HEENT Flashcards
1
Q
Conjunctivitis Visual acuity Pain FB sensation Photophobia Discharge
A
VA- no Pain- no FB- gritty Photophobia- no D/c- yes
2
Q
Subconjunctival hemorrhage Visual acuity Pain FB sensation Photophobia Discharge
A
NO TO ALL
caution on coumadin check INR
3
Q
Blepharitis Visual acuity Pain FB sensation Photophobia Discharge
A
VA-no Pain- no FB- no Photophobia- no d/c- yes crusting yellow
4
Q
Stye
A
pimple, painful, erythema
5
Q
Chalazion
A
plugged membolian gland, not painful
6
Q
Open angle glaucoma Visual acuity Pain FB sensation Photophobia Discharge
A
Visual acuity YES Pain YES FB sensation Photophobia YES Discharge
EMERGENCY
headache nausea vomiting
7
Q
Physical exam findings acute angle glaucoma
A
hand over eye
pupil- abnormal, fixed
cloudy haze over eye
ciliary flush
8
Q
Foreign body Visual acuity Pain FB sensation Photophobia Discharge
A
Visual acuity Pain maybe FB sensation Yes Photophobia maybe Discharge Yes-watery
9
Q
Corneal abrasion Visual acuity Pain FB sensation Photophobia Discharge
A
Visual acuity maybe Pain yes FB sensation YES!! cornea= fb sensation Photophobia yes Discharge watery
10
Q
Keratitis- define Visual acuity Pain FB sensation Photophobia Discharge
A
infection of cornea Visual acuity probably Pain yes FB sensation yes Photophobia yes Discharge various (herpes, bacterial from contacts)
REFER to OPTHAMOLOGY
11
Q
Episcleritis- define Visual acuity Pain FB sensation Photophobia Discharge
asociated with??
A
infection on top of sclera Visual acuity no Pain ache FB sensation no Photophobia no Discharge no
superficial gritty
chrons lyme
12
Q
Scleritis Visual acuity Pain FB sensation Photophobia Discharge
associated with??
A
Visual acuity Yes Pain Yes FB sensation No Photophobia Possible Discharge Tearing
need to be seen by opthamology within 48 hours for ocular steroids
autoimmune: RA lupus
13
Q
Iritis-define Visual acuity Pain FB sensation Photophobia Discharge
PE FINDING
associated with:
A
inflamed ciliary body Visual acuity Yes Pain Yes FB sensation No Photophobia YES (INTENSE) Discharge watery or none
pinpoint pupil doesn’t respond to light
associated with: idiopathic or undiagnosed syphillis sarcoid
Opthamology within days
14
Q
Hyphema- define Visual acuity Pain FB sensation Photophobia Discharge
A
blood anterior chamber Visual acuity yes Pain yes FB sensation no Photophobia no Discharge no
trauma
15
Q
Hypopion-define Visual acuity Pain FB sensation Photophobia Discharge
A
pus anterior chamber Visual acuity yes Pain yes FB sensation no Photophobia no Discharge
keratitis—
16
Q
Pterygium and Pinguecela Visual acuity Pain FB sensation Photophobia Discharge
A
NO to all
pterygium- spend outside time on water; overgrowth of clear tissue not harmful
pinguecela- same but doesn’t cross into the iris
17
Q
Eye conditions to refer
A
keratitis scleritis iritis hyphema hypopion GLAUCOMA
18
Q
Conjuncitivitis
Organisms
Treatment
A
Staph, strep pneumo, h. flu (esp. kids)
also pseudomonas
Erythromycin ointment if pseudomonas (contact lens wearer) then fluoroquinolone like cipro or tobrex
19
Q
Conjunctivitis Bacterial Viral Allergic Chemical
A
bacterial- kids, unilateral, d/c throughout day not just morning, thick globby
viral- watery, stringy, clear, bilateral, cold or URI
allergic- itchy, watery, other sx sneezing or conj edema
chemical- swimming, pool, sunscreen, mixed up eye drops
20
Q
Open angle glaucoma
what vision problem? symptoms? PE?
Macular degeneration? common in?
A
peripheral vision loss, painless, increased cup to disc ratio
increased risk: + fh, AA, diabetic
central vision loss, women/europen/fair skin, smoking, family hx/sun exposure
21
Q
Blepharitis
organism
can lead to?
treatment
what if suspected cellulitis?
associated with??
A
-staph
-can lead to stye or chalazion
-erythromycin
if suspected cellulitis need abx stable in presence of beta lactamase- do not choose 1st generation cephalosporin like keflex- choose dicloxacillin or 2nd gen like levaquin
associated with eczema or seborrhea
22
Q
Angular chelitis
organism
A
candida albicans, staph
treat with nystatin
htn
23
Q
white/red painless patch in mouth
risk
A
squamous cell carcinoma: back in two weeks send to ENT if didnt go away
risk: smoking, etoh, chewing tobacco
HPV- young men
24
Q
Oropharyngeal candidiasis
treatment
A
nystatin
clotrimazole lozenges
25
Canker sore aka
caused by
PE
treatment
aphthous ulcer
stress, food sensitivity, b12 deficiency, cbc
grey flatish with erythema painful
triamcinolone-oral steroid in orabase QID TID
magic mouthwash
26
Sinusitis
symptoms
Exam
Treatment when?
pain pressure halitosis fever headache cough
PE: bacterial red maybe just one side (unilateral, hurts here)
+/- transillumination (doesnt diff. between viral and bacterial)
Sx >10d
double sickening
severe 3-4 days (fever 102, purulent drainage, facial pain)
27
Sinusitis orgranism
Sinusitis treatment
PCN allergic?
Kids?
2nd line for tx failure
s. pneumo, h. flu, m. catarrhalis
Augmentin/amoxicillin
allergic: doxy
kids allergic: cefixime + clindamycin, levaquin
5-7 days adults, 10-14 days kids
2nd line: high dose augmentin, cefixime,
28
Sinusitis treatment
improve within ____
consider starting 2nd line drug for:
3-5 days
```
age 65
antibiotics in last month
hospitalization past 5 days
comorbidities
immunocompromised
```
29
Presbyscusis:
slowly progressive ____
_____ goes first
usually _____
Presbyopia: define, difficulty with ___
cataracts are ____
hearing loss, high frequency goes first, usually bilateral
presbyopia: hardening of lens, difficulty with near vision
cataracts are common
30
Pediatric bacterial pharyngitis
Classic presentation:
Accounts for ___ to ___% of all cases of pharyngitis age ___ to ____
occurs during which season?
Which age group?
may not have a fever
wake up with headache, abdominal pain, n/v *sandpaper rash
other: exudates, white coating of tongue, petechiae, inflamed uvula, tender ANTERIOR cervical nodes
15-30% of all cases age 5-15
Winter and early spring
School age* but younger if contact
31
Pediatric bacterial pharyngitis
When do you treat?
Incubation period
Clinical improvement
in pediatrics should be confirmed with throat culture before initiated
2-4 days; fever/symptoms usually resolve 3-4 days even without abx
Improvement within 48 hours
32
Pedatric bacterial pharyngitis
Treatment
If allergic?
Oral pen v X10 days
Amoxicillin is recomennded for children because it comes as chewable, good flavors
Macrolides, azithromycin
Rapid strep + TREAT - culture
33
Complications of group A strep
NONSUPPURATIVE
SUPPURATIVE
NONSUPPURATIVE: Acute rheumatic fever, scarlet fever, streptococcal toxic shock syndrome, acute glomerulonephritis, PANDAS
SUPPURATIVE (EXUDATE ASSOCIATED)
tonsillopharyngeal cellulitis or abscess, OM, sinusitis, necrotizing fascitis, strep bacteremia, meningitis or brain abscess
34
Epiglottitis
Define
Symptoms
Bacteria
Treatment
Inflammation of epiglottis (anterior to larynx)
Abrupt rapid- THREE D's
Dysphagia, drooling, distress
Tripod position
H.flu*** less frequent because of vaccine
3rd generation:
Ceftriaxone or cefotaxime +
Clindamycin or vancomycin
35
Mononucleosis
Classic presentation
PE findings
fever, pharyngitis, adenopathy, fatigue, atypical lymphocytosis
PE: *Lymph nodes: POSTERIOR cervical node enlargement (unilateral or bilateral) *Splenomegaly (50-60% of patients fade by 3 weeks)
*Maculopapular rash (follows ampicillin or amoxicillin)
36
Mononucleosis
Diagnosis
```
*+ Epstein Barr titer OR + monospot
(if only been 4 or 5 monospot will be -, Epstein barr will be positive right away: 2 weeks probably monospot +)
*Lymphocytosis
*10% atypical lymphocytes on smear
*Elevated LFT
```
Epstein barr- sore throat, fever, malaise, lymphadenopathy (adolescent think mono)
37
Monospot based on the detection of _____
heterophile antibodies (antibodies to epstein barr virus)
38
Mononucleosis
| transmission
salivary secretions
EBV can be shed in the oropharynx for a decade, doesn't mean will pass it on for all those years
39
Mononucleosis
Treatment
Sports
May do short burst steroid if really uncomfortable
SUPPORTIVE care
Tylenol or NSAID
Rest
Sports: 50% develop enlarged spleen, avoid activities for rupture* also fatigue
Can monitor lymphocytes (variable wait 2-4 weeks without activity)
40
```
Otitis Media
Incidence
how many by one year?
how many by two-three years?
Boys vs. girls
```
Most common office visit
60-80% have by one year
80-90% by 2-3 years
Boys more common
41
Otitis Media
Preceded by
Structure
viral URI-->edema, congestion
Eustachian tube more horizontal, doesn't angle to drain
42
```
Otitis media
Age:
Predisposing factors:
Highest risk:
Other risks:
```
Age: 6-18 months of age
Predisposing: Bottle feeding,day care
Highest risk: URI
Other risks: Tobacco smoke air pollution
43
OM
| Organisms
Streptococcus pneumonia
Haemophilus flu
Moraxella catarrhalis
Even with pneumococcal vaccine, these remain consistent
44
OM
| insufflator
want drum to move back and forth= healthy
| doesn't move= not healthy
45
OM S/S
Ear pain (tugging, not eating if
46
Differentiate acute otitis media (AOM) from otitis media with effusion
with effusion= bulging TM, no light reflex
| this is more common
47
Treatment OM
2nd line:
If h. flu suspected?
If allergy?
First line: amoxicillin
90 mg/kg (2 doses) X 10 days
2nd line:
Augmentin or beta-lactam abx
H. flu (conj, congestion, cough TRIPLE C)=
Augmentin
Allergy: azithromycin
48
Most common cause of tonsillitis in children
Adenovirus
49
Viral pharyngitis
| Etiologic agents
```
Respiratory viruses
Adenoviruses
Coxsackie A virus
Influenza
Parainfluenza virus
```
50
Viral pharyngitis
Most common cause and where it is found
Associated with
Duration
Adenovirus daycare centers and households with young children
Respiratory febrile illness, young children
5-7 days, can persist 2 weeks
51
Adenovirus transmission
cause of
transmitted by
killed by
treatment
Viral pharyngitis, febrile respiratory illness in young children
aerosol droplets
fecal oral
contaminated fomits
survive for long periods BLEACH
treatment: supportive
52
```
Adenovirus symptoms
Two main:
Associated with:
Other general symptoms:
Symptoms that may be confused with other illness:
```
pharyngitis coryza
(associated with conj, laryngirtis, bronchitis, OM, pneumonia) most common cause tonsillitius
Fever malaise, HA, myalgia, abdominal pain
Exudative tonsillitis and cervical adenopathy (may be indistinguishable with group A strep)
