HEENT Flashcards
4 cardinal symptoms of rhinosinusitis
1) anterior/posterior nasal mucopurulent drainage
2)nasal obsrtuction/congestion
3) facial pain/pressure
4) hyposmia/anosmia
chronic vs acute rhinosinusitis. Bacterial vs viral rhinosinusisti
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)
What is the treatment for bacterial rhinosunusitis
amoxicillin or augmentin
Physical exam findings of allergic rhinitis
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
Treatment for allergic rhinitis
1) intranasal steroids (fluticasone, mometasone)
2) anti-histamine (cetirizine, , loratadine )
3)Intranasal decongestant (Oxymetazoline nasal spray, phenylephrine (Sudafed PE)) only use for 5 days
What is rhinitis medicamentosa
rebound nasal congestion with intranasal decongestant use >5 days
What is aphthous ulcers
small painful sore in the mouth that is often triggered by trauma.
Aphthous ulcers presentation
lip, cheek or under tongue.
painful Ulcer: fibrous membrane cap (yellowish-white or gray), well-defined margins with a red halo.
What is blepharitis?
Inflammation of the eyelid margins cauinf eye redness, irritation, FB sensation.
FLAKING AND CRUSTING of eyelids & lashes
What is the most common cause of blepharitis?
Staphylococci
treatment of blepharitis
warm compress, wash w baby shampoo. topical abx if refractory
What is cholesteatoma
keratinizing squamous epithelium cell grows in the middle ear.
primarily affect children
Presentation of cholesteatoma
foul-smelling otorrhea
conductive hearing loss
growth can destroy osscile, lead to facial nerve paralysis & temporal bone erosion.
Diagonisis of cholesteatoma
CT of the temporal bone.
surgery ( mastoidectomy) is indicated
anterior nose bleed site
kiesselbach’s venous plexus.
posterior nose bleed
sphenopalatine artery
treatment for anterior nosebleeds
Nasal decongestant (will cause vasoconstriction): Afrin, oxymetazoline, phenylephrine.
Silver nitrate stick for chemical cautery
viral conjunctivitis is cause by
it is the most contagious conjunctivitis caused by adenovirus. spread by direct contact
Bacterial conjuctivitis is cuased by
adults: staph aureus
Children: Strep pneumo
presentation of viral conjuctivitis
1) start unilaterally then bilaterally
2) pink or red conjunctiva
3) clear watery, stringy discharge
4) preauricular LAD
viral vs bacterial vs allergic conjuctivitis discharger
viral: watery & stringy
Bacterial: purulent, white, yellow/green discharge
allergic: watery, mucous discharge.
Bacteral Conjunctivitis presentation
1) unilateral
2) thick mucopurulent discharge
3) Crusting, difficulty opening eye in AM.
treatment for Bacteral Conjunctivitis
symptomatic management + macrolide eye drops
cipro if eye contact wearer.
Allergic Conjunctivitis presentation
1) bilateral eye itching
2) watery or stringy
3) conjunctiva edema
Allergic Conjunctivitis treatment
antihistamine drops: topical naphazoline/pheniramine
scrape/sratch injury on the corneal epithelium
corneal abrasion
Diagnosis of corneal abrasion
fluorescein staining
tx corneal abrasion
erythromycin drops
A serious infection affecting multple layers of the cornea that is seen in contact lens wearers
corneal ulcer
Physical exam finding of corneal ulcer
round or irregular ulcer w white hazy base.
corneal ulcer diagnosis
slit-lamp w/ fluorescein staining
Management for corneal ulcer
1) topic cipro for pseudomonas coverage
2) cyclopentolate for pain
3) emergent ophthalmology referral
a larger triangular fibrovascular wedge in the conjuctival tissue
pterygium
develops due to chronic UV light exposure.
starts medially(nose then growth laterally)
cause irritation and foreign body sensation
conservative management
an infectious obstruction of the nasolacrimal duct (inferomedial region)
dacryocystitis
erythema, edema, warmth & pain of medial cathus of the eye + purulent discharge.
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.
dacryocystitis
inflammation of lacrimal (tear-producing) glands usually caused by bacteria or a virus that initiates the inflammation (supratemporal)
Dacryoadenitis
triad of acute angle closure glaucoma
injected conjunctiva, steamy (cloudy) cornea, and fixed dilated pupil
Tonometry showing IOP >30 is diagnosistic for
acute angle closure glaucoma
cupping of the optic nerve may occur
1st line treatment for open angle glaucome
prostaglandins (Iatanoprost, travoprost)
Acute narrow angle-closure glaucoma
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
Trauma causes blood to collect in the anterior chamber of the eye
Hyphema
->eye-shield, pain drops & steriod drops
treatment for papilledema
acetazolamide to decrease IOP
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.
Macular degeneration: gradual painless central vision loss.
->metamorphopsia (distortion on amsler grid)
->dry macular degeneration (mc): gradual macula atropy (drusen bodies = yellow retinal deposits)
zinic & antioxidant vitamin
dry age-related macular degeneration
VEGF inhibitors (e.g., bevacizumab)
Wet age-related macular degeneration
true or false laryngitis is alway viral in nature with hoarseness following an URI
True
consider squamous cell cancer if it last >2 wks
tx w vocal rest
teardrop-shaped growths partially obstructing the nasal passages
nasal polyps
-> topical nasal corticosteroids
Peritonsillar abscess presentation
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
Centor score for strep pharyngitis
- Absence of a cough
- exudates
- fever (> 100.4 F)
- cervical lymphadenopathy
3 out 4 = rapid strep test
