NURS 640 CORRECT STUDY QUESTIONS AND
ANSWERS SURE A+
✔✔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
✔✔Epistaxis - ✔✔**
Risk factors: trauma, anticoag, dry membranes
TX: direct pressure usually effective, vasocontrictors, packing, cautery.
if uncontrolled: URGENT packing/procedure, assess CBC/PT/PTT, hold anticoags
✔✔mouth and throat subjective - ✔✔acute/chronic
sx noted by pt
,associated events/recent illness
HEENT disorders, cancer, immunocomprimised
Smoking/tobacco
✔✔mouth and throat PE - ✔✔oropharynx: membranes, detition, lesions, inflammation,
infection
larynx: voice quality, cough
neck: massess, lesions
✔✔testing mouth and throat - ✔✔rapid GABHS
throat bacterial culture
lateral neck xray
can also get CT
✔✔additional intervention needed with mouth and throat - ✔✔airway compromise
clinical deterioration
complications of untreated inf: cardiac, renal
✔✔candidiasis - ✔✔risk factor: immunocompromised, acute immunosuppression, DM,
poor oral hygiene, dentures, anemia
DDx: cancer, HIV
-white lesions common
TX: antifungal- swish and swallow, troches, oral/systemic
W HIV: treat longer and possibly more agents
Always treat dentures as well
✔✔Group A Beta Hemolytic Strep - ✔✔Throat swab and culture needed
if not treated, risk of: rheumatic fever, glomerulonephritis
-centor criteria aid in dx
-marked lymphadenopathy sus for other causes
-rhinorrhea w/o exudate sus for viral cause
*TX: abx after confirmation (PCN or cefurozime), supportive care (salt water gargle,
hydration)
*tx hx of rheumatic fever
✔✔centor criteria - ✔✔**
1 point for each
-fever
-absence of cough
-anterior cervical, tender lymph
-tonsillar exudate/swelling
- sub point for age >44
, 0-1: unlikely strep
2-3: rapid antigen swab/culture
4: likely GABHS, treat
✔✔Peri tonsillar abscess - ✔✔**
cellulitis of surrounding tissue
-sever sore throat, "HOT POTATO" voice, soft palate deviation
TX: IV or PO abx (able to swallow?)
augmentin or clinda
✔✔deep neck infections - ✔✔ludwig angina: cellulitis, mouth floor infection
abscess- dental most common. dont r/o malig. edema/erythema of neck/chin/mouth.
TX: PCN + flagyl (IV for abscess)
✔✔eopiglottitis - ✔✔rapid worsening sore throat
"Thumb sign" on Xray
TX: IV abx, IV steroids, monitor for airway comp
✔✔Squamous cell carcinoma - larynx - ✔✔male, age 50-70
tobacco use
HBV in nonsmokers
sx: change in voice, throat pain, airway compromise, weight loss
TX: depends of extent and cell type
✔✔vocal cord paralysis - ✔✔d/t: nerve damage, lesion, surgical adverse effect, tumor
evaluate for cranial nerve deficits
protect airway!
✔✔FB - throat - ✔✔Trachea/bronchi
- risk factor: dentures, advanced age
EMERGENCY!! will need surgical removal
esophagus
-not emergency of airway uneffected.
endoscopy for removal
✔✔neck mass - ✔✔consider malignancy
>40 increased cancer risk
<30 or >70 consider lymphoma
✔✔Pulm- acute development - ✔✔PE
ANSWERS SURE A+
✔✔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
✔✔Epistaxis - ✔✔**
Risk factors: trauma, anticoag, dry membranes
TX: direct pressure usually effective, vasocontrictors, packing, cautery.
if uncontrolled: URGENT packing/procedure, assess CBC/PT/PTT, hold anticoags
✔✔mouth and throat subjective - ✔✔acute/chronic
sx noted by pt
,associated events/recent illness
HEENT disorders, cancer, immunocomprimised
Smoking/tobacco
✔✔mouth and throat PE - ✔✔oropharynx: membranes, detition, lesions, inflammation,
infection
larynx: voice quality, cough
neck: massess, lesions
✔✔testing mouth and throat - ✔✔rapid GABHS
throat bacterial culture
lateral neck xray
can also get CT
✔✔additional intervention needed with mouth and throat - ✔✔airway compromise
clinical deterioration
complications of untreated inf: cardiac, renal
✔✔candidiasis - ✔✔risk factor: immunocompromised, acute immunosuppression, DM,
poor oral hygiene, dentures, anemia
DDx: cancer, HIV
-white lesions common
TX: antifungal- swish and swallow, troches, oral/systemic
W HIV: treat longer and possibly more agents
Always treat dentures as well
✔✔Group A Beta Hemolytic Strep - ✔✔Throat swab and culture needed
if not treated, risk of: rheumatic fever, glomerulonephritis
-centor criteria aid in dx
-marked lymphadenopathy sus for other causes
-rhinorrhea w/o exudate sus for viral cause
*TX: abx after confirmation (PCN or cefurozime), supportive care (salt water gargle,
hydration)
*tx hx of rheumatic fever
✔✔centor criteria - ✔✔**
1 point for each
-fever
-absence of cough
-anterior cervical, tender lymph
-tonsillar exudate/swelling
- sub point for age >44
, 0-1: unlikely strep
2-3: rapid antigen swab/culture
4: likely GABHS, treat
✔✔Peri tonsillar abscess - ✔✔**
cellulitis of surrounding tissue
-sever sore throat, "HOT POTATO" voice, soft palate deviation
TX: IV or PO abx (able to swallow?)
augmentin or clinda
✔✔deep neck infections - ✔✔ludwig angina: cellulitis, mouth floor infection
abscess- dental most common. dont r/o malig. edema/erythema of neck/chin/mouth.
TX: PCN + flagyl (IV for abscess)
✔✔eopiglottitis - ✔✔rapid worsening sore throat
"Thumb sign" on Xray
TX: IV abx, IV steroids, monitor for airway comp
✔✔Squamous cell carcinoma - larynx - ✔✔male, age 50-70
tobacco use
HBV in nonsmokers
sx: change in voice, throat pain, airway compromise, weight loss
TX: depends of extent and cell type
✔✔vocal cord paralysis - ✔✔d/t: nerve damage, lesion, surgical adverse effect, tumor
evaluate for cranial nerve deficits
protect airway!
✔✔FB - throat - ✔✔Trachea/bronchi
- risk factor: dentures, advanced age
EMERGENCY!! will need surgical removal
esophagus
-not emergency of airway uneffected.
endoscopy for removal
✔✔neck mass - ✔✔consider malignancy
>40 increased cancer risk
<30 or >70 consider lymphoma
✔✔Pulm- acute development - ✔✔PE
