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HEENT Flashcards

1
Q

Most common etiology of viral conjunctivitis

A

Adenovirus

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2
Q

Most common cause of viral conjunctivitis

A

Swimming pools

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3
Q

Signs/symptoms of viral conjunctivitis

A

Foreign body sensation
Erythema
Itching
Normal vision

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4
Q

Preauricular lymphadenopathy, copious watery discharge from eyes, scanty mucoid discharge. Often bilateral

A

Viral conjunctivitis

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5
Q

Management of viral conjunctivitis

A

Supportive - cool compresses, artificial tears

Antihistamines for itching/redness

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6
Q

Signs/symptoms of allergic conjunctivitis

A

Conjunctival erythema paired with other allergic symptoms

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7
Q

Cobblestone mucosa appearance to the inner/upper eyelid, itching, tearing, redness, stringy discharge. Usually bilateral, +/- conjunctival swelling

A

Allergic conjunctivitis

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8
Q

Treatment for allergic conjunctivitis

A

Topical antihistamine: olopatadine

Topical NSAID: ketorolac

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9
Q

Most common causes of bacterial conjunctivitis

A

Staph aureus
Strep pneumoniae
H influenzae

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10
Q

Purulent discharge from eye, lid crusting, usually no vision changes

A

Bacterial conjunctivitis

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11
Q

Management of bacterial conjunctivitis

A

Topical abx - erythromycin, fluoroquinolones (moxi), sulfonamides, aminoglycosides

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12
Q

Management of bacterial conjunctivitis if contact lens wearer

A

Cover pseudomonas

Fluoroquinolone of aminoglycoside

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13
Q

Orbital cellulitis is usually secondary to:

A

sinus infections

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14
Q

Orbital cellulitis most commonly occurs in:

A

children

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15
Q

Decreased vision, pain with ocular movement, proptosis (bulging eye), eyelid erythema and edema

A

Orbital cellulitis

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16
Q

Diagnosis of orbital cellulitis

A

High resolution Ct scan

MRI

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17
Q

Management of orbital cellulitis

A

IV abx - vancomycin, clindamycin, cefotaxime

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18
Q

Stable ocular alignment is not present until the age of:

A

2-3 months

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19
Q

Convergent strabismus - deviated inward (cross eyed)

A

Esotropia

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20
Q

Divergent strabismus - deviated outward

A

Exotropia

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21
Q

Diagnosis of strabismus

A

Hirschberg corneal light reflex testing - often used as a screening test
Cover/uncover test
Convergence testing

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22
Q

Management of strabismus

A

Patch therapy - cover normal

Corrective surgery - if severe or unresponsive to conservative therapy

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23
Q

If strabismus is not treated before 2 years of age, __________ may occur

A

Amblyopia (decreased visual acuity not correctable by refractive means)

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24
Q

Infection of middle ear, temporal bone, and mastoid air cells. Most commonly preceded by a viral URI

A

Acute otitis media

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25
Q

4 most common organisms of acute otitis media

A

Strep pneumo
H influenzae
M catarrhalis
Strep pyogenes

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26
Q

Risk factors for otitis media

A 
Eustachian tube dysfunction
Young (ET is wider, shorter and more horizontal)
Daycare
Pacifier/bottle use
Parental smoking
Not being breastfed
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27
Q

Fever, otalgia, ear tugging in infants, conductive hearing loss, stuffiness

A

Acute otitis media

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28
Q

Rapid relief of ear pain + otorrhea

A

Tympanic membrane perforation

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29
Q

Management of otitis media

A
  1. Amoxicillin 10-14 days
  2. Augmentin or Cefixime
  3. If PCN allergic, erythromycin, azithromycin, bactrim
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30
Q

Management for severe, recurrent cases of otitis media

A

Myringotomy (surgical drainage)

Tympanostomy

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31
Q

Treatment for chronic otitis media - perforated TM + persistent or recurrent purulent otorrhea +/- pain

A

Topical ofloxacin or ciprofloxacin

Avoid water/moisture/topical aminoglycosides in ear when TM rupture

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32
Q

3 main types of rhinitis

A

Allergic
Infectious
Vasomotor

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33
Q

Nonallergic/noninfectious dilation of the blood vessels (ex temperature change)

A

Vasomotor rhinitis

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34
Q

MC infectious cause of rhinitis

A

Rhinovirus (common cold)

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35
Q

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

36
Q

Pale/violaceous, boggy turbinates, nasal polyps with cobblestone mucosa of the conjunctiva

A

Allergic rhinitis

37
Q

Erythematous turbinates indicates

A

Viral rhinitis

38
Q

Management of viral rhinitis

A

Intranasal corticosteroids

39
Q

Management of rhinitis

A
  1. Oral antihistamines

2. Decongestants - oral, intranasal

40
Q

Weber: lateralizes to normal ear

A

Sensorineural loss

41
Q

Weber: lateralizes to affected ear

A

Conductive loss

42
Q

Most common cause of conductive hearing loss

A

Cerumen impaction

43
Q

Most common cause of sensorineural hearing loss

A

Presbycusis

44
Q

Inflammation of the mastoid air cells of the temporal bone

A

Mastoiditis

45
Q

Etiology of mastoiditis

A

Usually a complication of prolonged or inadequately treated otitis media

46
Q

Signs/symptoms of mastoiditis

A
  1. Deep ear pain, fever

2. Mastoid tenderness, may develop cutaneous abscess

47
Q

Complications of mastoiditis

A

Hearing loss, labyrinthitis, vertigo, CN VII paralysis, brain abscess

48
Q

Diagnosis of mastoiditis

49
Q

Management of mastoiditis

A
  1. IV antibiotics + middle ear/mastoid drainage hallmark

2. Mastoidectomy if refractory or complicated

50
Q

Excess H2O or local trauma changes the normal acidic pH of the ear, causing bacterial overgrowth

A

Otitis externa

51
Q

Most common etiology of otitis externa

A

Pseudomonas (MC)
Proteus
Staph aureus

52
Q

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

A

Otitis externa

53
Q

Management of otitis externa

A

Protect ear against moisture
Ciprofloxacin/dexamethasone
Ofloxacin safe
Aminoglycoside combination

54
Q

Management of malignant otitis externa

A

Seen in DM and immunocompromised

IV ceftazidime or Piperacillin + fluoroquinolones

55
Q

Acute ear pain, hearing loss, +/- bloody otorrhea, +/- tinnitus and vertigo

A

Tympanic membrane perforation

56
Q

Most commonly occurs due to penetrating or noise trauma, pressure

A

Tympanic membrane perforation

57
Q

Treatment for tympanic membrane perforation without infection

A

Most heal spontaneously

Follow up to ensure resolution

58
Q

Most common epistaxis form

59
Q

Most common site of bleeding in anterior epistaxis

A

Kiesselbach’s Plexus

60
Q

Most common risk factors for posterior epistaxis

A

Hypertension and atherosclerosis

61
Q

Most common site of bleeding in posterior epistaxis

A

Palatine artery

62
Q

Management of epistaxis

A
  1. Pressure while seated and leaning forward
  2. Topical decongestants/vasoconstrictors
  3. Cauterization if bleeding can be visualized
  4. Nasal packing
63
Q

Most common causes of pharyngitis

A

Adenovirus
Rhinovirus
Enterovirus GABHS for streptococcal pharyngitis

64
Q

Signs/symptoms of pharyngitis

A
  1. Sore throat

2. Pain with swallowing

65
Q

Management for viral pharyngitis

A

Fluids, warm saline gargles, topical anesthetics, lozenges, NSAIDs

66
Q

Centor Criteria for Strep Throat

A
  1. Fever > 100.4
  2. Pharyngotonsillar exudates
  3. Tender anterior cervical lymphadenopathy
  4. Absence of cough
67
Q

Center Criteria Interpretation

A

Score 0-4
0-1: no abx or culture needed
2-3: throat culture
4-5: give antibiotics

68
Q

Diagnosis of strep throat

A

Rapid antigen detection test

Throat culture - definitive diagnosis (gold standard)

69
Q

Management of strep throat

A

Penicillin G or VK first line
Amoxicillin, augmentin
Macrolides if PCN allergic (azithromycin, erythromycin, clarithromycin)

70
Q

Complications of strep throat

A
  1. Rheumatic fever
  2. Glomerulonephritis
  3. Peritonsillar abscess, cellulitis
71
Q

Inflammation of the epiglottis that may interfere with breathing (medical emergency)

A

Epiglottitis

72
Q

Most common cause of epiglottitis

A

Haemophilus influenzae type B - reduced incidence due to Hib vaccination

73
Q

Signs/symptoms of epiglottitis

A

3 D’s - dysphagia, drooling, distress

Fever, odynophagia, inspiratory stridor, dyspnea, hoarseness, muffled voice, tripoding

74
Q

Suspect in pt with rapidly developing pharyngitis, muffled voice and odynophagia out of proportion to physical findings

A

Epiglottitis

75
Q

Diagnosis of epiglottitis

A
  1. Laryngoscopy - direct visualization - cherry red epiglottis
  2. Lateral cervical radiograph - thumb sign
  3. If high suspicion, do not attempt to visualize the epiglottis with tongue depressor
76
Q

Management of mild epiglottitis - no stridor at rest, no respiratory distress

A

Cool humidified air mist, hydration
Dexamethasone provides significant relief as early as 6 hours after dose (oral or IM)
Supplemental O2 in pts with sats < 92%
Patients can be discharged home

77
Q

Management of moderate epiglottitis - stridor at rest with mild to moderate retractions

A

Dexamethasone PO or IM + supportive treatment +/0 nebulized epinephrine
Should be observed for 3-4 hours after clinical intervention
May be discharged home if improvement is seen

78
Q

Management of severe epiglottitis - stridor at rest with marked retractions

A

Dexamethasone + nebulized epinephrine and hospitalization

79
Q

Causes of oral candidiasis

A

HIV
Use of steroid inhalers without spacer
Antibiotic use
Diabetics

80
Q

Diagnosis of oral candidiasis

A 
White curd-like plaques (+/0 leave behind erythema/bleeds if scraped)
Potassium hydroxide (KOH) smear: budding yeast/pseudohyphae
81
Q

Management of oral candidiasis

A

Nystatin liquid tx of choice

Clotrimazole troches, oral fluconazole

82
Q

Tonsillitis –> cellulitis –> _______________

A

Abscess formation - peritonsillar abscess

83
Q

Most common causes of peritonsillar abscess

A 
Strep pyogenes (GABHS)
Staph aureus
84
Q

Signs/symptoms of peritonsillar abscess

A

Dysphagia, pharyngitis
Muffled “hot potato voice”
Difficulty handling oral secretions, trismus
Uvula deviation to the contralateral side
Tonsillitis, anterior cervical lymphadenopathy

85
Q

Diagnosis of peritonsillar abscess

A

CT scan first line to differentiate cellulitis vs abscess

86
Q

Management of peritonsillar abscess

A

Antibiotics + aspiration or I and D
Unasyn, clindamycin, penicillin G + metronidazole
Tonsillectomy if recurrent

Pediatric EOR (10 decks)

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