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AGNP (AANP) HEENT Systems Review

Terms in this set (47)

Chalazion
Chronic inflammation of the meibonian gland (specialized sweat gland) of the eyelids. If enlarges or does not go away, biopsy to R/O squamous cell cancer. May need surgery.
Hordeolum (stye)
Painful acute bacterial infection of a hair follicle on the eyelid. Tx: antibiotic drops (Gentamain, Sulfa)
Pterygium
A yellow triangular (wedge -shaped) thickening of the conjunctiva that extends to the cornea on the nasal or temporal cornea. Due to UV-damaged collagen from chronic sun exposure. Usually asymptomatic. Can be red/inflamed at times. Tx: If inflamed, use week steroid eye drops only during exacerbations. Removed surgical if encroaches cornea & affects vision.
Primary OPEN-Angle Glaucoma
Gradual onset of increased intraocular pressure (IOP) due to blockage of the drainage of aqueous humor inside the eye. The retina (CN 2) undergoes ischemic changes &, if untreated, becomes permanately damaged. Most common type of glaucoma. Elderly, Africans, Diabetics. Complains of gradual changes in peripheral vision (lost first) & then central vision. Tx: Betimol (timolol) beta-blocker eye drops that lower IOP. Side effects: broncho-spasm, fatigue, depression, heart failure, bradycardia. Contraind: asthma, emphysema, COPD, Heard block, heart failure.
Primary Angle CLOSURE Glaucoma
Sudden blockage of aqueous humor causes marked increased of the IOP causing ischemia & permanent damage to the optic nerve (CN 2). Older patient C/O acute onset of severe frontal headache or severe eye pain with blurred vision & tearing. Seeing halos around lights. Maybe accompanied by severe N/V. Eyes: fixed & mid-dilated cloudy pupil that looks more oval than round-shaped. Conjunctival injection with increased lacrimation. Immediate referral to ophthalmology-
Macular Degeneration
Gradual changes in the pigment of the macula (area of central vision) result in blindness. Cause is unknown. Leading cause of blindness in the elderly in this country. More common in elderly & smokers. 2 types: atrophic (dry form) & exudative (wet form). Check central vision with Amsler Grid test (center of grid is distorted, blind spot or scotoma, or wavy lines). Increase intake of antioxidants (Vit. C & E, beta carotene, zinc) & the herbs lutein 7 bilberry. Refer to opthalmologist.
Allergic Rhinitis
Inflammatory changes of the nasal mucosa due to allergy to certain allergens. Atopic family history. May have season or daily symptoms. C/O nasal congestion with clear mucus discharge. Sometimes accompanied by nasal itch & frequent sneezing. Coughing from post nasal drip. Nose: blue tinge or pale boggy nasal turbinates. Mucus clear. Tx: Nsal steroid sprays (fluticasone/Flonase); Oral anithistamines (Zyrtec, Claritan).
Acute Otitis Media
Acute infection of middle ear, usually unilateral. Caused by s. pneumoniae (gram +). Increase rates of beta-lactam resistance strain. H. influenzae (gram-), m. catarrhalis (gram-). C/O ear pain, popping noises, muffled hearing, recent history of cold/AR. Tympanic membrane bulging or retraction with displaced light reflex.
Acute Sinusitis
An infection of the sinuses by both gram + & gram - bacteria. The maxillary & frontal sinuses commonly affected. Caused by s. pneumoniae (gram +). Increase rates of beta-lactam resistance strain. H. influenzae (gram-), m. catarrhalis (gram-). C/O unilateral facial pain which worsen when bending, with pain in upper molar teeth or frontal headache. Tx for AOM & AS: Amox gold standard. 2nd line: Augmentin, Cefuroxine, Bactrim, cefprozil, ceftriaxone, or for PCN allergy-Z-Pack
Tee, age 64, presents with a sore throat. Your assessment reveals tonsillar exudate, anterior cervical adenopathy, presence of a fever, and absence of a cough. There is a high probability of which causative agent?
Group A beta-hemolytic streptococcus
Strep Throat
Acute infection of the pharynx cause by the beta streptococcus (gram+) Group A bacteria. Symptoms include pharyngitis, pain on swallowing, mildly enlarge sub-mandibular and anterior cervical nodes. Throat C & S, PCN X 10 Days, pain control. If PCN allergy: Z-pack for 5 days or Levaquin for 10 days.
Otitis Externa (swimmer's ear)
Bacterial infection of the external ear canal. P. aeruginosa (gram -), S. aureus (gram +). C/O external ear pain, swelling& green purulent discharge. Corticosporin ear drops QID X 7 days.
Acute Mononucleosis
Infection by EBV transmitted through oral contact, which lies latent in pharyngeal tissue. Classic triad: fatigue, acute pharyngitis, lymphadenopathy. May have abd pain due to hepatomegaly &/or splenomegaly. Order abd U/S, avoid all contact sports, symptom management
3 most likely causative pathogens in adult ABRS?
S. pneumoniae, H. Influenzae, M. catarrhalis
Tx of ARBS with adults with mild disease & no prior antimicrobial activity in past 4-6 weeks
1. Amox 1.5-4gm/day
2. Augmentin 1.75-4g/250 mg/day (clavulanate as beta lactamase inhibitor)
3. Cefpodoxime, cefuroxine, cefdinir
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