HEENT Flashcards
1
Q
Describe the clinical course of bacterial pharyngitis
4; causes, s/s, dx, tx
A
- Caused by GABHS, neisseria, gonorrhea, and diptheria
- S/s of GABHS: abrupt onset in a 5-15 year old, high fever, maliase, sore throat, n/v, headache, petechiae, tonsillar exudate, lymph
- DX: throat culture
- TX: PCN, amox
2
Q
Describe clinical course of pharyngitis
3; causes, s/s, TX
A
- Caused by adenovirus, coxsackie, echovirus, herpes, EBV, CMV
- s/s gradual onset, nasal sx, sore throat, cough, fever
- TX: supportive care
3
Q
What is myopia? (2)
A
- “Nearsightedness”, visual image focused in front of the retina making it difficult to see things from far away
- s/s: squinting, unable to read blackboard
4
Q
What is hyperopia? (2)
A
- Farsightedness, visual image focused behind the retina, making it difficult to see things up close
- S/S: HA, eye strain, maybe asymptomatic, REFER
5
Q
Describe the clinical course of epiglottitis and what is the management?
(5; definition, organisms, s/s, dx, tx)
A
- Severe inflammation of the supraglottic structures leading to life threatening airway obstruction
- Usually bilateral = H.flu, staph, GABHS, strep pneumo, most common b.w 2-7 years
- S/s: high fever, severe sore throat, muffled voice, drooling, tripod position, irritable, toxic, cherry red epiglotitis
- DX: radiograph = thumb sign
- TX: EMERGENCY, keep child calm, antibiotics, maintain airway
6
Q
What is a peritonsillar abscess and what is the management?
5; definition, organisms, s/s, tx, more common
A
- Infection of tonsils and surrounding tissues, leads to abscess form
- Caused by GABHS, staph, anaerobes
- S/S: fever, severe sore throat, toxic appearance, muffled voice, drooling, bad breath, unilateral tonsillar swelling, uvula displacement away from affected side
- TX: REFER EMERGENCY, I&D, antibiotics
- More common in adolescents
7
Q
What is a retropharyngeal abscess and what is the management?
(5; definition, organisms, most common, s/s, tx)
A
- Posterior pharynx abscess with retropharyngeal nodes
- Caused by GABHS or staph
- Most common in children <4 years
- S/S: fever, severe sore throat, drooling, hyperextension of head, toxic appearing, stridor, prom swelling of posterior pharynx wall - diagnostic
- TX: REFER EMERGENCY, I&D, antibiotics
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
9
Q
Describe allergic rhinitis and how it is managed?
3; definition, s/s, tx
A
- IgE mediated response to allergens producing nasal mucosa inflammation
- S/S chronic nasal d/c itching, tearing, snoring with sleep, allergic shiners/salute, swollen boggy mucosa
- TX: nasal steroids, antihistamines, topical antihistamines, cromolyn, avoid allergens
10
Q
What are some causes of epistaxis and how is it managed?
2; definition, tx
A
- Nose bleed, due to increased vascularity in Kiesselbach’s triangle, caused by trauma, dry nasal mucosa, infection, substance abuse, systemic disease
- TX: apply pressure to anterior nasal septum, tilt head forward, phenylephrine drops, packing, refer to ENT if repeat/severe
11
Q
What are the signs and symptoms of FB in nose?
s/s, tx
A
- s/s unilateral, purulent d/c, sneezing, mild discomfort, rarely pain
- TX: remove object if possible, refer to ENT if unable
12
Q
What can cause sensorineural hearing loss? (3)
A
- Damage to the cochlea/auditory nerve
- Caused by the noise, anomaly, meningitis, hyperbili, kernicterus, gent, LBW, measles, mumps, intracranial hemorrhage
- high frequency hearing loss
13
Q
What can cause conductive hearing loss? (3)
A
- Blocked transmission of sound waves
- can be congenital/acquired, OME, AOM, cerumen, FB, perforated TM, cholesteatoma
- low frequency HL
14
Q
Describe conjunctivitis of the newborn and what is the management?
(4; definition, causes, bacterial tx, viral tx)
A
- Infection or inflammation in the 1st month of life
- Causes: viral (HSV), chemical, gonococcal, chlamydia, bacterial (HIB, staph, group B)
- OTHER bacterial tx: Tx with erythromycin ointment or gentamycin
- Viral: refer antiviral therapy
15
Q
Gonoccocal conjunctivitis (2) s/s, tx
A
- Acute purulent d/c with chemosis, and lid edema
2. TX: hospitalize cefotaxime
16
Q
Chlamydia Conjunctivitis (2) s/s, tx
A
- mild d/c, + pneumonia, afebrile, staccato cough,
2. TX: oral erythromycin, or sulfonamide
17
Q
What is astigmatism and what is the management?
(3; definition, s/s, tx
A
- Refractive error due to irregular curvature of the cornea
- s/s: eye pain, headache, fatigue, reading problems
- TX: refer, patching, corrective lens
18
Q
What are the s/s and TX for a FB in the eye?
2; s/s and tx
A
- s/s: pain, striation on the cornea, tearing FB sensation, irregular pupil, perforated wound
- Tx: do not remove intraocular FB, irrigate to remove FB, topical antibiotic, patch eye
19
Q
What are the clinical signs of a corneal abrasion and what is the management?
(3; causes, s/s, tx)
A
- Caused by abrasions, trauma, FB, contact lens, UV light exposure
- s/s FB sensation, pain, photophobia, tearing, blepharospasm, decrease in vision, +staining
- TX: rest, topical antibiotic, oral analgesics, f/u 24 hours and REFER (woodslamp?)
20
Q
What is amblyopia? (3; definition, s/s, tx)
A
- Decrease in visual acuity caused by abnormal develop, secondary to abnormal visual stim, result of strabismus, refractive error differences, sensory deprivation
- s/s: wandering eye, - red light reflex, strabismus
- 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
- 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
- S/S: drowsiness, pain, hx of injury, light sensitivity, blood in ant chamber, visual acuity changes
- 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
- Orbital: inflammation of the orbital contents, most common organisms = staph, Strep, H.Flu, often associated with sinusitis/ethmoiditis
- Opthalmoplegia, proptosis, decreased visual acuity, decreased ocular mobility, lid edema, fever, headache
- TX: refer, systemic antibiotic therapy
23
Q
What is dacryostenosis and what is the management?
3; definition, s/s, tx
A
- Nasolacrimal duct obstruction (blocked tear ducts) in an infant
- s/s continuous/intermittent tearing, d/c blepharitis, nasal d/c
- 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
- Chronic, inflammation/obstruction of meibomian glands in the post margins of lids
- nodular, non-tender mass/cyst, red conjunctiva, if large can lead to astigmatism
- TX: warm soaks, erythromycin ointment of sulfacetamide drops, refer for I&D if it does not resolve
25
What is a hodeolum and what is the management?
| 3; definition (organism), s/s, TX
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
What is blepharitis and what is the management?
| definition, s/s, tx
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
What is Nystagmus?
| 3
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
what are the clinical signs of retinoblastoma?
| 2; definition, tx
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
Describe retinopathy of prematurity
| 3; definition, s/s, TX
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
What is glaucoma and what is the management
| 5; definition, s/s, secondary s/s, tx, seen in
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
Describe cataracts and what is the management?
| definition, s/s, tx
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
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
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
What is strabismus? (4)
Define tropia/phoria
Define exotropia, esotropia, hypotropia, hypertropia
s/s
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
How is strabismus dx? (3)
1. Corneal light reflex or hirschberg test
2. cover/uncover
3. alternating cover
35
How is strabismus managed? (1)
1. TX = occulude/patch good eye, orthotic exercises, surgical alignment, corrective lens
36
Describe conjuctivitis of childhood and what is the management? (5; definition, bacterial organisms, viral organisms, s/s, tx)
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
What is otitis externa and what is the management?
| 4; definition, causes, s/s tx)
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
What are the causes signs and symptoms of acute otitis media?
definition, dx, s/s, causes
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
How is otitis media treated?
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
What is a cholesteatoma?
| definition, s/s, TX
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
What is a nasal polyp and what is the management? (3)
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
What are s/s of retinal detachment and what is the management? definition, s/s, manage
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
What is the clinical course for a burn to the eye?
| definition, s/s, tx
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
What is the clinical course for sinusitis and what is the management?
Definition, major vs. minor s/s, tx
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
What is the treatment for GABHS pharyngitis? (2 and an alternative)
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
What is the treatment for chronic symptomatic carriage of GABHS? (3 options)
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
