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HEENT / Lymph Flashcards

(59 cards)

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1
Q

differences between arteries and veins in the Eyes

A

Arteries – narrower

Veins –> PULSATE

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2
Q

Arteries indent and displace veins d/t HTN.
Results in Tapering of the veins as they cross arteries

What do you suspect?

A

AV Nicking

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3
Q

microinfarction of the with gradual vision loss. Fundoscopic exam shows white spots.

What do you suspect?
How do you tx?

A

Cotton wool spots

Tx: manage underlying cause. Typically DM or HTN

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4
Q

What are flame hemorrhages?

A

Blot & Dot hemorrhage

hard exudates, microaneurysms

Gradual vision loss

Tx DM/HTN

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5
Q

what is the most common cause of vision loss in older adults?

A

Macular dengeration

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6
Q

patient has loss of bilateral central vision over several years… What do you suspect?

A

Macular degeneration

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7
Q

what is the fist sign of macular degeneration?

A

Center blind spot (Scotoma) or curving of straight lines

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8
Q

What is cataracts?

A

Damage to the LENS of the eye

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9
Q

what are the key exam findings in cataracts?

A

Diminished/ opacified red reflex

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10
Q

what is the most common reason for development of cataracts?

A

AGE! most common in senile patients

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11
Q

A patient comes for treatment of allergies with a hx of glaucoma. What cant your prescribe?

A

Nasal steroids

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12
Q

what is the treatment for cataracts?

A

ONLY SURGERY. Lens removal/replacement

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13
Q

Why is papilledema an emergency?

A

Sign of increased intracranial pressure!

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14
Q

S/S of papilledema?

A

engorged and tortuous retinal veins

Hyperemic and swollen optic disc – loss of optic cup

Retinal hemorrhages around disc
loss of peripheral edema

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15
Q

**Remember **

If pt on beta blocker eye gtt for glaucoma, prescribed BB for cardiac reasons can cause ADDATIVE effect

A
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16
Q

What is the most common type of glaucoma?

A

Open-angle glaucoma

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17
Q

Pt complains of bilateral, gradual loss of vision that is painless. What do you suspect?

A

Open-angle glaucoma

“Slow killer of vision”

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18
Q

What is angle closure glaucoma presentation

also called closed-angle, narrow angle

A

SUDDEN, unilateral, painful

Headache, nausea, vomiting
blurry vision, hazy vision 
halo around lights
photophobia 
poorly reacting pupils

EMERGENCY! - blindness in 2-5 days

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19
Q

what eye disorder can present similarly to migraines?

A

Angle-closure glaucoma

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20
Q

Treatment for open-angle glaucoma?

A
  • topical BB - caution in pts already taking oral BB
  • Miotics: Pilocarpine
  • Systemic agents: Carbonic anhydrase inhibitors
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21
Q

what is a pinguecula?

A

yellow, raised growth on conjunctiva

-usually on side of the eye near your nose (can occur on either side)

Deposit of protein, fat, or calcium

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22
Q

What is a pterygium?

A

growth of fleshy tissue (has blood vessels) that invades the cornea and affects vision

redness and swelling of the conjunctiva, mostly while the pterygium grows

feels like sand/grit is stuck in eye
dry, itchy, burning eyes

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23
Q

Step assessment for foreign body in eye

A

visual acuity of both eyes

Snellen / pen light

Exam slit lamp

fluorescein stain - assess for corneal defects

eyelid eversion - remove foreign body with wet cotton swab if NOT embedded

***If embedded patch on eye and send to Ophthalmology!!

Updated tetanus

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24
Q

Allergic rhinitis S/S

Study These Flashcards
A
  • Clear BILATERAL rhinorrhea
  • nasal stuffiness
  • allergic shiners - dark under eyes
  • pale, boggy nasal mucosa
  • transverse crease of nose - d/t whipping nose
  • sore throat/mouth upon waking
  • palpable lymph nodes
  • enlarged tonsils and adenoids –> leads to increased risk of otitis media
25
what would you treat a sinus infections with?
Amoxicillin or Augmentin Same as ear infection
26
Pharm management for allergic rhinitis
***Always use localized agents before systemic! - Saline nasal sprays - wash off offending particles prior to other nasal medications - Nasal steroids - preferred agent (Fluticasone propionate- Flonase) or Budesonide - Nasal antihistamine sprays - azelastine (can be combined with fluticasone) - oral antihistamines (non sedating)
27
is sinusitis typically viral or bacterial?
Typically VIRAL --- tx symptomatic only
28
what suggests bacterial sinusitis?
>10 days, acute fever, s/s worsen after initial improvement (secondary infection)
29
Tx for bacterial sinusitis?
ABX Amoxicillin/ Augmentin Doxycycline, Levofloxacin or moxifloxacin if PCN allergy ***NO MACROLIDE ---high resistance No improvment after 3-7 days of ABX therapy, consider broader cover abx -partial response consider additional 10-14 days of same or different abx
30
How do you demine who gets a rapid strep test?
Use Modified Centor Criteria --> point system based on symptoms +1 for each : tonsillar exudate, tendery anterior chain adenopathy, fever, <15yr. 0 point : 15-45yr -1 Point: >45yrs or cough ***cough almost always excludes streptococcus!
31
Most common pathogen for acute epiglottitis?
``` Haemophilus influenza type B (COP) Streptococcus pneumoniae (3p lecture) ```
32
patient comes in with marked edema of the supraglottic structures with difficulty swallowing. what should you suspect?
Epiglottitis --- MEDICAL EMERGENCY
33
Signs of acute epiglottitis?
xray --> steeple sign/ thumb sign inflammation and edema of supraglottic structures (epiglottis, aryepiglottic folds, arytenoids) DO NOT attempt to visualize pharynx if suspected, can cause spasming and completely obstruct airway
34
What causes mononucleosis?
Epstein barr virus
35
Symptoms of infectious mononucleosis
i. Fatigue, malaise ii. Headache, sensitivity to light iii. Sore throat - becomes progressively worse iv. enlarged tonsils w/ whitish-yellow covering v. Lymph nodes in neck frequently enlarged/ painful vi. Pink, measles-like rash can occur (more likely if pt given abx for throat infection) vii. Enlarged spleen -- no contact sports Jaundice
36
Tx for mono
2-4 weeks revcovery w/o medications Antivirals not helpful symptom management only ibu/acetaminophen - pain/fever salt water gargle - sore throat rest/fluids avoid contact sports d/t enlarged spleen
37
What is conductive hearing loss?
inability of ossicles to conduct sound properly. Sounds are perceived by brain but are diminished but NOT distorted. often caused by cerumen impaction, otitis media, foreign objects, TM perf,
38
Sensorineural hearing loss
inability of eardrum to virate in response to sound sound perceived is diminished & Distorted involves 8th cranial nerve causes: anything that prevents sound from traveling through the inner ear or prevents the CN VIII from funtioning - hair cell destruction - damage to CN 8 - acoustic neuroma - Menieres disease - ototoxic drugs (aspirn, gentamicin, lasix) - noise injury - childhood infections - mumps, meningitis, scarlet fever - presbycusis
39
disruption in transmission of sound to the cochlea affecting the 8th cranial nerve is what kind of hearing loss?
Sensorineural
40
Medications that can result in ototoxicity
Aminoglycosides "micin/mycin" (gentamicin, streptomycin) Loop diuretics (bumex, lasix, demadex) asprin Quinidine - excessive tonic water (malaria prevention)
41
what is vertigo
sensation of motion (self or surroundings) different than dizziness
42
most common causes of vertigo
Meniere's disease - lasts hours. w/ tinnitus, nausea, vomitting Benign positional vertigo (BPV) - lasts minutes, associated with nystagmus and head position changes. NO hearing changes
43
tx for vertigo
ensuring safety PT/OT Antihistamine (meclizine) Anticholinergic (Scopolamine)
44
how does lymphatic system drainage move
Lympahtic system drains from peripheral towards CENTRAL. Ex: lymphatic swelling in right hand will trave UP towards armpit
45
what is Chyle?
lymph from digestive system --> contains emulsified fats
46
what is the largest component of the lymphatic system?
Spleen
47
What drains to the Right lymphatic duct?
if you took a person and turned them into a clock... 8oc -midnight = RIGHT DUCT right arm right chest right hemisphere of head/neck
48
What drains into the Left (Thoracic) duct?
12 to 8 o'clock BOTH lower extremities L Arm L hemisphere of head/neck
49
what do the right lymphatic ducts connect to drain lymph back to bloodstream?
the subclavian vein
50
Where is virchows node?
left supraclavicular lymph node
51
what is troisier's sign?
enlarged, hard, PAINLESS virchow's node (Left supraclavicular lymph node) Indicates cancer (gastic, ovarian, testicular, breast)
52
how will virchows node present if infection is suspecteD?
Enlarged, PAINFUL causes: TB, Sarcoidosis, toxoplasmosis
53
what are the primary lymphoid organs?
Thymus & Bone marrow
54
What are the secondary lymphoid organs?
Lymph nodes, Spleen & Lymphoid nodules
55
what is a cholesteatoma?
middle ear tumor
56
what is cheilitis?
actue or chronic inflammation of lips
57
white oral plaque in mouth that is PAINLESS... what should you suspect?
leukoplakia - can be precancerous lesion
58
PT with acute rhinosinusitis that symptoms began 3 days ago, how should this be treated?
Decongestants and OTC analgesics MOST ARE VIRAL. IF longer than 7days or show signs of infection then treat with Amoxicillin with clavulanate
59
which medication should be given for peripheral vertigo?
meclizine

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