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EENT Flashcards

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1
Q

Hordeolum (Stye) (-1-)
Def: a -2- abscess on the upper or lower eyelid, which is -3-
Causes/Incidence
> -2- -4-

A
  1. HOT (red, abrupt)
  2. staphylococcal/-us
  3. extremely common
  4. aureus
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2
Q 
Hordeolum (Stye) - DDx
> -1-
> -2-
> -3-
> -4-
A
  1. conjunctivitis
  2. chalazion
  3. blepharitis
  4. dacryocystitis
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3
Q

Hordeolum (Stye) - S/S
> -1-
> -2- (acutely -3-) and edema
> -4- to the -5-

A
  1. Abrupt onset
  2. localized pain
  3. tender
  4. pain proportionate
  5. degree of edema
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4
Q

Hordeolum (Stye) - Mgmt
-1- several times a day
Often -2-
Topical bacitracin or -3- may be considered
Refer to -4- if there is -5- w/in approximately 48 hours

A
  1. warm compresses
  2. bursts/resolves spontaneously
  3. erythromycin ophthalmic ointment
  4. ophthalmologist for I&D
  5. no resolution
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5
Q

Chalazion (-1-)
Def: a granulomatous (beady nodule) on the eyelid; infection or -2- of the meibomian gland
Note: a chalazion is a hard, -3- cyst; it differs from styes in that chalazia are usually -4-

A
  1. Cold (not painful)
  2. retention cyst
  3. non-tender
  4. painless
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6
Q

Chalazion - S/S
> -1-
> -2-
> -3- if the cyst is -4- to impress the -5-; may cause astigmatism due to pressure on the -5-

A
  1. Red conjunctiva
  2. itching
  3. visual distortion
  4. large enough
  5. cornea
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7
Q

Chalazion - S/S
> -1- sensitivity
> Increased -2-

A
  1. Light

2. tearing

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8
Q

Chalazion - Mgmt
> -1-
> Referral -2- (-3-)

A
  1. warm compresses
  2. for surgical removal
  3. usually the course
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9
Q

Conjunctivitis
Def: the -1- eye disorder; a(n) inflammation/infection of the -2- that covers the front of the eye and lines the inside of the eyelids resulting from a(n) -3-

A
  1. most common
  2. mucous membrane
  3. variety of causes (allergies, chemical irritation, bacteria, viruses, gonococcus/chlamydia)
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10
Q

Conjunctivitis - S/S
> -1-, irritation
> -2-
> Eyelids may be -3- with -4-

A
  1. inflammation, redness
  2. increased tears
  3. crusty and sticky
  4. mucopurulent discharge
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11
Q

Conjunctivitis - Labs/Dx

-1- when indicated (e.g., if -2- is suspected)

A
  1. gram stain & culture

2. gonorrhea

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12
Q

Conjunctivitis - Mgmt
Type: -1-
Discharge: none
Tx considerations: -2-; flushing with -3-

A
  1. Chemical
  2. self-limiting
  3. normal saline
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13
Q

Conjunctivitis
Type: -1-
Discharge: -2-
Tx considerations: -3- ointment; -4- ophthalmic -5-

A
  1. bacterial
  2. purulent, thick
  3. erythromycin 0.5% ophthalmic (as young as newborn)
  4. Polytrim
  5. solution or ointment
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14
Q

Conjunctivitis
Type: -1-
Discharge: -2-, regardless of -3-
Tx considerations: -4- or -5-

A
  1. Gonococcal - EMERGENCY
  2. copious, green, purulent
  3. activity/sleep
  4. Emergent ceftriaxone
  5. cefotaxime IM
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15
Q

Conjunctivitis - Mgmt
Type: -1-
Discharge: none
Tx considerations: -2- opthalmic -3-; -4- ophtalmic -3-; -5-

A
  1. chlamydial
  2. erythormycin
  3. ointment
  4. tetracycline
  5. oral azithromycin
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16
Q

Conjunctivitis
Type: allergic
S/S - Discharge: -2-, -3-, -4-
Tx considerations: -5-; prescription antihistamine -6-

A
  1. stringy (clear)
  2. increased tearing
  3. bilateral
  4. oral antihistamines
  5. eye drops (olopatadine)
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17
Q 
Conjunctivitis - Mgmt
Type: -1-
Discharge: -2-
Tx considerations:
> -3- care
>> mild: -4- drops
>> moderate: decongestants/antihistamines, NSAIDs
> Sulfacetamide 10% ophthalmic solution for -7-
A
  1. Viral
  2. watery
  3. symptomatic
  4. saline (artificial tears, refrigerated is best)
  5. bacterial (secondary) prophylaxis
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18
Q

Conjunctivitis - Mgmt
Type: -1-; emergency
Discharge: -2- and -3-
Tx considerations: -4- to the -5-

A
  1. Herpetic
  2. bright red
  3. irritated
  4. emergency referral
  5. ED/ophthalmologist (esp. re: lesions on face near/approaching eye)
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19
Q

Cataracts
Def: an abnormal, uniform, -1- of the eye seen in children with co-morbid syndromes (e.g. -2-, -3-, -4-, atopic dermatitis)

A
  1. progressive opacity
  2. Down
  3. Marfan
  4. DM
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20
Q 
Cataracts - Causes/Incidence
> -1-
> Prolonged -2-
> -3-
> -4-
> -5-
A
  1. congenital
  2. steroid use
  3. infection
  4. injury
  5. radiation (onc)
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21
Q 
Cataracts - S/S
> -1- vision
> -2-
> Poor -3-
> -4-
A
  1. clouded, blurred, dim
  2. white fundus reflex (absent red reflex)
  3. visual fixation
  4. photophobia
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22
Q 
Cataracts
> Lab/Dx
>> -1-
> Mgmt
>> -2- removal
A
  1. none indicated

2. refer for surgical

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23
Q

Strabismus
Def: strabismus is a(n) -1- as a result of -2-. If acquired -3- of age, strabismus is usally related to an underlying problem

A
  1. ocular misalignment
  2. uncoordinated ocular muscles
  3. after 6 mo
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24
Q

Strabismus - S/S
> -1-: eyes deviate -2-
> -3-: eyes deviate -4-

A
  1. Esotropia
  2. inward
  3. exotropia
  4. outward
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25
Strabismus - S/S > -1-: eyes deviate -2- > -3-: eyes deviate -4- > Hirschberg: -5-
1. hypertorpia 2. up 3. hypotropia 4. down 5. light reflex: asymmetric
26
Strabismus - Mgmt -1- > if fixed or -2- of age or more > -3- for -4- (-5-)
1. Refer to ophthalmology 2. continuous at 6 months 3. Immediately 4. hyper-/hypotropia 5. indicative of CNS lesion (also refer to neuro)
27
``` Otitis Externa (Swimmer's Ear) Def: inflammation of the -1- > Causes/Incidence >> Infection >>> -2- >>> -3- >> Recent history of -4- ```
1. external auditory meatus 2. bacterial (usually gram-neg) 3. fungal 4. water exposure
28
OE - S/S > -1- (-2-) > Purulent and sometimes, -3-
1. otalgia 2. esp. when pulling pinna/auricle 3. malodorous discharge (pseudomonas)
29
OE - PE Findings > -1- of the -2- > -3- of the -2- > -4- (sometimes with odor)
1. erythema 2. ear canal 3. edema 4. purulent exudate
30
OE - PE Findings > -1- of -2- or when the -3- > -4-
1. pain upon manipulation 2. auricle 3. tragus is compressed 4. TM: clear, flat
31
OE - lab/dx | Pneumatic -1- should -2-
1. otoscopy (if possible r/t edema) | 2. demonstrate mobility
32
``` OE - mgmt > -1- > -2- or injury > Topical ear mediations >> Bacterial >>> -3- and -4- ```
1. remove purulent debris 2. protect from moisture 3. ciprofloxacin 4. dexamethasone otic drops
33
``` OE - mgmt > Topical ear mediations >> Fungal >>> -1- (e.g., -2-) > Pain mgmt (-3-) > prevention; -4- afer bathing and/or swimming ```
1. antifungal drops 2. clotrimazole 1% solution 3. acetaminophen or ibuprofen 4. dry external ear
34
AOM Def: a bacterial infection of the mucosally lined air-containing spaces of the temporal bone that can interfere with air conduction. -1- is repsonsible for anout 30-50% and -2- for about 20% of AOM cases
1. S. pneumoniae | 2. H. influenzae
35
``` AOM - S/S > Decreased -1- > -2- > -3- > -4-/-5- ```
1. hearing 2. fever 3. otalgia 4. nausea 5. vomiting
36
``` AOM - PE Findigns > -1- >> -2- >> -3- > -4- exudate > -1- often -5- ```
1. TM 2. erythema 3. edema 4. purulent 5. bulges ("hot ear")
37
AOM - Lab/Dx | -1- of TM with -2-
1. Impaired mobility | 2. pneumatic otoscopy
38
AOM - MGMT > -1- mgmt: -2- > Observation period for healthy children: -3-
1. pain 2. acetaminophen 3. 48-72 hours
39
AOM - MGMT Meds > -1- PO for -2- > -3- recommended for -4-
1. amoxicillin 80-90 (**HIGH DOSE**) mg/kg/day BID 2. 10 days 3. amox-clavu 4. resistant strains
40
AOM - MGMT Prevention > -1-: -2-, -3-, annual -4- > Avoid -5-
1. vax 2. Hib 3. PCV13 4. flu 5. second hand smoke
41
Serous Otitis Media/Otitis Media w/ Effusion (OME) Def: the presence of -1- in the -2- w/o s/s of AOM; also known as chronic OME. S/S > -3- > -4- when pressure altered > -5- ear
1. fluid (clear) 2. middle ear(s) 3. hearing loss 4. popping sensation 5. fullness in the
42
OME - PE Findings > -1- behind the -2- > Decreased -3- > -4- tests suggestive of -5-
1. air bubbles 2. TM 3. membrane mobility 4. Weber & Rinne 5. conductive hearing loss
43
OME - Labs/Dx | -1- via -2-
1. decreased hearing | 2. audiometry
44
``` OME - Mgmt > watchful monitoring: -1- > abx therapy: -2- > -3-: -4- > -5- months ```
1. 3 months 2. no long-term efficacy 3. antihistamines/decongestants 4. ineffective 5. re-evaluate in 3-6
45
Hearing Loss | def: any degree of -1- ability to -2-; may be -3-.
1. impairment in the 2. aprehend sound 3. conductive, sensorineural, or mixed
46
``` Hearing Loss Conduction Causes > -1- impaction/foreign body (-2-) > -3- > -4- > -5- ```
1. Cerumen 2. most treatable 3. hematoma 4. OM 5. perforated TM
47
``` Hearing Loss > Sensorineural Loss >> Impaired transmission of sound through the -1- >> Causes >>> -2- >>> -3- >>> -4- disease >>> -5- ```
1. nervous system 2. acoustic neuroma 3. syphillis 4. CNS 5. medication toxicity
48
Understanding -1- & -2- tests > Expected findings >> -1- test: Sound -3- and not lateralize >> -2- test: -4- > -5-
1. Weber (weber-head) 2. Rinne (like the wind!) 3. should be heard equally in both ears 4. air conduction 5. bone conduction
49
``` Hearing Loss S/S Findings w/ Hearing Loss > Conductive hearing loss >> Weber: sound -1- to the -2- >> Rinne: -3- in affected ear (i.e. -4-) ```
1. lateralizes 2. affected ear 3. abnormal 4. AC < BC
50
``` Hearing Loss S/S Findings w/ Hearing Loss > -1- >> Weber: sound -2- to the -3- >> Rinne: -4- in the -5- ```
1. Sensorineural hearing loss 2. lateralizes 3. unaffected ear 4. AC > BC 5. affected ear
51
``` Hearing Loss Lab/Dx > Otoscopic ex: -1- and TM > General -2- > -3- > -4- a neuro condition is suspected ```
1. inspect canal 2. neuro exam 3. audiometric testing 4. CT scan if
52
``` Hearing Loss Mgmt > remove -1- > -2- > Refer for -3- ```
1. foreign body/cerumen 2. refer for audiogram 3. further evaluation/hearing aid
53
Allergic Rhinitis | Def: -1- to -2-
1. immune-mediated response | 2. allergens
54
``` Allergic Rhinitis S/S > -1- discharge > -2- > -3- eyes > -4- (from -5-) ```
1. postnasal (clear/white) 2. sneezing 3. itchy 4. HA 5. nose blowing, even
55
``` Allergic Rhinitis Mgmt > -1- (often requires skin-prick test or other ID measure; not possible for all allgerns) > -2- antihistamines (e.g., -3-) > -4- (e.g., -5-) ```
1. avoid allergens 2. second-generation 3. loratidine, cetirizine, fexofenadine 4. Intranasal corticosteroids 5. budesonide, fluticasone
56
``` Common Cold Def: -1-, a -2- URI S/S > -3- > -4- ```
1. viral rhinitis 2. self-limiting 3. sore throat 4. Malaise
57
``` Common Cold Mgmt > -1- and -2- > No -3-; avoid antitussives for children -4- > (-5-) ```
1. rest 2. hydration 3. OTC cold preps (decongestants, antihistamines, antitussives, expectorants) 4. < 6 years of age 5. should be resolved by day 12 (consider DDx for longer)
58
Common Cold Mgmt > No -1- > -2- mgmt w/ -3-
1. abx 2. pain/fever 3. acetaminophen or ibuprofen
59
(Rhino-)Sinusitis Def: Occurs when an undrained collection of pus accumulates in one or more of the paranasal sinuses in -1-. The -2- and -3- are the -4-.
1. children age 4+ 2. maxillary 3. ethmoid sinuses 4. most commonly affected
60
(Rhino-)Sinusitis | Def: Typical pathogens are the same as those of -1- (-2-): -3-, -4-, -5-
1. AOM 2. all connected: sinuses, nasal, optical, and otic passages 3. S. pneumoniae 4. H. influenzae 5. M. catarrhalis
61
``` (Rhino-)Sinusitis S/S > -1- over the -2- > -3- > Discolored -4- ; halitosis ```
1. pain & pressure 2. cheeks 3. HA 4. nasal discharge
62
(Rhino-)Sinusitis S/S > -1- and cough (usually during day, worse at night) > -2-, worse when -3-
1. post-nasal drip 2. dull, throbbing pain 3. head is dependent
63
``` (Rhino-)Sinusitis Labs/Dx > Dx is often made on -1- > Radiological studies are rarely needed >> -2- preferred over -3-: more sensitive but more expensive; only used for -4- ```
1. clinical presenation 2. CT scan 3. x-ray 4. more complicated sinusitis
64
(Rhino-)Sinusitis Mgmt Uncomplicated w/ mild symptoms, treat outpt: -1- for -2- or -3- whichever's longer; -4- to -5- if no -6-
1. Amox-clav 2. 10 days 3. 7 days post-symptom 4. *change abx!* 5. a secondary abx such as Levaquin (levofloxacin) 6. improvement by day 3
65
(Rhino-)Sinusitis Mgmt Uncomplicated w/ mild symptoms, treat outpt: > -1- are not -2- in acute sinusitis but may be used in chronic sinusitis > -3- managed with -4- > -5- care
1. Decongestants & antihistamines 2. useful 3. pain 4. acetaminophen 5. supportive
66
(Rhino-)Sinusitis Mgmt Chronic, refractory, or -1-: -2-
1. recurrent sinusitis | 2. referral to ENT
67
Epistaxis (Nosebleed) S/S > Bleeding usually only from -1- (-2-) > -3- because of -4- the -5- into stomach
1. one nostril 2. 2 nostrils is concerning for coagulopathy 3. stomach upset 4. blood dripping from 5. back of the throat
68
Epistaxis (Nosebleed) S/S -1-; septal erosion (may be caused by -2-)
1. Friability | 2. inhaled substance abuse
69
``` Epistaxis (Nosebleed) Mgmt > -1- > -2- (i.e., triangle): -3- of the -4- for 10 minutes > Apply -5- ```
1. Sit upright 2. pressure at **Kiesselbach's plexus** 3. anterior inferior aspect 4. nasal septum (end of bony ridge) 5. ice
70
Pharyngitis/Tonsilitis | Def: -1- of the -2- behind the nose and mouth and/or the -3- in the throat, to the side of the root of the tongue
1. Inflammation 2. membrane-lined cavity 3. lymphoid masses
71
Pharyngitis/Tonsilitis Causes/Incidence > -1- > -2-
1. Viruses (EBV, flu, RSV) | 2. GABHS
72
``` Pharyngitis/Tonsilitis Bacterial Causes/Incidence > -1- > -2- > -3- (-4-) ```
1. N. gonorrheae* 2. mycoplasma 3. chlamydia trachomatis* 4. *good history in adolescent pts
73
``` Pharyngitis/Tonsilitis S/S > -1- > Dysphagia; -2- > -3- > -4- (more pronounced in -5- infections) ```
1. erythematous pharynx 2. cough 3. malaise 4. fever 5. bacterial
74
``` Pharyngitis/Tonsilitis S/S > -1- (bacterial) > -2- > -3- > -4- with sandpaper-like -5- ```
1. **anterior** cervical adenopathy 2. painful throat 3. exudate 4. scarlet fever 5. rash
75
Pharyngitis/Tonsilitis Labs/Dx > -1- (fever, cough, sore throat, abdominal pain, n/v) > -2- (15+) > -3- (2-) > -4- (-1-'s symptoms + HA, malaise, myalgias; diarrhea?)
1. Rapid strep 2. heterophile antibody test (monospot) 3. RSV PCR 4. rapid flu
76
``` Pharyngitis/Tonsilitis Mgmt > -1- care >> -2- >> -3- >> antipyretics (-4-) ```
1. supportive 2. fluids/hydration 3. warm saltwater gargles 4. acetaminophen
77
Pharyngitis/Tonsilitis Mgmt > Abx only for -1- >> -2- 250 mg orally 2-3 times daily for 10 days >> If -3- 20 mg/kg orally 2 times daily for 10 days >> -4- at least -5- initiation
1. Strep infection 2. PCN VK 3. allergic, then macrolide (even for mild allergy) 4. return to school/day care 5. 12 hours after treatment
78
Epiglottitis Common pathogens include strept-, pneumococci, and -1-; NOT -2- Causes/Incidence Peak incidence occurs b/t the ages of -3-
1. H. influenzae B 2. Chlamydia Trachomatis 3. 6 and 12 years
79
``` Epiglottitis S/S > -1- high fever > -2- appearance > -3- > -4- of the neck > Rapidly progressive signs of -5- ```
1. sudden onset 2. toxic 3. restless, fearful, garbled speech 4. leaning forward, hyperextending 5. respiratory distress
80
Epiglottitis Labs/Dx -1- a -2-, appearing on a-3-
1. Thumb sign 2. thumb-shaped path 3. radiograph of the neck
81
``` Epiglottitis Mgmt > -1- > Do not -2- > -3- as soon as possible > -4- until pathogen is identified ```
1. immediate hospitalization 2. perform pharyngeal exam 3. Intubation capabilities 4. IV 3rd gen cephalosporin (ceftriaxone, cefaxotime, cefdinir)
82
Croup | Def: ... infection of the larynx
parainfluenza viral
83
Croup Causes/Incidence > -1- can -2- from mild to quite severe > peak incidence is from -3-
1. Severity 2. range 3. 6 mo to 3 years of age
84
Croup Causes/Incidence > Affects -1- than -2- > Most common in -3-
1. males more often 2. females 3. fall & winter
85
``` Croup S/S > Recent symptoms of a(n) -1- > -2- > Lungs -3- ```
1. URI 2. bark-like cough 3. typically clear
86
Croup Lab/Dx > -1-: shows -2- in severe forms > Appearance of a -3- of the -4- radiograph of the neck (-5-)
1. Pulse ox 2. hypoxia 3. "steeple-shaped" narrowing 4. trachea on frontal 5. *C*roup *C*hurch-->steeple
87
``` Croup Mgmt > moderate disease: -1- support; -2- > may require -3- > short course of -4- ```
1. hospitalize for respiratory 2. IV fluids 3. nebulized racemic epinephrine 4. corticosteroids
88
Epiglottitis vs. Croup > -1- infection vs. -2- infection > 6-10 years of age vs. 6 mo to 3 years fo age > X-ray: thumb sign vs. -3-
1. bacterial 2. viral 3. steeple
89
Epiglottitis vs. Croup > bacterial infection vs. viral infection > -1- of age vs. -2- of age > X-ray: -3- vs. steeple
1. 6-10 years 2. 6 mo to 3 years 3. thumb sign
90
Infectious Mononucleosis | Def: an -1- due to the -2-, occuring most often between -3- of age
1. acute infectious disease 2. EBV 3. 15 - 25
91
``` Mono Causes/Incidence > mode of -1- > incubation period: -2- > Usually -3-, but -4- may last for -5- ```
1. transmission is saliva (resp. droplet) 2. 1-2 months 3. self-limited 4. malaise & fatigue 5. months
92
Mono S/S > -1- > -2- (most severe)
1. fever | 2. pharyngitis
93
``` Mono PE Findings > -1- > -2- on -3- > -4- in 50% of cases, -5- in only 20% > -6- trunk ```
1. **posterior** cervical lymphadenopathy 2. white exudate 3. tonsils 4. **splenomegaly** 5. **HEPATOMEGALY** 6. maculopapular/petechial rash on
94
``` Mono Lab/Dx > lymphocytic leukocytosis; -1- > positive heterophil and -2- > -3- in EBV > -4- in EBV ```
1. neutropenia 2. Monospot 3. early (acute convalescent stage) rise in IgM (IMmediate) 4. permanent rise in IgG (Gone)
95
Mono Mgmt > -1- (e.g., -2-, warm saline gargles) > Oral -3- when -4- threatens -5-
1. supportive care 2. NSAIDs 3. corticosteroids 4. enlarged lymph tissue (tonsils) 5. airway obstruction
96
Mono Mgmt -1- (-2-) to -3- (even without clinically detectable splenomegaly)
1. avoidance of contact sports 2. 3 weeks to several (3) months 3. avoid splenic rupture
97
``` Corneal Abrasion > -1- eye injury in children >> causing -2- > Can be detected by -3- >> Topical -4- ```
1. Common 2. pain, tearing, photophobia 3. Wood's lamp/fluorescein dye 4. ophthalmic anesthetic (for Ax only, no repeat use)
98
Corneal Abrasion > Mgmt >> topical ophthalmic -1- times a day for a few days >>> positive response to treatment: -2- days. >> Topical -3- >> Oral -4- intermittently
1. antibiotic applied 4 2. continue for 2-3 3. steroids not recommended (lower resistance to infection) 4. acetaminophen/ibuprofen & cool compresses
99
``` Corneal Abrasion > Mgmt >> Patching is -1- >>> does not -2- >>> barrier -3- >> Most steadily -4- >>> Persistent/increasing pain/discomfort -5-: refer to ophthalmology ```
1. no longer recommended 2. reduce discomfort/speed healing 3. to antibiotic Tx 4. heal in 24-48 hours 5. after 24 hours
100
A one-week history of fever, exudative pharyngitis, cervical lymphadenopathy, and -1- in an adolescent raise suspicion for mononucleosis. The most -2- to order would be a -3-. This is a nonspecific test and is positive in 85% of adolescents with mononucleosis within the -4- of the illness but is often negative in children under the age of -5-.
1. hepatosplenomegaly 2. appropriate laboratory test 3. heterophile antibody test (monospot) 4. first two weeks 5. 4 years
101
Mono A -1- does not provide any specific diagnostic information. The -2- tests for recent strep infection, but -3- is a differentiating symptom from strep. CMV is a good differential diagnosis as it can cause -4-, but the presence of -3- & -5- are more specific for mono.
1. complete blood count 2. antistreptolysin O titer 3. (hepato-)splenomegaly 4. fatigue and adenopathy 5. pharyngitis
102
The most common cause of mono is EBV. -1- can be used for -2- if heterophile antibody testing is negative and there is -3- of mononucleosis, or in -4- in which heterophile antibody tests are -5-.
1. Epstein-Barr titers 2. preliminary mono testing 3. still strong suspicion 4. young children 5. unreliable
103
Croup is a common illness in children -1- years of age with a predilection for infants and toddlers -2- months of age. Croup can be caused by -3-. Presentation includes fever, rhinorrhea, -4-, -5-, retractions that range from mild to severe, and an increased respiratory rate.
1. younger than 6 2. 6 to 36 3. viruses and allergens 4. hoarse “barking” cough 5. upper airway stridor
104
Croup Symptoms usually worsen at night including the -1-, which can be -2- to parents and caregivers. Hypoxia occurs as a -3-. A fever of up to 102˚ F (38.9˚ C) may be -4- or an indication of a more severe illness but, in isolation, does not warrant -5-.
1. cough and stridor 2. especially frightening 3. very late sign 4. part of croup 5. urgent re-evaluation
105
Croup Severity progresses from symptoms that are present when -1-, to symptoms present -2-. A barky cough in the morning is a -3- of croup.
1. crying/active/upset (mild) 2. *while at rest (severe)* 3. common feature
PNCB CPNP-PC
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