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HEENT Flashcards

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1
Q

Cerumen Impaction

A

Ear wax impaction;
most common cause of conductive hearing loss;
PE: cerumen visible in ear;
TX: irrigation, manual removal

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2
Q

Eustacian Tube Dysfunction

A

Air/fluid trapped in middle ear space;
Occurs after URI, allergy flare or flight;
PE: Pressure, fullness, popping with swallowing;
TX: decongestants, antihistamines, nasal steroid spray, autoinsufflation

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3
Q

Barotrauma

A

Middle ear damage due to pressure change affecting temporal bone spaces;
Diving, flying, forceful nose blowing;
Vertigo, tinnitus
PE: ecchymosis or hemorrhage in middle ear, retracted TM
TX: decongestants, analgesics, anti-inflammatories, tubes

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4
Q

Otitis Externa

A

Infection of skin of external ear due to trauma or moist environment - usually bacterial (P. aeruginosa, Staph aureus);
PE: white discharge from ear, painful edema of EAC, tragus pain;
TX: ear hygiene, dry ear precautions; Floxin drops w/ wick if needed. Debride if fungal

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5
Q

Acute Otitis Media

A

Infection of middle ear; Common pathogens: Strepto pneumonia, Moraxella catarrhalis, Haemophilus influenzae
PE: tugging ear, fever, fussiness, anorexia; bulging non-motile TM, fluid in ear
TX: ABX for 7-10 day (Amox, Augmentin); Adjuvant therapy

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6
Q

Otitis Media w/ Effusion

A

Fluid from Acute OM or ETD;
PE: serous fluid behind TM, TM nonmotile, hearing loss
TX: observation, consider tubes if tx fails
MOST COMMON CAUSE OF PED HEARING LOSS W/ LANGUAGE DELAYS

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7
Q

TM Perf

A

Hole in TM;
PE: hole in TM, Hearing loss, otalgia, tinnitus, vertigo
TX: Heal on its own; abx drops if infection (Ofloxacin, Ciprodex); dry ear; refer to ENT if marginal

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8
Q

Cholesteatoma

A

Tissue accumulation in middle ear;
Caused by chronic ETD, recurrent ear infection;
PE: drainage, hearing loss, retracted TM, white mass visible behind TM
TX: Surgical excision

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9
Q

Mastoiditis

A

Infection of Mastoid air cells; Comp of Acute OM; S. pneumonia, S. aureus
PE: fever, adenopathy, mastoid tender/edema/red
TX: IV ABX (Ceftazidime & Vanco)
Myringotomy w/ tube insertion
EMERGENCY

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10
Q

Tinnitus

A

Ringing of ears;
associated with SN hearing loss;
TX: no cure, check for underlying causes and tx, mask sound,

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11
Q

Sudden SN HL

A

hearing loss due to hereditary or age (MMR); noise induced
DX: AC>BC lateralization to good ear
TX: high dose steroids, tx underlying

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12
Q

Peripheral Vertigo

A

sudden fatigable vertigo;
head movement, stress, diet, closed eyes;
Causes: vestibular neuronitis, Benign paroxysmal positional vertigo, meniere’s dz, labyrnthitis, tumors;
PE: worse w/ eyes closed, horizontal/rotary nystagmus
TX: Acute vestibular suppression (short term)
Epley maneuver for BBPV

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13
Q

Central Vertigo

A

Gradual onset, mild, non-fatigable vertigo; weakness & numbness
Better w/ eyes closed
Vertigal Nystagmus

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14
Q

Meniere’s Disease

A

dilation of endolymphatic space
PE: episodic vertigo, SN hearingloss, tinnitus
TX: low salt & diuretics, vestibular suppressants for acute attacks

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15
Q

Labyrinthitis

A

inflammation of inner ear nerves
PE: vertigo, hearing loss, tinnitus
TX: Steroids, anti-vertigo, vestibular rehab

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16
Q

Vestibular-Neuronitis

A

Acute inflammation of inner ear;
PE: vertigo
TX: steroids, atni-vertigo, vestibular rehab

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17
Q

Vestibular Schwannoma

A

Noncancerous benign, encapsulated growth that is sporadic (most common cerebellar pontine angle tumor);
CN 8 vestibulocochlear nerve
PE: progressive asymmetric high tone hearing loss, tinnitus, vertigo increasing
TX: surgery, radiation

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18
Q

Trauma (Hematoma)

A

Accumulation of blood in perichondrial space
PE: Edema, bruising, loss of carilage landmarks
TX: I&D, closure, pressure dressing, quinolone

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19
Q

Rhinitis

A

inflammation of nasal mucosa - edema, vasodilation, rhinorrhea;
seasonal allergies
PE: clear rhinorrhea, sneezing, itching, eye sx, nasal congestion, polyps
TX: steroid spray, decongestants, antihistamines, aticholinergics, saline irrigation

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20
Q

Rhinosinitus/Sinusitis

A

Inflmmation & Obstruction of sinus outflow tracts;
Viral (Rhinovirus), Bacterial, Fungal
PE: pain/pressure, decreased smell/taste, rhinorrhea, cough, fever
CT GOLD STANDARD
TX: alalgesics, saline, nasal steroids, decongestants; augmentin for bacterial

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21
Q

Nasal Foreign Body

A

PE: Unilateral, foul smelling nasal drainage/blood
TX: remove object; positive pressure, instrumentation w/ lidocaine and Afrin

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22
Q

Nasal Polyps

A

Usually lateral nasal wall & bilateral
Postnasal drip, rhinorrhea, hyponasality
PE: smooth, pale, clustered grapelike
TX: Nasal steroid spray, oral steroids, polypectomy, tx underlying allergies

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23
Q

Epistaxis

A 
Nose Bleed
Trauma, infection/inflammation, etc...
Anterior: Kiesselback's plexus
Posterior: Woodruff's plexus
TX: Vasoconstriction (Afrin); Pressure on tip of nose leaning forward 10 min; Nasal packing 3-5d, anti-staph ABX; Anterior- silver nitrate cauterization
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24
Q

Nasal Fracture

A

Most common facial fracture
PE: palpable deformity, epistaxis, edema, nasal obstruction
TX: Closed reduction (w/in first 1-3 hrs before swelling, or 3-10d after swelling, before healing) or Open reduction (3-6m after failed closed reduction)

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25
Acute Viral Pharyngitis
40-60% pharyngitis; PE: Low fever, Progressively worse, generalized adenopathy, URI sx, more indolent TX: Supportive (bed rest, hydration, lozenges); precautions (wash hands, throw away toothbrush)
26
Acute Bacterial Pharyngitis
Casued by Group A B-hemolytic Streptococcus (GABHS); PE: High fever, Sudden onset, anterior cervical lymph nodes, NO COUGH OR RHINORRHEA, exudate on red, swollen tonsils, HA, nausa, abd pain TX: ABX, PCN
27
Peritonsillar Abscess
Spread of infx out of tonsillar capsule; GABHS, Fusobacterium PE: Odynophagia, trismus (locked jaw), uvula deviated to other side, tonsilar asymmetry, soft palate swelling, drooling, hot potato voice TX: ENT consult, Needle aspiration vs I&D, IV ABX (Unasyn, clinda), PO ABX d/c (Augmentin, Clinda)
28
Acute Laryngitis
Mostly Viral (Rhinovirus) PE: dysphonia (low voice), low fever, cough, rhinitis, PND TX: voice rest, hydration, no smoking, ABX if bacterial
29
Epiglottitis
Epiglottitis blocks airflow; Caused by Haemophilis influenzae B (rare in peds due to vaccine) PE: sudden and short course, High fever, dysphagia, drooling, dyspnea, Sniffing position, NO COUGH OR VOICE CHANGES, thumb print sign TX: Secure airway, IV ABX and steroids x7-10 days EMERGENCY
30
Croup
URI bocks breaking; caused by Parainfluenza 1; most common cause of stridor PE: Gradual onset, long course (3-7d), barking cough, better in recumbent, worse at night, hoarsness, stridor, low fever, NO DYSPHASIA OR DROOLING TX: Assess airway, humidified oxygen, IV fluids, nebulized racemic EPI, Steeple Sign
31
Mononucleosis
EBV, herpes virus; 15-24 yrs PE: fatigue, anorexia, HA, sore throat, cough, nausea, white patches similar to strep, enlarged spleen TX: Supportive (Tylenol, NSAIDs, Hydration, Rest)
32
Aphthous Ulcers
Sores inside mouth or base of gums, most common oral ulcer PE: painful white ulcers with surrounding redness TX: resolved in 1-2 wks, avoid spicy/salty food, topical corticosteroids or local anestheics, silver nitrate cauterization, ABX mouthwash
33
Oral Herpes Simplex
HSV-1, cold sores, fever blisters PE: itching, burning, tingling, small painful blister - vesicular TX: resolves in 1-2 wks, antivirals
34
Oral Candidiasis (Thrush)
Yellow plaque; opportunistic infection PE: friable, white cheesy plaque CAN SCRAPE OFF, Odynophagia TX: oral hygiene, tx underlying problem, topical antifungals (Nystatin swish and swallow)
35
Oral Leukoplakia
Yellow lesions; precursor to oral malignancy PE: white, plaque that CANNOT SCRAPE OFF TX: ENT referral, surgical excision, cryotherapy,
36
Neck space infections
Odontic (most common adult), tonsils (most common pedi), trauma, URI, salivary glands, IV PE: erythematous, tender neck with LAD, fever, torticollis, trismus, hoarseness, dysphasia, dyspnea, stridor TX: secure airway, ABX, local drainage C&S, tooth extraction, debridement of osteomyelitis bone
37
Sialoadenitis
Inflammation and Infectin of Salivary Gland; Bacterial (S. aureus), Viral (HIV, mupms, influenza, etc) PE: erythema, tenderness, warm gland, warm purulent discharge, trismus TX: rehydration, warm compress, ABX
38
Blepharitis
Inflammation of eyelids that affects eyelash or tear duct; PE: lids crusting, itching, tearing, microbe infestation TX: lid hygiene, topical ABX (Bacitracin, Erythromycin)
39
Hordoleum (Stye)
Acute staph infection of glads of zeis and moll PE: Painful, warm, swollen lump on eyelid TX: Compress and ABX. Good Hygiene
40
Chalazion
Lipogranuloma obstruction of Meibomian gland DEEP within lid PE: painless, cold, hard, lump found at middle part of ye TX: Warm compress and hygiene, topical ABX w/ steroids (progress to oral) Surgery if vision affected
41
Ectropion
Outward turning of lower eyelid PE: tearing, irritation, scaring, dryness, keratitis (redness) from exposure, eyelid laxity TX: tear supplements (lubrication) and surgery, eye taping, topical ABX
42
Entropion
Inward turning of eyelid causing lash conjunctival irritation. Lashes rub on conjunctiva & cornea. More painful than ectropion PE:tearing, irritation, scaring, dryness, keratitis TX:eye taping, ABX, surgery (Epilation Blepharoplasty)
43
Dacrocystitis
Infection and obstruction of lacrimal sac Caused by: S. aureus/epidermis, beta hemolytic strep, diphtheroids PE: pain, swelling, erythema usually lower eyelid, tender lacrimal sac w/ purulent discharge TX: compress, ABX (oral and topical)
44
Viral Conjunctivitis
Cause: Adenovirus (85%) PE: water discharge, sandy feeling on eye, redness, tearing, burning, preauricular adenopathy, blurred vision TX: limited, hygiene, tx othery sx VERY CONTAGIOUS - BILATERAL
45
Bacterial Conjunctivitis
Cause: S. aureus (adults), Haemophilus influenzae (preschoolers) PE: mucopurulent thick, green discharge, crusted in AM. Pain, FB sensation, redness, light sensitive, blurred vision TX: ABX (Sulfacetamide, Erythromycin)
46
Cataracts
Clouding in one or both lenses from aging, metabolic d/o, trauma, genetics PE: progressive blurred vision, poor night vision, halo around lights, faded colors, no pain/redness TX: remove cataract
47
Corneal ulcer
Erosion of outer layer of cornea due to trauma, infection PE: SEVERE PAIN, watery eyes, white patch, photophobia, blurry/hazy vision, red eye, itching TX: initiate ABX, Refer to Optha
48
Bacterial Keratitis
Inflammed cornea PE: expanding oval, yellow-white dense infiltrate, pain, redness, impaired eyesight, photophobia TX: ABX (topical: ciprofloxacin, ofloxacin)
49
Herpes simple Keratitis
Herpes in eye PE: Herpes lesion (dendritic ulcer w/ bulbs) visible w/ fluoresceine dye TX: Acyclovir, Trifluorothymidine, debridement
50
Corneal abrasion
Scratch on cornea due to trauma, contacts, FB PE: Excruciating eye pain, difficulty opening eye, tearing, photophobia, blurred vision TX: Antibiotic, cycloplegic drops, bandage contact lens, patching
51
Pterygium
Triangular fibroavascular elevated growth, can cross cornea. Due to UV exposure, elements PE: dry, burning sensation, red, blurry vision TX: observe, lubricants and UV protection, steroid drops, surgery if vision impacted
52
Orbital Cellulitis
Infection of orbital muscles and fat behind eye PE: sudden pain, erythema, edema of lids with proptosis, fever, pupils with APD, decreased eye movement TX: EMERGENCY, IV ABX
53
Nystagmus
Rhythmic regular oscillation of eyes PE: vertigo, blurred vision. TX: baclogen, gabapentin, contacts, tenotomy, acupuncture, PT, OT Vertical: CNS dysfunction Horizontal: Labrunt, vestibular nerve dysfunction
54
Optic Neuritis
Inflammation of optic nerve MS if most common cause PE: monocular vision loss, pain with eye movement TX: IV steroids (methylprednisolone IV), refer to neurology
55
Pepilledema
Swelling of optic disc and anterior bulging of physiologic cup due to increased intracranial pressure PE: intermittent HA, dizziness, blurred vision TX: tx underlying cause
56
Macular Degeneration
Dry-age, leading cause of vision loss in elderly Wet-hemorrhage, neovasculation PE: Painless, central vision loss, wavy vision, no erythema. DRY PE: geographic atrophy of retina, drusen deposits WET PE: neovascular (gray, green discoloration) fluid in subretina TX DRY: AREDS Vitamins TX WET: UV protection, anti Vegf intraocular injections
57
Diabetic Retinopathy
Leading cause of blindness in ages 20-65yrs PE: +/- visual acuity changes, cotton wool spots w/ fundoscope, flame hemorrhages TX: control DM, HTN, and/or hyperlipidemia, retinal laser photocoagulation
58
Hypersensitive Retinopathy
Long term uncontrolled HTN or sudden increased BP (AV nicking) PE: diplopia, HA, 'silver/copper wiring', flame hemorrhages TX: control HTN
59
Retinal Detachment
Spontaneous or Trauma PE: curtains coming down across vision, floaters, unilateral, painless, no erythema TX: EMERGENCY, supine w/ head facing origin of tear, reattach retina
60
Amaurosis Fugax
Cholesterol plaque emboli from carotid artery plaque, blockage of central retinal artery = sudden vision loss PE: curtains coming down, painless resolved w/in hr TX: resolves spontaneously, surgical decompression, massage, CO2 breathing
61
Amblyopia (lazy eye)
early childhood, caused by strabismus, uremia, or toxins PE: decreased vision in one eye, red reflex asymmetry TX: patching better eye to train weak eye
62
Open-Angle Glaucoma
Most common glaucoma Decreased aqueous outflow and increased aqueous production INCREASED INTRAOCULAR PRESSURE PE: slow vision loss, peripheral then central, cupping of optic discs TX: IV aceteazolmide, peripheral iridtomy (hole in iris)
63
Closed-Angle Glaucoma
Iris root occludes trabecular meshwork - complete obstruction of aqueous fluid drainage, rapid increase in IOP PE: severe pain, blurred vision, HA, N/V, fixed dilated pupil TX: Constrict pupil to drain, prostaglandin analogs, trabeculoplasty (opens trabecular meshwork)
64
Scleritis
Inflammation of sclera, systemic immunologic disease PE: severe, constant eye pain, worse at night, radiated to face, HA, erythema TX: topical and systemic corticosteroids
65
Strabismus
Adults: trauma, microvascular infarct, intracranial hemorrhage, brain tumor PE: diplopia, deviation of gaze (in, out, up, down) TX: glasses, surgery If not treated, can lead to amblyopia
66
Retinal Artery Occlusion
Evaluate carotid for emboli, vasculitis, HTN, HLD Ischemic or thrombus to major retinal arterial PE: sudden, profound monocular vision loss, arterial narrowing, cherry red spot TX: EMERGENCY, hypotensive drugs, global pressure
67
Retinal Vein Occlusion
Evaluate carotid for emboli, vasculitis, HTN, HLD Ischemic or thrombus to major retinal arterial PE: vision decreased upon waking, blood and thunder retina TX: EMERGENCY, hypotensive drugs, global pressure
68
Orbital Blowout Fracture
FX of 1+ bone of orbit due to trauma PE: double vision, reduced eye movement, bruising, tender, swelling, red eye, numbness of cheek, nose, teeth TX: Oral cephalexin. Simple- ice, decongestant, oral steroid. Isolated- refer in 3-10d
69
Hyphema
Hemorrhage into anterior chamber PE: blurred vision, blood in ant chamber TX: Opthalm, Rest, No ASA or anticoagulents
70
Globe Rupture
Integrity of outer membrane of eye is disrupted by blunt penetrating trauma (blunt injury, chemicals) PE: complete loss of vision or decreased acuity, pain in eye, tear drop pupil TX: Opthalm, Antiemesis and sedation, IV ABX, Fox Shield over eye, surgical repair

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