HEENT Flashcards
With sensorineural hearing loss, the Rinne test findings would be?
Normal: AC>BC
With conductive hearing loss, Rinne test findings would be?
BC>AC
Pt complains of acute onset severe eye pain, photophobia and blurred vision in one eye. The Fluorescein exam shows fern like lines in the corneal surface. What disorder do you suspect?
Herpes Keratitis
Round corneal abrasions noted in the center are common with this type of keratitis?
Contact Lens-related
Treatment for Keratits/corneal abrasion that is not Herpetic would include coverage for what organism? And which abx are recommended?
Pseudomonas: cirpofloxacin, ofloxacin, or Polytrim (trimethoprim-polymixinB)
What is the treatment for Hordeolum?
Warm compresses 5x a day for 10 min.
Systemic Abx if infection has spread into preseptal cellulitis
This eye condition is caused by excessive UV exposure resulting in thickening of conjunctiva extending across the cornea generally on nasal or temporal side of the eye?
Pterygium
Primary open-angle glaucoma presents with pressures above -___?
22
Primary open-angle glaucoma typically develops slowly and is often insidious in the early stages? T or F
True
Common treatment of primary open-angle glaucoma are?
Timolol 0.5% (beta-blocker)
Latanoprost (Xalatan): topical prostaglandin ey
Patient presenting with sudden onset severe unilateral eye pain, blurred or loss of vision, halos around lights, frontal headache w/ N/A is suspected to have what disorder?
Primary Angle-Closure Glaucoma, a medical emergency
The limbus is what?
The area between the cornea and sclera
Persons with autoimmune disorders such as RA, lupus, ankylosis spondylitis, and sarcoidosis are at risk for what eye disorder?
Anterior uveitis (Iritis)
What helps to differentiate bacterial conjunctivitis from anterior uveitis (iritis)?
Lack of purulent drainage with anterior uveitis
What area of the eye is responsible for central vision?
Macula
Gradual (or sudden) painless loss of central vision in one or both eyes of a smoker is concerning for?
Macular degeneration
The pt complaint of dry, gritty eyes who is using OTC tear solutions more that 3 times a day who is found to have dry mouth and poor dentition is suspected to have?
Sjorgren’s syndrome
Patient has complaint of red, dry and itchy eyes with crusting and flaking at lash border is diagnosed with blepharitis. What is the treatment?
Mild diluted soap scrub (Johnson’s baby shampoo), warm compresses 2-4 times a day. Erythromycin solution 2-3 times a day may be indicated.
Entropion is the ____ turning of the Lowe eyelid?
Inward
Ectropion is the ____ of the lower eye lid?
Outward and downward retraction
Atope is _____?
History of allergic reactions
Pt exam reveals pale and boggy nasal turbinates, posterior pharynx with thick yellow to clear mucus, and dark under eye circles. What are these findings suggestive of?
Allergic rhinitis
What is the recommended treatment for allergic rhinitis?
First line: elimination of allergen, nasal steroids (flucitasone). Adding nasal antihistamines (azelastine), oral decongestants (in adults) and 2nd generation antihistamines if failure to improve.
Prolonged use of what common nasal sprays causes rhinitis medicamentosa?
Afrin
Prolonged use of nasal decongestant sprays can cause what condition?
Rhinitis medicamentosa
What are the risks of untreated GABHS?
Scarlet fever (strawberry tongue and sloughing of the skin
Acute rheumatic fever (heart valve and joint involvement)
PTA
Post-streptococcal glomerulonephritis (abrupt onset proteinurea w/ HTN & edema)
What are the most common pathogens in OM?
Strep pneumoniae
H. Influenzae
Morexella
Bullous myringitis presents with and how is it treated
Conductive hearing loss and sx similar to OM but more painful. Bullae (blisters) on TM.
Treatment: amoxicillin 500mg tie x 5-7 (up to 10) days but may move to augment or omnicef if unresponsive.
Otitis Media w/ Effusion (serous otitis media) appears as?
Bulging or retracted TM w/o erythema. Fluid generally appears amber. Is common after bout of AOM.
What is the treatment for OM w/ effusion?
Oral decongestants & steroid nasal spray
What are the most common organisms in swimmer’s ear (OE)?
Pseudomonas (gram-)
S. Aureus (gram +)
What is the treatment for OE?
Cortisporin (Polymyxin B-neomycin-hydrocortisone) ear 4 gtts 4x a day for 7d
OR
Cipro HC optic bid x7 days
Teenager who presents w/ sore throat, fever, and fatigue found to have posterior cervical lymphadenopathy and exudative tonsils with history of close and intimate contact (kissing) is suspected to have what condition?
Infectious mononucleosis
What is a major and frequent complication of mono?
Hepatosplenomegaly
Dil-Hallpike and Epley maneuvers are helpful in diagnosing which condition?
Benign Postural Vertigo (BPV)
Acoustic Neuroma presents as?
Chronic hearing loss and tinnitus caused CN VIII pressure by tumor Schwann tumor affecting the vestibular portion. Sx are slow and insidious. If trigeminal nerve is affected, facial numbness and pain can occur.
How does Ménière’s disease present?
Triad of recurrent vertigo, tinnitus and unilateral hearing loss. May or may not experience N/V.
What is the treatment for BPV?
Meclizine q4-8 hrs
What is the treatment for Ménière’s disease
Referral to ENT
Salt restriction
Vestibular suppression meds, antiemetics
New onset of dizziness, what differentials should be considered?
BPV Cerebellar Infarct Stroke Hypoglycemia Near syncope Arrhythmias
How does BPV usually present?
Sudden onset dizziness, c/o room spinning w/ positional changes and N/V. Nystagmus is typically found.
These spots are often found w/ measles?
Koplick spots (oral white spots w/ blue center)
Timolol (betimol) has what type of contraindications?
Same as oral beta-blockers
A white-yellowish cauliflower-like mass location superior to the TM is what condition?
Cholesteatoma
Patients with cholesteotoma often present with what symptoms?
Hearing loss and foul smelling discharge from the ear
In the Rinne-Webber test, what is a normal result?
Weber: no lateralization
Rinne; AC>BC
In conductive hearing loss, what is found in the Rinne-Webber test?
BC>AC
What are some causes of conductive hearing loss?
Cerumen impaction, AOM, and cholesteotoma
With the conductive hearing loss, the Weber testing hearing is lateralized to which side first?
The affected side
Weber-Rinne tests which CN?
CN VIII (acoustic)
When conducting a Weber test, is sound is heard on one side before another, is that a normal finding?
No, that is lateralization which is abnormal. Should be heard equally
What are a few types of sensorineural hearing loss?
Presbycusis and Ménière’s disease
With sensorineural hearing loss, what is the expected finding in a RInne test?
AC>BC
What test would be done to look for corneal abrasion or keratitis?
Fluoroscein test
Clouding of the cornea and absence of red light reflex is suggestive of what disorder?
Cataract
Patients with cataracts often complain of what issues?
Difficulty with night vision, halos around lights and blurred vision.
What is the palpebral conjunctiva?
The mucosal lining of the eyelids
What is the mucosal lining covering the eyeball?
Bulbar conjunctiva
To be farsighted is?
Hyperopia (blurred near vision) with good distance vision
To be nearsighted is?
Myopia- near is intact but distance is blurred
Copper and silver wire arterioles, AV nicking and flame hemorrhages is often found with what underlying condition?
Hypertensive retinopathy
Microaneurysms, cotton wool spots and flame hemorrhages is found in which condition?
Diabetic retinopathy
Papilledema appears as what and is caused by?
Swollen optic disk w/ blurred edges. Due to increased ICP.
A deeply cupped disk is suspicious for which condition?
Acute angle closure glaucoma
Non-tender, enlarged (>1cm) and fixed nodes are suspicious for what condition?
Cancer (malignancy)
The parotid duct is responsible for what and located where?
Major salivatory gland located dismally in the cheek superior the ear
Sialandenitis is what?
Swelling to one side of the face (mumps, parotid gland)
Painful lump under tongue is likely?
Sialolithiasis: a calculi or stone in a salivary duct/gland.
What is the normal cup to disk ratio?
> 0.5
Mildly dull painful red eye accompanied by vision changes, constricted, none reactive and irregularly shaped pupils is what condition?
Uveitis
What is the treatment for Uveitis?
Pupil dilation, corticosteroids, addressing underlying autoimmune cause
A benign and painless bony protuberance on the hard palate is?
Torus palatines
This condition is caused by UV exposure producing yellow triangle wedge-shaped thickening of the conjunctive that extends across the cornea to the nasal side.
Pterygium
What is the treatment for Pterygium and pinguecula?
Artificial tears, strong UV protection and referral to optho for possible steroid eye drops
Pinguecula appears as?
Smaller raised white/yellow growth on bulbar conjunctiva next to cornea
How is corneal abrasion treated?
Topical abx: polytrim (trimethoprim-polymixinB), Ciprofloxacin for 3-5 days
How does a detached retina present?
Sudden onset of unilateral floaters and reduction in vision w/ sense of looking through a curtain, or complete loss of vision. Sudden flashes of light (photopsia) is common. May have photophobia
Gradual change in peripheral vision leading to tunnel vision with disc cupping and IOP of >20 are associated with?
Open-Angle Glaucoma
What medications are typically used to treat glaucoma?
Timolol (beta-blocker)
Latanoprost- topical prostaglandin
When would Timolol be contraindicated?
Persons with asthma, COPD, and heart failure
This type of macular degeneration is most common?
Wet (80%)
