HEENT review

Question 1

Weber test results

Answer 1

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

Question 2

Rinne test results

Answer 2

Tuning fork on mastoid process

• conductive loss: bone conduction heard better than air conduction.
• sensorineural opposite is true

Question 3

External otitis

Answer 3

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

Question 4

Acute otitis media

Answer 4

S/sx: otalgia, aural pressure, hearing loss, often fever
Physical: erythema, decreased mobility of TM
Treatment: 1st: amoxicillin, 2nd erythromycin + sulfonamide

Question 5

Chronic otitis media

Answer 5

Chronic otorrhea with or without otalgia
TM perf, with conductive hearing loss
Tx: removal of infected debris
- abx drops, ofoxacin or cipro with dexa

Question 6

Cholesteatoma

Answer 6

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

Question 7

Mastoiditis

Answer 7

Postauricular pain and erythema accompanied by spiking fever
- often follows several weeks of inadequately treated acute otitis
Tx: IV cefazolin

Question 8

Presbycusis

Answer 8

Sensorineural hearing loss in adults. Age-associated

symmetrical high frequency hearing loss

Question 9

Labyrinthitis

Answer 9

Inflammation of the inner ear
Causes severe vertigo, nausea, vomiting, gait instability
Tx: viral: bedrest. bacterial: based on culture

Question 10

Eustachian tube dysfunction

Answer 10

Common in adults predispose to acute otitis media

Presentation: ear pain, ear pressure, popping or cracking sensation

Question 11

Acute Otitis media treatment

Answer 11

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.

Question 12

Cholesteatoma

Answer 12

Benign tumor that occurs in middle ear or mastoid.
s/sx: hearing loss, dizziness, otorrhea.
Has potential for CNS complications

Question 13

Benign paroxysmal positional vertigo (BPPV)

Answer 13

One of the most common causes of vertigo
Usually triggered by changes in position of the head
Tx: Brandt and Daroff exercises

Question 14

Allergic rhinitis treatment

Answer 14

Antihistamines are 1st line
Intranasal cromolyn
Intranasal steroids
Decongestants

Question 15

Chronic sinusitis

Answer 15

Lasting longer than 12 weeks

Tx: abx, intranasal steroids

Question 16

Acute sinusitis

Answer 16

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

Question 17

Group A beta hemolytic strep pharyngitis or tonsillitis

Answer 17

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

Question 18

Aphthous stomatitis

Answer 18

Canker sores
Etiology: unclear
Tx: most treatment uneffective, can use topical steroids

Question 19

Oral candidiasis

Answer 19

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

Question 20

Periorbital cellulitis

Answer 20

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

Question 21

Orbital (postseptal) cellulitis

Answer 21

Eti: sinusitis
age mean; 12 years
s/sx: proptosis (eyes bulging out), chemosis (edema of conjunctiva)

Question 22

Decongestants

Answer 22

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

Question 23

Antihistamines

Answer 23

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

Question 24

Ipratropium (Atrovent Nasal)

Answer 24

Indication: allergic/nonallergic rhinitis, COPD
CI: hypersensitivity
AE: bronchitis, COPD exacerbation, sinusitis, dyspnea, UTIs

Question 25

Antitiussives

Answer 25

Codeine, dextromethorphan, benzonatate (tessalon pearls), hydrocodone
Indications: cough that is exhausting and preventing sleep
CI: productive cough, sensitive to “caine” drugs
AE: opioids: respiratory depression, constipation, N/V
dextro: drowsiness, palpitations
T-pearls: bronchospasm, chest numbness, chills

Question 26

expectorants

Answer 26

Guaifenesin (Mucinex)
Indication: cough
AE: dizziness, drowsiness, stomach pain, N/V, HA etc.

Question 27

Corneal keratitis/ulceration

Answer 27

Eti: bacterial: contact lense wearers, viral: HSV
Bacterial: s/sx: rapid pain, photophobia, decreased vision, ulceration
Viral: Pain, photophobia, blurred vision, tearing, redness, clear vesicles on corneal epithelium, dendritic ulcers

Question 28

Blepharitis

Answer 28

Eti: chronic bilateral inflammation of the lid margins
Anterior: (outside edge)staph or seborrheic
Posterior: (inside edge) inflamed meibomian glands
Tx: keep lids clean and free of crusts, warm compresses
Abx: if bacterial

Question 29

Hordeolum/Chalazia

Answer 29

Stye
Hordeolum: infection of the glands of the eye lid
Chalazia: chronic lipogranulomatous inflammation of the glands
Tx: warm compresses, lid scrubs, abx ointment

Question 30

Conjunctivitis

Answer 30

eti: bacterial (staph, strep, chlamydia/gonorrhea
s/sx: bacterial: acute onset, minimal pain, some pruritis, some preauricular adenopathy, chemosis (swelling of conjunctiva), discharge is purulent, copious and thick
viral: discharge is clear/watery
tx: bacterial: abx drops
viral: artifical tears
allergic: ketorolac (anti-infammatory)

Question 31

Differential diagnosis for Red Eye

Answer 31

Dry eye, blepharitis, chalazion, pinguecula/pterygium, subconjunctival hemorrhage, conjunctivitis, scleritis, corneal abrasion, corneal ulcer, HSV, VZV, angle closure glaucoma, iritis, uveitis, endophthalmitis, orbital cellulitis

Question 32

Conditions that require immediate referral to an ophthalmologist

Answer 32

Sudden vision loss without inflamed eye: vitreous hemorrhage, retinal artery occlusion, optic neuritis
Sudden vision loss with inflamed eye: acute glaucoma, corneal ulcer, acute anterior uveitis, orbital cellulitis, ocular trauma