HEENT (FNP) BOARD REVIEW QUESTIONS
AND ACCURATE SOLUTIONS LATEST
UPDATE GUIDE.
What are objective findings in allergic rhinitis?
Nose has blue-tined or pale boggy nasal turbinate’s
Mucus is clear
Posterior pharynx reveals thick mucus, with colors ranging from clear, white,
yellow, or green (rule out sinusitis)
Undereye "circles" (Veno dilation)
Children may have transverse nasal crease from frequent rubbing (allergic
salute)
Posterior pharynx may show cobblestoning (hyperplastic lymphoid tissue)
What treatment plan is appropriate for allergic rhinitis?
First-line treatment: Topical nasal sprays
- Use nasal steroid spray daily (OTC): Fluticasone (Flonase) BID, triamcinolone
(Nasacort Allergy 24 hr), one to two sprays once a day
- If only partial relief, another option is topical antihistamine nasal spray
azelastine (Astelin) daily or BID
- If no relief, consider combination product (azelastine and fluticasone nasal
spray)
- Use cromolyn sodium nasal spray TID (less effective than steroids)
,Use decongestants (i.e., pseudophedrine, or Sudafed) PRN. Do not give to
infants/young children
Consider oral antihistamines PRN. Second-generation antihistamines (OTC) are
less sedating: cetirizine (Zyrtec). Loratadine (Claratin) PO once daily or PRN.
Be careful with diphenhydramine (Benadryl); it causes sedation
Ideally eliminate environmental allergans
Dust mite allergies: Avoid using ceiling fans, no stuffed animals or pets in bed,
use a HEPA filter for air conditioners, room filters, and the like. Refer to
allergist.
What are complications of allergic rhinitis?
Acute sinusitis
Acute otitis media
What causes rhinitis medicamentosa?
Prolonged use of topical nasal decongestants (>3 days) causes rebound
effects that result in severe and chronic nasal congestion
Patients present with daily severe nasal congestion and nasal discharge
(clear, wartery, mucus)
What is a classic presentation of epistaxis (nosebleeds)?
Acute onset of nasal bleeding secondary to trauma (i.e., nose picking)
Bright-red blood may drip externally through the nasal passages and/or the
posterior pharynx
Profuse bleeding can result in vomiting of blood
What is the treatment is indicated for epistaxis (nosebleeds)?
,Apply direct pressure on teh frint of the nose for several minutes
Nasal decongestants (i.e, Afrin) to shrink tissues and helps to stop bleeding
Apply triple antibiotic ointment or petroleum jelly in front of the nose using
cotton swab for a few days
What are complications of epistaxis (nosebleeds)?
Posterior nasal bleeds may hemorrhage
Refer to ED
What is the classic case of streptococcal pharyngitis/tonsillopharyngitis
(strep throat)?
All ages are affected, but is most common in children
Abrupt onset of fever, sore throat, pain on swallowing, and mildly enlarged
submandibular nodes
May have purulent exudate on tonsils
Anterior cervical nodes mildly enlarged and tender (anterior cervical adenitis)
Adult may report having a child attending preschool
What is Centor criteria?
Clinical decison tool used to help diagnose "strep" throat. Criteria for strep
throat include tonsilar exudate, tender anterior cervical adenopathy, history
of fever, and absence of cough.
What are objective findings of streptococcal pharyngitis/tonsillopharyngitis
(strep throat)?
Pharnyx dark to pink bright red. Adults usually afebrile (or mild fever)
May have tonsillar exudate that is yellow to green color. May have petechiae
, on the hard palate (roof of the mouth). Anterior cervical lymph nodes mildly
enlarged
What treatment plan is indicated for streptococcal
pharyngitis/tonsillopharyngitis (strep throat)?
Rapid antigen detection testing (RADT) is a repid "strep" test or throat C&S
First line: Oral penicillin V 500 mg BID to TID x 10 days
Alternative: Amoxicilliin 500 mg BID x 1o days
- Penicillin or beta-lactam allergy: Azithromycin (Z-pak) x 5 days
Throat pain and fever: Ibuprofen (Advil) or acetaminophen (Tylenol)
Symptomatic treatment: Salt water gargles, throat lozenges; drink more fluids
Repeat C&S after antibiotic treatment (test-of-cure): History of mitral valve
prolapse or heart valve surgery
What are complications of streptococcal pharyngitis/tonsillopharyngitis
(strep throat)?
Scarlet fever (scarlatina): Sandpaper-textured pink rash with sore thorat and
strwberry tongue (red sore tongue). Rash starts on the head and neck and
spreads to the trunk, then the extremities. Next, the skin desquamates (peels
off). Increased risk of acute rheumatic fever.
Acute rheumatic fever: Inflammatory reaction to strep infection that may
affect the heart and valves, joints, and the brain
Peritonsillar abscess: Displaced uvula, red bulging mass on one side of the
anterior pharyngeal space, dysphagia, fever. Refer to ED STAT.
Postsreptococcal glomerulonephritis: Abrupt onset of proteinuria, hematuria,
AND ACCURATE SOLUTIONS LATEST
UPDATE GUIDE.
What are objective findings in allergic rhinitis?
Nose has blue-tined or pale boggy nasal turbinate’s
Mucus is clear
Posterior pharynx reveals thick mucus, with colors ranging from clear, white,
yellow, or green (rule out sinusitis)
Undereye "circles" (Veno dilation)
Children may have transverse nasal crease from frequent rubbing (allergic
salute)
Posterior pharynx may show cobblestoning (hyperplastic lymphoid tissue)
What treatment plan is appropriate for allergic rhinitis?
First-line treatment: Topical nasal sprays
- Use nasal steroid spray daily (OTC): Fluticasone (Flonase) BID, triamcinolone
(Nasacort Allergy 24 hr), one to two sprays once a day
- If only partial relief, another option is topical antihistamine nasal spray
azelastine (Astelin) daily or BID
- If no relief, consider combination product (azelastine and fluticasone nasal
spray)
- Use cromolyn sodium nasal spray TID (less effective than steroids)
,Use decongestants (i.e., pseudophedrine, or Sudafed) PRN. Do not give to
infants/young children
Consider oral antihistamines PRN. Second-generation antihistamines (OTC) are
less sedating: cetirizine (Zyrtec). Loratadine (Claratin) PO once daily or PRN.
Be careful with diphenhydramine (Benadryl); it causes sedation
Ideally eliminate environmental allergans
Dust mite allergies: Avoid using ceiling fans, no stuffed animals or pets in bed,
use a HEPA filter for air conditioners, room filters, and the like. Refer to
allergist.
What are complications of allergic rhinitis?
Acute sinusitis
Acute otitis media
What causes rhinitis medicamentosa?
Prolonged use of topical nasal decongestants (>3 days) causes rebound
effects that result in severe and chronic nasal congestion
Patients present with daily severe nasal congestion and nasal discharge
(clear, wartery, mucus)
What is a classic presentation of epistaxis (nosebleeds)?
Acute onset of nasal bleeding secondary to trauma (i.e., nose picking)
Bright-red blood may drip externally through the nasal passages and/or the
posterior pharynx
Profuse bleeding can result in vomiting of blood
What is the treatment is indicated for epistaxis (nosebleeds)?
,Apply direct pressure on teh frint of the nose for several minutes
Nasal decongestants (i.e, Afrin) to shrink tissues and helps to stop bleeding
Apply triple antibiotic ointment or petroleum jelly in front of the nose using
cotton swab for a few days
What are complications of epistaxis (nosebleeds)?
Posterior nasal bleeds may hemorrhage
Refer to ED
What is the classic case of streptococcal pharyngitis/tonsillopharyngitis
(strep throat)?
All ages are affected, but is most common in children
Abrupt onset of fever, sore throat, pain on swallowing, and mildly enlarged
submandibular nodes
May have purulent exudate on tonsils
Anterior cervical nodes mildly enlarged and tender (anterior cervical adenitis)
Adult may report having a child attending preschool
What is Centor criteria?
Clinical decison tool used to help diagnose "strep" throat. Criteria for strep
throat include tonsilar exudate, tender anterior cervical adenopathy, history
of fever, and absence of cough.
What are objective findings of streptococcal pharyngitis/tonsillopharyngitis
(strep throat)?
Pharnyx dark to pink bright red. Adults usually afebrile (or mild fever)
May have tonsillar exudate that is yellow to green color. May have petechiae
, on the hard palate (roof of the mouth). Anterior cervical lymph nodes mildly
enlarged
What treatment plan is indicated for streptococcal
pharyngitis/tonsillopharyngitis (strep throat)?
Rapid antigen detection testing (RADT) is a repid "strep" test or throat C&S
First line: Oral penicillin V 500 mg BID to TID x 10 days
Alternative: Amoxicilliin 500 mg BID x 1o days
- Penicillin or beta-lactam allergy: Azithromycin (Z-pak) x 5 days
Throat pain and fever: Ibuprofen (Advil) or acetaminophen (Tylenol)
Symptomatic treatment: Salt water gargles, throat lozenges; drink more fluids
Repeat C&S after antibiotic treatment (test-of-cure): History of mitral valve
prolapse or heart valve surgery
What are complications of streptococcal pharyngitis/tonsillopharyngitis
(strep throat)?
Scarlet fever (scarlatina): Sandpaper-textured pink rash with sore thorat and
strwberry tongue (red sore tongue). Rash starts on the head and neck and
spreads to the trunk, then the extremities. Next, the skin desquamates (peels
off). Increased risk of acute rheumatic fever.
Acute rheumatic fever: Inflammatory reaction to strep infection that may
affect the heart and valves, joints, and the brain
Peritonsillar abscess: Displaced uvula, red bulging mass on one side of the
anterior pharyngeal space, dysphagia, fever. Refer to ED STAT.
Postsreptococcal glomerulonephritis: Abrupt onset of proteinuria, hematuria,
