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Flashcards in ENT Deck (253):
1

Hypertension causes this, which is a stiffening of vessels in the eyes

AV Nicking

2

Diabetes causes these in the eyes

Cotton wool spots

3

Loss of central vision..most common cause of permanent vision loss in older adults

Macular degeneration

4

Central blind spot

Scotoma

5

Symptoms of eye pain, conjunctival redness, and a pupil that reacts poorly to light is

Angle closure glaucoma

6

What type of glaucoma rarely has symptoms

Open angle glaucoma

7

Common non-cancerous growth on cornea and conjunctiva which can cause blindness

Pterygium

8

Yellow, white deposit on the conjunctiva that doesn't cause symptoms

Pinguecula

9

Yellow plaque on the inner canthus that indicates increased lipids

Xanthelasmas

10

Hard, non tender nodule of the eyelid caused by inflammation of the meibomian gland

Chalazion

11

Inflammation of the sebaceous glands at the base of the eyelashes

Stye

12

Always start the assessment of an eye patient with

Assessing visual acuity/Snellen

13

A patient who has acute sinusitis complains of pain in her upper teeth. Which sinus cavities are probably infected

Maxillary

14

What is the goal of rhinosinusitis

Promote drainage

15

Nasal congestion, obstruction
Purulent nasal discharge
Maxillary tooth discomfort
Facial pain/pressure that is worse with bending forward

Acute rhinosinusitis

16

A patient has rhinosinusitis. How do you treat

Watchful waiting for 10 days
No macrolides
Augmentin
5-7 days

17

Anterior cervical node inflammation is associated with

Strep throat

18

Posterior cervical node inflammation is associated with

Mono

19

Rebound stuffiness from using a topical vasoconstrictor such as oxymetazoline spray

Rhinitis medicamentosa

20

How do you treat rhinitis medicamentosa

Topical nasal steroid in 1 nostril, then the other one. Wean off

21

A common wider effect of using topical nasal steroids

Epistaxis

22

What type of drug can cause dry mucus membranes and sedation

Antihistamines

23

A 78 year old with hearing aids complains of itching in both ears. What is the likely diagnosis

Otitis externa

24

What condition is associated with tragal tenderness

Otitis externa

25

What condition is associated with a ruptured ear drum

Otitis media

26

Loss of high frequency sounds in older adults

Presbycusis

27

Weber test for conductive hearing loss

Bad ear larteralizes to bad ear

28

Weber test for sensorineural loss

Good ear lateralizes to good ear

29

Rinne test for conductive loss

AC>BC good ear
BC>AC bad ear

30

Rinne test for sensorineural loss

AC>BC good ear
AC>BC bad ear

31

Sound can not get into external or middle ear ex. Cerumen impaction

Conductive hearing loss

32

This type of hearing loss involves the inner ear or 8th CN

Sensorineural hearing loss

33

Hearing or acoustic cranial nerve number

8

34

What type of hearing loss is presbycusis

Sensorineural hearing loss

35

What is the most common pathogen in ABRS, AOM (acute otitis media), and CAP (community acquired pneumonia)

Streptococcus pneumoniae

36

What is the Weber test result for conductive hearing loss

Sound lateralizes to the affected ear

37

What is the Weber test result for sensorineural hearing loss

Sound lateralizes to the unaffected ear

38

What is the Rinne test result for conductive hearing loss

Negative
Bone conduction is better than air conduction

39

What is the Rinne test result for sensorineural hearing loss

Positive or Negative
Air conduction is better than bone conduction

40

How do you treat Bells Palsy

Oral corticosteroids

41

What is the triad of an opthological emergency and needs referral?

Red eye, painful eye, new onset vision change

42

Are retinal ateries wider or narrower than veins?

Narrower

43

In a funduscopic exam in a patient with angle-closure glaucoma would reveal

A deeply cupped optic disk

44

Peripheral vision loss is associated with

Untreated open angle glaucoma

45

Floating spots in visual field is associated with

Proliferative diabetic retinopathy

46

Central vision loss is associated with

Macular degeneration

47

What is the name of the test for macular degeneration

Amsler Grid Test

48

Measurement of intraocular pressure, glaucoma screening test

Tonometry

49

Aging problem with vision that leads to close vision problems

Presbyopia

50

Systemic corticosteroid use leads to this eye condition

Cataracts

51

Painless, gradual onset of increased introcular pressure leading to blindness

Open angle glaucoma

52

Sudden increase in intraocular pressure

Angle closure glaucoma

53

Diminished sense of smell with resulting decline in fine taste discrimination

Anosmia, hyposmia

54

Loss of 8th cranial nerve sensitivity

Presbycusis

55

What type of hearing loss is cerumen impaction

Conductive hearing loss

56

How do you treat suppurative conjunctivitis

Cipro, Levo, or moxifloxacin optholmic

57

Chronic otitis media infections can lead to

Cholesteatoma

58

What part of the eye is responsible for the sharpest vision 2020 vision

Fovea of the Macula

59

What part of the eye is responsible for central vision

Macula

60

If the borders of the disc margins on both eyes are blurred, what is this associated with

Papilledema

61

Acute onset of severe eye pain, photophobia, and blurred vision in one eye. Diagnosed by using fluorescein dye. A black lamp in a darkened room is used to search for fern like lines in the corneal surface. In contrast, corneal abrasion’s appear more linear. Infection permanently damages corneal epithelium, which may result in corneal blindness.

Herpes keratitis

62

Elderly patient with acute onset of severe eye pain accompanied by headache, nausea/vomiting, halos around lights, and decreased vision. Examination reveals a mid dilated pupil that is oval shaped. The cornea appears cloudy. Funduscopic examination reveals cupping of optic nerve. Ophthalmologic emergency. If the rise and intraocular pressure is lower, patient may be a symptomatic.

Acute angle closure glaucoma

63

Patient may complain of sudden onset of floaters or black dots in visual field, Scotoma i.e. retinal attachment, blurred vision, photophobia, Eye pain , or severe discomfort i.e. uveitis, glaucoma.

Acute vision loss

64

Cauliflower like growth accompanied by foul smelling discharge. Hearing loss on affected ear 👂 On examination, no Tympanic membrane or ossicles are visible because of distraction by the tumor. History of chronic otitis media infection. The mass is not cancerous, but It can erode into the bones of the face and damage the facial nerve cranial nerve number seven. Treated with antibiotics and surgical debridement. Refer to head, eyes, ears, nose, and throat specialist.

Cholesteatoma

65

Acute onset of a bruise behind the ear over the mastoid area after a recent history of trauma. Indicates a fracture of the basilar skull. Search for a clear golden serous discharge from the Ear 👂 or nose 👃 Refer to emergency department for skull 💀 x-rays and antibiotics.

Battle sign

66

What does it mean if there is clear golden fluid discharge from the ear and nose

Indicative of a basilar
skull fracture. CSF slowly leaks through the fracture. Testing the fluid with the urine dipstick will show that it is positive for glucose, whereas plain mucus or mucopurulent drainage will be negative. Refer to ED.

67

A rare but life-threatening complication with a high mortality rate. Patient with a history of a sinus or facial infection will manifest with a severe headache accompanied by a high fever. Rapid decline in level of consciousness terminating in coma and death. Refer to ED.

Cavernous Sinus Thrombosis

68

Severe sore throat with difficulty swallowing, ODonophahia, trismus, and a hot potato voice. One sided swelling of the peritonsillar area and soft palate. Affected area is markedly swollen and appears as a bulging red mass with the uvula displaced from the mass. Accompanied by malaise, fever, and chills. Refer to ED for incision and drainage.

Peritonsillar abscess

69

Sore throat, fever, and markedly swollen neck i.e. bull Neck. Low-grade fever, hoarseness, and Dysphagia. The posterior pharynx, tonsils, uvula, and soft palate are coated with a great to yellow color pseudomembrane that is hard to displace. Very contagious. Refer to ED

Diphtheria

70

Should a red reflex be present on fundoscopic exam

Yes if not it is indicative of cataracts

71

How should the optic disc be in a fundoscopic exam

Sharp outline

72

What should the cup disk ratio be in a funduscopic exam

Less than 0.5

73

What is narrower arteries or veins

Arteries

74

Which is larger veins or arteries in the eye

Veins

75

What part of the eye is responsible for color perception, 2020 vision, and sharp vision

Cones

76

What part of the eye is responsible for detecting light and shadow, depth perception, night vision.

Rods

77

What part of the eye is responsible for central vision. This is the area of the eye that determines 2020 vision.

Macula

78

The fovea is located

In the middle of the macula

79

Inner conjunctiva with mildly elevated lymphoid tissue resembling cobblestones. Maybe seen in atopic patients, allergic rhinitis, allergic conjunctivitis.

Cobblestoning

80

Age related visual change due to a decreased ability of the eye to accommodate and Stiffening of the lenses. Usually starts at the age of 40. There is difficulty focusing, which results in markedly decreased ability to read print at close range.

Presbyopia

81

What should the tympanic membrane of the ear look like

Translucent off white to gray color with the cone of light intact

82

How do you measure the presence of fluid inside the middle ear. Results in a straight line versus a Peaked shape.

Tympanogram

83

All cartilage injuries must be referred to

Plastic surgeon. The outer ear has a large amount of cartilage.

84

Does cartilage regenerate

No refer injuries to plastic surgeon

85

What do the nasal turbinates look like in allergic rhinitis

Bluish, pale, and or Boggy

86

Lower third of the nose is made out of

Cartilage and this tissue does not regenerate. If damaged, refer to plastic surgeon.

87

Appears on the surface and under the tongue. Maybe cancerous. Patients with a history of chewing tobacco are at high risk of oral cancer.

Leukoplakia

88

Painful and look like shallow ulcers of soft tissue

Apthous stomatitis (cancer sores)

89

What do you do if a patient has an avulsed tooth

Store in a cool milk. No ice. See dentist ASAP for reimplantation.

90

What are you assessing for in the posterior pharynx

Post nasal drip as in acute sinusitus, allergic rhinitis. Posterior pharyngeal lymph nodes that are mildly enlarged and distributed evenly on the back of the throat as in allergies and allergic rhinitis. Hard palate look for any openings as in cleft palate, ulcers, redness.

91

Unknown cause. Map like appearance On tongue surface. Patches may move from day to day. May complain of soreness with acidic foods, spicy foods.

Geo graphic tongue

92

Painless bony protuberance midline on the hard palate or roof of the mouth. Maybe asymmetrical. Skin should be normal. Does not interfere with normal function.

Torus Palatinus

93

Uvula is split into two sections ranging from partial to complete. May be a sign of an occult cleft palate and is rare.

Fishtail or split uvula

94

Is vertical nystagmus normal or abnormal

Abnormal

95

Optic disc swollen with blurred edges due to increased intracranial pressure secondary to bleeding, brain tumor, abscess, pseudotumor cerebri

Papilledema

96

Hypertension stiffens vessels
Arteries indent and displace veins
Considered mild retinopathy
This is

AV nicking

97

Mainly caused by diabetes in the eye, can be from hypertension. Microinfarct occurs and is considered moderate retinopathy

Cotton wool spots

98

Can be caused by hypertension and diabetes and micro infarct occurs in the eye. Considered moderate retinopathy. Blot and dot hemorrhages, hard exudates, microaneurysms are considered moderate novelty. Refer to ophthalmology.

Flame hemorrhages

99

Copper and silver wire arterioles

Hypertensive retinopathy

100

Microaneurysms caused by neovascularization. Cotton wool spots.

Diabetic retinopathy

101

Opacity of the corneas. Chronic steroid use causes this

Cataracts

102

Small size red papules with blue white centers inside the cheeks by the lower molars

Koplick’s spots as seen in measles

103

Elongated papilla on the lateral aspects of the tongue that are pathognomic for HIV infection. Caused by Epstein bar virus infection.

Hairy leukoplakia

104

A bright white plaque caused by chronic irritation such as chewing tobacco or snuff. Rule out cancer of the mouth. Or on the inner cheeks (buccal mucosa).

Leukoplakia of the oral Mucosa/tongue

105

Mucosal lining inside the mouth

Buccal mucosa

106

Mucosal lining inside eyelids

Palpebral conjunctiva

107

Mucosal lining covering the eyes

Bulbar conjunctiva

108

Refers to the area where uvula, tonsils, anterior of throat are located

Soft palate

109

The roof of the mouth

Hard palate

110

Far sighted Ness

Hyperopia

111

What measures central distance vision

Snellen chart

112

If a patient is illiterate, how do you measure central distance vision

Tumbling E chart

113

Blind spot

scotoma

114

What chart is used for color blindness

Ishihara chart

115

What defines legal blindness

Defined as a best corrected vision of 20/200 or less or a visual field less than 20° (tunnel vision)

116

What is the test for hearing and what is a normal finding

Weber test is done by placing the tuning fork midline on the fore head. Normal finding is no lateralization. If lateralization, hearing the sound in only one ear, abnormal finding.

Rinne test is done by placing the tuning fork first on the mastoid process, then the front of the ear. Time each area. Normal finding is air conduction lasts longer than bone conduction (can hear longer in front of ear 👂 than in mastoid)

117

What type of herpes virus causes herpes keratitis and corneal abrasion

Shingles. Corneal abrasion will report sudden onset of symptoms with foreign body sensation.

118

Shingles affects which cranial nerve

Trigeminal number five

119

What diagnostic test is used for herpes keratitis

Use fluorescein dye strips with a black lamp in a darkened room. Herpes keratitis this appears as a fernlike line. In contrast corneal abrasion’s usually appear more linear.

120

What is the treatment plan for herpes keratitis and corneal abrasion

Refer herpes keratitis patient to ED or ophthalmologist ASAP. They will be given Zovirax or Valtrex BID. Avoid steroid up Opthalmic drops for herpes keratitis. If corneal abrasion‘s, rule out penetrating trauma, vision loss, soil/dirt. Check vision. Flush Eye with normal Saline to remove foreign body. If UnAble to remove, refer. If corneal abrasion, use topical opthalmic antibiotic such as erythromycin or Polytrim applied To affected eye times 3 to 5 days. Do not patch Eye. Follow up in 24 hours. If not improved, refer. Consider Eye pain prescription hydrocodone with acetaminophen and prescribe enough for 48 hours of use.

121

A painful acute bacterial infection of the hair follicle on the eyelid

Hordeolum (style)

122

Patient complains of an itchy eyelid and an onset that is acute of nature of a Pustule on either upper or lower eyelid that eventually becomes painful.

Hordeolum (stye)

123

What is the treatment plan for hordeolum (stye)

Antibiotic drops or ointment such as sulfa drops, erythromycin drops. Warm packs b.i.d. or TID until pustule drains

124

A chronic inflammation of the meibomian gland (specialized sweat gland) of the eyelids

Chalazion

125

Patient complains of a gradual onset of a small superficial nodule that is discreet and movable on the upper eyelid that feels like a bead. Painless. Can slowly en large overtime. Benign

Chalazion

126

What is the treatment plan for chalazion

If Nodule enlarges or does not resolve in a few weeks, biopsy to rule out squamous cell carcinoma. If large and affects vision, surgical removal is an option.

127

Yellow triangular thickening of the bulbar conjunctiva (skin covering eyeball). Located on the inner and outer margins of the cornea. Caused by UV light damage to collagen.

Pinguecula

128

A yellow triangular (wedge shaped) thickening of the conjunctiva that extends to the cornea on the nasal or temporal cornea. Due to UV damaged collagen from chronic sun exposure. Usually asymptomatic. Can be red/inflamed at times

Pterygium

129

What is the treatment plan for both pinguecula and pterygium

If inflamed, use week steroid eyedrops only doing exacerbations. Recommend use of good quality sunglasses 🕶 Remove surgically if encroaches cornea and affects vision.

130

Blood that is trapped underneath the conjunctiva and sclera secondary to broken arterioles . Can be caused by coughing, sneezing, heavy lifting, vomiting, or can occur spontaneously. Results within 1 to 3 weeks when the blood is reabsorbed like a bruise with color changes from red to green to yellow. If on aspirin, anticoagulants, and has hypertension there is an increased risk for this condition.

Sub conjunctiva hemorrhage

131

What is the treatment plan for sub conjunctiva hemorrhage

Watchful waiting and reassurance of patient. Follow up until resolution.

132

Gradual onset of increased intraocular pressure greater than 22 mmHg due to blockage of the drainage of aqueous humor inside the eye. The retina cranial nerve 2 undergoes ischemic changes and if untreated becomes permanently damaged. Most common type of glaucoma.

Primary open angle glaucoma

133

If a funduscopic exam shows cupping what does that mean

Increased intraocular pressure and it is too high. Refer to ophthalmologist.

134

What is the treatment plan for primary open angle glaucoma

Check intro ocular pressure as normal range is 10 to 22 mmHg. Refer patient to ophthalmologist for follow-up. Medications used are Betimol (timolol) which is a beta blocker eye drops that lower intro ocular pressure. Side effects include bronchospasm, fatigue, depression, heart failure, and bradycardia. Contra indicated an asthma, empysema, COPD, second to 3rd° heart block, and heart failure.

135

Sudden blockage of aqueous humor causes marked increase of the intraocular pressure causing ischemia and permanent damage to the optic nerve 2

Primary angle closure glaucoma

136

An older patient complains of acute onset of a severe frontal headache or severe eye pain with blurred vision and tearing. Seeing halos around lights. Maybe accompanied by severe nausea and vomiting.

Primary angle closure glaucoma

137

Fixed and mid-dilated cloudy pupil that looks more oval then round shaped. Conjunctiva injection with increased lacrimation.

Primary angle closure glaucoma

138

What is the treatment plan for primary angle closure glaucoma

Refer to ED

139

Higher risk with autoimmune disorders such as rheumatoid arthritis, lupus, ankylosing spondylitis, sarcoidosis, syphilis, others. Complains of red sore eyes. Appears like Redeye but with increased tearing. No purulent discharge as in bacterial conjunctivitis. Refer to ophthalmologist for management.

Anterior uveitis (iritis)

140

Most common cause of permanent vision loss in older adults. Symptom is loss of central vision over the years. First sign is central Blindspot or scotoma or curving of straight lines. Peripheral and color vision are normal.

Macular degeneration

141

A 70-year-old patient presents to your clinic with Eye pain, conjunctival redness, and a pupil that reacts poorly to light. What could be the cause?

Angle closure glaucoma
Refer

142

Do patients have symptoms in open angle glaucoma

Rarely

143

Do patients have symptoms in closed angle glaucoma

Patients have acute symptoms

144

Can pterygium cause blindness

Yes

145

Yellow plaque on the inner canthus. 50% of people have elevated lipids with this condition

Xanthelasmas

146

How do you assess all Eye complaintsis

Always start by assessing visual acuity. And document for both eyes. Examination with slit lamp and binocular loop after selling examination or pen light.
Fluorescein staining is used to assess for corneal defects (should be done as last part of examination)
Lid eversion: flip the eyelid with cotton swab for suspected foreign body; remove visible object using wet cotton swab

147

Went to refer to ophthalmology

Change in vision
Foreign body sensation
Photophobia

148

Opacity in the lens of the eye which decreases visual acuity

Cataract

149

Does the patient have peripheral vision with macular degeneration

Yes

150

What is the treatment plan for macular degeneration

Refer to ophthalmologist. Patient is given a copy of the Amsler grid and asked to focus on the center dot and view the grid 12 inches from eyes. Patient checks visual field loss daily to weekly.

AREDS formula ocular vitamins are given: high dose antioxidants and zinc. Patients should consult their opthomologist before taking ocular vitamins.

151

Chronic autoimmune disorder characterized by decreased function of the lacrimal and salivary gland’s. It can occur alone or with autoimmune disorder such as rheumatoid arthritis

Sjögren’s syndrome

152

The classic symptoms are daily symptoms of dry eyes and dry mouth for several months greater than three months. Complains of chronic dry eyes and that both eyes have Sandy or gritty sensation (keratoconjunctivitis sica). Ocular symptoms are associated with chronic dry mouth. Oral examination shows swollen and inflamed salivary gland’s.

Sjogren’s Syndrome

153

What is the treatment plan for Sjögren’s syndrome

Over-the-counter tear substitute drops TID. Refer to ophthalmologist if patient has keratoconjunctivitis

154

A chronic condition of the base of the Eyelashes caused by inflammation. Complains of itching or irritation in the Eyelashes area upper/lower or both, Eye redness, and sometimes crusting

Blepharitis

155

What is the treatment plan for blepharitis

Johnson’s baby shampoo with warm water. Scrub eyelid margins until resolved. Consider a topical antibiotic solution such as erythromycin eyedrops to eyelids 2 to 3 times daily.

156

When a patient has green mucus what must be ruled out

Sinusitis

157

What is the treatment plan for allergic rhinitis

Nasal steroid spray’s daily like fluticasone or Flonase b.i.d. Decongestants such as pseudo-ephedrine or Sudafed PRN. Do not give to infants 👶🏻 /young children. Zyrtec 10 mg daily or PRN or combined antihistamine with decongestants. Dust mite allergies: avoid using ceiling fans, no stuffed animals or pets in bed, use a HEPA filter, and the like.

158

What are complications of allergic rhinitis

Acute sinusitis and acute otitis media

159

Prolonged use of topical nasal decongestants greater than three days, causes rebound effects that result in severe and chronic nasal congestion. Patient presents with severe nasal congestion and clear, watery, mucus nasal discharge.

Rhinitis medicamentosa

160

What puts a patient at a higher risk for epistaxis

Aspirin use, cocaine abuse, severe hypertension, anticoagulants

161

What is the treatment plan for epistaxis

Tilt head slightly forward and apply pressure over nasal bridge for several minutes. Use nasal decongestants (i.e. Afrin) to shrink tissue. Nasal packing. Antibiotic prophylaxis for staph and strep as needed

162

What is a complication of epistaxis

Posterior nasal bleeds may hemorrhage (refer to ED)

163

What are rare sequelae of strep throat

Scarlet fever and rheumatic fever

164

What is the treatment plan for strep throat

Throat culture and sensitivity or rapid strep testing. First line is penicillin QID times 10 days. Ibuprofen or acetaminophen for throat pain and fever. Symptomatic treatment: salt water gargles, throat lozenges. Drink more fluids. Repeat culture if high-risk: history of mitral valve prolapse’s or heart valve surgery. If the patient is penicillin allergic, Z pack azythromycin can be given x 5 days. Or Levaquin x 10 days (contraindicated if age less than 18)

165

Sandpaper texture pink rash, acute pharyngitis findings

Scarlet fever

166

Inflammatory reaction to strep infection that may affect the heart and the valves, joints, and the brain.

Rheumatic fever

167

Displaced uvula, red bulging mass on one side of anterior pharyngeal space, dysphagia, fever. Refer to ED stat

Peritonsillar abscess

168

Acute infection of the middle ear cavity with bacterial pathogens due to mucus that becomes trapped in the middle ear secondary to temporary eustachian tube dysfunction. The infection is usually unilateral, but may at times involve both ears. Most have a middle ear effusion.

Acute otitis media

169

What organisms are usually associated with acute otitis media

Streptococcus pneumoniae. High rates of beta-lactam resistant strains.
Haemophilus influenzae
Moraxella catarrhalis

170

What is otaglia

Ear pain

171

A type of acute otitis media infection, but causes more pain. Presence of blisters on a reddened and bulging tympanic membrane. Conductive hearing loss. Caused by different types of pathogens. Treated the same as bacterial acute otitis media.

Bullous myringitis

172

What would the weber exam show for conductive hearing loss

Lateralization in the affected ear

173

Complains of unilateral facial pressure that worsens when bending down, along with pain in the upper molar teeth or frontal headache. Coughing is made worse when supine. Self treatment with over-the-counter cold and sinus remedies provides no relief of symptoms.

Bullous myringitis

174

When do patients with bullous myringitis follow up

Within 48 to 72 hours, symptoms will start to improve. If not getting better, check ears again for bulging and erythema. Switch to second line drug such as Augmentin or Ceftin.

175

How do you treat acute otitis media and bullous myringitis

Amoxicillin is the gold standard for any age group. First line is amoxicillin 500 mg to 875 mg b.i.d. to TID times 10 to 14 days. Or consider starting with second line antibiotic Augmentin, Ceftin, Cefzil if severe disease i.e. severe ear pain or fever. Most patients will respond within 48 to 72 hours. If no improvement noted, then switch to second line drug. Use adjunct for symptoms such as a decongestant (psuedoephedrine and phenylephrine), Saline nasal spray or mucolytic (guaifenesin), analgesic for ear pain. If allergic rhinitis consider steroid nasal spray (Flonase, Vancenase). Educate about auto-insufflation (pinch nose and blow hard). Popping noises may be heard. No systemic corticosteroids!!

176

When should second line treatment be considered for acute otitis media and bullous myringitis

History of antibiotic use in the past three months, no response to amoxicillin, or severe case of acute otitis media with high fever and severe pain.
Time duration is from 10 to 14 days.
Augmentin
Cefdinir
Cefpodoxime
Ceftriaxone
Ceftin

For penicillin allergic patients Z pack azithromycin x 5 days.
Bactrim DS PO BID
Levaquin or moxifloxacin if 18 years or older. Increases risk of tendonitis and Achilles’ tendon rupture

177

What is the maximum amount of time that a topical decongestant such as Afrin can be used in acute otitis media

Three days or it will cause rebound

178

This is a complication of acute otitis media that is a cauliflower like growth accompanied by foul smelling ear 👂 discharge. No tympanic membrane or ossicles are visible. History of chronic otitis media infections. Mass is not cancerous but It can Erode into the bones of the face and cause damage to the facial nerve cranial nerve number seven

Cholesteatoma

179

A complication of acute otitis media that causes a red and swollen mastoid that is tender to palpation. Treat with antibiotics. Refer.

Mastoiditis

180

This is a complication of acute otitis media that is more common in children. Edema and redness Periorbital area and diplopia. Abnormal EOM extraorbital muscles testing of affected orbit. Pain, fever, toxicity. Refer to ED.

Preorbital or orbital cellulitis

181

This complication of acute otitis media presents with an acute onset of high fever, Stiff neck, severe headache, photophobia, toxicity. Positive Brezinski or Kernigs sign. Refer to ED stat

Meningitis

182

This complication of acute otitis media is life-threatening and a medical emergency with high mortality. Refer to ED. Complains of acute headache, abnormal neurological exam, confused, febrile, toxic.

Cavernous sinus thrombosis

183

May follow acute otitis media. Can be caused by chronic allergic rhinitis. Complains of ear 👂 pressure, popping noises, and muffled hearing in affected ear 👂 Serous fluid inside middle ear is Sterile

Otitis media with effusion

184

What is the treatment plan for otitis media with effusion

Oral decongestants such as pseudo-ephedrine or phenylalanine. Steroid nasal spray b.i.d. to TID times few weeks or Saline nasal spray PRN. Allergic rhinitis, steroid nasal spray’s with long acting antihistamine like Zyrtec

185

Bacterial infection of the skin of the external ear canal. More common during warm and humid weather.

Otitis externa

186

What organisms are responsible for otitis externa

Pseudomonas aeruginosa
Staphylococcus aureus

187

Complains of external ear pain, swelling, and green purulent discharge. History of recent activities that include swimming or wetting ears.

Otitis externa

188

Ear pain with manipulation of the external ear or Tragus. Purulent green discharge. Erythematous and swollen ear canal that is very tender.

Otitis externa

189

What is the treatment plan for otitis externa

Corticosporin optic suspension QID x 7 days. Keep water out of ear during treatment. If patient has recurrent episodes, prophylaxis is Otic Domedoro or alcohol and vinegar

190

What are complications of otitis externa

Malignant otitis media which is seen in diabetics/immunocompromised, aggressive spread of infection to surrounding soft tissue/bone. A cellulitis infection. Hospitalized for high doses of antibiotics and surgical debridement.

191

Infection by the Epstein bar virus. Peak ages of acute infection are between 15 and 24 years. After acute infection, Epstein bar virus lives Latent in oral pharyngeal tissue. Can become re-activated and causes symptoms. Virus is shed mainly through saliva.

Infectious mononucleosis

192

What is the classic triad of infectious mononucleosis

Fatigue, acute pharyngitis, lymphadenopathy

193

Or posterior or anterior know it’s associated with infectious mononucleosis

Posterior cervical nodes

194

With mono, what does abdominal pain mean

Possibly hepato-megaly and or spleno megaly

195

What would a CBC show for mono nucleos sis

Atypical lymphocytes and lymphocytosis greater than 50%. Repeat CBC until resolves

196

What is the diagnostic test for mono

Heterophile anti-body test (mono spot) which will be positive

197

Can a generalized read maculopapular rash be present in mono

Yes

198

What is the treatment plan for mono

Order abdominal ultrasound if splenomegaly/hepato- megaly is present, especially if patient is an athlete, A physically active adult, or an athletic coach. Educate athlete to avoid contact sports and heavy lifting until hepato-megaly and or spleno megaly resolves. Repeat abdominal ultrasound in 4 to 6 weeks. Symptomatic treatment. Avoid using amoxicillin if patient has strep throat due to drug rash from 70 to 90%.

199

What are complications from mono

Splenomegaly/spleen rupture which is rare but serious complications of mono. Airway Obstruction. Neurologic Guillain-Barre, aseptic meningitis, optic neuritis, others. Blood dyscrasias such as atypical lymphocytes. Repeat CBC until lymphocytes normalize.

200

Skin fissures and maceration of the corners of the mouth. Multiple etilologies such as an over salivation, iron deficiency anemia, secondary bacterial infection, vitamin deficiencies.

Cheilosis

201

What is the treatment plan for cheilosis

Apply triple antibiotic ointment b.i.d. or TID until healed. Remove or treat underlying cause.

202

What is the treatment for otitis externa

Corticosporin otic drops

203

What is otitis externa’s common bacterial pathogen

Pseudomonas

204

What is a complication of Periorbital sinusitis

Cholesteatoma

205

Rinne test result of bone conduction greater than air conduction means

Conductive hearing loss

206

Weber and Rinne are testing which cranial nerve

Cranial nerve eight acoustic

207

Is lateralization on the weber exam in abnormal or normal finding

Abnormal

208

What is the normal finding in the Rinne test

Air conduction lasts longer than bone conduction or air conduction is greater than bone conduction

209

What does 20/40 vision mean

Patient can see at 20 feet what a person with normal vision can see at 40 feet

210

What is one of the most common over-the-counter treatment for cerumenosis

Carbamide peroxide

211

A patient who has acute sinusitis complains of pain in her upper teeth. Which sinus cavities are probably infected.

Maxillary

212

Nasal congestion or obstruction, purulent nasal discharge, maxillary tooth discomfort, facial pain, pressure worst when bending forward

Acute rhinosinusitis

213

How do you treat rhinosinusitis

Relieve symptoms such as nasal stuffiness and rhinorrhea, promote drainage, prevent complications.

214

When do you give antibiotics for acute rhinosinusitis

Watchful waiting for at least 10 days. augmentin. No macrolides

215

What symptoms are suggestive of acute bacterial rhinosinusitis

Symptoms persist for greater than 10 days without clinical improvement. Onset with severe symptoms such as fever or purulent drainage lasting at least three consecutive days at the beginning of the illness. Symptoms worsened after initial improvement. 40 to 70% of patients with Acute bacterial rhinosinusitis will clear spontaneously. Promote drainage.

216

If a patient is allergic to penicillin and has acute bacterial rhinosinusitis what should be given to them

Doxycycline. Levaquin or moxifloxacin can also be given. No macrolides.

217

For a pediatric patient with acute bacterial rhinosinusitis what medication should be given

First line is amoxicillin or Augmentin. Alternatives are Cefdinir, cefuroxine, or Cefpodoxime. Avoid sulfa drugs and azithromycin.

218

When should noticeable improvement occur after antibiotic initiation for the treatment of acute bacterial rhinosinusitis

3 to 5 days

219

What is a possible complication of acute bacterial rhinosinusitis

Periorbital cellulitis

220

What are indications for patient referral for acute rhinosinusitis

High fever of 102°F, abnormal vision, Periorbital Edema

221

A patient with sinusitis has developed a fever of 102° and apparent Periorbital cellulitis. What is the imaging study of choice

CT scan with contrast.
CT is for cavity
C=cavity
Contrasts bone from soft tissue

222

Can group A strep cause acute glomerulonephritis

Yes

223

A 15-year-old presents with suspected pharyngeal group a strep infection. Which cervical nodes most likely correlate with those found in a patient with group a strep infection

Anterior, typically symmetric

224

What is the centor criteria for strep

Absence of cough 1 point
+ anterior cervical nodes 1 point
Temp greater than 100.4F 1 point
Tonsillar exudates or swelling 1 point
Age
3-14 1 point
15-44 0 point
45 years and older -1 point

Consider screening if centor score is 2 or more
Screen adults with centor score greater than or equal to 3
Adults at high risk for infection (chronic steroid use, DM poorly controlled, immunocompromised), throat culture if RADT negative.

225

If group a strep is not treated with an antibiotic within 24 to 48 hours then

It will spontaneously resolved within 2 to 5 days

226

If the rapid strep test is negative what needs to be done in order to efficiently rule out strep throat

Throat culture

227

A 15-year-old presents with suspected mononucleosis. Which cervical node’s most closely correlates with those found in a patient who has mono

Posterior, typically symmetric

228

What are the three F’s & L of mono

Fever, pharyngitis, fatigue, lymphadenopathy

229

When is the mono spot test most likely positive

Second or third week of illness

230

What diagnostic studies are needed for mono

Mono spot, EBV titers, CBC which shows lymphocytosis, atypical lymphocytes, elevated ALT and AST

231

A 16-year-old who was diagnosed with mononucleosis asked how soon he might be able to resume sports. What should the nurse practitioner reply

About 3 to 4 weeks after onset of symptoms. Must wait until spleen goes back to normal size.

232

A life-threatening infection of the epiglottis and surrounding tissues which can cause sudden and critical narrowing of the airway; a medical emergency; cellulitis of the epiglottis

Epiglottitis

233

What is the presentation of epiglottitis in adults

Sore throat, fever, muffled voice, drooling, hoarseness, thumb sign which is enlarged epiglottitis protruding from the angeterior wall of the hypopharynx

234

Is epistaxes a disease

It is a symptom

235

What is oxymetazoline spray

Afrin
Overuse=rhinitis medicamentosa

236

Cerumen impaction, ear plugs, fluid on the middle ear, wearing of headphones 🎧 can cause what type of hearing loss

Conductive hearing loss

237

Hereditary hearing loss, presbycusis, noise exposure, meniere’s disease, acoustic tumors, trauma are all examples of

Sensorineural hearing loss

238

Progressive, symmetric loss of high-frequency sounds over many years in elderly patient. Results in diminished nonverbal executive function and decrease cycle motor speed.

Presbycusis

239

How do you treat presbycusis

Hearing aid

240

What are risk factors for angle closure glaucoma

Family history, age greater than 60 years old, female, hyperopia or farsightedness, medications such as antihistamine, anticholinergic agents, phenylephrine, HCTZ, sulfa drugs, TCA, beta blockers which increase intraocular pressure

241

A 24-year-old female complains of intermittent, irritated, dry, red eyes. How can this be treated

Baby shampoo lid scrubs as this is used to treat blepharitis

242

Screening for increased intraocular pressure or early glaucoma is

Best performed by an eye specialist

243

An elderly patient presents with a gray white ring around the periphery of the iris. This is probably

A normal variant associated with the aging process.

244

Does the Hirschberg test test for visual acuity

No. The Harrisburg test evaluates ocular muscle coordination

245

What is the most common cause of pharyngitis and a six-year-old

Viral. Encourage supportive and symptomatic care.

246

What other symptoms besides tragel tenderness presents with otitis externa

Otic itching

247

A 45-year-old diabetic patient with Periorbital cellulitis secondary to a sinus infection. What course of action should be taken

Consider a collaboration with a physician regarding antibiotic treatments, culture, and subsequent action. Periorbital cellulitis is a medical emergency

248

Is papilledema seen in diabetic retinopathy

No

249

An eight-year-old presents to the health clinic with a history of acute onset sore throat and respiratory rate of 34 per minute in the last 30 minutes. The child’s history is positive for fever and pharyngitis for two days. What is the diagnosis

Epiglottitis

250

The diagnosis of Ménière’s disease is based on

Exclusion of other path ologies

251

A 15-year-old swim team member presents with mild swimmers ear. Vital signs are normal. What is the most appropriate therapy for this patient

Hydrocortisone-Bacitracin-Polymixin B (Cortisporin) otic solution

252

What is an example of a first generation antihistamine

Desloratadine

253

Family health history falls under which area

Health and illness pattern