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NUR: 718 > HEENT > Flashcards

HEENT Flashcards

1
Q

Hordeolum (“Stye”)

most common causative organism

A

Staphylococcus abscess

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2
Q

Hordeolum (“Stye”) - external vs. internal

A

external - glands in eyelash follicle or lid margin

internal - inflammation of Meibomian gland

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3
Q

Hordeolum (“Stye”) - symptomology

A
  • localized edema (“bump”) and redness
  • acutely tender
  • pain proportional to amount of edema
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4
Q

Hordeolum (“Stye”) - exam findings

A
  • erythema
  • edema
  • tender
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5
Q

Hordeolum (“Stye”) - management

A
  • most resolve spontaneously without intervention over several days
  • warm, moist compresses 5-10 min. 3-5x/day
  • don’t wear eye makeup
  • possibly refer to ophthalmology
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6
Q

Hordeolum (“Stye”) - why refer to ophthalmology

A
  • no start to resolution in 1- weeks
  • bacitracin or erythromycin eye drops
  • incision and drainage
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7
Q

Chalazion - what is it?

A

granulomatous inflammation of Meibomian gland

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8
Q

Chalazion - symptomology

A
  • may be asymptomatic
  • itchy
  • flesh-colored “bump”
  • vision changes if “bump” is large
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9
Q

Chalazion - exam findings

A
  • flesh-colored, hard, swollen/indurated area
  • NON-tender
  • adjacent conjunctival injection
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10
Q

Chalazion - management

A
  • may resolve spontaneously over days or weeks
  • warm compresses 10-15 min. few times/day
  • possible referral to ophthalmology
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11
Q

Chalazion - why refer to ophthalmology

A
  • if eyelid is swollen causing drooping or obstruction of vision
  • corticosteroid injections
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12
Q

Cataracts - what are they?

A
  • abnormal, uniform opacity
  • leading cause of blindness
  • chronic, progressive
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13
Q

Cataracts - symptomology

A
  • may have increase in near-sightedeness before lens opacity starts to appear
  • progressive loss of vision
  • glare
  • NO pain
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14
Q

Cataracts - exam findings

A
  • loss of red reflex! (or darkening of red reflex)

- opacity on fundoscopic exam

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15
Q

Cataracts - management

A
  • glasses/magnifying glass
  • contact lenses
  • home safety
  • surgical tx to remove opacity
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16
Q

Age Related Macular Degeneration - what is it?

A
  • acute/chronic deterioration of central vision
  • older ages, white/Caucasian, female > male
  • irreversible
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17
Q

Age Related Macular Degeneration - 2 types

A
  • non-exudative (dry)

- exudative (wet)

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18
Q

Age Related Macular Degeneration - Nonexudative (dry) symptomology

A
  • slow, progressive loss over span of years
  • visual fluctuation
  • difficulty with night vision
  • distortion
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19
Q

Age Related Macular Degeneration - Exudative (dry) symptomology

A
  • progressive loss over span of months
  • acute or insidious
  • painless
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20
Q

Age Related Macular Degeneration - management

A
  • antioxidants (vit. A & E, copper, zinc, carotenoids) can help reduce speed of progression
  • VEFT inhibitors (ophthalmology rx)
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21
Q

Conjunctivitis (“pink eye”) - most common causes

A
  • bacterial or viral

- can also be allergic or contact (chemical irritants)

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22
Q

Conjunctivitis (“pink eye”) - general symptomology

A
  • NO effect on vision
  • diffuse conjunctival injection
  • mild pain possible (more discomfort or annoying sensation)
  • very itchy = allergic
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23
Q

Conjunctivitis (“pink eye”) - viral common cause

A

Adenovirus

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24
Q

Conjunctivitis (“pink eye”) - viral symptomology

A
  • typically bilateral
  • discharge = copious, watery
  • marked foreign body sensation
  • associated with UTI, pharyngitis, fever, malaise
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25
Q

Conjunctivitis (“pink eye”) - viral management

A
  • symptomatic (cold compresses)
  • artificial tears
  • antihistamine/ decongestant drops
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26
Q

Conjunctivitis (“pink eye”) - viral exception!

A

Herpes Simplex Virus (HSV)

  • unilateral
  • lid vesicles
  • possible acute hemorrhagic conjunctivitis
  • tx = topical antiviral (ganciclovir) and/or systemic (acyclovir)
  • REFER!
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27
Q

Conjunctivitis (“pink eye”) - bacterial symptomology

A
  • uni- or bilateral
  • discharge = copious, mucopurulent, possible eyelash matting
  • self-limiting (10-14 days without tx)
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28
Q

Conjunctivitis (“pink eye”) - bacterial common cause

A

Staphylococci (MSSA, MRSA)

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29
Q

Conjunctivitis (“pink eye”) - bacterial management

A
  • erythromycin ointment or trimethroprim- polymyxin B drops
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30
Q

Conjunctivitis (“pink eye”) - bacterial exception!

A

Gonoccocal Conjunctivitis

  • EMERGENCY!
  • copious purulent drainage
  • corneal involvement may lead to perforation
  • tx: ceftriaxone 1g IM, topical (erythromycin, bacitracin)
  • REFER to ophthalmology
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31
Q

Corneal Abrasion - symptomology

A
  • tearing
  • blephorospasm
  • severe pain, foreign body sensation
  • watery or purulent discharge
  • blurry vision common
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32
Q

Corneal Abrasion - exam findings

A
  • Fluorescein stain - dye uptake at site of corneal defect (using slit-lamp)
  • circumcorneal injection
  • consider retained foreign body
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33
Q

Corneal Abrasion - managment

A
  • cycloplegic drops (1%) for exam only
  • simple/clean - topical erythromycin
  • dirty/contacts - ophthalmic ciprofloxacin
  • tetanus booster
  • patching and steroid preps contraindicated
  • ophthalmology follow-up within 24 hours
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34
Q

Corneal Foreign Body - symptomology

A
  • foreign body sensation
  • pain
  • tearing
  • redness
  • photophobia
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35
Q

Corneal Foreign Body - exam findings

A
  • normal or decreased visual acuity
  • conjunctival injection
  • visible foreign body
  • rust ring
  • epithelial defect with fluorescein stain
  • corneal edema
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36
Q

Corneal Foreign Body - management

A
  • cycloplegia drops (1%) for exam
  • remove foreign body
  • antibiotic drops (tobramycin, polymyxin B)
  • ophthalmology follow-up
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37
Q

Diabetic Retinopathy - 2 types

A
  • non-proliferative

- proliferative (less common, more severe)

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38
Q

Diabetic Retinopathy - non-proliferative phases

A
  • mild: at least 1 microaneurysm
  • moderate: microaneurysms and hemorrhages
  • severe (4-2-1): hemorrhages and microaneurysms in 4 quadrants, venous bleeding in 2+ quadrants, and intraretinal abnormalities in 1+ quadrants
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39
Q

Diabetic Retinopathy - proliferative hallmark sign

A

Neovascularization

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40
Q

Diabetic Retinopathy - symptomology

A
  • early/initial: asymptomatic
  • advanced: floaters, blurry vision, progressive visual acuity loss
  • visual acuity and symptoms are poor guides to presence of diabetic retinopathy
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41
Q

Diabetic Retinopathy - exam findings

A
  • microaneurysm: earliest, sign, looks like small dots
  • dot/blot hemorrhages: look similar to microaneurysms but in deeper layers
  • flame-shaped hemorrhage
  • cotton-wool spots
  • venous looping/ beading: significant predictor of proliferative from non-proliferative
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42
Q

Diabetic Retinopathy - workup/ diagnostics

A
  • lab: diabetes workup
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43
Q

Diabetic Retinopathy - management

A
  • control diabetes #1 (control sugar, BP, lipids)
  • REFER to ophthalmology (retina specialist)
  • annual screenings
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44
Q

Retinal Detachment - what is it?

A
  • separation of inner layers of retina from underlying retinal epithelium
  • can be spontaneous or penetrating/ blunt trauma
  • spontaneous generally affects > 50 years
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45
Q

Retinal Detachment - symptomology

A
  • photopsia: perceived flashes of light
  • rapid loss of vision in curtain-like fashion
  • may describe vision loss as a shadow
  • floaters
  • NO pain or redness
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46
Q

Retinal Detachment - workup / exam findings

A
  • ask about previous eye trauma, surgeries, conditions
  • visual acuity
  • external signs of trauma
  • assess pupil reaction
  • intraocular pressure (tonometry)
  • ophthalmoloscopic exam
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47
Q

Retinal Detachment - management

A
  • emergent referral to ophthalmology
  • NPO
  • protect globe if traumatic
  • avoid pressure on eye, limit activity
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48
Q

Central/Branch Retinal Artery Obstruction - most common cause

A

Embolus (cholesterol)

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49
Q

Central/Branch Retinal Artery Obstruction - risk factors

A
  • same as CVD

- smoking, HTN, CAD, high cholesterol, hx of TIA

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50
Q

Central/Branch Retinal Artery Obstruction - symptomology

A
  • acute, painLESS partial loss of vision
  • “descending nightshade”
  • monocular
  • central or sectoral visual deficits
  • may be asymptomatic
  • may c/o amaurosis fugax (transient loss of vision in one eye)
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51
Q

Central/Branch Retinal Artery Obstruction - workup / exam findings

A
  • ESR
  • consider coag panel: PTT, fibrinogen, CBC, lipid
  • ophthalmoscopic exam: box cars (segmented or narrowed flow) or cherry spots
  • CV work-up
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52
Q

Central/Branch Retinal Artery Obstruction - treatment

A
  • acute/rapid presentation: supine/ HOB flat
  • ocular massage
  • acetazolamide 500 mg IV (lower s intraocular pressure)
  • long-term antiplatelet therapy for stroke prevention
53
Q

Chronic (Angle-Closure) Glaucoma - symptomology

A
  • initially asymptomatic

- loss of peripheral fields (slow and insidious)

54
Q

Chronic (Angle-Closure) Glaucoma - exam finding

A
  • optic disk cupping! - looks at cup to disc ratio
  • visual field abnormalities
  • elevated IOP: > 20 mmHg
55
Q

Chronic (Angle-Closure) Glaucoma - management

A
  • aimed at lowering IOP
  • prostaglandin analogues (-prost)
  • beta blockers (-lol)
56
Q

Acute (Angle-Closure) Glaucoma - symptomology

A
  • cloudy/blurry vision or vision loss
  • extreme orbital pain
  • headache
  • halos around lights
  • GI symptoms (nausea, abdominal pain)
57
Q

Acute (Angle-Closure) Glaucoma - exam findings

A
  • ocular injections
  • corneal haziness
  • minimally reactive pupil
  • elevated IOP: 40-90 mmHg
58
Q

Acute (Angle-Closure) Glaucoma - management

A
  • LOWER IOP
  • refer to ophthalmology
  • carbonic anhydrase inhibitor (acetazolamide 500 mg IV x1)
  • once IOP decreases: cholinergic agonists (Pilocarpine 1 drop q15min for 1 hour)
  • definitive tx: laser peripheral iridotomy
59
Q

Bell’s Palsy - symptomology

A
  • acute onset of unilateral upper/lower facial paralysis with no other neuro symptoms (except those listed)
  • posterior auricular pain
  • decreased tearing
  • otalgia (aching of ear or mastoid)
  • weakness of facial muscles
  • poor eyelid closure
  • paresthesias of cheek/mouth
  • blurry vision
60
Q

Bell’s Palsy - exam findings

A
  • flattening of forehead/ nasolabial folds
  • lateralization with neuro exam (ex: when pt. smiles)
  • varying degree of neuro deficits
61
Q

Bell’s Palsy - House Brackman Facial Nerve Grading System

A

Grade 1: normal function
Grade 2: mild dysfunction, normal symmetry at rest
Grade 3: mod. dysfunction, can close eye with effort
Grade 4: mod-severe dysfunction, incomplete eye closure
Grade 5: sev. dysfunction, only barely perceptible motion
Grade 6: no movement

62
Q

Bell’s Palsy - Acute management

A
  • 4 day window to treat
  • corticosteroids (prednisone 60-80 mg x 5-7 days) for grade 1-3
  • antivirals (valcyclovir 1g TID x 7 days) + corticosteroid for grades 4-6
  • lubricating eye drops and protective measures
63
Q

Bell’s Palsy - long term management

A
  • refer to facial nerve specialist if symptoms persist or recurrent problems
64
Q

Vertigo - symptomology

A
  • intermittent/episodic dizziness

- nausea (typically no vomiting)

65
Q

Vertigo - work-up

A
  • Head impulse test (HIT)
  • Dix-Hallpike Test
  • Epley maneuvers
  • refer if not BPPV
  • antihistamine antiemetic (promethazine)
  • anticholinergics (scopolamine patch)
66
Q

Vertigo - Head impulse test (HIT)

A
  • sit face to face with provider holding patient’s head from the front
  • ask patient to fix their gaze on target (examiner’s nose)
  • turn the head rapidly to one side and then the other watching for presence or absence of corrective movement
  • normal: eyes continue to fixate on target
  • abnormal: eyes have to make corrective movement to re-fixate
67
Q

Vertigo - Dix-Hallpike Test

A
  • tests for BPPV
  • rapidly moving patient from sitting to supine position with head turned 45 degrees to right
  • after waiting 20-30 seconds, patient returned to sitting position
  • nystagmus = BPPV
68
Q

Vertigo - Epley maneuvers

A
  • series of maneuvers used to treat BPPV
  • turn head toward size that causes vertigo
  • quickly lay down on back, keeping head in same position and just off edge of table
  • slowly move head toward opposite side
  • turn body so that it is now in line with head
  • sit upright
  • may have to repeat
69
Q

Trigeminal Neuralgia - symptomology

A
  • brief/paroxysmal episodes of stabbing unilateral facial pain
  • usually one side of mouth and shoots towards ears or eyes
  • typically 2nd/3rd division of trigeminal nerve
  • exacerbated by touch, movement, eating
70
Q

Trigeminal Neuralgia - exam findings

A
  • normal neuro exam
71
Q

Trigeminal Neuralgia - diagnosis of exclusion

A

A. recurrent paroxsymal attacks of unilateral facial pain (plus B & C)
B. pain characteristics- seconds to 2 minutes, electric-like shock, stabbing, shooting
C. precipitated by innocuous stimuli within trigeminal distribution
D. not attributed to other causes

72
Q

Trigeminal Neuralgia - management

A
  • antiepileptic (carbamazepine)
73
Q

Hearing Loss - Conductive, what is it?

A
  • dysfunction of external/middle ear
  • mechanism: obstruction (cerumen), mass loading (effusion), stiffness (otosclerosis), discontinuity (ossicular dissruption)
  • persistent loss
74
Q

Hearing Loss - sensory, what is it?

A

deterioration of chochlea

75
Q

Hearing Loss - Neural, what is it?

A

lesions of CN VIII, auditory nuclei, ascending tracts, or auditory cortex)

76
Q

Hearing Loss - sensorineural, what is it?

A
  • most common form
  • gradual, progressive
  • presbycusis - high-frequency loss
  • others - excessive noise, head trauma, systemic disease
77
Q

Hearing Loss - evaluation/ work-up

A
  • Weber Test
  • Rinne Test
  • Formal audiometric studies (REFER)
  • screening (> 65 or exposure populations)
78
Q

Hearing Loss - Weber test

A
  • tuning fork on forehead
  • conductive: sound is louder in poorer-hearing hear
  • sensorineural: sound radiates to better ear
79
Q

Hearing Loss - Rinne test

A
  • tuning fork on mastoid
  • normal: air conduction > bone conduction
  • conductive: bone conduction > air conduction
  • sensorineural: air conduction > bone conduction (but less than normal hearing)
80
Q

Hearing Loss - management

A
  • REFER
  • treat cause when possible
  • hearing amplification
81
Q

Otitis Externa - common cause

A

pseudomonas or staph. aureus

82
Q

Otitis Externa - symptomology

A
  • otalgia/hearing loss
  • fullness or pressure
  • tinnitus
  • itching
  • severe deep pain
  • discharge
83
Q

Otitis Externa - exam findings

A
  • pain with palpation or traction of pinna (hallmark)
  • erythema, edema
  • narrowing of EAC
  • TM likely difficult to visualize
84
Q

Otitis Externa - management

A
  • antibiotics (antibiotic + glucocorticoid) (ex: cipro + hydrocortisone)
  • ear wick to penetrate if edema severe
  • analgesics
  • refer if concern for TM rupture
85
Q

Otitis Media - common causes

A
  • streptoccocus

- viral (when prescpitated by URI)

86
Q

Otitis Media - symptomology

A
  • decreased hearing
  • otalgia
  • fever
  • aural pressure
  • vertigo
  • n/v
87
Q

Otitis Media - exam findings

A
  • erythematous TM

- possible bulla on TM

88
Q

Otitis Media - management

A
  • antibiotics: amoxicillin/clavulanate (augmentin)
  • duration 5-7 days, will notice improvement 48 hours after start of tx
  • refer if recurrent or chronic
89
Q

Allergic Rhinitis (“hay fever”) - symptomology

A
  • sneezing, itching
  • rhinorrhea +/- post-nasal drip
  • congestion, headache
  • earache
  • eye swelling
  • fatigue, drowsiness, malaise
90
Q

Allergic Rhinitis (“hay fever”) - exam findings

A
  • allergic shiners
  • nasal crease/ allergic salute
  • nasal turbinates boggy, swollen, pale/grey/blue
  • secretions thin/watery
91
Q

Allergic Rhinitis (“hay fever”) - management

A
  • anthistamines (2nd gen = non-drowsy) +/- decongestants

- refer to ENT it don’t or are not longer responding to first-line

92
Q

Acute Sinusitis/ Rhinosinusitis - causes

A

VIRAL or bacterial

93
Q

Acute Sinusitis/ Rhinosinusitis - symptomology

A
  • pain in cheeks, facial pressure
  • redness of nose, cheeks, eyes
  • postnasal drainage
  • stuffy nose
  • cough or sore throat
  • fever (bacterial)
  • duration > 7 days
94
Q

Acute Sinusitis/ Rhinosinusitis - exam findings

A
  • tenderness to palpation of sinuses
  • facial erythema
  • periorbital edema
  • purulent secretions
95
Q

Acute Sinusitis/ Rhinosinusitis - workup

A
  • viral: usually < 10 days that are consistent and not worsening
  • bacterial: persistent symptoms > 10 days without improvement or biphasic pattern, onset of severe illness like high fever, nasal drainage, facial pain or at least 3-4 consecutive days at beginning
  • severity of illness alone is not sufficient evidence to start antibiotics
96
Q

Acute Sinusitis/ Rhinosinusitis - complications

A
  • orbital cellulitis/ abscess = most common bacterial complication
97
Q

Acute Sinusitis/ Rhinosinusitis - management

A
  • analgesics (NSAIDs)
  • oral/nasal decongestants
  • bacterial also: if not getting better after 7 days, can start antimicrobial therapy (amoxicillin or augmentin)
98
Q

Epistaxis - posterior vs. anterior

A

Anterior - usually venous, oozing, most common

Posterior - usually arterial, problematic because of airway compromise and difficult to control

99
Q

Epistaxis - physical exam

A
  • have equipment ready: illumination, suction, topical meds, cautery, packing materials
  • if already packed, remove packing
  • vasoconstrictor: helps reduce bleeding making it easier to visualize
  • topical analgesic (lidocaine)
  • nasal speculum - spread vertically
100
Q

Epistaxis - management

A
  • manual hemostasis with pressure
  • vasoconstrictor, cautery
  • packing if not responsive to cautery
  • avoid strenuous activity 7-10 days, hot showers
101
Q

Oral Cancer - leukoplakia

A
  • very small plaque that occurs from chronic irritation
  • looks like white patches
  • some will go on to develop squamous carcinoma
102
Q

Oral Cancer - Erythroplakia

A
  • erythematous component
  • very high malignant rate
  • tobacco and heavy drinkers
  • looks like red velvety asymptomatic patch
  • almost always on floor of mouth, ventral tongue, or soft palate
103
Q

Oral Cancer - Oral Lichen Planus

A
  • potentially malignant
  • lacy pattern
  • buccal mucosa
104
Q

Oral Cancer - workup

A
  • incisional biospy
  • exfoliative cytologic exam
  • REFER to head and neck surgeon, specialist, or ENT
105
Q

Oral Candidiasis - what is it?

A
  • thrush
  • immunosuppressed population
  • common adults who wear dentures, poor dental hygiene, DM, anemia
  • overgrowth of yeast on oral mucosa
106
Q

Oral Candidiasis - common causative agent

A

C. albicans

107
Q

Oral Candidiasis - symptomology

A
  • pain

- white rash in mouth

108
Q

Oral Candidiasis - exam findings

A
  • creamy-white, curd-like, fluffy patches
  • erythematous wound bed
  • note recent antibiotic or steroid use
109
Q

Oral Candidiasis - management

A
  • antifungals: nystatin (not very palatable), clotrimazole
110
Q

TMJ Syndrome - what is it?

A
  • myofascial pain dysfunction (tension + spasm)
  • internal derangement (often articulating discs)
  • degenerative joint disease (arthritic changes)
  • female > male
111
Q

TMJ Syndrome - symptomology

A
  • chronic pain in muscle of mastication
  • locking of jaw
  • ear clicking or popping
  • headache or neck-ache
  • bite that feels uncomfortable
  • bruxism/ teeth clenching
112
Q

TMJ Syndrome - exam findings

A
  • ROM limitation
  • palpable spasm of facial muscles
  • clicking or popping of TMJ
  • tenderness to palpation
  • crepitus over joint
  • lateral deviation of mandible
113
Q

TMJ Syndrome - management

A
  • analgesics (NSAIDs)
  • muscle relaxants (benzos)
  • moist heat and massage
  • refer to ENT if persists
114
Q

Pharyngitis - causes

A
  • viral

- group A beta-hemolytic strep

115
Q

Pharyngitis - symptomology

A
  • sore throat
  • dysphagia
  • malaise
  • rhinorrhea (viral)
  • fever (bacterial)
116
Q

Pharyngitis - exam findings

A
  • erythematous pharynx
  • exudate (bacteria)
  • anterior cervical adenopathy (bacterial)
117
Q

Pharyngitis - workup

A
  • GABHS rapid test

- throat culture

118
Q

Pharyngitis - Centor Criteria for GAS - don’t test until they meet criteria

A
  • fever (1 pt)
  • anterior cervical adenopathy (1 pt)
  • tonsillar exudate (1 pt)
  • absence of cough (1 pt)
    score 0-1: treat supportively
    score 4: can be treated with antibiotics with need for test, presumed positive
119
Q

Pharyngitis - management

A
  • viral: analgesics + supportive measures

- bacterial GAS: penicillin V (500 mg BID x 10 days) or amoxicillin

120
Q

Epiglottis/ Supraglottitis - most common cause

A
  • H. influenzae
121
Q

Epiglottis/ Supraglottitis - symptomology

A
  • rapid onset of sore throat
  • odynophagia out of proportion
  • muffled voice (hot potato voice)
  • sepsis
122
Q

Epiglottis/ Supraglottitis - exam findings

A
  • tripod positioning
  • tongue out
  • drooling
  • stridor (late finding)
  • cervical adenopathy
  • fever
  • hypoxia
  • respiratory distress
  • severe pain on palpation
  • toxic appearance
  • swollen, erythematous epiglottis
123
Q

Epiglottis/ Supraglottitis - workup

A
  • nasopharyngoscopy/ laryngoscopy (specialist)
  • XR = “thumb sign” - fat epiglottis that looks like a thumb
  • cultures
124
Q

Epiglottis/ Supraglottitis - managment

A
  • ABCs!
  • admit to ICU (potential intubation)
  • antibiotics: ceftriaxone 1g PLUS vanco, clindamyin, or oxacillin
125
Q

Peritonsillar Abscess - symptomology

A
  • fever, malaise
  • headache, neck pain
  • throat pain
  • dysphagia
  • hot-potato voice
  • odynophagia
  • otaliga
126
Q

Peritonsillar Abscess - exam findings

A
  • mild-moderate distress
  • tachycardia
  • dehydration
  • drooling
  • trismus (trouble opening mouth)
  • muffled voice
  • rancid breath
  • cervical lymphadenitis (anterior chain)
  • asymmetric tonsillar hypertrophy
  • displacement on tonsil
  • contralateral deviation of uvula
127
Q

Peritonsillar Abscess - workup

A
  • CBC, monospot, cultures, rapid strep
  • CT, intraoral ultrasound, XR
  • fine needle aspiration
128
Q

Peritonsillar Abscess - management

A
  • ABCs
  • analgesics
  • drainage
  • IV hydration
  • empiric antibiotics
  • antipyretics
  • refer if necessary

NUR: 718 (8 decks)

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