Diagnosis and Management of EENT and Upper Respiratory Disorders Flashcards
(110 cards)
1
Q
Fundoscopic Exam:
a) Uses the ____ hand for ophthalmoscope, uses the ___ eye for the patient’s right eye
b) Start with wheel at 0
c) Starts about ___” from the patient with both eyes open
d) Moves into within __ to ___” from patient’s eye
e) Should function as one with an ophthalmoscope
2. After obtaining a red reflex, the exam should proceed from the optic disc and end with fovea or each eye
A
a) right
c) 12
d) 1 to 2”
2
Q
Inspection of the Optic Disc:
1) Shape: Doughnut- like with an ____/____ neuroretinal rim and a central white depression (physiologic cup)
A
1) orange/ pink
3
Q
Inspection of the Optic Disc:
2) Cup/ disk ratio: Cup should not be more than ___ the size of the disc diameter (if larger, consider glaucoma)
A
1/2
4
Q
Retinal vessels:
1) Arteries are bright red and narrow than veins; A: V ratio = ____ or ____
A
2: 3 or 4: 5
5
Q
Macula:
1) Centered ruffly ___ to ___ disc diameter temporal to the optic disc and is avascular
2) The fovea centralis is a ____ mm- diameter reflective area that looks slightly darker and lies in the center of the macular region
3) The patient should look directly into the light of the ophthalmoscope if the macula is difficult to visualize
4) Macular degeneration (deterioration of a central portion of vision; the leading cause of vision loss)
A
1) 2 to 2.5
2) 2.5 mm
6
Q
20/20 means that “ the patient can see at 20 feet what the normal person can see at 20 feet” ( the larger the denominator, the poorer the patient’s vision)
A
Snellen’s eye chart
7
Q
” Farsightedness”
A
Hyperopia
8
Q
” Nearsightedness”
A
Myopia
9
Q
Common after age 40; results in greater difficulty maintaining a clear focus at a near distance due to a lessening of the flexibility of the crystalline lens and weakening of the ciliary muscle with the control lens focusing
A
Presbyopia
10
Q
Cloudy appearance of the cornea with a gray/ white arc or circle around the limbus due to deposition of lipid material; the arcus has no effect on vision
A
Arcus senilis
11
Q
Raised, wedge-shaped growth of thin, noncancerous tissue over the conjunctiva
A
Pterygium
12
Q
The acute inflammatory, a most commonly infectious, process affecting the eyelid; usually caused by Staphylococcus aureus
A
Hordeolum (Stye)
13
Q
Signs and symptoms of _____ (___):
1) Abrupt onset accompanied by pain or erythema of the eyelid
2) Localized, tender mass developing in the eyelid
A
Hordeolum (Stye)
14
Q
Management of Hordeolum (Stye):
- Warm _______
- Topical _____ or erythromycin ophthalmic ointment
- Refer to an ophthalmologist if not resolved in less or equal to 2 days
A
- compresses
2. bacitracin
15
Q
Beady nodule on the eyelid; infection or retention cyst of a meibomian gland; usually on the upper eyelid
A
Chalazion
16
Q
______ are usually painless apart from the tenderness caused by localized swelling
A
Chalazion
17
Q
Signs/ symptoms:
1) swelling on the eyelid
2) Eyelid tenderness
3) Sensitivity to light
4) Increased tearing
5) If very large: May cause astigmatism due to pressure on the cornea
A
Chalazion
18
Q
Management of Chalazion:
1) _____ compresses
2) Referral for ____ ____
A
1) Warm
2) surgical removal
19
Q
Staphylococcus infection or seborrheic dermatitis of the lid edge
A
Blepharitis
20
Q
Sign and Symptoms:
1) Red, scaly, greasy flakes
2) Thickened, crusted lid margins
3) Burning
4) Itching
5) Tearing
A
Blepharitis
21
Q
Management of Blepharitis:
1) Hot _______
2) Topical antibiotics: _____ or erythromycin
3) Vigorously scrub lashes and lid margins with eyes closed and follow with a thorough rinsing
A
1) compresses
2) Bacitracin
22
Q
The most common eye disorder; inflammation/ infection of the conjunctiva (“pink-eye”) resulting from allergies, chemical irritation, bacterial, viral or gonococcal/ chlamydial infections
A
Conjunctivitis
23
Q
Sign and symptoms of conjunctivitis:
1) _____
2) Burning
3) Redness
4) Increased tearing
5) ____ ____
6) Swelling of eyelids
7) The sensation of a foreign body in eth eye
8) Eyelids may show a crust of sticky, mucopurulent discharge
A
1) Itching
5) blurred vision (possible)
24
Q
_______ Conjunctivitis discharge is purulent
A
Bacterial
25
Treatment for Bacterial conjunctivitis is:
1) Self-limited
2) Antibiotics drops:
a) _______
b) Ofloxacin
c) Ciprofloxacin
d) ________
e) Gentamycin ophthalmic solution
2) a) Levofloxacin
| d) Tobramycin
26
______ or ______ conjunctivitis is copious pururlent secretion
Gonococcal or Chlamydial
27
Treatment for Gonococcal conjunctivitis is?
Ceftriaxone 250 mg IM
28
Treatment for Chlamydial conjunctivitis is?
1) Erythromycin ophthalmic ointment
| 2) Oral: tetracycline, erythromycin, clarithromycin, azithromycin, doxycycline
29
_______ conjunctivitis is stringy; increased tearing
Allergic
30
Treatment for allergic conjunctivitis is?
Oral antihistamines
31
_______ conjunctivitis is watery?
Viral conjunctivitis
32
Treatment for viral conjunctivitis is?
Symptomatic care
33
Pathologic for this is:
| 1) Increased intraocular pressure
Glaucoma
34
Open-angle glaucoma is associated with ______?
Chronic
35
Closed-angle glaucoma is associated with _______?
Acute
36
____ angle = chronic
1) Asymptomatic
2) Elevated IOP
3) Cupping of the disc
4) Constriction of visual fields
Open-angle
37
_____ angle = acute
1) Extreme pain
2) Blurred vision
3) Halos around lights
4) pupil dilated or fixed
Closed-angle
38
Laboratory/ diagnostics: _______ screening nationally recommended by age 40
Tonometry
39
Management of open-angle = chronic glaucoma
1) Alpha 2 adrenergic agonist (______, Alphagan)
2) Beta-adrenergic blockers (Timolol)
3) Miotic agents (______)
1) Brimonidine
| 3) Pilocarpine
40
Closed-angle = acute:
1) Carbonic anhydrase inhibitor: [__________ (Diamox)]
2) Osmotic diuretics (Mannitol)
3) surgery
Acetazolamide
41
Pathological for ___________:
1) Clouding and pacification of the normally clear lens of the yey
2) The highest cause of treatable blindness
3) Most common surgical procedure in patients age 65+ = senile cataracts
Cataracts
42
Signs and symptoms of Cataracts:
1) _____
2) Heredity
3) Trauma
4) Toxins, drugs, tobacco, and alcohol theories
5) _______
6) Diabetes
7) AV sunlight exposure
8) Others
1) Aging
| 5) Congenital
43
Signs and symptoms of cataracts:
1) _______
2) Clouded, blurred or dim vision
3) Halos around lights
4) Difficulty with vision at night
5) Sensitivity to light and glare
6) Fading/ yellowing of colors
7) _____ (double vision) in a single eye
8) The need for brighter light for reading and other activities
9) No ____ _____
10) The opacity of the lens
1) Painless
7) Diplopia
9) red reflex
44
Management of cataracts include:
1) Change _____ as the cataract develops
2) Refer to ophthalmologist
3) Surgery
1) glasses
45
A separation of the light-sensitive membrane in the back of the eye ( the retina) from its supporting layers
Retinal Detachment
46
Signs and symptoms of ____ ___:
1) Flashes of light (photopsia), especially in peripheral vision
2) Floaters in the eye
3) Blurred vision
4) Shadow or blindness in a part of the visual field of one eye
Retinal detachment
47
Management of retinal detachment include?
Referral for surgery
48
Inflammation and/or infection of the external auditory canal (and/ or auricle and tympanic membrane)
Otitis externa
49
Acute localized otitis externa
Furunculosis
50
Acute diffuse bacterial ___ ____: Most common in swimmers and in hot, humid climates of otitis externa
swimmer's ear
51
```
Signs and symptoms of acute localized (furunculosis):
1) Cause: ______ ______
a) Pustules and furuncles in the outer third
of the ear, canal
b) Severe pain (otalgia) with the area of
cellulitis
c) Itching
d) ______
e) Scaling
f) ______
g) Fissuring
h) Possible exudates
```
1) Staphylococcus aureus
d) Erythema
f) Crusting
52
Management of Otitis Externa is:
a) Cleansing and debridement of the ear
b) Topical otic drops: ______ otic, others
c) Pain control: NSAIDs, topical corticosteroids
b) Cortisporin
53
Presence of fluid in the middle ear accompanied by signs/ symptoms of infection?
Acute Otitis Media and Serous Otitis Media
54
Are chronic otitis media often resulting in effusion AK?
Serous Otitis Media
55
The most common cause of ___ (often viral) leading to Acute Otitis Media and Serous Otitis Media?
URI
56
The most common bacterial pathogens for acute otitis media and serous otitis media include?
a) ____ ______ (40 to 50% of cases)
a) Streptococcus pneumonia
57
The most common bacterial pathogens for acute otitis media and serous otitis media include?
b) ____ _____(20 to 30% of cases)
b) Haemophilus influenza
58
The most common bacterial pathogens for acute otitis media and serous otitis media include?
c) _____ _____ ( 10 to 15% of cases)
Moraxella catarrhalis
59
Signs and symptoms of acute or serous otitis media?
a) _____ (slight to severe), spreading to the temporal region
b) Otorrhea
c) Vertigo
d) Nystagmus
e) ______
f) Fever
g) Lethargy
h) Nausea and vomiting
i) Anorexia
a) Otalgia
| e) Tinnitus
60
Local _______: erythema with diminished light reflex; fluid in middle ear
inflammation
61
______ phase: Middle ear serous exudate
Exudative
62
_______ phase (serous): Purulent exudates; retraction and poor motility of the tympanic membrane; membrane becomes bulging and convex; membrane may rupture
Suppurative
63
______ alone of the tympanic membrane is not a diagnostic criterion- it may occur with any inflammation of the upper respiratory tract, crying or nose blowing
Erythema
64
Management of acute otitis media or serous otitis media include:
1) most uncomplicated cases resolve spontaneously or with hydration, avoidance of irritants, use of topical or decongestants and cool mist humidifiers
2) Antibiotic therapy only for suspected bacterial cases: ______
2) Amoxicillin
65
Type of chronic otitis media consisting of peeling layers of the scaly or keratinized epithelium; if untreated, may erode the middle ear leading to nerve damage and deafness
Cholesteatoma
66
Signs and symptoms of cholesteatoma:
1) Squamous epithelium lined sac, filled with desquamated ____
2) Chronic infection
3) Painless otorrhea, either unremitting or frequently recurrent
4) ___ ____ (ossicular damage)
5) Canal filled with mucopus and granulation tissue
6) Tympanic membrane perforation (90% of cases)
1) keratin
| 4) Hearing loss
67
Management of cholesteatoma include:
| 1) Referral for _____
sugery
68
Sensation of motion either of the person or the environment
Vertigo
69
____ ____ ____ ___(BPPV) is the most common form of vertigo, characterized by the sensation of motion initiated by sudden head movements
Benign paroxysmal positional vertigo
70
Common Causes of Vertigo include:
a) _____ ____
b) Medications
c) Otitis media or labyrinthitis
d) Meniere's disease
e) Acoustic neuroma
f) Head trauma or neck injury
g) _________
h) Cerebellar hemorrhage
a) Brain Tumors
| g) Migraines
71
Signs and symptoms of Vertigo:
a) The sensation of disorientation or motion
b) Positive ____ _____ (Nylen- Barany maneuver)
c) Nausea and vomiting
d) Sweating
e) Abnormal eye movement (nystagmus)
f) Hearing loss
g) _____
h) Visual disturbances
i) Weakness; difficulty walking
j) Difficulty speaking
k) Decreased level of consciousness
b) Dix- Hallpike
| g) Tinnitus
72
Laboratory/ diagnostics for vertigo:
a) ____ ____
b) VDRL/ RPR
c) Serum medication levels
d) Hearing examination
e) Blood glucose and ____ may be helpful
a) CT scan
| e) ECG
73
Management of vertigo:
a) _______ ( Valium)
b) Meclizine hydrochloride (Antivert)
c) Diphenhydramine (Benadryl)
d) Scopolamine transdermal patch
e) _______
a) Diazepam
| e) Antiemetics
74
Loss of the ability to detect pure tones in decibels >20 dB
Hearing loss
75
Conductive causes of hearing loss:
a) Foreign body in the ear canal/ cerumen build-up (most common causes of hearing loss; most treatable)
b) _______
c) Perforated tympanic membrane
d) _____ ______
e) Otitis externa
f) Otosclerosis
b) Hematoma
| d) Otitis media
76
Sensorineural Causes:
a) Dame to hair cells and/ or nerves that sense sound waves
b) Acoustic trauma
c) Barotrauma (usually in drivers)
d) Head trauma
e) Ototoxic Drugs: Aminoglycosides, diuretics, salicylates, NSAIDs, antineoplastics
f) Meniere's disease
g) Acoustic ______
h) Infections: Mumps, measles, herpes zoster, syphilis, meningitis, etc.
i) Others
b) trauma
| g) neuroma
77
Normal findings for hearing loss:
| a) ______ test: SOund lateralizes to the affected ear
a) Weber test
78
Normal findings for hearing loss:
| b) _____ test: Abnormal in the affected ear (i.e. AC < BC)
b) Rinne test
79
Conductive Hearing Loss:
| 1) ____test: Sound lateralizes to the affected ear
Weber test
80
Conductive Hearing Loss:
| 2) _____test: Abnormal in the affected ear (i.e. AC < BC)
Rinne test
81
Sensorineural Hearing Loss:
| 1) ____ test: Sound lateralizes to the unaffected ear
Weber
82
Sensorineural Hearing Loss:
| 2) _____ test: Normal in the affected ear
Rinne
83
Sings and symptoms: Hearing Loss
| a) ____ and _____ of hearing loss clues the practitioner as to the underlying cause
Speed and severity
84
Laboratory/ Diagnostics: Hearing Loss
a) _______ exam: Inspect canal and tympanic membrane
b) General neurological exam
c) Audiometry testing
d) CT scan, if the neurological condition is suspected
e) Serum blood tests as needed
a) Otoscopic exam
85
Management: Hearing Loss
a) Conductive hearing loss
1) _____ canal
2) Treat underlying cause
b) Sensorineural hearing loss: Refer
1) Clear
86
Viral rhinitis; self-limiting (5 to 10 days); caused by any 1 of more than 200 viruses (rhinovirus, coronavirus, respiratory syncytial virus, adenovirus, etc.)
Common Cold
87
Signs/ symptoms: Common cold
a) Watery rhinorrhea
b) Erythematous nasal mucosa
c) _______
d) Nasal and sinus blockage
e) Headache
f) ____ _____
g) Cough
h) Malaise
c) sneezing
| f) Sore throat
88
Management: Common cold
a) Supportive care
b) ________, stream/ humidifier
c) Fever and pain: Tylenol, Motrin, Advil
d) Warm _____ water gargles
b) hydration
| d) salt
89
Inflammation of the pharynx or tonsils
Pharyngitis/ Tonsillitis
90
Causes: Pharyngitis/ Tonsillitis
1) Viruses (respiratory syncytial virus, influenza A and B, ____ _____, etc.)
2) Bacteria
1) Epstein- Barr
91
Signs/ symptoms: Pharyngitis/ Tonsillitis
a) ________ pharynx
b) Rhinorrhea (viral)
c) Cough
d) Anterior cervical adenopathy
e) ____ (bacterial)
f) Painful throat
g) _______ rash
a) Erythematous pharynx
e) Fever
g) Maculopapular rash
92
Centor criteria: Pharyngitis/ Tonsillitis
Clinical features most suggestive of group A B-hemolytic strep pharyngitis include (FLEA)
1) _____
2) Lack of cough
3) Pharygotonisllar Exudate
4) ______cervical adenopathy
1) Fever
| 4) Anterior
93
Laboratory/ diagnostics: Pharyngitis/ Tonsillitis
1) ___ ___ _____ ______ test
2) Monospot
3) CBC with differential
1) A rapid streptococcal antigen test
94
Management of: Pharyngitis/ Tonsillitis
1) Fluids/ hydration
2) ____ water gargles
3) Aspirin/ Tylenol
4) Antibiotics for streptococcal infection (____, ______)
5) ______ for gonococcal infection
6) Refer
2) Salt
4) Penicillin V, Erythromycin
5) Ceftriaxone
95
Acute, febrile illness caused by infection with influenza type A and B virus
Influenza ("flu")
96
Signs/ Symptoms: Influenza
1) Abrupt onset of:
a) ______
b) Headache
c) _____
d) Coryza
e) Anorexia
f) ________
g) Cough
a) Fever
c) Myalgias
f) Malaise
97
Laboratory/ Diagnostics: Influenza
| 1) Virus isolation from ___ or ____ swab or sputum specimens (most rapid diagnostics)
1) nasal or throat
98
```
Management: Influenza
1) Supportive care:
a) Antipyretics
b) Antibiotics only if a bacterial infection is
proven/ suspected
2) Neuraminidase inhibitors (shorten the duration of symptoms by ____ days; effective for both influenza A and B):
a) _______ (Relenza): Inhaler
b) ________ (Tamiflu): Oral
```
2) two
a) Zanamivir
b) Oseltamivir
99
Symptomatic infection caused by Epstein-Barr virus; common in people ___ to ___ years of age: Mononucleosis
1) Incubation period: ___ to ___months; usually self -limited, but malaise and fatigue may last months
15 to 24
| 1) 1 to 2 months
100
Signs/ Symptoms: Mononucleosis
1) _____
2) Chills
3) Malaise/fatigue
4) Anorexia
5) Pharyngitis (most ____ symptom)
6) White Tonsillar exudates
7) Adenopathy/ lymphadenopathy (______ vertical region)
8) Splenomegaly (usually during the 2nd week of illness)
1) Fever
5) severe
7) posterior
101
Laboratory/ diagnostics: Mononucleosis
a) _____ positive
b) Increased WBC with relative lymphocytosis and neutropenia
a) Monospot
102
Management of Mononucleosis:
a) Supportive care
b) _______/ steroid taper for severely enlarged tonsils
c) Contacts sports should be avoided (____ weeks to months), as splenic rupture may occur, even without clinically detectable splenomegaly
b) Prednisone
| c) 3 weeks
103
Inflammation of the mucous membranes lining one or more of the paranasal sinuses; almost always accompanied by inflammation of the nasal mucosa
Sinusitis (Rhinosinusitis)
104
Causes of Sinusitis (Rhinosinusitis):
1) Streptococcus pneumoniae
2) _______ ________
3) Various anaerobes
2) Haemophilus influenzae
105
Signs and symptoms of Sinusitis (Rhinosinusitis):
1) Often a history of recent respiratory illness with some improvement, then relapse
2) Red nasal _____
3) Pain/ pressure over face, nose, cheeks, teeth (molars)
4) Purulent ____ drainage (bacterial)
5) Fever (bacterial)
6) Tenderness over sinuses
7) ________ in supine or bending position ("dull/ throbbing")
8) Foul-smelling nasal or postnasal drainage
2) mucosa
4) nasal
7) Headache
106
Laboratory/ drainage of Sinusitis:
1) _______ as needed
2) Radiographs/ ____
3) Decreased transillumination
1) Culture
| 2) CT
107
Management of Sinusitis:
1) Hydration
2) Oral _________/ antihistamines
3) Analgesics
4) Antibiotics ONLY for bacterial cases: ____/____ (Augmentin), clarithromycin (Biaxin), etc. Consider second-line agents if not an improvement after 72 houses.
5) Supportive care
2) decongestants
| 4) Amoxicillin/ clavulanate
108
Signs/ symptoms:
a) Bleeding usually comes from only 1 nostril
b) Blood can also drip down back of the throat and into the stomach causing nausea
c) Signs of excessive blood loss:
1) Dizziness
2) ________
3) Confusion
4) ________
c) 2) Weakness
| 4) Fainting
109
Incidence/ Cause: Nose bleeds
a) The ______ septum is the most frequent site of nose bleeds
b) Easy to control, either by the nurse practitioner or measures taken at home
c) ______ septum nose bleed is more complicated, normally originating from an artery in the back of the nose (more profuse bleeding may be noted; refractory to basic management)
a) anterior
| c) Posterior
110
Management of nose bleeding
1) Sit upright
2) The constant ______ to the nose
c) Apply ice
2) pressure
