PC2Exam1Other2

Viral and Bacterial Sinusitis

• Acute bacterial rhinosinusitis typically affects the maxillary and frontal sinuses following a viral URI ("common cold") or allergic rhinitis.
• Fluid gets trapped leading to secondary bacterial infections.
• Common bacterial culprits are S. pneumoniae and H. influenzae.
• Symptoms include unilateral facial or upper molar pain (maxillary sinus) or frontal sinus pain along with nasal congestion lasting 10+ days.
• Purulent (dark yellow to green) nasal and/or postnasal drip is also typical.
• Other symptoms are hyposmia (reduced ability to smell) and postnasal drip cough that worsens when lying down and may disrupt sleep. -OTC cold and sinus remedies are ineffective.
• Examination findings include posterior pharynx purulent postnasal drip, tenderness to palpation on the front cheek (maxillary) or frontal sinus area above the inner canthus of the eye, a positive transillumination of the frontal and maxillary sinus (duller glow of light on infected side).
• Treat with antibiotics if symptoms persist for >10 days, worsen, are severe (toxic, high fever, pain, purulent nasal discharge for 2-3 days or longer), or patient is immunocompromised.
• First-line antibiotic for adults:* Amoxicillin-clavulanate (Augmentin) BID x 7 days, instruct patients regarding GI side effects
• First-line antibiotic for Kids:* Amoxicillin 90mg/kg/day
• Penicillin allergy alternatives are : Levofloxacin (risk of tendon rupture), doxycycline, cefdinir (Omnicef), or cefuroxime (Ceftin).
• For pain or fever, Ibuprofen or acetaminophen can be used. Medications like pseudoephedrine (Sudafed) or pseudoephedrine combined with guaifenesin (Mucinex D), Afrin are useful for drainage, Afrin should be limited to a maximum use of 3 days to avoid rebound congestion.
• Also recommend saline nasal spray (Ocean Spray), steroid nasal spray (Flonase), mucolytics (guaifenesin), and increased fluid intake to thin mucus.
• Cough can be managed with Dextromethorphan (Robitussin) or Benzonatate (Tessalon Perles), caution with Benzonatate as toxic for children <10 years, pills should be swallowed whole (not crushed/chewed).
• Complications include periorbital or orbital cellulitis (more common in children), characterized by swelling and redness at the periorbital area, double-vision or impaired vision, and fever.
• Abnormal EOM, altered LOC, or mental status changes require further investigation.
• Meningitis: presents with acute onset of high fever, stiff neck, severe headache, photophobia, positive Brudzinski's/Kernig's sign, and toxic appearance, refer to ED.
• Cavernous sinus thrombosis : includes acute headache, abnormal neurologic exam, confusion, fever, life-threatening emergency with high mortality, refer to ED.

Hearing Loss

• Hearing loss occurs when sound waves do not reach the brain, impacts one or both ears.
• Can range from mild to severe. common causes are aging, exposure to loud noises, cerumen impaction, ear infections or ruptured eardrum can prevent sound waves from reaching the inner ear.
• Aminoglycoside antibiotics, loop diuretics & chemotherapy meds are Rx that can cause HL, Diseases like Hypertension, strokes, diabetes and genetic conditions also associated with hearing loss.
• Symptoms include difficulty hearing conversational speech or loud sounds, difficulty picking out words against background noise, higher-pitched tones may sound muffled, asking people to repeat themselves
• Treatments include hearing aids, cochlear implants, surgery, and special training.

Retinal Detachment

• Myopia, Trauma, Glaucoma, PVD, Hx of cataract surgery put people more at risk.
• Symptoms include sudden flashes of light or a shower of floaters, visual field loss ("curtain coming across vision"), poor visual acuity.
• Emergent referral.

Allergic Rhinitis

• This is the inflammation of the nasal mucosa due to allergy.
• Commonly presents as chronic or seasonal nasal congestion with clear mucus rhinorrhea or postnasal drip, cough that worsens when supine, nasal, throat, eye itching, watery eyes and sneezing.
• Examination usually findings include pale, boggy turbinates, clear rhinorrhea, PND (clear to yellow/thick if r/o sinusitis), undereye dark circles ("raccoon eyes"), transverse nasal crease ("allergic salute"), and cobblestoning in posterior pharynx.
• Nasal steroid sprays (OTC Fluticasone, triamcinolone) are first-line once daily, if only partial relief add topical antihistamine azelastine, and if still no relief use combination product azelastine and Fluticasone (Dymista).
• Decongestants (pseudoephedrine), oral antihistamines PRN, second-generation antihistamines (cetirizine, loratadine) for less sedating, and eliminate environmental allergens.
• Complications include acute sinusitis, acute otitis media and rhinitis medicamentosa

Impacted Cerumen

• Ear wax impaction causes hearing loss, pain, itching, and other symptoms.
• Symptoms include itching/odor or ringing noises, feeling of fullness, hearing loss, earache, discharge.
• Earwax is normally expelled by jaw movement however sometimes this process does not work.
• Drops with glycerin or peroxide is used to soften impacted earwax.
• Irrigation can be preformed
• Special tools can be used to manually removing the earwax.
• Do not put objects into the ear canal and cleaning only the outer portion of ear with wet washcloths will prevent impaction.

Epistaxis

• Anterior nasal bleeds are more common than posterior bleeds.
• Risks include Aspirin/NSAID use, cocaine abuse, hypertension, anticoagulant use, most stop on their own.
• Acute onset of nasal bleeding is a common presentation.
• May drip externally or vomit blood if swallowed.
• Apply direct pressure on the anterior nose for several minutes and can use nasal decongestant to shrink the tissue and stop bleeding.
• Apply triple antibiotic ointment or petroleum jelly inside the nose with a cotton swab for a few days and Cauterization with silver nitrate or electrical device in office with local anesthetic if needed.

Foreign Body in Ear

• May cause pain, itching, noise, can be visible or more hidden, difficulty removing.
• Symptoms: Pain, Itching, Noise, Redness, Drainage and Hearing difficulties.
• Treatment depends on the object but can use Tweezers (if visible & graspable), water( if no hole in eardrum) using rubber-bulb syringe. Oil or alcohol if its an insect, magnets for metal/suction catheter.
• A medical professional may need to use special instruments to extract.
• Do not put a cotton swab or matchstick into the ear; use water, oil if there is a an opening in ear drum.
• Avoid these

Periorbital Cellulitis

• Infection and inflammation of the eyelid and skin around the eye.
• Symptoms: Redness around the eye or in the white of the eye, Swelling of the eyelid, Eye swelling, .Causes: a Bacterium such as Staphylococcus, streptococcus, or Haemophilus, Minor scratch/injury to the eye, Spread of infection from another part of the body like cough or impetigo, Insect bites
• Treat with antibiotics (oral typically 24-48 hours) Cool compress to reduce swelling and discomfort is recommended.
• Complications: Orbital cellulitis, loss of vision, meningitis, brain abscess and cavernous sinus thrombosis
• Seek immediate medical care for vision changes or difficulty moving the eye, eye looks bulging/symptoms worsen after treatment.

Eustachian Tube Dysfunction

• ETD occurs when the Eustachian tubes are blocked or are not opening properly.
• This prevents fluid and pressure from draining properly from the middle ear.
• Symptoms include ear pain, feeling of fullness, ringing, popping, or clicking sounds in the ears.
• There may be difficulty hearing, dizziness/vertigo, or tugging.
• Causes include common cold, URI, allergies, chronic mucus drainage, and swelling at the opening of the ET, Treatment: Yawning, eating and drinking, decongestant, steroid nasal spray, steam applications and antihistamine.

Nasopharyngitis

• Contagious viral infection that inflames nasal passages and throat, also known as the "common cold."
• Symptoms: Runny/stuffy nose, coughing, sore throat, sneezing, headache, fatigue, low-grade fever
• Causes: Rhinovirus, RSV, Parainfluenza virus, adenovirus, coronaviruses spread through air or touching contaminated.
• Medications such as decongestants, antihistamines, and NSAIDs can treat symptoms.
• Prevention: Wash hands, avoid cough and sneeze in face.
• Usually resolves in 8-10 days, but can last longer

Pharyngitis/Tonsillitis

• If cough, a stuffy nose, rhinitis, and watery eyes suspected think viral over bacterial.

Streptococcal Pharyngitis Assessment

• Most common in childern and adults around children.
• Presents with fever, sore throat, difficult to swallow, submandibular lymphadenopathy, exudate found on tonsils.
• Tonsillar exudate, tenderness from front anterior cervical adenopathy, history of fever, but absence of cough are CENTOR Criteria findings.
• Pharynx dark pink to bright red and may be Petechiae on the hard palate with lymph nodes enlarged in examination.
• Rapid antigen testing (RADT) "rapid strep test" or throat culture is used for diagnosis.
• First line treatment is Oral Penicillin V 500 mg BID to TID x 10 days Azithromycin (Zpak) x 5 days if penicillin allergy, ibuprofen and throat lozenges are symptom relief options. Tooth brush and salt water may help.
• May return to work or school after 24 hours of antibiotic and no longer contagious.

Complications of Streptococcal

• Scarlet fever (scarlatina), Sandpaper-textured pink rash with sore throat and strawberry tongue.
• Rash starts on head and neck then spreads to trunk and the extrem.
• Inflam. reaction that affects the heart and valves, joints, and brain is rheumatic fever risk.
• Fever, painful and tender knees, ankles, elbows , wrists, Red, hot or swollen joints, bumps that are painless nodules beneath skin and fatigue/chest pain can indicate it.
• Displaced uvula, red bulging mass on front of pharyngeal space, difficult to swallow, fever, increased saliva, drooling, muted “hot potato” voice is Peritonsillar abscess

Post-Streptococcal Glomerulonephritis

• Abrupt Proteinuria, hematuria, dark-colored urine, plus RBC casts accompanied by edema.

Otitis Externa

• Inflammation/infection of external ear canal, also know as Swimmers Ear.
• Bacterial, fungal, moisture, trauma, absence of earwax, diabetes all increase liklihood.
• Pain with movement of tragus Hall mark redness, pain and edema in canal may be present.
• Itching, discharge and normal TM may be some things seen.
• Use combinations of antibiotics with steriods if intact hydrocortisone/neomycin/polymycin B (Cortisporin).
• Ciproflaxin/dexamethasone sterile may be used with ruptured TM/tobramycin and dexamethasone may be used with ruptured TM and. Ooxacin (Floxin) may be used over 12 years with ruptured Tm
• Avoid exposure to humid dry ears and dont put objects in.

Epiglottitis

• Life threatening bacterial or viral infection when throat injur causes epiglottis to swell.
• Swallowing hard, drooling, hoarseness high pitch sound or voice increases or becomes difficult to breath are key symptoms.
• Oxygen Emergency mask is needed and antibiotics such as Ceftriaxone should be give. Antibiotics, throat infections, and injury can causes infection.
• Hib Vaccine will prevent epiglottitis.

Actue Otitis Media

• Ear infection with bulging of ear and ear effusion causes by middle inflammation.
• Viruses and bacteria Strep are key causes.
• Rapid pain Fever light reflex landmarks displaced.
• Amoxicillin is key treatment and treat eustachiac tube.

Acute otitis Media w/ Effusion

• Fluid in ear from infection that is no longer there.
• Fullness feeling decreased decreased retracted hearing.
• Decongestants are the main source to treatment .

Infectious Mononucleosis

• Infection by the Epstein-Barr Virus (EBV).
• "Kissing disease."
• Shed through saliva.
• Symptoms:
• Presents similarly to viral and strep pharyngitis (acute symptoms, not prolonged).
• More common in 15 to 24 years.
• Classic triad of fever, pharyngitis, and lymphadenopathy (50%)
• Prolonged fatigue (several weeks and may last months) enlarged cervical lymph nodes (may be tender) enlarged tonsils with white exudate.
• Monospot (heterophile antibody) test.
• Hepatomegaly (20%) and 50% Splenomegaly.
• Ruptured spleen=Catastrophic event.
• Order abdominal ultrasound if splenomegaly/hepatomegaly is present.
• Repeat abdominal US in 4-6 weeks if abnormal to document resolution.
• Treat symptoms

Mastoiditis

• Infection of the mastoid bone=Usually caused by middle ear infection> Damage to mastoid bone or pus-filled.
• Symptoms:
• redness, swelling, and tenderness around the bone=Fever and ear pain, Lethargy.
• Abnormal tympanic membrane, fever, otalgia, otorrhea, narrowing of auditory canal.
• refer CT for posib IV abx
• Menegitis and hearing loss come with.
• Consult
• Risk closing airways

Dental Abscess Treatment

• Pus fills gums, teeth, or jawbone from caused by bacterial infection, requires urgent dentist.
• Pain can be caused that spreads to jaw and face or down the neck when lying.
• Incision and drainage from Procedures, minor surgery of gum used for drain pus.

Conjunctivitis

• Inflammation of the conjunctiva
• Viral
• Highly contagious
• Symptoms include injected conjunctiva, profuse tearing, watery mucus
• Burning/sandy feeling with URI Predrome

•   Causes- adenovirus
  

•   Testing done to see if bacterial
  

• Treat artificial tears and itch symptoms
• Herpetic: Burning sensation and rare itches unilateral rare nodes on neonates.

•   Refer to ophthalmologist
  

• Bacterial: Pus, Redness, stuck closed in morning
• Multiple staph Causes in contact wear
• Flurodrops and kids are drops
• STI: From clams or g Chlamydial 5 days after birth Unilateral bilaterally to be purulent swelling adults for genitals
• Treat: Ceft and erthy. Allergic reaction cause redness, swelling, Take good care

TMJ

Conditions where jaw pain and muslces pain dysfunction

• grinding and fatigue of the muscles injury
• pain when yapping
• Locking is treatment.
• diagnosis

Blepharitis

• inflammation from the eyelids- itching burning lids scaling,
• Staph and rosea, seb dermatitis if anteior

Hordeolum(sty)

Infection involving the gland

• staph ar Zudden onset
• warm compress Non express

Chalazion(gland infalm)

• Benign EtiolObstruct Does not I globe, paipable l edema
• not needed topical
• consult and cure

Stomatitis

Inflammation of the mount

• Pain/redswelling eating
• bacterial/vial poor oral allergy iritaion
• Treat soft diet is to avoid

ocular foreign body

• Someting stuck
• Red foreigness light sense and blurry
• florens staining look

Herpangina

• Painful v sore A or b
• Treat symptoms and isolate

Iritis/Uvelitius/kertities

• eye infections
• pain
• sens
• Treatment: drops loss

Aphthous Ulcer

• Also known as canker sores, are painful sores that appear in the mouth.
• Symptoms: Small, shallow, white or yellowish sores that have a red border.
• Can appear on the gums, tongue, cheeks, lips, or throat.
• Can be caused by a deficiency in vitamin B iron .
• Treatments include topical anesthetics, mouth rinses, and corticosteroid ointments.recurred multiple times.
• Major: ulcers often heal with scarring.

Periobtal Edema

Emergent referral for CT Concern is that abscess has formed.

Acute-Angle Closure

• Treatment: Refer for emm Assessment:

Corneal Aabrassion

• Complete or par
• Grit open close is painfull
• Test visual Flores after ex

Subcnuntvial hemm

Hemorrage bad bad Breakin vessel sud sneeze

Nasolacrimila Drut Obstr

Tear drigane broke

• s ymptmos tret acnd stine surgey.

Hyphenma

Dacroyteniso

Stao and strep

• warm comp Orzl abm</