HEENT Flashcards
Diseases caused by S. pneumoniae
COMPS Conjuctivitis Otitis media Meningitis Sinusitis
Prevnar vaccine covers this
Diseases caused by H. influenzea
COMPS Conjuctivitis Otitis media Meningitis Pneumonia Sinusitis
More than 30% PCN resistant. Most cephalosporins will remain stable in the presence of beta-lactamase
Diseases that are caused by M. catarrhalis
Less common in ABRS, AOM or CAP
More than 90% PCN resistant via beta-lactamase production
Signs and symptoms of acute bacterial rhinosinusitis (ARBS)
Persistent not improving (>10 days)
Severe (fever >102, purulent nasal drainage, facial pain, >3-4 days)
Worsening or double sickening
Symptom treatment of ABRS
Saline Nasal irrigation
Intranasal corticosteroids
Antibiotic treatment for ABRS
FIRST LINE : Augementin
Or If PCN allergy: Doxycycline Or Levofloxacin if worried about DRSP Or Moxifloxacin
Substrate
A medication or substance that is metabolized By the isoenzyme, utilizing the enzyme in order to be modified so we can reach drug site of action and/or be eliminated
Example: more than 50% of all prescription medications are CYP450 3A4 substrates (sildenafil, atorvastatin, alprazolam)
Inhibitor
Blocks the activity of the iso enzyme, limiting substrate excretion, allowing increase in substrate levels, and possible risk of substrate induced toxicity
Ex: clarithromycin is a inhibitor
Inducer
Accelerates the activity of the iso enzymes so that the substrate is pushed out the exit pathway leading to a reduction in substrate
Ex: at Johns wort is inducer
Myopia
Near sighted
Presbyopia
Worsening ability to follow an object. Blurred vision for near sight/close objects. Almost all adults >40 years.
Acute open angle glaucoma
Painless, caused by gradual increase in intercranial pressure. Presentation with gradual loss of peripheral vision.
Acute closed angle glaucoma
Unilateral acute onset of pain, redness, peripheral vision loss. Acute onset of ICP.
Macular degeneration
Loss of central vision. Most common cause of older adult vision loss.
Wet or dry disease.
Atropic macular degeneration is caused by damage to central portion of the macula (fovea) which is responsible for sharpest & color vision (a lot of cones). Usually dry disease - Caused by withering of blood vessels and vision cells of choroid (vascular tissue behind eye).
No treatment for this form. Mild central vision loss presentation. Visual aids required.
Bacterial conjunctivitis
Use optic FQ - cipro, Levo, moxifloxacin
Sensory hearing loss
Rinne AC > BC, lateralizarion to good ear
Conductive hearing loss
Rinne BC>AC, lateralization to bad ear
Glaucoma treatment
Optic formulation of BB and prostaglandin eye drops.
Same contraindications with optic BB (COPD, Asthma etc)
Sjögren’s syndrome
Dry eyes, dry mouth for more than 3 months. Autoimmune disease. Decrease function of lacrimal and salivary glands.
Blepharitis
Inflammation of eyelids. Associated with seborrheic dermatitis & roceasa
Centor criteria
Tonsular exudate, tender anterior lymph nodes, history of fever, absence of cough.
Strep treatment
First line: penicillin x 10 days or amoxicillin x 10 days.
If allergy - azithromycin x five days
AOM treatment
First line - Amox x 5-7 days or 10 days if severe
Allergy- augmentin or cefdinir x 5 days
OR levofloxacin or moxifloxacin x 5 days
ABRS
First line: augmentin x 5-7 days
Allergy: Doxy or levofloxacin x 5-7 days
Allergy with rash only : cefdinir
** if anaphylactic PCN allergery - avoid Cephalosporins as well.
Most common pathogen for otitis externa
Pseudomonas aeruginosa
S. Aureus
Otitis externa
Treatment: neomycin + hydrocortisone formulation
Or FQ ear formulation (ofloxacin or cipro)
** if concerned for TM rupture - only use FQ, avoid neomycin- ototoxic.
Mono triad symptoms
Fever, pharyngitis, lymphadenopathy (posterior usually indicates viral infection).
Ruq & Luq abdominal pain sometimes.
Symptomatic treatment
CBC will show lymphocytosis
Test: heterophile antibody test
** no contact sports for at least 4 weeks ** risk of splenic rupture
If mono is misdiagnosed for step and treated with amoxicillin - most patient will break out in a rash.
Seasonal allergy controller treatment
Intranasal Flonase
& montelukast as add on therapy
Sym treatment:
2nd generation antihistamine- citazine or loratadine
Ocular antihistamine
Snellen chart
20/40 means patient stands 20 feet away and can read what a normal person can see at 40 feet.
Patient always stands 20 feet away from sign (never changes)
Child should have near 20/20 vision at what age?
Age 6 refer if one or both eyes are not close to 20/20
Vital URI symptomatic treatment
Saline spray
Pseudoephedrine (Sudafed)
Tylenol or NSAID
Fontanelle closure
Posterior by 3 months and anterior close between 12-18 months.
If anterior fontanels close prematurely- refer to ped neurosurgeon
Cover/uncover test
Strabismus
Fovea
Center of macula -responsible for central vision (sharpest vision) 20/20 and color vision (high number of cones)
Vital conjuctivitis
Contagious, avoid school until resolved. Use lubricant eye drops, cool compresses. Avoid sharing towels or wash clothes.
Tympanography
Puff of air to visualize TM movement. Usually NOT present with AOM.
Confrontation
Tests peripheral vision
“Tell me when you see my fingers”
Tonometer or tonometry
Test for glaucoma
Red light reflex
Tests for cataracts and retinoblastoma
