NR511 Midterm
A red tongue with enlarged papillae, sometimes seen with strep throat is called a _____ tongue Raspberry Sandpaper Strawberry Blackberry - CORRECT ANSWER Strawberry
Age-related hearing loss (presbycusis) is classified as which type of hearing loss? - CORRECT ANSWER Sensorineural
Characteristics of AGE: - CORRECT ANSWER Nausea
Vomiting
Diarrhea
Fever
Abd pain/cramping
Fatigue
Malaise
Anorexia
Tenesmus
Rectal burning d/t frequent diarrhea
Rectal abrasion
Rectal bleeding
Passing stool w/blood and mucus
Severe dehydration Increased HR
Dizziness
Clinical characteristics of GERD: - CORRECT ANSWER Heartburn
Regurgitation
Water brash (reflex salivation)
Dysphagia
Sour taste in mouth in the morning
Odynophagia (painful swallowing)
Belching
Coughing
Hoarseness
Wheezing usually at night
Substernal or retrosternal chest pain
Aggravating: reclining after eating, eating large meal, alcohol, chocolate, caffeine, fatty/spicy food, nicotine, constrictive clothes, heavy lifting, straining, bending over.
Alleviating: antacids, sitting upright after meal, eating small meals
Compare and contrast otitis media and otitis externa. - CORRECT ANSWER Definition:
OE: inflammation of membranous lining of auditory canal and/or contiguous structures of outer ear.
OM: Inflammation of structures within middle ear
Epidemiology/causes:
OE: 10-20x more likely to occur during warmer/summer months than in cooler seasons. Adults >50 = greatest risk. No ethnic or gender predispositions. Immunocompromised people at greater risk (esp of invasive disease). Excess moisture from any cause increases risk. Seborrheic dermatitis, hearing aids, ear plugs, cotton swabs all increase risk with extended use.
OM: Incidence increases in winter. Most common in very young or elderly. Native American (esp Navajo) and Native Alaskans = higher prevalence. Men and women = risk. More rare in adults. Risk factors: allergies, sinusitis, rhinitis, pharyngitis, recent/recurrent URI, perforation of eardrum, active/passive smoking.
Pathogens:
OE: Pseudomonas aeruginosa (most common cause of diffuse infection). Staph aureus. Group A strep pyogenes. Bacteroids. Peptostreptococcus. Aspergillus niger. Pityrosporum. Candida albicans.
OM: Strep pneumoniae (most frequent cause in adults). H influenzae. Moraxella catarrhalis. Strep aureus and strep pyogenes far less common causes.
Clinical presentation:
OE Subjective: acute, severe otalgia that may worsen at night. Worsens with pulling pinna or applying pressure to tragus. Chewing may exacerbate pain in severe cases. Initially ear may feel full/obstructed with temporary conductive hearing loss. May be pruritic. Systemic symptoms may be present with infectious etiology. Chronic illness may include dryness and pruritis of ear canal. OE Objective: tenderness on traction of pinna, pain w/pressure of tragus. Purulent drainage may be present w/bacterial infection. Canal may be reddened and edematous. Usually lacks cerumen. Auditory canal appears edematous/erythematous. Diffuse cases may have localized pustules or furuncles in canal or external processes. Green exudate w/Pseudomonas. Yellow crusting in midst of purulent drainage w/Staph. Fungal infections have fluffy white/black malodorus carpet of growth. Allergic reactions are scaly, cracked, and/or weepy tissue. Usually no lymphadenopathy. TMJ tenderness may be present in invasive disease.
OME Subjective: Stuffiness, fullness, loss of acuity unilaterally. Pain is rare. Popping, crackling, gurgling. Rarely causes vertigo. AOM Subjective: Deep ear pain. Fever. unilateral hearing loss. Recent URI. Dizziness. Vertigo. Tinnitus. Chronic repeated bouts of AOM.
OME Objective: external ear usually unremarkable. Mucus membranes may be infected or edematous. TM may be dull but not bulging. AOM Objective: TM may be amber or yellow-orange. TM may be infected and pinkish gray to fiery red. TM typically full and bulging w/absent or obscured bony landmarks and cone light reflex. Discharge present if TM perf'd. Otorrhea may be purulent or mucoid. Chronic OM has perf'd, draining TM and possibly invasive granulation tissue. Lymphadenopathy or preauricular and post cervical nodes is common. If OM along with acute mastoiditis, tenderness over mastoid will be present.
Management:
OE: Localized application of heat or ice for pain. NonRx pain reliever for mild to mod pain. Tyl #3 for severe pain. Keep ear dry. Gentle cleaning of ear canal. Eval otic discharge and edema of auditory canal and TM. Select local med appropriate for etiology. May need I&D of pustules or furuncles. Diffuse infection may be treated empirically. Topical otic preps. Abx: 1st gen cephs or pcns, 2nd gen cephs, fluroquinolones, ceftazidime.
OM: Uncomplicated is often self-limiting. Treatment recommended for chronic or recurrent OM. Supportive treatment indicated for acceptance of pt's auditory hearing loss r/t chronic dz. If symptoms persist >12wks, 10-day abx course is warranted. Abx: amox, augmentin, 2nd/3rd gen cephs. Steroids not recommended for kids.
Compare and contrast the two coding classification systems that are currently used in the US healthcare system. - CORRECT ANSWER ICD: International classification of disease codes are used to provide payer info on necessity of visit or procedure performed. Shorthand for pt's dx. CPT: common procedural terminology codes offer the official procedural coding rules and guidelines required when reporting medical services and procedures performed by physician and non-physician providers. Must have corresponding ICD.
Correctly ID a pt as a new or established given historical info. - CORRECT ANSWER Pt status: whether or not pt is new or established.
New: has not received professional service from provider in same group within past 3 years.
Established: has received professional service from provider in same group in last 3 years.
A red tongue with enlarged papillae, sometimes seen with strep throat is called a _____ tongue Raspberry Sandpaper Strawberry Blackberry - CORRECT ANSWER Strawberry
Age-related hearing loss (presbycusis) is classified as which type of hearing loss? - CORRECT ANSWER Sensorineural
Characteristics of AGE: - CORRECT ANSWER Nausea
Vomiting
Diarrhea
Fever
Abd pain/cramping
Fatigue
Malaise
Anorexia
Tenesmus
Rectal burning d/t frequent diarrhea
Rectal abrasion
Rectal bleeding
Passing stool w/blood and mucus
Severe dehydration Increased HR
Dizziness
Clinical characteristics of GERD: - CORRECT ANSWER Heartburn
Regurgitation
Water brash (reflex salivation)
Dysphagia
Sour taste in mouth in the morning
Odynophagia (painful swallowing)
Belching
Coughing
Hoarseness
Wheezing usually at night
Substernal or retrosternal chest pain
Aggravating: reclining after eating, eating large meal, alcohol, chocolate, caffeine, fatty/spicy food, nicotine, constrictive clothes, heavy lifting, straining, bending over.
Alleviating: antacids, sitting upright after meal, eating small meals
Compare and contrast otitis media and otitis externa. - CORRECT ANSWER Definition:
OE: inflammation of membranous lining of auditory canal and/or contiguous structures of outer ear.
OM: Inflammation of structures within middle ear
Epidemiology/causes:
OE: 10-20x more likely to occur during warmer/summer months than in cooler seasons. Adults >50 = greatest risk. No ethnic or gender predispositions. Immunocompromised people at greater risk (esp of invasive disease). Excess moisture from any cause increases risk. Seborrheic dermatitis, hearing aids, ear plugs, cotton swabs all increase risk with extended use.
OM: Incidence increases in winter. Most common in very young or elderly. Native American (esp Navajo) and Native Alaskans = higher prevalence. Men and women = risk. More rare in adults. Risk factors: allergies, sinusitis, rhinitis, pharyngitis, recent/recurrent URI, perforation of eardrum, active/passive smoking.
Pathogens:
OE: Pseudomonas aeruginosa (most common cause of diffuse infection). Staph aureus. Group A strep pyogenes. Bacteroids. Peptostreptococcus. Aspergillus niger. Pityrosporum. Candida albicans.
OM: Strep pneumoniae (most frequent cause in adults). H influenzae. Moraxella catarrhalis. Strep aureus and strep pyogenes far less common causes.
Clinical presentation:
OE Subjective: acute, severe otalgia that may worsen at night. Worsens with pulling pinna or applying pressure to tragus. Chewing may exacerbate pain in severe cases. Initially ear may feel full/obstructed with temporary conductive hearing loss. May be pruritic. Systemic symptoms may be present with infectious etiology. Chronic illness may include dryness and pruritis of ear canal. OE Objective: tenderness on traction of pinna, pain w/pressure of tragus. Purulent drainage may be present w/bacterial infection. Canal may be reddened and edematous. Usually lacks cerumen. Auditory canal appears edematous/erythematous. Diffuse cases may have localized pustules or furuncles in canal or external processes. Green exudate w/Pseudomonas. Yellow crusting in midst of purulent drainage w/Staph. Fungal infections have fluffy white/black malodorus carpet of growth. Allergic reactions are scaly, cracked, and/or weepy tissue. Usually no lymphadenopathy. TMJ tenderness may be present in invasive disease.
OME Subjective: Stuffiness, fullness, loss of acuity unilaterally. Pain is rare. Popping, crackling, gurgling. Rarely causes vertigo. AOM Subjective: Deep ear pain. Fever. unilateral hearing loss. Recent URI. Dizziness. Vertigo. Tinnitus. Chronic repeated bouts of AOM.
OME Objective: external ear usually unremarkable. Mucus membranes may be infected or edematous. TM may be dull but not bulging. AOM Objective: TM may be amber or yellow-orange. TM may be infected and pinkish gray to fiery red. TM typically full and bulging w/absent or obscured bony landmarks and cone light reflex. Discharge present if TM perf'd. Otorrhea may be purulent or mucoid. Chronic OM has perf'd, draining TM and possibly invasive granulation tissue. Lymphadenopathy or preauricular and post cervical nodes is common. If OM along with acute mastoiditis, tenderness over mastoid will be present.
Management:
OE: Localized application of heat or ice for pain. NonRx pain reliever for mild to mod pain. Tyl #3 for severe pain. Keep ear dry. Gentle cleaning of ear canal. Eval otic discharge and edema of auditory canal and TM. Select local med appropriate for etiology. May need I&D of pustules or furuncles. Diffuse infection may be treated empirically. Topical otic preps. Abx: 1st gen cephs or pcns, 2nd gen cephs, fluroquinolones, ceftazidime.
OM: Uncomplicated is often self-limiting. Treatment recommended for chronic or recurrent OM. Supportive treatment indicated for acceptance of pt's auditory hearing loss r/t chronic dz. If symptoms persist >12wks, 10-day abx course is warranted. Abx: amox, augmentin, 2nd/3rd gen cephs. Steroids not recommended for kids.
Compare and contrast the two coding classification systems that are currently used in the US healthcare system. - CORRECT ANSWER ICD: International classification of disease codes are used to provide payer info on necessity of visit or procedure performed. Shorthand for pt's dx. CPT: common procedural terminology codes offer the official procedural coding rules and guidelines required when reporting medical services and procedures performed by physician and non-physician providers. Must have corresponding ICD.
Correctly ID a pt as a new or established given historical info. - CORRECT ANSWER Pt status: whether or not pt is new or established.
New: has not received professional service from provider in same group within past 3 years.
Established: has received professional service from provider in same group in last 3 years.
