HEENT Flashcards
(125 cards)
1
Q
red eye red flags (7)
A
decreased visual acuity
ciliary flush
severe FB sensatio
corneal opacity
fixed pupil
severe HA w/ nausea
photophobia
2
Q
chemosis is associated w/
A
allergic conjunctivitis
3
Q
acute/ subacute painless vision loss, progressive scotoma
A
retinal detachment
4
Q
tension HA frequency
A
intermittent/ chronic (waxes and wanes)
5
Q
EBV dx
A
monospot
CBC w/ diff (increased atypical lymphocytes)
also cx for strep
6
Q
EBV tx
A
supportive
activity restriction (to avoid splenic rupture)
maintain hydration
maybe steroids if severe
7
Q
abortive tension HA tx
A
NSAIDS
8
Q
what medications can cause rhinitis
A
topical decongestants
anti-hypertensives (alpha/ beta blockers)
oral contraceptives
9
Q
burning, red eyes with mucopurulent discharge
A
bacterial conjunctivitis
10
Q
conjunctivitis + adherent lids
A
bacterial conjunctivitis
11
Q
allergic rhinitis refractory tx
A
immunotherapy w/ an allergist
12
Q
matting means what
A
sticking together (like adherent lids) seen in conjunctivitis
13
Q
double worsening/
double sickening
A
bacterial sinusitis
14
Q
no current infection but recent AOM/ SAR/ eustachian tube dysfunction
A
otitis media with effusion
15
Q
malaise
sore throat
fever
enlarged, tender cervical LAD
red throat/ tonsils and exudates
abdominal pain
A
EBV
16
Q
epiglottitis tx
A
admit
intubate
abx
17
Q
blood and thunder retinal appearance
A
central retinal vein occlusion
18
Q
when do you avoid giving ampicillin and amoxicillin in a pt w/ strep
A
when they also have EBV
19
Q
retinal hemorrhages and dilated retinal veins
A
blood and thunder seen in central retinal vein occlusion
20
Q
w/ otitis externa, what do you ALWAYS document
A
the appearance of the TM
21
Q
OE with TM perforation management
A
ofloxacin otic solution (floxin otic)
22
Q
abortive cluster HA tx
A
O2
23
Q
what tx is not helpful with nonallergic (vasomotor) rhinitis
A
immunotherapy
oral antihistamines
24
Q
pale boggy nasal mucosa
A
allergic rhinitis
25
bluish purple rings around both eyes
allergic shiners seen with allergic rhinitis
26
malignant OE tx
admit
IV cipro
ENT referral
27
Group A Strep pharyngitis tx:
first line:
PCN allergy:
PLUS:
first line: PCN (Pen VK, amoxicillin) or ceph (cephalexin)
PCN allergy: azithromycin/ clindamycin
PLUS
supportive tx: lozenges, NSAIDS, acetaminophen
28
what triggers nonallergic (vasomotor) rhinitis
perfumes
cigarette smoke
weather conditions
hot/ spicy foods
ETOH, cleaning products
29
AOM 1st line abx tx
HD amoxicillin 90 mg/kg/day divided Q12
30
associated sxs w/ tension HA
NO associated sxs (n/v, phonophobia or photophobia)
31
retinal detachment tx
REFER immediately
32
acute eye pain
FB sensation
lacrimation
photophobia
corneal abrasian
33
pharyngitis with cough and rhinorrhea is probably of what etiology
viral
34
migraine frequency
chronic
35
clear rhinorrhea
sneezing
itchy eyes/ nose
nasal congestion
post nasal drip
cough
conjunctival injection
allergic rhinitis
36
edema of the conjunctiva
chemosis
37
epiglottitis etiology
H flu
Type B HiB
38
thumb sign on lateral neck xray
epiglottitis
39
OE with fluffy, white, black discharge
fungal
40
what do you not do with a pt with epiglottitis
stick something in their throat
41
conjunctivitis + chemosis,
matting,
hx of atopy
allergic conjunctivitis
42
OE with NO TM perforation management
cortisporin otic suspension (polymyxin, neomycin, and hydrocortisone)
43
corneal abrasion tx
topical abx (erythromycin ointment/ trimethoprim-polymyxin drops)
+ contact wearers get pseudo coverage (fluoroquinolone)
+ oral pain meds
44
associated sxs w/ migraine
photophobia
phonophobia
n/v
+/- aura
45
acute, total, painless vision loss
+ whitening of retina
+ afferent pupillary defect
central retinal artery occlusion
46
drooling
tripod position
sniffing position
anorexic
epiglottitis
47
what do you NOT do to tx corneal abrasion
do NOT give topical steroids or anesthetic drops,
do NOT patch
48
malignant otitis externa is most common in
immunocompromised pts (elderly, DM, HIV)
49
best initial test for malignant OE
CT
50
what is rhinitis medicamentosa
rebound congestion (rhinitis) that is induced by overuse of topical decongestants
51
uni/bilateral, throbbing HA
migraine
52
prophylactic migraine HA tx
BB
TCA
CCB
anticonvulsants
avoid triggers
53
different abx used in AOM tx
HD amoxicillin
augmentin
cefdinir, cefuroxime, cefpodoxime
IM/ IV ceftriaxone
azithromycin
54
4 sxs of OE
ear pain with movement
pruritis
conductive hearing loss
discharge
55
AOM ceftriaxone dose
50 mg IM/ IV once daily x 1-3 days
56
abrupt onset sore throat
odynophagia
arthralgias/ myalgias
fever
anorexia
N/V
fine sandpaper-like rash
streptococcal pharygitis
57
bulging red TM with distorted landmarks
effusion
poor TM mobility
AOM
58
nasal congestion
purulent nasal discharge
HA
facial pain/ pressure
PND
halitosis
decreased sense of smell
dental pain
cough from PND
bacterial sinusitis
59
when do you tx bacterial sinusitis with abx
persistent, not improving sxs for more than 10 days
or
severe sxs (fever \> 102, purulent nasal discharge, 3-4 days of sinus pain)
or
a viral URI that lasted for 5-6 days, improved, then worsened (double worsening)
60
nonallergic (vasomotor) tx
avoid triggers
nasal steroids
nasal antihistamine spray
atrovent
61
bacterial sinusitis tx:
first line abx tx
PCN allergy tx
PLUS
first line: augmentin
PCN allergy: doxycycline/ levofloxacin
PLUS
sxs meds: saline irrigation, analgesics, mucolytics, nasal steroids, decongestants
62
what abx do you avoid with a pt with strep and EBV
amoxicillin
ampicilin
63
denie morgan lines
skin folds under eyes consistent with allergic conjunctivitis
associated with allergic rhinitis
64
associated sxs w/ cluster HA
ipsilateral ptosis
lacrimation
conjunctival injection
rhinorrhea
nasal congestion
sweating
65
burning, red eyes with watery discharge
viral conjunctivitis
66
bacterial conjunctivitis tx
topical abx
quinolones for contact wearers
DC contacts
67
OE with green, yellow discharge
pseudomonas
68
unilateral, stabbing, severe HA
cluster HA
69
nasal congestion
rhinorrhea
PND
but NO: ocular/ nasal itching or sneezing
chronic nonallergic (vasomotor) rhinitis
70
what are some associated sxs you should ask about in regards to HA
nausea, vomiting, photophobia, phonophobia, focal neuro sxs
71
when do you give a pt w/ AOM abx
under 6 mos OR over 6 mos w/ severe sxs
OR
6-23 mos and bilateral
OR
a joint decision with the parents
72
cherry red spot in macula
central retinal artery occlusion
73
when is PND worse
what is it associated with
**at night and in the morning**
**associated with:**
**rhinitis** (allergic/ chronic nonallergic vasomotor)
**bacterial sinusitis**
74
prophylactic cluster HA tx
verapamil
avoid triggers (smoking)
75
HA red flags
* first time and severe (especially if pt is over 50)
* nuchal rigidity
* vision changes
* papilledema/ retinal hemorrhage
* neuro signs
* fever
* hypertension
* "worst HA of life"
* HA precipitated by exertion
* hx of trauma/ malignancy/ coagulopathy
* change in HA pattern
76
this type of HA happens more in males
cluster HA
77
middle ear fluid WITHOUT sxs of acute infection
otitis media with effusion
78
what does pharyngitis and tonsilitis often present with
rhinorrhea and cough
| (as part of the common cold)
79
conjunctivitis + URI sxs, preauricular LAD, matting
viral conjunctivitis
80
if you don't give abx to AOM, what do you do?
observation w/ 48 to 72 hour FU
81
ear pain that increases with movement
otitis externa
82
what do you need to do w/ a corneal abrasian
evert the eyelid
83
abortive migraine HA tx
NSAIDS
triptans
84
severe otalgia
otorrhea
life threatening
malignant otitis externa
85
tender tragus
otitis externa
86
acute painless vision loss
retinal detachment/ central retinal artery occlusion/ central retinal vein occlusion
87
when do you NOT tx bacterial sinusitis w/ abx
if the sxs are mild and short lived
| (likely viral caused)
88
amber/ straw colored fluid behind TM
air fluid level
bubbles
otitis media with effusion
89
cobblestoning
allergic rhinitis
90
which conjunctivitis can be unilateral (as well as bilateral)
bacterial
91
otitis media with effusion tx
self limiting
observation
tympanostomy tubes for persistent fluid/ hearing loss
92
pharyngitis/ tonsillitis dx
throat cx (gold standard but takes 24-48 hours)
rapid antigen detection test (Group A Strep)
monospot (EBV)
heterophile antibodies
93
which conjunctivitis can feel "gritty" and burning
viral
94
floaters, a curtain over vision, photopsias
retinal detachment
95
peritonsillar abscess etiology
Group A Strep
staph aureus
resp anearobes
H. Flu
96
drooling
fever
severe sore throat
no cough
epiglottitis
97
bacterial sinusitis complications
osteomyelitis
periorbital/ orbital cellulitis
meningitis
brain abscess
epidural abscess
**REFER IMMEDIATELY**
98
what are severe signs/ sxs associated with AOM
moderate/ severe otalgia
otalgia for more than 48 hours
temp higher than 39
99
most cases of pharyngitis and tonsilitis are of what etiology
**viral**: rhinovirus, adenovirus, parainfluenza
only 20% are bacterial
100
hot potato voice
peritonsillar abscess
101
itchy, red eyes with watery discharge
allergic conjunctivitis
102
cluster HA frequency
intermittent
| (30 mins to 3 hours)
103
scotoma
partial loss of vision/ blind spot
104
prophylactic tension HA tx
reduce stress, encourage stretching
105
allergic conjunctivitis tx
artificial tears
topical antihistamines
mast cell stabilizers
106
what are the aggravating/ alleviating factors you should ask about in regards to HA
light
darkness
movement
stress
food
drink
107
ddx: ear pain
* otitis externa
* AOM
* cerumen impaction
* FB
* dental probs
* trauma
* bells palsy
* sinusitis
* pharyngitis
* lymphadenitis
* barotrauma
* TMJ syndrome
* eustachian tube dysfunction
108
allergic rhinitis tx
avoid allergens
nasal steroids
antihistamines
decongestants
antileukotriene agents (montekulast)
109
severe sore throat
drooling
trismus
unilateral peritonsillar swelling
deviated uvula
peritonsillar abscess
110
what complicates OE tx
atopic dermatitis
contact dermatitis
fungal infection
111
malignant OE aka
necrotizing external otitis
112
hearing loss
ear fullness
afebrile
otitis media with effusion
113
bilateral, squeezing, band-like HA
tension HA
114
allergic salute
allergic rhinitis
115
HA that usually begins around the eye
cluster HA
116
medication overuse HA severity and location
varies
117
not eating
tugs at ear
irritable
restless
hearing loss
URI sxs
AOM
118
photopsias
light flashes
119
peritonsillar abscess tx
monitor airway
surgical drainage
supportive care (fluids, pain control)
IV abx
120
which conjunctivitis is chronic
allergic (seasonal)
121
viral conjunctivitis tx
lubricant drops
compresses
self limiting
122
most effective singe agent maintenance therapy for allergic rhinitis
nasal steroids
123
most malignant OE is caused by
pseudomonas
124
acute, blurry, painless loss of vision
+ afferent pupillary defect
central retinal vein occlusion
125
splenomegaly
EBV
