HEENT Flashcards
Allergic rhinitis common triggers
- Pollen
- Dust mites
- Pet dander
Allergic rhinitis treatment
Eliminate triggers
First line-medication: Fluticasone (Flonase) reduces inflammation in nasal passages
Antihistamines: Cetirizine (Zyrtec), Loratadine (Claritin)
Nasal saline rinse
Sinusitis signs and symptoms
Facial pressure, nasal congestion, reduced sense of smell
Sinusitis first-line treatments
Symptomatic relief: decongestants, nasal corticosteroids
Most cases are viral and will resolve on their own
What is sinusitis?
Sinuses become inflamed and swollen
Often follows viral URI leading to blocked drainage pathways and mucus in sinuses
Sinusitis indications for antibiotics
If symptoms last > 10 days or if symptoms worsen
Sinusitis first-line antibiotics
Amoxicillin or Augmentin
Orbital cellulitis
Complication of sinusitis
Infection involving tissues within orbit, can lead to vision loss
Signs and symptoms: severe eye pain, swelling, vision changes, bulging of eye, restricted eye movement, pain with eye movement
Refer to ED!
Preseptal cellulitis
Infection of eyelid and surrounding skin in front of orbital septum
Doesn’t typically affect vision
Symptoms: swelling/redness of eyelid, no eye pain or vision loss
Viral pharyngitis
Cough
Runny nose
Conjunctivitis
Bacterial pharyngitis
Sudden onset
Cough absent*
Palatal petechiae
White plaques
Signs and symptoms of tonsillitis
Swollen tonsils, sore throat, difficulty swallowing
Diagnostic tests for strep throat
Rapid strep test
Throat culture
First line treatment for strep throat
Penicillin V potassium
Amoxicillin
Epistaxis
Nosebleed
Epistaxis anterior bleed
Typically from Kiesselbach plexus
More common, less severe
Epistaxis posterior bleed
More serious, less common
Often require medical intervention
Epistaxis management
- Sit up and lean forward slightly
- Hold pressure for 10-15 minutes
- Potential nasal packing and topical vasoconstrictors (Afrin)
If bleeding persists/recurs, investigate for underlying disorders like HTN or clotting disorders
Why is epiglottis considered an emergency?
Can obstruct the airway
Common presentation of epiglottitis
High fever
Sore throat
Drooling
Difficulty breathing
Stridor **
**Tripod position **
Epiglottitis immediate management
Immediate ED referral
Preventive measure for epiglottitis
HIB vaccination
What is aphthous stomatitis?
Small, painful ulcers inside mouth
Aphthous stomatitis typical treatment options
Topical corticosteroids
Mouth rinse
How does chronic ulcerative stomatitis differ from canker sores?
Recurrent painful ulcers in mouth
Ulcers persist for a long time and resistant to standard treatments
Management of chronic ulcerative stomatitis
Hydroxychloroquine (Plaquenil)
What is geographic tongue?
Map-like patches on tongue
Geographic tongue treatment recommendations
Benign
Avoid irritants
Topical corticosteroids
Clinical presentation of leukoplakia
White patches on mucous membranes of mouth
Leukoplakia can be a sign of:
Oral cancer, or benign
Remove irritants like tobacco use
Oral hairy leukoplakia is usually found:
Sides of the tongue
Oral hairy leukoplakia is associated with which virus?
Epstein-Barr virus
Oral candidiasis typical presentation
White, creamy patches
Common patient populations at risk for oral candidiasis
Immunocompromised patients
Certain medications (steroids)
Prevention tip for patients using inhaled corticosteroids
Rinse mouth after inhalation
Treatment options for oral candidiasis
Antifungal (Fluconazole)
How to differentiate oral candidiasis from leukoplakia
Oral candidiasis: white patches can be easily scraped off
Leukoplakia: cannot be wiped off
What is otitis media?
Infection of middle ear
Most common pathogen of otitis media
S. Pneumoniae
Otitis media clinical findings
Ear pain, fever, hearing loss
Bulging red tympanic membrane
Otitis media treatment
Amoxicillin
What is otitis media with effusion?
Fluid in the middle ear without signs of infection
Common symptoms of otitis media with effusion
Ear fullness, hearing loss
Otitis media with effusion management
Usually resolves on its own
May need ENT referral for drainage of fluid
What is otitis externa (swimmer’s ear)?
Infection of external ear canal
Otitis externa clinical findings
Pain, discharge, ear swelling/redness
Otitis externa common pathogen
Pseudomonas
Otitis externa treatment
Topical antibiotics (ciprofloxacin drops)
Topical corticosteroid for pain
Otitis externa treatment if tympanic membrane is ruptured
Avoid neomycin/gentamicin drops
What is a cholesteatoma?
Abnormal growth of skin cells in the middle ear, right behind eardrum
Cholesteatoma symptoms
Hearing loss, discharge
Cholesteatoma exam findings
Retraction pocket or white mass behind eardrum (cauliflower-like mass)
Cranial nerve that can be impacted with cholesteatoma
CN VII (Facial)
Can erode bones of middle ear
What can cholesteatoma lead to?
Facial paralysis
Cholesteatoma management
ENT referral
What is conductive hearing loss?
Occurs when sound waves can’t reach the middle ear
Causes of conductive hearing loss
Ear wax, otitis media, perforated eardrum
Think “C” for conductive as “see” (caused by things you can see)
What is sensorineural hearing loss?
Involves damage to middle ear or auditory nerve
Causes of sensorineural hearing loss
Aging, noise exposure, ototoxic medications
Rinne test is best for identifying:
Conductive hearing loss
Rinne test normal (positive) result
AC > BC
Rinne test result in conductive hearing loss
BC > AC
How is the Rinne test performed?
Strike tuning fork, then place under pinna on mastoid process. When sound stops, move tuning fork in front of ear
Rinne test memory trick
Rinne under the pinne
How is the Weber test performed?
Place struck tuning fork on center of forehead, ask which ear sound is heard better in
Weber test normal finding
Sound does not lateralize (sound equal in both ears)
Weber test, sounds lateralizes to the affected ear in:
Conductive hearing loss
Weber test, sounds lateralizes to the unaffected ear in:
Sensorineural hearing loss
What is benign paroxysmal positional vertigo (BPPV)?
Tiny crystals in the inner ear become dislodged and move into ear canal
BPPV diagnostic maneuver
Dix-Hallpike maneuver
Have patient quickly lie back with head turned to one side. If vertigo and nystagmus triggered, positive test
BPPV treatment maneuver
Epley maneuver
What is Ménière disease caused by?
Fluid imbalance in inner ear
Ménière disease typical presentation
Recurrent episodes of vertigo, tinnitus, hearing loss, and ear pressure
Usually unilateral
Possible nystagmus
Biggest concern with Ménière disease?
Potential permanent hearing loss
Causes of lymphadenopathy
Infections, autoimmune diseases, malignancy
Lymphadenopathy common locations
Cervical
Axillary
Inguinal
When should we worry about lymphadenopathy?
If hard, fixed, or nontender
Symptoms along with lymphadenopathy that raise concern for malignancy
Fever, night sweats, weight loss
Concern for malignancies such as lymphoma
When do we refer out for visual acuity?
20/40 or worse in either eye
Refer to optometrist for corrective lenses
What result qualifies as legal blindness?
20/200
What is the Ishihara test used to assess?
Color vision
Why do we assess the red reflex?
Check for abnormalities in the back of the eye
How do we perform red reflex test?
Use an ophthalmoscope to look for red reflection from retina when light shined into the eye
Red reflex test normal and abnormal findings
Normal: red, uniform
Abnormal: white reflection (leukokoria) or dark spots can indicate cataracts, retinoblastoma, or other ocular pathologies
Amblyopia causes
Strabismus
Difference in prescription between two eyes
Amblyopia treatment
Correct underlying causes
Glasses, eye patch
Bacterial conjunctivitis presentation
Unilateral, then spreads to other eye
Purulent drainage
Viral conjunctivitis presentation
Unilateral, then spreads to other eye
Serous/watery drainage
Preauricular or submandibular lymphadenopathy
Allergic conjunctivitis presentation
Bilateral
Serous/watery drainage, stringy/ropy
Bacterial conjunctivitis treatment
Antibiotic eye drops
Viral conjunctivitis treatment
Symptomatic treatment
Allergic conjunctivitis treatment
Antihistamine or antiinflammatory eye drops
What is blepharitis?
Inflammation of eyelid margins
Blepharitis clinical findings
Redness
Irritation
Crusting
Blepharitis treatment
Good eyelid hygiene
Warm compresses
Antibiotic/steroid eye drops if needed
What is a hordeolum (stye)?
Acute, painful infection of eyelash follicle or sebaceous gland
What causes hordeolums?
Staphylococcus
Hordeolum clinical findings
Red, swollen bump on eyelid
Hordeolum treatment
Warm compresses
Topical antibiotics as needed
Difference between a chalazion and a hordeolum?
Chronic, painless lump in the eyelid
Not an infection
Chalazion treatment
Warm compresses
Gentle massage
What are subconjunctival hemorrhages?
Small blood vessels break under the conjunctiva
Subconjunctival hemorrhage clinical findings
Bright red patch on white part of eye
Subconjunctival hemorrhage treatment
Usually resolve on their own
No treatment typically needed
Consider underlying conditions such as HTN or blood disorders
What is a pterygium?
Benign growth of the conjunctiva that encroaches onto the cornea
Major cause of pterygium
UV exposure
Pterygium symptoms
Redness, irritation
Visual impairment in advanced cases
Pterygium prevention
Wear sunglasses with UV protection
What is a pinguecula?
Yellowish benign growth, usually near the cornea
Pinguecula symptoms
Generally asymptomatic
May cause irritation
Pinguecula treatment
Lubricating eyedrops
Sunglasses with UV protection
Pi_n_guecula memory trick
Remember the “n” for not crossing cornea
What are xanthelasmas?
Yellowish plaques that occur on the eyelids due to lipid accumulation
Condition we should be concerned about with xanthelasmas?
Dyslipidemia
What is arcus senilis?
Gray or white arc visible above and below outer part of cornea
Watch for dyslipidemia
Keratoconjunctivitis sicca is commonly known as:
Dry eye syndrome
Keratoconjunctivitis sicca symptoms
Burning, redness, blurred vision
Keratoconjunctivitis sicca risk factors
Aging, staring at screens, environmental factors (wind or dry air)
Keratoconjunctivitis sicca treatment
Artificial tears
Lubricating eye drops
Lifestyle modifications (cut back on screen time, humidifier)
What is AV nicking?
Arteries cross and indent a vein in the eye which causes compression of the vein
Associated with chronic hypertension
What are copper wire arterioles?
Arterioles become thickened and copper colored due to chronic hypertension
Associated with chronic hypertension
What are flame hemorrhages?
Flame shaped hemorrhages in the retina
Associated with chronic hypertension but may be caused by other conditions that cause retinal bleeding
What are cotton wool spots?
Fluffy white patches on the retina caused by microinfarctions of the retinal nerve fiber layer
Cotton wool spots underlying conditions
Diabetes
Hypertension
Cotton wool spots indicate:
Part of the retina isn’t getting enough blood flow (retinal ischemia)
What is papilledema?
Swelling of the optic disc due to increased intracranial pressure
Sudden onset of vision changes, including blurred or double vision, flickering, and loss of vision lasting seconds at a time
What does papilledema look like on the fundoscopic exam?
Blurred or elevated optic disc
Why is papilledema an emergency?
Indicates that something is increasing ICP (brain tumor, hemorrhage, severe head injury)
Central retinal artery occlusion (CRAO) common clinical presentation
Sudden, painless vision loss in one eye due to obstruction of central retinal artery leading to retinal ischemia
CRAO fundoscopic exam findings
Sudden, painless vision loss (curtain coming down)
Pale retina with cherry red spot at the fovea
CRAO management
ED or urgent ophthalmology referral
Glaucoma is characterized by:
Increased intraocular pressure leading to optic nerve damage
Which type of glaucoma is most common?
Open-angle glaucoma
Open-angle glaucoma
Drainage angle for eye fluid remains open, but trabecular meshwork is partially blocked
Open-angle glaucoma symptoms
Asymptomatic early
Peripheral vision loss with progression
How do we measure intraocular pressure?
Tonometry
Acute angle-closure (closed-angle) glaucoma
Drainage angle is completely blocked which leads to rapid rise in intraocular pressure
Closed-angle glaucoma symptoms
Severe eye pain, redness, headache, blurred vision
Closed-angle glaucoma management
Emergency!
Immediate treatment needed to prevent vision loss
Closed-angle glaucoma treatment options
Beta blockers
Prostaglandin analogs
Surgery
Retinal detachment
New onset floaters, flashes of light, curtain-like shadow over visual field
What causes retinal detachment?
Retina separates from underlying tissue
Retinal detachment management
Prompt surgical intervention to prevent permanent vision loss
Most common cause of difficulty seeing at night
Cataracts
Cataracts occur when the lens of the eye:
Becomes cloudy
Cataracts clinical findings
Blurred vision, difficulty seeing at night, light sensitivity, halos around lights
Cataracts curative treatment
Surgical removal of cloudy lens and replacement with artificial lens
Central vision loss is consistent with:
Macular degeneration
Dry (atopic) macular degeneration
Most common type!
Characterized by gradual thinning of the macula, usually progresses slowly
Wet (neovascular) macular degeneration
More severe!
Caused by abnormal blood vessel growth under retina that can lead to rapid vision loss
Treatment: medications, laser therapy
Eye pain, redness, tearing, and sensitivity to light after mowing the grass, what is the diagnosis?
Corneal abrasion
Corneal abrasion causes
Minor trauma, foreign objects (dirt, grass, sawdust)
Corneal abrasion diagnostic test
Fluorescein staining
Corneal abrasion treatment
Antibiotic eye drops
What if they wear contact lenses and have a corneal abrasion?
Stop wearing contacts until healed
What neurologic condition predisposes patients to corneal abrasion?
Bell palsy
What is iritis?
Inflammation of the iris
Iritis typical clinical presentation
Pain, redness, photophobia, decreased vision
Iritis hallmark physical exam finding
Constricted pupil that may be irregular
Iritis management
Immediate ophthalmology referral for treatment with corticosteroids and pupil dilating drops
What is herpes keratitis?
Infection of cornea causes by herpes
Herpes keratitis clinical presentation
Eye pain, redness, blurred vision, discharge
How do we confirm diagnosis of herpes keratitis?
Look for presence of dendritic ulcers on the cornea by using fluorescein staining
Herpes keratitis treatment
Antivirals
Refer to ophthalmology
