HEENT Flashcards
If left untreated, strabismus can lead to what condition?
Amblyopia (or “lazy eye”)
Which cranial nerve palsies are associated with strabismus?
3rd (occulomotor)
4th (trochlear)
6th (abducens)
What are the 5 criteria for the Centor scoring system?
Used to determine need to complete a throat culture for strep pharyngitis
1. Fever
2. Tonsillar exudate
3. Anterior cervical adenopathy
4. Absence of cough
Rapid antigen testing should be done with scores greater than 2
What potential febrile condition can develop as a result of untreated group A strep pharyngitis?
Acute rheumatic fever
What is the most common cause of blepharitis?
Dysfunctional meibomian gland
What is the most common type of oral cancer?
Squamous cell carcinoma
What is the most common cause for auricular hematomas?
Blunt trauma to the ear (wrestlers) leads to blood accumulation
In conductive hearing loss, Weber will localize to what ear?
What is the most common cause of conductive hearing loss?
The affected ear
Cerumen impaction
What is the normal intraocular pressure?
10-20
What are the three auditory ossicles?
Malleus, incus, and stapes
Name three things that increase the risk of otitis media in a child?
- Smoker in the house
- Bottle Feeding
- Day Care
- Younger age
What is the most commonly affected sinus in acute sinusitis?
Maxillary
How do you treat allergic rhinitis?
Intranasal corticosteroid and antihistamines
Describe the results of a Weber test for a patient with conductive hearing loss
Sound is heard louder in the affected ear
What is the most common site of epistaxis?
Kiesselbach’s plexus
List a few possible causes of unilateral hearing loss
- Labyrinthitis
- Foreign body
- Acoustic neuroma
How long do typical episodes of vertigo last in Meniere disease?
1-6 hours
What is the first line treatment for seasonal allergies?
Intranasal steroids
Are anterior or posterior nosebleeds more common?
Anterior
Define conductive hearing loss
Problem is with conducting sound waves into the ear
Describe the results of a Weber test for a patient with sensorineural hearing loss
The sound will be louder in the unaffected ear
What is the treatment for an external ear hematoma
Drainage ASAP
If > 7 days urgent referral to ENT or plastic surgeon
What is a good first line antibiotic for otitis media
Amoxicillin x10 days
A patient presents with a hot potato or muffled voice. What is the most likely diagnosis?
Peritonsillar abscess
What is the first line treatment for small nasal polyps?
Topical intranasal corticosteroids for 1-3 months
Where do you place the tuning fork for a Weber test?
Middle of the forehead
A 45 year old female complains of feeling the ground rolling under her feet from time to time. The episodes are short. What is the most likely diagnosis?
Benign paroxysmal positional vertigo
What is the treatment of choice for strep throat?
Penicillins are the preferred choice; Penicillin V in adults and Amoxicillin in kiddos
Macrolides or cephalasporins may be used if there is an allergy
Small grouped vesicles on the vermillion border should make you think of what diagnosis?
Herpes
What is the longest time limit for using phenylephrine?
Five days due to rebound nasal congestion
How do you administer the Rinne hearing test?
Place a tuning fork on the mastoid and then move it next to the ear
Positive heterophile antibody should make you think of what diagnosis?
EBV - infectious mononucleosis
What does Kiesselbach’s plexus refer to?
A group of veins in the anterior nose, which are the most common site of epistaxis
Where is the problem located with sensory hearing loss?
The inner ear or the vestibulocochlear nerve
How do you make a definitive diagnosis of an acoustic neuroma?
MRI
What is the most important function of the Eustachian tube?
Equalizing pressure across the tympanic membrane
Are oral herpes best treated with topical or systemic antivirals?
Topicals are first-line
What is the first line treatment for symptomatic vertigo?
Antihistamines such as Meclizine
What is the most common presenting sign of an acoustic neuroma?
Unilateral hearing loss
A patient presents with right sided hearing loss and otorrhea. Otoscopic exam reveals a TM perforation with keratinized debris. What is the most likely diagnosis?
Cholesteatoma
A child presenting with an erythematous sandpaper rash and erythematous tongue should make you think of what diagnosis?
Scarlet Fever
A patient presents with a round ulcer in her mouth that is yellow-grey and has a red halo. It is on the buccal mucosa and it is painful. What is the most likely diagnosis?
Aphthous ulcer
A patient presents drooling, with stridor and in a tripod position. What diagnosis should you be concerned about?
Epiglotitis
A patient presents with a history of smoking presents with a new onset of hoarseness. This has been persistent. What is the most likely diagnosis?
Laryngeal squamous cell carcinoma
Describe the results of a Rinne test in a patient with conductive hearing loss
Sound will be louder with the tuning fork on the mastoid
No light reflex and a bulging tympanic membrane should make you think of what diagnosis?
Otitis media
If a patient is being seen with hearing loss related to cerumen impaction what will the Rinne test show?
Sound will be louder with the tuning fork on the mastoid
White oral lesions which can be scraped off leaving punctate bleeding should make you think of what diagnosis?
Oral candida
A white oral lesion which cannot be scraped off should make you think of what diagnosis?
Oral leukoplakia
What are the most common pathogens causing otitis externa?
Psuedomonas and Enterobacteria
What is required to make the clinical diagnosis of otitis media?
- Bulging tympanic membrane on exam
- Signs of acute inflammation (marked erythema of the TM, fever, or ear pain)
- Middle ear effusion
What are the most common etiologies of acute otitis media?
S. pneumonia, H. Influenza (more common to cause bilateral OM), chlamydia (< 6 months)
What are the indications for tympanostomy tubes?
What are other names for ear tubes?
- > 3 episodes of OM in the past 6 months
- > 4 episodes of OM in the past 12 months
Tympanostomy, myringtomy
What is the most common cause of fungal pharyngitis?
Inhaled steroid use
What is the presentation of mononucleosis?
What is the name of the viral test for mono?
- Fever
- Sore throat
- Lymphadenopathy
- Splenomegaly
Heterophile agglutination test (monospot)
What is the Centor Score?
Used to diagnose strep pharyngitis
Centor Score
1. Absence of a cough
2. Exudates
3. Fever (> 100.4 F)
4. Cervical lymphadenopathy
If 3/4 criteria are met get a rapid strep test
What type of lymphadenopathy is present in strep pharyngitis?
Cervical Lymphadenopathy
What is the first line treatment for group A strep?
What are complications associated with strep?
Penicillin
Azithromycin if penicillin-allergic
Rheumatic fever and post strep glomerulonephritis
What is the treatment for mononucleosis?
Symptomatic and avoid contact sports; antibiotics such as amoxicillin or ampicillin may cause a rash
For strenuous contact sports patients should stay out for four weeks after illness onset
A 4 year old girl presents with purulent yellow discharge around her eyes. You notice crusting. Her mother says she wakes up with discharge in her eyes and it improves throughout the day. What is the most likely diagnosis?
Bacterial conjunctivitis
Contact lens users are at a higher risk for conjunctivits caused by what pathogen?
What is the treatment?
Pseudomonas
Fluorquinolone (ciprofloxacin)
What are the 3 D’s of epiglotitis?
- Dysphagia
- Drooling
- Respiratory Distress
What virus causes supraglottic inflammation and obstruction of the airway?
Haemophilus influenza type B (Hib)
What classic finding is seen on x-ray with epiglotitis?
Thumbprint sign on lateral neck film from the swelling
A 2 year old arrives at the ED with a swollen and erythematous eyelid, proptosis, pain with movement of the eye, and an inability to adduct or abduct his eye. What is the most likely diagnosis?
What is the treatment?
Orbital Cellulitis
Hospitalization and IV abx (vanco)
What is the treatment for otitis externa?
Ciprofloxacin and dexamethasone drops for 7 days
What is exotropia?
Outward turning of the eyes
What is esotropia?
In turning of eyes
What results if strabismus isn’t treated before age 2?
Amblyopia (lazy eye)
A 10-year-old patient presents with nasal congestion and a clear nasal discharge for the past three weeks. He also has a frequent cough, especially at night. What is the most likely diagnosis?
Allergic Rhinitis
An 11-year-old boy with a peanut allergy suddenly develops hoarseness, difficulty breathing, and swollen lips after eating a snack at a party. The most immediate action should be:
Administer epinephrine
A 6-month-old female infant is brought to the clinic by her parents as a new patient for well-child examination. The patient was delivered at term and has been healthy. However, the parents are concerned that the patient sometimes seems cross eyed. Strabismus is suspected. Which test is most likely to confirm this diagnosis?
Cover Test
What class of antibiotics is non-ototoxic and can be used in a tympanic membrane perforation?
Floxacin drops
What is the name of a benign tumor of cranial nerve VIII?
Acoustic neuroma
What type of hearing loss is associated with normal aging?
Sensory
