HEENT Flashcards
What can present with painful ulcers and bleeding of the gums and bad breath that is often associated with smoking or a viral infection?
Acute Necrotizing Ulcerative Gingivitis - Vincent’s Disease (trenchmouth)
What are the signs/symptoms of acute tonsilitis?
Painful swallowing
Dysphagia
May have fever
Enlarged & tender lymph nodes in upper neck
Throat redness
May have tonsil calculi
What is the treatment for bacterial acute tonsilitis?
1st line: amoxicillin
Clindamycin if penicillin allergy
What can present with nasal secretion, congestion, facial pressure, & headache?
Acute viral/bacterial rhinosinusitis
What is the treatment for acute viral/bacterial rhinosinusitis?
Viral: supportive care with anti-inflammatories, decongestants, fluids
Bacterial: augmentin
What are the signs/symptoms of allergic rhinosinusitis?
Clear rhinorrhea
Sneezing
Itchy eyes and throat
Possible swollen turbinates
Eye discharge
Cobblestoning of pharynx
Fluid behind TM
Allergic “shiners”
What is the treatment for allergic rhinosinusitis?
Antihistamines
What presents with painful, small round lesions w/a red halo and is found on buccal or labial mucosa?
Aphthous ulcers (canker sores)
What presents with recurrent episodes of vertigo depending on head movement/position & may have N/V?
Benign Paroxysmal Positional Vertigo (BPPV)
How do you test for BPPV?
Check for nystagmus with Dix-Hallpike maneuvers (eyes will move towards affected ear)
How do you treat BPPV initially?
Can attempt Epley maneuver
Refer to ENT
Symptomatic relief
What commonly presents in infants with URI symptoms such as coughing and weezing?
Bronchiolitis
What commonly causes bronchiolitis?
RSV
What is the treatment for bronchiolitis?
Supportive care for outpatient non severe cases
Severe cases will likely need hospital admission for respiratory support and fluids
How is chronic sinusitis defined?
Infection lasting > 12 weeks
What presents with respiratory distress and a “tripod” posture in children, and a severe sore throat, dysphagia, and drooling?
Epiglottitis
What diagnostic sign will you see on an x-ray in a patient with epiglottitis?
Thumbprint sign
What is the most important thing to do for a patient with confirmed or suspected epiglottitis?
Secure the airway
What presents with prolonged malaise (fatigue), tonsil and lymph node enlargement, & possibly tonsil exudate, and what causes it?
Infectious mononucleosis caused by the Epstein-Barr virus
How do you treat infectious mono?
Supportive care
Abx if co-infected with strep
Physical limitations due to enlarged spleen
NO AMOXICILLIN due to causing a rash
What diagnostic lab can be drawn if you suspect infectious mono?
Monospot rapid test
What is the most common cause of croup?
Parainfluenza
What are the signs/symptoms of croup?
Seen in younger children
More seen in the winter
Barking cough
Biphasic stridor
URI symptoms
What is the treatment for croup?
Mild: supportive care
Mod-Severe: Dexamethasone or nebulized epinephrine
What is a complication of acute otitis media that can present with pain, fever, toxicity, fluctuance over mastoid, a prominent pinna, facial paralysis, vertigo, & changes in mental status?
Mastoiditis
What is the treatment for mastoiditis?
Empiric IV abx (vanc + metronidazole + cefepime)
What is the criteria for diagnosing Meniere disease?
2 or more episodes of vertigo lasting 20 mins - 12 hrs each
Low to mid frequency sensorineural hearing loss
Fluctuating aural symptoms (hearing loss, fullness, tinnitus)
What is the treatment for Meniere disease?
Meclizine/Antivert (25mg TID)
Scopolamine patch
Diuretics (HCTZ)
Low sodium diet
Possible endolymphatic shunt
What are the signs/symptoms of otitis externa?
Pain
Itching
Drainage
Swelling
Hearing loss
Erythema
What is the treatment for otitis externa?
Mild: acetic acid-hydrocortisone drops
Mod: cover for staph and pseudomonas (cipro-hydrocortisone or neomycin-polymyxin B-hydrocortisone) drops
Sev: cover for staph and pseudo (same as above), but may need systemic abx
Consider wick placement
Manage pain
What are the signs/symptoms of otitis media?
Pain
Fever
Irritability
Purulent drainage
Hearing loss
URI symptoms
What diagnostic test can be performed when assessing for otitis media?
Tympanic mobility test (pneumatic otoscopy)
What is the first line treatment for otitis media?
Augmentin
What should be considered in children with frequent otitis media infections?
Myringotomy tubes
What is the treatment for a perforated TM?
Small: most close on their own
Large: ENT referral
What can present with fever, sore throat, trismus (can’t open mouth), muffled voice; may have unilateral symptoms, bulging tonsil, & uvular deviation?
Peritonsillar abscess
What is the treatment for a peritonsillar abscess?
I&D
Possibly tonsillectomy & antibiotics
Can be life threatening if it blocks airway
What are most cases of pharyngitis caused by and what is the treatment?
Most caused by virus and do not require abx (supportive care)
What can present with headache, earache, & pain aggravated by jaw movement?
TMJ
What is the treatment for TMJ?
NSAIDS
Soft diet
Heat/massage
Dental referral
