AGNP AANP CORE REVEWS ANSWERS AND
QUESTIONS SET A+
✔✔glaucoma labs/diagnostics - ✔✔tonometry: screen nationally rec by AGE 40 & in
DM**
✔✔open-angle glaucoma tx - ✔✔prostaglandin analogs (-prost)***
alpha 2-adrenergic blockers, beta-adrenergic blockers, miotic agents
✔✔closed-angle glaucoma tx - ✔✔carbonic anhydrase inhibitor (acetazloamide
[Diamox])
osmotic diuretics (mannitol)
surgery
✔✔cataracts - ✔✔C = cloudy
clouding & opacification of lens of eye
highest cause of treatable blindness
most common surgical procedure in pts 65+ = senile cataracts
✔✔cataracts causes - ✔✔age, genetics, trauma, toxins, drugs, ETOH, DM, AV sunlight
exposure
✔✔cataracts s/sx - ✔✔PAINLESS; no red reflex***
cloudy blurred or dim vision, halos around lights, difficulty with night vision, light/glare
sensitivity, fading/yellowing of colors, diplopia in single eye, opacity of lens
✔✔cataracts tx - ✔✔refer to ophtho, surgery
,✔✔retinal detachment - ✔✔separation of light membrane in back of eye (retina) from
supporting layers
✔✔retinal detachment s/sx - ✔✔**flashes of light (photopsia) especially in peripheral
vision**
**floaters in the eye**
**shadow or blindness in part of visual field of one eye**
blurred vision
✔✔retinal detachment tx - ✔✔EMERGENCY - refer for surgery
✔✔otitis externa - ✔✔inflam and/or infx of external auditory canal
✔✔otitis externa types - ✔✔acute localized (furunculosis)
acute diffuse bacterial (swimmer's ear)
others- chronic, fungal, eczema
✔✔acute localized otitis externa (furunculosis) s/sx & cause - ✔✔cause- staph aureus
pustules & furuncles, severe pain w/ area of cellulitis, itching, red, scaling, crusting,
fissuring, possible exudates
✔✔otitis externa tx - ✔✔cleansing & debridement of ear
topical otic drops: hydrocortisone/neomycin/polymyxin otic
pain control: NSAIDs, topical corticosteroids
✔✔acute otitis media - ✔✔fluid in MIDDLE EAR with s/sx of infection
✔✔serous otitis media - ✔✔chronic otitis media resulting in effusion (fluid on ear)
✔✔otitis media causes - ✔✔most common = URI (viral)
most common bacterial pathogens: 1. strep pneumoniae 2. Haemophilus influenzae 3.
Moraxella catarrhalis
"some people have increased medication concerns"
✔✔otitis media s/sx - ✔✔local inflamm- red with diminished light reflex, fluid
exudative phase- middle ear serous exudate
,suppurative phase (serous)- purulent exudates, RETRACTION & POOR MOTILITY OF
TM; bulging convex membrane
✔✔is erythema alone of the TM diagnostic of otitis media? - ✔✔NO - may occur with
any inflammation of upper resp tract, crying, or nose blowing
✔✔otitis media tx - ✔✔uncomplicated resolve spontaneously
abx for bacterial: AUGMENTIN 1ST LINE, followed by cephalosporin (cefdinir,
cefpodoxime, cefuroxime)
✔✔cholesteatoma - ✔✔type of chronic otitis media with peeling layers of scaly or
keratinized epithelium
If untreated, may erode middle ear causing nerve damage and deafness
✔✔cholesteatoma s/sx - ✔✔desquamated keratin, chronic infx, painless otorrhea,
hearing loss, canal filled with mucopus & granulation tissue
TM perf 90% cases
✔✔cholesteatoma tx - ✔✔refer for surgery
✔✔vertigo - ✔✔sensation of motion, "room spinning"
✔✔benign paroxysmal positional vertigo (BPPV) - ✔✔most common form of vertigo,
sensation of motion initiated by sudden head movements
✔✔vertigo causes - ✔✔brain tumors, meds, otitis media or labyrinthitis, Meniere's,
acoustic neuroma, trauma, migraines, cerebellar hemorrhage
✔✔vertigo s/sx - ✔✔**POSITIVE DIX-HALLPIKE (NYLEN-BARRANY MANEUVER)-
reproduces sx***
Positive Romberg
disorientation or motion, n/v, sweating, abnormal eye movement (nystagmus), hearing
loss, tinnitus, visual disturbs, weakness, difficulty speaking, decreased LOC
✔✔vertigo labs/diagnostics for further workup - ✔✔CT, VDRL/RPR (neurosyph), med
levels, whisper test, BG, ECG, tick lab (lyme dz)
✔✔vertigo tx - ✔✔meclizine, diphenhydramine, scopolamine patch, antiemetics,
diazepam
, ✔✔hearing loss - ✔✔loss of ability to detect pure tones in decibels >20 dB
✔✔conductive hearing loss causes - ✔✔foreign body, cerumen build-up, hematoma,
TM perf, OM, OE, otosclerosis
✔✔sensorineural hearing loss causes - ✔✔presbycusis, damage to hair cells/nerves,
acoustic trauma, barotrauma, head trauma, ototoxic drugs (aminoglycosides, diuretics,
salicylates, NSAIDs, antineoplastics), Meniere's, acoustic neuroma, infx (measles,
mumps, herpes zoster, syphilis, meningitis)
✔✔hearing loss diagnostics - ✔✔whisper test 1st, if positive then Weber & Rinne
✔✔hearing loss cranial nerve - ✔✔CN VIII
✔✔Rinne & Weber normal findings - ✔✔Rinne- AC > BC
Weber- sound heard b/l equal, DOES NOT LATERALIZE**
✔✔conductive hearing loss rinne & weber - ✔✔Rinne- abnormal in affected ear AC <
BC
Weber- sound lateralizes to affected ear
✔✔sensorineural hearing loss rinne & weber - ✔✔Rinne- normal in affected ear
Weber- lateralizes to unaffected ear
✔✔hearing loss labs/diagnostics - ✔✔otoscopic exam, neuro exam, audiometry, CT,
blood tests
✔✔hearing loss tx - ✔✔conductive- clear canal, tx underlying cause
sensorineural- refer
✔✔common cold cause - ✔✔rhinovirus, RSV, coronavirus, adenovirus etc
✔✔common cold s/x - ✔✔watery rhinorrhea, red mucosa, sneezing, nasal/sinus
blockage, sore throat, cough, malaise
✔✔common cold tx - ✔✔supportive care, humidifier, hydration, warm salt water gargles
✔✔pharyngitis/tonsillitis cause - ✔✔inflammation of pharynx/tonsills
d/t virus (RSV, flu, Epstein-Barr)
✔✔pharyngitis/tonsillitis s/sx - ✔✔anterior cervical adenopathy = strep***
red pharynx, rhinorrhea, fever, painful throat, maculopapular rash = strep, cough
QUESTIONS SET A+
✔✔glaucoma labs/diagnostics - ✔✔tonometry: screen nationally rec by AGE 40 & in
DM**
✔✔open-angle glaucoma tx - ✔✔prostaglandin analogs (-prost)***
alpha 2-adrenergic blockers, beta-adrenergic blockers, miotic agents
✔✔closed-angle glaucoma tx - ✔✔carbonic anhydrase inhibitor (acetazloamide
[Diamox])
osmotic diuretics (mannitol)
surgery
✔✔cataracts - ✔✔C = cloudy
clouding & opacification of lens of eye
highest cause of treatable blindness
most common surgical procedure in pts 65+ = senile cataracts
✔✔cataracts causes - ✔✔age, genetics, trauma, toxins, drugs, ETOH, DM, AV sunlight
exposure
✔✔cataracts s/sx - ✔✔PAINLESS; no red reflex***
cloudy blurred or dim vision, halos around lights, difficulty with night vision, light/glare
sensitivity, fading/yellowing of colors, diplopia in single eye, opacity of lens
✔✔cataracts tx - ✔✔refer to ophtho, surgery
,✔✔retinal detachment - ✔✔separation of light membrane in back of eye (retina) from
supporting layers
✔✔retinal detachment s/sx - ✔✔**flashes of light (photopsia) especially in peripheral
vision**
**floaters in the eye**
**shadow or blindness in part of visual field of one eye**
blurred vision
✔✔retinal detachment tx - ✔✔EMERGENCY - refer for surgery
✔✔otitis externa - ✔✔inflam and/or infx of external auditory canal
✔✔otitis externa types - ✔✔acute localized (furunculosis)
acute diffuse bacterial (swimmer's ear)
others- chronic, fungal, eczema
✔✔acute localized otitis externa (furunculosis) s/sx & cause - ✔✔cause- staph aureus
pustules & furuncles, severe pain w/ area of cellulitis, itching, red, scaling, crusting,
fissuring, possible exudates
✔✔otitis externa tx - ✔✔cleansing & debridement of ear
topical otic drops: hydrocortisone/neomycin/polymyxin otic
pain control: NSAIDs, topical corticosteroids
✔✔acute otitis media - ✔✔fluid in MIDDLE EAR with s/sx of infection
✔✔serous otitis media - ✔✔chronic otitis media resulting in effusion (fluid on ear)
✔✔otitis media causes - ✔✔most common = URI (viral)
most common bacterial pathogens: 1. strep pneumoniae 2. Haemophilus influenzae 3.
Moraxella catarrhalis
"some people have increased medication concerns"
✔✔otitis media s/sx - ✔✔local inflamm- red with diminished light reflex, fluid
exudative phase- middle ear serous exudate
,suppurative phase (serous)- purulent exudates, RETRACTION & POOR MOTILITY OF
TM; bulging convex membrane
✔✔is erythema alone of the TM diagnostic of otitis media? - ✔✔NO - may occur with
any inflammation of upper resp tract, crying, or nose blowing
✔✔otitis media tx - ✔✔uncomplicated resolve spontaneously
abx for bacterial: AUGMENTIN 1ST LINE, followed by cephalosporin (cefdinir,
cefpodoxime, cefuroxime)
✔✔cholesteatoma - ✔✔type of chronic otitis media with peeling layers of scaly or
keratinized epithelium
If untreated, may erode middle ear causing nerve damage and deafness
✔✔cholesteatoma s/sx - ✔✔desquamated keratin, chronic infx, painless otorrhea,
hearing loss, canal filled with mucopus & granulation tissue
TM perf 90% cases
✔✔cholesteatoma tx - ✔✔refer for surgery
✔✔vertigo - ✔✔sensation of motion, "room spinning"
✔✔benign paroxysmal positional vertigo (BPPV) - ✔✔most common form of vertigo,
sensation of motion initiated by sudden head movements
✔✔vertigo causes - ✔✔brain tumors, meds, otitis media or labyrinthitis, Meniere's,
acoustic neuroma, trauma, migraines, cerebellar hemorrhage
✔✔vertigo s/sx - ✔✔**POSITIVE DIX-HALLPIKE (NYLEN-BARRANY MANEUVER)-
reproduces sx***
Positive Romberg
disorientation or motion, n/v, sweating, abnormal eye movement (nystagmus), hearing
loss, tinnitus, visual disturbs, weakness, difficulty speaking, decreased LOC
✔✔vertigo labs/diagnostics for further workup - ✔✔CT, VDRL/RPR (neurosyph), med
levels, whisper test, BG, ECG, tick lab (lyme dz)
✔✔vertigo tx - ✔✔meclizine, diphenhydramine, scopolamine patch, antiemetics,
diazepam
, ✔✔hearing loss - ✔✔loss of ability to detect pure tones in decibels >20 dB
✔✔conductive hearing loss causes - ✔✔foreign body, cerumen build-up, hematoma,
TM perf, OM, OE, otosclerosis
✔✔sensorineural hearing loss causes - ✔✔presbycusis, damage to hair cells/nerves,
acoustic trauma, barotrauma, head trauma, ototoxic drugs (aminoglycosides, diuretics,
salicylates, NSAIDs, antineoplastics), Meniere's, acoustic neuroma, infx (measles,
mumps, herpes zoster, syphilis, meningitis)
✔✔hearing loss diagnostics - ✔✔whisper test 1st, if positive then Weber & Rinne
✔✔hearing loss cranial nerve - ✔✔CN VIII
✔✔Rinne & Weber normal findings - ✔✔Rinne- AC > BC
Weber- sound heard b/l equal, DOES NOT LATERALIZE**
✔✔conductive hearing loss rinne & weber - ✔✔Rinne- abnormal in affected ear AC <
BC
Weber- sound lateralizes to affected ear
✔✔sensorineural hearing loss rinne & weber - ✔✔Rinne- normal in affected ear
Weber- lateralizes to unaffected ear
✔✔hearing loss labs/diagnostics - ✔✔otoscopic exam, neuro exam, audiometry, CT,
blood tests
✔✔hearing loss tx - ✔✔conductive- clear canal, tx underlying cause
sensorineural- refer
✔✔common cold cause - ✔✔rhinovirus, RSV, coronavirus, adenovirus etc
✔✔common cold s/x - ✔✔watery rhinorrhea, red mucosa, sneezing, nasal/sinus
blockage, sore throat, cough, malaise
✔✔common cold tx - ✔✔supportive care, humidifier, hydration, warm salt water gargles
✔✔pharyngitis/tonsillitis cause - ✔✔inflammation of pharynx/tonsills
d/t virus (RSV, flu, Epstein-Barr)
✔✔pharyngitis/tonsillitis s/sx - ✔✔anterior cervical adenopathy = strep***
red pharynx, rhinorrhea, fever, painful throat, maculopapular rash = strep, cough
