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HEENT Flashcards

1
Q

Ectropion and Entropion are v similar, but with ENtropion- worry about eyeball damage (corneal abrasion or ulcer)

A

Tx for both:

Eye drops vs Surgery

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2
Q

Dacryocystitis

A

inflection of lacrimal sac, NASAL/MEDIAL side of eye

Tx for Acute: Warm compress and BIG GUY ABX
-Clinda or Vanco + Ceftriaxone

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3
Q

Blepharitis- inflammation of eyelid margin, crusting, scaly, red-rimming

A

Assoc w: Down syndrome, Rosacea, Seborrheic dermatitis

Tx: Eyelid hygeine (warm compress, scrub, wash w baby shampoo)

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4
Q

Hordeolum aka

A

Stye

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5
Q

Hordeolum (stye) is caused by:

A

Staph Aureus

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6
Q

Hordeolum (stye) can be inside or outside of eyelid

Tx:

A

Warm compress
Most pop and drain spont within 2 days

If not gone in 2 days: IandD + Abx maybe

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7
Q

Chalazion- painless granuloma of internal Mebomian sebaceuous gland

A

Non tender, localized eyelid swelling

Conjunctival surface of eyelid
Larger and slower growing than stye

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8
Q

Tx for Chalazion

A

Eyelid hygiene and Warm compress
often resolve in days-weeks

Refractory- eye doc referral for Steroid injection

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9
Q

Pterygium “TERY is SCARY”

A

triangular shaped, growing mass that starts medially and extends across eye

Red, annoying, feels liek FB

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10
Q

Tx for Pterygium

A

Observation

Removal IF the growth affects vision

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11
Q

Retinoblastoma

A

Most diagnosed <3 YO

messed up RB1 gene

Abnormal WHITE REFLEX on eye exam

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12
Q

Tx for Retinoblastoma

A

Radiation, Chemo, Enucleation

Assoc with BONE NEOPLASMS

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13
Q

Prognosis for Retinoblastoma

A

Survival >95% if treated promptly

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14
Q

Most common cause of permanent blindness in OLDER folk (>75YO)

A

Macular Degeneration

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15
Q

Macular Degeneration

Dry vs Wet

A

Dry:
-Most common type, progressive over decades

Wet:
-not as common but more aggressive, in months

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16
Q

Macular Degeneration vision loss

A

Central

Metamorphopsia- straight lines appear bent

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17
Q

What will you see on Fundoscopic exam with Macular Degeneration?

A

Dry: Drusen bodies (small round yellow/white spots on outer retina)

Wet: new, abnormal vessels

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18
Q

Tx of (Dry) Macular Degeneration

A

Zinc

Vitamins (C, E)

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19
Q

Tx of (Wet) Macular Degeneration

A

Bevacizumab (intravitreal VEGF inhib)

Laser

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20
Q

Most common cause of Retinopathy in younger ppl

20-74 YO

A

Diabetic Retinopathy

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21
Q

Tx for Diabetic Retinopathy

A

Strict glucose control
Laser therapy

for Proliferative type: Add Bevacizumab

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22
Q

Cotton wool spots can be seen with both

A

DM and HTN Retinopathy

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23
Q

Central vision loss

A

Macular Degeneration

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24
Q

Tx for Otitis Externa

A 
Corticosporin Otic (combo-poly, neo, hydroc)
if TM is okay

if not- Ofloxacin Otic “Floxin Otic”

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25
Q

Otitis Externa can lead to—>

A

Malignant Otitis Externa

necrotizing

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26
Q

Pseudomonas is most common cause of

A

Otitis externa
Malignant otitis externa
Chronic Otitis media

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27
Q

Risk factor for Necrotizing Malignant Otitis externa

A

Old Diabetic pts!!

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28
Q

Tx for Necrotizing Malignant Otitis externa

A

IV Cipro

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29
Q

Mastoiditis

A

a complication of Acute Otitis Media

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30
Q

Mastoiditis

A

Deep ear pain, worse at night
fever
Bulging, red TM

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31
Q

Tx for Mastoiditis

A

IV Vanco +

Ceftazadime, Cefepime, or Piper-tazo

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32
Q

Tx for Chronic Otitis Media

A

Cipro, OR

Ofloxacin

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33
Q

Acute Otitis Media

A

6 mo-18 mo common

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34
Q

Cause of AOM

A

Strep PNA

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35
Q

Preceded by viral, Ear tugging, fever, bulging and red TM

A

AOM - acute otitis media

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36
Q

Tx for AOM- Acute Otitis Media

A

Amoxicillin 90 mg/kg/day
or
Augmentin

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37
Q

tx for AOM if PCN allergy

A

Cephalosporin!

Oral- Cefdinir, Cefuroxime
IM- Ceftriaxone (Rocephin)

Severe allergy: Azithro

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38
Q

Most common cause of Positional Vertigo

A

BPPV

Rolling over in bed
Sudden, episodic, lasting <60 seconds

Tx: Canalith reposition- Epley Maneuver

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39
Q

Why are meds pretty useless in BPPV?

A

bc sx only last <60 seconds

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40
Q

Tx for “Sinus Infection”

Acute Rhinosinusitis

A

AUGMENTIN

Amoxicillin-Clavulanic acid

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41
Q

2nd line tx for ‘Sinus infection”

Acute Rhinosinusitis

A

Doxy

Levofloxacin (Levaquin)

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42
Q

Most sinus infections are

A

viral

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43
Q

If sinus infection is bacterial

A

Strep PNA

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44
Q

When to give abx for Sinus infection?

A

sx present for >10-14 days w worsening, or earlier if sx are severe

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45
Q

Chronic sinusitis (chronic sinus infection)

A

> 12 weeks

MORE THAN 3 MONTHS OF THIS ISH

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46
Q

Tx of chronic sinus infection

A

Irrigate
Steroids
ENT f/u

may need abx

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47
Q

Rhinitis

A

Allergies
Common cold
Vasomotor

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48
Q

1st line tx for Rhinitis

A

Intranasal Steroids

  • Mometasone
  • Fluticasone
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49
Q

Tx for Rhinitis (intranasal steroids) are most effective for

A

Allergic type

esp w Nasal polyps

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50
Q

1st line Tx for Strep throat

A

PCN

or Keflex

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51
Q

If PCN allergy, what is tx for Strep throat?

A

Azithromycin

Clindamycin

52
Q

Most common (non concerning) HA

A

Migraine
Cluster
Tension

53
Q

HA imp Qs

A 
Location
Quality
Timing (onset)
Severity of pain
Agg/Alleviate
Fam hx****
ROS assoc sx
54
Q

Things you might not remember to ask about HA

A

Family hx of HAs
Timing onset
Is it worse with exertion?

55
Q

Band like
Both sides
Intermitent, squeezing
No n/v, photophobia, phonophobia

A

TENSION headache

56
Q

More common in Males

stabbing, severe

Intermittent

Ptosis, lacrimation, conjunctival redness, rhinorrhea, sweating

A

CLUSTER headache

yikes

57
Q

Unilateral or bilateral
THROBBING
chronic
photophobia, N/V,

maybe Aura

A

MIGRAINE headache

58
Q

Migraine

Unilateral or Bilateral?

A

Can be either

59
Q

Another Q to ask with HA

A

What meds have you been taking? Have you recently stopped meds?

Med overuse HA; onset when you suddenly stop med

60
Q

HA warning signs

A 
1st HA in >50 YO
Intense HA w/o hx of HA
Neck rigid
Meningeal sx (Brudskinski, Kurnig)
Visual changes
Papilledema
Retinal hemorrhage
New neuro sx
Fever
High BP
Worse HA of life
Prec by exertion
Hx head trauma, CA, or coag dz
Marked change in HA pattern
61
Q

When to image?

A 
Unexp vitals
AMS
Onset HA w exertion
HA worsen under obs
Neck rigid
1st HA in pt over 50 YO
Focal neuro sx
"WHOL"
62
Q

HA tx

A

Avoid trigger

Non pharm: exercise, nutrition, no tobacco/alc, behavior mod, biofeedback, acupuncture

Pharm: Abortive vs prevention

63
Q

Abortive med for Migraine

A

Triptan or

NSAIDs

64
Q

Abortive tx for Cluster HA

65
Q

Abortive tx for Tension HA

66
Q

Proph tx for Migraine

4 things- A,B,C,T

A

Anticonv
B-blocker
CCB
TCA

67
Q

Proph tx for Cluster HA

A

Verapamil (CCB)

Avoid triggers (Smoking)

68
Q

Proph tx for Tension HA

A

Reduce stress

Encourage stretching

69
Q

Dont forget to ask with Eye complaint

A

Do you wear contacts?

70
Q

Sjogren syndrome is assoc w

71
Q

“Coughing a lot, then woke up with this”

A

Subcojunctival hemorrhage

tx: will go away on own, benign

72
Q

Concerns w subconjunctival hemorhage

A

if pt on Warfarin

if there was Trauma

73
Q

Burning, gritty eye complaint

74
Q

Burning or general eye irritation

75
Q

Itching/watery eye complaint

76
Q

Watery d/c from eye

77
Q

Thick, mucopurulent d/c from eye

78
Q

Tx for Viral eye conjunctivitis

A

Good hygeine
Lubricant drops
Warm compress

79
Q

Tx for Bacterial eye conjunctivitis

A

Topical abx

if pt has contacts: Use FlouroQ Drop!!!

80
Q

Tx for Allergic eye conjunctivitis

A

Artificial tears

Topical antihistamine/ Mast cell stabilizer

81
Q

Chemosis

A

Conjunctiva is SWOLLEN

associated with allergic conjunctivitis

82
Q

Tx for Corneal abrasion

A

Erythromycin, Bactrim

If pt has contacts: Need Psuedomonas coverage- Cipro, Ofloxacin, Gentamicin

83
Q

What to avoid with Corneal abrasion

A

AVOID topical steroids

AVOID anesthetic drops

84
Q

Do you prescribe Topical Steroids or Anesthetic drops with corneal abrasion?

A

NO
NO NO NO

can inhibit the speed of healing and mask worsening sx

85
Q

Red flags of a red eye

A 
Dec visual acuity
Ciliary flush (red circle around iris)
Severe FB sensation
Corneal opacity
Fixed pupil
Severe HA w nausea
86
Q

Ciliary flush

A

Acute glaucoma

87
Q

Retinal detachment

A

Floaters
“Curtain over field of vision”
light flashes
Acute or subacute vision loss- PAINLESS

NO PAIn

88
Q

Unique feature of retinal detach

A

PAINLESS

no pain

89
Q

Progressive scotoma- partial loss of vision or “blind spot”

A

Retinal detachment

90
Q

Two types of Retinal Vascular Occlusions

Eye blood clot

A

CRAO: Central retinal artery occlusion

CRVO: Central retinal vein occlusion

91
Q

CRAO

A

Cherry red spot

92
Q

CRVO

A

Blood and thunder

93
Q

CRAO

cherry red spot in macula

A

Acute, total, painless vision loss

Afferent pupillary defect

Whitening of retina

94
Q

CRVO

blood and thunder retinal appearance

A

Acute, BLURRY, painless loss of vision

95
Q

Why is blood and thunder on CRVO?

A

back up of blood in veins

96
Q

Otitis externa tx

A

Ofloxacin otic solution “Floxin Otic”

97
Q

Otitis externa tx

most common: combo

A

Corticosporin Otic Suspension (polymyxin, neomycin, and hydrocortisone)

ONLY IF TM IS OKAY and not perforated

98
Q

Tx for OE

A

Corticosporin Otic (if TM is okay)
or
Ofloxacin Otic

99
Q

Malignant OE
–>
complication of OE

A

Elderly DM
get a CT
** IV CIPRO **

100
Q

Tx Acute Otitis Media with Abx IF:

A
  • younger than 6 mo
  • Severe sx (pain severe or more than 2 days, fever high)
  • bilateral ear infection in younger than 2 YO
101
Q

Tx for AOM

Acue otitis media

A

Amoxicillin

if allergic:

  • Oral Cefuroxime, Cefdinir
  • IM Ceftriaxone (Rocephin)
  • Azithro if severe allergy
102
Q

Tx for Allergic Rhinitis

Classic “Allergies:

A

Nasal steroid 1st ***
Antihistamine-decongestant
Antileukotriene (Montelukast/Singulir)

103
Q

What causes Rebound congestion?

Decongestants or Steroids?

A

Decongestant!!

also: anti-HTN, a blockers, b-blockers, birth control can all cause nasal congestion

104
Q

When to treat Sinus infection

A

Has it lasted longer than 10 days?

Is it severe?
-fever 102, purulent d/c, facial pain at least 3-4 consec days at beg onset

Is it double worsening?

105
Q

Abx tx for Bacterial Sinus infection

A

AUGMENTIN

if PCN allergy: Doxy, Levaquin

106
Q

Sinus infection

A

1st line: Augmentin

2nd line: Doxy or Levaquin

107
Q

Sore throat Gold standard testing

A

Throat culture

24-48 hrs

108
Q

Abrupt onset sore throat
Fever, anorexia
N/V
myalgia

A

Strep throat

109
Q

Classic strep throat rash

A

Fine, sand paper like

Pastia’s line

110
Q

if pt has runny nose and cough

A

think viral

111
Q

Tx for Strep throat

A

PCN!!

If PCN allergy: Azithromycin, Clindamycin

112
Q

Mono

A 
Epstein Barr virus
Malaise, sore throat, fever, TIRED
Enlarged, TENDER cervical lymphadenopathy
`
Abd pain, splenomegaly
113
Q

Dx for Mono

A

Monospot

CBC w diff (look for increase in Atypical Lymphocyte)

114
Q

Mono are at risk for

A

SPLENIC RUPTURE

115
Q

tx for Mono

A 
SUPPORTIVE
Activity restriction (2-4 weeks)

+/- Steroids if severe

116
Q

If pt has Strep throat AND Mono, are there abx you should avoid?

A

AVOID Amoxicillin or Ampicillin

Can cause: rash (generalized, red, maculopapular rash)

117
Q

Avoid AMPICILLIN in pt with

A

MONO and STREP THROAT

118
Q

Hot potato voice

A

Peritonsillar Abscess

119
Q

Hot potato voice, Severe fever, Drooling, Trismus

Deviated uvula

A

Peritonsillar Abscess

120
Q

Tx for Peritonsillar abscess

A

Monitor for airway obs
SURGICAL drainage
Supportive- pain
IV Abs

121
Q 
Stridor
Tripod position
Looks toxic
Drooling
Anxious
A

Acute Epiglottitis

EMERGENCY
Absolutely do not swab throat

122
Q

Acute Epiglottitis

A

H.flu (Hib)

Drooling, fever, no cough

Toxic, tripod

Be ready to intubate

123
Q

Acute Epiglottitis

A

Lat Neck X Ray

“thumb sign”

124
Q

Thumb sign on X Ray

A

enlarged epiglottitis

Hospitalize, Abx, maybe intubate

125
Q

All pts with Sore Throat need to have what exam?

A

ABDOMINAL!!

Clinical Prep (41 decks)

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