Adult Nurse Practitioner Test Review-HEENT.

Adult Nurse Practitioner Test Review-HEENT. Chalazion - ANSWER Chronic inflammation of the meibonian gland (specialized sweat gland) of the eyelids. If enlarges or does not go away, biopsy to R/O squamous cell cancer. May need surgery. Hordeolum (stye) - ANSWER Painful acute bacterial infection of a hair follicle on the eyelid. Tx: antibiotic drops (Gentamain, Sulfa) Pterygium - ANSWER A yellow triangular (wedge -shaped) thickening of the conjunctiva that extends to the cornea on the nasal or temporal cornea. Due to UV-damaged collagen from chronic sun exposure. Usually asymptomatic. Can be red/inflamed at times. Tx: If inflamed, use week steroid eye drops only during exacerbations. Removed surgical if encroaches cornea & affects vision. Primary OPEN-Angle Glaucoma - ANSWER Gradual onset of increased intraocular pressure (IOP) due to blockage of the drainage of aqueous humor inside the eye. The retina (CN 2) undergoes ischemic changes &, if untreated, becomes permanately damaged. Most common type of glaucoma. Elderly, Africans, Diabetics. Complains of gradual changes in peripheral vision (lost first) & then central vision. Tx: Betimol (timolol) beta-blocker eye drops that lower IOP. Side effects: broncho-spasm, fatigue, depression, heart failure, bradycardia. Contraind: asthma, emphysema, COPD, Heard block, heart failure. Primary Angle CLOSURE Glaucoma - ANSWER Sudden blockage of aqueous humor causes marked increased of the IOP causing ischemia & permanent damage to the optic nerve (CN 2). Older patient C/O acute onset of severe frontal headache or severe eye pain with blurred vision & tearing. Seeing halos around lights. Maybe accompanied by severe N/V. Eyes: fixed & mid-dilated cloudy pupil that looks more oval than round-shaped. Conjunctival injection with increased lacrimation. Immediate referral to ophthalmology- Macular Degeneration - ANSWER Gradual changes in the pigment of the macula (area of central vision) result in blindness. Cause is unknown. Leading cause of blindness in the elderly in this country. More common in elderly & smokers. 2 types: atrophic (dry form) & exudative (wet form). Check central vision with Amsler Grid test (center of grid is distorted, blind spot or scotoma, or wavy lines). Increase intake of antioxidants (Vit. C & E, beta carotene, zinc) & the herbs lutein 7 bilberry. Refer to opthalmologist. Allergic Rhinitis - ANSWER Inflammatory changes of the nasal mucosa due to allergy to certain allergens. Atopic family history. May have season or daily symptoms. C/O nasal congestion with clear mucus discharge. Sometimes accompanied by nasal itch & frequent sneezing. Coughing from post nasal drip. Nose: blue tinge or pale boggy nasal