ANCC FNP Exam
Treatment for mild allergic conjunctivits
Topical antihistamines/mast cell stabilizer
NSAIDs and topical corticosteroids are not first line
Pt with allergic conjunctivitis often produce inadequate amount of tears (oral antihistamines may induce dry eye syndrome)
Oral hairy leukoplakia
elongated papilla of the lateral aspect on the tongue
What causes oral hairy leukoplakia?
EBV
Koplik’s spot
clusters of small red papules with white centers located on the buccal mucosa by the lower molars (o = kopliks)
Prodromic viral of measles appears 2-3 days before the rash
Geographic tongue
inflammatory disorder that usually appears on top and side of the tongue
multiple fissures and irreregular smoother areas on its surface that make it look like a topographic map
Cheilosis
painful inflammation and cracking of the corners of the mouth
Peritonsillar abscess
severe sore throat, difficulty swallowing, trismus, and muffled “hot potato” voice
abscess displaces the uvula
pterygium
yellow, triangular thickening of the conjunctiva that extends across the cornea on the nasal side
Pinguecula
yellowish, raised growth on the conjunctiva next to the cornea
Chalazion
chronic inflammation of the meibomian gland
Normal intraocular pressure
8-21mm Hg
Intermittent Esotropia
common in infants younger than 20 weeks
resolves spontaneously
refer if present after 20 weeks
Kawasaki Disease
high fever, enlarged lymph nodes, conjunctivitis, dry, cracked lips
strawberry tongue
most cases under 5 years of age
pharyngitis
acute infection of the pharynx
stuffy nose, rhinitis with clear mucus, and watery eyes
allergic rhinitis
inflammatory changes of the nasal mucosa due to an allergy response
most common sign: transverse nasal crease (allergic salute)
tonsillitis
inflammation of the tonsils
sore throat, difficulty swallowing, tender lymph nodes
Treatment for otitis externa
Use aluminum acetate solution PRN (provides soothing, effective relief of minor skin irritations and inflammation)
keep water out of the ear
Polymyxin B-neomycin-hydrocortisone suspension drops QID x 7 days and/or ofloxacin drops
Bullous Myringitis
small, fluid-filled blisters form on the eardrum
First permanent teeth to erupt
first molars at about 6 years of age
viral keratoconjunctivitis
pink eye
treatment- symptomatic
cold compresses and slightly chilled artificial tears
avoid touching eyes, haring towels, frequent eye washing
children should not attend school until symptoms resolve
what causes viral keratoconjunctivits?
adenovirus
contagious for 10-12 days
self limiting
Transmission of sound through the ear
- sound waves are collected in the pinna
- transmission of vibrations through the hammer, anvil and stirrup
3.nerve impulses stimulate in the inner ear - vibrations are transmitted of the cerebral cortex auditory center
5.sound is interpreted by the cerebral cortex
Ishihara chart
screening a patient for colour blindness
Tx for otitis media
1st line- amoxicillin
blepharitis
chronic condition caused by inflammation of the eyelids
contact lens keratitis
eye pain, redness, excessive tearing, lesion on the cornea
1st line- topical abx
primary angle-closure glaucoma
sudden blockage of the aqueous humor
increased intraocular pressure
Acute Rhinosinusitis
inflammation of the mucosal lining of nasal passages, lasting up to 4 weeks, caused by allergens
Acute Bacterial Rhinosinusitis
secondary bacterial infection, usually following viral URI
Diseases caused by S. pneumoniae
COMPS
Conjunctivitis
Otitis media
Meningitis
Pneumonia
Sinusitis
Diseases caused by H. influenza
COMPS
Conjunctivitis
Otitis media
Meningitis
Pneumonia
Sinusitis
Common features of ABRS
fever and symptoms duration of more than 10 days
maxillary toothache
initial symptom improvement and then worsening of symptoms (double sickening)
cacosmia (sense of bad odor in the nose)
unilateral facial pain
7 day tx is the best
Tx for ABRS in adults
Initial therapy: amoxicillin or amox-clav
Beta-lactam allergy:
No anaphylaxis (cefdinir, cefpodoxime, cefuroxime)
anaphylaxis (levo, moxi, doxycycline)
*macrolide abx (azithro, clarithro, erythro) and TMX-SMX (Bactrim) not recommended in ABRS tx
Doxycycline
pregnancy risk: Cat D
Resp fluroquinolones
pregnancy risk: Cat C
Normal hearing
no lateralization
AC>BC
Sensorineural hearing loss
lateralization to good ear (sound is heard louder in the normal ear)
AC>BC
Conductive hearing loss
lateralization to bad ear (sound is heard louder in the bad ear)
BC>AC
Allergic rhinitis
inflammatory, IgE mediated disease due to genetic and environmental interactions and characterized by nasal congestion, rhinorrhea, sneezing, intraocular and/or nasal itching
Allergic rhinitis treatment
1st line- avoid allergen
controller
- intranasal corticosteroids (fluticasone propionate (flonase), triamcinolone)- number of days prior to symptom relief
- intranasal antihistamine (azelastine)- rapid symptom relief
Reliever therapy - 2nd gen PO antihistamine (loratadine (clairtin), cetirizine (zyrtec)
- ocular antihistamines- helpful in managing allergic conjunctivitis signs and symptoms (olopatadine, azelastine)
Sinus present at birth
ethmoid and maxillary
Sinus develop at 5 years of age
Frontal
Sinus develop at 12 years of age
Sphenoid
Oral Cancer
most cases involve squamous cell carcinomas of the tongue and mouth floor
Risk factor for SCC oral cancer
More potent
- longstanding HPV infection, especially HPV-16, tobacco use, alcohol misuse
Less potent - male gender, advancing age (2/3 of individuals age >55 years at time of diagnosis)
Risk reduction for SCC oral cancer
HPV-9 immunization
avoidance/cessation of tobacco use
Presentation of SCC oral cancer
painless, ulcerating oral lesions, usually presents for many months prior to presenting clinically
adjacent lymphadenopathy= immobile, nontender nodes usually >1 cm in diameter
Macular degeneration
thickening, sclerotic changes in retinal basement membrane complex
painless vision changes including distortion of central vision
fundoscopic exam- drusen (soft yellow deposits in the macular region) often visible
risk factors
- light eye-colour, age, women, smoker
Test for macular degeneration
abnormal Amsler grid test
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For reference https://www.nursingworld.org/our-certifications/family-nurse-practitioner/