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family med > HEENT > Flashcards

HEENT Flashcards

1
Q

4 cardinal symptoms of rhinosinusitis

A

1) anterior/posterior nasal mucopurulent drainage
2)nasal obsrtuction/congestion
3) facial pain/pressure
4) hyposmia/anosmia

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2
Q

chronic vs acute rhinosinusitis. Bacterial vs viral rhinosinusisti

A

chronic rhinisunusitis is inflammtation of the nasal passage & paranasal sinus last >12 weeks.
Acute rhinosinusitis last <4 weeks
–>Viral last less than 10 days
–>bacterial last greater than 10 day and follows a viral URI (worsening of symptoms)

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3
Q

What is the treatment for bacterial rhinosunusitis

A

amoxicillin or augmentin

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4
Q

Physical exam findings of allergic rhinitis

A

pale boggy nasal mucosa w hypertrophic tubinates.
cobblestone appearace of posterior pharyngeal wall

allergic shiner: dark dsicoloration under eye
allergic nasal crease: transverse crease from upward wiping

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5
Q

Treatment for allergic rhinitis

A

1) intranasal steroids (fluticasone, mometasone)
2) anti-histamine (cetirizine, , loratadine )
3)Intranasal decongestant (Oxymetazoline nasal spray, phenylephrine (Sudafed PE)) only use for 5 days

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6
Q

What is rhinitis medicamentosa

A

rebound nasal congestion with intranasal decongestant use >5 days

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7
Q

What is aphthous ulcers

A

small painful sore in the mouth that is often triggered by trauma.

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8
Q

Aphthous ulcers presentation

A

lip, cheek or under tongue.
painful Ulcer: fibrous membrane cap (yellowish-white or gray), well-defined margins with a red halo.

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9
Q

What is blepharitis?

A

Inflammation of the eyelid margins cauinf eye redness, irritation, FB sensation.
FLAKING AND CRUSTING of eyelids & lashes

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10
Q

What is the most common cause of blepharitis?

A

Staphylococci

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11
Q

treatment of blepharitis

A

warm compress, wash w baby shampoo. topical abx if refractory

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12
Q

What is cholesteatoma

A

keratinizing squamous epithelium cell grows in the middle ear.
primarily affect children

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13
Q

Presentation of cholesteatoma

A

foul-smelling otorrhea
conductive hearing loss

growth can destroy osscile, lead to facial nerve paralysis & temporal bone erosion.

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14
Q

Diagonisis of cholesteatoma

A

CT of the temporal bone.
surgery ( mastoidectomy) is indicated

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15
Q

anterior nose bleed site

A

kiesselbach’s venous plexus.

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16
Q

posterior nose bleed

A

sphenopalatine artery

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17
Q

treatment for anterior nosebleeds

A

Nasal decongestant (will cause vasoconstriction): Afrin, oxymetazoline, phenylephrine.

Silver nitrate stick for chemical cautery

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18
Q

viral conjunctivitis is cause by

A

it is the most contagious conjunctivitis caused by adenovirus. spread by direct contact

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19
Q

Bacterial conjuctivitis is cuased by

A

adults: staph aureus
Children: Strep pneumo

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20
Q

presentation of viral conjuctivitis

A

1) start unilaterally then bilaterally
2) pink or red conjunctiva
3) clear watery, stringy discharge
4) preauricular LAD

21
Q

viral vs bacterial vs allergic conjuctivitis discharger

A

viral: watery & stringy
Bacterial: purulent, white, yellow/green discharge
allergic: watery, mucous discharge.

22
Q

Bacteral Conjunctivitis presentation

A

1) unilateral
2) thick mucopurulent discharge
3) Crusting, difficulty opening eye in AM.

23
Q

treatment for Bacteral Conjunctivitis

A

symptomatic management + macrolide eye drops

cipro if eye contact wearer.

24
Q

Allergic Conjunctivitis presentation

A

1) bilateral eye itching
2) watery or stringy
3) conjunctiva edema

25
Q

Allergic Conjunctivitis treatment

A

antihistamine drops: topical naphazoline/pheniramine

26
Q

scrape/sratch injury on the corneal epithelium

A

corneal abrasion

27
Q

Diagnosis of corneal abrasion

A

fluorescein staining

28
Q

tx corneal abrasion

A

erythromycin drops

29
Q

A serious infection affecting multple layers of the cornea that is seen in contact lens wearers

A

corneal ulcer

30
Q

Physical exam finding of corneal ulcer

A

round or irregular ulcer w white hazy base.

31
Q

corneal ulcer diagnosis

A

slit-lamp w/ fluorescein staining

32
Q

Management for corneal ulcer

A

1) topic cipro for pseudomonas coverage
2) cyclopentolate for pain
3) emergent ophthalmology referral

33
Q

a larger triangular fibrovascular wedge in the conjuctival tissue

A

pterygium
develops due to chronic UV light exposure.
starts medially(nose then growth laterally)
cause irritation and foreign body sensation
conservative management

34
Q

an infectious obstruction of the nasolacrimal duct (inferomedial region)

A

dacryocystitis

erythema, edema, warmth & pain of medial cathus of the eye + purulent discharge.

34
Q

a 58-year-old woman presents to the emergency department with a 3-day history of increasing pain, redness, and swelling in the inner corner of her left eye. She also reports some purulent discharge from the same eye. She denies any vision changes or trauma. On physical examination, you note localized erythema, warmth, and swelling over the medial canthal area of her left eye. Her visual acuity is normal.

A

dacryocystitis

35
Q

inflammation of lacrimal (tear-producing) glands usually caused by bacteria or a virus that initiates the inflammation (supratemporal)

A

Dacryoadenitis

36
Q

triad of acute angle closure glaucoma

A

injected conjunctiva, steamy (cloudy) cornea, and fixed dilated pupil

36
Q

Tonometry showing IOP >30 is diagnosistic for

A

acute angle closure glaucoma
cupping of the optic nerve may occur

37
Q

1st line treatment for open angle glaucome

A

prostaglandins (Iatanoprost, travoprost)

37
Q

Acute narrow angle-closure glaucoma

A

Acetazolamide IV is the first-line agent - decrease IOP by decreasing aqueous humor production

Topical beta-blockers (ex. timolol) reduces IOP without affecting visual acuity

Miotics/cholinergics (ex. Pilocarpine, Carbachol)

Peripheral iridotomy is the definitive treatment

38
Q

Trauma causes blood to collect in the anterior chamber of the eye

A

Hyphema

->eye-shield, pain drops & steriod drops

39
Q

treatment for papilledema

A

acetazolamide to decrease IOP

40
Q

a 62-year-old male who arrives for his follow-up visit for chronic central visual loss. He describes a phenomenon of wavy or distorted vision that has deteriorated rather quickly. The patient is frustrated because he “just can’t drive anymore,” and he is “having difficulty seeing words when he reads.” When looking at a specific region of the Amsler grid, he reports a dark “spot” in the center, with bent lines. On the fundoscopic exam, you note areas of retinal depigmentation along with the presence of yellow retinal deposits.

A

Macular degeneration: gradual painless central vision loss.
->metamorphopsia (distortion on amsler grid)
->dry macular degeneration (mc): gradual macula atropy (drusen bodies = yellow retinal deposits)

41
Q

zinic & antioxidant vitamin

A

dry age-related macular degeneration

42
Q

VEGF inhibitors (e.g., bevacizumab)

A

Wet age-related macular degeneration

43
Q

true or false laryngitis is alway viral in nature with hoarseness following an URI

A

True
consider squamous cell cancer if it last >2 wks
tx w vocal rest

44
Q

teardrop-shaped growths partially obstructing the nasal passages

A

nasal polyps
-> topical nasal corticosteroids

45
Q

Peritonsillar abscess presentation

A

1) muffles hot potato voice
2) trismus (difficulty opening mouth)
3) deviation of uvula

associated with anterior cervical LAD

will have a hx of sore throat

46
Q

Centor score for strep pharyngitis

A
  1. Absence of a cough
  2. exudates
  3. fever (> 100.4 F)
  4. cervical lymphadenopathy

3 out 4 = rapid strep test

family med (3 decks)

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