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HEENT Flashcards

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1
Q

What is the presentation of acute otitis media

A

bulging of TM
other signs of acute inflammation (erythema of TM, fever, ear pain
middle ear effusion

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2
Q

what are the common pathogens causing Acute otitis media

A

S. Pneumoniae (25%)
H. Influenzae (20%)
M. Catarrhalis

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3
Q

how do you diagnose Acute Otitis Media

A

otoscope examination
- bulging, loss of landmarks, redness, TM injection

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4
Q

what is the treatment of acute otitis media

A

high dose amoxicillin or Augmentin or cephalosporin (penicillin allergic)

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5
Q

what is the duration of treatment for acute otitis media

A

< 2years old: 10 days
>2 years old: 5-7 days

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6
Q

what are other non medication treatments for recurrent acute otitis media

A

tympanostomy
tympanocentesis
myringotomy

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7
Q

what are complications of acute otitis media

A

mastoiditis and bullous myringitis

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8
Q

what is the most common cause of pharyngitis

A

viral - adenovirus is m/c

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9
Q

what is the presentation of mononucleosis phayngotonsillitis

A

fever
sore throat
lymphadenopathy
splenomegaly
atypical lymphocytes
+ heterophile agglutination test (monospot)

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10
Q

when should gonorrhea pharyngitis be considered

A

in pts with recent sexual encounters or with non-resolving pharyngitis

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11
Q

when should fungal pharyngitis be considered

A

pts using inhaled steroids

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12
Q

what is the cause of step pharyngitis

A

Group A B-hemolytic streptococci (GABHS) - S. pyogenes

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13
Q

How is strep pharyngitis diagnosed

A

Centor Score (3 or 4)
1. absence of a cough
2. exudates
3. fever (>100.4)
4. cervical lymphadenopathy

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14
Q

if patient has a negative Centor score, what is the next step

A

throat culture

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15
Q

what is the treatment of Group A Strep pharyngitis

A

Penicillin = first line
azithromycin if penicillin allergic

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16
Q

what are complications of strep pharyngitis

A

rheumatic fever
post-strep glomerulonephritis

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17
Q

what is the treatment of mononucleosis pharyngitis

A

symptomatic and avoid contract sports; abx such as amoxicillin or ampicillin may cause a rash

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18
Q

when can people return to sport s/p mononucleosis diagnosis

A

for athletes planning to resume non-contact sports: 3 weeks from symptom onset
for strenuous contact sports: 4 weeks after illness onset

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19
Q

what is the treatment of fungal pharyngitis

A

clotrimazole
miconazole
or nystatin

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20
Q

what is the treatment of gonorrhea pharyngitis

A

IM ceftriaxone and azithromycin for second agent

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21
Q

pt presents with clear nasal drainage, pruritis, pale, blish, boggy mucosa, what is their likely diagnosis

A

allergic rhinitis

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22
Q

how do you diagnose allergic rhinitis

A

history and occasionally skin testing

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23
Q

what is the treatment options for allergic rhinitis

A

avoid any known allergins
use antihistamines
cromolyn sodium
nasal or systemic corticosteroids
nasal saline drops or washes
immunotherapy

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24
Q

what is the presentation of viral conjunctivitis

A

copious watery discharge, scant mucoid discharge.

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25
what is the most common bug cause of viral conjunctivitis
Adenovirus
26
what is the presentation of bacterial conjunctivitis
purulent (yellow) discharge, crusting, usually worse in AM/ may be unilateral
27
what are the common causes of bacterial conjunctivitis
- s. pneumonia, s. aureus - acute mucopurulent - M. catarrhalis, gonococcal - those not responding to conventional treatment - chlamydia - newborn
28
how do you diagnose chlamydia conjunctivitis
Giemsa stain - inclusion body
29
what is the presentation of allergic conjunctivitis
red eyes itching and tearing usually bilateral cobblestone mucosa in inner/upper eyelid
30
what is the treatment of bacterial conjunctivitis
Gentamicin/tobramycin (tobrex) Erythromycin ointment - chlamydia for newborns Trimethobrim and polymyxin B
31
what needs to be added for coverage in bacterial conjunctivitis with those who wear contact lenses
fluoroquinolones
32
what is the treatment of Neisseria conjunctivitis in those with contact lenses
prompt referral and topical and systemic abx
33
what is the treatment of chlamydial conjunctivitis with those using contact lenses
systemic tetracyclines or erythromycin x 3weeks topical ointments assess for STD or child abuse
34
35
what is the pathogen that causes epiglottitis
Haemophilus infleunzae type B (Hib) - usually unvaccinated children or underserved areas
36
when is Hib vaccine administered in kids
2,4,6,12-15 months
37
what is the presentation of epiglotittis
stridor, restlessness, cough, dyspnea, fever, dysphagia, drooling, respiratory distress (tripod)
38
what are the 3D's of epiglottitis
Dysphagia Drooling Respiratory Distress
39
how do you diagnose epiglotitis
secure airway culture for H. flu lateral neck x-ray
40
what is the hallmark sign on x-ray for epiglotitis
thumbprint sign
41
what is the treatment of epiglotitis
intubation if necessary supportive care ceftriaxone may tx outpt if stable
42
what is the most common site for anterior nose bleeds
kiesselbach's plexus or Little's area
43
what is the typical source for posterior nose bleeds
sphenopalatine artery (woodruff's plexus)
44
what is important to preventatively treat for with patients who require anterior nasal packing for nosebleeds
must be treated with abx (cephalosporin) to prevent toxic shock syndrome
45
what should be ruled out with recurrent epistaxis
HTN or hypercoagulable disorder
46
what is Weber Test
tuning fork placed on center of the head to see if the sound lateralizes
47
for a webers test, if the sound lateralizes to the affected side, what does that indicate?
conductive hearing loss
48
for weber test, if the sound lateralizes to the unaffected ear, what does that indicate
sensorineural hearing loss
49
what is the rinne test
tuning fork placed on mastoid then up the the hear (should continue to hear)
50
in a rinne test, if it results in bone > air what does that indicate?
conductive hearing loss
51
in rinne test, if it results in air > bone, what does that indicate?
sensorineural hearing loss
52
if a patient has conductive hearing loss, what should the results of the WEber and Rinne test be?
Weber: hear in the bad ear Rinne: Bone > air
53
if a patient has sensorineural hearing loss what should the results of their weber and rinne be?
Weber: hear in good ear Rinne: Air>bone
54
what are common causes of sensorineural hearing loss
noise-induced, infection, drug-induced, congenital, meniere disease, CNS lesions
55
what are common causes of conductive hearing loss
cerumen impaction, otitis external, esostosis tmpanic membrane perforation otitis media, otosclerosis, neoplasms
56
what is exostosis
bony outgrowths of external auditory canal related to exposure to cold water
57
what is a complication of acute otitis media that leads to a suppurative infection of mastoid air cells
mastoiditis
58
what is the presentation of mastoiditis
fever otalgia pain and erythema of ear forward displacement of external ear
59
what are common pathogens causing mastoiditis
S. pneumonia, H. influenzae. M. catarrhalis, S. aureas, S. pyogenes
60
how do you diagnose mastoiditis
clinical CT of temporal bone with contrast (complicated/toxic)
61
how do you treat mastoiditis
oral abx or IV abx (ceftriaxone)
62
how is oral candidiasis diagnosed
potasium hydroxide prep (KOH) = revealing budding yeast and pseudohyphae
63
what is the treatment of oral candidiasis
nystatin oral fluconazole
64
what is an infection of the orbital muscles and fat behind the eye
orbital cellulitis
65
what is periorbital cellulitis
infection of only the skin around the eye
66
what is the presentation of orbital cellulitis
decrease EOM pain with movement of eye and proptosis signs of infection
67
how do you diagnose orbital cellulitis
CT scan of orbits confirm CBC and blood cultures occasioanlly
68
how do you treat orbital cellulitis
Hospitalization and IV broad-spectrum abx (vanco)
69
what is the presentation of bacterial otitis externa
edema with cheesy white discharge, palpitation of the tragus is painful
70
when is malignant otitis externa commonly seen
in diabetic patients
71
what are the pathogens that cause bacterial otitis externa
pseudomonas aeruginoasa (swimmers ear) S.aureus (digital trauma)
72
what is the treatment of bacterial otitis externa with performation or chance of perforation
ciprofloxacin 0.3% and dexamethasone 0.1% suspension: 4 drops BID for 7 days or ofloxacin 0.3% solution 10 drops once daily for 7 days
73
what drops are commonly used for bacterial otitis media
cortisporin otic drops
74
what is the treatment of diabetic or immunocompromised pts with bacterial otitis externa
hospitalization with IV abx (caused by aspergillus)
75
what is the presentation of fungal otitis externa
pruritis weeping pain and hearing loss swollen, moist and wet appearance
76
what is the pathogen causing fungal otitis externa
Aspergillus niger (black) A.flavus (yellow) A. fumigatus (grey) candida albicans
77
what are the treatment options for fungal otitis externa
2% acetic acid 2-4 drops QID clotrimazole 1% solution itraconazole oral
78
pt presents with a severe sore throat, lateral uvula displacement and bulging tonsil what is the likely diagnosis
peritonsillar abscess
79
what is the common pathogen causing peritonsillar absecesses
streptococcus pyogenes
80
how do you diagnose peritonsil abscess
XR, CT or US of neck needle aspiration of tonsillar mass and cultures
81
what is the treatment for a peritonsilar abscess
aspiration I&D and/or abx (IV amox, ambox-sulbactam, clinda)
82
what is exotropia
out-turning of eyes
83
what is esotropia
in-turning of eyes
84
what is hypertropia
upward deviation of eyes
85
what is hypotropia
downward deviation of eyes
86
how are stabismus diagnosed?
cover/uncover test
87
what is the presentation of TM perforation
pain otorrhea hearing loss/reduction
88
what is the treatment of TM perforation
most heal spontaneously keep clean and dry treat with abx
89
what antibiotics are non-ototoxic
floxin drops
90
when should surgery be persued with TM perforation
if it persists past 2 months

Pediatrics - clinical (13 decks)

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