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68 Cards in this Set
- Front
- Back
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Commonly overlooked cause of laryngitis
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GERD
- as in asthma esp during nighttime, acid comes back up and drips back down, irritating the throat |
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Dacryocystitis sxs + sns
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1. pain, erythema, edema around sac
2. watery eyes, conjunctivitis, blepharitis, fever D. treatment 1. hot packs 2. antibiotics 3. nasolacrimal dilation |
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Blepharitis definition + etiology
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A. inflammation of lid margins
B. etiology 1. bacteria - staph 2. seborrhea |
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Blepharitis sxs + sns + tx
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C. sxs & sns
1. pruritis, edema, erythema, burning, loss of lashes, lacrimation, photophobia D. treatment 1. recurrent and resistant 2. improved lid hygiene 3. antibiotic ointment |
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Hordeolum definition + etiology
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VII. Hordeolum
A. stye B. localized infection of glands in lids 1. external a. Zeis or Moll glands at hair follicles 2. internal a. meibomian glands on inside of lids C. etiology 1. staph 2. recurrence common |
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Hordeolum sxs + sns + tx
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D. sxs & sns
1. external a. superficial, at base of eyelash b. pain, redness, tenderness of lid margin c. small, round, tender induration d. lacrimation, photophobia 2. internal a. deeper, seen through conjunctiva b. localized pain, redness, edema c. elevation or yellow area on conjunctival side of lid E. treatment 1. hot compresses 2. incision |
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Chalazion definition + sxs + sns
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VIII. Chalazion
A. chronic enlargement of a meibomian gland from occlusion of its duct 1. often follows inflammation of the gland B. sxs & sns 1. painless, slow growing, round mass in lid C. treatment 1. most disappear in a few months 2. hot compresses, incision |
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Conjunctivitis definition + etiology + sxs + sns + tx
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IX. Conjunctivitis
A. conjunctival inflammation B. etiology 1. viruses, bacteria 2. allergies, irritants C. sxs & sns 1. burning pain 2. mucoid or mucopurulent discharge 3. hyperemia of bulbar and palpebral conjunctiva 4. pre-auricularlymphadenopathy D. treatment 1. hygiene a. both physician and patient wash hands well b. use only own towels 2. antibiotic drops - gentamicin 3. herbal eye washes |
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Uveitis etiology + sxs + sns + tx
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X. Uveitis
A. inflammation of uveal tract (iris, ciliary body, choroid) & retina B. etiology 1. unknown 2. 40% from systemic disease C. sxs & sns 1. hazy vision, black floating spots 2. severe pain, redness, photophobia mean iritis D. diagnosis 1. direct damage and complications are often severe 2. if suspected, refer for immediate opthalmic evaluation 3. consider sarcoidosis E. treatment 1. local and systemic corticosteroids |
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Cataract sxs + sns + etiology
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XI. Cataract
A. opacity of the lens of the eye B. etiology 1. aging, exposure to x-rays, systemic disease (DM), uveitis, corticosteroids C. sxs & sns 1. progressive, painless loss of vision D. treatment 1. lens replacement |
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Glaucoma definition + etiology
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XII. Glaucoma
A. increased intraocular pressure (IOP) 1. may lead to slight visual loss or blindness from atrophy of optic nerve head (pushes back on optic disk + nerve) 2. open angle (too much fluid but outflow fine) a. aqueous humor pressure build up without blockage of outflow 3. closed angle a. sudden blockage of aqueous humor outflow (pressure build up) B. etiology 1. unknown 2. DM - diabetes px at much higher risk 3. hypothyroidism - higher incidence 4. familial |
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Glaucoma sxs + sns + diagnosis/tx
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C. sxs & sns
1. progressive loss of peripheral vision (narrows until like tunnel) 2. mild HA or eye pain - feels funny 3. vague visual disturbances 4. frequent eyeglass lens changes 5. seeing halos around electric lights - incandescents 6. impaired dark adaptation - driving @ nite D. diagnosis 1. tonometry E. treatment 1. increase aqueous outflow- open 2. decrease aqueous production- closed 3. many different types of pharmaceutical eyedrops do these |
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Retinal detachment Etiology + sxs + sns
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A. separation of retina from underlying epithelium
B. etiology 1. posterior vitreous detachment- vitreous behind lens 2. trauma 3. DM - diabetes 4. uveitis - includes retina + choroid C. sxs & sns 1. *painless 2. dark floaters, flashes of light (stotoma), blurred vision 3. curtain over field of vision - gets thicker + thicker D. immediate referral to ophthalmologist |
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Macular degeneration definition + types
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XIV. Macular Degeneration (most clear vision from macula)
A. atrophy or degeneration of the macula - very common + treatable 1. age-related macular degeneration 2. AMD or ARMD (same thing) B. types 1. wet AMD = 15% but most serious a. blood vessels multiply behind macula - push it outward, bleeding b. blood leakage behind macula c. macular separation from underlying epithelium d. 85% of all vision loss of AMD = dry AMD a. break down of cells of macula b. drusen formation - pigment formed in cells of macula i. possible oxidative damage to cells as result of drusen c. most common form d. 85% of all AMD e. all AMD begins with dry form 30% px over 70 get this - main cause cigarettes / caucasean |
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Macular degeneration epidemiology + etiology
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C. epidemiology
1. age a. mostly in people over 60 b. 30% chance when over 70 D. etiology 1. unknown 2. oxidative damage to macula 3. smoking 4. obesity 5. ethnicity a. Caucasian 6. family hx 7. gender a. women at higher risk than men |
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Macular degeneration sxs + sns + diagnosis
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E. sxs & sns
1. gradual or sudden painless loss of visual acuity (dry form- gradual loss) (wet- can be sudden 2. visual distortion from one eye (usu one - cataract + glaucoma usu both eyes) a. straight lines look crooked - amsler grids 3. fundoscopic hemorrhages - can see with ophthalmascope F. diagnosis 1. sxs 2. tonometry 3. Amsler grid 4. fluoroscein angiogram |
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Macular degeneration tx
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G. treatment
1. laser therapy-wet form a. photodynamic 2. AREDS – age related eye disease study of National Eye Institute a. vit. C 500 mg/day b. vit. E 400 IU/day - mixed tocopherols c. beta-carotene 15mg/day - free readical quencher - stops oxidative damage (pre-vit A- gets cleaved) (give px mixed carotenoids -- don't give to smokers) i. equivalent to 25,000 IU vit. A/day d. zinc 80 mg/day e. copper 2 mg/day - to balance zinc (to not mess up cholesterol - if too much zinc without copper the HDL goes down LDL go up 3. diet a. dark green leafy vegetables b. colored fruits and vegetables i. lutein- abundant in spinach, collard greens, egg yolks, corn - 15 mg/day. Lutein more in macula than anything else Zeaxanthin ( corn yellow) also found in macula - c. bilberry 80 mg 1-3x/day. Strenghthen retinal vessels -has anthocyans (bioflavanoids - connective tissue/ vessel walls) ESP good for wet form early stages) |
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Nose related px history
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I. History
A. frequent colds, nasal stuffiness, nasal discharge, sinus trouble, head pain, hay fever, nosebleeds, sense of smell, unusual odors B. past or present trauma |
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Nose related physical exam
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A. inspect for deformity, asymmetry, inflammation
B. inspection through anterior naris 1. limited to vestibule, anterior septum, lower and middle turbinate C. tilt patient’s head back, insert otoscope 1. inspect mucosa a. color (pink), edema, exudates, bleeding i. red, swollen - rhinitis (bacterial or viral) ii. pale, swollen - allergies 2. septum a. deviation, bleeding,perforation 3. lower and middle turbinates a. color, swelling, exudates, polyps D. palpation 1. frontal sinuses a. middle and medial supra-orbital ridge 2. maxillary sinuses a. maxilla - under eyes |
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Nose related testing + emergencies
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III. Testing
A. cultures of nasal discharge B. x-rays, CT scans of sinuses IV. Emergencies A. epistaxis if severe 1. usually associated with liver disease B. fractures if nasal bones displaced |
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Epistaxis definition + etiology
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V. Epistaxis
A. nosebleed B. etiology 1. trauma a. digital (nose picking) b. fractures 2. local infections 3. systemic infections 4. drying of membranes 5. atherosclerosis 6. hypertension 7. liver disease 8. diseases with bleeding tendencies a. leukemia, thrombocytopenia, aplastic anemia |
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Epistaxis tx
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C. treatment
1. stop bleeding a. pinch ala nasi together for 5-10 minutes b. cotton pledget c. cauterization 2. find and tx underlying cause |
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Rhinitis definition + etiology
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A. acute URI with edema of nasal mucous membrane, nasal discharge, and obstruction
B. etiology 1. respiratory viruses 2. bacteria a. streptococcus (pneumoccal and pyogenes), staphylococcus |
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Rhinitis sxs + sns
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C. sxs & sns
1. nasal discharge 2. nasal obstruction 3. erythematous, edematous mucosa |
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Allergic rhinitis
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F. allergic rhinitis
1. may be seasonal due to wind-borne pollens 2. sneezing, rhinorrhea, congestion, pruritis 3. pruritis of nose, mouth, pharynx, and eyes 4. lacrimation, sneezing, watery nasal discharge 5. frontal HA, irritability, anorexia, depression, insomnia 6. injected conjunctiva 7. swollen, pale, or gray nasal mucosa 8. dx by history and eosinophils in nasal secretions 9. tx with oral antihistamines 10. cromolyn sodium for prevention 11. desensitization |
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Sinusitis definition + clasification
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A. inflammation in paranasal sinuses due to viral, bacterial, fungal infections or allergic reactions
B. classification 1. acute a. less than 4 weeks in duration 2. subacute a. 4 – 12 weeks in duration 3. chronic a. 3 months or longer in duration |
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Sinusitis etiology + sxs/sns
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1. acute
a. preceded by viral uri b. strep, staph, hemophilus 2. chronic a. 25% due to dental infections C. sxs & sns 1. tender and swollen over the sinuses 2. frontal pain and HA 3. facial pain, HA, toothache 4. loss of smell (anosmia-none) 5. halitosis 6. erythematous, edematous nasal mucosa 7. mucopurulent nasal discharge 8. decreased transillumination |
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Loss of smell could be...
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Zinc xu \ tumor
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Sinusitis labs
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1. culture and sensitivity of discharge
2. x-rays a. of sinuses and apices of teeth (R/O periapical abscess) 3. CT scan a. better definition of extent and degree of infection b. polyps |
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Which turbinates are part of the ethmoid bone?
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Middle + superior turbinates (prt of ethmoid bone)
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Peduculated lesions
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Polyps (usu hang down from turbinates)
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Pharynx related px history
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Hx: problems in mouth, sores, sore tongue, condition of teeth and gums, bleeding gums, unusual or bad tastes, sore throats, hoarseness, difficulty swallowing, “swollen glands” in neck
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Pharynx rElated physical exam
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A. inspect lips, gums, teeth, buccal mucosa, tongue for color, masses, bleeding, edema, ulceration
B. visualize pharynx with tongue depressor 1. soft palate, uvula, anterior and posterior tonsillar pillars, tonsils, posterior pharynx C. palpate lymph nodes 1. pre and post auricular, occipital, tonsillar, submaxillary, submental, superior cervical, posterior cervical, deep cervical, supraclavicular a. size, tenderness |
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Child with frequent nosebleeds must rule out....
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Leukemia (CBC must be normal to rule out)
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Often elderly px with hypertension may have what symptom?
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Epistaxis- drying of membranes/arteriosclerosis
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Pharynx testing + emergencies
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III. Testing
A. culture and sensitivity IV. Emergencies A. epiglottitis 1. severe pain on swallowing, breathing difficulty |
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Pharyngitis definition + etiology
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A. inflammation of pharynx
B. etiology 1. usually viral 2. group A Beta hemolytic streptococcus pyogenes a. beefy red pharynx with exudates i. in 20% of patients with strep ii. others asx or mild sxs b. scarlet fever i. strep produces erythrogenic toxin ii. diffuse pink-red rash over abdomen, lateral chest, skin folds iii. strawberry tongue iv. Pastia’s lines |
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Pharyngitis sxs + sns /labS
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1. sore throat, pain on swallowing, fever, cervical lymphadenopathy
D. laboratory 1. leukocytosis a. left shift if strep 2. rapid strep test 3. culture for strep if rapid test negative but suspect still suspect strep |
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Pharyngitis tx
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1. none if viral
2. antibiotics (penicillin, amoxicillin, erythromycin) if strep a. to prevent rheumatic fever, glomerulonephritis 3. vit. C, vit. A, zinc 4. revulsive hydro to neck 5. hydrastis |
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Tonsillitis definition + etiology
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A. inflammation of the tonsils
B. etiology 1. strep 2. sometimes viral |
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Tonsillitis sxs + sns
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1. sore throat, pain on swallowing often referred to ears
2. high fever, HA, malaise, vomiting 3. tonsils edematous and erythematous 4. purulent exudate 5. membrane on tonsils that peels away without bleeding |
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Tonsillitis labs + tx same as pharyngitis
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Lab: leukocytosis / shift to left if strep (rapid strep test: if negative do culture for strep if still suspected)
Tx: none if viral Antibiotics (penicillin, amoxicillin, erythromycin) if strep Vit c, vit a, zinc (any mucus membrane inflammation anywhere) Revulsive hydro to neck Hydrastis |
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Laryngitis definition + etiology
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A. inflammation of larynx
B. etiology 1. viral uri most common cause 2. bronchitis, influenza, pneumonia, pertussis, measles, diphtheria 3. excess use of voice 4. cigarette smoke or inhalation of other irritants 5. allergic reaction 6. GERD |
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Laryngitis Sxs + sns + diagnosis
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1. unnatural change of voice
2. hoarseness, aphonia 3. tickling, rawness, urge to clear throat 4. fever, malaise, pain, dyspnea if severe D. diagnosis 1. indirect laryngoscopy |
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Infectious Mononucleosis definition etiology + epidemiology
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A. viral infection causing fatigue, fever, pharyngitis, lymphadenopath
B. etiology 1. EBV - epstein Barr virus (related to varicela/herpes, hides in dorsal root ganglia///many ppl have been exposed to it) 2. CMV - cytomegalovirus (can cause chronic fatigue or mono-like) C. epidemiology 1. found in 50% children under age of 5 2. persists for life 3. most common between ages of 15 – 17 4. commonly transmitted by kissing asx individual |
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Chronic sinusitis could be caused by what 1/4 of the time?
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Abscess/infection of abscess of tooth
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Infectious Mononucleosis sxs + sns + diagnosis
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1. *fatigue, HA, *sore throat, fever
2. myalgia 3. loss of appetite 4. hepatomegaly, splenomegaly (some cases - cause jaundice) Diagnosis 1. leukocytosis a. atypical lymphocytes (not markers of disease - need monospot) 2. monospot a. heterophile antibodies - what looking for in monospot i. positive one week after sxs begin b. antibody titer for EBV - unless serial tirers not that useful, many ppl have varicela virus |
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Ear relevant px history
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I. History
A. hearing, ringing noises, drainage, earaches, infections, spinning sensation |
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Ear related physical exam
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A. inspection of the auricle
B. palpate tragus C. palpate mastoid process D. otoscope to inspect tympanic membrane - pneumatic 1. malleus, cone of light, color, fluid levels E. auditory acuity 1. whispers, fingers rubbing, watch ticking |
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Ear relevant Testing + emergencies
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III. Testing
A. audiometry - quantitates hearing loss IV. Emergencies A. ear trauma 1. fractures of temporal bone B. sudden severe ear pain - perforation C. acute hearing loss D. discharges E. vertigo 1. must distinguish between peripheral and central |
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Otitis Externa definition + etiology
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A. infection in the ear canal
1. swimmer’s ear B. etiology 1. bacteria 2. water, hair spray, trauma from cleaning the canal |
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Otitis Externa sxs + sns
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1. pruritis, pain, foul-smelling discharge
2. possible hearing loss from blockage of canal 3. tenderness on traction of pinna & pressure on tragus 4. skin of canal may be red, swollen, moist Tx: topical antibiotics |
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Otitis media definition + classification + etiology
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A. bacterial or viral infection in middle ear
1. often 2o to uri B. classification 1. AOM – acute otitis media a. 2 weeks duration 2. OME – otitis media with effusion a. fluid behind tympanic membrane after infection 3. COME – chronic otitis media with effusion a. fluid remains or returns 4. recurrent OM a. 4 episodes in 6 months or 6 episodes in 1 year B. etiology 1. bacteria and viruses a. pneumo, strep, staph, hemo |
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Otitis media sxs + sns
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1. earache – pulling at ears
2. fever 3. possible hearing loss 4. erythematous, bulging tympanic membrane with loss of landmarks and light reflex 5. possible perforation |
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Otitis media diagnosis + tx
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1. clinical
2. complications a. mastoiditis, labyrinthitis, facial paralysis, hearing loss, meningitis, brain abscess E. treatment 1. watchful waiting a. if fever <102 F (39 C) 2. antibiotics a. amoxicillin, azithromycin 3. food and environmental sensitivities 4. avoid added sugars and simple carbohydrates 5. herbs - systemic and local drops 6. revulsive hydrotherapy 7. endonasal technique |
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Serous Otitis Media definition + etiology
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A. effusion in middle ear from otitis media
B. eustachian tube may be blocked from inflammation or allergies |
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Serous otitis media sxs + sns + tx
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1. retraction of tympanic membrane
2. accentuated landmarks and diminished light reflex 3. amber or gray fluid in middle ear 4. fluid or air bubble levels D. Treatment 1. antibiotics 2. myringotomy (tympanostomy) 3. food sensitivities 4. tx as in otitis media |
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RiskS to consider with strep
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Scarlet fever - strep produces erythrogenic toxin (red on trunk)
Rheumatic fever- usu mitral valve involvement Glomerulonephritis - post streptococcal (glomerulous the problem/ major job filtering protein) |
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Strep classic presentation
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Grp A hemolytic streptococcus pyogenes - Beefy red pharynx with exudates ///20 % present this way, the rest anything goes
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Mastoiditis definition + etiology
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A. bacterial infection in mastoid process
1. coalescence of mastoid air cells B. etiology 1. bacteria as in otitis media 2. untreated acute otitis media |
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Mastoiditis sxs + sns + tx
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1. usually more than 2 weeks after untreated otitis media
2. erythema, edema, tenderness, fluctuation over mastoid process 3. auricle displaced laterally and inferiorly 4. persistent, throbbing pain 5. hearing loss increasing D. treatment 1. antibiotics |
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Menieres disease definition + etiology
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A. recurrent vertigo, sensory hearing loss, tinnitus
1. with endolymphatic hydrops B. etiology 1. unknown 2. head injuries 3. otitis 4. viral infections 5. alcohol use |
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Tonsillitis usu caused by...
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Pharyngitis /// + usu strep
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Menieres disease sxs + sns
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1. sudden vertigo
a. lasts 1-24 hours b. gradual subsidence 2. fullness or pressure in affected ear 3. hearing loss worsens progressively over years 4. constant or intermittent tinnitus 5. usually unilateral a. 10-15% bilateral |
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Menieres disease diagnosis + tx
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D. diagnosis
1. clinical 2. caloric stimulation tests 3. CT scans a. RO other causes of sxs D. treatment 1. diuretics 2. low salt diet 3. surgical a. labyrinthectomy b. cut vestibular nerve 4. food sensitivities 5. manipulation |
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Eye relevant history + physical exams
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I. History
A. vision, glasses or contacts, last eye exam B. glaucoma, cataracts C. blurred vision, double vision E. pain, redness, watery eyes, discharge, blind spots II. Physical Exam A. eyelids, lacrimal apparatus B. PERRLA C. extraocular movements - H and X in space D. visual fields E. fundoscopic exam |
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Eye relevant testing + emergencies
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III. Testing
A. visual acuity - eye chart B. fluoroscein dye - corneal abrasions green C. ultrasound 1. retinal tumors, detachments, vitreous hemorrhages D. tonometry IV. Emergencies A. foreign bodies that penetrate the globe B. trauma to the globe C. acute visual loss or disturbance D. sudden severe pain E. uveitis F. retinal detachment |
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Dacryocystitis definition + etiology
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A. infection of lacrimal sac
B. usually 2o to obstruction of nasolacrimal duct 1. congenital dacryostenosis, trauma, deviated septum, rhinitis, polyps |
