HEENT

Question 1

Blepharitis

Answer 1

inflammation of the eyelids margin

2 categories : Anterior and Posterior

Question 2

What is the anterior blepharitis ?

Answer 2

–>involves the anterior lid margin surrounding the lid margin and is usually associated with Staphylococcal infection or seborrhea

Question 3

what is the posterior blepharitis?

Answer 3

–> the posterior lid margin associated with meibomian gland dysfunction and rosacea
–> posterior blepharitis is caused by melbomian gland dysfunction and an alteration in meibomian gland secretions.
As a result of oil secretions or solidification of meibum, a chalazion or hordeolum may develop.

Question 4

what is anterior staphylococcal blepharitis

Answer 4

is a cell mediated response resulting in lid margin inflammation

Question 5

what is anterior seborrheic blepharitis

Answer 5

often associated with generalized seborrhea

Question 6

hx & clinical presentation of Eye -Blepharitis

Answer 6

Inflammation of the eyelids
Swollen and erythematous eyelids : burning tearing or foreign body sensation, itching redness, discharge, absent lashes, lashes crusted with meibum
Seborrheic blepharitis may have greasy scales along the lid margins with foamy tears, disuse seborrhea of the scalp and ears.
ROSACEA is related to the meibomian gland dysfunction. Patients may have erythema or telangiectasia over the cheeks and nose or pustular skin eruptions

Question 7

Eye- Blepharitis management

Answer 7

Lid Hygeine
-warm moist compresses for 5-10 minutes
-lids scrubs with Q-tips and baby shampoo
Antibiotic ointment : Erythromycin or bacitracin
Artificial tears
Referral to Ophthalmologist for corticosteroids

Question 8

Eye- Hordeolum

Answer 8

An acute infection of a gland in the eyelid
inflamed area of eyelid where the eyelash meets the eyelid
Bacteria (usually staphylococcus) gets into the oil glands that lubricates the eye.
Similar process to pimple

Question 9

HX & clinical presentation of Hordeolum

Answer 9

swollen single gradually emerging red bump on the eyelid
Gritty scratchy sensation
Sensitivity to light, tearing, tenderness on the eyelid.

Question 10

Hordeolum management

Answer 10

usually self limited
spontaneous improvement in 1-2 weeks with conservative treatment
frequent warm moist compresses
teaching: light and gentle massage
lid hygiene with lid scrubs
Refers to Ophthalmologist if incision and drainage needed.

Question 11

Eye - Chalazia

Answer 11

chronic sterile lipogranulomatous inflammatory lesion of the meibomian gland
Lipogranuloma caused by a blockage in the Meibomian gland or oil gland that lubricates the eye . A gradually localized enlarging nodule where glands are located near the eyelashes.

Question 12

HX and clinical presentation of Chalazia

Answer 12

Hard, non-tender module found on the mid portion of the eyelid away from the lid border
may develop on lid margin with lid tenderness, pain, and swelling
Eyelid tenderness, increased tearing
Gradually enlarging nodule on the eyelid, sensitivity to light pain or pressure if pressing against the cornea.

Question 13

Chaliazion management

Answer 13

usually self limited in 25-50% of cases
Spontaneous improvement in 1-3 months with conservative treatment
Frequent warm, moist compresses to liquify glandular secretions
Teaching Gentle massage to express impacted secretions
Referral to Opthalmologist for corticosteroid injections or incision and drainage if necessary

Question 14

Eye - Viral Conjunctivitis

Answer 14

inflammation of the conjunctiva or the transparent mucosal tissue than lines the eye and inner surface of the eyelids.
Generally caused by adenovirus
highly contagious

Question 15

hx and clinical presentation of Viral Conjunctivitis

Answer 15

red eye (from corners inward) 
Excessive watering 
itching
watery discharge
Photophobia 
Foreign body sensation 
Begins in one eye and spreads to the other 
Abrupt onset
50% may have tender pre auricular lymph nodes.

Question 16

Viral conjunctivitis management

Answer 16

self limiting and usually lasts 5-14 days
treatment is supportive
artificial tears
cool compresses
Teaching Good hand hygiene, don’t share towels
avoid contact lens use until resolved and discard used lenses.

Question 17

Allergic Conjunctivitis

Answer 17

airborne allergen comes in contact with the ocular surface
inflammatory response occurs
IgE mast cell-mediated response and hypersensitivity.

Question 18

Allergic Conjunctivitis history and clinical presentation

Answer 18

Allergic Rhinitis
Headache
fatigue
often have the positive family hx of hay fever or atopy
Generally begins simultaneously in both eyes
itching
periocular skin discoloration thickening, erythema

Question 19

management of allergic conjunctivitis

Answer 19

cool compresses
teaching : remove irritants
oral/systemic antihistamines 
opthalmic antihistamines 
---> Naphcon A Vasocon (otc)

Question 20

Bacterial conjunctititis

Answer 20

bacterial infection of the conjunctiva membrane lining the eyelid by a wide range of gram-positive and gram negative organisms

Staphylococcus aureus is MOST COMMON
Tears contain enzymes and antibodies that kill bacteria.

Question 21

History and clinical presentation of bacterial conjunctivitis

Answer 21

red eye (corners inward)
blurred vision, crust or matted discharge forming on eyelid over night 
early morning glued eyes
thick mucoid discharge
absence of itching

Question 22

bacterial conjunctivitis management

Answer 22

antibiotic drops or ointment

• -> TOBRAMYCIN, FLUOROQUINOLONE, TRIMETHOPRIM-POLY B
• > Warm compresses frequently
• -> teaching should include-changing pillowcases daily, dispose of eye cosmetics. Do not share towels or handkerchief. Good hand hygiene. Contact lens cleaning and/or disposal

Question 23

Cornea abrasion patho

Answer 23

a cut or scratch or abrading of the thin, clear, protective coat of the anterior portion of the ocular epithelium often the result of trauma

Question 24

cornea abrasion clinical presentation

Answer 24

pain (sand or grit) tearing, photophobia, hx of event, contact lenses
photophobia known or suspected foreign body

Question 25

cornea abrasion management

Answer 25

``` visualize eye structures observe for foreign body perform a visual acuity EOM fluorescein staining-visualize with cobalt blue light Do not patch symptoms should resolve in 24-72 hours Teaching - Do not rub Refer to Ophthamologist if pain worsens or persists ```

Question 26

Glaucoma - Angle closure | patho

Answer 26

increased pressure occurs when the exit of aqueous humor fluids is suddenly blocked and results in quick, severe pain

Question 27

Glaucoma-Angle closure history and clinical presentation

Answer 27

``` SUDDEN & SEVERE pain cloudy vision nausea/vomiting red eye rainbow-likE halos around lights oval pupil from bowed iris cloudy cornea may have hx of recent eye dilation ```

Question 28

Glaucoma-Angle closure management

Answer 28

this is a Medical Emergency | Immediately Referral to Ophthalmologist

Question 29

Uveitis -patho

Answer 29

inflammation of the uvea or the middle portion of the eye involves the middle, pigmented vascular structures includes the ciliary body, chorioid Noninfectious, autoimmune or infectious causes Maybe isolated to the eye or the associated with system diseases

Question 30

Uveitis -history and clinical presentation

Answer 30

``` redness of the eye (from center outward) Blurred vision Photophobia Eye pain floaters Headaches ```

Question 31

Uveitis - management

Answer 31

underlying causes immediate and emergent referral to ophthamologist dark glasses steroid eye drops managed by ophthalmologist

Question 32

Allergic Rhinitis -patho

Answer 32

allergic inflammation of the nasal membranes generally caused by breathing in pollen, dust, dander or insect venom allergen triggers the production of antibody immunoglobulin E (IgE) When caused by pollens of plants it is called pollinitis when caused by grass it is called hay fever

Question 33

Allergic Rhinitis physical and clinical presentation

Answer 33

``` Rhinorrhea-generally clear pale, boggy nasal mucosa itching watery eyes nasal congestion swollen nasal turbinates eyelid swelling lower eyelid venous stasis (allergic shiners) sneezing no fever ```

Question 34

Allergic Rhinitis management

Answer 34

#1AVOID IRRITANTS (patient teaching) Saline Nasal Spray (may use in pregnancy) intranasal corticosteroids-beclomethazone (may be used in pregnancy) Antihistamines --1st generation-sedating --2nd generation- 1st line chlorpheniramine (may be use in pregnancy) DECONGESTANTS--> NOT FOR PREGNANT USE limit to 3 days or less (rebound effect)

Question 35

Epistaxis - patho

Answer 35

bleeding that occurs from broken capillaries in the nose mostly occur in the front of the nasal septum may result from some kind of trauma may have hx of allergies, snoring, hypertension, headaches, foreign object. Lesion on nasal mucosa

Question 36

Epistaxis : clinical presentation

Answer 36

bloody nasal discharge Damage to nasal mucosa from foreign object or lesion high blood pressure

Question 37

Epistaxis management

Answer 37

pinch lower part of the nose to apply direct pressure lean forward or tilt head forward to facilitate clot formation and avoid post nasal drainage cautery or packing may be required C&S if lesion is present treat underlying cause teaching: NO foreign objects in nose (including fingers)

Question 38

sinusitis- acute pathophysiology

Answer 38

obstruction of the sinus ostia which is a small opening in which the maxillary, frontal, ethmoid and sphenoid sinuses drain into the nasal cavity mucous stasis may allow pathogens to grow viral or bacterial

Question 39

Sinusitis- Acute or chronic hx & physical presentation

Answer 39

facial pain headache teeth pain ear pain/pressure cough increased pressure above, below, or behind eyes on leaning forward social hx smoking or second hand smoke. Environmental exposures Acute symptoms: fever and purulent nasal discharge, persistant >10 days Tenderness over sinus cavity.

Question 40

Sinusitis-management

Answer 40

most cases resolve without treatment saline decongestant or corticosteroid nasal spray analgesic and antipyretic tylenol or NSAID for symptoms greater than 10 days-->AMoxicillin Doxycycline, trimethoprim/sulfamethoxazole

Question 41

Ear-Auricle disorders patho

Answer 41

Auricle consists of skin over cartilage patho: is dependent on problem such as --> - Rheumatoid nodules - Tophi - Hematoma - Carcinoma - Infection

Question 42

Ear-Auricle disorders history & clinical presentation

Answer 42

- deformity of auricle - discharge drainage - lesion

Question 43

Ear-Auricle disorders management

Answer 43

specific to the problem: Biopsy lesions--> Basil cell carcinoma ** pearly borders with ulcerated center -->Squamous cell carcinoma ** rough, scaly surface Pressure dressings for trauma califlower ear Piercings: alcohol for cleaning topical antibiotic for infection oral/systemic antibiotics such as cephalexin or dicloxacillin or ceftriaxone or cephalexin IM/IV

Question 44

Ear-Otitis Externa pathophysiology

Answer 44

inflammation of the ear canal Usually bacterial or fungal Most often caused by --> staphylococcus aureus (including MRSA), pseudomonas, candida, aspergillus, Cerumen impaction

Question 45

Ear-otitis Externa hx & clinical presentation

Answer 45

``` pain & tenderness on palpation of traugus social hx- swimming hx of cleaning ear with a Q-tip allergies hearing aids ```

Question 46

Ear-otitis Externa management

Answer 46

cerumen removal if impacted teaching : no Q-tips in ears Antibiotic/steroid ear drops: CIPRODEX, CORTISPORIN OTIC keep ear canals dry for 7-10 days Alcohol or vinegar drops Limit use of ear plugs/phones and hearing aids until resolved Antifungals for fungal infections : FLUCONOZOLE

Question 47

Ear-Acute Otitis Media pathophysiology

Answer 47

infection of the middle ear causing inflammation and pain which may be fungal, bacterial or viral Bacteria most often associated are S.pneumonia, H. Influenza introduced in the eustacian tube through the nasopharynx following an upper respiratory infection or allergies.

Question 48

Ear-Acute Otitis Media history and clinical presentation

Answer 48

``` earache lymphadenopathy headache fever upper respiratory symptoms nausea/vomiting dizziness Sore throat Cough ```

Question 49

Ear-acute otitis media management

Answer 49

analgesic: topical (antipyrine/benzocaine) Oral (tylenol or ibuprofen) Antibiotics: amoxicillin, amoxicillin clavulanate, azithromycin (for penicillin allergy) antihistamines: 2nd generation

Question 50

Mouth-Aphthous Stomatitis pathophysiology

Answer 50

chronic inflammation of the oral mucosal tissue with ulcers painful, shallow, recurrent ulcers of the oral mucosa May be caused by: direct trauma vitamin deficiency anemia allergies

Question 51

Mouth-Aphthous Stomatitis history & clinical presentation

Answer 51

circular shallow ulcers covers by a gray membrane and raised border that is inflamed minor occurence 1-5 ulcers Major recurrence 2 or more large ulcers Herpetiform-recurrent with 5-100 ulcers

Question 52

Aphthous Stomatitis management

Answer 52

self limiting correct vitamin deficiency teaching: eliminate causes Magic mouthwash: benedryl, maalox or mylanta may include Nystatin if fungal etiology is suspected swish and swallow

Question 53

Mouth-glossitis pathophysiology

Answer 53

--> inflammation and depapilation of the dorsal side of the tongue

Question 54

mouth-glossitis hx and clinical presentation

Answer 54

finger-like bumps on the surface of the tongue may be missing swollen, tender tongue, smooth surface. Pale or fire red Dry mouth recent infections injury low Fe+, skin conditions, Yeast, sore tongue difficulty chewing swallowing or speaking swollen tongue

Question 55

Glossitis management

Answer 55

Good oral hygiene magic mouthwash : nystatin, benedryl, mylanta, lidocaine Teaching : avoid irritants : food & beverage Correct dietary/vitamin deficiencies antibiotics/antifungals

Question 56

Thrust -pathophysiology

Answer 56

skin and mucous membrane infections caused by Candida albicans Yeast infection of the mucus membrane lining the mouth and tongue

Question 57

thrust - hx and clinical presentation

Answer 57

white velvery sores over red tissue that may bleed easily

Question 58

thrust- management

Answer 58

nystatin 4-6ml (100,000u/ml) swish and swallow | Diflucan 100-200 mg daily for moderate to severe disease in immunocompromised persons

Question 59

mouth- strep pharyngitis pathophysiology

Answer 59

inflammation of the pharynx and surrounding lymph tissue | strep throat is caused by group A streptococus bacteria

Question 60

mouth- strep pharyngitis hx and clinical presentation

Answer 60

``` sore throat fever headache n/v swollen lymph nodes ```

Question 61

Centor Score

Answer 61

Patients are judge on 4 criteria. each is worth 1 point * fever * Tonisilar exudate * tender anterior cervical adenopathy * absence of cough Add patient's age to criteria Age 15 subtract 1 point 0 or 1 point - no ABT or throat culture needed 2-3 point- should have throat culture and ABT if positive 4-5 points- treat empirically with ABT

Question 62

Strep pharyngitis management

Answer 62

based on RST culture empirical treatment based on Centor sc pencicillin- Amoxicillin azithromycin if PCN allergic teaching : dispose of toothbrush in 3 days tylenol or NSAIDS for pain or fever

Question 63

Mouth infectious Mononeucleosis pathophysiology

Answer 63

viral infection caused by Epstein Barr or cytomegalovirus

Question 64

Mouth infectious Mononeucleosis history and clinical presentation

Answer 64

``` fever sore throat swollen lymph nodes severe fatigue splenomegaly ```

Question 65

Mouth infectious mononeucleosis management

Answer 65

fluids rest analgesics or NSAIDS for pain and fever salt water gargles corticosteroids for extreme swelling of throat/tonsils teaching: no contact sports for 4-6 weeks extremely infectious.