HEENT SFU PA prog HP II
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| 6 bones of the skull | Parietal, Occipital, Frontal, Temporal, Sphenoid & Ethmoid
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| Sutures between the bones of the skull in children are _________. | cartilaginous
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| Posterior fontanel closes in _____ months. | 2-4 months
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| Anterior fontanel closes in _____ months. | 9-18 months
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| A bulging fontanel indicates ______. | increased intracranial pressure
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| A depressed fontanel indicates ______. | dehydration
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| Profuse enlargement of the skull bones with facial bones being WNL is known as __________. | HYDROCEPHALUS
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| 3 causes of HYDROCEPHALUS are_______. | 1) Increased CSF secretion 2)inadequate absorption of CSF 3)of path of CSF
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| HYDROCEPHALUS Tx? | treat the etiology or if no cause then shunt implant
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| How would the ventricles appear on CT scan in a case of HYDROCEPHALUS? | ventricles are enlarged
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| 5 layers of the scalp | 1) cutis (skin) 2)subcutis (connective tissue) 3)galea aponeurotica (muscle) 4) loose connective tissue (bursa) 5)pericranium (periosteum layer of the bone)
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| What structure is involved in a tension headache? | The galea aponeurotica
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| Scalp lacerations that penetrate the galea aponeurotica have a tendency to be _____ wounds. | gaping
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| A scalp laceration can be lethal because the scalp is ___________ and can therefore _________. | A scalp laceration can be lethal because the scalp is well-vascularized and can therefore bleed profusely.
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| Scalp laceration Tx | Replace fluids with immediate surgery.
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| 7 things possibly found on PE with a skull fracture | 1)Bony stepoff 2)CSF/Blood discharged from the ear 3)Hemotympanum 4)Battle sign 5)Raccoon eyes 6)Papilledema due to increased ICP 7)CSF from nares
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| Does an epidural hematoma cross the suture line? | No, it does not cross the suture line
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| An Epidural Hematoma on CT assumes what shape? | football shape
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| An Epidural Hematoma can be due to the fracture of what bones? | temporal and/or parietal bones
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| What vessel is involved in an Epidural Hematoma? | middle meningial artery
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| A loss of consciousness followed by an asymptomatic lucid interval, followed by a loss of consciousness is the pattern associated with what head injury? | Epidural Hematoma
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| Epidural Hematoma TX? | holes drilled into the skull, for surgical decompression
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| Subdural Hematoma what vessels? | Venous
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| How quickly is the bleed from a Subdural Hematoma? | Slow bleed, due to the fact that it is a venous injury
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| What is seen on a CT with a Subdural Hematoma? | Does not cross the midline, but does cross the suture line.
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| How does a Subdural Hematoma patient present? | Pt does not look bad, unless the bleed is rapid
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| Which is more deadly? Subdural or Epidural Hematoma? | Subdural hematomas are statistically more lethal than Epidural Hematomas.
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| What are the 3 components of the Glasgow Coma Scale? | 1)Eye opening, 2)Verbal response, and 3)Motor response
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| Glasgow Score between what numbers? | between 3-15 Glasgow Score
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| A Glasgow Score of _____ indicates a critical or severe brain injury. | < 8
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| A moderate Glasgow Score would be between ___ and ___. | 9-12
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| Glasgow Score possible injury | >12
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| thyroid disease association with hair? | LIU
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| A recurrent nonscarring type of hair loss that can affect any hair-bearing area. | alopecia areata
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| Hairs tapering toward the proximal end toward scalp | alopecia areata
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| compulsive pulling/ripping out of hair | Trichotillomania
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| Pathopneumonic of Alopecia Areata | Exclamation point hairs
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| Alopecia Areata ..scalp only? | No! Most commonly occurs on the scalp, but can occur other places.
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| Alopecia Areata peak age range is _____. | 15-29 y/o
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| ANDROGENETIC ALOPECIA Male pattern | thinning in temporal region with receding of hairline
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| ANDROGENETIC ALOPECIA Female pattern | diffuse thinning on the crown of the head
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| ANDROGENETIC ALOPECIA occurs in females most often at what time in their lives? | postmenopausal, >65
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| Is the nasal mucosa erythematous in a healthy individual? | Yes. Normally erythematous, and darker than the oral mucosa.
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| Repeated IgE inflammatory response secondary to repeated exposure to allergens can cause _____________. | mast cell degeneration
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| Inflammatory response affects what 5 HEENT areas? | 1)Nose, 2)Eyes, 3)Eustacian tube & middle ear, 4)Sinuses, and 5)Pharynx
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| ALLERGIC RHINITIS Risk factor | FmHx of allergic rhinitis
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| The triad associated with ALLERGIC RHINITIS | 1)Asthma, 2)Atopic dermatitis/eczema, and 3)Allergic rhinitis
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| ALLERGIC RHINITIS Pts complain of : | paroxysmal episodes of sneezing, congesion, watery eyes, pruritis on eyes nose and palate, fatigue, malaise, and drowsyness from meds
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| What 5 things would you expect to find on physical exam while inspecting the mucosa with a case of ALLERGIC RHINITIS? | 1)Vascular engorgement, 2)Venous congestion, 3)Pale nares, 4)Bluish nares, 5)Fluid in the eustacian tube, nares, and possibly ears
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| allergic rhinitis PE of eyes ? | Itchy and Allergic shiners
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| allergic rhinitis PE of external nose ? | Nasal crease on bridge of nose from rubbing so much
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| 2 types of allergic rhinitis. | Seasonal and perennial
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| If young person in ED with ST changes: | look up nose
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| Common injury secondary to nose trauma | DEVIATED SEPTUM
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| Name 4 complications associated with a deviated septum. | 1)Decreased patency in affected nostril 2)Epistaxis 3)Blockage of ostea of maxillary sinus causing sinusitis 4) Decreased drainage (blockage)
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| Is a DEVIATED SEPTUM always the result of trauma? | Congenital deviation also occurs, but rarely.
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| When cauterizing a bleed in the nose, what should you always remember? | Cauterize only one side, because bilateral treatment will result in a burn hole.
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| Epistaxis: evidence of other underlying disease states (3) | 1) Rashes 2)Jaundice 3)Telangectasias
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| epistaxis, pledgelets soaked with | vasoconstricting: Topical cocaine,Lidocaine,
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| epistaxis (not posterior) tx | 1)pledgelets 2)Pack nose 3)Silver nitrate 4) Silver nitrate
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| How should a posterior bleed be handled? | Referral to ENT due to Tx difficulty.
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| Eccymosis below the eyes should cause suspicion of _____. | NASAL BONE FRACTURE(S)
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| External nare deformity suspecious of? | NASAL BONE FRACTURES
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| Epistaxis is it a requirement for Nasal bone Fx? | No! Epistaxis is not a 100% requirement
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| NASAL BONE Fx suggestions: | 1) External nare deformity 2)Crepitus and mobility of nasal bone on palpation 3) Septal malformation 4)Nasal trauma with obstruction 5) Nasal trauma with obstruction 6)Epistaxis is not a 100% requirement
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| Entropion is caused by a _______. | muscle spasm
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| 5 Sx associated with Entropion. | 1)Eye is irritated, 2)sand or gritty sensation of the eye, 3)redness secondary to inflammation, 4)excessive tearing, 5)photophobia
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| Ectropion Commonly seen in ____ secondary to _______ | • Commonly seen in elderly secondary to lax muscle tone
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| Thickening of the bulbar conjunctiva that does not disrupt vision. | Pinguecula
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| Pterygium extends from the ____ to the ____. | Extends from the conjunctiva to the cornea.
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| • Deposits of fatty material on the surface of the skin | Xanthelasma
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| • Only ½ of pts with this have a lipid disorder, but can occur in the presence of hypercholesterolemia | Xanthelasma
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| Does not go away with treatment of cholesterol, though ½ of pts with this eye condition have a lipid disorder. | Xanthelasma
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| Generic term for inflammation of the eyelids and eyelid margin. | Blepharitis
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| 2 etiologies of Blepharitis | 1)Seborrheic (most common)
2)Staphylococcal bacterial infection
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| o Staphylococcal- bacterial infection of eyelid what sign? | broken or misdirected eyelashes,erythema, tenderness to palpation
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| What is a Hordeolum? | Painful, erythematous, edematous infection of a hair follicle of the eye lash.
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| This is sometimes called the furuncle of the eyelid, | Hordeolum
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| A granuloma (hardened tissue) of the meibomian gland on the tarsal plates on the under side of the eyelids. NOT on the edge of the eyelid or eyelashes. | Chalazion
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| what is more- superficial vessels ..ciliary or Conjunctical vessels? | Conjunctical
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| A deep engorgement of the ciliary vessels around the limbus may indicate an inflammation of one or more of what 3 structures? | cornea, iris, or ciliary bodies
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| Conjunctivitis is an inflammation of _____. | the palpebral and/or bulbar conjunctiva
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| 5 types of conjunctivitis. | 1)Bacterial 2)Viral 3)Allergic 4)Chemical 5)Chlamydial
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| Clear, watery discharge, stringy in consistency from the eyes describes what type of Conjunctivitis? | Allergic (hay fever, environmental causes)
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| When can a pt with Bacterial Conjunctivitis return back to school? | 24 hrs after the start of the antibiotic
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| inflammation of the choroids ? | • Ciliary injection- iritis, uveitis- inflammation of the choroids (ciliary body)
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| The HLA B27 marker is associated with what other diseases? | Reiter’s Syndrome, ankylosing spondylitis, IBS
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| Uveitis is sometimes associated with what other diseases? | Glaucoma and HLA B27 related diseases such as Reiter’s.
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| Blood between conjunctiva and sclera is called ____. | Subconjunctival Hemorrhage
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| Pooling of bright red blood in the inferior of the iris, well demarcated-flat line, no change in the shape of the pupil, clouding on the inferior portion of the pupil | Hyphema
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| Subconjunctical Hemorrhages occur how and in whom? | Increased pressure seen often in people who do strenuous activity such as heavy lifting, vaginal delivery, vomiting (R/O bleeding disorder)
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| If the eyes look deviated but the light reflex is the same on both pupils, what is this condition called? | Pseudostrabismus
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| canthus (pl. canthi ) what is it and what can it trick you in to thinking? | The angle formed by the meeting of the upper and lower eyelids at either side of the eye, Can make you think the eyes are deviated when they are not
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| Amblyopia what 3 things can lead to it? | strabismus, structural abnormality: cataract , and one eye has different refraction than the other
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| While conducting a pediatric eye examination you cover the bad eye and the child sees fine. When you cover the good eye, how does a child react? | The child squints and tries to get the cover off the eye.
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| The palbebral margin is turned internally toward the eye with what condition? | Entropion
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| Entropion Caused by: | Muscle (orbicularis oculi ) spasm or relaxation
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| Turning of the palbebral margin outward and away from the eye is known as _________. | ectropion
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| o small, benign, yellow-white mass of degenerated tissue on eye and does not interfere with vision | Pinguecula
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| Pinguecula what side most often | more commonly on the nasal side
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| Often yellowish in color, this appears and feels like a thickening on the bulbar conjunctiva. | Pinguecula
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| Pinguecula what location ( oclock) | o Common on 3 and 9 o’clock position
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| Pinguecula cause ? | UV light Often seen with aging
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| I have Xanthelasma what do you want to check? | o Serum lipid levels (fasting lipid profile)
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| Xanthelasma TX | Treat their high cholesterol if they have it but will need o Surgical removal if cosmetic issue
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| Staphylcoccal Blepharitis S/SX? | 1)excessive tearing, 2)pruritis, 3)possible photophobia
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| Low grade bacterial infection of the eyelids. | Staphylcoccal Blepharitis
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| Staphylcoccal Blepharitis | o Blepharitis in general is an inflamm of the eyelids
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| Staphylcoccal BlepharitisTX | Eye hygiene – particularly related to eye makeup , 2) wash hands 3) Warm washcloths 4) Cleaning of the eyelids with water + baby shampoo/sodium bicarbonate
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| Staphylcoccal Blepharitis..Contagious? | No! common in adults but not contagious
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| Greasy, flaky, scaling condition, particularly around the eyelashes, secondary to accelerated shedding of skin cells. | Seborrheic Blepharitis
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| what is moore common Staph or Seborrheic Blepharitis? | Seborrheic Blepharitis is more common
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| Seborrheic Blepharitis.. what 2 other places do you looak at and why? | o Note dandruff on scalp and eyebrows
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| Caused by a blockage of the meibomian gland on the underside of the eye. | Chalazion
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| Chalazion what are you worried about? | o Concerned with corneal damage when blinking
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| o Infection at the distal tip of the eyelid around the hair follicle of the eyelash (furuncle of the eyelash) what is it? | Hordeolum/stye
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| Hordeolum/stye..whats the organisim? | Staph in 90-95% of the cases
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| Hordeolum/stye after 2-3 days of warm compress what do you do? | I & D if pus doesn’t pass (use of an #11 blade or an 18G needle)
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| Inflamm of the palpebral and bulbar conjunctiva is called? | Conjunctivitis
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| Conjunctivitis Etiologies include | Bacterial, either: gonorrhea or everything else,2) Viral 3)Allergic 4)Chemical 5)Chlamydia
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| With what condition do pts present with 1) Pruritic eye 2)Clear, watery, thin discharge 3)Fair amount of conjunctival injection | Viral Conjunctivitis
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| What eye condition? Discharge is seropurulent or pussy, Often have a pos STD hx, Chronic with exacerbations and remissions | Chlamydia conjunctivitis
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| What eye condition usually begins with excessive bilateral tearing, with stringy, clear discharge, and pruritis? | Allergic Conjunctivitis
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| Allergic Conjunctivitis Tx | 1)Identify and avoid the irritant, 2)Antihistamine
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| Sx: Wake up with pruritic crusts on eye, eyelids and eyelashes are mashed together, and large amounts of discharge. Dx? | Bacterial Conjunctivitis
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| Infant conjunctivitis what organisims and how? | N. Gonorrhea and Chlamydia – transmitted during delivery
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| Bleeding in between the conjunctiva and the sclera causes a ___________. | Subconjunctival Hemorrhage
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| Subconjunctival Hemorrhage causes? | of heavy lifting,vaginal deliveries,URI with hard cough,violent sneezing/coughing/vomitting
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| Subconjunctival Hemorrhage TX? | spontaneously absorb
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| If you see a pt with a spontaneous subconjunctival hemorrhage without any obvious etiology, what type of disorder should you consider? | bleeding disorder
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| o Hemorrhage into the anterior chamber of the eye? | Hyphema
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| Hyphema TX | note pt c/o blurred vision and pain,r/o other damage that may have been done , And refer!! Mild – resolve on its own Severe – drain by an ophthalmologist
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| Blood between the iris and the cornea is seen with a ________. | Hyphema
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| Bleeding of vessels of the iris leak into the clear aqueous fluid causing a ________. | Hyphema
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| 2 complications associated with hyphema. | 1)Corneal injuries from the backside 2)Glaucoma
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| Tx for a Corneal abrasion | 1)Antibiotic eye drops 2)Tetanus 3)Patch (controversial); do not tape the eyebrows if you choose this Tx option.
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| Pt complains of eyeerythema, pruritis, photophobia and decreased vision A`o Fluorescein stain will show dendrites whats the Dx | Herpetic Keratitis
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| Herpetic Keratitis TX? | Refer to ophthalmology Treatment includes short term topical acyclovir ointment or long-term oral acyclovir to reduce reoccurrence.
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| Most frequent cause of corneal related blindness in the US. | Herpetic Keratitis
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| Why does Ophthalmic Herpes Zoster affect the eye? | It is a herpetic infection of the tissue of the ophthalmic division of the trigeminal nerve.
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| If orbital eccymosis and edema is seen in a pt, what should always be in the DDx? | Orbital Fracture
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| This condition causes a swollen eyelid and conjunctiva, difficulty moving the eye secondary to congestion, and a protruding eye. 90% of the cases come from spread of infection from the paranasal sinuses. | Orbital Cellulitis
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| Orbital Cellulitis without TX can lead to what? | The infection can go to the optic nerve and/or bone, and systemically can lead to blindness and/or death.
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| Orbital Cellulitis TX | Referral to ophthalmology, In patient Abx
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| o It is a bacterial infection of the lacrimal sac caused by obstruction of the nasolacrimal system. S. aureus is usually the causative organism. (step spmetimes) what? | Dacryocystitis
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| Why is Dacryocystitis common in infants? | Infants have underdeveloped lacrimal ducts.
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| Dacroadentitis is seen with what illness? | mumps
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| A coal miner with one fixed and constricted pupil would most likely be diagnosed with ______. | Horner's syndrome. One would expect to find a Pancoast tumor.
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| In this condition, there is damage to the sympathetic nervous system, usually at the level of the cervical plexus of the neck. This causes innervation of the pupil and levator palpebrae superioris to be disrupted. | Horner’s syndrome
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| You examine a pt with the fundoscope and see no red reflex and a clouding and discoloration of the lens. Pt has progressive painless vision loss. What is your DX? | Cataract
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| Pt complains of cloudy vision, difficulty reading, decreased night vision, and images having a yellowish tint. DX? | Cataract
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| What are Cataracts caused by? | As a pt ages, the lens hardens and loses elasticity which causes protein to clump together and form opaque congregations on the lens.
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| Cataract TX? | Once the clouding of the lens has occurred, surgery is the only treatment
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| Inflammatory process in the temporal artery that results in an occlusion of the artery branch that goes to the eye. | Temporal Arteritis/Giant Cell Arteritis
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| Temporal Arteritis/Giant Cell Arteritis who? | o Exclusively in pts who are >50yo
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| Temporal Arteritis/Giant Cell Arteritis PE? | Auscultate temporal artery to listen for a bruit,,Order an ESR
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| Temporal Arteritis/Giant Cell Arteritis DX by? | o Dx confirmed by temporal artery biopsy
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| Temporal Arteritis/Giant Cell Arteritis TX? | steroids, to decrease inflammation
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| Central Retinal Artery Occlusion symptom? | Painless, sudden, unilateral loss of vision.
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| far-sighted medical term? | Hyperopia
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| The cup-to-disc ratio is normally __. | 1:3
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| ocup looks enlarged: (pressure in the eye is pushing the disc back making the cup look bigger) what Dx? | glaucoma
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| Disc margins are usually blurry or cannot be seen on what side? | nasal
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| Disc color if too pale | decreased blood supply (optic atrophy = decr blood and O2)
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| A disk that is too dark is associated with what condition? | HTN and hyperemia (increased swelling)
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| Optic disc margin variations Crescent – brown/black crescent along the edge of the disc what DX? | oNormal variant
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| Papilledema is optic disc swelling secondary to ___? | ICP
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| Papilledema 6 causes | 1) Tumor or space occupying lesion 2) Hemorrhagic stroke 3)Cerebral edema 4) Subarachnoid hemorrhage 5)Meningitis 6)• Increased CSF production
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| Fundiscopic exam:No cup or disc | Papilledema
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| the leading cause of blindness in the eyes in the US? | DM
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| EyeHemorrhages and exudates DM whatts it like? | DM more venous – veins leak and put out exudates along the fovea background that don’t follow the streak pattern
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| In eyes normal: see vein up to the edge of the artery, can be seen b/c arterial wall is__ | arterial wall is transparent
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| In the eyes, thickened arterial walls cause a loss of ____. | transparency
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| How does A/V nicking appear on fundoscopic exam? | The vein does not come up to the edge of the artery. Arterial wall edges become thickened and lose transparency.
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| nicking comorbid conditions? 2 | DM, HTN) – means condition is not being controlled well
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| Hemorrhages from the arterioles in the eye appear as ______. | Linear and flame-like streaks
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| venous eye Hemorrhages what does it look like? | veins leak and put out exudates along the fovea background that don’t follow the streak pattern typical in DM
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| Esotropia | eye turns in
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| Is strabismus always permanent? | No,it can be either transient or permanent.
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| If the patient has an equal light reflex and only appear to have strabismus, what is this condition called? | pseudostrabismus
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| Condition due to an imbalance of the eye muscles. Etiology is not well understood. | Strabismus
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| When strabismus develops in adulthood the chief complaint will be _______. | diplopia
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| Type of strabismus often seen in children at the end of the day when the child is tired. | Intermittent strabismus
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| Condition in which the brain sees 2 images, which eventually leads the brain to ignore input from one eye. | Amblyopia
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| o Children should have an eye exam before | 6 years old
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| strabismus Testing | Cover Uncover Test
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| Inward turning of the eyelid margin. | Entropion
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| Entropion Usually the __ lid | •Usually the lower lid
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| Name 5 symptoms associated with entropion. | 1)Eye is irritated, 2)sand or gritty sensation of the eye, 3)redness secondary to inflammation, 4)excessive tearing, 5)photophobia
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| 2 Entropion TX options. | 1)Surgery 2)Tape eyelid down
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| margins of the lower lid to turn out called? | Ectropion
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| 2 treatment options for Ectropion. | Surgery or artificial tears, to keep the eye lubricated.
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| Yellow Thickening of the bulbar conjunctiva that • Does not disrupt the vision what is it? | Pinguecula
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| Pinguecula what causes it? | UV light exposure
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| Pinguecula TX 2 | wear sunglasses and monitor
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| Pinguecula that grows onto the cornea. | Pterygium
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| Pterygium vision is? | Disrupted
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| Pterygium TX 1 | surgical removal
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| Pterygium is were | • Extends from conjunctiva to the cornea
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| Yellow raised plaques that are well demarcated, can stay same size or increase in size. | Xanthelasma
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| Xanthelasma were do they occur? | around the eyes andelbows, knees, hands, feet
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| Xanthelasma made of | adipose tissue
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| Generic term for inflammation of the eyelids and eyelid margin. | Blepharitis
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| Blepharitis Etiologies:2 | o Seborrheic- more common 2) Staphylococcal
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| Blepharitis:Staphylococcal what are you conserned about? | styes
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| inflammation of the eyelids and eyelid marginwith erythema, tenderness to palpation, see broken or misdirected eyelashes DX? | Staphylococcal Blepharitis
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| scaling along the eyelashes, secondary to an accelerated shedding of skin cells w/sebaceous cell dysfunction what condition? | Seborrheic Blepharitis
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| Painful, erythematous, edematous infection of a hair follicle of the eye lash. | Hordeolum
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| Hordeolum Etiology | usually staphylococcal • Can be due to previous blepharitis, but not always
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| • Called furuncle of the eyelid | Hordeolum
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| This is a hard & painless, granuloma (hardened tissue) of the meibomian gland. It is located on the tarsal plates under the eyelids. It is not located along the edge of the eyelids or eyelashes. | Chalazion
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| Chalazion are you worried? | • Concerned b/c they can scratch the cornea by blinking
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| Chalazion tx | excised, they have a tendency to grow back
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| Hordeolum tx | warm compresses,antibiotics, drain with an 11 blade or an 18 gauge needle
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| If a patient presents with red eyes, what needs to be determined? | Whether it is conjunctival injection or ciliary injection.
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| Name the condition: Pt presents with a red eye. The redness moves along the conjunctiva, more peripherally, and the redness does not extend to the limbus. | Conjunctival Injection
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| deep engorgement of the ciliary vessels around the limbus, deeper and indicates inflammation of the cornea, iris, or ____bodies what kind of injection? | ciliary injection
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| Conjunctivitis PE 5 things | 1)starting with visual acuity, 2)foreign body-eversion of the eyelid, 3)florescene staining, 4)slit lamp, 5)tonometry
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| Labs should be ordered in a case of conjunctivitis when? | Rarely, but labs are ordered when Neisseria Gonorrhea is suspected in newborns.
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| Conjunctivitis Pt education: | extremely contagious to others and self; use warm compresses to remove the crusting; don’t reuse wash cloth, concerned with pts that use eye makeup due to contamination, can go back to school 24 hrs after the start of the antibiotic
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| Injection- deeper and come off of the limbus, may be just millimeters in length, also have eye pain what | Ciliary injection
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| Iritis & uveitis results in inflammation of the ____. | choroids (ciliary body)
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| Ciliary injection | Limbic Flush?,pain on palpaton of eyelid,o Irregularly shaped pupil,pain, acute onset of discomfort, ,Photophobia
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| Ciliary injection what marker asssociation? | HLA B27
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| Orbital Fracture what examin first? | Visual acuity first
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| Orbital Fracture EOM finding (maybe)? | o Decreased ability to look up
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| Orbital Fracture who refer to? | maxillofacial specialist
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| Orbital Cellulitis organisims? 3 | o Staph ae, strep pyogenes, strep pneumo
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| Orbital Cellulitis were is infection from? | paranasal sinuses
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| can see things near but not far away what? | Myopia-
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| Myopia-image falls in front of OR inback of retina the retina???? | image falls in front of the retina
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| Vessels of eye that are smaller, lighter in color, and have a bright light reflex. | Arteries
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| Vessels of the eyes that are larger, appear darker red, and do not have much of a light reflex. | Veins
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| 3 possible causes of Papilledema. | 1)Increased ICP 2) Tumor 3) hemorrhage
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| Herpetic Keratitis Caused by | Simplex Type I (90% of time)
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| Herpetic Keratitis pt coplains of what 3 things? | o Erythema, puritic, decreased vision
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| Fluorescein staining reveals a dendritic lesion with multifigured, linear branches containing terminal buds. What is your diagnosis? | Herpetic Keratitis
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| What are the 4 classic symptoms of Meniere's Disease? | 1)periodic episodes of vertigo or dizziness, 2) progressive low frequency hearing loss, 3)sustained tinnitus or loud ringing in the ears, and 4)a sensation of fullness of pressure within the ear
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| What's your DX? Vertigo is experienced weeks to months, followed by periods of remission. | Meniere’s Disease
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| Patients with Meniere’s disease describe the onset of symptoms as ___ reaching a peak within _____ and lasting about ______, typically. | Patients with Meniere’s disease describe the onset of symptoms as acute reaching a peak within minutes and lasting about 20 minutes, typically.
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| Meinerre’s Disease TX ? (3) | 1) Low Na diet 2) o Low frequency diuretic 3)o Acute attacks- Antivert used to lessen symptoms
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| Aphthous Ulcer • Usually not systemic disease but can be caused by (3) | o 1) Anemia, 2) Crohn’s, 3)HIV
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| Aphthous Ulcer Etiology ? | unknown, may be an immune system disruption
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| Is an aphthous ulcer infectious, contagious, or sexually transmitted? | Non-infectious, non-contagious, and is not sexually transmitted.
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|
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| menstrual cycle any connection to Aphthous Ulcer? | Yes Aphthous UlcerCan by cyclical with menstrual cycle
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| 3 types of Aphthous Ulcer clue :related to size | <5 mm and >10mm and pinpoint ulcers- typically on the tongue
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| On PE in the oral cavity you see a yellowish, elevated spots with a red halo,o Tissue around in healthy and not affected what the DX? | Aphthous Ulcer
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| How long do pinpoint ulcers, typically found on the tongue, take to heal? | Pinpoint aphthous ulcers tend to heal within 1 month.
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| Aphthous Ulcer ,<5 mm, how long to heal? | heal within 1-2 weeks
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|
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| Aphthous Ulcer >10mmhow long to heal? any scar? | longer to heal then 1-2 weksand may leave scars
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| Aphthous UlcerTX? Cure? | No cure,o Topical anesthetic- lidocaine, zylocanine, benzocanie,o Antibacterial mouth wash to prevent secondary infection
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|
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| What are some possible causes of inflammation or swelling of the vocal cords? | Overuse of the voice, infection, viral URI, bronchitis, pneumonia, laryngitis, intubation, and/or damage to the recurrent laryngeal nerve.
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|
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| What condition presents with the following symptoms?: Hoarse or abnormal voice, aphonia, throat irritation, possible cough. This can also occur if a patient recently had a URI and constantly screams at kids. | Laryngitis
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| Laryngitis tx? | Shut up already!
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| Oral Candidiasis “Thrush” found in what 3 places? | 1) mouth, 2)GI tract, 3 ) female genital tract
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| I have DM( often Hyperglucemic) HIV ,CA and take systemic steriods and Antibiolics and wear dentures. what I at risk for ? | Oral Candidiasis “Thrush”
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| Oral Candidiasis “Thrush” name two drugs and one warning | Nystain 2)clotrimizole- pt should not become pregnant while taking this
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| Oral Candidiasis “Thrush” DX test and pos results? | • KOH slide show hyphe or pseudohype
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| • PE: oral lesion are white, raised, painless, distict patches, rest of tissue is normal, under the patches the tissue is erythemitous what in Diff DX? | Oral Candidiasis Oral Leukoplakia
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| Oral Candidiasis “Thrush” Risk factors | , immunocompromised (DM, HIV, carcinoma), antibiotic use (any), denture wearers, systemic steroids, hyperglycemia
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|
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| network of vessels on the anterior portion of the nasal septum on the medial side, most common site of bleeding | Kiesselbach’s Plexus
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|
||||
| - 2nd most common site of bleeding, anterior bleed site | Inferior turbinate
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|
||||
| septal necrosis what is the cause? | significant pressure may lead to decreased oxygenated blood to the septum can be from a bilateral Nasal septal hematoma
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|
||||
| This is associated with allergic rhinitis and asthma. Patients with this tend to have allergies to aspirin and NSAIDS. | Nasal Polyp
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|
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| Pt presents with ao Unilateral foul smelling discharge and a change on voice what do you suspect? | Nasal Foreign body
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|
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| Sinusitis Organisms? | strep pneumoniae and staph (same for otitis media)
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|
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| How Diagnosis Sinusitis? | 1)Transilluminate 2)o X-ray in the “Water’s View”- look for soft tissue density and air fluid levels within the sinuses
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|
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| PE- grayish to pink grape-like structures within the nasal cavity, size is variable, result of inflammation what? | Nasal Polyp
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|
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| Fontanels _______ closes before the ____ | Posterior closes before the anterior
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|
||||
| Subdural Hematoma or Epidural Hematoma which is more lethal? | Subdural Hematoma :More lethal
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|
||||
| pt haso Pain when you push on eyelid, o Irregularly shaped pupil,Photophobia and limbic flush whats DX? | • Ciliary injection- iritis, uveitis- inflammation of the choroids (ciliary body)
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|
||||
| How should a hyphema be managed? | Restrict eye movement, shield the eye, and/or tape both eyes closed.
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|
||||
| On PE, lateral border of the disc is blurred; visual acuity is normal what | Papilledema
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|
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