HEENT Flashcards
Cerumen Impaction
Ear wax impaction;
most common cause of conductive hearing loss;
PE: cerumen visible in ear;
TX: irrigation, manual removal
Eustacian Tube Dysfunction
Air/fluid trapped in middle ear space;
Occurs after URI, allergy flare or flight;
PE: Pressure, fullness, popping with swallowing;
TX: decongestants, antihistamines, nasal steroid spray, autoinsufflation
Barotrauma
Middle ear damage due to pressure change affecting temporal bone spaces;
Diving, flying, forceful nose blowing;
Vertigo, tinnitus
PE: ecchymosis or hemorrhage in middle ear, retracted TM
TX: decongestants, analgesics, anti-inflammatories, tubes
Otitis Externa
Infection of skin of external ear due to trauma or moist environment - usually bacterial (P. aeruginosa, Staph aureus);
PE: white discharge from ear, painful edema of EAC, tragus pain;
TX: ear hygiene, dry ear precautions; Floxin drops w/ wick if needed. Debride if fungal
Acute Otitis Media
Infection of middle ear; Common pathogens: Strepto pneumonia, Moraxella catarrhalis, Haemophilus influenzae
PE: tugging ear, fever, fussiness, anorexia; bulging non-motile TM, fluid in ear
TX: ABX for 7-10 day (Amox, Augmentin); Adjuvant therapy
Otitis Media w/ Effusion
Fluid from Acute OM or ETD;
PE: serous fluid behind TM, TM nonmotile, hearing loss
TX: observation, consider tubes if tx fails
MOST COMMON CAUSE OF PED HEARING LOSS W/ LANGUAGE DELAYS
TM Perf
Hole in TM;
PE: hole in TM, Hearing loss, otalgia, tinnitus, vertigo
TX: Heal on its own; abx drops if infection (Ofloxacin, Ciprodex); dry ear; refer to ENT if marginal
Cholesteatoma
Tissue accumulation in middle ear;
Caused by chronic ETD, recurrent ear infection;
PE: drainage, hearing loss, retracted TM, white mass visible behind TM
TX: Surgical excision
Mastoiditis
Infection of Mastoid air cells; Comp of Acute OM; S. pneumonia, S. aureus
PE: fever, adenopathy, mastoid tender/edema/red
TX: IV ABX (Ceftazidime & Vanco)
Myringotomy w/ tube insertion
EMERGENCY
Tinnitus
Ringing of ears;
associated with SN hearing loss;
TX: no cure, check for underlying causes and tx, mask sound,
Sudden SN HL
hearing loss due to hereditary or age (MMR); noise induced
DX: AC>BC lateralization to good ear
TX: high dose steroids, tx underlying
Peripheral Vertigo
sudden fatigable vertigo;
head movement, stress, diet, closed eyes;
Causes: vestibular neuronitis, Benign paroxysmal positional vertigo, meniere’s dz, labyrnthitis, tumors;
PE: worse w/ eyes closed, horizontal/rotary nystagmus
TX: Acute vestibular suppression (short term)
Epley maneuver for BBPV
Central Vertigo
Gradual onset, mild, non-fatigable vertigo; weakness & numbness
Better w/ eyes closed
Vertigal Nystagmus
Meniere’s Disease
dilation of endolymphatic space
PE: episodic vertigo, SN hearingloss, tinnitus
TX: low salt & diuretics, vestibular suppressants for acute attacks
Labyrinthitis
inflammation of inner ear nerves
PE: vertigo, hearing loss, tinnitus
TX: Steroids, anti-vertigo, vestibular rehab
Vestibular-Neuronitis
Acute inflammation of inner ear;
PE: vertigo
TX: steroids, atni-vertigo, vestibular rehab
Vestibular Schwannoma
Noncancerous benign, encapsulated growth that is sporadic (most common cerebellar pontine angle tumor);
CN 8 vestibulocochlear nerve
PE: progressive asymmetric high tone hearing loss, tinnitus, vertigo increasing
TX: surgery, radiation
Trauma (Hematoma)
Accumulation of blood in perichondrial space
PE: Edema, bruising, loss of carilage landmarks
TX: I&D, closure, pressure dressing, quinolone
Rhinitis
inflammation of nasal mucosa - edema, vasodilation, rhinorrhea;
seasonal allergies
PE: clear rhinorrhea, sneezing, itching, eye sx, nasal congestion, polyps
TX: steroid spray, decongestants, antihistamines, aticholinergics, saline irrigation
Rhinosinitus/Sinusitis
Inflmmation & Obstruction of sinus outflow tracts;
Viral (Rhinovirus), Bacterial, Fungal
PE: pain/pressure, decreased smell/taste, rhinorrhea, cough, fever
CT GOLD STANDARD
TX: alalgesics, saline, nasal steroids, decongestants; augmentin for bacterial
Nasal Foreign Body
PE: Unilateral, foul smelling nasal drainage/blood
TX: remove object; positive pressure, instrumentation w/ lidocaine and Afrin
Nasal Polyps
Usually lateral nasal wall & bilateral
Postnasal drip, rhinorrhea, hyponasality
PE: smooth, pale, clustered grapelike
TX: Nasal steroid spray, oral steroids, polypectomy, tx underlying allergies
Epistaxis
Nose Bleed Trauma, infection/inflammation, etc... Anterior: Kiesselback's plexus Posterior: Woodruff's plexus TX: Vasoconstriction (Afrin); Pressure on tip of nose leaning forward 10 min; Nasal packing 3-5d, anti-staph ABX; Anterior- silver nitrate cauterization
Nasal Fracture
Most common facial fracture
PE: palpable deformity, epistaxis, edema, nasal obstruction
TX: Closed reduction (w/in first 1-3 hrs before swelling, or 3-10d after swelling, before healing) or Open reduction (3-6m after failed closed reduction)
Acute Viral Pharyngitis
40-60% pharyngitis;
PE: Low fever, Progressively worse, generalized adenopathy, URI sx, more indolent
TX: Supportive (bed rest, hydration, lozenges); precautions (wash hands, throw away toothbrush)
Acute Bacterial Pharyngitis
Casued by Group A B-hemolytic Streptococcus (GABHS);
PE: High fever, Sudden onset, anterior cervical lymph nodes, NO COUGH OR RHINORRHEA, exudate on red, swollen tonsils, HA, nausa, abd pain
TX: ABX, PCN
Peritonsillar Abscess
Spread of infx out of tonsillar capsule; GABHS, Fusobacterium
PE: Odynophagia, trismus (locked jaw), uvula deviated to other side, tonsilar asymmetry, soft palate swelling, drooling, hot potato voice
TX: ENT consult, Needle aspiration vs I&D, IV ABX (Unasyn, clinda), PO ABX d/c (Augmentin, Clinda)
Acute Laryngitis
Mostly Viral (Rhinovirus)
PE: dysphonia (low voice), low fever, cough, rhinitis, PND
TX: voice rest, hydration, no smoking, ABX if bacterial
Epiglottitis
Epiglottitis blocks airflow; Caused by Haemophilis influenzae B (rare in peds due to vaccine)
PE: sudden and short course, High fever, dysphagia, drooling, dyspnea, Sniffing position, NO COUGH OR VOICE CHANGES, thumb print sign
TX: Secure airway, IV ABX and steroids x7-10 days
EMERGENCY
Croup
URI bocks breaking; caused by Parainfluenza 1; most common cause of stridor
PE: Gradual onset, long course (3-7d), barking cough, better in recumbent, worse at night, hoarsness, stridor, low fever, NO DYSPHASIA OR DROOLING
TX: Assess airway, humidified oxygen, IV fluids, nebulized racemic EPI, Steeple Sign
Mononucleosis
EBV, herpes virus; 15-24 yrs
PE: fatigue, anorexia, HA, sore throat, cough, nausea, white patches similar to strep, enlarged spleen
TX: Supportive (Tylenol, NSAIDs, Hydration, Rest)
Aphthous Ulcers
Sores inside mouth or base of gums, most common oral ulcer
PE: painful white ulcers with surrounding redness
TX: resolved in 1-2 wks, avoid spicy/salty food, topical corticosteroids or local anestheics, silver nitrate cauterization, ABX mouthwash
Oral Herpes Simplex
HSV-1, cold sores, fever blisters
PE: itching, burning, tingling, small painful blister - vesicular
TX: resolves in 1-2 wks, antivirals
Oral Candidiasis (Thrush)
Yellow plaque; opportunistic infection
PE: friable, white cheesy plaque CAN SCRAPE OFF, Odynophagia
TX: oral hygiene, tx underlying problem, topical antifungals (Nystatin swish and swallow)
Oral Leukoplakia
Yellow lesions; precursor to oral malignancy
PE: white, plaque that CANNOT SCRAPE OFF
TX: ENT referral, surgical excision, cryotherapy,
Neck space infections
Odontic (most common adult), tonsils (most common pedi), trauma, URI, salivary glands, IV
PE: erythematous, tender neck with LAD, fever, torticollis, trismus, hoarseness, dysphasia, dyspnea, stridor
TX: secure airway, ABX, local drainage C&S, tooth extraction, debridement of osteomyelitis bone
Sialoadenitis
Inflammation and Infectin of Salivary Gland; Bacterial (S. aureus), Viral (HIV, mupms, influenza, etc)
PE: erythema, tenderness, warm gland, warm purulent discharge, trismus
TX: rehydration, warm compress, ABX
Blepharitis
Inflammation of eyelids that affects eyelash or tear duct;
PE: lids crusting, itching, tearing, microbe infestation
TX: lid hygiene, topical ABX (Bacitracin, Erythromycin)
Hordoleum (Stye)
Acute staph infection of glads of zeis and moll
PE: Painful, warm, swollen lump on eyelid
TX: Compress and ABX. Good Hygiene
Chalazion
Lipogranuloma obstruction of Meibomian gland DEEP within lid
PE: painless, cold, hard, lump found at middle part of ye
TX: Warm compress and hygiene, topical ABX w/ steroids (progress to oral) Surgery if vision affected
Ectropion
Outward turning of lower eyelid
PE: tearing, irritation, scaring, dryness, keratitis (redness) from exposure, eyelid laxity
TX: tear supplements (lubrication) and surgery, eye taping, topical ABX
Entropion
Inward turning of eyelid causing lash conjunctival irritation. Lashes rub on conjunctiva & cornea. More painful than ectropion
PE:tearing, irritation, scaring, dryness, keratitis
TX:eye taping, ABX, surgery (Epilation Blepharoplasty)
Dacrocystitis
Infection and obstruction of lacrimal sac
Caused by: S. aureus/epidermis, beta hemolytic strep, diphtheroids
PE: pain, swelling, erythema usually lower eyelid, tender lacrimal sac w/ purulent discharge
TX: compress, ABX (oral and topical)
Viral Conjunctivitis
Cause: Adenovirus (85%)
PE: water discharge, sandy feeling on eye, redness, tearing, burning, preauricular adenopathy, blurred vision
TX: limited, hygiene, tx othery sx
VERY CONTAGIOUS - BILATERAL
Bacterial Conjunctivitis
Cause: S. aureus (adults), Haemophilus influenzae (preschoolers)
PE: mucopurulent thick, green discharge, crusted in AM. Pain, FB sensation, redness, light sensitive, blurred vision
TX: ABX (Sulfacetamide, Erythromycin)
Cataracts
Clouding in one or both lenses from aging, metabolic d/o, trauma, genetics
PE: progressive blurred vision, poor night vision, halo around lights, faded colors, no pain/redness
TX: remove cataract
Corneal ulcer
Erosion of outer layer of cornea due to trauma, infection
PE: SEVERE PAIN, watery eyes, white patch, photophobia, blurry/hazy vision, red eye, itching
TX: initiate ABX, Refer to Optha
Bacterial Keratitis
Inflammed cornea
PE: expanding oval, yellow-white dense infiltrate, pain, redness, impaired eyesight, photophobia
TX: ABX (topical: ciprofloxacin, ofloxacin)
Herpes simple Keratitis
Herpes in eye
PE: Herpes lesion (dendritic ulcer w/ bulbs) visible w/ fluoresceine dye
TX: Acyclovir, Trifluorothymidine, debridement
Corneal abrasion
Scratch on cornea due to trauma, contacts, FB
PE: Excruciating eye pain, difficulty opening eye, tearing, photophobia, blurred vision
TX: Antibiotic, cycloplegic drops, bandage contact lens, patching
Pterygium
Triangular fibroavascular elevated growth, can cross cornea. Due to UV exposure, elements
PE: dry, burning sensation, red, blurry vision
TX: observe, lubricants and UV protection, steroid drops, surgery if vision impacted
Orbital Cellulitis
Infection of orbital muscles and fat behind eye
PE: sudden pain, erythema, edema of lids with proptosis, fever, pupils with APD, decreased eye movement
TX: EMERGENCY, IV ABX
Nystagmus
Rhythmic regular oscillation of eyes
PE: vertigo, blurred vision.
TX: baclogen, gabapentin, contacts, tenotomy, acupuncture, PT, OT
Vertical: CNS dysfunction
Horizontal: Labrunt, vestibular nerve dysfunction
Optic Neuritis
Inflammation of optic nerve
MS if most common cause
PE: monocular vision loss, pain with eye movement
TX: IV steroids (methylprednisolone IV), refer to neurology
Pepilledema
Swelling of optic disc and anterior bulging of physiologic cup due to increased intracranial pressure
PE: intermittent HA, dizziness, blurred vision
TX: tx underlying cause
Macular Degeneration
Dry-age, leading cause of vision loss in elderly
Wet-hemorrhage, neovasculation
PE: Painless, central vision loss, wavy vision, no erythema.
DRY PE: geographic atrophy of retina, drusen deposits
WET PE: neovascular (gray, green discoloration) fluid in subretina
TX DRY: AREDS Vitamins
TX WET: UV protection, anti Vegf intraocular injections
Diabetic Retinopathy
Leading cause of blindness in ages 20-65yrs
PE: +/- visual acuity changes, cotton wool spots w/ fundoscope, flame hemorrhages
TX: control DM, HTN, and/or hyperlipidemia, retinal laser photocoagulation
Hypersensitive Retinopathy
Long term uncontrolled HTN or sudden increased BP
(AV nicking)
PE: diplopia, HA, ‘silver/copper wiring’, flame hemorrhages
TX: control HTN
Retinal Detachment
Spontaneous or Trauma
PE: curtains coming down across vision, floaters, unilateral, painless, no erythema
TX: EMERGENCY, supine w/ head facing origin of tear, reattach retina
Amaurosis Fugax
Cholesterol plaque emboli from carotid artery plaque, blockage of central retinal artery = sudden vision loss
PE: curtains coming down, painless resolved w/in hr
TX: resolves spontaneously, surgical decompression, massage, CO2 breathing
Amblyopia (lazy eye)
early childhood, caused by strabismus, uremia, or toxins
PE: decreased vision in one eye, red reflex asymmetry
TX: patching better eye to train weak eye
Open-Angle Glaucoma
Most common glaucoma
Decreased aqueous outflow and increased aqueous production INCREASED INTRAOCULAR PRESSURE
PE: slow vision loss, peripheral then central, cupping of optic discs
TX: IV aceteazolmide, peripheral iridtomy (hole in iris)
Closed-Angle Glaucoma
Iris root occludes trabecular meshwork - complete obstruction of aqueous fluid drainage, rapid increase in IOP
PE: severe pain, blurred vision, HA, N/V, fixed dilated pupil
TX: Constrict pupil to drain, prostaglandin analogs, trabeculoplasty (opens trabecular meshwork)
Scleritis
Inflammation of sclera, systemic immunologic disease
PE: severe, constant eye pain, worse at night, radiated to face, HA, erythema
TX: topical and systemic corticosteroids
Strabismus
Adults: trauma, microvascular infarct, intracranial hemorrhage, brain tumor
PE: diplopia, deviation of gaze (in, out, up, down)
TX: glasses, surgery
If not treated, can lead to amblyopia
Retinal Artery Occlusion
Evaluate carotid for emboli, vasculitis, HTN, HLD
Ischemic or thrombus to major retinal arterial
PE: sudden, profound monocular vision loss, arterial narrowing, cherry red spot
TX: EMERGENCY, hypotensive drugs, global pressure
Retinal Vein Occlusion
Evaluate carotid for emboli, vasculitis, HTN, HLD
Ischemic or thrombus to major retinal arterial
PE: vision decreased upon waking, blood and thunder retina
TX: EMERGENCY, hypotensive drugs, global pressure
Orbital Blowout Fracture
FX of 1+ bone of orbit due to trauma
PE: double vision, reduced eye movement, bruising, tender, swelling, red eye, numbness of cheek, nose, teeth
TX: Oral cephalexin. Simple- ice, decongestant, oral steroid. Isolated- refer in 3-10d
Hyphema
Hemorrhage into anterior chamber
PE: blurred vision, blood in ant chamber
TX: Opthalm, Rest, No ASA or anticoagulents
Globe Rupture
Integrity of outer membrane of eye is disrupted by blunt penetrating trauma (blunt injury, chemicals)
PE: complete loss of vision or decreased acuity, pain in eye, tear drop pupil
TX: Opthalm, Antiemesis and sedation, IV ABX, Fox Shield over eye, surgical repair
