NURS 640 UPDATED EXAMS TEST PAPER
QUESTIONS AND ANSWERS SURE A+
✔✔Corneal ulcer - ✔✔watery purulent discharge, blurred vision, mod/sev pain, normal
pupils, photophobia
Consider "red eye"
✔✔Foreign body - Eye - ✔✔conjunctival/corneal
-"something in my eye"
-AVOID anesthetic drops for home use
-attempt removal when indicated
Intraocular
- "something hit my eye"
-no FB visual
-REFER
✔✔Corneal abrasion - ✔✔- pain/photophobia
-hx of trauma
- no FB
- staining can visualize abrasion
- ointment and anti-inflammatory
✔✔contusion- eye - ✔✔surrounding trauma- ex: orbit fx
,can develop immediately or delayed onset
TREAT: rest, avoid ASA/NSAIDs
✔✔Diabetic retinopathy - ✔✔1/3 of diabetics
- visual loss can be present
- abnormal retinal vessels, edema, exudate
✔✔Hypertensive Retinocoroidopathy - ✔✔acute
- HTN crisis
-cotton wool spots, hemorrhage, edema, exudate, stellate patterns.
- rapid reduction of BP may make worse
chronic
-abnormal arterioles, light reflection, AV
-flame hemorrhage
✔✔blood dyscrasia- eye - ✔✔eye involvement with thrombocytopenia, severe anemia,
sickle cell
✔✔HIV/AIDS - eye - ✔✔HIV retinopathy, CMV retinitis, HSV infection, herpes zoster
✔✔subjective ear - ✔✔Acute/chronic
history and sx
PMH: co-morbidities, drugs w ototoxic
PSH: HEENT sx
✔✔Ototoxic medications - ✔✔amino glycosides
loop diuretics
certain neoplastic agents (cisplatin)
✔✔Ear PE - ✔✔scope: Canal, TM, Middle ear
external ear: trauma, erythema, edema
✔✔Vertigo testing - ✔✔nystagmus assessment
neuro assessment: romberg, balance, gait
✔✔Cerumen impaction - ✔✔sx: dizzy, hearing reduction, pain
if asymptomatic: ceruminolytics
w sx: irigation (BODY TEMP), manual removal
✔✔external otitis - ✔✔external to the TM.
bacterial or fungal
often from excessive moisture (swimmers ear)
Tx: reduce excess moisture, local anti-microbial to treat infection
✔✔malignant external otitis - ✔✔immunocomprimised
, persistent otitis eveolves to osteomylitis of the skull base.
- foul aural drainage
- granulations, otalgia, CN deficits, CT shows osseous erosion
TX: IV abx
✔✔acute otitis media - ✔✔fluid accumulation within the middle ear
common in kids
sx: otalgia, erythema, decreased TM mobility, bulging TM
TX: oral abx
surgical intevention if unresponsive to abx.
if swelling over mastoid, URGENT INTERV
✔✔nose subjective - ✔✔acute/chronic
discharge and description
HEENT diseases, recent illness, anticoag meds
HEENT surgery
✔✔nose PE - ✔✔discharge: blood, discolored, clear
inspect nasopharynx oropharynx, ears, neck: membranes, septum, scabbing, polyps,
signs or URI
palpate paranasal sinuses
✔✔Viral rhinosinusitis - ✔✔benign and self-limited
need to distinguish from bacterial
- drainage often clear
TX: supportive, nasal saline, oral decongestants, avoid nasal decongestants
✔✔Acute bacterial rhinosinusitis - ✔✔-purulent yellow/green discharge
-facial pain/pressure
-fever, malaise, HA
maxillary most common. can be from NG or ET in hospital.
**Dx: by clinical sx - imaging not necessary
*TX: NSAIDs, decongestants, nasal corticosteroids
*abx- limit if can. use for severe sx, high risk pts, sx >10 days
*amoxicillin is first line
✔✔Allergic Rhinitis - ✔✔sx: eye irritation, pruritic, conjunctival erythema, excess tearing
- can be seasonal or yearly
TX: intranasal steroids, antihistamines, anti-luekotriene agents, nasal saline irrigation,
immunotherapy
QUESTIONS AND ANSWERS SURE A+
✔✔Corneal ulcer - ✔✔watery purulent discharge, blurred vision, mod/sev pain, normal
pupils, photophobia
Consider "red eye"
✔✔Foreign body - Eye - ✔✔conjunctival/corneal
-"something in my eye"
-AVOID anesthetic drops for home use
-attempt removal when indicated
Intraocular
- "something hit my eye"
-no FB visual
-REFER
✔✔Corneal abrasion - ✔✔- pain/photophobia
-hx of trauma
- no FB
- staining can visualize abrasion
- ointment and anti-inflammatory
✔✔contusion- eye - ✔✔surrounding trauma- ex: orbit fx
,can develop immediately or delayed onset
TREAT: rest, avoid ASA/NSAIDs
✔✔Diabetic retinopathy - ✔✔1/3 of diabetics
- visual loss can be present
- abnormal retinal vessels, edema, exudate
✔✔Hypertensive Retinocoroidopathy - ✔✔acute
- HTN crisis
-cotton wool spots, hemorrhage, edema, exudate, stellate patterns.
- rapid reduction of BP may make worse
chronic
-abnormal arterioles, light reflection, AV
-flame hemorrhage
✔✔blood dyscrasia- eye - ✔✔eye involvement with thrombocytopenia, severe anemia,
sickle cell
✔✔HIV/AIDS - eye - ✔✔HIV retinopathy, CMV retinitis, HSV infection, herpes zoster
✔✔subjective ear - ✔✔Acute/chronic
history and sx
PMH: co-morbidities, drugs w ototoxic
PSH: HEENT sx
✔✔Ototoxic medications - ✔✔amino glycosides
loop diuretics
certain neoplastic agents (cisplatin)
✔✔Ear PE - ✔✔scope: Canal, TM, Middle ear
external ear: trauma, erythema, edema
✔✔Vertigo testing - ✔✔nystagmus assessment
neuro assessment: romberg, balance, gait
✔✔Cerumen impaction - ✔✔sx: dizzy, hearing reduction, pain
if asymptomatic: ceruminolytics
w sx: irigation (BODY TEMP), manual removal
✔✔external otitis - ✔✔external to the TM.
bacterial or fungal
often from excessive moisture (swimmers ear)
Tx: reduce excess moisture, local anti-microbial to treat infection
✔✔malignant external otitis - ✔✔immunocomprimised
, persistent otitis eveolves to osteomylitis of the skull base.
- foul aural drainage
- granulations, otalgia, CN deficits, CT shows osseous erosion
TX: IV abx
✔✔acute otitis media - ✔✔fluid accumulation within the middle ear
common in kids
sx: otalgia, erythema, decreased TM mobility, bulging TM
TX: oral abx
surgical intevention if unresponsive to abx.
if swelling over mastoid, URGENT INTERV
✔✔nose subjective - ✔✔acute/chronic
discharge and description
HEENT diseases, recent illness, anticoag meds
HEENT surgery
✔✔nose PE - ✔✔discharge: blood, discolored, clear
inspect nasopharynx oropharynx, ears, neck: membranes, septum, scabbing, polyps,
signs or URI
palpate paranasal sinuses
✔✔Viral rhinosinusitis - ✔✔benign and self-limited
need to distinguish from bacterial
- drainage often clear
TX: supportive, nasal saline, oral decongestants, avoid nasal decongestants
✔✔Acute bacterial rhinosinusitis - ✔✔-purulent yellow/green discharge
-facial pain/pressure
-fever, malaise, HA
maxillary most common. can be from NG or ET in hospital.
**Dx: by clinical sx - imaging not necessary
*TX: NSAIDs, decongestants, nasal corticosteroids
*abx- limit if can. use for severe sx, high risk pts, sx >10 days
*amoxicillin is first line
✔✔Allergic Rhinitis - ✔✔sx: eye irritation, pruritic, conjunctival erythema, excess tearing
- can be seasonal or yearly
TX: intranasal steroids, antihistamines, anti-luekotriene agents, nasal saline irrigation,
immunotherapy
