CMN 568 UNIT 1 STUDY QUESTIONS AND ANSWERS

CMN 568 UNIT 1 STUDY QUESTIONS
AND ANSWERS
thextestxusedxtoxcheckxforxcornealxlightxreflexxinxeachxeye,xandxitsxsymmetryxisxcalledx-xans--
hirshbergxtest

Whatxisxthexdifferencexinxrecurrentxsinusitisxandxchronicxsinusitisx-xans--
recurrentxisxdefinedxasxsuccessivexepisodesxofxbacterialxinfectionsxofxthexsinusesxeachxlast
ingxlessxthanx30xdaysxandxseparatedxbyxintervalsxofxatxleastx10xdays.x
chronicxisxdefinedxasxepisodesxofxinflammationxofxthexparanasalxsinusesxlastingxmorexthanx
90xdays.

firstxlinexofxtreatmentxofxAOMxinxchildren?x-xans--amoxicillinx80-
90mg/kg/dayxdividedxbyx2xdoses

Ax3xy/oxpresentsxwithxAOMxandxmotherxreportsxseverexallergyxtoxPCN.xWhatxisxanxalternati
ve?x-xans--Axmacrolide,xBactrim,xorxclindamycin

5xy/oxpresentsxw/AOMxandxmotherxreportsxaxmildxrashxw/PCNxmedication.xWhatxisxanxalter
nativexforxtreatment?x-xans--2ndxorx3rdxgenerationxcephalosporins

whatxdiseasexprocessxmayxbexobservedxbyxunequalxpupilsx(anisocoria),xeyelidxptosis,xirisxh
eterochromia,xandxanhidrosis?x-xans--hornersxsyndrome

whatxtraitxcanxquicklyxleadxtoxopticxatrophyxandxpermanentxvisionxlossxwithxevenxmoderatex
elevationsxofxintraocularxpressurexANDxshouldxbextestedxforxallxAfricanxAmericansxwhosexs
tatusxisxunknownxwhenxhyphemaxisxobserved?x-xans--sicklexcell

whatxwouldxbexyourxtreatmentxplanxforxanxanaphylacticxreactionxduextoxaxbeexstingxonxanxu
pperxlimb?x-xans---
Forxanaphylaxisxyou'llxgivexEPIx1:1000x).01xmg/kgx(maxxdosex0.3xinxPedsxandx0.5xinxadults)
xIM

-Benadrylx1-2mg/kgxpedsxw/maxxdosex50xmgxIV
-ranitidinexmaxxdosex1xmg/kdxpedsxw/maxxdosex50mg/kdxIV
-crystalloidxbolusx(20mg/kgxoverx1xhour)
-solumedeolx1mg/kgxforxPedsxIV
-sometimesxalsoxanxalbuterolxneb

whatxarexthexmostxcommonxantibioticsxtoxcausexanaphylaxisx-xans--amoxicillin
ampicillin
TMP-SMZx(trimethoprim-sulfonamide)

,whatxisxthex1stxlinexofxtreatmentxforxallergicxrhinitisx-xans---non-
sedatingxantihistamines:xLORATADINE,xCETRIZINE
-intranasalxcorticosteroids
-mastxcellxstabilizers:xCROMOLYN
-Montelukast:xSINGULAR

whatxisxthex1stxlinextreatmentxforxBacterialxRhinosinusitisxinxadults?x-xans--
OTCxNSAIDSxorxacetaminophen
nasalxcorticosteroids
decongestants
-
diagnosisxisxmadexwhenxsymptomsxlastxlongerxthanx10xdaysxw/oximprovementxORxworseni
ngxofxsymptomsxw/inx20xdaysxafterxinitialximprovementxofxsymptoms.
-
forxptsxw/focalxsignsxsuchxasxperiorbitalxedema,xseverexsinusxtenderness,xorxseverexheada
che--doxnotxwaitx10xdaysxforxantibiotics
------1stxlinextherapy:xamoxicillin,xbactrim,xdoxycycline,xamoxicillian-clavulanate
------1stxlinextherapyxafterxrecentxabxxuse:xlevofloxacin,xamoxicillain-clavulanate

whatxantibioticxdoxyouxavoidxifxyouxthinkxthexpatientxmayxhavexmono?x-xans--
amoxicillinxb/cxdrugxoftenxprecipitatesxaxrash

everyxptxwhoxcomplainsxofxhearingxlossxshouldxbexreferredxforxaudiologicxevaluationxexcep
txinxwhatxscenario?x-xans--whenxthexcausexisxeasilyxremediable.
example:xcerumenximpactionxorxotitisxmedia.xhavexchildxreturnxatx4xwkxintervalsxtoxcheckxpr
ogressxofxeffusion.xreferxforxaudiologyxafterx3xmoxofxcontinuousxeffusionxinxchildrenx<3yrxorx
atxriskxofxlanguagexdelay

whatxisxthex1stxlinextreatmentxforxacutexbacterialxpharyngitisxinxadults?xinxpeds?x-xans--
Adultsx&xchildrenx>x27kg:xPenicillinxVKx250xmgxorallyxTIDxorx500xmgxBIDxforx10xdays.xPenic
illinxGxIMxifxcompliancexorxamoxicillin
--erythromycin/azithromycinxorxcephalosporinsxarexusedxifxPCNxallergy.
PEDS:xpenicillinxVKx50-
70xmg/kg/dxinx3xdividedxdoses,xbenzathinexpenicillinx600,000xunitsxIMxinx<27kg,x1.2xmillionx
unitsxifx>27kg,xsinglexdose.xForxPCNxallergyxusexazithromycin

Axnursexpractitionerxisxexaminingxthexeyesxofxax5-year-
old.xOnxshiningxaxlightxontoxthexcorneaxsoxthatxitxisxseenxonxbothxeyes,xthexNPxnotesxthatxisxit
xatxthex10xo'clockxinxthexrightxeyexandx2xO'clockxinxthexleftxeye.xInterpretationxofxthisxfindingxi

s:x
A.xnystagmusx
B.xMyopiax
C.xNormalx
D.xStrabismusx-xans--strabismus

Thexfollowingxstatementxofxstrabismusxisxtruexexcept:x

, A.xEsotropiaxmayxbexintermittentxupxtoxagex6xmonthsx
B.xExotropiaxisxnormalxafterxagex2xmonthsx
C.xStrabismusxmayxbexlatentx(occursxonlyxunderxbinocularxvision)x
D.xStrabismusxrequiresxophthalmologicalxreferralxifxpresentxafterxagex1xyearx-xans----
exotropiaxisxnormalxafterx2xmoxofxage
--
strabismusxrequiresxanxophthalmologicalxreferralxifxpresentxafterxthexagexofx1xyrx(earlierxtxxi
sxbetter)

Ax45xyoxmailxcomesxthexclinicxwithxc/oxrightxeyexpain.xItxhasxbeenxoccuringxconstantlyxoverxt
hexlastxtwoxdaysxandxisxassociatedxwithxredness.xTherexhasxbeenxnoxincreasexlacrimation,x
purulentxdischarge,xorxHA.xInxadditionxtoxthexfundusocpicxexam,xitxisxcrucialxthatxthexNPxacc
ess:x
A.xvisualxfieldsx
B.xCranialxnervex7,x
C.xVisualxacuity,x
D.xThexcornealxreflexx-xans--visualxacuity

Ax75xyoxptxc/oxintensexeyexpainxandxgeneralizedxHA,xafterxwatchingxaxmoviexinxthextheater.x
ThexNPxrecordsxthexfollowingxfindingsxODxwithxredxscleraxandxdilatedxpupil,xODx>xOS,xdecr
easedxVAxOD,xOSxWNL,xnoxtemporalxtenderness.xThesexfindingsxarexmostxappropriatelyxs
uggest:xA.xAcutexglaucoma,x
B.xOpenxanglexglaucoma,x
C.xTemporalxarteritis,x
D.xretinalxdetachmentx-xans--acutexglaucoma

AxNPxsuspectsxthatxaxscratchyxfeelingxinxaxpt'sxeyexisxaxcornealxabrasion.xTherexisxphotoph
obiaxandxerythema,xbutxnoxdrainagexorxchangexinxvisualxacuity.xPERRLAxisxnoted.xAnxappr
opriatexNPxinterventionxatxthisxtimexwouldxinclude:x
A.ximmediatexreferralx
B.xinstillationxofxanestheticxocularxdrops,x
C.xopthalmicxantibioticxgttsxandxpatchingxthexeyex
D.xinstillationxofxmydriaticxgttsx-xans--instillationxofxanestheticxocularxdrops

AxptxisxsuspectedxtoxhavexbacterialxconjunctivitisxOU.xThexNPxperformsxflouresceinxtestxan
dxnotesxaxdendriticxappearancexonxthexcornea.xThisxisxprobably:x
A.xglaucoma,x
Bxherpes,x
Cxaxneisseriaxgonorrheaxinfectionx
D.xhyphemax-xans--herpes

OnxexamxofxaxptxwithxepistaxisxthexNPxnotexthatxtherexisxoozingxofxbloodxfromxthexKisselbac
h'sxplexus.xThisxis:x
A.xoftenxmanagedxbyxpinchingxthexnasalxalaxtogetherxforx10xminutesxwhilexthexptxleansxbac
kward