ENT Flashcards Preview

joy's deck for FNP > ENT > Flashcards

Flashcards in ENT Deck (57):
1

herpes keratitis

SEVERE eye pain, photophobia, blurred vision
fernlike lines in corneal surface (using black lamp)
EMERGENCY=blindness

2

acute angle closure glaucoma

elderly, severe eye pain, n/v, "halos". exam: dilated oval shaped pupil, cloudy cornea, "cupping". EMERGENCY

3

cholesteatoma

cauliflower like growth with foul smelling ear discharge
hearing loss
hx of otitis media, not concerous by may effect CN 7

refer

4

battle sign

bruise behind the ear (mastoid) area after recent trauma
indicates skull fracture
look for clear golden discharge
Emergency

5

clear fluid from nose or ear

sign of skull fracture
test fluid with urine dipstick=glucose (CSF)

emergency

6

cavernous sinus thrombosis

hx of sinus injection with SEVERE headache/fever,

7

peritonsillar absess

severe sore throat, odonophagia (painful swallowing), truisms (jaw tightening), "hot potato", uvula displaced, fever.

Refer to ED fro incision and drainage

8

diptheria

swollen "bulls neck"
posterior pharynx coated with gray/yellow psudomembrane, very contagious. ED

9

normal eye findings

veins larger than arteries

10

leukoplakia

on the tongue, may be cancerous, high risk in tobacco users

11

apthous stomatitis ( canker sores)

painful shallow ulcers of soft tissue

12

geographic tongue

map like appearance on tongue
patches may move
soreness with acidic/spicy foods
benign

13

torus palatinus

benign
bony protuberance midline on the hard palate

14

fishtail or split uvula

benign
may be a sign of occult cleft lip

15

nystagmus

few beats on extreme lateral gaze that resolves when back to midline .

VERTICAL nystagmus is ALWAYS abnormal

16

papilledema

swollen optic disc
secondary to bleeding, brain tumor, abscess, pseudo tumor cerebri

17

hypertensive retinopathy

silver/copper wire arterioles

18

diabetic retinopathy

microaneurysms caused by neovascularization (new arteries in the retina fragile)

On funduscopic exam, cotton wool spots, flame hemorrhages (similar lesions are also caused by the alpha-toxin of Clostridium novyi), and dot-blot hemorrhages.



19

cataracts

opacity of the cornea
chronic steroid can cause

20

allergic rhinitis

blue tinged or pale/swollen boggy nasal turbinates

21

koplik spots

measles
small red papules with blue/white centers inside the cheeks by the lower molars

22

hairy leukoplakia

elongated papilla on the lateral tongue, HIV injection caused by EBV

23

leukoplakia of the tongue

bright white plaque caused by chewing tobacco or chronic infection ( rule out cancer)

24

nystagmus

horizonal is normal, vertical his not
rule out strabismus

25

abnormal vision test

2 line difference between each eye

26

test for color blindess

ishihara chart

27

vision test if illiterate

tumbling E chart

28

legal blindess

20/200 or visual field

29

normal rinne test

air conduction > bone conduction ( can hear longer in front of the ear than on mastoid bone)

30

herpes keratitis

look for herpetic rash not eh side of the temple/tip of the nose (rule out shingles) of CN 5

The trigeminal nerve (the fifth cranial nerve, or simply CN V) is a nerve responsible for sensation in the face and certain motor functions such as biting and chewing. It is the largest of the cranial nerves.

31

corneal abrasions

appear linear line on back lamp ( fernlike for herpes keratitis)

flush out with saline, if unable to remove refer
if corneal abrasion, use topical antibiotic (erythro, plytrim). do NOT patch eye. f/u in 24 hours

32

hordeolum (stye)

painful bacterial infection of a hair follicle of the eyelid
antibiotic drops (sulfa or erythromycin gtts), warm packs

33

chalazion

chronic inflammation of the meibomian gland (sweat gland) of the eyelids
"PAINLESS" nodule to the upper eyelid, benign
tx: if nodule enlarges or does not resolve in a few weeks, biopsy to r/u squamous cell cancer.

34

pinguecula

yellow triangular thickening of the bulbar conjunctiva caused by UV damage

A pinguecula (above) is a yellowish patch or bump on the conjunctiva, near the cornea. It most often appears on the side of the eye closest to the nose. It is a change in the normal tissue that results in a deposit of protein, fat and/or calcium. It is similar to a callus on the skin.

35

pterygium

yellow triangular thickening of the conjunctiva that extends to the cornea on the nasal or temporal cornea du to UV.

A pterygium (also known as surfer's eye or farmer's eye) is a triangular-shaped growth of fleshy tissue on the white of the eye that eventually extends over the cornea. This growth may remain small or grow large enough to interfere with vision. A pterygium can often develop from a pinguecula.

36

subconjuctival hermorrhage

blood trapped under conjunctiva and sclera, resolves within 1-3 wks.
watchful waiting

37

primary open angle glaucoma

gradual >IOP, >22mm hg dt lbokcage of the drainage of aqueous humor. CN2 can be permanently damaged (glaucoma, 60-70%)

most common in elderly, AA
gradual change in peripheral first. if shoes "cupping"- refer

tx:
BB gtts Betimol (timolol)
side effects: fatigue/depression, bradycardia
contraind: heart block, heart failure, copy/astham/emphysema

38

closed angel glaucoma

SUDDEN blockage, increase IOP causing ischemia and permanent CN 2 damage

ie: elder with sudden headache and eye pain, sees halos, n/v

objective: fixed, mid dilated cloudy pupil. oval shaped. REFER ED

39

anterior uveitis (iritis)

inflammation of the iris

refer to opthamalogist
higher risk with autoimmune; RA, lupus, anklosing spodylitis, etc.

complains of red sore eyes, no discharge

40

age related macular degeneration

higher risk in smokers
gradual damage to the macula
treatment: refer
pt is given AMSLER grid (focus on central dot and view grad 12" from eye). check daily or weekly

"areds" formula ocular vitamins (Antioxidents and zinc)

41

sjorgrens syndrome

autoimmune. 3 months, gritty eyes (keratoconjuntivitis sicca). swollen salivatory glands

OTC tear substitute eye gtts, refer

42

belpharitis

chronic condition, inflammation of base of eyelashes, redness, crusting

tx: baby shampoo until resolved. or erythromycin gtts

43

allergic rhinitis

chronic nasal congestion, clear mucus post nasal drip, cough worse in supine.

objective: blue tinged or pale boggy nasal turbinates
mucus clear
tx: flonase, decongestants, zyrtec, avoid dust mite allergies

complications: acute sinusitis
acute otitis media

44

rhinitis medicamentosa

prolonged use of topical nasal decongestants (>3 days) causes rebound.

45

epistaxis

tilt head forward and apply pressure, use afrin prn, nasal packing, antibiotic prophylaxis for staph/strep prn.

posterior nose bleeds refer to ED

46

strep throat

acute infection of the pharynx
B. streptocuccus gram + group A
classic example: acute onset of pain on swallowing, mild submandibular nodes, no rhinitis, pharynx pink/red, afebrile, tonsillar exudate, pettechiae on the palate

Tx: throat culture and sensitivity (C&S) or rapid strep test
first line: PCN QID x 10 days
salt water gargles, throat lozenges
repeat culture if high risk: hx of mitral valve or valve surgery

pcn allergy:
azithromyzin ( zpack) x 5 days
levo x 10 days ( contraindicated if

47

acute otitis media

acute infection middle ear
organisms: S. pneumoniae, h. influenza, m. catarrhalis
classic ex: ear pain (otalgia), popping nose, hx of cold/allergies.

48

bullous myringitis

AOM but causes more PAIN
blisters (or bulla) on tempanic membrane, hearing closs

49

tx for AOM

amoxicillin gold standard for all age groups
or 2nd line augmenting, ceftin, cefzil
(use 2nd line if antibiotic use in past 3 mos, no response to amoxicillin, or severe AOM (high fever, severe pain).

if allergic to PCN:
azithro, bacterium, levo (>18 yo dt risk of tendinitis/achilles tendon rupture

complications:
meningitis ( positive brudzinski or kerning sign)

50

otitis externa ( swimmers ear)

bacterial infection of the skin of the external ear canal
p. aeruginosa
s. aureus

external ear pain, swelling, green discharge
"ear pain with tragus".

tx: cortisporin otic suspension qid x 7 days. keep water out of ear. if recurrent, prophylaxis is otic domeboro (boric) or alcohol and vinegar (vosol)

51

mono

EPV
15-24yo
triad; fatigue, pharyngitis, lymphadenopathy
stomach pain ( dt splenomegaly)
objective: cbc (>50% lymphocytes)
Positive mono spot
tender cervical nodes, tonsils inflamed

Tx: abdomen US if splenomegaly
no contact sports 4-6 wks
avoid amoxicillin if patient has strep throat

** keep checking lymphocytes until normal**

52

cheilosis

skin fissures corner of the mouth
apply topical antibiotic

53

tx for otitis externa

corisporin otic drops
otitis externa = pseudomonas

54

if pt has used antibiotics in the past 3 months

do nOT use amox
use augmenting of ceftin

55

PCN allergy

use macrolides, sulfa (avoid cephalosporins if true PCN allergy)

56

weber and rinne test which CN

8 (acoustic)

57

most common cerumen tx

carbamide peroxide