Leik FNP Prep Exam > HEENT > Flashcards

HEENT Flashcards

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1
Q

Acute angle close glaucoma

A

Older adult patient
Acute onset of severe eye pain
W/ headache, n/v, halos around lights, lacrimation, and decreased vision

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2
Q

What would you see on exam of a patient with acute angle-closure glaucoma?

A

Mid-dilated
Oval-shaped pupil (s)
Cornea= cloudy
Fundoscopic exam= cupping of optic nerve
Rise in IOP
***Opthalmogic emergency Refer to ED

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3
Q

What is auricular hematoma?

A

Direct blunt trauma to ear
Hematoma should be drained- can cause cauliflower ear

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4
Q

What is basilar skull fracture?

A

Temporal bone is most commonly fractured
Caused in adults include falls, assaults car, collisions, and penetrating missiles

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5
Q

 what is seen in basilar skull fracture?

A

Periorbital ecchymosis (raccoon eyes)
Mastoid ecchymosis (battle sign)
Appears 1 to 3 days after trauma
Hemotympanum (blue to purple color of TM)

Clear rhinorrhea or otorrhea= CSF leak

** serious head injury

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6
Q

What is cholesteatoma?

A

May be asymptomatic or may complain of hearing loss and intermittent ear discharge (otorrhea) from one ear that is foul smelling and purulent

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7
Q

What is seen on exam of a cholesteatoma?

A

Perforation of the TM on the superior quadrant
Cauliflower like or pearly white mass
Intact TM with missing landmarks with white mass behind the TM

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8
Q

How is cholesteatoma treated?

A

Treated with antibiotics and surgical excision and repair

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9
Q

What is diphtheria?

A

Infectious disease caused by gram + corynebacterium diptheriae

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10
Q

What are the symptoms of diphtheria?

A

Sore throat
Malaise
Low grade fever
Cervical lymphadenopathy
Possible swelling of submandibular region and anterior neck ( bull neck)
1/3 of cases posterior pharynx, tonsils, uvula, and soft palate coated with gray to yellow pseudo membrane

Very contagious

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11
Q

What is herpes simplex keratitis?

A

Acute onset of severe eye pain
Photophobia
Tearing
Blurred vision in 1 eye

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12
Q

What is the treatment for herpes simplex keratitis?

A

Depends on episode is caused but active viral replication or immune response to past infection
Epithelial herpes simplex keratitis -use antiviral therapy
Stromal keratitis -combination therapy with a topical glucocorticoid and antiviral treatment

** do not use topical glucocorticoids when active herpes simplex virus epithelial diseases present!!

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13
Q

What part of the eye is the fundal background a deep red color, without exudate or hemorrhages?

A

Peripheral retina

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14
Q

What is round sphere with sharp margins, orange/pink neuroretinal rim and a central white depression (physiologic cup)?

A

Optic nerve

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15
Q

True or false the cup should be more than half the size of the disc diameter?

A

False it SHOULD NOT be more than half the size of the disc diameter

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16
Q

What is dark spot located in the exact center of the posterior portion of the retina and what is this responsible for?

A

Macula
Responsible for central vision,
sharpest vision 20/20 vision and color vision

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17
Q

What is the center of the macula?

A

Fovea centralis

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18
Q

What do diseases of macula cause?

A

Central vision loss

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19
Q

Vasculature of eye: where do blood vessels arise from which side of the optic disc

A

The nasal side of the optic disc

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20
Q

Are arteries brighter red and narrowers than veins in the eye? Ratio?

A

Yes

A:V ratio= 2:3 or 4:5

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21
Q

What are cones of eye for?

A

Color perception
Sharpest vision 20/20 vision

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22
Q

What are the rods of the eye for?

A

Low light vision ( night vision)
Peripheral vision

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23
Q

What are the bones of the ear made of?

A

Malleous
Incus
Stapes

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24
Q

What does the normal TM look like?

A

Translucent off-white to great color with cone of light intact
Lateral process of vous is located to the upper quadrant of the TM in lies in front of pars flaccida

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25
What does the pars tensa look like normally?
Located to lower aspect and appears to bulge slightly
26
True or false the pars tensa is area where the cone of light is visible
True
27
Does cartilage found in the nose and ears regenerate?
No
28
What part of the nose is responsible for 90% of nosebleeds
Kiesselbach’s plexus
29
What ages are the four types of sinuses present?
Ethmoid & maxillary (present at birth) Frontal ( age 5 years) Sphenoid ( age 12 years)
30
What medications can cause bleeding gums?
Phenytoin ( Dilantin) for seizures causes gingival hyperplasia
31
What infection can cause the anti-your cervical lymph nodes to become enlarged?
Viral or bacterial infections (Strep throat)
32
What can cause the posterior cervical lymphadenopathy?
Mononucleosis
33
What is the term used when distance vision is intact but your vision is blurry
Hyperopia “farsightedness
34
What term is used when your vision is intact but distance vision is blurry
Myopia “nearsightedness”
35
What term is used for a lazy eye?
Amblyopia
36
What is miosis of eye?
Excessive construction of the people of the eye
37
What is ptosis?
Drooping of the upper eyelid
38
What is the pathognomonic for Kolpik’s spots?
Measles Clusters of small whitish, grayish, or bluish elevation with and erythematous base seen on the buccal mucosa opposite of molar teeth
39
What is anterior uveitis (iritis)?
Insidious onset of eye pain with conjunctival injection Frequently occurs in association with other infections and inflammatory diseases, such as rheumatoid arthritis, lupus, and ankylosing spondylitis, sarcoidosis and syphilis
40
What is blepharitis?
A chronic condition caused by inflammation of the eyelids (hair follicles, meibomian glands)
41
What is the treatment anterior uveitis (iritis)?
Referred to optimist for management ASAP within 24 hours because it can result in blindness
42
What is the treatment for blepharitis?
Gentle scrub of eyelid margins until it resolves Topical antibiotic solution -erythromycin eyedrop Apply warm compress Avoid trigger such as allergens cigarette smoking in contact lenses
43
What is chalazion?
Chronic inflammation of the meibomina gland
44
What is the treatment for chalazion?
Play swarm compresses on eyelid at least twice a day of facilitate drainage Antibiotics often did not indicated
45
What is the treatment for corneal abrasion?
Ophthalmic antibiotic with pseudomonal coverage-especially for contact lens users Ciprofloxacin ( Ciloxan) Ofloxacin ( Ocuflox) Trimethoprim-Polymyxin b (polytrim) DO NOT EYE PATCH
46
What is the medical term for stye?
Hordeolum
47
What is the treatment for hordeolum (stye)
Most resolved spontaneously and do not require specific intervention
48
What is infectious keratitis?
History of contact lens patient complains of acute onset of redeye, blurred vision, watery, eyes photophobia
49
What is the treatment for infectious keratitis?
Check visual, cutie, and check peoples with penlight Flush eye out with sterile normal saline Eyelid to look for foreign body So contact lens use Initiation of topical anabiotic therapy Avoid glucocorticoids Pain prescription hydrocodone with acetaminophen for 48 hours Topical pain, med ketorolac tromethamine (Acular) 1st 4xs/day- contraindicated if allergy to NSAID
50
What is open angle glaucoma?
Progressive, peripheral visual field loss followed by central field loss Seen an elderly patient, especially those with diabetes
51
What is the treatment for open angle glaucoma?
Check IOP with Toni meter (normal range 8-21 mmhg) Xalatan ( Latanoprost)- increases aqueous outflow Timolol 0.5% (Betimol)- decrease aqueous production CONTRAINDICATIONS Asthma COPD Second or third-degree heart block Heart failure
52
53
54
What is the organism that causes acute otitis media?
Most common Streptococcus pneumoniae Hemophilia influenzae Group A strep, staph aureus & moraxella catarrhalis less frequently causes
55
What are the objective findings for cute otitis media?
Bulging TM Reduce mobility of TM Erythematous TM Partial or complete opacification of TM Conductive hearing loss may be demonstrated in Weber exam Rinne test is BC >AC
56
What is the treatment plan for acute otitis media?
Antibacterial therapy 1st line (any age group) =amoxicillin -clavulanate, if no antibiotics in prior month PCN allergy 2nd or 3rd gen cephalosporin (ex. cefdinir)
57
What is otitis externa?
Aka swimmers ear & external otitis Information of the skin of the external ear canal (rarely fungal)
58
What organisms cause otitis externa?
Pseudomonas aeurginosa Staph epidermidis S. aureus
59
What is the treatment for otitis externa?
Mild (intact, TM characterized by minor discomfort, pruritus, and minimal canal edema)= non antibiotic acidifying agent & glucocorticoid ( acetic acid hydrocortisone) Moderate intact TM, intermediate degree of pain, pruritus, canal may ne partially occluded.= topical antibiotic & glucocorticoid (ciprofloxacin-hydrocortisone) 1 week Severe disease intact TM,intense pain, canal completely occluded from edema= topical antibiotic & glucocorticoid (ciprofloxacin-hydrocortisone) 1 week with wick placement Immunocompromised patients are treated with topical and systemic For non-intact TM= topical fluuroquinolone (ciprofloxacin) or oral antibiotics (levofloxacin 500mg PO once daily)
60
What is **Ménière's disease** characterized by?
* Recurrent vertigo * Tinnitus * Progressive hearing loss * Nausea/vomiting during episodes ## Footnote It is a peripheral vestibular disorder attributed to excess endolymphatic fluid pressure causing episodic inner ear dysfunction.
61
What triggers **BPPV** (Benign Paroxysmal Positional Vertigo)?
* Sudden head movements * Positions that induce vertigo ## Footnote It is caused by calcium carbonate crystals (otoconia) trapped in the semicircular canals, leading to brief episodes of vertigo that last less than 1 minute.
62
What are the common symptoms of a **vestibular schwannoma**?
* Chronic hearing loss * Chronic tinnitus * Facial numbness and pain (if trigeminal nerve is compressed) * Unsteadiness while walking (if vestibular nerve is involved) * Facial paresis and taste disturbances (if facial nerve is involved) ## Footnote These tumors account for 80-90% of CPA tumors in adults and have slow and insidious symptoms.
63
What initial lifestyle changes are recommended for managing **Ménière's disease**?
* Salt restriction (2-3 g/day) * Avoid triggers (e.g., MSC and nicotine) * Minimize caffeine and alcohol intake (one serving/day) ## Footnote These changes can help manage symptoms effectively.
64
What is the **gold-standard test** to identify posterior canal BPPV?
Dix-Hallpike maneuver ## Footnote This test is essential for diagnosing the most common subtype of BPPV.
65
What are the treatment options for persistent **BPPV**?
* Particle repositioning maneuver (Epley maneuver or Semont maneuver) * Antiemetics (e.g., Meclizine, prochlorperazine) ## Footnote These treatments help alleviate symptoms and manage episodes effectively.
66
What diagnostic tests are suggested for detecting **vestibular schwannoma**?
* Weber and Rinne tests * Audiometry (best initial screening test) * MRI or CT to detect CPA tumor ## Footnote Diagnosis may also be suggested by the presence of asymmetric sensorineural hearing loss or other cranial nerve deficits.
67
True or false: **Vestibular suppressants** and antiemetic medications are used PRN for managing symptoms.
TRUE ## Footnote These medications can help manage acute symptoms of vertigo and nausea.
68
What should patients with **BPPV** avoid doing after treatment?
Sleeping on the side of the affected ear for several days ## Footnote This precaution helps prevent recurrence of symptoms.
69
Vestibular neuritis
Due to inflammation of the vestibular portion of the eight CNs caused by viral or bacterial infection. Sudden onset of severe vertigo with nausea, vomiting, and gait impairment. Labyrinthitis with unilateral hearing loss. Episodes can last from hours to days.
70
Cerebellar infarction or hemorrhage
(cerebellar stroke) Sudden onset of severe headache, vertigo, nausea/vomiting, motor deficits, impaired gait, imbalance, impaired control arm/leg movements, slurred speech (dysarthria). High mortality.
71
What is the assessment and treatment for vestibular neuritis ?
HINTS and, if indicated, MRI to rule out vascular event. Steroid taper; vestibular suppressants and antiemetics PRN for symptom management in the first 24 to 48 hours. If suspect bacterial infection, treat with broad-spectrum antibiotic, and refer to ENT specialist. Call 911. MRI is gold standard for diagnosing infarction on the brain.
72
Allergic rhinosinusitis
Inflammatory changes mucosa due to allergy. Increases risk of sinusitis. May have intermittent, seasonal, or daily symptoms. Atopic family history (asthma, eczema). May be allergic to dust, pollen, mold and cockroach.
73
Treatment for allergic rhinosinusitis
Use nasal spray with azelastine. If no relief, consider combination product (azelastine and fluticasone nasal spray).
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