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Board Review > HEENT > Flashcards

HEENT Flashcards

1
Q

S/S acute angle closure glaucoma

A
  • acute onset of severe eye pain
  • headache
  • nausea/vomiting
  • halos around lights
  • lacrimation
  • decreased vision

Examination reveals mid-dilated, oval-shaped pupil(s). The cornea appears cloudy.

Fundoscopic examination reveals cupping of the optic nerve.

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2
Q

Auricular Hematoma Treatment

A

The hematoma should be drained as soon as possible. If the hematoma is not drained, it can result in cauliflower ear

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3
Q

Cholesteatoma

A

a growth behind your eardrum (tympanic membrane). It develops when dead skin cells gather behind your eardrum to form a lump or cyst that may look like a pearl. You can be born with a cholesteatoma, but it usually happens because you have a retracted eardrum or a ruptured eardrum.

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4
Q

S/S of Cholesteatoma

A

May be asymptomatic.

  • hearing loss and intermittent ear discharge (otorrhea) from one ear that is purulent and foul smelling

On examination
- perforation of the TM on the superior quadrant
- cauliflower-like or pearly-white mass

OR
- intact TM with missing landmarks with the white mass visible behind the TM

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5
Q

Treatment of Cholesteatoma

A

Antibiotics and/or surgical repair

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6
Q

Herpes Simplex Keratitis

A

a viral infection of the cornea caused by the herpes simplex virus (HSV). It can lead to serious eye complications, including scarring and blindness, if left untreated

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7
Q

S/S of Herpes Simplex Keratitis

A
  • Pain
  • Burning
  • Irritation
  • Photophobia
  • Blurred vision
  • Redness
  • Tearing
  • Foreign body sensation
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8
Q

Treatment for Herpes Simplex Keratitis

A

Antivirals

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9
Q

Optic neuritis

A

Occurs when swelling (inflammation) damages the optic nerve — a bundle of nerve fibers that transmits visual information from your eye to your brain. Common symptoms of optic neuritis include pain with eye movement and temporary vision loss in one eye.

Should be referred to neurology

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10
Q

Orbital cellulitis

A

Acute onset of erythematous swollen eyelid with proptosis (bulging of the eyeball) and pain in affected eye.

Unable to perform full range of motion (ROM) of the eyes (abnormal extraocular movement [EOM] exam) with pain on eye movement.

Look for history of recent rhinosinusitis or upper respiratory infection (URI).

Caused by acute bacterial infection of the orbital contents (fat and ocular muscles).

Refer to ED

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11
Q

Vestibular Schwannoma

A

noncancerous tumor that develops on the acoustic nerve VIII. May involve the facial nerve resulting in facial weakness or paralysis

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12
Q

S/S of vestibular schwannoma

A
  • unilateral hearing loss (sensorineural)
  • tinnitus
  • unsteadiness while walking and episodes of veering or tilting that vary in severity.
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13
Q

Virchow’s Node

A

Enlarged and hard left-sided supraclavicular node(s) associated with malignancy.

Highly suggestive of cancers of the stomach, colon, pancreas, gallbladder, kidneys, ovaries, testicles, prostate, or lymphoid tissue.

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14
Q

Cones help with what kind of vision?

A

Color vision

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15
Q

Rods help with what kind of vision?

A

Low light, night and peripheral vision

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16
Q

Myopia

A

nearsightedness

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17
Q

Hyperopia

A

Farsightedness

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18
Q

Ambylopia

A

Lazy eye

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19
Q

Miosis

A

Excessive constriction of pupil

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20
Q

Ptosis

A

Drooping of upper eyelid

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21
Q

Ectropion

A

Eyelid is turned outward or sags away from the eye. It causes irritation and eye dryness. More common in the elderly.

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22
Q

Entropion

A

Eyelid (usually the lower eyelid) is turned inward. The eyelashes continuously rub against the cornea, causing irritation, watery eyes, redness, pain, and/or foreign body sensation. More common in the elderly.

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23
Q

Mild hypertensive retinopathy

A

Generalized retinal arteriolar narrowing, arteriolar wall thickening, arteriovenous nicking (“nipping”), and opacification of the arteriolar wall

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24
Q

Moderate hypertensive retinopathy

A

Hemorrhages, either flame- or dot-shaped, cotton-wool spots, hard exudates, and microaneurysms.

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25
Q

Severe hypertensive retinopathy

A

Mild and moderat symptomsplus optic disc edema (papilledema). Requires rapid lowering of blood pressure.

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26
Q

Torus Palatinus

A

Painless bony protuberance midline on the hard palate (roof of the mouth); may be asymmetric; skin should be normal.
Does not interfere with normal function.

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27
Q

Oral Hairy Leukoplakia

A

Unusual disease of the lingual squamous epithelium.

Lesions are corrugated painless plaques on the lateral aspects of the tongue that cannot be scraped off.

Often seen in immunocompromised patients (e.g., HIV infection)

Associated with Epstein–Barr virus (EBV) infection.

Treated with antivirals.

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28
Q

Koplik’s Spots

A

Clusters of small whitish, grayish, or bluish elevations with an erythematous base, typically seen on the buccal mucosa opposite the molar teeth.

Pathognomonic for measles

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29
Q

Oral Leukoplakia

A

Bright-white to light-gray plaques on the tongue, floor of mouth, or inner cheeks (buccal mucosa) caused by chronic irritation, such as from tobacco use (smoked and smokeless) and alcohol drinking.

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30
Q

Canker sores

A

Usually caused by trauma. Resolve in 7-10 days.

Treat symptoms with “magic mouthwash” (combination of liquid diphenhydramine, viscous lidocaine, and glucocorticosteroid). Swish, hold, and spit every 4 hours as needed.

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31
Q

Snellen chart measures….

A

Central vision

32
Q

Rosenbaum test measures….

A

Near visual acuity

33
Q

Ishihara chart measures…

A

color vision

34
Q

Sensorineural hearing loss - Weber and Rinne tests

A

Weber: Lateralization to “good” ear (sound is heard louder in the ear that is normal)

Rinne: AC > BC

35
Q

Conductive hearing loss - Weber and Rinne tests

A

Weber test: Lateralization to “bad” ear (sound is heard louder in the affected ear)

Rinne Test: BC > AC

36
Q

Macular Degeneration

A

Gradual or sudden and painless loss of central vision in one or both eyes. Reports that straight lines (doors, windows) appear distorted or curved. Peripheral vision is usually preserved.

Refer to opthalmologist

37
Q

Irisitis (akal Anterior Uveitis)

A

Insidious onset of eye pain with conjunctival injection.

Note that “injection” of the eye means the superficial blood vessels of the conjunctiva are prominent [red eyes]) located mainly on the limbus (junction between cornea and sclera)

Refer to opthamologist within 24 hours.

38
Q

Infectious Keratitis

A

Acute onset of red eye, blurred vision, watery eyes, photophobia, and sometimes a foreign-body sensation in affected eye. History of using contacts past prescribed time schedule, sleeping with contact lenses, bathing/showering or swimming with contacts, extended lens use, and/or poor disinfection practices.

Urgent referral to ophthalmologist. Consider topical pain medication

39
Q

Open-Angle Glaucoma

A

progressive peripheral visual field loss followed by central field loss (late manifestation). Patients rarely experience symptoms as long as central vision is preserved. While not always, can be associated with increased IOP secondary to increased aqueous production and/or decreased outflow.

Referral to ophthamologist. Beta blocker eye drops

40
Q

Pinguecula

A

Raised, yellow-to-white, small, round lesion arising at the limbal conjunctiva next to the cornea.

Caused by chronic sun exposure.

41
Q

Pterygium

A

A yellow, triangular (wedge-shaped) thickening of the conjunctiva that extends across the cornea on the nasal side. “Surfer’s eye”. caused by chronic sun exposure.

  • use artificial tears
  • good sunglasses
  • surgical removal if interferes with vision
42
Q

Sjögren’s Syndrome

A

Chronic autoimmune disorder characterized by decreased function of the lacrimal and salivary glands.

Persistent dry eyes and dry mouth (xerostomia) for more than 3 months.

Use OTC tear-substitute eye drops three times daily (TID).

Refer to MDT for management.

43
Q

Acute Bacterial Rhinosinusitis

A

Inflammation of the nasal cavity and paranasal sinuses; generally lasts less than 4 weeks

Fluid is trapped inside the sinuses, causing secondary bacterial (e.g., S. pneumoniae, H. influenzae) or viral infection. Antibiotics rarely needed; viral infections are causative in most cases.

44
Q

Treating acute bacterial rhinosinusitis

A

Symptom management for first 10 days, most likely resolve on its own.

Treat with antibiotics if there are severe symptoms (toxic, high fever, pain, purulent nasal or postnasal drip for ≥2 to 3 days, maxillary toothache, unilateral facial pain, sense of bad odor in nose [cacosmia], initial symptom improved, then worsening of symptoms), patient is immunocompromised, or symptoms present for >10 days (or have worsened).

Amoxicillin–clavulanate (Augmentin) (500 mg/125 mg PO three times daily or 875 mg/125 mg PO twice daily [BID])

45
Q

AOM - s/s

A
  • Bulging TM
  • reduced mobility of the TM when pneumatic pressure is applied
  • may also see erythematous TM and/or partial or complete opacification of the TM
  • purulent discharge if TM ruptured
  • conductive hearing loss may be demonstrated: Weber exam shows lateralization to the “bad”/affected ear; Rinne test result is BC > AC
46
Q

Treatment for AOM

A

Give amoxicillin-clavulanate 875 mg/125 mg PO twice daily.

47
Q

Bullous Myringitis

A

Infectious condition characterized by the presence of blisters (bullae) on a reddened and bulging TM. Conductive hearing loss

48
Q

AOE

A

Infection and inflammation of the skin of the external ear canal.

Causes ear pain, swelling, discharge, pruritus, and hearing loss (if ear canal is blocked with pus).

History of recent activities that involve swimming or getting ears wet.

49
Q

Treatment for AOE

A

Topical ciprofloxacin-hydrocortisone for 1 week.

50
Q

Otitis Media With Effusion

A

Middle ear fluid without active infection. May follow AOM. Can also be caused by chronic allergic rhinitis, recent viral infection, or barotrauma.

Fluid behind the TM is often yellow or clear. An air-fluid level and/or bubble may be seen

Patient complains of ear pressure, popping noises, and muffled hearing in affected ear. Often, characterized by a temporary conductive hearing loss and aural fullness typically without pain.

51
Q

Treatment for otitis media with effusion

A

Watchful waiting, should resolve within 12 weeks.

52
Q

Common bacterial pathogens in otitis externa…

A

P. aeruginosa, S. epidermidis, and S. aureus

53
Q

Dix–Hallpike maneuver

A

Gold-standard clinical test for BPPV disease

With patient sitting, turn head 45 degrees to affected side and lower patient to 10% below level. If it induces vertigo BPPV is diagnosed.

54
Q

Ménière’s disease

A

Peripheral vestibular disorder attributed to excess endolymphatic fluid pressure causing episodic inner ear dysfunction.

55
Q

BPPV

A

Peripheral vertigo due to calcium carbonate crystals (otoconia) trapped in the semicircular canals.

Abrupt onset with brief episodes of vertigo that last <1 minute induced by sudden head movements and positions.

56
Q

Ménière’s disease treatment

A

Treatment involves:

Salt restriction (2–3 g/day); avoid triggers (e.g., MSG and nicotine); minimize intake of caffeine, alcohol (one serving/day).

Vestibular suppressant PRN; antiemetic medication PRN.

57
Q

BPPV treatment

A

Treatment with a particle repositioning maneuver: Epley maneuver or Semont maneuver.

Antiemetics: Meclizine PO q4–8h (vertigo); prochlorperazine IM, rectal suppository, or PO (nausea/vomiting).

Advise to avoid sleeping on the side of the affected ear for several days.

58
Q

Gold standard for stroke diagnosis

A

MRI

59
Q

Vestibular schwannoma (acoustic neuroma)

A

CN VIII (vestibular portion) tumors. Schwann cell–derived tumors non cancerous.

Refer to ENT for treatment.

60
Q

Vestibular neuritis (labyrinthitis)

A

Due to inflammation of the vestibular portion of the eight CNs caused by viral or bacterial infection. Sudden onset of severe vertigo with nausea, vomiting, and gait impairment. Labyrinthitis with unilateral hearing loss. Episodes can last from hours to days.

61
Q

Treatment for vestibular neuritis

A

Steroid taper; vestibular suppressants and antiemetics PRN for symptom management in the first 24 to 48 hours.

If suspect bacterial infection, treat with broad-spectrum antibiotic, and refer to ENT specialist.

62
Q

Epley Maneuver

A

Used for treating BPPV.

Do the dix-hallpike maneuver and then wait for symptoms to subside. Turn head 90 degrees the other direction, have the patient turn onto the other side maintaining position of 45% and the patient should be facing down. Remain there until symptoms subside.

Helps remove crystals causing vertigo.

63
Q

Cheilitis

A

Acute or chronic inflammation of the lips often involving the lip vermilion and the vermilion border, the surrounding skin, and/or the oral mucosa. Often a result of contact irritants or allergens, chronic sun exposure, infection, or atopic disease.

64
Q

Angular Cheilitis

A

Painful skin fissures and maceration at the corners of the mouth due to excessive moisture and secondary infection with Candida albicans (yeast) or bacteria (Staphylococcus aureus).

65
Q

Treatment for angular cheilitis

A

Check vitamin B12 level; consider checking other B vitamins (B3, B6, B9).
Remove underlying cause. Check if dentures fit correctly; if loose, refer to dentist.
If yeast infection is suspected, microscopy with potassium hydroxide (KOH). If positive (pseudohyphae and spores), treat with topical azole ointment (e.g., clotrimazole, miconazole) twice a day.
If suspect staphylococcal infection, order C&S. If positive, treat with topical mupirocin ointment twice a day.
When infection has cleared, apply barrier cream with zinc or petroleum jelly at night. High rate of recurrence.

66
Q

Infectious Mononucleosis triad

A

Fever, pharyngitis, lymphadenopathy (>50% cases).

Other findings include splenomegaly, palatal petechiae, and occasionally a generalized maculopapular, urticarial, or petechial rash

67
Q

Treatment for infectious mononeucleosis

A

Supportive.

Limit strenuous physical activity until after 4 weeks (may need US to confirm resolution of splenomegaly)

68
Q

Mumps

A

ever, headache, fatigue, myalgia, and anorexia. and parotitis (inflamed parotid gland)

Nationally notifable

69
Q

Mumps treatment

A

supportive. Resolves 1-2 weeks

70
Q

Dacryostenosis

A

Blocke nasolacriminal duct. Types include:

  1. congenital
  2. primary - cause by infection or idiopathic fibrosis
  3. secondary drainage obstruction caused by infection, fracture, sinus surgery, inflammation, tumors
71
Q

Hyphema

A

hemorrhage into interior chamber of the eye as a result of iris or ciliary body rupture, usually a result of trauma.

72
Q

Cluster headache s/s

A

Clinical features include severe, unilateral, sharp or stabbing pain, with autonomic symptoms ipsilateral to the headache such as ptosis, miosis, lacrimation, conjunctival injection, rhinorrhea, and/or nasal congestion.

72
Q

Initial treatment for cluster headaches

A

Initial acute therapy includes either oxygen inhalation or pharmacotherapy with triptans (e.g., subcutaneous sumatriptan) for treatment of an acute cluster headache attack.

73
Q

Symptoms of preseptal cellulitis

A

Preseptal cellulitis does not involve the globe or orbit of the eye and is restricted to the eyelid and surrounding soft tissue

74
Q
A

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