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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
Otitis Externa can lead to--->
Malignant Otitis Externa | necrotizing
26
Pseudomonas is most common cause of
Otitis externa Malignant otitis externa Chronic Otitis media
27
Risk factor for Necrotizing Malignant Otitis externa
Old Diabetic pts!!
28
Tx for Necrotizing Malignant Otitis externa
IV Cipro
29
Mastoiditis
a complication of Acute Otitis Media
30
Mastoiditis
Deep ear pain, worse at night fever Bulging, red TM
31
Tx for Mastoiditis
IV Vanco + | Ceftazadime, Cefepime, or Piper-tazo
32
Tx for Chronic Otitis Media
Cipro, OR | Ofloxacin
33
Acute Otitis Media
6 mo-18 mo common
34
Cause of AOM
Strep PNA
35
Preceded by viral, Ear tugging, fever, bulging and red TM
AOM - acute otitis media
36
Tx for AOM- Acute Otitis Media
Amoxicillin 90 mg/kg/day or Augmentin
37
tx for AOM if PCN allergy
Cephalosporin! Oral- Cefdinir, Cefuroxime IM- Ceftriaxone (Rocephin) Severe allergy: Azithro
38
Most common cause of Positional Vertigo
BPPV Rolling over in bed Sudden, episodic, lasting <60 seconds Tx: Canalith reposition- Epley Maneuver
39
Why are meds pretty useless in BPPV?
bc sx only last <60 seconds
40
Tx for "Sinus Infection" | Acute Rhinosinusitis
AUGMENTIN | Amoxicillin-Clavulanic acid
41
2nd line tx for 'Sinus infection" | Acute Rhinosinusitis
Doxy | Levofloxacin (Levaquin)
42
Most sinus infections are
viral
43
If sinus infection is bacterial
Strep PNA
44
When to give abx for Sinus infection?
sx present for >10-14 days w worsening, or earlier if sx are severe
45
Chronic sinusitis (chronic sinus infection)
>12 weeks MORE THAN 3 MONTHS OF THIS ISH
46
Tx of chronic sinus infection
Irrigate Steroids ENT f/u may need abx
47
Rhinitis
Allergies Common cold Vasomotor
48
1st line tx for Rhinitis
Intranasal Steroids - Mometasone - Fluticasone
49
Tx for Rhinitis (intranasal steroids) are most effective for
Allergic type esp w Nasal polyps
50
1st line Tx for Strep throat
PCN or Keflex
51
If PCN allergy, what is tx for Strep throat?
Azithromycin | Clindamycin
52
Most common (non concerning) HA
Migraine Cluster Tension
53
HA imp Qs
``` Location Quality Timing (onset) Severity of pain Agg/Alleviate Fam hx**** ROS assoc sx ```
54
Things you might not remember to ask about HA
Family hx of HAs Timing onset Is it worse with exertion?
55
Band like Both sides Intermitent, squeezing No n/v, photophobia, phonophobia
TENSION headache
56
More common in Males stabbing, severe Intermittent Ptosis, lacrimation, conjunctival redness, rhinorrhea, sweating
CLUSTER headache yikes
57
Unilateral or bilateral THROBBING chronic photophobia, N/V, maybe Aura
MIGRAINE headache
58
Migraine Unilateral or Bilateral?
Can be either
59
Another Q to ask with HA
What meds have you been taking? Have you recently stopped meds? Med overuse HA; onset when you suddenly stop med
60
HA warning signs
``` 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
When to image?
``` 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
HA tx
Avoid trigger Non pharm: exercise, nutrition, no tobacco/alc, behavior mod, biofeedback, acupuncture Pharm: Abortive vs prevention
63
Abortive med for Migraine
Triptan or | NSAIDs
64
Abortive tx for Cluster HA
Oxygen!!!
65
Abortive tx for Tension HA
NSAIDs
66
Proph tx for Migraine | 4 things- A,B,C,T
Anticonv B-blocker CCB TCA
67
Proph tx for Cluster HA
Verapamil (CCB) Avoid triggers (Smoking)
68
Proph tx for Tension HA
Reduce stress | Encourage stretching
69
Dont forget to ask with Eye complaint
Do you wear contacts?
70
Sjogren syndrome is assoc w
Dry eye
71
"Coughing a lot, then woke up with this"
Subcojunctival hemorrhage tx: will go away on own, benign
72
Concerns w subconjunctival hemorhage
if pt on Warfarin | if there was Trauma
73
Burning, gritty eye complaint
Viral
74
Burning or general eye irritation
Bacterial
75
Itching/watery eye complaint
Allergic
76
Watery d/c from eye
Viral
77
Thick, mucopurulent d/c from eye
Bacterial
78
Tx for Viral eye conjunctivitis
Good hygeine Lubricant drops Warm compress
79
Tx for Bacterial eye conjunctivitis
Topical abx | if pt has contacts: Use FlouroQ Drop!!!
80
Tx for Allergic eye conjunctivitis
Artificial tears | Topical antihistamine/ Mast cell stabilizer
81
Chemosis
Conjunctiva is SWOLLEN associated with allergic conjunctivitis
82
Tx for Corneal abrasion
Erythromycin, Bactrim If pt has contacts: Need Psuedomonas coverage- Cipro, Ofloxacin, Gentamicin
83
What to avoid with Corneal abrasion
AVOID topical steroids | AVOID anesthetic drops
84
Do you prescribe Topical Steroids or Anesthetic drops with corneal abrasion?
NO NO NO NO can inhibit the speed of healing and mask worsening sx
85
Red flags of a red eye
``` Dec visual acuity Ciliary flush (red circle around iris) Severe FB sensation Corneal opacity Fixed pupil Severe HA w nausea ```
86
Ciliary flush
Acute glaucoma
87
Retinal detachment
Floaters "Curtain over field of vision" light flashes Acute or subacute vision loss- PAINLESS NO PAIn
88
Unique feature of retinal detach
PAINLESS no pain
89
Progressive scotoma- partial loss of vision or "blind spot"
Retinal detachment
90
Two types of Retinal Vascular Occlusions Eye blood clot
CRAO: Central retinal artery occlusion CRVO: Central retinal vein occlusion
91
CRAO
Cherry red spot
92
CRVO
Blood and thunder
93
CRAO cherry red spot in macula
Acute, total, painless vision loss Afferent pupillary defect Whitening of retina
94
CRVO blood and thunder retinal appearance
Acute, BLURRY, painless loss of vision
95
Why is blood and thunder on CRVO?
back up of blood in veins
96
Otitis externa tx
Ofloxacin otic solution "Floxin Otic"
97
Otitis externa tx most common: combo
Corticosporin Otic Suspension (polymyxin, neomycin, and hydrocortisone) ONLY IF TM IS OKAY and not perforated
98
Tx for OE
Corticosporin Otic (if TM is okay) or Ofloxacin Otic
99
Malignant OE --> complication of OE
Elderly DM get a CT *** IV CIPRO ***
100
Tx Acute Otitis Media with Abx IF:
- younger than 6 mo - Severe sx (pain severe or more than 2 days, fever high) - bilateral ear infection in younger than 2 YO
101
Tx for AOM | Acue otitis media
Amoxicillin if allergic: - Oral Cefuroxime, Cefdinir - IM Ceftriaxone (Rocephin) - Azithro if severe allergy
102
Tx for Allergic Rhinitis Classic "Allergies:
Nasal steroid 1st *** Antihistamine-decongestant Antileukotriene (Montelukast/Singulir)
103
What causes Rebound congestion? Decongestants or Steroids?
Decongestant!! also: anti-HTN, a blockers, b-blockers, birth control can all cause nasal congestion
104
When to treat Sinus infection
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
Abx tx for Bacterial Sinus infection
AUGMENTIN if PCN allergy: Doxy, Levaquin
106
Sinus infection
1st line: Augmentin 2nd line: Doxy or Levaquin
107
Sore throat Gold standard testing
Throat culture | 24-48 hrs
108
Abrupt onset sore throat Fever, anorexia N/V myalgia
Strep throat
109
Classic strep throat rash
Fine, sand paper like Pastia's line
110
if pt has runny nose and cough
think viral
111
Tx for Strep throat
PCN!! If PCN allergy: Azithromycin, Clindamycin
112
Mono
``` Epstein Barr virus Malaise, sore throat, fever, TIRED Enlarged, TENDER cervical lymphadenopathy ` Abd pain, splenomegaly ```
113
Dx for Mono
Monospot | CBC w diff (look for increase in Atypical Lymphocyte)
114
Mono are at risk for
SPLENIC RUPTURE
115
tx for Mono
``` SUPPORTIVE Activity restriction (2-4 weeks) ``` +/- Steroids if severe
116
If pt has Strep throat AND Mono, are there abx you should avoid?
AVOID Amoxicillin or Ampicillin Can cause: rash (generalized, red, maculopapular rash)
117
Avoid AMPICILLIN in pt with
MONO and STREP THROAT
118
Hot potato voice
Peritonsillar Abscess
119
Hot potato voice, Severe fever, Drooling, Trismus Deviated uvula
Peritonsillar Abscess
120
Tx for Peritonsillar abscess
Monitor for airway obs SURGICAL drainage Supportive- pain IV Abs
121
``` Stridor Tripod position Looks toxic Drooling Anxious ```
Acute Epiglottitis EMERGENCY Absolutely do not swab throat
122
Acute Epiglottitis
H.flu (Hib) Drooling, fever, no cough Toxic, tripod Be ready to intubate
123
Acute Epiglottitis
Lat Neck X Ray | "thumb sign"
124
Thumb sign on X Ray
enlarged epiglottitis Hospitalize, Abx, maybe intubate
125
All pts with Sore Throat need to have what exam?
ABDOMINAL!!

Clinical Prep (41 decks)

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