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PANCE > 5. ENT > Flashcards

5. ENT Flashcards

1
Q
  1. Otoscopy shows cerumen impacted - type of hearing loss/Tx?
  2. Perforated TM - Tx?
A
  1. MC Conduction hearing loss
    • Tx: Hydrogen peroxide 3%, Carbamide peroxide
  2. Heal its own
  • Avoid water/mositure/aminoglycosides if TM rupture
  • only abx is ofloxacin can be use
  • Surgery may need if past two month
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2
Q

Pt complains Pain on traction of the ear canal/tragus

ID/Pathogen/Patient/Presentation/PE/Tx/Complication

A

Name: OE (Otitis externa)

Pathogen: Pseudomonas

Patient: Swimming or exposure moisture

Presentation: malodorous discharge and pruritus

PE: tenderness with tragus or pinna

Tx: Cipro (ofloxacin safe to use TM perforation), Hydrocortisone

Complication: Osteomyelitis at skull (Necrotizing)

  • often cause due to DM or immunocompromised
  • Tx: IV piperacilin or ceftazidime + FQ
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3
Q

Pt’s ear cartilage thickening which looks like cauliflower ear. Pt had hx of blunt trauma.

ID/Patho/Tx

A

ID: Auricular hematoma

Patho: blunt trauma

Tx

  • Evacuate blood < 7days, abx (cephalexin)
  • ENT referral >7days
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4
Q

Pt complains of Gradually Unilateral sensorineural hearing loss and Tinnitis over months. Other result pending at this time.

ID(other name)/Involve nerve/Dx/Tx

A

ID: Acoustic neuroma (CN8) - other name: Vestibular schwannoma

Involve nerve

  • hearing loss - cochlear nerve
  • ataxia - vestibular nerve
  • facial - Facial nerve

Dx: MRI

Tx: Surgery

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5
Q

Pt recently had airplane trip. Pt complains of ear fullness after get off airplane.

ID/Patho/Patient/Tx

A

ID: Barotrauma

Patho: rapid pressure change due to eustachian tube closer -> inability of ET to equalize pressure

Patient: diver or flying

Tx: Autoisufflation (swallowing, yawning), decongestant or antihistamine

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6
Q

Vertigo

  1. No hearing loss + episodic vertigo - ID/Patho/Dx/Tx
  2. hearing loss + episodic vertigo - ID/Patho/Extra sx/Tx
  3. No hearing loss + Cont’ Vertigo - ID/Patho/Tx
  4. Hearing loss + Cont’ Vertigo - ID/Patho/Patient/Extra sx/Tx
A
  1. BPPV (benign paroxymal positional vertigo
    • Patho: displaced otolith
    • Dx: Dix-hallpike test - Place 30 degree head -> quick move 90 degree of one side -> check delayed nystagmus (POSITIVE)
    • Tx: Epley maneuver (reposition to put otolith back to normal)
  2. Meniere
    • Patho: Inner ear distention by excessive fluid
    • Extra sx: Tinnitus
    • Tx: vestibular rehabilitation(Main), Low salt diet and diuretic, Meclizine(vertigo)
  3. Vestibular neuronitis
    • Patho: inflammation of vestibular (MC after viral infection)
    • Tx: Corticosteriod + Meclizine (for vertigo)
  4. Labyrinthitis (라베리나이티스)
    • Patho: cochlear hearing loss
    • Patient: recent URI
    • Extra sx: Tinnitus
    • Tx: Corticosteriod + Meclizine (for vertigo)
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7
Q

Central vs Peripheral vertigo

Onset/effect position/direction nystagmus/Neurologic

A

Central

  • Onset: gradual or sudden
  • Head position: Do not effect
  • Direction nystagmus: bidirection horizon or vertical
  • Neruologic finding: yes

Peripheral

  • Onset: Sudden
  • Head position: worsened by position
  • Direction nystagmus: Unidirection (never vertical)
  • Neurologic finding: No
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8
Q

Pt complain of painless brown/yellow discharge with strong order and granulation tissue

ID/Patient/Dx/Tx

A

ID: Cholesteatoma

Patient: MC has hx of Chronic ET

Dx: Otoscopy (granulation tissue)

Tx: Tympanomastoid surgery

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9
Q

Pt had hx of URI few days ago. Pt complain of ear pain. PE reveals bulging and red TM w/ effusion

ID/Pathogen/PE/Dx/Tx

A

ID: AOM (acute otitis media)

Pathogen: S. Pneumo, H.flu, Moraxella catarrhalis, Strep pyogenes

Presentation: URI sx

PE: Bulging, red TM (decreased TM mobility)

Dx: Otoscopy

Tx:

  • One time - AMOX, if PCN allergy Cefixime or cefidinir
  • recurrent - Augmentine, if PCN allergy -> Clinda + cefixime or cefidinir
  • acetic acid drops - someone who can’t afford medication
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10
Q

Sensory vs conduct hearing loss

Result of hearing test/MC cause

A

Sensory normal ear to lateralization + AC >BC

  • Presbyacusis(Aging) MC

Conduct: Affected ear to lateralization + BC >AC

  • Cerumen impaction MC
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11
Q

Pt had hx of OM. Pt present mastoid tenderness and deep ear pain

ID/Patient/Dx/Tx

A

ID: Mastoiditis

Patient: hx of Otitis Externa

Dx: CT scan

Tx: IV abx + drainage + admission

  • Refractory - mastoidectomy
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12
Q

Pt states his ear continues Perforated TM and recurrent purulent otorrhea for months

ID/Pathogen/Tx

A

ID: Chronic otitis media

Pathogen: Pseudomonas, S. Aureus

Tx: Oflaxacin

  • no water, aminoglycosides in the ear if TM rupture
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13
Q

Pt had Ear fullness, poping of ears. But PT reveals normal otoscopy exam. No pain.

ID/Patient/Dx/Tx

A

ID: Eustachian tube dysfunction

Patient: hx of URI or allergy rhnitis

Dx: Normal otoscopy exam

Tx: Decongestants

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14
Q

bugs in ear

ID/MC risk/Tx

A

ID: Foreign body in the ear

MC risk: 6y> children

Tx: kill bug first by using mineral oil -> remove

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15
Q

Pt present with nose area tenderness. PE revealed Sinus pain with pressure and worse with bending down & leaning forward

ID/Pathogen/MC site/Duration/PE/Dx/Tx

A

ID: Acute Sinusitis

Pathogen: S. Pneumo, H flu, GABHS, M catarrhalis

MC site: Maxillary

Duration: 1-4 weeks (if more than 10-14 days bacterial)

PE: Opacification with transillumination, tenderness nose area

Dx: CT scan

Tx: Symptomatic therapy (1st)

  • Abx use only if presistant more than 10 days or faicial swelling - AMOX, augmentin
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16
Q

Pt has long hx of facial pressure pain x 12wks. Upon PE, revealed black eschar on palate, face.

ID/Complication/Tx

A

ID: Chronic sinusitis

Complication: Mucormycosis

Tx: IV amphotericin

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17
Q

Pt complain of Clear rhinorrhea and Nasal polyps. Pt states nasal congestion worse in the morning

ID/Patho (2 type)/Patient(triad)/PE/Dx/Tx

A

ID: Rhinitis

2 type

  • Allergy - MC type - IgE mediated mast cell histamine release
  • Infection - Rhinovirus MC infection

Patient: hx of asthma, dermatitis and rhinitis altogether make up atopy

PE

  • Transverse nasal crease/infraorbita edema/cobblestone - allergy
  • Erythmatous turbinates - viral

Dx: elevated IgE

Tx

  • Intranasal steriod (flonase) Best option for seasonal allergic rhinitis
  • If Failed Flonase then use antihistamine - Azaletine
  • Decongestant - 3-5 days use only (rebound congestion)
    • DO not use it for allergic rhinitis monotherapy
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18
Q

Pt present for annual exam. PE shows nasal polyp but otherwise normal exam

ID/Patient/Triad/Tx

A

ID: Nasal polyps

Patient: allergic MC

Triad: Samter Triad: asthma + allergy/NSAID/ASA sensitivity + nasal polyps

Tx: Flonase

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19
Q

Nasal bleeding

ID/2 type/Risk/Tx/Prevention/Special consideration

A

Name: Epistaxis

2 type

  • Anterior - Kiesselbach’s plexus MC site
  • Posterior - Palatine artery MC site

Risk

  • Anterior - nasal trauma MC
  • Posterior - HTN, atherosclerosis

Tx

  • Direct pressure (1st) - Compress the Kiesselback plexus with the child in an upright position and head tilted forward
  • Decongestant or cocain 4% helpful
  • Continue bleeding posterior - may consider hospitalization

Prevention: avoid exercise, spicy food

Special consideration: Septal hematoma - consider loss of cartilage if hematoma not removed

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20
Q

Children + foul odor in nose

Name/Dx/Tx

A

Name: Nasal Foreign body

Dx: Rigid or flexible fiberoptic endoscopy

Tx: Remove

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21
Q

Strep throat

Pathoge/4 sx/Criteria interpretation/Dx/Tx/Complication

A

Pathogen: GAS

Strep throat 4 sx

  • Fever (101.5)
  • Lymadenopathy (neck)
  • Absent of cough
  • Pharyngotonsillar exudate

Criteria interpretation

  • 0-1 point - No abx No culture
  • 2 - Rapid test(1st) if Neg do culture
  • 3-4 - Rapid test(1st) and culture + Abx

Dx

  • Rapid strep test (1st screening) if negative should do culture
  • Culture (Definitive)

Tx

  • PCN
  • Macrolide if PCN allergy

Complication: Glomerulonephritis, Rheumatic fever

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22
Q

Muffle (hot potato voice) + Uvula deviation to contralateral side

Name/Pathogen/Dx/Tx

A

Name: Quinsy (peritonsillar abscess)

Pathoge: GAS

Dx: CT

Tx: I&D followed by augmentin,

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23
Q

Vocal abuse (singers, screaming) + hoarseness

Name/Patho/MC cause/Tx

A

Name: Laryngitis

Patho: Inflammation of the larynx

MC cause: Viral infection MC

Tx: Supportive

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24
Q

White curd like plaque able to scrape and bleeding after scrape

Name/Pathogen/Risk/Dx/Tx

A

Name: Oral Candidiasis (thrush)

Pathogen: Candida albicans

Risk: often hx of DM (check glucose)

Dx: KOH smear (budding yeast/pseudohyphae)

Tx: Nystatin liquid, Oral fluconazole

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25
Q

Painless white patchy lesion that cannot scraped off

Name/Patho/Dx/Tx

A

Name: Oral leukoplakia

Patho: Precancerous hyperkeratosis

Dx: Biopsy

Tx: Cryotherapy, laser ablation

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26
Q

Painless white plaque along the lateral tongue borders or buccal mucosa (irregular hairy or feathery)

Name/Risk/Tx

A

Name: Oral hairy leukoplakia

Risk: Epstein-Barr virus, HIV related

Tx: No specific tx, Acyclovir

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27
Q

Yellow centered surrounded by red halo

Name/Tx

A

Name: Aphthous ulcers (Canker sore, ulcerative stomatitis)

Tx: Viscous Lidocaine 2-5%, topical oral steriod

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28
Q

Postprandial(after food) salivary gland pain & swelling + No trismus + No ductal discharge

Name/Gland duct/Tx

A

Name: Sialolthiasis

Gland duct: Wharton (submandibular), Stensen (parotid)

Tx: sialogogues (tart, hard candies, lemon drop)

29
Q

Postprandial gland swelling and pain + tenderness at the duct opening + Trismus + ductal discharge

Name/Pathogen/patho/Dx/Tx

A

Name: Sialadenitis

Pathogen: S. Aureus

Patho: Infection of parotid or submandibular (salivery gland)

Dx: CT scan

Tx

  • Sialogogues (Tart hard candies or lemon drop)
  • IV dicloxacillin or nafcillin + Metronidazole or Clindamycin if severe
30
Q

Lacy leukoplakia of the oral mucosa (Wickham striae)

Name/Risk/Tx

A

Name: Oral lichen planus

Risk: Hep C infection

Tx: Corticosteroids

31
Q

Sudden onset fever and gum swelling or bleeding (gingivitis)

Name/Risk/Tx

A

Name: Acute herpetic gingivostomatitis

Risk: HSV 1 infection children (6month - 5y)

Tx: self limited

32
Q

vesicles that rupture and become ulcerative lesion with grayish exudates + fever

Name/Tx

A

Name: Acute herpetic pharyngotonsillitis

Risk: HSV 1 children

Tx: Oral hygiene - resolve within 7-14 days

33
Q

Swelling & erythema of the upper neck & chin with PUS on the floor of the mouth + Phonation is muffled and tongue protrusion

Name/Patho/PE/Dx/Tx

A

Name: Ludwig’s angina

Patho: cellulitis of the sublingual & submaxillary spaces in the neck

PE

  • upwardly displaced tongue as cellulitis and pus gather in the floor of the mouth
  • Phonation is muffled and tongue protrusion

Dx: CT

Tx: AMP/sulbactam, pen + Metro or clinda

34
Q

swelling angle of mendible + Trismus

Name/Pathogen/Risk/Tx

A

Name: Pariotitis

Cause: S Aureus

Risk: hx of dehydration or intubation

Tx: IV abx

35
Q

Stridor + Trismus + neck rigidity + muffle voice

Name/Patho/Risk/Pathogen/Dx/Tx

A

Name: Retropharyngeal abscess

Patho: infection and thickened prevertebral space

Risk: 3-5 y children

Pathogen: S. Aureus, GAS

Dx: Lateral neck x-ray (widened retropharyngeal space twice the size of the vertebral body in C2-4)

Tx: IV Abx, I & D

36
Q
  1. Shine on unaffected eye both constrict but shine on affected eye both dilate = Name/MC cause
  2. Accomodation but does not react to light = Name/MC cause
  3. Bitemporal heteronymous hemianopsia = MC cause
  4. Vision curtain lift up usually within 1 hour called as?
A
  1. Marcus gunn pupil - MC Optic neuritis (MS)
  2. argyll-robertson pupil - MC neurosyphilis
  3. Pituitary adenoma
  4. Amaurosis fugax
37
Q

Prulent and yellow discharge + Worst in the morning, hard to open eye due to cursting.

Name/Patho(2 case)/PE/TX (2 case)

A

Name: Bacterial conjunctivitis

Patho

  • MC case: infection (Staph A)
  • Lens wearers: Pseudomonas

PE: Prulent, yellow discharge

Tx

  • General infection: Erythromycin, Polymix B meds
  • Lens wearer: FQ (moxifloxacin)
38
Q

Pt complaining of itch eye and tearing. No prulent discharge.

ID/Presentation/PE/Tx

A

ID: Allergic conjuctivitis

Presentation: itching

PE: Cobblestone mucosa

Tx: H1 blocker (olopatadine)

39
Q

Pt complaining of Copious watery discharge and bilateral pink or red eye.

ID/Patho/Presentation/PE/Tx

A

ID: Viral conjunctivitis

Presentation: red or pink eye

PE: Corpious watery discharge, preauricular lymphadenopathy

Tx: Cool compress, artificial tear, antihistamine if itch

40
Q

New born baby less than 14 days comes with eyelid swelling and discharge

ID/Patho/Patient/PE/Dx/Tx

A

ID: Chlamydial conjunctivitis

Patho: Chlamydia trachomatis

Patient: Neonate 5-14 days

PE: Eye swelling and mucoprulent discharge

Dx: Culture

Tx: Oral erythromycin

41
Q

New born baby less than 5 days comes with swelling and discharge

ID/Patho/Patient/Dx/Tx

A

ID: N. Gonorrhoea conjunctivitis

Patho: N. Gonorrhoea

Patient: Neonate 0-5 days

PE: Eye swelling and mucoprulent discharge

Dx: Culture

Tx: Ointment erythromycin

42
Q

61 y pt present to clinic for gradual blurre vision over few months

ID/Patho/Patient/Presentation/PE/Tx/Differential

A

ID: Cataract

Patho: Lens opacification (thicken)

Patient: OLD

Presentation: Gradual blurreness or double vision

PE: Clouding lens (NO red light reflex)

Tx: Surgical removal

Differential: Retinoblastoma - white pupil + Absent red reflex

43
Q

Pt used extensive contact lens uses. Oval ulcer with ragged edge reveals upon test. Patient complain of pain and foreign body senation.

ID/Patho/Patient/PE/Dx/Tx

A

ID: Corneal ulcer

Patho: Staph A (if lens - Pseudomona)

Patient: hx of lens use or trauma

PE: Oval ulcer with ragged edges

Dx: Fluorescein dye test

Tx: Emergent ophthalmo consult

44
Q

Pt who is welder comes to clinic for bilateral decreased vision acuity and pain.

ID/Patient/Presentation/PE/Dx/Tx

A

ID: Ultraviolet Keratitis

Patient: Welder or skier

Presentation: bilateral vision acuity decreased

PE: Multiple punctate lesion

Dx: fluorescein staining

Tx: NSAID

45
Q

Pt present to clinic for foregin body sensation. Upon exam, revealed dendritic lesion on cornea.

ID/Colonized/Presentation/PE/Dx/Tx

A

ID: Herpes simplex keratitis

Colonized: trigeminal ganglion (V1)

Presentation: Unilateral pain, Foregin body sesation

PE: Cillary flush

Dx: Slit lamp (dendritic)

Tx: Acyclovir

46
Q

Pt has hx of prolong exposure to sunlight. PE reveals triangular-shaped growth on medial aspect of eye.

ID/Patient/Presentation/PE/Tx

A

ID: Pterygium

Patient: prolong exposure of sunlight, Sand wind

Presentation: foreign body sensation

PE: Triangular-shaped growth on medial aspect of eye (Corneal involved)

Tx: Artificial tear, sunglasses, surgical excision

47
Q

Pt has yellow, brown fleshy mess on the conjunctiva. Do not involve corneal.

ID/PE/Tx

A

ID: Pinguecula

PE: Nasal side of Sclera (No involve Corneal)

Tx: Observe

48
Q

Pt present with Unilateral tender and swelling at inframedial of eye.

ID (2 case)/Involved gland/Presentation(2 case)/Complication/Tx

A

ID: Dacryocystitis vs dacryoadenitis

Involve gland: lacrimal

Presentation

  • Cystitis (infection) - inframedial, overflow tearing
  • Adenitis (inflammation) - supratemporal

Complication: preseptal or orbital cellulitis

Tx:

  • Mild - clindamycin
  • Severe - Vanco
49
Q

Pt woke up in the morning with crusting, scaling, red-rimming of eyelid. Also able to see eyelash flaking.

ID/Patho/Presentation/PE/Dx/Tx/Associated with other Dz

A

ID: Blepharitis

Patho: MC caused by dysfuntional of meibomian gland

Presentation: eyelash flaking

PE: Crusting, scaling, red-rimming of eye

Dx: Slit exam

Tx

  • Supportive: warm compress
  • Abx for flare up: erythromycin

Associated with other Dz: seborrhea, and Rosacea

50
Q

Hordeolum vs Chalazion

Patho/Presentation/Location/Tx

A

Hordeolum

  • Patho: infection
  • Presentation: Tender
  • Location: Near follicle
  • Tx: warm compress + I&D

Chalazion

  • Patho: Obstruction of meibomian gland
  • Presenation: nontender
  • Location: upper lid
  • Tx: Warm compress (if prolong I&D)
51
Q

Entropion vs Ectropion

Patho/Presentation/PE/Tx

A

Ectropion

  • Patho: caused by aging
  • Presentation: Dry eye
  • PE: eyelid outward
  • Tx: Surgical correction

Entropion

  • Presentation: foreign body sensation
  • PE: eyelid inward
  • Tx: Surgical correction
52
Q
  1. eye rapidly moves called as?
  2. if eye movement up and down caused by what?
  3. if eye movement horizontal caused by what?
  4. Gaze-evoked caused by what?
A
  1. Nystagmus
  2. CNS dysfunction
  3. Labyrinth or vestibular
  4. MC and benign
53
Q

Pt complains of monocular vision loss and pain worse with eyemovement

ID/Patho/Associated Dz/Medication/Presentation/PE/Dx/Tx

A

ID: Optic Neuritis

Patho: Demyelinating inflammation of the optic nerve

Associated dz: Multiple sclerosis

Medication: Ethambutal

Presentation

  • Monocular vision loss
  • eye pain with move
  • loss of color vision
  • Transient vision loss due to increased body temp (uhthoff’s phenomenon)

PE: Marcus-gunn pupil

Dx: MRI (confirm)

Tx: IV methylprednisolone (will return if tx)

54
Q

Pt present to urgent care for acute onset of HA and blurred vision. PE revealed ICP increased and optic disc swelling.

ID/Patho/Presentation/PE/Dx/Tx

A

ID: Papilledema

Patho: ICP increased

Presentation: Acute onset of HA, blurred vision

PE: Optic disc swelling

Dx: Fundoscopy

Tx: Acetazolamide

55
Q

Pt presents with painful eye swelling and limited extraocular movement.

ID/Patient/Presentation/PE/Dx/Tx/Comparable dz

A

ID: Orbital cellulitis

Patient: Children, bacterial rhinosinusitis

Presentation: swelling eye

PE: Painful eye and limited extraocular movement, proptosis

Dx: Clinically

Tx: Vanco + piperacillin

Comparable dz: pre-orbital cellulitis (eye movement doesn’t cause pain)

56
Q

70 y pt present with gradual central field vision loss with Scotoma (blind spot) and Metamorphopsia (line bent)

ID/Patient/Presentation/PE/Dx/Tx

A

ID: Macular degeneration

Patient: 50y< (MC blindness in elderly)

Presentation

  • Dry - Drusen - accumulation of waste products(breakdown of retina) from the retinal pigment
  • Wet - Sudden Abnormal vessel

PE: Dry (Gradual vision loss), Wet (Sudden vision loss)

Dx: Amsler grid (dry), Fluorescein angiography (wet)

Tx

  • Dry - Zinc, Vitamin A,C,E (slow down progression)
  • Wet - - Zumab meds
57
Q

Pt complain with Flash light, floater, and Unilater vision loss (curtain down)

ID/Patho/Presentation/Dx/Tx/Avoid/Confused w/ other

A

ID: Retinal detachment

Patho: Retinal tear

Presentation: Painless loss of vision, floaters, flashing light, curtain down

Dx: Funduscopy - flapping (haze gray w/ white fold)

Tx: Ophtho Emergency

Avoid: DO NOT USE MIOTIC DROP

Confused with other: Amaurosis fugax - Curtain lifts up

58
Q

Pt reports progressive central vision loss. Pt has hx of DM.

ID/Patient/Presentation/PE/Tx

A

ID: Diabetic retinopathy

Patient: DM

Presentation: Progressive central vision loss, Red spot and floaters

PE: Microaneurysms (cotton-wool spot, hemorrhages)

Tx: DM control (1st), Laser surgery or Vitrectomy

59
Q

Children loss of red reflex upon exam.

ID/Patho/PE/Special comment

A

ID: Retinoblastoma

Patho: MC loss function of the retinoblastoma gene

PE: white pupil (leukocoria)

Special comment: MC eye tumor in children

60
Q

Pt had hx of trauma to the orbit. Upon PE, revealed that pt unable to upward gaze and enophthalmos (eyeball socket inward)

ID/Presentation/PE/Mc site/Muscle entraped/Dx/Tx

A

ID: Orbital floor fx

Presentation: Limited upward gaze

PE: Enophthalmos

MC site: Maxillary

Muscle entrapt: inferior rectus

Dx: CT scan (tear drop)

Tx

  • Nasal decongestants (decrease pain)
  • Avoid blowing nose
  • Corticosteriod (reduce edema)
  • Abx
  • Surgical repair
61
Q

Pt recently had penetrating eye injury.

ID/Patho/Patient/PE/Dx/Tx

A

ID: Globe rupture

Patho: Full thickness injury to the sclera

Patient: Recent penetrating injury or trauma, blunt trauma

PE: teardrop pupil, seidel sign (aqueous flows on fluorescain test)

Dx: CT

Tx: Emergency ophthalmology consult + eye shield + elevated head 45 degree

62
Q

Pt had hx of blunt trauma. Pt complains of blurre vision and PE revealed blood in the anterior chamber.

ID/Patient/Presentation/PE/Tx

A

ID: Hyphema

Patient: hx of trauma

Presentation: blurred vision

PE: Blood in the anterior chamber

Tx: eye protection + rest with head elevated 30-45 degrees all the time + opthalmology consultation

63
Q

CRAO vs CRVO

Risk/Presentation/Dx/Tx

A

CRAO

  • Risk: Atherosclerotic disease (Ophtho ER)
  • Sx: sudden Mono vision loss + amurosis fugax
  • Dx: fundoscopy - Cherry red macula (red spot)
  • Tx: Lower IOP (mannitol IV) + ophtalmology consult

CRVO

  • Risk: DM, HTN
  • Sx: sudden Mono vision loss
  • Dx: fundoscopy - Thunder & blood appearance (extensive retinal hemorrhage) + tortorus vein seen
  • Tx: Opthalmology consult
64
Q

Pt has Foregin body sensation, tearing, and painful eye

ID/Presentation/Dx/Tx (1st thing first)

A

ID: Ocular foreign body & Corneal abrasion

Presentation: foreign body sensation

Dx: Fluorescein staining

Tx: visual acutiy check 1st

  • If foreign body - remove with irrigation + ABX
  • if abrasion - small no patch, larger then 5mm Patch it but no longer than 24hours + ABX
  • if contact lens - NO PATCH, use CIPRO drop
  • if Rust ring - remove rust ring at 24 hour
65
Q

Chemical burn

Type/Tx

A

Ophtho Emergency

Type

  • Alkali burn - worse than acid, denature protein
  • Acid burn - coagulative necrosis

Tx

  • Irrigation with Lactaed ringers or Normal saline
  • PH & visual acuity after irrigation
  • ABX - moxifloxacin
66
Q

Acute closed vs open Glaucoma

Sx/PE/Dx/Tx/Contraindication (closed only)

A

Acute (closed)

  • Sx: Sudden painful unilateral eye (halo around light)
  • PE: Cloudiness + fixed nonreactive pupil
  • Dx: Tonometry (IOP high 30
  • Tx: Timolol (reduce IOP, 1st) + Pilocarpine +Acetazolamide (severe case)
    • Dilation of the pupils is contraindicated in acute closed-angle glaucoma.

Chronic (open)

  • Sx: Painless bilateral peripheral vision loss (tunnel vision)
  • PE: Cupping of optic disk
  • Tx: Prostaglandin
    • Laser therapy if failed meds
67
Q

Esotropia vs exotropia

ID/Patho/Dx/Tx

A

ID: Strabismus

Patho: misalignment of the eyes (Newborn - stable ocular alignment not present until 2-3month of life)

  • Esotropia - Deviated inward
  • Exotropia - Deviated outward
  • Hypertropia - Upward
  • Hypotropia - Down

Dx: Hirschberg Corneal light reflex test (cover/uncover test)

Tx: Patchy therapy, corrective surgery

68
Q

Pt has hx of HLA-B27. PE reveals cilliary injection and inflammatory cells & flare

ID/Patient/Location/Tx

A

Name: Uveitis (iritis)

Patient: hx of HLA B27

Location

  • Anterior - unilater eye pain + redness
  • Posterior - decreased vision

Tx

  • Anterior - topical corticosteriod (scopolamine)
  • Posterior - systemic corticosteriod

PANCE (12 decks)

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