HEENT Flashcards
What is Herpes Keratitis? What are the S/S?
Acute onset of severe eye pain, photophobia, tearing and blurred vision in ONE eye. Infection will permanently damage the corneal eptihelium causing blindness.
What are the 2 types of HERPESVIRUS that infects the eyes?
- Herpes Simplex Virus: Due to self-inoculation “cold sore” 2. Herpes Zoster Ophthalmicus (Shingles of Trigemenial Nerve): Cranial Nerve V; acute eruption of crusty rashes that follow the opthalmic branch of trigeminal nerves: 1 side of the forehead, eyelids, tip of nose
* * Refer to ED**
What is Acute Angle-Closure Glaucoma?
Sudden blockage of aqueous humor that causes increased ICP, resulting in ischemia and permanent damage to the optic nerve (CN2)
S/S of Acute Angle-Closure Glaucoma
Objective findings: Fixed and mid dilated, cloudy pupils (4-6mm) that look more oval than round, pupil reacts slowly to light, conjunctival injection with increased lacrimation
Subjective finding: HA, N/V, halos around lights and decreased vision
**Refer to ED —> Ophthalmological Emergency!
S/S of Optic Neuritis
Occurs in young adults with new or intermittent loss of vision of 1 eye, accompanied by nystagmus or other abnormal eye movement.
Objective findings: NEUROLOGICAL (seen in multiple sclerosis): Aphasia, paresthesiam abnormal gait, spasticity.
Subjective findings: Daily fatigure upon awakening that worsens as the day goes on. Heat sensitivity (exacerbates symptoms)
Refer to Neurologist
What is Cholesteatoma?
“Cauliflower like” growth accompanied with foul-smelling ear discharge
Mass is NOT cancerous but can erode into the bones of the face and damage the facial nerve ( CN VII)
S/S of Cholesteatoma and Treatment
Exam: No tympanic membrane or ossicles are visible d/t destruction by the tumor
Subjective finding: hearing loss
TX: ATB and surgical debridement
Refer to Otolaryngologist
What is periorbital ecchymosis?
“Raccoon Eyes”- is bruising around eyes and behind the ears (mastoid area) that appears 2-3 days AFTER trauma.
assessment needs for periorbital ecchymosis
Physical exam (quickly after trauma) may not show clinical signs immediately
Assess for clear golden serous drainage from the nose/ear. Use urine dipstick- if CSF is present it will show + for glucose
Rule out basilar and/or temporal bone skull fracture.
Refer to ED
What is Presbyopia?
Age-related visual change d/t a decreased ability of the eye to accomadate stiffening of the lenses. Usually begins at age 40. Near vision is affected with decreased ability to read small print at close range.
What is cerum?
Ear wax- color ranges from yellow to dark brown
S/S of Peritonsillar Abscess
Subjective findings: severe sore throat, difficulty swallowing (Odynophagia), “hot potato voice”, Trismus (jaw mm spasm, making is difficult to open jaw), malaise, Chills
Objective findings: Unilateral swelling of peritonsillar area and soft palate. Swollen, bulging red mass with uvula displaced away from the mass. Fever
Refer to ED
Conditions that cause post nasal drip
Acute sinusitis
Allergic rhinitis
What is Papilledema?
Optic disc swollen with blurred edges d/t increase intracranial pressure secondary to bleeding, brain tumor, abscess and pseudotumor cerebri
Describe Cheilosis
Painful skin fissures and maceration at the corners of the mouth due to excessive moisture. Can be acute or chronic.
Commonly found in the elderly with dentures. Other etiologies: nutritional deficiencies, Lupus, Autoimmune disease, irritant dermitits, squamous cell carcinoma, pacifer use.
Secondary infections with Candida Albicans (yeast) or Baceria (Staphylococcus Aureus)
How do you treat Cheilosis
Check B12 level to rule out pernicious anemia, remove underlying cause (unfitted dentures), for yeast infection= topical azole ointment (Clotrimazole, miconazole) BID, for bacterial infection= C&S and treat with topical mupirocin ointment BID, once infection is clear use barrier cream with zinc or petroleum jelly at night.
High rate for recurrence
Hyperopia
“Farsightedness” Distance vision is intact- near vision is blurry
Myopia
“Nearsightedness”. Near vision is intact, distance is blurry
What is a Snellen test used for? How is it administered?
Snellen test is used for testing of central distance vision.
Have the person stand 20 feet away from chart
How do you test vision in an illiterate person?
Use Tumbling E Chart
What does the Snellen test results mean?
Top # = Distance in feet at which the patient stands from chart or picture eye chart (20ft)
Bottom # = number of feet that patient can see compared to a person with normal vision (20/20 or less)
At what age should children reach visual acuity of 20/20? When should you refer a child to an ophthalmologist?
Visual acuity should be reached by 6 years old
If the childs vision is not at least 20/30 in either eye by age 6, refer to ophthalmologist
Weber Test
Place a tuning fork on midline on forehead.
Normal findings: No lateralization
Abnormal findings: Lateralization (hearing sound in only 1 ear)
Rinne Test
Place tuning fork 1st on mastoid process and then in front of the ear. Time each area
Normal finding: Air conduction (AC) last longer than bone conduction (BC)
Conductive hearing loss (outer ear/middle ear)
Any obstruction (or conduction) of the sound waves will cause conductive hearing loss
- Blockage of the outer ear (ceruminosis, otitis externa)
- Fluid inside of the middle ear (otitis media, serous otitis media)
Sensorineural hearing loss (Inner ear)
Damage (aging) of the cochlea/vestibule (Presbycusis, Meneres disease) and/or to the nerve pathways (CN VIII or acoustice nerve) causes sensorineural hearing loss
* Ototoxic drugs (oral aminoglycosides, erythromycin, tetracyclines, high dose aspirin, sildenafil)
*stroke
Sensorineural hearing loss = permanent hearing loss
Weber and rinne tests results are opposite of each other
Sensorineural hearing loss = AC>BC
Conductive Hearing loss = BC>AC
Describe pinguecula
Raised yellow-white small round growth in the bulbar conjunctiva (skin covering eyeball) next to cornea
Located on nasal/temporal side of eye
Caused by: chronic sun exposure
Describe pterygium
Yellow triangular (wedged-shaped) thickening of conjunctiva that extends across the cornea on the nasal side.
Results from chronic sun exposure
Can be inflammed at times
Persons may c/o foreign body sensation in eye
Treatment of Pinguelcula and Pterygium
If inflammed: refer to ophthalmologist for script of weak steroid eye drops to use only during exacerbations
Artifical tears PRN
good quality sunglasses
remove surgically if they affect the cornea and vision
Describe Chalazion
Chronic inflammation of the meibomian gland (special sweat gland) of the eyelids
May resolve in 2-8 weeks
S/S: gradual onset of a small superficial nodule on upper eyelid that feels like a bead (person describes it as painless) Can enlarge overtime and press on cornea and cause blurred vision
TX: I&D, surgical removal, intrachalazion corticosteriod injections by ophthalmologist
What are some autoimmune disorders that cause eye problems?
- Rheumatoid Arthritis
- Lupus
- Ankylosing Spondylitis
Age-Related macular degeneration
Gradual damage to the pigment of the macula (area of central vision) that results in 2 types:
- Atrophic (Dry form)
- Exudative (wet form)
S/S of age-related macular degeneration and treatment
Gradual or sudden painless loss of central vision
Subjective findings: persons reports that straight lines (doors, windows) that appear distored or curved
TX: refer to ophthalmologist
Allergic Rhinitis
Inflammatory change of the nasal mucosa d/t alleries.
Increased risk of sinusitis
May have intermittent, seasonal or daily symptoms
Atopic Family HX (asthma, eczema), Dust mites (daily symptoms), mold/grass (summer), ragweed pollen (fall)
S/S of allergic rhinitis
Subjective findings: person c/o chronic or seasonal nasal congestion with clear mucus rhinorrhea or post nasal drip, nasal itch, frequent sneezing
Objective findings: Blue tinged/pale boggy nasal turbinates, clear mucus, posterior pharynx = thick mucus may be clear, white, yellow or green (need to rule out sinusitis), undereye circles (venodilation)
In children: transverse nasal crease from frequent rubbing (allergic salute), posterior pharynx = cobblestoning
Treatment for allergic rhinitis
- nasal steriod sprays daily (OTC): Fluticasone (Flonase), Trimcinolone (Nasacort allergy)
- if partial relief with OTC: Topical antihistamine nasal spray: Azelastine (Astelin)
- If no relief with OTC: combination product: Azelastine and Fluticasone nasal spray
- Decongestants: Pseudoephedrine/Sudafed (do not give to infants or children)
- Oral antihistamines: second generation antihistamine (OTC): Cetirizine (zertec), Loratadine (Claritin), diphenhydramine (Benadryl)
Eliminate environmental allergens
- Avoid using ceiling fans, no stuffed animals or pets, use HEPA filter for air conditioners, room filters
Describe rhinitis medicamentosa
Prolonged use of topical nasal decongestants (>3 days) causes rebound effects that result in severe and chronic nasal congestion
S/S: severe nasal congestion and nasal discharge (clear, watery mucus)
What are the criteria used to diagnose strep throat?
4 components of the Centor Criteria are: fever, tonsillar exudate, anterior cervical lymphadenopathy, and absence of cough
Describe aphthous stomatitis
“Canker sores”
Painful shallow ulcers on soft tissue of the mouth that usually heal within 7-10 days
TX: Magic Mouthwash (liquid diphenhydramine, viscous lidocaine, glucocorticosteriod): swish, hold and spit Q 4 hrs
Describe Leukoplakia
White to light gray patch that appears on tongue, floor of mouth or inside of cheek
Rule out oral cancer
Aging in the eye
- Cornea: thicker and less curved, decreased sensitivity to touch, formation of a gray ring at the edge of cornea (arcus senilis)
- Anterior Chamber: decrease in size and volume caused by thickening of lens. Occasional exerts pressure on schlemm canal and may lead to IOP and glaucoma
Aging in the eye
- Lens: increase in thickness and opacity (yellowing), loss of elasticity. Decrease in refraction with increase light scattering, decrease color vision (blue/green), delayed dark adaptations, cataracts
- Ciliary mm: reduction in pupil diameter, atrophy of radial dilation mm. Persistent constriction (senile miosis), decrease critical flicker frequency
Aging in the eye
- Retina: reduction in # of rods at periphery, loss of rods and associated nerve cells. Increase in minimum amt of light necessary to see an object.
- Macula: atrophy. Loss of vision
- Vitreous: Liquefaction of vitreous and decrease in gel volume. Risk for retinal detachment.
Glaucoma
IOP > 12-20mmgh with death of retinal ganglion cells and optic nerve axons.
Resistance to aqueous humor outflow
Chronic IOP decreases peripheral vision and then central vision and blindness
Loss of vision from pressure on the optic nerve
Glaucoma Treatment
Early detection and initiation of treatment to prevent optic neuropathy and visual impairment.
Pharmaceutical eyedrops to reduce secretion or increased absorption of aqueous humor
Surgery
Color Blindness
Inherited trait
Generally an X-linked recessive trait
Most common: red/green
What tests checks for color blindness?
Color plate test or Ishihara color test: Look at an image made of colored dots with a color # or shape in the middle. Different color plates can check for differerent types of color blindness
Anomaloscope test
Hue test
