HEENT Flashcards
Nerve that supplies mandible to midline
Inferior alveolar nerve
(Also innervates anterior 2/3 of tongue and oral floor)
Infraorbital nerve
Maxillary teeth, midline to canine
Buccal soft tissue of upper lip
Lateral nose
Lower eyelid
Posterior superior alveolar nerve
1-3 maxillary molars
Bilateral facial nerve palsy
Lyme disease
Neonatal conjunctivitis timeline and bug
0-5 days: neisseria
5d-5w: chlamydia
5w-5y: heamophilus, strep
Eye tearing in newborn with vesicles
Heroes simplex keratitis
Herpes zoster opthalmicus
VZV in trigeminal ganglion (V1)
Punctuate corneal keratitis: ground glass appearance due to stromal edema
Psuedodendrites
Hutchison sign: vesicles on tip of nose due to nasocilliary branch involvement
Optho consult
Seidel sign
Seen with flourescein stain: streaming of aqueous humor due to full thickness corneal abrasion
Preseptal cellulitis
Seen primarily in peds
No eye involvement
Oral abx (amoxicillin)
Treat preseptal cellulitis
Augmentin
Stye
Infection of the oil gland at the lash line; pustule at lid margin
Chalazion
Inflammation of the eyelid secondary to meibomian gland blockage in the tarsal plate
Wet compresses and erythromycin
Bacterial conjunctivitis in contact lens wearers
Cover for pseudomonas - topical cipro or tobramycin
HSV of eyes
Dendrite or geographic ulcer on slitlamp
Decreased corneal sensation
Optho consult
Corneal ulcer
Slit lamp: white hazy infiltrate, iritis and hypopyon
Iritis
Red eye, photophobia, and decreased vision
Consensual pain
Treat with cycloplegics (homatropine, cyclopentolate, scopolamine)
Full-thickness lid lacerations
Investigated to rule out an associated corneal laceration and globe ruptur
Next step with suspected globe rupture
Place eye shield
CT of the orbit
Hyphema
Presence of blood in the anterior chamber
Optho consult
HOB at 30-45
Acute angle Closure glaucoma
Sudden onset severe eye pain and/or headache, cloudy vision, colored halos around lights, and vomiting
mid-dilated sluggish pupils, ciliary flush, hazy cornea
Optic Neuritis
Presents with acute vision loss, specifically color vision, foggy vision, afferent pupillary defect
Assoc w/ MS
Swollen, hyperemic optic disc
Uthoff phenomena: vision decreases with increase in body temperature
IV steroids (NOT PO)
Central retinal artery Occlusion
Sudden, painless, severe mon-ocular loss of vision; hx of amaurosis fugax
Marked APD, superficial opacification/whitening of retina in posterior pole, and bright red macula
Massage the eye, call optho
Central retinal Vein Occlusion
Acute, pain- less monocular vision loss
Optic disc edema, cotton wool spots, and retinal hemorrhages: “blood and thunder fundus”
Retinal Detachment and Floaters
Sudden flashes of light, floaters, or a dark veil or curtain-like defect
Erysipelas
Red, raised, puffy appearance with a sharply defined, palpable border
Penicillin
Impetigo
nonbullous: erythematous rash with vesicles that break and form the characteristic amber crust; mupirocin
Bullous: vesicles that enlarge to form bullae with clear yellow fluid
Viral Parotitis (Mumps)
Gland is tense and painful, but lacks erythema and warmth
Suppurative Parotitis
Occurs in patients with diminished salivary flow via retrograde bacteria flow
Fever, trismus, erythema, and pain over the parotid gland; Pus from Stensen’s duct
Optimize salivary flow
Sialolithiasis
Stones in a stagnant salivary duct
Diagnose Masticator Space abscess
Contrast-enhanced CT scan
Trigeminal Neuralgia treatment
Carbamazapine
Lateral Sinus Thrombosis
Headache is common and papilledema, sixth nerve palsy, and vertigo
nafcillin, ceftriaxone, metronidazole
Bullous Myringitis
Painful bulla on the TM
Cerumen Impaction
Hydrogen peroxide, sodium bicarbonate, mineral oil, or carbamide peroxide otic
Nasal Septal Hematoma
Horizontal I&D
Bilateral nasal packing
Augmentin
Brain abscess
Spread from sinusitis or OM
CT/MRI w/contrast: ring enhancing lesion
HA, fever, focal neuro deficits
Sx of IIHTN
Headache
CN VI palsy
Papilledema
Pulsatile tinnitus
Classification of dental fx
Ellis
I: enamel only
II: enamel and dentin
III: enamel, dentin and pulp
Use Calcium hydroxide in II and III
Bacterial tracheitis
Peak incidence at 3-4y
Lining of trachea sloughs off
Viral prodrome similar to croup but child becomes toxic appearing including fever and sx of airway obstruction, ins and exp stridor
XR may show mild subglottic narrowing
Poor response to croup tx
Pott Puffy Tumor
Subperiosteal abscess or osteo of frontal bone from spread of sinusitis
Usually seen in children
Cranial CT or MRI
Endophthalmitis
Infection of anterior, posterior and vitreous chamber of eye
Can see pus in the anterior chamber (hypopyon)
Can be iatrogenic after cataract surgery
Vitreous hemorrhage
Injury to retina, uveal tract and vascular structures
Floaters and decreased visual acuity
Non-painful
Most likely to cause TM rupture
Descent barotrauma
Most common site of oral cancer
Tongue
Treat hemotympanum due to barotrauma
Anticongestants
Pericoronitis
Inflammation of overlying tissue of newly ruptured molar
Most likely location of esophageal FB in peds? Vs adult?
Cricopharyngeus
Lower esophageal sphincter
Menierie disease
Tinnitus, hearing loss, dizziness, clustered attacks with long intervals symptom free
Vestibular neuronitis
Vertigo for days, no auditory sx
Labrynthitis
Dizziness and hearing loss preceded by HEENT infection.
Normal optic nerve sheath diameter
<5
>5 correlates to intracranial pressure >20
Dacryocystits
Lacrimal duct infection
Staph and strep
Fluorescein dye disappearance test
Warm compresses, massage, clinda
Necrotizing otits externa
Adults with DM or immunocompromised
Granulation tissue, purulent drainage, CN palsy (facial nerve)
IV abx with pseudomonas coverage
Where does perf in Boorhaves typically happen?
Left posterolateral aspect of distal intrathoracic esophagus
Optic neuritis
Demyelination of optic nerve
Vision loss - central scotoma, pain with movement, loss of color, edematous optic disc, afferent pupillary defect
IV steroids
Orbital cellulitis
Painful EOM, diplopia, proptosis, chemosis
