NSG 555 - Nurse Practitioners in Primary Care II
Exam 1
Question:
nasal tumors and polyps--most common
Answer:
inverted papilloma between nose and maxillary sinus Highly vascular benign tumor Common in boys of adolescent age
Question:
nasal polyps
Answer:
inflammatory disorder of nose and paranasal sinuses that can result in chronic nasal obstruction and a diminished sense of smell
common in 1/3 of patients/children with CF
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Question:
pathophys of nasopharynx tumors
Answer:
dx difficult because varied pathophys.
more common in men, assoc. with smoking, etoh, sunlight exposure
Question:
clinical presentation/PE of nasal tumors
Answer:
mimic rhinitis or sinusitis unilateral nasal obstruction + pain, hemorrhage, HA, visual/olfactory changes
nasal obstruction, d/c, facial swelling, recurrent epistaxis (these are usually benign and can be seen)
Question:
nasal polyps presentation and PE
Answer:
nasal obstruction, hyposmia/anosmia, recurrent sinusitis, HA, post-nasal drip, intrinsic asthma . teardrop or grap shaped.
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use pen light to look at nares, assess lymph nodes,
Question:
diagnostics nasal polyps
Answer:
endoscopic eval and biopsy is gold standard
CBC
sinus x-ray, may need CT/MRI to assess bone involvement
Question:
priority differential dx for nasal tumors/polyps
Answer:
benign/malignant polyps, granulomatosis with polyangiitis (wegeners), mucoceles, granulomas without systemic improvement
wegeners granulomatosis: systemic vasculitis by
glomerulonephritis+granulomas of nose and lungs. destruction of bone, cartilage, soft tissue of nose found on biopsy to be malignant neoplasms.Often first s/s is resp. tract symptoms
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Question:
pharm management of nasal polyps
Answer:
glucocorticoids: nasal topical, if not helpful then use short course of oral
corticosteroids
antihistamines may help s/s but not polyps themselves
CAM: intranasal capsaicin may help reduce size of polyp
surgery, they frequently return
consult rheumatology: IF GPA is suspected
consult ENT: if unrelieved by nasal corticosteroids see ENT. all suspected
tumors refer to ENT
Question:
acute bronchitis def/epidemiology
Answer:
acute, self limited inflammation of trachea and major bronchi
cough of 1-3 weeks WITHOUT bronchial consolidation (simila rot pna or underlying c/p disease
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