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HEENT disorders Flashcards

1
Q

Acute rhinosinusitis defined

A

inflammation of the mucosal lining of nasal passages and paranasal sinuses lasting up to 4 weeks
can be cause by allergens, virus, bacteria and fungi

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2
Q

Acute bacterial rhinosinusisits defined

A

secondary bacterial infection of paranasal sinuses following a viral URI
“sinus infection”

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3
Q

What questions to ask prior to antimicrobial therapy

A

what are the most likely pathogens
what is the spectrum of the given antimicrobial
what is the likelihood of the resistant pathogen
what is the danger if there is tx failure

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4
Q

Pathogens that cause acute bacterial rhinosinusitis

A

S. pneumoniae (most common)
H. influenzae (common cause of recurrent infections and those who are tobacco users
M. cat (least common)

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5
Q

S. pneumoniae description

A

gram pos diplococci

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6
Q

H. influenza description

A

gram neg bacillus

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7
Q

M. cat description

A

gram neg coccus

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8
Q

drug resistance in s. pneumonia

A

> 25% drug resistance from altered protein binding and can limits its ability to bind to pathogen

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9
Q

drug resistance to h. influenza

A

> 30% PCN resistant from production of beta-lactamase

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10
Q

drug resistance to m. cat

A

> 90% PCN resistance from beta-lactamase

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11
Q

Risk factors for abx resistance

A 
age < 2 and >65
daycare
prior abx within past month
comorbidities
immunocompromised
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12
Q

Needing Abx therapy without risk for resistance

A

start first line antimicrobial and do 5-7 days

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13
Q

Needing abx therapy with risk of resistance

A

start 2nd line antimicorbial and do for 7-10 days

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14
Q

First line therapy for ABRS (bacterial sinusitis)

A

High dose Amox 3-4g/day
Amox-clavulanate (augmentin) 500/125 TID
Amox-clavulanate (augmentin) 875/125 BID

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15
Q

What does claculanate do with drug resistance?

A

it is a beta lactamase inhibitor and allows amox to have activity against beta lactamase producting organisms such as h.influenza and m. cat

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16
Q

Second line therapy for ABRS

A

Amox-clavulanate 2000/125 PO BID

Doxy 100 mg PO BID

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17
Q

Doxy cautions

A

Pregnancy category D
Can stain teeth
sit upright 30 minutes following taking

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18
Q

Tx choices for ABRS with beta-lactam allergy

A

Doxy
Levofloxacin 500 daily
moxifloxacin 400 daily
(these are active against drug resistant s. pneumo, gram neg and are stable in presence of beta lactamase

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19
Q

Tx choice for abx resistance or failed initial therapy

A

Amox-clavulanate 2000/125 BID
Levofloxacin 500 daily
moxifloxacin 400 daily

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20
Q

Trimethoprim-sulfamethoxazole for ABRS

A

bactrim

not a good option, does not always cover

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21
Q

3 questions to ask when choosing abx therapy

A

Is it gram pos or neg?
Is it safe?
Is it stable in beta lactamase

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22
Q

S/S of otitis externa

A

erythema of external ear

discomfort when tragus is pulled

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23
Q

Normal finding with unilateral AOM with ear fullness

A

weber test lateralization to the affected ear
shows conductive hearing loss
ear fullness is a normal finding

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24
Q

hearing loss associated with presbycuis presentation

A 
age r/t
slowly progressive
symmetic
high frequency
"sensoryneural"
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25
Q

Controller medications for allergic rhinitis

A

intranasal corticosteroids
leukotriene receptor antagonist/modifiers
mast cell stabilizers both intranasal and ophthalmic

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26
Q

Intranasal corticosteroids used for allergic rhinitis

A 
beclomethasone
budesonide
ciclesonide
flunisolide
fluticason
triamcinolone
"the ides and one's"
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27
Q

Leukotriene receptor antagonists/modifiers used for allergic rhinitis

A

montelukast (Singulair)

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28
Q

Intranasal mast cell stabilizers for AR

A

cromolyn

safe and less effective than corticosteroids

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29
Q

Opthalmic mast cell stabilizers for AR

A

cromolyn
nedocromil
improves when combined with antihistamines

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30
Q

Use of intranasal corticosteroids

A

can cause nasal irritation and bleeding
some systemic bioavailability in elderly
takes 1-2 weeks to reach optimal efficacy
can be used in acute sinusitis

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31
Q

1st generation antihistamines for reliever meds for AR

A 
diphenhydromine
chlorpheniramine
hydroxyzine
block histamine 1 receptors
have anticholinergic effects
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32
Q

2nd generation antihistamines for reliever meds for AR

A 
loratadine
desloratadine
cetirizine (zyrtec)
levocetirizine
fexofendadine (Allegra)
better than 1st generation
little benefit with nasal congestion
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33
Q

nasal antihistamines for reliever meds for AR

A

azelastine
olopatadine
for non-allergic AR and nasal congestion
systemic absorption so drowzy

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34
Q

opthalmic antihistamines for relieve meds for AR

A

olopatadine
azelastine
bepotastine
for ocular allergy symptoms

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35
Q

Oral decongestants for relieve meds for AR

A

Sudafed
“vasoconstric”
alpha adrenergic agonist

36
Q

Caution for oral degongestants

A 
elderly
young
HTN
bladder neck obstruction
glaucoma
hyperthyroid
37
Q

Nasal decongestants for relieve meds for AR

A

oxymetazoline (Afrin)
phenylephrine
limit use to 5-7 days
can cause rebound congestion

38
Q

Intranasal antocholinergic use

A

ipratropium bromide (Atrovent)
only reduces rhinorrhea
use with corticosteroids

39
Q

short-term oral cortocosteroid use

A

for severe nasal symptoms
not for single use or recurrent use
prednisone 20mg BID x 5-7 days

40
Q

Anticholinergic side effects from 1st generation antihistamines

A 
Dry as a bone
Red as a beet (flushed)
Mad as a hatter (confused)
Hot as a hare (hyperthermia)
Can't see (vision)
Can't pee
Can't spit
Can't shit
41
Q

adverse S/E from oral decongestants

A

increase in BP

42
Q

s/s of allergic conjunctivitis

A

hyperemic bulbar and palebral conjunctiva

rope like pale yellow d/c

43
Q

meds to avoid is someone with allergic rhinitis who is a machine operator

A

1st generation antihistamines- cause drowsiness

44
Q

painless ulceration with indurated margins on the lateral tongue with a firm, non tender submandibular node could be

A

squamous cell carcinoma
most oral cancers are squamous cell
squamous cell = non tender

45
Q

leukoplakia described

A

white plaque that is painless
no ulcer
can’t scrape off

46
Q

aphthous stomatitis described

A

ulcer on the lip

47
Q

CN for puffing out cheeks

A

VII

48
Q

CN for smelling

A

I

49
Q

CN for following finger with eyes

A

III

50
Q

CN for shrugging shoulders

A

XI

51
Q

CN for sticking out tongue

A

XII

52
Q

What cranial nerve does bell’s palsey typically affect

A

VII

53
Q

Tx bell’s palsey

A

oral corticosteroids

54
Q

How often to assess visual acuity in adult and child

A

annually

55
Q

What vision complaints warrant a referral to eye specialist

A

change in baseline vision

eye pain and redness

56
Q

normal eye exam for 55 year old woman

A

sharp disc margins

57
Q

lid ectropion =

A

sagging eyes

happens in older adults

58
Q

found on funduscopic exam with angle-closure glaucoma

A

deeply cupped optic disk

59
Q

peripheral vision loss

A

untreated open-angle glaucoma

60
Q

central vision loss

A

macular degeneration

61
Q

screening tool for macular problems

A

amsler grid test

62
Q

when is tonometry used for eye exam

A

increased occular pressure

glucoma screening test

63
Q

slit-lamp exam

A

looks at anterior eye including the cornia, conjunctiva, sclera and iris

64
Q

the purpose of snellen eye chart is to determine

A

visual acuity

65
Q

presbyopia

A

problems with close vision
due to hardening of lens
happens to majority over 45

66
Q

senile cataracts

A

progressive vision dimming, trouble with distance
close up vision good
caused by lens clouding

67
Q

risk factors for senile cataracts

A

smoking
poor nutrition
sun exposure
cortocosteroid therapy

68
Q

angle closure glaucoma

A 
unilateral
acutely red
painful
vision change
firm eye ball
halos seen around lights
REFER
69
Q

open angle glaucoma

A

loss of peripheral vision if untreated
painless
gradual onset of pressure

70
Q

evaluation and management of open angle glaucoma

A

periodic screening with tonometry
visual fields assessment
tx with topical miotics, beta blockers or surgery

71
Q

age-r/t macular degeneration

A

central vision issues
often seen yellow deposits in macular
due to sclerotic changes in retinal basement membrane

72
Q

risk factors for macular degeneration

A

aging
tobacco
sun
fam hx

73
Q

Anosmia

A

diminished sense of smell
due to neural degeneration
there is also decline in fine taste

74
Q

Presbycusis

A

difficulty with conversation in noisy environment
due to loss of 8th cranial nerve sensitivity
accelerated by excessive noise exposure

75
Q

cerumen impaction

A

causes conductive hearing loss

76
Q

common pathogen of otitis externa

A

pseudomonas strep pneumo
proteus strep pneumo
s. aureus

77
Q

tx for otitis externa

A

acetic acid with propylene drops for mild

ciprofloxacin for mod to severe

78
Q

do not use if TM ruptured

A

neomycin products

79
Q

malignant otitis externa in persons with DM, HIV

A

from pseudomonas strep pneumo
oral cipro
risk for osteomyelitis of skull or TMJ
MRI or CT to rule out osteomyelitis

80
Q

common pathogens of suppurative conjunctivitis

A

s. aureus
s. pneumo
h. influenza

81
Q

tx for suppurative conjunctivitis

A

“floxacins”
polymyxin B and trimethoprim
azithromycin 1%

82
Q

s. pneumo is resistant to

A

tobramycin

gentamicin

83
Q

exudate pharyngitis common pathogens

A

Group A, C G strep
viral
M. pneumoniae

84
Q

Tx for exudate pharyngitis

A

PCN V x 10 days
Erythromycin x 10 days
Azithromycin x 5 days
Clarithromycin x 10 days

85
Q

common cause of pharyngitis is children

A

group A strep

86
Q

why test for group A strep

A

prevention of rheumatic fever and eradication of organism

87
Q

tx for recurrent culture proven group S pyogenes

A

consider coinfection with beta lactame producting organism

consider amox-clavulanate or clinda

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