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BOARDS--GET IT!!! > HEENT flashcards > Flashcards

HEENT flashcards

1
Q

Describe the clinical course of bacterial pharyngitis

A
  • -caused by GABHS, N. gonorrhea, and diphtheria
  • -S/S of GABHS: abrupt onset in a 5-15 y.o., high fever, malaise, sore throat, N/V, HA, petechiae, tonsillar exudate, lymph
  • -GABHS: late winter to early spring
  • -DX: throat culture
  • -TX: penicillin, amoxicillin
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2
Q

Describe the clinical course of pharyngitis

A
  • -caused by adenovirus, coxsackie, echovirus, herpes, EBV, CMV
  • -S/S: gradual onset, nasal sx, sore throat, cough, fever
  • -TX: supportive care
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3
Q

What is myopia?

A
  • -“nearsightedness”, visual image focused in front of retina making it difficult to see things from far away
  • -S/S: squinting, unable to read blackboard
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4
Q

What is hyperopia?

A
  • -“far-sightedness”, visual image focused behind the retina, making it difficult to see things up close
  • -S/S: HA, eye strain, may be asymptomatic
  • -> REFER
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5
Q

Describe the clinical course of epiglottitis and how it is treated.

A
  • -Severe, rapidly developing inflammation of the supraglottic structures leading to life-threatening upper airway obstruction
    • -> usually bacterial: H. flu, staph, GABHS, strep pneumo
    • -> most common b/t 2-7 yrs
  • -S/S: high fever, severe sore throat, muffled voice, drooling, choking sensation, tripod position, irritable, toxic, cherry red epiglottis, soft inspiratory stridor, retractions, nasal flare
  • -DX: radiograph: “thumb sign”
  • -TX: EMERGENCY, keep child calm, antibiotics (IV therapy 2-3 days, such as ceftriaxone), maintain airway (intubate or tracheotomy)
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6
Q

What is the thumb sign?

A
  • -a thickened, swollen epiglottis seen on lateral neck radiograph
  • SIGN OF EPIGLOTTITIS*
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7
Q

What is a peritonsillar abscess and how is it managed?

A
  • -infection of tonsils and surrounding tissues, leads to access formation
  • -caused by GABHS, staph, anaerobes
  • -S/S: fever, severe sore throat, toxic appearance, muffled voice, drooling, bad breath, unilateral tonsillar swelling, uvula displacement away from affected side
  • -TX: REFER–EMERGENCY, I&D, antibiotics
  • -more common in adolescents
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8
Q

What is a retropharyngeal abscess how it is treated?

A
  • -posterior pharynx abscess with retropharyngeal nodes
  • -caused by GABHS or staph aureus
  • -most common in children
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9
Q

What is cleft lip/palate and how is it treated?

A
  • -Lip: failure of embryonic structures of the oral cavity to join palate, failure of palatal shelves to fuse
  • -bifid uvula = marker for submucosal cleft palate
  • -DX: audiogram needed d/t frequent otitis media assoc. w/cleft palate
  • -TX: surgical repair, teach feeding technique
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10
Q

Describe allergic rhinitis and how it is managed.

A
  • -IgE-mediated response to allergens producing nasal mucosa inflammation
  • -S/S: chronic nasal d/c, snoring w/sleep, allergic shiners/salute, swollen boggy mucosa
  • -TX: nasal steroids, antihistamines, topical antihistamines, cromolyn, avoid allergens, montelukast if also asthma
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11
Q

What are some causes of Epistaxis and how is it managed?

A
  • -Nosebleed, d/t increased vascularity in Kiesselbach’s triangle, caused by trauma, dry nasal mucosa, infection, substance abuse, systemic disease
  • -TX: apply pressure to ant. nasal septum, tilt head forward, phenylephrine drops, packing, refer to ENT if repeat/severe
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12
Q

What are the signs and symptoms of a FB in the nose?

A
  • -S/S: unilateral, purulent d/c, sneezing, mild discomfort, rarely pain
  • -TX: remove object if possible, refer to ENT if unable to remove
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13
Q

What can cause sensorineural hearing loss?

A
  • -damage to the cochlea/auditory nerve
  • -caused by noise, anomaly, meningitis, hyperbilirubinemia, kernicterus, gent, LBW, measles, mumps, intracranial hemorrhage
  • -high frequency hearing loss
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14
Q

What can cause conductive hearing loss?

A
  • -blocked transmission of sound waves
  • -can be congenital/acquired, OME, AOM, cerumen, FB, perforated TM, cholesteatoma
  • -low frequency hearing loss
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15
Q

Describe conjunctivitis of the newborn and how it is managed.

A
  • -Infection or inflammation in the 1st month of life, causes include viral (HSV), chemical, gonococcal, chlamydia, bacterial (HIB, staph, Group B)
  • -Gonococcal: acute, purulent d/c with chemises & lid edema. TX; hospitalize, cefotaxime
  • -Chlamydia: mild d/c + pneumonia, afebrile, staccato cough. TX: oral erythromycin or sulfonamide
  • -Other BacT: TX w/erythromycin ointment or gentamycin
  • -Viral: refer antiviral therapy
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16
Q

What is astigmatism and how is it treated?

A
  • -Refractive error d/t irregular curvature of the cornea
  • -S/S: eye pain, HA, fatigue, reading problems
  • -TX: REFER, patching, corrective lenses
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17
Q

What are the s/s & tx for a FB in the eye?

A
  • -S/S: PAIN, striation on the cornea, tearing, FB sensation, irregular pupil, perforated wound
  • -TX: do not remove intraocular FB, irrigate to remove FB, topical antibiotic, patch eye
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18
Q

What are the clinical signs of a corneal abrasion and how is it treated?

A
  • -caused by abrasions, trauma, FB, contact lens, UV light exposure
  • -S/S: FB sensation, pain, photophobia, tearing, blepharospasm, decreased vision, straining
  • -TX: rest, topical antibiotic, oral analgesics, f/u in 24 hrs, REFER
19
Q

What is amblyopia?

A
  • -decreased visual acuity caused by abnormal development, s/t abnormal visual stimuli, result of strabismus, refractive error differences, sensory deprivation
  • -S/S: wandering eye, absent red reflex, strabismus
  • -TX: REFER, corrective lenses, patching “good eye,” reassure, support
20
Q

What is a hyphema & how is it treated?

A
  • -blunt trauma to the globe results in blood in the anterior chamber, can also be caused by bleeding d/o’s, lead to increased risk of glaucoma
  • -S/S: drowsiness, pain, hx of injury, light sensitivity, blood in ant. chamber, visual acuity changes
  • -TX: REFER, decreased activity, rest in supine position w/elevated head, patch eye, may need hospitalization
21
Q

What is orbital cellulitis and how is it treated?

A
  • -Orbital: inflammation of the orbital contents, most common organisms staph, strep +, H. flu, often assoc. w/sinusitis/ethmoiditis
  • -ophthalmoplegia, proptosis, decreased visual acuity, decreased ocular motility, lid edema, fever, HA
  • -TX: REFER, systemic antibiotic therapy
22
Q

What is dacryostenosis and how is it treated?

A
  • -nasolacrimal duct obstruction (blocked tear ducts) in an infant
  • -S/S: continuous/intermittent tearing, d/c, blepharitis, nasal d/c
  • -TX: massage, should disappear by 12 mos–if not, refer
23
Q

What is a chalazion and how is it managed?

A
  • -chronic inflammation/obstruction of meibomian gland in the post margins of the lids
  • -nodular, non-tender mass/cyst, red conjunctiva, if large can lead to astigmatism
  • -TX: warm soaks, erythromycin ointment or sulfacetamide drops, refer for I&D if does not resolve
24
Q

What is a hordeolum and how is it managed?

A
  • -acute inflammation of the sebaceous glands of the eyelids, usually caused by staph (AKA STYE)
  • -S/S: sudden onset tenderness, redness, swelling w/FB sensation, pain on palpation
  • -TX: warm compresses, erythromycin/bacitracin ointment, I&D if severe
25
Q

What is blepharitis and how is it managed?

A
  • -acute/chronic inflammation of the eyelash follicles and meibomian glands, can be seborrheic, ulcerated, or bacterial (staph = most common cause)
  • -S/S: irritation/burning FB sensation, erythema, pruritus, loss of eyelashes, flaky/scaly debris or hard scales at base of eyelash–will bleed if removed
  • -TX: moist compresses, wash with baby shampoo, topical antibiotic (erythromycin), selenium sulfide for seborrheic, remove contact lenses, throw away make-up
26
Q

What is Nystagmus?

A
  • -involuntary horizontal/vertical/rotary/mixed movement of the eyes
  • -can be familial, also assoc. w/albinism, refractive errors, CNS disease, ear disease, & retinal disease
  • -TX: refer to ophtho, monitor, TX underlying cause
27
Q

What are the clinical signs of retinoblastoma?

A
  • -intraocular tumor
  • -S/S: squinting, eyes turn outward more than inward, may have a painful red eye, hyphema, pink mass, cam be seem on fundoscopic, leukokoria, decreased visual acuity, photophobia
28
Q

Describe retinopathy of prematurity

A
  • -developmental vascular d/o that results in abnormal growth of retinal vessel and incomplete vascularization of the retina…EGA and LBW infants
  • -S/S: leukokoria, optic nerve, pallor, glaucoma, cataracts, strabismus, detached retinas, retinal/iris changes, vitreous haziness/hemorrhage
  • -TX: monitor routinely, refer to vision services, yearly ophthalmologic exam, cryosurgery
29
Q

What is glaucoma and how is it managed?

A
  • -increased intraocular pressure d/t a disturbance in the circulation of aqueous fluid, can be congenital or juvenile (trauma, disease, steroid use)
  • -S/S: “classic triad” –> tearing, photophobia, excessive blinking (blepharospasm); hazy cornea, corneal edema or ocular enlargement
  • -Seconday S/S: pain, vomiting, blurry vision, pupil dilation, erythema, asymmetry b/t eyes
  • -TX: surgery, topical B blockers, topical Carb anhydrase inhibitors, etc. can result in blindness
  • -seen w/Marfan, NF, Pierre Robins, congenital rubella
30
Q

Describe cataracts and how they are managed

A
  • -partial/complete opacity of the lens, can be congenital or acquired, unilateral/bilateral, can result in amblyopia
  • -S/S: lens opacity, variable visual defects, hx of prenatal infection, drug exposure, or hypocalcemia
  • -TX: surgical removal of the lens w/use of corrective lens, possible watch and wait, depending on severity
  • -black dots or white area in red reflex
31
Q

What are the stages of normal visual development?

A
  • -20/30 by 5 yrs, 20/40 by 3 yrs, 20/20 by 6 yrs
  • -Birth: sees & responds to change, fixes on contrasts (B&W), + pupillary reflex, jerky movements
  • -2-4 wks: follows objects sporadically
  • -3-4 mos: recognizes parents, smiles, focuses near and far, begins to develop depth perception, esotropia = normal
  • -4mos: normal color vision
  • -6-10mos: follows toy in all directions
  • -12mos: close to fully developed
32
Q

What is strabismus?

A
  • -Tropia = constant deviation
  • -Phoria = intermittent deviation
  • -defect in ocular alignment: deviate outward (exotropia), deviate inward (esotropia), upward (hypertropia), downward (hypotropia); sclera b/t the cornea & inner canthus is obscured (pseudostrabismus)
  • -S/S: person squinting, head tilting, face turning, over pointing, decreased visual acuity, nystagmus
33
Q

How is strabismus diagnosed?

A
  • -DX: corneal light reflex or Hirschberg test
  • -cover/uncover
  • -Alternating cover
34
Q

How is strabismus managed?

A

–TX: “occlude/patch” good eye, orthotic exercises, surgical alignment, corrective lenses

35
Q

Describe conjunctivitis of childhood and how is it managed?

A
  • -infection of the palpebral lining of the conjunctiva
  • -Bacterial: s. aureus, HIB, strep pneumo
  • -Viral: adenovirus, HSV, varicella, also allergic d/t seasonal allergies
  • -S/S: pruritus, FB sensation, tearing, HA, photosensitivity, watery, mucous, purulent mucous, erythema of the conjunctiva, chemosis, papillary hypertrophy
  • -TX: topical tobramycin, sulfacetamide, polymyxin, fluoro, refer if viral, allergic: tx underlying allergies
36
Q

What is otitis external and how is it managed?

A
  • -acute infection/inflammation of ext. auditory canal, “swimmer’s ear,” also fungal
  • -causes: pseudomonas & staph, more common in summer d/t water exposure
  • -S/S: itching, pain when moving the tragus, swollen EAC, pressure/fullness in the ear, black spots on TM (fungal)
  • -TX: analgesics, otic antibiotic drops (ciprofloxacin, polymyxin, Neosporin), mycotic drops (2% boric acid in the ethanol), avoid water in ears, avoid cleaning the ears
37
Q

What are the causes, s/s of AOM?

A
  • -acute infection of the middle ear
  • -DX: rapid onset of S/S of ME inflammation & effusion wth MEE (middle-ear effusion)
  • -S/S: ear pain, irritability, fever, ottorhea, presence of MEE
38
Q

How is otitis media treated?

A
  • -“watchful waiting” for 48-72 hrs if dc is unclear, sx are not severe, child is over 6mos or over 2yrs (see below)
  • -1st line TX: amoxil HD 80-90 mg/kg/day
  • -2nd line TX (with fever, TX fail): Augmentin 90 mg/j/d, alt for pen allergy: azithromycin, clarithromycin, ceftriaxone
  • -TX all pts 2yrs with severe illness
  • -TX pain with analgesics (acet/ibuprofen)
39
Q

What is a cholesteatoma?

A
  • -epidermal cyst of the middle ear, can be congenital or acquired
  • -S/S: vertigo, hearing loss, chronic OM w/purulent d/c, pearly white lesion behind the TM
  • -TX: refer to ENT for surgical removal
40
Q

What is the clinical course for sinusitis and how is it treated?

A
  • -Chronic ( >30days) or acute ( >10days) infection and inflammation of paranasal sinus, caused by viral, bacterial (S. pneumo, H. flu, M. cat), or anaerobes (more common in chronic)
  • -Major S/S: facial congestions/fullness, fever (acute), purulent/discolored rhinorrhea, facial pain, nasal obstruction, hyposmia/anosmia
  • -Minor S/S: HA, halitosis, fatigue, dental pain, otalgia, cough
  • -TX: Augmentin, HD Amoxil, pen allergic: z pack azithromycin, 2nd line: cefuroxime/cefpodoxime/cefdinir
41
Q

What is a nasal polyp and what disease should be considered?

A
  • -benign nasal tumor
  • **think cystic fibrosis–> refer for sweat test
  • -also seen in allergic children
  • -will look like a grape-like mass b/t the turbinates
42
Q

What are the s/s of retinal detachment & how is it managed?

A
  • -caused by trauma (abuse), congenital abnormality (cataracts, Ehlers-Dalos, sticklers, Marfan), or retinal disease
  • -S/S: blurry vision, “flashing lights sensation,” darkening of retinal vessels
  • -REFER to ophthalmology
43
Q

What is the clinical course for a burn to the eye?

A
  • -can be thermal, chemical, or UV light
  • -S/S: pale, necrotic appearance of surrounding skin, corneal opacity, decreased visual acuity, initial pain or delayed pain (UV burns), photophobia, tearing, swollen corneas, pinpoint Fluorescein stain
  • -TX: topical anesthetic, immediate irrigation for chemical burns, REFER

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