NP717 HEENT EXAM REVISED [100% PASS]

NP717 HEENT EXAM REVISED [100% PASS] A patient presents with severe eye pain, foreign body sensation, tearing, and photophobia. They are contact lense users and have a whitish lesion on the cornea found during PE. What is this and what is appropriate management? *Ans* Corneal ulcer - ophthalmologic emergency - refer to ED. Most commonly caused by pseudomonas, staph, or step - can permanently impair vision d/t scarring or perforation. A patient presents with acute onset of sever unilateral eye pain, photophobia, tearing, and blurred vision. During the fluorescein dye process, fernlike lines in the corneal surface are seen. What is this and what is appropriate management? *Ans* Herpes keratits - either herpes simplex or herpes zoster. Refer to ED. An elderly patient presents with acute onset of severe eye pain w/headache, N/V, halos around lights, lacrimation, and decreased vision. What is this and what is normally found on physical exam? *Ans* Acute angle-closure glaucoma Mid-dilated pupil(s) that is oval shaped, cloudy cornea, cupping of optic nerve. Ophthalmologic emergency. If chronic angle-closure glaucoma - possibly asymptomatic or dull ache/blurred vision. A young caucasian woman in her 20s/30s reports loss of visual acuity over hours to days. Color vision is affected and a central scotoma (blind spot central vision) is common. May have other neurologic sx including aphasia, paresthesia, abnormal gait, or spasticity. May also have higherthan-normal temperature that worsens sx (Uhthoff phenomenon). Has recurrent episodes. What is this? Tx? *Ans* Multiple sclerosis (optic neuritis). - refer to neurology A patient has an acute onset of erythematous swollen eyelid with proptosis (bulging of the eyeball) and pain in the affected eye. Unable to perform full ROM (abnormal extra-ocular movement) w/o pain. What do you expect? Management? *Ans* Orbital cellulitis - look for hx of recent rhino-sinusitis or URI - serious complications - refer to ED Retinal detachment is an emergency requiring immediate refer to ED. S/sx? *Ans* sudden onset of floaters (or increase in floaters) associated w/"looking through the curtain" sensation w/sudden flashes of light. Central vision may be intact or lost if macula is detached. Patient presents with a severe sore throat, difficulty swallowing, odynophagia (pain on swallowing), trismus (jaw muscle spasm) and a "hot potato" voice. PE shows unilateral swelling of the peritonsillular area and soft palate. Accompanied by malaise, fever, and chills. Dx? Management? *Ans* peritonsillar abscess - refer to ED Normal findings in the eyes include _____? *Ans* Fundi: veins are larger and darker in color