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CPNP EXAM PREP > EENT > Flashcards

EENT Flashcards

1
Q

Mild injection of the conjunctiva present several hours after birth

A

Chemical conjunctivitis
Irritation from the use of opthamalic preparation at birth

APPEARS IN FIRST 24 hours

decrease due to the discontinuation of six silver nitrate.

Last no longer than 3 to 4 days.

No tx

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2
Q

Copious purulent discharge 2 to 5 days after birth from Eyes

A

Gonococcal conjunctivitis due to the transmission of necessariea gonorrhea

Highlighter green

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3
Q

Mild mucopurulent discharge from eyes few days to 2nd weeks after birth typically day 7 to 14

A

Chlamydia conjunctivitis

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4
Q

Gonorrhea diagnostic test conjunctivitis

A

Gram stain of conjunctiva scrapings and Prulent discharge or Gram stain shoes gram negative intercellular diplococci verified by culture either the chocolate agar or thyar Martin medium

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5
Q

Gonococcal conjunctivitis management

A

Ocular emergency can cause blindness hospitalization is necessary

Irrigation with normal Saline

Systematic antibiotics IV or IM

IV Pen G
Or
Ceftriaxone / cefotaxime x7 days
do you not give Rocephin in newborns with hyperbili

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6
Q

Pneumonia is also associated with this can have increased WOB and mild to moderate injection and Chemosis of conjunctiva

A

Chlamydia trachomatis conjunctivitis

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7
Q

Chlamydia conjunctivitis test

A

Giemsa Stain of conjunctival scrapings may reveal intracytoplasmic inclusion bodies

Immunofluorescent in a body staining of conjunctival scrapings highly sensitive and specific

CXR if PNA

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8
Q

Chlamydia tracomatis conjunctivitis management

A

Erythromycin eye ointment x2-3 week

Oral erythromycin can treat the conjunctivitis and may prevent subsequent pneumonia

Oral sulfonamides (trimethoprim , sulfamethoxazole) if intolerant to erythromycin

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9
Q

Bright red and irritated conjunctiva can also have satellite lesions

A

HSV conjunctivitis

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10
Q

HSV diagnostics

A

Fluorescein exam looking for satellite lesions, obtain HSVPCR and culture

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11
Q

First line treatment for her herpes simplex virus conjunctivitis (HSV)

A

Acyclovir
Warm compress to remove excudate
Hand washing
Hospitalized if conjunctivitis or satellite lesions

Immediate referral to ophthalmologist

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12
Q

Pathogens of bacterial conjunctivitis

A

Staphylococcus aureus, H.influenzae, streptococcus pneumonia, and Moraxella catarrhalis

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13
Q

Occurs in about 25% of young children less than three years and most often associated with H.influenzae in the ipsilateral (same) eye/ear

A

Conjunctivitis Otitis syndrome

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14
Q

Primarily due to adenovirus viruses 3,4 and seven

A

Viral conjunctivitis

Can result from HSV, varicella, herpes zoster

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15
Q

Commonly associated with seasonal allergies Both eyes feel itchy and watery

A

Allergic and vernal (chronic) Conjunctivitis

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16
Q

Cobblestone appearance of bilateral conjunctiva

A

Allergic conjunctivitis

Affects both eyes accompanied by nasal congestion, sneezing, I would swelling and sensitivity to light

not contagious

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17
Q

Allergic conjunctivitis management

A

Decongestants, topical Antihistamines, oral

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18
Q

Viral conjunctivitis has what type of discharge

A

Watery or thick stringy mucoid

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19
Q

Watery discharge lasting 10 to 14 days scratchy sensation and some URI symptoms affecting one or both eyes

A

Viral conjunctivitis

Highly contagious AKA PINK EYE

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20
Q

Bacterial conjunctivitis has what type of discharge

A

Perulent , glued eyes after sleeping
Can I have crusting upon awakening green yellow color

Begins unilateral

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21
Q

Viral conjunctivitis treatment

A

Symptomatic care
Mild: saline/artificial tears refrigerated is best
Moderate: decongestant/anti-histamines, NSAIDs

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22
Q

Bacterial conjunctivitis management

A

Erythromycin 0.5% opthamalic ointment

Polytrim (polymyxin B sulfate trimethoprim) Tobramyosin, Vigamox

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23
Q

Use the cover and cover test to see the reflection of light in both eyes

A

Corneal light reflex

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24
Q

I bought is too long causing the visual image to fall in front of the retina

A

Myopia

My=me I have this can’t see far away
Occurs during school age can’t see the board

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25
Q

Nearsightedness

A

Myopia

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26
Q

Pupils should see a crisp Red/orange and round retina

A

Red light reflex

2.5 years till melynization

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27
Q

Farsightedness

A

Hyperopia

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28
Q

Eyeball is too short Visual images focus behind the retina ability to see objects clearly at a distance but not in close range

A

Hyperopia

Mom

Complaints of inability to read
Can I have a headache, ice cream, squinting, Eye rubbing

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29
Q

Hyperopia can resolve by what year

A

Resolves by 6 years

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30
Q

Passing vision screen for a three-year-old

A

20/50

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31
Q

Passing vision screen for a four-year-old & 5 year old

A

20/40

20/30

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32
Q

Amaurosis

A

Blindness

And ability to distinguish light from darkness to partial vision

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33
Q

Legal blindness

A

Distant visual acuity of less than 20/200 corrected

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34
Q

Low vision

A

Visual cue between 20/70 and 20/200 corrected

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35
Q

Primary blindness

A

Present at birth

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36
Q

First symptom of blindness

A

Can I have nystagmus

Enlarged or clouded cornea
Abnormal or absent red light reflex
Fixed or intermittent strabismus be on six months
Developmental delays, increased anxiety around strangers, increase self stimulating behavior hand flapping rocking
Wondering eye
Chronic tearing

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37
Q

Diagnostic test of blindness

A

Ophthalmologist exam showing abnormal vision
Developmental testing
CT or MRI to rule out pathologic abnormalities

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38
Q

Causes of amblyopia

A

Trauma, organic lesion, cataract

Sensory stimulation deprivation or disuse during infancy and early childhood

Rarely bilateral

Can occur with strabismus

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39
Q

Diagnosis and management of amblyopia

A

Specific ophthalmology findings rule out underlying causes like cataracts diseases of that eye

Early detection, part referral to ophthalmologist
Corrective lenses
Patch use focusing on stimulation of the amblyopic eye

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40
Q

Involuntary rhythmic or jerky movements of the eyes

A

Nystagmus
Normal until one month of age , acute acquired nystagmus is concerning

Associated with albinism, refractive errors, central nervous system abnormalities , may be familial

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41
Q

Treatment for nystagmus

A

Referred to ophthalmologist three underline problem as possible

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42
Q

Crossed eye

A

Muscles of iron not coordinated

Strabismus

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43
Q

Esotropia

A

Eye turned inwardly

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44
Q

Exotropia

A

Eye turned outward

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45
Q

Hypertropia

A

Eye turned upward

Hyper =UP

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46
Q

Hypertropia

A

Eye turned downward

Hypo=down

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47
Q

What is the evaluation test for strabismus

A

Cover and uncover test
EOM testing
Vision acuity
Pupil test hirschburg Looking for lateral motion of the covered Eye

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48
Q

Hirschburg test

A

Pupillary light reflex looking for the lateral motion of the eye Will be unequal if strabismus is present

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49
Q

Treatment for strabismus

A

Treat once ocular misalignment > 6 months of age or if Constant or fixed strabismus at any age or hyper/hypertropia immediately, and urgent referral if any underlying CNS abnormality is suspected

Treatment may include:
surgery between six months and two years of age

patching or covering of the unaffected known as occlusion therapy

Correct of lenses
Orthotic exercises
Medication atropine sulfate (dilates unaffected eye forces you said the deviating Eye)

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50
Q

Lazy eye or decrease visual acuity and one or both eyes caused by an inadequate or an unequal visual stimulation

A

Amblyopia

Dad has this!!!

Occurs in visually immature children lack of clear image on the retina due to immature visual system

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51
Q

When does a child reach visual maturity

A

7-9 years

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52
Q

Automated vision screening including photo screening an auto refraction is preferred for children at what age to test vision

A

6 months to 3years

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53
Q

Visual acuity charts are the reliable method of screening for vision and children’s at what age

A

Ages 4 to 5 years

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54
Q

If unable to test visual acuity how long should the provider wait to reattempt

A

4 to 6 months

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55
Q

If four years of age and unable to test visual acuity when should the provider attempt again

A

One month

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56
Q

Each eye with a different refractive error variation axle or curvature of the cornea light focus front or behind cornea

A

Anisometropia

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57
Q

Results on there is an uneven curvature of the cornea causing blurred vision at near and far distances

A

Astigmatism

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58
Q

Opacity of the lens

A

Cataract

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59
Q

Sign and symptoms of Cataracts

A 
Gauze  over the lens
Poor visual acuity
Dim vision
PAINLESS
photophobia 
May be associated with hypoglycemia, hypo parathyroidism, galactosemia, microphathlmos

Black dots surrounded by red reflex, white plaque opacities, leukocoria

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60
Q

Causes of Cataract in children

A

A. Trauma to the eye, possibly due to child abuse
B. Systematic disease like DM, trisomy 21, hypo parathyroidism, a topic dermatitis, Marfan syndrome
C. Complication of other ocular abnormalities E.G. glaucoma, strabismus

D. 30% hereditary

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61
Q

Leukocoria

A

Absent red reflex

Seen in Cataracts

62
Q

Cataract treatment

A

Prompt referral to ophthalmologist, surgery indicated for visual correction

63
Q

Increased intraocular pressure from disruption of aqueous fluid involving one or both eyes in can result in optic nerve damage

A

Glaucoma

64
Q

Glaucoma that occurs within the first three years of life; 40% present at birth; 85% by one year of age

A

Congenital glaucoma

65
Q

Glaucoma that begins between three and 30 years

A

Juvenile glaucoma

66
Q

Causes of glaucoma

A

Secondary causes include trauma, intraocular hemorrhage, tumor, cataracts, corticosteroid use

67
Q

classic triad photophobia, abnormal overflow of tears (Epiphora), Eyelid spasm (blepharospasm)

May also have decreased vision and persistent ACUTE extreme pain of eye

A

Signs and symptoms of glaucoma

Deep cupping of optic disc, corneal haziness in Edema, conjunctival injection, corneal enlargement > 12 mm

68
Q

What is the management of glaucoma

A

Glaucoma pressure test will show increased pressure

Immediate prompt referral to ophthalmologist to confirm diagnosis and initiate therapy surgery is often the first line

69
Q

Granulomatous inflammation of the Meiobian glands occurring on the conjunctiva aspect the inner lining of the eyelid, nontender cyst

A

Chalazion

70
Q

Signs and symptoms of a Chalazion

A 
Slow growing
painless, mass on eyelid 
most often upper eyelid
Minimal redness/slight edema 
Firm nontender localized nodule often midline
71
Q

Mangement chalazion

A

Small ones may resolve without treatment

Apply warm compresses 2 to 3 times a day for 20 minutes

72
Q

Integrity of the eye is disruptive loss of vitreous humor

A

Ruptured globe

73
Q

Signs and symptoms of a ruptured globe

A

Pain, photophobia, injection, hyphema

Distortion of eye “pupil leaking”

74
Q

Management of ruptured globe

A

Emergent referral to ophthalmology

75
Q

Loss of epithelial lining from corneal surface of one or both eyes

A

Corneal abrasion

76
Q

Sensation of a foreign body, pain, photophobia, tearing, decreased vision, may have mild sclera erythema

A

Corneal abrasion symptoms

77
Q

What antibiotic is used for corneal abrasion ?

A

Polytrim (Bactrim) Antibiotic drops also symptomatic care

78
Q

How do you diagnose and evaluate a corneal abrasion?

A

Fluorescein staining cobalt blue light (woods lamp)

Dye shows scratches

79
Q

Blood in anterior chamber of eye

A

Hyphema

Opthamalic emergency , reduced activity

80
Q

Unilateral or bilateral obstruction nasal lacrimal duct

A

Dacryostenosis

Blocked tear ducts

81
Q

Dacryostenosis

A

Spontaneous resolution by 12 months

Constant wet / tearing eye no redness

82
Q

Dacrocystitis

A

Dacro =lacro

Infection of obstructed duct

83
Q

Fever, erythema, edema, tenderness pver NLD

A

Dacrocysitis

84
Q

Dacrocystitis treatment

A

ED IMMEDIATELY

ABx drops

85
Q

Cats eye / Leukocoria

A

Retinoblastoma

Whiteness in picture

86
Q

Retinoblastoma

A

Cats eye
Hereditary-bilateral
Non hereditary- unilateral

Cancer
Refer to opthomologist

87
Q

Vascular pathologic disease of retina

A

Retinopathy of prematurity

Increased vascularization of the eye refer to pediatric opthamology
Laser therapy

88
Q

An acute / Sudden localized inflammation of the sebaceous glands of the eyelids

A

Hordeolum ( stye)

Red tender papule

89
Q

Most common infectious pathogen for a stye?

A

S. Aureus

P. Argunosia

90
Q

Stye treatment

A

Spontaneous rupture common
Warm compresses

Sulfacetamide 10%
Polymyxin B -bacitracin
Or erythromycin

91
Q

Inflammation infection of the soft tissues of the orbit posterior of the orbital septum can involve the ocular muscles and optic nerve

A

Orbital cellulitis

92
Q

Inflammation infection of the skin and subcutaneous tissue surrounding the eye

Unilateral eyelid edema

A

Periorbital cellulitis

Warmth redness fever may occur
Vision normal

93
Q

Acute infection of the external auditory canal

Swimmers ear

A

External Otitis media EOM

94
Q

Management of EOM

A

Otis drops

Ofloxacin , ciprodex, neomycin, polymyxin,fluoroquinolone

95
Q

Sensorineural hearing loss

A

Resulting damage to the cochlear structure of the inner ear were auditory nerve

Can be caused by torches, prematurity, medication exposure, or inherited

96
Q

Conductive hearing loss

A

Normal bone conduction and reduced air condition due to the obstruction Results from blocked transmission soundwave from external auditory canal to inner ear
this is more common

97
Q

Causes include OME, wax, foreign body

A

Causes of conductive hearing loss

98
Q

Hearing screening

A

Screen at birth

Repeat screen by 1 month

DX @3 months

Treated at six months or sooner

99
Q

Symptomatic infection of the middle ear

A

Acute otitis media AOM

6-36 months most common

100
Q

Causes of AOM

A

Viral

S.pneumoniae
M.catarrhalis
H.Flu (PCN resistance)

101
Q

What is the gold standard for diagnosing AOM

A

Pneumatic Otoscopy

Tympanometry confirms

102
Q

Red TM, distorted landmarks, rupture with drainage

A

AOM

103
Q

Treatment for AOM

A

Amoxicillin 80-90 mg/kg/day BiD divided

2nd line augmentin

<2 x10 days
>6 5-7 days

104
Q

No improvement of AOM in 72 hours of amoxicillin treatment

A

Assume beta lactamase

Augmentin , Cefdinir

105
Q

OME

A

Otitis media with effusion
AKA serous otitis media

Fluid in middle ear space (thickened mucus production)
Decreased mobility with no signs of AOM
Bubbles
Yellow/dull color or translucent TM, appears retracted to the negative pressure and middle ear, no vascularity

This case is resolved on own without anabiotic‘s, refer if longer than three months or associated hearing loss

106
Q

What’s causes OME

A

Caused by viral illness/allergies , hypertrophic adenoids
Eustachian tube dysfunction
Sequel to AOM 25% to 35% of all cases

107
Q

Most common cause of conductive hearing loss

A

OME

108
Q

Tympanostomy tubes

A

Surgical incision of the eardrum and placement of ventilation tube to relieve pressure and drain pus/fluid from middle ear

109
Q

Mastoiditis

A

Infection of mastoid cells
Redness behind ear (post auricular swelling)

Concurrent/recurrent AOM occurs secondary to this

fever , otalgia

110
Q

Mastoiditis management

A

CT bony involvement
CBC elevated WBC‘s
Culture to rule out sepsis
Refer ent, po / I’ve abx and mastiodectomy

111
Q

FB in ear mangement

A

Remove
Refer ent
Otic abx drops

112
Q

FB nose

A

Remove object
Angel kids parents mouth to mouth
Ent if unable to get out

Initial symptoms of sneezing, mild discomfort can lead to infection

113
Q

Pressure at kiesselbachs triangle

A

Management of epitaxis

114
Q

Epitaxsis

A

Common and dry climates
Usually benign or mechanical nasal picking
Chronic use of nasal decongestion AFRIN
Apply ice
CBC, platelets, PT, PTT if bleeding disorder suspected

115
Q

Rhinitis

“AR”

A

URI
Caused by a variety of viruses most common rhinovirus a.k.a. the common cold

7 to 10 days; Day 1 to 3 ramping up; day 5 to 7 worst; day 10 to 14 resolution signs and symptoms

Acute onset of symptoms low-grade fever, pharyngitis, rhinorrhea, conjunctivitis, cough (nonproductive) worsens at night due to postnasal drip, allergic shiners and salute with nasal crease, nasal mucosa pill, boggy and Edematous , sinus h/a

116
Q

Rhinitis management

A

Symptomatic, no cold medications under the age of 6, hydration, nasal bulb suctioning, rest

Anti- histamine, Benedryl, nasal spray (beclomethasone /fluticasone) , normal saline

117
Q

Sinusitis

A

Common in school agers

Do not diagnose b4 9 years
S/s: sinus pressure, purlent drainage

118
Q

The diagnosis of acute bacterial sinusitis is made when______.

A

Diagnosis of acute bacterial sinusitis is made when a child with an acute upper respiratory tract infection presents with:

  1. persistent illness nasal discharge or daytime cough or both lasting more than 10 days without improvement
  2. A worsening course Or new onset of nasal discharge, daytime cough, or fever after initial improvement
  3. Severe onset concurrent fever and nasal discharge for at least three consecutive days
119
Q

Sinusitis management

A 
Amoxicillin clavulanate (augmentin)x10 days
Levaquin if no improvement

Decongestants/Anna histamines are not useful
Pain management

humidification
Nasal spray budesonide is a topical inhaled steroid
Use with caution for no more than three days
Swimming in moderation

120
Q

Centor criteria

A

Pharyngitis/tonsillitis clinical features most suggestive of group a beta-hemolytic streptococci (GABHS) =FLEA

  1. fever
  2. lack of cough
  3. pharyngal tonsillar excudate
  4. anterior cervical adenopathy

2 or more do a strep test!!!!

121
Q

Group a beta-hemolytic Streptococcus GABHS

A

Strep pharyngitis
Abrupt onset of sore throat, no nasal symptoms, or cough, fetid breath, fever common , headache, nausea, belly pain, vomiting

122
Q

Why do we treat strep pharyngitis

A

Treating to prevent rheumatic fever

123
Q

Scarletintinform rash

A

Scarlet fever secondary to strep pharyngitis

124
Q

Treatment of choice for strep pharyngitis

A

Penicillin or amoxicillin 50 mg /kg/day PO q day or divided twice a day

Change tooth brush after 48 hours
Pain meds
Hydrate I

125
Q

Treatment for strep pharyngitis in penicillin allergic

A

Keflex cephalexin 25 to 50 mg/kilogram/day divided b.i.d.

Azithromycin 12 mg/kilogram/day x5 day

126
Q

Caused by the Epstein bar virus EBV

A

Mononucleosis

127
Q

Signs and symptoms Low grade fever, cervical lymph nodes swelling, sore throat, fatigue, anorexia, slow onset, possible excudate

A

Mononucleosis

Can I also have splenomegaly, and maculopapular for Petechial rash

128
Q

Classic triad of MONO

A

Fever, pharyngitis, lymphadenopathy

129
Q

IGM versus IgG in EBV

A

Mother’s before grandmother
Early rise IgM (positive) permanent rise IgG

+IGM = early primary infection
+ IGG = past infection
+IGM & IGG = acute primary infection
-IGM &IGG= negative EBV status

130
Q

How long should a person with infectious mononucleosis avoid sports or activity

A

3 weeks due to the risk of splenomegaly and splenic rupture

131
Q

What drugs do not treat infectious mononucleosis with?

A

Amoxicillin it will give a rash

132
Q

Left upper quadrant pain in infectious mononucleosis

A

Complication of mono =ruptured spleen

133
Q

A 15-year-old male presents with complaints of general malaise and fatigue for the past few weeks without resolution. He has also had a fever and sore throat. All the final exam findings with support the diagnosis of infectious mononucleosis except:

White excudate on tonsils
Hepatomegaly
Maculopapular rash
Diffuse cervical lymphadenopathy

A

Hepatomegaly

Mono has splenomegaly not hepatomegaly all the other are findings of mononucleosis

134
Q

Sore throat with bulging posterior soft palate and deviation of you allowed to opposite side that’s unilateral

A

Peritonsillar abscess

Airway emergency!!!

135
Q

What causes a peritonsillar abscess?

A

Complication of pharyngitis due to the accumulation of purulence in a tonsillar fossa causing a cellulitis that leads to abscess

136
Q

Treatment of peritonsillar abscess

A

Needle aspiration, IV anabiotic‘s penicillin, nafcillin,oxacillin
Hydration

137
Q

Lateral neck radiography or CT shows a widen retropharyngeal space

A

Diagnostic study indicative of retropharyngeal abscess

138
Q

Retropharyngeal abscess

A

Inflammation of the posterior aspect of the pharynx and retropharyngeal lymph nodes causing sore throat with bulging pharynx can be an airway emergency

Fever , pain swallowing and refusal
Turn head
Emergency referral to ENT

139
Q

Seal like cough

A

Croup

140
Q

What causes croup

A

Para influenza virus of the Larynx

141
Q

Steeple sign

A

Diagnostic x-ray finding indicative of croup

Not necessary dx test

142
Q

What is the management of croup?

A

Symptom Medicare, single dose Decadron 0.8 mg/kilogram PO x once

143
Q

Following a URI in a 3 to 10 year old, unable to swallow sitting in a tripod position and breathing really fast

A

Epiglottitis

Bacterial infection

144
Q

Thumbs sign

A

X-ray finding indicative of epiglottitis steeple sign would show croup

145
Q

High fever , drooling, sore throat, unable to swallow

A

Epiglottitis

146
Q

Oral Candidiasis

A

Thrush common used infection of the oral Mucosa

White patches in mouth can be painful or not

Treat with Mr. and oral suspension four times a day times 10 days
Treat breast feeding mother (cross infection)

Sterilize pacifiers /nipples

147
Q

What pathogens cause epiglottis

A

Beta-hemolytic streptococci, pneumococci, H influenzae

Decreasing of influenzae with the use of HiB vaccine

148
Q

What finding may accompany macrocephaly?

  1. pulsating anterior fontanelle
  2. Sunken Fontanel
  3. premature closure suture lines
  4. Widened suture lines
A

Widen suture lines

Pulsating anterior fontanelle can be a normal variant or due to increased ICP. Sunken fontanelle can accompany dehydration and premature closure of suture lines = small head

149
Q

Which of the following conditions increases the risk of developing hydrocephalus?

Bilateral cephalohematoma‘s
Craniostenosis
Prematurity
familial microcephaly

A

Prematurity

Bilateral cephalohematoma as a result of underline skull fracture
Craniostenosis (premature closure of the sutures) can result in increase cranial pressure if severe and family macrocephaly is normal and not associated with pathology

150
Q

Confirming the diagnosis of chlamydia Conjunctivitis in the newborn would best be done by obtaining which of the following?

Cervical swab of the mother
You’re in PCR from the mother
Culture from the eye discharge
Culture of the conjunctival scrapings

A

Culture of conjunctival scrapping

Chlamydia is a intracellular organism and needs epithelial cells test sample

Testing the mother would not directly tell us what is causing the newborn symptoms

151
Q

Automated vision screenings including photo screening and auto reflection is preferred for children aged ____ to _____. Visual acuity charts continue to be a reliable method of screening for children aged _____ to ____ years.

A

6 months to 3 years

CPNP EXAM PREP (17 decks)

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