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N810 > HEENT > Flashcards

HEENT Flashcards

1
Q

Differential Diagnosis TMJD

A

1) Tooth abscess
2) Wisdom teeth eruption
3) AOM
4) Otitis Externa
5) Temporal arteritis
6) Parotitis
7) Herpes zoster/Posterhepetic neuralgia
8) Trigeminal neuralgia

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2
Q

TMJD Facts

A

May be temporary or last for years
Women > Men
Most commonly 20-40yo

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3
Q

TMJD Classification

A

1) Myofascial pain
2) Internal Derangement
3) Trauma
4) Arthritis

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4
Q

TMJD Causes

A

Bruxism
Capsule inflammation
Abnormalities in the disk or joint
Any combination of the above

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5
Q

TMJ S/S

A
  • Pain in the face, TMJ area, neck, and shoulders
  • Pain in or around ear when chewing, speaking, yawning
  • Limited ability to open the mouth very wide
  • Jaws that get “stuck” or “lock” in the open or closed position
  • Clicking, popping, or grating sounds when opening or closing
  • Difficulty chewing or a sudden uncomfortable bite
  • swelling on ipsilateral side
  • Other S/S: toothaches, headaches, neck pain, dizziness, otalgia, heaing problems, upper shoulder pain, & tinnitus
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6
Q

TMJD Exam

A
  • Palpate TMJ
  • ROM
  • should be able to fit 3rd-5th finger into open mouth
  • Limited ROM is 2 or less fingers
  • Oral Exam
  • Examination of ear canal and TM
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7
Q

TMJD Diagnostics

A
  • After conservative therapy has failed or if internal derangement is suspected
  • Panorex
  • MRI to view soft tissue
  • CT to see detail of bones in joint
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8
Q

TMJ Treatment

A
  • Heat/cold
  • Soft diet
  • NSAIDs
  • Muscle relaxants
  • Anxiolytics
  • Antidepressants
  • Low level laser therapy
  • Night Guard
  • Corrective dental intervention
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9
Q

Temporal Arteritis (Giant cell arteritis [GCA]) Facts

A 
Most commonly 50-72yo
Systemic illness
Symptomatic blood vessel inflammation
Biggest complication = blindness
Linked with Polymyalgia Rheumatica (~50%)
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10
Q

GCA and vision loss

A
  • ~20% of patients develop vision loss
  • May be first sign of GCA
  • Usually begins suddenly with unilateral problems
  • If untreated second eye can be affected (Rare)
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11
Q

GCA S/S

A
  • Appears gradually
  • Most common s/s: temporal HA, Jaw or arm pain/weakness, difficulty seeing clearly, new cough
  • Other s/s: low-grade fever, fatigue, weight loss, scalp tenderness
  • Jaw pain (claudication)
  • Arm claudication
  • Upper respiratory complaints
  • Thoracic aortic aneurysm
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12
Q

GCA Diagnosis

A 
Consider in pt >50 when:
- New HA
- Abrupt visual disturbance
- S/S polymyalgia rheumatica
- Jaw claudication
- Unexplained fever/anemia
high ESR and/or high serum CRP
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13
Q

GCA Treatment

A

1) Refer to rheumatologist
- Rheumatologist will confirm with a biopsy
- treat with high dose steroids, DMARDs, & biologics

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14
Q

Pharyngitis & common cold

A
  • Sore throat is not usually primary symptom
  • Nasal s/s tend to precede throat s/s (soreness, scratchiness, irritation)
  • Non-productive cough may be present
  • Low-grade fever (more common in children)
  • Hoarseness
  • Severe odynophagia is unusual
  • Chills, malaise, and myalgia are usually not prominent
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15
Q

Pharyngitis & adenovirus

A
  • Common among children and military personnel
  • Present with sore throat (more than cold), high fever, dysphagia, & conjunctivitis
  • AKA pharyngoconjunctival fever
  • May have history of swimming within previous week
  • Military personnel tend to be more ill
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16
Q

Pharyngitis and EBV

A
  • More common in adolescents and young adults

- Sore throat and fatigue are most common symptoms

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17
Q

Pharyngitis & Influenza

A
  • Sore throat may be CC in flu patients

- Abrupt onset with myalgias, HA, fever, chills, and dry cough

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18
Q

Other viral forms of pharygitis

A

1) Enterovirus: more common in childhood
2) RSV: s/s = rhinorrhea, sore throat, low-grade fever, & cough
3) CMV: Pts. older than those with EBV
4) HIV: similar presentation to EBV

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19
Q

Viral Pharyngitis S/S (general)

A
  • Most: Fever, fatigue
  • Edema and erythema are typical
  • May have exudate, but not as much as with bacterial
  • Preauricular/cervical lymphadenopathy
  • Palatal petechiae, especially in EBV
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20
Q

Viral pharyngitis diagnostics

A
  • CBC
  • Rapid strep test
  • Monospot
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21
Q

Viral pharyngitis treatment

A
  • ABX do not hasten recovery
  • Salt water gargle, hydration, rest
  • APAP or Ibuprofen (NOT ASA, it increases viral shedding)
  • Do not EVER use ASA with young children or adolescents due to risk of Reye’s Syndrome
  • Anesthetic gargle/lozenges
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22
Q

Epstein-Barr Virus

A

Infectious mononucleosis

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23
Q

Mono Facts

A

Infection throughout the entire reticular endothelial system (liver, spleen, lymph nodes)
Transmitted through saliva, mucus, and coughing
Incubation = 1-2mo

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24
Q

Mono S/S

A

Early
- Fever, lymphadenopathy, pharyngitis, rash, periorbital edema, (rarely) bradycardia

Later

  • Hepatomegaly, palatal petechiae, jaundice, uvular edema, splenomegaly
  • (rarely) splenic rupture
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25
Q

Mono Labs

A
  • Monospot (most common; may require patient to have had Dz for 1-2wk before testing positive)
  • ELISA
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26
Q

Mono Treatment

A

Supportive

  • Hydration, rest, ibuprofen, AVOID APAP, no physical activity for 3-6wk, No sports for 6wk+
  • Closely monitor patients with extreme tonsillar edema for airway obstruction; steroid therapy may be indicated
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27
Q

Bacterial pharyngitis

A

Most common cause = Group A Beta-Hemolytic Streptococcus

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28
Q

GABHS S/S

A
  • **Absence of rhinitis, conjunctivitis, cough
  • Tonsillar edema/exudate
  • Anterior cervical lymphadenopathy
  • Palatine petechiae
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29
Q

GABHS Labs

A
  • rapid strep test (95%Sp, 80-95%Sn)

- Throat culture (99%Sp, 97%Sn)

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30
Q

Strep Scoring

A
  • **0-1=Probably not GABHS
  • **1-3=Possible infection, rapid strep testing and treat accordingly
  • **4-5=Probably infection - treat empirically with ABX if appropriate
  • Fever +1
  • Absence of cough +1
  • Tender anterior cervical lymph nodes +1
  • Tonsillar swelling and/or exudate +1
  • Age 45 -1
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31
Q

GABHS treatment

A 
First Line
- Benzathine penicillin G IM
- Penicillin V PO
- Amoxicillin
- Erythromycin (PCN allergy)
- Cephalexin
Second Line
- 2nd Gen Cephalosporin
---Ceftin, Cefzil
- Clarithromycin
- Azithromycin
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32
Q

GABHS Why treat?

A
  • Prevention of spread
  • Shortens duration
  • Prevents: rheumatic fever, peritonsillar abscess, poststreptococcal glomerulonephritis
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33
Q

Recurrent tonsillitis

A
  • Culture when asymptomatic
  • Refer to ENT
  • Tonsillectomy: >6x/1yr; 5x/yr for 2yr; 3x/yr for 3yr
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34
Q

Allergic Rhinitis S/S

A
  • Timing, Hx, Environmental exposure
  • sneezing, clear congestion, watery eyes, HA
  • Pale, pink mucosa
  • cobblestoning
  • serous otitis
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35
Q

AR Treatment

A 
Intranasal steroids
- Flonase (fluticasone)
- Veramyst
- Rhinocort
- Nasacort AQ
- Nasonex
Intranasal Antihistamine
- Astelin - 2sp q nostril BID
- Astepro - 1-2sp BID
- Patanase - 2sp BID
Oral Antihistamines
- Allegra
- Clarinex
- Claritin
- Xyzal
- Zyrtec
Leukotriene Antagonist
- Singulair
Decongestants
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36
Q

Mild Intermittent AR

A
  • Oral antihistamines
  • Intranasal antihistamine
  • Decongestant
  • Intranasal decongestant (Limit use)
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37
Q

Moderate-to-severe intermittent AR

A
  • Oral antihistamines
  • Intranasal antihistamine
  • Oral decongestant (combo)
  • Intranasal steroid
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38
Q

Mild Persistent AR

A
  • Oral antihistamine
  • Intranasal antihistamine
  • Oral decongestant
  • Intranasal steroid
39
Q

Moderate-to-severe persistent AR

A

1st-Line intranasal steroid

- oral steroid

40
Q

Viral Sinusitis S/S

A
  • Sneezing
  • HA
  • Fever
  • Clear Mucus
  • Timing
  • Pink to dark pink nasal mucosa
  • Swollen turbinates
  • Lymphadenopathy
  • PND
  • Conjunctivitis
41
Q

VS Treatment

A
  • Decongestant
  • Antihistamine
  • Intranasal anticholinergic (Atrovent/Ipratropium IN)
  • Short term intranasal decongestant (Vicks, Sinex, Afrin)
  • Pain relief (IBU, APAP)
42
Q

Bacterial Sinusitis S/S

A
  • Duration of Sx
  • Unilateral sinus pressure
  • Fever
  • Periorbital edema
  • Congestion
  • Tooth pain
  • Tenderness with percussion
  • Erythematous, edematous turbinates
  • Mucopurulent drainage
43
Q

BS Diagnostics

A
  • Sinus X-ray
  • CT scan
  • ** Refer when: no response to Tx, fever, pain with EOM, periorbital cellulitis
44
Q

BS Treatment

A 
If no ABX in previous month
- Amoxicillin
- Augmentin XR
- Omnicef
- Cefzil
ABX in previous month
- Augmentin XR
- Levaquin
- Avelox
45
Q

BS Alternative treatment

A
  • Biaxin
  • Zithromax
  • Bactrim
46
Q

BS 1st Choice Tx

A

If Seriously ill or if initial treatment has failed:

High dose augmentin

47
Q

More BS TX

A
  • Afrin
  • Topical nasal steroids
  • Oral steroids
  • Decongestants
  • Guaifenesin
48
Q

Chronic Rhinosinusitis

A
  • Nasal Lavage
  • Neti pot
    sterile H2O
49
Q

URI

A
  • Non-specific term
  • Acute infection of sinuses, pharynx, trachea, and/or bronchi
  • Causes: Viral, bacterial (pharyngitis/tonsillitis, sinusitis, bronchitis
50
Q

Viral URI S/S

A
  • Onset
  • Congestion, sneezing, sore throat
  • Exposure
  • Transmission (aerosol, droplet, direct contact)
51
Q

Viral URI Tx

A
  • Pain relief/antipyretic
  • Nasal steroids
  • Decongestant
  • Expectorant
  • Fluids
  • Rest
  • If not resolved in 7-10d, return
52
Q

Influenza S/S

A

RAPID onset

- Fever, malaise, HA, cough, sore throat

53
Q

Flu Dx

A

Rapid antigen test

viral culture

54
Q

Flu Tx

A
  • Only lessens duration by 1-2d
  • Tamiflu
  • – Diagnosed with Influenza A or B
  • – Very expensive
  • Relenza (zanamivir)
  • – Treats A or B
  • – Inhalation
  • – Contraindicated with Hx of lung Dz
  • Symmetrel (amantadine) & Flumadine (rimantadine)
  • – only effective against A
  • – High rates of resistance
  • – Not usually prescribed
55
Q

Flu Who to treat

A
  • Age
  • Timing
  • Chronic Dz
  • Pregnancy
56
Q

Flu Shot

A
  • Indication: >6mo
  • Contraindications: severe egg allergy, reaction to previous vaccine, <6mo
  • Takes 2wk to develop antibodies
  • Killed virus
  • Contains 2A and 1B virus
57
Q

Flu Nasal inhalation

A

Indications: age 5-49yo
Contraindications: Lung Dz, Pregnancy, 49yo

58
Q

Red Eye

A 
Conjunctivitis
- Viral=more common
- Bacterial=more common in children
Subconjunctival hemorrhage
Foreign body/abrasion
Acute angle glaucoma
Iritis
59
Q

Red eye pertinent negatives

A
  • No Photophobia
  • No eye pain
  • No change in acuity
  • May c/o irritation but can open eye
60
Q

Ophthalmology referral

A

1) Reduction in acuity
2) Ciliary flush
3) Photophobia
4) Severe foreign body sensation
5) Corneal opacity
6) Fixed pupil
7) Severe HA with nausea

61
Q

Viral conjunctivitis

A
  • Self-limiting
  • Topical antihistamines if allergic component (Naphcon-A, Ocuhist)
  • Topical lubricants
  • Avoid spreading to other eye
  • NO steroids –> if needed, refer
  • VERY contagious
62
Q

Bacterial Conjunctivitis

A

Common organisms: S. pneumoniae, H. influenzae, S. Aureus, M. catarrhalis

  • S. aureus more common in adults, others more common in children
  • Do not overlook possibility of chlamydial conjunctivitis
63
Q

BC Tx

A

Topical ABX

  • Erythromycin
  • Polytrim
  • Bleph 10 (contains sulfa)
  • Fluoroquinolones
64
Q

Allergic Conjunctivitis

A 
Symptomatic relief
Topical Gtts
- Antihistamine/Mast cell stabilizer
--- Patanol
--- Optivar
--- OTC Zaditor (combo)
--- OTC Alamast (MCS)
- Oral antihistamines
65
Q

Subconjunctival hemorrhage

A
  • Reassurance
  • Cool compress
  • Lubricating ointment
66
Q

Foreign Body/Abrasion

A 
Conjunctival
- Removal if visualized and can be washed out
- Topical ABX for 2-3d
Corneal
- Refer
67
Q

Acute angle glaucoma

A

EMERGENCY

  • Usually older and in distress
  • Slumped over, covering the eye or clutching to frontal/temporal area
  • C/O HA and malaise
  • As pressure rises N/V
  • “The worst HA of my life”
  • Visual acuity rapidly deteriorates; photophobia; NO FB sensation
  • Red eye w/o discharge; pupil becomes fixed
  • Within hours –> cornea becomes hazy
  • rapid Tx is critical
68
Q

AAG Evaluation

A
  • Snellen chart
  • Near vision test
  • – Exact acuity is not important
  • Document in crude categories (reading vision, form vision, light perception)
  • Assess acuity before checking pupils or placing drops
69
Q

Blepharitis

A

Inflammation of lid margin

- Staph infection, seborrhea, meibomian gland abnormality

70
Q

Bleph Tx

A 
Lid hygiene
- Warm compress
- wash with q-tip, water, and baby shampoo
Topical ABX
- Eythromycin oint
- Bleph 10
- Tobrex
- Polytrim (limited effectiveness against staph)
Topical lubricants
71
Q

Hordeolum

A

Obstruction of meibomian glands

  • Staph infection
  • Difficult to differentiate from acute/inflamed chalazion
72
Q

Hordeolum Tx

A

Lid Hygiene
Topical ABX
If unresolved - Refer

73
Q

Chalazion

A

Blockage of meibomian gland

  • Chronic
  • Tx=referral
74
Q

Otitis Media

A
  • Analgesics
  • Treatment of URI S/S
  • Amoxicillin HD (Fever, significant hearing loss, severe pain, and/or marked erythema)
    Alternative
  • Augmentin
  • Cefdinir
  • cefpodoxima
  • Macrolide (erythromycin/sulfisoxazole, azithromycin, clindamycin)
75
Q

Serous Otitis (SO)

A 
Otitis media with effusion = the presence of middle-ear effusion in the absence of acute s/s of infection
- Allergies
- URI
Obstruction of ET
- Refer
76
Q

SO S/S

A
  • No clinical signs of acute illness
  • Hearing loss (~weeks to months)
  • Insomnia
  • Vertigo
77
Q

SO Tx

A
  • Majority resolve without intervention
  • Watchful waiting, pharmacologic Tx, & surgery
  • – Tx depends on the risk for speech, language, or learning development problems
78
Q

Conductive Hearing Loss

A

Outer ear canal

  • Cerumen (warm water irrigation, cerumen spoon, Debrox/Cerumenex)
  • Foreign body (warm water irrigation, removal with tweezers, referral)
  • Insect (instill warm oil, then extract)
79
Q

Otitis Externa

A 
Topical gtts
- Floxin otic
- Ciprodex otic
- Cortisporin otic
Oral ABX
80
Q

Perforated TM

A
  • 2mm refer
81
Q

Myringosclerosis

A

Scarring of TM in response to infection of inflammation

- Refer

82
Q

Sensorineural Hearing Loss

A 
More common in children and elderly
refer for audiology
Possible causes:
- Presbycusis (older adults)
- Ototoxic drugs
Tumors (Acoustic neuroma)
- Meniere's disease
83
Q

Tinnitus

A

Character

  • High pitched (sensorineural hearing loss)
  • Low pitched (Idiopathic, Meniere’s)
  • Pulsatile (vascular)
  • Ocean sounds (Eustachian tube dysfunction)
  • Popping or clicking (ETD, TMJ)
84
Q

Laryngitis Treatment: Croup

A
  • Humidified air
  • Oxygen
  • Racemic epinephrine
  • Steroids
85
Q

Laryngitis Tx: Acute epiglottitis

A
  • Intubation
  • ABX: 2nd gen. Cephalosporin; Bactrim
  • Steroid
86
Q

Laryngitis Tx: Diptheria

A
  • ETT
  • ABX: PCN
  • Antitoxin
87
Q

Laryngitis Tx: Pertussis

A
  • Erythromycin
88
Q

Laryngitis Tx: Candidiasis

A
  • clotrimazole

- oral fluconazole

89
Q

Laryngitis Tx: Blastomycosis, Histoplasmosis, Coccidioidomycosis, Cryptococcosis

A
  • Amphotericin B IV
  • Ketoconazole PO
  • Itroconazole
90
Q

Laryngitis Tx: Reflux

A
  • PPI
91
Q

Bronchitis S/S

A
  • ** Cough w/o nasal congestion or rhinorrhea
  • s/s last ~3wk
  • r/o PNA with absence of fever, tachypnea, tachycardia
92
Q

Bronchitis Causes

A
  • Viral
  • Adenovirus, coronavirus, Influenza, metapneumovirus, parainlfuenza, RSV, rhinovirus
  • Bacterial
  • bordatella pertussis (macrolide)
  • Chlamydia pneumonia
  • Mycoplasma pneumonia
93
Q

Bronchitis Tx

A

*** Antitussives

N810 (18 decks)

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