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HEENT Flashcards

1
Q

What is a primary headache?

A

It has no underlying cause → consists of tension headaches, cluster headaches, and migraines

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2
Q

What is a secondary headache?

A

It is associated with an underlying illness such as an infection, trauma, stroke, or hypertensive crisis

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3
Q

What are some facts about tension headaches?

A
  1. most common type of headache
  2. women get it more than men
  3. incidence decreases with age
  4. unclear pathophysiology
  5. caused by stress, anxiety, and head/neck movements
  6. episodic or chronic (occurs at least 15 days/month)
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4
Q

What are the symptoms of a tension headache?

A
  1. constant, dull pressure → not pulsating
  2. bilateral tightness pain → hatband pattern
  3. photophobia and phonophobia could be present (sensitive to light and sound)
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5
Q

What are some facts about migraine headaches?

A
  1. second most common primary headache
  2. women get it more than men
  3. peaks between 18-54 years of age
  4. duration can last from 4 hours-3 days
  5. caused by neuronal or vascular changes
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6
Q

What are the symptoms of a migraine headache?

A
  1. throbbing/pulsating pain → is unilateral
  2. nausea and vomiting
  3. photophobia and phonophobia (sensitivity to light and sound)
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7
Q

What are the symptoms of aura?

A
  1. tingling of extremities
  2. flashes of light or blind spots
  3. sensory changes
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8
Q

What are some common characteristics of aura?

A
  1. is a neurologic symptom that can last from 5-60 minutes
  2. starts before or at the onset of a migraine
  3. affects half of the visual field
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9
Q

What are some facts about cluster headaches?

A
  1. less common but is the most severe primary headache
  2. men have it more than women
  3. can last 15 minutes - 3 hours that occur in series that can last weeks to months
  4. caused by hypoxia or histamine/serotonin release
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10
Q

What are the symptoms of cluster headaches?

A
  1. circadian rhythm of painful attacks
  2. unilateral and usually centered around or behind the eye
  3. constant/severe pain
  4. nausea and vomiting
  5. photophobia and phonophobia
  6. nasal stiffness, rhinorrhea (thin clear nasal discharge), eyelid swelling
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11
Q

What are the most common treatments for a tension headache?

A

analgesics, caffeine, stress management

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12
Q

What are the most common treatments for a migraine headache?

A

lying down in a dark room, botulism toxin, triptans

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13
Q

What is the most common treatment for a cluster headache?

A

oxygen

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14
Q

What are non-pharmacologic treatments for headaches?

A
  1. avoid triggers
  2. stress management and relaxation training
  3. heat/cold packs
  4. massage
  5. exercise and stretching
  6. sleep hygiene
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15
Q

What are some OTCs to treat headaches?

A
  1. acetaminophen
  2. NSAIDS (ibuprofen, naproxen)
  3. Excedrin (acetaminophen, aspirin, caffeine)
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16
Q

What is an important counseling tip for OTC analgesics?

A

they can cause a rebound headache → don’t take for more than 15 days per month

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17
Q

When do you refer a patient for a headache/head condition?

A
  1. uncontrolled hypertension
  2. recent trauma
  3. neck stiffness
  4. signs of infection/fever
  5. signs of stroke
  6. excessive drowsiness
  7. confusion
  8. having more than 15 tension headaches per month
  9. new onset of headaches if older than 50 years old
  10. standard treatments are ineffective
  11. migraine or cluster headaches
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17
Q

When do you refer a patient for a headache/head condition?

A
  1. uncontrolled hypertension
  2. recent trauma
  3. neck stiffness
  4. signs of infection/fever
  5. signs of stroke
  6. excessive drowsiness
  7. confusion
  8. having more than 15 tension headaches per month
  9. new onset of headaches if older than 50 years old
  10. standard treatments are ineffective
  11. migraine or cluster headaches
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18
Q

What does SCHOLAR stand for?

A 
S - scholar
C - characteristics 
H - history
O - onset
L - location
A - aggravating factors
R - remitting factors
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19
Q

What are some SCHOLAR questions for head conditions?

A

S - What symptoms are you experiencing? Any smells, visual changes, sensitivities or light/sound, aura, nausea, vomiting?
C - Describe the pain. What does it feel like? Throbbing vs pressure vs sharp/severe
H - How often do the symptoms happen? Has this happened before? Have any life changes occurred recently?
O - When did the pain/symptoms begin? Was it gradual or sudden?
L - Where is the pain located? Is it one side of the face, across the forehead, around the eye?
A - What makes the pain worse?
R - What makes the pain better? What have you tried to help the pain?

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20
Q

What is conjunctivitis?

A
  1. also known as pink eye
  2. inflammation of the conjunctiva (thin, transparent layers of mucus membrane that lines the inner surface of the eye/eyelid)
  3. causes include: infectious (bacterial/viral), allergic, nonspecific
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21
Q

What is viral conjunctivitis?

A
  1. is the most common infectious cause (up to 80%)
  2. most commonly caused by adenovirus
  3. lasts 1-3 weeks
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22
Q

What are the symptoms of viral conjunctivitis?

A
  1. begins in one eye and spreads to the other
  2. blurred vision
  3. watery discharge
  4. pink/red eye
  5. low grade fever
  6. other respiratory symptoms → rhinitis (stuffy nose), sore throat, cough
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23
Q

What is the treatment for viral conjunctivitis?

A
  1. lubricants (artificial tears)
  2. ocular decongestants or antihistamines (like ketotifen)
  3. cold compress
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24
What is bacterial conjunctivitis?
1. caused by S. aureus, S. pneumonia, H. influenzae | 2. lasts 2 weeks
25
What are the symptoms of bacterial conjunctivitis?
1. purulent yellow/green ocular discharge 2. begins in one eye and spreads to the other 3. blurred vision 4. pink/red eye 5. eye discomfort/swelling
26
What is the treatment for bacterial conjunctivitis?
antibiotics
27
What is allergic conjunctivitis?
1. affects up to 40% of the population | 2. caused by triggers → animal dander, dust mites, pollen
28
What are the symptoms of allergic conjunctivitis?
1. itchy eyes 2. clear watery discharge 3. bilateral 4. pink/red eye 5. eye discomfort/swelling 6. sneezing/rhinorrhea
29
What is the treatment for allergic conjunctivitis?
1. allergen avoidance 2. topical antihistamine/vasoconstrictor eye drops (Naphcon-A) 3. mast cell stabilizers (Cromolyn eyedrops)
30
What are the causes of dry eye conjunctivitis?
1. increased age 2. women get it more than men 3. allergens 4. medications (anticholinergics, diuretics, decongestants, antidepressants, hormone replacement therapy) 5. dry air
31
What are the symptoms of dry eye conjunctivitis?
1. sandy, gritty feeling | 2. feels like something is stuck in the eye
32
What are some non-pharmacologic treatments for dry eye conjunctivitis?
1. avoid allergens 2. avoid prolonged viewing of computer screens 3. discontinue topical or systemic medications causing dry eyes 4. humidifier 5. wear sunglasses when outdoors
33
What is a pharmacologic treatment for dry eye conjunctivitis?
artificial tears (polyethylene glycol) in liquid, gel, or ointment
34
What are the causes of irritant conjunctivitis?
1. foreign object in the eye 2. chlorine 3. smoke
35
What is the treatment for irritant conjunctivitis?
1. carefully remove the object 2. remove contacts and flush the eye with clean water 3. do not rub eyes
36
What is the cause of blepharitis?
can be allergic or bacterial cause
37
What are the symptoms of blepharitis?
1. inflammation of the eyelid → shows as a lump near the edge of the eyelid 2. swollen itchy eyelid
38
What is the treatment for blepharitis?
1. warm compress 2. eyelid cleansing 3. artificial tears 4. can lead to the formation of a stye if left untreated
39
What eye conditions are self treatable?
dry eye conjunctivitis, allergic conjunctivitis, viral conjunctivitis
40
When do you refer for an eye condition?
1. pain in the eyeball itself 2. significant vision changes 3. photophobia (light sensitivity) 4. severe foreign body sensation 5. any corneal irregularity 6. eye trauma 7. symptoms get worse or do not improve 8. soft tissue swelling near the eye 9. intense redness in the eyes 10. contact lens wearers 11. chemical exposure to the eye
41
How do you administer eyedrops?
1. Wash hands before and after use 2. Remove glasses or contacts 3. Remove the cap and make sure nothing touches the bottle tip 4. Tilt head back or lie down → pull lower lid of eye down to form a pocket 5. Hold eye drop bottle near eyelid but not touching anything 6. look up and away from the top and place one drop into the eye 7. hold eyelid to allow solution to spread then close the eye and apply light pressure to nasolacrimal opening on side of nose for 30 seconds to avoid systemic absorption and loss of product 8. wipe excess liquid away 9. wait 5 minutes before applying another drop
42
What are some SCHOLAR questions for eye conditions?
S - What symptoms are you experiencing? Any itching, discharge, pain? C - If discharge is present, describe it. Is it clear, watery, purulent? H - Has these symptoms happened before? Have you been in contact with anyone with similar symptoms? O - When did the symptoms begin? L - Are the symptoms in one or both eyes? Did it start in just one eye? A - What makes the symptoms worse? R - What makes the symptoms? What have you tried to help the symptoms?
43
What is acute otitis media?
inflammation of the middle ear and is more common in children less than 6 years old
44
What are the causes of acute otitis media?
bacteria or viruses
45
What are the symptoms of acute otitis media?
1. ear pain (children tug at their ear) 2. decreased hearing 3. fever
46
What is the treatment for acute otitis media?
1. over 2/3 of cases resolve spontaneously 2. analgesic/antipyretics for 48 hours 3. antibiotics (but 75% of cases are resolved without antibiotics)
47
What is otitis media with effusion?
associated with fluid in the middle ear
48
What are the causes of otitis media with effusion?
allergic rhinitis and post acute otitis media
49
What are the symptoms of otitis media with effusion?
1. fullness in ear/decreased hearing 2. ear popping when yawning 3. no pain or fever
50
What is the treatment of otitis media with effusion?
1. usually resolves without treatment 2. analgesics 3. no antibiotic therapy 4. pressure equalization tubes
51
What is otitis externa?
also known as swimmer's ear and is infection/inflammation of the external ear canal
52
What are the causes of otitis externa?
1. trauma (cleaning ears with cotton swabs) 2. wearing earpieces chronically 3. constant moisture (sweat or water)
53
What are the symptoms of otitis externa?
1. ear pain and swelling 2. purulent discharge 3. fever 4. hearing loss depending on amount of swelling and debris
54
What is the treatment for otitis externa?
1. antimicrobial drops 2. glucocorticoid drops 3. antiseptic drops 4. oral analgesics
55
What is cerumen impaction?
a build up of cerumen (ear wax) blocking the ear canal
56
What are the causes of cerumen impaction?
1. narrow ear canal | 2. improper ear cleaning (cotton swabs)
57
What are the symptoms of cerumen impaction?
1. difficulty hearing 2. pain and ringing in the ear 3. itching
58
What are the different treatments for cerumen impaction?
1. observation → removed naturally over time 2. cerumenolytic agents → water based (acetic acid, hydrogen peroxide, saline), oil based (mineral oil), carbamide peroxide (Debrox) 3. irrigation → flush out cerumen with water and syringe/irrigator 4. manual removal → done in medical setting using ear probes, hooks, forceps
59
What is not recommended for treating cerumen impaction?
ear candling
60
What are the causes of water clogged ears?
swimming and bathing
61
What is the treatment for eater clogged ears?
ear drying agents that contain isopropyl alcohol and using ear plugs while in the water
62
What is ototoxicity?
damage to the hearing or function of the ears
63
What are the causes of ototoxicity?
medications, chemicals, infections
64
What are the symptoms of ototoxicity?
1. hearing loss 2. tinnitus (ringing) 3. dizziness and loss of balance
65
What are the different ototoxic medications?
1. aminoglycosides → gentamicin, tobramycin, neomycin 2. salicylates → aspirin 3. chemotherapy → cisplatin, carboplatin 4. loop diuretics → furosemide, torsemide, bumetanide 5. antimalarials → quinine, chloroquine
66
What ear conditions are self treatable?
impacted cerumen and water-clogged ears
67
When do you need to refer a patient with an ear condition?
1. signs of infections 2. foreign objects in ear 3. signs of trauma/bleeding 4. ruptured tympanic membrane 5. ongoing symptoms that last for more than 4 days 6. children under 12 7. immuno-compromised 8. past radiation to the head or neck 9. cognitive impairment
68
How do you administer eardrops?
1. wash hands before and after 2. clean outside of the ear with a damp cloth 3. warm the ear drops by holding the bottle with the hand for a few minutes 4. tilt head to the side or lie down with the affected ear facing up → adults: pull top of ear upward, children: pull top of ear back and downward 5. drop appropriate number of drops into ear without touching the bottle to the ear 6. keep ear tilted for 3-5 minutes 7. wipe excess fluid away 8. wait 5-10 minutes before switching to other ear
69
What SCHOLAR questions should be used for ear conditions?
S - What symptoms are you experiencing? Any fever? C - If there is pain, what does it feel like? Describe any ear discharge H - Have these symptoms happened before? Any changes in medications? Have you injured your ear? O - When did the symptoms begin? L - Are the symptoms in one or both ears? A - What makes the symptoms worse? R - What makes the symptoms? What have you tried to help the symptoms?
70
What is allergic rhinitis?
inflammation of nasal mucus membranes in sensitized patients
71
What is allergic rhinitis normally caused by?
inhaling airborne allergens such as pollen, grasses, weeds, dust mites, animal dander, molds (reaction → release of mediators → vasodilation and nasal secretions)
72
What are the symptoms of allergic rhinitis?
1. clear rhinorrhea 2. sneezing 3. nasal congestion 4. postnasal drip 5. watering eyes 6. itchy eyes, ears, or nose
73
What are some non-pharmacologic treatments for allergic rhinitis?
1. avoid allergens 2. remove mold in the house 3. moisture control 4. keeps windows closed 5. nasal saline rinses (Neti Pot) and sprays 6. adhesive nasal strips
74
What are some pharmacologic treatments for allergic rhinitis?
1. antihistamines → oral (cetrizine, loratadine, fexofenadine) and intranasal (azelastine which is Rx only) 2. decongestants → oral (pseudoephedrine, phenylephrine) and intranasal (oxymetazoline) 3. intranasal corticosteroids → Flonase, Nasacort 4. Montelukast (Rx only)
75
What is an important thing to note when using intranasal decongestants for allergic rhinitis?
More than a 3 day use of intranasal decongestants (aka Afrin) can cause rebound congestion
76
What is sinusitis?
the inflammation and infection of sinuses
77
What are the causes of sinusitis?
viral upper respiratory infection or bacteria
78
What are the symptoms of sinusitis?
1. get better after a week then get suddenly worse 2. purulent yellow/green nasal discharge 3. headache 4. facial pain/pressure 5. fever
79
What is the treatment for sinusitis?
1. antibiotics (if a bacterial cause) 2. analgesics 3. oral or intranasal decongestants
80
When do you refer a patient for nose conditions?
1. symptoms that last for more than 10-14 days 2. a cold that worsens after 7 days 3. signs of infection 4. severe headache that is not relieved by OTC medications 5. vision changes
81
How do you administer a nasal spray?
1. blow nose gently before use 2. wash hands before and after 3. remove cap from container 4. some nasal sprays need tp be primed 5. tilt head slightly forward and press your finger against one side of the nose to close one nostril 6. gently insert the spray into other nostril and thumb supporting the bottom of the bottle and press down on the applicator with 2 fingers 7. breathe in through the nose and out through the mouth 8. repeat process for other nostril if needed 9. avoid blowing your nose for several minutes after using the spray
82
What SCHOLAR questions should be used with nose conditions?
S - What symptoms are you experiencing? Any pain or fever? C - Describe any nasal discharge H - Have these symptoms happened before? What allergies do you have? O - When did the symptoms begin? L - Are the symptoms in one or both nostrils? A - What makes the symptoms worse? R - What makes the symptoms better? What have you tried to help the symptoms?
83
What is pharyngitis?
it is the inflammation of the throat → also known as a sore throat
84
What are the causes of pharyngitis?
virus or bacteria (Streptococcus pyogenes)
85
What are the symptoms of pharyngitis?
1. pain with swallowing or talking 2. scratchy throat 3. hoarse voice 4. red swollen tonsils (with or without pus) 5. foul swelling breath 6. fever
86
What is the treatment for pharyngitis?
1. saltwater gargle 2. hydration 3. cough drops (benzocaine) 4. oral anesthetic throat spray (phenol) 5. analgesics 6. antibiotics (if bacterial cause)
87
When do you refer a patient for a throat condition?
1. signs of infection 2. difficulty breathing 3. difficulty swallowing 4. symptoms not relieved after 7 days
88
What are canker sores?
non-contagious ulcers within the inner tissues of the mouth including the lips, cheeks, and tongue
89
What are some causes of canker sores?
stress, food sensitivities, nutrient deficiencies (folate, B12), hormonal changes
90
What are the symptoms of canker sores?
painful small white sores
91
What are some treatments for canker sores?
1. avoid substances that worsen the symptoms | 2. local anesthetics → viscous lidocaine (Rx only) or benzocaine
92
What are cold sores?
highly contagious blisters on the lips, chin, cheeks, or nostrils
93
What is the cause of cold sores?
Herpes simplex virus type 1
94
What are the symptoms of cold sores?
painful red blisters that rupture and form a crusty lesion
95
What is the treatment for cold sores?
1. applying cooling materials 2. avoid substances that may worsen symptoms 3. topical antiviral → docosanol (Abreva) 4. other antivirals (acyclovir, valacyclovir, Rx only)
96
What is oral candidiasis?
is a fungal infection in the mouth → also known as oral thrush
97
What are the causes of oral candidiasis?
caused by candida albicans in which medications can cause this (steroids, chemotherapy)
98
What are the symptoms of oral candidiasis?
1. white patches in the mouth 2. cotton-like feeling in the mouth 3. pain with swallowing
99
What is the treatment for oral candidiasis?
antifungal medication such as nystatin and clotrimazole
100
What is gingivitis?
it is the inflammation of the gums
101
What is the cause for gingivitis?
bacteria in the mouth that infects the tissue surrounding the tooth to form plaque
102
What are the symptoms of gingivitis?
1. bad breath 2. red or swollen gums 3. tender or bleeding gums
103
What is the treatment for gingivitis?
antiseptic rinses and referral to the dentist
104
When do you refer a patient for mouth conditions?
1. oral candidiasis 2. gingivitis 3. immuno-compromised 4. symptoms not relieved after 14 days 5. lesions covering large area with severe pain
105
What SCHOLAR questions do you ask a patient for mouth/throat conditions?
S - What symptoms are you experiencing? Any pain or fever? C - Describe any changes in color of your tonsils H - Have these symptoms happened before? Have you been in contact with anyone experiencing similar symptoms recently? O - When did the symptoms begin? L - Where are you experiencing these symptoms? A - What makes the symptoms worse? R - What makes the symptoms better? What have you tried to help the symptoms?

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