HEENT MDT

Question 1

•Vision returns to normal within 24 hours, usually within 1 hour
>24 HOURS
•Sudden, painless loss

Answer 1

Acute vision loss

Question 2

•Eyes are “redrimmed” and scales or granulations can be seen clinging to the lashes

• itching, burning, mild pain, foreign body sensation, tearing.
• ** erythema of the lids, and crusting around the eyes upon awakening

Answer 2

Blepharitis

Question 3

• Blood underneath the conjunctiva, often in one sector of the eye and the entire view of the sclera may be covered by blood
• caused by Valsalva maneuver; coughing, sneezing, vomiting

Answer 3

Conjunctival hemorrhage

Question 4

• Itching, burning, tearing, gritty or foreign body sensation; history of recent URI or contact with someone with viral conjunctivitis

•Watery discharge, red and edematous eyelids, pinpoint subconjunctival hemorrhages

• Itching, watery discharge, and a history of ALLERGIES.

•Occurs bilaterally

Answer 4

Viral/Allergic Conjunctivitis

Question 5

• Redness, foreign body sensation,
  discharge;
• itching is much less prominent
• Purulent white-yellow discharge or mild to moderate degree

Answer 5

Bacterial nongonoccol conjunctivitisq

Question 6

• Severe purulent discharge,
• hyperacute onset
• marked chemosis, preauricular adenopathy
• Sexual history relevant

Answer 6

Gonococcal Conjunctivitis

Question 7

Disposition for gonoccocol conjunctivitis?

Answer 7

MEDEVAC if corneal involvement

Question 8

Foreign body sensation, tearing, history of trauma; with or without a rust ring

Answer 8

Ocular Foreign Body

Question 9

• Erythema and edema of lid and conjunctivae; discharge, ocular pain or foreign body sensation, photophobia and/or blurred vision
• Visual acuity is decreased possibly
• Cornea reveals a round or irregular ulcer, with a hypopyon (white, hazy base)
• Common with contact lens wearers

Answer 9

Corneal ulcer

Question 10

Disposition for corneal ulcer

Answer 10

MEDEVAC - corneal perforation or scarring. Permanent vision loss

Question 11

•ACUTE NONGRANULOMATOUS
ANTERIOR UVEITIS - Pain, redness, photophobia, visual loss, hypopyon (WBC pool) and fibrin within the anterior chamber, KPs seen on the corneal endothelium

•GRANULOMATOUS ANTERIOR
UVEITIS - Blurred vision in a mildly inflamed eye, “mutton fat” KPs and iris nodules

•POSTERIOR UVEITIS - Gradual loss of vision in a minimally inflammed eye, vitreous opacity

Answer 11

Uvueitis

Question 12

• periorbital swelling, nasal congestion/discharge, sinus
• headache/pressure/congestion, tooth pain,
• infra- and/or supraorbital pain
• Eyelid edema, erythema, warmth, and tenderness, Conjunctival chemosis, injection, proptosis and restricted extraocular motility

Answer 12

Cellulitis

Question 13

• Severe pain, tearing, and photophobia

* History of trauma to the eye, commonly involving a foreign object (fingernail, piece of paper, or contact lens)

Answer 13

Corneal abrasion

Question 14

TX for corneal abrasian

Answer 14

Stop wearing contacts

Question 15

• Flashes of light, floaters, a
• curtain or shadow moving over the field of vision
• peripheral or central visual loss, or both

Answer 15

Retinal detachment

Question 16

• Caused by use of a sunlight without eye protection, exposure to a welding arc, or snow blindness

•Numerous, microdots on the corneal surface after staining and
under high magnification

Answer 16

UV Keratitis / Flash burn

Question 17

History of oral or genital herpes infection

• Punctate keratitis
• Dendritic keratitis (branching epithelial ulceration with bulbs at the end of each branch)
• Geographic ulcer (large, amoebashaped corneal ulcer with a dendritic edge)
• Eyelid may have typical herpetic vesicular eruptions
• Palpable preauricular node

Answer 17

Herpetic lesion

Question 18

History of auricular trauma

•Edematous, fluctuant, and ecchymotic pinna with loss of normal cartilaginous landmarks

Answer 18

Auricular Hematoma

Question 19

History of prolonged eustachian tube dysfunction

•Examination will reveal an epitympanic retraction pocket or a marginal tympanic membrane perforation that exudes keratin debris, or granulation tissue

Answer 19

Cholesteatoma

Question 20

Disposition for Cholesteatoma?

Answer 20

MEDEVAC - damage can occur of the ossicles bonesq

Question 21

Severe ear pain

• Fullnes or “underwater sensation”, hearing loss or “muffled hearing”
• Tinnitus
• “Popping or snapping noises

Answer 21

Eustachian tube dysfunction

Question 22

Complication from acute otitis media (ask medical Hx)

• Post auricular pain and erythema accompanied by a spiking fever
• Edema, tenderness, protrusion of the auricle and the obliteration of the post auricular crease

Answer 22

Mastoiditis

Question 23

Disposition for Mastoiditis

Answer 23

MEDEVAC - can lead to serious systemic infections

Question 24

Otalgia, aural pressure, decreased hearing, fever, and history of URI

• Erythema and hypo mobility of tympanic membrane
• Severe - TM bulging (rupture imminent), mastoid tenderness

Answer 24

Otitis Media

Question 25

Purulent yellow-green nasal discharge or expectoration * Facial pain or pressure over the affected sinus or sinuses * Nasal obstruction and acute onset of symptoms * Associated cough, malaise, fever and headache

Answer 25

Sinusitis

Question 26

Purulent yellow-green nasal discharge or expectoration * Facial pain or pressure over the affected sinus or sinuses * Nasal obstruction and acute onset of symptoms * Associated cough, malaise, fever and headache

Answer 26

Sinusitis

Question 27

Rapidly developing sore throat or odynophagia is out of proportion to minimal oropharyngeal findings •Laryngoscopy may demonstrate swollen, erythematous epiglottis Muffled voice, High Fever, Inspitory stridor

Answer 27

Epiglottitis

Question 28

Disposition for epiglottitis?

Answer 28

MEDEVAC

Question 29

* White painless lesion that cannot be scraped or removed that may be several centimeters in diameter * Usually superficial but may have submucosal depth upon palpation * May have wrinkled "wet finger" appearance

Answer 29

Leukoplakia

Question 30

* Severe sore throat, odynophagia, muffled "hot potato" voice, trismus (lockjaw), inferior and medial displacement of the infected tonsil, contralateral deflection of the swollen uvula. lockjaw * Moist and translucent, palatal edema, tender cervical lymphadenopathy, drooling, dehydration, color ranging from none too deep erythema

Answer 30

Peritonsillar Abscess

Question 31

* After an incubation period of 2-5 days a sudden onset of sore throat, painful swallowing, chills, fever, headache, nausea, and vomiting * Erythema of the tonsils, tonsillar pillars, and an edematous uvula * CENTOR Criteria - Fever >100.4, tender anterior cervical lymphadenopathy, no cough, pharyngotonsillar exudates

Answer 31

Pharyngitis/Tonsilitis

Question 32

* Acute swelling of the parotid or submandibular glands * Increased pain and swelling with meals * Tenderness and erythema of the duct opening * Pus can often be massaged from the duct

Answer 32

Sialadenitis

Question 33

Disposition for sialadenitis?

Answer 33

MEDEVAC

Question 34

* Minor cases are usually asymptomatic * Halitosis (hot breath), sore throat, white debris, bad taste (metallic) in the back of the throat, dysphagia, earache Enlarged tonsils

Answer 34

Tonsillitis