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HEENT Flashcards

1
Q

Describe the clinical course of bacterial pharyngitis

4; causes, s/s, dx, tx

A
  1. Caused by GABHS, neisseria, gonorrhea, and diptheria
  2. S/s of GABHS: abrupt onset in a 5-15 year old, high fever, maliase, sore throat, n/v, headache, petechiae, tonsillar exudate, lymph
  3. DX: throat culture
  4. TX: PCN, amox
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2
Q

Describe clinical course of pharyngitis

3; causes, s/s, TX

A
  1. Caused by adenovirus, coxsackie, echovirus, herpes, EBV, CMV
  2. s/s gradual onset, nasal sx, sore throat, cough, fever
  3. TX: supportive care
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3
Q

What is myopia? (2)

A
  1. “Nearsightedness”, visual image focused in front of the retina making it difficult to see things from far away
  2. s/s: squinting, unable to read blackboard
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4
Q

What is hyperopia? (2)

A
  1. Farsightedness, visual image focused behind the retina, making it difficult to see things up close
  2. S/S: HA, eye strain, maybe asymptomatic, REFER
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5
Q

Describe the clinical course of epiglottitis and what is the management?
(5; definition, organisms, s/s, dx, tx)

A
  1. Severe inflammation of the supraglottic structures leading to life threatening airway obstruction
  2. Usually bilateral = H.flu, staph, GABHS, strep pneumo, most common b.w 2-7 years
  3. S/s: high fever, severe sore throat, muffled voice, drooling, tripod position, irritable, toxic, cherry red epiglotitis
  4. DX: radiograph = thumb sign
  5. TX: EMERGENCY, keep child calm, antibiotics, maintain airway
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6
Q

What is a peritonsillar abscess and what is the management?

5; definition, organisms, s/s, tx, more common

A
  1. Infection of tonsils and surrounding tissues, leads to abscess form
  2. Caused by GABHS, staph, anaerobes
  3. S/S: fever, severe sore throat, toxic appearance, muffled voice, drooling, bad breath, unilateral tonsillar swelling, uvula displacement away from affected side
  4. TX: REFER EMERGENCY, I&D, antibiotics
  5. More common in adolescents
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7
Q

What is a retropharyngeal abscess and what is the management?
(5; definition, organisms, most common, s/s, tx)

A
  1. Posterior pharynx abscess with retropharyngeal nodes
  2. Caused by GABHS or staph
  3. Most common in children <4 years
  4. S/S: fever, severe sore throat, drooling, hyperextension of head, toxic appearing, stridor, prom swelling of posterior pharynx wall - diagnostic
  5. TX: REFER EMERGENCY, I&D, antibiotics
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8
Q

What is cleft lip/palate and how is it tx?

2; definition, tx

A

Lip: failure of embryonic structures of the oral cavity to join palate, failure of palatal shelves to fuse
TX: surgical repair, teach feeding technique

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9
Q

Describe allergic rhinitis and how it is managed?

3; definition, s/s, tx

A
  1. IgE mediated response to allergens producing nasal mucosa inflammation
  2. S/S chronic nasal d/c itching, tearing, snoring with sleep, allergic shiners/salute, swollen boggy mucosa
  3. TX: nasal steroids, antihistamines, topical antihistamines, cromolyn, avoid allergens
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10
Q

What are some causes of epistaxis and how is it managed?

2; definition, tx

A
  1. Nose bleed, due to increased vascularity in Kiesselbach’s triangle, caused by trauma, dry nasal mucosa, infection, substance abuse, systemic disease
  2. TX: apply pressure to anterior nasal septum, tilt head forward, phenylephrine drops, packing, refer to ENT if repeat/severe
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11
Q

What are the signs and symptoms of FB in nose?

s/s, tx

A
  1. s/s unilateral, purulent d/c, sneezing, mild discomfort, rarely pain
  2. TX: remove object if possible, refer to ENT if unable
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12
Q

What can cause sensorineural hearing loss? (3)

A
  1. Damage to the cochlea/auditory nerve
  2. Caused by the noise, anomaly, meningitis, hyperbili, kernicterus, gent, LBW, measles, mumps, intracranial hemorrhage
  3. high frequency hearing loss
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13
Q

What can cause conductive hearing loss? (3)

A
  1. Blocked transmission of sound waves
  2. can be congenital/acquired, OME, AOM, cerumen, FB, perforated TM, cholesteatoma
  3. low frequency HL
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14
Q

Describe conjunctivitis of the newborn and what is the management?
(4; definition, causes, bacterial tx, viral tx)

A
  1. Infection or inflammation in the 1st month of life
  2. Causes: viral (HSV), chemical, gonococcal, chlamydia, bacterial (HIB, staph, group B)
  3. OTHER bacterial tx: Tx with erythromycin ointment or gentamycin
  4. Viral: refer antiviral therapy
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15
Q 
Gonoccocal conjunctivitis (2)
s/s, tx
A
  1. Acute purulent d/c with chemosis, and lid edema

2. TX: hospitalize cefotaxime

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16
Q 
Chlamydia Conjunctivitis (2)
s/s, tx
A
  1. mild d/c, + pneumonia, afebrile, staccato cough,

2. TX: oral erythromycin, or sulfonamide

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17
Q

What is astigmatism and what is the management?

(3; definition, s/s, tx

A
  1. Refractive error due to irregular curvature of the cornea
  2. s/s: eye pain, headache, fatigue, reading problems
  3. TX: refer, patching, corrective lens
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18
Q

What are the s/s and TX for a FB in the eye?

2; s/s and tx

A
  1. s/s: pain, striation on the cornea, tearing FB sensation, irregular pupil, perforated wound
  2. Tx: do not remove intraocular FB, irrigate to remove FB, topical antibiotic, patch eye
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19
Q

What are the clinical signs of a corneal abrasion and what is the management?
(3; causes, s/s, tx)

A
  1. Caused by abrasions, trauma, FB, contact lens, UV light exposure
  2. s/s FB sensation, pain, photophobia, tearing, blepharospasm, decrease in vision, +staining
  3. TX: rest, topical antibiotic, oral analgesics, f/u 24 hours and REFER (woodslamp?)
20
Q

What is amblyopia? (3; definition, s/s, tx)

A
  1. Decrease in visual acuity caused by abnormal develop, secondary to abnormal visual stim, result of strabismus, refractive error differences, sensory deprivation
  2. s/s: wandering eye, - red light reflex, strabismus
  3. TX: refer, corrective lens, patching good eye, reassure, support
21
Q

What is a hyphema and what is the management?

3; definition, s/s, tx

A
  1. Blunt trauma to the globe results in blood in the anterior chamber, can also be caused by bleeding disorders, lead to high risk of glaucoma
  2. S/S: drowsiness, pain, hx of injury, light sensitivity, blood in ant chamber, visual acuity changes
  3. TX: refer, decrease activity, rest in supine position with elevated head, shield eye, may need hospitalization
22
Q

What is orbital cellulitis and what is the management?

3; definition, s/s, tx

A
  1. Orbital: inflammation of the orbital contents, most common organisms = staph, Strep, H.Flu, often associated with sinusitis/ethmoiditis
  2. Opthalmoplegia, proptosis, decreased visual acuity, decreased ocular mobility, lid edema, fever, headache
  3. TX: refer, systemic antibiotic therapy
23
Q

What is dacryostenosis and what is the management?

3; definition, s/s, tx

A
  1. Nasolacrimal duct obstruction (blocked tear ducts) in an infant
  2. s/s continuous/intermittent tearing, d/c blepharitis, nasal d/c
  3. TX: massage, should disappear by 12 mo, if not refer
24
Q

What is chalazion and what is the management?

3, definition, s/s, TX

A
  1. Chronic, inflammation/obstruction of meibomian glands in the post margins of lids
  2. nodular, non-tender mass/cyst, red conjunctiva, if large can lead to astigmatism
  3. TX: warm soaks, erythromycin ointment of sulfacetamide drops, refer for I&D if it does not resolve
25
Q

What is a hodeolum and what is the management?

3; definition (organism), s/s, TX

A
  1. Acute inflammation of the sebaceous glands of the eyelids, usually caused by staph
  2. s/s sudden onset, tenderness, redness, swelling with FB sensation, pain on palpation
  3. TX: warm compresses, erytho/bacitracin ointment, I&D if severe
26
Q

What is blepharitis and what is the management?

definition, s/s, tx

A
  1. Acute/chronic inflammation of the eyelash follicles, and meibomian glands, can be seborrheic, ulcerated or bacterial (staph = most common)
  2. s/s: irritation/burning, FB sensation, erythema, pruritis, loss of eyelashes, flaky/scaly debris or hard scales at base of eyelash - will bleed ifremoved
  3. TX = moist compresses wash with baby shampoo, topical antibiotic (erythromycin), selenium sulfide for seborrheic, remove contact lens, throw away make-up
27
Q

What is Nystagmus?

3

A
  1. Involuntary horizontal/vertical/rotary/mixed movement of the eyes
  2. Can be familial, also associated with albinism, refractive errors, CNS disease, ear disease, and retinal disease
  3. TX - refer to optho, monitor, tx underlying cause
28
Q

what are the clinical signs of retinoblastoma?

2; definition, tx

A
  1. Intraocular tumor
  2. s/s = squinting, eye turns outward more than inward, may have painful red eye, hyphema, pink mass, can be seen on fundo, leukocoria, decreased visual acuity, photophobia
29
Q

Describe retinopathy of prematurity

3; definition, s/s, TX

A
  1. Developmental vascular disorder that results in abnormal growth of retinal vessel and incomplete vascularization of the retina ~EGA, and LBW infants
  2. s/s leukocoria, optic nerve, pallor, glaucoma, cataracts, strabismus, detached retina, retinal/iris change, vitreous haziness/hemorrhage
  3. TX: monitor routinely, refer for vision services, yearly opthal exam, cyrosurgery
30
Q

What is glaucoma and what is the management

5; definition, s/s, secondary s/s, tx, seen in

A
  1. Increase IOP due to a disturbance in the circulation of aqueous fluid, can be congenital or juvenile (trauma, disease, steroid use)
  2. s/s = CLASSIC triad = tearing, photophobia, excessive blinking (blepharospasms), hazy cornea, corneal edema or ocular enlargement
  3. Secondary s/s = pain, vomit, blurry vision, pupil dilation, erythema, asymm between eyes
  4. Tx: surgery, topical B Blockers, topical carb anhydrase inhibitors can result in blindness
  5. Seen with marfan, NF, Pierre robin, cong rubella
31
Q

Describe cataracts and what is the management?

definition, s/s, tx

A
  1. Partial/complete opacity of the lens, can be congenital or acquired, unilateral/bilateral, can result in amblyopia
  2. s/s: lens opacity, variable visual defects, hx of prenatal infection, drug exposure, or hypocalcemia
  3. tx: surgical removal of the ens with use of corrective lens, possible watch and wait, depending on severity
    Black dots or white area in red reflex*
32
Q

What are the stages of normal visual development?

3 years, 5 years, 6 years
Birth, 2-4 wks, 3-4 mo, 4 mo, 6-10 mo, 12 mo

A

20/40 by 3 years, 20/30 by 5 years, 20/20 by 6 years

Birth: sees and responds to change, fixes on contrasts (B&W) + pupillary reflex, jerky movements
2-4wks: follows objects sporadically
3-4 mo: recognizes parents smiles, focuses near and far, begin to develop of depth perception, esotropia=norm
4 mo: norm color vision
6-10 mo: follows toy in all directions
12 mo: close to fully developed

33
Q

What is strabismus? (4)
Define tropia/phoria
Define exotropia, esotropia, hypotropia, hypertropia
s/s

A
  1. Tropia - constant deviation
  2. Phoria - intermittent deviation
  3. Defect in ovular alignment, deviate outward (exotropia), deviate inward (esotropia), upward (hypertropia), downward (hypotropia), sclera between the cornea and inner canthus is obscured (pseudostrabismus)
  4. s/s: person squinting, head tilting, face turning, over pointing, decrease in visual acuity, nystagmus
34
Q

How is strabismus dx? (3)

A
  1. Corneal light reflex or hirschberg test
  2. cover/uncover
  3. alternating cover
35
Q

How is strabismus managed? (1)

A
  1. TX = occulude/patch good eye, orthotic exercises, surgical alignment, corrective lens
36
Q

Describe conjuctivitis of childhood and what is the management? (5; definition, bacterial organisms, viral organisms, s/s, tx)

A
  1. Infection of the palpebral lining of the conjunctiva
  2. Bacterial = s. aureus, HIB, strep pneumo
  3. Viral = adenovirus, HSV, varicella, also allergic due to seasonal allergies
  4. s/s = pruritis, FB sensation, tearing, HA, photosensitivity, watery, mucous, purulent mucous, erythema of conjunctiva, chemosis, papillary hypertrophy
  5. TX: topical tobramycin, sulfacetamide, polymycin, fluoro, refer if viral, allergic = tx underlying
37
Q

What is otitis externa and what is the management?

4; definition, causes, s/s tx)

A
  1. acute infection/inflammation of ext auditory canal, swimmers ear, also fungal
  2. causes: pseudomonas and staph, more common in the summer due to water exposure
  3. s/s itching pain when moving the tragus, swollen EAC, pressure/fullness in ear, black spots on TM (fungal
    TX: analgesics, otic antibiotic drops (ciprofloxacin, polymycin, neosporin), mycotic drops (5% boric acid in ethanol), avoid water in ears, avoid cleaning the ears
38
Q

What are the causes signs and symptoms of acute otitis media?
definition, dx, s/s, causes

A
  1. Acute infection of middle ear
  2. DX: rapid onset of s/s of ME inflammation and effusion with MEE
  3. s/s ear pain, irritable, fever, otorrhea, presence of MEE
39
Q

How is otitis media treated?

A
  1. Watchful waiting: For 48-72 hours if d/c is unclear sx are not severe, child is over 6 mo or over 2 years (See below)
  2. 1st line = amox HD 80-90 mg/kg/day
  3. 2nd line tx = with fever, tx fail, augmentin 90mg/kg/day, alt for PCN allergy = azizthromycin, clarithromycin, ceftriaxone

TX all patients <6mo
TX all patients 6mo-2year with def dx
TX all patients > 2 years with severe illness
TX pain with analgesics - acet/ibuprofen

40
Q

What is a cholesteatoma?

definition, s/s, TX

A
  1. epidermal cyst of the middle ear, can be congenital or acquired
  2. s/s = vertigo, hearing loss, chronic OM with purulent d/c pearly white lesion behind TM
  3. Refer to ENT for surgical removal
41
Q

What is a nasal polyp and what is the management? (3)

A
  1. Benign nasal tumor
  2. Think CF* refer for sweat test, also seen in allergic children
  3. Will look like a grape mass between the turbinates
42
Q

What are s/s of retinal detachment and what is the management? definition, s/s, manage

A
  1. Cause by trauma (abuse), congenital abnormality (cataracts, ehlers-danlos, sticklers, Marfan) or retinal disease
  2. s/s = blurry vision, flashing light sensation, darkening of retinal vessels
  3. REFER to opthal
43
Q

What is the clinical course for a burn to the eye?

definition, s/s, tx

A
  1. can be thermal, chemical or UV light
  2. s/s - pale, necrotic appearance of surrounding skin, corneal opacity, decrease in visual acuity, initial pain or delayed pain (UV burns), photophobia, tearing, swollen cornea, pinpoint fluoro stain
  3. TX = topical anesthetic, immediate irrigation for chemical burns, REFER
44
Q

What is the clinical course for sinusitis and what is the management?
Definition, major vs. minor s/s, tx

A
  1. Chronic (>30 days) or acute (>10 days), infection and inflammation of paranasal sinus, caused by viral, bacterial (s. pneumo, H. flu, M. cat) or anaerobes
  2. major s/s=facial congestions/fullness, fever(acute), purulent discolored rhinorrhea, facial pain, nasal obstruction, hyposmia/anosmia
  3. minor s/s = HA, halitosis, fatigue, dental pain, otalgia pain
  4. TX = augmention, HD amoxil, PCN allergy = z pack
    2nd line = cefuroxime, cefpodoxime, cefdinir
45
Q

What is the treatment for GABHS pharyngitis? (2 and an alternative)

A
  1. PCN w/ Potassium
    = 27g: 250mg divided BID or TID for 10 days
    >27g: 500mg divided BID or TID for 10 days
  2. Amox suspension 50mg/kg once daily or 25mg/kg BID for 10 days

Alt is hypersensitivity to PCN: Azithro or Clinda

46
Q

What is the treatment for chronic symptomatic carriage of GABHS? (3 options)

A
  1. Clindamycin 20-30mg/kg/day in 3 doses for 10 days
  2. Amox-Clav 40mg/kg/day in 3 doses for 10 days
  3. PCN 50mg/kg/day in 4 doses for 10 days with use of Rifampin 20mg/kg/day once in last 4 days of treatment

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