HEENT Exam Questions and Complete Solutions Graded A+

  Herpes keratitis - Answer: Acute onset of severe pain photophobia tearing and blurred vision in one eye How is herpes keratitis dx - Answer: Fluorescein dye fern like lines in the corneal surface Two types of herpes keratitis - Answer: Herpes simplex- cold sore Herpes varicella zoster or shingles-irruption of crusty rash that follows trigeminal nerve Acute angel closure glaucoma - Answer: Elderly patients with acute onset of severe eye pain Accompanied with nausea vomiting halos around lights with decreased vision Mid dilated pupil that is oval shape cornea appears cloudy funduscopic exam reveals cupping of optic nerve Multiple sclerosis - Answer: Young adults with newer in committed loss of vision of one eye alone or accompanied by nystagmus or other abnormal eye movements Neurological symptoms aphasia parenthesis abnormal gait Daily fatigue on awakening that worsens as day goes on Heat exacerbates and worsening symptoms orbital cellulitis - Answer: Acute onset erythematous swollen eyelid with proptosis (bulging eyeball) Look for history of recent rhinosinusitis or upper respiratory infection retinal detachment patient presents complaining of - Answer: Sudden onset of shower of floaters "looking through curtains" with sudden flashes of light (photopsia) Cholesteatoma define- objective exam shows- pmhx- mass can cause- aka- - Answer: Cauliflower like growth in the middle ear. Pt c/o foul smelling discharge and hearing loss. On exam, no TM or ossicles visible because of destruction by tumor PMhx of chronic OM. The mass is not cancerous but it can erode in to the bones of the face and damage CN7. Tx = ENT referral for sx, abx. Mass is usually made of epithelium and cholesterol. AKA pearl tumor. Battle Sign def- Rule out- - Answer: Raccoon eyes (Periorbital ecchymosis) bruising behind the ears that appear 2-3 days after trauma Physical exam does not show the signs immediatelySearch for a clear golden serous drainage from the ear or nose Rule out basilar or temporal bone skull fracture Clear golden fluid discharge indicative of how do you test it? - Answer: Indicative Of basilar skull fracture CSF slowly leaks testing the fluid with the urine dipstick will show that it is positive for glucose peritonsillar abscess - Answer: severe sore throat and difficulty swallowing, odonophagia (pain on swallow) trsmus (jaw pain) and a "HOT POTATO" voice. refer to ED for incision and drainiage Diphtheria - Answer: Sore throat fever and markedly swollen neck "BULL NECK" Cones - Answer: Color vision Rods - Answer: Light, shadow, night vision Fundi - Answer: veins are larger and darker than arteriers Macula - Answer: central vision fovea - Answer: 20/20 sharpest vision presbyopia - Answer: Age related visual change, stiffening of lens, starts at the age of 40 near vision is affected decreased ability to read small print at close range tympanogram - Answer: most objective measure to test for presence of fluid inside middle ear four sinuses and when do they develop - Answer: Ethmoid and maxillary sinus- birth Frontal-5 years Sphenoid-12 years leukoplakia define- cause- indicates- - Answer: thickened, white, leathery-looking spots on the inside of the mouth that can develop into oral cancer Associated with chewing or smoking tobacco and alcohol use Also early sign of HIV apathous stomatitis - Answer: Canker sores heal within 7 to 10 days tx with magic mouthwash Avulsed tooth - Answer: Store and cool milk no ice Name 3 salivary glands - Answer: parotid, submandibular, sublingual posterior pharynx - Answer: ■ Look for POSTNASAL drip (acute sinusitis, allergic rhinitis). ■ Laying down supine worsens post nasal drip cough ■ HARD PALATE: Look for any openings (cleft palate), ulcers, redness. geographic tongue - Answer: Map like appearance patches, soreness with acidic foods, spicy food torus palatinus - Answer: painless bony protuberance midline of the hard palate(roof of mouth). fishtail - Answer: Uvula split May be a sign of occult cleft palate -rare papilledema - Answer: swelling of the optic disc with blurred edges due to increased intercranial pressure (ICP) Blurred disk margins hypertensive retinopathy - Answer: Copper and silver wire arterioles Artveriovenous nicking- arteriole crosses vein, it indents the vein Retinal hemorrhage Flame hemorrhages diabetic retinopathy what would you see on eye exam - Answer: Micro-aneurysms Neovascularization Cotton wool spots Cataracts definition Test- And symptoms - Answer: Opacity of the lens Test for Cataracts= red reflex Symptoms include difficulty with glare, headlights when driving at night, HALOS around lights, blurred vision allergic rhinitis physical exam shows - Answer: Blue tinged or pale and swollen boggy nasal turbinates Kopilk's Spots - Answer: Clusters of small sized red papules with white centers inside the cheeks Pathognomonic-Measles Nasla Polyps - Answer: Increased risk for aspirin sensitivity or allergy Hairy Leukoplakia - Answer: Pathognomic HIV caused by Epstein-Barr virus Cheilosis - Answer: Painful skin fissures and maceration at the corners of the mouth due to excessive moisture Most common and elderly with dentures -poorly fit denatured Secondary infection with Candida albicans yeast Treatment plan for cheilosis - Answer: Check B12 level to rule out pernicious anemia Remove underlying cause-Correct fit dentures Treat yeast When infection has cleared use barrier cream with zinc or petroleum jelly apply at night hyperopia - Answer: farsightedness myopia - Answer: nearsightedness Abnormal Snellen - Answer: two line difference between each eye confrontation exam - Answer: peripheral vision exam Ishihara chart - Answer: color blindness Snellen chart test what - Answer: central vision Legal blindness - Answer: 20/200 Children have 20/20 vision by - Answer: 6 years old Weber test - Answer: Weber it's the right or left ear Rinne test - Answer: Ruben under the pinne normal AC>BC Sensorineural AC>BC- Weber lateralized good ear Conductive BC>AC -Weber lateralized bad ear Sensorineural hearing loss - Answer: usually results in permanent hearing loss Hordeolum - Answer: sty; an acute infection of a sebaceous gland of the eyelid Painful Tx hot compress x5-10 mins bid or tid Chalazion - Answer: a nodule or cyst, usually on the upper eyelid, caused by obstruction in a sebaceous gland NOT painful Pinguecula what is it What cause it Recommendation - Answer: Yellow to white small round growth Located on the nasal and temporal side of eye Caused by chronic sun exposure Recommend good quality sunglasses Removed surgically if encroaches on cornea and affects vision Pterygium what is it What causes it Aka Recommendation - Answer: Yellow triangular thickening across the cornea on nasal side From chronic sun exposure A.k.a. surfers eye Recommend good quality sunglasses Removed surgically if encroaches on cornea and affects vision Subconjunctival hemmorhage define- caused by- tx- - Answer: Blood trapped underneath Scalera Caused by coughing sneezing heavy lifting vomiting local trauma Resolves in 1 to 3 weeks Tx watchful waiting Primary open angle glaucoma - Answer: IOP greater than 22 Gradual changes and peripheral vision lost first then central vision Funder scopic exam shows cupping IOP high Tonometer - Answer: best test for galcoma normal 18-21 IOP greater then 30 urgent referral Betimol is treatment for what How does it work - Answer: medication for glaucoma beta blocker decrease aqueous production Xalatan treatment for what? How does it work - Answer: Topical prostaglandin increases Aqueous outflow For open angle glaucoma Primary angle closure glaucoma - Answer: sudden blockage of aqueous humor causes marked increas of the IOP, causing ischemic and permanent damage to optic nerv (II) case:older pt co/o acute onset of a severe frontal headache or sever eye pain with blurred vision and tearing. Seeing halos around lights. May c/o nausea vomiting Eyes fixed and mid-dilated cloudy more oval than round pupils react slowly to light Classic presentation of primary angle closure glaucoma - Answer: Acute onset of decreased/blurred vision with severe eye pain and frontal headache that is accompanied by nausea and vomiting Objective findings for a primary angle closure glaucoma - Answer: Eye: fixed and mid dilated cloudy pupil 4-6MM that looks More oval then round pupils react slowly to light Anterior Uveitis (iritis) - Answer: Insidious onset of pain with redness Age-related macular degeneration (AMD) define Leading cause of? More common in who? - Answer: Is loss of central vision caused by gradual damage to the pigment of the macula leading cause of blindness and elderly more common in smokers Two types of Age-related macular degeneration (AMD) - Answer: Dry form or wet form the dry form is more common and is less severe the wet form is responsible for 80% of vision loss Treatment plan for age related macular degeneration - Answer: Referred to ophthalmology and give a copy of Amsler grid Focus eye center dot and view grid 12 inches from face patient checks visual field loss daily to weekly Classic patient presentation of age related macular degeneration - Answer: Elderly smoker complains of gradual or sudden painless loss of central vision in one or both eyes Reports that straight line such as doors and windows appear distorted or curved Sjögren's syndrome - Answer: Autoimmune disorder Decrease function of the lacrimal and salivary gland Classic patient presentation of Sjögren's syndrome - Answer: Patient reports dry and dry mouth (xerostomia) for longer than three months eyes have Sandy or gritty sensation (keratoconjctivitis sicca) have used over the counter artificial tears more than three times per day marked increase in dental caries or examination shows swollen and inflamed salivary gland's blepharitis - Answer: Chronic condition caused by inflammation of the eyelid complains of itching or irritation in the eyelid gritty sensation eye redness and crusting Treatment plan for blepharitis - Answer: Johnson's baby shampoo with warm water Allergic rhinitis - Answer: Atopic family history asthma and eczema Nose has blue tinged or pale boggy nasal turbinates mucus clear Treatment plan for allergic rhinitis - Answer: First line treatment plan topical nasal steroid sprays over-the-counter fluticasone Flonase Next step anti-histamines such as Zyrtec Rhinitis medicamentosa - Answer: Prolonged use of Topical nasal decongestant more than three days because rebound effect affects epistaxis bleed is coming from where - Answer: Anterior nasal bleeds are the result of bleeding from the kiesselbach's plexus Posterior nasal bleeds are serious and can lead to severe hemorrhage Treatment plan for epistaxis - Answer: Apply direct pressure on the front of the nose several minutes use nasal decongestant such as Afrin to shrink tissue to help stop bleeding Apply triple anabiotic ointment or petroleum jelly in front of the nose using cotton swab for a few days Streptococcal pharyngitis/tonsillopharyngitis "strep throat" - Answer: Suspect viral ideology or coinfection's if coughing symptoms such a stuffy nose rhinitis with clear mucus and watery eyes (Coryza) Treatment plan for strep throat - Answer: First line oral penicillin 500 mg b.i.d. to TID times 10 days Strep throat treatment plan if beta lactation allergy - Answer: If patient has Penicillin or beta-lactam allergy= is it through myosin Z pack times five days Complications of strep throat - Answer: Scarlett fever acute-sandpaper rash Strawberry tongue rheumatic fever -inflammation of heart vales Peritonsillar abscess poststreptococcal glomerulonephritis-protein urea hematuria dark colored urine Acute otitis media pathogens - Answer: S. Pneunoniae Haemophilus influenza Mira Ella catarrhalis Bulbous Myringitis - Answer: Type of AOM infection that is more painful due to presence of blisters Conductive hearing loss Same treatment as bacterial AOM Acute bacterial rhinosinusitis ABRS - Answer: The maxillary and frontal sinuses are most commonly affected patient complains of bad head cold Facial pain or upper molar pain with nasal congestion for 10 days or longer with perulent nasal drainage Test for acute bacterial rhinosinusitis - Answer: Transillumination positive glow of light on infected Sinus is duller compared with normal sinus Treatment for acute bacterial rhinosinusitis - Answer: Augmentin Treatment for acute bacterial rhinosinusitis if type 1 allergy -anaphylaxis - Answer: LevoFloxin or doxycycline Treatment for acute bacterial rhinosinusitis if type 2 allergy - Answer: Cefdinur (omnicef) Otitis externa swimmers ear most common pathogen - Answer: #1 pseudomonas aeruginosa #2 s. Aureus Treatment plan for otitis externa - Answer: Polymyxin B- neomycin-hydrocortisone Non-ototoxic ear drop (ruptured TM) - Answer: Ofloxacin Infectious mononucleosis - Answer: Caused by EBV most common 15-24 kissing Classic mono patient - Answer: Fatigue may last weeks to months may have abdominal pain due to hepatomegaly or splenomegaly Mono treatment plan - Answer: Limit physical activity 4 weeks to reduce risk of splenic rupture Repeat abdominal ultrasound in 4 to 6 weeks Avoid using amoxicillin if patient has strep throat-Morbilliform rash arcus senilis - Answer: White, gray, or blue opaque ring in the corneal margin common in older adults also indicates hypercholesteremia if developed early in life What was the abx for concurrent Strep and Mono? - Answer: Z-pack per Sarah Michelle's review... or a cephalosporin if they are not allergic to penicillin... Positive chvostek's - Answer: Contraction of facial muscles when facial nerve is tapped Briskly in front of the ear Indicates low calcium With a conduction hearing loss, how will the Webber test respond? - Answer: lateralize to the affected ear With sensorineural loss, weber lateralizes to? - Answer: unaffected ear good ear