Heent

Front 1

What is the name of the bacteria that causes "pink eye"?

Back 1

Non Neisseria conjunctivitis

Front 2

Is pink eye most often bacterial or viral?

Back 2

Viral

Front 3

What is the most common viral cause of pink eye?

Back 3

Adenovirus

Front 4

Herpes zoster opthalmicus spreads down from what nerve?

Back 4

Opthamalmic nerve

Front 5

In allergic conjunctivitis, what allergen is the contributing agent in the spring? What about in the summer?

Back 5

Grass pollen
Ragweed pollen in the summer

Front 6

A foreign body sensation in the eye is a common symptom caused by what virus?

Back 6

Adenovirus

Front 7

Bacterial conjunctivitis is unilateral or bilateral?

Back 7

Unilateral but bilateral after 48hrs

Front 8

Allergic conjunctivitis causes the appearance of ___ conjunctiva.

Back 8

Cobblestone

Front 9

When performing an H&P, what is assessed in the lymphatic region for viral and chlamydial infections?

Back 9

Enlargement of preauricular nodes

Front 10

Corneal involvement/traumatic injury may require what to observe for injury?
What must you administer before the staining?

Back 10

Staining with flourasceinuse blue light illumination to observe for corneal scratches
Anesthetic drops before staining.

Front 11

How long should you wait until referral is necessary to do when daily with conjunctivitis?

Back 11

24hours

Front 12

What was the eye drop of choice for conjunctivitis?

Back 12

Cipro/Ciloxan 0.3% ointment ½ in ribbon q 8 hrs on day 1-2, then ½ in, q 12 hrs on days 3-7

Front 13

Topical non-steroids are a good option and have minimal side effect? Give a drug ex.

Back 13

Acular solution 1 drop QID

Front 14

Gonococcal & ___ conjunctivitis need to be referred out.

Back 14

Chlamydial

Front 15

The expected course and progress of viral conjunctivitis can persist for?

Back 15

10 days

Front 16

Bacterial conjunctivitis persist for how long?

Back 16

2-4 days with treatment

Front 17

How long does viral herpes simplex last?

Back 17

2-3 weeks

Front 18

Acute obstruction and infection of eyelid gland (meibomian gland) is called?

Back 18

Hordeolum

Front 19

Chronic obstruction and inflammation of meibomian gland with leakage of sebum into surrounding tissue with resulting lipogranuloma

Back 19

Chalazion

Front 20

What is the casautive organsims for chalazion and hordeolum

Back 20

Staph aureus

Front 21

Patients with seborrheic dermatitis or acne rosacea are at increased risk for single, multiple, or recurrent ___.

Back 21

Chalazia

Front 22

____ (blepharal refers to eyelid) common chronic bilateral inflammation of the edges of the eyelids

Back 22

Blepharitis

Front 23

Ilotycin/Erythomycin opht. Oint. 2-5 times daily is administered for the treatment of?

Back 23

Hordeleum

Front 24

What is the treatment for acute attack glaucoma?

Back 24

Constriction of pupil with 4% pilocarpine and lowering IOP with .5% apracolidine &.5% timolol, & 500mg of acetozalamide

Front 25

Tonometry reveals elevated introcular pressure (> 21mm Hg) but highly variable commonly seen in?

Back 25

Chronic open angle glaucoma

Front 26

In acute glaucoma, what is seen with the optic disc?

Back 26

Cupping of optic disc

Front 27

What is the treatment plan for acute glaucoma?

Back 27

Topical adrenergic agonists (epinephrine) colinergic agents (pilocarpine), beta blockers.

Front 28

With cerumen impaction, the use of water at what temperature will avoid vestibular caloric response

Back 28

37 C

Front 29

When irrigating ear cannel for cerumen, how should the stream be directed?

Back 29

Stream should be directed at the ear canal wall adjacent to the cerumen plug

Front 30

Irrigation should be performed only when the tympanic membrane is?

Back 30

Known to be intact

Front 31

Following irrigation, the ear canal should be thoroughly dried (e.g., Instilling isopropyl ETOH & what other factor can contribute to drying the ear canal. This reduces the likelihood of external otitis.

Back 31

using hair dryer on low setting

Front 32

What can we mix to create a cerumen removal?

Back 32

Baking soda & water: ¼ tsp to 1 cup of water

Front 33

Perforation of the tympanic membrane requires ____.

Back 33

Systemic antibiotics

Front 34

Sensory innervation of the ear
is derived from ___

Back 34

the trigeminal, facial, glossopharyngeal, vagal and upper cervical nerves.

Front 35

Temporomandibular point dysfunction is a common cause of ___
.

Back 35

Ear pain

Front 36

Most otitis externa caused by fungal infection is attributed to the causative agent ____

Back 36

Aepergillus (90% cases)

Front 37

Itching in canal or outer ear
flaking, crusting, or weeping skin is caused by what class of otitis externa?

Back 37

Seborrheic or eczematoid

Front 38

Itching in canal, ear pain
muffled hearing from the swelling occlude canal, watery or thick discharge from the ear (scanty to purulent; black or dark if fungal) is KK of what type of otitis externa?

Back 38

Infectious otitis externa

Front 39

When should a patients ear cannal be cultured?

Back 39

Only if the patient is immunosuppressed or does not respond to treatment

Front 40

If the pt present with facial paralysis (CN VII palsy with otitis media, what should you do as an NP?

Back 40

Refer out!

Front 41

Pain that increases on movement (e.g., chewing, moving jaw) is termed?

Back 41

Otalgia

Front 42

What is the treatment option for otalgia in otitis media

Back 42

Auralgan Otic Soln – prn, 2 drops q 3 hrs (no perforation

Front 43

With significant swelling in the ear canal due to otitis media, what intervention can be performed?

Back 43

Introduce a cotton wick deep in the canal by use of forceps helps deliver otic drops.

Front 44

For acute bacterial otitis externa with an intact TM, what is the treatment option?

Back 44

Cipro HC 3 drops q12 hrs for 7 days (first line)

Front 45

For acute bacterial otitis externa with a perforated TM, what is the treatment option?

Back 45

Floxin otic 0.3% singles – 2 containers daily each ear for 7 days
Floxin 0.3% otic soln 10 drops daily for 7 days

Front 46

When considering an antibacterial/ antifungal + astringent what can you as the NP prescribe?

Back 46

Otic Domoboro

Front 47

What are some education guidelines for pt who develops frequent otitis media?

Back 47

Restrict swimming until symptoms subside, Use wax-moldable earplugs
Recurrent infections are common; diluted ETOH can be used after contact with water (50/50 solution of white vinegar and rubbing ETOH in both ear canals at end of each swim and/or upon arising and hs
Avoid trauma to canal
Avoid prolonged exposure to moisture

Front 48

5-7 days after an URI, what is a typical condition you would expect to develop.

Back 48

AOM

Front 49

The bacteria that is the most common pathogens both in adults and children are Moraxella catarrhalis: 10-15%
Hemophilus influenzae: 20-25%

Back 49

Moraxella catarrhalis-90% of these produce beta-lactamases that hydrolyze amoxicillin and some cephalosporins
Hemophilus influenzae-40% of these produce beta-lactamases that hydrolyze amoxicillin and some cephalosporins

Front 50

Your pt presents with otalgia, intense pain, followed by acute relief. As an NP what are you suspecting happend?

Back 50

Membrane rupture that produces relief followed by the onset of otorrhea.

Front 51

AOM 1st line treatment consist of what medication regimen?

Back 51

Amoxicillin (cat. B) 500 mg – 1 gm tid x 5-7 days; it is probably the most effective of penicillin/ cephalosporins against a relatively resistant (but not highly resistant) pneumococci

Front 52

What are some alternative 1st line treatment regimen for AOM?

Back 52

Z pack x 5 days or 500 mg daily x 3 days
Trimethoprim-sulfamethoxazole (Bactrim DS, Septra) (Cat. C – 3rd trimester)
1 tab q 12 hrs x 5-7 days

Front 53

What is the 2nd line treatment of AOM?

Back 53

Amoxicillin/ clavulanate (Augmentin XR) (Cat. B) 2 tabs q 12 hrs for 5-7 day
Omnicef 300 mg q 12 hrs for 5-7 days
Ceftin 250-500 mg q 12 hrs for 5-7 days

Front 54

When should the selection of alternative drugs be considered for AOM?

Back 54

Pts with a PCN allergy
persistent symptoms after 48-72 hrs. of amoxicillin
AOM within 1 mos. amoxicillin Rx

Front 55

Based on clinical evidence for the tmt duration of AOM, is their a difference in the success rate of a shorter duration of treatment plan vs longer duration of treatment.

Back 55

Nope! :)

Front 56

Antihistamines are NOT recommended for the resolution of AOM because?

Back 56

They lead to decreased ciliary motility

Front 57

What two subcategories of medication would you consider prescribing to your pt with AOM?

Back 57

Pain management: ASA, Tylenol, Codeine 30 mg with ASA q 4 hrs prn = Ibuprofen 400 mg
& Systemic decongestants

Front 58

When should you as the NP consider referring your pt out after a dx of AOM?

Back 58

Severe, pain
Failure to improve symptomatically in 48 hrs.
Not improved after 10 days of Rx
Hearing loss of longer than 3 wks.
Bulging membrane with severe pain and vertigo
Signs of meningitis (e.g., lethargy, stiff neck)

Front 59

What sinus's are the most frequently affected?

Back 59

Maxillary

Front 60

Suspicious of ___ ____when pt. has had a prolonged cold and has not improved with OTC decongestants and antihistamines.

Back 60

Acute sinusitis

Front 61

Maxillary sinusitis is associated with ___

Back 61

Dental abscess

Front 62

The major diagnostic dilemma is to differentiate between sinus infection and ____.

Back 62

Allergy

Front 63

Mucopurulent discharge: thick, brown, tenacious nasal secretions suggest extramucosal ____

Back 63

Fungal disease

Front 64

__ ___ is considered the “gold standard” for establishing sinusitis.

Back 64

Sinus aspiration

Front 65

Acute sinusitis (ss <30 days) 1st line treatment is treated with?

Back 65

Amoxicillin 500 mg tid x or 875 mg bid for 10-14 days
Augmentin 875 mg bid for 14 days
Augmentin XR 2 tabs bid for 10 days
Keflex 500 mg bid-tid for 10-14 days

Front 66

If acute sinusitis does not get better after 3 days of treatment, what abx should be considered?

Back 66

Baxin

Front 67

If after 10 days of Baxin treatment for acute sinusitis, what abx should be considered?

Back 67

azithromycin

Front 68

2nd line treatment for acute sinusitis are what 2 drugs and doses?

Back 68

1. Augmentin 1000mg or XR 2 tabs twice daily for 10 days
2. Levaquin 500 mg daily for 10-14 days

Front 69

For a PCN allergy, what are the drug combo's considered in acute sinusitis?

Back 69

Biaxin 500 mg bid for 10 days or 1000 mg XL daily for 10 days
Z pack for 5 days
Doxycycline 100 mg bid for 10 days
Bactim DS 1 tab bid for 14 days

Front 70

Antihistamines may ___ secretions; nonsedating antihistamines are < likely to thicken secretions

Back 70

Thicken

Front 71

With acute sinusitis, what is the criteria for referring out?

Back 71

If symptoms worsen or do not improve after 48 hrs. or treatment
Patients with sinusitis that recurs 3+ times per year refer to otolaryngologist
What are you concerned about in a patient that has recurrent sinusitis?

Front 72

Allergen exposure results from a ___ response.

Back 72

IgE-mediated immunological reaction

Front 73

Presence of eosinophils suggests ___

Back 73

allergy

Front 74

Presence of neutrophils suggest?

Back 74

Infection

Front 75

RAST (radioallergosorbent) measures

Back 75

Pt.’s level of IgE to an allergen; more expensive and less sensitive than skin testing

Front 76

When viewing CBC results, what combinations let you know when an infection is bacterial or viral? 

Back 76

A wbc w/diff

Front 77

The differential is the percentage of the various types of ___ present

Back 77

white blood cells present

Front 78

The appearance of bands, immature WBCs in the circulation is referred to as a

Back 78

“SHIFT TO THE LEFT.”

Front 79

Asthma and what other condition seem to co-exist?

Back 79

Allergic rhinitis

Front 80

Antihistamines do not antagonize released histamine but only___.

Back 80

Prevent further release.

Front 81

The topical nasal spray Nasalcrom is a _____.

Back 81

Mast cell stabilizer

Front 82

What can you as the NP replace Clarinex, Allegra, and Zyrtect with in case of treatment failure?

Back 82

Singulair 10 mg in pm

Front 83

Patanol 0.1% 1 drop twice daily
Pataday 0.2% one drop daily
Optivar .05% one drop daily
are all used for the treatment of what?

Back 83

Itchy eyes

Front 84

Antihistamines may cause or worsen __ ___ in men with prostates and/or BPH

Back 84

urinary retention

Front 85

30-60% of sore throats are viral or bacterial?

Back 85

Viral

Front 86

___ ___ is the gold standard for the dx of streptococcal pharyngitis

Back 86

Throat culture

Front 87

First line treatment of strep throat is?

Back 87

PCN VK 500 mg bid or tid for 10 days
Amoxicillin 500 mg tid for 14 days

Front 88

Consider these drugs, For PCN allergy: ceftin
Erytab 500 mg bid for 10 days
Biaxin 500 mg twice daily for 10 days
better than azithromycin for strep
for strep throat drug management if the pt is?

Back 88

For PCN allergy

Front 89

Mono's incubation period is?
Fever can reach as high

Back 89

1-2 months

Front 90

In infectious mono, leukocytosis is often observed with a rate of?

Back 90

10,000-20,000

Front 91

Detection of the ___with the monospot test is the characteristic lab abnormality. These antibodies are detected in 90% of patients with mono, but it can take up to 3 weeks to become positive.

Back 91

Heterophil antibodies

Front 92

___ infection can, at times, present like infectious mononucleosis

Back 92

Cytomegalovirus (CMV)

Front 93

What factors can increase WBC count?

Back 93

Leukemia and trauma

Front 94

____ efficacy is not proven in URI

Back 94

Expectorants