HEENT Flashcards
What is the presentation of acute otitis media
bulging of TM
other signs of acute inflammation (erythema of TM, fever, ear pain
middle ear effusion
what are the common pathogens causing Acute otitis media
S. Pneumoniae (25%)
H. Influenzae (20%)
M. Catarrhalis
how do you diagnose Acute Otitis Media
otoscope examination
- bulging, loss of landmarks, redness, TM injection
what is the treatment of acute otitis media
high dose amoxicillin or Augmentin or cephalosporin (penicillin allergic)
what is the duration of treatment for acute otitis media
< 2years old: 10 days
>2 years old: 5-7 days
what are other non medication treatments for recurrent acute otitis media
tympanostomy
tympanocentesis
myringotomy
what are complications of acute otitis media
mastoiditis and bullous myringitis
what is the most common cause of pharyngitis
viral - adenovirus is m/c
what is the presentation of mononucleosis phayngotonsillitis
fever
sore throat
lymphadenopathy
splenomegaly
atypical lymphocytes
+ heterophile agglutination test (monospot)
when should gonorrhea pharyngitis be considered
in pts with recent sexual encounters or with non-resolving pharyngitis
when should fungal pharyngitis be considered
pts using inhaled steroids
what is the cause of step pharyngitis
Group A B-hemolytic streptococci (GABHS) - S. pyogenes
How is strep pharyngitis diagnosed
Centor Score (3 or 4)
1. absence of a cough
2. exudates
3. fever (>100.4)
4. cervical lymphadenopathy
if patient has a negative Centor score, what is the next step
throat culture
what is the treatment of Group A Strep pharyngitis
Penicillin = first line
azithromycin if penicillin allergic
what are complications of strep pharyngitis
rheumatic fever
post-strep glomerulonephritis
what is the treatment of mononucleosis pharyngitis
symptomatic and avoid contract sports; abx such as amoxicillin or ampicillin may cause a rash
when can people return to sport s/p mononucleosis diagnosis
for athletes planning to resume non-contact sports: 3 weeks from symptom onset
for strenuous contact sports: 4 weeks after illness onset
what is the treatment of fungal pharyngitis
clotrimazole
miconazole
or nystatin
what is the treatment of gonorrhea pharyngitis
IM ceftriaxone and azithromycin for second agent
pt presents with clear nasal drainage, pruritis, pale, blish, boggy mucosa, what is their likely diagnosis
allergic rhinitis
how do you diagnose allergic rhinitis
history and occasionally skin testing
what is the treatment options for allergic rhinitis
avoid any known allergins
use antihistamines
cromolyn sodium
nasal or systemic corticosteroids
nasal saline drops or washes
immunotherapy
what is the presentation of viral conjunctivitis
copious watery discharge, scant mucoid discharge.
what is the most common bug cause of viral conjunctivitis
Adenovirus
what is the presentation of bacterial conjunctivitis
purulent (yellow) discharge, crusting, usually worse in AM/ may be unilateral
what are the common causes of bacterial conjunctivitis
- s. pneumonia, s. aureus - acute mucopurulent
- M. catarrhalis, gonococcal - those not responding to conventional treatment
- chlamydia - newborn
how do you diagnose chlamydia conjunctivitis
Giemsa stain - inclusion body
what is the presentation of allergic conjunctivitis
red eyes
itching and tearing
usually bilateral
cobblestone mucosa in inner/upper eyelid
what is the treatment of bacterial conjunctivitis
Gentamicin/tobramycin (tobrex)
Erythromycin ointment - chlamydia for newborns
Trimethobrim and polymyxin B
what needs to be added for coverage in bacterial conjunctivitis with those who wear contact lenses
fluoroquinolones
what is the treatment of Neisseria conjunctivitis in those with contact lenses
prompt referral and topical and systemic abx
what is the treatment of chlamydial conjunctivitis with those using contact lenses
systemic tetracyclines or erythromycin x 3weeks
topical ointments
assess for STD or child abuse
what is the pathogen that causes epiglottitis
Haemophilus infleunzae type B (Hib)
- usually unvaccinated children or underserved areas
when is Hib vaccine administered in kids
2,4,6,12-15 months
what is the presentation of epiglotittis
stridor, restlessness, cough, dyspnea, fever, dysphagia, drooling, respiratory distress (tripod)
what are the 3D’s of epiglottitis
Dysphagia
Drooling
Respiratory Distress
how do you diagnose epiglotitis
secure airway
culture for H. flu
lateral neck x-ray
what is the hallmark sign on x-ray for epiglotitis
thumbprint sign
what is the treatment of epiglotitis
intubation if necessary
supportive care
ceftriaxone
may tx outpt if stable
what is the most common site for anterior nose bleeds
kiesselbach’s plexus or Little’s area
what is the typical source for posterior nose bleeds
sphenopalatine artery (woodruff’s plexus)
what is important to preventatively treat for with patients who require anterior nasal packing for nosebleeds
must be treated with abx (cephalosporin) to prevent toxic shock syndrome
what should be ruled out with recurrent epistaxis
HTN or hypercoagulable disorder
what is Weber Test
tuning fork placed on center of the head to see if the sound lateralizes
for a webers test, if the sound lateralizes to the affected side, what does that indicate?
conductive hearing loss
for weber test, if the sound lateralizes to the unaffected ear, what does that indicate
sensorineural hearing loss
what is the rinne test
tuning fork placed on mastoid then up the the hear (should continue to hear)
in a rinne test, if it results in bone > air what does that indicate?
conductive hearing loss
in rinne test, if it results in air > bone, what does that indicate?
sensorineural hearing loss
if a patient has conductive hearing loss, what should the results of the WEber and Rinne test be?
Weber: hear in the bad ear
Rinne: Bone > air
if a patient has sensorineural hearing loss what should the results of their weber and rinne be?
Weber: hear in good ear
Rinne: Air>bone
what are common causes of sensorineural hearing loss
noise-induced, infection, drug-induced, congenital, meniere disease, CNS lesions
what are common causes of conductive hearing loss
cerumen impaction, otitis external, esostosis
tmpanic membrane perforation
otitis media, otosclerosis, neoplasms
what is exostosis
bony outgrowths of external auditory canal related to exposure to cold water
what is a complication of acute otitis media that leads to a suppurative infection of mastoid air cells
mastoiditis
what is the presentation of mastoiditis
fever
otalgia
pain and erythema of ear
forward displacement of external ear
what are common pathogens causing mastoiditis
S. pneumonia, H. influenzae. M. catarrhalis, S. aureas, S. pyogenes
how do you diagnose mastoiditis
clinical
CT of temporal bone with contrast (complicated/toxic)
how do you treat mastoiditis
oral abx or IV abx (ceftriaxone)
how is oral candidiasis diagnosed
potasium hydroxide prep (KOH) = revealing budding yeast and pseudohyphae
what is the treatment of oral candidiasis
nystatin
oral fluconazole
what is an infection of the orbital muscles and fat behind the eye
orbital cellulitis
what is periorbital cellulitis
infection of only the skin around the eye
what is the presentation of orbital cellulitis
decrease EOM
pain with movement of eye and proptosis
signs of infection
how do you diagnose orbital cellulitis
CT scan of orbits confirm
CBC and blood cultures occasioanlly
how do you treat orbital cellulitis
Hospitalization and IV broad-spectrum abx (vanco)
what is the presentation of bacterial otitis externa
edema with cheesy white discharge, palpitation of the tragus is painful
when is malignant otitis externa commonly seen
in diabetic patients
what are the pathogens that cause bacterial otitis externa
pseudomonas aeruginoasa (swimmers ear)
S.aureus (digital trauma)
what is the treatment of bacterial otitis externa with performation or chance of perforation
ciprofloxacin 0.3% and dexamethasone 0.1% suspension: 4 drops BID for 7 days
or
ofloxacin 0.3% solution 10 drops once daily for 7 days
what drops are commonly used for bacterial otitis media
cortisporin otic drops
what is the treatment of diabetic or immunocompromised pts with bacterial otitis externa
hospitalization with IV abx (caused by aspergillus)
what is the presentation of fungal otitis externa
pruritis
weeping
pain and hearing loss
swollen, moist and wet appearance
what is the pathogen causing fungal otitis externa
Aspergillus niger (black)
A.flavus (yellow)
A. fumigatus (grey)
candida albicans
what are the treatment options for fungal otitis externa
2% acetic acid 2-4 drops QID
clotrimazole 1% solution
itraconazole oral
pt presents with a severe sore throat, lateral uvula displacement and bulging tonsil what is the likely diagnosis
peritonsillar abscess
what is the common pathogen causing peritonsillar absecesses
streptococcus pyogenes
how do you diagnose peritonsil abscess
XR, CT or US of neck
needle aspiration of tonsillar mass and cultures
what is the treatment for a peritonsilar abscess
aspiration
I&D
and/or
abx
(IV amox, ambox-sulbactam, clinda)
what is exotropia
out-turning of eyes
what is esotropia
in-turning of eyes
what is hypertropia
upward deviation of eyes
what is hypotropia
downward deviation of eyes
how are stabismus diagnosed?
cover/uncover test
what is the presentation of TM perforation
pain
otorrhea
hearing loss/reduction
what is the treatment of TM perforation
most heal spontaneously
keep clean and dry
treat with abx
what antibiotics are non-ototoxic
floxin drops
when should surgery be persued with TM perforation
if it persists past 2 months
