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FNP 1 > EENT > Flashcards

EENT Flashcards

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1
Q

Proper way to conduct an eye exam

A 
right hand, right eye, right eye
start with wheel at 0
start 12' away
move in to 1-2" away 
after red reflex, then exam from the optic disc and end with the fovea of each eye
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2
Q

what is the shape of the optic disc

A

Doughnut-like with an orange/pink neuroretinal rim and a central white depression (physiologic cup)

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3
Q

What should the cup/disc ratio be?

A

cup should not be more than 1/2 the size of the disc diameter

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4
Q

consider________ if the cup is more than 1/2 the size of the disc diameter

A

glaucoma

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5
Q

describe retinal vessels

A

arteries are brighter red and narrower than veins

A:V ratio 2:3 or 4:5

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6
Q

Where is the macula located

A

centered 2-2.5 disc diameters temoral to the optic disc and is avascular

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7
Q

What are the characteristics of the fovea centralis

A

2.5mm diameter reflective area that looks slightly darker and lies in the center of the macula region

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8
Q

have the patient look______ if the macula is difficult to visualize

A

directly into the light

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9
Q

What is hyperopia

A

Farsightedness, gero patient

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10
Q

What is myopia

A

Nearsightedness, younger patients

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11
Q

What is presbyopia

A

lessing of the crystalline lens and weakening of the ciliary muscles which controls the lens focusing leading to greater difficulty maintaining a clear focus at a near distance. Common after age 40

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12
Q

At what snellen do you refer a patient

A

20/30

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13
Q

What is arcus senilis

A

cloudy appearance of the cornea with a gray/ white arc or circle around the limbus due to the disposition of LIPID material. No affect on vision

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14
Q

S/SX of a hordeolum (stye)

A

abrupt onset, pain, erythema

localized tender mass developing in the eyelid

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15
Q

management of the hordeolum

A

warm compresses to bring to a head
Topical bacitracin or erythromycin opthalmic ointment
Refer to ophthla if no resolution in 2 days

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16
Q

Chalazion definition

A

beady nodule on the eye lid, infection or retention cyst of a meibomian gland, usually on the upper eyelid

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17
Q

What differentiates a hordeolum and a chalazion

A

hordeolum hurts

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18
Q

S/SX of chalazion

A 
swelling on the eyelid 
eyelid tenderness
sensitivity to light
increased tearing 
if large: can cause astigmatism due to pressure on the cornea
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19
Q

Management of chalazion

A

warm compresses, refer for surgery

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20
Q

define blepharitis

A

staph or seborrheic dermatitis of the lid edge

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21
Q

s/sx of blepharitis

A 
red, scaly, greedy flakes
Thickened crusted lid margins
Burning
itching
tearing
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22
Q

management of blepharitis

A

Hot compresses
Topical antibiotics, bacitracin or erythromycin
vigourous scrub

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23
Q

What should conjunctivitis not include in s/sx

A

pain

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24
Q

type of discharge with bacterial conjunctivitis

A

purulent

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25
type of discharge with gonococcal or chlamydial conjunctivitis
copious purulent
26
Treatment for bacterial conjunctivitis
self limiting | Antibiotics drops: Levo, ofloxacin, cipro, tobra, gent
27
type of discharge with allergic conjunctivitis
stringy, increased tearing
28
Discharge for viral conjunctivitis
watery
29
management of allergic conjunctivitis
oral antihistamines, not gtt because can worsen glaucoma
30
What is the pathology of glaucoma
Increased intraocular pressure Open angle- chronic Closed angle- acute
31
s/sx of open angle glaucoma
``` chronic asymptomatic elevated IOP cupping of the disc Constriction of the visual fields ```
32
s/sx of closed angle glaucoma
``` acute Extreme pain blurred vision halos around lights Pupil fixed or dilated ```
33
diagnostics of glaucoma
tonometry, screening nationally recommended by age 40
34
Management of open angle glaucoma
Alpha 2-adrenergic agonists- brimonidine, alphagan Beta-adrenergic blockers- timolol Miotic agents- pilocarpine
35
Pathology of cataracts
Clouding and opacification of the normally clear lens of the eye
36
s/sx of cataracts
``` Painless, clouded blurred or dim vision Halos around lights, NOT PAINFUL Difficulty with vision at night Sensitivity to light and glare fading/ yellowing of colors diplopia (2x vision) in a single eye The need for brighter light for reading NO RED REFLEX Opacity of the lens ```
37
s/sx of retinal detachment
Flashes of light (photopsia) especially in peripheral vision FLOATERS IN THE EYE blurred vision shadow or blindness in a part of the visual field of one eye
38
Management of otitis externa
Cleansing and debridement of the ear Topical otic drops: Cortisporin otic, others Pain control: NSAIDS, topical corticosteroids
39
What is streptococcus pneumoniae the key bacterial pathogen of?
Otitis media, Sinusitis Meningitis CAP
40
What is the most common source of otitis media in adults
viral
41
What are the 3 phases of otitis media and what does it entail?
Local inflammation: erythema with diminished light reflex, fluid in the middle ear Exudative phase: middle ear serous excudate Suppurartive phase (serous)- purulent excudates; retraction and poor motility of the ™. Membrane becomes bulging and convex (IS SUPPOSED TO BE CRESENT). membrane may rupture
42
Management of otitis media in the adult
``` uncomplicated will resolve itself hydration avoid irritants topical or oral decongestants cool mist antibiotic if suspected: AMOX ```
43
Define Cholesteatoma
Type of chronic otitis media consisting of peeling layers of scaly or keratinized epithelium; if untreated may erode the middle ear causing nerve damage and deafness
44
define vertigo
sensation of motion of either of the the person or the environment
45
define benign paroxysmal positional vertigo
most common form of vertigo- characterized by the sensation of motion initiated by sudden head movements
46
Causes of vertigo
``` brain tumors medications otitis media or labrinthitis Meniere's disease Acoustic neuroma Head trauma or neck injury Migraines Cerebellar hemorrhage ```
47
Labs/ diagnostics of vertigo
``` CT scan VDRL/RPR serum medication levels hearing exam Blood glucose and ECG may be helpful ```
48
Management of vertigo
``` Diazepam Meclizine hydrochloride diphenhydramine scopolamine patch antiemetics ```
49
What are some of the medications that cause sensorineural hearing loss?
``` OTOTOXIC DRUGS: Aminoglycosides diuretics salicylates NSAIDS Antineoplastics ```
50
What are some infections that cause sensorineural hearing loss?
Mumps, measles, herpes zoster, syphilis, meningitis
51
What are the 3 components of meniers disease?
sensorineural hearing loss, tinnitus, vertigo
52
What do the weber and rinne test show in conductive hearing loss?
weber: sound lateralizes to the affected ear | Rinne test: Abnormal in the affected ear (AC
53
What will the weber and rinne test show in sensorineural hearing loss?
Weber: Sound lateralized to the unaffected ear Rinne: Normal in the affected ear
54
define the common cold
Viral rhinitis: self-limiting (5-10 days) caused by any 1 or more of the 200 viruses (Rhinovirus, coronavirus, RSV, adenovirus…)
55
What is the Centor Criteria?
``` clinical features most suggestive of group A B-hemolytic strep pharyngitis (FLEA) Fever >38C or 100.4F Lack of cough Exudate Anterior cervical adenopathy If 2 or 3- rapid strep test ```
56
management of pharyngitis
``` Fluids/ hydration salt water gargles asa/ tylenol ANX for strep- PCN V, erythromycin) Ceftriaxone for gonococcal infection ```
57
Lab/diagnostic for pharyngitis
rapid streptococcal antigen test Monospot CBC with diff
58
labs/ diagnostic for influenza
virus isolation from nasal or throat swab or sputum specimen (most rapid)
59
When would you RX a antibiotic in influenza
if bacterial infection is suspected or patient is asthma, COPD, or immune compromised
60
What are neuraminidase inhibitors and what do they do?
Shorten the duration of symptoms by 2 days, effective for both influenza A and B. Must give within 48 hours or exposed Zanamivir Osteltamivir (tamiflu)
61
What virus causes mononucleosis
epstein-barr virus
62
What age group is most common for mono?
15-24 yo
63
What kind of adenopathy is seen with mononucleosis
posterior cervical region
64
What is the most severe symptom of mono?
pharyngitis, white tonsillar excavates
65
What occurs usually during the 2nd week of mono illness?
Spelnomegaly
66
What are the labs/ diagnostics of mono
Monospot positive | Increased WBC and relative lymphocytosis and neutropenia
67
What are the indications of a bacterial rhino sinusitis
purulent nasal drainage | fever
68
How long is mono incubation?
1-2 months, usually self limited, but malaise and fatigue may last months
69
What is the management of rhinosinusitis
``` Hyrdation Oral decongestants (sudafed, mucinex) Analgesics Antibiotics only if bacterial is suspected- AMOX+CLAV= Augmentin, or clarithromycin (Biaxin) supportive care ```
70
What is the most frequent location of nose bleeds
anterior spetum
71
What might uncontrolled nose bleeds be an indication of?
posterior septum nose bleed- more complicated, artery in the back of the nose.
72
If no resolution of nosebleed after____ minutes, refer to ENT
10
73
what kind of eye drops are used in the management of open angle glaucoma
miotic agents to produce miosis which symptomatically lowers IOP (pilocarpine)
74
what teeth erupt by 12.5 years
all teeth except the third molar | the second molar erupts by 11.9 (lower) and upper by 12.25

FNP 1 (2 decks)

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