HEENT Flashcards
1
Q
Eye physical exam
A
inspect, extraoccular movement, visual fields, visual acuity, PERRLA, fundoscope
2
Q
Hyperopia/Myopia/Presbyopia
A
hyperopia = farsighted – myopia = nearsighted Presbyopia - needs reading glasses common after age 40
3
Q
Chalazion
A
chronic inflammatory lesion develops when meibomian tear glad becomes obstructed. Starts with eyelid swelling and erythema and then evolves into a painless, rubbery nodular lesion. Seen in pts with blepharitis or rosasea. Hordeolum leads to these. Painless. Nontender. No discharge. Can cause astigmatism from pressure.
4
Q
Chalazion Treatment
A
Small ones resolve without treatment. Larger use a hot compress and allow them to drain. If symptomatic may need I and D or opthamology to use glucocorticoid injection. Chronic check for carcinoma.
5
Q
Hordeolum
A
Acute purulent inflammation of the eyelid. Commonly caused by Staph Aureus. Internal: inflammed meibomian gland under the conjunctival eyelide. External: sty, on the eyelash follicle or tear gland. TENDER red bump.
6
Q
Treatment Hordeolum
A
Both internal and external hordeola can be treated with warm compresses, placed off and on for about 15 minutes at a time approximately four times per day If the Hordeolum does not reduce in size within one to two weeks, refer to an ophthalmologist for consideration of I and C, Topical bacitracin or erythromycin optic ointment.
7
Q
Periorbital cellulitis
A
Eyelid and facial swelling, low grade fever, recent sinusitis. Usually caused by staph/strep. Clindamycin x 10 days. Clinda covers MRSA and all 25 strep.
8
Q
Orbital Cellulitis
A
Pain with eye movement, lid and facial swelling, orbital cellulitis affecting orbital muscles = pain w movement, can lead to orbital abscess and meningitis, encephalitis. Treat w Vanco or Rocephin
9
Q
Need to be mgmt by opthamologists
A
acute angle closure glaucoma, iritis and infectious keratitis
10
Q
Conjunctiva portion covering the globe and the lid
A
globe - bulbar and lid - tarsal
11
Q
Bacterial Conjunctivitis
A
normal vision, mucopurulent discharge, discharge all day. highly contagious. caused by staph, strep, hem influenza, and moraxella. eye redness and eye discharge usually unilateral. stuck shut in the morning. yellow white and green discharge all day long. purulent discharge.
12
Q
Tx Bacterial Conjunctivitis:
A
Erythromycin 5mg/gram ointment 4 x a day x 1 week or Azithromycin 1% 1 drop BID x 2 days then 1 drop daily 5 days
13
Q
Hyperacute Bacterial Conjunctivitis
A
Neisseria species, particularly N. gonorrhoeae, can cause a hyperacute bacterial conjunctivitis. The organism is usually transmitted from the genitalia to the hands and then to the eyes, usually presents w urethritis, chemosis, lid swelling and tender preauricular lymphadenopathy. Starts within 12 hours of inoculation. Tx Ceftriaxone IM can lead to blindness need to be hospitalized
14
Q
Viral Conjunctivitis
A
Typically caused by adenovirus. May be part of a viral prodrome. normal vision, mucoserous discharge, “gritty” “burning” “sandy” , preauricular lymph node, tarsal conjunctiva may be bumpy, hx URI. second eye involved 24-48 hours.
15
Q
Viral Conjunctivitis tx
A
Cool compress, decongestant, handwashing
16
Q
Epidemic keratoconjunctivitis(EKC)
A
A form of viral conjunctivitis; the corneal and conjunctival epithelium are both involved.
Caused by adenovirus 8, 19, 37. same s.s as viral, may also feel multiple FB sensations caused by corneal infiltrates. may threaten vision, refer to opthalmology
17
Q
Allergic Conjunctivitis
A
Caused by airborne allergens contacting the eye that release of chemical mediators including histamine, eosinophil chemotactic factors, and platelet-activating factor
presents as bilateral redness, watery discharge, and itching Itching is the cardinal symptom of allergy, distinguishing it from a viral etiology. Normal vision. Watery discharge. Prominent chemosis. Diffuse injection, watery discharge, may have morning crusting May have extreme bullous chemosis if hypersensitive to cats
18
Q
Treat for Allergic Conjunctivitis
A
Naphcon-A occurlar decongestant or mast cell stabilizer Patonol
19
Q
Nonallergic Noninfectious Conjunctivitis
A
Bilateral red eye and discharge that is mucus. Cause is transient mechanical or chemical insult
20
Q
Red eye with change of vision can be these:
A
Iritis, acute closed angle glaucoma, Keratitis
21
Q
Keratitis s/s
A
pupil very small, 1-2mm and very photophobic
22
Q
Closed angle glaucoma s/s
A
pupil is midsize 4-5mm and fixed does not react to light, also has corneal edema and high intraoccular pressure
23
Q
very small pupils 1-2mm
A
corneal abrasion, infectious keratitis, iritis
24
Q
test for corneal abrasions
A
flouroscein examination
25
purulent discharge found in
bacterial conjunctivitis and bacterial keratitis
26
emergent referral red eye
angle closure glaucoma, hyphema, hypopyon, bacterial keratitis. urgent- iritis, viral keratitis
27
Blephoritis and treatment
pink eyelid edges, crusting, Chronic inflammation. Treatment: clean with diluted baby shampoo
28
Pseudomonas and treatment
pink eye with no or minimal discharge, no change in vision, wears contacts. need a fluroquinolone -- cipro or moxi
29
Corneal abrasion and treatment
normal or decrease acuity, photophobia, FB sensation, watery discharge need fluroscein stain. if >2mm need opthamology. give abx to prevent corneal ulceration. Treatment: topical abx.hx of Trauma or contacts. will see epithelial defect on exam. Treat need pain control, topic abx no eye patch no topic pain relievers.
30
Corneal ulcer
pain, sensitivity to light, acuity normal or decreased, purulent discharge, FB sensation, white infiltrate. cornal opacification. refer 12-24 hours need culture and topic fq antibiotics. can lead to corneal scaring and perforation
31
At risk for glaucoma
increased IOP, myopia, DM, blacks, elderly, hypothyroid, family hx, htn
32
Patho of open angle glaucoma
In open-angle glaucoma, optic nerve damage results in a progressive loss of retinal ganglion cell axons, which is manifested initially as visual field loss and, ultimately, irreversible blindness if left untreated. related to increased aqueous production and decreased outflow
The optic nerve or "disc" takes on a hollowed-out appearance on ophthalmoscopic examination, which is described as "cupping."
33
s/s open angle Glaucoma
peripheral field loss then central loss, slow onset, IOP > 22,
34
angle closure glaucoma patho
When this drainage pathway is narrowed or closed, inadequate drainage leads to elevated intraocular pressure and damage to the optic nerve . Acute angle-closure glaucoma occurs in eyes with a certain anatomical predisposition. It presents as a painful red eye and must be treated within 24 hours to prevent permanent blindness
35
s/s closed angle glaucoma
severe unilateral eye pain, blurred vision, halos, photophobia, nausea, conjunctival erythema, and corneal edema.
36
Glaucoma screening
A typical frequency for repeat evaluation for individuals between ages 40 and 60 is every three to five years for those without risk factors
every one to two years for those with one or more risk factors The AAO also suggests periodic examination for black men and women between ages 20 to 39.
37
Optic disc cupping
A cup whose diameter is greater than 50 percent of the vertical disc diameter is indicative of glaucoma
38
Cataract
Opacity of the lens, age related after age 70 some sort of cataract is expected, s/s frequent glasses prescription changes, film over the eye, halos pt c/o problem driving at night or reading signs, fine print. increased nearsightedness.
39
Risk factors for cataracts
age, smoking, alcohol, low education, malnutrition, inactivity, sunlight, metabolic syndrome, diabetes, systemic corticosteroid use, statin use
40
immature cataract
can view the retina and transmits the red reflex
41
mature cataract
no longer transmits red reflex
42
hypermature cataract
brown nucleus, white liquified cortex,
43
diagnosis of cataract
painless decline in vision, fundoscopic exam to see lens opacity, may have darkened red reflex or opacities in red reflex -- need opthamologic exam non urgent
44
patho retina detachment
Retinal detachment occurs when the multilayer neurosensory retina separates from the underlying retinal pigment epithelium and choroid, can be caused by leak in the retina or a break
45
vitreous traction
a condition in which the vitreous gel has an abnormally strong adhesion to the retina.
The gel tends to pull forward and can cause vessel and retinal distortion causing retinal swelling and decreased vision
46
s/s retinal detachment
floaters like cobwebs or houseflies, caused by the vitreous gel separating from the retina, at night may see flashes of light -- need urgent evaluation
47
Iritis/Uveitis
Reduced visual acuity,(+) photophobia, pain, no discharge , MIOTIC or irregular pupil, PERILIMBAR flush
48
Impacted cerumen s/s
Dizziness, hearing loss, tinnitus, discomfort and otitis externa
49
Treatment for Impacted Cerumen
3% hydrogen peroxide or mineral oil/almond oill/olive oils or debrox which is non water and non oil. Can manually use a curette, forceps or spoon
50
impact on hearing loss on the elderly
social isolation, personal safety, communication
51
Neurosensory loss
From hairs in ear not converting sound, from age presbycusis
52
Conductive loss
mechanical from wax, ear drum, bones, fluid in middle ear
53
If abrupt or acute hearing loss
refer immediately
54
Subjective questions to ask for hearing loss
head injury, noise exposure, ototoxic medications like aspirin, aminoglycosides, furosemide, quinine drugs. S/s of vertigo, pain, fullness, tinnitus, cranial neuropathies
55
Objective Exam hearing loss
head and neck, test cranial nerves, use pneumatic otoscope for TM mobility, auditory tests like weber (normal heard equal both ears) it will lateralize to the bad year if conductive loss, and lateralize to the good ear if sensorineual loss. Rinne normally AC
56
Diagnostics hearing loss
Audiometry - pure tone, speech and impedance. MRI or CT. Labs: CBC r/o anemia, infection. VDRL or RPR r/o syphillis. Rheumatoid factors. TSH for hypo or hyperthyroid
57
MGMT hearing loss
Refer to ENT or audiology. Treat any infections. Hearing aid if conductive loss. Surgery for: 1 tumors, 2 TM perforation patch, 3 otosclerosis (progressive disease affecting the bone surrounding the inner ear and footplate of stapes)
58
Presbycusis
age related hearing loss, degeneration within the cochlea, sensorineual, usually both ears, treatment: better communication, hearing aids but 3000 each, cochlear implants
59
Vertigo
room spinning. DD: presyncope, dizziness, benign parozymal positional vertigo, labyrinthritis, meniere's disease. Most are benign positional.
60
Test for vertigo
Dix Hallpike manuever
61
Middle ear disorders
1) acute otitis media 2) otitis media with effusion 3) middle ear effusion
62
Otitis Media
Eustachian tube dysfunction where it is not draining the ear fluid may be resulting from congestion which impedes drainage, caused from an URI with edema. May be from secretions building up and increased bacteria. Half the time they are bacterial. Narrow ET in children, greater risk. Also high risk are smokers and those exposed to second hand smoke. ET Tube dysfunction, sequelae of URI w middle ear congestion, leads to increase in infection there
63
s/s Otitis Media, Caused by
Inflamed middle ear with acute onset of ear pain, otorrhea if severe, distorted TM, systemic symptoms. Caused by step pneumoniae, hemop influenza and moraxella. Pneumatic Otoscopy - if no fluid the TM will move, if there is fluid it will not move
64
OME v AOM
OME fluid is trapped in the middle ear and inflammed. AOM fluid is trapped in the middle ear and becomes INFECTED.
65
Otitis Media Mgmt
Acetaminophen for pain. Amoxicillin 500mg TID x 7 days or Ceftin or Azithromycin follow up in 2-3 days. Decongestants, humidifiers. Abx only if suspect bacterial.
66
Otitis Externa
Cellulitis of externa ear canal, known as swimmers ear. Presents w unilateral pain worse when moving tragus, fullness, itching, drainage or otorrhea with debris, low grade fever, possibly hearing loss if obstructed ear canal blocking TM
67
Otitis Externa Exam
Some lymphadenopathy, pain when move the ear, redness and swollen ear canal, exudates in the canal, blocked TM, c&s of drainage, if malignant need CT or MRI
68
OE mgmt
NSAIDs, topical med with wick. Uncomplicated: staph: yellow, crusting give Corticosporin Optic 4 drops 4 x a day x 7 days. Pseudomonas is green drainage. Give corticosporin. Fungal white and fluffy, fluconazole 200mg
69
Malignant otitis externa
life threatening, more common in dm and immunocompromised, due to pseudomonas, s/s: severe pain, necrosis, osteomylitis. need to be hospitalized. give quinolones. IV abx may be needed
70
Cholesteatoma
middle ear or mastoid secondary to a tympanic membrane perforation or as a primary lesion, commonly from ET dysfunction
71
Primary Cholesteatoma
Prolonged exposure to negative middle ear pressure causing the tympanic membrane to retract, a pocket may get stuck behind TM causing inflammation, this creates keratinized squamous debris leading to cholesteatoma. can cause errosion of ossicles leading to hearing loss
72
s/s cholesteatoma
can be asymptomatic, can have hearing loss but usually late if leads to TM perforation it will cause fast hearing loss, dizziness and/or otorrhea. Characteristic s/s include a squamous epithelium lined sac filled with desquamated keratin, painless drainage, a canal with granulation tissue, and hearing loss from ossicle damage. TM perforation 90% of the time. Tx need CT for damage and fistula formation and surgery
73
Influenza
caused by influenza A and B viruses. s/s of upper resp or lower resp involvement with systemic illness s/s fever, headache, myalgia, weakness. Self limited when uncomplicated but is assoc w increased morbidity. February is the peak month.
74
Influenza transmission
Droplets through respiratory secretions via sneezing or coughing or contacted w surfaces however drop is the best mode
75
Incubation period for influenza
1-4 days, average is 2 days. Transmission to other contacts happens at 3-4 days.
76
Viral shedding
5 days - longer shedding periods occur in older adults, children, patients w chronic illness and immunocomprimised
77
Cold v Flu
Cold: rarely a fever, rarely a headache, slight aches, never exhaustion, stuffy nose, sneezing and sore throat common, mild to moderate hacking cough. Flu: high fever, headaches are common, sever aches and pains, usual fatigue up to 2-3 weeks, usual extreme exhaustion, sometimes stuffy nose, sneezing, sore throat, can have severe chest discomfort and cough. Cold: fatigue, stuffy nose, sneezing, coughing, mild chest discomfort. Flu: high fever, headache, severe aches and pains, exhaustion, severe chest discomfort.
78
s/s flu
abrupt onset of fever, headache, myalgia, malaise, usually w URI s/s like cough, congestion, sneezing. Fever 100-104 as high as 106.
79
physical findings - objective - of influenza pt
pt may feel hot and flushed, mild cervical lymphadenopathy. unremarkable exam of the chest. leukocytes elevate later in the illness. WBC > 15,000 = bacterial superinfection
80
lab testing
rapid antigen test, immunofluorescence assays, reverse transcriptase polymerase chain reaction - best one.
81
rapid antigen testing
immunoassays that identify A and B viral nucleoprotein antigens in a resp specimen, takes 15 minutes but RT-PCR and viral culture is the best. Can get a false positive on a rapid antigen from live attenuated influenza vaccine.
82
Immunofluorescence
antibody staining, results in hours, lower sensitivity than viral culture. Need resp epithelial cells.
83
Nucleic Acid tests
reverse transcriptase polymerase chain reaction most sensitive, rapid results, diff between h1n1 and avian flu. takes 4-6 hours but usually is not performed in house and has to been sent w other samples. need resp sample or throat swab.
84
Viral culture
nasal wash, throat swab or bronchoalveolar lavage specimens, gold standard but takes 2-3 days. not useful for initial clinical mgmt, but can be a confirming screen test for Public Health Surveillance
85
Serologic Testing
not useful for diagnosis of acute illness but can diagnose retrospectively. 10 - 14 days later a 4x increase in antibody titers will diagnose. CANT diagnose acute influenza
86
Choosing a test
RT-PC is the preferred test and yields rapid results also diff between h1n1 and avian flu. Rapid antigen testing or direct or indirect immunofluorescent antibody staining may be used as screening tests, but follow-up testing with RT-PCR and/or viral culture should be considered in the following situations:
A patient has a negative screening test when community influenza activity is high and laboratory confirmation of influenza infection is desired.
A patient has a positive screening test when the community prevalence of influenza is low, making a false-positive result more likely.
A patient has had recent exposure to pigs or poultry and infection with a novel influenza A virus is a consideration.
87
Diagnosing flu
use clinical symptoms. can use RT-PCR or rapid antigen testing during flu season. Detecting that someone has the flu is great for decrease inappropriate antibiotic use, decreasing healthcare costs, and decreasing emergency dept visit
88
Who gets tested for the flu
Immunocompetent, fever, respiratory illness and present within 5 days of illness onset. OR those who are immunocomprimised with fever and resp illness flu s/s REGARDLESS of time of illness or inpatients with acute resp illness and fever with community acquired pneumonia REGARDLESS of time of onset, anyone who post hospital discharge has fever and resp symptoms, regardless of onset. 5 days for healthy people with flu s/s and regardless of onset anyone immunocomprimised outpt, inpatient with s/s flu, inpatient s/s CAP, flu s/s after hospital admission.
89
started pt on antiviral but now testing came back that they dont have flu... now what
continue antiviral
90
test these patients for flu any time of year
if presented w in 5 days of onset: healthcare workers and residents, visitors of an institution w a flu outbreak who present w resp symptoms, those epidemiologically linked to a flu outbreak
91
benefit of antiviral therapy
shorten duration of symptoms by 1/2-3 days, best when given in the first day of symptoms, reduces the severity and complications of the flu, duration of hospitalization in those w severe flu, and decreased mortality
92
active against influenza a and b
end in mirvir - zanamivir (relenza) , oseltamivir (tamiflu) and peramirvir (rapivab)
93
Active against only A
adamantanes - amantadine and rimantadine only in select circumstances
94
Weekly Monitoring for Flu treatment
Assess risk for oseltamivir resistance. Weekly surveillance data to determine which type of influenza is circulating. Treat those w a negative rapid antigen with high symptoms suspicious for flu
95
Recc treatment for flu
Neuaminidase inhibitor either zanamivir (relenza) 10mg inhalations twice daily for 5 days or oseltamivir (tamiflu) 75mg BID for 5 days (if tamiflu resistance is not suspected) if cannot tolerate either of these they need IV Rapivab referred to hospital
96
high risk complications that need to get flu treatment even if >48 hours
children 65, asthma, cardiac disease, DM, CVA, mental retardation, HIV, pregnant women, native americans and alaskan americans, morbid obese, residents of nursing homes
97
Symptom mgmt
acetaminophen for myalgia and fever, no ASA r/t Reyes, cough is self limited so no cough suppressants, hydration, antibiotics only for bacterial complications w bacterial pneumonia, otitis media or sinusitis
98
uncomplicated flu disease progression
gradual improvement over 2-5 days. may have persistant weakness or fatigue = postinfluenza asthenia can last for several weeks
99
most common complication of the flu
pneumonia. can be primary viral pneumonia, secondary bacterial pneumonia or a mixture of both
100
Blepharitis
inflammation of the eyelid caused either by staph or obstructed gland. Red, scaly, greasy flakes on the eyelid and lid margins. May feel like itching or burning. Baby shampoo scrubs and hot compresses. If bacterial can use erythromycin.
101
Test to measure intraoccular pressure
for glaucoma patients, screening begins at 40 use tonometry
102
Fundoscopic exam for cataract
reveals altered red relex that is a dark spot or a diminished red reflex, cloudy lens on inspection, advanced the pupil will appear white
103
Chronic otitis media with effusion
excess drainage without other s/s. Augmentin for 10 days, 875/125 and refer to ENT could be due to tm perforation
104
Med mgmt vertigo
antihistamines like antivert and benadryl. Can also try scopolamine patches, antiemetics and valium.
105
Most common reversible causes of hearing loss
cerumen build up, foreign body
106
Common conductive causes of hearing loss
hematomas, otitis media, otitis externa, otosclerosis
107
sensorineural loss
damage to hair cells, loud noise, head trauma, menieres disease, acoustic neuroma, barotrauma with scuba divers
108
Weber
normal is when sound is heard bilaterally in both ears and does not lateralize. If it lateralizes to the affected ear then it is conductive hearing loss in that ear, if it lateralizese to the unaffected ear then it is sensorineural hearing loss
109
Rinne
ac is greater than bc is normal. when bc is greater than ac, it is abnormal and indicates conductive hearing loss in the affected ear.
110
Unexplained conductive hearing loss needs
a ct scan.
111
treat conductive hearing loss
treating underlying cause such as ear infection, hematoma, otosclerosis.
112
treat sensorineural loss
need referral to specialist
113
Common Cold
viral rhinosinusitis. usually lasts 5-10 days and is self limiting. caused by usually adenovirus, coronavirus and rhinovirus. s/s watery rhinorrhea, red nasal mucosa, sneezing, congestion, headache, sore throat, malaise.
114
treat common cold
rest, hydration, warm salt water gargles, nasal irrigation, humidifier. Can use decongestants. Tylenol for pain.
115
Strep pharyngitis symptoms
FLEA - Fever over 100.4, Lack of cough, Exudate on tonsils, Anterior cervical lymphadenopathy
116
Tonsillitis, symptoms, treatment
fever, sore throat, foul breath, trouble swallowing, painful swallowing, tender anterior cervical lymph nodes, tonsillar exude. If viral - supportive treatment saltwater gargles, rest, humidifier, avoid cigarette smoke, lozenges, warm and cold food, fluids. If bacterial then PCN x 10 days
117
Peritonsillar abscess, symptoms, treatment
Severe throat pain usually unilateral, fever, drooling, foul breath, trismus, hot potato voice. uvula deviation to contralateral side. Treatment: need incision and drainage, abx to cover strep and staph so Clindamycin or Augementin x 14 days
118
Viral Pharyngitis - caused by, symptoms, treatment
Caused by adenovirus, rhinovirus. more than one mucus membrane is affected. sore throat and congestion. Sore throat AND conjunctivitis, runny nose, cough, low grade fever. Red throat, no exudate, Supportive therapy.
119
Bacterial Pharyngitis caused by, symptoms, treatment
only throat - no congestion, no cough. most common is Group A beta hemoliticus GABH = sudden onset of sore throat, high fever, lack of cough, tonsilar exudate, anteriocervical lymphadenopathy, 0-1 no test, no treat. all 4- no test, treat. 2-3 - test if positive then treat if neg no abx. and it will resolve use soup and magic mouthwash. if positive PCN V po x 10 days. if PCN allergy, use macrolides. treatment for bacterial will decrease chance of peritonsillar abcess or RF.
120
Mononucleosis symptoms, dx and tx
Malaisa, headache and low grade fever come before the sore throat, leads to fatigue. tonsillitis with tender POSTERIOR cervical, axillary and or inguinal lymph nodes, splenmegaly, hepatomegaly, lethargy, malaise, low grade fever. shows atypical lymphcytes on blood smear with elevated LFTs. Use a monospot to look for EBV antibodies if negative with high suspicion repeat in 2 days. supportive treatment rest hydration salt water gargles take it easy at home. no sports for 4 weeks. amox will lead to rash. may get prednisone for severe tonsillitis.
121
Viral rhinosinusitis caused by, symptoms, treatment
adenovirus, coronavirus, rhinovirus, symptoms of nasal congestion, nasal discharge, sore throat, cough, conjunctivitis - more than one mucus membrane. supportive treatment. will resolve within 10 - 14 days. "common cold"
122
Bacterial Rhinosinusitis
caused by strep pneumonia, h influenzae, moraxella catarrhalis. s/s nasal congestion, purulent nasal discharge especially from one nostril, facial pain while bending, high fever. more than 10 days. double worsening better than worse. tx: augmentin if pcn allergy can use levaquin. can also be self limiting.
123
Allergic Rhinitis
nasal congestion, clear nasal discharge, itching, tearing, conjunctivitis, allergic shiners, pale and swollen nasal mucosa
124
Iritis/Uveitis
reduced vision, photophobia, pain, no discharge, MIOTIC pupil, perilimbal flush -- need referal, treat the pain
125
Hyphema
normal or reduced acutiy, possible photophobia, blood in the anterior chamber -- need emergent referal for globe rupture. ct head to r/u serious injury
126
Secondary Aquired Cholestoma
caused by a TM perforation first, accumulating debris.
127
TM perforation
conductive hearing loss. heals spontaneously. causes scarring. caused by: trauma, infection, neoplasm, FB. pain relieved by perforation. will drain afterwards.
128
Sensorineural Loss - weber/rinne
weber: lateralizes to the unaffected ear that they are not complaining about. rinne: ac > bc
129
Conductive Loss - weber/rinne
Weber: lateralizes to the poor ear that they are complaining about. Rinne: bc greater than or equal to ac
130
Normal hearing weber and rinne
weber lateralzed equal. ac > bc rinne
131
presbyopia
result of aging, leads to difficulty seeing close objects. develops at age 40.
132
cholesteoma
occurs 90 of time with TM perforation, usually painless, obstructed TM by scaly epithelium
133
glaucoma screening
screen every 4 years start at age 40, visual acuity tested q3y prior
134
where do anterior nosebleeds occur
kiesselbach plexus -- most common
135
anterior nose bleeds caused by
nose picking, low moisture level, allergic rhinitis, FB will also have purulent discharge, chronic excoriation from drug use, facial trauma
136
osler weber rendu disease
coagulapathy disorder hereditary causes friable lesions and port wine stains, easily bleed in throat and bowels. need electrocautery to treat
137
recurrent posterior bleeds or massive hemorrhage could be caused by
carotid artery aneurism
138
packing
brisk bleeding despite packing think posterior bleed, all posterior bleeds need ENT consult
139
meds to stop nose bleed
topical lidocaine, topical cocaine, oxymetazoline or afrin, injectable lidocaine
140
stop the bleed
blow nose for clots, spray two puffs of afrin, pinch nose for 10 minutes. or bend forward and place cotton into nostril, cough up pharynx blood, use cold compress on bridge of nose. pack if bleeding rapidly occurs. wait for 30 minutes. give antibiotic ointment for mucusa 3x daily for 3 days.
141
primary influenza pneumonia
when the flu infection produces severe pneumonia. think this when symptoms continue to persist, high fever and trouble breathing. ct scan shows bilateral opacities, with or with out consolidation
142
secondary bacterial pneumonia
relapse after the flu with higher fevers, cough, purulent sputum, and infiltrates.flu leads to loss of cilia, predispose patients to bacterial infection of the lung
143
myositis secondary to flu
extreme tenderness on the affected muscles most commonly in the legs, CK levels increased and myoglobinuria if renal failure from it
144
cns involvement secondary to flu
encephalopathy, encephalitis, guilliane barre,
145
cardiac involvement secondary to flu
ekg involvement most likely from underlying cardiac disease, may have transient ekg changes. rare myocarditis.
146
toxic shock secondary to flu
s aureus infection toxic shock seen with influenza B
147
flu vaccine for those healthy up to 49 years nonpregnant
quad inactivated flu or LAIV
148
older than 50 and with contraindication to live
contradindicated live to immunocomprimised, chronic heart or lung, pregnancy, allergy. only give inactivated
