Midterm

Question 1

Taking a client history (OLDCARTS)

Answer 1

Assesses the client’s HPI
Onset
Location
Duration
Characteristics
Aggravating factors
Relieving factors
Treatments
Severity/symptoms

Question 2

What is needed to make a sound clinical decision?

Answer 2

Evidence-based research
Clinical practice guidelines
Published evidence-based algorithms

Question 3

Specificity of a diagnostic study

Answer 3

High specificity: a high percentage of healthy individuals will show a normal result

Low specificity: getting a positive result when it is not present; a high number of false positives; meaning a healthy person has a disease when they actually do not

If a diagnostic study has high specificity, then a high percentage of healthy individuals will show a normal result

Question 4

Sensitivity of a diagnostic study

Answer 4

Sensitivity: the proportion of true positives out of all patients with designated condition

Highly sensitive tests will lead to positive findings for patients with disease

Question 5

Reimbursement: Traditional Medicare

Answer 5

How clients cover their out-of-pocket expenses when on traditional Medicare
Typically, the client will obtain a secondary insurance plan to cover the 20% client out-of-pocket expenses
Part A: Inpatient hospital stay; Skilled nursing care; Hospice; Home care
Part B: Outpatient services; Provider visits; Surgery; Lab tests; Medical equipment; Preventative exams
Part C: Wellness services; Vision exams; Hearing exams; Eye glasses; Hearing aids
Part D: Prescription drugs

Question 6

Reimbursement of NPs

Answer 6

NPs are reimbursed at 85% of the physician’s fee

Question 7

Reimbursement: Medicare Advantage Plans

Answer 7

Advantage plans offer all of the benefits of Medicare

Usually offers additional benefits and lower co-payments

Medicare Advantage carriers are paid subsidies per member for services rendered by Centers for Medicare and Medicaid Services (CMS)
These carriers offer traditional CMS services in addition to other health services at a lower cost

Question 8

Reimbursement: Third Party Payer

Answer 8

Third-party payers fall into 7 general categories:
Medicare
Medicaid
Indemnity insurance companies
Managed care organization
Worker’s compensation
Veteran’s Administration
Auto liability

Question 9

Third Party Payer

Answer 9

A third-party payer is anentity that pays medical claims on behalf of the insured individual. Examples of third-party payers include government agencies, insurance companies, health maintenance organizations (HMOs), and employers. Deeper definition Third-party payers pay for covered insurance expenses for an insurance recipient or a designated beneficiary.

Question 10

Fungal Skin Infections

Answer 10

Assess: papular rash, satellite lesions
Diagnose: based on presentation; common type: candida albicans
Treat: antifungal cream, pill; keep area as dry as possible; favors moisture, warmth and poor air circulation (consider the location of the rash
Who is at risk? Can be opportunistic (immunocompromised patients); look at patient’s age; older, younger (could be diaper rash); diabetics, antibiotic therapy; conditions that alter cellular immunity, such as AIDS, diabetes mellitus, corticosteroid treatment, bone marrow transplant, chemotherapy, invasive parenteral catheterization and invasive monitoring devices in intensive care units.
What is the risk of it developing into something else? Not likely
Do I need to refer the patient? Only if no improvement

Question 11

Common Types of Fungal Infections-Consider appearance and distribution

Tinia vesicolor

Answer 11

Assess: Flat to slightly elevated brown papules and plaques that scale when they are rubbed along with areas of hypopigmentation; pruritic; most commonly found on trunk and shoulders

Tinia infections are classified by location on the body

Question 12

Common Types of Fungal Infections-Consider appearance and distribution

Balantis

Answer 12

Candidiasis in the glans of the penis

Question 13

Common Types of Fungal Infections-Consider appearance and distribution

Tinia corporis

Answer 13

Annual lesions with scaly borders and central clearing on the trunk; has ring-shaped lesions (ring worm) with scaly borders and central clearing or scaly patches with distinct borders on exposed skin surfaces or on the trunk.

Tinia infections are classified by location on the body

Question 14

Common Types of Fungal Infections-Consider appearance and distribution

Tinia pedis

Answer 14

Athlete’s foot-feet and between toes

Tinia infections are classified by location on the body

Question 15

Common Types of Fungal Infections-Consider appearance and distribution

Tinia cruis

Answer 15

Jock itch - groin

Tinia infections are classified by the location on the body

Question 16

Onychomycosis-Fungal Infection of Nail Bed

Answer 16

Tinea unguium
White or yellow nail discoloration, thickening of the nail, and separation of the nail from the nail bed. Toenails or fingernails may be affected, but it is more common for toenails
Treatment: Topical antifungals such as nystatin (Nyamyc, Pedi-Dri, Nystop; effective for Candida only), clotrimazole (Lotrimin), miconazole (Monistat-Derm), naftifine (Naftin), terbinafine (Lamisil), and ciclopirox (Loprox) are effective in treating onychomycosis.

Question 17

Dry Skin

Answer 17

Who is at-risk? Older adults
Teachable moment: Encourage the use of tepid water and a mild cleansing cream or soap.

Question 18

Bacterial Skin Infections: Warm, Red, Painful without sharply demarcated border

Cellulitis & Folliculitis

Answer 18

Cellulitis: is a spreading infection of the epidermis and subcutaneous tissue that usually begins after a break in the skin

Folliculitis: bacterial infection of the hair follicle; papules are characteristic of folliculitis

Question 19

Bacterial Skin Infections: Warm, Red, Painful without sharply demarcated border

Impetigo

Answer 19

Impetigo: highly contagious bacterial skin infection and most commonly affects young children, although anyone can get it if infected; non-pharmacologic management involves the use of solutions or substances to debride the lesions and to expose the skin surfaces where the bacteria are present.

Both bullous and nonbullous types of impetigo produce symptoms such as burning and pruritus. In addition, regional lymphadenopathy is seen. When the face is involved, the cervical lymph nodes (and sometimes the preauricular and submandibular nodes) are enlarged; when the lesions are present on the upper extremities, the axillary nodes become enlarged.

Question 20

Epidermal Inclusion Cyst

Answer 20

The client with an epidermal inclusion cyst will report a history of the cyst on the same site for months to years. In contrast, furuncles are an acute process, taking only several days to form. Another characteristic of an epidermal inclusion cyst is a cheesy white discharge with a strong odor when it is expressed.

Question 21

Skin Inflammations: Urticaria

Answer 21

Hives: Look at the location of the rash; the first step is to determine the need for epinephrine; Look for respiratory symptoms, difficulty breathing, hoarseness; look at location of rash; is it on the neck, around the face, etc.; if it is, epinephrine must be administered.
Sometimes all choices may seem correct; in that case, the question is prompting you to prioritize your NP actions. Look for what should be done first.
Cholinergic urticaria: Cholinergic urticaria are hives or wheals that are pruritic and occur on the trunk and arms following exercise, anxiety, elevated body temperature, hot baths and showers.
Treated with antihistamines
History taking is important in determining rash development

Question 22

Skin Inflammations: Atopic Dermatitis

Answer 22

Is a long-term type of inflammation of the skin. It results in itchy, red, swollen, and cracked skin.
is characterized by an extremely low threshold for pruritus and has been referred to as “the itch that rashes.” Almost always, the itch occurs before the rash appears, and scratching the rash worsens it clinically.
The cardinal sign of atopic dermatitis is severe pruritus.
In children, the primary locations are the antecubital fossae and popliteal fossae.

Question 23

Viral Skin Infection: Herpes Simplex

Answer 23

May have no symptoms but can still be infected. Common symptoms include:
Blistering sores - either oral or genital
Itching
Pain during urination - in case of genital herpes
Fever
Headache
Tiredness
Lack of appetite

Immunocompromised clients are treated with Famciclovir (Famvir) or Valacyclovir (Valtrex) (Remember the goal of treatment is to suppress)

Question 24

Viral Skin Infection: Herpes Zoster

Answer 24

Caused by varicella-zoster characterized by painful rash with blisters.

Herpes zoster is characterized by a unilateral vesicular rash along a dermatome, most commonly a thoracic or lumbar dermatome. The rash begins as erythema, then changes to papular lesions that rapidly form vesicles. The vesicles rupture, releasing infectious fluid, and then form scabs.

Question 25

Acne

Answer 25

Results from clogged or plugged hair follicles present under the skin.
Small to large, red bumps on the skin which may be painful and pus-filled in some cases.
Benzoyl peroxide (Benzac) is first-line treatment for acne
Good candidates for oral antibiotic treatment include those at risk for pigmentation changes or scarring, nodulocystic acne and those who want quick relief from inflammatory acne.
Teaching: Sunscreen should be used with all acne medications.
Other key information includes washing the face gently at least twice a day with an antibacterial soap

Question 26

Rosacea

Answer 26

A common skin condition that causes blushing or flushing and visible blood vessels in the face
May also produce small, pus-filled bumps that flare-up for weeks-months and then subside
There is a familial tendency, and several genes have been identified. Neurovascular dysregulation, infection, and factors that trigger altered innate and adaptive immune response are involved (i.e., chronic sun exposure and damage, heat, drinking alcohol or hot beverages, hormonal fluctuations, Demodex folliculorum [mites] colonization, and mental stress and anxiety).
Metronidazole cream is the mainstay of therapy, but it may take up to 6 to 8 weeks for a therapeutic response to be seen
Clients should be taught to identify triggers, how to apply sunscreen and how to protect the face from cold air and wind.

Question 27

Seborrhea Keratosis

Answer 27

Lesions are superficial epithelial growths that originate from the horny layer of the epidermis and are the result of a benign proliferation of immature keratinocytes.
Who is at-risk? Although seborrheic keratosis occurs in both men and women, the typical client is an older white woman who complains of the cosmetic effects of the lesion. The client typically complains of the unsightliness of the lesion, itching, and constant irritation from friction or clothing.

Question 28

Seborrhea Keratosis

Answer 28

Inspection of the lesions may reveal dark keratin plugs or firm, horny cysts on their surface.
These are epidermal tumors, but they are not considered malignant or premalignant because they do not undergo transformation into cancerous lesions.
The differential diagnoses for seborrheic keratosis include benign pigmented nevi, pigmented basal cell carcinoma (BCC), and malignant melanoma

Question 29

Pre-Cancerous lesions: Actinic Keratosis

Answer 29

Assess:
Inspection: the question may provide a description of the rash; flesh colored, hard, sand-paper like
Diagnose: Based on presentation-Lesions are found on sun-exposed areas of skin that have been damaged by cumulative sun exposure.
Treat: most often cryotherapy
Who is at risk? Sun exposure
What is the risk of it developing into something else? Pre-cancerous lesion that can progress to a squamous cell carcinoma
Do I need to refer the patient? To dermatologist to help prevent its progression

Question 30

Malignant melanoma

Answer 30

Who is at-risk? Increased age, immunosuppression and exposure to indoor tanning are risk factors for malignant melanoma.

Is the most aggressive skin cancer; the thickness of the lesion impacts prognosis

Question 31

Lipoma

Answer 31

Is a benign rubbery, smooth and round mass of compressible tissue with soft texture

Benign tumors of fat, formed between the skin and the underlying muscle. Lipomas can grow anywhere in the body where fat cells are present. Most seen in neck, shoulders, armpits, and thigh.

Question 32

Scabies

Answer 32

An intensely itchy rash caused by a mite known as Sarcoptes scabie
Can last several days or weeks
Transmitted through direct contact
Clinical diagnosis of scabies is almost never made until hypersensitivity has occurred.
Differential diagnoses for scabies includes atopic dermatitis, contact dermatitis and folliculitis
Ivermectin (Stromectol) is the most common and best systemic treatment for scabies.

Question 33

Parasitic Skin Infection: Pediculosis

Answer 33

A hallmark of nits is that they are firmly cemented in place and, therefore, do not slide easily on the hair shaft, compared with dandruff scales. Sebaceous plugs result from plugged oil glands on the scalp and (unlike nits) do not originate on the hair shaft.

Patient education is essential when treating pediculosis:
itching may continue for up to a week after successful treatment because of the slow resolution of the inflammatory reaction caused by the lice infestation.

Question 34

Furuncle (Boil)

Answer 34

Painful red bumps under the skin due to infection of hair follicles or in oil glands. It starts as red, tender lump at the infection area and may grow to form pus-filled lumps.

If the furuncle or carbuncle is located on the axilla, a differential diagnosis to consider is hidradenitis suppurativa (A long-term skin condition characterised by painful bumps under the skin. It usually occurs in the armpits, groin, buttocks or breasts)

Question 35

Warts

Answer 35

Caused by the human papillomavirus; most warts recur despite treatment.

Abrading the skin can spread the virus; vigorous rubbing, shaving, and nail biting, can do the same

The major characteristic of filiform/digitate warts is that they are easily treatable but recur.

Question 36

Eye Disorders: Conjunctivitis-various causes-Viral or bacterial

Answer 36

The causative organism of viral conjunctivitis is adenovirus.

It can present with or without cold symptoms. Patients complaint of itchy, red eyes and may have clear to no discharge. Preauricular lymph node swelling and tenderness is hallmark for viral conjunctivitis.

Skin vesicles (if present) and a corneal infection with a “dendrite” appearance are hallmark characteristics of HSV-1 or HSV-2 conjunctivitis.

Question 37

Eye Disorders: Conjunctivitis-various causes-Viral or bacterial

Answer 37

It is important to teach the patient how to put drops in and advise to avoid touching the tip of the bottle to any conjunctival or skin surface. Women should be instructed to throw away all eye makeup products due to contamination and to start with new products when the infection clears. Likewise, disposable contact lens wearers will need to discard the contacts, refrain from wearing any during treatment, and start with a new pair when clinical symptoms resolve. Bacterial conjunctivitis is very contagious, so the patient should stay home from work or school until 24 hours of antibiotic treatment or as soon as clinical improvement (decreased redness and discharge) is noted.
See Table 19.1 for medications used to treat conjunctivitis

Question 38

Bacterial conjunctivitis

Answer 38

Red eye with crusted eye lid denotes bacterial conjunctivitis

The client’s visual acuity will be normal with bacterial conjunctivitis. The client will have watery and itching eyes and may have associated photophobia.

Table 19.1: Drugs commonly prescribed for conjunctivitis.

Question 39

Cataracts

Answer 39

Cataracts produce a gradual, painless, and progressive loss of vision, although many clients are unaware of any vision problems due to the gradual nature on onset.

No evidence that taking supplements such as vitamin E, Vitamin C and beta-carotene helps in the prevention and treatment of cataracts

Age-related cataracts tend to be bilateral in nature and may manifest as blurred or distorted vision, with complaints of a glare when driving at night or in bright light.

Question 40

Blepharitis

Answer 40

Blepharitis is an inflammation around the eyelid margins that is caused by staphylococcal infection at the lash base and dysfunctional Meiobian glands.

May be treated with Bacitracin 0.5% ointment

For resistant staphylococcal infections, discontinue the Bacitracin and order a quinolone antibacterial ointment or a sulfacetamide/corticosteroid combination that, like erythromycin, has been shown to be effective against Staphylococcus.

Question 41

Chalazion

Answer 41

A cyst or small lump or swelling which develops in the eyelid as a result of blockage in a gland. It is usually not painful.

A chalazion that persists for more than 4 weeks needs referral to an ophthalmologist for incision and drainage, biopsy, or local injection directly with glucocorticoids.

Question 42

Dry Eyes

Answer 42

History-taking is important for any eye complaint and should focus on current medications, any symptoms of fever, genital discharge, rash or joint pain; smoking history or second-hand smoke exposure

Dry eye commonly affects both eyes and is often described as “a feeling of sand in the eyes,” especially when blinking. The eyes feel hot, irritated, and gritty and may become reddened. The client may present with complaints of blurred vision, lack of tears, burning, itching, foreign body sensation, sensitivity to light, and loss of glossy appearance of the cornea.

Question 43

Dry Eyes

Answer 43

In addition to a slit-lamp examination, a Schirmer test to quantify lacrimal secretions may be done.

First-level treatment for dry eyes is client education

Self-care includes: wearing goggles when swimming; using a preservative-free artificial tears preparation; taking frequent rest periods from the computer and hand-held electronic devices

Question 44

Epiphora

Answer 44

is an overflow of tears onto the face, other than caused by normalcrying

Is a result of insufficient tear film drainage from the eyes; tears roll down the face rather than through the nasolacrimal system

Who is at-risk? It is an especially common complaint in elderly clients and individuals with allergies.

Question 45

Epiphora

Answer 45

Treatment of excessive tearing secondary to trauma or infection includes the use of topical antibiotics. Corticosteroid eye drops and anesthetic drops should not be used because they may block healing and increase the risk of infection.

Question 46

Subconjunctival hemorrhage

Answer 46

Bright red blood in a sharply defined area surrounded by normal-appearing conjunctiva indicates subconjunctival hemorrhage.

Risk factors include
valsalva type maneuvers, blood-thinners, diabetes and HTN.
is self-limiting and resolves on it’s own.
Patients with visual changes or with more extensive hemorrhage should be referred to an ophthalmologist or ER.

Question 47

Herpes zoster ophthalmicus (HZO)

Answer 47

Is shingles involving the eye or the surrounding area.

Common signs include a rash of the forehead with swelling of the eyelid. There may also be eye pain and redness, inflammation of the conjunctiva, cornea or uvea, photophobia, mucoid discharge. Fever and tingling of the skin and allodynia near the eye may precede the rash. Cornea may be clear or cloudy

Question 48

Herpes zoster ophthalmicus (HZO)

Answer 48

The first line of defense against HZO is prevention through vaccination.

Standard treat­ment for HZ is antiviral medication (acyclovir), preferably initiated within 72 hours of rash onset

Question 49

Hordeolum (Stye)

Answer 49

A small red, painful lump in the edge of the eyelid.

Usually caused by a bacterial infection

May be present inside or outside the eyelid on one or both eyes and is characterized by red, hot, exquisitely tender swelling near the edge of the eyelid. Most cases get better on their own and do not require treatment.

Question 50

Sinusitis

Answer 50

Invasive complications such as infection of an adjacent cranial structure (mastoiditis, meningitis, etc.) require a referral to a specialist.

With ethmoid sinus problems, the pain is felt behind the eye and high on the nose.

The maxillary sinus is the largest of the paranasal sinuses and is the most commonly affected sinus. There is usually pain and pressure over the cheek. Inability to transilluminate the cavity usually indicates a cavity filled with purulent material. Discolored nasal discharge, as well as a poor response to decongestants, may also indicate sinusitis.

Question 51

Sinusitis

Answer 51

If a patient has a URI for at least 7 days, the presence of 2 or more of the following signs and symptoms will confirm the diagnoses of sinusitis: colored nasal drainage, a poor response to decongestants, facial or sinus pain (especially if aggravated by postural change) and headache.

Viruses may produce all of the clinical manifestations described, however, patients who meet the 7-day criteria are more likely to have bacterial rather than a viral URI.

Question 52

Otitis externa

Answer 52

Otitis externa: A classic sign of acute otitis externa is tenderness on traction of the pinna and/or pain on applying pressure over the tragus. There is typically an erythematous ear canal, and usually a history of recent swimming; important to dry out the ear

Question 53

Otitis media

Answer 53

Acute otitis media: ear infection; Diagnosis of acute otitis media is made by otoscopic examination. The tympanic membrane will appear red and bulging with or without visible effusion. Light reflex is usually diminished or absent. Mobility is decreased (not increased). The external auditory canal is red and erythematous; healthy pediatric clients with mild symptoms and no day-care attendance and no antibiotics within the past 90 days, the standard Amoxicillin dose is: 40–45 mg/kg/day PO in two divided doses for 10 days

Question 54

Otitis media

Answer 54

should be seen for follow-up in 48 to 72 hours if symptoms have not resolved. Otherwise, a follow-up appointment may be scheduled several days after the completion of pharmacotherapy.

Impact of AOM on speech and language
A change in hearing threshold greater than 25 dB and has speech and language delays would indicate more aggressive treatment is needed. Referral may be necessary

Question 55

Acute Angle-Closure Glaucoma

Answer 55

Results in increased intraocular pressure (IOP). Is an emergency where left untreated, can cause blindness

Occurs suddenly with a dramatic onset of symptoms, including blurred vision, red eye, unilateral pain, pressure, headache, seeing halos around lights and photophobia followed by loss of peripheral vision, then central vision loss.

The NP must assess the patient’s vision loss upon presentation

Sudden and severe IOP elevation can cause severe damage to the optic nerve

Question 56

Strategy to Relieve Middle Ear Pressure due to Barotrauma

Answer 56

Barotrauma of the auditory canal, causing a sensation of abnormal middle ear pressure, may be relieved by the use of nasal steroids and oral decongestants.

Question 57

Hearing Loss

Answer 57

Sensorineural loss comes from exposure to loud noises, inner ear infections, tumors, congenital and familial disorders, and aging. Presbycusis is an example of true sensorineural loss. Any client who presents with sudden sensorineural hearing loss should be referred to an otorhinolaryngologist for further diagnosis and treatment.

Question 58

Hearing Loss

Answer 58

Conductive hearing loss: In conductive hearing loss, bone conduction is greater than air conduction, so the patient will report the bone conduction sound longer than the air conduction sound. Serous otitis media can result in conductive hearing loss. Produces a high-frequency hearing loss that is bilateral and symmetrical

Cerumen impaction is the cause of a conductive hearing loss; differential diagnosis would be otitis externa

Question 59

Hearing Loss

Answer 59

In the Weber test, a vibrating tuning fork is placed on the top of the head equidistant from the patient’s ears. In the normal patient, the Weber tuning fork sound is heard equally loud in both ears. In a patient with conductive hearing loss the Weber tuning fork sound is heard louder in “bad” ear. In sensorineural hearing loss, the tuning fork is heard louder in the “good” ear.

The clinician should perform Weber & Rinne, tests to determine whether hearing loss is primarily conductive or sensorineural.

Refer back to NR509-Advanced Health Assessment

Question 60

Tinnitus

Answer 60

Ringing or buzzing noise in one or both ears that may be constant or come and go, often associated with hearing loss.

Can be caused by the presence of middle ear fluid; Special tests to determine the presence of middle ear fluid may be considered, such as tympanometry, acoustic reflex measurement, or acoustic reflectometry.

Bilateral, high-pitched tinnitus may occur with severe hypertension (diastolic blood pressure exceeding 120 mm Hg); blood pressure should be evaluated via orthostatic measurements

Question 61

Tinnitus

Answer 61

Strategies to minimize symptoms of tinnitus include playing background music during the daytime and before sleep to mask the noise of tinnitus, smoking cessation and decreasing the intake of caffeine, chocolate, alcohol, and salt. Fatigue may also increase tinnitus; therefore, clients should be instructed in proper sleep hygiene and encouraged to rest during the course of the day. Chewing gum or swallowing should be encouraged during descent on airplanes to promote eustachian tube opening and equalization of middle ear pressure through deglutition (swallowing).

Severe tinnitus is associated wit depressive disorders; the NP should screen for psychologic disorders

Question 62

Mononucleosis

Answer 62

Fatigue, sore throat, and low-grade fever.

Nasal and throat mild erythema

Edematous, enlarged tonsils bilaterally, with erythema of the pharyngeal wall and tonsillar exudates.

Inflamed posterior cervical lymph nodes.

Question 63

Mononucleosis

Answer 63

This presentation could be a viral pharyngitis; however, with posterior cervical lymphadenitis, you would suspect mononucleosis.

If a client has persistent sore throat, fever and malaise and has not responded to treatment, tests for infectious mononucleosis and streptococcal antibiotic sensitivity should be performed. Perform a Monospot test next

Question 64

Epiglottitis

Answer 64

A symptom cluster of severe throat pain with difficulty swallowing, copious oral secretions, respiratory difficulty, stridor, and fever but without pharyngeal erythema or cough is indicative of epiglottitis.

Question 65

Epiglottitis

Answer 65

In a pediatric client with acute epiglottitis, a number of symptoms can indicate that airway obstruction is imminent: stridor, restlessness, nasal flaring, as well as the use of accessory muscles of respiration.

Question 66

Pharyngitis

Answer 66

Inflammation of pharynx that cause discomfort, scratchiness, pain and difficulty in swallowing.

Symptoms of fatigue, fever, pharyngitis accompanied by cervical lymphadenopathy may be evaluated by Monospot, strept test, and throat culture

Question 67

Pharyngitis

Answer 67

Treatment in adults with NKA to PCN who are suspected of having Group A beta hemolytic streptococcal pharyngitis includes a 10-day course of penicillin V potassium (Pen-Vee K; 500 mg PO twice daily or 250 mg PO four times daily) or benzathine penicillin (Bicillin;1.2 million units IM once) as an alternative to prolonged oral medication.

Question 68

Hoarseness (dysphonia)

Answer 68

Marked by changes in the pitch or quality of the voice, which may sound weak, scratchy or husky.
Caused by misuse or overuse of the voice, viruses, and growths on the vocal cords like cysts, papillomas, polyps and nodules, among other things. GERD may also result in hoarseness
Laryngoscopy
Papillomatosis is a differential diagnosis of hoarseness, which is related to an infection

Question 69

Throat disorders: Peritonsilar Abcess

Answer 69

Peritonsilar cellulitis and abscess are acute pharyngeal infections most common among adolescents and young adults.

Infection is virtually always unilateral and is located between the tonsil and the superior pharyngeal constrictor muscle.

Question 70

Throat disorders: Peritonsilar Abcess

Answer 70

Symptoms of peritonsilar abcess include gradual onset of severe unilateral sore throat, odynophagia, fever, otalgia, and asymmetric cervical adenopathy. Trismus, similar to lock jaw or “hot potato” voice (speaking as if a hot object was in the mouth), is common. A toxic appearance (e.g., poor or absent eye contact, failure to recognize parents, irritability, inability to be consoled or distracted, drooling, severe halitosis, tonsillar erythema, and exudates can also be observed. In patient’s with a peritonsilar abscess, there is more of a discrete bulge, with deviation of the soft palate and uvula. Patients should be referred to the emergency room immediately as maintaining airway patency and preventing sepsis is of concern.

Question 71

Nose Disorders: Rhinitis (Hay fever)

Answer 71

Allergic rhinitis results from immunoglobulin E (IgE)-mediated type I hypersensitivity to airborne irritants affecting eyes, nose, sinuses, throat, and bronchi.

The symptoms of allergic rhinitis are similar to those of viral rhinitis but usually persist and are seasonal in nature. When assessing the nasal mucosa, you will observe that the turbinates are usually pale or violaceous because of venous engorgement.

Question 72

Allergic Rhinitis

Answer 72

Inflammation of the nose caused by an allergen (pollen, dust, mold, animal dander)

Occurs seasonally or year-round

Symptoms: sneezing, runny nose, red, watery and itchy eyes

Diagnosis: history-taking, examination of the nasal passages

Question 73

Allergic Rhinitis

Answer 73

Teaching includes the importance of avoiding environmental triggers; this is the best way to avoid symptoms of allergic rhinitis.

Viral rhinitis: Watery rhinorrhea, nasal congestion, “nasal” speech, and forced mouth breathing are common complaints of clients with viral, allergic, vasomotor, or medication-related rhinitis.

Overuse of decongestant nasal sprays can cause rebound rhinitis- is characterized by nasal congestion without rhinorrhea following the short-term use of topical vasoconstrictive medications. Can be remedied by immediately stopping all topical decongestant use. The condition typically resolves after 2 to 3 weeks.

Question 74

Atopic Triad

Answer 74

A genetic predisposition toward allergic reactivity may be the most important etiological factor in all atopic conditions.

A personal or family history of all or part of the “atopic triad”—asthma, allergic rhinitis, and eczema—is often present.