HEENT Flashcards
ACUTE VISION LOSS
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
1. 2. 3. 4. 5. 6. 7.
BLEPHRITIS
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
ANTERIOR AND POSTERIOR
- Common chronic bilateral inflammatory condition of the lid margins.
- Itch, burn, mild pain, FBS, **crusting around the eyes upon awakening
- **frothy tears, erythema of the lids
- None
- Baby soap, warm compress, massage, artificial tears, abx if caused by staph
- ROB
- Conjunctivitis, pediculosis, rosacea
CONJUNCTIVAL HEMMORHAGE
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- Ruptured blood vessels from pressure, HTN, topical steroid therapy, etc.
- Red eye, FBS, usually asx
- Blood in conjunctiva, often unilateral.
- Complete eye. Bleeding studies, CT/MRI
- None or artifical tears
- ROB
- Conjunctivitis, Scleritis, Conjunctival Lacerations, Foreign Body, Open Globe
Conjunctivitis (Viral)
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- Inflammation of the conjunctiva (Adenovirus)
2.Itching, burning, tearing, gritty or FBS; hx of URI or contact with someone with viral conjunctivitis. - Watery discharge, red and edematous eyelids, pinpoint subconjunctival
hemorrhages, punctate keratopathy (epithelial erosion in severe cases),
membrane/pseudomembrane (severe cases). - None
- tears, Antihistamine drops, steroids (consult ophthalmology first)
- ROB
- Acute uveitis, Foreign body, Chlamydial keratoconjunctivitis
OCULAR FOREIGN BODY
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- superficially or partially embedded on the cornea or conjunctiva
- FBS, tearing, hx of trauma
- Conjunctival injection, eyelid edema, mild AC reaction, rust ring and SPK.
- Fluorescein( corneal abrasions), Slit lamp, US or CT.
- visual acuity, anesthetic, antibiotics
- MEDEVAC (I think?)
- Laceration, Penetrating wound
CORNEAL ABRAISION
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
1.
- Severe pain, tearing, photophobia,
- **foreign body (fingernail, contact lens)
- Slit lamp
- Antibiotic, NSAID)
- MEDADVICE
- Conjunctival abrasion, Subconjuctival hemmorrhage, Foreign body
HORDEOLUM
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- Staphylococcus, blepharitis or acne rosacea.
- FBS
- eyelid tenderness, swelling, visible, palpable
- None
- Warm compresses, massage, no makeup
- ROB
- chalazion, Blepharitis, Cellulitis
CHALAZION
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- outflow of these sebaceous secretions is obstructed
- hard, nontender
- Edema, Erythema
- None
- Warm compresses, massage, no makeup
- ROB
- chalazion, Blepharitis, Cellulitis
HYPHEMA
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- Trauma or recent ocular surgery, red blood cells within the anterior chamber, Herpes, zoster
- Pain, photophobia, blurred/clouded vision, trauma hx
- Blood or clot in anterior chamber
- Complete eye exam, CT
- opthalmology NOW, bed rest-head elevated, rigid shield
- MEDEVAC
- Ruptured globe, penetrating ocular injury
UVEITIS/IRITIS
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- inflammation of the uveal tract. Herpes, syphilis, SLE
- Pain, redness, photophobia
- Hypopyon, Keratic precipitates
- Complete ocular examination
- Cycloplegic, Topical steroid
- MEDEVAC
- Keratitis, Conjunctivitis, Hypopyon
ORBITAL CELLULITIS
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- infection that can affect the skin and/or the eyes. Paranasal sinus infection. periorbital/dental infection. Staph, strep.
- Red eye, pain, nasal congestion/discharge, sinus
headache/pressure/congestion, tooth pain - warmth, tenderness, restricted extraocular motility
- HX, Complete eye examine, CT, CBC w/ diff
- IV antibiotics Augmentin
- MEDEVAC
7.
ORBITAL FRACTURE
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
1. 2. 3. 4. 5. 6. 7.
PTERYGIUM
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- degeneration of fibrovascular. sunlight exposure, chronic inflammation and oxidative stress
- Irritation, redness, decreased vision; may be asx
- Wing-shaped fold from the interpalpebral conjunctiva and extending onto the cornea. Usually nasal in location
- Slit lamp
- Protect eyes, tears, Corticosteroids
- ROB (i think)
7.
RETINAL DETACHMENT (Rhegmatogenous retinal detachment) 1. Defintion/Causes 2. SX 3. Physical Exam Findings 4. Labs/Rad 5. Tx 6. Disposition 7. DDX
- Most common. Usually spontaneous. Nearsightedness and cataract extraction- most common predisposing causes.
- Flashes of light, a curtain or shadow over the field of vision, peripheral or central visual loss, or both
- retina is seen hanging in the vitreous like a gray cloud, One or more retinal tears or holes
- Complete eye exam, us, ct
- urgent ocular surgery
- MEDEVAC
- Ocular trauma, Choroidal detachment
BURNS
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- sunlamp without eye protection, welding
- pain, FBS, photophobia, hx, sx worsen 6 to 12 hours after the exposure. Usually bilateral.
- numerous, microdots on the corneal
- Slit lamp
- Oxycodone, Antibiotic, pressure patch
- MEDADVICE (I think?)
- Ocular foreign body, Corneal abrasion
PENETRATING WOUND TO THE EYE
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
1.
2. Pain, decreased vision, loss of fluid from eye
3.
4. DX by penlight, indirect ophthalmoscope, slit lamp, x ray
5. Protect, Systemic antibiotics, within 6 hour
6. MEDEVAC
7. Hyphema, Intraocular foreign body,
HERPATIC LESION TO THE EYE
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- Herpes simplex
- Hx of herpes, photophobia, pain
- Conjunctiva can be injected, Dendritic keratitis,
- None
- antiviral,
- MEDEVAC
- Corneal ulcer, Fungal keratitis, Herpes zoster opthalmicus
LEGEND
FBS
- Foreign Body Sensation
CORENAL ULCER
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
1. Bacteria: Pseudomonas, Strep, Staph Viruses: Herpes, Varicella Fungi: candida Contact use 2. discharge, FBS, photophobia, 3. hypopyon, opacity or infiltrate 4. None 5. antibiotics, NO PATCH, ophthalmologist within 12 to 24 h. 6. MEDEVAC 7. None
HORDEOLUM
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- painful, localized to eyelid margin. photophobia, FBS
- tearing, small, yellowish pustule at base of eyelash, edema
- none
- warm compress, no eye makeup (antibiotics if it doesnt resolve)
- ROB
- Chalzion, blephritis
CHALAZION
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- nontender
- small nodule in eyelid center, edema, swelling
- none
- warm compress, no eye makeup (antibiotics if it doesnt resolve)
- ROB
- hordeolum, blephritis
HYPHEMA
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- collection of blood in anterior chamber, usually from trauma or ocular surgery
- pain, photophobia, burred vision, hx of trauma
- blood in anterior chamber
- complete eye exam, consider CT scan of the orbits and bran
- bed rest with elevation of head, limited activity, rigid shield over eye, only tylenol
- ROB
- ruptured globe, penetrating eye injury
UVEITIS/IRITIS
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- pain, photophobia, vision loss
- redness, KP, vitreous opacity, hypopyon, inflammed
- complete eye exam, labs for sarcoidosis, syphillis, TB
- medication only to be given under supervision of an ophthalmologist
- MEDEVAC
- retinal detachment
ORBITAL CELLULITIS
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- pain, blurred vision, headache, pressure, congestion, tooth pain, eyelid is tender
- pain, blurred vision, headache, pressure, congestion, tooth pain, eyelid is tender
- red eye, periorbital swelling, nasal discharge, eyelid edema/erythema, conjunctival injection, proptosis and restricted extraocular motility
- CT scan, CBC with diff, blood cultures/stains
- augmentin+ceftriaxone, nasalspray
- MEDEVAC
- sinusitis
ORBITAL FRACTURE
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- 7.
PTERYGIUM
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- sunlight exposure, chronis inflammation and oxidative stress
- painless
- wing shaped fold from the nose to cornea
- slit lamp to examine lesion
- eye protections, artificial tears
- ROB
*surgery is required if pterygium threatens the visual axis
CORNEAL ABRASION
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- severe pain, photophobia
- tearing
- slit lamp to identify dimensions of abrasion
- contact wearers- ciprofloxin, ketorolac, and NSAIDS
non contact wearers- erythromycin? - MEDADVICE?
- ulcer, foreign body
RETINAL DETACHMENT
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- 7.
FLASH BURN
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- sunlight without protection, welding arc, snow blindness
- numerous, microdots on corneal surface after staining
- slit lamp examination
- ROB?
- corneal abrasion, foreign body
PENETRATING WOUND TO THE EYE
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- 7.
HERPATIC LESION OF THE EYE
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- 7.
AURICULAR HEMATOMA
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- Edematous, fluctuant, and ecchymotic pinna with loss of normal cartilaginous landmarks
- Semicircular incision through the skin to drain, Irrigations, Wound dressing, Neomycinbacitracin-polymyxin B (Neosporin)
- •Cellulitis of the auricle
•Auricular Laceration
BAROTRAUMA
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- Damage to the tympanic membrane caused by rapid changes in pressure; most common etiology is flying
- Severe inner pain, conductive hearing loss, possible vertigo,
- Possible TM perforation, TM may be bulging, Fluid in the ear canal
- Pseudoephedrine, Antihistamines
- Vertigo, Eustachian Tube Dysfunction
CERUMEN IMPACTION
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- Decrease in hearing, and/or sensation of pressure or fullness
- cerumen impaction, TM may or may not be visible
- Cerumen loops/scoops, Ear irrigation using body temperature water, Carbamide Peroxide (Debrox) 2-5 drops
- Foreign body, Otitis Media
CHOLESTEATOMA
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- prolonged eustachian tube dysfunction
- epitympanic retraction pocket or a marginal tympanic membrane perforation that exudes keratin debris, or granulation tissue
- •CT to visualize the bony destruction
- Surgical marsupialization , if drainage give antibiotics
- MEDEVAC
- Otitis Media, cerumen impaction
FOREIGN BODY OF THE EAR
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- Muffled sounds, severe pain, and hearing disturbances/changes
- Cerumen loops/scoops, Right angle hook, alligator forceps, Live objects should be drowned with Lidocaine 2%
- 7.
EUSTACHIAN TUBE DYSFUNCTION
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- Severe ear pain, Fullnes or “underwater sensation”, hearing loss or “muffled hearing,” Tinnitus, “Popping or snapping noises”
- audiometric testing baseline
- Pseudoephedrine 60mg,
Oxymetazoline 1-2 sprays,
Fluticasone propionate (Flonase) 1-2 sprays
Cetirizine (Zyrtec) 5-10mg,
Fexofenadine (Allegra) 60mg - TM Perforation, cholesteatoma
NOISE INDUCED HEARING LOSS
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- Sudden hearing loss 3 days or less into sensory and conducting. ear fullness, dizziness or vertigo, tinnitus
- Audiogram testing confirms significant hearing loss, Weber conductive hearing loss and Rinne tests sensory hearing loss
- Remove member from further exposure, patient education, refer to specialist for further eval
- cerumen impaction, eustachian tube dysfunction
7.
MASTOIDITIS
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- complication ofrom acute otitis media
- post auricular pain, erythema,
- fever, edema, protrusion of the auricle, no post auricle crease
- mastoid radiography, CT, culture of drainage
- antibiotics, I&D may be indicated
- MEDEVAC
- Otitis Media, Cellulitis?
OTITIS EXTERNA
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- History of water exposure (swimmers ear) or mechanical trauma (scratching, Qtips), Painful
- erythema, edema,
purulent exudate - Gram staining of discharge
- Ciprofloxacin Otic (Cetraxal)
- ROB
- Otitis Media, eustachian tube
OTITIS MEDIA
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- Otalgia, aural pressure, decreased hearing, history of URI
- fever, erythema, hypo mobility of tympanic membrane, TM bulging, mastoid tenderness
- Tympanocentesis for bacterial, fungal culture
- Amoxicillin/Clavulanate
(Augmentin) 875mg PO BID - ROB
- Otitis Externa, TM Perforation
TINNITUS
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- hearing changes, headache, noise intolerance, vertigo,
TMJ dysfunction, “ringing noise” - Conductive hearing loss
- CBC, TSH, HIV, RPR/autoimmune panel, MRI with or without contrast, CT scan for pulsatile tinnitus
- Referral to Audiologist for comprehensive hearing evaluation, PT education on benign nature of tinnitus and importance of PPE
- ROB
7.
TM PERFORATION
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- Can occur secondary to middle ear
infections, or as a result of
barotrauma, blunt/penetrating/acoustic trauma, or lightning strikes - Acute onset of pain, hearing loss; associated vertigo or tinnitus, nausea and vomiting, and history of recurrent ear infections
- Visible perforation of the tympanic membrane; otorrhea (pus, blood, or clear fluid from canal)
- audiogram as soon after the injury as possible
- Amoxicillin/Clavunalate (Augmentin)
875mg OR Doxycycline 100mg
Educate PT to NOT ALLOW WATER TO ENTER EAR CANAL - 7.Barotrauma, Otitis Media
EPITAXIS
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- Acute , unilateral bleeding
- Coagulation Tests - PT, PTT, TT
- Nasal foreign body, Nasal Fracture
NASAL POLYPS
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- allergic rhinitis
- usually appear smooth and rounded, moist and translucent, variable size, color ranging from nearly none too deep erythema
- CT of the nose and paranasal sinuses
- Fluticasone Nasal (Flonase), Prednisone, massive polyps are removed surgically
- ROB
- Allergic rhinitis
NASAL FRACTURE
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- 7.
ALLERGIC RHINNITIS/URI
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- nose: Clear rhinorrhea, nasal pruritus, and sneezing, pale or violaceous turbinates, nasal polyps (chronic allergic rhinitis)
Eye: Irritation, pruritus, conjunctival erythema, excessive tearing
Ass. Sxs.:Cough, bronchospasm, wheezing, eczematous dermatitis - Topical Intranasal Steroids for 1-3 months, , Antihistamines, Intranasal Anticholinergic Agent - Ipratropium Bromide (Atrovent)
- ROB
7.Sinusitis, Nasal polyps
SINUSITIS
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- Facial pain or pressure over the affected sinus or sinuses
- Purulent yellow-green nasal discharge or expectoration, Associated cough, malaise, fever and headache
- When difficult to evaluate, Xray’s,
CT scans, MRI, cultures - NSAIDS , Pseudoephedrine (Sudafed) 3060mg, (antibiotics used for only for SSx for >10 days) Amoxicillin/Clavunalate (Augmentin), If PCN allergy, Doxycycline 100mg
- ROB
- allergic URI, Periorbital Cellulitis
EPIGLOTTITIS
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- sore throat or odynophagia is out of proportion
- Muffled voice, High Fever, Inspitory stridor
- Xrays-“thumb sign” Laryngoscopy may demonstrate swollen, erythematous epiglottis
- IV Antibiotics - Ceftriaxime 2grams IV q8-12hrs, Corticosteroid - Dexamethasone
(Decadron) 4-10mg IV bolus - MEDEVAC
- Laryngeal Foreign Body, Tonsillitis
LEUKOPLAKIA
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- 7.
PERITONSILLAR ABSCESS
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- 7.
PHARYNGITIS TONSILITIS
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- 7.
SIALADENITIS
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- 7.
TONSILITIS
- Defintion/Causes
- SX
- Physical Exam Findings
- Labs/Rad
- Tx
- Disposition
- DDX
- 7.