Module 4 EENT Practice Questions Flashcards
Which of the following would you expect in a patient with acute otitis media?
- Fluid in the middle ear for at least 3 months
- Fluid in the middle ear and a tympanic membrane that is translucent
- Erythema of the ear canal and a grey tympanic membrane
- An erythematous, opaque tympanic membrane
An erythematous, opaque tympanic membrane
The first-line antibiotic therapy for an adult with no known drug allergies and suspected group A beta hemolytic streptococcal pharyngitis is
Penicillin
What evidence-based tool was developed to assist clinical decision-making when caring for a patient complaining of a sore throat?
Centor score
A patient presents for their annual GYN visit. They report waking up yesterday with redness in their left eye. Subjective data also includes - constant watery discharge from the left eye, a feeling of sand in the eye, and they are unable to wear contacts due to discomfort the need to rub their eye. What is the most appropriate plan for this patient?
Review hand hygiene, use of cold compresses and recommend wearing glasses until the symptoms have subsided
A patient presents with sudden and severe pain in the right eye after the eyes were dilated for a vision exam. Physical exam findings: the eye is red, with a rainbow-like halo around the pupil and a cloudy cornea. What should the NP do next?
Urgent referral to an ophthalmologist
A patient presents with eye irritation. They report their eye was “pasted shut” this morning on arising and is itching and painful. On exam the eye is noted to have conjunctival erythema and purulent discharge. The patient denies any previous occurrence of any similar conditions and denies any allergies. What treatment plan should you initiate based on the subjective and objective data provided?
Topical antibiotics to the affected eye four times a day for 1 week
An 18-year-old college freshman is complaining of headache, fatigue, malaise, sore throat, fever, lack of appetite, and “swollen glands.” They also report feeling “ill” with a headache and fatigue before the sore throat started. Vital signs: T-102.1*F, R-20, P-94, BP-124/70. Swollen, tender cervical lymph nodes, swollen red tonsils, and petechiae on the palate. What is the most likely diagnosis?
Infectious Mononucleosis
While performing the Rinne test during a physical examination, the patient reports the sound lateralizes to the left ear, with air conduction being greater than bone conduction. This would indicate:
Sensorineural loss in the right ear
A patient presents to the clinic. Physical exam findings show mild seborrhea and inflammation of the eyelids that affects only the eyelash hair follicles. There is no ulceration or masses in the eyelids, and the pre-auricular lymph nodes are non-palpable. What is the best treatment for this client?
Dilute baby shampoo for lid cleansing and warm moist soaks
An 18-year-old complains of cold symptoms, headache, nasal congestion, sore throat and “throbbing” of the ear at night for 3-4 days, . The patient admits to muffled hearing but denies ringing in the ears. Vital signs: T101.0*F; R:20; P:84; BP: 110/72 What physical assessments should be performed to accurately diagnose the ear problem?
Examine mouth, eyes, and nose for lesions, appearance and hydration status. Palpate frontal and maxillary sinuses. Palpate pre and post auricular lymph nodes and her cervical lymph nodes. Perform an otoscopic examination of both ears and assess tympanic membrane position, translucency, mobility, color, and fluid level.
An 18-year-old has had cold symptoms including headache, nasal congestion, and sore throat for 6 days and was seen in clinic 3 days ago for right ear “throbbing.” Physical Exam: right tympanic membrane is red, bulging, and immobile, and purulent fluid is visible behind the membrane. VS: T-102.4*F; R-22; P-88; BP- 130/76. What is the best management plan?
Prescribe Amoxicillin 500 mg bid X 7 days
During an annual exam, a patient reports painful sores inside their mouth “every couple of months” and currently has several painful, shallow ulcerations on the oral mucosa. History is negative for the use of tobacco in any form, alcohol, or recreational drugs. Patient is healthy, has no dental appliances, and takes no medications. Physical exam includes: BP 110/68, P-72, R-16, T-98.6*F, and several lesions with a gray-yellow base surrounded by erythema and sizes ranging between 3mm and 8mm. What is your management plan?
Prescribe Dexamethasone elixir 0.5mg/ml strength, to use 5-mL of elixir as swish and spit, four times a day
A 25-year-old patient presents to the clinic with complaints of itchy, runny nose, sneezing, and watery, itching eyes. The patient reports the condition worsens in the spring but denies fever or headache. What pharmacological treatment options are the appropriate for this patient?
First generation antihistamines, second generation antihistamines and intranasal steroids
A 40-year-old teacher presents to the clinic complaining of a frontal headache x two days. Other symptoms include nasal congestion, sore throat, and yellow nasal drainage. The patient also reports a recent “cold”. Physical exam includes: BP 124/78, P 88, R 20, T 100.1*F, general survey includes speech with a hyponasal quality, no facial asymmetry, and minimal periorbital edema. The headache worsens with bending forward. No polyps or obstructions visible in the nares. Teeth are intact with no visible caries.What is the management plan today?
Watchful waiting
What pharmacological management options are available to a patient with blepharitis?
Antibiotic ointment :Erythromycin / bacitracin 0.3 % tobrex ophthalmic soln. 2x/d for 7-10 days
What non-pharmacological management options are available to a patient with blepharitis?
Hygiene, warm compresses(diluted baby shampoo) for 5-10m
What are the risk factors for bacterial conjunctivitis?
Spread by infectious persons with Haemeophilus influenza or strep.
Also consider STI: chlamydial, gonococcal
What are the risk factors for viral conjunctivitis?
Aenovirus, HSV, molluscum contagiosum
Seen in children direct contact with infectious persons, crowded areas
What are the risk factors for allergic conjunctivitis?
people that suffer from allergies, environmental, ragweed, household chemicals, pet dander
What objective data may we see with otitis externa?
Pain/tenderness of auricle and/or tragus Erythema and edema of canal Debris and sloughing tissue in canal TM erythematous Dry canal Cerumen that is light brown or golden and flaky Narrow canal
What subjective data may we see with otitis media?
ear pain on the inside fever Worse pain when prone (face down) Tinnitus nasal congestion hearing loss recent ear infection or URI in severe cases nausea and diarrhea
What objective data may we see with otitis media?
fluid behind the tympanic membrane
TM bulging and obscured landmarks
Drainage=possible perforation
tympanic membrane may be grey to red in color
What pharmacological management options are available to a patient with otitis media?
OTC NSAIDS
1st line tx: amoxicillin (PCN) if allergic Cefdinir( cephalosporin)
What do we know are some complications of untreated or recurrent cases of otitis media?
perforated eardrum (most common complication) Otitis Media with Effusion (OME)
At what point would the APRN transfer care of the patient with otitis media?
tympanic membrane perforation
Unresponsive to antibiotics after 48-72 hrs
facial nerve paralysis
focal neurological signs
pain, swelling behind the ear after developing otitis media
new onset vertigo= mastoid/labyrinthitis, imaging is required
What would we tell the patient who asks about returning to work with otitis media? Are they contagious? What about hearing impairment?
They can return to work once symptoms have resolved, and they are not contagious. The hearing loss can last for a while and take weeks to resolve.
Can you list some complications for the patient diagnosed with otitis externa?
***Hearing loss
malignant otitis externa
bacterial infection that extends into the cartilage and bone. This is life threatening
What is the pathophysiology of epistaxis?
Caused by broken capillaries in the nose. Nose bleeds often occur in the front of the nasal septum.
Many nose bleeds occur from irritants such as: allergies, trauma, blowing forcefully, nose picking, foreign bodies, neoplasm, ETOH or drug use.
What differential diagnoses are important when considering rhinitis in a patient?
nasal septal trauma
Drug use
intranasal masses or tumors
What patient teaching should be covered for rhinitis?
avoid irritants (wear a mask if possible)
use saline nasal sprays (this is safe in pregnancy)
control environmental conditions if possible
Use nasal inhaler correctly
Decongestants inly for 3 days max
can use antihistamines. 1st generation safe in pregnancy but can be sedating. Do not use decongestants in pregnancy, especially during the first trimester. Second generation antihistamine Zyrtec is safe in pregnancy
What group of medications for rhinitis do we not want to use during the first trimester of pregnancy?
Decongestants as there is a risk of birth defects.
List the education for a patient regarding the proper way to use nasal steroids.
- shake the bottle and prime before using spray (spray into the air a few times)
- blow nose before spraying
- keep head upright and aim nozzle toward the outer wall of the nostril
- use a finger to close off the nostril that is not getting any medication
- gently sniff NOT SNORT as medication is sprayed by breathing in slowly
- do not blow nose for up to 10 minutes and try not to sneeze
- clean sprayer once a week
What is the pharmacological management for a patient with viral pharyngitis?
throat lozenges
NSAIDs
possible dexamethasone to relive pain (controversial)
What is the pharmacological management for a patient with bacterial pharyngitis?
pen V (first treatment choice) amoxicillin (pcn drug class) if allergic to penicillin then give: cephalexin (cephalosporin), azithromycin (macrolide) , or clindamycin (macrolide)
How does the clinical presentation differ in viral and bacterial pharyngitis?
Viral: Malaise & myalgias, Cough , Fatigue, May have rhinitis, conjunctivitis, congestion & sputum w/cough, Mily erythema, Little or no exudate, Pharynx may be swollen or pale
Bacterial: Patchy white or yellow exudate, Pharyngeal petechiae, Tender anterior cervical, Adenopathy, + RADT (Rapid GAS test), Nausea/vomiting, May have abdominal pain. Erythema of throat and tonsils
What is the clinical presentation you would expect to see in a patient with suspected aphthous ulcers?
oral or round ulcers in the mouth
yellow-white-or grey membranes
Locations: buccal mucosa, lateral or ventral side of the tongue, floor of the mouth, soft palate, and/ or oropharynx, lips
What virus is usually the culprit of aphthous ulcers?
HSV
What subjective data would you expect from a patient with suspected mononucleosis?
gradual onset, fever, fatigue, body aches, sore throat
What objective data would you expect from a patient with suspected mononucleosis?
high fever, pharyngal erythema, tonsillar hypertrophy, white-green-or grey exudate, petechiae on hard palate junction, anterior and posterior cervical adenopathy, rash/jaundice
In what age group of patients do we often find mononucleosis?
Teens
