FNP-ENT Flashcards
Herpes Keratitis
Symptoms, causes, treatment, complication(s).
- 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
Acute Angle-Closure Glaucoma:
Symptoms, signs, tx/disposition
- Symptoms: acute onset severe eye pain, headache, n/v, halos around lights, decreased vision.
- Signs: mid-dialted OVAL-SHAPED pupil
- Refer to ED
Multiple Sclerosis-Eyes
Symptoms, disposition
- 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
Orbital cellulitis
S/S, causes, disposition
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
Retinal Detachment
Symptoms, disposition
- 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
Cholesteatoma
S/S, tx, disposition
- 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
Battle Sign
What is it?
What do you do?
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
CSF fluid from skull
panic or chill?
how to test.
- 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)
Peritonsillar Abscess
S/S, dispostion
- 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
Diptheria
S/S, dispostion
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
Presbyopia
- Normal finding, age related
- decreased ability to read small print
- d/t stiffening of the lenses
- usual onset around 40 y.o.
How many sinuses are there?
- 4 in adults
- ethmoid, maxillary, frontal, sphenoid
- Children have ethmoid and maxillary at birth, frontal by 5 yo and sphenoid by 12 yo
Leukoplakia
- 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
Diabetic Retinopathy
signs
- cotton wool spots
- microaneuryms
Cataracts
S/S
- Symptoms: complain of glare, halos aroud lights, blurred vision
- OPACITY of the lens
- up to 20% of adults are affected (65-74)
Allergic Rhinitis
s/s
- Blue-tinged or pale and swollen (boggy) nasal turnbinates
- Clear nasal discharge
- itchy nose
- congestion
Koplik’s Spots
describe. indicative of what?
- clusters of sm. red papules with wht. centers inside the buccal mucosa (inside the cheeks) near the lower molars.
- Measels (!)
Hairy Leukoplakia
describe, cause, indicative of?
- version of leukoplakia
- elongated papilla on lateral aspects of the tongue
- difficult to remove
- EBV infxn
- Consider HIV infxn
Cheilosis
(Angular Cheilitis, Perleche)
describe, causes, etiology, tx
- 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
Visual Test Results:
What does it mean when someone has 20/60 vision?
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)
What are the cones in the eye responsible for?
- Color (COnes=COlor)
- 20/20 vision
- sharp vision
What are rods in the eye responsible for?
- Detecting light and shadow
- night vision
What are some characteristics of the fundus of the eye?
- Veins are larger than arteries
- Veins appear darker in color than arteries
What are the macula and fovea resposible for?
Macula
- responsible for central vision
Fovea
- set in the middle of the macula
- responsiblew for sharp, 20/20 vision
- contains a large # of cones
What is a typanogram used for?
- 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)
Bluish, pale and/or boggy turbinates are often indicative of what?
Allergic rhinitis
Optic disc with blurred edges is called __________ and may be due to?
- Papilledema
- ICP (Intracranial pressure)
- secondary to bleeding, brain tumor, abscess, pseudomotor cerebi
Hypertensive retinopathy hallmarks
- copper and silver wire arterioles
- artereovenous nicking
- retinal hemorrhages
Diabetic retinopathy hallmarks
- microaneuryms
- neovscularization
- cotton wool spots
What causes arteriovenous nicking?
when an arteriole crosses a retinal vein, it indents the vein.
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: ___________.
- opacity
- 20%
- grey
- difficulty with glare, halos around lights, blurred vision
At what age should visual acuity be 20/20?
age 6
refer to opthalmology if it isn’t at least 20/30
A Rinne test measures ________ hearing loss. A normal finding is: ________. How is it performed?
What might cause an abnormal result?
- 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
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?
- 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)
- for sensorneural loss, lateralization to “good” ear
Corneal abrasion
s/s, testing
- 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
Hordeolum (stye)
s/s, cause, tx
- 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
Chalazion
s/s, cause, tx
- 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
Pinguecula
description, cause and treatment
- 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.
Pterygium (Surfer’s eye)
description, cause and treatment
- 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.
Subconjuctival hemorrhage
description, cause and treatment
- 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.
Open-Angle Glaucoma
description, cause and treatment
- 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
Angle-Closure Glaucoma
description, cause and treatment
- 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
Age-Related Macular Degeneration (AMD)
description, cause and treatment
- 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
Allergic Rhinitis
treatment
- 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.
Epistaxis (nosebleed)
Anterior vs. posterior
- 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
Hallmarks of Scarlet fever (Scarletina)
- Sand-paper textured pink rash.
- strawberry tongue (red, sore)
Complications of strep throat
- scarletina
- Acute rheumatic fever
- Peritonsillar abscess
- Poststreptoccal glomerulonephritis
Acute otitis media (AOM; Purlulent or suppurative otitis media)
S/S, cause, treatment
- 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
Bullous Myringitis
what is it? treatment
- type of AOM
- more painful d/t to presence of blisters on tm
- Caused by mycoplasma, virus, bacteria
- Treat the same as AOM
Sinus Infection (Acute Bacterial Rhinosinusitis (ABRS)
s/s, cause, tx
- 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
Otitis Externa
(Swimmer’s Ear)
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.
Infectious Mononucleosis
(EVB infection)
s/s, cause, tx
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)
- limit physical activoty (contact sports esp.) for 4 weeks (splenic rupture risk)
