HEENT Flashcards by Marialaina Tomolonis

Diagnose

Hordeolum (Stye)

Warm compress mainstay

If no drainage after 48 hours I&D

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Chalazion

Eyelid hygiene, warm compress

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Difference between Hordeolum and Chalazion

Hordeolum is painful swelling with redness

Chalazion is painless swelling

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Dacryocystitis

Systemic abs. Clinda + 3rd gen cephalosporin

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clinical description of pt:

Present with Redness to nasal side of lower lid. What is the TX for this?

This is Dacrocystitis

Tx with systemic abx - clinda and 3rd gen ceph (omnicef)

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MC pathogen of dacrocystitis

S. Aureus

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What eye condition is assoc. w/ UV exposure in sunny climates as well as sand wind and dust?

Pterygium & Pinguecula

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Diff between Pterygium and Pinguecula

Pterygium grows

Pinguecula: Does not grow

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What structures make up the orbital floor?

Maxillary,

Zygomatic

Palatine

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Pt presents w/ Dec VA, “sunken” eye, Double vision, and anesthesia to anteriomedial cheek

w/u and Tx?

Ct scan to assess severity

Nasal decongestants (pain), Avoid nose blowing, Prednisone, Clinda or Unasyn

Ophtho referral

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Pt presents w/ misshapen eye w/ prolapse of ocular tissue, VA markedly reduced, enophthalmos, severe conjunctival hemorrhage, obscured red reflex, Teardrop shaped pupil

DX W/u

Globe Rupture

Seidel’s test (flourescene dye parting by clear stream of aqueous humor)

Ophtho emergency!!! - Rigid eye sheild

If blood in anterior chamber place pt as 45deg to keep RBC’s from staining cornea.

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What is the most common cause of permanent legal blindness and vision loss in the elderly?

Macular degeneration

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What do presence of Drusen indicate?

Small, round, yellow-white spots on outer retina

Dry (atrophic) Macular degeneration

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What are drusen?

small, round, yellow-white spots on the outer retina d/t an accumulation of waste product from the pretinal pigment epithelium

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Pt presents with what manifestations in macular degeneration?

Bilateral blurred/loss of central vision

Scotomas (blind spots, shadows)

Metamorphosia (straight lines appear bent)

gradually occuring sx.

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What is the most common cause of new, permanent vision loss/blindness in ages 25-74

Diabetic retinopaty

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describe

What are these assoc. w/

Cotton Wool spots

Non-proliferative Diabetic retinopathy

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4 grades of HTN retinopathy

Arterial narrowing
AV nicking

3 Flame shaped hemorrhage

4 Papilledema

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What sg are present on funduscopc exam in HTN retinopathy

Copper and silver wiring

AV nicking

Flame shaped hemorrhage, and cotton wool spots

Papilledema

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Etiology of Papilledema

Optic nerve swelling 2ry to intracranial pressure

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w/u for papilledema

MRI/CT to r/o mass effect

Lumbar puncture

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Tx for papilledema

Diretics and acetazolamide

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Clinical presentation states pt w/ floaters, flashing lights, shadow “curtain” in peripheral no pain/redness.

DX Tx

Retinal detachment

Ophtho emergency. keep patient supine

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What test can be used to detect fB?

Flourosceine Dye

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Organisms in Orbital Cellulitis

S. pneumo GABHS Hflu S aureus

Orbital cellulitis presentation

Dec vision Pain w/ movement Proptosis eyelid edema exopthalmos

W/u for orbital cellulitis

High res CT scan

Tx for orbital cellulitis

IV VAnco, clinda, cefotaxime

halo's around lights make you think \_\_\_\_

Glaucoma

Mid-dilated, nonreactive pupil makes you think \_\_\_\_

glaucoma

Steps to manage glaucoma

1. dec iop (acetazolamide IV, manitol) 2. topical beta blocker (Timolol) 3. Open the angle (cholinergics pilocarpine) 4. Periphera iridotomy-definitive tx.

Mc pathogen of viral cojunctivitis

Adenovirus (swimming ppool mc source)

Clinical sx. of viral cojunctivitis

Preauricular lymphadenopathy w/ URI sx, copious WATERY drainage, scant mucoid d/c, often bilaterally

TX for viral cojunctivitis

cool compress, antihistamines

Allergic conjunctivitis differs from viral conjunctivitis in that it \_\_\_\_\_

(similar in that it may have the same URI sx), Key term is "cobblestone mucosa" in upper eyelid, itching tearing, redness, STRINGY d/c

Bacterial Conjunctivitis is different than viral or allergic conjunctivitis becaues it has \_\_\_\_

purulent (instead of mucoid or stringy) d/c, Lid crusting,

MC pathogen in bact. conjunctivitis

Staph/strep. Contact lens wearers-think pseudomonas

TX of bact. conjunctivitis

For contact lens wearers consider pseudomonas - tx w/ FQ, or tobrex Otherwise topical Emycin

MC etiology of optic neuritis

Clinical manifestation of optic neuritis

1. Color vision loss 2. scotoma (blind spot) 3. Ocular pain worse w/ eye movement

Define Marcus Gunn Pupil

When light is shown from unaffected eye to affected eye the pupils appear to dilate rather than constricut (deayed response to affected nerve)

"Limbic flush" is related to what dx?

Uveitis (iritis)

Pale retina w/ "chery red-macula" (red spot)

Central Retinal artery occlusion

"Blood and thunder appearance"

Central retinal vein occlusio

"Box car appearance"

Central retinal artery occlusion

Absent red reflex w/ lens opacification

Cataract

White pupil w/ absent red reflex

Retinoblastoma

Which artery is commonly involved in amaurosis fugax

External Carotid artery

What is a normal cup to disk ratio?

1:2 The disk should be 2x as large as the cup

MC pathogen of OE

Pseudomonas

Tx of OE

Cipro/dexamethasone

MC organisms of AOM

S pneumo (MC) H flu Moraxella catarrhalis S pyogenes

Tx for AOM

1. Amoxicillin 10-14d (cefixime in children, Augmenting 2ndline) 2. If pcn allergic - emycin 3. myringotomy 4. tympanostomy

Deep ear pain, mastoid tenderness concerning for?

mastoiditis

TX for mastoiditis

AV ABX w/ myringotomy (ampicillin, cefuroxime)

Weber

fork on center of head to see if sound lateralizes Lateralizes --\> Bad ear with CHL Lateralizes --\> Better ear with SNHL

Rinne

Put fork on mastoid and then up to the ear (should continue to hear) CHL if Bone\>air SNHL if Air\>Bone

Eustachian tube dysfunction tx

1. Decongestants (pseudoephedrine, phenylephrine, oxymetazoline nasal spray). 2. Auto insufflation (yawn, swallow) 3. Nasal steroids

Accoustic neuroma- Define

Cranial nerve 8 schwannoma-benign tumor of schwann cells

Unilateral hearing loss is _____ until proven otherwise

acoustic neuroma

Sx of BPPV

Episodic vertigo, No hearing loss

Sx. of menieres

Episodic vertigo Hearing loss

Sx of Vest neuritis

continuous vertigo no hearling loss

Sx. of Labrythitis

Cont vertigo hearing loss

Which vertiginous d/o is caused by displaced otoliths?

BPPV

Which vertiginous d/o is caused by distention of endolymphatic compartment of inner ear by excess fluid?

menieres dz

diagnostic test of choice for acute sinusitis

CT scan

Pathogens of acute sinusitis

Same as AOM - Strep pneumo, GABHS, H flu, M catarrhalis

DOC for acute sinusitis

Amoxicillin

Chronic sinusitis is defined as?

sinusitis \>8wks

MC pathogen of chronic sinusitis

staph aureus

MC type of rhinitis

allergic

Clear rhinorrhea, w/ nasal poyps worse in AM

Allergic rhinitis

Wharton's duct is located where?

Submandibular

Stensos dunct is located where?

parotid glands

White patchy lesions that can't be rubbed off in a smoker

Leukoplakia

Oral hairy leukoplakia is caused by?

EBV

If you see oral hairy leukoplakia what should you be concerned for?

HIV

white curd like plaquest that may or may not leave behind erythema/bleeding if scraped?

Oral candidiasis

Dx of oral candidiasis

KOH smear - budding yeast/hypae

Management of oral candidiasis

Nystatin tx. of choice, fluconazole po

Small round oval or painful ulcers w/ erythematous halos

Aphthous ulcers

for aphthous ulcers

topical analgesics (triamcinolone or orabase) Cemetidine if recurrent

dysphagia, "hot potato" voice, difficult oral secretion, tismus, uvula deviation. W/u and TX

Peritonsillar abscess CT scan Drainage and abx - unasyn or clinda

pathogen of peritonsilalr abscess

strep pyogenes

Pathogen of epiglottitis

H flu B (MC cause) S pneumo becoming more common now though d/t vaccine

Primary manifestation of HSV1 in children

Acute herpetic geinivostomatitis

Gingivitis (gum swelling w/ friable/bleeding gums)

Acute herpetic gingivostomatitis

Think begnign if \_\_\_

it hurts if its acute Or if it rubs off

Think cancer (in the mouth if)

It's painless/lesion ulcer If chronic No matter how small in innocent appearing

Tx odontogenic pathology with what?

Pen VK or clinda

What is the most common eitology of laringitis

viral

HEENT Flashcards

(93 cards)