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IDC Stuff > HEENT > Flashcards

HEENT Flashcards

1
Q

A sensation is defined as what?

A

Conscious or subconscious awareness of changes in the external or internal enviroment.

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2
Q

What are the 5 special senses?

A 
smell
taste
vision
hearing
equilibrium
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3
Q

What do somatic senses include?

A

tactile
thermal
pain
proprioceptive

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4
Q

What do visceral senses provide senses for?

A

Internal organs

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5
Q

What are the four conditions that must be satisfied for sensation to occur?

A

Stimulus
Sensory receptor must convert stimulus to an electrical signal
A nerve pathway conducts information to the brain
A region of the brain translates or integrates the nerve impulse into a sensation

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6
Q

What is primarily a function of the cerebral cortex IRT to sensations?

A

Perception of conscious awareness and interpretation of sensations

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7
Q

What are the functional classifications of receptors?

A 
Mechanoreceptor
Thermoreceptor
Nociceptors
Photoreceptors
Chemoreceptors
Osmoreceptors
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8
Q

What type of receptor detects mechanical deformation of adjacent cells?

A

Mechanoreceptors

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9
Q

What type of receptor detects changes in temperature?

A

Thermoreceptor

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10
Q

What type of receptor detects pain?

A

Nocicereceptor

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11
Q

What type of receptor detects light?

A

Photoreceptor

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12
Q

What type of receptor dects the presence of chemicals in solution?

A

Chemoreceptor

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13
Q

What type of receptor detects the osmotic pressure in fluids?

A

Osmoreceptors

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14
Q

Somatic (body) sensations arise from stimulation of what?

A

Sensory receptors in the skin, mucous membrane, muscles, tendons and joints.

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15
Q

Tactile receptors for somatic sense are for what?

A

Touch, pressure, vibration, itch and tickle

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16
Q

Thermal receptors in the somatic senses are for what?

A

Warm and cold

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17
Q

Pain receptors are located in the entire body except where?

A

Brain

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18
Q

Encapsulated tacticle sensations?

A

touch pressure and vibration

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19
Q

Free tactile sensations?

A

Tickle and itch

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20
Q

Where are cold and hot receptors located in the skin?

A

Cold-Epidermis

Hot-Dermis

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21
Q

What temperatures activate cold receptors?

A

10-40 Celsius (50-105 F)

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22
Q

What temperatures activate warm receptors?

A

32-48 Celsius (90-118F)

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23
Q

What temperatures stimulate nociceptors and elicit pain?

A 
Below 10C (50F) 
Above 48C (118F)
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24
Q

Proprioceptors are located where?

A

Muscle spindles in muscles
Tendon organs in tendons
Joints in and around synovial
Hair cells in middle ear

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25
Q

Olfactory epithelium is found in the inferior space of what structure?

A

cribriform plate

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26
Q

What are the three types of cells in the olfactory epithelium?

A

receptor
supporting
basal

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27
Q

The olfactory tract will project to the cerebral cortex also know as the?

A

frontal and temporal lobe

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28
Q

Axons form CN I and extend through the cribriform plate via what?

A

holes

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29
Q

What are the five primary tastes of gustation aka the sense of taste?

A 
Sweet
Salty
Bitter 
Sour
Umami
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30
Q

What are raised bumps on the tongue, where the majority of gustation receptor cells are located, called?

A

Taste buds or fungiform papillae

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31
Q

Taste buds convey impulses to what cranial nerves?

A

VII (ant 2/3)
IX (post 1/3)
X (epiglottis)

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32
Q

The lacrimal glands drain from the surface of the eye through what structure before reaching the nasolacrimal duct?

A

Lacrimal canaliculi

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33
Q

What are the six extrinsic muscles that work to move the eyeball?

A 
Superior Rectus
Inferior Rectus
Medial Rectus
Lateral Rectus
Superior Oblique
Inferior Oblique
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34
Q

What are the external layers of the eyeball?

A

Fibrous tunic
Vascular tunic (middle)
Retina (inner)

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35
Q

What does the fibrous tunic contain?

A

Posterior sclera

Anterior cornea

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36
Q

What does the vascular tunic or middle layer contain?

A

Choroid
Ciliary body
Iris
Uvea

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37
Q

The retina or inner layer has what layers?

A

Neural
Pigmented
Inner and outer synaptic

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38
Q

What are the photoreceptors in the eyes called?

A

Rods and cones

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39
Q

Rods allow us to see what?

A

Shades of gray in dim light

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40
Q

Cones are instrumental for what?

A

Color vision

Visual acuity

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41
Q

What are the interior cavities of the eye that are separated by the lens?

A

Anterior cavity

Vitreous chamber

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42
Q

The anterior cavity contains what type of fluid?

A

Aqueous humor

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43
Q

The vitreous chamber, the larger cavity, contains what type of fluid?

A

Vitreous body (clear, jelly-like fluid)

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44
Q

The pressure in the eye, intra ocular pressure (IOP) is produced by mainly what fluid?

A

Aqueous humor

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45
Q

What maintains the shape of the eyeball?

A

IOP

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46
Q

Accommodation is the ability of the lens to instantly change curvature for what?

A

Near and far vision

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47
Q

Vitamin A deficiency decreases rhodopsin that leads to what condition?

A

night blindness

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48
Q

Sight is perceived in what area of the brain?

A

Occipital lobe

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49
Q

What is another term for the ear?

A

Auricle

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50
Q

What is secreted in the external auditory canal?

A

Cerumen

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51
Q

What are the three bones in the auditory ossicles?

A

Malleus (makes contact with TM)
Incus
Stapes

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52
Q

The middle ear is connected to the upper part of the throat via what?

A

Eustachian tube

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53
Q

What fluid surrounds the membranous labyrinth, inside the bony labyrinth, of the middle ear?

A

perilymph

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54
Q

What is the fluid that is inside of the membranous sacs of the membranous labyrinth?

A

endolymph

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55
Q

Where do vestibulo impulses of CN VIII travel to via cochlear branch?

A

midbrain and thalamus

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56
Q

Where do the cochlear impulses of CN VIII travel to via the cochlear branch?

A

Temporal lobe

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57
Q

Auditory axons crossing enables what for hearing?

A

Impulses are received from both ears regardless of side of noise.

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58
Q

What are the two kinds of equilibrium?

A

Static

Dynamic

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59
Q

Static equilibrium refers to

A

linear acceleration/deceleration

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60
Q

Dynamic equilibrium refers to

A

rotational acceleration/deceleration

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61
Q

What are the receptor organs for equilibrium in the internal ear?

A

Saccule
Utricle
Semicircular ducts

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62
Q

Linkage between what structures in the brain play a role in maintaining equilibrium?

A

Medulla cerebellum

Cerebrum

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63
Q

What are the salivary glands?

A

Parotid
Submandibular
Sublingual

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64
Q

What landmarks comprise the anterior triangle of the neck?

A

Sternocleidomastoid muscles
mandible
the midline

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65
Q

What structures make up the posterior triangle of the neck?

A

Trapezius
Sternocleidomastoid muscles
clavicle

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66
Q

What are the Lymph nodes of the head and neck?

A 
Post/preauricular
Parotid
Tonsillar
Submandibular
Submental
Anterior deep/superficial chain
Posterior deep/superficial chain
supraclavicular chain
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67
Q

What is the structure that consists of two lateral lobes and resembles a butterfly on the neck?

A

Thyroid (right side 25% larger)

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68
Q

What are characteristic facies?

A

expression or appearance that is characteristic of a clinical condition or syndrome

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69
Q

Temporomandibular joint space symptoms may cause what?

A

Tinnitus

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70
Q

What is another name for the parotid duct?

A

Stensen duct

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71
Q

What is another name for the submandibular duct?

A

Wharton duct

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72
Q

Bruits over the eye may suggest what?

A

Cerebral aneurysm

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73
Q

Bruits over the temporal artery are associated with what

A

temporal arteritis

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74
Q

Grittiness of the thyroid on palpation may indicate?

A

Thyroiditis

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75
Q

Cushing syndrome is characterized by what facies?

A

rounded, moon-shaped face

thin erythematous skin

76
Q

Hyperthyroidism facies are

A

prominent eyes
lid retraction
staring/startled expression

77
Q

Lupus or SLE facies are?

A

butterfly rash
blush with swelling
scaly, red maculopapular lesions

78
Q

Thyroglossal duct cyst is identified by?

A

freely moving cystic mass
high in neck
midline

79
Q

Torticollis, generally from birth trauma, tumors, trauma, infection or drug ingestion is also known as?

A

Wry neck

80
Q

What are some Thyroid diseases?

A

Hypo/hyperthyroidism
Myxedema
Graves’ disease
Hashimoto disease

81
Q

What are the two layers of the conjunctiva?

A

Palpebral

Bulbar

82
Q

What eye muscles does CN III control

A

Sup/Infer/medial rectus

inferior oblique

83
Q

What eye muscles does CN IV control

A

Superior oblique

84
Q

What muscles does CN VI control?

A

Lateral rectus

85
Q

The uvea is composed of what structures?

A

iris
ciliary body
choroids

86
Q

Periorbital edema is always abnormal and may represent what conditions?

A

Thyroid eye disease
Allergies
Renal Disease
Xanthelasma (lipids)

87
Q

Cover-uncover test identifies what condition?

A

Strabismic eye

88
Q

The macula or fovea is located where in relation of the optic disc?

A

2 disk diameters laterally or temporally from the optic disc

89
Q

Anterior blepharitis involves what stuructures?

A

lid skin, eyelash and associated gland

90
Q

Posterior blepharitis results from what

A

inflammation of meibomian glands

91
Q

Dx?

A

Blepharitis

92
Q

Sxs of blepharitis?

A

redrimmed
granulations clinging to lashes
tears may be frothy or abnormally greasy

93
Q

Tx of blepharitis?

A 
Baby shampoo
warm compress 
massage
artificial tears
Bacitracin ointment
94
Q

What glands are associated with hordeolum and chalazion?

A

Gland of Zeis

Meibomian

95
Q

DX?

A

Hordeolum

96
Q

DX?

A

Chalazion

97
Q

Tx of hordeolum or chalazion?

A 
Warm compress 15 min x4/day
massage
discontinue makeup
Do not squeeze
Bactrim BID 5-7 days
98
Q

Definitive care if unresolved hordeolum or chalazion?

A

Referral to ophthalmology for I&D

99
Q

What are the types of conjunctivitis?

A

Viral
Allergic
Bacterial (non-gonococcal)
Bacterial (gonococcal)

100
Q

What is the most common cause of viral conjuctivitis?

A

Adenovirus

101
Q

What type of conjunctivitis would typically present with bilateral clear discharge?

A

Allergic

102
Q

Nongonococcal Bacterial Conjunctivitis is caused by what typically?

A 
Staphylococcus aureus
Staphylococcus epidermidis
Hemophilus influenzae
Streptococcus pneumonia
Moraxella catarrhalis
103
Q

Gonococcal Bacterial conjunctivitis is typically acquired through?

A

infected genital secretions

104
Q

DX

A

Viral conjunctivitis

105
Q

DX?

A

Bacterial Conjunctivitis

106
Q

What are distinguishing symptoms for nongonococcal and gonococcal bacterial conjunctivitis?

A

preauricular adenopathy and hyperacute onset with gonococcal

107
Q

Symptoms of conjunctival hemorrage?

A

Red eye, foreign body sensation, usually asymptomatic unless there is associated chemosis

Blood underneath the conjunctiva, often in one sector of the eye and the entire view of the sclera may be covered by blood

108
Q

Tx of conjunctival hemorrhage?

A

None required (clears within 2 to 3 weeks)

Artificial Tears for irritation

109
Q

Tx of conjunctival hemorrhage?

A

None required (clears within 2 to 3 weeks)

Artificial Tears for irritation

110
Q

Symptoms of pterygium

A

Caused by sunlight exposure, chronic inflammation and oxidative stress

Wing shaped fold of fibrovascular tissue arising from the interpalpebral conjunctiva and extending onto the cornea, usually nasal in location

111
Q

Tx of pterygium

A

Protect eyes from sun, dust, and wind (UV blocking sunglasses or goggles)

Artificial Tears

Surgical removal if vision is affected

112
Q

Ocular foreign body sxs

A

Foreign body sensation, tearing, history of trauma; with or without a rust ring

113
Q

ocular foreign body tx

A

Topical Anesthetic - Proparcaine (Alcaine) 0.5%

Remove foreign body with saline irrigation

Non contact lens wearers
Erythromycin

Contact lens wearers
Ciprofloxacin

114
Q

Sxs of corneal abrasion

A

Severe pain, tearing, and photophobia

History of trauma to the eye, commonly involving a foreign object (fingernail, piece of paper, or contact lens)

115
Q

Tx of corneal abrasion

A

Non contact lens wearers
Erythromycin

Contact lens wearers
Ciprofloxacin

Acetaminophen 325-1000mg NSAIDS

116
Q

Sxs of corneal ulcer

A

Cornea reveals a round or irregular ulcer opacity or infiltrate

Severe ocular pain, photophobia, or blurred vision

Risk factor contact lens wearers

117
Q

Tx of corneal ulcer

A

Ciprofloxacin

Refer to an opthalmologist to be seen within 12 to 24 hours

DO NOT patch the eye due to risk of Pseudomonas infection

118
Q

Sxs of Hyphema

A

Trauma or recent ocular surgery
are the most common risk factors

Blood or clot or both in the anterior chamber that may be black or red

Pain, sensitivity to light, blurred, clouded or blocked vision, history of blunt trauma

119
Q

Tx of Hyphema

A

IMMEDIATE Optometry consult Bed rest with elevation of the head
Place a rigid shield over the involved eye

Avoid antiplatelet/anticoagulant medications (Aspirin/NSAIDS)

Mild Analgesics only! -
Acetaminophen

120
Q

Uveitis or iritis sxs?

A

Pain, redness, photophobia, visual loss,

hypopyon (WBC pool) and fibrin within the anterior chamber

121
Q

Tx of uveitis or iritis?

A

Only to be initiated by the opthalmologist Clycloplegic

Topical Steroid

122
Q

orbital cellulitis sxs?

A

Risk factors:
Paranasal sinus infection, dental infection, orbital trauma

eyelid edema, erythema, warmth, tenderness, periorbital swelling, tooth pain

restricted extraocular motility with pain with eye movement

123
Q

Orbital cellulitis Tx

A

Augmentin 875mg PO Ceftriaxone (Rocephin) 2g IM

Surgery may be required to drain the paranasal sinuses or orbital abscess

124
Q

Orbital fracture sxs?

A

Pain on attempted eye movement and local tenderness, eyelid edema, crepitus (particularly after nose blowing)

Step off deformity along frontal sinus

Restricted eye movement especially in upward or lateral gaze or both, subcutaneous or conjunctival emphysema, point tenderness,

125
Q

Tx of orbital fracture

A

Prophylactic oral antibiotics Augmentin 500/125mg TID,

PCN Allergy Doxycycline 100mg PO

Nasal Decongestants Oxymetazoline (Afrin) BID for 3 days
(Instruct PT to NOT BLOW THEIR NOSE)

Immediate surgical repair if suspected muscle entrapment

126
Q

What is another term for corneal ulcer?

A

infectious keratitis

127
Q

What is the biggest risk factor of corneal ulcers?

A

improper contact lens use

128
Q

What is a common bacteria to cause corneal ulcerations?

A

Pseudomonas aeruginosa

129
Q

Hypopyon may come from what disorders?

A

infection

autoimmune

130
Q

The middle layer of the eye is the vascular tunic or the?

A

uvea

131
Q

Acute iritis or uveitis is typically from?

A

infection

132
Q

Chronic iritis or uveitis is from?

A

autoimmune disorders

133
Q

examples of autoimmune disorders that could cause iritis or uveitis are?

A

spondylarthritis
sarcoidosis
SLE (Lupus)
multiple sclerosis

134
Q

nongranulomatus uveitis would indicate what onset?

A

acute

135
Q

What may be seen on the corneal endothelium in uveitis?

A

keratic precipitates

136
Q

Orbital cellulitis usually comes from

A

paranasal sinuses

dental infection

137
Q

what are the three types of orbital fractures?

A

orbital rim
blowout
orbital floor

138
Q

tx of orbital fracture?

A

Prophylactic oral antibiotics Augmentin 500/125mg TID,

PCN Allergy Doxycycline 100mg PO

Nasal Decongestants Oxymetazoline (Afrin) BID for 3 days
(Instruct PT to NOT BLOW THEIR NOSE)

Immediate surgical repair if suspected muscle entrapment

139
Q

Transient visual loss can be caused by?

A

change in BP
TIA
Migraine

140
Q

What can methanol poisoning or toxins cause in the eyes?

A

Long lasting sudden vision loss

141
Q

Sxs of retinal detachment?

A

Flashes of light, floaters, a curtain or shadow moving over the field of vision, peripheral or central visual loss, or both

Risk factors
50 y/o Nearsightedness Cataracts

142
Q

Sxs of flash burn

A

Caused by use of a sunlamp without eye protection, exposure to a welding arc, or snow blindness

Numerous, microdots on the corneal surface after staining

143
Q

Tx of flash burn

A

Pain management
Consider opioids

Antibiotics
Erythromycin

Pressure patch for the more affected eye

144
Q

Sxs of chemical burn to eyes

A

Risk factor
Job exposure Improper PPE use

Excessive tearing, severe eye pain, photophobia, inability to open eyelids

145
Q

Tx of chemical burn to eyes

A

Immediate irrigation with normal saline for 30 minutes

Erythromycin 0.5% every 1-2 hrs

146
Q

Penetrating wound to eye sxs

A

Pain, decreased vision, loss of fluid from eye, Hx of trauma, fall, or sharp object entering globe

Low intraocular pressure

147
Q

Tx of penetrating eye wound

A

Protect the eye with a shield at all times
Elevate the head of the bed to 45 degrees

Cefazolin (Ancef, Kefzol) 1 gm IV

Tetanus shot is last dose over 5 years

Ondansetron (Zofran) 4mg PO/IV

MEDEVAC Surgical repair ASAP

148
Q

Herpetic Lesion of eye sxs

A

Photophobia, pain, eye redness, and decreased vision

History of oral or genital herpes infection

Dendritic keratitis branching

Eyelid may have typical herpetic vesicular eruptions

Palpable preauricular node

149
Q

tx of herpetic lesion

A

Topical antiviral

Valacyclovir (Valtrex) 500mg PO or Acyclovir 400mg PO

150
Q

Tx of foreign body of ear

A

Cerumen loops/scoops, alligator forceps

Live objects should be drowned with Lidocaine 2%

Irrigation should not be done unless the TM is completely visualized

Topical antibiotics

151
Q

Tx of cerumen impaction

A

Ear irrigation using body temperature water

Carbamide Peroxide (Debrox) 2-5 drops max of 4 days

152
Q

Tx of mastoiditis

A

Cefazolin 0.5-1.5g IV TID

Surgery: Tympanocentesis and myringotomy
I&D of periosteal abscess Mastoidectomy may be indicated

153
Q

tx of otitis externa

A

Drying Agent - 50/50 Alcohol/White Vinegar

Ciprofloxacin Otic (Cetraxal)

Removal of purulent debris filling the ear canal

Apply ear wick if there is substantial edema

Severe cases
Ciprofloxacin 500mg PO

154
Q

Tx of otitis media

A

Amoxacillin/Clavulanate (Augmentin) 875mg

Ceftriaxone 1 gram IM OR Doxycycline 100mg

Nasal Decongestants

Surgical drainage for severe cases Tympanocentesis

155
Q

Tx of eustachian tube dysfunction

A

Decongestant Pseudoephedrine 60mg

Oxymetazoline 1-2 sprays

156
Q

Tx of TM perforation

A

Spontaneous healing occurs in most cases can take 5-6 days to heal

MOI dictates Systemic Antibiotics : Augmentin) 875mg
Doxycycline 100mg

157
Q

barotrauma tx

A 
Decongestant
Pseudoephedrine (Sudafed) 60mg, Oxymetazoline (Afrin)

Antihistamines as needed for symptomatic relief

158
Q

Eustachian tube is excessively open due to

A

patulous dysfunction

159
Q

Eustachian tube fails to dilate properly in

A

dilatory dysfunction

160
Q

Eustachian tube is normally

A

closed

161
Q

most common reasons for hearing loss

A

age (presbyacusis)

trauma(4000hz)

162
Q

Ototoxicity can be caused by

A

aspirin

antibiotics

163
Q

tinnitus is divided into two types

A

objective

subjective

164
Q

What labs would you want to get for a patient with tinnitus?

A

CBC
TSH
HIV
RPR

165
Q

Locations for epistaxis

A

anterior- kiesselbach plexus

posterior-sphenopalatine artery

166
Q

What coags labs would you want for epistaxis pt?

A

PT
TT
aPTT

167
Q

Tx of Epistaxis

A

-Direct pressure by compression of the nares continuously for 10-15 minutes
-Oxymetazoline (Afrin) PLUS tampon
-Lidocaine
-Cauterized with silver nitrate
-Nasal packing
Antibiotics - Cephalexin (Keflex) 500mg, Clindamycin 150mg x5 days (toxic shock)

168
Q

complications of epistaxis?

A

syncope

169
Q

Reasons for polyps

A 
allergies
asthma
cystic fibrosis
alcohol
aspirin
170
Q

Major complication of fractured nose?

A

septal hematoma

171
Q

tx of allergic rhinitis

A

Intranasal Steroids - Flonase

Antihistamines

Avoiding or reducing expoure to airborne allergens

Nasal saline irrigations

172
Q

Tx of sinusitis

A

NSAIDS for pain

Oral/nasal decongestant Pseudoephedrine (Sudafed) Nasal Oxymetazoline (Afrin)

Antibiotics if purulent discharge
Augmentin for more than 10 days

Severe - high dose Augmentin 2000mg
If PCN allergy - Doxycycline 100mg

173
Q

typical pathogens of bacterial rhinosinusitis?

A 
S pneumoniae
streptococci
H influenzae
S aureus
moraxella catarrhalis
174
Q

predisposing factors of epiglottis

A

DM pts

contact with A-beta-hemolytic strep

175
Q

sxs of epiglottis

A

Rapidly developing sore throat or difficulty swallowing is out of proportion to findings

176
Q

tx of epiglottis

A

IV Antibiotics -
Ceftriaxone 2g IV
Levo 750mg IV

Corticosteroid
Dexamethasone (Decadron) 4- 10mg IV bolus

177
Q

PTA sxs?

A

Severe sore throat, difficulty swallowing,
muffled “hot potato” voice

trismus (lockjaw), inferior and medial displacement of the infected tonsil, swollen uvula,

Uvula will be deveated, drooling, dehydration

178
Q

PTA Tx

A

Antibiotic - IV Cefazolin (Ancef) PLUS Metronidizole

Surgery
Needle aspiration WATCH THE AIRWAY!

179
Q

Centor critera

A 
Fever >100.4
Tender anterior cervical lymphadenopathy
NO cough
pharyngotonsillar exudates
Age
(MUST HAVE 3 SYMPTOMS!)
180
Q

labs for pharyngitis

A

Rapid strep
monospot
throat culture
HIV

181
Q

Most common organism recovered from drainage in sialadenitis?

A

S aureus

182
Q

Sxs of sialadentitis

A

Acute swelling of the parotid or submandibular glands

Increased pain and swelling with meals

Tenderness and erythema of the duct opening

Pus can often be massaged from the duct

183
Q

Tx of sialadentitis

A

Antibiotics
Clindamycin 450mg PO TID
PLUS
Ciprofloxacin 500mg BID

Measures to increase salivary flow: hydration, warm compress, sialagogues (lemon drops, gum), massage of gland

184
Q

Complications of sialadentitis

A

ludwigs angina

185
Q

sxs of tonsiloliths

A

Halitosis
White debris
Bad taste in the back of the throat

IDC Stuff (67 decks)

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