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
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
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
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
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)
6
Q
What is the thumb sign?
A
- -a thickened, swollen epiglottis seen on lateral neck radiograph
- SIGN OF EPIGLOTTITIS*
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
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
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
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
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
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
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
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
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
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
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
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
