HEENT Flashcards
Croupy Cough & Drooling, sore throat possibly Sniff Dog Position.
Epiglottitis
Do not examine throat. Secure Airway FIRST then give ABX
Thumb sign on X Ray
Epiglottitis
Epiglottitis Pathogen and Rx
H.Flu is #1 but can be Strep or Staph
GET/GIVE the Hib Vaccine!
Rx Cephtriaxone IM but obtain blood cultures first!
Thick Grey Adherent Exudate in the oropharynx
Diptheria
Low fever & sore throat then development of a grey pseudomembrane in the oropharynx that can actually block the airway. A classic sign with the membrane is the “Bull’s Neck” Thickening of the neck just below the jaw.
Dipheria can also present as cutaneous ulcerations
GET THE VACCINE
The pseudomembrane is HIGHLY infectious, it covers an ulceration.
Normal Weber Test
Tuning Fork on medial forehead - no lateralization of sound is normal.
Lateralization is abnormal
Normal Rinne Test
Sound is heard longer through air than through bone.
Fork is rung & placed on Mastoid, sound disappears and fork is moved to pinna. Sound should still be audible via air. If not, think blockage.
Adie’s Pupil
Slow pupillary rxn to light and accommodation
First Signs of Iron Toxicity
Vomiting & Bloody diarrhea
Iritis
Inflammation of the iris
this hurts each time the pupil accommodates
Rx is:
Corticosteroid drops to reduce inflammation BETHAMETHASONE DROPS
Anticholinergic drops (to dilate pupil and keep it from moving which causes pain) HOMATROPINE DROPS
Strabismus Test
Cover/UnCover Test
eyes are alternately covered. Direction of eye movement is noted when each eye is uncover
ESO= eyes move out when uncovered EXO= eyes move in when uncovered
Adie’s Pupil
SLUGGISH Rxn to light and better at accommodation
Rapid Onset N/V/Sever Vertigo without Tinnitus. Preceded by URI
Vestibular Neuronitis aka Labrynthitis
IV Rehydration can go a long way to relieve sxs
You’ll need to rule out Central Vertigo (CNS Causes like MS, Tumors, Cerebellar Insult/bleed) with careful Hx and even MRI but then H1 Blockade is a good option: Dramamine
Benedryl, Antivert… Might also try Scopolomine for N/V of motion sickness but anticholinergics are a mixed blessing…
Vertigo/Nausea occurs on change in position, especially head movement
BPPV
Benign Paroxysmal Positional Vertigo
Otoliths Knocked Loose
MOST COMMON CAUSE OF VERTIGO!!!
Dix-Halpike to Dx
Epley Maneuver to Rx
Send them to the chiropractor
Painless variable/gradual loss of vision.
Retinal Exam shows hemorrhages and a swollen optic disc
Central Retinal Vein Occlusion
Drainage of the retina is blocked, essentially it’s atherosclerosis.
There is a MAB for this (Lucentis) though it’s more for wet Macular Degeneration and I’m not sure how it works in a blockage. It inhibits angiogenesis, formation of collateral vessels, which, if there were no way to drain new vessels, would be a good thing to disrupt. It costs $2000 per dose and is injected into the vitreous humor.
For the record, Retinal ARTERY occlusion presents with SUDDEN painless loss of vision, not Variable or Gradual
“Flashes of light” + Floaters followed by
loss of vision “like a curtain pulled across my field of vision” Painless
Retinal Detatchment
Common in DM
