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FNP Review > EENT > Flashcards

EENT Flashcards

1
Q

Most common bacterial pathogen in bacterial sinusitis, acute otitis media, & community acquired pneumonia?

A

Streptococcus pneumoniae (gram + diplococci)

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2
Q

Common pathogen in bacterial rhino sinusitis, comm acquired pneumonia (particularly with tobacco use).

A

H. Influenza (gram - bacillus)

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3
Q

Less common pathogen in bacterial rhino sinusitis, uncommon cause of comm acquired pneumonia

A

M. Catarrhalis (gram - coccus)

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4
Q

Antibiotic resistance risk factors

A 
Age 65
Daycare
Prior abt in the past month
Prior hospitalization w/in the past 5 days
Comorbidities 
Immunocompromised
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5
Q

Symptomatic treatments for bacterial rhino sinusitis

A

Nasal saline irrigation
Intranasal corticosteroids (when accompanying allergic rhinitis)
Topical or systemic decongestant

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6
Q

Treatment of bacterial rhino sinusitis (adults)

A

Duration- 10-14 days
1st line- amox./clavulanate 500/125mg po TID or 875/125mg BID, TMP/SMX (Bactrim), doxycycline

2nd line- amox/clavulanate 2000/125mg BID (? Resistance) or doxycycline 100mg BID or 200mg QD

PCN/ceph. Allergy- doxycycline 100mg BID or 200mg QD, or Levaquin 500mg QD (? Resistance) or Moxifloxacin 400mg QD (? Resistance)

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7
Q

CYP450 3A4 substrate

A

Utilizes a specific enzymatic pathway.

Medication that is metabolized by the isoenzyme, utilizing this enzyme in order to be modified so it can reach drug site of action &/or be eliminated

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8
Q

CYP450 3A4 inhibitor

A

Blocks a specific enzymatic pathway, keeps substrate (medication) from exiting (leads to toxicity)

Blocks the activity of the isoenzyme limiting substrate excretion, allowing increase of substrate levels & possible risk of substrate induced toxicity.

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9
Q

CYP450 3A4 inducer

A

Pushes the substrate out the exit pathway.

Accelerates the activity of the isoenzyme so that substrate is pushed out the exit pathway, leading to reduction in substrate (medication) level.

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10
Q

Treatments of allergic rhinitis

A
  • Avoidance measures
  • Controller meds (1st line- Intranasal corticosteroids, ex. Flonase, nasocort), add on treatment- singulair.
  • Reliever meds (2nd gen antihistamines- Claritin, Zyrtec), Intranasal antihistamine- asteline, astepro) ocular antihistamine- patanol, pataday.
  • Immunotherapy- ex-Xolair
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11
Q

Characteristics of eye discharge with allergic conjunctivitis?
Bacterial conjunctivitis?
Viral conjunctivitis?

A

Allergic- ITCHING, stringy, rope like discharge, tearing, mild lid edema, bilateral conjunctival hyperemia.

Bacterial- UNILATERAL, mucopurulent discharge, crusty drainage in eyelids, conjunctival injection/hyperemia

Viral- watery discharge, acute onset, highly contagious, conjunctival hyperemia, edema.

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12
Q

Clinical findings in closed-angle glaucoma?

A

A deeply cupped optic disc
Usually unilateral, acutely red, & painful (due to sudden increase in intraocular pressure)
Vision changes including halos around lights.

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13
Q

Pt complaints with open-angle glaucoma?

A

Peripheral vision loss (due to gradual onset of increased intraocular pressure leading to optic atrophy)
Avoidable with appropriate, ongoing intervention

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14
Q

Pt complaints with macular degeneration?

Clinical findings?

A

Painless vision changes including distortion of central vision (due to thickening, sclerotic changes in retinal basement membrane complex)
Clinical- Drusen (soft yellow deposits in the macular region) often visible with funduscopic exam.

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15
Q

Ophthalmologic test for early detection of Macular degeneration?

A

Amsler grid test

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16
Q

Ophthalmologic test for measuring intraocular pressure (test for glaucoma)

A

Tonometry

17
Q

Definition of Anosmia/hyposmia?

A

Diminished sense of smell, with resulting decline in fine taste discrimination (due to neural degeneration)
*accelerated by tobacco use

18
Q

Definition of presbycusis?

A

Difficulty with conversation in noisy environment. Person can hear, but it’s hard to understand what is said (due to loss of 8th CN sensitivity)

19
Q

Treatment of suppurative (purulent) conjunctivitis?

A

1st line- ophthalmic fluroquinolone (levofloxicin, Moxifloxacin)
Alternative- polymixin B with trimethoprim solution or azithromycin 1% ophthalmic solution. Tobramycin 0.3%, gentamicin 0.3% solution.

20
Q

Treatment of otitis externa?

A

Mild- acetic acid with propylene glycol & hydrocortisone gtts.
Moderate to severe- ciprofloxacin with hydrocortisone gtts.

21
Q

Treatment of Malignant otitis externa in pt with DM, HIV, or on chemotherapy? (Invasive form that can lead to osteomyelitis of cartilage/bone)

A

Oral ciprofloxacin for early disease, suitable for outpatient use.
Send to ER or ENT

22
Q

Treatment of exudative pharyngitis?

A

1st line- PCN VK po x10 days, or benzathine Pcn IM x1dose

Alternative- erythromycin x10 days, 2nd generation cephalosporin x4-6 days, azithromycin x5 days

23
Q

Treatment of otitis media?

A

Amoxicillin, azithromycin, augmentin, cefdinir (omnicef), clindamycin for persistent AOM

24
Q

What are nasal polyps?

What conditions are they seen with?

A

Pale, sack-like growths of tissue, that may be inflamed.

May be present with chronic allergic rhinitis, chronic sinusitis, asthma, ASA sensitivity, & cystic fibrosis.

25
Q

Diabetic retinopathy definition?

3 stages?

A 
Damage to the retina caused by complications of Diabetes. 
Stages: 
1. Background DM retinopathy 
2. Pre-proliferative DM retinopathy 
3. Proliferative DM retinopathy
26
Q

Subjective & objective findings with DM retinopathy?

A

Sub- visual changes
Obj- microaneurysms, intra-retinal hemorrhage, macular edema, & lipid deposits.
Nerve layer infractions, COTTON WOOL SPOTS, venous dilation & retinal hemorrhage.

27
Q

Only pharmacological agent found to slow progression of DM retinopathy?

A

ACE inhibitor- Lisinopril

28
Q

Risk factors for Tinnitus?

A

Ménière’s disease, labyrinthitis, HTN, head trauma, thyroid dysfunction.
Meds with reversible effects-salicylate, quinine, indocin, alcohol.
Meds with irreversible effects- streptomycin, gentamicin, vancomycin (aminoglycosides)

29
Q

Management of tinnitus?

A

Avoidance of offending med- (such as ASA, NSAIDS)
Antidepressants may be helpful.
Supplements- (vitamin A, C, B12, nicotinic acid, magnesium or copper).
Tinnitus-masking devices.
Learning to cope with tinnitus is necessary.

30
Q

Temporomandibular Joint Disease TMJ definition & symptoms?

A

A cluster of disorders related to mastication.

Sx- (most common)-pain in the muscles of mastication, preauricular area, & tenporomandibular area.

31
Q

Treatment of TMJ?

A

PT, behavioral therapy.

Meds- NSAIDS, muscle relaxants, antidepressants, topical analgesics.

FNP Review (15 decks)

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