Rapid DDx: HEENT Flashcards by Anthony Carli

Firm Painless Lump on Eyelid

Erythema

Swelling

Chalazion

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Floaters

Blurred Vision

Impaired color/night vision

Ocular Pain

Photophobia

Excessive lacrimation

posterior uveitis

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Red eye

eyelid Edema

chemosis

purulent d/c

Bacterial conjunctivitis

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Red eye

eyelid Edema

chemosis

watery/stringing d/c

viral conjunctivitis

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Red eye

eyelid Edema

chemosis

watery, mucoid d/c

allergic conjunctivitis

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Red eye

eyelid Edema

chemosis

profuse, hyperpurulent d/c

gonococcal d/c

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elderly patient

bilateral sxs:

Eye irritation/dryness

sagging eyelid

everted eyelid/lashes

ectropion

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elderly patient

bilateral sxs:

corneal abrasion/FB sensation

Chemosis

lacrimation

inverted eyelid/lashes

entropion

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tearing

tenderness, erythema, edema, warmth on medial canthal side of lower lid

acute dacrocystitis

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mucopurulent drainage from puncta

no acute signs of infx

chronic dacrocystitis

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crusting, scaling eyelid

red rim of eyelid

flakes on lashes/lid margins

blepharitis

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lid erythema

painful, warm nodule/pustule on eyelid

hordeolum

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yellow, elevated nodule on nasal side of sclera

non-growing/non-progressing

pinguecula

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Triangular shaped mass that started at medial side of eye

lateral growth

pterygium

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diplopia w. upward gaze

orbital emphysema

anesthesia to anteromedial cheek

orbital blowout fx

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< 3 yo

leukocoria (absent red light reflex)

retinoblastoma

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Age > 75

Bilateral, progressive central vision loss

metamorphopsia (bending of straight lines)

dry macular degeneration

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Age > 75

bilateral, aggressive central vision loss

metamorphopsia (bending of straight lines)

wet macular degeneration

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Previous cataract surg

Photopsia (flashing lights) –> floaters

progressive unilateral peripheral vision loss

“curtain coming down”

retinal detachment

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Day 1 neonate

conjunctivitis sxs

chemical conjunctivitis

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Day 2-5 neonate

conjunctivitis sxs

gonococcal conjunctivitis

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Days 5-7 neonate

conjunctivitis sxs

chlamydial conjunctivitis

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FB sensation in eye

tearing

Red and painful eye

photophobia

ocular FB/corneal abrasian

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Chemical exposure

ocular pain

decreaed vision

blepharospasm (difficulty opening eye)

photophobia

ocular chemical burn

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Hx of sinus infx ocular pain with EOMs Ophthalmoplegia (weakness of EOMs) proptosis (bulging)

orbital cellulitis

hx of sinus infx unilateral ocular pain eyelid erythema and edema no proptosis or EOM pain/weakness

preseptal cellulitis

Contact lens wearer ocular pain photophobia eye redness vision changes

bacterial keratitis

acute onset unilateral ocular pain, photophobia, redness and blurred vision.

herpes keratitis

hx inflammatory/autoimmune dz unilateral severe ocular pain, photophobia, redness, blurred/decreased vision constricted pupil

anterior uveitis

hx inflammatory/autoimmune dz blurred/decreased vision floaters constricted pupil low pain

posterior uveitis

> 60 yo DM + TOBB + GC use slow, progressive vision loss difficulty with night driving/reading signs both eyes

cataract

Normal vision HA Vomiting Nausea

papilledema

Woman < 40 yo painful vision loss decreased color vision (desaturation) Central scotoma Marcus-Gunn Pupil Unilateral sxs, developed over a day or so

Optic neuritis

Sudden onset severe, unilateral ocular pain halos around lights loss of peripheral vision (tunnel vision) N/V, HA Worse in dim rooms

Acute narrow angle closure glaucoma

bilateral, painless, slow peripheral vision loss progress to central vision loss

open angle claucoma

transient monocular vision loss "curtain came down" complete recovery within an hour

amaurosis fugax

Hx of atherosclerotic disease acute, painless monocular vision loss w. amaurosis fugax ipsilateral carotid bruit

central retinal artery occlusion (CRAO)

sudden onset painless monocular vision loss +/- marcus gunn pupil

central retinal vein occlusion (CRVO)

Hx of swimming, Q tip use ear pain EAC pruritis

otitis externa

severe auricular pain otorrhea CN palsies Radiation of pain to TMJ/pain with chewing

Malignant OE

Hx AOM Deep ear pain worse at night fever lethargic, malaise

Mastoiditis

Persistent, recurrent purulent otorrhea painless feeling of ear fullness conductive hearing loss

chronic otitis media

6-18 mo Fever otalgia ear tugging

acute otitis media

hx of resolved AOM feeling of fluid in ear no fever, pain, erythema

otitis media with effusion

Ear fullness/pressure popping of ears feeling of being underwater fluctuating conductive hearing loss tinnitus

eustachian tube dysfunction

Hx diving ear pain ear fullness hearing loss

barotrauma

Hx of ear fullness and gradual conductive hearing loss

cerumen impaction

Hx of Q-tip use, loud concerts acute ear pain hearing loss pain relief with bloody otorrhea

TM perforation

Hx of ear infx painless, foul smelling brown/yellow ear d/c

cholesteatoma

FHx of conductive hearing loss slow, progressive conductive hearing loss at low frequencies no vertigo

otosclerosis

recurrent, episodic, sudden onset peripheral vertigo lasts 60s or less provoked by rolling over in bed, etc. no hearing loss

BPPV

Hx viral illness continuous peripheral vertigo N/V Gait disturbance horizontal/rotary nystagmus

Vestibular Neuritis

Hx viral illness continuous peripheral vertigo N/V Gait disturbance horizontal/rotary nystagmus unilateral hearing loss tinnitus

labrynthitis

Episodic peripheral vertigo lasting minutes/hours fluctuating sensorineural hearing loss tinnitus ear fullness horizontal nystagmus NV

Menieres disease

Unilateral sensorineural hearing loss

acoustic neuroma

Unilateral sensorineural hearing loss tinnitus vertigo HA facial numbness Facial paresis

acoustic neuroma

Duration < 4 weeks Hx viral URI facial pain/pressure worse bending over HA purulent nasal d/c fever nasal congestion worse after period of improvement

acute rhinosinusiis

Duration > 12 weeks acial pain/pressure worse bending over HA purulent nasal d/c nasal congestion

chronic sinusitis

Hx DM/immunocompromise sxs of sinusitis progressive loss of CNS function

mucormycosis

Clear, watery rhinorrhea itching of nose, eyes, ears sneezing nasal congestion bluish discoloration around eyes

allergic rhinitis

hx allergic rhinitis anosmia obstructed nose breathing

nasal polyps

ST painful swallowing/phonation cough, hoarseness, coryza, conjunctivitis, diarrhea

viral acute pharyngitis

ST painful swallowing/phonation

acute pharyngitis

age > 3yo dysphagia fever ST Anterior cervical LAD

strep pharyngitis

Hx of viral URI sxs hoarseness or aphonia dry/scratchy throat

laryngitis

age 15-30 yo hx of pharyngitis muffled voice dysphagia drooling trismus (lock jaw)

peritonsilar abscess

age 2-4 yo torticollis neck stiffness, esp. with neck extension hot potato voice trismus drooling

retropharyngeal abscess

HCV infx lacy leukoplakia/wickham striae painless

reticular oral lichen planus

HCV infx red patches along lacy reticular leukoplakia painful

erythematous oral lichen planus

HCV infx erosions, painful ulcers along lacy reticular leukoplakia

erosive oral lichen planus

Hx of dental infx tender, symmetric, swelling "woody" induration and erythema on upper neck and chin crepitus pus on floor of mouth swelling of tongue no LAD/abscess

ludwig's angina

immmunocompromised or oral CS use white, curd like plaques on oral mucosa or tongue painless easily scraped off

oropharyngeal candidiasis

small, painful, shallow oval ulcer with erythematous halo on buccal or labial mucosa

apthous ulcer

painless white patchy lesion on oral mucosa cannot be scraped off

oral leukoplakia

painless, erythematous soft and velvety patch in oral cavity on mouth floor, soft palate and ventral tongue

erythroplakia

sudden onset of salivary gland pain and swelling occurs when eating or when about to eat occurs roof of mouth (stensens) or under tongue (wharton's)

sialolithiasis (salivery gland stone)

sudden onset firm, tender gland swelling with purulent d/c able to express pus if duct is massaged dysphagia trismus fever/chills

acute bacterial sialadenitis

age 6mo-5 yo hx of fever, anorexia and malaise then appearance of oral lesions ulcerative lesions of gingiva, vesicles on mucous membraines perioral vesicular lesions clustered on erythematous base

acute herpetic gingivostomatitis

adult age fever, malaise, HA ST ulcerative lesion with grayish exudate on posterior pharyngeal mucosa

acute herpetic pharyngotonsilitis

Hx of EBV + HIV painless, white smooth or hairy plaque on lateral tongue can't be scraped off

oral hairy leukoplakia

Rapid DDx: HEENT Flashcards

(80 cards)