NURS /
621
/ /
Midterm
/ /
Exam Questions With Correct Answers
/ // // // //
Dx: //Acute //otitis //media //- //verified //answer(s)-✔✔H&P:
• //Ear //pain //(typical)
• //Decreased //hearing //(typical)
• //Fever //(sometimes)
• //Recent //URI //or //exacerbation //of //seasonal //allergic //rhinitis //(can //be)
• //Unilateral //(usual)
•/
/Bulging /
/tympanic /
/membrane /
/(needed /
/to /
/distinguish /
/from /
/otitis /
/media /
/with /
/effusion). /
/Can /
/also //be //erythematous //or //opacified. //Tympanic //membrane //can //rupture //(feels //relief //of //ear
//pain, //may //then //have //purulent //otorrhea)
• //Dysequilibrium //(not //common)
• //Conductive //hearing //loss //(usually //transient)
• //High //fever, //severe //pain //behind //ear, //facial //paralysis //(unusual //complications)
,DDx //Otitis //Media //- //verified //answer(s)-✔✔• //Otitis //externa
o //More //painful, //normal-appearing //ear //drum
• //Eustachian //tube //dysfunction
o/
/Check /
/if /
/recurrent /
/unilateral /
/AOM /
/(>2 /
/over //
6/
/months). /
/Do /
/fiberoptic /
/nasopharyngoscopy //and/or //contrast //MRI //of //skull //base //to //rule //out //malignant //process
• //Herpes //zoster //infection
o/
/Development /
/of /
/dermatomal /
/vesicular /
/rash /
/that /
/evolves /
/into /
/crusted /
/lesions. /
/Pain /
/may /
/precede /
/rash. /
/Ramsay /
/Hunt /
,/syndrome /
/presents /
/with /
/triad /
/of /
/ipsilateral /
/facial /
/paralysis, //ear //pain, //and //vesicles //involving //auditory //canal //and //auricle. //Can //cause //vertigo
Lab/diagnostics //Otitis //Media //- //verified //answer(s)-
✔✔• //Common //organism: //strep //pneumoniae, //H. //influenza. //Group //A //beta-
hemolytic //strep, //staph //aureus, //M. //catarrhalis //less //frequently
• //Otoscopic //exam //(standard) //
o //Redness, //opacification, //bulging //TM
o //Otitis //media //with //effusion: //TM //cloudy, //yellowish //or //opaque //when //fluid //in //middle //ear
• //Pneumatoscopy //(allows //eval //of //tympanic //membrane //motion)
• //Weber //(demonstrates //conductive //hearing //loss)
o //Perceived //louder //in //infected //ear //(common)
o //If //sensorineural //loss, //sound //may //lateralize //in //noninfected //ear //(rare)
Txt //Plan //Otitis //Media //- //verified //answer(s)-
✔✔• /
/Amoxicillin: /
/500 //mg //Q12 //hours //or //250 //mg //Q //8 //hours //10 //days...if //severe: //875 //mg //Q12 //hours //or //500
//mg //TID //5-7 //days
• //Augmentin //(if //amoxicillin //fails. //Tx //for //another //10 //days)
• //PCN //allergy:
o //Cefdinir //(3rd //gen //cephalosporin): //300 //mg //BID //or //600 //mg //once //daily
o //Cefpodoxime //200 //mg //BIC
o //Cefuroxime //(2nd //gen): //500 //mg //Q12 //hours
, o //Ceftriaxone //(3rd //gen): //2 //g //IM //or //IV //once
• //Severe //allergy //to //beta-lactam:
o //Macrolide: //erythromycin, //azithromycin, //clarithromycin
F/U //Otitis //Media //- //verified //answer(s)-
✔✔• /
/Should //start //to //improve //within //48 //to //72 //hours //- //if //no //improvement //should //be //re-
examined
Edu //Otitis //Media //- //verified //answer(s)-
✔✔• /
/If //TM //ruptures, //it //will //heal //in //most //cases. //Tx //with //oral //and //topical //abx //(ofloxacin)
• //Most //effusions //will //resolve //over //12 //weeks //- //use //oral //decongestants
Viral //Conjunctivitis //- //verified //answer(s)-✔✔o //Viral:
/
/Injection, /
/watery /
/discharge /
/during /
/the /
/day, /
/scant, /
/stringy /
/that /
/is /
/mucus /
/rather /
/than /
/pus. /
/Burning, /
/sandy, /
/or /
/gritty /
621
/ /
Midterm
/ /
Exam Questions With Correct Answers
/ // // // //
Dx: //Acute //otitis //media //- //verified //answer(s)-✔✔H&P:
• //Ear //pain //(typical)
• //Decreased //hearing //(typical)
• //Fever //(sometimes)
• //Recent //URI //or //exacerbation //of //seasonal //allergic //rhinitis //(can //be)
• //Unilateral //(usual)
•/
/Bulging /
/tympanic /
/membrane /
/(needed /
/to /
/distinguish /
/from /
/otitis /
/media /
/with /
/effusion). /
/Can /
/also //be //erythematous //or //opacified. //Tympanic //membrane //can //rupture //(feels //relief //of //ear
//pain, //may //then //have //purulent //otorrhea)
• //Dysequilibrium //(not //common)
• //Conductive //hearing //loss //(usually //transient)
• //High //fever, //severe //pain //behind //ear, //facial //paralysis //(unusual //complications)
,DDx //Otitis //Media //- //verified //answer(s)-✔✔• //Otitis //externa
o //More //painful, //normal-appearing //ear //drum
• //Eustachian //tube //dysfunction
o/
/Check /
/if /
/recurrent /
/unilateral /
/AOM /
/(>2 /
/over //
6/
/months). /
/Do /
/fiberoptic /
/nasopharyngoscopy //and/or //contrast //MRI //of //skull //base //to //rule //out //malignant //process
• //Herpes //zoster //infection
o/
/Development /
/of /
/dermatomal /
/vesicular /
/rash /
/that /
/evolves /
/into /
/crusted /
/lesions. /
/Pain /
/may /
/precede /
/rash. /
/Ramsay /
/Hunt /
,/syndrome /
/presents /
/with /
/triad /
/of /
/ipsilateral /
/facial /
/paralysis, //ear //pain, //and //vesicles //involving //auditory //canal //and //auricle. //Can //cause //vertigo
Lab/diagnostics //Otitis //Media //- //verified //answer(s)-
✔✔• //Common //organism: //strep //pneumoniae, //H. //influenza. //Group //A //beta-
hemolytic //strep, //staph //aureus, //M. //catarrhalis //less //frequently
• //Otoscopic //exam //(standard) //
o //Redness, //opacification, //bulging //TM
o //Otitis //media //with //effusion: //TM //cloudy, //yellowish //or //opaque //when //fluid //in //middle //ear
• //Pneumatoscopy //(allows //eval //of //tympanic //membrane //motion)
• //Weber //(demonstrates //conductive //hearing //loss)
o //Perceived //louder //in //infected //ear //(common)
o //If //sensorineural //loss, //sound //may //lateralize //in //noninfected //ear //(rare)
Txt //Plan //Otitis //Media //- //verified //answer(s)-
✔✔• /
/Amoxicillin: /
/500 //mg //Q12 //hours //or //250 //mg //Q //8 //hours //10 //days...if //severe: //875 //mg //Q12 //hours //or //500
//mg //TID //5-7 //days
• //Augmentin //(if //amoxicillin //fails. //Tx //for //another //10 //days)
• //PCN //allergy:
o //Cefdinir //(3rd //gen //cephalosporin): //300 //mg //BID //or //600 //mg //once //daily
o //Cefpodoxime //200 //mg //BIC
o //Cefuroxime //(2nd //gen): //500 //mg //Q12 //hours
, o //Ceftriaxone //(3rd //gen): //2 //g //IM //or //IV //once
• //Severe //allergy //to //beta-lactam:
o //Macrolide: //erythromycin, //azithromycin, //clarithromycin
F/U //Otitis //Media //- //verified //answer(s)-
✔✔• /
/Should //start //to //improve //within //48 //to //72 //hours //- //if //no //improvement //should //be //re-
examined
Edu //Otitis //Media //- //verified //answer(s)-
✔✔• /
/If //TM //ruptures, //it //will //heal //in //most //cases. //Tx //with //oral //and //topical //abx //(ofloxacin)
• //Most //effusions //will //resolve //over //12 //weeks //- //use //oral //decongestants
Viral //Conjunctivitis //- //verified //answer(s)-✔✔o //Viral:
/
/Injection, /
/watery /
/discharge /
/during /
/the /
/day, /
/scant, /
/stringy /
/that /
/is /
/mucus /
/rather /
/than /
/pus. /
/Burning, /
/sandy, /
/or /
/gritty /
