PCC - HEENT Flashcards
N/V
Nausea and vomiting
HA
headache
PERRLA
pupils equal, round, reactive to light and accomodation
Dx
Diagnosis
ou
both eyes
os
left eye
od
right eye
au
both ears
as
left ear
ad
right ear
PCP
Primary care physician
APAP
acetaminophen
Primary Headaches
-No underlying illness
-Examples:
Migraine
Tension
Cluster
Secondary Headaches
-Associated with underlying illness: Trauma Stroke Substance withdrawal Infections Hypertensive crisis Concussion
Cluster Heahaches
Characteristics: Male >> Female Onset around 30 years old Duration of 15 minutes up to 3 months Causes Hypoxia Sudden release of histamine or serotonin
Cluster Headaches Symptoms
Symptoms: Constant and severe pain Usually unilateral; centered around the eye Episodic or chronic Tearing of affected eye Drooping eyelid Nasal stuffiness Nausea and vomiting Photophobia Phonophobia
Migraine Headaches
Characteristics: Female >> Male Causes Hormonal, vascular changes, or neuronal changes Change in sleeping patterns Missing meals Increased intake of fatty foods Weather changes Onset between 15 – 35 years old Duration per episode: 4 hours – 3 days
Migraine Headaches Symptoms
Pulsating or throbbing pain
Usually unilateral near the temples
Nausea/Vomiting
Sensitivity to light, sound, movement
Migraine Headaches Warning Signs may occur hours to days before episode
Psychologic, neurologic, or autonomic
Roughly 10% of patients experience an aura
Migraine Headache Aura = neurologic symptoms prior to migraine attack
-Visual symptoms: Flashes of light or blind spots -Sensory or motor symptoms: Tingling/numbness of extremities Dysphasia/Aphasia Weakness Hemiparesis
Tension Headaches
-Most common type of headache
-Causes
Stress or anxiety
-Symptoms
Often described as “band-like” pain
Dull, non-pulsating tightness/pressure
Usually bilateral
Episodic or chronic
Sensitivity to light and sound (photophobia and phonophobia)
Self-care
-Pharmacologic: OTC products
-Non-pharmacologic
Heat
Cold compress
Massage
Sleep hygiene
Stress management
Relaxation techniques
Avoiding triggers
Primary Headache: When to refer
Patient has symptoms suggestive of migraine or cluster headache
Headache associated with significant hypertension
Headache lasting >10 days
>3 headaches per week
Last trimester of pregnancy (preeclampsia)
Stiff neck (possible infection)
Head trauma
Symptoms resistant to self-care
Conjunctivitis
-Conjunctiva Clear membrane lining the inner surface of the eye and eyelid -Conjunctivitis (AKA pink eye) Inflammation of the conjunctiva -Meds that cause conjunctivitis: Amiodarone Isotretinoin Bisphosphonates COX-2 inhibitors
Viral Conjuntivitis
-Cause Typically preceded by sore throat or cold (Adenovirus) -Symptoms Pink/red eye Watery discharge Blurred vision Low-grade fever -Duration: 1-3 weeks -Only symptomatic treatment Lubricants (e.g. artificial tears) Ocular decongestants (e.g. Naphazoline - Naphcon-A ® )
Bacterial Conjuntivitis
-Common bacterial causes: S. aureus, S. epidermidis, S. pneumoniae, H. influenzae
-Symptoms
Pink/red eyes
Purulent discharge (green/yellow)
Eye discomfort/pressure
Crusted eyelids
Eyelid edema
Blurred vision
-Duration: roughly 2 weeks
-Treatment: requires antibiotics
Allergic Conjuntivitis
-Cause: exposure to allergens
-Signs/symptoms Pink/red eyes Clear watery discharge May be stringy and white Burning or itching Eye discomfort Eyelid edema Usually affects BOTH eyes
-Treatment: Topical antihistamine: Pheniramine eyedrops - Naphcon-A Mast cell stabilizers: Cromolyn eyedrops Anti-inflammatory agents: Naphazoline eyedrops - Naphcon-A
Other Types of Conjunctivitis
-Dry Eye
Caused by inadequate lubrication of eye from tears
Symptoms include redness, burning, stinging, and blurry vision
Treatment:
May treat with ocular lubricants (e.g. artificial tears)
Avoid prolonged viewing of electronic screens
Humidifiers
-Irritant
Caused by objects
Do no rub
Treat by removing any contacts & flushing the eye
Glaucoma
-Group of eye disorders involving optic neuropathy
Changes in optic disc
Loss of visual sensitivity & field
-Caused by:
Reduced blood flow, retinal ischemia, increased intraocular pressure
Primary (hereditary) vs. Secondary (disease, trauma, or drugs)
-Symptoms
Occurs after significant damage
Open Angle Glaucoma
Most Common
Causes: steroid, anticholinergic
Symptoms: rarely occur unless there is severe damage
Closed Angle Glaucoma
Emergency!
o Rapid increased intraocular pressure can lead to vision loss within 1 day
Causes: antihistamines, CNS stimulants, SSRI
Symptoms: blurred vision, halos with light, ocular pain, HA, N/V
Open Angle Glaucoma Treatment
Treatment: Nonselective beta blockers Prostaglandin analogues Alpha 2 agonists (brimonidine) Carbonic anhydrase inhibitors
Closed Angle Glaucoma Treatment
Pilocarpine
Hyperosmotic agents
Secretory inhibitor
Blepharitis
-Infection of eyelid which may lead to sty formation
-Caused by bacteria
Hands
Cosmetics
Contact Lenses
-Symptoms
Lump on or near edge of eyelid
Painful
Swollen
Pus-filled
-Treatment
Warm compress
Lubricants (e.g. artificial tears)
Eye Condition: Refer if…
Symptoms of infection Conditions resistant to self-care (72 hours) Exposure to chemicals Trauma to eye Glaucoma Signs/symptoms of vision loss
Otitis Media
-Inflammation of middle ear Common in children <3 years of age -Causes Bacterial Viral Allergies Irritants ( e.g. cigarette smoke)
Acute Otitis Media
- Most common
- Rapid onset symptoms: pain, fever, discharge, redness, pulling at ears, irritable, crying
- Treatment: antibiotics, analgesics, antipyretics, local heat
Otitis media + effusion
Not associated with symptoms of infection
Symptoms: rhinitis, cough, diarrhea
Treatment of symptoms: analgesics, antipyretics, local heat
Otitis Externa
-Inflammation of skin lining the outer ear canal
-Causes
Prolonged exposure to moisture or injury to ear
Bacterial or fungal growth
-Risk factors:
Disrupting the externa with cotton swabs or hairpins
-Symptoms
Pain, ear discharge, hearing loss, itching, swelling or redness, burning, stinging,
fever
-Treatment
Antibiotics, glucocorticoids, acidifying solutions such as aluminum acetate
Warm water or saline
Cerumen Impaction
-Buildup of cerumen (ear wax) leading to blockage of ear canal
-Ear wax protects the ear
Traps dust and prevents bacteria and small objects from entering ear
Too much wax can block the ear canal
-Symptoms
Earache, fullness in ear, tinnitus, partial hearing loss, itching
-Treatment
Carbamide peroxide (Debrox®)
Baby oil
Glycerin (Neotic ®)
Ear candling (not recommended)
Water Clogged Ears
-Causes Swimming Bathing Scuba diving Being in a humid climate -Symptoms Ear fullness Gradual hearing loss Itching Ear drying agent Isopropyl alcohol (Swim-EAR) -Ear plugs (prevention) Low heat
Ototoxicity
-Damage to the hearing or balance functions of the ear
Reversible vs. Irreversible
-Causes
Chemicals
Infections
-Symptoms
Tinnitus, hearing loss, dizziness, loss of balance
Medications Causing Ototoxicity
- Quinine
- Salicylates (aspirin)
- Aminoglycosides
- Platinum antineoplastic agents
- loop diuretics
Ears: Refer when…
Hearing loss, ear pain, drainage, tinnitus Symptoms of infection Symptoms of otitis media and externa Perforated eardrum Foreign objects in ear
Sinusitis (Head Cold)
-Inflammation and swelling of sinuses
Interferes with drainage & causes mucus buildup
-Viral sinusitis
Symptoms last up to 10 days
Symptoms: HA, congestion, low fever, nasal discharge , and halitosis
-Bacterial sinusitis
Symptoms increase in severity after 7-10 days
Symptoms: worsening congestion, facial pain, thick yellow-green nasal discharge, toothache, fever, halitosis
-Treat symptoms with oral or topical decongestants
(e.g. Pseudoephedrine – Sudafed ® or oxymetazoline – Afrin ® )
AVOID antihistamines
Allergic Rhinitis
-Inflammation of nasal mucous membrane
-Cause
Exposure to allergen
-Types:
Seasonal
Persistent (perennial)
-Treatment:
Oral or topical antihistamines
(Oral: Cetirizine - Zyrtec ®; Topical: Azelastine –Astelin ®)
Oral or topical decongestants
(Oral: Pseudoephedrine – Sudafed ®; Topical: Oxymetazoline – Afrin ® )
Intranasal corticosteroids (e.g. Fluticasone – Flonase ®)
-Symptoms
Clear rhinorrhea
Sneezing
Congestion
Post-nasal drip
Itching eyes, ears, nose, throat
Watery eyes
Periorbital swelling
Nose: Refer when…
Severe HA not relieved by OTC products Symptoms of systemic infection Symptoms lasting >10 days Cold that worsens after 7 days Changes in vision Symptoms resistant to self-care
Cold Sores
-Blisters located on lips, chin, cheeks, or in nostrils
-Common cause: Herpes simplex virus 1 (HSV-1)
Recurrences likely due to stress or weakened immune system
-Symptoms
Red, painful blisters, oozing/yellow crusting of blister, tingling & itching
-Treatment (self limiting)
Topical antivirals - docosanol (Abreva®)
Canker Sores
-Small, round sores inside of mouth Cheek, under tongue, gums, or in back of throat -Causes Stress Food allergies Hormonal changes Malnutrition B-12, folate, zinc, iron -Symptoms Sore usually has red edge with white center Painful -Treatment (self-limiting) Local anesthetics (benzocaine)
Gingivitis
-Inflammation of the gums
-Causes
Bacteria leading to accumulated plaque
Poor hygiene
-Symptoms
Red/tender gums
Swollen gums
Gums that bleed easily
Receding gums
Bad breath
Oral Candidiasis (Thrush)
-Fungal infection of the mouth
-Cause
Candida albicans
-Risk Factors
Weak immune system
Dentures
Infants
Steroid medications
Smoking
Dry mouth
-Symptoms
Creamy white lesion
Cottage cheese appearance
Slight bleeding if lesions are scraped
‘Cotton mouth’ sensation
Loss of taste
Mouth: Refer when…
Lesions associated with significant pain/large area Gingivitis Oral candidiasis Symptoms lasting >14 days Immunocompromised patients Frequent recurrence of cold sores Symptoms resistant to self-care
Pharyngitis
-Inflammation of the throat
-Non-infectious
Allergies
Sinusitis
Post-nasal drip
Malignancies
-Viral
Cough
Scratchy throat
Fever
-Bacterial (strep throat)
Pain (worse when swallowing or talking)
Scratchy throat
Dry throat
Swollen or red glands/tonsils
White patches on tonsils
Fever
Throat: Refer if…
Symptoms of infection (strep throat)
Difficulty breathing
Difficulty swallowing
Symptoms >7 days
Rapid Diagnostic Tests (RDTs)
-Community pharmacy based point of care testing Influenza A & B Group A Streptococcus (strep throat) HIV HCV H. Pylori -Collaborative Practice Agreements
