HEENT Flashcards
(101 cards)
1
Q
Obstructed meibomian gland
A
chalazion
2
Q
chalazion
A
Obstructed meibomian gland s/s – firm, painless, swelling, and redness
Spontaneous rupture may occur and most resolve spontaneously
Treatment- Warm compresses, (no evidence)
Antibiotics – rarely indicated
I & D if unresponsive to conservative therapy (refer)
3
Q
pain or painless a chalzion
A
painless, shouldnt complain of pain but mild tenderness to palpation or touch espiecally if it large enough
4
Q
nontender upper lid rubbery nodule
A
chalazion
5
Q
hurts nodule in the eye
A
stye/hordeolum
6
Q
Inflammation with or without infection
of the conjunctiva
A
conjunctivitis
7
Q
retinal arteries
A
bright* with red light reflex; narrower; thinker walls (more musclar)
straighter branches
Arteries are lighter, narrower, and have more prominent light reflex — not darker/wider.
8
Q
retinal veins
A
darker red or purplish broader than arteries; wider; no pulsation, drain deoxygenated blood
curved winding
more prone for hemrrhages
Veins are darker and wider, and have less prominent light reflex.
9
Q
blind spot of the eye
A
optic nerve
10
Q
fundoscopic exam you usually start with the whell at?
A
0
start about 12 inches away from the patient you find the red reflex and going to follow that red reflex to about one to 2 inches away from the patient
11
Q
macula is the
A
sharper spot
12
Q
If you’re having trouble visualizing the macula, where would you have your patient look?
A
into the light
This shifts their gaze to the center of the retina—the macula, specifically the fovea, which is responsible for central vision. Since the macula lies temporal (lateral) to the optic disc, this maneuver aligns your view with the macula’s location.
13
Q
lookind at the patient at what area is going to be the optic disc?
A
MEDIALLY (SAID IT THREE TIMES)
14
Q
optic disc is going to have what is known as the
A
physiological cup
15
Q
optic disc cup-to-disc ratio (CDR)
A
is a measurement used in eye exams to assess the relative size of the optic cup (the central depression in the optic disc) compared to the overall optic disc.
It’s an important indicator in evaluating for glaucoma and other optic nerve pathologies.
16
Q
normal ratio for the CDR
A
Typically ≤ 0.3 (i.e., the cup is about one-third or less the diameter of the disc).
A ratio > 0.6 is generally considered suspicious for glaucoma, especially if asymmetric between the two eyes (difference > 0.2).
> than 1/2 known as cupping
17
Q
top differentilas with cupping disc elavted ratio?
A
glaucoma or papillaedema
18
Q
macula densa has the
A
phobia centralis
19
Q
The___________ is a small, central pit in the macula of the retina responsible for the sharpest vision.
A
fovea centralis (often just called the fovea)
20
Q
The macula densa is found medially or temporally?
A
temporally
21
Q
Fluorescein staining of the cornea (illuminate the injury) when for what condition
A
Corneal abrasion
22
Q
What kind of lamp to use for a corneal abrasion
A
Slit lamp. Stains the eye blue to view the cut for example
- Fluorescein staining of
the cornea (illuminate
the injury)
23
Q
Management of a corneal abrasion
A
Antibiotics
–Oflaxacin, ciprofloxacin, erythromycin, sulfacetamide, tobramycin, gentamicin
Anticholinergic agents (ophthalmology Rx)
–Cyclopentolate HCL 1%, atropine, scopolamine
•Tetanus vaccine (Tdap
24
Q
Do you give topical antibiotics for corneal abrasion
A
Do not send home with this it’s only for the exam
25
Management for the corneal abrasion do you send home with an eye patch
Not recommended anymore
26
Common cause of overuse of contact lenses
Corneal ulcer
27
Corneal ulcers grow what
Neovascularizarion
28
Rupture of small subconjunctival blood vessels..
*Caused many times by forceful Coughing, Sneezing, vomiting,
*Uncontrolled hypertension
*Does not affect vision
Subconjunctiva hemorrhage
looks bad but benign
29
Subconjuctiva hemorrhage
Rupture of small subconjunctival blood vessels..
•Caused many times by forceful Coughing, Sneezing, vomiting,
•Uncontrolled hypertension
•Does not affect vision
30
Looking through the ophthalmoscope is going to give you findings of what
end organ perfusion
31
AV nicking
uncontrolled hypertension
32
cotton wool spots
hypertension and/or diabetes
33
microvascular hemorrhages
uncontrolled hypertension
34
Uncontrolled hypertension two things you can see in the eyes
AV nicking and microvascular hemorrhages
35
The Patient presents with moderate to severe pain What are some differentials other than conjunctivitis
uveitis or keratitis, or acute angle closure glaucoma
36
categories of conjunctivitis
Bacterial
– Gonococcal/chlamydial
* Viral
* Allergic
* Chemical
37
presentation of Bacterial conjuctivitis
unilateral and more purlent discharge not pain
38
conjuctivitis presentation of the sub category: Gonococcal/chlamydial
copious amount of green gooey discharge
39
presentation of Viral conjunctivitis
bilateral in nature and clear watery discharge the key
no antibiotics
40
Presentation of *allergic conjunctivitis
stringy like mucus sneezing seasonal in nature and hx of allergies
41
Presentation of * Chemical conjuctivitis
exposure to acid or alkaline, alkaline is worse; rust removers are alkaline, patients like you, asphalt, and or cement, it is problematic.
Alkaline will lead to permanent blindness
42
visual acuity test
Patient stands 20 feet (6 meters) away.
Asked to read the smallest line of letters possible.
Result is recorded as a fraction:
20/20 = normal vision
20/40 = sees at 20 feet what a normal person sees at 40
20/200 = legally blind in the U.S.
higher the denominator the worse the visual acuity
43
pinhole exam
They wear glasses
Correction you force the exam to correct
44
Conjunctivitis management for Bacterial
– Antibiotics—Topical antimicrobial agents
such as Sulfacetamide, erythromycin,
gentamicin, ciprofloxacin*** safe bet for contact lenses or ofloxacin
45
treatment for viral conjunctivitis
support care, cool compress, artificial tears
46
allergic conjunctivitis treatment
oral antihistamines sertizine, Zyrtec; h1 blocker; systemic antihistimines
47
Conjunctivitis management for Bacterial ( STI)
ceftriaxone 500mg IM x 1
Doxycycline or azithromycin
48
intense pain******
* Sense of foreign body
in the eye
* Redness
* Tearing
* Decreased visual
acuity
* photophobia*****
* Evert lid to inspect for
signs of trauma,
document findings with
location.
corneal abrasion
49
Management of corneal abrasion
* Antibiotics main stream therapy
– Oflaxacin, ciprofloxacin, erythromycin,
sulfacetamide, tobramycin, gentamicin
* Anticholinergic agents (ophthalmology Rx)
– Cyclopentolate HCL 1%, atropine, scopolamine
* Tetanus vaccine (Tdap)
topical anesthesics during the exam not sto send home***
50
tetanus tdap for corneal abrasion**** important bullet here
wood and or metal getting into the eye, need to cover for the tetanus
Something clean you can cover for 10 years but if it's something dirty 5 years also covers for cell pertussis
51
avoid ______ in the eye
steroids
52
retinal detachment
separation of the neural retina from the choroid
is a medical emergency where the neurosensory retina separates from the underlying retinal pigment epithelium (RPE), leading to vision loss if not treated promptly.
⚠️ Key Points:
Feature Description
Cause Most commonly due to a retinal tear or hole, allowing fluid to accumulate under the retina.
Types 1. Rhegmatogenous (most common – due to tear)
2. Tractional (due to fibrous tissue pulling, e.g., in diabetic retinopathy)
3. Exudative (fluid buildup without a tear – due to inflammation, tumor, or systemic disease)
Risk Factors - High myopia
- Trauma
- Previous eye surgery (e.g., cataract)
- Family history
- Retinal degeneration (e.g., lattice degeneration)
👁️ Symptoms:
Sudden appearance of floaters
Flashes of light (photopsia)*******
A "curtain"***** or shadow descending over vision
Blurred or reduced vision
No pain (retina has no pain receptors)
53
seeing a V on the ultrasound for retinal dettachment usually means what
the macula is involved
54
Sudden appearance of floaters
Flashes of light (photopsia)*******
A "curtain"***** or shadow descending over vision
Blurred or reduced vision
No pain (retina has no pain receptors)
painless* floaters and flashers***
retinal detachment
55
Painless visual changes, floaters, blurred
vision, light flashes
* As detachment becomes pervasive a
curtain may obscure part or all of the field
of vision
retinal detachment
56
retinal detachment
Painless visual changes, floaters, blurred
vision, light flashes
* As detachment becomes pervasive a
curtain may obscure part or all of the field
of vision
57
An older adult presents with sudden onset of
severe eye pain, headache, nausea, and blurred
vision. On examination, the pupil is mid-dilated
and non-reactive to light, and the cornea appears
hazy. Intraocular pressure is 45 mmHg. Which of
the following best describes this classic
presentation?
A. Acute angle-closure glaucoma
B. Open-angle glaucoma
C. Central retinal artery occlusion
D. Viral conjunctivitis
A. Acute angle-closure glaucoma
58
During a fundoscopic exam, the AGACNP observes the
retinal vessels to assess for systemic disease. Which of the
following findings best describes the normal structural
differences between retinal arteries and veins?
A. Retinal arteries are darker, wider, and have less prominent
light reflex than veins.
B. Retinal veins are narrower, lighter in color, and display a
bright central light reflex.
C. Retinal arteries are lighter in color, narrower, and have a
more prominent light reflex compared to veins.
D. Retinal veins and arteries are indistinguishable during
routine examination.
✅ C. Retinal arteries are lighter in color, narrower, and have a more prominent light reflex compared to veins.
59
A 58-year-old patient presents with eye redness,
mild discharge, and itching. The AGACNP
suspects conjunctivitis. Which of the following
findings would be atypical and should prompt
consideration of an alternative diagnosis?
A. Tearing and mild conjunctival injection
B. Itching and watery discharge
C. Foreign body sensation without vision loss
D. Moderate to severe eye pain
D. Moderate to severe eye pain
60
Disorder of progressive visual loss.
* Peripheral vision decreases first.**** initially this
* Often caused by increased
intraocular pressure that leads to
partial or complete blindness
glaucoma
they can see well int he center, but they are starting to lose the peripheral vision; families will tell you this; and its becuase the pressure is so high pushing on the optic nerve
61
things that cause the pupils to dilate can cause?
angle closure glaucoma, things like inhaled glucocorticoids; any sympathomimetic lots of decongestants like farina Sudafed's sudafedrine all those medications dilate your pupils like anticholinergics; antidepressants, di[hredrimine; dilate angle make it worse or a dark room makes it worse
62
intraocular pressure nomrmals
5-15; 5-20
above 20 it is elevated
acute angle glacuoma above 40 (pushing on a golf ball, it was tight)
63
acute versus chronic angle glaucoma
Acute = rapid onset, dramatic symptoms, emergency; sudden minutes to hours; inc pressure >40 severe eye pain older age female ; pupil poorly responsive red eye***
Chronic = silent progression, gradual damage; slower and often asymptomatic progression
64
Tonometry
Measures IOP
Screens for and monitors glaucoma
45 degree angle not flat
balloon and touching the balloon
Breathe, do not hold the breath
65
Pachymetry
Measures corneal thickness
Adjusts IOP readings and glaucoma risk
66
Gonioscopy
Views anterior chamber angle
Differentiates types of glaucoma
67
management for glaucoma
Immediate referral to ophthalmologist
Laser surgery vs. medical treatment
Prostaglandins analog –Prost ending drugs
Beta blockers
Alpha-agonists
Cholinergic agents
Carbonic anhydrase inhibitors
68
Drugs for the management of glaucoma
diamox; a carbonic anhydrase inhibitor; or mannitol ; or chronic- prostaglandin latanoprost (Prost)**** once daily
could also given timolol BB to decrease aquenous humor production
69
managment for open angle:
BLT
Latanoprost 1 drop (PM DAILY)
* Timoptic opthalmic solution 0.25% to
0.5% 1 drop bid
* Brimonidine 2 or 3 times daily
70
managemtn for closed angle
Closed angle
* An ophthalmologic emergency!!!!!
Consult Ophthalmologist as soon as
diagnosis is suspected
* Timolol
* Apraclonidine
* Pilocarpine
* Acetazolamide 500mg PO or IV
71
lashes come off easily flakey edema greasy erthema
blepharitis
72
acute inflammation of the zeis gland or eyelash follicles
hordeolum
H for hurts***
73
bug that causes blephritis
staph aureus
could be chronic like patient with ezxcema inc likelyhood to getting this
74
management for blephirits
topical antiseptic ointemnt;l baby shampoo and use the toothbrush to brush off the flakes; clean; shouldnt affect the vision
75
bug that causes a stye
staph aurues again
76
patient higher risk of getting inflammation to the eyelid
patient with eczema
77
Diffuse swelling,
tender, erythema of lid
margin
* Diffuse s/s and
localized tenderness
at culprit gland
* Self-limiting, improves
spontaneously
* Treatment- Warm
compress, antibiotics
(topical vs oral)
stye/hordeolum
78
preseptal celulitis
Infection anterior to the orbital septum; Less severe, non-vision threatening; gradual and yes eyelid sweliing
Oral antibiotics (e.g., amoxicillin-clavulanate, clindamycin)
79
perorbital celulitis
moves the eye with the ocular mvoement hurts and pain, lateral gaz eof the eye causes pain
iv vanco---IV antibiotics (e.g., ceftriaxone + vancomycin)
need to be admitted
80
81
82
Senineuro hearing loss things that cause it
Measles nerve problems drugs like gentamicin vancomycin. Not an air problem. Barotrauma autistic trauma
NSAIDs and diuretics are ototoxic and also stroke could cause it
83
Rhine and Weber
Normal tuning fork middle of the skull the sound is symmetrical that’s Weber
Rhine tuning fork mastoid when you stop hearing and bring to the front and when you stop.
Air conduction is greater than bone. A two to one ratio. So the example is if they hear for 15 seconds on the bone they should hear for 30 seconds on the air
84
Conductive hearing loss what would the Weber test tell us
There would be hearing loss on the affect ear
So it lateralize to the same side the affected ear
85
If you do the Weber test on the sensorineural hearing loss
It will go to the unaffected ear since that ear has a nerve to listen too
86
87
The ratio for the rhine test in a sensorineural hearing loss will be
Normal
Normal limits
88
Otitis media
Painful inflammation of external auditory canal and auricle
Commonly known as swimmers ear
Fungi bacterial or trauma
Painful
Tenderness to the movement of the pin a or the tragus
89
Patient coming in with recurrent ear infections and or skin infections a top differential
Diabetes
Get a finger stick
90
What kind of hearing loss would otitis externa have
Conductive
91
Treatment management for otitis externa 
You can do a clinical practice we put an earwick. Make sure that when you’re doing the earwick that you lubricated with an oil based something like Pearson because the Pena is already inflamed and irritated. 
92
When do I take out the earwick? How do you educate the patient? 
When the swelling goes down, it’ll automatically fall out. That makes sense.
93
Medication management for otitis externa check for tympanic membrane involvement if it’s been perforated why and what drugs 
So management here is key hydrocortisone neomycin polymycin these drugs, though especially something like gentamycin if that’s in panic membrane is perforated can cause auto toxicity. So a safe bet will be ciprofloxacin and dexamethasone. 
94
If your patient has more a diffuse cellulitis with otitis externa, what PO medication can you give
Ciprofloxacin
95
If you’re out camping and you don’t have access to drugs or meds and you have titis external, what can you do?
You can put acid/vinegar 
96
An infectious or inflammatory process
within the middle ear
• May be acute or chronic
Acute Otitis Media (AOM) or
Otitis Media with effusion (OME)
97
Eustachian tube dysfunction or
congestion
Otitis media
98
What are the infectious agents that can cause otitis media
Infectious causative agents
– URI viral common
– Strep pneumo, H influenzae, M catarrhalis
• Common in children but also seen in
those with cleft palate, Down’s
syndrome, allergic rhinitis
99
Physical exam findings for otitis media
•Red, dull, bulging
tympanic membrane with
poor mobility
100
Treatment medications for otitis media
EAR Ache A amoxicillin
oxicillin 875 BID
• Severe disease 875mg q12 hr or 500mg q8hr
• PCN allergies
– Ceftriaxone 2gm IM/IV x1
– Cefuroxime 500mg q12hr
– Severe allergy to beta lactam choose a macrolide:
azithromycin, Clindamycin
• Should see improvement in 48-72 hrs. if no
improvement, re-examin
101
A type of of chronic otitis media
• Poor function in the eustachian tube leads to negative pressure in the middle ear.
This pulls a part of the tympanic
membrane into the middle ear, creating a
pocket or cyst that fills with old skin cells
and other waste materi
Cholesteoma
