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FNP~EENT
Assess, Dx, Tx
Question | Answer |
---|---|
What is the normal shape of the "optic disc" | doughnut-like with an orange/pink neuroretinal rim & a central white depression (physiologic cup) |
cup/disc ratio | cup should not be more than 1/2 size of disc diameter, if so consider glaucoma |
T/F: arteries are brighter re and narrower than veins | True |
What is the A:V ratio | 2:3 or 4:5 |
another name for "hordeolum" | stye |
What organism is usually responsible for a hordeolum/stye? | Staphylococcus aureus |
s/sx's of hordeolum/stye | ~abrupt onset ~erythema of eyelid ~pain ~localized tender mass |
Management of hordeolum/stye | ~warm compress ~topical abx oint ~refer to opth if not resolved in 2 days |
What is a "chalazion"? | beady nodule on eyelid; infection or retention cyst of a meibomian gland |
Differentiate between "chalazion" and "hordeolum" | chalazion's are usually painless except for the initial tendereness when they swell up |
s/sx's of a chalazion... | ~swelling on eyelid ~tenderness ~sensitivity to light ~increased tearing ~if very large blurred vision due to pressure on the cornea |
Management of a chalazion... | ~warm compress ~MUST refer for surgical removal |
What is "blepharitis"? | staph infection or seborrheic dermatitis of the lid edge (eyelash roots) |
s/sx's of blepharitis... | ~red scaly, greasy flakes ~itching ~tearing ~thickened, crusted lid margins ~burning |
Management of blepharitis... | ~hot compress ~topical abx ~vigorous scubbing of lashes and lid margins with eyes closed followed by rinsing |
What are some causes of conjunctivitis (pink eye)? | ~allergies ~chemical irritation ~bacterial ~viral ~GC/CT infections |
T/F: conjunctivitis is painful | False |
s/sx's of conjunctivitis... | ~itching ~burning ~redness ~^tears ~blurred vission ~swellen eyelids ~sensation of foreign body in eye ~crust of sticky, micropurulent d/c |
"bacterial" conjunctivitis d/c is... | purulent |
"GC/CT" conjunctivitis d/c is... | copious, purulent |
'allergic" conjunctivitis d/c is... | stringy; ^tearing |
"viral" conjunctivitis d/c is... | watery |
Treatment for "bacterial" conjunctivitis... | ~*self-limiting ~*Abx drops: Levofloxacin, Ofloxin, Cipro, Tobramycin, Gent. opth gtts |
Treatment for "GC/CT" conjunctivitis... | ~GC: Ceftriaxone 250mg IM ~CT: EES oint, Oral EES, Azithro...***TCN, clarithro, doxy (not to be given to pregnant women) |
Treatment for "allergic" conjunctivitis... | ~oral antihistamines, i.e. benadryl |
Treatment for "viral" conjunctivitis... | ~symptomatic care |
What are cataracts? | clouding and opacification of the normally clear lens of the eye |
s/sx's of cataracts... | ~painless ~clouded, blurred or dim vision ~increasing difficulty with night vision ~sensitivity to light and glare ~halos around lights ~need for brighter light ~dbl vision in one eye ~fading or yellowing of colors ~frequent change in eyeglasses |
Cataracts PE findings... | ~no red reflex ~opacity |
Management of cataracts... | refer to opth. |
What is chronic open- angle glaucoma? | chronic, slowly progressive optic nerve damage associated with elevated IOP |
What is primary closed-angle glaucoma? | acute elevated intraocular pressure associated with closure of the filtration angel or obstruction in the circulating pathway of the aqueous humor |
s/sx's of open-angle... | ~^IOP >21 ~red eye ~restricted/constricted vision/field ~cupping of disc *ratio > 0.5 ~initially asymptomatic, until far advanced ~*painless |
s/sx's of closed-angle... | ~elevated IOP > 40 ~hazy cornea ~acute red eyes ~severe periocular pain ~blurred vision ~ cupping of disc *cup to disc ratio >0.5 ~"halos around lights"vomiting, unilateral H/A~*EMERGENCY |
Management of "open-angle"... | ~Miotic agents ~Timolol |
Management of "closed-angle"... | ~Diamox ~Mannitol IV ~Surgery |
What is "conductive" hearing loss? | physical problems with the movement of the sound wave through the ear (i.e. blockage of the ear canal) *air |
Causes of "conductive" hearing loss... | ~foreign body (*cerumen buildup most common cause) ~hematoma ~perforated TM ~otitits media ~otitis externa ~otosclerosis |
What is "sensorineural" loss? | damage to hair cells and/or nerves that sense sound waves |
Causes of "sensorineural" loss... | ~acoustic trauma ~barotrauma (usually in divers) ~head trauma ~ototoxic drugs ~Me'nier's dz ~acoustic neuroma ~infections: mumps, measles, herpes zoster, syphillis, meningitis, etc. ~presbycusis |
Normal findings in "Weber" | sound heard bilaterally equal, does NOT lateralize |
Normal findings in "Rinne" | AC > BC 2:1 |
Weber results in conductive hearing loss... | sound lateralizes to the affected ear (i.e. stick finger in ear and talk) |
Rinne results in conductive hearing loss... | abnormal in the affected ear (i.e., AC < BC...because air can't get through |
Weber results in sensorineural hearing loss... | sound lateralizes to the unaffected ear |
Rinne results in sensorineural hearing loss... | normal in affected ear |
Management of conductive hearing loss... | ~clear canal ~treat underlying cause |
Management of sensorineural loss... | ~refer |
Presentation of "uveitis"... | pupil usually constricted, nonreactive, irregularly shaped, ciliary flush |
Intervention for "uveitis"... | Refer to Opth, Acute use of topical or systemic corticosteroids and cyclopegics |
Cataracts affect distant/near vision... | Distant vision is affected |
Vision loss commonly reported in "macula degeneration"... | Central vision affected, most debilitating |
"Amsler Grid" (staring at the dots on the paper) is screening test for... | macular degeneration testing |
Etiology of "presbyopia"... | hardening of the lens |
"Presbyopia" results in... | close vision problems |
Etiology of "senile cataracts"... | lens clouding |
"Senile Cataracts" result in... | progressive vision dimming, distance vision problems |
Etiology of "hyposomia"... | neural degeneration |
"Hyposomia" results in... | gradual decline in fine taste (largely a function of smell) |
Etiology of "presbycusis"... | loss of 8th cranial nerves sensitivity |
"Presbycusis" results in... | difficulty w/ conversation in noisy environment; can hear but cannot understand |
Etiology of "cerumen impaction"... | conductive hearing loss |
"Cerumen Impaction" results in... | general diminution of hearing |