: allergic rhinitis, tonsillar/adenoid hypertrophy, sinusitis, eustachian dysfunction
OME
what is Result of post nasal drainage, URI/allergies
Eustachian Dysfunction
what has Ear pain/fullness/popping sensation, decreased hearing
Eustachian Dysfunction
person with Eustachian Dysfunction has increased risk of?
AOM/OME
what is Inflammation –> poor pressure regulation middle ear
Eustachian Dysfunction
what has pk incidence at 6-24 months
AOM
what is Infection of middle ear cavity assoc with effusion
AOM
what is recurrent OM
> 3 episodes in 6 months, or > 4 in 1 yr
what may resent as Poor feeding, fever, pain / irritability, pulling on ear, vomiting and
Otoscopic findings
AOM
what has Bulging TM
Impaired visiblility of landmarks
Red, white, yellow
Bullae
AOM
what is the triad of findings with AOM
Recent, usually abrupt onset of illness (URI often)
Signs/symptoms of middle ear inflammation
Otalgia (ear tugging in infant), irritability/crying, otorrhea, and/or fever
Otoscopic findings ( evidence of effusion )
Bulging tympanic membrane (highest predictive value) , limited or absent mobility, air fluid level, or otorrhea
what is the #1 cause of AOM
strep pneumo
how do you treat a <6mo old with certain dx of AOM
abx
how do you treat a <6mo old with uncertain diagnosis of AOM
abx
what is treatment for 6mo old - 2 year old with certain dx of AOM
abx
what is treatment for 6mo old - 2 year old with uncertain dx of AOM
Antibacterial therapy if severe illness; observation option if non-severe illness
what is treatment for 2-12 y/o with certain dx of AOM
abx if severe; obs if not
what is treatment for 2-12 y/o with uncertain dx of AOM
observation
what is the DOC for AOM
amoxicillin
what is 2nd line tx of AOM or 1st if severe w/fever?
Amoxicillin-clavulanate or ceftriaxone IV
how do you avoid AOM
Breastfeeding for at least the first 6 months
Avoiding supine bottle-feeding (bottle propping)
Elimination of pacifier use in the second 6 months of life
Elimination of exposure to passive tobacco smoke
Don’t be a boy, don’t be LBW, don’t be born prematurely,
Don’t go to childcare,
Don’t have a cleft palate
what is indicated for *chronic OME with conductive hearing loss or failed tx for recurrent AOM
PE tubes
what are complications of OME/AOM
Hearing deficits, tympanoslerosis, perforation, mastoiditis
what is white plaques on TM ‘scars’
Decrease mobility of TM
tympanosclerosis
when can prophylactic abx be used for ear infection
AOM, not for OME
what is the most common organism of mastoiditis
strep pneumo and pyogenes
what has postauricular pain, fever, displacement of pinna.
mastoiditis
what are 2 complications of mastoiditis
Meningitis is a complication so evaluate for stiff neck, high fever, severe headache, meningeal signs
Brain absess in 2% of pt – assoc with persistent headaches, recurrent fevers, neurologic changes
how do you treat mastoiditis
Myringotomy to obtain culture. Hopitalization with IV ABX. If severe, corticalmastoidectomy.
what is Growing mass of epithelial tissue within middle ear and temporal bone
cholesteatoma
what is a mass that is Invasive to local structures damaging ear anatomy, may lead to permanent hearing loss. Invasion into bone and brain may lead to abscess, severe morbidity/mortality if untreated
cholesteatoma
what can cause cholesteatoma
May be congenital or acquired (recurrent OM, TM injury)
what is the mainstay tx of cholesteatoma
Surgical removal mainstay of Tx
what is Most common cause of conductive hearing loss in children
OM
when doesAAP recommends hearing and language evaluation in children
with OME >3months
Sensorineural Hearing Loss (SNHL) is due to
to defect in cochlear recptor cells or auditory nerve (CN VIII)
Congenital or Acquired
what are the risk factors of sensorineural HL (7)
LBW < 1500g , low apgars (0-4 at 1 min , 0-6 at 5min, hypoxia, TORCH, hyperbilirubinemia( kernicterus), mechanical ventilation > 5days
acquired causes of SNHL(4)
Ototoxic medications – Gentamicin,
Infection – meningitis, syphillis, lyme disease
CMV – loss is progressive in ~ 50%
Autoimmune or neoplastic conditions
how do you test hearing in birth to 4mo
startle to sounds
how do you test hearing in 4 mo to 2 yrs
test by using soft soundmaker outside childs field of vision
no teeth by ___ is concerning. what else is concerning
15mo
single tooth eruption - missing mirror pair
what is risk of natal teeth
no roots so fall out –> aspirate
1 pathogen of dental carries
strep viridans
what is 10+ small mouth ulcers on buccal mucosa, anterior pillars, inner lips, tongue, gingiva (not posterior pharynx)
+ fever
+ cervical adenopathy
HSV
how do you treat and not treat HSV?
symptoms.(no corticosteroids – spread infx) If caught early could start oral acyclovir
what causes thrush?
candida albicans
what is White curd-like plaques on inner cheeks
that Does not scrape off; child refuses feeding
thrush
how do you treat thrush
Nystatin
what is Erosions to mucosa of Unknown etiology but + familial component, has increased Incidence with stress, recent illness, irritants (spicy, acidic salty foods/drinks), and Vitamin deficiency
and is Not infection?
oral aphthae
how do you treat oral aphthae
Dietary avoidance, mucosal protectants, pain mgmt
