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FNP III - Test 1 > Module 2 - HEENT > Flashcards

Module 2 - HEENT Flashcards

1
Q

Occurs naturally in older adults; prevalence increases with age
Associated w/ decreased QOL, functional ability, increase in safety issues (falls, MVA), some cognitive impairment r/t decreased vision
Progressive and irreversible → surgical removal safe and effective

-> Increasing age, DM, smoking, fam hx, long term corticosteroid use, HTN, trauma, UV light exposure without protection

A

Cataracts

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2
Q

Opacity of lens
Patient ℅ glare or halo around lights (esp at night), difficulty night driving, polyopia (multiple images), difficulty reading newspaper

A

Cataracts

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3
Q

PE for cataracts

What to expect?

A 
Visual exam (decreased visual acuity), normal pupillary response, haziness during fundoscopic exam
Evaluate red reflex 1 ft away from patient→ if yellowish/whitish tint present inside pupil, refer
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4
Q

Tx for cataracts

A

Watchful waiting if early
Slow progression by: decreasing sun exposure (sunglasses, hats), smoking cessation
Refer if
-> Main cause of vision loss; functioning and ability to perform ADLs affected; pt understands surgery is needed and is agreeable

Main tx: surgical correction

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5
Q

Leading cause of blindness worldwide
Pressure buildup in eye where too much pressure on optic nerve r/t fluid buildup → causes irreversible damage to optic nerve and permanently changes sight

A

Glaucoma

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6
Q

“silent stealer of sight” (MOST COMMON)

Triad—> tearing, photophobia, excessive blinking (blepharospasm)

A

Open angle glaucoma

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7
Q

Vision damage irreversible; significant progression by time central vision affected

> 50 y/o, fam hx, African Americans, thin central cornea, myopia, DM2, corticosteroid use (long term)

Most do not complain of sx; some may ℅ peripheral vision loss
Triad—> tearing, photophobia, excessive blinking (blepharospasm)

A

Open angle glaucoma

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8
Q

PE for open-angle glaucoma

diagnostics?

A

Fundoscopic exam → optic disk cupping

Tonometer (measures intraocular pressure) → ophthalmology

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9
Q

Tx for open-angle glaucoma?

goals?

A

Topicals (drops to lower eye pressure: beta adrenergic antagonists, cholinergic eye drops) → expensive!
Book: BB- Timolol
Carbonic anhydride- Dorzolamide/ Brinzolamide
Surgery for severe cases

Goal= Decrease IOP & stop damage

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10
Q

education for open-angle glaucoma?

A

All members needs to get IOP checked
Med compliance
No excessive physical/ emotional stress, no straining
F/U is for LIFE- q3-6mo

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11
Q

True angular abnormality
Usually found when pt ℅ unilateral HA, visual blurring/cloudiness, rings around lights, n/v, photophobia
- Females, older age, asian descent
Ophthalmologic emergency → REFER

A

closed angle glaucoma

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12
Q

May see hazy cornea, nonreactive pupils that are semi dilated, scleral injection
tx= surgery
Ophthalmologic emergency → REFER

A

closed-angle glaucoma

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13
Q

Leading cause of blindness in those over 50 y.o in the US

A

Macular degeneration/ ARMD (age-related MD)

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14
Q

Two types of Macular degeneration/ ARMD

A

Dry (better prognosis) and wet

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15
Q

Early, intermediate and advanced sx of Macular degeneration/ ARMD

A

Early (dry): Asx
Intermediate (dry): vision changes, blurred in one or both eyes, difficulty with fine motor(reading, driving)
Advanced (wet/bad prognosis): Acute onset, metamorphosis (wavy—> straight lines)

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16
Q

PE for Macular degeneration/ ARMD

diagnostics?

A

Fundoscopic exam- dilation needed
Visual acuity. Confrontation
External/lids

Dx= Amsler grid (test each eye)

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17
Q

Tx for Macular degeneration/ ARMD diagnostics?

A

There is no cure
STOP smoking
Dry (better prognosis): High dose antioxidant vitamins/ Beta carotene + zinc: reduce risk and slow progression
Wet MD: intravitreal vascular endothelial growth factor (VEGF) injections: slow down progression + improve vision
Laser surgery

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18
Q

Localized bacterial infection of the skin and subq tissues anterior to the orbital septum (outside of bony orbit)
AKA: affects soft tissues in front of orbital septum

Typically seen in children
More common in winter r/t increase in sinus infections
(Hib, staph aureus, MRSA, strep)

A

Periorbital (preseptal) cellulitis

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19
Q

Swelling around eyelid and eye (periorbital), erythema and warmth in area, painful (but not painful to move eye), conjunctivitis may be present or the cause, blurred vision possible BUT pupillary response should be normal

A

Periorbital (preseptal) cellulitis

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20
Q

Tx for Periorbital (preseptal) cellulitis

A

Try to identify source of infection

If mild (no fever, mild erythema, patient stable) outpt with abx
-> Amox-clav (augmentin) OR 3rd gen cephalosporin

If MRSA suspected
Double strength trimeth-sulfa (bactrim), clindamycin, or doxy (no doxy <9 y/o)

Requires CLOSE followup, check back in 24 hours, if no improvement or worsens → refer for IV abx
If questioning preseptal vs orbital → refer for CT

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21
Q

More serious than periorbital; must differentiate btw the two; refer if you can’t!
Infection located posterior to orbital septum
Frequently preceded by a sinus infection (ethmoid sinuses)
Can have serious complications (blindness, death)
Can put pressure on optic nerve if the infection spreads which can lead to brain abscess and sepsis
(roup A beta-hem strep, s aureus, s pneumoniae, Hib, other strep, anaerobic microorganisms)

A

Orbital cellulitis

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22
Q

Pain, vision loss, restricted motility/EOM, eye erythema and edema, exophthalmos (bulging of eye), proptosis and diplopia, fever (usually >102), systemic malaise, pain with mvmt of eye

A

Orbital cellulitis

23
Q 
Group 1: preseptal cellulitis
Group 2: orbital cellulitis
Group 3: subperiosteal abscess
Group 4: intraorbital abscess
Group 5: cavernous sinus thrombosis
A

Chandler Classification for Acute Sinusitis

24
Q

Tx for Orbital cellulitis

A

Refer to ED or ENT (if fast) → EMERGENCY

CT to confirm dx, IV abx, surgical intervention common

25
Q

NP role in Orbital cellulitis

A

Take complete hx, assess visual acuity and ocular ROM, full HEENT exam and inspect nares, check neck flexibility (r/o meningitis), determine preseptal vs orbital (if considering orbital → refer)
Understand complications: meningitis or progression down grade scale

26
Q

Occurs when the sensory portion of the retina is separated from the underlying epithelium

Result of: vitreous fluid moving through a small hole in the retina, inflammation, tumor, trauma, adhesions mechanically pulling on retina

A

Retinal detachment

27
Q

PE for possible retinal detachment

A

Visual acuity, visual field testing, fundoscopic exam
Optometry: slit lamp, dilated exam
Can use US
REFER immediately if RD is suspected → most require surgery

28
Q

NP role for retinal detachment

A

Identify high risk, complete hx of vision and changes, fundoscopic exam (dilated is better), know s/s and know how to refer

29
Q

an intraocular tumor that develops in the retina, more common in childhood (<15y.o)

The majority unilateral, but can be bilateral (hereditary) white pupil (leukocoria) “ cat eye reflex”
Strabismus (most common), decreased visual acuity
Orbital cellulitis, photophobia, hyphema, hypopyon (pus)

A

retinoblastoma

30
Q

Screening for retinoblastoma

A

All infants red light reflex screening before discharge from nursery + every visit

31
Q

High-risk retinoblastoma screening rules?

A 
High risk: Dilated exam
0-3 months: monthly
3–12 months:Q2mo
12-36months: Q3mo
36-60month: Q4-6mo
32
Q

High-risk retinoblastoma screening rules?

A 
High risk: Dilated exam
0-3 months: monthly
3–12 months:Q2mo
12-36months: Q3mo
36-60month: Q4-6mo
33
Q

Symptom, NOT a diagnosis
Varying degrees, may have a benign cause (typically) or may be more serious
Most episodes acute and limited
RF= Viral infection, vocal abuse (yelling, screaming, singing), smoking, inhaling an irritant, recent intubation, allergies, GERD
Serious causes: allergic reactions (anaphylaxis), epiglottitis, trauma, neoplastic lesions

A

Hoarseness/Dysphonia

34
Q

tx for Hoarseness/Dysphonia caused by acute laryngitis

A

(most viral): supportive care, lozenges, cool drinks, vocal rest, steroids occasionally

35
Q

Tx for Hoarseness/Dysphonia caused by GERD?

A

H2 blocker or PPI

36
Q

What to do if Hoarseness/Dysphonia persisits > 2-3 weeks?

A

refer to ENT

37
Q

Benign tumor found in middle ear made of of keratinized epithelial cells that can grow, causing damage to middle ear structures, or even extend into external ear canal
Can be congenital or acquired
Serous OM + hearing loss → 🚩 red flag
Although benign, becomes a prob when grows and causes damage

A

Cholesteatoma

38
Q

Congenital vs. Acquired Cholesteatoma

A

Congenital: whitish or pearl-like mass behind translucent TM
Acquired: found on the TM and can be associated with a defect

39
Q

Dx and Tx for Cholesteatoma

A

TM exam with otoscope; audiograph to assess hearing (ENT), CT to verify

Surgery for removal; early identification associated with better outcomes

40
Q

how does labyrinthitis differ from benign paroxysmal positional vertigo (BPPV)

A

BPPV attacks are shorter, caused by debris, WORSE with lying down

41
Q

: vertigo AND hearing loss in one ear; acute onset lasts days to couple weeks; n/v; fullness or tinnitus in affected ear; URI sx; Sx IMPROVE while pt is laying down with eyes closed

A

labyrinthitis

42
Q

how to manage labyrinthitis

A

Bed rest, antiemetics for nausea, meds to suppress vertigo (meclizine/antivert, dramamine, low dose ativan/diazepam)
If no improvement in 2 weeks or worsens in any way → ENT

43
Q

Chronic ringing in one or both ears, COMMON
is a symptom, NOT a disease → find the cause if possible
>6 mos considered chronic

A

Tinnitus

44
Q

What is important to differentiate in pts with tinnitus?

A

ringing in one or both ears

Ask pt to describe sound (can be high pitched, roaring, pulsating, rushing)

Audiogram → will demonstrate high-frequency hearing loss
test for syphilis and lyme dx if unilateral

45
Q

Meds that can cause tinnitus

A

Loop diuretics, salicylates (ASA), NSAIDS, quinine, abx (aminoglycosides, erythro, vanc, polymyxin B, neomycin), some chemo, topical agents, antiseptics

Typically they damage the cochlea and auditory nerve, vestibular system
If caught early, typically reversible

46
Q

How to dx tinnitus

A 
Hearing tests (Weber/Rinne, audiogram) test for acuity or loss
Labs for suspected etiology
47
Q

How to manage tinnitus

A

Refer unilateral or pulsatile to specialist
Find cause to manage or reduce further damage
Counseling if depressed or severely affected
Stop any ototoxic drugs, decrease caffeine and nicotine, no loud noises, ear protection, white noise for sleeping

48
Q

Triad: vertigo, tinnitus, hearing loss

A

Meniere Disease

dx of exclusion

49
Q

Chronic condition of inner ear (recurrent vertigo and hearing loss)
Excess fluid and pressure in the labrinth of the inner ear that distends the structures and damages the vestibular system (balance) and cochlear hair cells (hearing)

A

Meniere Disease

50
Q

Intermittent attacks of vertigo lasting minutes - hours, n/v, pressure in ear
HEENT- exclude AOM/ infection, Neuro
Weber: sound to unaffected ear; rinne: A>B
Nystagmus during attacks

A

Meniere Disease

51
Q

Dx for Meniere Disease

A

Clinical or response to tx
Criteria: 2 episodes spontaneous vertigo at least 20 mins, audiogram hearing loss, tinnitus/ fullness, and exclusion of other causes
MRI- r/o CNS lesion
Labs: TSH, RPR (syphillis), BS, Lyme serologies

52
Q

Mgmt for Meniere Disease

A 
No cure
Refer to otolaryngologist for testing and mgmt 
Viral: anti-virals
Mgmt vertigo 
Autoimmune: + response to steroid
53
Q

How to manage sx of Meniere Disease

A

Anti-emetics + antihistamines w/ anti-cholingeric effects suppress the vestibular system while improving antiemetics relief
-> Meclizine (least sedating), promethazine, dimenhydrinate

Vertigo
-> Benzos ( GABA agonist effect)- daily not d/t ADDICTION and W/D
Quick onset with duration for vertigo attack (ok if infrequent)

Lower Na intake- decreases build up of pressure

FNP III - Test 1 (6 decks)

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