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3P > HEENT / Lymph > Flashcards

HEENT / Lymph Flashcards

1
Q

differences between arteries and veins in the Eyes

A

Arteries – narrower

Veins –> PULSATE

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2
Q

Arteries indent and displace veins d/t HTN.
Results in Tapering of the veins as they cross arteries

What do you suspect?

A

AV Nicking

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3
Q

microinfarction of the with gradual vision loss. Fundoscopic exam shows white spots.

What do you suspect?
How do you tx?

A

Cotton wool spots

Tx: manage underlying cause. Typically DM or HTN

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4
Q

What are flame hemorrhages?

A

Blot & Dot hemorrhage

hard exudates, microaneurysms

Gradual vision loss

Tx DM/HTN

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5
Q

what is the most common cause of vision loss in older adults?

A

Macular dengeration

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6
Q

patient has loss of bilateral central vision over several years… What do you suspect?

A

Macular degeneration

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7
Q

what is the fist sign of macular degeneration?

A

Center blind spot (Scotoma) or curving of straight lines

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8
Q

What is cataracts?

A

Damage to the LENS of the eye

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9
Q

what are the key exam findings in cataracts?

A

Diminished/ opacified red reflex

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10
Q

what is the most common reason for development of cataracts?

A

AGE! most common in senile patients

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11
Q

A patient comes for treatment of allergies with a hx of glaucoma. What cant your prescribe?

A

Nasal steroids

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12
Q

what is the treatment for cataracts?

A

ONLY SURGERY. Lens removal/replacement

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13
Q

Why is papilledema an emergency?

A

Sign of increased intracranial pressure!

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14
Q

S/S of papilledema?

A

engorged and tortuous retinal veins

Hyperemic and swollen optic disc – loss of optic cup

Retinal hemorrhages around disc
loss of peripheral edema

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15
Q

**Remember **

If pt on beta blocker eye gtt for glaucoma, prescribed BB for cardiac reasons can cause ADDATIVE effect

A
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16
Q

What is the most common type of glaucoma?

A

Open-angle glaucoma

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17
Q

Pt complains of bilateral, gradual loss of vision that is painless. What do you suspect?

A

Open-angle glaucoma

“Slow killer of vision”

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18
Q

What is angle closure glaucoma presentation

also called closed-angle, narrow angle

A

SUDDEN, unilateral, painful

Headache, nausea, vomiting
blurry vision, hazy vision 
halo around lights
photophobia 
poorly reacting pupils

EMERGENCY! - blindness in 2-5 days

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19
Q

what eye disorder can present similarly to migraines?

A

Angle-closure glaucoma

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20
Q

Treatment for open-angle glaucoma?

A
  • topical BB - caution in pts already taking oral BB
  • Miotics: Pilocarpine
  • Systemic agents: Carbonic anhydrase inhibitors
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21
Q

what is a pinguecula?

A

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

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22
Q

What is a pterygium?

A

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

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23
Q

Step assessment for foreign body in eye

A

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

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24
Q

Allergic rhinitis S/S

A
  • 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
25
Q

what would you treat a sinus infections with?

A

Amoxicillin or Augmentin

Same as ear infection

26
Q

Pharm management for allergic rhinitis

A

***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)
27
Q

is sinusitis typically viral or bacterial?

A

Typically VIRAL — tx symptomatic only

28
Q

what suggests bacterial sinusitis?

A

> 10 days, acute fever, s/s worsen after initial improvement (secondary infection)

29
Q

Tx for bacterial sinusitis?

A

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

30
Q

How do you demine who gets a rapid strep test?

A

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!

31
Q

Most common pathogen for acute epiglottitis?

A 
Haemophilus influenza type B (COP)
Streptococcus pneumoniae (3p lecture)
32
Q

patient comes in with marked edema of the supraglottic structures with difficulty swallowing. what should you suspect?

A

Epiglottitis — MEDICAL EMERGENCY

33
Q

Signs of acute epiglottitis?

A

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

34
Q

What causes mononucleosis?

A

Epstein barr virus

35
Q

Symptoms of infectious mononucleosis

A

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

36
Q

Tx for mono

A

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

37
Q

What is conductive hearing loss?

A

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,

38
Q

Sensorineural hearing loss

A

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
39
Q

disruption in transmission of sound to the cochlea affecting the 8th cranial nerve is what kind of hearing loss?

A

Sensorineural

40
Q

Medications that can result in ototoxicity

A

Aminoglycosides “micin/mycin” (gentamicin, streptomycin)
Loop diuretics (bumex, lasix, demadex)
asprin
Quinidine - excessive tonic water (malaria prevention)

41
Q

what is vertigo

A

sensation of motion (self or surroundings)

different than dizziness

42
Q

most common causes of vertigo

A

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

43
Q

tx for vertigo

A

ensuring safety
PT/OT

Antihistamine (meclizine)
Anticholinergic (Scopolamine)

44
Q

how does lymphatic system drainage move

A

Lympahtic system drains from peripheral towards CENTRAL.

Ex: lymphatic swelling in right hand will trave UP towards armpit

45
Q

what is Chyle?

A

lymph from digestive system –> contains emulsified fats

46
Q

what is the largest component of the lymphatic system?

A

Spleen

47
Q

What drains to the Right lymphatic duct?

A

if you took a person and turned them into a clock… 8oc -midnight = RIGHT DUCT

right arm
right chest
right hemisphere of head/neck

48
Q

What drains into the Left (Thoracic) duct?

A

12 to 8 o’clock

BOTH lower extremities
L Arm
L hemisphere of head/neck

49
Q

what do the right lymphatic ducts connect to drain lymph back to bloodstream?

A

the subclavian vein

50
Q

Where is virchows node?

A

left supraclavicular lymph node

51
Q

what is troisier’s sign?

A

enlarged, hard, PAINLESS virchow’s node (Left supraclavicular lymph node)

Indicates cancer (gastic, ovarian, testicular, breast)

52
Q

how will virchows node present if infection is suspecteD?

A

Enlarged, PAINFUL

causes: TB, Sarcoidosis, toxoplasmosis

53
Q

what are the primary lymphoid organs?

A

Thymus & Bone marrow

54
Q

What are the secondary lymphoid organs?

A

Lymph nodes, Spleen & Lymphoid nodules

55
Q

what is a cholesteatoma?

A

middle ear tumor

56
Q

what is cheilitis?

A

actue or chronic inflammation of lips

57
Q

white oral plaque in mouth that is PAINLESS… what should you suspect?

A

leukoplakia - can be precancerous lesion

58
Q

PT with acute rhinosinusitis that symptoms began 3 days ago, how should this be treated?

A

Decongestants and OTC analgesics

MOST ARE VIRAL.

IF longer than 7days or show signs of infection then treat with
Amoxicillin with clavulanate

59
Q

which medication should be given for peripheral vertigo?

A

meclizine

3P (16 decks)

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