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Comps - Mod 2 > NP 615 Test 3 - Sheet1-2 > Flashcards

NP 615 Test 3 - Sheet1-2 Flashcards

1
Q

Etiology of “red eye”

A

Very common. Allergy, infection, chemicals, trauma or systemic disease. Usually self limiting.

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2
Q

Management of most eye conditions

A

Can be done in the office

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3
Q

Considerations of eye pain

A

Decide whether the pain is coming from the eye or is referred from surrounding structures

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4
Q

Assessment of eye conditions

A

Always assess visual acuity, acute problems with vision require referral

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5
Q

Chemical splashes to eye

A

Priority is first immediate irrigation

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6
Q

Items to cover in a history of ocular problem

A

Onset. Duration of symptoms, Change in vision. Photophobia. Pain. Mechanism of injury. Use of contacts. History of eye surgery. Current meds. Recent exposure to new cosmetics or person with eye infection. Systemic complaints - fever, rash, genital discharge

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7
Q

Physical exam of eye

A

Must have visual acuity of each eye. Inspect lids and conjunctiva. Examine periorbital areas. Test extraocular muscle mobility. Inspect cornea for abrasions, haziness, ulcerations, dendrites. Note PERRLA. Determine presence of red fundus reflex. Examine fundus and optic disk

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8
Q

Refer to ophthalmologist

A

Limbal flush. Irregular pupil. Muscle paresis. Hazy cornea. Corneal dendrite. Corneal ulcer. Vision loss. Elevation of retina on funduscopic exam. Papilledema. Painful eye, red eye, and vision changes.

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9
Q

Etiology of epistaxis

A

Inflammatory, traumatic or systemic cause, and most are idiopathic

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10
Q

Most common cause of anterior nose bleeds in persons younger than 40

A

Local insult to the nasal mucosa and results in anterior bleed

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11
Q

Most common nose bleed of persons older than 40

A

Posterior epistaxis - potentially more serious

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12
Q

Etiologies of 10-15% of adult sore throats

A

Strep pharyngitis

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13
Q

Populations least often affected by streptococcal sore throats

A

Children younger than 3 and adults over 50

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14
Q

Onset of strept

A

Acute, difficulty swallowing, pharyngeal erythema, exudate (50 percent), fever greater than 101.

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15
Q

Pharyngitis that requires prompt recognition and referral

A

Epiglottitis and peritonsillar / retropharyngeal abscess

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16
Q

What causes peritonsilar / retropharyngeal abscess and epiglottitis to be emergent

A

Mechanical obstruction to the flow of air and produces stridor

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17
Q

Triad which aids in differentiating epiglottis from croup

A

Drooling, agitation, and the absence of a cough

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18
Q

Mean ages of those affected with epiglottitis

A

Children 3-7, but an occur at any age

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19
Q

Removing impaled foreign bodies

A

Should only occur in the OR

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20
Q

Misleading pt descriptions of foreign bodies of the eye

A

Can be misleading. Corneal abrasions also give the same sensation

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21
Q

When a child presents with foul odor from mouth, ear, or nose

A

May likely have a foreign body

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22
Q

Anaphylaxis

A

A clinical syndrome and may vary widely among patients

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23
Q

Presentation of early signs of anaphylaxis

A

Can be subtle and not recognized. Must maintain a high degree of suspicion of even innocous signs and symptoms

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24
Q

Major signs of anaphylaxis

A

Obtain a history of prior occurrences, flushing, urticaria, laryngeal edema / stridor, bronchospasm, hypotension, tachycardia, and anxiety

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25
Q

Acute respiratory distress etiology during anaphylaxis

A

Laryngeal edema

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26
Q

Treatment triad of anaphylaxis

A

Epinephrine, benadryl, and steroids.

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27
Q

Urticaria

A

Fairly common and involves the epidermis and upper layers of the dermis and does not last more than 24-48 hrs. May be with or without angioedema or with a generalized anaphylactic reaction.

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28
Q

Angioedema

A

Less frequent and involves the deeper layers of the dermia

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29
Q

Clinical appearance of urticarial lesions

A

Superficial and are red and swollen (“Flare adn wheal”) along with pruritis

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30
Q

Clinical appearance of angioedema

A

Involves deeper layers and may appear normal and only swelling is noted

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31
Q

Most common offending agent of urticaria

A

Ingested food, drugs, or insect bites, but can be caused by anything. Most causes are never identified

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32
Q

Most common presentation of snake bites

A

Most often children and affecting the lower extremities

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33
Q

First step in management of snake bites

A

Determine whether or not envenomation has occurred

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34
Q

If pt calls your clinic with snake bite

A

Deflect them from your clinic and have them go immediately to an ED

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35
Q

Process of thermo-regulation

A

Process of heat accumulation versus heat dissipation.

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36
Q

When do heat emergencies occur

A

When the body is unable to adequately dissipate heat

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37
Q

Factors that predispose one to heat emergencies

A

Medical conditions, age, drugs, behaviors

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38
Q

Keys to preventing death due to heat exposure

A

Early recognition and prompt, appropriate management

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39
Q

First step in prevention of heat-related illnesses

A

Patient and community education

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40
Q

Causes of tissue injuries secondary to burns

A

Application of heat, chemicals, electricity, or radiation

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41
Q

Classifications of burns

A

Partial thickness - first and second degree and full-thickness - third degree

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42
Q

Characteristics of burns which aid in decision to transfer, treat, or hospitalize

A

Initial assessment. Knowing cause of burn. Location. Age of pt.

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43
Q

Smoke inhalation and burns

A

All those burned inside a closed areas must be assumed until proven otherwise

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44
Q

Provider responsibility of human and animal bites

A

Provide immediate first aid, and determine the risk for infection, disability, and complications

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45
Q

Animal bites and infection

A

Cat bites most frequently infected. Dogs - greater than 90 percent of all animal bites. Must be reported to local health department.

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46
Q

Injuries assocated with animal bites

A

Causes punctures, lacerations or avulsions, crush injuries, or fractures.

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47
Q

Potential complications of animal bites

A

Infection and / or rabies

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48
Q

Human bites

A

Less common, but more potentially more serious.

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49
Q

Treatment of bites

A

Remember to assess Td status and complicating wound healing factors - such as PAD or diabetes

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50
Q

Clinical presentation of CA-MRSA

A

Often has a dark or black center and is often attributed to spider bites

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51
Q

Treatment of CA-MRSA

A

Wound cultures should be obtained and abscesses usually require antimicrobial treatment

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52
Q

Suspicion of meningococcemia

A

Rashes that do not blanch, associated with fever and nuchal rigidity

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53
Q

Suspicion of Stevens-Johnson Syndrome (Erythema Multiforme)

A

Epidermal detachment, bullae, mucosal ulcerations, and truncal target lesions

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54
Q

Suspicion of necrotizing fascitis (scalded skin syndrome)

A

Painful, red, swollen and warm areas with sharp margins. Quickly spreads and seen primarily in patients with diabetes or any immunocompromised condition

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55
Q

Causative factor of necrotizing fascitis

A

Most commonly group A strep or staphylococcal

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56
Q

Out-pt treatment of CA-MRSA

A

I and D is primary therapy. Emperic antimicrobials if presence of systemic symptoms, severe local symptoms, immune suppression, extremes in age, or lack of response to I and D alone). Obtain culture for antibiotic susceptibility.

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57
Q

Transmission of MRSA

A

Usually by direct skin-to-skin contact or contact with surfaces that have been contaminated.

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58
Q

Protection from MRSA

A

Practice good hygiene - most important. Shower after sports. Cover skin abrasions until healed. Avoid sharing personal items - towels or razors. High touch surfaces should be cleaned regularly.

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59
Q

Most appropriate initial action of recent dog bite

A

Irrigate the wound

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60
Q

Best way to treat anterior nose bleed

A

Sit down, apply pressure to anterior nose for 20 minutes

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61
Q

Treatment of a recent upper extremity burn caused by spilled hot coffee with several areas where bullae have formed

A

Cover with nonadherent guaze

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62
Q

Most important component of managing an asthma exacerbation in a clinic setting

A

Use of short-acting beta agonists to relieve airflow obstruction

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63
Q

Best treatment of a pustular lesion suspected to be CA-MRSA

A

I and D and send specimen for culture and sensitivity

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64
Q

A fluorescein exam is performed to detect…

A

Presence of corneal abrasions

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65
Q

According to the CDC the treatment for HA-MRSA is the same for the treatment of CA-MRSA

A

FALSE

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66
Q

A visual acuity test is used to diagnose glaucoma

A

FALSE

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67
Q

An alternate to the Snellen chart would be

A

Holding up two fingers and light perception

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68
Q

A rust colored stain on the cornea should be treated by

A

Referral to an ophthamologist

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69
Q

Consequence of MRSA in the healthcare setting

A

Bloodstream infections, pneumonia, and surgical site infections

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70
Q

Treatment of MRSA in the hospital setting

A

Vancomycin, linezolid, or clindamycin

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71
Q

Bacterial conjunctivitis

A

Complains of a red, irritated eye, and perhaps a gritty or foreign-body sensation; a thick, purulent discharge that continues throughout the day; and crusting or matting of the eyelids on awakening. Most often unilateral

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72
Q

Viral conjunctivitis

A

Complaints may be discomfort or burning, with clear tearing, preauricular lymphadenopathy, or symptoms of URI

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73
Q

Allergic conjunctivitis

A

Main complaint of itching, with minimal conjunctival injection, seasonal recurrence, and cobblestone hypertrophy of the tarsal conjunctivae or bubble-like chemosis of the conjunctiva covering the sclera

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74
Q

Dry eye

A

If few symptoms are present on awkening but discomfort worsens during the day and can be the result of eye-opening during sleep

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75
Q

Indication of more serious eye problem

A

Deep pain not relieved by topical anesthetic, severe pain of sudden onset, photophobia, vomiting, decreased vision, and injection that is more pronounced around the limbuc (ciliary flush)

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76
Q

Treatment of bacterial conjunctivitis

A

Apply warm or cool compresses q4hr, instil ophthalmic antibiotic such as polymyxin B or cipro

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77
Q

Treatment of mild to moderate viral and chemical conjunctivitis

A

Apply cool compresses and weak topical vasoconstrictors, such as Naphcon every 3-4 hr

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78
Q

Treatment of allergic conjunctivitis

A

Cool compresses and H1-antihistamine and mast cell stabilizer meds - Zaditor and Optivar

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79
Q

Most serious complication of contact lens wearers

A

Microbial keratitis - severe pain, irritation, photophobia, and tearing associated with infiltrates and most common cause is Pseudomonas

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80
Q

Treatment of corneal abrasion

A

Install topical anesthetic drops, perform complete eye exam. Perform fluorescein exam. Remove foreign bodies. Treat with antibiotic drops such as polymyxin B. Prescribe analgesics. Follow up with ophthamologist. Do not patch eye.

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81
Q

Treatment of conjunctival foreign body

A

Anesthetic drops. Visual acuity. Eye exam. Examine inside of upper and lower lids. Remove loose foreign body. Fluorescein exam. Saline irrigation is needed.

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82
Q

Treatment of corneal foreign body

A

Anesthetic drops. Visual acuity. Eye exam with magnification. Look for leakage of intraocular fluid. If suspicion of intraocular foreign body, CT scan. Remove if able. Antibiotic eye drops and NSAID eye drops. Oral analgesics maybe.

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83
Q

Hordeolum - style

A

Usually at the eye lid. Eye exam. Antibiotic drops. Warm compresses for 15 minutes qid. Follow up if not better in 2 days. May I&D if no better in 2 days

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84
Q

Iritis

A

Unilateral eye pain, blurred vision, and photophobia, pink-color to eye, usually no discharge. Limbal blush or ciliary flush is usually early sign.

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85
Q

Treatment of iritis

A

Anesthesic, eye exam, attempt to determine cuase. Determine intraocular pressure. Arrange for follow up in 24 hrs. Oral pain medication - NSAIDs. Not typically treated with antibiotics.

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86
Q

Periorbital and conjunctival edema

A

Chemosis - edema of conjunctiva - harmless. Determine cause, eye exam, use steroids and Patanol. Cool compresses. Watch for signs of infection. No heat.

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87
Q

Periorbital ecchymosis (black eye)

A

May have subconjunctival hemorrhage. Determine mechanism of injury. Eye exam. Rule out blow-out fracture of orbit. Assess for bony deformity. CT scan if suspicion of fracture. Edema will subside in 12-24 hrs and discoloration may take weeks to clear. Tylenol.

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88
Q

Subconjunctival hemorrhage

A

May be spontaneous or after coughing or vomiting. No pain or visual loss. Looks scary. Look for trauma, eye exam, should resolve in 2-3 weeks.

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89
Q

Ultraviolet keratoconjunctivitis (welder’s burn)

A

Severe, intense, burning eye pain, usually bilateral, beginning 6-12 hr after brief exposure without eye protection. Conjunctival injection and tearing. Ophthalmic anesthetic drops, eye exam, cool compresses, rest, analgesics, lubricate, NSAID eye drops (Diclofenac), should resolve in 24-36 hrs. No eye patches

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90
Q

Common sources for corneal abrasions

A

Direct trauma - fingers, tree branches, makeup applicators, airbags from MVCs, contact lenses. Surface foreign bodies - dust, chemicals

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91
Q

Clincal presentation of corneal abrasions

A

Severe pain in affected eye. Foreign body sensation maybe. Blurred vision, redness, tearing, light sensitivity, eyelid swelling, adn blepharospasm

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92
Q

Management of corneal abrasions

A

Supportive care. Ophthalmic antibiotic ointment - polymyxin B. No patching. Oral analgesics are first-line pain control. No steroids. Should resolve in 3-5 days

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93
Q

Most critical type of chemical burn to eye

A

Alkaline - can penetrate the anterior eye chamber and cause damage to intraocular structures within minutes

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94
Q

Complications of corneal abrasions

A

Infection - rare and preventable

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95
Q

Common cause of proptosis among adults

A

Infectious cellulitis of the orbit

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96
Q

Characteristics of infectious cellulitis

A

Usually develops in conjunction of infection of face, sinuses, and oropharynx.

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97
Q

Preseptal cellulitis

A

Infection of the structures anterior to the orbital septum. Can occur because of infection, lid or facial trauma, and URI. Typically unilateral. Presents with eyelid edema and erythema. May have decreased visual acuity because of optic nerve compromise

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98
Q

Diagnosis of preseptal cellulitis

A

CBC, blood cultures, CT scan is mandatory

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99
Q

Management of preseptal cellulitis

A

Broad-spectrum antibiotics - celphalosproin or amoxil/clavulante. Clindamycin if MRSA. Follow up with 12-24 hrs.

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100
Q

Complications of perseptal cellulitis

A

Can be fatal. Blindness - 11 percent. Central retinal artery or vein thrombosis. Brain abscess.

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101
Q

Indication of teardrop-shaped pupil

A

Globe rupture

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102
Q

Intraocular pressure measurements

A

Normal - below 20 mmHg. Urgent ophthalmologic evaluation - between 21-30. Emergency situation - above 30 mmHg

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103
Q

Conjunctivitis

A

Inflammation of the conjunctiva - commonly called pink eye - 80% are viral and most common organism is adenovirus and is spread by direct contact.

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104
Q

Gonococcal conjunctivitis

A

Typically seen in adults and neonates. If seen in a child consider sexual abuse. Rapid progression is hallmark symptoms. In 2 days can lead to permanent vision loss.

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105
Q

Chlamydial conjunctivitis

A

Typically in sexually active adults - white, stringy discharge is typical and can last for months with exacerbations and remissions.

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106
Q

Characteristics of viral conjunctivitis

A

More common in patients older than 12, more commonly associated with burning and foreign body symptoms

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107
Q

Characteristics of bacteial conjunctivitis

A

Typically accompanied by purulent discharge - yellow or green. Both eyes are glued shut in morning. Itching is less common

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108
Q

Contusions of the eye

A

Eye is impacted but the wall of the eye remains intact

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109
Q

Lamellar laceration of the eye

A

Partial-thickness wound to the eye wall, but the integrity of the globe is maintained

110
Q

Presbyopia

A

Normal occurrance around age 42-43. Due to decreased flexibility of the human lens. OTC glasses usually help.

111
Q

Anisocoria

A

Any variance in the size of pupils between eyes. Can be benign. Can suggest a neurologic, pharmacologic, or anatomic abnormality.

112
Q

Characteristics of acute rise in intraocular pressure

A

Firm, painful eye that is inflamed and associated with a cloudy cornea. Represents an emergency with a strong potential for irreversible vision loss

113
Q

Causes of chemosis - balloon-like swelling of the conjunctiva

A

Allergies, mechanical ventilators, trauma, and local inflammation

114
Q

Epiphoria

A

Excessive tearing. Can be caused by obstruction of the normal tear drainage system or due to irritation or inflammation. Bilateral occurrence in infants is cardinal sign of congenital glaucoma

115
Q

Live bug in ear

A

Fill canal with mineral oil, lidocaine, or benzocains/antipyrine to kill bug

116
Q

Alkaline battery in ear

A

Capable of producing a liquefactive necrosis within hours. No irrigation.

117
Q

Auricular hematoma - cauliflower ear

A

Occurs from direct, blunt trauma causing a shearing force. Requires immediate treatment to prevent cauliflower ear and infection and is permanent. Needle aspiration and I&D are treatments of choice. Antistaph antibiotics and close follow-up. Use epi only to numb.

118
Q

Nasal fractures

A

Most common trauma to nose. Nasal pyramid is the commonly fractured bone in the body

119
Q

Assessment of a nasal fracture

A

Determine presence of periorbital ecchymosis, epistaxis, or CSF leakage, trauma to neck or teeth, respiratory and c-spine stability

120
Q

Classic signs of nasal fractures

A

Tenderness, crepitation, or movement of bones on palpation.

121
Q

Incidences of epistaxis

A

Younger than 18 and older than 50

122
Q

Where most anterior nose bleeds occur

A

Kiesselbach’s plexus - a vascular plexus on the anterior nasal septum - very vulnerable

123
Q

Where most posterior nose bleeds occur

A

Within the posterior branches of the sphenopalatine artery, are idiopathic or associated with vascular disease and can be difficult to control

124
Q

If nose bleeds do not stop with direct pressure

A

Cautery with a silver nitrate stick, nasal packing with a nasal tampon. Packing is not removed for 48-72 hrs. Amoxicil/clavulante or bactrim DS is also prescribed.

125
Q

Canker sores

A

Present as one or more flat, even-bordered, round or oval ulcers with a central friable pseudomembranous base surrounded by a bright red halo. Pain is greater than the size of the lesion wound suggest

126
Q

Steroid use in a pt with herpes mouth sores

A

Do not give!

127
Q

What to do for avulsed tooth

A

Obtain mechanism of injury. Exam for lacerations. Check for fractures with x-ray. Chest x-ray if tooth can not be located. Do not implant primary teeth. If partially out, push back in. May store it under the tongue until at dr office. Irrigate socket and tooth and push back in. Provide antibiotic prophylaxis.

128
Q

Burning mouth syndrome, burning tongue - glossodynia

A

Burning, tingling, scalded, or numb sensation in anterior two thirds of tongue that worsens throughout the day. Mostly affects women

129
Q

Treatment of cellulitis and facial swelling associated with dental pain

A

10 day course of penicillin VK 500 mg quid. Can drain the abscess/

130
Q

Use of clove oil secondary dental extractions

A

Do not use in a tooth cavity when an abscess or cellulitis are present

131
Q

Pericoronitis

A

Edema and pain often associated with eruption of wisdom teeth

132
Q

What to do for pericoronitis

A

Irrigate with weak peroxide solution. Analgesics. Penicillin if cellulitis is present. Flush food out of mouth. follow up with dentist.

133
Q

Postextraction alveolar osteitis - dry socket

A

Severe, dull, throbbing pain 2-4 days after tooth extraction. May radiate into ear and is not relieved by analgesics. May last 10-40 days if not treated.

134
Q

What to do for alveolar osteitis - dry socket

A

Local anesthetic. Irrigate with NS and remove debris. Pack with goal soaked in oil of cloves. Take 4000 mg/day of vitamin C. Opiods for relief.

135
Q

Pulpitis

A

Acute toothache with sharp, throbbing pain often worse when laying down.

136
Q

What to do for pulpitis

A

Analgesics. Use oil of cloves soaked cotton for cavities. Referral to dentist within 12 hrs. No antibiotics

137
Q

Ellis class I tooth fracture

A

Involves the enamel only and can be filed down with emory board

138
Q

Ellis class II tooth fracture

A

Exposes yellow dentin. Cover with calcium hydroxide composition or dermabond. follow up with dentist next day

139
Q

Ellis class III tooth fracture

A

Exposes pulse. Be seen by dentist within 3 hrs. Analgesics

140
Q

Suturing lacerations that extend across the border of the lips

A

Bein with approximation of vermilion border to avoid unsightly scars.

141
Q

Mucocele - mucous cyst

A

Soft, rounded, nontender, fluctuant cyst, most often found inside the lower lip and usually develop rapidly

142
Q

Perleche - angular cheilitis

A

Inflammation and soreness at corners of the mouth. Topical antifungal cream for a few weeks. Keep dry.

143
Q

Sialolithiasis - salivary duct stone

A

More commen in men. Rapid swelling beneath jaw while eating. May be painful and usually subsides within 2 hrs. Often transient. Sucking on lemon drops help expel stone. Augmentin if purulent drainage from duct.

144
Q

Temporomandibular disorder - TMJ

A

Pain that is dull and unilateral, centered in temple above and behind eye and in and around the ear. Pain with opening and closing mouth. Anti-inflammatories. Follow up with dentist if pain persists after 2-4 weeks.

145
Q

Temporomandibular joing dislocation - jaw dislocation

A

Can occur with or without trauma. Attempt reduction if no trauma. If trauma, x-ray to rule out fractures. After reduction, soft collar to reduce ROM of TMJ. Refer to oral surgeon.

146
Q

Acute uvular edema

A

Foreign body sensation or lump or fullness in the throat. Uvula is boggy, swollen, pal,e and genatinous looking. May be caused by strep, allergic reaction, or H. influenzae

147
Q

Epiglottitis

A

Acute inflammation of epiglottis and typically caused by a bacterial infection. More comon in adults. Rare and can be deadly.

148
Q

Clinical presentation of epiglottitis

A

Severe odynophagia, dysphagia, fever, SOA, inability to swallow, lymphadenopathy, cough, drooling, stridor, respiratory distress, hoarseness, tripod positioning, use of accessory muscles. Do not examine pharynx with tongue depressor!

149
Q

Management of epiglottitis

A

Sit upright, humidified oxygen, close observation of airway, antibiotics, and steroids. Hospitalization. Avoid sedation. Immediately refer to ED. Protect airway

150
Q

Peritonsillar abscess

A

Accumulation of pus located within the peritonsillar tissue. Most common deep infection of head and neck.

151
Q

Presentation of peritonsillar abscess

A

Typically fever, chills, fatigue, malaise, foul breath, and severe odynophagia, may appear acutely ill and complain of pain radiating to eat on affected side. Usually unilateral.

152
Q

Management of peritonsillar abscess

A

Oral antibiotics are not enough. Surgical intervention is required with needed aspiration, I&D, or tonsillectomy. Hydration. Can be very serious if abscess ruptures.

153
Q

Most common causes of pharyngitis

A

Rhinovirus and adenovirus

154
Q

Presentation of viral pharyngitis and tonsillitis

A

More common, suden onset of sore throat, fever, malaise, cough, headache, myalgias, fatigue, rhinitis, conjunctivitis, congestion, and productive cough

155
Q

Centor score of 4 regarding GAS - pharyngitis and tonsillitis

A

Indicates a presumative diagnosis and confirmatory testing is not necessary

156
Q

Presentation of infectious monomucleosis

A

More common in adolescents and young adults. Headache, malaise, fatigue, and anorexia prior to sore throat. Hepatosplenomegaly. Positive monospot test.

157
Q

Presentation of URI

A

Cough, congestion, rhinitis, sneezing, injected conjunctiva, erythematous and edematous nasal mucosa, erythematous pharynx

158
Q

Presentation of anaphylactic reaction

A

Depends on organ system affected

159
Q

Common presentation of anaphylaxis

A

Urticaria, erythema, pruritus, cutaneous wheals, angioedema, syncope, nausea, vomiting, vertigo, flushing, and weakness

160
Q

Management of anaphylaxis

A

Protect the airway is main concern. Epi IV is first-line treatment.

161
Q

Epi dose in adult

A

1:1000 dilution - 0.2-0.5 mg IM or SC every 5-15 minutes as needed to a max dose of 1 mg

162
Q

Epi dose in child

A

1:1000 dilution - 0.01 mg/kg per dose in children, max of 0.3 mg, IM or SC; repeat every 20 minutes to 4 hours as needed to a max dose of 0.5 mg/dose

163
Q

Acute urticaria

A

Intense itching. Rash consists of sharply defined, slightly raised wheals surrounded by erythema and tends to be circular or apear as incomplete rings. Lasts no more than 8-12 hrs. May occur immediately after contact or be delayed by days.

164
Q

Management of acute urticaria

A

Identify cause if possible. Epi 0.3 mg IM. Benadryl 25-50 mg IV. Tagamet, zantac, or pepcid. Prednisone immediately and for 4 days. No topical steroids or antihistamines.

165
Q

Prevelance of acute urticaria

A

More common in young adults, children, and atopic individuals. Often attributed to exposure to food allergens, food additives, medications, contrast.

166
Q

Prevelance of chronic urticaria

A

More common in middle-aged women and does not show the same predilection for individuals with atopy. 60% are idiopathic. Can last more than 6 months

167
Q

Six “i’s” to include with history of urticaria

A

Infections, ingestants (food), injectants (drugs), insect stings, inhalants (pollen), and internal disease

168
Q

Heat stroke

A

Core body temps exceed 103 degrees and CNS abnormalities occur - seziure, confusion, hallucinations, headache, bizarre inappropriate behavior, psychosis, coma, dehydration, tachycardia, tachypnea. Key characteristics are red, hot, dry skin.

169
Q

Heat exhaustion

A

Less severe in which core temp is higher than 100 degrees, but no more than 104. Can rapidly progress to more severe and potentially fatal heat stroke. Generalized malaise, cramps, nausea, vomiting, hypotension, tachycardia, sweating, thirst, vertigo, anorexia, anxiety, but no CNS involvement

170
Q

Heat syncopy

A

Vertigo that occurs with standing for long periods or sudden rising during heat exposure

171
Q

Heat cramps

A

Muscle pains or spasms occurring in individuals performing physical activity in heat

172
Q

Management of heat-related illnesses

A

Maintain airway. Vital signs. Transport to ED. IV fluids. O2. Goal is to lower core body temp, rehydrate, and replenish electrolytes.

173
Q

Complications of heat-related emergencies

A

Rhabdomyolysis, renal, hepatic, or cardiac failure. Injuries can be permanent.

174
Q

Frostbite

A

90 percent occur in hands and feet and classified as grades I-IV on basis of severity or simply as superficial or deep.

175
Q

Hypothermia

A

Core body temp below 95 degrees.

176
Q

Partial-thickness frostbite

A

Blistering can occur within 24-48 hrs. With rewarming, area will appear mottled and swollen, with superficial blisters developing within 6-24 hrs

177
Q

Deep frostbite

A

Skin may be hard or wooden in appearance. Through the next several days, there is progression from edema, nonblanching, cyanosis, and hemorrhagic blisters to tissue necrosis.

178
Q

Management of frostbite

A

Do not massage. Wrap wounds in non-adherent dressings. Analgesics. Transport to ED

179
Q

Frostnip

A

Occurs when skin surfaces, such as tip of nose and ears, are exposed to an environment cold enough to freeze the epidermis. They become hyperemic and very painful when rewarmed

180
Q

Epidermal burns

A

1st degree. Painful, red, and moist. Blistering does not occur. Healing within 5-7 days with no scarring. Most common is sunburn

181
Q

Superficial partial thickness burns

A

One type of 2nd degree. Involves the epidermal layer and several dermal layers. Painful and heal with minimal scarring in 2-3 weeks.

182
Q

Deep partial thickness burns

A

One type of 2nd degree. Involve the epidermal and dermal layers and may involve some of the dermal appendages. Not painful because of loss of sensory nerves. May take more than 3 weeks to heal.

183
Q

Rule of 9s

A

Head and each arm = 9 percent. Genitals = 1 percent. Anterior, posterior trunk and each leg = 18 percent

184
Q

Goal of burn treatment

A

Stop burn, identify extent of burn, administer pain meds quickly.

185
Q

Full-thickness burns

A

3rd degree. Dry, leathery, and insensitive. Color can be white, brown, or black.
Cause significant scarring, loss of function, and usually require skin
grafting. Doesn’t blanch and is insensitive. Swelling may be massive

186
Q

Full-thickness burns - 4th degree

A

Involves all tissue as well as bone. Has a charred appearance

187
Q

Dressings for partial and full-thickness burns

A

LR 4 ml x wt in kg x percent TBSA. 1/2 in first 8 hrs, 1/4 in second and third 8 hr segments

188
Q

Initial fluid resuscitation of burns

A

LR 4 ml x wt in kg x percent TBSA. 1/2 in first 8 hrs, 1/4 in second and third 8 hr segments

189
Q

Factors that determine severity and distribution of electrical injuries

A

Type of current, voltage, amperage, tissue resistance, surface contacted, pathway of current, duration of contact, and other associated trauma

190
Q

Lichtenberg’s flowers

A

Linear, punctate, feathery burns often associated with lightening injuries

191
Q

Zone of coagulation

A

The innermost zone of a burn and represents the most damaged area. Cellular death and thrombosis of blood vessels occurs in this area.

192
Q

Zone of stasis

A

Second zone of burn and is where blood flow is compromised. May quickly progress to ischemia or may return to normal.

193
Q

Zone of hyperemia

A

Outermost zone. Received minimal damage and is characterized by increased blood flow and will fully recover

194
Q

Low-risk burn patients

A

Those between ages 10-50

195
Q

High-risk burn patients

A

Younger than 10 and older than 50 or those with underlying medical conditions such as heart disease, diabetes, or pulmonary problems

196
Q

First intention wound healing

A

Skin is closed with sutures, staples, skin adhesive, or Steri-stripe. Can be lacerations or surgical wounds

197
Q

Second intention wound healing

A

Wound is left open to heal on its own. This is slower and allows for granulation from the inside out. Can be caused by abscess, ulceration, puncture, or bite.

198
Q

Third intention wound healing

A

Delayed primary closure. Contaminated wounds may be closed 4-5 days after occurrence

199
Q

Puncture wounds

A

Difficult to predict outcome because inability to visualize the end of the wound. Area of injury, level of contamination affect healing.

200
Q

Treatment of choice of puncture wounds

A

Copious irrigation - no pressure irrigation

201
Q

Treatment for stepping on a nail through rubber soled shoe

A

Often includes Pseudomonas and treat with fluoroquinolone for adults and bactrim for children

202
Q

Risks of infection with bites

A

Dogs - less frequent. Cats - more frequently because usually deeper and smaller punctures. Human - often infected with staph

203
Q

Closing bites

A

Bites on the hands, any human or cat bites should not be closed. No closure if more than 8 hrs old.

204
Q

Treatment of infected bites

A

Fresh cat and human bites - 3-5 days prophylaxis. Infection - 7-14 days when soft tissue involved: 21 days if bones or joints involved. Augmentin 500 mg tid for 5-7 days most effective. Cultures of new wounds not effective

205
Q

Reactions to stings

A

Can be local, toxic, systemic, or delayed reactions.

206
Q

Toxic reactions to stings

A

GI distress, lightheadedness, syncope, headache, fever, drowsiness, muscle spasms, edema, and occassionally seizures

207
Q

Systemic reaction to stings

A

Anaphylaxis, which initially is manifested as itchy eyes, facial flushing, generalized urticaria, and dry cough. Finally respiratory distress.

208
Q

Delayed reaction to stings

A

Can occur after 10-14 days and cause fever, malaise, headache, urticaria, lymphadenopathy, polyarthritis, and more systemic illnesses

209
Q

Management of stings

A

Local wound care, removal of stinger, ice packs, H1 and H2 blockers, topical steroids, topical or systemic antibiotics, NSAIDs.

210
Q

Systemic reaction to brown recluse spider bite

A

Fever, chills, nausea, vomiting, myalgia, arthralgia, petechiae, hemolysis, or seizures within 24-48 hrs

211
Q

Response to black widow spider

A

May be mild to moderate painful, erythema, swelling, and muscle cramping begins at the site within 30 min to 12 hrs. HTN can be serious, anxiety and confusion can occur

212
Q

Mainstay for therapy of moderate to severe venomous snakebites

A

Antivenom

213
Q

Emperical treatment of MRSA abscesses

A

Bactrim DS 10 days - 1-2 tabs q12 hr. Severe infections with vancomycin IV

214
Q

Goal of wound healing through sutures/staples

A

Facilitate decreased healing time, reduce infection, and minimize scarring

215
Q

Initial assessment of the eye

A

Subjective; history - HPI, past medical and ocular history, family history, social history, and occupation

216
Q

Things to cover in history of ocular problem

A

Onset. Duration of symptoms. Change in vision. Photophobia. Pain. Mechanism of injury. Use contact lenses. History of eye surgery. Current meds. Recent exposure to new cosmetics, deodorants, or persons with eye infection. Systemic complaints - fever, rash, genital discharge.

217
Q

Objective data of eye

A

Thorough exam of eye, structure and function, enlarged lymph nodes adn rashes. Visual acuity, pupil responses. Intraocular pressure (opth), visual fields (opth), and extraocular movements. Eye lids and lashes. Lacrimal system. Anterior and posterior segments of eye

218
Q

Red eye

A

Hyperemia of the conjunctiva or sclera. Redness of the adnexal structures or periocular areas.

219
Q

Common causes of red eye

A

Conjunctivitis - allergic, bacterial, or viral. Episcleritis or scleritis - inflammatory conditions

220
Q

Episcleritis

A

Inflammatory. Involves the tissue between the conjunctiva and the sclera

221
Q

Scleritis

A

Inflammatory. Involves the sclera

222
Q

Causes of sudden vision loss

A

Acute angle-closure glaucoma. Central retinal vessel occlusion. Hypema or trauma. Endophthalmitis. Iritis or uveitis. Meningitis. Migraine. Optic or retrobulbar neuritis. Retinal hemorrhage. Stroke. Vitreous hemorrhage.

223
Q

Causes of graudual vision loss

A

Amblyopia. Cataracts. Corneal opacities. Glaucoma. Iritis or uveitis. Macular degeneration. Pituitary tumor. Retinal detachment. Vitreous opacities.

224
Q

Herpes simplex conjunctivitis

A

Subjective - red eye, photophobia, eye pain, blurred vision, foreign-body sensation. Objective - periorbital vesicles (weeping areas around eye). Fluorescein staining (dendritic pattern with bulbar terminal ending - branching). Refer to eye dr.

225
Q

Who should be referred regarding eye complaints

A

Acute change in vision. Concern for sight threatening disease. Recent trauma, ocular surgery, use of contact lenses. Neonates. Immunocompromised patients.

226
Q

Iris

A

Pigmented structure that forms the posterior aspect of the anterior chamber and acts as a shutter for the eye by controlling the amount of light through the pupil. Blood vessels not typically seen on surface.

227
Q

How to assess the iris

A

Use a penlight and a magnifying glass

228
Q

Nevi neoplasms of the iris

A

Nevi neoplasms - melanoma.

229
Q

Lisch nodules of the iris

A

Harmartomas (dark pigmented dome shaped areas that project from the surface of the iris

230
Q

Waardenburg syndrome of iris

A

Genetic abnormalities. Hearing loss and changes in coloring of hair, skin, and eyes. Often have very pale blue eyes or different colored eyes or an iris composed of different colors.

231
Q

Sarcoidosis of iris

A

Inflammatory nodules.

232
Q

Iris neovascularization

A

Presence of abnormal blood vessels and suggest ocular ischemia. Seen in - Proliferative diabetic retinopathy and Central retinal vein occlusion. Requires urgent ophthalmology consultaiton.

233
Q

Uveitis

A

Inflammation of the uveal tract. Contains the iris, ciliary body, and choroid

234
Q

Evaluation of iritis or uveitis

A

Objective findings. Instillation of a topical anesthetic if needed. Limbal flush. Slip lamp exam - WBCs in clear aqueous humor. Pupil reaction - sluggish in the affected eye.

235
Q

Limbal flush

A

Circumcorneal injection - a table of fine ciliary vessels - visible through the sclera

236
Q

Management of iritis

A

Refer to ophthalmologist. Urgen problem - can lead to blindness if not treated properly.

237
Q

Angle-closure glaucoma

A

Presentation is acute. An ocular emergency. Needs immediate attention. Ultimately results in increased intraocular pressure and decreased visual fields.

238
Q

Charcteristics of angle-closure glaucoma

A

Severe eye pain. N and V. Halos around lights. Photophobia. Corneal cloudy with variable decrease in vision. Conjunctival hyperemia. Pupil mid-dilated adn fixed. Firm globe. Shallow anterior chamber.

239
Q

Typical case presentation of angle-closure glaucoma

A

Elderly pt who presents with periorbital pain and visual disturbances. Pain is severe and boring, ipsilateral headache. Blurred vision, halos, N and V, abd pain. Past medical history - may have no history of glaucoma. Medications - ANticholinergics, sympathomimetics, recent headaches.

240
Q

Physical exam of angle-closure glaucoma

A

Only able to visualize hand movements. Pupil irregular shaped, fixed and dilated. Slit-lamp - corneal edema, irregular pupil shape. Increased IOP - greater than 20

241
Q

Corneal surface of eye

A

Injury causes epithelium interruption of corneal. Common causes finger, tree branches, makeup applicators, contact lenses, deployment of airbags. Surface foreign bodies - dust. Chemical splashes.

242
Q

Diagnostics of corneal ulcer/foreign body

A

Fluorescein stain. Corneal ulcer (C and S if immediate opth consult can not be obtained)

243
Q

Preseptal cellulitis

A

An infection of the structures anterior to the orbital septum. Absent are: proptosis, ophthalmoplegia and visual loss

244
Q

Orbital cellulitis

A

Occurs posterior to the orbital septum. 90 percent of cases occur as a secondary extension of acute or chronic bacterial sinusitis. Infections of face, eyelids, lacrimal sac, dental. After trauam, orbital or periorbital surgery. Can lead to rapid blindness and fatal consequences.

245
Q

Traumatic ocular disorder

A

May be mechanical or chemical injuries. Presentation is highly variable.

246
Q

Laceration of cornea - tes

A

Seidel’s test - moistened fluorescein strip is liberally applied to the ocular surface. When viewed with a cobalt blue light source, a laceration is confirmed if a stream of aqueous disrupts the thick layer of fluorescein.

247
Q

Acid chemicals in the eye

A

Can be quite destructive to the ocular surface - however the eye proteins act as an acid buffer to limit ocular penetration

248
Q

Alkaline chemicals in the eye

A

They release hydoxyl ions that interact with the structural proteins of the eye wall and allow deeper ocular penetration

249
Q

Initial treatment of chemicals to the eye

A

Immediate copious irrigation and requires emergent follow up

250
Q

Normal pH of eye

A

7.0-7.3. You must neutralize the chemical and return the pH to neutral to avoid further eye injury

251
Q

Reasons to refer to ophthalmologist

A

Limbal flush, irregular pupil, muscle paresis, hazy cornea, corneal dendrite, corneal ulcer, vision loss, elevation of retina on fundascopic exam, papilledema, and painful eye, red eye, and vision change.

252
Q

Management of epiglottitis

A

Emergency. Surgical intervention - needle aspiration I&D, or tonsillectomy. Antibiotics - cephalexin or another first generation cephalosporin with or without metronidazole. Cefuroxime (with or without metrodnidazole).

253
Q

Management of heat illness

A

Goal is lowering of core body temperature, rehydration, and electrolyte replenishment

254
Q

When to refer heat related illnesses

A

Refer a heat stroke or heat exhaustion immediately to an ED

255
Q

Pathophysiology of anaphylaxis

A

There is a rapid release of immunoglobulin E immune response mediators from mast cells and basophils

256
Q

When to transfer or refer burns to a burn center

A

Third-degree (full-thickness) over 5 percent. Second-degree (partial-thickness) burns over 10-15 percent (5-10 percent in children under 10). Extensive burns involving the face, hands feet, joints, or genitalia. Elderly patients and patients with significant comorbidity.

257
Q

Vision threatening conditions

A

Pain, redness, vision change

258
Q

Eye hemorrhage

A

No subjective symptoms. No treatment necessary.

259
Q

Keratitis

A

Inflammation of cornea associated with pain, photophobia, corneal cloudiness with stromal involvement. Refer to opthalmology urgently.

260
Q

Hyphema

A

Blood layering the anterior chamber usually after blunt trauma. Refer urgently to ophthalmology.

261
Q

Periorbital cellulitis

A

Acute infection of tissues surrounding eye. May progress to orbital cellulitis with protrusion of eyeball. Complications include meningitis. Refer to hospitalization and IV antibiotics

262
Q

Foreign object

A

Even small abrasions can cause intense pain and photophobia. Easily seen. Usually heal within 24 hours. May need to be treated with prophylactic topical antibiotics, analgesics. No patching. Reevaluate within 24 hrs.

263
Q

Dendritic ulcer

A

Associated with herpes simplex infection. Immediate referral to ophthalmology.

264
Q

Ruptured globe

A

Hemorrhage, limited EOM, and extrusion of eye contents. Irregular tear shaped pupil

265
Q

Treatment of ruptured globe

A

Cover with shield. No pressure. Supine at 30 degrees. NO drops or ointments. NPO. Transport immediately.

266
Q

Acute glaucoma

A

Aqueous fluid can’t assess drainage pathways causing ocular pressure to increase rapidly. Ophthalmological emergency and can lose vision in eye within hours.

267
Q

Symptoms of acute glaucoma

A

Severe pain. Red eye. Nausea and vomiting. Halos. Photophobia. Cornea may be cloudy. Pupil may be middilated and sluggish. Eye can feel rock hard.

268
Q

Retinal detachment

A

When retina is lifted from its normal position. Symptoms - floaters in field of vision, light flashes, appearance of curtain. Immediate referral.

269
Q

Chemosis

A

No pain. No vision loss. Complaint of itching. Treat with topical antihistamines and cool cloths

270
Q

Steroid and antibiotic use with eye injuries

A

Use of steroids with bacterial infections will exacerbate infection. Steroids with corneal abrasions can lead to corneal melting. Treating herpatic keratitis with antibiotic will delay treatment and lead to serious complications.

Comps - Mod 2 (9 decks)

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