FNP Board Review: HEENT Exam 179
Questions And Answers Verified 100%
Correct!!!
What med is inappropriate for treatment of a patient who has acute rhinosinusitis?
CORRECT ANSWERS Amoxicillin
What are indications for urgent referral in Acute Bacterial Rhinosinusitis (ABRS)?
CORRECT ANSWERS High persistent fever > 102 F
Periorbital edema
Vision change
Severe headaches
How is allergic rhinitis managed? CORRECT ANSWERS Intranasal glucocorticoids:
single most effective treatment
- Ex: budesonide, fluticasone, mometasone, ciclesonide
Antihistamines (nonsedating and sedating available)
What is the most common bacterial cause of pharyngitis? CORRECT ANSWERS
Streptococcus Group A
What is the most common cause of pharyngitis? CORRECT ANSWERS Viral
What are signs and symptoms of Group A Strep (GAS) pharyngitis? CORRECT
ANSWERS Sudden onset sore thorat
Fever
Tonsillopharyngeal edema
Tonsillar exudates
Cervical lymphadenitis (anterior)
Scarlatiniform skin rash
History of GAS exposure
What are causes of noninfectious phayrngitis? CORRECT ANSWERS Allergies
(seasonal and environmental)
GERD
Smokers
Secondhand smoke
Dry environments
What is the usual causative agent of mononucleosis? CORRECT ANSWERS Epstein
Barr virus
,What is an example of co-infection pharyngitis? CORRECT ANSWERS Mononucleosis
(virus) + Strep (bacteria)
What treatment is inappropriate in a patient with strep and mono? CORRECT
ANSWERS Penicillin cannot be used
What are complications of streptococcus? CORRECT ANSWERS Acute rheumatic
fever
Poststreptococcal reactive arthritis
Scarlet fever
Acute glomerulonephritis
PANDAS syndrome
What are characteristics of mononucleosis? CORRECT ANSWERS Fever
Tonsilar pharyngitis
Lymphadenopathy
What triad is found in infectious mononucleosis? CORRECT ANSWERS Fever
Pharyngitis (can be painful, severe, exudative)
Lymphadenopathy (anterior and posterior nodes)
What finding is almost always present in infectious mononucleosis? CORRECT
ANSWERS Fatigue
What are diagnostic studies used to diagnose infectious mononucleosis? CORRECT
ANSWERS Monospot used for screening of heterophil antibodies: most likely time to be
positive is 2nd or 3rd week of illness
EBV titers (only order if presentation is unusual)
CBC (lymphocytosis is common)
Atypical lymphocytes (75% of patients)
Elevated ALT, AST
When should activity be resumed in patients with mononucleosis? CORRECT
ANSWERS No earlier than 21 days after illness onset
Spelenic injury risk (50% have splenomegaly): percussion, palpation vs ultrasound
(ultrasound safest before return to contact sports, but expensive). Rupture risk is
negligible after the 4th week
Resolution of fatigue...could take up to 3 or more months (risk of chronic fatigue
syndrome)
, What are tips to improve fundoscopic exam? CORRECT ANSWERS Darken the room
Right eye to right eye, right hand
Touch your left thumb to the patient's right eyebrow
Patient looks straight ahead
Elicit red reflex
Then stay focused on the red reflex as you look for the optic disc
What are normal findings of the fundoscopic exam? CORRECT ANSWERS Red reflex:
should be present
Optic disc: sharp outline
Cup to disc ratio: should be <0.5
Retinal circulation: venous pulsations: follow vessels peripherally in all directions
Arteries are narrower than veins. Veins pulsate!
What can be found on fundoscopic exam in those with hypertension? CORRECT
ANSWERS Retinopathy
What are forms of retinopathy? CORRECT ANSWERS Cotton wool spots
Flame Hemorrhages
AV Nicking
What are causes of cotton wool spots? CORRECT ANSWERS HTN, DM, other causes:
microinfarction occurs
What are causes of flame hemorrhages? CORRECT ANSWERS HTN, DM, other
causes
What are flame hemorrhages? CORRECT ANSWERS Moderate retinopathy
Blot and dot hemorrhages, hard exudates, microaneurysms are considered "moderate
retinopathy"
What are sensory impairments in older adults? CORRECT ANSWERS Age-related
macular degeneration (AMD)
Cataract
Open Angle Glaucoma
Presbyopia
Diabetic retinopathy
Questions And Answers Verified 100%
Correct!!!
What med is inappropriate for treatment of a patient who has acute rhinosinusitis?
CORRECT ANSWERS Amoxicillin
What are indications for urgent referral in Acute Bacterial Rhinosinusitis (ABRS)?
CORRECT ANSWERS High persistent fever > 102 F
Periorbital edema
Vision change
Severe headaches
How is allergic rhinitis managed? CORRECT ANSWERS Intranasal glucocorticoids:
single most effective treatment
- Ex: budesonide, fluticasone, mometasone, ciclesonide
Antihistamines (nonsedating and sedating available)
What is the most common bacterial cause of pharyngitis? CORRECT ANSWERS
Streptococcus Group A
What is the most common cause of pharyngitis? CORRECT ANSWERS Viral
What are signs and symptoms of Group A Strep (GAS) pharyngitis? CORRECT
ANSWERS Sudden onset sore thorat
Fever
Tonsillopharyngeal edema
Tonsillar exudates
Cervical lymphadenitis (anterior)
Scarlatiniform skin rash
History of GAS exposure
What are causes of noninfectious phayrngitis? CORRECT ANSWERS Allergies
(seasonal and environmental)
GERD
Smokers
Secondhand smoke
Dry environments
What is the usual causative agent of mononucleosis? CORRECT ANSWERS Epstein
Barr virus
,What is an example of co-infection pharyngitis? CORRECT ANSWERS Mononucleosis
(virus) + Strep (bacteria)
What treatment is inappropriate in a patient with strep and mono? CORRECT
ANSWERS Penicillin cannot be used
What are complications of streptococcus? CORRECT ANSWERS Acute rheumatic
fever
Poststreptococcal reactive arthritis
Scarlet fever
Acute glomerulonephritis
PANDAS syndrome
What are characteristics of mononucleosis? CORRECT ANSWERS Fever
Tonsilar pharyngitis
Lymphadenopathy
What triad is found in infectious mononucleosis? CORRECT ANSWERS Fever
Pharyngitis (can be painful, severe, exudative)
Lymphadenopathy (anterior and posterior nodes)
What finding is almost always present in infectious mononucleosis? CORRECT
ANSWERS Fatigue
What are diagnostic studies used to diagnose infectious mononucleosis? CORRECT
ANSWERS Monospot used for screening of heterophil antibodies: most likely time to be
positive is 2nd or 3rd week of illness
EBV titers (only order if presentation is unusual)
CBC (lymphocytosis is common)
Atypical lymphocytes (75% of patients)
Elevated ALT, AST
When should activity be resumed in patients with mononucleosis? CORRECT
ANSWERS No earlier than 21 days after illness onset
Spelenic injury risk (50% have splenomegaly): percussion, palpation vs ultrasound
(ultrasound safest before return to contact sports, but expensive). Rupture risk is
negligible after the 4th week
Resolution of fatigue...could take up to 3 or more months (risk of chronic fatigue
syndrome)
, What are tips to improve fundoscopic exam? CORRECT ANSWERS Darken the room
Right eye to right eye, right hand
Touch your left thumb to the patient's right eyebrow
Patient looks straight ahead
Elicit red reflex
Then stay focused on the red reflex as you look for the optic disc
What are normal findings of the fundoscopic exam? CORRECT ANSWERS Red reflex:
should be present
Optic disc: sharp outline
Cup to disc ratio: should be <0.5
Retinal circulation: venous pulsations: follow vessels peripherally in all directions
Arteries are narrower than veins. Veins pulsate!
What can be found on fundoscopic exam in those with hypertension? CORRECT
ANSWERS Retinopathy
What are forms of retinopathy? CORRECT ANSWERS Cotton wool spots
Flame Hemorrhages
AV Nicking
What are causes of cotton wool spots? CORRECT ANSWERS HTN, DM, other causes:
microinfarction occurs
What are causes of flame hemorrhages? CORRECT ANSWERS HTN, DM, other
causes
What are flame hemorrhages? CORRECT ANSWERS Moderate retinopathy
Blot and dot hemorrhages, hard exudates, microaneurysms are considered "moderate
retinopathy"
What are sensory impairments in older adults? CORRECT ANSWERS Age-related
macular degeneration (AMD)
Cataract
Open Angle Glaucoma
Presbyopia
Diabetic retinopathy
