clin med #4
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Created by:
zkhamisiasl on August 1, 2011
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173 terms
Terms | Definitions |
|---|---|
 erythema, tenderness, swelling of the gum, lymphadenopathy, foul smell, drainage sore on the gum | dental abscess |
| Tx for dental abscess | amoxicillin or metronidazole |
| preodonitis, trench mouth, erythema, swelling, fever, pain | Gingivitis |
| Tx for gingivitis | removal of plaque, good dental hygiene, removal of cause |
| grey-white lesion with erythematous border, single lesion, burning or tingling prior to ulceration | aphthous stomatitis "Canker sore" |
| Tx of canker sore | minor= none Majore=topical or systamic corticosteroid, lidocain |
| Dew drops on a Rose petal, flu-like symptoms, burning, tenderness, pain, | herpes labialis, cold sores, fever blister |
| Dx of Herpes labialis | viral culture |
| topical agents for herpes labialis | abreva, penciclovir, acyclovir |
| oral agents for herpes labialis | valtrex, famvir, acyclovir |
| recurring inflammation of the angle of the mouth, irritation, pain, ithching, edema, scaling develop | angular cheilitis, perleche |
| tx of angular cheilitis | clotrimazole, miconazole, bactroban, amoxicilin |
| white too creamy plaques, removal with a dry gauze pad leaves an erythematous or pin point bleeding, odynophagia, diminished taste | candidiasis |
| Dx of Thrush | KOH |
| Tx of Thrush | Nystatin, clotrimazole, ketoconazole |
| white lacy pattern, erosive form may be painful with beefy desquamation, may be resemble leukoplakia | oral lichen planus |
| Tx of oral lichen planus | fluocininide or clobetasol( topical corticosteroid) |
| chronic white patches or plaques in mucosal surface, 80% tobbaco use, | oral leukoplakia |
| Dx of oral leukoplakia | Biopsy |
| Tx of oral leukoplakia with biopsy found of hyperkeratosis | close follow up and education |
| Tx of oral leukoplakia with biopsy found of epithelial dysplasia | cryotherapy, electrocautery, topical 5-fluorouracil |
| Tx of oral lecoplakia with biopsy found squamous cell carcinoma | sugical excision of the jaw or the lesion |
| viral induced hyperplasia, white or grayish -white well demarcated, lesion do not rub off, hairy texture, biopsy reveal epstein barr virus | oral hairy leukoplakia |
| Tx of oral hairy leukoplakia | podophyllin |
| oral hairy leukoplakia | pathonemonic for HIV |
| most common cause of common cold | Rhinoviruses |
| rhinitis, nasal discharge, sore throat, malaise faver, conjunctivitis, nasal discharge any color, can be clear and turn to yellow green anytime, red external naras, sneezing, in children can vimit phlame | common cold |
| anterior epistaxis | kiesselbach plexus |
| posterior epistaxis | sphenoplatine artery |
| caused by HTN, use of cocain, nasal surgery, tumor | posterior epistaxis |
| caused by nasotracheal, nasogastric tube, nose blowing | anterior epistaxis |
| tx of anterior epistaxis | nasal tamponade, electrical cautry, nasal paking |
| tx of posterior epistaxis | posterior nasal packing, angiographic embolization |
| snoring, diffeculty breathing through the nose, nasal congestion, sinus infx, facial pain, | Deviated septum |
| Tx of Deviated septum | septoplasty |
| teardrop shape, benign growth on the nasal, obstruction sleep apnea, usually bilateral | nasal polyps |
| Dx of nasal polyps | nasal endoscopy, CT |
| Tx of nasal polyps | nasal cortico. oral cortico. polypectomy, endoscopic polyp surgery |
| cause by hot spicey food, PND, rhinorrhea, sneezing | vasomotor rhinitis |
| Tx of vasomotor rhinitis | nasal glucocor. topical astelin, ipratropium, deconjestant, turbinectomy |
| sudden hearing loss, fullness and pressure in the ear, tinnitus, dizziness | cerumen impaction |
| Tx of cerumen impaction | cerumenolytic agents (debrox or cerumenex), irrrigation |
| Tx of insect in the ear | kill the insect prior to removal with mineral oil, lidocaine, emla cream, then remove with irrigation, or mechanical extraction |
| wrestelers' ear, treanng of the perichondrial vessels, cauliflower ear | Auricular hematoma |
| formation of ------is an indication for referral after aurical hematoma | granulation tissue |
| Tx of aurical hematoma | evacuate subperichondrial blood and prevent its reaccumulation |
| bacterial cause of AOM | S. pneumonia, H. influenzae, M. catarrahalis |
| erythema of the TM, Otalgia or ear pulling in infants, bulging of TM, Opacity of TM, limited or absent mobility of teh TM, Otorrhea, air fluid level behind the TM, fever, loss of balance | AOM |
| Dx of AOM | always clinical dx, tympanogram, for the persistent infx tympanocentesis |
| Tx for + dx of AOM, fever> 39 and moderate to sever pain | first line= Amoxicilin, 2nd line= augmentin |
| Tx for nonsever AOM, fever<39, mild to modrate pain | conservative tx |
| tx of AOM if amoxicilin allergy non type one hypersensitivity | cefdinir, cefpodoxime, cefuroxime |
| tx of AOM if amoxicilin allergy-type I hypersensitivity | azitromycin, erythromycin, Bactrim |
| tx if AOM persists | clindomycin, tympanocentesis |
| follows AOM, fluid behind the TM, no inflammation, conductive hearing loss, dull TM | OME |
| OME>3 months, change balance and decrease speech | chronic otitis media |
| three apisodes of AOM within six months or four episodes within a year, lack of speech development, hearing loss | ROM |
| Tx of ROM | prophylaxis= sulfi, amoxicillin 3 months trial Tympanostomy tube |
| pathogens of OE | strep, pseudomonas, staph, proteus |
| pathogens of chronic or necrotizing OE | pseudomonas |
| itching ear, otaldia, ear drainage, decrease sense of hearing, pre-auricular lymphadenopathy and swelling, TRAGAL TENDERNESS, exteral canal edema, exudate, erythema | OE |
| tx of OE | cortisporin, FQ, cipro HC otic, ciprodex |
| tx of OE with fungal infx | clotrimazole, Itraconazole |
| tx of TM rupture in OE | Tolnaftate |
| to rule out osteomyelitis | CT or MRI |
| tx of necrotizing or malignant OE | Quinolones like cipro |
| follows AOM, MASTOID TENDERNESS, SWELLING OVER MASTOID | mastoiditis |
| tx of acute mastoiditis | hosp. antibiotic, analgesices, myringotomy, cortical mastoidectomy |
| dx of mastoiditis | x-ray, CT |
| deafness, dizziness and vertigo, painless, recurring otorrhea, FACIAL NERVE EXPOSURE, MAYBE PARALYSIS | cholesteatoma |
| arise as a consequence of squamous epithelium trapped within the temporal bone embryogenesis | congenital cholesteatoma |
| occure as a direct consequence of some type of injury to tympanic membrane, porforation of OM or trauma, surgical manipulation of the TM | secondary cholesteatoma |
| dx of cholesteatoma | CT |
| tx of cholesteatoma | surgical excision |
| THUMB SIGN, onset rapid, pt prefer to sit, MUFFlEd voice, Dysphagia, drooling, restlessness, minimal cough, sore throat, Hoarseness, difficulty swallowing SALIVA, SNIFFING POSITION, TRIPOD, NOISY, HIGH-PITCHED SQUEAKY inhalition | Epiglottitis |
| tx of epiglottitis | needle cricothyroidotomy, intubation, IV ceftriaxone |
| bacterial cause of pharyngitis | Group A Beta Hemolytic strep (strep throat) |
| sore throat, fever>100.4, malaise, anorexia, vomiting, rash, PHARYNGEAL and TONSILLAR Erythema and exudate, Palate PATECHIAE, ANTERIOR CERVICAL ADENOPATHY | pharyngitis |
| dx of pharyngitis | RADT |
| Gold standard to dx pharyngitis | Throat Culture |
| tx of pharyngitis with penicillin allergy | Macrolides, or Cephalosporine |
| first line tx of pharyngitis with no allergy | Penicillin, Benzathine Penicillin, amoxicillin |
| 2nd line tx of pharyngitis with no allergy | Augmentin |
| complication of pharyngitis | scarlet fever, rheumatic fever, peritonsillar abscess |
| HOT POTATO VOICE, TRISMUS, nack pain, headache, dysphagia, otalgia, odenophagia, TACHYCARDIA, RANCID OR FETOR BREATH, CERVICAL Lymphadenitis, asymmetric tonsillar hypertrophy, fluctuance, erythema and exudate of tonsil | peritonsillar abscess |
| tx of peritonsillar abscess | needle aspiration, abscess incision and drainage, tonsillectomy |
| tx of pharyngitis if gonorrhea is the cause | ceftriaxone or cipro |
| tx of pharyngitis if chlamydia is the cause | azithromycin and doxycyline |
| Gray pseudomembrane adhering to pharynx | diphtheriae |
| tx of diphtheriae | anttitoxin and erythromycin |
| absent or low grade fever, pharyngeal edema/erythema, lack of exudate, ulcer, HEPATOSPLENOMEGALY, POSTERIOR CERVICAL ADENOPATHY, CORYZA | viral pharyngitis |
| Dx of viral pharyngitis | rapid strep/influnza, throat culture, monospot, herpes culture |
| Tx of viral pharyngitis | Analgesics/antipyretics, throat lozenges, influenza vaccine, Acyclovir if herpes |
| Generalized Lymphadenopathy, SPLENOMEGALY, cervical adenopathy, headache, MYALGIA, chills, fatigue, fever, skin rash, sore throat, INCREASE WBC, HETEROPHIL antibody | Mononucleosis, Epstein-Barr viral infection |
| Tx of Mononucleosis, Epstein-Barr viral infection | rest, analgesic, avoid excessive PE, prednisone, NO ANTIVIRAL |
| anterior ethmoid, frontal and maxillary sinuses drain into | middle meatus |
| posterior ethmoid drains into | upper meatus |
| middle meatus and upper meatus drain into | ostomeatal complex |
| nasal congestion, PURULENT RHINORRHEA, FACIAL PAIN, PND, anosmia cough, fever headache | sinusitis |
| nasal congestion, RHINORRHEA CLEAR, Runny nose, ITCHING and RED EYEs, SEASONAL SYMPTOMES | rhinitis |
| Most upper respiretory infexs are | viral |
| tx of viral rhinosinusitis | rest, fluids, nasal lavage, decongestants |
| bacterial cause of rhinosinusitis | S. pneumococcus, H. influenza, M.catarrhalis |
| mucopurulent nasal discharge, swelling of nasal mucosa, mild erythema, facial pain, PERIORBITAL SWELLING | rhinosinusitis |
| Dx of rhinosinusitis | Transillumination, Rhinoscopy, CT SCAN MAXILLARY AND ETHMOID SINUSES |
| ABx for acte Bacterial rhinosinusitis | Amoxicillin, Augmentin, cefuroxime, cefprozil |
| Dx of chronic rhinosinusitis | CT or MRI scanning to evaluate anatomic defects, tumors, fungi, allergy testing, cultures |
| infection and small abscess of gland of the eye lid, pain, redness, swelling/pustulate | Hordeolum |
| tx of hordeolum | worm compresses, QID 10-15 minute a day, topical +/- ABX |
| inflammation of the meibomiann gland of the eyelid, strerile chronic lipogranulomatous inflammation , hard nontender nodule in upper or lower lid | chalazion |
| tx of chalazion | self-limiting, worm compress, lid hygiene |
| bilateral inflammation of eyelid, red-rimmed, scales/granulation clinging to lashes CAUSED BY CHEMICAL or STAPH/SEBORRHEIC , burning, itching, | blepharitis |
| Tx of blepharitis | lid hygeine, baby shampoo |
| nasolacrimal duct obstruction, CHRONIC or INTERMITTENT tearing, most cause of tearing in childern, mostly caused by UNOPENED valve of HASNER | Dacryostenosis |
| tx of decryostenosis | NLD massage, if not resolved in 6-12 months of age NLD probing |
| infection of lacrimal sac d/t decryostenosis, +/- fever, discharge, prulent, pain, redness, crusting | decryocystitis |
| tx of decryocystitis | referral for childern and infents, systemic abx to prevent cellulitis |
| obstruction of proximal and distal valves, noted shortly after birth, BLUISH SWELLING overlying the lacrimal sac, superior displacment of the medial canthal tendone | decryosystocele |
| Tx of decryocystocele | urgent referral |
| inward turning of lid margin/dry eye | Entropion |
| eversion of the eyelid margin/dry eye | Ectropion |
| tx of entropion/extropion | eye lubrication/surgery |
| NO PROPTOSIS, Va and EOM and pupillary responses are normal, edema, erythema, pain and mild feverusually exogenous source/contiguous infection, ANTERIOR to orbital septum | preorbital cellulitis |
| most arise in paranasal sinus infx, edema, erythema, PROPTOSIS, decrease VA and EOM and pupillary responses, pain with eye movement, fever is high | orbital cellulitis |
| NEXT STEP IN PREORBITAL CELLULITIS | CT to rule out preorbital from orbital cellulitis |
| Tx of preorbital and orbital cellulitis | HOS. and ABx |
| harmless growth, yellow elevated conjunctival nodule, usually seen midally, occasionally inflamed | pinguecula |
| tx of pinguecula | no tx or if inflamed topical steroid |
| Triangular encroachment onto the cornea, Fleshy, irritative response to UV light, wind, dry environment, redness, tearing | pterygium |
| tx of pterygium | surgery if vision is affected, but might reoccure |
| caused by coughing, sneezing, straining, heavy lifting, trauma, painless, no vision change, RUBTURE of small blood vesels under the conjunctiva | subconjunctival hemorrhage |
| tx of subconjunctival hemorrhage | reassurance, resorbs 1-3 weeks |
| FB sensetion, ithching, burning, discharge, sense of fullness around the eye, STUCK SHUT IN THE MORNING, HYPEREMIA, epiphoria, exudate, chemosis, conjunctival injection, | conjunctivitis |
| next step in evaluating conjunctivitis | Flurescein stain |
| swimming pool, highly contagious, usually one eye but soon bilat. usually follows a URI symptoms such as FEVER, PREAURICAL lymphadenopathy, WATERY DISCHARGES, +/- foollicular appearance, , Marked diffused injection with watery discharge, mostly in kids | viral conjunctivitis, PINK EYE |
| tx of viral conjunctivitis | supportive, hygeine, cool compresses, |
| mostly in adults, purulent discharge usually white-yellow and constant | acute bacterial conjunctivitis usually caused by s. aureus |
| Tx of acute bacterial conjunctivitis | topical ointment abx such as erythromycin or bacitracin |
| usually caused by gonorrheal, copious purulent discharge seen with chemosis, lid swelling, TENDER PREAURICULAR lymphadenopathy | hyperacute bacterial conjunctivitis |
| tx of hyperacute bacterial conjunctivitis | emergency referral, ceftriaxone |
| gonococcal conjunctivitis of the newborn, copious purulent discharge within 1-7 days after birth, prevented by silver nitrate | ophthalmia neonatorum |
| tx of ophthalmia neonatorum | ceftriaxone IV/IM, systamic erythromycin |
| itchy, redness, tearing, ropy discharge, bilateral, mild injection of palpebra/bulbar conjunctiva to sever chemosis, LIGHT REFLEX when u shine in it | allergic conjunctivitis |
| tx of allergic conjunctivitis | OTC topical antihistamine, cold compress |
| common in elderly women, dryness, redness, scratchy feeling, loss of LUSTER, slit-lamp may show INJECTION, ulceration/mucous strands | keratoconjunctivitis sicca |
| Tx of keratoconjunctivitis sicca | artificial tear/lubricant drop |
| injection that redness is most pronounced in a ring at the limbus | Ciliary flush |
| ocular(achy) pain, photophobia, blurred vision, decrease VA, cilliry flush, miosis( CONSTRICTED PUPIL), clear cornea, | Uveitis/Iritis |
| Tx of Uveitis/Iritis | referral,topical steriod, |
| blood in anterior chamber, blunt truma, pain, blurred, vision, SLUGGISH/PEAKED PUPIL | Hyphema |
| Acute corneal abrasion, tearing, photophobia, scarring may occure | corneal abrasion |
| Dx of corneal abrasion | h/o truma, fluorescein stain, r/o FB |
| caused by UV lighting, tenning booth, welding, tearing, pain, DELAYED by 6-12 hrs pain and photophobia, punctate staining of bilateralcorneal | UV keratitis |
| tx of UV keratitis | refer, ibuprophen, binocular pathching, cyclopentolate |
| caused mostly by staph, pseudomonas for CONTACT WEARERS that sleep with their contact, corneal haze, can lead to CORNEAL UNCER, | bacterial keratitis |
| tx of bacterial keratitis | gram stain, FQ, HOS?, NO CL wear |
| most common cause of corneal ulceration, unilateral red eye, Dendritic ULCER | herpes simplex keratitis |
| tx of Herpes simplex keratitis | urgent referral, topical and oral antiviral, NO TOPICAL STEROID |
| truma, stress, fever, malais, Unilateral periorbital burning or itching, 1-2 days later the painful vesicular pustural erution occure, HUTCHINSON's sign( rash over tip of the nose) | herpes zoster ophthalmicus |
| tx of herpes zoster ophthalmicus | urgent referral, oral antiviral, topical steroid |
| first sign is myoptic shift, blurred or double lesion, sensitivity to glare, complain with night driving, opacification of red reflex, decrease VA, visible cataract with scope exam, most common cause of leukocornia and blindness in children, and in U.S. | cataracts |
| tx of cataracts | if vision impaired laser of extraction |
| other cause of cataracts | TORCH |
| life-threatning cause of leukocoria | retinoblastoma |
| only sign of retinoblastoma | abnormal red reflux, also may present with strabismus, retinal detachment, red painful eye, and glycoma |
| pathophysiology of aqueous humor flow, IOP>21.5mm Hg, D. AH drainage, Inc. IOP, pressure on optic nerve, Cupping of optic disc and pallor, Loss of peripheral vision first( TUUNEL VISION), | Glaucoma |
| associated with an open anterior chamber angle, no early symptoms, bilateral visual field loss"tunnel vision", increase cup to disc ratio, pallor of optic disc, peripheral visual field defect, silent onset | OPEN-ANGLE GLAUCOMA |
| Tx of open-angle glaucoma | Trabeculectomy, laser trabeculoplasty,pilocarpine, and prostaglandin to increase the darinage, (BB, inhabitir of carbonic anhydrase enzym, alpha agonists, destruction of ciliary body) to decrease secretion, |
| associated with narrow or closed anterior chamber angle, iris bow forward which causes the angle to close, risk factors are asian, FHx, hyperopia, cataract, iritis, Unilateral red eye, acute onset of sever pain, N/V, HALOS AROUND THE LIGHT, HAZY/STEAMY Ncornea, limbal flash, PUPIL FIXED, indurated eye, iris is bowed forward, lid edema, IRREGULAR IRIS AND PUPIL | Angle-closure Glaucoma |
| tx of angle closure glycoma | ocular emergency, BB(TIMOLOL)and miotic to pull iris away(PILOCARPINE), carbonic anhydrase inhibitor(acetazolamide), osmotic diuretics(MANNITOL), ER, iriodotomy or iriodectomy |
| rapid vision loss, demyelination disorder, 18-45, pain with eye movement, cental scotoma of vision loss, loss of color vision (bright red look pink), delayed/ reduced pupillary response to light, FLAME HEMORRHAGE, DISC MARGINS BLURRY, PAPILLITIS, may be associated with multiple sclerosis or SLE | optic neuritis |
| Tx of optic neuritis | treroids to speed up visual recovery reserved for demyelinating causes |
| caused by increased ICP, usually bilat. subsequenses of HTN, hemorrhagic stroks, and subdural hematoma | Papilledema |
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