HEENT Flashcards
hordeolum description, s/s, tx
“stye”, abcess on the eyelid - unilateral
localized pain, swelling, erythema
self-resolving, warm/moist compress, bacitracin/erythromycin in acute phase by optho after 1-2 weeks
chalazion description, s/s, tx
granulomatous inflammation of meimobian gland
painless, localized eyelid swelling
large lesions - warm compress, refer to optho for drainage/steroids
difference btw hordeolum & chalzaion
hordeolum - tender
chalazion - non-tender
cataracts description, s/s, tx
gradual, progressive thickening off the lens d/t protein buildup (normal process of aging)
progressive loss of vision, distance w distance vision, loss of red reflex
surgical treatment if sx impair with ADLs
age-related macular degeneration description, s/s, tx
loss of central vision
non-exudative (dry) - more common, over years
exudative (wet) - over months, more severe
dry - antioxidants
wet - VEGF inhibitors
conjunctivitis transmission
contact
viral conjunctivitis s/s
bilateral
gritty feeling in eyes, irritation
conjunctival injection
wattery/serous drainage, perfuse tearing, morning crusting
pathogen cause of viral conjunctivitis
adenovirus
viral conjunctivitis tx
supportive care
cold compress, artificial tears
complicated viral conjunctivitis & tx
unilateral
herpes simplex virus
tx w topical antivirals - gancyclovir
refer to optho! can threaten vision
bacterial conjunctivitis pathogens
staph aureus - adults
strep pneumoniae - military/colleges
s/s of bacterial conjunctivitis
unilateral or bilateral
redness, purulent thick discharge
bacterial conjunctivitis treatment
req for contact wearers!
erythromycin, fluoroquinolone/bacitracin topical
contacts - fluoroquinolone & no contacts
complicated bacterial conjunctivitis & s/s & tx
gonocococcal conjunctivitis
copious purulent drainage
corneal involvement can lead to corneal perf
emergency!
1 g ceftriaxone IM, topical fluoroquinolone, refer!
corneal abrasion description, s/s
trauma to cornea
extreme pain, foreign body sensation, wattery/purulent discharge
corneal abrasion diagnosis & management
fluorescein strip - dye uptake
abx to prevent superinfection
large - cycloplegic drops <48 h
small clean - topical erythromycin/tobramycin bacitracin/polymyxin
dirty - cipro, ofloxacin, tobramycin
tetanus
optho f/u within 24h
diabetic retinopathy classifications
non-proliferative - less severe, more common
proliferative - neovascularization, may have retinal detachment
s/s of diabetic retinopathy
early - asymptomatic
late - floaters, blurred vision, progressive visual acuity loss
cotton-wool spots
micro aneurysms - early, hemorrhages
visual acuity & symptoms are poor guides presence of DR!!!
diabetic retinopathy diagnostics & management
ophthalmoscopic exam
fluorescein angiography
optical coherence tomography
DM control & annual screening
refer!!! retinal specialist
retinal detachment def & mgmt
separation of inner layers of retina from the underlying retinal pigment epithelium
spontaneous or due to trauma
rhegmetogenous - common, non-traumatic
nonrhegmatogenous - d/t stress/traction
emergency! refer to optho for surgery
s/s of retinal detachment
photopsia - flashes of light
rapid loss of vision in curtain-like fashion “shadow, cloud”
floaters
no pain or redness
central retina artery obstruction def, s/s
medical emergency!
most often caused by embolus
acute, painless, partial loss of vision (descending nightshade, monocular)
fundoscope - box car/cherry red spots
central / branchh renal artery obstruction mgmt
r/o other causes
ocular massage
acetazolamide & beta blocker while waiting for optho
optho - revascularization & anterior chamber paracentesis
chronic glaucoma s/s, mgmt
asymptomatic, then loss of peripheral fields
optic disc cupping
IOP >20 mg Hg
prostaglandin analogues
B-blockers
laser therapy/surgery
acute glaucoma s/s, mgmt
ocular emergency!!
red, painful eye, cloudy blurred vision, nausea
minimally reactive pupil
IOP 40-90 mmHg
acetazolamide
beta blocking drops
bells palsy s/s, tx
acute onset of unilateral upper/lower facial paralysis
no other neuro deficits
prednisone 60-80 mg x5-7 days
diagnostic tests for benign positional vertigo
Dix-hallpike test
empley Maneuvers
tx for benign positional vertigo
antihistamines
anticholinergics
s/s of benign positional vertigo
room spinning after head movement
s/s of trigeminal neuralgia
paroxysmal episodes of stabbing unilateral facial pain
starts near mouth, shoots up
exacerbated by touch, eating
first line management for trigeminal neuralgia
carbamazepine
weber test interpretation
conductive - sound is louder poorer-hearing ear
sensorineural - sound radiates to better ear
rinne test interpretation
normal - air>bone
conductive - bone>air
sensorineural - air > bone (but less time than normal)
who needs hearing screening?
> 65 or exposure populations
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acute otitis external s/s
fullness, itching, pail
pinna erythema, edema, discharge, TM erythematous
acute otitis external tx
fluoroquinolone OR neomycin/polymixin B
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s/s of otitis media
decreased hearing, fever, N/V
erythematous, bulging TM
otitis media tx
amoxicillin/clavulanate (augmentin)
5-7 days
treat all abx!!
exam findings for allergic rhinitis
allergic shiners - dark circles around eyes
nasal crease - in lower half of nose
boggy, swollen, nasal turbinates
thin, wattery secretions
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bacterial rhinosinusitis tx
amoxicillin or amoxicillin-clavulanate (augmentin)
oral candidiasis pathogen
Candida albicans
oral candidiasis tx
fluconazole PO 7-14 days
pharyngitis pathogen
group A B-hemolytic strep
bact pharyngitis tx
penicillin V 500 mg or amoxicillin
epiglottitis pathogen
H. flu
alert for epiglottitis
rapidly developing sore throat, hot potato voice
epiglottis s/s, diagnostics
tripoding, uncontrolled secretions, stridor - late, adenopathy, drooling
thumb sign on CXR
epiglottis management
ABCs
ceftriaxone & another agent
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