HEENT

Question 1

Diseases caused by S. pneumoniae

Answer 1

COMPS
Conjuctivitis
Otitis media
Meningitis 
Sinusitis

Prevnar vaccine covers this

Question 2

Diseases caused by H. influenzea

Answer 2

COMPS
Conjuctivitis 
Otitis media
Meningitis
Pneumonia 
Sinusitis 

More than 30% PCN resistant. Most cephalosporins will remain stable in the presence of beta-lactamase

Question 3

Diseases that are caused by M. catarrhalis

Answer 3

Less common in ABRS, AOM or CAP

More than 90% PCN resistant via beta-lactamase production

Question 4

Signs and symptoms of acute bacterial rhinosinusitis (ARBS)

Answer 4

Persistent not improving (>10 days)
Severe (fever >102, purulent nasal drainage, facial pain, >3-4 days)
Worsening or double sickening

Question 5

Symptom treatment of ABRS

Answer 5

Saline Nasal irrigation

Intranasal corticosteroids

Question 6

Antibiotic treatment for ABRS

Answer 6

FIRST LINE : Augementin

Or If PCN allergy:
Doxycycline 
Or
Levofloxacin if worried about DRSP
Or 
Moxifloxacin

Question 7

Substrate

Answer 7

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)

Question 8

Inhibitor

Answer 8

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

Question 9

Inducer

Answer 9

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

Question 10

Myopia

Answer 10

Near sighted

Question 11

Presbyopia

Answer 11

Worsening ability to follow an object. Blurred vision for near sight/close objects. Almost all adults >40 years.

Question 12

Acute open angle glaucoma

Answer 12

Painless, caused by gradual increase in intercranial pressure. Presentation with gradual loss of peripheral vision.

Question 13

Acute closed angle glaucoma

Answer 13

Unilateral acute onset of pain, redness, peripheral vision loss. Acute onset of ICP.

Question 14

Macular degeneration

Answer 14

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.

Question 15

Bacterial conjunctivitis

Answer 15

Use optic FQ - cipro, Levo, moxifloxacin

Question 16

Sensory hearing loss

Answer 16

Rinne AC > BC, lateralizarion to good ear

Question 17

Conductive hearing loss

Answer 17

Rinne BC>AC, lateralization to bad ear

Question 18

Glaucoma treatment

Answer 18

Optic formulation of BB and prostaglandin eye drops.

Same contraindications with optic BB (COPD, Asthma etc)

Question 19

Sjögren’s syndrome

Answer 19

Dry eyes, dry mouth for more than 3 months. Autoimmune disease. Decrease function of lacrimal and salivary glands.

Question 20

Blepharitis

Answer 20

Inflammation of eyelids. Associated with seborrheic dermatitis & roceasa

Question 21

Centor criteria

Answer 21

Tonsular exudate, tender anterior lymph nodes, history of fever, absence of cough.

Question 22

Strep treatment

Answer 22

First line: penicillin x 10 days or amoxicillin x 10 days.

If allergy - azithromycin x five days

Question 23

AOM treatment

Answer 23

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

Question 24

ABRS

Answer 24

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.

Question 25

Most common pathogen for otitis externa

Answer 25

Pseudomonas aeruginosa

S. Aureus

Question 26

Otitis externa

Answer 26

Treatment: neomycin + hydrocortisone formulation
Or FQ ear formulation (ofloxacin or cipro)

** if concerned for TM rupture - only use FQ, avoid neomycin- ototoxic.

Question 27

Mono triad symptoms

Answer 27

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.

Question 28

Seasonal allergy controller treatment

Answer 28

Intranasal Flonase

& montelukast as add on therapy

Sym treatment:
2nd generation antihistamine- citazine or loratadine
Ocular antihistamine

Question 29

Snellen chart

Answer 29

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)

Question 30

Child should have near 20/20 vision at what age?

Answer 30

Age 6 refer if one or both eyes are not close to 20/20

Question 31

Vital URI symptomatic treatment

Answer 31

Saline spray
Pseudoephedrine (Sudafed)
Tylenol or NSAID

Question 32

Fontanelle closure

Answer 32

Posterior by 3 months and anterior close between 12-18 months.

If anterior fontanels close prematurely- refer to ped neurosurgeon

Question 33

Cover/uncover test

Answer 33

Strabismus

Question 34

Fovea

Answer 34

Center of macula -responsible for central vision (sharpest vision) 20/20 and color vision (high number of cones)

Question 35

Vital conjuctivitis

Answer 35

Contagious, avoid school until resolved. Use lubricant eye drops, cool compresses. Avoid sharing towels or wash clothes.

Question 36

Tympanography

Answer 36

Puff of air to visualize TM movement. Usually NOT present with AOM.

Question 37

Confrontation

Answer 37

Tests peripheral vision

“Tell me when you see my fingers”

Question 38

Tonometer or tonometry

Answer 38

Test for glaucoma

Question 39

Red light reflex

Answer 39

Tests for cataracts and retinoblastoma