Test 1 Flashcards
blocked meibomian gland
chalazion
chalazion
nontender, painless nodule that is inside the lid
trx for chalazion
warm, moist compress to eye 5-6x/day
Hordeolum is caused by
Staph aureus
internal hordeolum
chalazion
external hordeolum
stye
topical atbx are usually not effective for
hordeolum
Red, inflamed eyelids with crusting
blepharitis
risk factors for blepharitis
chalazion or hordeolum, immunocompromised, DM, acne
S/S of blepharitis
itching, tearing, photophobia, absence of eyelashes
main cause of viral conjunctivitis
adenovirus
drainage in viral conjunctivitis
serous or serosanguinous
symptoms of viral conjunctivitis last for
5-14 days
nonpharm trx for viral conjunctivitis
cool compresses and artificial tears
most common cause of bacterial conjunctivitis in children
H. influenza, Strep pneumonia
most common cause of bacterial conjunctivitis adults
Staph aureus
trx for bacterial conjunctivitis
trimethoprim-polymyxin B and fluoroquinolone gtts QID for 1 week
trx for allergic conjunctivitis
fenofexadine or loratadine
S/S of nasolacrimal duct obstruction
chronic tearing, eyelash debris, conjunctival injection;
congential nasolacrimal duct obstruction closes by
6 months
management for nasolacrimal duct obstruction
warm compress, massage
infection of the anterior portion of the eyelid
preseptal cellulitis
S/S of preseptal cellulitis
ocular pain, eyelid swelling and erythema
causes of preseptal cellulitis
insect bite, eyelid trauma, Strep pneumnoia, Staph aureus
diagnosis of preseptal cellulitis
contrast CT of orbit and sinuses
trx for preseptal cellulitis
clindamycin
infection of the orbit
orbital cellulitis
Complications of orbital cellulitis
loss of vision
s/s of orbital cellulitis
eyelid weakness, pain with eye movement, vision impairment, sinusitis
blood cultures in adults with orbital cellulitis
negative
trx for orbital cellulitis
vancomycin + IV unasyn or zosyn
risk factors for cerumen impaction
hx of seborrheic dermatitis or psoriasis, Qtips, excessive swimming
causes of conductive hearing loss
foreign body, otitis media, perf eardrum, otosclerosis of ossicles
when hearing improves in noisy environment
conductive hearing loss
Weber test in conductive hearing loss
sound lateralizes to impaired ear
Rinne test in conductive hearing loss
BC > AC
causes of sensorineural hearing loss
loud noise exposure, trauma, aging
when hearing worsens in noisy enviornment
sensorineural hearing loss
Weber test in sensorineural hearing loss
sound lateralizes to good ear- damage to inner ear impairs transmission
Rinne test in sensorineural hearing loss
AC > BC
The ear canal is often swollen, narrowed, moist, pale, and tender. It may be reddened.
otitis externa
Bacterial causes of otitis externa
Pseudomonas
Fungal causes of otitis externa
Aspergillus
S/s of otitis externa
otalgia, redness/edema to ear canal, itching, purulent discharge, normal TM
Drops in otitis externa
lie with affected ear up and maintain position for 5 min.
trx for otitis externa
ciprofloxacin + hydrocortisone 3 gtts BID x 7 days
causes of otitis media
S. pneumonia and H. influenza
s/s of otitis media
earache, fever, hearing loss, red and bulging TM.
risk factors for otitis media
daycare, URI, allergic rhinitis, secondhand smoke, first ep of AOM
trx for AOM:
amoxicillin 875 mg PO bid x 5-7 days
trx for AOM with PCN allergy
azithromycin 500 mg PO daily x 3 days
complication of recurrent AOM
cholesteatoma
management of epistaxis
applying direct pressure for 15 min sitting upright and leaning forward.
trx for anterior nare epistaxis
silver nitrate stick
trx for posterior nare epistaxis
referral to hospital or ENT.
counseling for epistaxis
avoid alcohol, vigorous exercise, ASA, and spicy foods.
s/s of rhinitis
allergic shiners, conjunctival injection, pale/boggy turbinates, clear nasal drainage
give diphenhydramine cautiously in patients with
BPH, COPD, and glaucoma
topical nasal steroids for rhinitis
Budesonide, flonase, and nasonex
s/s of sinusitis
fever, yellow nasal discharge, sinus tenderness, cough
acute sinusitis is for less than
4 weeks
causes of sinusitis
Strep pna, H. influenza, M catarrhalis, rhinovirus
most common cause of sinusitis in smokers
H. influenza
s/s of bacterial infection of sinusitis
fever, purulent nasal discharge for > 10 days
rebound nasal congestion
caused by use of sympathomimetic sprays or decongestants for > 1 week
pharm trx options for sinusitis
amoxicillin, augmentin, azithromycin, levqaquin
most common age for epiglotitis
children age > 7
usually appears as a cottage cheese like lesion that is easily removed by a swab; the underlying tissue may bleed after manipulation
candida albicans
diagnosis of candida albicans
hyphae on microscopic evaluation
trx for candida albicans
nystatin 5 mL S&S 4xday
white patches on the oral mucosa that remains despite attempts to rub it off.
leukoplakia
Borrelia burgdorferi
spread in tick bites that can cause Lyme disease
s/s of lyme disease
erythema migrans, fatigue, headache, fever, body aches, joint pain
screening for lyme disease
ELISA followed by Western Blot
trx for Lyme disease
doxycycline 100 mg PO bid for 14 days
Rickettsia rickettsii
bacteria that causes Rocky Mountain Spotted Fever
S/S of Mountain Spotted Fever
maculopapular rash begins around the wrist and ankles
number one cause of lower respiratory tract infection in children under one year old.
RSV
RSV s/s in children
PNA, wheezing, SOB
RSV s/s in adults
URI symptoms: cough, rhinorrhea, conjunctivitis, ear/sinus infections
trx not recommended for RSV
bronchodilators and corticosteroids
MRSA infected furuncles are resistant to
beta lactams and cephalosporins
trx for MRSA infected furuncles
clindamycin, Bactrim, Doxycycline
when to give HPV
age 9 in males and females
pencillin covers
gram +
extended spectrum PCN covers
gram+, gram -, beta lactam
Tetracyclines cover
gram -, atypical, MRSA
sulfonamides cover
gram -, MRSA
1st gen cephalosporins cover
gram +
2nd gen cephalosporins cover
gram+, gram -
3rd gen cephalosporins cover
weak gram +, gram -, b-lactam
azithromycin covers
gram +, gram -, atypicals
3rd generation fluoroquinolones cover
gram +, gram -, atypicals, b-lactam
rare retinal tumor in children
retinoblastoma
a patient with narrow angle glaucoma should avoid which OTC meds?
antihistamines and decongestants
used to measure intraoccular pressure
tonometer
acute conjunctivitis at birth may be caused by
N gonorrhea
loss of central vision
macular degeneration
age when vision progresses to 20/20 to 20/25
6 years
age when frontal sinuses develop
4-6 years
prophylaxis for allergic rhinitis
topical corticosteroid, mast cell stabilizer, saline rinses
rinne test is a test for
sensorineural hearing loss
s/s of otitis media with effusion
TM opaque, decrease TM mobility, bubbles
test to help confirm the presence of fluid in the middle ear
tympanometry
first DOC for otitis media
PCN
if there is atbx failure with otitis media, then add
b-lactamase coverage
if there is severe otalgia and fever in otitis media, then given an atbx that has
gram +, gram -, and beta lactam coverage
first line trx for bacterial pharyngitis
PCN
if there is a chronic or recurring pharyngitis, then
culture throat
most pharyngitis is
viral
beta lactam atbx
augmentin, 3rd or 4th gen cephalosporins and fluoroquinolones
grayish membrane on uvula and pharynx
diptheria
monospot is most likely to be positive ____ after infection
2-3 weeks
s/s of herpangina
sore throat, drooling, fever, ulcerations on tonsils and uvula, diarrhea, fever
hot potato voice indicates
peritonsillar abscess
cause of fifth’s disease
parovirus 19
s/s of fifth’s disease
slapped cheek, lacy rash on trunk and extremities
no longer communicable when rash erupts
fifth’s disease
duration of fifth’s disease
4-28 days
duration of herpangina
1 week
cause of roseola
human herpes virus 6
s/s of roseola
rose-pink maculopapular rash on trunk
red papules to soft palate or base of uvula in roseola
nagayama spots
cause of hand foot and mouth disease
coxsackie virus A16
cause of epiglottitis
H. influenza type B, strep, staph
s/s of epiglottitis
fever, stridor, drooling, beefy red pharynx, sniffing posture
s/s of peritonsillar abscess
unilateral sore throat, fever, cervical lymphadenopathy, trismus, uvula deviated to opposite side
cause of peritonsillar abscess
streptococcus
viral causes of pharyngitis
rhinovirus, adenovirus
bacterial causes of pharyngitis
GABHS, H. influenza, Mycoplasma
centor criteria
fever, anterior cervical lymphadenopathy, tonsillar exudate, absence of cough
s/s of viral pharyngitis
sore throat, pharyngeal edema, nasal congestion, cough, diarrhea, conjunctivitis
high risk of this with hand foot and mouth disease
dehydration d/t inability to swallow
common in women with Fifth’s disease
arthralgias for up to 21 days
causes of herpangina
enterovirus 71, coxsackie A16 and B virus
s/s of roseola
fever for 2-3 days, then rash on trunk and arms
complication of rocky mountain spotted fever
vasculitis
varicella vaccine
given at 12-15 months then 4-6 years
“bull neck” noted in
diptheria
DTap schedule
2, 4, 6, 15-18 months, and 4-6 years
TDaP schedule
11-12 years, then booster of Td every 10 years
H. influenza type b most common in
children less than 5
Hib immunization given
2, 4, 12-15 months
non-typable H influenza is frequently the cause of
otitis media
MMR vaccine given at
12-15 months then 4-6 years
white spots that form inside mouth
Koplik spots in rubeola (measles)
common sign of mumps
tender and swollen salivary glands
PCV13 given in children at
2, 4, 6, 12-15 months
most common cause of diarrhea in children
rotavirus
rotavirus vaccine given at
2 and 4 months
triangular shaped thickening of the bulbar conjunctiva
pterygium
First line drug for management of allergic rhinitis
topical nasal steroid
how many doses of hep B for a normal child?
3
sickle cell disease is indicated for which vaccine?
PPSV23 and PCV13
which vaccine-preventable infections can result in cirrhosis and cancer of the liver?
hep B
The inactivated poliovirus vaccine creates neutralizing antibodies to the virus after which dose?
3rd dose
diphtheria can increase the risk of death d/t complications of the
cardiac system
Which serotype(s) of the human papilloma virus can cause cancer?
16 & 18
there is no vaccine for this virus
RSV
drugs that can cause fever of unknown origin
anticonvulsants, beta-lactams, sulfa, allopurinol, heparin
vaccines that contain live viruses
influenza, shingles, MMR, varicella, rotavirus, typhoid, and smallpox
these people should not receive live attenuated viruses
immuno-deficient
HPV type 6 and 11 cause
genital warts
trx for posthereptic neuralgis
TCA such as amitrypilline