HEENT Flashcards
What is HEENT?
Head, Eyes, Ears, Nose, and Throat
Describe SCHOLAR
S–> Symptoms
C–> Charactersitics
H–> History
O–> Onset
L–> Location
A–> Aggravating Factors
R–> Remitting Factors
Head: What are the three headaches?
- Migraine
- Cluster Headache
- Tension Headache
Is there an external cause? No.
- Migraine
- Tension
- Cluster
Is there an external cause?
Yes
- Infection
- Brain tumor
- stroke
- Trauma
What are the factors of a migraine headache?
- More common in women than men
- greater than 50% of those affected report severe disability and need for bed rest during an attack
- Highest prevalence between ages of 18 to 44
- Mechanism is not entirely understood
What are the main migraine symptoms?
- Photophobia
- Phonophobia
- Onset: Sudden
- Duration: 4-72 hours
- Recurring episodes of throbbing head pain
- Frequent unilateral
- Can be associated with nausea, vomiting, and senstivity to light or sound.
What is a Migraine “Aura”?
- Experienced by 25% of patients
- Occurs prior to or at the onset of the migraine
- Typically evolves over 5 minutes or longer and often lasts less than 60 minutes
- Symptoms:
- Paresthesia or numbness involving arms and face
- Changes in vision/blind spots/flashes of light
- Sensory changes
What are absortive therapies that will help with migraines?
- Ergots
- Triptans
- CGRP antagonists
- NSAIDS/Analgesics
Referral required
What are preventative therapies for migraines?
- Beta Blocker
- Anti-eipleptic Agents
- CGRP antagonists
- Biologics
- Botulism toxin (Botox)
What are non-pharmacologic treatments for migraines?
- Rest/sleep in dark, quiet environment
- Ice pack
- Avoid triggers
What is the most common type of headache?
Tension headache
Are tension headaches more common in males or females?
Females
What is the least studied of all headache types?
Tension headache
What is the defining characteristic of a tension headache?
Episodic or chronic nature.
What are the key characteristics of tension headaches?
- coexisting migraine
- depression
- anxiety
- poor stress management
What are the symptoms of a tension headache?
- Onset: Gradual
- Duration: Variable, hours to days
- Bilateral dull, non-pulsatile tightness, or pressure
- Described as having a “hatband” pattern
- +/- Photophobia or Phonophobia
- Less debilitating than a migraine
What are acute treatment options for tension headaches?
- Can treat OTC
- Max number of days for acute treatment= 15 days/month
- Examples: Aleve, Excedrin, Motrin, Tylenol
Who are most affected by cluster headaches?
- Men
- 85% of individuals with cluster headaches are tobacco smokers or have a smoking history.
What severity is a cluster headache?
Most severe, but least common primary headache disorder
What are the potential causes of a cluster headache?
- Hypoxia
- Genetic predisposition
- Hypothalamic dysfunction
Describe the cluster headache symptoms.
- Onset: Sudden
- Duration: 15 mins to 3 hours
- Commonly at night and frequently in the spring and fall
- Excruciating, penetrating pain that is deep, non-pulsating, behind the eye
- Cranial autonomic symptoms: Lacrimation, nasal stuffiness, rhinorrhea, eyelid edema, facial sweating.
What are common treatments for cluster headaches?
Pharmacological treatment is oxygen, but referral is required.
What are non-pharmacological treatments for ALL headache types?
- Avoiding stress and triggers
- Exercise, massages, stretching, sleep hygiene, etc.
- Heat or cold packs
When do you refer for headaches?
- Uncontrolled hypertension
- Secondary headache
- Neck Stiffness
- Fever, weakness, fatigue
- Severe head pain
- Mental status change
- Frequent occurences (>15 per month)
- Rapid onset of maximum pain
- OTCs ineffective
- Migraine/cluster headaches
What is the conjunctiva?
The thin mucus layer on the outside of the eye.
What is conjuctivitis?
- Inflammation of the conjunctiva
- Known as “pink eye”
- May last 2-3 weeks
- Can be…
- bacterial
- viral
- allergic
- miscellaneous (dry eye contact)
What is bacterial conjunctivitis?
A red eye with a sticky yellow or yellow/green discharge. Eyelids may be stuck together upon waking. Can affect one or both eyes. Usually spread by direct contact only.
What is viral conjunctivitis?
The type of conjuctivitis most commonly associated with the term “pink eye.” Appearance: red, itchy, watery eye. Can affect one or both eyes. Highly contagious.
What is allergic conjunctivitis?
Very similar in appearance to viral conjunctivitis but accompanied by nasal congestion, sneezing, eyelid swelling and sensitivity to light. Both eyes are affected. Not contagious.
What are common causes of bacterial conjunctivitis?
Staphylococcus aureus
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
What is the common presentation of the eye for bacterial conjunctivitis?
- Redness, discharge
- Eye is “stuck shut” in the morning
- Purulent discharge - yellow/green
- Most commonly unilateral
What is a common treatment for bacterial conjunctivitis?
Antibiotic eye drop (RX only)
Referral required
What are the causes of viral conjunctivitis?
Adenovirus
What is the common presentation of viral conjunctivitis?
- Watery eyes
- Burning, sandy, gritty feeling in the eye
- Morning crusting
- 2nd eye often involved within 24-48 hours
- Part of viral upper respiratory infection
What is the common treatment for viral conjunctivitis?
- Lubricants/Artificial Tears
- Ocular Decongestants (i.e. phenylephrine, naphazoline, etc.)
What are common causes of allergic conjunctivitis?
Airborne allergens
What is the common presentation of the eyes for allergic conjunctivitis?
- Redness, watery discharge, itching
- Both eyes often involved
- Often with other allergic symptoms; nasal congestion, sneezing, wheezing
- Eye rubbing can worsen symptoms
What are common treatments for allergic conjunctivitis?
- Ocular Antihistamines (i.e., ketotifen)
- Ocular Mast Cell Stabilizers (i.e., cromolyn)
- Ocular Decongestants (i.e., phenylephrine)
- Oral Antihistamine (i.e., cetirizine)
Can treat OTC
What are some common causes of dry eye conjunctivitis?
- Age >65 years
- Female Sex
- Allergens
- Medications (anticholinergics, diuretics, decongestants, antidepressants)
- Weather (Dry air, etc)
How does dry eye conjuctivitis present itself?
- Red/Pink eyes (+/-)
- Sandy/gritty feeling
- One or Both Eyes Affected
What treats dry eye conjunctivitis?
Artificial tears
Can treat OTC
What are causes of contact/irritant conjunctivitis?
- Foreign body in the eyes (chemicals, smoke, objects, chlorine, etc)
What is the presentation of contact/irritant conjunctivitis?
- Remove objects
- Eye flush with clean water
Referral required
What are non-pharmacologic conjunctivitis treatment?
- Wash hands frequently
- Avoid sharing objects
- Cold compress
- Avoid eye rubbing
- Specific recommendations- allergic (avoid allergens), dry eye (avoid triggers, limit screentime, air humidifiers)
What are the causes of Blepharitis?
- Infection (bacteria)
- Allergies
How does Blepharitis present?
- Swollen, itchy eyelids
- Crusting/Matting of Eyelashes
- Blurred Vision
What is the treatment of blepharitis?
- Artificial tears
- Warm compresses
- Eyelid Cleansing
Can treat OTC
- Blepharitis = inflammation of eye lid
- Stye = hordeolum
When do you refer for eye disorder treatment?
- Signifant reduction in visual acuity
- Trauma
- Intolerable Eye Pain or Inflammation
- Inability to Open Eye(s) to Remove Foreign Body
- Symptoms that have persisted over 72 hours
- Contact lens wearers
- Exposure to chemicals
- Bacterial conjunctivitis
- Sensitivity to light
What are key counseling tips for eye drops?
- Wash hands with soap + water & dry
- Remove glasses or contact lenses (if applicable)
- Shake (if applicable) & remove cap w/o touching dropper tip
- Tilt head back or lie down; pull lower eyelid down forming pocket
- Hold dropper over the eye directly w/o allowing the tip to touch the eye
- Look up & away from tip & place drop in pocket of eye
- Hold eyelid so drop can spread, then close eye; apply punctal occlusion for ~30 seconds
- Wipe any excess liquid from face
- Wash hands well to remove any medication
What is the ear anatomy?
Outer ear, middle ear, inner ear
What is acute otitis externa?
Inflammation and/or infection of external ear canal (swimmer’s ear)
What are the causes of acute otitis externa?
- Frequent/constant moisture
- Trauma (Q-tips, etc.)
- Chronic earpiece wearing (hearing aid, etc.)
- Fungal/bacterial infections
What are the symptoms of acute otitis externa?
- Ear pain/swelling + purulent discharge
- Tenderness and/or redness of outer ear
- Hearing impairment
What are treatment options for acute otitis externa?
- Eardrops (antibacterial and steroid)
- OTC oral analgesic or NSAID as needed
Referral required
What are the causes of acute otitis media?
- Bacteria
- Virus
What are common symptoms for acute otitis media?
- Ear pain (tugging ear, cranky child, etc)
- Decreased hearing
- Fever
What are treatment options for acute otitis media?
- Most cases resolve on their own
- Analgesics or antipyretics
- Oral antibiotics in cases unresolved in 48 hours
Referral required
What is acute otitis media?
Inflammation of the inner ear
What is otitis media with effusion?
Fluid collection in middle ear
What are the causes of otitis media with effusion?
- Allergic rhinitis
- Post-acute otitis media
What are symptoms of otitis media with effusion?
- Fullness in ear and/or decreased hearing
- Ear popping when yawning
- No pain, bulging eardrum, or fever
What are treatment options for otitis media with effusion?
- Most cases resolve on their own
- Analgesics
- No antibiotics
- Pressure equalization tubes
Can treat OTC
What are the causes of whater clogged ear?
- Swimming
- Bathing
What are symptoms of water clogged ear?
- Popping sensation in ear
- Tinnitus (ringing in the ears)
- Reduced hearing capacity
What are treatment options for water clogged ears?
- Ear drying agents (isopropyl alcohol)
- Ear plugs while in water
Can treat OTC
What is cerumen impaction?
Ear wax blocking the ear canal.
What are causes of cerumen impaction?
- Narrow ear canal
- Infrequent or excessive cleaning
- Using cotton swabs
What are symptoms of cerumen impaction?
- Hearing impairment
- Pain, fullness, or ringing in ears
What are common treatments for cerumen impaction?
- Watchful waiting
- Cerumenolytic agents (mineral oil, carbamid peroxide (Debrox), acetic acid, saline, and hydrogen peroxide
Can treat OTC
What are the causes of ototoxicity?
- Medications
- Chemicals
What are symptoms of ototoxicity?
- Hearing loss, tinnitus (ringing in the ears), dizziness
What is a common treatment for ototoxicity?
Stop/avoid offending agent.
What are common ototoxic medications?
- Aspirin
- Loop diuretics: Furosemide, torsemide, bumetanide
- Aminoglycosides (an antibiotic class): gentamycin, tobramycin, neomycin.
- Chemotherapeutic Agents: cisplastin, carboplastin
- Antimalarials: guinine, chloroquine
When do you refer for ear disorder treatment?
- Severe ear pain and visible swelling
- Signs of infection
- Foreign objects in ear
- Trauma/Bleeding
- Ruptured Tympanic Membrane (Eardrum)
- Tympanostomy tubes present
- worsening of symptoms attempted treatment greater than 4 days
- children less than 12
- Ear surgery within 6 weeks
- Cognitive impairment
- Acute otitis media and externa
What are the ear drop counseling tips?
- Wash hands with soap and water and dry
- Clean outside of ear with damp cloth
- Warm eardrops to body temperature in palm of hand and shake
- Tilt head to the side or lie down with affected ear facing up
- Pull ear; adults upward; kids backward and downward
- Place correct number of drups into the ear canal and gently press tragus
- Keep ear tilted for 3-5 mins
- Wipe away excess drops (if neccesary)
- Recap and wash hands
What is allergic rhintis?
Inflammation of nasal mucus membranes
What are common causes of allergic rhinitis?
Common allergens like…
* Pollen
* Pet Dander
* Dust mites
* Weeds
* Molds
What are symptoms of allergic rhinitis?
- Watery eyes
- Clear rhinorrhea
- Post-nasal drip
- Sneezing
- Coughing
- Itchy eyes, ears, and/or nose
What is a non-pharmacological treatment for allergic rhinitis?
- Allergen avoidance
- Nasal saline rinses
- Nasal strips for sleeping
What are some pharmacological treatments for allergic rhinitis?
Pharmacologic Treatment:
* Intranasal steroid sprays (fluticasone, budesonide)
* Oral antihistamines (cetirizine, fexofenadine, levocetirizine, loratadine)
* Intranasal antihistamines (azelastine)
* Decongestants (pseudoephedrine, phenylephrine, intranasal oxymetazoline
* Montelukast (RX only)
Can treat OTC
Can only use montelukast for 3 days, rebound congestion can occur
What is sinusitis?
Inflammation and/or infection of the sinuses.
Describe bacterial sinusitis.
- Usually gets better than suddenly worse after 1 weeks
- Purulent nasal discharge
- Referral required
Describe viral sinusitis.
- Most common type
- Usually self-limiting
- Last less than 1 week
- Can treat OTC
What are non-specific symptoms of sinusitis?
- Headache
- Facial pain/pressure
- Fever
What is a treatment for bacterial sinusitis?
Antibiotic
What is a treatment for BOTH viral and bacterial sinustitis?
- Analgesics (NSAIDs or acetaminophen)
- Oral or intranasal decongestants
When can you treat OTC for nose disorders?
- Symptoms lasting less than 7 days
- Presence of mild symptoms only that appear to be getting better
When do you refer for nose disorder treatment?
- Worsening of new symptoms or new symptoms during self treatment
- Symptoms lasting over 7 days
- Signs of bacterial infection (purulent discharge, initial improvement when worsening)
- Fever over 100.4 degrees F
- Chest pain/shortness of breath
What are key counseling points for nasal sprays?
- Blow nose gently
- Wash hands with soap and water and dry
- Remove cap from the nasal spray
- Tilt head slightly forward and press finder on opposite side of nasal administration to open nasal passage
- Insert applicator into nostrol, angling toward outside of nose and press down on the applicator to spray into nostril
- Breath in through nose deeply and out through mouth
- Repeat in other nostril and recap
- Wash hands well to remove any medication
What are the key characteristics of bacterial pharyngitis?
- Exudative tonsillar hypertrophy
- Curdlike plaques
What are key characteristics of viral pharyngitis?
Pharyngeal redness and Tonsillar erythema
What are the symptoms of pharyngitis?
- Odynophagia
- Sore throat
- Tonsillar swelling and pus
- Bad breath
- Fever
What are treatment options for pharyngitis?
- Saltwater gargle
- Hydration
- Benzocaine/Menthol cough drops
- Phenol spray
- Oral analgesics
- Antibiotics (if bacterial)
Referral required if
* Dysphagia or Dyspnea (trouble swallowing or breathing)
* Fever over 100.4 F
* Bacterial cause
* Symptoms lasting longer than 7 days
What causes canker sores?
- Vitamin B deficiencies
- Stress
- Food insensitivities
- Hormonal changes
What are symptoms of canker sores?
- White, painful sores
- Located on Inner Lining of Mouth
What are possible treatments of canker sores?
Avoid triggers/stressors
Topical benzocaine (OTC)
Viscous Lidocaine (RX)
What causes cold sores?
Herpes Simplex Type I Virus
What are symptoms of cold sores?
Reddish, painful sores that may rupture and form crusty lesions. May flare more when stressed.
What are treatment options for cold sores?
- Avoid stressors, sharing drinks, or foods during flares
- Cool packs
- Docosanol (abreva- OTC)
- Oral Antivirals (acyclovir- RX only)
Can INITIALLY treat OTC
What are causes of oral candidiasis?
- Candida albicans (most common)
- Local immunosuppression (inhaled steroids, chemotherapy, etc)
What are the symptoms of oral candidiasis?
- White patches/plaque on tongue/inner cheek/throat
- “Cotton mouth”
- Ocassional Odynophagia
What is a line of treatment for oral candidiasis?
Antifungal (RX only)
What causes gingivitis?
Mouth bacteria
What are the symptoms of gingivitis?
- Bad breath
- Red/Swollen gums
- Gums that bleed easier
How to treat Gingivitis?
Antiseptic rinses (RX only)
Referral required
When do you refer for oral disorder treatment?
- Immunocompromised patients
- Oral candidiasis
- Symptoms not relieved in 1-2 weeks
- Bacterial Pharyngitis
- Lesions covering large area or causing significant pain
- Gingivitis
