HEENT 2

Question 1

hordeolum aka

Answer 1

stye

Question 2

hordeolum (style) is what

Answer 2

an external hordeolum is an abscess of a hair follicle and sebaceous gland in the upper or lower eyelid

Question 3

an external hordeolum is an abscess of a hair follicle and sebaceous gland in the upper or lower eyelid

Answer 3

hordeolum/style

Question 4

internal hordeolum/stye involves

Answer 4

inflammation of the meibomian gland

Question 5

hordeolum/style tx
3

Answer 5

1. most resolsve on own
2. hot compresses 5-10minutes 2-3 x day
3. if infection spreads (preseptal cellulitis), start empiric abx tx

Question 6

keratitis

Answer 6

inflammation of the cornea

Question 7

infectious keratitis - pt c/o
5

Answer 7

acute onset of red eye
blurred vision
water eyes
photophobia
sometimes a foreign body sensation

Question 8

red, painful eye in any contact lens wearer

Answer 8

infectious keratitis

Question 9

infectious keratitis tx plan
7

Answer 9

1. always check visual acuity and pupils with penlight
2. if suspect bacterial infection, obtain C&S of eye discharge
3. flush eye with sterile NS to remove foreign body
4. urgent opthalmologic referral & start topical empiric abx tx
5. stop contact lens use, do not patch eye
6. consider pain script
7. consider topical pain meds (ketorolac tromethamine 1 gtt 4 x day)

Question 10

open angle glaucoma is characterized by

Answer 10

progressive peripheral visual field loss followed by central field loss (late manifestation)

Question 11

open angle glaucoma classic case

Answer 11

most often in elderly with diabetes; gradual changes in peripheral vision (lost first) then central vision; complains of missions portions of words when reading

Question 12

open angle glaucoma opthalmoscopic exam reveals

Answer 12

cupping, the optic nerve taking on a hollowed appearance; if cupping, the IOP is too high, refer to opthalmologist

Question 13

open angle glaucoma tx plan
2

Answer 13

1. check IOP with tonometer; normal range is 8-21 mmHg
2. IOP 30 or more is considered very high, urgent referral within 24 hours to opthalmologist or referral to ED

Question 14

1st and 2nd leading cause of blindness in the world

Answer 14

1. cataracts
2. open angle glaucoma

Question 15

open angle glaucoma meds
2

Answer 15

1. xalatan (Latanoprost) - topical prostaglandin eye drops to increase aqueous outflow
2. timolol 0.5% (Betimol) - beta blocker eye drops to decrease aqueous production

Question 16

pterygium

Answer 16

“surfers eye” - a yellow, triangular (wedge shaped) thickening of the conjunctiva that extends across the cornea on the nasal side

Question 17

“surfers eye” - a yellow, triangular (wedge shaped) thickening of the conjunctiva that extends across the cornea on the nasal side

Answer 17

pterygium

Question 18

pterygium results from

Answer 18

chronic sun exposure

Question 19

pterygium tx plan
3

Answer 19

1. manage sx with topical lubricants (eye drops)
2. good quality sunglasses
3. surgical removal if encroaches on cornea and affects vision

Question 20

pinguecula

Answer 20

raised, yellow to white, small, round lesions arising at the limbal conjunctiva next to the cornea; caused by chronic sun exposure

Question 21

sjogrens syndrome

Answer 21

chronic autoimmune disorder characterized by decreased function of the lacrimal and salivary glands

Question 22

chronic autoimmune disorder characterized by decreased function of the lacrimal and salivary glands

Answer 22

sjogren’s syndrome

Question 22

subconjunctival hemorrhage

Answer 22

blood that is trapped underneath the conjunctiva and sclera secondary to broken arterioles

Question 23

subconjunctival hemorrhage resolves in

Answer 23

1-3 weeks like a bruise, blood reabsorbed

Question 23

inflammation of the nasal cavity and paranasal sinuses

Answer 23

acute bacterial rhinosinusitis

Question 24

acute bacterial rhinosinusitis classic case

Answer 24

pt c/o unilateral pain or upper molar pain (maxillary sinus) with nasal congestion for 10 days or longer with purulent nasal and/or postnasal drip

Question 25

maxillary sinus location

Answer 25

front cheek

Question 26

ABRS tx plan

Answer 26

self limiting disease, symptom mgmt with oral fluids and saline nasal irrigation f/u in 10 days, if better no abx needed

Question 27

ABRS abx tx first line

Answer 27

augmentin 500/125 PO TID or 875/125 PO BID

Question 28

ABRS PNC allergy or alt abx 2

Answer 28

doxy BID 100 mg PO 3rd gen cephalosporin like cefixime 400 mg or cefpodoxime 200 mg BID

Question 29

ABRS - for drainage, what oral decongestants

Answer 29

pseudoephedrine (Sudafed) or pseudoephedrine combined with guaifenesin (Mucinex D)

Question 30

most common bacterial pathogens for AOM 2

Answer 30

stept pneumoniae hemophilus influenzae

Question 31

AOM first line treatment for any age group

Answer 31

augmentin 875/125 PO BID

Question 32

AOM tx PNC allergy

Answer 32

cefdinir

Question 33

may mimic AOM

Answer 33

bullous myrinigits - limited to the TM and does not affect the contents of the middle ear

Question 34

infectious condition characterized by the presence of blisters (bullae) on a reddened and bulging TM

Answer 34

bullous myringitis

Question 35

most common organisms to cause otitis externa 3

Answer 35

1. pseudomonas aeruginosa (gram neg) 2. staphylococcus epidermidis (gram pos) 3. S. aureus (gram pos)

Question 36

otitis externa med tx (intact TM)

Answer 36

topical abx with a glucocorticoid - cipro hydrocortisone for 1 week

Question 37

otitis externa med tx (TM not intact) 2

Answer 37

topical fluoroquinolone (e.g. ciprofloxacin) or oral abx (e.g. levofloxacin 500 mg PO 1 x day)

Question 38

otitis externa tx plan - keep what out of ears

Answer 38

keep water out of ear during treatment; hearing aids and other devices should not be worn until pain and discharge subsides