Diagnosis and Management of EENT and Upper Respiratory Disorders Flashcards
Fundoscopic Exam:
a) Uses the ____ hand for ophthalmoscope, uses the ___ eye for the patient’s right eye
b) Start with wheel at 0
c) Starts about ___” from the patient with both eyes open
d) Moves into within __ to ___” from patient’s eye
e) Should function as one with an ophthalmoscope
2. After obtaining a red reflex, the exam should proceed from the optic disc and end with fovea or each eye
a) right
c) 12
d) 1 to 2”
Inspection of the Optic Disc:
1) Shape: Doughnut- like with an ____/____ neuroretinal rim and a central white depression (physiologic cup)
1) orange/ pink
Inspection of the Optic Disc:
2) Cup/ disk ratio: Cup should not be more than ___ the size of the disc diameter (if larger, consider glaucoma)
1/2
Retinal vessels:
1) Arteries are bright red and narrow than veins; A: V ratio = ____ or ____
2: 3 or 4: 5
Macula:
1) Centered ruffly ___ to ___ disc diameter temporal to the optic disc and is avascular
2) The fovea centralis is a ____ mm- diameter reflective area that looks slightly darker and lies in the center of the macular region
3) The patient should look directly into the light of the ophthalmoscope if the macula is difficult to visualize
4) Macular degeneration (deterioration of a central portion of vision; the leading cause of vision loss)
1) 2 to 2.5
2) 2.5 mm
20/20 means that “ the patient can see at 20 feet what the normal person can see at 20 feet” ( the larger the denominator, the poorer the patient’s vision)
Snellen’s eye chart
” Farsightedness”
Hyperopia
” Nearsightedness”
Myopia
Common after age 40; results in greater difficulty maintaining a clear focus at a near distance due to a lessening of the flexibility of the crystalline lens and weakening of the ciliary muscle with the control lens focusing
Presbyopia
Cloudy appearance of the cornea with a gray/ white arc or circle around the limbus due to deposition of lipid material; the arcus has no effect on vision
Arcus senilis
Raised, wedge-shaped growth of thin, noncancerous tissue over the conjunctiva
Pterygium
The acute inflammatory, a most commonly infectious, process affecting the eyelid; usually caused by Staphylococcus aureus
Hordeolum (Stye)
Signs and symptoms of _____ (___):
1) Abrupt onset accompanied by pain or erythema of the eyelid
2) Localized, tender mass developing in the eyelid
Hordeolum (Stye)
Management of Hordeolum (Stye):
- Warm _______
- Topical _____ or erythromycin ophthalmic ointment
- Refer to an ophthalmologist if not resolved in less or equal to 2 days
- compresses
2. bacitracin
Beady nodule on the eyelid; infection or retention cyst of a meibomian gland; usually on the upper eyelid
Chalazion
______ are usually painless apart from the tenderness caused by localized swelling
Chalazion
Signs/ symptoms:
1) swelling on the eyelid
2) Eyelid tenderness
3) Sensitivity to light
4) Increased tearing
5) If very large: May cause astigmatism due to pressure on the cornea
Chalazion
Management of Chalazion:
1) _____ compresses
2) Referral for ____ ____
1) Warm
2) surgical removal
Staphylococcus infection or seborrheic dermatitis of the lid edge
Blepharitis
Sign and Symptoms:
1) Red, scaly, greasy flakes
2) Thickened, crusted lid margins
3) Burning
4) Itching
5) Tearing
Blepharitis
Management of Blepharitis:
1) Hot _______
2) Topical antibiotics: _____ or erythromycin
3) Vigorously scrub lashes and lid margins with eyes closed and follow with a thorough rinsing
1) compresses
2) Bacitracin
The most common eye disorder; inflammation/ infection of the conjunctiva (“pink-eye”) resulting from allergies, chemical irritation, bacterial, viral or gonococcal/ chlamydial infections
Conjunctivitis
Sign and symptoms of conjunctivitis:
1) _____
2) Burning
3) Redness
4) Increased tearing
5) ____ ____
6) Swelling of eyelids
7) The sensation of a foreign body in eth eye
8) Eyelids may show a crust of sticky, mucopurulent discharge
1) Itching
5) blurred vision (possible)
_______ Conjunctivitis discharge is purulent
Bacterial
Treatment for Bacterial conjunctivitis is:
1) Self-limited
2) Antibiotics drops:
a) _______
b) Ofloxacin
c) Ciprofloxacin
d) ________
e) Gentamycin ophthalmic solution
2) a) Levofloxacin
d) Tobramycin
______ or ______ conjunctivitis is copious pururlent secretion
Gonococcal or Chlamydial
Treatment for Gonococcal conjunctivitis is?
Ceftriaxone 250 mg IM
Treatment for Chlamydial conjunctivitis is?
1) Erythromycin ophthalmic ointment
2) Oral: tetracycline, erythromycin, clarithromycin, azithromycin, doxycycline
_______ conjunctivitis is stringy; increased tearing
Allergic
Treatment for allergic conjunctivitis is?
Oral antihistamines
_______ conjunctivitis is watery?
Viral conjunctivitis
Treatment for viral conjunctivitis is?
Symptomatic care
Pathologic for this is:
1) Increased intraocular pressure
Glaucoma
Open-angle glaucoma is associated with ______?
Chronic
Closed-angle glaucoma is associated with _______?
Acute
____ angle = chronic
1) Asymptomatic
2) Elevated IOP
3) Cupping of the disc
4) Constriction of visual fields
Open-angle
_____ angle = acute
1) Extreme pain
2) Blurred vision
3) Halos around lights
4) pupil dilated or fixed
Closed-angle
Laboratory/ diagnostics: _______ screening nationally recommended by age 40
Tonometry
Management of open-angle = chronic glaucoma
1) Alpha 2 adrenergic agonist (______, Alphagan)
2) Beta-adrenergic blockers (Timolol)
3) Miotic agents (______)
1) Brimonidine
3) Pilocarpine
Closed-angle = acute:
1) Carbonic anhydrase inhibitor: [__________ (Diamox)]
2) Osmotic diuretics (Mannitol)
3) surgery
Acetazolamide
Pathological for ___________:
1) Clouding and pacification of the normally clear lens of the yey
2) The highest cause of treatable blindness
3) Most common surgical procedure in patients age 65+ = senile cataracts
Cataracts
Signs and symptoms of Cataracts:
1) _____
2) Heredity
3) Trauma
4) Toxins, drugs, tobacco, and alcohol theories
5) _______
6) Diabetes
7) AV sunlight exposure
8) Others
1) Aging
5) Congenital
Signs and symptoms of cataracts:
1) _______
2) Clouded, blurred or dim vision
3) Halos around lights
4) Difficulty with vision at night
5) Sensitivity to light and glare
6) Fading/ yellowing of colors
7) _____ (double vision) in a single eye
8) The need for brighter light for reading and other activities
9) No ____ _____
10) The opacity of the lens
1) Painless
7) Diplopia
9) red reflex
Management of cataracts include:
1) Change _____ as the cataract develops
2) Refer to ophthalmologist
3) Surgery
1) glasses
A separation of the light-sensitive membrane in the back of the eye ( the retina) from its supporting layers
Retinal Detachment
Signs and symptoms of ____ ___:
1) Flashes of light (photopsia), especially in peripheral vision
2) Floaters in the eye
3) Blurred vision
4) Shadow or blindness in a part of the visual field of one eye
Retinal detachment
Management of retinal detachment include?
Referral for surgery
Inflammation and/or infection of the external auditory canal (and/ or auricle and tympanic membrane)
Otitis externa
Acute localized otitis externa
Furunculosis
Acute diffuse bacterial ___ ____: Most common in swimmers and in hot, humid climates of otitis externa
swimmer’s ear
Signs and symptoms of acute localized (furunculosis):
1) Cause: \_\_\_\_\_\_ \_\_\_\_\_\_
a) Pustules and furuncles in the outer third
of the ear, canal
b) Severe pain (otalgia) with the area of
cellulitis
c) Itching
d) \_\_\_\_\_\_
e) Scaling
f) \_\_\_\_\_\_
g) Fissuring
h) Possible exudates1) Staphylococcus aureus
d) Erythema
f) Crusting
Management of Otitis Externa is:
a) Cleansing and debridement of the ear
b) Topical otic drops: ______ otic, others
c) Pain control: NSAIDs, topical corticosteroids
b) Cortisporin
Presence of fluid in the middle ear accompanied by signs/ symptoms of infection?
Acute Otitis Media and Serous Otitis Media
Are chronic otitis media often resulting in effusion AK?
Serous Otitis Media
The most common cause of ___ (often viral) leading to Acute Otitis Media and Serous Otitis Media?
URI
The most common bacterial pathogens for acute otitis media and serous otitis media include?
a) ____ ______ (40 to 50% of cases)
a) Streptococcus pneumonia
The most common bacterial pathogens for acute otitis media and serous otitis media include?
b) ____ _____(20 to 30% of cases)
b) Haemophilus influenza
The most common bacterial pathogens for acute otitis media and serous otitis media include?
c) _____ _____ ( 10 to 15% of cases)
Moraxella catarrhalis
Signs and symptoms of acute or serous otitis media?
a) _____ (slight to severe), spreading to the temporal region
b) Otorrhea
c) Vertigo
d) Nystagmus
e) ______
f) Fever
g) Lethargy
h) Nausea and vomiting
i) Anorexia
a) Otalgia
e) Tinnitus
Local _______: erythema with diminished light reflex; fluid in middle ear
inflammation
______ phase: Middle ear serous exudate
Exudative
_______ phase (serous): Purulent exudates; retraction and poor motility of the tympanic membrane; membrane becomes bulging and convex; membrane may rupture
Suppurative
______ alone of the tympanic membrane is not a diagnostic criterion- it may occur with any inflammation of the upper respiratory tract, crying or nose blowing
Erythema
Management of acute otitis media or serous otitis media include:
1) most uncomplicated cases resolve spontaneously or with hydration, avoidance of irritants, use of topical or decongestants and cool mist humidifiers
2) Antibiotic therapy only for suspected bacterial cases: ______
2) Amoxicillin
Type of chronic otitis media consisting of peeling layers of the scaly or keratinized epithelium; if untreated, may erode the middle ear leading to nerve damage and deafness
Cholesteatoma
Signs and symptoms of cholesteatoma:
1) Squamous epithelium lined sac, filled with desquamated ____
2) Chronic infection
3) Painless otorrhea, either unremitting or frequently recurrent
4) ___ ____ (ossicular damage)
5) Canal filled with mucopus and granulation tissue
6) Tympanic membrane perforation (90% of cases)
1) keratin
4) Hearing loss
Management of cholesteatoma include:
1) Referral for _____
sugery
Sensation of motion either of the person or the environment
Vertigo
____ ____ ____ ___(BPPV) is the most common form of vertigo, characterized by the sensation of motion initiated by sudden head movements
Benign paroxysmal positional vertigo
Common Causes of Vertigo include:
a) _____ ____
b) Medications
c) Otitis media or labyrinthitis
d) Meniere’s disease
e) Acoustic neuroma
f) Head trauma or neck injury
g) _________
h) Cerebellar hemorrhage
a) Brain Tumors
g) Migraines
Signs and symptoms of Vertigo:
a) The sensation of disorientation or motion
b) Positive ____ _____ (Nylen- Barany maneuver)
c) Nausea and vomiting
d) Sweating
e) Abnormal eye movement (nystagmus)
f) Hearing loss
g) _____
h) Visual disturbances
i) Weakness; difficulty walking
j) Difficulty speaking
k) Decreased level of consciousness
b) Dix- Hallpike
g) Tinnitus
Laboratory/ diagnostics for vertigo:
a) ____ ____
b) VDRL/ RPR
c) Serum medication levels
d) Hearing examination
e) Blood glucose and ____ may be helpful
a) CT scan
e) ECG
Management of vertigo:
a) _______ ( Valium)
b) Meclizine hydrochloride (Antivert)
c) Diphenhydramine (Benadryl)
d) Scopolamine transdermal patch
e) _______
a) Diazepam
e) Antiemetics
Loss of the ability to detect pure tones in decibels >20 dB
Hearing loss
Conductive causes of hearing loss:
a) Foreign body in the ear canal/ cerumen build-up (most common causes of hearing loss; most treatable)
b) _______
c) Perforated tympanic membrane
d) _____ ______
e) Otitis externa
f) Otosclerosis
b) Hematoma
d) Otitis media
Sensorineural Causes:
a) Dame to hair cells and/ or nerves that sense sound waves
b) Acoustic trauma
c) Barotrauma (usually in drivers)
d) Head trauma
e) Ototoxic Drugs: Aminoglycosides, diuretics, salicylates, NSAIDs, antineoplastics
f) Meniere’s disease
g) Acoustic ______
h) Infections: Mumps, measles, herpes zoster, syphilis, meningitis, etc.
i) Others
b) trauma
g) neuroma
Normal findings for hearing loss:
a) ______ test: SOund lateralizes to the affected ear
a) Weber test
Normal findings for hearing loss:
b) _____ test: Abnormal in the affected ear (i.e. AC < BC)
b) Rinne test
Conductive Hearing Loss:
1) ____test: Sound lateralizes to the affected ear
Weber test
Conductive Hearing Loss:
2) _____test: Abnormal in the affected ear (i.e. AC < BC)
Rinne test
Sensorineural Hearing Loss:
1) ____ test: Sound lateralizes to the unaffected ear
Weber
Sensorineural Hearing Loss:
2) _____ test: Normal in the affected ear
Rinne
Sings and symptoms: Hearing Loss
a) ____ and _____ of hearing loss clues the practitioner as to the underlying cause
Speed and severity
Laboratory/ Diagnostics: Hearing Loss
a) _______ exam: Inspect canal and tympanic membrane
b) General neurological exam
c) Audiometry testing
d) CT scan, if the neurological condition is suspected
e) Serum blood tests as needed
a) Otoscopic exam
Management: Hearing Loss
a) Conductive hearing loss
1) _____ canal
2) Treat underlying cause
b) Sensorineural hearing loss: Refer
1) Clear
Viral rhinitis; self-limiting (5 to 10 days); caused by any 1 of more than 200 viruses (rhinovirus, coronavirus, respiratory syncytial virus, adenovirus, etc.)
Common Cold
Signs/ symptoms: Common cold
a) Watery rhinorrhea
b) Erythematous nasal mucosa
c) _______
d) Nasal and sinus blockage
e) Headache
f) ____ _____
g) Cough
h) Malaise
c) sneezing
f) Sore throat
Management: Common cold
a) Supportive care
b) ________, stream/ humidifier
c) Fever and pain: Tylenol, Motrin, Advil
d) Warm _____ water gargles
b) hydration
d) salt
Inflammation of the pharynx or tonsils
Pharyngitis/ Tonsillitis
Causes: Pharyngitis/ Tonsillitis
1) Viruses (respiratory syncytial virus, influenza A and B, ____ _____, etc.)
2) Bacteria
1) Epstein- Barr
Signs/ symptoms: Pharyngitis/ Tonsillitis
a) ________ pharynx
b) Rhinorrhea (viral)
c) Cough
d) Anterior cervical adenopathy
e) ____ (bacterial)
f) Painful throat
g) _______ rash
a) Erythematous pharynx
e) Fever
g) Maculopapular rash
Centor criteria: Pharyngitis/ Tonsillitis
Clinical features most suggestive of group A B-hemolytic strep pharyngitis include (FLEA)
1) _____
2) Lack of cough
3) Pharygotonisllar Exudate
4) ______cervical adenopathy
1) Fever
4) Anterior
Laboratory/ diagnostics: Pharyngitis/ Tonsillitis
1) ___ ___ _____ ______ test
2) Monospot
3) CBC with differential
1) A rapid streptococcal antigen test
Management of: Pharyngitis/ Tonsillitis
1) Fluids/ hydration
2) ____ water gargles
3) Aspirin/ Tylenol
4) Antibiotics for streptococcal infection (____, ______)
5) ______ for gonococcal infection
6) Refer
2) Salt
4) Penicillin V, Erythromycin
5) Ceftriaxone
Acute, febrile illness caused by infection with influenza type A and B virus
Influenza (“flu”)
Signs/ Symptoms: Influenza
1) Abrupt onset of:
a) ______
b) Headache
c) _____
d) Coryza
e) Anorexia
f) ________
g) Cough
a) Fever
c) Myalgias
f) Malaise
Laboratory/ Diagnostics: Influenza
1) Virus isolation from ___ or ____ swab or sputum specimens (most rapid diagnostics)
1) nasal or throat
Management: Influenza
1) Supportive care:
a) Antipyretics
b) Antibiotics only if a bacterial infection is
proven/ suspected
2) Neuraminidase inhibitors (shorten the duration of symptoms by \_\_\_\_ days; effective for both influenza A and B):
a) \_\_\_\_\_\_\_ (Relenza): Inhaler
b) \_\_\_\_\_\_\_\_ (Tamiflu): Oral2) two
a) Zanamivir
b) Oseltamivir
Symptomatic infection caused by Epstein-Barr virus; common in people ___ to ___ years of age: Mononucleosis
1) Incubation period: ___ to ___months; usually self -limited, but malaise and fatigue may last months
15 to 24
1) 1 to 2 months
Signs/ Symptoms: Mononucleosis
1) _____
2) Chills
3) Malaise/fatigue
4) Anorexia
5) Pharyngitis (most ____ symptom)
6) White Tonsillar exudates
7) Adenopathy/ lymphadenopathy (______ vertical region)
8) Splenomegaly (usually during the 2nd week of illness)
1) Fever
5) severe
7) posterior
Laboratory/ diagnostics: Mononucleosis
a) _____ positive
b) Increased WBC with relative lymphocytosis and neutropenia
a) Monospot
Management of Mononucleosis:
a) Supportive care
b) _______/ steroid taper for severely enlarged tonsils
c) Contacts sports should be avoided (____ weeks to months), as splenic rupture may occur, even without clinically detectable splenomegaly
b) Prednisone
c) 3 weeks
Inflammation of the mucous membranes lining one or more of the paranasal sinuses; almost always accompanied by inflammation of the nasal mucosa
Sinusitis (Rhinosinusitis)
Causes of Sinusitis (Rhinosinusitis):
1) Streptococcus pneumoniae
2) _______ ________
3) Various anaerobes
2) Haemophilus influenzae
Signs and symptoms of Sinusitis (Rhinosinusitis):
1) Often a history of recent respiratory illness with some improvement, then relapse
2) Red nasal _____
3) Pain/ pressure over face, nose, cheeks, teeth (molars)
4) Purulent ____ drainage (bacterial)
5) Fever (bacterial)
6) Tenderness over sinuses
7) ________ in supine or bending position (“dull/ throbbing”)
8) Foul-smelling nasal or postnasal drainage
2) mucosa
4) nasal
7) Headache
Laboratory/ drainage of Sinusitis:
1) _______ as needed
2) Radiographs/ ____
3) Decreased transillumination
1) Culture
2) CT
Management of Sinusitis:
1) Hydration
2) Oral _________/ antihistamines
3) Analgesics
4) Antibiotics ONLY for bacterial cases: ____/____ (Augmentin), clarithromycin (Biaxin), etc. Consider second-line agents if not an improvement after 72 houses.
5) Supportive care
2) decongestants
4) Amoxicillin/ clavulanate
Signs/ symptoms:
a) Bleeding usually comes from only 1 nostril
b) Blood can also drip down back of the throat and into the stomach causing nausea
c) Signs of excessive blood loss:
1) Dizziness
2) ________
3) Confusion
4) ________
c) 2) Weakness
4) Fainting
Incidence/ Cause: Nose bleeds
a) The ______ septum is the most frequent site of nose bleeds
b) Easy to control, either by the nurse practitioner or measures taken at home
c) ______ septum nose bleed is more complicated, normally originating from an artery in the back of the nose (more profuse bleeding may be noted; refractory to basic management)
a) anterior
c) Posterior
Management of nose bleeding
1) Sit upright
2) The constant ______ to the nose
c) Apply ice
2) pressure
