NURS 621 Midterm Exam questions with correct
answers
Dx: Acute otitis media Correct Answer-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 Correct Answer-• 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 Correct Answer-• 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 Correct Answer-• 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 Correct Answer-• Should start to improve within 48 to
72 hours - if no improvement should be re-examined
Edu Otitis Media Correct Answer-• 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 Correct Answer-o Viral:
Injection, watery discharge during the day, scant, stringy that is mucus
rather than pus. Burning, sandy, or gritty feelin gin one eye. Morning
crusting with scant mucus throughout the day. Second eye usually
becomes involved within 24-48 hours
Usually gets worse for the 1st 3-5 days, with gradual resolution over the
following 1 or 2 weeks for total course of 2-3 weeks.
Chlamydial Conjunctivitis Correct Answer-o Chlamydial
Unilateral, sometimes bilateral, follicular conjunctivitis. Weeks to
months, does not respond to topical abx therapy. Can be associated
keratitis
Dx confirmed with Giemsa or direct fluorescent antibody staining or
conjuctival smears, culture, or PCR of swabbed specimens
answers
Dx: Acute otitis media Correct Answer-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 Correct Answer-• 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 Correct Answer-• 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 Correct Answer-• 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 Correct Answer-• Should start to improve within 48 to
72 hours - if no improvement should be re-examined
Edu Otitis Media Correct Answer-• 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 Correct Answer-o Viral:
Injection, watery discharge during the day, scant, stringy that is mucus
rather than pus. Burning, sandy, or gritty feelin gin one eye. Morning
crusting with scant mucus throughout the day. Second eye usually
becomes involved within 24-48 hours
Usually gets worse for the 1st 3-5 days, with gradual resolution over the
following 1 or 2 weeks for total course of 2-3 weeks.
Chlamydial Conjunctivitis Correct Answer-o Chlamydial
Unilateral, sometimes bilateral, follicular conjunctivitis. Weeks to
months, does not respond to topical abx therapy. Can be associated
keratitis
Dx confirmed with Giemsa or direct fluorescent antibody staining or
conjuctival smears, culture, or PCR of swabbed specimens
