Conjunctivitis causes impaired vision. T/F
False: vision changes is a red flag finding
What are some physical findings of a foreign body on the eye?
rust ring" appearance of dark specs against iris, red eye, sensation of something in the eye, photophobia, tearing, frequent eye rubbing
What are the 3 most commons pathogens of conjunctivitis?
Streptococcus pneumoniae, H. influenza, Staph. aureus
What are the top 4 differential diagnosis of conjunctivitis?
FB in eye, Corneal abrasion, Dacrycocysitis, Uveitis/scleritis/iritis
What diagnostic study is used for FB of eye and corneal abrasion?
Fluorescein with slit or woods lamp
If there is a confirmed corneal abrasion, what must provider do next during physical assessment?
Evert the eyelid to make sure there is no FB
If the woods lamp and fluorescein turn green to an particular area, what does this indicate?
Corneal abrasion or FB
What eye disorder is seen in those with Graves disease?
Exophthalmos
What does 20/40 mean during a visual acuity test?
at 20 feet the patient can read print that a person with normal vision could read at 40 feet.
What is dacryocysitis?
infection of the lacrimal sac secondary to obstruction
What would you see in a CBC in some diagnosed with dacryocysitis?
Leukocytosis
These listed physical findings are seen in what eye disorder...central redness, pupil affected is smaller, visual acuity is decreased and photophobia is present, pain is moderate and aching
Iritis
What is the most common inflammation of the eye lid disorder?
Blepharitis
T/F: Blepharitis is unilateral and painful.
False: bilateral and painless
A granulomatous reaction in the meibomian gland on the tarsal plate of the eye lid is called?
Chalazion
A chalazion is usually painless correct?
Yes
What are 3 differential diagnosis of a chalazion?
Hordeolum, Blephritis, embedded foreign body
This disorder usually acutely manifests as a palpable indurated area, with pus and surrounding edema, unilateral with localized pain?
Hordeolum (sty)
During the weber test lateralization with to the better ear describes what kind of hearing loss?
Sensorineural
T/F: conductive hearing loss consists of issues with the middle ear and external auditory canal?
True
Risk factors such as allergies, Eustachian tube obstruction, heredity are common in what kind of hearing loss?
Conductive
Hearing seems to improve in noisy environments with SNHL. T/F
False - CHL
What are some diagnostic studies for hearing loss?
Weber, Rinne, audiometry, whisper test
What is a significant physical finding of otitis media?
Immobility of the TM
List some risk factors for AOM?
- Children younger than 6
- attends daycare
- first episode < 12 months
- second hand smoke
- allergic rhinitis
- bottling while laying supine
What are 4 differential diagnosis of AOM?
Otitis Externa, Cholesteatoma, cerumen impaction, mastoiditis
What key diagnostic study is used to DX Otitis Media with effusion?
pneumatic otoscopy
What is the most common pathogen of otitis externa?
Pseudomonas
What is the most significant physical finding of otitis externa?
pain with movement of the pinna
Allergic Rhinitis is a common causes of what king of response?
IgE mediated
Risk factors of allergic rhinitis include:
- Family HX
- age 10-20y/o
-Repeated exposure to substance
- Atopic disease such as asthma, dermatitis, conjunctivitis
In a nasal smear for allergic rhinitis, what are you looking for?
eosinophil
What is a waters view sinus radiographs looking at?
an occipitomental (waters view) is looking at the maxillary sinuses
What do the nasal turbinates' look like on PE for allergic rhinitis?
pale and boggy
What are 3 differential diagnosis of allergic rhinitis?
vasomotor rhinitis, rhinitis medicamentosa, nasal foreign body
During the collection of pt history, pt reports chronic use of nasal sprays and nasal decongestants, presents to you with swollen mucosa. What is your diagnosis?
Rhinitis Medicamentosa
What is the most common pathogen for acute bacterial sinusitis?
Strep
Children with sinusitis may present with what symptoms that differ from adults?
halitosis, reduced sense of smell, morning cough in the absence of facial pain
The DX of sinusitis in children have to include 2 of the 3 criteria, which are?
- cough
-purulent nasal d/c
-purulent pharyngeal drainage
What are some common differential DX of sinusitis?
dental abscess, viral/bacterial/allergic rhinitis, headache
This disorder is usually a complication of pharyngitis or tonsillitis?
peritonsillar abscess
What may you find on PE of someone with possible peritonsillar abscess?
asymmetrical swelling of the uvula, tonsils or posterior pharynx, a visible abscess, cervical lymphadenopathy
What are 3 differential DX of peritonsillar abscess?
Epiglottitis, pharyngitis, laryngitis
Your patient is 7 years old, mother brings him in reporting he has had trouble breathing and cannot swallow, you noticed their is drool hanging from patients face, once the child opens his mouth what would the pharynx look like?
beefy red pharynx - associated with epiglottitis
What do you NOT do as a provider during your assessment if epiglottitis is suspected?
Do NOT examine the pharynx with use of a tongue depressor
What is fungal pharyngitis associated with?
Thrush
Bacterial Pharyngitis is commonly associated with what pathogen?
Group A B-hemolytic Streptococcus
What diagnostic test would you run if suspecting bacterial pharyngitis?
rapid strep test, culture and mono spot
What PE findings would you suspect to find in bacterial pharyngitis?
cervical adenopathy, fever > 102, absence of other URI findings, petechiae on soft palates, exudate
Epiglottitis is usually seen with what pathogen?
H. influenza type B
What disorder is associate with Epstein-Barr virus?
Mono
The spleen in not enlarged in those with Mono. T/F
False- splenomegaly occurs in 50% of cases
If chronic fatigue syndrome is being considered as a differential DX, what diagnostic test should be ordered?
Mono spot
Posterior nodes are more common in Strep or mono?
Mono
A 2 y/o child is brought into the clinic with a barking cough, hoarseness, nasal flaring and low grade fever, What is your first diagnosis?
Croup
Acute laryngitis is worse at the beginning of the day but gets better as the day goes on. T/F
False - gets worse as the day goes on
A patient who suffers from a chronic cough enters the clinic and you immediately notice stridor during inspiration and expiration, what are you suspecting?
Vocal cord paraylsis
Croup is most commonly found in what age children?
3 months - 3 years
What would you find on PE if suspecting viral pharyngitis/tonsillitis?
conjunctivitis, nasal congestion, hoarseness, cough, diarrhea or viral rash
What is the most common age for pharyngitis/tonsillitis?
5-18y/o
What is the leading cause of permanent blindness in the eldery?
macular degeneration
At what age can you start performing a visual acuity?
3 y/o
What is myopia?
nearsightedness
what is hyperopia?
Farsightedness
At what age should visual acuity be assessed annually?
After the age of 40
This disorder is also known as crossed eye and is a common cause of vision loss in children?
Strabismus
The disorder is referred to as lazy eye, there is reduced visual acuity in one eye that is not corrected with lenses.
Amblyopia
What is the leading cause of age-related blindness in the US?
Macular degeneration
The amsler grid is a vision test used to test for what eye disorder?
Macular degeneration
Early signs of macular degeneration according to the amsler grid consist of what?
lines may be wavy or distorted, blurred or missing area of vision
You have a 65 y/o patient that has been seen prior to visit for conjunctivitis, the patient is back today with no improvement and is beginning to have visual changes but remains to have no pain. What may you consider evaluating for in this patient?
Glaucoma or macular degeneration
A slow rise in intraocular pressure is consist with what type of glaucoma?
primary open angle
A sudden increase in intraocular pressure is consist with what type of glaucoma?
Acute- closed angle
A patient comes in the clinic and reports seeing floaters and having brief flashes of light, what diagnosis may you come up with?
Retinal detachment
If a patient you dx with strep and prescribed amoxicillin comes back with a generalized rash, what would you suspect your new DX would be?
Mono
Chlamydial conjunctivitis occurs at what time frame after birth?
1-2 weeks
Gonococcal conjunctivitis occurs at what timeframe after birth?
2-4 days
Eyelid margins turn inward is known as:
Entropion
Eyelid margins turn outward is known as:
Extropion
A patient comes into the clinic and reports he got hit in the face with a base ball bat, when examining the eye you noticed there is blood in the anterior chamber of the eye. These findings are consistent with?
Hyphema
Can a red bulging ear drum only be indicative of AOM? T/F
False, crying can create bulging of the eardrum
A child came to the office for a F/U DX of AOM, the child appears to be still pulling at their ear and mother reports the child still has a fever and foul drainage has been coming out of the child's ear. What is your differential DX?
Mastoiditis
When can a RAST study be performed?
in patients with severe allergic rhinitis
Decreased transillumination, frontal headaches worse with bending over and periorbitial edema can indicate signs of?
sinusitis
What viruses can cause pharyngitis/tonsillitis?
Rhinovirus, adenovirus, mono, parainfluenza
What is a differential diagnosis for a infant/children with hoarseness, if mother has a hx of HPV?
Laryngeal papillomas
What does aphonia mean?
loss of ability to speak
What is the most common viral infection leading to croup in young children?
parainfluenza 1
Medications that are can cause tinnitus include all of the following except
A. ASA
B. Lasix
C. Anticonvulsants
D. Norvasc
D. Norvasc
At what age should an infant turn their head towards a sounds?
6 months
How do you assess hearing in school aged children?
Stand 2-3 feet in front of the child and ask them to do something like point to something on their body.
Otitis Media is a frequent complication of tonsillitis in children. T/F
True