EENT / Family Nurse Practitioner Board Review questions and answers

A patient presents to clinic with the complaint of a red eye. Which assessment below rules out the most worrisome diagnoses?

Usual Visual Acuity- Not that the what the acuity is but rather that the vision is normal.

This will rule out Infectious keratitis, iritis, angle closure glaucoma.

AV nicking - what does it indicate?

HTN - artherosclerotic changes in the retinal vasculature, (not acute HTN)

This is indicative of chronic HTN

What can an older adult use for the common cold if they have HTN & Glaucoma?

Guaifenesin

Don't use pseudoephedrine this can increase B/P

Oxymetolazine- can cross the mucous membranes and increase B/P too.

Diphenhydramine- is a sedating antihistamine and has anticholinergic properties which are not good for Glaucoma.

A patient presents with Tragal Pain the most common Dx is

Otitis Externa "Swimmers Ear" An infection of the external canal.

What is the GOLD standard treatment of all Allergic Rhinnitis (hay fever) symptoms

A Nasal Steroid

Arcus Senilis is described as

Normal in people >50 years old.

It is an arc or circle around the cornea. The arc is due to deposits of lipids in the cornea.

WHEN SEEN in younger people it may be correlated with lipid abnormality.

A White chalky mark on the surface of the TM is

probably scarring from rupture or tube placement.

The most common cause of acute pharyngitis in children is

Respiratory Viruses. THE MOST COMMON bacterial cause is Strep Pyogenes.

What other symptom might a patient with Otitis Externa exhibit? Other than Tragus pain?

Itching.

A 4 year old child with Otitis media with Effusion probably just had:

Acute Otitis Media - OME frequently follows an Acute Otitis Media. The fluid can be present for months after an infeciton.

A 32 year old patient is a newly diagnosed diabetic. She has developed a sinus infection. Her symptoms have persisted for 10 days. Six weeks ago she was treated with Amoxicillin for an upper respiratory infection. It cleared without incident. What should be recommended today?

-Augmentin.

-Amoxicillin is not used when a beta-lactamase organism is suspected. It should be suspected because she took an ATB 6 weeks ago. Augmentin covers beta lactam producers.

-we can assume it is bacterial because she has had it for 10 days, a virus would have run it's course by now.

Papilledema represents...

swelling of the optic nerve head and disc indicating IOP.

-This is NOT a common finding in headaches

pterygium

triangular opaque tissue on the nasal side of the conjunctiva that grows toward the iris.

Initially asymptomatic, can cause irritation as it grows and can grow and obstruct vision as it extends onto the cornea.

Associated with chronic sun exposure

Hordeolum (stye)

(stye) red, PAINFUL pustule that is a localized infection of THE GLAND at eyelid margin.

Xanthelasma

soft, raised yellow plaques occurring on the skin at the inner corners of the eyes (medial aspect)

Pinguecula

a benign, harmless yellowish triangular nodule. That does not affect vision.

Effusion is

A stage in the healing process of otitis Media seen about 4 weeks out.

-It needs to be monitored NOT given another ATB if Asymtpomatic.

The most common etiology of A 6 day old with bilateral mucopurulent eye drainage

mother has Chlamydia

A Painless red eye that does not impact vision but ocular surface has blood red area is called

subconjuctival hemorrhage

Group A Strept pharyngitis:

Usually has an ABRUPT onset of multiple symptoms. It can be accompanied by abdominal pain. Sore throat, fever, headache etc.

Angioedema can be caused by which medication?

ACE Inhibitors especially in African American Patients

Which antihistamine is preferred for treating allergic rhinitis in adolescents and adults

Once daily- non sedating. These are generally the second generation antihistamines.

Kisselbach's Plexus

What is the most common location of anterior epistaxis (nose bleeds) FUN FACT- most nose bleeds occur in men

Children 2 Years and Older with Mild-Mod Otitis Media Should be Given ATB for

5-7 days, UNDER 2 should be Tx for 10 Days

Cotton wool spots

Are caused because of edema to the surface layer of the retina. This could be due to HTN or DM.

acute angle closure glaucoma

Acute Pain

Blurred Vision

Dilated pupil

N/V Are Common

Shallow anterior chamber

Halos around lights

Conjunctival Redness

Most common in adults >60

Symptoms are more common at night when the light levels diminish

Mydriasis (of pupil)

Mydriasis is the dilation of the pupil

myosis

Miosis, or myosis, is excessive constriction of the pupil.

Chronic angle closure glaucoma

Progression (slow onset) Usually no pain- slow onset of glaucomatous cupping and significant visual field loss; IOP may be normal or elevated; ocular pain and headache can occur

A medication considered first line Treatment for a patient with allergic rhinitis is a

topical nasal steroid

a nonsedating antihistamine can be added after a topical nasal steroid has been started.

An NP examines a screaming 2 year old child what is a normal finding

pink mucous membranes and rarely red from crying

Which long acting antihistamine in sedating

Zyrtec (Cetirizine)

The rash seen with a PCN Allergy will be described as

Hives

A patient with Mastoiditis may have a

displaced pinna

Allergic Rhinnitis (Hay Fever) GOLD standard Tx

Nasal Steroid

Sudden decreased visual acuity and a fixed pupil may be from

Glaucoma - REFER Urgently!

strabismus - Persistent

REFER!

The oral health risk assessment should start being done at

6 months

mononucleosis

infectious disease marked by increased numbers of leukocytes and enlarged cervical lymph nodes

Viral infection effecting adolescents and people in their 20s.

Splenomegaly occurs in about 50% of people

Most likely see Lymphocytosis on a CBC

If a patient gets C.Diff

the most important thing is to STOP the offending ATB therapy if possible.

Pulpitis

Inflammation of the dental pulp

May have pus around the gum area

the main S/Sx if pain brought on by temp changes

Initial vision screening should take place at

3 y.o.

ruptured tympanic membrane

tear in the tympanic membrane due to excessive pressure or infection.

May seen bright red blood in the external canal NOT clear fluid.

No ACTIVE bleeding should be present