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Clin Med 4 > HEENT > Flashcards

HEENT Flashcards

1
Q

red eye red flags (7)

A

decreased visual acuity

ciliary flush

severe FB sensatio

corneal opacity

fixed pupil

severe HA w/ nausea

photophobia

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2
Q

chemosis is associated w/

A

allergic conjunctivitis

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3
Q

acute/ subacute painless vision loss, progressive scotoma

A

retinal detachment

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4
Q

tension HA frequency

A

intermittent/ chronic (waxes and wanes)

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5
Q

EBV dx

A

monospot

CBC w/ diff (increased atypical lymphocytes)

also cx for strep

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6
Q

EBV tx

A

supportive

activity restriction (to avoid splenic rupture)

maintain hydration

maybe steroids if severe

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7
Q

abortive tension HA tx

A

NSAIDS

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8
Q

what medications can cause rhinitis

A

topical decongestants

anti-hypertensives (alpha/ beta blockers)

oral contraceptives

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9
Q

burning, red eyes with mucopurulent discharge

A

bacterial conjunctivitis

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10
Q

conjunctivitis + adherent lids

A

bacterial conjunctivitis

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11
Q

allergic rhinitis refractory tx

A

immunotherapy w/ an allergist

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12
Q

matting means what

A

sticking together (like adherent lids) seen in conjunctivitis

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13
Q

double worsening/

double sickening

A

bacterial sinusitis

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14
Q

no current infection but recent AOM/ SAR/ eustachian tube dysfunction

A

otitis media with effusion

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15
Q

malaise

sore throat

fever

enlarged, tender cervical LAD

red throat/ tonsils and exudates

abdominal pain

A

EBV

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16
Q

epiglottitis tx

A

admit

intubate

abx

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17
Q

blood and thunder retinal appearance

A

central retinal vein occlusion

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18
Q

when do you avoid giving ampicillin and amoxicillin in a pt w/ strep

A

when they also have EBV

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19
Q

retinal hemorrhages and dilated retinal veins

A

blood and thunder seen in central retinal vein occlusion

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20
Q

w/ otitis externa, what do you ALWAYS document

A

the appearance of the TM

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21
Q

OE with TM perforation management

A

ofloxacin otic solution (floxin otic)

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22
Q

abortive cluster HA tx

A

O2

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23
Q

what tx is not helpful with nonallergic (vasomotor) rhinitis

A

immunotherapy

oral antihistamines

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24
Q

pale boggy nasal mucosa

A

allergic rhinitis

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25
Q

bluish purple rings around both eyes

A

allergic shiners seen with allergic rhinitis

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26
Q

malignant OE tx

A

admit

IV cipro

ENT referral

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27
Q

Group A Strep pharyngitis tx:

first line:

PCN allergy:

PLUS:

A

first line: PCN (Pen VK, amoxicillin) or ceph (cephalexin)

PCN allergy: azithromycin/ clindamycin

PLUS

supportive tx: lozenges, NSAIDS, acetaminophen

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28
Q

what triggers nonallergic (vasomotor) rhinitis

A

perfumes

cigarette smoke

weather conditions

hot/ spicy foods

ETOH, cleaning products

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29
Q

AOM 1st line abx tx

A

HD amoxicillin 90 mg/kg/day divided Q12

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30
Q

associated sxs w/ tension HA

A

NO associated sxs (n/v, phonophobia or photophobia)

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31
Q

retinal detachment tx

A

REFER immediately

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32
Q

acute eye pain

FB sensation

lacrimation

photophobia

A

corneal abrasian

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33
Q

pharyngitis with cough and rhinorrhea is probably of what etiology

A

viral

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34
Q

migraine frequency

A

chronic

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35
Q

clear rhinorrhea

sneezing

itchy eyes/ nose

nasal congestion

post nasal drip

cough

conjunctival injection

A

allergic rhinitis

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36
Q

edema of the conjunctiva

A

chemosis

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37
Q

epiglottitis etiology

A

H flu

Type B HiB

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38
Q

thumb sign on lateral neck xray

A

epiglottitis

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39
Q

OE with fluffy, white, black discharge

A

fungal

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40
Q

what do you not do with a pt with epiglottitis

A

stick something in their throat

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41
Q

conjunctivitis + chemosis,

matting,

hx of atopy

A

allergic conjunctivitis

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42
Q

OE with NO TM perforation management

A

cortisporin otic suspension (polymyxin, neomycin, and hydrocortisone)

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43
Q

corneal abrasion tx

A

topical abx (erythromycin ointment/ trimethoprim-polymyxin drops)

+ contact wearers get pseudo coverage (fluoroquinolone)

+ oral pain meds

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44
Q

associated sxs w/ migraine

A

photophobia

phonophobia

n/v

+/- aura

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45
Q

acute, total, painless vision loss

+ whitening of retina

+ afferent pupillary defect

A

central retinal artery occlusion

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46
Q

drooling

tripod position

sniffing position

anorexic

A

epiglottitis

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47
Q

what do you NOT do to tx corneal abrasion

A

do NOT give topical steroids or anesthetic drops,

do NOT patch

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48
Q

malignant otitis externa is most common in

A

immunocompromised pts (elderly, DM, HIV)

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49
Q

best initial test for malignant OE

A

CT

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50
Q

what is rhinitis medicamentosa

A

rebound congestion (rhinitis) that is induced by overuse of topical decongestants

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51
Q

uni/bilateral, throbbing HA

52
Q

prophylactic migraine HA tx

A

BB

TCA

CCB

anticonvulsants

avoid triggers

53
Q

different abx used in AOM tx

A

HD amoxicillin

augmentin

cefdinir, cefuroxime, cefpodoxime

IM/ IV ceftriaxone

azithromycin

54
Q

4 sxs of OE

A

ear pain with movement

pruritis

conductive hearing loss

discharge

55
Q

AOM ceftriaxone dose

A

50 mg IM/ IV once daily x 1-3 days

56
Q

abrupt onset sore throat

odynophagia

arthralgias/ myalgias

fever

anorexia

N/V

fine sandpaper-like rash

A

streptococcal pharygitis

57
Q

bulging red TM with distorted landmarks

effusion

poor TM mobility

58
Q

nasal congestion

purulent nasal discharge

HA

facial pain/ pressure

PND

halitosis

decreased sense of smell

dental pain

cough from PND

A

bacterial sinusitis

59
Q

when do you tx bacterial sinusitis with abx

A

persistent, not improving sxs for more than 10 days

or

severe sxs (fever > 102, purulent nasal discharge, 3-4 days of sinus pain)

or

a viral URI that lasted for 5-6 days, improved, then worsened (double worsening)

60
Q

nonallergic (vasomotor) tx

A

avoid triggers

nasal steroids

nasal antihistamine spray

atrovent

61
Q

bacterial sinusitis tx:

first line abx tx

PCN allergy tx

PLUS

A

first line: augmentin

PCN allergy: doxycycline/ levofloxacin

PLUS

sxs meds: saline irrigation, analgesics, mucolytics, nasal steroids, decongestants

62
Q

what abx do you avoid with a pt with strep and EBV

A

amoxicillin

ampicilin

63
Q

denie morgan lines

A

skin folds under eyes consistent with allergic conjunctivitis

associated with allergic rhinitis

64
Q

associated sxs w/ cluster HA

A

ipsilateral ptosis

lacrimation

conjunctival injection

rhinorrhea

nasal congestion

sweating

65
Q

burning, red eyes with watery discharge

A

viral conjunctivitis

66
Q

bacterial conjunctivitis tx

A

topical abx

quinolones for contact wearers

DC contacts

67
Q

OE with green, yellow discharge

A

pseudomonas

68
Q

unilateral, stabbing, severe HA

A

cluster HA

69
Q

nasal congestion

rhinorrhea

PND

but NO: ocular/ nasal itching or sneezing

A

chronic nonallergic (vasomotor) rhinitis

70
Q

what are some associated sxs you should ask about in regards to HA

A

nausea, vomiting, photophobia, phonophobia, focal neuro sxs

71
Q

when do you give a pt w/ AOM abx

A

under 6 mos OR over 6 mos w/ severe sxs

OR

6-23 mos and bilateral

OR

a joint decision with the parents

72
Q

cherry red spot in macula

A

central retinal artery occlusion

73
Q

when is PND worse

what is it associated with

A

at night and in the morning

associated with:

rhinitis (allergic/ chronic nonallergic vasomotor)

bacterial sinusitis

74
Q

prophylactic cluster HA tx

A

verapamil

avoid triggers (smoking)

75
Q

HA red flags

A
  • first time and severe (especially if pt is over 50)
  • nuchal rigidity
  • vision changes
  • papilledema/ retinal hemorrhage
  • neuro signs
  • fever
  • hypertension
  • “worst HA of life”
  • HA precipitated by exertion
  • hx of trauma/ malignancy/ coagulopathy
  • change in HA pattern
76
Q

this type of HA happens more in males

A

cluster HA

77
Q

middle ear fluid WITHOUT sxs of acute infection

A

otitis media with effusion

78
Q

what does pharyngitis and tonsilitis often present with

A

rhinorrhea and cough

(as part of the common cold)

79
Q

conjunctivitis + URI sxs, preauricular LAD, matting

A

viral conjunctivitis

80
Q

if you don’t give abx to AOM, what do you do?

A

observation w/ 48 to 72 hour FU

81
Q

ear pain that increases with movement

A

otitis externa

82
Q

what do you need to do w/ a corneal abrasian

A

evert the eyelid

83
Q

abortive migraine HA tx

A

NSAIDS

triptans

84
Q

severe otalgia

otorrhea

life threatening

A

malignant otitis externa

85
Q

tender tragus

A

otitis externa

86
Q

acute painless vision loss

A

retinal detachment/ central retinal artery occlusion/ central retinal vein occlusion

87
Q

when do you NOT tx bacterial sinusitis w/ abx

A

if the sxs are mild and short lived

(likely viral caused)

88
Q

amber/ straw colored fluid behind TM

air fluid level

bubbles

A

otitis media with effusion

89
Q

cobblestoning

A

allergic rhinitis

90
Q

which conjunctivitis can be unilateral (as well as bilateral)

91
Q

otitis media with effusion tx

A

self limiting

observation

tympanostomy tubes for persistent fluid/ hearing loss

92
Q

pharyngitis/ tonsillitis dx

A

throat cx (gold standard but takes 24-48 hours)

rapid antigen detection test (Group A Strep)

monospot (EBV)

heterophile antibodies

93
Q

which conjunctivitis can feel “gritty” and burning

94
Q

floaters, a curtain over vision, photopsias

A

retinal detachment

95
Q

peritonsillar abscess etiology

A

Group A Strep

staph aureus

resp anearobes

H. Flu

96
Q

drooling

fever

severe sore throat

no cough

A

epiglottitis

97
Q

bacterial sinusitis complications

A

osteomyelitis

periorbital/ orbital cellulitis

meningitis

brain abscess

epidural abscess

REFER IMMEDIATELY

98
Q

what are severe signs/ sxs associated with AOM

A

moderate/ severe otalgia

otalgia for more than 48 hours

temp higher than 39

99
Q

most cases of pharyngitis and tonsilitis are of what etiology

A

viral: rhinovirus, adenovirus, parainfluenza

only 20% are bacterial

100
Q

hot potato voice

A

peritonsillar abscess

101
Q

itchy, red eyes with watery discharge

A

allergic conjunctivitis

102
Q

cluster HA frequency

A

intermittent

(30 mins to 3 hours)

103
Q

scotoma

A

partial loss of vision/ blind spot

104
Q

prophylactic tension HA tx

A

reduce stress, encourage stretching

105
Q

allergic conjunctivitis tx

A

artificial tears

topical antihistamines

mast cell stabilizers

106
Q

what are the aggravating/ alleviating factors you should ask about in regards to HA

A

light

darkness

movement

stress

food

drink

107
Q

ddx: ear pain

A
  • otitis externa
  • AOM
  • cerumen impaction
  • FB
  • dental probs
  • trauma
  • bells palsy
  • sinusitis
  • pharyngitis
  • lymphadenitis
  • barotrauma
  • TMJ syndrome
  • eustachian tube dysfunction
108
Q

allergic rhinitis tx

A

avoid allergens

nasal steroids

antihistamines

decongestants

antileukotriene agents (montekulast)

109
Q

severe sore throat

drooling

trismus

unilateral peritonsillar swelling

deviated uvula

A

peritonsillar abscess

110
Q

what complicates OE tx

A

atopic dermatitis

contact dermatitis

fungal infection

111
Q

malignant OE aka

A

necrotizing external otitis

112
Q

hearing loss

ear fullness

afebrile

A

otitis media with effusion

113
Q

bilateral, squeezing, band-like HA

A

tension HA

114
Q

allergic salute

A

allergic rhinitis

115
Q

HA that usually begins around the eye

A

cluster HA

116
Q

medication overuse HA severity and location

117
Q

not eating

tugs at ear

irritable

restless

hearing loss

URI sxs

118
Q

photopsias

A

light flashes

119
Q

peritonsillar abscess tx

A

monitor airway

surgical drainage

supportive care (fluids, pain control)

IV abx

120
Q

which conjunctivitis is chronic

A

allergic (seasonal)

121
Q

viral conjunctivitis tx

A

lubricant drops

compresses

self limiting

122
Q

most effective singe agent maintenance therapy for allergic rhinitis

A

nasal steroids

123
Q

most malignant OE is caused by

A

pseudomonas

124
Q

acute, blurry, painless loss of vision

+ afferent pupillary defect

A

central retinal vein occlusion

125
Q

splenomegaly

Clin Med 4 (9 decks)

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