HEENT Flashcards
Common cold
Most common virus : Rhino virus
Nasal congestion, sore throat, low grade fever
Tx : symptomatic , Sudafed, Afrin nasal spray
Duration 1.5 weeks
Self limiting
Conjunctivitis - definition
Inflamed lining of the inside surface of the lids and surface of the globe to the limbus
Conjunctivitis - clinical presentation
Redness, discharge, foreign body sensation, preauricular tenderness
NO ocular pain or vision loss
Viral conjunctivitis
Red, watery d/c
Symptoms worse 3-5 but resolve in 7-14 days
Associated with URI
Tx: symptomatic
Bacterial Conjunctivits
Red eye, yellow copious discharge, crusting over lid, sudden onset
Gram + organism
- staphylococcus aureus
- strep pneumonia
- Haemophilus influenza
Tx : bacitracin or iieotcyin (erythromycin)
Allergic conjunctivitis
Exposure with allergen
Tx: moderate- symptomatic
Severe - zaditor ( eye drops, antihistamine )
Allergic Rhinitis
Inflammation of mucous membrane often after an exposure to an allergen which releases a histamine
- increased mucus production
- local vasodilation
- Mucosal edema
Clinical presentation : runny nose with clear d/c. Afebrile
Tx: remove allergens, intranasal corticosteriods, antihistamine 2nd generation (Claritin)
Epistaxsis
Local or systemic
Location of bleed
- anterior ( involing kiessebach plexus)
- posterior ( concerning)
- blood into pharynx, causing nausea , see ENT
Apply direct pressure bottom of nose
Avoid ASA, NSAIDS, increase humidifiers, Vaseline to promote hydration
Sinusitis - definition
Inflammation of the mucus membrane that lines the paranasal sinus which causes blockage of normal drainage pathways
- decrease mucus clearing, increase mucus retention, promotes bacterial growth
Bacterial sinusitis
Symptoms for > 10 days without improvement Pathogens - streptococcus pneumonia - h. Flu - morexella
Clinical presentation
- fever, nasal d/c, cough, ill appearing, no improvement
Tx: uncomplicated - observe for 7-10 days
1. Augmentin 500 mg or 750 q 12 hrs 7-10 days
2. PCN allergy : Doxycline, Moxiflacin, levoflocin
3. Preg: Azithromycin
Nasal corticosteriods
Allergic or viral sinusitis
Symptoms peak at 3-5 days but improve
Tx: analgesics, topical decongestions or oral
Do not use antihistamines
Chronic rhinosinusitis
Treat underlying cause
Nasal corticosteriods
Oral corticosteriod burst
Consider specialist
Recurrent rhinosinisutis
Increase antibiotic dose and length
Use second line
Topical steroid
Refer to specialists
Pharyngitis - viral
Pathogens
- adenovirus
- coronavirus
- coxasckie
Clinical presentation
- gradual onset
- URI, Conjunctivits, afebrile
- wax and wane
Tx: NSAIDs, tylenol, gargle w/ warm water
Pharyngitis - bacterial
Pathogens
- strep group A
- n. Gonorrhea
Clinical presentation
- sudden onset, fever 101 , headache, beefy red throat with exudate, enlarged anterior cervical nodes
DX: strep test, CBC with diff, mono spot
TX: Penicillin VK 500 mg BID or TID for 10 days
PCN allergy : Azithromycin 500 mg /day for 5 days or 500 mg on day 1 and 250 mg 2-5 or clindamycin 300 mg 4 x a day for 10 days
Pharyngitis - non infectious
Allergic
No fever, persistent post nasal drip
Tx: symptomatic relief, avoid allergen, use antihistmines
Mono
Acute viral syndrome
Pathogen: Epstein Barr virus
Clinical presentation : fever, exudative pharyngitis ( white or grey), posterior cervical lymphadenopathy , palatial petechial rash , fatigue, enlarged spleen
3-4 weeks with lingering fatigue for 6-12 months
DX: strep test, mono spot ( may not get early disease), CBC w/ diff ( > atypical lymphocytes)
Tx: NSAIDS, tyenlol, no contact sports
Acute Otitis Media
Middle ear inflammation
Frequent in winter months after URI
Pathogens
- s. Pneumonia
- h. Flu
Clinical presentation : earache, fever, hearing loss, vertigo
Unilateral , TM is red, and bulging , conductive hearing loss ( Weber test would have affected ear hearing noise louder) , preauricular and cervical adenopathy
Tx: amoxcillin 500 mg BID for 5-7 days,
- if no better in 48 -72 hours switch to augmentin 500 mg BID for 10 days
PCN allergy Azithromycin : 500 mg day 1 then 250 mg daily for 2-5 day
Otitis externa
Diffused inflammation of external auditory canal , can be bacterial or fungal
Associated with moist environments - swimmers ear
Clinical presentation : itching, purulent d/c, tenderness of Tragus, pinna, diffuse canal edema
Canal red and swollen, difficult to insert ear speculum
Tx: remove exudative debris, via mechanical or irrigation
Use cortisporsin otic suspension - 3-4 drops in canal TID 7-10 days
Serous otitis media
Fluid in middle ear with NO sign of infection
Clinical presentation: hearing loss, or fullness, preceding URI
Fluid is visualized and clear
Tx: resolves on its own, can linger for 12 weeks
- autoinsufflation
- decongestant
Ear cerumen impaction
Anatomical narrowing of ear canal
Clinical presentation : hearing loss, ear fullness, tinnitus, dizziness
Dx: based on history and inspection of ear canal
Tx: removal of cerumen
- debris, irritation, manual removal
Asymptomatic patients may not require removal
Aggressive irrigation = perforated TM, maceration of skin and potential infection
Aphthous ulcers
Canker sores
Common with pt with celeriac, IBS and HIV
Small clearly defined painful oral lesions that are shallow oval shaped with grayish base, heal time 10-14 days
Tx: triamcinolone/ oracort symptomatic relief via gel applied to ulcer BID or QID until healed
Candidiasis tx for partials of dentures
Remove thoroughly and clean daily
Soak in 1:1 dilution of chlorhexidine gluconate
1% sodium hypochlorite ( if no metal )
Benzalkonium chloride 1:750 if metal used
Get new toothbrush
May use fungizone on tissue side or nystatin power before insertion
Xerostomia
Dry mouth
Tx: saliva stimulants, artificial salvia products
