Exam 3 HEENT Treatments Flashcards
(133 cards)
1
Q
Bells Palsy
A
Tape eye shut at night, wetting drops to keep eye moist if patient can’t close it
Corticosteroids - Prednisone - MAINSTAY
artificial tears
what it it is viral pathology? acyclovir
2
Q
Horners Syndrome
A
MAP
3
Q
Trigeminal Neuralgia
A
Anticonvulsants: carbamazepine, gabapentin
TCAs: Ami -Nor - triptyline
Surgery: rhizotomy and neurectomy
4
Q
Blepharitis
A
keep lids clean
avoid make-up
lid massage w/ abs ointment
baby shampoo/ lid cleanser
5
Q
Chalazion
A
warm compresses
steroid injection
surgery
6
Q
Ectropion
A
artificial tears
surgery
7
Q
Entropion
A
surgery
artificial tears
abc ointment (azithromycin)
8
Q
Hordeolum
A
warm compresses
abc ointment
lid hygiëne
PO abs if periorbital cellulitis
9
Q
cataract
A
surgery - new lens
10
Q
Conjunctivitis viral
A
cold compresses
steroids topical
artificial tears
11
Q
Conjunctivitis bacterial
A
tobramycin
trimethoprim + polymyxin B
gentamycin
ECN ointment
12
Q
conjunctivitis allergic
A
Ah drops - olopatadine
cold compresses
steroids
artificial tears
13
Q
Dacryocystitis
A
Empiric abs
IV abs
I/D
dacryocystorhinostomy
14
Q
Pinguecula
A
artificial tears
steroids
15
Q
Pteryguim
A
surgery - autograft
artificial tears
16
Q
Uveitis
A
Mydraitic / cycloplegic gtts (cyclopentolate, tropicamide)
topical corticosteroids - mainstay (prednisone?)
PO steroids
17
Q
acute otitis external
external ear
A
pain relief ( NSAIDS and Tylenol) eradication of infection with ciprofloxacin or ofloxacin
18
Q
mastoiditis organisms
A
strep pneumo
H flu
M cat
always a complication of AOM 80%
19
Q
mastoiditis
external ear
A
pipercillin - tazobactam plus vancomycin
narrow down ATB once culture is back from tympanocyntesis
myringotomy
mastoidectomy if no improvment in 48 hrs.
20
Q
Eustachian tube dysfunction
A
Viral URI cause - systemic decongestants (pseudo ephedrine) intranasal decongestants (oxymetazoline) auto inflation but not with active infection Allergic cause - desensitization or intranasal steroids
21
Q
acute otitis media
sensorineural hearing loss b/c scarring TM
A
mot resolve spontaneously
systemic pain: ibuprofen, acetaminophen, oxycodone, hydrocodone
topica painl: antipyrine, benzocaine, lidocaine (contraindicated with TM perforation)
if ABS indicated then first line is amoxicillin, cephalosporins,
augmentin
ofloxacin,
ceftriaxone (IV), clindamycin if PCN allergy
failure of sec ABS then clinda + 3rd gen ceph.
22
Q
otitis media w/ effusion
not like AOM cause this is not painful, AOM is painful
A
90% resolve spontaneously AH decongestants corticosteroids ABS all are unproven to work tympanovstomy tubes - surgery
23
Q
chronic otitis media
conductive hearing loss b/c TM is perforated
A
organisms are: Pseudomonas, Proteus, staph
Tx: ofloxacin or ciprofloxacin with dexamethasone (steroid) , these are topical ABS
Definitive Tx: TM repair (90% success), mastoidectomy if irreversible infection
24
Q
cholesteatoma (acquired or congenital) - retraction of TM interrupts normal squamous migration - keratin accumulates
A
osteoclastic activity
surgical - excise all of it or it will recur
remove infected debris, keep ears dry, ATB drops or maybe steroid drops
25
congenital disorder of the middle ear = EAC ATRESIA from agenesis of EAC
narrowing of EAC b/c of failure to develop completely
| results in conductive hearing loss
26
Overly patent (branching) ET
avoidance of decongestants
| myringotomy to decrease TM stretch
27
congenital disorder of the middle ear = MICROTIA (anotia)
small, collapsed or only a lobe
| anotia = complete absence of the ear and canal
28
congenital disorder of the middle ear = Lop Ears
folded down or protruding
| Tx: otoplasty
29
congenital disorder of the middle ear = Low Set
upper pole below eyebrow level, check kidneys
30
congenital disorder of the middle ear = PRE AURICULAR TAGS
cosmetic problem
31
TM perforation
will usually resolve on own
avoid water
surgically close the TM
surgically repair ossicle chain
32
Hematoma of external ear
compression of ear
I / D
compression
TAPE IT!
33
Barotrauma
yawn, sneeze
autoinflation
decongestants - pseudophedrine
if severe: Myringotomy
34
Foreign Body (ear)
```
Warm water irrigation
cerumenolytics - EPO colase
curette or forceps
lidocaine mineral oil
DO NOT ADD WATER why? organic substances will swell
```
35
Open Angle Glaucoma
Prostaglandin - latanoprost, bimatoprost
B-adrenergic - timolol
Combination drops - better compliance
Laser therapy or surgery
36
Closed Angle Glaucoma
```
halo around lights, steamy cloudy cornea
Primary:
IV azetazolamide
Diuretics - acetazolamide
anterior chamber paracentesis
once IOP is down then topical pilocarpine
Secondary:
systemic azetazolamide
treat cause
```
37
Optic neuritis
| unilateral
inflammation of optic nerve
if demyelinated : prednisolone
treat cause = MS, DM , HTN
38
Papilledema
| bilateral
```
inflammation of optic disc
progressive vision loss tX:
treat HTN/mass
weightless
Acetazolamide - PO or injection
cerebral spinal shunt
optic nerve fenestration
```
39
Retinal Detachment
| unilateral-painless, 25% turn b/l
```
retinal tear / tractional detachment = pre-retinal fibrosis
Tx: laser photocoagulation
cryotherapy
sub retinal drainage
pneumatic retinoplexy (bubble therapy)
```
40
Retinal vascular occlusion - ARTERY (unilateral)
cherry red spot on fovea and box car segmentation of VEINS (not arteries)
ocular massage, O2, lay flat, IV acetazolamide , anterior chamber paracentesis (like closed glaucoma)
IV thrombolytics (heparin, coumadin- uhhh! cause it is a clotting issue)
41
Retinal vascular occlusion - ARTERY due to Giant Cell Arteritis (GAS) or Temporal Arteritis ---- JC
corticosteroids
| biopsy of temporal artery (ouch!)
42
Retinal vascular occlusion Vein (unilateral)
neovascular glaucoma - photocoagulation
intravitreal triamcinolone for macular edema - steroid injection into the eye
tissue plasminogen activator (TPA) into retinal venous system for strokes
43
neovascular glaucoma
photocoagulation
44
macular edema
intravitreal triamcinolone
45
Proliferative Diabetic Retinopathy
vessel proliferation
neovascularization
control BG, BP, lipids, monitor renal function
Tx: pan retinal laser photocoagulation (NIGHT / COLOR LOSS) or vitrectomy (do this before hemorrhage occurs and causes tractional retinal fibrosis
mydriatic drops
IF MACULAR EDEMA - LASER PHOTOCOAGULATION
46
NON - proliferative diabetic retinopathy
not forming new vessels
47
Hypertensive Retinopathy
worse in young patients with rapid rise in BP
breaks endothelial integrity
occludes capillary arterioles
(cotton-wool spots, retinal hemorrhages, edema, exudates)
CHRONIC HTN - INCREASES DEVELOPMENT OF ATHEROSCLEROSIS - and retinal arterioles become narrow and tortuous (copper silver wiring, AV nicking, superficial hemorrhages - flame)
48
Strabismus (eyes don't line up) problem with EOMs
vertical = hyper/hypotropia
horizontal = exotropia (eyes turn out)/esotropia (eyes turn in)
Tx: glasses, exercises, eye muscle surgery
49
Amblyopia - "lazy eye"
| one eyes experiences a blurred view while the other is normal
most common vision loss in children - only seen in children (one or both eyes)
50
strabismic amblyopia
brain ignores the eye that isn't straight, decrease in vision
51
deprivation amblyopia
congenital cataract or othercontition deprives eye of vision
52
refractive amblyopia
unequal amount of refractive error, brain ignores the worse eye
53
amblyopia treatment
glasses may help
patching the normal eye (allows weaker eye to get stronger)
Atropine eye drops in good eye to make it blurry
surgery on eye muscles if from strabismus
54
Hyperopia - farsightedness
"plus" or CONVEX lens
55
Myopia - nearsightedness
| light rays at converging at a point before the retina
"minus" or CONCAVE lens
56
Presbyopia
plus lenses for near work (reading distance)
57
Age-related macular degeneration
```
laser photocoagulation - reduces druse, but it can still progress
For neovascular (WET) - vascular growth inhibitors
intravitreal injection
For Atrophic (DRY) - no treatment
```
58
Presbycusis
| sensoneural hearing loss
hearing aid
| Coenzyme Q10
59
Otosclerosis
| conductive hearing loss
hearing aid
| stapedectomy
60
tinnitus
avoid excessive noise
mask tinnitus by music or hearing aid
avoid ototoxic medications - gentamicin
TCA's
61
Vertigo
vestibular suppressants
62
benign (paroxysmal) positional vertigo
dix hall pike DX
Eply maneuver (trying to get otoliths back into utricle)
N/V/Tinnitus
horizontal nystagmus (like peripheral vertigo)
anti vestibular medication
benzodiazepines (diazepam)
AH (meclizine)
63
Meniere Disease
Triad = vertigo, hearing loss, tinnitus
distention in the inner ear and impaired reabsorption of endolymphatic fluid
caloric test
FTA-ABS - fluorescent treponemal abs absorption
diuretic - azetazolamide
If severe - intratympanic gentamicin, intratympanic corticosteroids, surgery, AH, low sodium diet = first line,
64
Labyrinthitis
viral infection of the inner ear
vertigo (days to weeks) and hearing loss
does not have tinnitus like MD
Tx: AH, benzodiazepines
if febrile - abs
if herpes - Ramsay hunt syndrome - acyclovir
symptomatic TX: vestibular suppression like benzodiazepines and AH
65
Acoustic Neuroma (vestibular schwannoma)
Benign tumor of CN VIII sheath - schwann cells)
depends on severity: observation, surgical excision, radiation
if from neurofibromatosis TII (bilateral acoustic neuromas) - then consider chemotherapy with bevacizumab (which is a vascular growth inhibitor used in "wet" ARMD)
can consider surgical excision
but we also may choose not to treat considering patient population
66
Alkali burns
immediate topical anesthetic (proparacaine, tetracaine)
copious amounts of irrigation 2-3L
double eversion of the lids to remove material
remove particles with forceps or moist cotton swab
Irrigate until pH of 6.8 - 7.4
NO ACID FOR A ALKALI BURN CAUSE IT WILL CAUSE AN EXOTHERMIC REACTION AND CAUSE FURTHER BURN
Mydriatic / cycloplegic drops to dilate pupil and paralyze the ciliary muscles
ABS ointment
maybe PO narcotics
check IOP
67
Acid burns
```
cause more damage then alkali, but less serious b/c acids do not penetrate as deeply but they can still cause blindness
ex. nail polish remover / battery acid
topical anesthetic
copoius irrigation (water ot ringers)
DO NOT NEUTRALIZE WITH ALKALI
check for ulcerations
PO narcotics
```
68
Thermal Burns
burn of the lids, cornea, conjunctiva
(superficial or severe)
Tx: systemic analgesia, topical anesthetic, mydriatic drops if corneal invlovement
69
UV radiation
actinic keratitis, snow blindness, welders arc burn
burns conreal epithelium cuasing pain photophobia
Tx: PO analgesics, Mydriatic drops and abs , topical anesthetic for eye exam (DO NOT LET PATIENT TAKE HOME)
70
Corneal Ulcer
corneal transplant - universal donor so no type and screen
Can be caused by: acanthameoba keratitis, fungal keratitis, herpes simplex keratitis, exposure keratitis (eyelids do not close) = dendritic lesions, FB, SJOGRENS (dry mouth and eyes)
Tx: pain meds, protective glasses, corticosteroids drops, Empiric ABS (like dactrocystitis) but taper off when culture is back
71
Corneal Abrasion
Sx: tearing, photophobia, blurry vision
regenerates 24-28 hrs
tx aimed at pain relief and infection prevention
cycloplegics for ciliary spasm
Patch for pain releif but no patch if fingernails, plant or CL
abrasions form contacts need pseudomonas coverage so give them cipro
DO NOT GIVE PRESCRIPTION FOR TOPICAL ANESTHETICS FOR HOME!
72
Foreign Body (eye)
Removal: topical anesthetic, irrigate with NS, try moist cotton swab, 25 guage needle bevel up to try and poke it out using a slit lamp
Dispostion: topical ABS, cycloplegics, oral analgesics, tetanus,
73
Hyphema
blood in the anterior chamber from trauma or surgry
grade 1 = less than 1/3 chamber filled
can clot and get stuck
Tx: monitor IOP resloves in 5-6 days
74
Globe rupture
DO NOT MEASURE IOP
from severe trauma it can rupture the thinner parts of the eye like the sclera and limbus
anisicoria - irregular pupil
Tx: do not manipulate eye, elevate the head of bed, protective shield, Broad specturm ABS, tetanus, sedation and analgesics and antiemetics for anti vomitting (cause vomitting increases IOP when can cause the globe to ooze)
NPO ?
75
Blow out fracture
can trap inferior rectus and disrupt upward gaze
most COMMON is the inferior wall (maxillary sinus)
fracture followed by medial wall (ethmoid)
Tx: not an emergency, can repair up to 3-10 days later, waters view xray showing maxillary sinus cloudy, CT, oral ABS
76
Nystagmus
help with school or social situation
regular eye exams
contacts better then glasses
surgically you can reattach the extraocular muscles
Medical: BOTOX or Baclofen - CNS depressor
77
Temporal Arteritis
AKA Giant cell artritis and also seen with retinal ARTERY occlusion
JAW CLAUDICATION
Tx: immediate prednisone
polymyalgia rheumatica - disease of connective tissue causing pain and stiffness of muscles
78
Preseptal Cellulitis
PO ABS
hot packs
caused by staph or strep
no eye involvement so there is no eye pain when eye moves
Infection of the eyelids and periocular tissue ANTERIOR to the orbital septum
79
Postseptal Cellulitis
Admit
IV ABS - broad spectrum w/ anaerobic and aerobic coverage
eye involvement so eye movement are painful
Infection of the eyelids and periocular tissue POSTERIOR to the orbital septum
80
How can you differenciate between post and pre septal cellulitis?
get a CT w/ contrast and you can see if the globe is involved or is it just preseptal
81
Diagnostic Criteria for Temporal Arteritis
you need 3 of the 5:
1. > 50 y.o.
2. unilateral headache, new onset
3. temproal artery tenderness
4. ESR > 50 mm
5. abnormal biopsy of temporal artery = vasculitis
82
Common cold
```
adenovirus, rhinovirus
nasal saline
decongestants (pseudoephedrine)
analgesics (acetaminophen)
worse symptoms: nasal steroids (fluticasone), nasal anticholinergics (ipratropium), oral steroids taper
EBM - zinc decrease illness time
```
83
Influenza
orthomyxovirus
Neuraminidase inhibitors: oseltamivir, zanamivir
patient education - quadravelent vaccine
84
Rhinitis
allergic: saline drops, avoid potential sources, corticosteroids, AH (loratadine- claritin), decongestants, nasal anticholinergics, mast cell stabilizers
Vasomotor: avoid irritant
Medicamentosa: discontinue decongestants
severe: immunosuppressants
85
nasal polyps
nasal corticosteroids
| excision if no improvement
86
Olfactory dysfunction
evaluate reversible cause: infection, allergies, tumor
| NO TX FOR PRIMARY OLFACOTRY DYSFUNCTION
87
Epistaxis
first line: direct pressure for 15 min, sitting position leaning forward (if still bleeding consider posterior bleed)
second line: nasal stimulants vessel constriction: cocaine, phenylephrine, oxymetazoline, cauterize with silver nitrate
If bleeding persists: nasal packing with ABS cephalexin or clindamycin. If anterior pack for 5 days, of posterior consult ENT
if severe: nasal artery ligation
88
Sinusitis
patient education - will improve in 2 weeks w/p treatment
nasal washes ot steam
Mild: NSAIDS (ibuprofen), nasal decongestants pseudo ephedrine, nasal corticosteroids - fluticasone
Moderate/severe: ABS for 10 days - first try penicillin (augmentin, amoxicillin). If PCN allergic then tetracycline (doxycycline) or macrolide (azithromycin). refractory treatment = quinolone (levofloxacin, moxifloxacin)
Chronic: antibiotics for 3-4 weeks and same ABS as acute
89
Cavernous Sinus Thrombosis
start IV antibiotics immediately - PCN (Nafcillin) + cephalosporin 3rd ben (ceftriaxone) or vancomycin if MRSA is considered
Heparin is considered
90
Skull fractures
any open skull fracture requires ABS
Maxillary - wire shut
Mandibular - need surgery within couple days
Basilar - admit and aggressive evaluation (raccoon and battle sign)
91
Nasal FB
UNILATERAL NASAL DISCHARGE!!
vasoconstrictors (phenylephrine, oxymetazoline)
remove object with alligator forceps, wire curette, suction, positive pressure technique
if can't remove then ENT follow up
92
nasal fracture
LATERAL NASAL XRAY
tetanus update - anytime if open wound
antibiotics if open - PCN and if allergic then doxy or azithromycin
ENT follow up
93
Septal hematoma
I / D - bilaterally
packing x 2-5 days
oral ABS
ENT follow up
94
Angioedema
Discontinue suspected agent like AH, Steroids, Epi (IM, SubQ)
Surgery or Procedures: Endotracheal intubation, Cricothyrotomy
MILD: observe in ED, Oral meds
Moderate: admit
Severe: admit to ICU crib kit at bed side
95
Airway assessment
```
LEMON
Look externally for physical clues
Evaluate 3:3:2 rule- three finger width between incisors, three between mandible an hyoid and two between hyoid and thyroid
Mallampati - class 0-4:
0 = can see epiglottis
1 = SP, Fauces, Uv, pillars
2 = SP, F, U
3 = SP, U
4 = SP not visible
Obstructive - soft tissue swelling, obesity
Neck mobility - ROM
```
96
What are the 7 P's of Rapid Sequence Intubation?
```
Preparation - 10 min before
Pre oxygenation - 5 min
Pretreatment - 3 min
Paralysis - induction
Protection - 30 sec after
Placement - Proof - 45 sec after
Post- Intubation management - 60 sec after
```
97
Hereditary Angioedema
Generally refractory to these Tx: anabolic steroids, C1 esterase inhibitor, (berinert & Cinryze)
Kvllikrein inhibitor (Kalbitor $$$$$)
Bradykinin 2 receptor antagonist, Firazyr
98
Glossitis
Nutrition replacement
99
Glossodynia
burning and pain of tongue
stop smoking
benign
consider: Anxiolytic or Gabapentin ( also used in trigeminal neuralgia )
100
Aphthous Ulcer
maybe related to herpes Virus 6
Tx is supportive:
Diclofenac, or corticosteroids with adhesive base (or Orabase)
oral mouthwashes / prednisone
101
Oral Candidiasis (thrush)
Oral antifungals: Fluconazole
Nystatin liquid
Clotrimazole
If they have dentures then maybe Nystatin powder on them
102
Oral Herpes Simplex (cold sores)
Supportive Care: will go away on own,DO NOT GIVE CORTICOSTEROIDS
Magic Mouthwash (BMX)
1. benadryl - diph
2. Maalox
3. Xylocaine
Viscous Lidocaine 2%
If severe: oral antivirals like acyclovir
103
Oral Leukoplakia
Biopsy - premaglignant hyperkeratosis
ENT consult
Monitor for development into SCC
104
Oropharyngeal Abscesses
I / D
IV antibiotics like PCN, Macrolides, Cephalosporins
admit
cricothyrotomy kit besides
If peritonsillar (quinsy) then consider a tonsillectomy or oral ABS in minor cases
If sublingual (ludwig angina) then consider bilateral submittal incisions if airway threatened
105
Parotitis (Sialadenitis) viral
Self limited
| analgesics
106
Parotitis suppurative (bacterial)
```
IV ABS to cover staph
PCN
Cephalosporins
Clindamycin for MRSA often requires I / D
admit
```
107
Parotitis Juvenile recurrent
supportive care - analgesics
| oral ABS like PCN or cephalosporins
108
Sialolithiasis
Whartons duct most common
CT w/o contrast
stone removal
consider gland excision if severe or recurrent
Procedures: duct dilation, (make sure clamp proximal duct) or distal duct incision
Newer options: Extracorporeal shock-wave lithotripsy and fluoroscopically guided basket retrieval
Sialendoscopy
109
diseases of mouth and gums
normally strep mutant main pathogens
Increased acid
and decrease saliva
110
caries
loss of integrity of tooth enamel from hydroxyapatite dissolution maybe be from infection acid or no saliva
Tx: Fluoride rinse / topicals
111
Gingivitis
bacterial and particles constantly forming plaque and forms TARTAR
gums become red swollen and can bleed easily but this can be reversed with cleaning
no loss of bone and tissue
112
Periodontitis
forms from not treating gingivitis
the gums pull away from the teeth and form pockets and harbors bacteria and particles and then the bacterial toxins break down the bone and connective tissue and can destroy the gums and bones
113
Necrotizing Ulcerative Gingivitis (trench mouth, Vincents Infection)
Spirochetes and fusiform bacilli
painful acute gingiva inflammation and necrosis
Tx: warm half strength peroxide rinses
ABS 10 days
dentinal gingival curettage
114
Temporomandibular jaw disorders
NSAIDS (naprosyn)
massage
if severe: carbamazepine
Patient edu: jaw rest, soft food, avoid teeth clenching
Skeletal muscle relaxants - methocarbamol
Tricyclic antidepressants - nortriptyline
Corticosteroids - prednisone taper
Surgery: correct anatomic abnormalities 5% of cases
115
Acute Strep Pharyngitis
WE ONLY TREAT STREP TO PREVENT RHEUMATIC FEVER
first line - PCN, penicillinVK , penicillin G (bacillin LA)
amox, cephalosporins
If PCN allergic: clinda, azithromycin, clartihramycin
Surgery: tonsillectomy if recurrent
if peritonsillar abscess then I / D
116
Mononucleosis
```
EBV
supportive care
NSAIDS, tylenol , chloraseptic
steroids but not recommended
warm saline for throat gargles 4x / day
avoid contact sports
```
117
Diphtheria
Corynebacterium diphtheria gram +, drooling
grey membrane on tonsils extending to throat
Tx: STAT antitoxin form horse, PCN, erythromycin
isolation until 3 consecutive neg. cultures
remove membrane broncho/laryngoscopy
prevention: vaccine, booster
education - vaccine isolation
118
croup
steeple sign
acute laryngotracheobronchitis cause by parainfluenza
"Barking cough"
inspiratory stridor
worse at night - cool air outside during drive
steam in bathroom
119
Epiglossitis
from H. influenza type , 45 yo cause vaccine started in 80s
cherry red epiglottis, and thumbprint sign
Admit to ice/picu
airway protection
ceftriaxone
120
Foreign Bodies (throat)
trachea - ziemlich maneuver or cricothyrotomy , bronchoscopy and extraction
Esophagus - glucagon, benzodiazepines, if meat then papain,
swallow test with coke etc
121
Laryngitis
viral URI and common cause of hoarseness
rest voice
supportive care
stop smoking
NSAIDS
acetaminophen
Chloraseptic
No ABS
122
Sleep Apnea (obstructive)
you need @ lest 5 events of apnea / hr that last as long as 10 sec during a polysonmnogrpahy sleep study
education - weight loss
Tx: continuous positive airway pressure (CPAP)
Mandibular advancement splint (MAS)
surgical repair
123
general head and neck CA
chemo w. radiation ( cetuximab, methotrexate, 5 FU, cisplatin, docetaxel)
124
Oral CA
surgical excision
125
Salivary CA
parotid most common and are benign
Tx: excision (careful of facial nerve)
126
Larynx CA
chemo first
then
induction therapy w/ 3 agents : 5 FU, cisplatin, docetaxel
127
Neck CA
excision, radiation, chemo
Hx: drooling, dyspnea, odynophagia, dysphagia
PE: trismus - spasm of jaw muscles, Drooling, lymphadenopathy
128
TNM Staging 0 - III
no Nodes involved (N0) and no metastasis (M0)
| but III can have N1
129
N0
no regional LN involvement
130
N1
metastasis to a single ipsilateral LN
131
N2
metastasis to a single ipsilateral LN but 3 - 6 cm
132
N2c
LN involvement to contralateral
133
N3
metastases in LN
