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NURS 5433 Family 2: Module 1 - EENT)-Questions
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What are the 3 most common causative organisms for bacterial conjunctivitis? Strep pneumoniae, Haemophilus influenzae, Staphylococcus aureus A 19 year old presents with a complaint of bilaterally itchy, red eyes with tearing that occurs intermittently throughout the year and is often accompanied by a rope like eye discharge and clear nasal discharge. This is most consistent with what diagnosis? allergic conjunctivitis Treatment for allergic conjunctivitis Corticosteroid ophthalmic drops Treatment for viral conjunctivitis no drops needed Common cause of anterior epistaxis localized nasal mucosa trauma 1st line intervention for epistaxis Firm pressure to the area superior to the nasal alar cartilage Ms Murphy is a 58 year old woman presenting with a sudden left sided headache that is most painful in her left eye. Her vision is blurred, and the left pupil is slightly dilated and poorly reactive. The left conjunctiva is markedly injected, and the eyeball is firm. Vision screen with the Snellen chart is 20/30 OD; and 20/90 OS. What is the most likely diagnosis?
angle-closure glaucoma Mrs. Allen is a 67 year old female with type 2 DM who complains of seeing flashing lights and floaters, decreased visual acuity, and metamorphopsia in her left eye. What is the most likely diagnosis? Retinal detachment Which of the following is most likely to be found on the funduscopic exam in a patient with untreated POAG? excessive cupping of the optic disk A 22 year old female presents with a "pimple" on her right eyelid. Exam reveals a 2mm pustule on the lateral border of the right eyelid margin. What is this most consistent with? Hordeolum A 22 year old female presents with a 'bump" on her right eyelid. Exam reveals a 2 mm hard, nontender swelling on the lateral border of the right eyelid margin. What is this most consistent with? chalazion What is an independent risk factor for oral cancer? human papillomavirus type 16 What are top 3 causative pathogens for otitis externa? Pseudomonas aeruginosa, proteus Enterobacteriaceae, and staph aureus
What are treatment options for streptococcal pharyngitis for a patient with PCN allergy?
- azithromycin
- Clarithromycin
- Clindamycin What are the possible complications of GAS(Group A Streptococcus)? Glomerulonephritis, rheumatic fever What are the symptoms of Rheumatic Fever? Carditis and arthritis The rash associated with scarlet fever typically occurs how long after the start of the symptomatic infection? 2 days How do decongestants work? vasoconstriction Which of the following medications is most appropriate for allergic rhinitis therapy in an acutely symptomatic 24 year old machine operator? Loratadine(Claritin) According to Global Resources in Allergy (GLORIA) guidelines, what is recommended for intervention in persistent allergic conjunctivitis? Topical mast cell stabilizer with a topical antihistamine
What s/s is most consistent with the diagnosis of acute bacerial rhinosinusitis (ABRS)? Upper respiratory tract infection symptoms persisting beyond 7-10 days What is most common causative pathogen for bacerial rhinosinusitis (ABRS)? strep pneumoniae Blepharitis patho
- inflammation of the eyelid
- nonulcerative causes: psoriasis seborrhea, eczema, allergies, lice, trisomy 21, chemical or environmental irritants, eye makeup, and contact lenses
- ulcerative causes: lash follicle in meibomian glands of eyelid, pustules at base of hair follicles that crust and bleed, lashes become thick and break easily Blepharitis risk factors dry eye, frequent hordeolum or chazalium, facial or scalp seborrhea, immunocompromised, acne, diabetes, Retin-A use Blepharitis differential diagnosis
- bacterial infections (impetigo)
- viral infections (herpes)
- parasitic (demodex folliculorum)
- immunologic (atopic dermatitis, discoid lupus)
- dermatoses (psoriasis)
- benign eyelid tumor (actinic keratosis, subcutaneous papilloma)
- malignant eyelid tumors (basal cell carcinoma, squamous cell carcinoma, melanoma)
Hordeolum is painful and Chalazion is painless Bacterial conjunctivitis patho inflammation of the conjunctiva (front part of eye) caused by strep, h flu, or m catarrhalis (same bacteria caused by upper resp infection Conjunctivitis risk factors
- Bacterial: direct contact with patient and their secretions, or with contaminated object and surface (highly contagious)
- Viral: highly contagious; 2nd eye usually involved within 24-48 hours
- Allergic: wind, contact with allergen, often coexists with allergic rhinitis Conjunctivitis differential diagnosis foreign body, uveitis, iritis, scleritis, corneal abrasion, dacryocystitis, hyphema, angle-closure glaucoma, subconjunctival hemorrhage, periorbital cellulitis Conjunctivitis diagnostic testing
- 1st: always test visual acuity
- Snelling test
- if there are any visual acuity changes, refer to ophthamalogist
- dilated pupil exam to check the optic nerve for dysfunction and anterior chamber inflammation Bacterial conjunctivitis treatment
- Antibiotic therapy: gatifloxacin, levofloxacin, moxifloxacin
- chlamydial and gonococcal tx: both systemically and topically treat (systemic antibiotics - PCN and doxycycline)
Conjunctivitis follow up instructions
- follow up in 24 hours to assess effectiveness of tx
- allergic: improvement in 2-3 days expected
- bacterial or viral: improve in 2-4 days
- may return to work or school after 24 hours of topical therapy Viral Conjunctivitis patho inflammation of the conjunctiva caused by adenovirus, coxsackie virus, varicella, herpes, and herpes zoster Viral Conjunctivitis diagnostic tests Fluorescein stain with dendrites present (r/o corneal abrasion) if dendrites present, refer out immediately Viral Conjunctivitis patient education avoid herpes in the eye because it can cause blindness Allergic Conjunctivitis patho
- intermittent (seasonal)- IgE mediated; common triggers depend on time of year and geographic location; april-may: tree pollen; june-july: grass pollen; july-aug: mold spores and weed pollen
- persistent (perennial)- IgE mediated; common triggers are house dust mites (present in all geographic locations) Allergic Conjunctivitis treatment
- if infection is suspected, do a culture
- lid eversion by flipping eyelid with cotton swab and checked for foreign body and remove visible object with wet cotton swab Corneal abrasion treatment
- management is prevention
- eye rest
- antibiotic ointment or drops for 5-7 days to prevent bacterial infection
- traumatic/ foreign body/ recurrent abrasions: erythromycin ointment or sulfacetamide
- contact lens abrasions: ofloxacin, ciprofloxacin or tobramycin drops/ointment
- oral analgesics for pain
- eye lubricant
- tetanus prophylaxis
- ointment is preferred over drops bc it acts as a lubricant and may help facilitate regeneration of epithelium
- avoid contacts until healed
- ONLY an ophthamalogist should treat a corneal abrasion with an ophthalmic steroid Corneal abrasion follow up needed
- return in 24-48 hours to assess healing and status for large abrasions >4mm
- smaller abrasions do not require f/u as long as s/s improve
- follow up if no improvement in 24-48 hours Pingueculum s/s yellowish green growth on nasal aspect of the conjunctiva
Pterygium s/s vascular rise lesion that extends from conjunctiva to nasal cornea Pingueculum/Pterygium patho
- lesions of the conjunctiva that result from hyperplasia
- caused by chronic sun exposure and environmental irritants Pingueculum/Pterygium risk factors job working outside in wind with blowing dirt Pingueculum/Pterygium treatment
- lubricants and steroid therapy
- should not be removed unless absolutely necessary d/t risk of viral problems
- best treatment is a conservative approach unless they start growing over the pupil Dry eye risk factors
- Acquired disorders: sjogren's syndrome (disorder of the immune system that attacks its own healthy cells that produce saliva and tears), infection, and trauma
- Bell's palsy damages the facial nerve and they cannot close eyelid
- Meds that cause decreased tear production: anticholinergics such as antihistamines, beta- adrenergic blockers, and oxybutynin
- Menopausal women due to lack of estrogen
- patient's who sit at a computer for long due to decreased blink rates Dry eye treatment
- aniridia (partial or complete absence of iris) in newborn
- corneal abrasion
- dermatologic manifestations of albinism
- neonatal conjunctivitis Dacryostenosis diagnostic testing
- complete ophthalmic assessment, visual acuity test
- fluorescein dye disappearance test: place a drop of fluorescein in each eye, monitor with cobalt blue light; if pool still present after 5 minutes, test is positive for obstruction Dacryostenosis treatment
- massage lacrimal duct at least twice daily
- antibiotic drops if infected Dacryostenosis follow up if it doesn't clear, refer out for duct probing to open duct up and insert a catheter (this should completely cure it) Hyphemia patho
- hemorrhaging to interior chamber of eye
- blood in anterior chamber and visible fluid line in pupil *medical emergency! Hyphemia risk factors trauma to eye, penetrating injury, hemophilia, diabetes, anticoagulants (coumadin)
Hyphemia differential diagnosis
- globe trauma
- eye contusion
- systemic diseases (hemophilia, diabetes) Hyphemia diagnostic testing
- based on physical findings
- slit lamp biomicroscopy
- CT
- orbital ultrasonography
- ultrasound biomicroscopy
- fluorescein stain Hyphemia treatment prevention is key-wear eye protection, control diabetes, control bleeding Hyphemia follow up 3 - 4 days to assess for recurrent bleeding Glaucoma Patho
- 2nd leading cause of blindness
- Primary open-angle (chronic glaucoma): slow rise in intraocular pressure (above 25 mm of mercury)
- Angle-closure (acute glaucoma): sudden increase in intraocular pressure
Glaucoma follow up lifelong follow up with opthamalogist every 3-4 months Diabetic retinopathy patho caused by uncontrolled diabetes Diabetic retinopathy diagnostic testing changes in fundoscopic exam (microaneurysms, intro-retinal hemorrhage, macular edema, lipid deposits) Diabetic retinopathy treatment
- lisinopril (only med found to slow progression)
- laser surgery is the main treatment Macular degeneration Patho
- leading cause of blindness in patients over 60 yrs
- a slow progression atrophy and degeneration of retina
- wet: age related; new blood vessels develop under retina in macula and causes sudden distortion or loss of central vision Macular degeneration s/s yellow spots or drusen spots (in clumps of pigment and irregularly interspaced) Macular degeneration treatment
- prevention: no proven method
- no treatment for initial stage
- intermediate stage: high dose antioxidant vitamin and zinc supplements
- wet: thermal laser photocoagulation; refer out bc disease is progressive and it doesn't go away and patients usually end up blind Macular degeneration diagnostics
- 20/20 vision: do a pinhole test
- if vision corrects with pinhole, its uncorrected refractive error
- with refractive error- fundoscopic exam is normal Strabismus patho
- misalignment of eyes; eyes don't line up in same direction
- common in kids with cerebral palsy or premies that had retinopathy at birth
- seen in TBI
- weakness or paralysis of extraocular muscles in corresponding cranial nerves
- a disruption in normal ocular or orbital tissue develops and it affects movement of the eye
- congenital disorders: rubella, cataracts, apert syndrome, down syndrome, edwards syndrome
- other causes in kids: severe farsightedness and ocular tumors, kids with retinoblastoma
- adult causes: bolulism, graves, GBS, injury to eye, shellfish poisoning, stroke, TBI Strabismus risk factors family history, retinopathy because of prematurity, low birth weight, premature birth, smoking during pregnancy Strabismus differential diagnosis
- Auditory neuropathy spectrum disorder: inability to understand sound as it enters ear, due to damage to the inner ear or acoustic nerve Hearing loss risk factors
- CHL: chronic allergic conditions, conditions that cause eustachian tube obstruction, heredity
- SNHL: use of ototoxic drugs, aging (presbycusis), exposure to loud noises, syphilis, congenital rubella infection Hearing loss differential diagnosis conductive hearing loss, sensorineural hearing loss, conductive and sensorineural hearing losses, auditory neuropathy spectrum disorder Hearing loss diagnostic testing
- otoscopic exam
- audiometry: quantifies hearing loss
- tympanometry
- ABR or auditory evoked potential
- otoacoustic emissions (OAEs)
- brainstem audio-evoked response
- tuning fork
- whisper test
- CT or MRI head to r/o tumor
- rinne test Hearing loss non pharm treatment
- removal of cerumen with warm water
- close monitoring of hearing loss
- development of lip reading skills for untreatable forms
- telephone amplifying devices
- TV and radio listening system/ headphones
- hearing aid
- surgical repair of eardrum
- insertion of tymphanostomy tubes to remove fluid
- cochlear implant for severe hearing loss Hearing loss pharm treatment
- agents used to soften ear wax: cerumen impaction
- antibiotics
- corticosteroids as initial tx within 2 weeks of symptom onset
- hyperbaric oxygen therapy combined with steroid therapy within 2 weeks of onset
- intratympanic steroids: incomplete recovery from initial treatment Hearing loss follow up
- depends on etiology and severity of loss
- ENT referral
- genetic counseling and testing Otitis media causative organism streptococcus pneumoniae, H. influenzae, moraxella catarrhalis, group A beta-hemolytic streptococcus
