Week 7 - HEENT (Head, Ears, Eyes, Nose, and Teeth) Flashcards

Question

# Retinal Detachment (traumatic) Tell me about it ## Footnote What's the physical exam?

Answer 1

Blunt trauma may caused violent shifting of the vitreous body – causing renal tears Tears may ‘dissect’ the retina for the choroid (vascular layer) as blood enters this space and hematoma develops ## Footnote In acute injury, if patient reports seeing a flash of light, consider detachment May be a latent period between injury and detachment (up to months) Not painful – only symptom is VISUAL Perceived as a curtain descending over the visual field (progressive loss of vision) Loss of vision may also be sudden Reports of light flashes and cloudy vision Nothing visible (blood) on inspection

Answer 2

Spontaneous retinal detachment occurs most frequently in the elderly Results from fluid or blood leakage from vessels within the retina Causes: Hypertension, toxemia of pregnancy, papilledema (optic disc swelling) Retinal damage can progress slowly or enlarge quickly resulting in complete detachment

Answer 3

True ocular emergency Alkaline exposure dissolves tissues until it is removed Immediate Irrigation – minimum 20 minutes Remove any particles Severity can be judged by corneal cloudiness and scleral whitening ## Footnote Tend to be less devastating The body is better able to deal with acids Treatment is same as for alkali exposure

Answer 4

Affect the eye lids more than the globe Determine if vision is decreased/blurred Limit assessment to inspection Cover affected eyes with moist dressing Hot liquid splashes and cigarette ashes to the cornea usually results in a superficial corneal epithealial injury – treat as corneal abrasion ## Footnote Results in direct corneal epithelial damage Latent period of 6-10 hours Patient develops foreign body sensation, intense pain, tearing, photophobia and blepharospasms Cover the affected eyes for p

Answer 5

Hyphema is blood in the anterior chamber resulting from rupture of one or more iris vessels Extent varies from microscopic to ‘8 ball’ hyphemas in which the entire anterior chamber fills with blood ## Footnote **Clinical** **Features** Principle cause is traumatic, retinopathies in diabetic patients may also be causative **Physical** **Exam** C/O pain and cloudy vision (floaters/spots) Visible reddish tint in anterior chamber

Answer 6

Surgical management of malignancy Severe Infection Trauma A ball implant is then inserted

Answer 7

Orbital edema and ecchymosis Localized facial swelling Pain Tingling/Loss of sensation Diplopia Inability to elevate eye/restricted extraocular movements Subconjunctival hemorrhage Enophthalmos or exophthalmos Subcutaneous emphysema

Answer 8

Central retinal artery occlusion keratitis Corneal ulcers Acute glaucoma Acute iritis Conjunctivitis (bacterial/viral)

Answer 9

Blood supply to the retina is obstructed producing a painless, total or near total black out of vision Re-establishment of retinal circulation MUST be accomplished within 90 minutes to regain vision ## Footnote Predisposing factors Atherosclerosis of carotid artery (clot formation) Atrial Fibrillation Prolonged pressure on eye with swelling/tight dressing

Answer 10

Patient presents without pain Sudden loss of unilateral vision No history of trauma Associated with history of hypertension or hypercoagulable states | Immediate recognition Emotional Support Transport ## Footnote In 90-120 minutes, retina becomes necrotic and edematous – irreversible blindness

Answer 11

Inflammation of the cornea Caused by infections, hypersensitivity reactions, ischemia, defects in tears, trauma Presents as moderate to severe pain depending on the amount of epithelial disruption present Scar tissue formation is the leading cause of blindness Divided into non-ulcerative and ulcerative ## Footnote Integrity of the corneal epithelium is disrupted Symptoms include pain, increased tearing, photophobia, ocular irritation

Answer 12

Defined as a group of conditions characterized by increased intraocular pressure Caused by alterations in the circulation and resorption of aqueous humor Classified as open angle or closed angle ## Footnote Opacity of the lens of the eye or the capsule or both leading to a painless loss of vision Due to aging process, but can be caused by infection, injury, exposure to radiation or chemicals, UV radiation or metabolic disorders Presents with a distortion of the visual image especially at night or in bright light Management is surgical The iris may appear distorted in post-op surgery patients

Answer 13

Infections and accounts for the majority of “pink eye” Frequently occurs in conjunction with an URI Redness & tearing are common Treatment is symptomatic ## Footnote Presents with a mucopurulent discharge of varying colors (gray, yellow, green). Typically there is matting of the lashes in the morning, but minimal, if any pain. Treatment consists of topical antibiotic drops for one week Warm soaks should be used to keep the lids/lashes free

Answer 14

Degeneration of the macular area of the retina in the eye (the macula is in the center of the retina) Causes: Age related unknown, injury, inflammation, nutritional and hereditary factors implicated S/S: loss of central vision, visual distortion

Answer 15

Fever Periorbital edema Eye tenderness No proptosis (bulging eye) Visual Changes ## Footnote Pain with EOM Decreased visual acuity Ophthalmoplegias Spreads from adjacent infections Can extend into dural sinuses and meninges

Answer 16

Ear trauma Foreign body in ear Ruptured tympanic membrane ## Footnote Lacerations & contusions Thermal Injuries Chemical Injuries Traumatic perforations Barotitis (ears ‘pop’ from flying at high altitudes, scuba)

Answer 17

Patient usually state something is in ear Quite often an insect (adult), bead (peds) Patient may present with pain and purulent drainage and not be aware of foreign body Important: Is there a history of tympanic membrane rupture

Answer 18

Perforations of TM result from: acute changes in air or water pressure (blast injury), direct trauma (foreign body, Q-tips), caustics, lightning strike, otitis media, or associated temporal bone fractures. The patient may complain of slight hearing loss or pain The presence of concurrent vertigo or acute deafness suggests associated injuries to the semicircular canals ## Footnote Otitis media & otitis externa Meniere’s disease Tinnitus Labyrinthitis Vertigo

Answer 19

Defined as an inflammation of the outer ear The limited form of otitis externa is common to swimmers Physical findings may be limited to erythema ## Footnote Water-facilitates infection Bacteria – usually pseudomonas Fungal – aspergillosis and candida (immuno-compromised, chronic users of steroid drops) Malignant otitis externa: Osteomyelitis of the skull, begins as typical OE, nonresolving, OE defaults to this for diabetic, HIV, Ca pts

Answer 20

Otitis media includes the initial acute infection, otitis media with effusion, and chronic otitis media Acute Otitis Media (AOM) presents with the rapid onset of ear discomfort Typically follows URI Pain associated is not aggravated by movement ## Footnote Defined as a chronic disorder of the inner ear. Triad of symptoms: vertigo, tinnitus and sensorineural hearing loss Overaccumulation of fluid in the membranous labyrinth of the inner ear Onset of symptoms may be gradual or sudden

Answer 21

Severe rotary vertigo (may be associated with N/V) Tinnitus Nystagmus during acute attacks ## Footnote Most common complaint with otologic conditions Ranges from mild ringing to a loud roaring in the ear Causes include: presbycusis, otosclerosis, Meniere's, loud noise, certain drugs and a wide variety of pathological disorders Treatment is resolving underlying disorder

Answer 22

Infection of the labyrinth Clinical Manifestations: hearing loss, tinnitus and spontaneous nystagmus to the affected side Causes include: nearby infections of ear, nose or throat. Otitis media or meningitis; toxic effect of certain drugs ## Footnote Common clinical manifestation of many ear disorders Dizziness is described as a disturbed sense of the proper relationship to space Three systems combine to give input regarding balance: visual, vestibular and the proprioceptive system Associated symptoms of vertigo: Nausea/Vomiting, falling, nystagmus, hearing loss and tinnitus

Answer 23

Epistaxis Fractured nose Foreign Body in nose ## Footnote Highly vascular Bleeding may originate in the anterior or posterior nose Causes include medications, particularly antiplatelets or anticoagulants and: * Anterior: drying, infection, blunt, trauma, manipulation, cocaine use and local infection * Posterior: Blood dyscrasias, hypertension, diabetes and trauma

Answer 24

Trauma that produces a fracture of the nasal bones may come from frontal, superior to inferior or lateral direction Of these – laterally directed trauma most likely to fracture since no cartilage to absorb or dissipate the force Suspected in all patients with significant facial trauma ## Footnote Swelling Tenderness/Pain Crepitus Ecchymosis (bruising) Deformity Epistaxis

Answer 25

Most common for insertion of foreign bodies by children ## Footnote Patient was seen inserting the object Or presents with a purulent unilateral malodourous nasal discharge Body Odor

Answer 26

Inflammation with resulting infection of the mucous membranes of one of more paranasal sinuses Commonly follows URTI or viral rhinitis Causes include URI, nasal polyps, deviated septum, tooth abscess, abuse of nasal decongestants, swimming and diving, frequent changes in barometric pressure ## Footnote Constant, often severe pain and tenderness Maxillary sinus involvement may lead to teeth pain Headache Fever Purulent nasal discharge Sore Inflamed throat

Answer 27

Dull, intermittent or constant pain  Purulent nasal discharge   Chronic cough   Recurrent episodes   Loss of sense of smell

Answer 28

Blunt or penetrating trauma to the anterior neck can cause fracture or dislocation of laryngeal or tracheal cartilages  Need a high degree of suspicion for associated vascular injury   Injuries associated include fractures of hyoid bone, fractures of thyroid cartilage, fracture/dislocation of cricothyroid and fractures of trachea   ## Footnote History/Mechanism   Hoarseness or aphonia   Edema and bleeding (hemoptysis)

Answer 29

Bacterial – streptococcus/staphylococcus   Infection spreads into tissue between the tonsils and underlying muscle and creates an abscess   Untreated – infection can spread deep into neck with the potential for eroding a large vessel or aspiration of purulent drainage if abscess ruptures when patient is asleep   | Edema may threaten patency of the airway Erosion into the carotid artery ## Footnote Physical Exam/History   Sore throat x days with clinical progression to malaise and fever   Unilateral pain and difficulty swallowing   Patient may drool  Red edematous area above the tonsil between the soft palate and the tonsil often displacing the uvular  

Answer 30

Retropharyngeal space extends from base of skull to tracheal bifurcation   Fever, dysphagia, neck pain, sore throat, muffled voice, respiratory distress, stridor in kids   Immediate ENT consult is required   Fatal complication: airway compromised

Answer 31

Normal adult mouth has 32 teeth  3 Sections – crown, neck, root   Can involve fractures alone or fractures in combination of jaw (mandibular #) or facial bones   With fractured teeth, oral cavity should be examined for tooth fragments  ## Footnote Cold, fresh milk or saline for tooth transport   Do not rinse tooth   Take care NOT to handle by the root

Week 7 - HEENT (Head, Ears, Eyes, Nose, and Teeth) Flashcards

(55 cards)