HEENT review Flashcards
Weber test results
512 tuning fork on top of head
If sound lateralizes:
- conductive loss, sound heard better in bad ear
- sensorineural loss, sound heard better in good ear
Rinne test results
Tuning fork on mastoid process
- conductive loss: bone conduction heard better than air conduction.
- sensorineural opposite is true
External otitis
S/sx: otalgia, pruritus, purulent discharge
hx: recent h2o, mechanical trauma
patho: gram-negative rods: (pseudomonas, proteus etc)
or fungi: eg, aspergillus
TM moves normally with air pressure
Acute otitis media
S/sx: otalgia, aural pressure, hearing loss, often fever
Physical: erythema, decreased mobility of TM
Treatment: 1st: amoxicillin, 2nd erythromycin + sulfonamide
Chronic otitis media
Chronic otorrhea with or without otalgia
TM perf, with conductive hearing loss
Tx: removal of infected debris
- abx drops, ofoxacin or cipro with dexa
Cholesteatoma
An abnormal skin growth in the middle ear behind the eardrum.
Caused by repeated infections and or pulling inward on the eardrum.
- Can increase in size and destroy surrounding bones leading to hearing loss
Mastoiditis
Postauricular pain and erythema accompanied by spiking fever
- often follows several weeks of inadequately treated acute otitis
Tx: IV cefazolin
Presbycusis
Sensorineural hearing loss in adults. Age-associated
symmetrical high frequency hearing loss
Labyrinthitis
Inflammation of the inner ear
Causes severe vertigo, nausea, vomiting, gait instability
Tx: viral: bedrest. bacterial: based on culture
Eustachian tube dysfunction
Common in adults predispose to acute otitis media
Presentation: ear pain, ear pressure, popping or cracking sensation
Acute Otitis media treatment
Bacterial infection typically secondary to viral cold, most common S. Pneumoniae
Presentation: otalgia, erythema, hypomobility of TM
Tx: Observe w/o abx greater than 2 years
Treat with ABX if younger than 6 months, between 6mo and 2 years treat with ABX if middle ear effusion or inflammation
Greater than 2, treat bilateral disease, TM perf, immunocomp, emesis, fever greater than 39C.
Cholesteatoma
Benign tumor that occurs in middle ear or mastoid.
s/sx: hearing loss, dizziness, otorrhea.
Has potential for CNS complications
Benign paroxysmal positional vertigo (BPPV)
One of the most common causes of vertigo
Usually triggered by changes in position of the head
Tx: Brandt and Daroff exercises
Allergic rhinitis treatment
Antihistamines are 1st line
Intranasal cromolyn
Intranasal steroids
Decongestants
Chronic sinusitis
Lasting longer than 12 weeks
Tx: abx, intranasal steroids
Acute sinusitis
Lasting less than 4 weeks
s/sx: HA, malasie, body ache, cough
tx: typically self resolve, treat symptoms: nasal decongestants, irrigation
If last longer than 10 days: ABX
Group A beta hemolytic strep pharyngitis or tonsillitis
S/sx: temp greater than 100.4, tonsillar exudates, cervical adenopathy, sore throat with no cough
Dx: rapid strep test
Tx: Penicillin or amoxicillin, erythromycin and 1st gen ceph for pen allergy
Aphthous stomatitis
Canker sores
Etiology: unclear
Tx: most treatment uneffective, can use topical steroids
Oral candidiasis
Risk factors: dentures, poor oral hygiene, diabetics, anemia, chemotherapy, corticosteroids or abx, can be first manifestation of HIV
Dx: KOH prep
Tx: azoles: flucanazole, ketoconazole, clotrimazole
Periorbital cellulitis
Eti: trauma or bactermia
Age mean: 21 months
s/sx: periorbital induration, erythema, warmth, tenderness
Bacteria: staph a., group A strep
Bactermia: strep pneumo
Tx: oral abx: cephalexin, dicloxacillin, clinda
If evidence of bacteremia: maybe risk of meningitis and need LP
Orbital (postseptal) cellulitis
Eti: sinusitis
age mean; 12 years
s/sx: proptosis (eyes bulging out), chemosis (edema of conjunctiva)
Decongestants
Pseudoephedrine etc.
Indications: nasal congestion
CI: severe HTN, CAD, within 14 days of MAO, newborns, long term use, close angle glaucoma
AE: tremor, tesltessness, insomnia, N/V, tachycardia
Antihistamines
1st gen: hydroxyzine, benadryl
2nd gen: fexofenadine (Allegra), cetrizine (Zyrtec), loratadine (Claritin)
Indications: allergic rhinitis (meclizine for vertigo and inner ear issues), urticaria
CI: Lower respiratory tract infection, babies, nursing
AE: 1st: sedation, confusion, anticholinergic effects, xerostomia.
2nd: HA, GI upset, fatigue
Ipratropium (Atrovent Nasal)
Indication: allergic/nonallergic rhinitis, COPD
CI: hypersensitivity
AE: bronchitis, COPD exacerbation, sinusitis, dyspnea, UTIs
