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NURS 621 Midterm Exam with complete solutions 2024_2025.
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NURS 621 Midterm Exam with complete solutions 2024_2025.
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NURS 621 Midterm Exam with completesolutions 2024/2025
Dx: Acute otitis media - 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 - 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 - 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
• Pneumotoscopy (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 - 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 - ANSWER-• Should start to improve within 48 to 72 hours - if no
improvement should be re-examined
Edu Otitis Media - 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 - ANSWER-o Viral:
Injection, watery discharge during the day, scant, stringy that is mucus rather
than pus. Burning, sandy, or gritty feeling in 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 a total course of 2-3 weeks.
Chlamydial Conjunctivitis - 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 conjunctival
smears, culture, or PCR of swabbed specimens
Bacterial Conjunctivitis - ANSWER-o Bacterial:
Organisms: Staph aureus, strep pneumoniae, H influenza, M catarrhalis
Redness and discharge in 1 eye, but can be bilateral. "stuck shut" in the
morning. Purulent discharge, thick and globular, yellow, white, or green
Noninfectious Conjunctivitis - ANSWER-• Noninfectious
o Allergic:
Bilateral redness, watery discharge, and itching
o Nonallergic:
Conjunctivitis Lab/diagnostics: - ANSWER-Lab/diagnostics:
• Not normally necessary. They now have rapid test for adenoviral conjunctivitis
Conjunctivitis Tx plan: - ANSWER-RESOURCES
Conjunctivitis f/u - ANSWER-RESOURCES
Conjunctivitis education - ANSWER-RESOURCES
COPD H AND P - ANSWER-H&P:
• *Dyspnea - unpleasant sensation of labored breathing. Progressive and
persistent. Air hunger or gasping for breath
• Current/past tobacco - primary risk factor
• Chronic cough - may be 1st symptom to develop. Initially, intermittent but may
become daily. Rarely occurs only at night
• Chronic sputum production - usually from chronic bronchitis
• History of exposure to dust and chemicals - smoke from cooking and heating
fuels
COPD DDX - ANSWER-DDx:
• Asthma
• Alpha1-antitrypsin (AAT) deficiency - emphysema onset younger than 45, no
smoking hx, basilar hyperlucency, unexplained liver disease, necrotizing
panniculitis, fam hx
• CHF
• Bronchiectasis
• Tuberculosis
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