HEENT Flashcards
1
Q
Most common causes of pharyngitis
A
Adenovirus, Rhinovirus, Enterovirus
GABHS for streptococcal pharyngitis
2
Q
Signs/Symptoms of pharyngitis
A
- sore throat
2. pain with swallowing
3
Q
Management for viral pharyngitis
A
Fluids, warm saline gargles, topical anesthetics, lozenges, NSAIDs
4
Q
Centor Criteria for Strep Throat
A
- Fever > 100.4
- Pharyngotonsillar exudates
- Tender anterior cervical lymphadenopathy
- Absence of cough
5
Q
Centor Criteria Interpretation
A
Score 0-4
0-1 - no abx or culture needed
2-3 - throat culture
4-5 - give antibiotics
6
Q
Modified Centor Criteria
A
< 15 y/o add 1 point
> 44 y/o subtract 1 point
7
Q
Diagnosis of strep throat
A
Rapid antigen detection test
Throat culture - definitive diagnosis (gold standard)
8
Q
Management of strep throat
A
Penicillin G or VK first line, amoxicillin, augmentin
Macrolides if PCN allergic (azithromycin, clarithromycin, erythromycin)
9
Q
Complications of strep throat
A
- Rheumatic fever
- Glomerulonephritis
- Peritonsillar abscess, cellulitis
10
Q
Acute sinusitis is defined as:
A
1-4 weeks
11
Q
Etiologies of sinusitis
A
S. pneumo H. flu GABHS M. catarrhalis (same as otitis media)
12
Q
Signs/symptoms of sinusitis
A
Sinus pain/pressure -worse with bending down and leaning forward Headache, malaise Purulent sputum or nasal discharge Fever Nasal congestion
13
Q
Physical exam of sinusitis
A
Sinus tenderness on palpation
Opacification with transillumination
14
Q
Diagnosis of sinusitis
A
Clinical diagnosis
CT scan diagnostic test of choice
Sinus radiographs - water’s view
15
Q
Symptomatic management of sinusitis
A
- decongestants, antihistamines, mucolytics, intranasal corticosteroids, analgesics, nasal lavage
Indicated if sx < 7 days
16
Q
Antibiotic treatment for sinusitis
A
Sx should be present for > 10-14 days or earlier if: febrile, facial swelling, etc.
Amoxicillin drug of choice x 10-14 days
Doxycycline, Bactrim
17
Q
Chronic sinusitis is defined as:
A
> 12 consecutive weeks
18
Q
Most common bacterial cause of chronic sinusitis
A
S. aureus
19
Q
Most common fungal cause of chronic sinusitis
A
Aspergillus
20
Q
Mucormycosis
A
Fungi invade the sinuses and may enter the CNS
Seen in immunocompromised patients
21
Q
Signs/symptoms of mucormycosis
A
Acute sinusitis sx
May be associated with black eschar on palate, face
22
Q
Management of mycormycosis
A
IV amphotericin B first line
May need surgical debridement
23
Q
Canker sores, ulcerative stomatitis
A
Aphthous ulcers
24
Q
Small round or oval painful ulcers (yellow, white or grey centers) with erythematous halos. most commonly on buccal or labial mucosa
A
Aphthous ulcers
25
Management of aphthous ulcers
1. Topical analgesics, topical oral steroids (Triamcinolone)
| 2. Cimetidine may be used if recurrent ulcers
26
Inflammation of both eyelids. Common in pts with ___________ and ________
Blepharitis
Down syndrome
Eczema
27
Two types of blepharitis
1. Infectious (staph aureus or staph epidermidis)
| 2. Seborrheic
28
Signs/Symptoms of blepharitis
1. Eye irritation/itching
| 2. Eyelid burning, erythema, crusting, scaling, red-rimming and eyelash flaking
29
Management of blepharitis
Warm compresses, eyelid scrubbing/washing with baby shampoo
| May give azithromycin ointment/solution
30
Most common etiology of viral conjunctivitis
Adenovirus
31
Most common cause of viral conjunctivitis
Swimmin gpool
32
Signs/symptoms of viral conjunctivitis
Foreign body sensation
Erythema
Itching
Normal vision
33
Preauricular lymphadenopathy, copious watery discharge from eyes, scanty mucoid discharge. Often bilateral.
Viral conjunctivitis
34
Management of viral conjunctivitis
Supportive - cool compresses, artificial tears
| Antihistamines for itching/redness
35
Signs/symptoms of allergic conjunctivitis
Conjunctival erythema paired with other allergic symptoms
36
Cobblestone mucosa appearance to the inner/upper eyelid, itching, tearing, redness, stringy discharge. Usually bilateral, +/- conjunctival swelling
Allergic conjunctivitis
37
Treatment for allergic conjunctivitis
Topical antihistamine: olopatadine
| Topical NSAID: ketorolac
38
Most common causes of bacterial conjunctivitis
S. aureus
Strep pneumoniae
H. influenzae
39
Purulent discharge from eye, lid crusting, usually no vision changes
Bacterial conjunctivitis
40
Management of bacterial conjunctivitis
Topical abx - erythromycin, fluoroquinolones (moxi), sulfonamides, aminoglycosides
41
Management of bacterial conjunctivitis if contact lens wearer
Cover pseudomonas
| Fluoruquinolone or aminoglycoside
42
Infection of the lacrimal sac
Dacryocystitis
43
Tearing, tenderness, edema and redness to the nasal side of lower eyelid
Dacryocystitis
44
Management of dacryocystitis
Antibiotics - clindamycin
| Dacryocystorhinostomy
45
Local abscess of the eyelid margin
Hordeolum
46
Etiology of hordeolum
Staph aureus (90-95%)
47
Management of hordeolum
Warm compresses of eye
Most will eventually point and drain spontaneously
+/- topical erythromycin/bacitracin if actively draining
48
Inflammation of the vestibular portion of CN 8 - most common after viral infxn
Vestibular Neuritis
49
Vestibular neuritis + hearing loss/tinnitus from cochlear involvement
Labyrinthitis
50
Peripheral vertigo, dizziness, N/V, gait disturbances, horizontal nystagmus, hearing loss
Vestibular Neuritis and Labyrinthitis
51
Management of vestibular neuritis/labyrinthitis
Antihistamines (Meclizine), benzodiazepines
52
Inflammation of the larynx
Laryngitis
53
Most common etiology of laryngitis
Viral - adenovirus, rhinovirus, etc.
| Trauma (vocal abuse)
54
Hallmark of laryngitis
Hoarseness
55
Management of laryngitis
Vocal rest, warm saline gargles, anesthetics, lozenges, increased fluid intake
56
Excess H20 or local trauma changes the normal acidic pH of the ear, causing bacterial overgrowth
Otitis Externa
57
Most common etiology of otitis externa
Pseudomonas (MC)
| Proteus, S. aureus
58
1-2 days of ear pain, pruritus in the ear canal
May have had recent activity of swimming
Auricular discharge, pressure/fullness. Hearing usually preserved
otitis externa
59
Management of otitis externa
Protect ear against moisture
Ciprofloxacin/dexamethasone
Ofloxacin safe
Aminoglycoside combination
60
Management of malignant otitis externa
Seen in DM and immunocompromised
| IV Ceftazidime or Piperacillin + fluoroquinolones
61
Infection of middle ear, temporal bone, and mastoid air cells. Most commonly preceded by viral URI
Acute otitis media
62
4 most common organisms of acute otitis media
S. pneumo, H. influenzae, M. catarrhalis, strep pyogenes
63
Risk factors for otitis media
```
Eustachian tube dysfunction
Young (ET is wider, shorter and more horizontal)
Daycare
Pacifier/bottle use
Parental smoking
Not being breastfed
```
64
Fever, otalgia, ear tugging in infants, conductive hearing loss, stuffiness
Otitis media
65
Rapid relief of ear pain + otorrhea
Tympanic membrane perforation
66
Management of otitis media
1. Amoxicillin 10-14 days
2. Augmentin or Cefixime
3. If PCN allergic, erythromycin, azithromycin, Bactrim
67
Management for severe, recurrent cases of otitis media
Myringotomy (surgical drainage)
| Tympanostomy
68
Treatment for chronic otitis media - perforated TM + persistent or recurrent purulent otorrhea +/- pain
Topical ofloxacin or ciprofloxacin
| Avoid water/moisture/topical aminoglycosides in ear when TM rupture
69
Acute ear pain, hearing loss, +/- bloody otorrhea, +/- tinnitus and vertigo
tympanic membrane perforation
70
Most commonly occurs due to penetrating or noise trauma, pressure
Tympanic membrane perforation
71
Treatment for tympanic membrane perforation without infection
Most heal spontaneously. Follow up to ensure resolution
72
Eyelid and eyelashes turned outward. Due to relaxation of the orbicularis oculi muscle
Ectropion
73
Management of ectropion
Surgical correction if needed. Lubricating eye drops
74
Eyelid and lashes turned inward. Caused by spasms of the orbicularis oculi muscle
Entropion
75
Management of entropion
Surgical correction if needed. Lubricating eye drops for symptom relief.
76
Foreign body sensation in the eye, tearing, red and pain that is relieved with instillation of ophthalmic analgesic drops
Ocular Foreign body
| Corneal abrasion
77
Diagnosis of ocular foreign body / corneal abrasion
Pain relieved with instillation of ophthalmic analgesic drops
Fluorescein staining - abrasions
78
Management of ocular foreign body
Check visual acuity first
Remove foreign bodies with sterile irrigation
Avoid sending pts home with topical anesthetics
Antibiotic drops - erythro, polymyxin/trimethoprim
79
Management of corneal abrasion
Check visual acuity first
Patching not indicated for small abrasions, and no longer than 24 hours for large
Ciprofloxacin, erythromycin
80
Most common etiology of corneal ulcer? In contact lens wearers? With ocular trauma? Chronic topical steroid use?
HSV overall
Pseudomonas
Bacterial
Fungal
81
Ulceration usually has regular borders and will have accompanying purulent exudate
Corneal ulcer
82
Blue/green discharge with corneal ulcer
Pseudomonas
83
Dendrites on fluorescein staining with corneal ulcer
HSV
84
Satellite lesions around ulceration with corneal ulcer
Fungus
85
Increased intraocular pressure leads to optic nerve damage, leading to decreased visual acuity
Acute narrow angle-closure glaucoma
86
Decreased drainage of aqueous humor via trabecular meshwork and canal of schlemm in pts with preexisting narrow angle or large lens
Acute narrow angle-closure glaucoma
87
Leading cause of preventable blindness in US
Acute narrow angle-closure glaucoma
88
Precipitating factors for acute narrow angle-closure glaucoma
Mydriasis - pupillary dilation further closes the angle
| Dim lights, sympathomimetics and anticholinergics
89
Severe, sudden onset of unilateral ocular pain +/- nausea, vomiting, headache. Vision changes, blurring, halos around lights, peripheral vision loss (tunnel)
Acute narrow angle-closure glaucoma
90
Conjunctival erythema, steamy cornea, mid-dilated, fixed, non-reactive pupil, eye may feel hard to palpation
Acute narrow angle-closure glaucoma
91
Diagnosis of acute narrow angle-closure glaucoma
Increased IOP by tonometry (> 21 mmHg)
| Cupping of optic nerve of fundoscopy
92
Management of acute angle glaucoma
Ophthalmic emergency
Step 1: lower IOP (acetazolamide, BB, mannitol)
Step 2: Open the angle (cholinergics - pilocarpine, carbachol)
Peripheral iridotomy definitive treatment
93
Medications to avoid with acute angle glaucoma
Anticholinergics
| Sympathomimetics
94
Slow, progressive, bilateral peripheral vision loss
Chronic (open angle) glaucoma
95
2nd most common cause of blindness in the world (after cataracts)
Chronic (open angle) glaucoma
96
Risk factors for chronic (open angle) glaucoma
African-americans
> 40 y/o
Family history
DM
97
Increased IOP due to reduced aqueous drainage through the trabeculae, which eventually damages the optic nerve
Chronic (open angle) glaucoma
98
Gradual bilateral painless peripheral vision loss (tunnel vision) leading to central loss of vision
Chronic (open angle) glaucoma
99
Management of chronic (open angle) glaucoma
1. Prostaglandin analog - Latanoprost
2. Timolol (BB)
3. Brimonidine (AA)
4. Acetazolamide (carbonic anhydrase inhibitor)
5. Laser therapy if medical therapy fails (trabeculoplasty)
100
Visible blood in the anterior chamber of the eye
Hyphema
101
Complication of hyphema
Can lead to blindness if not properly attended to - leads to ocular hypertension
102
Diagnostic testing for hyphema
1. screen for sickle cell disease
| 2. if serious injury, CT scan for further evaluation
103
Treatment of hyphema
Eye shield, elevated head to 30 degrees
Give adequate analgesica (topical cycloplegics) and antiemetics to prevent increased ocular pressure
Topical steroids
Topical beta blockers if increased pressure
104
Surgery indications of rhyphema
Early corneal blood staining
> 1/2 of anterior chamber involved
Uncontrolled intraocular pressure
105
Risk factors for macular degeneration
1. Age > 50
2. Caucasian
3. Females
4. Smokers
106
Most common cause of permanent legal blindness and visual loss in teh elderly
Macular degeneration
107
Gradual breakdown of the macula leading to gradual blurring of central vision
Dry atrophic macular degeneration
108
Small, round, yellow-white spots on the outer retina (scattered, diffuse). Accumulation of waste products
Drusen - seen in macular degeneration
109
New, abnormal vessels grow under the central retina which leak and bleed, leading to retinal scarring - rarer than dry
Wet (neovascular or exudative) macular degeneration
110
Bilateral blurred or loss of central vision (including detailed and colored vision), scotomas (blind spots, shadows)
Macular degeneration
111
Straight lines appear bent
Metamorphopsia
| Macular degeneration
112
Object seen by the affected eye looks smaller than in the unaffected eye
Micropsia
| Macular degeneration
113
Diagnosis of macular degeneration
Amsler grid
| Wet: fluorescein angiography
114
Management of dry macular degeneration
Amsler grid to monitor stability
| Zinc, Vitamin A, C and E
115
Management of wet macular degeneration
1. Bevacizumab - VEGF
2. Laser photocoagulation
3. Optical tomography done to monitor treatment response
116
Optic nerve (disc) swelling secondary to increased intracranial pressure (classically bilateral)
Papilledema
117
Etiologies of papilledema (4)
1. Idiopathic intracranial HTN (pseudotumor cerebri)
2. Space-occupying lesion (cerebral tumor, abscess)
3. Increased CSF production
4. Cerebral edema, severe HTN (malignant)
118
Signs/Symptoms of papilledema
1. Headache
2. Nausea/vomiting
3. vision usually well preserved, but may have changes
119
Diagnosis of papilledema
1. Fundoscopy
2. MRI or CT scan to r/o mass
3. LP for increased CSF pressure
120
Management of papilledema
Diuretics (acetazolamide)
121
Elevated, superficial, fleshy, triangular-shaped growing fibrovascular mass
Pterygium
122
Associated with increased UV exposure in sunny climates, as well as sand, wind and dust exposure
Pterygium
123
Management of pterygium
Observation +/- artificial tears
| Removal if growth affects vision
124
Most common type of retinal detachment
Rhegmatogenous
| Retinal inner sensory layer detaches from choroid plexus
125
Most common predisposing factors for retinal detachment
Myopia (nearsightedness)
| Cataracts
126
Photopsia (flashing lights), floaters, progressive unilateral vision loss
Retinal detachment
127
Shadow "curtain coming down" in periphery initially, leading to loss of central visual field. No pain or redness of eye
Retinal detachment
128
Diagnosis of retinal detachment
Fundoscopy: detached tissue flapping in vitreous humor
129
Clumping of brown-colored pigment cells in anterior vitreous humor resembling tobacco dust
+ Shafer's Sign
| Retinal detachment
130
Management of retinal detachment
Ortho emergency
Keep patient supine
Don't use miotic drops
Laser, cryotherapy
131
Retinal artery thrombus or embolus
Central retinal artery occlusion (CRAO)
132
Acute, sudden, monocular vision loss, often preceded by amaurosis fugax
Central retinal artery occlusion (CRAO)
133
Diagnosis of CRAO
Fundoscopy
134
Pale retina with cherry-red macula on fundoscopy due to obstruction of blood flow. Box car appearance of the retinal vessels (due to segmentation). No hemorrhage.
Central Retinal Artery Occlusion (CRAO)
135
Management of CRAO
Ophtho emergency
No tx has shown effective but should be attempted
Decrease IOP - acetazolamide
Revascularization - place patient supine, orbital massage to dislodge clot
136
Central retinal thrombus, fluid backup in retina, acute sudden monocular vision loss
Central retinal vein occlusion (CRVO)
137
Risk factors for CRVO
1. HTN
2. DM
3. Glaucoma
4. Hypercoagulable states
138
Extensive retinal hemorrhages (blood and thunder appearance), retinal vein dilation, macular edema, optic disc swelling
Central retinal vein occlusion
139
Management of CRVO
No known effective tx
+/- anti-inflammatories, steroids, laser photocoagulation
May resolve spontaneously or progress to permanent vision loss
140
Most common cause of new, permanent vision loss/blindness in 25-74 y/o
Diabetic retinopathy
141
Retinal blood vessel damage, leading to retinal ischemia, edema
Diabetic retinopathy
142
Glycosylation (excess sugar attaches to the collagen of the blood vessels) leads to capillary wall breakdown
Diabetic retinopathy
143
Microaneurysms, blot and dot hemorrhages, flame-shaped hemorrhages, cotton wool spots, hard exudates, retinal vein bleeding (tortuous/dilated veins), closure of retinal capillaries
Nonproliferative diabetic retinopathy
144
Fluffy-gray white spots from nerve layer microinfarctions (soft exudates)
Cotton wool spots
| Nonproliferative diabetic retinopathy
145
Yellow spots with sharp margins often circinate (due to lipid or lipoprotein deposits from leaky blood vessls)
Hard exudates
| Seen in DM retinopathy and HTN retinopathy
146
Management of nonproliferative diabetic retinopathy
Panlaser treatment. Strict glucose control
147
Neovascularization leading to abnormal blood vessel growth and vitreous hemorrhage in DM pts
Proliferative diabetic retinopathy
148
Management of proliferative diabetic retinopathy
Bevacizumab - VEGF
Laser photocoagulation tx
Tight glucose control
149
Macular edema or exudates, blurred vision, central vision loss in DM pts
Maculopathy diabetic retinopathy
| Due to macular microaneurysm leakage, causing edema and damage
150
Management of maculopathy diabetic retinopathy
Laser
151
Damage to retinal blood vessels from long standing high blood pressure
Hypertensive retinopathy
152
Hypertensive retinopathy stage I
Arterial narrowing, copper wiring, silver wiring
153
Hypertensive retinopathy stage II
AV nicking (venous compression at arterial-venous junction from increased arterial pressure)
154
Hypertensive retinopathy stage III
Flame shaped hemorrhages, cotton wool spots
155
Hypertensive retinopathy stage IV
Papilledema
156
Management of hypertensive retinopathy
BP control
157
Abnormal keratinized collection of desquamated squamous epithelium, leading to mastoid bony erosion. Leads to chronic hearing loss
Cholesteatoma
158
Cholesteatoma is most commonly due to:
Chronic eustachian tube dysfunction
159
Painless otorrhea (brown/yellow discharge with strong odor), may develop vertigo/dizziness
Cholesteatoma
160
Diagnosis of cholesteatoma
Otoscope - +/- performation of TM
| Peripheral vertigo, conductive hearing loss (Weber/Rinne)
161
Conductive hearing loss testing
Weber: lateralization to affected ear
Rinne: BC > AC
162
Management of cholesteatoma
Surgical excision and reconstruction of the ossicles
163
Idiopathic distention of the endolymphatic compartment of the inner ear by excess fluid, causing increased pressure within the inner ear
Meniere disease
164
Signs/Symptoms of meniere disease
1. Episodic vertigo - lasts minutes to hours
2. Tinnitus
3. Ear fullness
4. Fluctuating hearing loss
5. May have nausea/vomiting
6. Horizontal nystagmus
165
Diagnosis of meniere disase
Transtympanic electrocochleography most accurate test during active episode
Audiometry
166
Management of meniere dz
1. Symptomatic: antiemetics, antihistamines (Meclizine), benzodiazepines, anticholinergics (scopolamine)
2. Preventative: diuretics (hydrochlorothiazide) reduces endolymphatic pressure
Avoid salt/caffeine/chocolate/EtOH
167
3 main types of rhinitis
Allergic
Infectious
Vasomotor
168
Nonallergic/noninfectious dilation of the blood vessels (ex temperature change)
Vasomotor rhinitis
169
MC infectious cause of rhinitis
Rhinovirus (common cold)
170
Sneezing, nasal congestion/itching, clear rhinorrhea. Eyes, ears, nose and throat may be involved. Allergic associated with nasal polyps and tends to be worse in the morning
Rhinitis
171
Pale/violaceous, boggy turbinates, nasal polyps with cobblestone mucosa of the conjunctiva
Allergic rhinitis
172
Erythematous turbinates indicates
Viral Rhinitis
173
Management of viral rhinitis
1. intranasal corticosteroids
174
Management of rhinitis
1. Oral antihistamines
| 2. Decongestants - oral, intranasal
175
Most common epistaxis form
Anterior
176
Most common site of bleeding in anterior epistaxis
Kiesselbach's Plexus
177
Most common risk factors for posterior epistaxis
Hypertension and atherosclerosis
178
Most common site of bleeding in posterior epistaxis
Palatine artery
179
Management of epistaxis
1. Pressure while seated and leaning forward
2. Topical decongestants/vasoconstrictors
3. Cauterization if bleeding can be seen
4. Nasal packing
180
Samter's Triad
1. Asthma
2. Nasal polyps
3. Aspirin/NSAID sensitivity/allergy
181
Most are incidental findings but if large, can cause nasal obstruction or anosmia (decreased smell)
Nasal polyps
182
Management of nasal polyps
Cause allergic rhinitis
Intranasal corticosteroids
Surgical removal may be needed
183
Tonsillitis leading to cellulitis, leading to abscess formation
peritonsillar abscess
184
Most common etiologies of peritonsillar abscess
```
Strep pyogenes (GABHS)
Staph aureus
```
185
Dysphagia, pharyngitis, muggled hot potato voice, uvula deviation to contralateral side, tonsillitis, anterior cervical lymphadenopathy
Peritonsillar abscess
186
Diagnosis of peritonsillar abscess
CT first line to differentiate cellulitis vs abscess
187
Management of peritonsillar abscess
Antibiotics + aspiration or I and D
Ampicillin/sulbactam, clindamycin, penicillin G + metronidazole
Tonsillectomy
188
Most common organism causing parotitis
Staph aureus
189
Parotitis often occurs in the setting of ___________, particularly among elderly postoperative pts
Dehydration
190
Sudden onset of firm, erythematous swelling of the pre and postauricular areas that extends to the angle of the mandible
Exquisite local pain and tenderness. High fevers, chills, and marked toxicity
Parotitis
191
Diagnosis of parotitis
Clinical
| Purulent drainage at duct of stenson should be collected for gram stain and culture
192
Management of parotitis
hydration and IV abx
| Nafcillin + metronidazole or clindamycin
193
Bacterial infection of the parotid or submandibular salivary glands
Sialadenitis
194
Most common cause of sialadenitis
Staph aureus
195
Acute pain, swelling and erythema near the gland especially with meals. Tenderness at duct opening. Dysphagia, trismus. May develop fever and chills
Sialadenitis
196
Diagnosis of sialadenitis
CT scan - to assess for associated abscess/extent of tissue involvement
197
Management of sialadenitis
1. Sialogogues (hard candies, lemon drops) to increase salivary flow
2. ABX - dicloxacillin, nafcillin, metronidazole or clinda
