HEENT/Respiratory Flashcards
Emphysema
Sx: Dyspnea, Exercise intolerance, Hard cough (no sputum), Barrel-chest, Sx worse laying, “Pink Puffer”
PE: Decreased breath sounds, Use of accessory muscles, Thin, Wheezes
Labs: Xray (depressed diaphragm), Spirometric testing (slow forced air expiration and low max mid-expiratory flow)
Tx: Quit smoking, Lecithin (2400mg/bid)
Common Cold/URI
Sx: Congestion, sneezing, post-nasal drip, fever, green discharge
PE: Tactile fremitis, ego phony, bronchophony, pectoriloquy, Sinuses may not transilluminate, Lymphadenopathy
Labs: CBC, CMP, Sputum culture, TB testing
Img: CXR
Ddx: Viral info, Allergic rhinitis, Sinusitis
Tx: Avoid sugar, Hydrotherapy, 1-8g/d Vit C, 15-25mg/d Zinc
Asthma
Three features: Obstruction, Inflammation, Irritability
Sx: Cough esp. at night, SOB, Sputum, Eczema, Chronic nasal congestion
PE: Wheezing, End-expiratory wheezing, Nasal polyps
Labs: CBC (Eosinophilia*), Allergy skin testing, IgE, Spirometry
Imx: CXR, CT
Ddx: Emphysema, Chronic bronchitis, GERD, Nasal polyps
Tx: Albuterol, Avoid allergens, Mg, Bromeliad, Vit C, B6
Bronchitis
Sx: Dry and nonproductive –> Mucoid productive cough. Nasal d/c.
PE: Wheezing, occasional crackling
Labs: WBC, Sputum culture
Imx: Xray
Ddx: Pneumonia, URI, Influenza, Asthma
Tx: Anti-allergen diet, Warm fluids, 25,000IU BID Vit A, 2gm Vit C QID, 1gm BID NAC, Amoxicillin
Pneumonia
Sx: Chill & fever, Pleurisy, Rusty sputum production, Tachycardia, N/V
PE: Tactile fremitus, dull percussion, bronchial breath sounds, whispered pectoriloquy, crackles (note uni or bilateral)
Labs: Sputum culture, WBC
Imx: Xray (consolidation)
Ddx: Bronchitis, Asthma, Cystic Fibrosis, Pulmonary Embolism, Pulmonary edema
Tx: Fluids, Low sugar, Vit C to bowel tolerance, Hydrate, Amoxicillin
Hay Fever/Allergic Rhinitis
Sx: Itchy watery nose/eyes, Allergic salute, Dry lips from mouth breathing
PE: Atopic Derm, Discolored nasal mucosa, Conjunctivitis, Allergic shiners, Transilluminate sinuses
Labs: Eosinophilia, Gamma globulin
Ddx: Sinusitis, Rhinitis, Cocaine use
Tx: Diet, 500mg NAC, Vit Supp,
Conjunctivitis
Sx: Dilated vessels, mb Purulent dc, Swollen eyelids
PE: Lymph (unless allergic), Conjunctival injection, PERRLA, Crescent shadow to ro Glaucoma
Labs: CBC, Culture d/c, Fluorescein stain to r/o foreign body
Ddx: Gonorrhea, Glaucoma, Acute uveitis*, Herpes simplex
Tx: Green tea bags, Vit A, Visine
Different types of Conjunctivitis causes
Bilateral: Infectious or Allergic
-Allergic: watery clear dc
-Viral: Pruritis, clear thin watery dc. Self resolved. Onset after URI.
-Bacterial: Rapid onset, fever. Tx w Abx (Erythromycin)
Unilateral: Toxic, chemical, mechanical, lacrimal origin
Strep Throat
Sx: Sore throat, No cough, Exudate, Enlarged tonsils, Fever >100.4
Labs: Rapid strep test and culture
Ddx: Pharyngitis, Mono, Peritonsillar abscess
Tx: HEMP, Bioveg, hydrotherapy, Amoxicillin
Sinusitis
Sx: Nasal congestion, purulent drainage, Tender sinus, Frontal HA
PE: Cant transilluminate sinuses, check ocular nerves (III IV) to r/o cavernous sinus thrombosis, Check for injection, r/o periorbital cellulitis
Labs: CBC
Imx: Xray
Ddx: Dental pain, TMJ, URI, Tumor
Tx: Eat as little as possible, Vit Supp, Hydrotherapy, Amoxicillin
Vertigo
Sx: Spinning, nystagmus, tinnitus (Menieres), N/V
PE: Orthostatic BP, Weber/Rinne, Nystagmus, Romberg test, Dix Hallpike (BPPV)
Labs: CBC (electrolyte imbalance?)
Imx: CT/MRI to ro tumor
Ddx: BPPV, Vestibular neuritis, Meziere’s, Middle ear info, Hypoglycemia
Tx: Anti inflammatory, Mg, B complex, Cervical adjustment
Influenza
Sx: Cough, conjunctivitis,chills, fever, myalgia
Labs: WBC norm or low
Ddx: UTI, Pneumonia (rales), Lyme, Malaria, EBV
Tx: Eat very little, Vit C to bowel tolerance, 1cap Elderberry QID
Otitis Media
Sx: Throbbing or no pain, Change in hearing, Dizzy, bulging red TM
PE: Absent landmarks, displace light reflex (do all EENT)
Labs: WBC, food allergy, culture dc
Ddx: Allergic rhinitis, head trauma, otitis external, influenza
Tx: Avoid risk factors, Vit C, Ear drops (Mullein, St Johns, Garlic)
Tuberculosis
Sx:
PRIMARY: Non-productive cough*, fever, pleuritic chest pain, can spread to bones/meninges/kidney/peritoneum
SECONDARY: Chronic cough, yellow green sputum, hemoptysis, wt loss, fever 2x/d, arthritis
PE: Pulse Ox, Cachexia, Lymphadenopathy, Tachycardia, Abn lung sounds (consolidation), mb Neuro
Labs: CBC normal, Quatiferon TB Gold, Acid fast strain of sputum, HIV testing
Imx: CXR
Ddx: Atypical pneumonia, Lung abscess, CA
Tx: Rifampin, Vit C/B/A
