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Rotation 4: FMI > HEENT > Flashcards

HEENT Flashcards

1
Q

blepharitis (blep=boogers in the eye)

what is this what is it caused by?

sxs?

tx? 3

A

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
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2
Q

Glaucoma

what is this?

what are the 2 types?

1 RF?

A

eye conditions that cause progressive optic nerve damage, leading to irreversible loss of vision

Types:

  1. open angle
  2. closed angle

RF:

elevated intraocular pressure

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3
Q

Closed angle glaucoma

what is this caused by? IOP?

5 key sxs?

3 tx options?

2

3

1

A

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

  1. Decrease aqueous production WITH BB or barconic anhydrase inhibitor

2. increase outflow with Prostaglandin, cholinergi, epi

***ALPHA AGONISTS DO BOTH OF THESE***

  1. Ultimately need laser (YAG periphreal iridotomy**)
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4
Q

Open angle glaucoma

what is this?

3 ways to dx?

3 tx options?

A

most often asymptomatic and chronic with IOP over 22, but can still have damage less than 22

DX:

  1. tonometry: tells IOP
  2. optic nerve eval through dilated pupil
  3. pachymetry: measure central corneal thickness

TX:

  1. pharmocological first then consider surgery

A. BB or carbonic anyhdrase inhibitor

B. Laser Trabeculoplasty

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5
Q

secondary glycoma

7 causes

A
  1. inflammation
  2. hyphema-blood in the anterior chamber
  3. angle recession-caused by blunt trauma to the TM
  4. neovascular- complication of diabetic retinopathy or vascular occlusion, BV can grow into the angle
  5. phacolytic
  6. pseudoexfoliation syndrome-white flakey material from the anterior surface clogs the TM
  7. pigment disruption-part of the iris flakes off and clogs the TM
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6
Q

Cataract

what is this?

patho?

3 sxs

3 types

A

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:

  1. gradual loss of vision
  2. increased glare
  3. decreased color preception

Types:

nuclear sclerosis

cortical

posterior subscapular

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7
Q

Nuclear sclerosis cataract

A

ellow or brown discoloration
of the central lens; even distribution;
distance vision blurred myopic shift (second sight)

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8
Q

cortical cataract

A

radial or spoke like opacities

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9
Q

posterior subscapular cataracts

A

plaque-like opacities
on the posterior aspect of the lens. Greater affect
on acuity and often in younger patients

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10
Q

whta are the reasons for doing cataract surgery?

A
  1. increase activitis of daily living
  2. prevent secondary glaucoma
  3. permit fundus visulization
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11
Q

what is a secondary cataract that is a complication of cataract surgery?

A

-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

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12
Q

Dry Macular degeneration

what is this?

age?

2 key findings?

tx considerations? 3 things

A

painless and progressive CENTRAL vision loss, OVER 50

FINDINGS:

  1. drusen-small yellow deposits lead to degenerative changes and atrophy
  2. changes on amsler grid

TX:

AREDS trial-tx with high antioxidants plus zinc can reduce up to 25%

(b-caretene, vit C, E, zinc)

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13
Q

Wet macular degeneration

what are the two things the contribut to this?

patho?

2 findings?

1 tx?

A

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:

  1. metamorphopsia-hemmorage causing wavy and distorted vision with paracentral scotomas “blind spots”

TX: ANTI-VEGF (vascular endothelial growth factor), 9/10 stabilize

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14
Q

chalazion (put it in my chalise)

what is this?

what is it caused by?

what can it cuase?

3 tx options?

A
  • 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
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15
Q

Allergic conjunctivitis

2 sxs?

2 tx?

warning?

A

itch with tearing, GLOSSY injection

-1st: OTC antihistamines
-2nd: mast cell inhibitors and
mild steroids

warning: steroids increase the interoccular pressure

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16
Q

Bacterial Conjunctivitis

1 key sxs of this?

2 common organisms?

2 tx options?

A

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

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17
Q

viral conjunctivitis

what is the MC cause of this?

2 sxs?

3 tx options?

A

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

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18
Q

Herpes simplex virus corneal ulcer

key description for this?

what to avoid?

A

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

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19
Q

Herpes zoster corneal ulcer

4 key sxs?

what is the sign that can indicate this?

A

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

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20
Q

what should you NEVER do for a bacterial or viral corneal ulcer or keratitis?

A

(NEVER PATCH AN EYE WITH BACTERIAL OR VIRAL CORNEAL ULCERS BECAUSE IT KEEPS THE VIRUS OR BACTERIA IN)

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21
Q

dacrocystitis

what 3 things are likely to cause this?

what is this?

3 sxs?

tx option general?

A

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

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22
Q

ectropion

what is this?

2 things that can cause this?

3 sxs?

2 tx options?

A

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)

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23
Q

entropion

what is this?

sxs?

tx?

A

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

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24
Q

hordelum

what is this? where is it?

what is blocked?

caused by?

tx general?

A

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

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25
pterygium ## Footnote 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
26
retinal detachment ## Footnote 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_**
27
Retinal detachment ## Footnote 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
28
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
29
what can happen at any time during diabetic retinpathy that is serious?
macular edema
30
nonproliferative diabetic retinopathy what is this? (3 things) 2 tx
enlarged and blocked blood vessels, microaneurysms, hard exudates Tx: control sugars and BP
31
proliferative diabetic retinopathy what is this classified by 2 tx options?
more advanced and severe, neovascularization, viterous hemmorage Tx: 1. control sugars 2. control BP SEVERE DISEASE IS PERMANENT
32
hypertensive retinopathy
- Asymptomatic, bilateral - acute hypertension most common cause - DIFFUSE ARTERIOLAR NARROWING - COPPER OR SILVER WIRING - ARTERIOVENOUS NICKING - HEME FLARES! PAPILLEDEMA
33
vertigo pattern ## Footnote 3 patterns it can present with indicating where the problem is
1. fast nystagmus that goes **_away from lesions or effected side_** ## Footnote 2. \*\*rotation goes away from effected side\*\* 3. falling towards affected side
34
vertigo: menieres disease what is this? another name? what is different anamomically? 4 sxs? 2 tx options?
progressive hearing loss of **_low frequency_** ## Footnote also known as "**_endolymphatic hydrops"_** \*\*\*distention of inner ear endolymphatic system\*\* sxs: 1. vertigo (mins to hours) 2. tinnitus 3. one-sided aural pressure 4. **_loss of low frequency hearing_** **_tx:_** **_1. diuretics: HCTZ_** **_2. very low salt restriction less than 1 g (YUCK)_**
36
vertigo: acoustic neuroma WHAT IS THIS? ANOTHER NAME? 3 SXS? 1 DX METHOD?
benign tumor effecting CN VIII ## Footnote 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)
37
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
38
what are 4 testing methods you would want to include in pt you are working up for dizziness?
1. orthos 2**_. cardiac testing_** _**\*\*DONT MISS THIS, consider EKG, echo, holter, event monitor, stress test, EP study, or tilt table for orthostatic hypotension**_ 3. swivel chair 4. provcation tests
39
vertigo ## Footnote 6 tx options
1. bedrest 2. vestibular rehab 3. vestibular suppression **_meclizine-antihistamine_** **_dimenhydrinate_** **_promethazine_** 4. benzodiazepines-diazepam (vallium) 5. steroids 6. epley maneuver \*\*if no resolution in sxs, than you would want to do imaging for tumor\*\*
40
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: 1. **_dimenhydrinate (dramamine)_** 2. **_anti-cholinergics like scopolamine_** (patch)
41
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: 1. abx if fever and signs of infection 2. vestibular suppressants for acute sxs
42
otitis media ## Footnote 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: 1. **streptococcus pneumoniae** **2. haemophileus influenzae** **3. moraxella catarrhalis** **4.** staph aureus 5. group A strep 6. viral infections-RSV, rhinovirus, enterovirus SXS: 1. otalgia 2. fever 3. diarreah 4. comiting
43
otitis media ## Footnote 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_**
44
SEROUS OTTITS with effusion ## Footnote 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\*\*\***
45
chronic ottits media
DIFFERENT CAUSATIVE ORGANISMS THAN ACUTE 1. pseudomonas argeniosa 2. S. aureus 3. proteus SXS 1. **_perforated tympanic membrane_** **_2. ossilar damaged with conductive hearing loss_** TX: topical abx drops, surgery is definitive tx
46
Otitis externa ## Footnote what is this known as? 2 causes? 2 main sxs? 2 tx options?
"swimmers ear" commonly from water exposure or trauma ## Footnote pseudomonas, proteus SXS: **_1. pain with tragus/auricle movement_** **_2.redness and swelling of canal_** TX: 1. otic drops aminoglycoside (gentamycin) or fluoroquinolone (floxcin) +/- corticosteroid drops
47
barotrauma ## Footnote 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: 1. yawning, swalling 2. nasal decongestant upon arriving, AFFRIN
48
tympanic membrane perforation ## Footnote what do you about this? avoid?
most resolve on their own surgery may be needed AVOID MOISTURE/WATER IN the ear to prevent infection
49
conductive hearing loss
sound impaired in the inner ear ## Footnote Causes: 1. cerumen 2. ottitis media 3. trauma/injury WEBER lateralizes to effected ear, Rinne tests shows greater bone conduction than air conduction
50
sensorineural hearing loss 3 causes
presbycusis Menieres disease accoustic neuroma
51
Menieres disease ## Footnote what is the cause of this? 3 sxs? 1 test? 2 first line tx options?
distension of the inner ear endolymphatic system 1. reccurrent vertigo 2. lower range hearing loss 3. tinnitis and unilateral aural pressure 4. _nystagmus to impaired side_ _TX: low sodium diet and diuretics_
52
Acoustic neuroma (vestibular schwannoma) what is this? sxs? 3 FAST OR SLOW? DX? 1 TX?
**_BENIGN TUMOR EFFECTIVE 8TH CRANIAL NERVE_** ## Footnote 1. unilateral progressive hearing loss with impaired speech 2. ACUTE 3. CONTINUOUS VERTIGO DX: MRI TX: surgery
53
SINUSITIS ## Footnote TX?
TX of 10-14 days or fever DOC amoxicillin
54
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
55
Laryngitis ## Footnote 2 causative? 2 key sxs? tx?
VIRAL or M. Catarrhalis or H. Influenzae SXS: HOARSNESS w/o pain classic TX: supportive typically.
56
aphthous ulcers ## Footnote causative? 3 sxs? tx?
human herpes 6 possibly? ## Footnote SXS: 1. painful 2. **_yellow-gray centers_** and red halos 3. recurrent TX: supportive or perhaps topical corticosteroids
57
Oral candidiasis causative agent? 2 causes? sxs? tx?
candidia albicans think dentures, immunocomp SXS: **_1. creamy white patches can be scraped off_** TX: 1. nystatin oral 2. or antifunal
58
leukoplakia 2 _defining sxs?_ 3 things correlate to? WHY IS THIS SILLY THING IMPORTANT?
SXS ## Footnote 1. painless, CANT BE WIPED OFF THINK SMOKING, ALOCHOL, GDENTURE **_CAN BE CANCEROUS, SQUAMOUS CELL CARCINOMA_**
59
Nasal Polyps ## Footnote descripvie words? often come with? what don't you give? tx?
sxs: 1. pale, boggy 2. often with allergies and asthma \*\*DONT GIVE ASA BECUASE OF RISK OF BRONCHOSPASM\*\*\* TX: 1. nasal corticosteroid 2. surgicaly removal
60
61
_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!!
63
herpes simplex ## Footnote 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: 1. 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**
64
acute hepetic gingivostomatits ## Footnote 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_**
65
acute herpetic pharyngotonsillitis ## Footnote 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)
66
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
67
what is herpetic whithlow?
herpes lesion on the FINGERS
68
where does Herpes simplex virus tend to hide?
dorsal root ganglion ## Footnote this is why it reactivates

Rotation 4: FMI (11 decks)

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