HEENT Adult Med
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- List some causes of conductive hearing loss
- Cerumen, middle ear effusion, FB, cholesteoma, otosclerosis
- List some causes of sensorineural hearing loss
- schwannoma, noise induced trauma, measles, mumps, meniere's, ototoxic meds - ASA, age, acustic neuroma
- What are some common causes of tinnitus
- Trauma, noise, meniers,
- What are the sx of external otitis
- px, reddness, swelling, dishcarge. Associated also with swimmer's ear.
- What is necrotizing otitis externa (malignant external otitis)
- persistent otitos in DM or immunocompromised evolving into osteomyelitis of the skull base.
- What are the most common bacterial pathogens causing acute OM
- strep pneumo, strep pyrogens, H. flu
- What is serous otitis media
- fluid build up behind TM, post infection, allergies
- How might a pt with Meniere's disease present
- vertigo, tinnitus, hearing loss. Episodic; >30 minutes <4 hours
- How might a pt with labyrinthitis present
- sudden acute vertigo. Most commong form of vertigo. Post URI
- How might a pt with benign positioning vertigo present
- sudden vertigo onset from a change in the person's head position. Ca+ sediment in hear canal breaks free
- How might a pt with acoustic neuroma (vestibular schwannoma) present
- hearing loss, unilateral, sudden. Sensorineuroal
- What is rhinitis medicamentosa
- chronic rebound nasal congestion from over use of afrin (oxymetazoline)
- How might a pt with acute sinusitis present
- facial px and tenderness, toothache, HA, fever
- How might a pt with nasal polyps present
- recurrent sinus infection because sinus's can't drain, chronic obstruction. Hx allergies or asthma
- How might a pt with nasopharyngeal carcinoma present
- vague sx, persistent unilateral nasal obstruction, proptosis, discharge, bleeding, ill-fitting dentures, doesn't get better
- What is a peritonsillar abscess (quinsy) how do you treat it
- abscess on tonsils. ST, fever, swollen glands, denies hoarsness - cough or coryza. Caused by Group A beta strep, mono, diphtheria. Tx I&D
- What is a complication of strep pharyngitis
- rhematic fever, glomerular nephritis
- What pathogens cause external otitis
- gram negative rods or fungi
- Describe typical SS adn Tx for: acute OM
- SS: pressure, decreased hearing often fever. Tx: ABX nasal decongestants
- Describe typical SS adn Tx for: Acute mastoiditis
- SS: post auricular px, erythema, spiking fever. Tx: IV antibiotics, myringotomy for culture and drainage
- Describe typical SS adn Tx for: Serous OM
- Tx: oral corticosteroids, and oral ABX like acute OM
- Describe typical SS adn Tx for: Chronic OM
- SS: purulent discharge, conductive hearing loss, increased SS during URI. Tx: removal of debris, protective earplugs, topical ABX
- Name some complications of middle ear infections:
- mastoiditis, petrous apicitis, otogenic skull osteomyelitis, facial paralysis, sinus thrombus, CNS infection
- What is cervical vertigo
- dysfunction of the cervical proprioception sites located in thefacet joints.
- What is perilymphatic fistula
- blunt head trauma like a hand slap to ear, extreme baro-trauma, vigorous valsavla. may require surgery
- What is acoustic neuroma
- benign lesion within internal auditory canal. unilateral hearing loss with sudden onset, decreased speech, continious disequilibrium.
- Describe 1. Cause 2. SS 3. Tx for: viral rhinitis (common cold)
- 1. rhinovirus, adenovirus, corona virus, RSV 2. HA, congestion, scratchy throat, malaise, fever less likely. 3. comfort measures, time
- Describe 1. Cause 2. SS 3. Tx for: allergic rhinitis
- 1. exposures creating release of IgE antibodies 2. sneezing, itching, etc. 3. intranasal steroids, topical antihistamines, systemci antihistamines
- Describe 1. Cause 2. SS 3. Tx for: rhinitis medicamentosa
- 1. chronic rebound nasal congestion associated iwth over use of afrin. 3. stop use of afrin - duh!
- Describe 1. Cause 2. SS 3. Tx for: acute sinusitis
- 1. URI, allergies, strep pneumo, H. flu, 2. facial px, HA, fever 3. ABX
- Describe 1. Cause 2. SS 3. Tx for: viral pharyngitis
- 1. HIV, flu, mono 2. URI sx 2. comfort measures, time
- Describe 1. Cause 2. SS 3. Tx for: bacterial pharyngitis
- 1. N. Gonorrhea, mycoplasma Pneumo, chlamydophilia Pneumo
- Describe 1. Cause 2. SS 3. Tx for: infectious mono
- 2. enlarged tonsils with shaggy white-purple membrane that may extend into nasopharynx, breath fetid
- Identify several causes of sores and ulceration in mouth
- candidiasis, aphthous ulcer (canker sores) herpes stomatitis, sialadenitits (stones in duct)
- Describe common cause of hoarseness
- vocal cord disorder due to harsh turbulent air flow from tumor or swelling; viral laryngitis or squamous cell carcinoma of larynx. If persists > 2 wks, further eval necessary.
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