PCC - HEENT Flashcards
1
Q
N/V
A
Nausea and vomiting
2
Q
HA
A
headache
3
Q
PERRLA
A
pupils equal, round, reactive to light and accomodation
4
Q
Dx
A
Diagnosis
5
Q
ou
A
both eyes
6
Q
os
A
left eye
7
Q
od
A
right eye
8
Q
au
A
both ears
9
Q
as
A
left ear
10
Q
ad
A
right ear
11
Q
PCP
A
Primary care physician
12
Q
APAP
A
acetaminophen
13
Q
Primary Headaches
A
-No underlying illness
-Examples:
Migraine
Tension
Cluster
14
Q
Secondary Headaches
A
-Associated with underlying illness: Trauma Stroke Substance withdrawal Infections Hypertensive crisis Concussion
15
Q
Cluster Heahaches
A
Characteristics: Male >> Female Onset around 30 years old Duration of 15 minutes up to 3 months Causes Hypoxia Sudden release of histamine or serotonin
16
Q
Cluster Headaches Symptoms
A
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
17
Q
Migraine Headaches
A
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
18
Q
Migraine Headaches Symptoms
A
Pulsating or throbbing pain
Usually unilateral near the temples
Nausea/Vomiting
Sensitivity to light, sound, movement
19
Q
Migraine Headaches Warning Signs may occur hours to days before episode
A
Psychologic, neurologic, or autonomic
Roughly 10% of patients experience an aura
20
Q
Migraine Headache Aura = neurologic symptoms prior to migraine attack
A
-Visual symptoms: Flashes of light or blind spots -Sensory or motor symptoms: Tingling/numbness of extremities Dysphasia/Aphasia Weakness Hemiparesis
21
Q
Tension Headaches
A
-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)
22
Q
Self-care
A
-Pharmacologic: OTC products
-Non-pharmacologic
Heat
Cold compress
Massage
Sleep hygiene
Stress management
Relaxation techniques
Avoiding triggers
23
Q
Primary Headache: When to refer
A
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
24
Q
Conjunctivitis
A
-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
25
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 ® )
```
26
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
27
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
```
28
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
29
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
30
Open Angle Glaucoma
Most Common
Causes: steroid, anticholinergic
Symptoms: rarely occur unless there is severe damage
31
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
32
Open Angle Glaucoma Treatment
```
Treatment:
Nonselective beta blockers
Prostaglandin analogues
Alpha 2 agonists (brimonidine)
Carbonic anhydrase inhibitors
```
33
Closed Angle Glaucoma Treatment
Pilocarpine
Hyperosmotic agents
Secretory inhibitor
34
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)
35
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
```
36
Otitis Media
```
-Inflammation of middle ear
Common in children <3 years of age
-Causes
Bacterial
Viral
Allergies
Irritants ( e.g. cigarette smoke)
```
37
Acute Otitis Media
- Most common
- Rapid onset symptoms: pain, fever, discharge, redness, pulling at ears, irritable, crying
- Treatment: antibiotics, analgesics, antipyretics, local heat
38
Otitis media + effusion
Not associated with symptoms of infection
Symptoms: rhinitis, cough, diarrhea
Treatment of symptoms: analgesics, antipyretics, local heat
39
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
40
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)
41
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
```
42
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
43
Medications Causing Ototoxicity
- Quinine
- Salicylates (aspirin)
- Aminoglycosides
- Platinum antineoplastic agents
- loop diuretics
44
Ears: Refer when...
```
Hearing loss, ear pain, drainage, tinnitus
Symptoms of infection
Symptoms of otitis media and externa
Perforated eardrum
Foreign objects in ear
```
45
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
46
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
47
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
```
48
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®)
49
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)
```
50
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
51
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
52
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
```
53
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
54
Throat: Refer if...
Symptoms of infection (strep throat)
Difficulty breathing
Difficulty swallowing
Symptoms >7 days
55
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
```
