Module 7: HEENT Disorders Part 2-edited

Question 1

What is the treatment of suppurative conjunctivitis?

Answer 1

• Primary: Ophthalmic treatment with FQ ocular solution (gatifloxacin, levofloxacin, moxifloxacin)
• Alternative: Ophthalmic treatment with polymyxin B plus trimethoprim solution or azithromycin solution

Question 2

What is the usual duration of influenza symptoms?

Answer 2

4–7 days

Question 3

What is the first-line treatment for uncomplicated hordeolum?

Answer 3

• Warm compresses to the affected area 10 minutes 3-4/day
• Rarely, incision and drainage are needed
• Oral antimicrobial therapy for an uncomplicated hordeolum is not warranted.

Question 4

What are treatment considerations for hordeolum?

Answer 4

• S. aureus is the most common pathogen, treatment options should include an antibiotic with gram-positive coverage and beta-lactamase stability with the possibility of methicillin-resistant strains
• Knowledge of local patterns of S. aureus is important

Question 5

Who are persons capable of transmitting influenza to those at high risk of influenza-related complications

Answer 5

• health-care workers and other care providers, e.g., volunteers, housekeeping staff
• household contacts (adults and children) of high-risk individuals including: high-risk groups mentioned above infants <6 months members of a household expecting a newborn during influenza season
• those providing regular child care to children aged 0–59 months, whether in or out of the home
• those providing services within closed or relatively closed settings to persons at high risk, e.g., crew on a ship

Question 6

What is the difference between hordeolum and a chalazion?

Answer 6

• A hordeolum (often called a stye) is usually caused by a staphylococcal infection of a hair follicle on the eyelid
• A chalazion is an inflammatory eyelid condition that may not involve infection but can follow hordeolum and is characterized by a hard, nontender swelling of the upper or lower lid

Question 7

What is the most common associated finding in cases of severe or refractory epistaxis?

Answer 7

Hypertension

Question 8

What are non-pharmacological interventions for a red eye?

Answer 8

• Stop wearing contact lenses until the problem is resolved
• Avoid makeup, smoke, wind and other irritants
• Apply cold compresses for allergic or viral conjunctivitis
• Apply warm compresses for blepharitis/styes

Question 9

Can egg-allergic adults and children receive influenza vaccinations?

Answer 9

• Egg-allergic adults and children may be vaccinated against influenza using a single, full dose of injectable trivalent or quadrivalent inactivated vaccine, or live attenuated inactivated vaccine administered intranasally without a prior influenza skin test, irrespective of the immunization setting or of a past severe reaction to egg.
• As with all vaccines, immunization providers should be prepared for and have the necessary equipment to respond to vaccine emergencies at all times.

Question 10

What is a key diagnostic findings in POAG?

Answer 10

Intraocular pressure greater than 25 mm Hg

Question 11

What are the risk factors for contracting influenza?

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Answer 11

Crowded environments such as long-term care facilities, barracks, schools, and correctional facilities

Question 12

What are the signs and symptoms of retinal detachment?

Answer 12

• Unilateral photopsia
• Increasing number of floaters in the affected eye
• Decreased visual acuity
• Metamorphopsia
• If retinal detachment is suspected, immediate referral to an ophthalmologist is needed.

Question 13

Which wounds are considered as highest risk for tetanus infection?

Answer 13

• Puncture wounds
• Wounds with devitalized tissue
• Soil-contaminated wounds
• Crush injuries

Question 14

What is the use of antiviral agents for treatment of influenza?

Answer 14

• The use of antiviral agents for treatment of influenza in healthy children and adults is not recommended
• However, they can be considered for treatment in individuals 1–64 years of age who have a chronic condition or are immunocompromised and in those ≥65 years of age when influenza is either laboratory confirmed or strongly suspected based on symptoms and known local circulation

Question 15

What is a challenges in protecting older individuals against influenza?

Answer 15

• Age-related immunosenescence, where older persons are unable to mount a protective immunogenic response to standard-dose vaccines.
• High-dose trivalent inactivated influenza vaccine (TIV-HD) contains 60 µg haemagglutinin per strain, in comparison with 15 µg in standard-dose TIV or QIV. Comparisons of this formulation with standard-dose TIV demonstrated that TIV-HD was moderately more effective in preventing symptomatic influenza and influenza-related hospitalizations. Suggesting that persons ≥65 years, especially residents in long-term care facilities, may be better protected by TIV-HD

Question 16

What is most likely to be found on the funduscopic examination in a patient with untreated POAG?

Answer 16

• Excessive cupping of the optic disk
• The optic disk and cup are “pushed in,” creating the classic finding often called “glaucomatous cupping”

Question 17

What are serious ophthalmic conditions to rule out in the assessment of the eye?

Answer 17

Serious ophthalmic conditions (e.g., corneal ulcer, acute angle-closure glaucoma, iritis, scleritis):

• trauma (e.g., chemical, foreign body)
• contact lens wearer
• possible corneal ulcer
• pain and/or severe photophobia
• possible acute angle-closure glaucoma (more common in older adults), corneal ulcer, iritis or scleritis
• significant vision changes
• possible glaucoma, iritis, corneal ulcer history of prior ocular disease (e.g., scleritis, iritis)

Question 18

What is a 1st line antiviral treat for influenza?

Answer 18

Oseltamivir 75 mg BID po × 5 days (ClCr >60 mL/min) – treats Type A (including H1N1) & Type B. A/E: N/V, insomnia, vertigo & bronchitis, HA, rash & ­ liver enzymes. Rare: behaviour changes, self‐injury & delirium; psychiatric events esp. in kids

Question 19

What are the classic components of an ophthalmological emergency that need urgent referral to an ophthalmologist?

Answer 19

• Limbal/ciliary injection (redness dominant at the corneoscleral junction), especially unilateral involvement
• Pain not relieved by test dose of topical anesthetic drop (proparacaine, tetracaine)
• Pupil abnormalities (miotic or mid-dilated and fixed, irregular, sluggish to light, painful pupillary constriction)
• Signs and symptoms of acute angle-closure glaucoma such as red, painful eye with raised intraocular pressure, blurred vision, headache, vomiting or coloured halos around lights
• History of iritis/scleritis/angle-closure glaucoma
• Recent trauma to eye including contact lens wear

Question 20

What age group should receive the zoster vaccine?

Answer 20

• Give a one-time dose at the age of 60 years or older (even if patient already had shingles). *The youngest age that Zostavax can be given is 50 years of age

Question 21

Which types of patients benefit from antiviral agents?

Answer 21

• Treat pts with severe illness or those likely to suffer complications or death (<2yr, <19yr on long-term ASA, >65, obese BMI >40, pregnant or <4wk postpartum, aboriginal, in LTC facility, some chronic medical condition (see below) or immunosuppressed
• Risk factors: neonates, infants, elderly, pregnancy, especially in 3rd trimester, chronic pulmonary diseases, cardiovascular diseases (including valvular problems & CHF), metabolic disease, morbid obesity, hemoglobinopathies, malignancy; immunosuppression, neuromuscular diseases that limit respiratory
• Not recommended for healthy children and adults
• Greatest preventive utility in LTC facilities; can be given prophylactically in an outbreak
• If given within 48‐72hr of symptom onset, can shorten course by 1 day & relieve symptoms to some extent

Question 22

What is influenza-like illness?

Answer 22

• Influenza-like illness (ILI) is defined as an acute onset of respiratory illness with fever, cough and one or more of: sore throat, arthralgia, myalgia or extreme exhaustion/weakness. GI symptoms may be present in children <5 years of age. Fever may not be prominent in children <5 years of age or adults ≥65 years of age

Question 23

Which persons are at high risk for influenza-related complications?

Answer 23

adults (including pregnant women) and children with the following chronic health conditions:

• cardiac or respiratory disorders (includes asthma, bronchopulmonary dysplasia, cystic fibrosis and COPD) requiring regular medical follow-up
• diabetes mellitus or other metabolic disorder cancer or immune-compromising conditions (due to underlying disease and/or therapy)
• renal disease
• anemia or hemoglobinopathy
• neurologic or neurodevelopmental conditions (children: seizure disorders, febrile seizures and isolated developmental delay; adults: neuromuscular, neurovascular, neurodegenerative or neurodevelopmental conditions and seizure disorders, excepting migraines and neuropsychiatric conditions without neurologic conditions)
• morbid obesity (BMI ≥40)
• children and adolescents (6 months–18 y) requiring chronic ASA therapy
• residents (of any age) of nursing homes and other long-term care facilities
• all persons ≥65 y
• all children 6–59 months
• all pregnant women (all trimesters)
• aboriginal persons

Question 24

What is a potential complication of hordeolum?

Answer 24

Cellulitis of the eyelid and is evidenced by widespread redness and edema over the eyelid