Clinical Management Week One

Red, hot, tender nail folds, with or without abscess

Swollen, tender, red, boggy nail fold, fluctuance rare

staph aureus, strept, pseudomonas, anaerobes

candida albicans, gram negative rods, atypical mycobacteria

warm soaks, oral antibiotics, I

Avoidance of water and irritants, use of topical steroids and antifungal agents, surgery

Pain, swelling or erythema concentrated on the palmer surface in the distal tuft

Clear vesicles grouped on an erythematous base

Area of cellulitis, immunosuppressed, diabetic, endocarditis prophylaxis

Poor healing, infection and premature closing of wound edges

Malignant lesions, facial lesions, and infected lesions

Length of time, family history, impaired healing

Signs of irritation, number and location

May not be effective, destroys hair growth, moderate pain, and pigment changes

Monitor for redness, discharge, fever, pain and streaking, protect healing crust.

Four digital nerves per digit, palmer nerve dominant digital nerves adjacent to phalanges

1-2 ml

20 minutes

Infection, hematoma, vascular puncture, and nerve injury

If infected or diabetic

Accumulation of blood between the nail plate and nail bed

R/o fracture, infection, injury, swelling, redness, temperature, cap refill

Crushed nail, hematoma over 50% of nail, fractured phalanx, subungual melanoma

Melanoma under the nail, common on dark skinned people, dark colored stripe along length of nail

Pasturella/augmentin

"stop" sign

adduction of hand

"Ok" sign

Vermillion border

Inflammation of the lid margin in the area of the lash follicles

staph aureus, and seborrheic dermatitis

Painful eyelids , swelling of lid, mucopurulent discharge, erythemia, loss of eye lashes

Painful eye lids, associated with dandruff/seborrhea, mild swelling, scaling of lid, loss of lashes

Hot compression, cleanse lashes with diluted baby shampoo, antibiotics

Staph-bacitracin, erythromycin, tetracycline

Focal chronic inflammation of the meibomian gland

Hard, nontender nodule, lid swelling, pain and tenderness possible w/ infection

Warm, moist compress, erythromycin ointment

Acute inflammation of the follicle of an eye lash or the sebaceous gland along lid margin

Staph aureus

Painful erythematous nodule at lid margin, sometimes purulent drainage

warm, moist compress, cleanse eyelids , erythromycin ophthalmic ointment

Inflammation of the conjuctiva characterized by vascular dilation, cellular infiltration and exudation

Staph, strep pneumonia, haemophilus influenza

acute onset, mild irritation, mild photophobia, excessive lacrimation, normal vision

Discharge, purulent-bacterial, mucopurulent-viral, mucoid and stringy-allergic, edema, clear cornea, PERRLA

Visual acuity, eye exam, culture, fluorescein stain to r/o ulcer, keratitis, foreign body

Inflammation of eye structures

Autoimmune reaction and infection

Periocular pain and photophobia, conjunctival vessels are most dilated at corneal edge, pupil irregular shape, floaters and hazy vision

Noninfectious-prednisolone acetate 1%, infectious-antimicrobial drops

Trauma, ocular infection, over 50, cataract extraction, usage of fluoroquinolones, family history

Increased floaters, cobweb, central vision intact, no pain or redness

Retina hanging in vitreous like a gray cloud

Referral, transfer patient with head back

Clouding or opacification of the lens

Protein coagulations form opague areas in crystalline lens, aging process, diabetics

UV radiation, corticosteroid use, tobacco, ETOH, eye injury, DM

Progressive vision loss, bilaterally, clody, foggy vision, glare, distortion

Surgery, nonsurgical management, anticipatory guidance

Increase in intraocular pressure

Emergency-peripheral iris bows forward and occludes meshwork causing a rise in IOP

Progressive microscopic blockage of aqueous outflow in the trabecular meshwork reslting in increase in pressure and damage of optic nerve

Extreme pain, blurred vision, halos, N/V, lacrimation

Ocular emergency, referral

Family history, AA, age, HTN, DM, topical steroids, trauma

Topicals to increase aqueous humor outflow, topicals to reduce aqueous production, systemics to reduce aqueous secretions

Inflammation of the mucous membranes lining the paranasal sinuses

Bacterial- strep, H. influenza, morexella, Nosocomial-staph aureus, pseudomonas, klebsiella

H/o recent URI, nasal discharge, HA, decreased smell, purulent pharyngeal secretions w/ cough

Erythema, swelling, facial tenderness, purulent nasal drainage, periorbital cellulitis and excessive tearing

Sinus xray, Ct scan, Transillumination

Patiens have < 10 days of symptoms that are not worensing

Persistent symptoms lasting more than 10 or more days

Cpap, sleeping position, avoid ETOH, weight loss

TSH, ABGs, PFTs, MRI

Infection of the tissue surrounding the cartilage of the earlobe, ear canal or both

Trauma, chemical, burn, mastoiditis, complication of piercing and insect bites

Pus accumulates between the cartilage and the layer of connective tissue around it. impinging on the blood supply to cartilage

Pseudomonas, staph aureus

Redness, pain, swelling of pinna, and tenderness

Fluoroquinolones-ciprofloxacin, steroids

Abscess formation, loss of cartilage, cauliflower ear

ENT when unresponsive to treatment w/in 48 hours, Involvement beyond auricle, bilateral involvement w/o hx of trauma

Abx- Amoxicillin

Cyst growth into the middle ear and mastoid, improper function of eustacin tube

Gradual hearing loss, otorhhea, h/o infection, perforation, retraction

Traumatic middle ear inflammation due to rapid negative pressure differential

Pain, fullness, conductive hearing loss, crying (children)

Valsalva, decongestant, antihistamine, activity

Inflammatory condition affecting the labyrinth in the cochlea and vestibular system, viral illness

Vertigo, N/V, hearing loss, nystagmus

Promethizine, meclizine, scopolamine patch, prednisone

Cause coagulation of which limits depth of injury

Causes liquefaction of proteins and can penetrate anterior chamber, needs longer irrigation

Erythemia Migrans rash, bull's eye appearance

Do not crush w/ finger, identify tick, avoid manipulation, ETOH, burning

suspicious, lesion on eyelid, lip, or penis, infection, bleeding disorder

Malaise, HA, low grade fever, moderate to high fever,

Fever, tender anterior cervical adenopathy, lack of cough, tonsillar exudate

RADT, cultures

PNC V, PNC G, Amoxicillin, Erythromycin