Study Guide: Module 4 EENT - Eyes, Ears, Nose, and Throat

### **Study Guide: Module 4 EENT** ### **Eyes** #### **Blepharitis** **One of the most common eye diseases**. It can be infectious or inflammatory. Not common to have blepharitis in both eyes at once. - - - - - - - - - - - - - - - - - - - - - -...

### **Study Guide: Module 4 EENT** ### **Eyes** #### **Blepharitis** **One of the most common eye diseases**. It can be infectious or inflammatory. Not common to have blepharitis in both eyes at once. - - - - - - - - - - - - - - - - - - - - - - - #### **Conjunctivitis** **Conjunctivitis is inflammation of the bulbar conjunctiva**, the transparent mucosal tissue lining the eye and [inner surface of the eyelids]. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - #### **Hordeolum** **Pathophysiology/Disease Process**: An acute infection and inflammation of one of the glands in the eyelid. Often confused with chalazion, a chronic, sterile, nontender lipogranulomatosis lesion of the meibomian gland. Often referred to as a \"sty\". - - - - - - - - - - - - - - - - - #### **Corneal Surface Defects and Ocular Surface Foreign Bodies** - - - - - - - - - - - - - - - - - - - - - - - ### **Emergent Eye Disorders** - - - - - - - - - - - - - - - - - - - - - - - - - ### **Ears** #### **Infected Piercings** - - - - #### **Otitis Externa** **Pathophysiology/Disease Process**: Cellulitis of the external auditory canal that may extend to the auricle, also known as \"swimmer\'s ear.\" 90% of cases have a bacterial cause. - - - - - - - - - - - - - - - - - - - - - - - - - - - #### **Otitis Media** **Pathophysiology/Disease Process**: Dysfunction of the middle ear and middle ear mucosa. Fluid and inflammation of the middle ear. Multifactorial. **[The usual causative organisms are *Streptococcus pneumoniae* and *Haemophilus influenzae*.]** Group A strep is also causative. [Could be viral], bacterial, or fungal. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - #### **Tympanic Membrane Perforation** - - - - - - - - - - - - - - - - - - - - - - ### **Nose** #### **Epistaxis** **Pathophysiology/Disease Process**: **[Bleeding that occurs from broken capillaries in the anterior nose. Mostly (90-95%) occurs in the front of the nasal septum near the Kiesselbach plexus]---**from membrane irritation. Posterior nosebleeds occur within the posterior branches of the sphenopalatine artery and are idiopathic or vascular disease-related. [Increased incidence in pregnancy.] - - - - - - - - - - - - - - - - - - - - - - - - - - - #### **Rhinitis** **Red Flags**: Recurrent epistaxis or sinusitis, pulmonary involvement, visual changes, unilateral symptoms, hilar adenopathy. **Pathophysiology/Disease Process**: **Allergic inflammation of the nasal membranes generally caused by breathing in pollen, dust, dander, or insect venom. The allergen triggers producing the antibody immunoglobulin E (IgE). When caused by pollens of plants, it is called pollenates. When caused by grass, it is called hay fever.** - - - - - - - - - - - - - - - - - - - - - - - - - #### **Sinusitis** **Pathophysiology/Disease Process**: **Abrupt onset with a duration of fewer than 4 weeks.** Obstruction of the sinus ostia, which is a small opening in which the maxillary, frontal, ethmoid, and sphenoid sinuses drain into the nasal cavity. Mucous stasis may allow pathogens to grow. **[Can be viral (most common), bacterial (*Strep pneumoniae*, *H. influenzae*, *Streptococcus pyogenes*, *Moraxella catarrhalis*), or fungal.]** May have a recent history of URI, allergic rhinitis, and exposure to secondhand smoke. Chronic sinusitis: more than 12 weeks, resists treatment. - - - - - - - - - - - - - - - - - - - - - - - - #### **Oral Infections** - - - - - - - - - - - - - - - - - - - - - - ### **Throat** #### **Pharyngitis** **Pathophysiology/Disease Process**: Results when the normal flora of the oral pharynx becomes harmful due to the weakening of the immune system. Develops from exposure to a virus or bacteria. Inflammation of the pharynx. Diagnosed clinically. Can be infectious or noninfectious. Can be acute or chronic. Viral is self-limiting, about 1 week. - - - - - - - - - - - - - - - - - - - - - - - - - - - - #### **Infectious Mononucleosis** **Pathophysiology/Disease Process**: Caused by the Epstein-Barr virus. Symptoms usually peak around day 7. Not just throat involvement! Spleen enlargement and liver issues can occur. **Subjective Data/Patient History**: **Gradual onset of fatigue, fever, body aches, and sore throat. Less common symptoms: headaches, rash, loss of appetite, and muscle weakness.** **Physical Exam/Objective Data: Classic [Triad: fever, pharyngitis, and lymphadenopathy. Typically febrile, pharyngeal erythema, tonsillar hypertrophy (3-4),] white to gray or green exudate, petechiae on hard-soft palate junction, anterior and posterior cervical adenopathy, and rash/jaundice.** **Risk Factors**: - - **Differential Diagnosis**: Streptococcal pharyngitis, epiglottitis, acute CMV infection, HIV **Diagnostics**: [Monospot], CBC w/ diff and CMP, throat culture **Management**: - - - **Complications**: **Majority will have no complications. Acute upper airway obstruction, hepatomegaly, splenomegaly, and splenic rupture.** **Patient Education**: Rest and hydration, saline gargles, throat lozenges, no contact sports until fully recovered, and ED precautions. No sharing drinks, kissing, etc. **Referral**: Immediate referral is indicated for drooping; airway compromise due to tonsillar enlargement or suspicion of tonsillar abscess; abdominal pain in the presence of fever, jaundice, or any history of abdominal trauma, including recent contact sport injuries, due to the risk of splenic rupture. #### **Peritonsillar Abscess** **Pathophysiology/Disease Process**: A complication of tonsillitis. Most often caused by group A strep. **Subjective Data/Patient History**: Sore throat, unable to swallow, voice sounds muffled, harder to breathe, and systemic symptoms (chills or fever). **Physical Exam/Objective Data**: Almost always unilateral, signs of airway obstruction - abscess so large that it causes uvular deviation and fills the entire oral pharynx, dysphagia, drooling, trismus, \"hot potato\" voice, and this patient will look ill. **Differential Diagnosis**: **Referral**: DANGER, DANGER, DANGER! ED referral needed. #### **Stomatitis and Aphthous Ulcerations** **Pathophysiology/Disease Process**: Stomatitis is inflammation of the soft tissues of the oral cavity and lips. Aphthous ulcerations (aka. apthous stomatitis and canker sores) are shallow, painful, often recurrent lesions of the oral mucosa. Most common mucosal lesions. **Most ulcerations are viral. Herpes simplex virus is one of the most common and is introduced to the oral mucosa via oral secretions. Can be bacterial in the form of gingivitis. May be a result of candidiasis. May be linked to autoimmune disorder.** **Subjective Data/Patient History**: **Painful ulcerations in the oral mucosa and difficulty chewing. Prodromal burning or pricking of the oral mucosa.** **Physical Exam/Objective Data**: R**ound or oval oral ulcers, white, yellow, or gray membrane, located on buccal mucosa, lateral or ventral tongue, can be on the floor of the mouth, soft palate, or oropharynx.** **Risk Factors**: - - - - - - - **Differential Diagnosis**: - - - - - - - - - - - - - - **Management**: - - - - - **Complications**: If severe and recurrent, consider disease processes and autoimmune diseases. **Patient Education**: **Patients with aphthous ulcers should be instructed to apply medication (paste) to dry ulcers and avoid food and drink for 30 minutes. They should also avoid predisposing factors.** **Referral**: Refer for recurrent ulcerations.