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leik HEENT Flashcards

1
Q

herpes in the eyes

A

fluroescien dye shows fernlike lines on corneal surface,
crusty rash along CN 5 opthalmic branch or any where aroundthe eyes
ED referral

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2
Q

acute CLOSED angle glucoma case

A

elderly patient with acute onset severe eye pain accompanied by headache, NV, HALOS around lights,
decreased vision

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3
Q

acute CLOSED angle glucoma exam

A

oval mild dialated pupil, cornea is cloudy, CUPPING OF OPTIC NERVE ON FUNDOSCPOIC EXAM,

can be asymptomatic
emergency, refer to ED opto now

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4
Q

MS optic neuritis case

A

young female, new or intermittant vision loss in ONE eye
with NYSTAGMUS,
can have neuro symptoms-
daily fatigue that gets worse over the day
heat sensitivy and exacerbation of symptoms
recurrent episodes
send to neurologist

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5
Q

orbital cellulitis

A 
acute onset erythematous swollen eye with proptosis (bulging eye) and pain
LOOK FOR RECENT RHINOSINUSITUS OR URI 
lost full ROM of eye and has EOM 
more common in kids in young adults
serious go to ED
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6
Q

retinal detachment

A

sudden onset, SHOWER OF FLOATERS, with LOOKING THROUGH CURTAIN sensation, sudden flashes of light, emergency go to ED

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7
Q

Cholesteatoma

A

cauiflower like growth with FOUL smelling discharge, hearing loss in affected ear, cant see tympanic membrane or ossicles cause tumor killed it

H/O chronic otitis media, not cancerous but can kill facial nerve CN 7, treat with ABX and surgical debridment,

refer to otolaryngologist

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8
Q

battle sign racoon eyes

A

periorbital ecchymosisand brusing behind the ears
2-3 days after trauma
clear or golden discharge from ear or nose first

R/O temporal or basilar boneskull fracture (urine dipstick, glucose + is CSF, plain mucous or mucopurlent is negative

go to ed, can cause intracranial hemmorhage

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9
Q

R/O temporal or basilar boneskull fracture (urine dipstick, glucose + is CSF, plain mucous or mucopurlent is negative

A

(urine dipstick, glucose + is CSF, plain mucous or mucopurlent is negative

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10
Q

peritonsillar abcess

A

odunophagia- pain on swallowing
SEVERE sore throat, HOT POTATO voice,
trismus-jaw muscle spasm making it difficult to open mouth
affected area is bulging red mass with uvula displaced away from the mass
malaise fever and chills
refer to ED

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11
Q

diptheria

A

BULL NECK- markedly swollen neck
sore throat
fever (low grade)
grey to yellow pseudomembrane on posterior pharynx, and soft palate

VERY CONTGEOUS- contact precautions, go to ED

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12
Q

eyes NORMAL

A

FUNDI veins are LARGER and darker than ARTERIES
CONES: for color
RODS for detecting light and shadow, night vision
Macula and FOVA- macula -central vision, fovea (holds lots of cones) in the middle determins sharpness of vision

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13
Q

presbyopia:

A

age realted visual change due to a decreased ability of the eye to accomadate stiffening of the lenses, starts at 40, near vision is affected with decreased ability to rea small print closely

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14
Q

Ears Normal

A

Bones- maleus, incus, stapes -smallest bone in body.
TM- appears translucent off whit to grey, with cone of light intact
Tympanogram, most effective method to test for fluid inside MIDDLE ear, in accute otitis media this wil show a STRAIGHT LINE vs a peaked shape
Pinna- large amount of cartilidge
cartilage dose not regenerate- refer injury to plastics

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15
Q

nose NORMAL

A

only inferior turbinates are visable
BLUE PALE or BOGGY are seenin allergic rhinitis
lower third of nose is cartilidge

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16
Q

SINUS NORMAL

A

Ethmoid
Maxillary both present at birth
Frontal - five years
Sphenoid- 12- at 12 they are all basically the size of an adults

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17
Q

MOUTH common issues 4

A

gingeval hyperplasia: white grey patch, on tongue, floor of mouth, or cheek- R/O oral cancer
Aphthous Stomatitis (canker sores):; painful shallow ulcers on soft tissue, usualy heal in 7-10 days, cause is unknown, tx with magic mouthwash
avulsed tooth: store in coo milk no ice, see dentist
vermillion border: on edgs of the lips,

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18
Q

tonsils

A

made of lymphoid tissue, butterfly shaped gland, with small pores that can secrete white exudate (MONO) or purulent exudate that is yellow green (STREP) penicillin Vk

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19
Q

posterior Pharynx

A

look for PNDL (acute sinusitis, allergic rhinitis) laying down supine makes postnasal drip cough worse,
evenly distributed posterior pharyngeal lymph nodes that are mildly enlarged can be allergies

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20
Q

benign variants tongue

A

tongue surface has a map like appearance, patches may move from day to day
can complain about sorness with acidic or spicy foods

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21
Q

Benign Variants torus plantis
fishtail uvula
physioligical gaze evoked nystagmus

A

painful bony protuberance midlin on the roof
uvula looks like fish tail
on extreme lateral vision but also watch out for brain lesions

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22
Q

papilledema

A

swollen optic disk with blurred edges sue to increased intracranial pressure ICP secondary to bleeding, brain tumor, abcess or pseudo tumor cerebri

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23
Q

hypertensive retinopathy

A

copper and silver wire aterioles caused by arteriosclerosis
arteriovenous nicking ( arteriole crosses the vein and dents it
retinal hemorrhages

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24
Q

diabetic retinopathy

A

microanurysms- new fragile arteries rupture

COTTON WOOL SPOTS- fluffy yellow white patches on the retina

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25
Cataracts
opacity in lens of eye can be central(nuclear) or on he sides (cortical) happens to 20% of older adults (65-74years) can happen at any time sx include difficulty with glare (like headlights when driving at night) halos around lights, and blurred vision.
26
allergic rhinitis sx
blue tinged or pale and swollen (boggy) nasal turninates associated with increased cleard discharge may have itchy nose and congestion tx with antihistimines
27
koplik spots
clusters of small sized red papules with white centers inside the buccal mucosa by the lower molars PATHOGNOMONIC for measles
28
treatment of measles
Medications. Fever reducers. You or your child may also take over-the-counter medications such as acetaminophen (Tylenol, others), ibuprofen (Advil, Children's Motrin, others) or naproxen (Aleve) to help relieve the fever that accompanies measles. Don't give aspirin to children or teenagers who have measles symptoms
29
nasal polops fun facts
painles soft round growth in the nose | increased risk of asa sensitivity
30
hairy leukoplakia
elongated papilla on the lateral aspects of the tongue that is related to HIV caused by EPstien baar virus infection of the tongue if on the cheek R/O ca
31
cheilosis (angualr, chelitis, perleche
painful skin fissures and maceration at the corners of the mouth from excessive moisture- more common in elderly with dentures, can be acute or chronic check denture fit, determine cause, apply barrier cream with zinc or petroleum jelly at night- high rate of recurrene secondary infection with candida albicans- yeast, tx with azole antifungal secondary with bacteria staphylcoccus aureeus- C and S and then treat with mupirocin ointment bid
32
hyperopia
farsighted - distance vision is good, near is blurry
33
myopia
nearsighted - near vision intact but distance is blurry
34
snellen
central distance vision, if illiterate use tumbling E's, pt stands 20 feet away if pt wears glasses test vision with glasses in both then R OD, and L OS abnormal is 2 line difference between each eye, less than four lettters out of six correct
35
legal blindness
defined as best corrected vision of 20/200 or tunnel vision or a visual field of less than 20 degrees
36
Weber and Rinne tests
normal -web no lateralization hears equally in both ears, AC is better than bone conduction web sound is louder in "good ear" presbucusis or menieres disease ac is still more than bone conduction web lateralization to bad ear, conductive loss, otitis media, ceruminosis, perfed membrain, BONE is better than Air
37
weber test
tuning fork midline on forhead
38
rinne
mastoid then at front, time each should hear longer in the front Air conduciton than on the bone
39
conductive hearing loss
outer and midde ear, like blockage Rinne BC is better than AC
40
sensorineural hearing loss
inner ear - aging damage, cn 8 acustic nerve, or ototox drugs, aminoglycosides, erythromycin,tetracyclines, high dose asa, dildenafil, and stroke usually permanently rinne AC is greater than BC
41
contact lens abrasions are
round
42
if suspected Eye infection
``` C and S of drainage topical opthalmic ointment with pseudomonal coverage (gram negative) for contact users meaning cipro- froliquinolone ofloxacin same, do not patch eye-see agin in 24 hrs if no improvement go to ED ```
43
herpes kerititis
no steroids
44
hordeolum 'stye"
abcess in eyelash follice/sebacious gland "external hordeolum-upper or lower eyelid interna hordeolum - meiobomian gland
45
hordeolum stye classic case and tx
acute onset swollen red one follicle on eyelid that slowly enlarges may spont rupture purluent exudate or spread to adjoining tissue tx hot compresses systemic abx ifit spreads (erthromycin macrolide gram plus and minus, or dicloxaillin - betal lactam, Gram-positive bacteria. It is active against beta-lactamase-producing organisms such as Staphylococcus aureus, which would otherwise be resistant to most penicillins. refer to opto for I and D
46
chalazion definition case tx
chronic inflamation of meibomian gland, my resolve spontaneously in 2-8 weeks gradual onset, small superficial node upper eyefels like a discrete bead, painless, can slowly enlarge, can cause blurred vision (rare) Tx is I and D, or steroid injecitons by opto
47
pinguecula vs pterygium
chronic sun exposure leads to formation of yellow pinguecula- raised yellow to white round growth inn the bulbar conjunctiva pterygium triangular wedge shaped thickinging of the cornae, sometimes called surfers eye can get red or inflamed, may have foreign body sensation
48
pinguecula vs pterygium tx
if inflamed refer to opto weak steroids for excerbations artificial tears PRN for agitation surgical dc if it starts to affectthe vision.
49
subconjunctival hemorhage
blood in the eye from cough sneese heavy lifitng, burst vessle, resolves like a bruise over a few weeks, worse with anticoags cc is brigh red blood ineye after cough, no pain or visual loss t is watchful waiting and f/u on resoution.
50
primary open angle glaucoma def
gradual onset of increased IOP greater than 22 due to blockage of drainage of aqueous huomor in the eye the retina CN 2, undergoes ischemic changes and can be permenantly damaged, most common type of guac 60-70%
51
primary open angle glaucoma classic case
AA or Cauc elderly pt with DM, asymptomatic early then PERIPHERAL vision loss first, missing portions when reading, if fundoscope exam shows cupping IOP is too high, refer to opthalmologist
52
primary open angle glaucoma treatment plan
IOP with tonometer-8-21 is normal | if 30 or more urgent referal to ED or opto
53
primary open angle glaucoma meds
betimol- timolol : BB for eyes,, dec aqueous production latanoprost xalatan: topical prostaglandin eye drops to promote aqueos outflow BB same side effects bronchospasm depression fatigue heart failure brady contraindicted in asthmatic, emphysema, copd and 2-3 heart block
54
primary closed angle glaucoma def
SUDDEN block of aqueous humor, marked increase in IOP, ischemia and permanaet damage to retina CN 2 causing vision loss
55
primary closed angle glaucoma
CC: old pt sudden decrease or blurred vision, SEVERE pain in EYE, frontal headace, Nausea and vomiting Eyes are mid dialated, cloudy pupil 4-6mm, more OVAL than ROUND, slow reaction to light, send to ED
56
Iritis- anterior uvitis from autoimmune disorders
red eyes no purluent drainage, though its serious and can lead to blindness, refer to opto
57
sarcoidosis classic
Common Signs and Symptoms Associated With Sarcoidosis A common presentation is with the Lofgren syndrome (fever, bihilar lymphadenopathy [BHL], ankle swelling, and erythema nodosum [EN]). ... A hallmark but relatively rare presentation of sarcoidosis is uveoparotid fever, also termed the Heerdfordt syndrome. Erythema nodosum is a type of skin inflammation that is located in a part of the fatty layer of skin. Erythema nodosum results in reddish, painful, tender lumps most commonly located in the front of the legs below the knees.Nov 5, 2019 Symptoms: Inflammation
58
AMD
asymptomatic early gradual damage too pigment of macula (area for central vision) LEADING CAUSE OF BLINDNESS IN THE ELDERLY more common in smokers
59
AMD types
atrophc dry- 85-90% less severe, | exudative wet- 15%- responsible for 80% of AMD blindness choroidal neovascularization
60
AMD classic case and treatment
elderly smoker, sudden or painless loss of central vision, in one or both eyes, straight lines like doors or windows are curved, peripehral vision usually ok tx is opto referral AMSLER grid- focus eye on center and view 12 inches from eye to check visual field loss (blurry, dots, may include ocular vitamins as directed by opto-lutein, zinc and zeaxthanin
61
Sjrogens syndrome def
chronic autoimmune- deceased frunciton of lacrimal and salivary gland, can occur alone or with other autoimmune like RA
62
sjrogens CC
dry eyes and xerostomia (dry mouth) for longer than THREE MONTHS, chronic dry eyes sandy gritty sensation (KERACONJUNCTIVA SICCA) have used otc drops more than three times a day, marked increase in dental caries, swollen and inflamed salivary glands refer to opto-dentist and rheum
63
blepharitis def and tx
chronic condition caused by eyelid inflamation, assocatied with sebrorric dermatitis and roseca, may have staph bacteria colonizzatin, itchy red crusty gritty eyes. tx is johnsons baby shampoo or perhaps erythromycin macrolide gram pos and neg eye ointment
64
allergic rhinitis def, cc,
10-30% of adults, associated with allergies, chronic or seasonal congestoin with CLEAR MUCUS or pND worse on supine, clicking sound to clear mucus, BLUE OR PALE TURBINATES, posterior oharynx has mucus that is thick, can be white yellow or green(R/O) sinusitis- cobbestone posterior pharynch from lymph nodes
65
allergic rhinitis tx
first: topical nasal sprays
66
topical nasal sprays discontinuation
use for more than three days and rebound sever nasal congestion rhinitis medicamentosa - severe congestion
67
nosebleed
anterior more commmon than posterior, most are self limiting kisselbachs plexus anterior vascular area- posterior can be severe- asa, nsaids, coke, htn
68
nosebleed cc
acute onset nasal bleed second to trauma, driect pressure to front of nose, affrin to shrink tissue, tripple abx or petrollium jelly for 3 days post. posterior might need to go to ed
69
streptococcal pharyngitis/tonsilloparyngitis (strep throat) def and cc
strep bacteria (streptococcus pyrogenes) Gram-positive, nonmotile, nonsporeforming coccus that occurs in chains or in pairs of most common pathogen is VIRAL (rhinovirus, adenovirus, RSV, suspect virus if cough and sx like clear watery sputem, stuffy nose, watery eyes (coryza) mostly childern- abrupt onset fever, sore throat pain on swallow, mildly large submandibular nodes, can have purulent exudate on tonsils, anterior cervical nodes can be big too, centro critera: tonsillar exudate, tender anterior cervical nodes, fever, abscence of cough
70
streptococcal pharyngitis/tonsilloparyngitis (strep throat) treatment plan
rapid antigen detecting test RADT- penicillin VK 500bid x10 days or ammox zpack for pcn allergy repeat RADT post treatment for proof of cure especialy for heart valve pts
71
streptococcal pharyngitis/tonsilloparyngitis (strep throat) complications
scarlet fever scarletina- sandpaper textured pink rash, straberry tongue, spreads from head to trunk then out thn skinn falls off, increased risk of rheumatic fever rheumatic fever heart joints and brain peritonsillar abces, displaced uvula, red bulging mass on anterior phartyngeal space, dysphagia and fever emergency to ed poststreptococcal glomurlonephritis protien, hematuria, dark uring with casts, htn and edema
72
AOM
usually kids outflow of eustaciean tubs blocked usually unilateral most have middle ear effusion
73
AOm in adults orginisms
S Pneumoniae 40% Streptococcus pneumoniae cells are Gram-positive with high rates of beta lactam resistance haemophilus influenzae 50% gram neg moraxella catarrhalis 20 gram neg
74
aom cc
otalgia ear pian, popping noise, muffled hearing, recent cold or allergic rintis , afebrile or low grade fever, adult infections are slower, PUS on pillow case from ruptured TM associated with reliefe of ear pain
75
bullous myringitis
type of AOM more painful due to presence of blisters, on red and bulging TM, conductive hearing loss webber fork on head and sound laterlizes to bad or affected ear indicated conductive hearing loss, rine test behind and in front of ear shows bone conduction is greater than air conduction same bacteria as AOM TM is bulging with displaced light reflex may look opaque flat line tracing on tympanogram is most objective finding
76
AOM tx
``` amoxicillin Showing results for amoxicillin class Search instead for ammoxicillin class if no abx in the prior month, ``` Amoxicillin is in a class of medications called penicillin-like antibiotics- Amoxicillin covers a wide variety of gram-positive bacteria, with some added gram-negative coverage compared to penicillin. if no response in two days switch to second line augumentin (PCN) Amoxicillin is a semisynthetic antibiotic with a broad spectrum of bactericidal activity against many gram-positive and gram-negative microorganisms. ... Thus, AUGMENTIN possesses the distinctive properties of a broad-spectrum antibiotic and a β-lactamase inhibitor cephalosprin and or floriquinolone for gram plus inus coverage
77
MEE after aom
can last for 8 weeks
78
ARBS acute bacterial rinosinutis def
max and frontal sinus most common, if frontal pain is over frontal sinus, may report hyposomia- reduced smell, fluid gets trapped in sinus causing secondary bacterial infection s. pneumonea gram positive H. influenzae gram negative or viral
79
ARBS acute bacterial rinosinutis cc
unlateral face pain, or molar pain (mailary sinus) nasal congestion over 10 days, purulent drip, no symptom releife with self tx, recent bad cold or rinitis flare
80
ARBS acute bacterial rinosinutis findings pearls
post pharynx: dark yellow or green PND tender sinus on palpation fever more in children transillumination ofsinus, (front and MX) positive = duller glow of light on affected sinus compared with normal sinus
81
ARBS acute bacterial rinosinutis tx
symptomatic: mild- uncomplicatd and healthy f/u in 10 days high rate of spontaneous resolution toxic, high fever, pain purulent pND, for 2-3 days or more or sx for 10 days use abx 1st augmentin- pcn allergy- levofloxacin floriquinolone
82
ARBS acute bacterial rinosinutis symptom tx
no systemic steroids decongest and promote drainage if abx fails try another, if it keeps failing refer to otolaryngologist
83
ARBS acute bacterial rinosinutis symptom need for emergent ed referral
mastoiditis- red swollen behind the ear orbital cellulitis- double or imparied vision, and fever, abnormal EOM meningitis- brudzinski does sit ups, kernigs does kicks cavernous sinus thrombosis- acute ha and change in neuro exam, life theratining and hihg mortality
84
OM with effusion aka serous otitis media def and cc
sterile serous fluid in middle ear, TM NOT RED, | tx with oral decongestants, steroid nasal spray or zyrtc for allergic rhinitis
85
otitis externa def and cc
bacterial infection of skin of external ear, rarely fungal, more common in summer, Pseudomonas aeruginosa gram negative or staph areus gram positive cc is swimmer ear pain swelling discharge, pruts, heairng loss, EAR PAIN WITH MANIPULATION OF TRAGUS, purulent green dischagre, red tender swollen ear canal
86
otitis externa tx
polymixin B and neomycin hydrocorticsone- cortisporin - for 7 days or cipro keep dry- propholayx iwth otic domeboro or alcohol and vinegar.
87
infectious mononucleosis
EBV herpesvirs family, peak is between 15-24 years, after acute infection EBV is latent in oropharyngeal tissue but can reactivate virsu shed thru saliva TRIAD IS fever pharyngitis lymphadenopathy
88
mono cc
smooching teen, sore throat and posterior servical node enlargment for a few weeks, fatigue, may be ab pain hepato or splenomegaly,
89
mono labs
cbc- lymphocytosis over 50% LFT's abnomal ALT. 7 to 55 units per liter (U/L) AST. 8 to 48 U/L. Bilirubin. 0.1 to 1.2 milligrams per deciliter off white color tonsils sometimes occasionally generalized red maculopapular rash
90
mono acute tx
limit activity-for 4 weeks ab us for splenomegaly/hepatomegaly repeat in 4 weeks abnormal initially to document resolution treat symptoms (virus) avoid AMOXICILLIN if pt has 'strep throat as well" 70% get drug rash, no smoocing
91
mono complication s
spleen rupture airway obstruction GB, aseptic meningitis, optic nuritis, blood ddyscrasias particularrly lymphocytes
92
diff on cbc values
``` Neutrophils: 6300 40-60% Lymphocytes: 4100 20-40% Monocytes: 1800 4-8% Eosinophils: 250 1-3% Basophils: 60 0-1% Bands 0 0-5% ```

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