Disorders

Question 1

Dry eye: Symptoms

Answer 1

Gritty feeling as if something is in the eye, with or without mild redness

Question 2

Dry eye: non pharm treatment

Answer 2

Avoiding environments that are dry, dusty, and cause evaporation of tears, humidifiers, point AC and heaters away from eyes, wear sunglasses in windy environments. Limit time spent looking at screens (or take frequent breaks). Eyelid hygiene. Warm compresses.

Question 3

Dry eye: Pharm treatment

Answer 3

Ocular lubricants are the first line treatment. Eye drops like artificial tears are more commonly recommended.(Patient should also seek the advice of an eye care professional)

Question 4

Dry eye

Answer 4

Common disorder of the eye. Often associated with aging. Common in patients with rheumatoid arthritis, thyroid disease and those taking certain medications (such as anticholinergics). (may also be caused by Sjogren’s Syndrome or female gender androgen deficiency)

Question 5

Conjunctivitis

Answer 5

Inflammation of the conjunctiva. Types: allergic, viral, bacterial. Most cases are self limiting.

Question 6

Allergic conjunctivitis: symptoms

Answer 6

occurs bilaterally. pink/red/clear, ITCHY, watery eyes.

Question 7

Allergic conjunctivitis: non pharm treatment

Answer 7

Most effective non pharm is allergen avoidance. Cold compresses (3-4 daily). Contacts should not be worn.

Question 8

Allergic conjunctivitis: pharm treatment

Answer 8

First line treatment: artificial tears as needed. If symptoms persist: topical antihistamine (AH)/ mast cell stabilizer.
Topical treatments: Ophthalmic Decongestants/Alpha-Adrenergic Agonists, Ophthalmic Antihistamines, Ophthalmic Antihistamine/Mast Cell Stabilizer
Oral treatments: Antihistamines (2nd generation)
Agent selection:

Question 9

Viral conjunctivitis: symptoms

Answer 9

Pink eyes with large amounts of watery discharge. Abrupt onset. No itching usually. Can have crusting of the affected eye. Typically begins in one eye and progresses to the other. Contagious for about a week. Self limiting within 1 to 3 weeks.

Question 10

Viral conjunctivitis: non pharm treatment

Answer 10

Hand washing. Cold compresses. Do not share towels or other objects that come into contact with eye. Avoid using contacts.

Question 11

Viral conjunctivitis: pharm treatment

Answer 11

No effective treatment for viral conjunctivitis. Artificial tears and ocular antihistamines can provide some relief. Referral is warranted if no improvements within 7 to 10 days.

Question 12

Bacterial conjunctivitis: symptoms

Answer 12

Can be unilateral or bilateral, mucopurulent discharge. Matting or crusting of the eyelids that is dark brown/green in color. Self limiting.

Question 13

Bacterial conjunctivitis: non pharm treatment

Answer 13

? Hand washing, cold compresses

Question 14

Bacterial conjunctivitis: pharm treatment

Answer 14

Antibiotics are not necessary, but they do reduce symptom duration from 6-10 day to 2-5 days.

Question 15

Glaucoma

Answer 15

Common eye disorder that causes irreversible blindness if left undiagnosed and untreated. 2nd leading cause of blindness. 6 times more likely in African americans.

Question 16

Glaucoma types:

Answer 16

Open angle: primary and secondary
Closed angle: chronic and acute
Open angle primary: most common
acute- medical emergency
?

Question 17

Glaucoma treatment:

Answer 17

Treatment of Closed angle glaucoma:
1st line- iridectomy (laser or surgery)
Treatment of open angle glaucoma:
1st line- Prostaglandin analogs and beta blockers
Oral medications are last line treatment because of the many side effects

Question 18

Otic disorders

Answer 18

self treatment should be restricted to external disorders.

Question 19

Excessive/impacted cerumen: symptoms

Answer 19

Clinical presentation: fullness or pressure, gradual hearing loss, sometimes a dull pain is present, vertigo and/or tinnitus can also be present, chronic cough, mild pain

Question 20

Excessive/impacted cerumen: non pharm treatment

Answer 20

Remove cerumen when it has migrated to the outermost portion of the EAC by using a wet, wrung-out washcloth draped over a finger. (not effective when cerumen is already impacted, but can prevent impactation)

Question 21

Excessive/impacted cerumen: pharm treatment

Answer 21

Carbamide peroxide 6.5% in anhydrous glycerin for cerumen softening (use twice daily but for no more than 4 consecutive days)

Question 22

Water-clogged ears: symptoms

Answer 22

Clinical presentation of water clogged ears: feeling of wetness or fullness, gradual hearing loss, can cause tissue maceration that can lead to itching, pain, inflammation, or infection

Question 23

Water-clogged ears: non pharm treatment

Answer 23

Gentle manipulation of the auricle while tilting the affected ear downward (helps removed excess water)

Question 24

Water-clogged ears: pharm treatment

Answer 24

Isopropyl alcohol 95% in anhydrous glycerin 5%.

Acetic acid 5% in a 50:50 mixture of isopropyl alcohol 95% (needs to be compounded)

Question 25

Tooth hypersensitivity: symptoms

Answer 25

short, sharp pain in response to a stimulus (thermal, chemical, or physical) that cannot be attributed to any other dental issue. The pain is caused by exposed dentin.

Question 26

Tooth hypersensitivity: Non pharm treatment

Answer 26

Identify and eliminate predisposing factors that may contribute to tooth hypersensitivity. Use a soft bristle toothbrush and brush less vigorously using standard fluoride containing toothpaste.

Question 27

Tooth hypersensitivity: pharm treatment

Answer 27

Toothpastes (dentifrices) containing a potassium salt decreases the nerve excitability….

Question 28

Oral disorders: exclusions for self-care

Answer 28

toothache
mouth soreness associated w/poor fitting dentures
presence of fever or swelling
loose teeth
bleeding gums in absence of trauma
broken or knocked-out teeth
severe tooth pain triggered or worsened by hot, cold or chewing
trauma to the mouth w/ bleeding, swelling, and soreness

Question 29

Teething discomfort: symptoms

Answer 29

Children may experience reddening, irritation, swelling, mild pain, low grade fever (not over 101), slight gum swelling, or excessive drooling while teething….

Question 30

Teething discomfort: non pharm treatment

Answer 30

Non pharmacological measures should be used before pharmacological measures. Pharmacological measures should be reserved as much as possible.
Gum massage, cold (not frozen) teething rings, or a cold wet cloth. Dry toast or teething biscuits (depending on patient’s age)

Question 31

Teething discomfort: pharm treatment

Answer 31

Benzocaine (not for use in children under 2) (do NOT use the 20% in children)
Appropriately dosed systemic analgesics, such as acetaminophen.

Question 32

Recurrent aphthous stomatitis (RAS): symptoms

Answer 32

(aphthous ulcers or canker sores)
precipitated by stress and local trauma.
Sores located on nonkeratinized mucosa, such as tongue, floor of mouth, soft palate, and inside lining of the lips and cheeks. Usually round or oval, flat or crater-like, gray to yellow in color with an erythematous halo of inflamed tissue surrounding the ulcer. Some patients experience a prodrome (prickling or burning sensation) 24-48 hours prior to when the ulcers appear.

Question 33

RAS: non pharm treatment

Answer 33

Increased consumption of nutrients
Ice
Stress reduction to prevent additional ulcers

Question 34

RAS: pharm treatment

Answer 34

Oral debriding and wound cleansing agents

Question 35

Herpes simplex labialis: symptoms

Answer 35

(fever blisters or cold sores) 
Primarily associated with oral lesions. 
Lesions on lips- can be intraoral on keratinized tissue
Preceded by a prodrome
Small, red papules
Erythematous border
Crust will form after lesions burst

Question 36

HSV-1: non pharm treatment

Answer 36

Keep the lesions clean with a gentle wash of warm water and mild soap. Keep hands clean with frequent washing.

Question 37

HSV-1: pharm treatment

Answer 37

Topical protectants: protect from infection, relieve dryness
Topical analgesics/anesthetics: burning, itching, and pain relief; no reduction in duration
Topical antiviral: Docosanol 10% (Abreva); reduces healing time, Apply during prodromal time (1st sign), Apply 5 times daily until healed (max 10 days)
Topical antibiotics: triple antibiotic ointment, 3-4 times daily, use only is secondary infection may be present
Antivirals: prescription needed

Question 38

HSV-1: exclusions for self treatment

Answer 38

Lesions present for longer than 14 days
increased frequency of outbreaks
compromised immunity
symptoms of systemic infection (fever, swollen glands, rash)
no previous diagnosis of a cold sore

Question 39

Dry Mouth

Answer 39

Result of limited or arrested salivary flow
also known as xerostomia
Symptoms: difficulty talking or swallowing
Risk factors: diabetes, depression, antihistamines, diuretics

Question 40

Dry mouth: non pharm treatment

Answer 40

avoid tobacco, avoid alcohol containing products, if medications are the cause of dry mouth-take meds one hour prior to meals, limit sugary or acidic foods, chew gum, increase water intake

Question 41

Dry mouth: pharm treatment

Answer 41

artificial saliva products as needed

Question 42

Dry mouth: exclusions for self care

Answer 42

Tooth erosion, decalcification, decay
candidiasis, gingivitis, periodontics
reduced denture-wearing time
mouth soreness associated with poor fitting dentures
presence of fever or swelling
loose teeth
bleeding gums in the absence of trauma
broken or knocked out teeth
severe tooth pain triggered or worsened by hot, cold, or chewing
trauma to the mouth with bleeding, swelling, and soreness

Question 43

Impacted Cerumen and Water-clogged ears: exclusions for self-care

Answer 43

severe pain
signs of infection
pain associated with ear discharge
bleeding or signs of trauma
presence of ruptured tympanic membrane (abrupt hearing loss and sharp pain)
ear surgery within prior 6 weeks
tympanostomy tube present
incapable of following proper instructions
hypersensitivity to recommended agents
less than 12 years old

Question 44

Ocular disorders: exclusions for self-treatment

Answer 44

Patients should be referred to a physician if they are experiencing:
eye pain
blurred vision that is not due to the use of eye ointments
light sensitivity
ocular trauma
chemical exposure
untreated symptoms that persist over 72 hrs. (except conjunctivitis)
eye exposure to heat (not sun exposure)
signs and symptoms of eyelid infection, except stye (red, thickened eyelids, scaling)

Question 45

Hordeolum vs chalazion

Answer 45

Hordeolum: (stye) eyelid gland infection, tender to touch, palpable tender nodule present, eyelid swelling, lid margin redness
Chalazion: noninfectious granuloma located near, but not on the eyelid, not tender to touch, similar appearance

Question 46

Hordeolum (stye): treatment

Answer 46

warm compresses (which brings blood to surface) should be applied for 5-10 minutes 3-4 times daily. apply gentle pressure by rolling the compress around the stye. External styes may be treated with topical antibiotic ointment.

Question 47

Chalazion: treatment

Answer 47

May be drained by warm compresses, but may not resolve. If the nodule doesn’t drain after 1 week of treatment, patients should seek medical care.