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FNP 1 > EENT > Flashcards

EENT Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

Proper way to conduct an eye exam

A 
right hand, right eye, right eye
start with wheel at 0
start 12' away
move in to 1-2" away 
after red reflex, then exam from the optic disc and end with the fovea of each eye
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2
Q

what is the shape of the optic disc

A

Doughnut-like with an orange/pink neuroretinal rim and a central white depression (physiologic cup)

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3
Q

What should the cup/disc ratio be?

A

cup should not be more than 1/2 the size of the disc diameter

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4
Q

consider________ if the cup is more than 1/2 the size of the disc diameter

A

glaucoma

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5
Q

describe retinal vessels

A

arteries are brighter red and narrower than veins

A:V ratio 2:3 or 4:5

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6
Q

Where is the macula located

A

centered 2-2.5 disc diameters temoral to the optic disc and is avascular

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7
Q

What are the characteristics of the fovea centralis

A

2.5mm diameter reflective area that looks slightly darker and lies in the center of the macula region

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8
Q

have the patient look______ if the macula is difficult to visualize

A

directly into the light

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9
Q

What is hyperopia

A

Farsightedness, gero patient

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10
Q

What is myopia

A

Nearsightedness, younger patients

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11
Q

What is presbyopia

A

lessing of the crystalline lens and weakening of the ciliary muscles which controls the lens focusing leading to greater difficulty maintaining a clear focus at a near distance. Common after age 40

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12
Q

At what snellen do you refer a patient

A

20/30

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13
Q

What is arcus senilis

A

cloudy appearance of the cornea with a gray/ white arc or circle around the limbus due to the disposition of LIPID material. No affect on vision

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14
Q

S/SX of a hordeolum (stye)

A

abrupt onset, pain, erythema

localized tender mass developing in the eyelid

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15
Q

management of the hordeolum

A

warm compresses to bring to a head
Topical bacitracin or erythromycin opthalmic ointment
Refer to ophthla if no resolution in 2 days

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16
Q

Chalazion definition

A

beady nodule on the eye lid, infection or retention cyst of a meibomian gland, usually on the upper eyelid

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17
Q

What differentiates a hordeolum and a chalazion

A

hordeolum hurts

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18
Q

S/SX of chalazion

A 
swelling on the eyelid 
eyelid tenderness
sensitivity to light
increased tearing 
if large: can cause astigmatism due to pressure on the cornea
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19
Q

Management of chalazion

A

warm compresses, refer for surgery

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20
Q

define blepharitis

A

staph or seborrheic dermatitis of the lid edge

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21
Q

s/sx of blepharitis

A 
red, scaly, greedy flakes
Thickened crusted lid margins
Burning
itching
tearing
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22
Q

management of blepharitis

A

Hot compresses
Topical antibiotics, bacitracin or erythromycin
vigourous scrub

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23
Q

What should conjunctivitis not include in s/sx

A

pain

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24
Q

type of discharge with bacterial conjunctivitis

A

purulent

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25
Q

type of discharge with gonococcal or chlamydial conjunctivitis

A

copious purulent

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26
Q

Treatment for bacterial conjunctivitis

A

self limiting

Antibiotics drops: Levo, ofloxacin, cipro, tobra, gent

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27
Q

type of discharge with allergic conjunctivitis

A

stringy, increased tearing

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28
Q

Discharge for viral conjunctivitis

A

watery

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29
Q

management of allergic conjunctivitis

A

oral antihistamines, not gtt because can worsen glaucoma

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30
Q

What is the pathology of glaucoma

A

Increased intraocular pressure
Open angle- chronic
Closed angle- acute

31
Q

s/sx of open angle glaucoma

A 
chronic 
asymptomatic
elevated IOP
cupping of the disc
Constriction of the visual fields
32
Q

s/sx of closed angle glaucoma

A 
acute
Extreme pain
blurred vision
halos around lights 
Pupil fixed or dilated
33
Q

diagnostics of glaucoma

A

tonometry, screening nationally recommended by age 40

34
Q

Management of open angle glaucoma

A

Alpha 2-adrenergic agonists- brimonidine, alphagan
Beta-adrenergic blockers- timolol
Miotic agents- pilocarpine

35
Q

Pathology of cataracts

A

Clouding and opacification of the normally clear lens of the eye

36
Q

s/sx of cataracts

A 
Painless, clouded blurred or dim vision
Halos around lights, NOT PAINFUL
Difficulty with vision at night
Sensitivity to light and glare
fading/ yellowing of colors
diplopia (2x vision) in a single eye
The need for brighter light for reading 
NO RED REFLEX
Opacity of the lens
37
Q

s/sx of retinal detachment

A

Flashes of light (photopsia) especially in peripheral vision
FLOATERS IN THE EYE
blurred vision
shadow or blindness in a part of the visual field of one eye

38
Q

Management of otitis externa

A

Cleansing and debridement of the ear
Topical otic drops: Cortisporin otic, others
Pain control: NSAIDS, topical corticosteroids

39
Q

What is streptococcus pneumoniae the key bacterial pathogen of?

A

Otitis media,
Sinusitis
Meningitis
CAP

40
Q

What is the most common source of otitis media in adults

A

viral

41
Q

What are the 3 phases of otitis media and what does it entail?

A

Local inflammation: erythema with diminished light reflex, fluid in the middle ear
Exudative phase: middle ear serous excudate
Suppurartive phase (serous)- purulent excudates; retraction and poor motility of the ™. Membrane becomes bulging and convex (IS SUPPOSED TO BE CRESENT). membrane may rupture

42
Q

Management of otitis media in the adult

A 
uncomplicated will resolve itself
hydration
avoid irritants
topical or oral decongestants
cool mist
antibiotic if suspected: AMOX
43
Q

Define Cholesteatoma

A

Type of chronic otitis media consisting of peeling layers of scaly or keratinized epithelium; if untreated may erode the middle ear causing nerve damage and deafness

44
Q

define vertigo

A

sensation of motion of either of the the person or the environment

45
Q

define benign paroxysmal positional vertigo

A

most common form of vertigo- characterized by the sensation of motion initiated by sudden head movements

46
Q

Causes of vertigo

A 
brain tumors
medications
otitis media or labrinthitis 
Meniere's disease 
Acoustic neuroma
Head trauma or neck injury
Migraines
Cerebellar hemorrhage
47
Q

Labs/ diagnostics of vertigo

A 
CT scan
VDRL/RPR
serum medication levels
hearing exam
Blood glucose and ECG may be helpful
48
Q

Management of vertigo

A 
Diazepam
Meclizine hydrochloride 
diphenhydramine
scopolamine patch 
antiemetics
49
Q

What are some of the medications that cause sensorineural hearing loss?

A 
OTOTOXIC DRUGS: 
Aminoglycosides
diuretics
salicylates 
NSAIDS
Antineoplastics
50
Q

What are some infections that cause sensorineural hearing loss?

A

Mumps, measles, herpes zoster, syphilis, meningitis

51
Q

What are the 3 components of meniers disease?

A

sensorineural hearing loss, tinnitus, vertigo

52
Q

What do the weber and rinne test show in conductive hearing loss?

A

weber: sound lateralizes to the affected ear

Rinne test: Abnormal in the affected ear (AC

53
Q

What will the weber and rinne test show in sensorineural hearing loss?

A

Weber: Sound lateralized to the unaffected ear
Rinne: Normal in the affected ear

54
Q

define the common cold

A

Viral rhinitis: self-limiting (5-10 days) caused by any 1 or more of the 200 viruses (Rhinovirus, coronavirus, RSV, adenovirus…)

55
Q

What is the Centor Criteria?

A 
clinical features most suggestive of group A B-hemolytic strep pharyngitis (FLEA)
Fever >38C or 100.4F
Lack of cough
Exudate
Anterior cervical adenopathy 
If 2 or 3- rapid strep test
56
Q

management of pharyngitis

A 
Fluids/ hydration
salt water gargles 
asa/ tylenol
ANX for strep- PCN V, erythromycin)
Ceftriaxone for gonococcal infection
57
Q

Lab/diagnostic for pharyngitis

A

rapid streptococcal antigen test
Monospot
CBC with diff

58
Q

labs/ diagnostic for influenza

A

virus isolation from nasal or throat swab or sputum specimen (most rapid)

59
Q

When would you RX a antibiotic in influenza

A

if bacterial infection is suspected or patient is asthma, COPD, or immune compromised

60
Q

What are neuraminidase inhibitors and what do they do?

A

Shorten the duration of symptoms by 2 days, effective for both influenza A and B. Must give within 48 hours or exposed
Zanamivir
Osteltamivir (tamiflu)

61
Q

What virus causes mononucleosis

A

epstein-barr virus

62
Q

What age group is most common for mono?

A

15-24 yo

63
Q

What kind of adenopathy is seen with mononucleosis

A

posterior cervical region

64
Q

What is the most severe symptom of mono?

A

pharyngitis, white tonsillar excavates

65
Q

What occurs usually during the 2nd week of mono illness?

A

Spelnomegaly

66
Q

What are the labs/ diagnostics of mono

A

Monospot positive

Increased WBC and relative lymphocytosis and neutropenia

67
Q

What are the indications of a bacterial rhino sinusitis

A

purulent nasal drainage

fever

68
Q

How long is mono incubation?

A

1-2 months, usually self limited, but malaise and fatigue may last months

69
Q

What is the management of rhinosinusitis

A 
Hyrdation
Oral decongestants (sudafed, mucinex)
Analgesics 
Antibiotics only if bacterial is suspected- AMOX+CLAV= Augmentin, or clarithromycin (Biaxin)
supportive care
70
Q

What is the most frequent location of nose bleeds

A

anterior spetum

71
Q

What might uncontrolled nose bleeds be an indication of?

A

posterior septum nose bleed- more complicated, artery in the back of the nose.

72
Q

If no resolution of nosebleed after____ minutes, refer to ENT

A

10

73
Q

what kind of eye drops are used in the management of open angle glaucoma

A

miotic agents to produce miosis which symptomatically lowers IOP (pilocarpine)

74
Q

what teeth erupt by 12.5 years

A

all teeth except the third molar

the second molar erupts by 11.9 (lower) and upper by 12.25

FNP 1 (2 decks)

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