NURS 640 LATEST EVALUATION EXAM
QUESTIONS AND ANSWERS SURE A+
✔✔Nasal vestibulitis & S. aureus nasal colonization - ✔✔Vestibulitis:inflammation of the
nasal vestibule, may be from folliculitis of the hairs usually from nasal manipulation or
hair trimming
S. aureus: leading nosocomial pathogen in the world, nasal canal is well defined risk
factor for development and spread (MRSA)
Dx: most have no symptoms, screen with nasal swab, SA nasal colonization 30%,
MRSA as high as 11% in ICU pts.
Treatment: Vestibularitis- systemic Abx against S aureus (dicloxacillin 250 mg orally
QID for 7-10 days). Topical Bacitracin or Mupirocin 2-3 x daily, rifampin 10 mg/kg BID
for 4 days. A furuncle can be incised and drained.
Adequate TX is important to prevent spread
✔✔Allergic rhinitis - ✔✔Clear rhinorrhea, sneezing, tearing, eye irritation, pruritis, xs
tearing, erythema
Assoc. Sx- cough, bronchospasm, eczematous dermatitis
Phys exam:
reveal inflamed, edematous and even pale boggy nasal mucosa,
turbinates pale or violaceous from venous engorgement this in contrast to the erythema
of viral rhinitis
Environmental allergen with allergen specific IgE
Season: common pollens and spores
, Year round (Perennial rhinitis) Dust, household mites, air pollution, and pet dander
DDx:
Viral rhinitis (common cold)
Viral conjunctivitis
Vasomotor rhinitis (cold air or irritant-induced)
Acute or chronic sinusitis
Rhinitis medicamentosa (drug induced)
Nasal polyps
Foreign body
Granulomatosis
Dx: LAB tests-clinical diagnosis, confirmation IgG mediated hypersensitivity, allergy skin
tests
Treatment
Intranasal corticosteroid sprays
Antihistamines
Anticholinergic agents
Sympathomimetics
Cromolyn sodium and sodium nedocromil
Nasal saline irrigation
Antileukotriene meds (montelukast alone or with cetirizine or loratadine
Immunotherapy
Outcome: prevention- avoid or reduce exposure,air purifiers, remove dust, cover
mattresses and pillow with plastic covers
✔✔Peritonsillar abscess - ✔✔Key feature
Infection penetrates the tonsillar capsule and involves surrounding tissues
Clinical Findings
Peritonsillar abscess (quinsy) and cellulitis with
Severe sore throat
Odynophagia (pain when swallowing)
Trismus (lock jaw)
Medial deviation of soft palate and peritonsillar fold
Abn muffled voice
Dx
Aspiration of pus
Treatment
Amoxicillin 500 mg 3 x day
Amoxicllin-sulbactam 875 mg bid
Clindamycin 300 mg 4x day
Incise and drain
✔✔Epiglottitis - ✔✔Should be suspected when a patient presents with a rapidly
developing sore throat or when odynophagia is out of proportion to apparently minimal
oropharyngeal findings on examination.
More common in diabetics and may be viral or bacterial.
QUESTIONS AND ANSWERS SURE A+
✔✔Nasal vestibulitis & S. aureus nasal colonization - ✔✔Vestibulitis:inflammation of the
nasal vestibule, may be from folliculitis of the hairs usually from nasal manipulation or
hair trimming
S. aureus: leading nosocomial pathogen in the world, nasal canal is well defined risk
factor for development and spread (MRSA)
Dx: most have no symptoms, screen with nasal swab, SA nasal colonization 30%,
MRSA as high as 11% in ICU pts.
Treatment: Vestibularitis- systemic Abx against S aureus (dicloxacillin 250 mg orally
QID for 7-10 days). Topical Bacitracin or Mupirocin 2-3 x daily, rifampin 10 mg/kg BID
for 4 days. A furuncle can be incised and drained.
Adequate TX is important to prevent spread
✔✔Allergic rhinitis - ✔✔Clear rhinorrhea, sneezing, tearing, eye irritation, pruritis, xs
tearing, erythema
Assoc. Sx- cough, bronchospasm, eczematous dermatitis
Phys exam:
reveal inflamed, edematous and even pale boggy nasal mucosa,
turbinates pale or violaceous from venous engorgement this in contrast to the erythema
of viral rhinitis
Environmental allergen with allergen specific IgE
Season: common pollens and spores
, Year round (Perennial rhinitis) Dust, household mites, air pollution, and pet dander
DDx:
Viral rhinitis (common cold)
Viral conjunctivitis
Vasomotor rhinitis (cold air or irritant-induced)
Acute or chronic sinusitis
Rhinitis medicamentosa (drug induced)
Nasal polyps
Foreign body
Granulomatosis
Dx: LAB tests-clinical diagnosis, confirmation IgG mediated hypersensitivity, allergy skin
tests
Treatment
Intranasal corticosteroid sprays
Antihistamines
Anticholinergic agents
Sympathomimetics
Cromolyn sodium and sodium nedocromil
Nasal saline irrigation
Antileukotriene meds (montelukast alone or with cetirizine or loratadine
Immunotherapy
Outcome: prevention- avoid or reduce exposure,air purifiers, remove dust, cover
mattresses and pillow with plastic covers
✔✔Peritonsillar abscess - ✔✔Key feature
Infection penetrates the tonsillar capsule and involves surrounding tissues
Clinical Findings
Peritonsillar abscess (quinsy) and cellulitis with
Severe sore throat
Odynophagia (pain when swallowing)
Trismus (lock jaw)
Medial deviation of soft palate and peritonsillar fold
Abn muffled voice
Dx
Aspiration of pus
Treatment
Amoxicillin 500 mg 3 x day
Amoxicllin-sulbactam 875 mg bid
Clindamycin 300 mg 4x day
Incise and drain
✔✔Epiglottitis - ✔✔Should be suspected when a patient presents with a rapidly
developing sore throat or when odynophagia is out of proportion to apparently minimal
oropharyngeal findings on examination.
More common in diabetics and may be viral or bacterial.
