APEA 3P ExAm PrEdictor

APEA 3P ExAm PrEdictor 2024/2025 – GuArAntEEd SuccESS with ExPErt VErifiEd Q&A

◉ Cataracts: Symptoms & Screening. Answer: Symptoms: Elderly with night vision issues Difficulty with glare (headlights when driving at night or sunlight) Halos around lights

Screening: Red Reflex Test o If cataracts are present the red reflex will be missing from the affected eye(s) Normal is a reddish-orange glow If no glow, dull, or white; the reflection is abnormal

◉ Age-Related Macular Degeneration: Symptoms & Treatment. Answer: Symptoms: Painless loss of "central vision" reports straight lines appear curved Periphery is preserved Leading cause of blindness in the elderly and more common in smokers

Treatment: Give Amsler grid or refer to ophthalmologist if Amsler grid is not an option

◉ Retinal Detachment: Symptoms & Treatment. Answer: Symptoms: Sudden onset of floaters Looking through the curtain Flashes of light Painless

Treatment: ER STAT

◉ Dacryocystitis: background& symptoms & treatment. Answer: Background: Infection of lacrimal sac/tear duct usually caused by blockage Common in infants, adults over 40 also have higher risk of developing

Symptoms: Thick eye discharge, pain, redness/swelling/warmth of lower eyelid, watery eye/excess tearing

Treatment: Lacrimal sac massage (downward toward mouth) 2-3 times daily; systemic antibiotics 7-10 days

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◉ Allergic Rhinitis: Background & symptoms & treatment. Answer: Background: Inflammatory changes of nasal mucosa due to allergies Atopic family history (asthma, eczema) May have seasonal or daily symptoms

Symptoms: Chronic nasal congestion with clear mucus discharge or post nasal drip Itchy nose, Frequent sneezing, Coughing worsens when supine due to post nasal drip, Blue-tinged or pale boggy (spongy) nasal turbinate's

Treatment: • First Line: Nasal steroid sprays (Fluticasone - Flonase) BID, triamcinolone (Nasacort Allergy) 1-2 sprays QD • Antihistamine Azelastine (Astelin) QD-BID • Decongestants Pseudoephedrine PRN.

Avoid in infants and children • Avoid triggers

◉ Epistaxis (Nosebleed): Background & Treatment. Answer: Background: Anterior nosebleed more common. Caused by bleeding at Kisselbach's plexus

Treatment: Have the pt. blow their nose first

Apply two sprays of topical nasal decongestant (Afrin). Pinch alae tightly against nasal septum and hold for 10 minutes

◉ Meniere's Disease: Symptoms. Answer: Vertigo Hearing loss Tinnitus

◉ Meniere's Disease Mnemonic: VAST. Answer: Vertigo (Episodic) Aural (auditory) fullness Sensorineural Hearing Loss (Fluctuating) Tinnitus (Subjective)

◉ Meniere's Disease Treatment. Answer: Usually, self-limiting. Treat acute attacks Antihistamines for vertigo Meclizine, dimenhydrinate Antiemetics for nausea/vomiting o Promethazine, prochlorperazine

◉ Acoustic Neuroma (Vestibular Schwannoma): Symptoms/DX/TX. Answer: Symptoms: Ages 30-60 Gradual onset, one-sided Sensorineural hearing loss, tinnitus that is insidious; CN 8 Facial numbness and pain if it compresses CN 5

Dx: Order an MRI o Benign tumor of CN 8 causing sensorineural hearing loss and

tinnitus. 2 / 3

If it compresses on CN 5 will have facial numbness and pain

Treatment: Surgery

◉ Cholesteatoma symptoms and treatment. Answer: Symptoms: Cauliflower Foul-smell Hearing loss (typically conductive unless it's way inner than can have sensorineural) If erodes bones in face affects CN VII

Treatment: SURGERY

◉ Battle Sign (Basilar Skull Fracture):. Answer: Bruising behind the ear (mastoid area) appear within 1-3 days after trauma

Parietal bone is most fractured. Linear fracture most common leaking of clear fluid from nose and eyes, raccoon eyes

Look for clear, golden serous discharge from the ear or nose

treat immediately-Refer to ER

◉ Benign Paroxysmal Positional Vertigo (BPPV): Symptoms & DX & Treatment.Answer: Symptoms: Vertigo lasting <1 minute caused by sudden head movements and position changes May lose balance and fall Due to calcium carbonate crystals (otoconia) being trapped in the semicircular canals

Dx: Gold Standard: Dix-Hallpike

Epley Maneuver in clinic or at home by pt Test won't ask how to conduct treatment just be able to associated Epley with BPPV

◉ Vestibular Neuritis and Labyrinthitis: Cause/ Symptoms/ TX. Answer: Viral infection/Inflammation

Symptoms: Sudden/rapid onset of severe vertigo with nausea/vomiting for 1-2 days and then symptoms lessen • Sensorineural hearing loss and tinnitus

Treatment: Ondansetron (Zofran)

Methylprednisolone taper

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