HEENT Flashcards
blepharitis (blep=boogers in the eye)
what is this what is it caused by?
sxs?
tx? 3
chronic inflammation of the eyelids by SEBORRHEA, _STAPH/STREP, DYSFUNCTION OF MEIBOMIAN GLAND **TARSAL GLAND_***associated with increased risk of chalazion and hordeolum
signs and symptoms:
- *-erythema of the lids
- dandraff like flaking and crustiness
- foreign body sensatio, hardened yellowish plaque**s
Tx:
- warm compress
- lid scrubs with Johnson Baby Shampoo
- topical antibiotics for infection bacitracin
Glaucoma
what is this?
what are the 2 types?
1 RF?
eye conditions that cause progressive optic nerve damage, leading to irreversible loss of vision
Types:
- open angle
- closed angle
RF:
elevated intraocular pressure
Closed angle glaucoma
what is this caused by? IOP?
5 key sxs?
3 tx options?
2
3
1
acutre rise in IOP due to the trabecular meshwork being occluded with IOP over 50
SXS:
PAINFUL
STEAMY CORNEA
FIX MID DILATED PUPIL
NAUSEA AND VOMITING
INFLAMMED EYE
TX: get pressure down ASAP
- Decrease aqueous production WITH BB or barconic anhydrase inhibitor
2. increase outflow with Prostaglandin, cholinergi, epi
***ALPHA AGONISTS DO BOTH OF THESE***
- Ultimately need laser (YAG periphreal iridotomy**)
Open angle glaucoma
what is this?
3 ways to dx?
3 tx options?
most often asymptomatic and chronic with IOP over 22, but can still have damage less than 22
DX:
- tonometry: tells IOP
- optic nerve eval through dilated pupil
- pachymetry: measure central corneal thickness
TX:
- pharmocological first then consider surgery
A. BB or carbonic anyhdrase inhibitor
B. Laser Trabeculoplasty
secondary glycoma
7 causes
- inflammation
- hyphema-blood in the anterior chamber
- angle recession-caused by blunt trauma to the TM
- neovascular- complication of diabetic retinopathy or vascular occlusion, BV can grow into the angle
- phacolytic
- pseudoexfoliation syndrome-white flakey material from the anterior surface clogs the TM
- pigment disruption-part of the iris flakes off and clogs the TM
Cataract
what is this?
patho?
3 sxs
3 types
opacity of the lens caused by insoluble protein caused by age, medication, illness, sun exposure
Patho: the lense is make of proteins arranged in a certain fashion but over time they can clump together and cloud the lense
SXS:
- gradual loss of vision
- increased glare
- decreased color preception
Types:
nuclear sclerosis
cortical
posterior subscapular
Nuclear sclerosis cataract
ellow or brown discoloration
of the central lens; even distribution;
distance vision blurred myopic shift (second sight)
cortical cataract
radial or spoke like opacities
posterior subscapular cataracts
plaque-like opacities
on the posterior aspect of the lens. Greater affect
on acuity and often in younger patients
whta are the reasons for doing cataract surgery?
- increase activitis of daily living
- prevent secondary glaucoma
- permit fundus visulization
what is a secondary cataract that is a complication of cataract surgery?
-The posterior capsule can become opacified
of varying degrees, weeks to months later.
-The symptoms can range from blurring vision
to glare -similar to the initial cataract.
Txed with YAG laser in office procedure
Dry Macular degeneration
what is this?
age?
2 key findings?
tx considerations? 3 things
painless and progressive CENTRAL vision loss, OVER 50
FINDINGS:
- drusen-small yellow deposits lead to degenerative changes and atrophy
- changes on amsler grid
TX:
AREDS trial-tx with high antioxidants plus zinc can reduce up to 25%
(b-caretene, vit C, E, zinc)
Wet macular degeneration
what are the two things the contribut to this?
patho?
2 findings?
1 tx?
neovascular (new growth) and exudative (hemmorage), 10% of those with macular dengen but 90% of blindness
patho: subretinal fluid accumulation from neovascularization or fragile vessels that rupture
FINDINGS:
- metamorphopsia-hemmorage causing wavy and distorted vision with paracentral scotomas “blind spots”
TX: ANTI-VEGF (vascular endothelial growth factor), 9/10 stabilize
chalazion (put it in my chalise)
what is this?
what is it caused by?
what can it cuase?
3 tx options?
- chronic granulomatous blockage of meibomian glands-raised and NONTENDER(not infectious)
- white or gray
- can cause STIGMATISMS if too large!! (deforms cornea)
treatment
- warm compresses
- surgical excision
- occasionally steroid injection into the lesion
Allergic conjunctivitis
2 sxs?
2 tx?
warning?
itch with tearing, GLOSSY injection
-1st: OTC antihistamines
-2nd: mast cell inhibitors and
mild steroids
warning: steroids increase the interoccular pressure
Bacterial Conjunctivitis
1 key sxs of this?
2 common organisms?
2 tx options?
red eyes with mucoprulent discharge often GLUED SHUT IN THE MORNING
COMMON: STREP PNEUM, STAPH AUREUS, HAEMOPHILIS
RARE: CHLAMYDIA AND GONNOREAH, VAGINAL DELIVERY
treat with fluoquinalones, sulphonamides
always ask about contact lense wearing, and if they use them as extended wear
viral conjunctivitis
what is the MC cause of this?
2 sxs?
3 tx options?
adenovirus (highly contagious)
red eye, watery discharge
always check the PREAURICLE node to see if it is swollen, can help identify it as viral and not bacterial
treat with cold compress, decongestants, and steroids
Herpes simplex virus corneal ulcer
key description for this?
what to avoid?
redeye, painful, watery discharge, reduced acuity, usually unilateral, densensitived cornea
LINEAR, BRANCHING, EPITHELIA ulcers with TERMINAL BULBS
treatment:
viroptic
zigran
AVOID TOPICAL STEROIDS WITH EPITHELIA DISEASE BECAUSE IT CAN MAKE VIRAL INFECTIONS WORSE
Herpes zoster corneal ulcer
4 key sxs?
what is the sign that can indicate this?
DERMATOMAL PAIN, paresthesias, numbness, and VESICULAR eruptions
Hutchinsons sign: if the tip of the nose is involved in the distribution of nasocilliary branch, predicts higher risk of eye involvement
what should you NEVER do for a bacterial or viral corneal ulcer or keratitis?
(NEVER PATCH AN EYE WITH BACTERIAL OR VIRAL CORNEAL ULCERS BECAUSE IT KEEPS THE VIRUS OR BACTERIA IN)
dacrocystitis
what 3 things are likely to cause this?
what is this?
3 sxs?
tx option general?
STAPH AUREUS, STREP, STAPH EPIDERMIDIDIS
INFECTION
nasolacriminal duct obstruction, -inflammation
-raised tender
-lacriminal duct/sac,
-purulent discharge
warm compress and oral or IV antibiotics, culture for sensitivity to guide antibiotic choice, may need to be drained
ectropion
what is this?
2 things that can cause this?
3 sxs?
2 tx options?
turning out of the eyelid,
AGE, FACIAL NERVE PALSY
symptoms: epiphora (excessive tearing falling off the cornea), dryness, discomfort,
if untreated can lead to conjunctivitis and keratitis
treatment:
artificial tears to bath the eye
blepharoplasty (surgical repair)
entropion
what is this?
sxs?
tx?
turning in of the eyelid, predominantly from aging foreign body sensation, tearing, discharge
if left untreated can lead to corneal scarring, nonreversible
treatment:
- surgical repair
hordelum
what is this? where is it?
what is blocked?
caused by?
tx general?
acute AND CENTRALIZED localized lesion (one little zone of the eyelid), painful and tender to touch
IN THE MEIBOMIAN GLAND AKA TARSAL, TYPICALLY STAPH
treatment:
warm compress
topical antibiotics
pterygium
what is this?
sxs?
3 tx options?
WING SHAPED fibrovascular growth arising from the conjunctiva and extending into the cornea
can be highly vascularized and FB sensation
can induce or increase astigmatism
treatment: artificial tears, steroids, and surgery regrowth possible
retinal detachment
what is this?
where is it most common?
2 key sxs?
- peeling away of the retina from the retinal pigmented epithelium (RPE)
- most common in superior temporal retinal area
- floaters may look like COBWEBS
- *-CURTAIN BEING DRAWN OVER THE EYE TOP TO BOTTOM**
Retinal detachment
4 sxs with this?
1 quick PE test?
2 tx with 1 key thing you MUST DO when you recognize a pt has this!
- flashes in light, increase in floaters, curtains or shadows in the periphreal fields and can cause central vision loss
- *-VISION BY CONFRONTATION**
- *ocular emergency, REMAIN SUPINE WITH HEAD TURNED TO THE SIDE**
- laser or cryrotherapy
what is the leading cuase of blindness in the working americas?
diabetic retinopathy, this is why you should always do annual exams and why it is important to educate patients about their A1c levels which is an early indicator of early stage diabetic so you can predict the health of the vasculature
what can happen at any time during diabetic retinpathy that is serious?
macular edema
nonproliferative diabetic retinopathy
what is this? (3 things)
2 tx
enlarged and blocked blood vessels, microaneurysms, hard exudates
Tx: control sugars and BP
proliferative diabetic retinopathy
what is this classified by
2 tx options?
more advanced and severe, neovascularization, viterous hemmorage
Tx:
- control sugars
- control BP
SEVERE DISEASE IS PERMANENT
hypertensive retinopathy
- Asymptomatic, bilateral
- acute hypertension most common cause
- DIFFUSE ARTERIOLAR NARROWING
- COPPER OR SILVER WIRING
- ARTERIOVENOUS NICKING
- HEME FLARES!
PAPILLEDEMA
vertigo pattern
3 patterns it can present with indicating where the problem is
- fast nystagmus that goes away from lesions or effected side
- **rotation goes away from effected side**
- falling towards affected side
vertigo:
menieres disease
what is this?
another name?
what is different anamomically?
4 sxs?
2 tx options?
progressive hearing loss of low frequency
also known as “endolymphatic hydrops”
***distention of inner ear endolymphatic system**
sxs:
- vertigo (mins to hours)
- tinnitus
- one-sided aural pressure
- loss of low frequency hearing
tx:
1. diuretics: HCTZ
2. very low salt restriction less than 1 g (YUCK)
vertigo:
acoustic neuroma
WHAT IS THIS?
ANOTHER NAME?
3 SXS?
1 DX METHOD?
benign tumor effecting CN VIII
aka vestibular schwannoma
sxs:
1. unilateral hearing loss with imparied speech discrimination
2. tinnitis
3. continuous vertigo
DX:
MRI IS THE TEST OF CHOICE!!!
(TX VERY INVOLED)
vertigo:
benign postitional vertigo
what is this caused by?
what to remember about this condition?
2 sxs?
how to dx?
tx option?
caused by displaced calcium carbonate crystals
Most commom cause of vertigo
SXS:
1 spinning provoked by changes in head positioning usually lasts 10-60 seconds but can last up to months
2. nystagmus with oscillation to lateral gaze
**over 2-3 beats is abnormal**
DX:
dix-hallpike: fatiguable horizontal nystagmus with rotary component
tx: epley maneuver
what are 4 testing methods you would want to include in pt you are working up for dizziness?
- orthos
2. cardiac testing
_**DONT MISS THIS, consider EKG, echo, holter, event monitor, stress test, EP study, or tilt table for orthostatic hypotension_
- swivel chair
- provcation tests
vertigo
6 tx options
- bedrest
- vestibular rehab
- vestibular suppression
meclizine-antihistamine
dimenhydrinate
promethazine
- benzodiazepines-diazepam (vallium)
- steroids
- epley maneuver
**if no resolution in sxs, than you would want to do imaging for tumor**
physiologic:
seasickness/motion sickness
what causes this?
5 sxs?
2 tx options?
alterations when the vestibular sense, visiual sense, and somatosensory sense** **don’t match
sxs:
N/V MC
dizziness
salivation
diaphoresis
malasie
TX:
- dimenhydrinate (dramamine)
- anti-cholinergics like scopolamine (patch)
vertigo:
labrynthitis
what is this?
how long does it last?
2 tx options?
acute severe vertigo** with vertigo and hearing loss from **several days to week
vertigo gets primarily better over time, but the hearing may or may not improve
Tx:
- abx if fever and signs of infection
- vestibular suppressants for acute sxs
otitis media
how does this normally occur?
3 main causes? 6 total?
4 sxs?
usually starts as viral URI that causes inflammation and occlusion of the eutachian tube, the secretions collect and then harbor the bacteria
MC CAUSES:
- streptococcus pneumoniae
2. haemophileus influenzae
3. moraxella catarrhalis
4. staph aureus
- group A strep
- viral infections-RSV, rhinovirus, enterovirus
SXS:
- otalgia
- fever
- diarreah
- comiting
otitis media
who do you tx? 2
who do you observe?
DOC? DOC2?
treat if:
child under 2 y/o OR older child with billateraly disease and otorrhea
observe in;
child over 2 with minimal sxs and unilateral disease
DOC: amoxicillin
DOC#2: amoxicillin clavulanate
And analgesic drops
SEROUS OTTITS with effusion
what is this?
what is the tx?
non-infected middle ear fluid, frequently occurs before or after AOM
THIS IS A PLUMBING PROBLEM SO DO NOT TX WITH ABX, TIME IS THE ONLY REMEDY
**TM NOT RED OR ANGRY, JUST FILLED WITH FLUID***
chronic ottits media
DIFFERENT CAUSATIVE ORGANISMS THAN ACUTE
- pseudomonas argeniosa
- S. aureus
- proteus
SXS
- perforated tympanic membrane
2. ossilar damaged with conductive hearing loss
TX:
topical abx drops, surgery is definitive tx
Otitis externa
what is this known as?
2 causes?
2 main sxs?
2 tx options?
“swimmers ear” commonly from water exposure or trauma
pseudomonas, proteus
SXS:
1. pain with tragus/auricle movement
2.redness and swelling of canal
TX:
- otic drops aminoglycoside (gentamycin) or fluoroquinolone (floxcin) +/- corticosteroid drops
barotrauma
what is this?
3 cuases?
2 sxs?
2 tx options?
inability to equalize pressure in the middle ear with eustachian tube dysfunction, can cause TM rupture
FLYING, diving, rapid altitude changes
SXS: ear pain/hearing loss
TX:
- yawning, swalling
- nasal decongestant upon arriving, AFFRIN
tympanic membrane perforation
what do you about this?
avoid?
most resolve on their own
surgery may be needed
AVOID MOISTURE/WATER IN the ear to prevent infection
conductive hearing loss
sound impaired in the inner ear
Causes:
- cerumen
- ottitis media
- trauma/injury
WEBER lateralizes to effected ear, Rinne tests shows greater bone conduction than air conduction
sensorineural hearing loss
3 causes
presbycusis
Menieres disease
accoustic neuroma
Menieres disease
what is the cause of this?
3 sxs?
1 test?
2 first line tx options?
distension of the inner ear endolymphatic system
- reccurrent vertigo
- lower range hearing loss
- tinnitis and unilateral aural pressure
- nystagmus to impaired side
TX: low sodium diet and diuretics
Acoustic neuroma
(vestibular schwannoma)
what is this?
sxs? 3 FAST OR SLOW?
DX?
1 TX?
BENIGN TUMOR EFFECTIVE 8TH CRANIAL NERVE
- unilateral progressive hearing loss with impaired speech
- ACUTE
- CONTINUOUS VERTIGO
DX: MRI
TX: surgery
SINUSITIS
TX?
TX of 10-14 days or fever
DOC amoxicillin
Group A Pharyngitis
4 qualifications
tx? 2 options
FEVER OVER 38/100.4
ANTERIOR CERVICAL
NO COUGH
TONSILAR EXUDATE
DX: rapid strep/throat cultures
TX: Penicillin or cefturoxime
Laryngitis
2 causative?
2 key sxs?
tx?
VIRAL
or M. Catarrhalis or H. Influenzae
SXS: HOARSNESS w/o pain classic
TX: supportive typically.
aphthous ulcers
causative?
3 sxs?
tx?
human herpes 6 possibly?
SXS:
- painful
- yellow-gray centers and red halos
- recurrent
TX:
supportive or perhaps topical corticosteroids
Oral candidiasis
causative agent?
2 causes?
sxs?
tx?
candidia albicans
think dentures, immunocomp
SXS:
1. creamy white patches can be scraped off
TX:
- nystatin oral
- or antifunal
leukoplakia
2 defining sxs?
3 things correlate to?
WHY IS THIS SILLY THING IMPORTANT?
SXS
- painless, CANT BE WIPED OFF
THINK SMOKING, ALOCHOL, GDENTURE
CAN BE CANCEROUS, SQUAMOUS CELL CARCINOMA
Nasal Polyps
descripvie words?
often come with?
what don’t you give?
tx?
sxs:
- pale, boggy
- often with allergies and asthma
**DONT GIVE ASA BECUASE OF RISK OF BRONCHOSPASM***
TX:
- nasal corticosteroid
- surgicaly removal
Herpes Simplex-2
what does this cause? what percent of the population is infected with this? where does this typically have predilection for? what do the lesions start and finish as? what percent of people will have reactivation in the first 12 months? how many reactivations will they have in their lifetime?
causes genital lesions
25% of the population infected with this
asymptomatic shedding and painful eruptions can occur
sacral root ganglion predilection
VESICLES rupture to form ULCERS
reactivation in 90% occur in the first 12 months!!
30% have 6 episodes in their lifetime!!
herpes simplex
what is a hint that an outbreak is going to occur? what is the important description of these? what are the two different types; where are they found and what percent of the population has them? how do you dx it and what do you see? what are the four treatment options?
prodromal phases: 24 hours before outbreak, get burning and tingling
“painful grouped vesicles on erythmatous base!”
HSV1: oral lesions 85% population infected; transmitted via saliva, outbreak triggered by random things
HSV2: genital herpes (more common and detrimental in women! more likely to have complications like ulcers and necrotic tissue), 25% population infected
DX:
- clinical for the most part
2. tzank smear, geimsa stain shows GIANT MULTINUCLEATED CELLS, can also check for antibodies for this via PCR
TX: supportive therapy
suppressive therapy
Acyclovir, valacyclovir, famcyclovir
acute hepetic gingivostomatits
what virus causes this? where does this tend to effect? how often are the outbreaks and who are they common in? what are three things you might find in this patient? explain the maturation of the vesicles?
HSV-1-trigeminal nerve predilection, eruptions 2x a year
common in 6 months-5 years CHILDREN
abrupt onset fever, anorexia, red mucosa
vesicles appear on gums, lip, tongue
vesicles colase to form ulcers or plaques
acute herpetic pharyngotonsillitis
what virus causes this? who is it the most common in? what are four symptoms you see with this? what do the lesions look like?
more common in HSV1 than HSV2
primarily in ADULTS
fever, malaise, headache, sore throat
vesicles on posterior pharynx and tonsils that RUPTURE to form ulcers (may have grayish exudate)
what are the 5 complications you worry about from herpes simplex virus?
1. herpetic withlow (vesicles on the fingers)
2. herpes gladiatorum (disseminated cutaneous infections common ing wrestlers)
3. keratoconjunctivitis (dendritic corneal ulcers)
4. HSV or CNS ENCEPHALOPATHY!! YIKES!! causes change in mental status and headache
5. infection during pregnancy can infect the child
what is herpetic whithlow?
herpes lesion on the FINGERS
where does Herpes simplex virus tend to hide?
dorsal root ganglion
this is why it reactivates
