ENT Flashcards
Hypertension causes this, which is a stiffening of vessels in the eyes
AV Nicking
Diabetes causes these in the eyes
Cotton wool spots
Loss of central vision..most common cause of permanent vision loss in older adults
Macular degeneration
Central blind spot
Scotoma
Symptoms of eye pain, conjunctival redness, and a pupil that reacts poorly to light is
Angle closure glaucoma
What type of glaucoma rarely has symptoms
Open angle glaucoma
Common non-cancerous growth on cornea and conjunctiva which can cause blindness
Pterygium
Yellow, white deposit on the conjunctiva that doesn’t cause symptoms
Pinguecula
Yellow plaque on the inner canthus that indicates increased lipids
Xanthelasmas
Hard, non tender nodule of the eyelid caused by inflammation of the meibomian gland
Chalazion
Inflammation of the sebaceous glands at the base of the eyelashes
Stye
Always start the assessment of an eye patient with
Assessing visual acuity/Snellen
A patient who has acute sinusitis complains of pain in her upper teeth. Which sinus cavities are probably infected
Maxillary
What is the goal of rhinosinusitis
Promote drainage
Nasal congestion, obstruction
Purulent nasal discharge
Maxillary tooth discomfort
Facial pain/pressure that is worse with bending forward
Acute rhinosinusitis
A patient has rhinosinusitis. How do you treat
Watchful waiting for 10 days
No macrolides
Augmentin
5-7 days
Anterior cervical node inflammation is associated with
Strep throat
Posterior cervical node inflammation is associated with
Mono
Rebound stuffiness from using a topical vasoconstrictor such as oxymetazoline spray
Rhinitis medicamentosa
How do you treat rhinitis medicamentosa
Topical nasal steroid in 1 nostril, then the other one. Wean off
A common wider effect of using topical nasal steroids
Epistaxis
What type of drug can cause dry mucus membranes and sedation
Antihistamines
A 78 year old with hearing aids complains of itching in both ears. What is the likely diagnosis
Otitis externa
What condition is associated with tragal tenderness
Otitis externa
What condition is associated with a ruptured ear drum
Otitis media
Loss of high frequency sounds in older adults
Presbycusis
Weber test for conductive hearing loss
Bad ear larteralizes to bad ear
Weber test for sensorineural loss
Good ear lateralizes to good ear
Rinne test for conductive loss
AC>BC good ear
BC>AC bad ear
Rinne test for sensorineural loss
AC>BC good ear
AC>BC bad ear
Sound can not get into external or middle ear ex. Cerumen impaction
Conductive hearing loss
This type of hearing loss involves the inner ear or 8th CN
Sensorineural hearing loss
Hearing or acoustic cranial nerve number
8
What type of hearing loss is presbycusis
Sensorineural hearing loss
What is the most common pathogen in ABRS, AOM (acute otitis media), and CAP (community acquired pneumonia)
Streptococcus pneumoniae
What is the Weber test result for conductive hearing loss
Sound lateralizes to the affected ear
What is the Weber test result for sensorineural hearing loss
Sound lateralizes to the unaffected ear
What is the Rinne test result for conductive hearing loss
Negative
Bone conduction is better than air conduction
What is the Rinne test result for sensorineural hearing loss
Positive or Negative
Air conduction is better than bone conduction
How do you treat Bells Palsy
Oral corticosteroids
What is the triad of an opthological emergency and needs referral?
Red eye, painful eye, new onset vision change
Are retinal ateries wider or narrower than veins?
Narrower
In a funduscopic exam in a patient with angle-closure glaucoma would reveal
A deeply cupped optic disk
Peripheral vision loss is associated with
Untreated open angle glaucoma
Floating spots in visual field is associated with
Proliferative diabetic retinopathy
Central vision loss is associated with
Macular degeneration
What is the name of the test for macular degeneration
Amsler Grid Test
Measurement of intraocular pressure, glaucoma screening test
Tonometry
Aging problem with vision that leads to close vision problems
Presbyopia
Systemic corticosteroid use leads to this eye condition
Cataracts
Painless, gradual onset of increased introcular pressure leading to blindness
Open angle glaucoma
Sudden increase in intraocular pressure
Angle closure glaucoma
Diminished sense of smell with resulting decline in fine taste discrimination
Anosmia, hyposmia
Loss of 8th cranial nerve sensitivity
Presbycusis
What type of hearing loss is cerumen impaction
Conductive hearing loss
How do you treat suppurative conjunctivitis
Cipro, Levo, or moxifloxacin optholmic
Chronic otitis media infections can lead to
Cholesteatoma
What part of the eye is responsible for the sharpest vision 2020 vision
Fovea of the Macula
What part of the eye is responsible for central vision
Macula
If the borders of the disc margins on both eyes are blurred, what is this associated with
Papilledema
Acute onset of severe eye pain, photophobia, and blurred vision in one eye. Diagnosed by using fluorescein dye. A black lamp in a darkened room is used to search for fern like lines in the corneal surface. In contrast, corneal abrasion’s appear more linear. Infection permanently damages corneal epithelium, which may result in corneal blindness.
Herpes keratitis
Elderly patient with acute onset of severe eye pain accompanied by headache, nausea/vomiting, halos around lights, and decreased vision. Examination reveals a mid dilated pupil that is oval shaped. The cornea appears cloudy. Funduscopic examination reveals cupping of optic nerve. Ophthalmologic emergency. If the rise and intraocular pressure is lower, patient may be a symptomatic.
Acute angle closure glaucoma
Patient may complain of sudden onset of floaters or black dots in visual field, Scotoma i.e. retinal attachment, blurred vision, photophobia, Eye pain , or severe discomfort i.e. uveitis, glaucoma.
Acute vision loss
Cauliflower like growth accompanied by foul smelling discharge. Hearing loss on affected ear 👂 On examination, no Tympanic membrane or ossicles are visible because of distraction by the tumor. History of chronic otitis media infection. The mass is not cancerous, but It can erode into the bones of the face and damage the facial nerve cranial nerve number seven. Treated with antibiotics and surgical debridement. Refer to head, eyes, ears, nose, and throat specialist.
Cholesteatoma
Acute onset of a bruise behind the ear over the mastoid area after a recent history of trauma. Indicates a fracture of the basilar skull. Search for a clear golden serous discharge from the Ear 👂 or nose 👃 Refer to emergency department for skull 💀 x-rays and antibiotics.
Battle sign
What does it mean if there is clear golden fluid discharge from the ear and nose
Indicative of a basilar
skull fracture. CSF slowly leaks through the fracture. Testing the fluid with the urine dipstick will show that it is positive for glucose, whereas plain mucus or mucopurulent drainage will be negative. Refer to ED.
A rare but life-threatening complication with a high mortality rate. Patient with a history of a sinus or facial infection will manifest with a severe headache accompanied by a high fever. Rapid decline in level of consciousness terminating in coma and death. Refer to ED.
Cavernous Sinus Thrombosis
Severe sore throat with difficulty swallowing, ODonophahia, trismus, and a hot potato voice. One sided swelling of the peritonsillar area and soft palate. Affected area is markedly swollen and appears as a bulging red mass with the uvula displaced from the mass. Accompanied by malaise, fever, and chills. Refer to ED for incision and drainage.
Peritonsillar abscess
Sore throat, fever, and markedly swollen neck i.e. bull Neck. Low-grade fever, hoarseness, and Dysphagia. The posterior pharynx, tonsils, uvula, and soft palate are coated with a great to yellow color pseudomembrane that is hard to displace. Very contagious. Refer to ED
Diphtheria
Should a red reflex be present on fundoscopic exam
Yes if not it is indicative of cataracts
How should the optic disc be in a fundoscopic exam
Sharp outline
What should the cup disk ratio be in a funduscopic exam
Less than 0.5
What is narrower arteries or veins
Arteries
Which is larger veins or arteries in the eye
Veins
What part of the eye is responsible for color perception, 2020 vision, and sharp vision
Cones
What part of the eye is responsible for detecting light and shadow, depth perception, night vision.
Rods
What part of the eye is responsible for central vision. This is the area of the eye that determines 2020 vision.
Macula
The fovea is located
In the middle of the macula
Inner conjunctiva with mildly elevated lymphoid tissue resembling cobblestones. Maybe seen in atopic patients, allergic rhinitis, allergic conjunctivitis.
Cobblestoning
Age related visual change due to a decreased ability of the eye to accommodate and Stiffening of the lenses. Usually starts at the age of 40. There is difficulty focusing, which results in markedly decreased ability to read print at close range.
Presbyopia
What should the tympanic membrane of the ear look like
Translucent off white to gray color with the cone of light intact
How do you measure the presence of fluid inside the middle ear. Results in a straight line versus a Peaked shape.
Tympanogram
All cartilage injuries must be referred to
Plastic surgeon. The outer ear has a large amount of cartilage.
Does cartilage regenerate
No refer injuries to plastic surgeon
What do the nasal turbinates look like in allergic rhinitis
Bluish, pale, and or Boggy
Lower third of the nose is made out of
Cartilage and this tissue does not regenerate. If damaged, refer to plastic surgeon.
Appears on the surface and under the tongue. Maybe cancerous. Patients with a history of chewing tobacco are at high risk of oral cancer.
Leukoplakia
Painful and look like shallow ulcers of soft tissue
Apthous stomatitis (cancer sores)
What do you do if a patient has an avulsed tooth
Store in a cool milk. No ice. See dentist ASAP for reimplantation.
What are you assessing for in the posterior pharynx
Post nasal drip as in acute sinusitus, allergic rhinitis. Posterior pharyngeal lymph nodes that are mildly enlarged and distributed evenly on the back of the throat as in allergies and allergic rhinitis. Hard palate look for any openings as in cleft palate, ulcers, redness.
Unknown cause. Map like appearance On tongue surface. Patches may move from day to day. May complain of soreness with acidic foods, spicy foods.
Geo graphic tongue
Painless bony protuberance midline on the hard palate or roof of the mouth. Maybe asymmetrical. Skin should be normal. Does not interfere with normal function.
Torus Palatinus
Uvula is split into two sections ranging from partial to complete. May be a sign of an occult cleft palate and is rare.
Fishtail or split uvula
Is vertical nystagmus normal or abnormal
Abnormal
Optic disc swollen with blurred edges due to increased intracranial pressure secondary to bleeding, brain tumor, abscess, pseudotumor cerebri
Papilledema
Hypertension stiffens vessels
Arteries indent and displace veins
Considered mild retinopathy
This is
AV nicking
Mainly caused by diabetes in the eye, can be from hypertension. Microinfarct occurs and is considered moderate retinopathy
Cotton wool spots
Can be caused by hypertension and diabetes and micro infarct occurs in the eye. Considered moderate retinopathy. Blot and dot hemorrhages, hard exudates, microaneurysms are considered moderate novelty. Refer to ophthalmology.
Flame hemorrhages
Copper and silver wire arterioles
Hypertensive retinopathy
Microaneurysms caused by neovascularization. Cotton wool spots.
Diabetic retinopathy
Opacity of the corneas. Chronic steroid use causes this
Cataracts
Small size red papules with blue white centers inside the cheeks by the lower molars
Koplick’s spots as seen in measles
Elongated papilla on the lateral aspects of the tongue that are pathognomic for HIV infection. Caused by Epstein bar virus infection.
Hairy leukoplakia
A bright white plaque caused by chronic irritation such as chewing tobacco or snuff. Rule out cancer of the mouth. Or on the inner cheeks (buccal mucosa).
Leukoplakia of the oral Mucosa/tongue
Mucosal lining inside the mouth
Buccal mucosa
Mucosal lining inside eyelids
Palpebral conjunctiva
Mucosal lining covering the eyes
Bulbar conjunctiva
Refers to the area where uvula, tonsils, anterior of throat are located
Soft palate
The roof of the mouth
Hard palate
Far sighted Ness
Hyperopia
What measures central distance vision
Snellen chart
If a patient is illiterate, how do you measure central distance vision
Tumbling E chart
Blind spot
scotoma
What chart is used for color blindness
Ishihara chart
What defines legal blindness
Defined as a best corrected vision of 20/200 or less or a visual field less than 20° (tunnel vision)
What is the test for hearing and what is a normal finding
Weber test is done by placing the tuning fork midline on the fore head. Normal finding is no lateralization. If lateralization, hearing the sound in only one ear, abnormal finding.
Rinne test is done by placing the tuning fork first on the mastoid process, then the front of the ear. Time each area. Normal finding is air conduction lasts longer than bone conduction (can hear longer in front of ear 👂 than in mastoid)
What type of herpes virus causes herpes keratitis and corneal abrasion
Shingles. Corneal abrasion will report sudden onset of symptoms with foreign body sensation.
Shingles affects which cranial nerve
Trigeminal number five
What diagnostic test is used for herpes keratitis
Use fluorescein dye strips with a black lamp in a darkened room. Herpes keratitis this appears as a fernlike line. In contrast corneal abrasion’s usually appear more linear.
What is the treatment plan for herpes keratitis and corneal abrasion
Refer herpes keratitis patient to ED or ophthalmologist ASAP. They will be given Zovirax or Valtrex BID. Avoid steroid up Opthalmic drops for herpes keratitis. If corneal abrasion‘s, rule out penetrating trauma, vision loss, soil/dirt. Check vision. Flush Eye with normal Saline to remove foreign body. If UnAble to remove, refer. If corneal abrasion, use topical opthalmic antibiotic such as erythromycin or Polytrim applied To affected eye times 3 to 5 days. Do not patch Eye. Follow up in 24 hours. If not improved, refer. Consider Eye pain prescription hydrocodone with acetaminophen and prescribe enough for 48 hours of use.
A painful acute bacterial infection of the hair follicle on the eyelid
Hordeolum (style)
Patient complains of an itchy eyelid and an onset that is acute of nature of a Pustule on either upper or lower eyelid that eventually becomes painful.
Hordeolum (stye)
What is the treatment plan for hordeolum (stye)
Antibiotic drops or ointment such as sulfa drops, erythromycin drops. Warm packs b.i.d. or TID until pustule drains
A chronic inflammation of the meibomian gland (specialized sweat gland) of the eyelids
Chalazion
Patient complains of a gradual onset of a small superficial nodule that is discreet and movable on the upper eyelid that feels like a bead. Painless. Can slowly en large overtime. Benign
Chalazion
What is the treatment plan for chalazion
If Nodule enlarges or does not resolve in a few weeks, biopsy to rule out squamous cell carcinoma. If large and affects vision, surgical removal is an option.
Yellow triangular thickening of the bulbar conjunctiva (skin covering eyeball). Located on the inner and outer margins of the cornea. Caused by UV light damage to collagen.
Pinguecula
A yellow triangular (wedge shaped) thickening of the conjunctiva that extends to the cornea on the nasal or temporal cornea. Due to UV damaged collagen from chronic sun exposure. Usually asymptomatic. Can be red/inflamed at times
Pterygium
What is the treatment plan for both pinguecula and pterygium
If inflamed, use week steroid eyedrops only doing exacerbations. Recommend use of good quality sunglasses 🕶 Remove surgically if encroaches cornea and affects vision.
Blood that is trapped underneath the conjunctiva and sclera secondary to broken arterioles . Can be caused by coughing, sneezing, heavy lifting, vomiting, or can occur spontaneously. Results within 1 to 3 weeks when the blood is reabsorbed like a bruise with color changes from red to green to yellow. If on aspirin, anticoagulants, and has hypertension there is an increased risk for this condition.
Sub conjunctiva hemorrhage
What is the treatment plan for sub conjunctiva hemorrhage
Watchful waiting and reassurance of patient. Follow up until resolution.
Gradual onset of increased intraocular pressure greater than 22 mmHg due to blockage of the drainage of aqueous humor inside the eye. The retina cranial nerve 2 undergoes ischemic changes and if untreated becomes permanently damaged. Most common type of glaucoma.
Primary open angle glaucoma
If a funduscopic exam shows cupping what does that mean
Increased intraocular pressure and it is too high. Refer to ophthalmologist.
What is the treatment plan for primary open angle glaucoma
Check intro ocular pressure as normal range is 10 to 22 mmHg. Refer patient to ophthalmologist for follow-up. Medications used are Betimol (timolol) which is a beta blocker eye drops that lower intro ocular pressure. Side effects include bronchospasm, fatigue, depression, heart failure, and bradycardia. Contra indicated an asthma, empysema, COPD, second to 3rd° heart block, and heart failure.
Sudden blockage of aqueous humor causes marked increase of the intraocular pressure causing ischemia and permanent damage to the optic nerve 2
Primary angle closure glaucoma
An older patient complains of acute onset of a severe frontal headache or severe eye pain with blurred vision and tearing. Seeing halos around lights. Maybe accompanied by severe nausea and vomiting.
Primary angle closure glaucoma
Fixed and mid-dilated cloudy pupil that looks more oval then round shaped. Conjunctiva injection with increased lacrimation.
Primary angle closure glaucoma
What is the treatment plan for primary angle closure glaucoma
Refer to ED
Higher risk with autoimmune disorders such as rheumatoid arthritis, lupus, ankylosing spondylitis, sarcoidosis, syphilis, others. Complains of red sore eyes. Appears like Redeye but with increased tearing. No purulent discharge as in bacterial conjunctivitis. Refer to ophthalmologist for management.
Anterior uveitis (iritis)
Most common cause of permanent vision loss in older adults. Symptom is loss of central vision over the years. First sign is central Blindspot or scotoma or curving of straight lines. Peripheral and color vision are normal.
Macular degeneration
A 70-year-old patient presents to your clinic with Eye pain, conjunctival redness, and a pupil that reacts poorly to light. What could be the cause?
Angle closure glaucoma
Refer
Do patients have symptoms in open angle glaucoma
Rarely
Do patients have symptoms in closed angle glaucoma
Patients have acute symptoms
Can pterygium cause blindness
Yes
Yellow plaque on the inner canthus. 50% of people have elevated lipids with this condition
Xanthelasmas
How do you assess all Eye complaintsis
Always start by assessing visual acuity. And document for both eyes. Examination with slit lamp and binocular loop after selling examination or pen light.
Fluorescein staining is used to assess for corneal defects (should be done as last part of examination)
Lid eversion: flip the eyelid with cotton swab for suspected foreign body; remove visible object using wet cotton swab
Went to refer to ophthalmology
Change in vision
Foreign body sensation
Photophobia
Opacity in the lens of the eye which decreases visual acuity
Cataract
Does the patient have peripheral vision with macular degeneration
Yes
What is the treatment plan for macular degeneration
Refer to ophthalmologist. Patient is given a copy of the Amsler grid and asked to focus on the center dot and view the grid 12 inches from eyes. Patient checks visual field loss daily to weekly.
AREDS formula ocular vitamins are given: high dose antioxidants and zinc. Patients should consult their opthomologist before taking ocular vitamins.
Chronic autoimmune disorder characterized by decreased function of the lacrimal and salivary gland’s. It can occur alone or with autoimmune disorder such as rheumatoid arthritis
Sjögren’s syndrome
The classic symptoms are daily symptoms of dry eyes and dry mouth for several months greater than three months. Complains of chronic dry eyes and that both eyes have Sandy or gritty sensation (keratoconjunctivitis sica). Ocular symptoms are associated with chronic dry mouth. Oral examination shows swollen and inflamed salivary gland’s.
Sjogren’s Syndrome
What is the treatment plan for Sjögren’s syndrome
Over-the-counter tear substitute drops TID. Refer to ophthalmologist if patient has keratoconjunctivitis
A chronic condition of the base of the Eyelashes caused by inflammation. Complains of itching or irritation in the Eyelashes area upper/lower or both, Eye redness, and sometimes crusting
Blepharitis
What is the treatment plan for blepharitis
Johnson’s baby shampoo with warm water. Scrub eyelid margins until resolved. Consider a topical antibiotic solution such as erythromycin eyedrops to eyelids 2 to 3 times daily.
When a patient has green mucus what must be ruled out
Sinusitis
What is the treatment plan for allergic rhinitis
Nasal steroid spray’s daily like fluticasone or Flonase b.i.d. Decongestants such as pseudo-ephedrine or Sudafed PRN. Do not give to infants 👶🏻 /young children. Zyrtec 10 mg daily or PRN or combined antihistamine with decongestants. Dust mite allergies: avoid using ceiling fans, no stuffed animals or pets in bed, use a HEPA filter, and the like.
What are complications of allergic rhinitis
Acute sinusitis and acute otitis media
Prolonged use of topical nasal decongestants greater than three days, causes rebound effects that result in severe and chronic nasal congestion. Patient presents with severe nasal congestion and clear, watery, mucus nasal discharge.
Rhinitis medicamentosa
What puts a patient at a higher risk for epistaxis
Aspirin use, cocaine abuse, severe hypertension, anticoagulants
What is the treatment plan for epistaxis
Tilt head slightly forward and apply pressure over nasal bridge for several minutes. Use nasal decongestants (i.e. Afrin) to shrink tissue. Nasal packing. Antibiotic prophylaxis for staph and strep as needed
What is a complication of epistaxis
Posterior nasal bleeds may hemorrhage (refer to ED)
What are rare sequelae of strep throat
Scarlet fever and rheumatic fever
What is the treatment plan for strep throat
Throat culture and sensitivity or rapid strep testing. First line is penicillin QID times 10 days. Ibuprofen or acetaminophen for throat pain and fever. Symptomatic treatment: salt water gargles, throat lozenges. Drink more fluids. Repeat culture if high-risk: history of mitral valve prolapse’s or heart valve surgery. If the patient is penicillin allergic, Z pack azythromycin can be given x 5 days. Or Levaquin x 10 days (contraindicated if age less than 18)
Sandpaper texture pink rash, acute pharyngitis findings
Scarlet fever
Inflammatory reaction to strep infection that may affect the heart and the valves, joints, and the brain.
Rheumatic fever
Displaced uvula, red bulging mass on one side of anterior pharyngeal space, dysphagia, fever. Refer to ED stat
Peritonsillar abscess
Acute infection of the middle ear cavity with bacterial pathogens due to mucus that becomes trapped in the middle ear secondary to temporary eustachian tube dysfunction. The infection is usually unilateral, but may at times involve both ears. Most have a middle ear effusion.
Acute otitis media
What organisms are usually associated with acute otitis media
Streptococcus pneumoniae. High rates of beta-lactam resistant strains.
Haemophilus influenzae
Moraxella catarrhalis
What is otaglia
Ear pain
A type of acute otitis media infection, but causes more pain. Presence of blisters on a reddened and bulging tympanic membrane. Conductive hearing loss. Caused by different types of pathogens. Treated the same as bacterial acute otitis media.
Bullous myringitis
What would the weber exam show for conductive hearing loss
Lateralization in the affected ear
Complains of unilateral facial pressure that worsens when bending down, along with pain in the upper molar teeth or frontal headache. Coughing is made worse when supine. Self treatment with over-the-counter cold and sinus remedies provides no relief of symptoms.
Bullous myringitis
When do patients with bullous myringitis follow up
Within 48 to 72 hours, symptoms will start to improve. If not getting better, check ears again for bulging and erythema. Switch to second line drug such as Augmentin or Ceftin.
How do you treat acute otitis media and bullous myringitis
Amoxicillin is the gold standard for any age group. First line is amoxicillin 500 mg to 875 mg b.i.d. to TID times 10 to 14 days. Or consider starting with second line antibiotic Augmentin, Ceftin, Cefzil if severe disease i.e. severe ear pain or fever. Most patients will respond within 48 to 72 hours. If no improvement noted, then switch to second line drug. Use adjunct for symptoms such as a decongestant (psuedoephedrine and phenylephrine), Saline nasal spray or mucolytic (guaifenesin), analgesic for ear pain. If allergic rhinitis consider steroid nasal spray (Flonase, Vancenase). Educate about auto-insufflation (pinch nose and blow hard). Popping noises may be heard. No systemic corticosteroids!!
When should second line treatment be considered for acute otitis media and bullous myringitis
History of antibiotic use in the past three months, no response to amoxicillin, or severe case of acute otitis media with high fever and severe pain. Time duration is from 10 to 14 days. Augmentin Cefdinir Cefpodoxime Ceftriaxone Ceftin
For penicillin allergic patients Z pack azithromycin x 5 days.
Bactrim DS PO BID
Levaquin or moxifloxacin if 18 years or older. Increases risk of tendonitis and Achilles’ tendon rupture
What is the maximum amount of time that a topical decongestant such as Afrin can be used in acute otitis media
Three days or it will cause rebound
This is a complication of acute otitis media that is a cauliflower like growth accompanied by foul smelling ear 👂 discharge. No tympanic membrane or ossicles are visible. History of chronic otitis media infections. Mass is not cancerous but It can Erode into the bones of the face and cause damage to the facial nerve cranial nerve number seven
Cholesteatoma
A complication of acute otitis media that causes a red and swollen mastoid that is tender to palpation. Treat with antibiotics. Refer.
Mastoiditis
This is a complication of acute otitis media that is more common in children. Edema and redness Periorbital area and diplopia. Abnormal EOM extraorbital muscles testing of affected orbit. Pain, fever, toxicity. Refer to ED.
Preorbital or orbital cellulitis
This complication of acute otitis media presents with an acute onset of high fever, Stiff neck, severe headache, photophobia, toxicity. Positive Brezinski or Kernigs sign. Refer to ED stat
Meningitis
This complication of acute otitis media is life-threatening and a medical emergency with high mortality. Refer to ED. Complains of acute headache, abnormal neurological exam, confused, febrile, toxic.
Cavernous sinus thrombosis
May follow acute otitis media. Can be caused by chronic allergic rhinitis. Complains of ear 👂 pressure, popping noises, and muffled hearing in affected ear 👂 Serous fluid inside middle ear is Sterile
Otitis media with effusion
What is the treatment plan for otitis media with effusion
Oral decongestants such as pseudo-ephedrine or phenylalanine. Steroid nasal spray b.i.d. to TID times few weeks or Saline nasal spray PRN. Allergic rhinitis, steroid nasal spray’s with long acting antihistamine like Zyrtec
Bacterial infection of the skin of the external ear canal. More common during warm and humid weather.
Otitis externa
What organisms are responsible for otitis externa
Pseudomonas aeruginosa
Staphylococcus aureus
Complains of external ear pain, swelling, and green purulent discharge. History of recent activities that include swimming or wetting ears.
Otitis externa
Ear pain with manipulation of the external ear or Tragus. Purulent green discharge. Erythematous and swollen ear canal that is very tender.
Otitis externa
What is the treatment plan for otitis externa
Corticosporin optic suspension QID x 7 days. Keep water out of ear during treatment. If patient has recurrent episodes, prophylaxis is Otic Domedoro or alcohol and vinegar
What are complications of otitis externa
Malignant otitis media which is seen in diabetics/immunocompromised, aggressive spread of infection to surrounding soft tissue/bone. A cellulitis infection. Hospitalized for high doses of antibiotics and surgical debridement.
Infection by the Epstein bar virus. Peak ages of acute infection are between 15 and 24 years. After acute infection, Epstein bar virus lives Latent in oral pharyngeal tissue. Can become re-activated and causes symptoms. Virus is shed mainly through saliva.
Infectious mononucleosis
What is the classic triad of infectious mononucleosis
Fatigue, acute pharyngitis, lymphadenopathy
Or posterior or anterior know it’s associated with infectious mononucleosis
Posterior cervical nodes
With mono, what does abdominal pain mean
Possibly hepato-megaly and or spleno megaly
What would a CBC show for mono nucleos sis
Atypical lymphocytes and lymphocytosis greater than 50%. Repeat CBC until resolves
What is the diagnostic test for mono
Heterophile anti-body test (mono spot) which will be positive
Can a generalized read maculopapular rash be present in mono
Yes
What is the treatment plan for mono
Order abdominal ultrasound if splenomegaly/hepato- megaly is present, especially if patient is an athlete, A physically active adult, or an athletic coach. Educate athlete to avoid contact sports and heavy lifting until hepato-megaly and or spleno megaly resolves. Repeat abdominal ultrasound in 4 to 6 weeks. Symptomatic treatment. Avoid using amoxicillin if patient has strep throat due to drug rash from 70 to 90%.
What are complications from mono
Splenomegaly/spleen rupture which is rare but serious complications of mono. Airway Obstruction. Neurologic Guillain-Barre, aseptic meningitis, optic neuritis, others. Blood dyscrasias such as atypical lymphocytes. Repeat CBC until lymphocytes normalize.
Skin fissures and maceration of the corners of the mouth. Multiple etilologies such as an over salivation, iron deficiency anemia, secondary bacterial infection, vitamin deficiencies.
Cheilosis
What is the treatment plan for cheilosis
Apply triple antibiotic ointment b.i.d. or TID until healed. Remove or treat underlying cause.
What is the treatment for otitis externa
Corticosporin otic drops
What is otitis externa’s common bacterial pathogen
Pseudomonas
What is a complication of Periorbital sinusitis
Cholesteatoma
Rinne test result of bone conduction greater than air conduction means
Conductive hearing loss
Weber and Rinne are testing which cranial nerve
Cranial nerve eight acoustic
Is lateralization on the weber exam in abnormal or normal finding
Abnormal
What is the normal finding in the Rinne test
Air conduction lasts longer than bone conduction or air conduction is greater than bone conduction
What does 20/40 vision mean
Patient can see at 20 feet what a person with normal vision can see at 40 feet
What is one of the most common over-the-counter treatment for cerumenosis
Carbamide peroxide
A patient who has acute sinusitis complains of pain in her upper teeth. Which sinus cavities are probably infected.
Maxillary
Nasal congestion or obstruction, purulent nasal discharge, maxillary tooth discomfort, facial pain, pressure worst when bending forward
Acute rhinosinusitis
How do you treat rhinosinusitis
Relieve symptoms such as nasal stuffiness and rhinorrhea, promote drainage, prevent complications.
When do you give antibiotics for acute rhinosinusitis
Watchful waiting for at least 10 days. augmentin. No macrolides
What symptoms are suggestive of acute bacterial rhinosinusitis
Symptoms persist for greater than 10 days without clinical improvement. Onset with severe symptoms such as fever or purulent drainage lasting at least three consecutive days at the beginning of the illness. Symptoms worsened after initial improvement. 40 to 70% of patients with Acute bacterial rhinosinusitis will clear spontaneously. Promote drainage.
If a patient is allergic to penicillin and has acute bacterial rhinosinusitis what should be given to them
Doxycycline. Levaquin or moxifloxacin can also be given. No macrolides.
For a pediatric patient with acute bacterial rhinosinusitis what medication should be given
First line is amoxicillin or Augmentin. Alternatives are Cefdinir, cefuroxine, or Cefpodoxime. Avoid sulfa drugs and azithromycin.
When should noticeable improvement occur after antibiotic initiation for the treatment of acute bacterial rhinosinusitis
3 to 5 days
What is a possible complication of acute bacterial rhinosinusitis
Periorbital cellulitis
What are indications for patient referral for acute rhinosinusitis
High fever of 102°F, abnormal vision, Periorbital Edema
A patient with sinusitis has developed a fever of 102° and apparent Periorbital cellulitis. What is the imaging study of choice
CT scan with contrast.
CT is for cavity
C=cavity
Contrasts bone from soft tissue
Can group A strep cause acute glomerulonephritis
Yes
A 15-year-old presents with suspected pharyngeal group a strep infection. Which cervical nodes most likely correlate with those found in a patient with group a strep infection
Anterior, typically symmetric
What is the centor criteria for strep
Absence of cough 1 point \+ anterior cervical nodes 1 point Temp greater than 100.4F 1 point Tonsillar exudates or swelling 1 point Age 3-14 1 point 15-44 0 point 45 years and older -1 point
Consider screening if centor score is 2 or more
Screen adults with centor score greater than or equal to 3
Adults at high risk for infection (chronic steroid use, DM poorly controlled, immunocompromised), throat culture if RADT negative.
If group a strep is not treated with an antibiotic within 24 to 48 hours then
It will spontaneously resolved within 2 to 5 days
If the rapid strep test is negative what needs to be done in order to efficiently rule out strep throat
Throat culture
A 15-year-old presents with suspected mononucleosis. Which cervical node’s most closely correlates with those found in a patient who has mono
Posterior, typically symmetric
What are the three F’s & L of mono
Fever, pharyngitis, fatigue, lymphadenopathy
When is the mono spot test most likely positive
Second or third week of illness
What diagnostic studies are needed for mono
Mono spot, EBV titers, CBC which shows lymphocytosis, atypical lymphocytes, elevated ALT and AST
A 16-year-old who was diagnosed with mononucleosis asked how soon he might be able to resume sports. What should the nurse practitioner reply
About 3 to 4 weeks after onset of symptoms. Must wait until spleen goes back to normal size.
A life-threatening infection of the epiglottis and surrounding tissues which can cause sudden and critical narrowing of the airway; a medical emergency; cellulitis of the epiglottis
Epiglottitis
What is the presentation of epiglottitis in adults
Sore throat, fever, muffled voice, drooling, hoarseness, thumb sign which is enlarged epiglottitis protruding from the angeterior wall of the hypopharynx
Is epistaxes a disease
It is a symptom
What is oxymetazoline spray
Afrin
Overuse=rhinitis medicamentosa
Cerumen impaction, ear plugs, fluid on the middle ear, wearing of headphones 🎧 can cause what type of hearing loss
Conductive hearing loss
Hereditary hearing loss, presbycusis, noise exposure, meniere’s disease, acoustic tumors, trauma are all examples of
Sensorineural hearing loss
Progressive, symmetric loss of high-frequency sounds over many years in elderly patient. Results in diminished nonverbal executive function and decrease cycle motor speed.
Presbycusis
How do you treat presbycusis
Hearing aid
What are risk factors for angle closure glaucoma
Family history, age greater than 60 years old, female, hyperopia or farsightedness, medications such as antihistamine, anticholinergic agents, phenylephrine, HCTZ, sulfa drugs, TCA, beta blockers which increase intraocular pressure
A 24-year-old female complains of intermittent, irritated, dry, red eyes. How can this be treated
Baby shampoo lid scrubs as this is used to treat blepharitis
Screening for increased intraocular pressure or early glaucoma is
Best performed by an eye specialist
An elderly patient presents with a gray white ring around the periphery of the iris. This is probably
A normal variant associated with the aging process.
Does the Hirschberg test test for visual acuity
No. The Harrisburg test evaluates ocular muscle coordination
What is the most common cause of pharyngitis and a six-year-old
Viral. Encourage supportive and symptomatic care.
What other symptoms besides tragel tenderness presents with otitis externa
Otic itching
A 45-year-old diabetic patient with Periorbital cellulitis secondary to a sinus infection. What course of action should be taken
Consider a collaboration with a physician regarding antibiotic treatments, culture, and subsequent action. Periorbital cellulitis is a medical emergency
Is papilledema seen in diabetic retinopathy
No
An eight-year-old presents to the health clinic with a history of acute onset sore throat and respiratory rate of 34 per minute in the last 30 minutes. The child’s history is positive for fever and pharyngitis for two days. What is the diagnosis
Epiglottitis
The diagnosis of Ménière’s disease is based on
Exclusion of other path ologies
A 15-year-old swim team member presents with mild swimmers ear. Vital signs are normal. What is the most appropriate therapy for this patient
Hydrocortisone-Bacitracin-Polymixin B (Cortisporin) otic solution
What is an example of a first generation antihistamine
Desloratadine
Family health history falls under which area
Health and illness pattern
