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FNP-ENT Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

Herpes Keratitis

Symptoms, causes, treatment, complication(s).

A
  • severe eye pain, photophobia, blurred vision in one eye. May have crusty rashes on ophthalmic branch (CN V, trigeminal)
  • use fluorescein dye to dx FERN-LIKE lines on corneal surface
  • Causes: herpes simplex or herpes zoster (shingles)
  • Refer to ED
  • Complication: corneal blindness
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2
Q

Acute Angle-Closure Glaucoma:

Symptoms, signs, tx/disposition

A
  • Symptoms: acute onset severe eye pain, headache, n/v, halos around lights, decreased vision.
  • Signs: mid-dialted OVAL-SHAPED pupil
  • Refer to ED
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3
Q

Multiple Sclerosis-Eyes

Symptoms, disposition

A
  • young female
  • Symptoms: new or intermittent loss of vision in one eye, nystagmus, (neuro symptoms: aphasia, paresthesia, ab. gait, spasticity, etc.). Dai;y fatigue upon awakening, worsening. Heat increases symptoms
  • Refer to neuro
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4
Q

Orbital cellulitis

S/S, causes, disposition

A

More common in young children than adults. Hx recent rhinosinusitis or URI.

  • Symptoms: acute onset erthymatous, swollen eyelid with poptosis (bulging eye), eye pain, limited ROM
  • Cause: acute bact. infxn of orbital contents
  • Refer to ED
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5
Q

Retinal Detachment

Symptoms, disposition

A
  • Sudden onset of shower of floaters, “feeling like you’re looking through a CURTAIN or UNDER WATER”, sudden flashes of light (photopsia)
  • Refer to ED
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6
Q

Cholesteatoma

S/S, tx, disposition

A
  • CAULIFLOWER-like growth
  • foul-smelling ear discharge
  • hearing loss
  • unable to visualiz tm, d/t destruction by tumor (not cancerous)
  • Tx: abx and surgical debridment
  • Refer to otolaryngoloist
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7
Q

Battle Sign

What is it?

What do you do?

A

Could be a sign of skull fracture.

  • “RACCOON EYES” (periorbital ecchymosis)
    • with brusing behind ear (mastoid area)
    • appears 2-3 days post trauma
  • Look for clear, golden fluid (CSF)
  • Refer to ED
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8
Q

CSF fluid from skull

panic or chill?

how to test.

A
  • Panic (but don’t actually). Indicative of basiliar skull fracture.
  • Refer to ED
  • test with urine dipstick to check for glucose (mucropurulent fluid will be negative)
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9
Q

Peritonsillar Abscess

S/S, dispostion

A
  • Symptoms: severe sore throat, pain on swallowing (odynophagia), trismus (muscale spasm in jaw), HOT POTATO voice
  • Signs: UNILATERAL swelling of peritonsillar area and soft palate, bulging red mass, UVULA DISPLACED away from mass, fever.
  • Refer to ED
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10
Q

Diptheria

S/S, dispostion

A

Notes: very contagious. Contact precautions

  • Symptoms: sore throat, fever, BULL NECK
  • Signs: post. pharynx, uvula, and soft palate are coated with GRAY to YELLOW PSEUDOMEMBRANE that is difficult to displace
  • Refer to ED
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11
Q

Presbyopia

A
  • Normal finding, age related
  • decreased ability to read small print
  • d/t stiffening of the lenses
  • usual onset around 40 y.o.
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12
Q

How many sinuses are there?

A
  • 4 in adults
    • ethmoid, maxillary, frontal, sphenoid
  • Children have ethmoid and maxillary at birth, frontal by 5 yo and sphenoid by 12 yo
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13
Q

Leukoplakia

A
  • White to light-grey patch (plaque) on tongue or inside of cheek.
  • caused by chronic irritation, r/o CA
  • risk factors=smoking, chewing tabacco, EtOH use
  • Consider hairy leukoplakia if on lat. aspect of tongue
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14
Q

Diabetic Retinopathy

signs

A
  • cotton wool spots
  • microaneuryms
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15
Q

Cataracts

S/S

A
  • Symptoms: complain of glare, halos aroud lights, blurred vision
  • OPACITY of the lens
  • up to 20% of adults are affected (65-74)
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16
Q

Allergic Rhinitis

s/s

A
  • Blue-tinged or pale and swollen (boggy) nasal turnbinates
  • Clear nasal discharge
  • itchy nose
  • congestion
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17
Q

Koplik’s Spots

describe. indicative of what?

A
  • clusters of sm. red papules with wht. centers inside the buccal mucosa (inside the cheeks) near the lower molars.
  • Measels (!)
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18
Q

Hairy Leukoplakia

describe, cause, indicative of?

A
  • version of leukoplakia
  • elongated papilla on lateral aspects of the tongue
  • difficult to remove
  • EBV infxn
  • Consider HIV infxn
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19
Q

Cheilosis

(Angular Cheilitis, Perleche)

describe, causes, etiology, tx

A
  • painful skin fissures at CORNER of mouth
  • Causes: excessive moisture, Candida albicans, Staph. aureus
  • mult. etiologies: dentures, pacifier use, oversalvation, lupius, autoimmune…
  • tx: remove underlying cause
    • if yeast infx topical azole
    • is staph, culture/spec. mupiricin BID
  • Prevent with petroleum jelly or zinc barrier cream
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20
Q

Visual Test Results:

What does it mean when someone has 20/60 vision?

A

They have to be 20 ft away from an object in order to see it, compared to a person with 20/20 (perfect vision) who can see the same item from 60 ft away.

  • (always use 20 as the first number)
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21
Q

What are the cones in the eye responsible for?

A
  • Color (COnes=COlor)
  • 20/20 vision
  • sharp vision
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22
Q

What are rods in the eye responsible for?

A
  • Detecting light and shadow
  • night vision
23
Q

What are some characteristics of the fundus of the eye?

A
  • Veins are larger than arteries
  • Veins appear darker in color than arteries
24
Q

What are the macula and fovea resposible for?

A

Macula

  • responsible for central vision

Fovea

  • set in the middle of the macula
  • responsiblew for sharp, 20/20 vision
  • contains a large # of cones
25
Q

What is a typanogram used for?

A
  • Most objective measure to test for fluid in the middle ear
  • Acute otitis media and serious otitis media will show a straight line upon testing (as opposed to a peaked shape)
26
Q

Bluish, pale and/or boggy turbinates are often indicative of what?

A

Allergic rhinitis

27
Q

Optic disc with blurred edges is called __________ and may be due to?

A
  • Papilledema
  • ICP (Intracranial pressure)
    • secondary to bleeding, brain tumor, abscess, pseudomotor cerebi
28
Q

Hypertensive retinopathy hallmarks

A
  • copper and silver wire arterioles
  • artereovenous nicking
  • retinal hemorrhages
29
Q

Diabetic retinopathy hallmarks

A
  • microaneuryms
  • neovscularization
  • cotton wool spots
30
Q

What causes arteriovenous nicking?

A

when an arteriole crosses a retinal vein, it indents the vein.

31
Q

Cataracts are an ________ of the lens of the eye. They affect up to ____% of older adults, but children can get them. The red light reflex test shows reflects _______ when cataracts are present. Symptoms include: ___________.

A
  • opacity
  • 20%
  • grey
  • difficulty with glare, halos around lights, blurred vision
32
Q

At what age should visual acuity be 20/20?

A

age 6

refer to opthalmology if it isn’t at least 20/30

33
Q

A Rinne test measures ________ hearing loss. A normal finding is: ________. How is it performed?

What might cause an abnormal result?

A
  • conductive
  • Air conduction lasts longer than bone conduction (AC>BC)
  • Palce a tuning fork 1st on mastoid process, then at the front of the ear. Time each area.
  • Otitis media, serous otitis media, cerumenosis, perforation of tm
34
Q

A Weber test measures ________ hearing loss. A normal finding is: ________. How is it performed?

What is considered an abnormal result and what might cause it?

A
  • sensorineural and conductive
  • no lateralization (sound heard equally in both ears)
  • Tuning fork is placed midline on forehead
  • Lateralization
    • for sensorneural loss, lateralization to “good” ear
      • damage to CVIII (acoustic nerve), aging, presbycusis, Ménère’s dz, otoxic drugs and stroke
    • for conduction loss, lat. to “bad” ear
      • Otitis media, serous otitis media, cerumenosis, perforation of tm (basically obstruction of sound waves)
35
Q

Corneal abrasion

s/s, testing

A
  • acute onset of severe eye pain with tearing
  • reports feeling of a FOREIGN BODY
  • use fluorescein dye with Wood’s lamp
    • abrasions appear round or linear
36
Q

Hordeolum (stye)

s/s, cause, tx

A
  • acute onset of swollen, red, warm abscess on upper or lower eyelid
  • Cause:
    • external-abscess of hair follicle and sebaceous glad
    • internal-inflammation of the meibomian gland
  • treatment:
    • hot compresses x5-10 mins, BID-TID until it drains
    • if infnx spreads to cellulitis-systemic abx
      • dicloxacillian or erythromycin PO QID
37
Q

Chalazion

s/s, cause, tx

A
  • gradual onset of small, superficial nodule opn upper eyelid that feels like a bead. Discrete and movable. Painless.
  • chronic inflammation of the meibomian gland.
  • treatment=I&D, steroid injection
    • refer to opthalmo
38
Q

Pinguecula

description, cause and treatment

A
  • raised yellow to white small, round growth in the bulbar conjunctiva (membrane covering eyeball)
  • located on nasal and temporal side of the eye
  • Cause: Chronic sun exposure
  • Treatment:
    • if inflammed, refer to optho
    • artificial tears PRN for irritiation
    • recommend sunglasses (100% for UVA and UVB)
    • remove surgically if encroaching cornea and affect vision.
39
Q

Pterygium (Surfer’s eye)

description, cause and treatment

A
  • yellow, trianglur thickening of the conjunctiva that extends across the cornea on the nasal side.
  • may be red or inflammed
  • Cause: Chronic sun exposure
  • Treatment:
    • if inflammed, refer to optho
    • artificial tears PRN for irritiation
    • recommend sunglasses (100% for UVA and UVB)
  • remove surgically if encroaching cornea and affect vision.
40
Q

Subconjuctival hemorrhage

description, cause and treatment

A
  • sudden on-set of bright red blood in one eye, denies pain, loss of vision.
  • blood that is trapped under the conjuctiva and sclera 2o to broken arterioles.
    • d/t seere coughing, sneezing or straining, or trauma such as a fall.
  • Watchful waiting and reassurance.
41
Q

Open-Angle Glaucoma

description, cause and treatment

A
  • gradual increase of IOP greater than 22 mmHg.
  • Cause:
    • blockage of the drainage of the aqueous humor in the eye.
  • Treatment:
    • check IOP with tonometer. Nornal range is 8-21mmHg
    • >30mmHg is very high
    • Refer to ED or opthalmo
    • meds: Betimol (beta blocker)
      • Latanoprost
42
Q

Angle-Closure Glaucoma

description, cause and treatment

A
  • Acute onset of decreased/blurred vision, severe eye pain, and frontal HA with n/v
  • Eyes are mid-dilated with cloudy pupil, pupil reacts slowly to light
  • SUDDDEN blockage of aqueous humor
  • Treatment: Refer to ED
43
Q

Age-Related Macular Degeneration (AMD)

description, cause and treatment

A
  • sudden or gradual loss of CENTRAL vision in one or both eyes
  • straight lines (like doors, windows) appear curved or distorted.
  • Peripheral vision is usually fine
  • Refer to opthalmo
44
Q

Allergic Rhinitis

treatment

A
  • 1st line: topical nasal sprays
    • OTC steroid sprays (flonase, nasacort allergy) BID
    • antihistamine nasal spray (Astelin) daily-BID
  • decongestants PRN
  • oral antihistamines (cetirizine (Zyrtec), loratadine (Claritin) PO, daily or PRN). Benadryl-careful of sedation
  • environemental control-HEPA filter, no stuffed animals in bed, etc.
45
Q

Epistaxis (nosebleed)

Anterior vs. posterior

A
  • Anterior:
    • milder, more common
    • self-limiting
    • result of bleeding from Kiesselbach’s plexus
    • treat with pressure and econgestant (Afrin) to shrink tissue.
  • Posterior:
    • may lead to hemorrhage
    • refer to ED
    • higher risk caused by blood thinners, cocaine use, severe HTN
46
Q

Hallmarks of Scarlet fever (Scarletina)

A
  • Sand-paper textured pink rash.
  • strawberry tongue (red, sore)
47
Q

Complications of strep throat

A
  • scarletina
  • Acute rheumatic fever
  • Peritonsillar abscess
  • Poststreptoccal glomerulonephritis
48
Q

Acute otitis media (AOM; Purlulent or suppurative otitis media)

S/S, cause, treatment

A
  • ear pain (otolagia), popping noises, muffled noises
  • Recent hx of URI or allergic rhinitis flare up
  • usually uni-lateral
  • most have MEE (middle ear effusion)
    • MEEs may last up to 8 weeks post tx!
  • afebrile or low-grade fever
  • conductive hearing loss
    • Weber=lateralization to “bad” ear
    • Rinne=BC>AC
  • TM=bulging, may look opaque, displaced light reflex, etythmatous, decreased mobility

Cause:

  • bacteria that is trapped in the middle ear
  • ususally S. pneumoniae in adults

Treatments: (usually respond in 48-72 hours)

  • 1st line=amox. 500mg, TID, x5-7 days. Severe=10 days
  • 2nd line=Augmentin TID, Cefdinir or levofloxacin
49
Q

Bullous Myringitis

what is it? treatment

A
  • type of AOM
  • more painful d/t to presence of blisters on tm
  • Caused by mycoplasma, virus, bacteria
  • Treat the same as AOM
50
Q

Sinus Infection (Acute Bacterial Rhinosinusitis (ABRS)

s/s, cause, tx

A
  • Unilateral facial pain, upper molar pain, with nasal congestion for >10 days.
  • Post. pharynx shows purulent piost nasal drip
  • Sinuses are tender to palpation over maxillary or frontal
  • fever more common in children
  • transillumination=glow is duller or absent on affected side
  • Fluid trapped in the sinus causing 2o bacterial infxn (S. pneumoniae, H. influenzae
  • Treatment: (abx if severe symptoms i.e., toxic, high fever, pain, >10 days. If < 10 days, treat symptoms.)
    • first line=Augmentin (1000/62.5mg or 2000/125mg), BID, x5-7 days
    • PCN allergy=Levofloxacin or doxycyclin
51
Q

Otitis Externa

(Swimmer’s Ear)

A

Common bact. pathogen=P. aeruginosa

  • complaints of external ear pain, swelling, discharge, hearing loss, hx or recent activities, swimming, ears getting wet.
  • Pain elicited upon manipulaitonof tragus or external ear.
  • Purulent discharge, erythematous, and swollen ear canal.
  • Tx= cortisporin otic drops QID, x4 days. Ofloxacin or ciprofloxacin drops BID, x7 days.
52
Q

Infectious Mononucleosis

(EVB infection)

s/s, cause, tx

A

peak ages= 15-24 years old

may be re-activated and cause symptoms again

Classic Triad: fever, pharyngitis, lymphadenopathy

  • in addition to above, extreme fatigue, may have abd. pain d/t to hetpatomegaly or splenomegaly.
  • CBC, increased lymphocytes >50%, LFTs abn for 80% for several weeks
  • large post. cervical nodes, tender to palpation
  • erythematous pharynx
  • inflammed tonsils, sometimes with exudate
  • may have maculopapular rash
  • Treatment:
    • limit physical activoty (contact sports esp.) for 4 weeks (splenic rupture risk)
      • US if spelomegaly is present or athlete, and again 4-6 weeks later to document resolution
    • treat symptoms
    • education:avoid kissing, sharing utensils, toothbrushes (gross) and drinks/glassware.
    • AVOID using amoxicillin (drug rash may occur)
53
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