Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

TMJD Facts

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

TMJD Classification

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

TMJD Causes

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

TMJ Treatment

A
  • Heat/cold
  • Soft diet
  • NSAIDs
  • Muscle relaxants
  • Anxiolytics
  • Antidepressants
  • Low level laser therapy
  • Night Guard
  • Corrective dental intervention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

GCA Treatment

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pharyngitis and EBV

A
  • More common in adolescents and young adults

- Sore throat and fatigue are most common symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pharyngitis & Influenza

A
  • Sore throat may be CC in flu patients

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Viral pharyngitis diagnostics

A
  • CBC
  • Rapid strep test
  • Monospot
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Epstein-Barr Virus

A

Infectious mononucleosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Mono Labs
- Monospot (most common; may require patient to have had Dz for 1-2wk before testing positive) - ELISA
26
Mono Treatment
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
27
Bacterial pharyngitis
Most common cause = Group A Beta-Hemolytic Streptococcus
28
GABHS S/S
* **Absence of rhinitis, conjunctivitis, cough - Tonsillar edema/exudate - Anterior cervical lymphadenopathy - Palatine petechiae
29
GABHS Labs
- rapid strep test (95%Sp, 80-95%Sn) | - Throat culture (99%Sp, 97%Sn)
30
Strep Scoring
* **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
31
GABHS treatment
``` First Line - Benzathine penicillin G IM - Penicillin V PO - Amoxicillin - Erythromycin (PCN allergy) - Cephalexin Second Line - 2nd Gen Cephalosporin ---Ceftin, Cefzil - Clarithromycin - Azithromycin ```
32
GABHS Why treat?
- Prevention of spread - Shortens duration - Prevents: rheumatic fever, peritonsillar abscess, poststreptococcal glomerulonephritis
33
Recurrent tonsillitis
- Culture when asymptomatic - Refer to ENT - Tonsillectomy: >6x/1yr; 5x/yr for 2yr; 3x/yr for 3yr
34
Allergic Rhinitis S/S
- Timing, Hx, Environmental exposure - sneezing, clear congestion, watery eyes, HA - Pale, pink mucosa - cobblestoning - serous otitis
35
AR Treatment
``` 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 ```
36
Mild Intermittent AR
- Oral antihistamines - Intranasal antihistamine - Decongestant - Intranasal decongestant (Limit use)
37
Moderate-to-severe intermittent AR
- Oral antihistamines - Intranasal antihistamine - Oral decongestant (combo) - Intranasal steroid
38
Mild Persistent AR
- Oral antihistamine - Intranasal antihistamine - Oral decongestant - Intranasal steroid
39
Moderate-to-severe persistent AR
1st-Line intranasal steroid | - oral steroid
40
Viral Sinusitis S/S
- Sneezing - HA - Fever - Clear Mucus - Timing - Pink to dark pink nasal mucosa - Swollen turbinates - Lymphadenopathy - PND - Conjunctivitis
41
VS Treatment
- Decongestant - Antihistamine - Intranasal anticholinergic (Atrovent/Ipratropium IN) - Short term intranasal decongestant (Vicks, Sinex, Afrin) - Pain relief (IBU, APAP)
42
Bacterial Sinusitis S/S
- Duration of Sx - Unilateral sinus pressure - Fever - Periorbital edema - Congestion - Tooth pain - Tenderness with percussion - Erythematous, edematous turbinates - Mucopurulent drainage
43
BS Diagnostics
- Sinus X-ray - CT scan * ** Refer when: no response to Tx, fever, pain with EOM, periorbital cellulitis
44
BS Treatment
``` If no ABX in previous month - Amoxicillin - Augmentin XR - Omnicef - Cefzil ABX in previous month - Augmentin XR - Levaquin - Avelox ```
45
BS Alternative treatment
- Biaxin - Zithromax - Bactrim
46
BS 1st Choice Tx
If Seriously ill or if initial treatment has failed: | High dose augmentin
47
More BS TX
- Afrin - Topical nasal steroids - Oral steroids - Decongestants - Guaifenesin
48
Chronic Rhinosinusitis
- Nasal Lavage - Neti pot sterile H2O
49
URI
- Non-specific term - Acute infection of sinuses, pharynx, trachea, and/or bronchi - Causes: Viral, bacterial (pharyngitis/tonsillitis, sinusitis, bronchitis
50
Viral URI S/S
- Onset - Congestion, sneezing, sore throat - Exposure - Transmission (aerosol, droplet, direct contact)
51
Viral URI Tx
- Pain relief/antipyretic - Nasal steroids - Decongestant - Expectorant - Fluids - Rest - If not resolved in 7-10d, return
52
Influenza S/S
RAPID onset | - Fever, malaise, HA, cough, sore throat
53
Flu Dx
Rapid antigen test | viral culture
54
Flu Tx
- 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
Flu Who to treat
- Age - Timing - Chronic Dz - Pregnancy
56
Flu Shot
- Indication: >6mo - Contraindications: severe egg allergy, reaction to previous vaccine, <6mo - Takes 2wk to develop antibodies - Killed virus - Contains 2A and 1B virus
57
Flu Nasal inhalation
Indications: age 5-49yo Contraindications: Lung Dz, Pregnancy, 49yo
58
Red Eye
``` Conjunctivitis - Viral=more common - Bacterial=more common in children Subconjunctival hemorrhage Foreign body/abrasion Acute angle glaucoma Iritis ```
59
Red eye pertinent negatives
- No Photophobia - No eye pain - No change in acuity - May c/o irritation but can open eye
60
Ophthalmology referral
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
Viral conjunctivitis
- 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
Bacterial Conjunctivitis
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
BC Tx
Topical ABX - Erythromycin - Polytrim - Bleph 10 (contains sulfa) - Fluoroquinolones
64
Allergic Conjunctivitis
``` Symptomatic relief Topical Gtts - Antihistamine/Mast cell stabilizer --- Patanol --- Optivar --- OTC Zaditor (combo) --- OTC Alamast (MCS) - Oral antihistamines ```
65
Subconjunctival hemorrhage
- Reassurance - Cool compress - Lubricating ointment
66
Foreign Body/Abrasion
``` Conjunctival - Removal if visualized and can be washed out - Topical ABX for 2-3d Corneal - Refer ```
67
Acute angle glaucoma
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
AAG Evaluation
- 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
Blepharitis
Inflammation of lid margin | - Staph infection, seborrhea, meibomian gland abnormality
70
Bleph Tx
``` 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
Hordeolum
Obstruction of meibomian glands - Staph infection - Difficult to differentiate from acute/inflamed chalazion
72
Hordeolum Tx
Lid Hygiene Topical ABX If unresolved - Refer
73
Chalazion
Blockage of meibomian gland - Chronic - Tx=referral
74
Otitis Media
- 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
Serous Otitis (SO)
``` 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
SO S/S
- No clinical signs of acute illness - Hearing loss (~weeks to months) - Insomnia - Vertigo
77
SO Tx
- Majority resolve without intervention - Watchful waiting, pharmacologic Tx, & surgery - -- Tx depends on the risk for speech, language, or learning development problems
78
Conductive Hearing Loss
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
Otitis Externa
``` Topical gtts - Floxin otic - Ciprodex otic - Cortisporin otic Oral ABX ```
80
Perforated TM
- 2mm refer
81
Myringosclerosis
Scarring of TM in response to infection of inflammation | - Refer
82
Sensorineural Hearing Loss
``` More common in children and elderly refer for audiology Possible causes: - Presbycusis (older adults) - Ototoxic drugs Tumors (Acoustic neuroma) - Meniere's disease ```
83
Tinnitus
Character - High pitched (sensorineural hearing loss) - Low pitched (Idiopathic, Meniere's) - Pulsatile (vascular) - Ocean sounds (Eustachian tube dysfunction) - Popping or clicking (ETD, TMJ)
84
Laryngitis Treatment: Croup
- Humidified air - Oxygen - Racemic epinephrine - Steroids
85
Laryngitis Tx: Acute epiglottitis
- Intubation - ABX: 2nd gen. Cephalosporin; Bactrim - Steroid
86
Laryngitis Tx: Diptheria
- ETT - ABX: PCN - Antitoxin
87
Laryngitis Tx: Pertussis
- Erythromycin
88
Laryngitis Tx: Candidiasis
- clotrimazole | - oral fluconazole
89
Laryngitis Tx: Blastomycosis, Histoplasmosis, Coccidioidomycosis, Cryptococcosis
- Amphotericin B IV - Ketoconazole PO - Itroconazole
90
Laryngitis Tx: Reflux
- PPI
91
Bronchitis S/S
* ** Cough w/o nasal congestion or rhinorrhea - s/s last ~3wk - r/o PNA with absence of fever, tachypnea, tachycardia
92
Bronchitis Causes
- Viral * Adenovirus, coronavirus, Influenza, metapneumovirus, parainlfuenza, RSV, rhinovirus - Bacterial * bordatella pertussis (macrolide) * Chlamydia pneumonia * Mycoplasma pneumonia
93
Bronchitis Tx
*** Antitussives

N810 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions