HEENT Flashcards
First line treatment for Seasonal allergic rhinitis
“Topical steroid nasal spray (e.g., Flonase)”
New-onset urticaria treatment
“Benadryl or Zyrtec work well. Benadryl causes sedation and effect lasts several hours. Zyrtec is nonsedating and lasts 24 hours.”
“present with generalized maculopapular rash, enlarged tonsils with cryptic exudate (white or darker color), sore throat, enlarged cervical nodes that are tender to touch.”
“Acute or reactivated mononucleosis”
“Treatment for otitis externa”
“Cortisporin Otic drops (topical antibiotic combined with a steroid).”
“Common bacterial pathogen in otitis externa is”
P. aeruginosa.
Ruptured spleen is
“a catastrophic event. Avoid contact sports (i.e., 4 weeks) until ultrasound documents resolution.”
“Betimol (timolol) ophthalmic drops have the same contraindications as”
oral beta blockers
“affected ear with hearing loss, no TM, purulent exudate with odor, and yellowish to whitish cauliflower-like mass inside the middle ear.”
Cholesteatoma
“Penicillin-allergic patients, use”
“macrolides, gram-positive coverage quinolones (avoid cephalosporins if had class I reaction or anaphylaxis from penicillins).”
“Rinne test result of BC greater than AC”
“conductive hearing loss (i.e., ceruminosis, AOM).”
“Weber test result is lateralization to the “bad” or affected ear with”
conductive hearing loss
“Weber or Rinne are tests of the”
“acoustic nerve or CN VIII.”
“Lateralization (hearing sound louder on one side) on the Weber exam is”
an abnormal finding
“Normal finding and sensorineural hearing loss results with the Rinne test is”
“air conduction that lasts longer than bone conduction (AC > BC)”
“20/40 vision means”
“Patient can see at 20 feet what a person with normal vision can see at 40 feet.”
“one of the most common OTC treatments for ceruminosis”
“Carbamide peroxide (similar to hydrogen peroxide)”
“check for corneal abrasions, keratitis.”
Use fluorescein strips
herpes keratitis
“cause is either herpes simplex or varicella zoster (shingles of trigeminal nerve ophthalmic branch). If herpes keratitis, refer to ED, ophthalmologist stat.”
“fern-like lines in the corneal surface”
Herpes keratitis
“Diagnosed by using fluorescein dye”
“Avoid steroid ophthalmic drops for herpes keratitis.”
“Diagnosed by using fluorescein dye. A black lamp in a darkened room is used to search for round or irregularly shaped”
corneal abrasions
“two types of herpesvirus that can infect the eyes”
“herpes simplex and herpes varicella zoster or shingles”
“infection is due to herpes simplex virus (due to self-inoculation “cold sore,” herpes whitlow), it is called”
herpes simplex keratitis
“infection is due to shingles of the trigeminal nerve (cranial nerve [CN] V) ophthalmic branch, it is called”
herpes zoster ophthalmicus.
“acute eruption of crusty rashes that follow the ophthalmic branch (CN V1) of the trigeminal nerve (one side of forehead, eyelids, and tip of nose).”
Herpes zoster ophthalmicus
Refer to ED.
“Examination reveals a mid-dilated pupil(s) that is oval shaped. The cornea appears cloudy. Funduscopic examination reveals cupping of the optic nerve”
“Acute Angle-Closure Glaucoma”
Refer to ED.
“Complains of daily fatigue on awakening that worsens as day goes on. Heat exacerbates and worsens symptoms (heat sensitivity). Has recurrent episodes.”
“Multiple Sclerosis (Optic Neuritis)”
Refer to neurologist.
“Acute onset of erythematous swollen eyelid with proptosis (bulging of the eyeball) and eye pain on affected eye.”
Orbital Cellulitis
“Serious complication. Refer to ED.”
“Sudden onset of a shower of floaters associated with “looking through a curtain” sensation with sudden flashes of light (photopsia)”
Retinal Detachment
Refer to ED.
“Cauliflower-like” growth accompanied by foul-smelling ear discharge. Hearing loss on affected ear. On examination, no tympanic membrane or ossicles are visible”
Cholesteatoma
Refer to otolaryngologist.
“Raccoon eyes” (periorbital ecchymosis) and bruising behind the ear (mastoid area) that appears about 2 to 3 days after trauma”
Battle Sign
Refer to ED
“Rule out basilar and/or temporal bone skull fracture”
“Clear Golden Fluid Discharge From the Nose/Ear”
basilar skull fracture
“Cerebrospinal fluid (CSF) slowly leaks through the fracture. Testing the fluid with a urine dipstick will show that it is positive for”
“glucose, whereas plain mucus or mucopurulent drainage will be negative. Refer to ED.”
“hot potato” voice
“Affected area is markedly swollen and appears as a bulging red mass with the uvula displaced away from the mass.”
Peritonsillar Abscess
Refer to ED
“markedly swollen neck (“bull neck”)”
“posterior pharynx, tonsils, uvula, and soft palate are coated with a gray- to yellow-colored pseudomembrane that is hard to displace.”
Diphtheria
“Very contagious. Contact prophylaxis required. Refer to ED.”
“The veins are larger than arteries; veins are darker (in color) than arteries”
Fundi
“For color perception, 20/20 vision, sharp vision”
Cones
“For detecting light and shadow, night vision”
Rods
“The macula is the area responsible for central vision; the fovea (which contains large numbers of cones) is set in the middle, the area of the eye that determines 20/20 vision (sharpest vision)”
Macula (and fovea)
“Age-related visual change due to a decreased ability of the eye to accommodate stiffening of the lenses; usually starts at the age of 40 years”
Presbyopia
“near vision is affected with decreased ability to read small print at close range”
Presbyopia
“Bones (ossicles) of the ear:”
“Malleus, incus, and stapes. The stapes is the smallest bone in the body.”
“Appears as translucent off-white to gray color with the “cone of light” intact.”
Tympanic membrane
“This is the most objective measure to test for presence of fluid inside middle ear (results in a straight line vs. a peaked shape). Acute otitis media and serious otitis media will show a straight line on testing.”
Tympanogram
“Has a large amount of cartilage. Refer injuries to plastic surgeon.”
Pinna
“A small cartilage flap of tissue that is on front of the ear.”
Tragus
“Is found on the nose and the ears. Does not regenerate. Refer injuries to plastic surgeon.”
Cartilage
“Ear wax; the color can range from yellow to dark brown.”
Cerumen
“the inferior nasal turbinates are”
visible
“The medial and superior turbinates are”
“not visible without special instruments.”
“Bluish, pale, and/or boggy nasal turbinates are seen in”
allergic rhinitis.
“Lower third of the nose is”
“cartilage. Cartilage tissue does not regenerate; if damaged, refer to plastic surgeon.”
Four sinus cavities
“ethmoid and maxillary sinuses (both present at birth), frontal (age 5 years), and sphenoid (age 12 years)”
“Mucous membranes are pink to dark pink and moist. Look for ulcers, fissures, leukoplakia, and inflammation.”
Mouth exam
“If the gums are red and swollen, the patient may have”
gingivitis
“gums may bleed when brushing teeth”
“gums are red and swollen”
“taking phenytoin (Dilantin) for seizures”
gingival hyperplasia
“tongue should red or swollen”
glossitis
“White to light-gray patch that appears on tongue, floor of mouth, or inside cheek”
leukoplakia
“Chewing or smoking tobacco and alcohol abuse are risk factors for”
Oral cancer
“Painful shallow ulcers on soft tissue of the mouth that usually heal within 7 to 10 days.”
“Aphthous stomatitis (canker sores)”
“Aphthous stomatitis (canker sores)” treatment
“Magic mouthwash” (combination of liquid diphenhydramine, viscous lidocaine, and glucocorticosteroid). Swish, hold, and spit every 4 hours as needed”
“Store in cool milk (no ice) and see dentist as soon as possible for reimplantation.”
Avulsed tooth
“edges of the lips”
Vermillion border
“The corners of the lips”
“oral commissure (cheilosis, perleche).”
three salivary glands
“parotid, submandibular, and sublingual”
Infected salivary glands
sialadenitis, sialadenosis, mumps
Salivary gland(s) “blocked with calculi or “stone”
sialolithiasis
“made up of lymphoid tissue. Butterfly-shaped glands with small pore-like openings”
palatine tonsils or tonsils
“Butterfly-shaped glands with small pore-like openings that may secrete thick white exudate”
mononucleosis
“Butterfly-shaped glands with small pore-like openings that may secrete purulent exudate that is a yellow to green color”
Step throat
“Posterior pharyngeal lymph nodes that are mildly enlarged and distributed evenly on the back of the throat”
allergies, allergic rhinitis
“soreness with acidic foods, spicy foods”
“Tongue surface has a map-like appearance; patches may move from day to day”
Geographic Tongue
“Painless bony protuberance midline on the hard palate (roof of the mouth)”
Torus Palatinus
“Uvula is split into two sections and resembles a fish tail”
“Fishtail or Split Uvula”
“prolonged extreme lateral gaze, a few beats of nystagmus that resolve when the eye moves back toward midline in healthy patients, is normal”
“Physiological Gaze-Evoked Nystagmus”
“Optic disc swollen with blurred edges due to increased intracranial pressure (ICP)”
Papilledema
“Copper and silver wire arterioles”
Arteriovenous nicking
Retinal hemorrhages
Hypertensive Retinopathy
“when arteriosclerotic arteriole crosses retinal vein, it indents the vein”
Arteriovenous nicking
“Cotton wool spots (fluffy yellow-white patches on the retina)”
“Microaneurysms (small bulges in retinal blood vessels that often leak fluid) caused by neovascularization (new fragile arteries in the retina that rupture and bleed)”
Diabetic Retinopathy
“Opacity of the lens of the eye, which can be central (nuclear cataract) or on the sides (cortical cataract); can appear at any age from birth (congenital cataracts) through adulthood to the elderly”
Three types of cataracts
“Blue-tinged or pale and swollen (boggy) nasal turbinates associated with increased in clear nasal discharge”
Itchy nose
Nasal congestion
Allergic Rhinitis
“Clusters of small-sized red papules with white centers inside the cheeks (buccal mucosa) by the lower molars”
Koplik’s Spots
Pathognomonic for measles
“Painless and soft round growths inside the nose. Look for fleshy mass inside nasal cavity.”
Nasal Polyps
“There is increased risk of aspirin sensitivity or allergy.”
“Elongated papilla on the lateral aspects of the tongue that is pathognomonic for HIV infection”
Hairy Leukoplakia
Caused by EBV
“Bright-white plaque caused by chronic irritation”
“Leukoplakia of the Oral Mucosa/Tongue”
“Painful skin fissures and maceration at the corners of the mouth due to excessive moisture”
“Cheilosis (Angular Cheilitis, Perleche)”
Cheilosis (Angular Cheilitis, Perleche) Treatment Plan for Suspected Yeast Infection
microscopy with KOH
“If positive (pseudohyphae and spores)”
“treat with topical azole ointment (e.g., clotrimazole, miconazole) BID.”
“When infection has cleared, use barrier cream with zinc or petroleum jelly applied at night. High rate of recurrence.”
“Cheilosis (Angular Cheilitis, Perleche) Treatment Plan for suspect staphylococcal infection
C & S
“If positive, treat with topical mupirocin ointment BID.”
“When infection has cleared, use barrier cream with zinc or petroleum jelly applied at night. High rate of recurrence.”
“Mucosal lining inside eyelids”
Palpebral conjunctiva
“Mucosal lining covering the eyes”
Bulbar conjunctiva
“Mucosal lining inside the mouth”
Buccal mucosa
“Refers to the area where uvula, tonsils, anterior of throat are located”
Soft palate
“Roof” of the mouth”
Hard palate
“Farsightedness”; distance vision is intact, but near vision is blurry”
Hyperopia
“Nearsightedness”; near vision intact, but distance vision is blurry”
Myopia
“Hyperplastic lymphoid tissue on the posterior pharynx”
Cobblestoning
“measures central distance vision”
Snellen chart
“If the person is illiterate, use the Tumbling E chart. Patient must stand 20 feet away from the chart.”
“Abnormal: Two-line difference between each eye; less than four letters out of six correct.”
“Ask patient to read small print to evaluate…”
Near Vision
“Use the “visual fields of confrontation” exam to evaluate”
Peripheral Vision
“Look for blind spots (scotoma) and peripheral visual field defects.”
“Use the Ishihara chart to evaluate…”
Color Blindness
“Definition of a Snellen test result 20/60:”
“the patient can see at 20 feet what a person with normal vision can see at 60 feet.”
Legal blindness
“Defined as a best corrected vision of 20/200 or less or a visual field less than 20 degrees (tunnel vision)”
“visual acuity (retina or CN II) is 20/20 in both eyes by age..”
Age 6
“child’s vision is not at least 20/30 in either eye by age 6 years, refer to ophthalmologist.”
Weber Test
“Place the tuning fork midline on the forehead.”
“Normal finding: No lateralization. “
“If lateralization (hears the sound in only one ear), abnormal finding.”
Rinne Test
“Place tuning fork first on mastoid process, then at front of the ear. Time each area.”
“Normal finding: Air conduction (AC) lasts longer than bone conduction (BC; i.e., can hear longer in front of ear than on mastoid bone).”
“Any type of obstruction (or conduction) of the sound waves will cause conductive hearing loss”
“Conductive Hearing Loss (Outer Ear and Middle Ear)”
“Damage (or aging) of the cochlea/vestibule (presbycusis, Ménère’s disease) and/or to the nerve pathways (CN VIII or acoustic nerve) causes sensorineural hearing loss.”
“Sensorineural Hearing Loss (Inner Ear)”
“History of using contacts past prescribed time schedule, sleeping with contact lens, bathes/showers or swims with contacts, extended lens use, and use of tap/well water or poor disinfection practices.”
“fluorescein dye strips with Wood’s lamp (black lamp) present in the center and are round”
“Contact Lens-Related Keratitis”
Eye removal of foreign body
“Flush eye with sterile normal saline”
“Evert eyelid to look for foreign body. If unable to remove, refer.”
Contact Lens Related Keratitis Treatment
Check visual acuity and pupils with penlight
Rule out trauma, foreign body, and infection
Suspect infection, C&S of eye discharge.
“topical ophthalmic antibiotic with pseudomonal coverage (especially if contact lens user) such as ciprofloxacin (Ciloxan), ofloxacin (Ocuflox), trimethoprim–polymyxin B (Polytrim) applied to affected eye × 3 to 5 days.”
Contact Lens Related Keratitis Treatment for Pain
“Consider eye pain prescription (hydrocodone with acetaminophen; prescribe enough for 48 hours of use).
Topical pain medication Acular 1 gtts QID (contraindication: allergy to nonsteroidal anti-inflammatory drugs [NSAIDs])”
Contact Lens Related Follow Up
“Do not patch eye. Follow up in 24 hours. If not improved, refer to ED or ophthalmologist stat (Zovirax or Valtrex BID).”
“swollen, red, and warm abscess on the upper or lower eyelid involving one hair follicle that gradually enlarges. May spontaneously rupture and drain purulent exudate”
Hordeolum (Stye)
“Style infection may spread to adjoining tissue”
preseptal cellulitis
Stye Treatment Plan
“Hot compresses × 5 to 10 minutes BID to TID until it drains”
“If infection spreads (preseptal cellulitis), systemic antibiotics such as dicloxacillin or erythromycin PO QID. Refer to ophthalmologist for incision and drainage (I&D).”
“gradual onset of a small superficial nodule on the upper eyelid that feels like a bead and is discrete and movable. Painless. Can slowly enlarge over time”
Chalazion
Chalazion Treatment
“I&D, surgical removal, or intrachalazion corticosteroid injections by ophthalmologist.”
“raised yellow to white small round growth in the bulbar conjunctiva (skin covering eyeball) next to the cornea. Located on the nasal and temporal side of the eye”
Pinguecula
“yellow triangular (wedge-shaped) thickening of the conjunctiva that extends across the cornea on the nasal side”
Pterygium
“Treatment Plan (Both Pinguecula and Pterygium)”
“If inflamed, refer to ophthalmologist for prescription of weak steroid eye drops only during exacerbations.
Use artificial tears PRN for irritation.
Recommend use of good-quality sunglasses (100% against UVA and UVB).
Remove surgically if encroaches on cornea and affects vision.”
“Complains of sudden onset of bright-red blood in one eye after an incident of severe coughing, sneezing, or straining. May also be due to trauma such as a fall. Denies visual loss and pain.”
Subconjunctival Hemorrhage
“Resolves within 1 to 3 weeks (blood reabsorbed) like a bruise, with color changes from red, to green, to yellow.”
Subconjunctival Hemorrhage Treatment Plan
“Watchful waiting and reassurance of patient. Follow up until resolution”
“Gradual changes in peripheral vision (lost first) and then central vision. May complain of missing portions of words when reading. If funduscopic exam shows cupping, IOP is too high. Refer to ophthalmologist.”
“Primary Open-Angle Glaucoma”
Primary Open Angle Glaucoma Treatment Plan
“Check IOP (use tonometer). Normal range: 8 to 21 mmHg.
IOP of 30 mmHg or more is considered very high. Urgent referral within 24 hours or less to ophthalmologist or refer to ED.”
Primary Open Angle Glaucoma Treatment Plan
“Betimol 0.5 % (timolol): Beta-blocker eyedrops (decrease aqueous production)
Latanoprost (Xalatan): Topical prostaglandin eyedrops (increase aqueous outflow)”
“referral within 24 hours or less to ophthalmologist or refer to ED.”
Acular contraindication
“contraindication: allergy to nonsteroidal anti-inflammatory drugs [NSAIDs]”
“Older patient complains of acute onset of decreased/blurred vision with severe eye pain and frontal headache that is accompanied by nausea and vomiting.”
“Primary Angle-Closure Glaucoma”
“Fixed and mid-dilated cloudy pupil (4–6 mm) that looks more oval than round. Pupil reacts slowly to light. Conjunctival injection with increased lacrimation.”
“Primary Angle-Closure Glaucoma”
Refer to ED
“Insidious onset of eye pain with conjunctival injection located mainly on limbus with no eye discharge”
Anterior Uveitis (Iritis)
Refer to ophthalmologist within 24 hours, can cause blindness
“Elderly smoker complains of gradual or sudden and painless loss of central vision in one or both eyes. Reports that straight lines (doors, windows) appear distorted or curved. Peripheral vision is usually preserved.”
Age Related Macular Degeneration
Age Related Macular Degeneration Treatment
Refer to ophthalmologist
Give Amsler grid to use daily or weekly
Ocular vitamins may be prescribed by ophthalmologist
