FNP-ENT Flashcards
(54 cards)
1
Q
Herpes Keratitis
Symptoms, causes, treatment, complication(s).
A
- severe eye pain, photophobia, blurred vision in one eye. May have crusty rashes on ophthalmic branch (CN V, trigeminal)
- use fluorescein dye to dx FERN-LIKE lines on corneal surface
- Causes: herpes simplex or herpes zoster (shingles)
- Refer to ED
- Complication: corneal blindness
2
Q
Acute Angle-Closure Glaucoma:
Symptoms, signs, tx/disposition
A
- Symptoms: acute onset severe eye pain, headache, n/v, halos around lights, decreased vision.
- Signs: mid-dialted OVAL-SHAPED pupil
- Refer to ED
3
Q
Multiple Sclerosis-Eyes
Symptoms, disposition
A
- young female
- Symptoms: new or intermittent loss of vision in one eye, nystagmus, (neuro symptoms: aphasia, paresthesia, ab. gait, spasticity, etc.). Dai;y fatigue upon awakening, worsening. Heat increases symptoms
- Refer to neuro
4
Q
Orbital cellulitis
S/S, causes, disposition
A
More common in young children than adults. Hx recent rhinosinusitis or URI.
- Symptoms: acute onset erthymatous, swollen eyelid with poptosis (bulging eye), eye pain, limited ROM
- Cause: acute bact. infxn of orbital contents
- Refer to ED
5
Q
Retinal Detachment
Symptoms, disposition
A
- Sudden onset of shower of floaters, “feeling like you’re looking through a CURTAIN or UNDER WATER”, sudden flashes of light (photopsia)
- Refer to ED
6
Q
Cholesteatoma
S/S, tx, disposition
A
- CAULIFLOWER-like growth
- foul-smelling ear discharge
- hearing loss
- unable to visualiz tm, d/t destruction by tumor (not cancerous)
- Tx: abx and surgical debridment
- Refer to otolaryngoloist
7
Q
Battle Sign
What is it?
What do you do?
A
Could be a sign of skull fracture.
- “RACCOON EYES” (periorbital ecchymosis)
- with brusing behind ear (mastoid area)
- appears 2-3 days post trauma
- Look for clear, golden fluid (CSF)
- Refer to ED
8
Q
CSF fluid from skull
panic or chill?
how to test.
A
- Panic (but don’t actually). Indicative of basiliar skull fracture.
- Refer to ED
- test with urine dipstick to check for glucose (mucropurulent fluid will be negative)
9
Q
Peritonsillar Abscess
S/S, dispostion
A
- Symptoms: severe sore throat, pain on swallowing (odynophagia), trismus (muscale spasm in jaw), HOT POTATO voice
- Signs: UNILATERAL swelling of peritonsillar area and soft palate, bulging red mass, UVULA DISPLACED away from mass, fever.
- Refer to ED
10
Q
Diptheria
S/S, dispostion
A
Notes: very contagious. Contact precautions
- Symptoms: sore throat, fever, BULL NECK
- Signs: post. pharynx, uvula, and soft palate are coated with GRAY to YELLOW PSEUDOMEMBRANE that is difficult to displace
- Refer to ED
11
Q
Presbyopia
A
- Normal finding, age related
- decreased ability to read small print
- d/t stiffening of the lenses
- usual onset around 40 y.o.
12
Q
How many sinuses are there?
A
- 4 in adults
- ethmoid, maxillary, frontal, sphenoid
- Children have ethmoid and maxillary at birth, frontal by 5 yo and sphenoid by 12 yo
13
Q
Leukoplakia
A
- White to light-grey patch (plaque) on tongue or inside of cheek.
- caused by chronic irritation, r/o CA
- risk factors=smoking, chewing tabacco, EtOH use
- Consider hairy leukoplakia if on lat. aspect of tongue
14
Q
Diabetic Retinopathy
signs
A
- cotton wool spots
- microaneuryms
15
Q
Cataracts
S/S
A
- Symptoms: complain of glare, halos aroud lights, blurred vision
- OPACITY of the lens
- up to 20% of adults are affected (65-74)
16
Q
Allergic Rhinitis
s/s
A
- Blue-tinged or pale and swollen (boggy) nasal turnbinates
- Clear nasal discharge
- itchy nose
- congestion
17
Q
Koplik’s Spots
describe. indicative of what?
A
- clusters of sm. red papules with wht. centers inside the buccal mucosa (inside the cheeks) near the lower molars.
- Measels (!)
18
Q
Hairy Leukoplakia
describe, cause, indicative of?
A
- version of leukoplakia
- elongated papilla on lateral aspects of the tongue
- difficult to remove
- EBV infxn
- Consider HIV infxn
19
Q
Cheilosis
(Angular Cheilitis, Perleche)
describe, causes, etiology, tx
A
- painful skin fissures at CORNER of mouth
- Causes: excessive moisture, Candida albicans, Staph. aureus
- mult. etiologies: dentures, pacifier use, oversalvation, lupius, autoimmune…
- tx: remove underlying cause
- if yeast infx topical azole
- is staph, culture/spec. mupiricin BID
- Prevent with petroleum jelly or zinc barrier cream
20
Q
Visual Test Results:
What does it mean when someone has 20/60 vision?
A
They have to be 20 ft away from an object in order to see it, compared to a person with 20/20 (perfect vision) who can see the same item from 60 ft away.
- (always use 20 as the first number)
21
Q
What are the cones in the eye responsible for?
A
- Color (COnes=COlor)
- 20/20 vision
- sharp vision
22
Q
What are rods in the eye responsible for?
A
- Detecting light and shadow
- night vision
23
Q
What are some characteristics of the fundus of the eye?
A
- Veins are larger than arteries
- Veins appear darker in color than arteries
24
Q
What are the macula and fovea resposible for?
A
Macula
- responsible for central vision
Fovea
- set in the middle of the macula
- responsiblew for sharp, 20/20 vision
- contains a large # of cones
25
What is a typanogram used for?
* _Most_ objective measure to test for fluid in the middle ear
* Acute otitis media and serious otitis media will show a straight line upon testing (as opposed to a peaked shape)
26
Bluish, pale and/or boggy turbinates are often indicative of what?
Allergic rhinitis
27
Optic disc with blurred edges is called __________ and may be due to?
* Papilledema
* ICP (Intracranial pressure)
* secondary to bleeding, brain tumor, abscess, pseudomotor cerebi
28
Hypertensive retinopathy hallmarks
* copper and silver wire arterioles
* artereovenous nicking
* retinal hemorrhages
29
Diabetic retinopathy hallmarks
* microaneuryms
* neovscularization
* cotton wool spots
30
What causes arteriovenous nicking?
when an arteriole crosses a retinal vein, it indents the vein.
31
Cataracts are an ________ of the lens of the eye. They affect up to \_\_\_\_% of older adults, but children can get them. The red light reflex test shows reflects _______ when cataracts are present. Symptoms include: \_\_\_\_\_\_\_\_\_\_\_.
* opacity
* 20%
* grey
* difficulty with glare, halos around lights, blurred vision
32
At what age should visual acuity be 20/20?
age 6
refer to opthalmology if it isn't at least 20/30
33
A Rinne test measures ________ hearing loss. A normal finding is: \_\_\_\_\_\_\_\_. How is it performed?
What might cause an abnormal result?
* conductive
* Air conduction lasts longer than bone conduction (AC\>BC)
* Palce a tuning fork 1st on mastoid process, then at the front of the ear. Time each area.
* Otitis media, serous otitis media, cerumenosis, perforation of tm
34
A Weber test measures ________ hearing loss. A normal finding is: \_\_\_\_\_\_\_\_. How is it performed?
What is considered an abnormal result and what might cause it?
* sensorineural and conductive
* no lateralization (sound heard equally in both ears)
* Tuning fork is placed midline on forehead
* Lateralization
* for sensorneural loss, lateralization to "good" ear
* damage to CVIII (acoustic nerve), aging, presbycusis, Ménère's dz, otoxic drugs and stroke
* for conduction loss, lat. to "bad" ear
* Otitis media, serous otitis media, cerumenosis, perforation of tm (basically obstruction of sound waves)
35
Corneal abrasion
s/s, testing
* acute onset of severe eye pain with tearing
* reports feeling of a FOREIGN BODY
* use fluorescein dye with Wood's lamp
* abrasions appear round or linear
36
Hordeolum (stye)
s/s, cause, tx
* acute onset of swollen, red, warm abscess on upper or lower eyelid
* Cause:
* external-abscess of hair follicle and sebaceous glad
* internal-inflammation of the meibomian gland
* treatment:
* hot compresses x5-10 mins, BID-TID until it drains
* if infnx spreads to cellulitis-systemic abx
* dicloxacillian or erythromycin PO QID
37
Chalazion
s/s, cause, tx
* gradual onset of small, superficial nodule opn upper eyelid that feels like a bead. Discrete and movable. Painless.
* _chronic_ inflammation of the meibomian gland.
* treatment=I&D, steroid injection
* refer to opthalmo
38
Pinguecula
description, cause and treatment
* raised yellow to white small, round growth in the bulbar conjunctiva (membrane covering eyeball)
* located on nasal and temporal side of the eye
* Cause: Chronic sun exposure
* Treatment:
* if inflammed, refer to optho
* artificial tears PRN for irritiation
* recommend sunglasses (100% for UVA and UVB)
* remove surgically if encroaching cornea and affect vision.
39
Pterygium (Surfer's eye)
description, cause and treatment
* yellow, trianglur thickening of the conjunctiva that extends across the cornea on the nasal side.
* may be red or inflammed
* Cause: Chronic sun exposure
* Treatment:
* if inflammed, refer to optho
* artificial tears PRN for irritiation
* recommend sunglasses (100% for UVA and UVB)
* remove surgically if encroaching cornea and affect vision.
40
Subconjuctival hemorrhage
description, cause and treatment
* sudden on-set of bright red blood in one eye, denies pain, loss of vision.
* blood that is trapped under the conjuctiva and sclera 2o to broken arterioles.
* d/t seere coughing, sneezing or straining, or trauma such as a fall.
* Watchful waiting and reassurance.
41
Open-Angle Glaucoma
description, cause and treatment
* gradual increase of IOP greater than 22 mmHg.
* Cause:
* blockage of the drainage of the aqueous humor in the eye.
* Treatment:
* check IOP with tonometer. Nornal range is 8-21mmHg
* \>30mmHg is very high
* Refer to ED or opthalmo
* meds: Betimol (beta blocker)
* Latanoprost
42
Angle-Closure Glaucoma
description, cause and treatment
* Acute onset of decreased/blurred vision, severe eye pain, and frontal HA with n/v
* Eyes are mid-dilated with cloudy pupil, pupil reacts slowly to light
* SUDDDEN blockage of aqueous humor
* Treatment: Refer to ED
43
Age-Related Macular Degeneration (AMD)
description, cause and treatment
* sudden or gradual loss of CENTRAL vision in one or both eyes
* straight lines (like doors, windows) appear curved or distorted.
* Peripheral vision is usually fine
* Refer to opthalmo
44
Allergic Rhinitis
treatment
* 1st line: topical nasal sprays
* OTC steroid sprays (flonase, nasacort allergy) BID
* antihistamine nasal spray (Astelin) daily-BID
* decongestants PRN
* oral antihistamines (cetirizine (Zyrtec), loratadine (Claritin) PO, daily or PRN). Benadryl-careful of sedation
* environemental control-HEPA filter, no stuffed animals in bed, etc.
45
Epistaxis (nosebleed)
Anterior vs. posterior
* Anterior:
* milder, more common
* self-limiting
* result of bleeding from _Kiesselbach's plexus_
* treat with pressure and econgestant (Afrin) to shrink tissue.
* Posterior:
* may lead to hemorrhage
* refer to ED
* higher risk caused by blood thinners, cocaine use, severe HTN
46
Hallmarks of Scarlet fever (Scarletina)
* _Sand-paper textured pink rash_.
* strawberry tongue (red, sore)
47
Complications of strep throat
* scarletina
* Acute rheumatic fever
* Peritonsillar abscess
* Poststreptoccal glomerulonephritis
48
Acute otitis media (AOM; Purlulent or suppurative otitis media)
S/S, cause, treatment
* ear pain (otolagia), popping noises, muffled noises
* Recent hx of URI or allergic rhinitis flare up
* usually uni-lateral
* most have MEE (middle ear effusion)
* **MEEs may last up to 8 weeks post tx!**
* afebrile or low-grade fever
* conductive hearing loss
* Weber=lateralization to "bad" ear
* Rinne=BC\>AC
* TM=bulging, may look opaque, displaced light reflex, etythmatous, decreased mobility
Cause:
* bacteria that is trapped in the middle ear
* ususally S. pneumoniae in adults
Treatments: (usually respond in 48-72 hours)
* 1st line=amox. 500mg, TID, x5-7 days. Severe=10 days
* 2nd line=Augmentin TID, Cefdinir or levofloxacin
49
Bullous Myringitis
what is it? treatment
* type of AOM
* more painful d/t to presence of blisters on tm
* Caused by mycoplasma, virus, bacteria
* Treat the same as AOM
50
Sinus Infection (Acute Bacterial Rhinosinusitis (ABRS)
s/s, cause, tx
* **Unilateral** facial pain, upper molar pain, with nasal congestion for **\>10 days**.
* Post. pharynx shows purulent piost nasal drip
* Sinuses are tender to palpation over maxillary or frontal
* fever more common in children
* transillumination=glow is duller or absent on affected side
* Fluid trapped in the sinus causing 2o bacterial infxn (S. pneumoniae, H. influenzae
* Treatment: (abx if severe symptoms i.e., toxic, high fever, pain, \>10 days. If \< 10 days, treat symptoms.)
* first line=Augmentin (1000/62.5mg or 2000/125mg), BID, x5-7 days
* PCN allergy=Levofloxacin or doxycyclin
51
Otitis Externa
| (Swimmer's Ear)
Common bact. pathogen=P. aeruginosa
* complaints of external ear pain, swelling, discharge, hearing loss, hx or recent activities, swimming, ears getting wet.
* Pain elicited upon manipulaitonof tragus or external ear.
* Purulent discharge, erythematous, and swollen ear canal.
* Tx= cortisporin otic drops QID, x4 days. Ofloxacin or ciprofloxacin drops BID, x7 days.
52
Infectious Mononucleosis
(EVB infection)
s/s, cause, tx
peak ages= 15-24 years old
may be re-activated and cause symptoms again
**_Classic Triad: fever, pharyngitis, lymphadenopathy_**
* in addition to above, extreme fatigue, may have abd. pain d/t to hetpatomegaly or splenomegaly.
* CBC, increased lymphocytes \>50%, LFTs abn for 80% for several weeks
* large post. cervical nodes, tender to palpation
* erythematous pharynx
* inflammed tonsils, sometimes with exudate
* may have maculopapular rash
* Treatment:
* limit physical activoty (contact sports esp.) for 4 weeks (splenic rupture risk)
* US if spelomegaly is present or athlete, and again 4-6 weeks later to document resolution
* treat symptoms
* education:avoid kissing, sharing utensils, toothbrushes (gross) and drinks/glassware.
* AVOID using amoxicillin (drug rash may occur)
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