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NM 703 Primary Care > Module 4 EENT > Flashcards

Module 4 EENT Flashcards

1
Q

What is Blepharitis?

A

Inflammation of the eyelids (most common eye disease)

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2
Q

What are the two types of Blepharitis and how are they caused?

A

Anterior: Staph aureus (most common) or seborrhea (excessive discharge of sebum)

Posterior: Meibomian gland dysfunction or rosacea

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3
Q

Who is most likely to experience Anterior Blepharitis?

A

Young to middle-aged women

Seborrheic: adult

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4
Q

Who is most likely to experience Posterior Blepharitis?

A

Older patients; may be caused by hormones imbalance

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5
Q

What subjective data may be reported with Blepharitis?

A 
**Swollen eyelids in the morning
Burning
Foreign body sensation
Tearing
Photophobia
Itching
Redness/Discharge
Painful Stye (hordleum)
Blurred vision
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6
Q

What objective data may be seen with Blepharitis?

A

A stye (hordeolum)

Lid/eye erythema/redness
ulceration at base of lashes
missing/misdirected eyelashes
greasy scales on lashes/eyelid,

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7
Q

What objective data may be seen specifically for Posterior Blepharitis?

A

Oily/frothy tear film. Rosacea in cheeks and nose (erythema)

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8
Q

What are our differential diagnoses for Belpharitis?

A

Dry eye syndrome
Conjunctivitis
Sebaceous carcinoma

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9
Q

What diagnostics should be done for Blepharitis?

A

None

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10
Q

How is Blepharitis managed?

A

***Lid hygiene, warm compresses (5-10minutes), lid scrub/baby shampoo wash, antibiotic ointment

Medications:erythromycin/bacitracin/ 0.3% Tobrex ophthalmic solution BID for 7-10 days

Rarely systemic antibiotics may be needed

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11
Q

What patient teaching should be reviewed for Blepharitis diagnosis?

A

A stye (hordeola) may develop that should self-resolve

Good and-hygiene

Replace mascara and eye makeup/mask regularly (q6months)

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12
Q

When should a patient be referred out with Blepharitis?

A

If treatment fails, secondary infection occurs, reoccurrence, vision loss

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13
Q

What medications can be prescribed for Blepharitis?

A

Erythromycin/Bacitracin-0.3% Tobrex ophthalmic solution BID for 7-10 days

Rarely systemic antibiotics may be needed

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14
Q

What is a Hordeolum?

A

Acute infection and inflammation of one of the glands in the eyelid. Often called a stye.

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15
Q

What is a hordeolum caused by?

A

Staph infection causes inflammation of a gland. Typically only effects one eye.

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16
Q

Who is at the highest risk of a hordeolum?

A

Most common in children and adolescents, but can affect any age group.

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17
Q

What subjective data is associated with a hordeolum?

A

Redness/Warmth
Painful enlarging bump-differentiating characteristic from chalazion
May or may not have eye discharge

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18
Q

How can we differentiate between a hordeolum and chalazion?

A

Painful enlarging bump in a hordeolum

chalazion is a small swelling or lump on your eyelid because of a blocked gland. Chlazion is not painful.

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19
Q

What objective data is associated with a hordeolum?

A

Pain and swelling at the site
Hard nodule
Make sure to evert the eyelid!!

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20
Q

What are our differential diagnosis associated with a Hordeolum?

A

Dry eye syndrome
Conjunctivitis
Sebaceous carcinoma

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21
Q

What diagnostics should be performed for a hordeolum?

A

None

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22
Q

How is a hordeolum managed?

A

Warm/moist compresses, good hand and eye hygiene, clean from inner to outer canthus, eye scrubs for recurrent lesions

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23
Q

What patient education is important to review with a hordeolum diagnosis?

A

Wash hands before cleaning, use cotton-tip applicator or face cloth, clean from inner to outer canthus, antibiotics are not indicated, replace eye makeup

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24
Q

What complications are associated with hordeolum? How should we treat them?

A

Recurrent lesions, enlarged stye may cause blurred vision, may progress to cellulitis or abscess requiring systemic antibiotics

REFER!!

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25
Q

What is Conjunctivitis?

A

Inflammation of the bulbar conjunctiva, the transparent mucosal tissue lining the eye, and inner surface of the eyelid.

May also be called Pink Eye

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26
Q

What is Viral Conjunctivits caused by? How can it spread?

A

Common type in children-Molluscum contagiosum

Adenovirus or HSV

Can be spread by direct contact or close proximity.

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27
Q

What risk factors are associated with Viral conjunctivits?

A

Common in areas of overcrowding such as schools, nursing homes, and summer camps.

Nearly half diagnosed have viral type

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28
Q

What subjective symptoms can be seen with all types of conjunctivitis?

A

Itching
Sticky drainage
Redness in affected eye-may start in one and move to the other

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29
Q

What objective data can be seen in all types of conjunctivitis?

A

Red eye
Excessive watery discharge: usually begins in one eye
Low-grade temp

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30
Q

What is important to include in the physical exam for conjunctivitis?

A

Follicles and overlying conjunctival blood vessels

Palpate the anterior cervical chain of lymph nodes to assess for URI

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31
Q

What are our differential diagnoses associated with all types of conjunctivitis?

A 
Herpetic eye disease
Gonococcal/chlamydia-related conjunctivitis
Subconjunctival Hemorrhage
Blepharitis
Foreign Body
Uveitis (inflammation inside your eye)
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32
Q

How can we diagnose Conjunctivitis? What diagnostics can be done?

A

Through a thorough exam and history taking

Diagnostics: gram-stained smears and cultures. PCR to check for STI (G/C)

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33
Q

What patient teaching should be included when diagnosing Conjunctivitis?

A

Infectious vs. non-infectious conjunctivitis: how to prevent spread

Avoid touching eyes, shaking hands, sharing towels and bedclothes, and swimming in public pools.
Good hand-washing techniques
Do not share eye medications
Replace eye makeup and mascara

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34
Q

How should viral conjunctivitis be treated?

A

Symptom management

  • artificial tears
  • cool compress
  • NO ANTIBIOTICS
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35
Q

What complications are associated with untreated conjunctivitis?

A

Visual disturbances

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36
Q

When should a patient with conjunctivitis be referred to an ophthalmologist?

A 
Immunocompromised individuals
Cultures grow MSRA
Concern for sight-threatening disease
Recent trauma, ocular surgery, contact lens wearing 
Decrease vision 
Ocular pain
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37
Q

Is it appropriate for the APRN to prescribe ocular steroids for conjunctivitis?

A

NO!!!

If a patient needs them-refer!

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38
Q

What is the usual cause for allergic conjunctivitis? When do we most often see it?

A

Usually environmental with ragweed being most common.
Household chemicals or pet dander.

Most often in spring and summer

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39
Q

What are the non-infectious causes of conjunctivitis?

A

allergic, primary ocular diseases, and systemic diseases or neoplastic processes.

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40
Q

What symptoms are only associated with allergic conjunctivitis?

A

HA and fatigue

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41
Q

Who is as risk for allergic conjunctivitis?

A

Affects up to 40% of US population.

75% of patients who suffer from allergic rhinitis also have associated conjunctivitis.

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42
Q

How is allergic conjunctivitis managed?

A

Preservative-free artificial tears, cool compresses

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43
Q

What is the second most common cause of Conjunctivitis? What is the usual causative agent?

A

Bacterial Conjunctivitis

Agents: Haemophilus influenzae or Strep

Spread by the infected individual or transfer of
organisms in one’s own nasal and sinus mucosa.

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44
Q

Who is at risk for bacterial conjunctivitis?

A

Someone who recently had a URI/the flu.

Adults: could be from Gonorrhea or Chlamydia infection

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45
Q

How does bacterial conjunctivitis typically present?

A

Rapid onset with severe symptoms

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46
Q

How is bacterial conjunctivitis (non gonorrhea or chlamydial) managed?

A

Preferred: Erythromycin ophthalmic ointment or

trimethoprim-polymyxin B drops. 0.5 in of ointment to lower lid or 1-2 drops four times a day for 4-7 days.

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47
Q

How is bacterial conjunctivitis treated if it is gonococcal? What if the patient has medication allergies?

A

Gonococcal: Ceftriaxone 250mg IM x AND Azithromycin 1 g orally. If PCN allergy: ciprofloxacin 500 mg

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48
Q

How is bacterial conjunctivitis treated if it is chlamydial?

A

Chlamydial: azithromycin 1 g orally one dose or doxycycline 100mg twice daily for 7 days

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49
Q

What symptoms are associated with emergency eye ursitis/uvetis?

A

**Worsened eye pain when exposed to bright light

Pain in the eye or brow region
Reddened eye, especially adjacent to the iris
Small or funny-shaped pupil
Blurred vision
Headache
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50
Q

What is our treatment for Emergent Eye

Iritis / Uveitis?

A

SEND TO ER!!

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51
Q

What are symptoms associated with Angle-Closure glaucoma? What risk factors are associated?

A

**ciliary flush!!

Risk factors: Hyperopia, thick cataractous lens
Halos around lights
Aching eye or brow pain
Headache
Nausea, vomiting
Reduced acuity
Eye redness
Closed angle on gonioscopy
Extremely elevated IOP
Corneal edema
Engorged conjunctival vessels
Fixed dilated pupil
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52
Q

What is our treatment for Angle-Closure glaucoma?

A

SEND TO ER!!

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53
Q

What is a ciliary flush? How should we treat it?

A

ring of red or violet spreading out from around the cornea of the eye.

ER!!

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54
Q

How is a mildly infected piercing treated?

A

Mild cases can be treated with topical alcohol and antibiotic ointment.

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55
Q

How can we treat a more concerning infected piercing?

A

More concerning cases may require oral
cephalosporin or penicillin

Keflex 500 mg BID

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56
Q

How can a severely infected piercing be treated?

A

Severe infections may require IV cephalosporin and referral to a physician.

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57
Q

What is Otitis externa?

A

Cellulitis of the external auditory canal
that may extend to the auricle

“Swimmer’s ear.”

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58
Q

Who is at risk of developing otitis externa? When do we see it most?

A

More prevalent in warmer months

Immunocompromised persons such as those with DM

People too diligent with cleaning cerumen

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59
Q

What differential diagnoses are associated with otitis externa?

A

Acute otitis media
Malignant otitis externa
Chronic suppurative otitis media

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60
Q

What subjective data is associated with otitis externa?

A

Pain of affected ear and auricle
Feeling of fullness or itching
Drainage

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61
Q

What objective data is associated with otitis externa?

A

Pain and tenderness on palpation of tragus
Pain with repositioning of auricle for inspection
Erythema and edema of canal
Debris and sloughed tissue in the canal
TM erythematous

Chronic otitis externa: cerumen present, dry, and narrow

62
Q

What diagnostics can be used for otitis externa?

A

Typically not necessary

If not resolved in two weeks, a culture may be warranted for sensitivity testing.

Microscopic analysis of drainage for fungal case

63
Q

How can otitis externa be managed?

A

Debridement for better penetration of ear drops.

Mild: Acetic acid 2% otic solution BID for 5-7days

Moderate: Acetic acid 2% and hydrocortisone 1% otic solution

Tylenol PRN

64
Q

What patient education should be reviewed for diagnosis of otitis externa?

A

“Don’t put anything smaller than your elbow in your ear.” (Avoid cotton-tipped swabs)

Improvements should occur within 48-72 hours. If it worsens, return to the clinic.

Resolution within 7-10 days.

Swimming increases exposure. Blow dryer to dry out ear after swimming. Ear plugs for swimming but these can contribute to problems.

65
Q

What complications are associated with otitis externa?

A

Malignant otitis externa

66
Q

When should a patient be referred with otitis externa?

A

No improvement after initial treatment.

Indications of hearing loss

67
Q

What is otitis media?

A

Dysfunction of the middle ear and middle ear mucosa. Fluid and inflammation of the middle ear.

68
Q

What organisms are causative agents of otitis media?

A

Streptococcus Pneumoniae
Haemophilus Influenzae
Group A.

69
Q

Who is at risk for otitis media?

A

Smoking or exposure
Viral URI or allergies
Children

70
Q

What subjective data may we see with otitis media?

A 
***Worse in prone position
Ear pain
Fever
Tinnitus
Nasal congestion
Hearing loss
Recent ear infection or URI
71
Q

What objective data may we see with otitis media?

A

Fluid behind the TM
Bulging of the TM with obscured landmarks.
Drainage may suggest perforation
TM may be gray to red in color

72
Q

What differential diagnosis are associated with otitis media?

A 
AOM vs. OME
Sepsis
Otitis externa
Mastoiditis
Myringitis
73
Q

What diagnostics can be used for otitis media?

A

Typically none: diagnosis primarily from PE and history

May consider CBC or culture of drainage

74
Q

How is otitis media typically treated?

A

OTC NSAIDs

Amoxicillin 500 mg orally every 12 hours x 5-7 days

75
Q

How is a severe case of otitis media treated?

A

Amoxicillin 875 mg every 12 hours or 500 mg every 8 hours x10 days

76
Q

How is otitis media typically treated if allergic to PCN?

A

Cefdinir 300 mg orally every 12 hours or 600 mg orally every 24 hours
Cefuroxime axetil 250 mg orally every 12 hours
Cefpodoxime proxetil 200 mg orally every 12 hours
Azithromycin 500 mg orally as single dose on day 1, then 250 mg orally once daily on days 2-5
Clarithromycin 500 mg orally every 12 hours

77
Q

What education should be covered for a patient with otitis media?

A

Watchful waiting has not proven effective in adults
Improvement should occur within 24-48 hours
Non-contagious and may return to work once acute symptoms have resolved
Take all antibiotics
Hearing impairment may continue for weeks

78
Q

What complications are associated with otitis media?

A 
Perforated eardrum (most common complication)
Otitis Media with Effusion (OME)
79
Q

When should a patient be referred with otitis media?

A

TM perforation
Unresponsive to antibiotics in 48-72 hours
Facial nerve paralysis and/or other focal neurologic signs

Pain and swelling behind the ear developing after otitis media, or new onset vertigo, may suggest mastoiditis, labyrinthitis, or petrositis

80
Q

How does Otitis Media with Effusion present?

A

Ear discomfort, a sensation of ear
fullness, or decreased hearing without pain;
symptoms may persist for weeks to months

81
Q

What is otitis media with effusion?

A

a collection of non-infected fluid in the middle ear space.

82
Q

How is otitis media with effusion treated?

A

Most cases have a spontaneous resolution, and watchful waiting is the most common approach; antibiotics are not helpful because it is a non-infectious disorder

83
Q

What is Rhinitis?

A

Allergic inflammation of the nasal membranes
generally caused by breathing in pollen, dust,
dander or insect venom.

“Common cold/Hay fever”

84
Q

What causes Rhinitis?

A 
Allergen triggers the production of antibody 
immunoglobulin E (IgE)

When caused by pollens of plants it is called
pollenates
When caused by grass it is called hay fever

85
Q

Who is at risk for rhinitis?

A

History of allergies and respiratory infections
Higher socioeconomic status
Environment: Air pollution

86
Q

What subjective data may we see with rhinitis?

A

Mild to severe symptoms

Rhinorrhea –generally clear
Itching watery eyes
Nasal congestion
Sneezing
Afebrile
History may include “allergies”
87
Q

What objective data may we see with rhinitis?

A

Eyelid swelling
Lower lid venous stasis (“allergic shiners”)
Pale, boggy, nasal mucosa
Swollen nasal turbinates

88
Q

What differential diagnosis are associated with rhinitis?

A

Nasal-septal trauma
Substance abuse
Intranasal masses or tumors

89
Q

What diagnostics can be used for rhinitis?

A

None

90
Q

How is rhinitis managed?

A

Eclomethasone dipropionate (Beconase AQ) 42 mcg: 1-2 sprays each nostril twice daily for patients ≥ 6 years old

Budesonide (Rhinocort Aqua) 32 mcg: 1-4 sprays each nostril once daily for patients ≥ 6 years old

Fluticasone propionate (Flonase) 50 mcg: 1-2 sprays each nostril once daily or 1 spray each nostril twice daily

Antihistamines:
1st generation-sedating
2nd generation-1st line Zyrtec(Cat B) or
Allegra (Cat C)

Decongestants (not for use in pregnancy),
limit to 3 days or less

91
Q

What patient teaching should be reviewed for rhinitis?

A

Avoid Irritants and allergens when possible or use PPE
Saline Nasal Spray (May use in pregnancy)
Decongestants cannot be used in pregnancy
Environmental Control
Use nasal inhaler correctly

92
Q

What complications are associated with rhinitis?

A

Rare but can be serious
Increased asthma
Sleep apnea

93
Q

When should a patient with rhinitis be referred?

A

Older adults with new onset rhinitis

Suspected anatomical deviations

94
Q

What is epistaxis?

A

Bleeding that occurs from broken capillaries in

the nose. Mostly occur in the front of the nasal septum

95
Q

What is the typical causes of epistaxis?

A

90% from local irritation such as allergy

trauma (nose picking or forceful blowing), foreign body, neoplasm, alcohol or cocaine use

96
Q

What are the risk factors for epistaxis?

A 
digital trauma (nose picking)
dry nasal mucosa such as due to dry air, use of nasal oxygen, or use of nasal steroid spray 
inflammation in rhinitis 
acute rhinosinusitis
septal deviation
systemic coagulopathy 
excessive bleeding 
anticoagulant medications (i.e. warfarin)
97
Q

What subjective data may we see with epistaxis?

A

Scant to copious blood emerging from nares
Nasal trauma
History of high blood pressure
Anticoagulant use

98
Q

What objective data may we see with epistaxis?

A

Trauma
Nasal obstruction

Note: protect airway and estimate blood loss

99
Q

What are the differential diagnosis associated with epistaxis?

A 
Hypertension
Use of anticoagulants 
Use of nasal steroids and/or allergic rhinitis
Cocaine use
Neoplasm
100
Q

What diagnostics can be used for epistaxis?

A

CBC with diff
Type and screen (if severe)
If taking anticoagulants, PT with INR

101
Q

How is epistaxis managed?

A

Likely resolved with direct
pressure

Topical nasal decongestants
Petroleum jelly can be used to protect against dryness
No foreign objects in the nose (including fingers)

Pinch the lower part of the nose to apply direct pressure. Sit upright, Lean forward, or tilt head forward to facilitate clot formation and avoid post-nasal drainage X 15 minutes.

102
Q

What condition may exacerbate/precipitate epistaxis?

A

Pregnancy (increased blood volume)

103
Q

What patient education should be reviewed for epistaxis?

A

Most cases are successfully treated with
pressure x 15 minutes
Identify and alleviate factors that cause
exacerbations
Avoid sticking fingers in nose
Keep nares moist with petroleum jelly

104
Q

What complications are associated with epistaxis?

A

Compromised respiratory function
Hypotension
Anemia

105
Q

When should a patient with epistaxis be referred?

A

Unable to control bleeding
Cautery
Nasal Packing

106
Q

What is sinusitis?

A

Obstruction of the sinus ostia, which is a small opening in which the maxillary, frontal, ethmoid and sphenoid sinuses drain into the nasal cavity.

107
Q

What can cause sinusitis?

A

Viral [Most common by far], Bacterial or Fungal

(Strep Pneumoniae, H. influenzae, Streptococcus pyogenes, Morazella cattarrhalis).

108
Q

What is the onset of sinusitis?

A

Abrupt onset with duration less than 4 weeks

109
Q

What medical or social history may a patient have with sinusitis?

A

Recent history of URI, Allergic Rhinitis, Exposure to second-hand smoke

110
Q

How can we tell the difference between sinusitis and rhinitis?

A

Sinusitis has: Fever, halitosis, acute onset, post nasal drip, decreased sense of smell/taste, fatigue

111
Q

Who is at risk for sinusitis?

A

History of asthma
Patients immunocompromised
Frequent rhinitis

112
Q

What subjective data may we see with sinusitis?

A 
Headache* / Facial pain
Nasal congestion
Dental pain
Postnasal Drip / Decreased sense of smell
Fever
Ear pain / pressure / fullness
Halitosis
Fatigue
113
Q

What objective data may we see with sinusitis?

A 
Hyponasal speech
Fever
Turbinate edema/erythema
Discharge: mucopurulent vs clear
Pressure around eyes on leaning forward
Pharyngitis
Cervical lymphadenopathy
114
Q

What differential diagnosis are associated with sinusitis?

A

Foreign body
Dental abscess
Trigeminal neuralgia
Meningitis

115
Q

What diagnostics can be done for sinusitis?

A

No specific testing
Based on PE and patient history
Requires specific symptoms and duration

116
Q

How is sinusitis (<10 days) managed?

A

Most cases resolve without treatment (usually viral)

Saline, Decongestant or Corticosteroid nasal
spray
Analgesic and Antipyretic-Tylenol or NSAID
“Watchful waiting”

117
Q

How is sinusitis managed if unresolved in 10 days?

A

Augmentin (amoxicillin-clavulanate) or
Doxycycline x 5-10* days
Refer if second antibiotic tx ineffective

118
Q

What patient teaching should be covered for sinusitis?

A 
Proper use of nasal steroids
Antibiotics not recommended for viral
Return if symptoms have not improved in 48-72 hours
Environmental control
Warm moist humidified air
119
Q

What complications are associated with sinusitis?

A

Chronic sinusitis

Orbital infection

120
Q

When should a patient with sinusitis be referred?

A

Unresolved in 10-14 days

121
Q

What is Pharyngitis and Tonsillitis?

A

When normal flora of the oral pharynx is becomes harmful due to weakening of the immune system. Develops from exposure to virus or bacteria.

122
Q

What risk factors are associated with tonsillitis and pharyngitis?

A

Seen in children and adults
Viral more common in adults than bacterial.
Bacterial more common in children

123
Q

What are the causative agents of pharyngitis and tonsillitis? Which is most common?

A

Common: Strep (rhinovirus)

Neisseria gonorrhea and chlamydia, strep A, coronavirus, etc.

124
Q

What subjective data may we see with viral Pharyngitis and Tonsillitis?

A 
Sudden onset
Feverish
Malaise & myalgias
Cough 
Headache
Fatigue
May have rhinitis, conjunctivitis,congestion & sputum w/cough
125
Q

What objective data may we see with viral Pharyngitis and Tonsillitis?

A

Low-grade fever
Mily erythema
Little or no exudate
Pharynx may be swollen or pale

126
Q

What subjective data may we see with bacterial Pharyngitis and Tonsillitis?

A 
Acute onset sore throat
Painful swallowing
Fever with chills
Headache
Nausea/vomiting
May have abdominal pain
127
Q

What objective data may we see with bacterial Pharyngitis and Tonsillitis?

A 
• Fever
• Erythema of throat and tonsils
• Patchy white or yellow exudate
• Pharyngeal petechiae
• Tender anterior cervical 
adenopathy
• + RADT (Rapid GAS test)
128
Q

What differential diagnosis are considered with Pharyngitis and Tonsillitis?

A
  • Infectious mononucleosis
  • Allergies
  • Thrush
  • Peritonsillar cellulitis/abscess
  • Pharyngeal abscess
  • Epiglottitis
  • Upper Respiratory Infection
  • Sexually Transmitted Infections (STI)
  • HIV (consider)
129
Q

What diagnostics may be used for Pharyngitis and Tonsillitis?

A

Rapid GAS test

Throat culture

130
Q

How is viral Pharyngitis and Tonsillitis managed?

A

Throat lozenges
NSAIDs
Corticosteroids (controversial)

131
Q

How is bacterial Pharyngitis and Tonsillitis managed?

A
  • penicillin V
  • in children, 250 mg orally 2-3 times daily for 10 days
  • in adults and adolescents, 250 mg orally 4 times daily or 500 mg orally twice daily for 10 days
  • Dosing of amoxicillin is 50 mg/kg orally once daily (maximum 1,000 mg) or 25 mg/kg orally (500 mg maximum dose) twice daily for 10 days
  • PCN allergic- Cephalexin, azithromycin, or Clindamycin
132
Q

What patient teaching should be reviewed with Pharyngitis and Tonsillitis?

A
  • Good handwashing
  • Stay away from those who are sick
  • Don’t drink after others
  • Don’t share toothbrushes
  • Adherence to antibiotic therapy
  • Contagious til 24 hours after start of antibiotics
  • Usually feel better within 24-28 hours after starting antibiotics
  • Importance of avoiding antibiotics with viral
133
Q

What complications are associated with Pharyngitis and Tonsillitis?

A
  • Upper airway obstruction
  • Sleep apnea
  • Sleep disturbances
134
Q

When should a patient with Pharyngitis and Tonsillitis be referred?

A

Potential airway obstruction

Peritonsillar abscess

135
Q

What subjective data may we see with Infectious Mononucleosis?

A
  • Gradual onset
  • Fatigue
  • Fever
  • Body aches
  • Sore throat
  • Less common (Headaches, Rash, Loss of appetite, Muscle weakness)
136
Q

What objective data may we see with Mononucleosis?

A 
• High fever 100.9 or >
• Pharyngeal erythema
• Tonsillar hypertrophy
• White to gray or green 
exudate
• Petechiae on hard-soft 
palate junction
• A&P cervical adenopathy
• Rash/jaundice
137
Q

Who is at highest risk for Mononucleosis?

A

Teens

“kissing virus”

138
Q

What diagnostics can be used for Mononucleosis?

A

CBC with diff

139
Q

How is Mononucleosis managed?

A
  • NSAIDS or Tylenol as labeled for fever (No ASA)
  • Patient education
  • Rest and Hydration
  • Saline gargles
  • Throat lozenges
140
Q

What are the danger signs of Mononucleosis?

A

Peritonsillar Abscess

141
Q

When should a patient with Mononucleosis be referred?

A
  • Pharyngeal abscess
  • Signs of airway obstruction
  • Dysphagia-difficulty swallowing
  • Drooling
  • Trismus “lockjaw”
  • Unilateral pharyngeal pain or swelling
142
Q

What is Aphthous Ulcer/Stomatitis?

A

Common mucosal lesions. Shallow, painful, often recurrent lesions of oral mucosa

Stomatitis is inflammation of soft tissues of oral cavity.

Mostly viral

143
Q

What is a common causative agent of Aphthous Ulcer/Stomatitis?

A

HSV

Bacterial: gingivitis

144
Q

Who is at risk for Aphthous Ulcer/Stomatitis?

A
  • Affects all age groups
  • Physical or emotional stress
  • Trauma
  • Vitamin B-12 deficiency
  • Poor oral hygiene
  • Ill-fitting dentures
  • Underlying disease
145
Q

What differential diagnoses should be considered with Aphthous Ulcer/Stomatitis?

A
  • Oral carcinoma
  • Drug reactions
  • Nutritional deficiencies
  • Hand-foot-mouth disease
146
Q

What subjective data may we see with Aphthous Ulcer/Stomatitis?

A
  • Painful ulcerations in the oral mucosa

* Difficulty chewing

147
Q

What objective data may we see with Aphthous Ulcer/Stomatitis?

A
  • Round or oval oral ulcers
  • White, yellow, or gray membrane
  • Located on buccal mucosa, lateral or ventral tongue.
  • Can be on floor of mouth, soft palate, or oropharynx
148
Q

How should Aphthous Ulcer/Stomatitis be managed?

A

Antibiotics not needed-Symptomatic treatment

  • Dexamethasone 5% oral past three times a day x 7 days
  • Clobetasol 0.05% past four times a day
  • If severe recurrent montelukast 10 mg/day x 1 month then 10 mg every other day for 1 month
  • Prednisone 25mg/day x 15 days then tapered over 2 months.
  • Lidocaine gel for topical pain
149
Q

What teaching should be reviewed with Aphthous Ulcer/Stomatitis?

A
  • Apply meds to dry ulcer and avoid food and drink x 30 minutes
  • Avoid predisposing factors
  • Vitamin B 12 1000 mcg sublingually daily
150
Q

What should be considered with severe/recurrent Aphthous Ulcer/Stomatitis?

A

Disease processes and autoimmune diseases

151
Q

When should a patient with Aphthous Ulcer/Stomatitis be referred?

A
  • Recurrent infections

* Severe infections

NM 703 Primary Care (8 decks)

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