HEENT Flashcards
Blepharitis
inflammation of the eyelids margin
2 categories : Anterior and Posterior
What is the anterior blepharitis ?
–>involves the anterior lid margin surrounding the lid margin and is usually associated with Staphylococcal infection or seborrhea
what is the posterior blepharitis?
–> the posterior lid margin associated with meibomian gland dysfunction and rosacea
–> posterior blepharitis is caused by melbomian gland dysfunction and an alteration in meibomian gland secretions.
As a result of oil secretions or solidification of meibum, a chalazion or hordeolum may develop.
what is anterior staphylococcal blepharitis
is a cell mediated response resulting in lid margin inflammation
what is anterior seborrheic blepharitis
often associated with generalized seborrhea
hx & clinical presentation of Eye -Blepharitis
Inflammation of the eyelids
Swollen and erythematous eyelids : burning tearing or foreign body sensation, itching redness, discharge, absent lashes, lashes crusted with meibum
Seborrheic blepharitis may have greasy scales along the lid margins with foamy tears, disuse seborrhea of the scalp and ears.
ROSACEA is related to the meibomian gland dysfunction. Patients may have erythema or telangiectasia over the cheeks and nose or pustular skin eruptions
Eye- Blepharitis management
Lid Hygeine
-warm moist compresses for 5-10 minutes
-lids scrubs with Q-tips and baby shampoo
Antibiotic ointment : Erythromycin or bacitracin
Artificial tears
Referral to Ophthalmologist for corticosteroids
Eye- Hordeolum
An acute infection of a gland in the eyelid
inflamed area of eyelid where the eyelash meets the eyelid
Bacteria (usually staphylococcus) gets into the oil glands that lubricates the eye.
Similar process to pimple
HX & clinical presentation of Hordeolum
swollen single gradually emerging red bump on the eyelid
Gritty scratchy sensation
Sensitivity to light, tearing, tenderness on the eyelid.
Hordeolum management
usually self limited
spontaneous improvement in 1-2 weeks with conservative treatment
frequent warm moist compresses
teaching: light and gentle massage
lid hygiene with lid scrubs
Refers to Ophthalmologist if incision and drainage needed.
Eye - Chalazia
chronic sterile lipogranulomatous inflammatory lesion of the meibomian gland
Lipogranuloma caused by a blockage in the Meibomian gland or oil gland that lubricates the eye . A gradually localized enlarging nodule where glands are located near the eyelashes.
HX and clinical presentation of Chalazia
Hard, non-tender module found on the mid portion of the eyelid away from the lid border
may develop on lid margin with lid tenderness, pain, and swelling
Eyelid tenderness, increased tearing
Gradually enlarging nodule on the eyelid, sensitivity to light pain or pressure if pressing against the cornea.
Chaliazion management
usually self limited in 25-50% of cases
Spontaneous improvement in 1-3 months with conservative treatment
Frequent warm, moist compresses to liquify glandular secretions
Teaching Gentle massage to express impacted secretions
Referral to Opthalmologist for corticosteroid injections or incision and drainage if necessary
Eye - Viral Conjunctivitis
inflammation of the conjunctiva or the transparent mucosal tissue than lines the eye and inner surface of the eyelids.
Generally caused by adenovirus
highly contagious
hx and clinical presentation of Viral Conjunctivitis
red eye (from corners inward) Excessive watering itching watery discharge Photophobia Foreign body sensation Begins in one eye and spreads to the other Abrupt onset 50% may have tender pre auricular lymph nodes.
Viral conjunctivitis management
self limiting and usually lasts 5-14 days
treatment is supportive
artificial tears
cool compresses
Teaching Good hand hygiene, don’t share towels
avoid contact lens use until resolved and discard used lenses.
Allergic Conjunctivitis
airborne allergen comes in contact with the ocular surface
inflammatory response occurs
IgE mast cell-mediated response and hypersensitivity.
Allergic Conjunctivitis history and clinical presentation
Allergic Rhinitis
Headache
fatigue
often have the positive family hx of hay fever or atopy
Generally begins simultaneously in both eyes
itching
periocular skin discoloration thickening, erythema
management of allergic conjunctivitis
cool compresses teaching : remove irritants oral/systemic antihistamines opthalmic antihistamines ---> Naphcon A Vasocon (otc)
Bacterial conjunctititis
bacterial infection of the conjunctiva membrane lining the eyelid by a wide range of gram-positive and gram negative organisms
Staphylococcus aureus is MOST COMMON
Tears contain enzymes and antibodies that kill bacteria.
History and clinical presentation of bacterial conjunctivitis
red eye (corners inward) blurred vision, crust or matted discharge forming on eyelid over night early morning glued eyes thick mucoid discharge absence of itching
bacterial conjunctivitis management
antibiotic drops or ointment
- -> TOBRAMYCIN, FLUOROQUINOLONE, TRIMETHOPRIM-POLY B
- > Warm compresses frequently
- -> teaching should include-changing pillowcases daily, dispose of eye cosmetics. Do not share towels or handkerchief. Good hand hygiene. Contact lens cleaning and/or disposal
Cornea abrasion patho
a cut or scratch or abrading of the thin, clear, protective coat of the anterior portion of the ocular epithelium often the result of trauma
cornea abrasion clinical presentation
pain (sand or grit) tearing, photophobia, hx of event, contact lenses
photophobia known or suspected foreign body
cornea abrasion management
visualize eye structures observe for foreign body perform a visual acuity EOM fluorescein staining-visualize with cobalt blue light Do not patch symptoms should resolve in 24-72 hours Teaching - Do not rub Refer to Ophthamologist if pain worsens or persists
Glaucoma - Angle closure
patho
increased pressure occurs when the exit of aqueous humor fluids is suddenly blocked and results in quick, severe pain
Glaucoma-Angle closure history and clinical presentation
SUDDEN & SEVERE pain cloudy vision nausea/vomiting red eye rainbow-likE halos around lights oval pupil from bowed iris cloudy cornea may have hx of recent eye dilation
Glaucoma-Angle closure management
this is a Medical Emergency
Immediately Referral to Ophthalmologist
Uveitis -patho
inflammation of the uvea or the middle portion of the eye
involves the middle, pigmented vascular structures
includes the ciliary body, chorioid
Noninfectious, autoimmune or infectious causes
Maybe isolated to the eye or the associated with system diseases
Uveitis -history and clinical presentation
redness of the eye (from center outward) Blurred vision Photophobia Eye pain floaters Headaches
Uveitis - management
underlying causes
immediate and emergent referral to ophthamologist
dark glasses
steroid eye drops managed by ophthalmologist
Allergic Rhinitis -patho
allergic inflammation of the nasal membranes generally caused by breathing in pollen, dust, dander or insect venom
allergen triggers the production of antibody immunoglobulin E (IgE)
When caused by pollens of plants it is called pollinitis
when caused by grass it is called hay fever
Allergic Rhinitis physical and clinical presentation
Rhinorrhea-generally clear pale, boggy nasal mucosa itching watery eyes nasal congestion swollen nasal turbinates eyelid swelling lower eyelid venous stasis (allergic shiners) sneezing no fever
Allergic Rhinitis management
1AVOID IRRITANTS (patient teaching)
Saline Nasal Spray (may use in pregnancy)
intranasal corticosteroids-beclomethazone (may be used in pregnancy)
Antihistamines
–1st generation-sedating
–2nd generation- 1st line chlorpheniramine (may be use in pregnancy)
DECONGESTANTS–> NOT FOR PREGNANT USE
limit to 3 days or less (rebound effect)
Epistaxis - patho
bleeding that occurs from broken capillaries in the nose
mostly occur in the front of the nasal septum
may result from some kind of trauma
may have hx of allergies, snoring, hypertension, headaches, foreign object. Lesion on nasal mucosa
Epistaxis : clinical presentation
bloody nasal discharge
Damage to nasal mucosa from foreign object or lesion
high blood pressure
Epistaxis management
pinch lower part of the nose to apply direct pressure
lean forward or tilt head forward to facilitate clot formation and avoid post nasal drainage
cautery or packing may be required
C&S if lesion is present
treat underlying cause
teaching: NO foreign objects in nose (including fingers)
sinusitis- acute pathophysiology
obstruction of the sinus ostia which is a small opening in which the maxillary, frontal, ethmoid and sphenoid sinuses drain into the nasal cavity
mucous stasis may allow pathogens to grow
viral or bacterial
Sinusitis- Acute or chronic hx & physical presentation
facial pain
headache teeth pain
ear pain/pressure
cough
increased pressure above, below, or behind eyes on leaning forward
social hx smoking or second hand smoke. Environmental exposures
Acute symptoms: fever and purulent nasal discharge, persistant >10 days
Tenderness over sinus cavity.
Sinusitis-management
most cases resolve without treatment
saline decongestant or corticosteroid nasal spray
analgesic and antipyretic tylenol or NSAID
for symptoms greater than 10 days–>AMoxicillin Doxycycline, trimethoprim/sulfamethoxazole
Ear-Auricle disorders patho
Auricle consists of skin over cartilage
patho: is dependent on problem such as –>
- Rheumatoid nodules
- Tophi
- Hematoma
- Carcinoma
- Infection
Ear-Auricle disorders history & clinical presentation
- deformity of auricle
- discharge drainage
- lesion
Ear-Auricle disorders management
specific to the problem:
Biopsy lesions–> Basil cell carcinoma
** pearly borders with ulcerated
center
–>Squamous cell carcinoma
** rough, scaly surface
Pressure dressings for trauma califlower ear
Piercings: alcohol for cleaning
topical antibiotic for infection
oral/systemic antibiotics such as cephalexin or dicloxacillin or ceftriaxone or cephalexin IM/IV
Ear-Otitis Externa pathophysiology
inflammation of the ear canal
Usually bacterial or fungal
Most often caused by –> staphylococcus aureus (including MRSA), pseudomonas, candida, aspergillus,
Cerumen impaction
Ear-otitis Externa hx & clinical presentation
pain & tenderness on palpation of traugus social hx- swimming hx of cleaning ear with a Q-tip allergies hearing aids
Ear-otitis Externa management
cerumen removal if impacted
teaching : no Q-tips in ears
Antibiotic/steroid ear drops: CIPRODEX, CORTISPORIN OTIC
keep ear canals dry for 7-10 days
Alcohol or vinegar drops
Limit use of ear plugs/phones and hearing aids until resolved
Antifungals for fungal infections : FLUCONOZOLE
Ear-Acute Otitis Media pathophysiology
infection of the middle ear causing inflammation and pain which may be fungal, bacterial or viral
Bacteria most often associated are S.pneumonia, H. Influenza introduced in the eustacian tube through the nasopharynx following an upper respiratory infection or allergies.
Ear-Acute Otitis Media history and clinical presentation
earache lymphadenopathy headache fever upper respiratory symptoms nausea/vomiting dizziness Sore throat Cough
Ear-acute otitis media management
analgesic: topical (antipyrine/benzocaine)
Oral (tylenol or ibuprofen)
Antibiotics: amoxicillin, amoxicillin clavulanate, azithromycin (for penicillin allergy)
antihistamines: 2nd generation
Mouth-Aphthous Stomatitis pathophysiology
chronic inflammation of the oral mucosal tissue with ulcers
painful, shallow, recurrent ulcers of the oral mucosa
May be caused by:
direct trauma
vitamin deficiency
anemia
allergies
Mouth-Aphthous Stomatitis history & clinical presentation
circular shallow ulcers covers by a gray membrane and raised border that is inflamed
minor occurence 1-5 ulcers
Major recurrence 2 or more large ulcers
Herpetiform-recurrent with 5-100 ulcers
Aphthous Stomatitis management
self limiting
correct vitamin deficiency
teaching: eliminate causes
Magic mouthwash: benedryl, maalox or mylanta
may include Nystatin if fungal etiology is suspected
swish and swallow
Mouth-glossitis pathophysiology
–> inflammation and depapilation of the dorsal side of the tongue
mouth-glossitis hx and clinical presentation
finger-like bumps on the surface of the tongue may be missing
swollen, tender tongue, smooth surface. Pale or fire red
Dry mouth
recent infections
injury
low Fe+, skin conditions, Yeast, sore tongue
difficulty chewing swallowing or speaking
swollen tongue
Glossitis management
Good oral hygiene
magic mouthwash : nystatin, benedryl, mylanta, lidocaine
Teaching : avoid irritants : food & beverage
Correct dietary/vitamin deficiencies
antibiotics/antifungals
Thrust -pathophysiology
skin and mucous membrane infections caused by Candida albicans
Yeast infection of the mucus membrane lining the mouth and tongue
thrust - hx and clinical presentation
white velvery sores over red tissue that may bleed easily
thrust- management
nystatin 4-6ml (100,000u/ml) swish and swallow
Diflucan 100-200 mg daily for moderate to severe disease in immunocompromised persons
mouth- strep pharyngitis pathophysiology
inflammation of the pharynx and surrounding lymph tissue
strep throat is caused by group A streptococus bacteria
mouth- strep pharyngitis hx and clinical presentation
sore throat fever headache n/v swollen lymph nodes
Centor Score
Patients are judge on 4 criteria. each is worth 1 point
- fever
- Tonisilar exudate
- tender anterior cervical adenopathy
- absence of cough
Add patient’s age to criteria
Age 15 subtract 1 point
0 or 1 point - no ABT or throat culture needed
2-3 point- should have throat culture and ABT if positive
4-5 points- treat empirically with ABT
Strep pharyngitis management
based on RST
culture
empirical treatment based on Centor sc
pencicillin- Amoxicillin
azithromycin if PCN allergic
teaching : dispose of toothbrush in 3 days
tylenol or NSAIDS for pain or fever
Mouth infectious Mononeucleosis pathophysiology
viral infection caused by Epstein Barr or cytomegalovirus
Mouth infectious Mononeucleosis history and clinical presentation
fever sore throat swollen lymph nodes severe fatigue splenomegaly
Mouth infectious mononeucleosis management
fluids
rest
analgesics or NSAIDS for pain and fever
salt water gargles
corticosteroids for extreme swelling of throat/tonsils
teaching: no contact sports for 4-6 weeks
extremely infectious.
