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FNP boards > Eye, ear, nose, and throat problems > Flashcards

Eye, ear, nose, and throat problems Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

What is conjunctivitis and what causes it?

A

Inflammation of the bulbar and/or palpebral conjunctiva

  • Commonly viral, but can be bacterial or allergic
  • If viral, commonly presents with URI, rhinorrhea, other common cold symptoms
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2
Q

Conjunctivitis clinical presentation

A
  • Allergic → ocular itch
  • Viral → no itch, common cold symptoms
  • Bacterial → clear to purulent discharge
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3
Q

Conjunctivitis treatment

A
  • Viral → self limiting
  • Allergic → ocular and systemic antiallergic medications
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4
Q

Four ophthalmological emergencies

A
  • Angle closure glaucoma
  • Anterior uveitis
  • Retinal detachment
  • Ocular injury
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5
Q

What is angle closure glaucoma (aka acute glaucoma)?

A

Sudden, marked increase in IOP

  • Can be diagnosed with tonometry (normal 8-22), but in outpatient will need to refer out
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6
Q

Angle closure glaucoma treatment

A

Goal: prompt IOP lowering and inflammation relieving with meds

  • Beta blocker drops
  • Alpha-2 agonist drops
  • Miotic or cholinergic drops
  • Oral carbonic anhydrase inhibitors
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7
Q

What is anterior uveitis (aka iritis)?

A

Most common form of intraocular inflammation and involves the eyes anterior uveal tract (iris and ciliary body)

  • Risk factor: underlying autoimmune disease (HLA-B27 serotype positive)
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8
Q

Anterior uveitis clinical presentation?

A
  • Rapid onset unilateral dully painful red eye with discomfort
  • Pain radiates to the temple and periorbital area
  • Vision change
  • Pupil constricted, nonreactive, irregularly shaped
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9
Q

Anterior uveitis treatment

A
  • Medications to assist in pupillary dilation (corticosteroids) via drops, injections, or systemically
  • Treatment of underlying autoimmune disease
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10
Q

What causes retinal detachment?

A

Inflammatory and/or vascular abnormalities or injury that allows fluid to build up encouraging separation of the inner retinal layer from the retinal pigment epithelium

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11
Q

Retinal detachment clinical presentation

A
  • Sudden onset, unilateral decreased visual acuity
  • Change in visual fields (“curtain being pulled down”)
    • New onset light flashes, floaters, wavy visual field
  • NOT red or painful
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12
Q

Retinal detachment treatment

A
  • Special surgery performed by ophthalmologist
  • No pressure should be put on eyeball
  • No vigorous physical activity
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13
Q

Ocular injury clinical presentation

A
  • Pain/discomfort
  • Decreased visual acuity and/or visual field alteration in affected eye
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14
Q

Ocular injury treatment

A
  • Immediate referral to ophthalmologist or ED for evaluation
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15
Q

What is primary open angle glaucoma (POAG)?

A

Elevated IOP caused by abnormal drainage of aqueous humor through the trabecular meshwork

  • Slowly progressive peripheral vision loss
  • “Silent thief of vision”
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16
Q

Primary open angle glaucoma clinical presentation

A
  • “Glaucomatous cupping” on fundoycopic exam (cup-to-disk ratio >0.3)
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17
Q

What are the three Ps of primary open angle glaucoma (POAG)?

A
  • Preventable
    • Risk factors: AA, DM, family history, history of eye trauma, advanced age
  • Painless
  • Permanent (peripheral vision loss is irreversible)
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18
Q

Primary open angle glaucoma treatment

A
  • Reduce production of intraocular fluid (beta adrenergic antagonists, alpha-2 agonist, carbonic anhydrase inhibitor)
  • Increase fluid outflow (prostaglandin analogues, biotic or cholinergic agents)
  • Surgical interventions by specialist
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19
Q

Three eyelid disorders

A
  • Hordeolum
  • Chalazion
  • Blepharitis
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20
Q

What is a hordeolum?

A

Forms as a result of a staph infection of the eyelid hair follicle with resulting focal abscess

  • Recurrent lesions common in presence of meibomian gland dysfunction
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21
Q

Hordeolum clinical presentation

A

Sudden onset warm, painful, swollen, red lump

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22
Q

Hordeolum and chalazion treatment

A

Warm compresses to area for 10 minutes or more, 4-5 times a day until clear

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23
Q

What is a chalazion?

A

Common eyelid condition that occasionally follows hordeolum

  • Eyelid sebaceous gland obstruction and inflammation
  • Without infection
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24
Q

Chalazion clinical presentation

A

Slowly developing, non tender, hard, localized eyelid swelling without redness or heat

  • Single lesion
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25
Q

What is blepharitis?

A

Inflammation and/or staph colonization of the meibomian glands at the base of each eyelash

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26
Q

Blepharitis clinical presentation

A
  • Has been present for a number of weeks to months prior to presentation
  • Lid redness, crusting, flaking
  • Mild burning, itching, grainy sensation
27
Q

Blepharitis treatment

A
  • Warm compresses multiple times/day
  • Gentle cleansing of lid margin with diluted baby shampoo
  • Application of topical antibiotic (bacitracin) to lid margin
28
Q

Otitis externa risk factors

A
  • History of recent ear canal trauma (vigorous use of cotton swab or other item to clean the canal)
  • Conditions in which moisture is held in ear canal (cerumen impaction, frequent swimming)
  • Freshwater aural exposure
29
Q

Otitis externa clinical presentation

A
  • If fungal → itch, thick and white ear discharge
  • Ear pain with tragus palpation or application of traction to pinna
    • Progressing over 1-2 days
  • Purulent or serous, foul smelling discharge
30
Q

Otitis externa (swimmer’s ear) treatment options

A
  • Ciprofloxacin otic drops with hydrocortisone
    • Addition of corticosteroid results in faster resolution of symptoms
  • Use ear wick with ear edema (left in place for 2-3 days)
  • Drops containing neomycin and amino glycoside should not be used if tympanic membrane rupture is present or suspected
  • To prevent reinfection, ear drops of 1:2 mixture of white vinegar and rubbing alcohol after swimming
  • NSAIDs or acetaminophen for pain management
31
Q

What is a complication of otitis externa?

A

Malignant or necrotizing OE - occurs in OE when patient is immunocompromised

  • Infection invades deeper soft tissue → osteomyelitis occurs of temporal bone
  • Imaging → CT and MRI
  • Treatment → surgical debridement, parenteral antimicrobial therapy
32
Q

What causes acute otitis media in teens and adults?

A

Eustachian tube dysfunction allowing negative pressure to be generated in middle ear → enables pharyngeal pathogens to be aspirated into middle ear

  • Eustachian tube dysfunction caused by viral URI or untreated allergic rhinitis
33
Q

Acute otitis media clinical presentation

A
  • Tympanic membrane erythema
  • Loss of tympanic membrane mobility
  • Visible bony landmarks
  • Ear pain
34
Q

Acute otitis media treatment

A

Adult AOM treated with antimicrobials (pediatrics “watch and wait”)

  • Standard dose oral amoxicillin if no prior antibiotic used within the last month
  • If recent antibiotic use → high dose amoxicillin, amoxicillin-clavulanate, cephalosporins for 5-7 days
  • Ibuprofen or acetaminophen for pain relief
35
Q

What is Menieres disease?

A

Inner ear disorder that causes episodes of vertigo

  • Believed to result from idiopathic endolymphatic hydrops (condition of increased hydraulic pressure within inner ear)
36
Q

Meniere’s disease clinical presentation

A
  • Onset: early to middle adulthood with peak incidence in 40-60s
  • Fluctuating hearing loss
  • Low tone tinnitus
  • Ear pressure
  • Episodic vertigo (aural fullness)
37
Q

Meniere’s disease diagnosis

A
  • Nystagmus (rhythmic oscillations of eyes)
  • Slow movement toward one side (affected side)
  • Rapid correction to midline
38
Q

Meniere’s disease diagnostic tests and maneuvers

A
  • Weber test lateralizes to unaffected ear
  • Rinne test is normal (air exceeds bone conduction)
  • Positive romberg test
  • Performing pneumatic otoscopy in affected ear elicits nystagmus
  • May have positive Dix-Hallpike test coexisting BPPV
39
Q

Meniere’s disease treatment

A
  • Antihistamines or antiemetics
  • Benzodiazepines (do not treat underlying condition)
  • Thiazide diuretics (do not help after attack is triggered)
  • Systemic corticosteroids
40
Q

What causes anterior epistaxis (nosebleed)?

A

Localized nasal mucosa dryness during winter months and trauma

41
Q

Allergic rhinitis symptoms

A
  • Sneezing
  • Pharyngeal and ocular itch
  • Nasal congestion
  • Rhinorrhea
  • Postnasal drip
42
Q

Treatment options for patients with symptom complaints (allergic rhinitis)

  • Nasal congestion is dominant complaint
A
  • Intranasal corticosteroid
  • Oral decongestant (sudafed)
43
Q

Treatment options for patients with symptom complaints (allergic rhinitis)

  • Intermittent sneezing, nasal itching, and rhinorrhea
A
  • Oral antihistamine
  • Intranasal antihistamine (astelin)
44
Q

Allergic rhinitis treatment options for mild vs moderate/severe symptoms

A

Mild → oral antihistamine

Moderate/severe → intranasal corticosteroid, intranasal antihistamine, combination therapy

45
Q

Antibiotic classes that is associated with the highest rates of antibiotic allergy

A

Beta lactams → pencillins, cephalosporins

  • IgE mediated type I reaction
    • Rapid onset maculopapular skin eruption
    • Urticaria
    • Pruritus
    • Cough and bronchospasm
    • CV compromise (tachycardia, hypotension)
46
Q

What is acute bacterial rhinosinusitis?

A

Inflammation of the lining of the membranes of the paranasal sinuses caused by bacterial infection

47
Q

Acute bacterial sinusitis diagnostic criteria

A

Presents with URI-like symptoms with persistent or worsening symptoms for 10+ days who continue to have (viral infections improve after 5-10 days):

  • Maxillary/facial pain
  • Purulent nasal discharge

“Double sickening” → 3-4+ days of URI-like symptoms that gradually improve and then suddenly worsen

Severe illness (pain and fever) that occurs 3-4 days after onset of symptoms

48
Q

Acute bacterial sinusitis treatment (first line and second line therapy)

A

First line → amoxicillin-clavulanate

Second line (if allergic) → doxycycline

49
Q

What is the most common form of oral cancer? How does it present?

A

Squamous cell carcinoma (SCC)

  • Painless
  • Firm ulceration or raised lesion
    • Present for a number of months prior to presentation
  • Lymphadenopathy → immobile nodes >1 cm, non tender
50
Q

Oral cancer management considerations

A

Referral to otolaryngology or oral surgery

51
Q

What is acute bacterial pharyngitis?

A

Group A beta-hemolytic streptococcus (GABHS) - aka strep throat

  • Common in school aged children
52
Q

Acute bacterial pharyngitis clinical presentation

A
  • Sore throat
  • Fever
  • Large, beefy tonsils with white exudate
  • Pharyngeal erythema
  • Palatal petechiae
  • Bilateral anterior cervical lymphadenopathy
53
Q

What is scarlet fever?

A

Associated with bacterial pharyngitis (usually on second day of illness)

  • Scarlatiniform rash
  • Fine sandpaper-like texture
  • No pruritus
  • Starts on trunk and spreads widely (sparing palms and soles)
54
Q

Acute bacterial pharyngitis (strep throat) and scarlet fever treatment

A
  • PCN formulations (if PCN allergy without immediate reaction, oral cephalosporin; if PCN allergy with immediate reaction, azithromycin or clindamycin)
    • Consider c. diff when prescribing clindamycin
  • Salt water gargles, throat lozenges, analgesics (ibuprofen, acetaminophen)
55
Q

True/false: Patients with bacterial pharyngitis are no longer contagious within 24 hours of starting antimicrobial therapy and when without fever

A

True

56
Q

Three complications that can occur with acute bacterial pharyngitis (strep throat)

A
  • Peritonsillar abscess
  • Acute glomerulonephritis
  • Rheumatic fever
57
Q

Peritonsillar abscess clinical presentation

A
  • Progressively worsening sore throat
  • Unilateral
  • Trismus
  • Drooling
  • Muffled, “hot potato” voice
  • Erythematous, swollen tonsils with contralateral uvular deviation
  • Cervical lymphadenopathy
57
Q

Peritonsillar abscess clinical presentation

A
  • Progressively worsening sore throat
  • Unilateral
  • Trismus
  • Drooling
  • Muffled, “hot potato” voice
  • Erythematous, swollen tonsils with contralateral uvular deviation
  • Cervical lymphadenopathy
58
Q

Peritonsillar abscess management

A
  • Prompt US or CT of affected region
  • Referral to ED and speciality ENT
59
Q

What is infectious mononucleosis?

A

Acute systemic viral illness caused by EBV (DNA herpes virus) that enters the body via oropharyngeal secretions

  • Affects B lymphocytes
60
Q

Infectious mononucleosis clinical presentation

A
  • 3-5 day prodrome → headache, malaise, myalgia, anorexia
  • Acute symptoms (last 5-15 days) → fatigue, exudative pharyngitis, tonsillar enlargement, fever, headache
    • Anterior and posterior cervical lymphadenopathy, splenomegaly and hepatomegaly
61
Q

Infectious mononucleosis diagnostic testing

A

Heterophile antibody test (monospot)

  • Positivity increases during the first six weeks of illness
62
Q

Infectious mononucleosis treatment and management

A

Supportive therapy or

  • Systemic corticosteroids (prednisone) to treat pharyngeal obstruction
  • Avoid amoxicillin or ampicillin → can cause rash (thought to be result of altered immune system during infection)
63
Q

Infectious mononucleosis important patient education considerations

A
  • Avoid collision or contact spots for at least one month to avoid splenic rupture
  • Consider US examination before clearing for sports

FNP boards (20 decks)

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