APEA 3P Exam 100% VERIFIED ANSWERS 2024/2025 CORRECT, Exams of Nursing

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APEA 3P Exam 100% VERIFIED

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Most common type of skin cancer in USA Skin cancer Most common type of skin cancer basal cell carcinoma basal cell carcinoma symptoms Appearance varies; smooth, shiny bump, pink to pearly white Basal cell carcinoma common locations cheeks, nose, face, neck, arms, back basal cell carcinoma diagnosis gold standard biopsy. if not an option, refer to derm Actinic keratosis Precursor to squamous cell carcinoma numerous dry, round and pink to red lesions w/ rough and scaly texture --> does not heal, slow growing in sun exposed areas Actinic keratosis diagnosis gold standard Biopsy. if not an option, refer to derm Actinic keratosis treatment gold standard

small- cryotherapy large- number 5-FU (5-flouracil aka efudex). 5-FU medication Causes skin to ooze, crust, scab and be red

• 5 - flouracil/ efudex-wear sunscreen!! * squamous cell cancer chronic red scaly rough textured lesion w/ irregular borders crusting or bleeding may be present Squamous cell carcinoma common locations rims of ears, lips, nose, face and top of hands precursor lesion to squamous cell cancer actinic keratosis squamous cell carcinoma diagnosis by? biopsy gold standard. if biopsy is not an option, refer to dermatology. Risk factors for skin cancer(melanoma and both non-melanoma) Blistering sunburn as a child, history of sunburns, light skin, chronic exposure to UV light (sunlight/tanning beds), moles, family hx for skin cancer Melanoma symptoms (ABCDE) asymmetry (shape/uneven texture) border (irregular/notched/blurred) color (variegated colors from black, blue, dark to light brown) diameter (size >6mm size of pencil eraser or larger) evolving (changes in color/size/shape) may be itchy Acral lengtiginous melanoma

Most common type of melanoma in dark skinned individuals (blacks & asians) --> look for longitudinal brown to black bands under the nailbed. a changing spot or mole in the palms, or the soles of the feet seborrheic keratosis soft, round, wart-like growth that is light tan to black and looks pasted on asymptomatic &benign Bacterial Meningitis Bacteria Streptococcus pneumoniae- most common strain Haemophilus influenzae Neisseria meningitidis Escherichia coli *others Bacterial meningitis symptoms (Classic Triad) High fever Nuchal rigidity rapid change in mental status w/ headache Triad=neck up erythematous spot-like rash (petechiae) ecchymosis to purple-colored lesions (purpura) which are non-blanchable Is bacterial meningitis a reportable disease yes! Treatment for Bacterial meningitis-patient IV Abx ASAP, resp/droplet iso for first 24-48 hrs, hydrate (low maintenance after initial fluid correction), Maintain ventilation and reduce increased intra cranial pressure if present (dexamethosone(to reduce inflammation, mannitol to diurese the brain), low stim environment, tx complications that may arrive and support family Treatment for bacterial meningitis-close encounter

Close contacts should be treated w/ rifampin 600 mg q 12 hours x 2 days **Rifampin changes urine color to reddish orange and can stain contacts **AVOID RIFAMPIN IN PREGNANCY Brudzinkski sign (meningeal irritation) Tests for meningeal irritation Patient supine, raise BACK of head and flex chin towards chest

• result if pt automatically beds both hips --Brudzinski and back of head start with B as well as bends-- Kernig's sign Tests for meningeal irritation patient supine. flex patients hips and knees in a right angle, then slowly straighten/extend the legs up
• result if when the patient complains of pain during extension of leg MCV4 (meningococcal vaccine) Age 11- 19 Give one dose of menactra or menveo primary dose given age 12 or younger give a booster at age 16- 18 MCV4 (meningococcal vaccine) Age 19- 21 Give one dose of menactra or menveo if never had either Rocky mountain spotted fever (RMSF) symptoms Fever chills N/V myalgia arthralgia 2 - 5 days later develop petechial rash on forearms, ankles, and wrists that spreads towards trunk and becomes generalised. sometimes rash develops on palms and soles

• RASH DEVELOPS INWARDS * RMSF pneumonic (RMSF)

R-Rash M-Muscle aches (myalgia) S-Stomach aches (nausea and vomiting) F-Fever (>102 F) Rocky Mountain Spotted Fever (RMSF): Located: •Think "Rocky"- North Carolina, Oklahoma, Arkansas, Tennessee, Missouri Spring to Fall (April to September) Rocky Mountain Spotted Fever (RMSF): DX PCR assay by indirect immunofluorescence antibody (IFA) assay for immunoglobulin G (IgG) for Rickettsia Rickettsii Rocky Mountain Spotted Fever (RMSF): tx Doxycycline is always first line for all ages 100 mg every 12 hours x 7-10 days Can be fatal if not treated within the first 5 days Erythema Migrans (early Lyme disease): Symptoms Usually appears in 7-14 days after being bitten by a deer tick; range 3-30 days Target bull's-eye Rash is hot to touch with rough texture. Expanding red rash with central clearing • Common locations are belt line, axillary area, behind the knees, and groin area • Positive for flu like symptoms. Lesions and rash resolve within a few weeks with or without treatment Erythema Migrans (early Lyme disease): DX Dx: • First step is enzyme immunoassay (EIA) also knows as ELISA if negative no further testing needed. If positive confirm with Western Blot test (aka indirect immunofluorescence assay (IFA) for Borrelia Burgdorferi

1. Enzyme immunoassay
2. western blot test (immunoflurorescence assay/ IFA) Exam Tip: E before I Will have increased ESR

Erythema Migrans (early Lyme disease): TX Doxycycline is always first line for all ages 100 mg BID x 10-21 days Remove ticks by grasping with tweezers or forceps close to the skin and pulling gently with steady pressure. After removing the tick, clean area with rubbing alcohol, iodine scrub, or soap and water. Dispose of the tick by flushing it into the toilet Tick repellant skin use DEET Tick repellant clothing use Permethrin Brown Recluse Spider Bite: SX

• Fever, chills • Nausea and Vomiting • Located in the arms, upper legs, or the trunk • Bitten area becomes swollen, red, and tender, or can be painless • Blisters appear within 24-48 hours • Necrotic in center, which kills the tissue **can be painless Brown Recluse Spider Bite treatment Treatment: • Ice packs to wound as the cold inactivates the toxin • Treat like cellulitis of the skin • Antibiotic ointment at first and watch Skin lesions primary skin lesions Macule Vesicle Papule MVP Size: <1 CM Macule Flat, nonpalpable, but visually distinct areas on the skin surface with color different from the person's normal skin; less than 1 cm FRECKLE

Vesicle elevated, raised lesion filled with serous fluid (herpetic lesions) Papule palpable solid lesion (acne, moles) primary skin lesions >1cm in size Nodule Plaque Bullae (Blister) Pustule Wheal Nodule raised solid lesion (BCC) Plaque solid raised lesion with flat top (psoriasis) Bulla/Bullae elevated superficial blister filled with serous fluid (2nd degree burn, impetigo) Pustule circumscribed elevated lesion containing pus (acne pustules) Secondary Skin Lesions-Lichenification thickening of the epidermis with exaggeration of normal skin due to chronic skin itching (eczema) Secondary skin lesions- Scale flaking skin (psoriasis) Secondary skin condition-crust

dried exudate (impetigo) Secondary skin condition-ulceration eroding of epidermis and dermis (if deep can involve subcutaneous tissue) Secondary skin condition-scar permanent fibrotic change following damage to dermis (surgical scars) Secondary skin condition-keloids/hypertrophic scars overgrowth of scar tissue (more common in Black and Asian descent) Rule of 9's Head and neck = 9% Upper Ex = 9% each Lower Ex = 9% each Front trunk = 18% Back trunk = 18% Rule of 9's =-child leg Chlid one leg=13.5% One leg adult =18% Rule of 9's =child head Child head- 18% (half of adult %) First degree (superficial): Red to bright red skin and tenderness/pain second-degree (partial-thickness) burns Painful red skin, bullae (blisters), reddened/weepy skin --> BLISTERS START AT SECOND DEGREE third-degree (full-thickness) burns

Pain sensation absent. Pale/white color, charred skin, leather-like texture Criteria for Burn Center Referral: Face, hands, feet, genitals, major joints Electrical burns, lightning burns Partial thickness burns >10% of total body surface area Third degree burns in any age group If pt. has a Sulfa allergy and can't use Silvadene what is the alternative? Bacitracin, Polysporin/Triple antibiotic cream or ointment Cellulitis Bacteria (Gram Positive): Streptococcus (beta hemolytic strep), Staph aureus (MRSA) Cellulitis Symptoms: Diffused pink to red colored skin, warm to touch, and may become abscessed If red streaks radiating from infection it has spread to lymph nodes (lymphangitis) Usually within the deep dermis and is poorly demarcated (poor boundaries) Most common location is the lower legs -->If pt. has DM and develops cellulitis watch for osteomyelitis Cellulitis treatment First line: Abscess/cellulitis is I&D (if <5 cm no PO antibiotic needed) • Check for tetanus vaccine status Nonpurulent: Cephalexin (Keflex) 500 mg or Dicloxacillin q 6 hours for 5-10 days Purulent (MRSA): Wound culture o Follow up in 48 hours Bactrim BS BID x 10 days o If you suspect osteomyelitis order an MRI If allergic to Penicillin: Azithromycin (Z-Pack x 5 days) Erysipelas:

Bacteria: Group A Streptococcus Located: • Involves upper dermis and superficial lymphatics • Found on the cheeks and shins Erysipelas: Symptoms Symptoms: • Bright red plaque or induration with sharp or elevated margins on the face or lower legs • If fever and chills present pt. is septic (hospitalization is recommended) Erysipelas: Treatment If treating facial erysipelas assume MRSA is present. Use appropriate antibiotics or refer to ER if septic Dicloxacillin QID, Cephalexin or Clindamycin x 10 days If allergic to Penicillin: Azithromycin (Z-Pack x 5 days) MRSA: Treatment Bactrim Doxycycline Minocycline Clindamycin --> If patient is allergic to Sulfa do not use Bactrim Human bites "Dirtiest" bite of all. Watch for closed-fist injuries of the hands (may involve joint capsule and tendon damage). Eikenella corrodens & numerous bacteria may be involved Animal bites: Cat bites have a higher risk of infection that dog bites Redness, swelling, pain Systemic symptoms may develop within 12-24 hours Treatment for human bites and animal bites •Augmentin 875/125 mg BID x 10 days or IV antibiotics in ER Penicillin Allergy § Doxycycline BID or Bactrim DS BID PLUS Flagyl BID or Clindamycin TID

Also give Tetanus booster if needed Evaluate for rabies prophylaxis Tetanus Vaccination Initial series (3 doses) DTaP (infants to age 6): 5 doses Ages 7 and older Td or Tdap Need every 10 years for lifetime Common reaction: pain at injection site in 24-48 hours Contaminated wounds: give one dose if last dose was more than 5 years ago or is due Impetigo Bacteria (Gram Positive): Beta Streptococcus or Streptococcus aureus Most common bacterial skin infection in young children ages 2- 5 Impetigo symptoms Itchy pink-red lesions, evolve into vesiculopustules that rupture easily, honeycolored crusts (from dried serous exudate) Very pruritic and contagious Impetigo Treatment Order C&S of fluid Severe Case= Keflex or Dicloxacillin QID x 10 days Penicillin Allergy o Give Azithromycin 250 mg x 5 days or o Clindamycin x 10 days **If no blisters- topical mupirocin ointment (bactroban) 2% x 10 days Acne Vulgaris (common acne): treatment First line is always topical retinoid such as tretinoin cream (Retin-A) Acne: Mild treatmetn

open comedones blackheads/closed comedones (whiteheads) w/ or w/o papules topical retinoid (Retin-A)

• Acne will worsen during first 4-6 weeks * IF no improvement in 8-12 weeks, increase dose or ADD benzoyl peroxide and/or erythromycin Acne: Moderate (topicals plus antibiotics) papules and pustules with comedones (3 part treatment) Topical retinoid (Retin-A) AND topical benzoyl peroxide AND oral antibiotic (Tetracycline or Minocycline) x 3-4 weeks --> Exam usually asks about moderate Acne: Severe painful indurated nodule, cysts, abscesses, pustules Accutane- check Liver function tests (LFTS) must use 2 forms of contraceptives, monthly pregnancy testing only prescribe 1 month supply of medication Usually, will refer to Dermatology Topical retinoid side effects Irritation, dry skin, flaking, redness during first 4 weeks due to increase in skin turnover After washing face wait 30 minutes before applying medication to help minimize irritation Acne medications to avoid in pregnancy (category X &C) Category X: Topical tazarotene (Tazorac), Accutane Category C: Topical retinoids (tretinoin, adapalene) Acne Rosacea Symptoms: • Chronic small acne like papules/pustules, and telangiectasias around nose, mouth, and chin symmetrically Treatment: First line: o (Avoid triggers of flushing (EtOH, excessive sun, spicy foods) Metro gel or Azelex gel QD-BID

Low dose Tetracycline 250 mg QID or doxycycline 100 mg QD if gel not effective or the patient has pustular/ocular rosacea Psoriasis Symptoms: • Inherited condition (atopy) Pruritic erythematous plaques Fine silvery-white scales with pitted fingernails Occurs on scalp, elbows, knees, sacrum, and intergluteal folds (extensor surfaces) Migratory arthritis Psoriasis treatment Treatment: • Topical steroids o Seven classes of steroids 10 o Avoid class I-III on children, and sensitive skin (face, groin, etc.) o Class I- super potent o Class VII least potent • Tar preps (mild cases)

• Anti-TNF (severe cases) or immunologics o Methotrexate, cyclosporine, etanercept, adalimumab Koebner phenomenon: New psoriatic plaques form over skin trauma Auspitz sign: Pinpoint bleeding when plaques are removed Atopic Dermatitis (Eczema): Inherited condition (atopy) Extremely itchy On neck, and hands as well as other flexural folds An IgE condition Small vesicles (MVP- macule, vesicle, papule all are <1 CM all others ≥1 CM) that rupture leaving painful, bright-red, weepy lesions Will become lichenified from itching Atopic dermatitis (eczema) treatment First Line: o Topical steroids and emollients Avoid hot water/soaps

Can take oral antihistamines to help with itching Avoid wool clothes Contact Dermatitis An inflammation of the skin caused by having contact with certain chemicals or substances; many of these substances are used in cosmetology. It is very pruritic, and usually there is no lichenification. Lesions evolve into vesicular bullae that easily rupture leaving bright-red moist areas that are painful Contact dermatitis Treatment:

• First Line: o Stop exposure to substance • Topical steroids QD to BID x 1-2 weeks • Consider referral to allergist for patch testing Scabies Pruritic rash located in the interdigital webs of the hands, axillae, breasts, buttock folds, waist, scrotum, and penis • Severe generalized itching that is worse at bedtime • Family member will have same symptoms o Apply cream to skin from neck to soles of feet. Leave on for at least 8-14 hours then rinse off. Repeat in 1 week o Scabies never go to scalp! o Treat everyone. Wash sheets and all other items in house in hot water --Scabies never go to scalp TREAT EVERYONE Pityriasis Rosea: Symptoms May be itchy Herald patch appears 2 weeks before full breakout Christmas tree pattern Rash on the hands or soles of the feet Pityriasis Rosea: Treatment Resolves on its own in about 4-6 weeks

Test for secondary syphilis with RPR then VDRL as screening • If positive then do FTA-ABS if this is positive patient has syphilis; treat appropriately Tinea Corporis (body-think of core): symptoms Ring like itchy rash, slowly enlarges with central clearing Tinea Corporis (body-think of core): Treatment Most respond to topical antifungals, if severe do oral Lamisil Med ends with azole on exam Tinea Capitis (scalp-think of baseball cap): symptoms &Treatment Scaly round itchy patches on the scalp. Hair becomes fragile at the roots and breaks (black dot sign) Treatment: Oral meds only (Griseofulvin, terbinafine, fluconazole, or itraconazole) Obtain baseline LFT and repeat in 2 weeks o Gold standard: § Griseofulvin QD-BID x 6-12 weeks Avoid hepatotoxic substances (alcohol, statins, acetaminophen) Avoid sharing combs, headgear, towels, pillows, and clothes with others Tinea Cruris (groin):symptoms and treatment Erythematous annular (ring-shaped) rash located in the groin area which can sometimes extend to buttocks Usually associated with tinea pedis Treatment: • Azole topical cream (Lamisil, Lotrimin, Monistat-Derm) x 7-14 days Tinea Pedis (Hands/Feet- think pedicure):symptoms and treatment Symptoms: • Scaling of the soles • Skin feels wet, strong odor, vesicles and bullae that rupture • "Two feet and one hand" disease (dominant hand used for itching the feet becomes infected) Treatment: Azole topical cream (Lamisil, Lotrimin, Monistat-Derm) x 7-14 days Onychomycosis aka tinea unguium (fingernail or toenail fungus): Symptoms and treatment

Symptoms: Elderly with yellow-colored nails Thickened nails with debris Treatment: Mild cases fingernails: o Topical Penlac Toenails: Systemic antifungals either 6 weeks or pulse therapy (once per week for 3- 4 cycles) Tinea Versicolor: Cause/symptom/treatmetn Cause: • Yeast Pityrosporum orbiculare or P. ovale Symptoms: • Multiple hypopigmented round macules on chest, shoulders, and/or back that appear after skin becomes tan from sun exposure Condition is asymptomatic • KOH slide will show hyphae and spores ("spaghetti and meatballs") Treatment: • Topical selenium sulfide and topical azole antifungals (Nizoral) or terbinafine (Lamisil) cream BID x 2 weeks • Hypopigmented spots may take several months to fill in Herpetic Whitlow (caused by herpes simplex): symptoms and treatment Symptoms: HSV 1 or HSV 2 infection Abrupt onset of small red papules/bumps which become vesicular Extremely painful, tingling, and burning sensation. Usually on index finger or thumb Treatment: Rest, elevation, and NSAIDs - As this is a self-limiting infection If recurrent or severe infection can prescribe oral acyclovir DO NOT chose topical acyclovir as an option because it's expensive and does not work well Varicella Zoster Virus (VZV): symptoms/lab/treatment Symptoms: Contagious for 48 hours before and until all lesions are crusted over Low grade fever Generalized lymphadenopathy Intense itching • Erythematous macules • Papules develop over macules, then vesicles erupt • "Initially on trunk, then scalp and face" Labs: • Gold Standard: PCR Treatment: • Supportive, antihistamines • Oral Acyclovir if given within the first 24 hours; will work best

Subungual Hematoma:Treatment Treat subungual hematoma by trephination If blood is not drained and the hematoma involves ≥25%, there is a high risk of ischemic damage to nail matrix Use either a large paperclip or 18-gauge needle and heat up the tip Position at 90 and apply steady pressure until you have blood draining Remove either the paperclip or needle and gently evacuate the blood Systemic Lupus Erythematosus: symptoms/treatment Symptoms: •Maculopapular butterfly-shaped rash on the middle of the face (malar rash) •May have nonpruritic thick scaly red rashes on sun-exposed areas Treatment: • Refer to rheumatology • Avoid sunlight and other UV light exposure can worsen the disease • Wear broad-spectrum sunblock that's effective against UVA and UVB Molluscum Contagiosum: cause/symptoms/tx Cause: • Poxvirus Symptoms: • White plug, dome shaped with central umbilication • Highly contagious (spreads via skin-to-skin contact) Treatment: • Typically resolves on its own if immunocompetent (watchful waiting) o Other options: cryotherapy, curettage, cantharidin • If sexually active CDC considers this an STI if in genital region Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN): symptoms Symptoms: • Classic is target or bull's-eye rash that occurs abruptly • Hives and blisters • Petechiae and purpura • Necrosis with sloughing of tissue • Extensive mucosal involvement • Prodrome of fever with flu like symptoms Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN): Triggers Mnemonic: SANA(p)

• Sulfonamides
• Anticonvulsants

• NSAIDs
• Allopurinol
• PCN

• HIV patients are at a higher risk for SJS & TEN * Acanthosis Nigricans: symptoms Velvety hyperpigmented patches most common on back of neck or skin folds • Usually associated with diabetes, metabolic syndrome, obesity, and cancer of the GI tract Scarlet Fever (Scarlatina): Symptoms "Sandpaper textured-pink rash with sore throat" Strawberry tongue, rash starts on head and neck, spreads to trunk. The skin THEN desquamates (peels/sheds) Associated with strep throat Lichen Planus: symptoms & Treatment Symptoms: • Small flat topped, red to purple bumps that may have white scales/flakes • Wispy grey white streaks called Wickham's striae • Found on the inner wrists, forearms, and ankles. If on scalp causes hair loss • Can be found in vulva and vagina with soreness, burning, and rawness Treatment: Topical Steroids (even in vaginal area for Lichen Sclerosus) Anthrax: Symptoms & treatment Symptoms: Animals/hides/hair/wool Lesions begin as papules that enlarges quickly within 24-48 hrs. Develop necrosis and ulceration (sort of like a recluse spider bite) Not contagious Treatment: Doxycycline, Cipro, or Levaquin BID x 7-10 days If you suspect BIOTERRORISM treat for 60 days Prophylaxis antibiotics are Cipro and Doxy

Hidradenitis Suppurativa: Symptoms & Treatment Symptoms: Recurrent episodes of painful large and tender red nodules, abscesses, and pustules in the axilla (most common), groin, perianal, and inframammary Due to occlusion of the hair follicles and pilosebaceous glands (apocrine glands) Treatment: •Avoid skin trauma, wear loose light clothing, avoid excessive heat, and friction Smoking cessation, lose weight if obese Avoid deodorant Doxycycline QD to BID x several months Blepharitis (inflammation of the eyelids): Symptoms/treatment Symptoms: Bilateral red and swollen edges of eyelids May have fine scales More common with seborrheic dermatitis Treatment: Scrub eyelids in warm water and baby shampoo Pterygium (Surfer's eye): Symptoms/Treatment Symptoms: Triangular-shaped white to yellow superficial growth On nasal side Caused by long term UV damage Treatment: Surgical remove if it grows into the pupil Prevention: wear sunglasses Pinguecula (think of Ping-Pong): Symptoms/Treatment Symptoms: White to yellowish small round superficial lesion on each side of the cornea Caused by long-term UV damage Treatment: • Prevention: wear sunglasses

Chalazion: Symptoms & Treatment Symptoms: Small painless nodule Chronic inflammation of the meibomian gland (specialized sweat gland) Grows gradually Treatment: • Hot compress QID if large otherwise no treatment Hordeolum (Stye): Symptoms and Treatment Symptoms: Painful • Swollen • Red, warm, abscess, and it's acute Think Hordeolum "Hurts" Treatment: • Hot compress until it drains QID • Avoid wearing eye make-up • Erythromycin or dicloxacillin QID if preseptal cellulitis develops 17 o Refer to ophthalmology for I&D Senile arcus: Symptoms and Treatment Symptoms: White-gray ring on edge of cornea in elderly and is bilateral Normal finding in elderly Result of lipid deposit Treatment: None Age less than 50 check lipid profile Xanthelasma: Symptoms and treatment/ DX Symptoms: • Soft yellow flat plaques on the upper and lower lids by the inner canthus or palpebrum

• Cholesterol plaques Dx: • Order fasting lipid profile to rule out hypercholesteremia Treatment: • Trichloroacetic acid, surgery, laser Allergic Conjunctivitis (Keratoconjunctivitis): Symptoms & Treatment Symptoms: Typically, bilateral itchy eyes with "stringy discharge and increased tearing" Type I sensitivity (IgE)

Rhinitis and allergic shiner Treatment: PO (oral) antihistamines Eye drops olopatadine (Patanol), Visine (short term or episodic use only) Cool compresses and avoid allergens *May be called keratoconjunctivitis on ANCC Bacterial Conjunctivitis: Symptoms and treatment Symptoms: • Acute onset of red eye • Dried yellow-green crusting on eyelids on awakening Treatment: Topical ophthalmic fluroquinolones (Ofloxacin) Q 2-4 hours x 2 days, then QID x 5 days Viral Conjunctivitis (Pink Eye): Symptoms and treatment Symptoms: • Acute onset of red eye • Complaint of itchy eyes; one or both eyes • Periauricular lymphadenopathy 18 • Very contagious Treatment: No treatment; frequent hand washing Keep away from school for 1 week Herpes Keratitis: Cause, symptoms, DX, TX Cause: Herpes Simples Virus or Shingles (Herpes Zoster) Symptoms: Abrupt onset of eye PAIN, blurred vision, and tearing, Vesicles and/or small rash on the temple on affected side Follows the V1 branch (ophthalmic branch) of the trigeminal nerve (CN V) Dx: Fluorescein dye o Shows "fern-like" lesion Treatment: Ophthalmologist or ER STAT Corneal Abrasion: Symptoms & DX & treatment & alternative meds Symptoms: Acute onset of severe eye PAIN Abrasion is round/irregular Foreign body sensation

Dx: Fluorescein dye. Will help rule out herpes keratitis Treatment: • Erythromycin ointment QID x 3-5 days DO NOT PATCH THE EYE Alternative Meds: Sulfacetamide 10% Ciprofloxacin or ofloxacin Acute Angle-Closure Glaucoma:symptoms and treatment Normal ICP: 8- 21 Acute angle glaucoma ICP >21 Symptoms: Acute onset of severe eye PAIN Decreased/Blurred Vision • Frontal Headache Nausea/Vomiting Cloudy cornea Mid-dilated oval/ovoid shape pupil and in a fixed position Pupil does not respond to light Treatment: ER STAT TIP: Disc cupping is only seen with glaucoma which is caused by increased ICP Papilledema: Symptoms & Treatment Symptoms: Optic disc swollen with blurred edges due to increased ICP (normal 8-21) secondary to bleeding, brain tumor, pseudotumor cerebri, etc. Treatment: ER Primary Open Angle Glaucoma: Symptoms & Treatment Symptoms: Affects CNII Gradual changes in peripheral vision which is LOST FIRST, then central vision Treatment: Check IOP (use tonometer) if elevated should refer to ophthalmologist

Medications: beta-blockers (timolol), topical prostaglandin eye drops (Xalatan) Avoid beta-blockers in patients who have asthma, emphysema, COPD, 2nd or 3rd degree heart block, and heart failure Cataracts: Symptoms & Screening Symptoms: Elderly with night vision issues Difficulty with glare (headlights when driving at night or sunlight) Halos around lights Screening: Red Reflex Test o If cataracts are present the red reflex will be missing from the affected eye(s) Normal is a reddish-orange glow If no glow, dull, or white; the reflection is abnormal Age-Related Macular Degeneration: Symptoms & Treatment Symptoms: Painless loss of "central vision" reports straight lines appear curved Periphery is preserved Leading cause of blindness in the elderly and more common in smokers Treatment: Give Amsler grid or refer to ophthalmologist if Amsler grid is not an option Retinal Detachment: Symptoms & Treatment Symptoms: Sudden onset of floaters Looking through the curtain Flashes of light Painless Treatment: ER STAT Dacryocystitis: background& symptoms & treatment Background: Infection of lacrimal sac/tear duct usually caused by blockage Common in infants, adults over 40 also have higher risk of developing

Symptoms: Thick eye discharge, pain, redness/swelling/warmth of lower eyelid, watery eye/excess tearing Treatment: Lacrimal sac massage (downward toward mouth) 2-3 times daily; systemic antibiotics 7- 10 days Allergic Rhinitis: Background & symptoms & treatment Background: Inflammatory changes of nasal mucosa due to allergies Atopic family history (asthma, eczema) May have seasonal or daily symptoms Symptoms: Chronic nasal congestion with clear mucus discharge or post nasal drip Itchy nose, Frequent sneezing, Coughing worsens when supine due to post nasal drip, Blue-tinged or pale boggy (spongy) nasal turbinate's Treatment: • First Line: Nasal steroid sprays (Fluticasone - Flonase) BID, triamcinolone (Nasacort Allergy) 1-2 sprays QD • Antihistamine Azelastine (Astelin) QD-BID • Decongestants Pseudoephedrine PRN. Avoid in infants and children • Avoid triggers Epistaxis (Nosebleed): Background & Treatment Background: Anterior nosebleed more common. Caused by bleeding at Kisselbach's plexus Treatment: Have the pt. blow their nose first Apply two sprays of topical nasal decongestant (Afrin). Pinch alae tightly against nasal septum and hold for 10 minutes Meniere's Disease: Symptoms Vertigo Hearing loss Tinnitus

Meniere's Disease Mnemonic: VAST Vertigo (Episodic) Aural (auditory) fullness Sensorineural Hearing Loss (Fluctuating) Tinnitus (Subjective) Meniere's Disease Treatment Usually, self-limiting. Treat acute attacks Antihistamines for vertigo Meclizine, dimenhydrinate Antiemetics for nausea/vomiting o Promethazine, prochlorperazine Acoustic Neuroma (Vestibular Schwannoma): Symptoms/DX/TX Symptoms: Ages 30- 60 Gradual onset, one-sided Sensorineural hearing loss, tinnitus that is insidious; CN 8 Facial numbness and pain if it compresses CN 5 Dx: Order an MRI o Benign tumor of CN 8 causing sensorineural hearing loss and tinnitus. If it compresses on CN 5 will have facial numbness and pain Treatment: Surgery Cholesteatoma symptoms and treatment Symptoms: Cauliflower Foul-smell Hearing loss (typically conductive unless it's way inner than can have sensorineural) If erodes bones in face affects CN VII Treatment: SURGERY Battle Sign (Basilar Skull Fracture):