HEENT / Lymph Flashcards
differences between arteries and veins in the Eyes
Arteries – narrower
Veins –> PULSATE
Arteries indent and displace veins d/t HTN.
Results in Tapering of the veins as they cross arteries
What do you suspect?
AV Nicking
microinfarction of the with gradual vision loss. Fundoscopic exam shows white spots.
What do you suspect?
How do you tx?
Cotton wool spots
Tx: manage underlying cause. Typically DM or HTN
What are flame hemorrhages?
Blot & Dot hemorrhage
hard exudates, microaneurysms
Gradual vision loss
Tx DM/HTN
what is the most common cause of vision loss in older adults?
Macular dengeration
patient has loss of bilateral central vision over several years… What do you suspect?
Macular degeneration
what is the fist sign of macular degeneration?
Center blind spot (Scotoma) or curving of straight lines
What is cataracts?
Damage to the LENS of the eye
what are the key exam findings in cataracts?
Diminished/ opacified red reflex
what is the most common reason for development of cataracts?
AGE! most common in senile patients
A patient comes for treatment of allergies with a hx of glaucoma. What cant your prescribe?
Nasal steroids
what is the treatment for cataracts?
ONLY SURGERY. Lens removal/replacement
Why is papilledema an emergency?
Sign of increased intracranial pressure!
S/S of papilledema?
engorged and tortuous retinal veins
Hyperemic and swollen optic disc – loss of optic cup
Retinal hemorrhages around disc
loss of peripheral edema
**Remember **
If pt on beta blocker eye gtt for glaucoma, prescribed BB for cardiac reasons can cause ADDATIVE effect
What is the most common type of glaucoma?
Open-angle glaucoma
Pt complains of bilateral, gradual loss of vision that is painless. What do you suspect?
Open-angle glaucoma
“Slow killer of vision”
What is angle closure glaucoma presentation
also called closed-angle, narrow angle
SUDDEN, unilateral, painful
Headache, nausea, vomiting blurry vision, hazy vision halo around lights photophobia poorly reacting pupils
EMERGENCY! - blindness in 2-5 days
what eye disorder can present similarly to migraines?
Angle-closure glaucoma
Treatment for open-angle glaucoma?
- topical BB - caution in pts already taking oral BB
- Miotics: Pilocarpine
- Systemic agents: Carbonic anhydrase inhibitors
what is a pinguecula?
yellow, raised growth on conjunctiva
-usually on side of the eye near your nose (can occur on either side)
Deposit of protein, fat, or calcium
What is a pterygium?
growth of fleshy tissue (has blood vessels) that invades the cornea and affects vision
redness and swelling of the conjunctiva, mostly while the pterygium grows
feels like sand/grit is stuck in eye
dry, itchy, burning eyes
Step assessment for foreign body in eye
visual acuity of both eyes
Snellen / pen light
Exam slit lamp
fluorescein stain - assess for corneal defects
eyelid eversion - remove foreign body with wet cotton swab if NOT embedded
***If embedded patch on eye and send to Ophthalmology!!
Updated tetanus
Allergic rhinitis S/S
- Clear BILATERAL rhinorrhea
- nasal stuffiness
- allergic shiners - dark under eyes
- pale, boggy nasal mucosa
- transverse crease of nose - d/t whipping nose
- sore throat/mouth upon waking
- palpable lymph nodes
- enlarged tonsils and adenoids –> leads to increased risk of otitis media
what would you treat a sinus infections with?
Amoxicillin or Augmentin
Same as ear infection
Pharm management for allergic rhinitis
***Always use localized agents before systemic!
- Saline nasal sprays - wash off offending particles prior to other nasal medications
- Nasal steroids - preferred agent (Fluticasone propionate- Flonase) or Budesonide
- Nasal antihistamine sprays - azelastine (can be combined with fluticasone)
- oral antihistamines (non sedating)
is sinusitis typically viral or bacterial?
Typically VIRAL — tx symptomatic only
what suggests bacterial sinusitis?
> 10 days, acute fever, s/s worsen after initial improvement (secondary infection)
Tx for bacterial sinusitis?
ABX
Amoxicillin/ Augmentin
Doxycycline, Levofloxacin or moxifloxacin if PCN allergy
***NO MACROLIDE —high resistance
No improvment after 3-7 days of ABX therapy, consider broader cover abx
-partial response consider additional 10-14 days of same or different abx
How do you demine who gets a rapid strep test?
Use Modified Centor Criteria –> point system based on symptoms
+1 for each : tonsillar exudate, tendery anterior chain adenopathy, fever, <15yr.
0 point : 15-45yr
-1 Point: >45yrs or cough
***cough almost always excludes streptococcus!
Most common pathogen for acute epiglottitis?
Haemophilus influenza type B (COP) Streptococcus pneumoniae (3p lecture)
patient comes in with marked edema of the supraglottic structures with difficulty swallowing. what should you suspect?
Epiglottitis — MEDICAL EMERGENCY
Signs of acute epiglottitis?
xray –> steeple sign/ thumb sign
inflammation and edema of supraglottic structures (epiglottis, aryepiglottic folds, arytenoids)
DO NOT attempt to visualize pharynx if suspected, can cause spasming and completely obstruct airway
What causes mononucleosis?
Epstein barr virus
Symptoms of infectious mononucleosis
i. Fatigue, malaise
ii. Headache, sensitivity to light
iii. Sore throat - becomes progressively worse
iv. enlarged tonsils w/ whitish-yellow covering
v. Lymph nodes in neck frequently enlarged/ painful
vi. Pink, measles-like rash can occur (more likely if pt given abx for throat infection)
vii. Enlarged spleen – no contact sports
Jaundice
Tx for mono
2-4 weeks revcovery w/o medications
Antivirals not helpful
symptom management only
ibu/acetaminophen - pain/fever
salt water gargle - sore throat
rest/fluids
avoid contact sports d/t enlarged spleen
What is conductive hearing loss?
inability of ossicles to conduct sound properly. Sounds are perceived by brain but are diminished but NOT distorted.
often caused by cerumen impaction, otitis media, foreign objects, TM perf,
Sensorineural hearing loss
inability of eardrum to virate in response to sound
sound perceived is diminished & Distorted
involves 8th cranial nerve
causes: anything that prevents sound from traveling through the inner ear or prevents the CN VIII from funtioning
- hair cell destruction
- damage to CN 8
- acoustic neuroma
- Menieres disease
- ototoxic drugs (aspirn, gentamicin, lasix)
- noise injury
- childhood infections - mumps, meningitis, scarlet fever
- presbycusis
disruption in transmission of sound to the cochlea affecting the 8th cranial nerve is what kind of hearing loss?
Sensorineural
Medications that can result in ototoxicity
Aminoglycosides “micin/mycin” (gentamicin, streptomycin)
Loop diuretics (bumex, lasix, demadex)
asprin
Quinidine - excessive tonic water (malaria prevention)
what is vertigo
sensation of motion (self or surroundings)
different than dizziness
most common causes of vertigo
Meniere’s disease - lasts hours. w/ tinnitus, nausea, vomitting
Benign positional vertigo (BPV) - lasts minutes, associated with nystagmus and head position changes. NO hearing changes
tx for vertigo
ensuring safety
PT/OT
Antihistamine (meclizine)
Anticholinergic (Scopolamine)
how does lymphatic system drainage move
Lympahtic system drains from peripheral towards CENTRAL.
Ex: lymphatic swelling in right hand will trave UP towards armpit
what is Chyle?
lymph from digestive system –> contains emulsified fats
what is the largest component of the lymphatic system?
Spleen
What drains to the Right lymphatic duct?
if you took a person and turned them into a clock… 8oc -midnight = RIGHT DUCT
right arm
right chest
right hemisphere of head/neck
What drains into the Left (Thoracic) duct?
12 to 8 o’clock
BOTH lower extremities
L Arm
L hemisphere of head/neck
what do the right lymphatic ducts connect to drain lymph back to bloodstream?
the subclavian vein
Where is virchows node?
left supraclavicular lymph node
what is troisier’s sign?
enlarged, hard, PAINLESS virchow’s node (Left supraclavicular lymph node)
Indicates cancer (gastic, ovarian, testicular, breast)
how will virchows node present if infection is suspecteD?
Enlarged, PAINFUL
causes: TB, Sarcoidosis, toxoplasmosis
what are the primary lymphoid organs?
Thymus & Bone marrow
What are the secondary lymphoid organs?
Lymph nodes, Spleen & Lymphoid nodules
what is a cholesteatoma?
middle ear tumor
what is cheilitis?
actue or chronic inflammation of lips
white oral plaque in mouth that is PAINLESS… what should you suspect?
leukoplakia - can be precancerous lesion
PT with acute rhinosinusitis that symptoms began 3 days ago, how should this be treated?
Decongestants and OTC analgesics
MOST ARE VIRAL.
IF longer than 7days or show signs of infection then treat with
Amoxicillin with clavulanate
which medication should be given for peripheral vertigo?
meclizine
