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FNP Boards > Ears/Nose > Flashcards

Ears/Nose Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

Cholesteatoma presentation

A 
Unilateral hearing loss
Purulent, foul discharge
Perforated TM
Cauliflower-like/ pearly-white mass
H/o recurrent OM
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2
Q

Cholesteatoma treatment

A

Antibiotics

Refer to ENT for surgical excision

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3
Q

Conductive hearing loss PE

A

Lateralization to “bad” ear

BC > AC

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4
Q

Sensorineural hearing loss PE

A

Lateralization to “good” ear

AC > BC

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5
Q

Auricular Hematoma Presentation

A

Blunt trauma to ear
Bleeding in cartilage
If not drained can result in cauliflower ear

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6
Q

Acoustic Neuroma CN VIII (Vestibular Schwannoma) presentation

A 
Asians
50-60s
Lasting 3-4 years
Unilateral sensorineural hearing loss 
Tinnitus
Unsteady gait
Possible facial nerve involvement CNVII
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7
Q

Acoustic Neuroma treatment

A

Refer to neurologist

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8
Q

Battle sign presentation

A 
Adult that fell/assaulted/MVA
Parietal bone linear fracture
Blue/purple color of TM
Otorrhea/rhinorrhea
After 1-3 days:
- Raccoon eyes
- Mastoid bruising
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9
Q

Battle sign treatment

A

Refer to ED

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10
Q

Tympanogram Normal vs Abnormal Result

A 
Normal = peaked line
Abnormal = straight line (as seen in OM)
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11
Q

AOM Presentation

A 
Child
Ear pain
Popping noises
Muffled hearing
Recent cold/allergic rhinitis
Low-grade fever
TM may be ruptured (blood/pus discharge)
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12
Q

Bullous Mygrinitis presentation

A 
Type of AOM
more painful
Blisters on TM
Red bulging or retracting TM
Conductive hearing loss
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13
Q

AOM abx treatment

A 
If no abx in last 30 days
1. Amoxicillin 500 mg tid x 5-10 days
If no response in 48-72 hours
2. Amox-clav, cefdinir, cefprozil bid OR 
levofloxacin, moxifloxacin qd x 5 days
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14
Q

How long can MEEs last after AOM is treated?

A

8 weeks

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15
Q

Acute Bacterial Rhino-sinusitis presentation

A 
Recent cold/allergic rhinitis
Facial pain
Nasal congestion >10 days
Purulent nasal drip
Hyposmia 
Postnasal drip cough
No relief from OTC decongestants
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16
Q

Acute Bacterial Rhino-sinusitis PE

A 
Dark yellow/green nasal discharge
Maxillary and frontal sinuses TTP
Boggy nasal turbinates
Transillumination dull on affected side
Possible fever
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17
Q

Acute Bacterial Rhino-sinusitis and AOM symptomatic treatment

A 
Pain relief
Hydration
Pseudoephedrine/Guaifenesin
Afrin (3 days max)
Saline nasal spray q 2-3 hrs
18
Q

Acute Bacterial Rhino-sinusitis abx treatment

A
  1. Amox-clav 1-2k mg bid x 5-7 days
  2. Cefdinir, cefpodoxime, cefuroxime
  3. Levofloxacin, doxycycline
19
Q

When to initiate antibiotics for Acute Bacterial Rhino-sinusitis?

A
  • high fever
  • nasal discharge >3 days
  • sxs > 10 days
  • maxillary toothache
  • unilateral facial pain
  • bad odor in nose
  • rebound sxs
  • ## immunocompromised
20
Q

Recurrent Acute Bacterial Rhino-sinusitis treatment

A

Refer to ENT

21
Q

Meningitis presentation

A 
Acute onset
High fever
Stuff neck
Severe headache
Photophobia 
\+ brudzinski or kernig signs
22
Q

Cavernous sinus thrombosis presentation

A 
Acute onset
Severe headache
Reduced sleep
Confusion
Fever
Abnormal neuro exam
23
Q

EOM/SOM PE

A

TM not red

fluid bubbles seen behind TM

24
Q

EOM/SOM treatment

A

Oral decongestants
Steroid nasal spray
Saline nasal spray
+ Zyrtec if c/b allergic rhinitis

25
Q

Otitis Externa (swimmer’s ear) presentation

A 
External and canal ear pain
Swelling
Purulent green discharge
Itching
Conductive hearing loss
Recent swimming
26
Q

Otitis Externa (swimmer’s ear) abx treatment

A

Corticosporin 4 gtt qid x 7 days
Ofloxacin, ciprofloxacin gtt bid x 7 days

Add oral abx if immunocompromised

27
Q

Otitis Externa (swimmer’s ear) recurrent treatment prophylaxis

A 
Otic domeboro (boric)
Alcohol and vinegar (VoSol)
28
Q

Mono presentation

A 
15-24 year olds
Fever
Pharyngitis
Lymphadenopathy (posterior cervical)
\+
Fatigue
Tonsillar exudate
Abdominal pain (HSM)
Recent kissing
29
Q

Mono labs

A

CBC - repeat until normal
LFTs
Monospot antibody
Abdominal US if HSM - repeat in 4 weeks

30
Q

Mono treatment plan

A

No physical activity for 4 weeks
Symptomatic treatment
Avoid sharing saliva
Do not give amoxicillin

31
Q

Ménière’s presentation

A

Recurrent vertigo
Tinnitus
Unilateral hearing loss
N/V

32
Q

Ménière’s treatment

A 
Salt restriction
Avoid nicotine, caffeine, alcohol
Vestibular suppressant PRN
Antiemetic PRN
Refer to ENT if persistent
33
Q

BPPV presentation

A

50-70s
Brief vertigo episodes c/b sudden head movements and position changes
Induced by trauma, aerobics, mtn biking

34
Q

BPPV diagnosis

A

Dix hall pike = gold standard

35
Q

BPPV treatment

A 
Epley
Meclizine (avoid in elderly)
Avoid sleeping on affected side x 1 wk
36
Q

Ceruminosis treatment

A

OTC carbamide peroxide (debrox)

37
Q

Allergic Rhinitis presentation

A 
H/o asthma, eczema
Chronic or seasonal nasal congestion 
Clear mucus rhinorrhea
Postnasal drip w/ cough
Nasal itch
Sneezing
Palatal click
38
Q

Allergic Rhinitis PE

A 
Boggy turbinates
Allergic salute in children
Cobblestoning
Posterior pharynx with mucus
Under eye “circles”
39
Q

Allergic rhinitis treatment

A

eliminate allergen

  1. Nasal steroid - fluticasone, triamcinolone
    • Azelastine
  3. Cromolyn sodium
  4. Decongestants PRN
  5. Second gen antihistamine PRN
40
Q

Rhinitis medicamentosa treatment

A

Stop nasal decongestants

Nasal saline spray

41
Q

Epistaxis causes

A

Trauma (nose picking)
Cocaine use
Anticoags/NSAIDs
Severe HTN

42
Q

Epistaxis treatment

A

Apply direct pressure
Afrin to help shrink tissue
Refer to ENT if recurrent for cauterization

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