67-100 Flashcards
67.S/S of central vs. branch retinal vein occlusion.
Retinal Vein Occlusions (Central and Branch)
Pathophysiology
- Sudden ______ loss of vision (branch 4x more common)
- Major predisposing factors are the etiologic factors associated with _______
S/S
No _____ or ______
Widespread or sectoral retinal _______
Visual impairment commonly first noticed upon _____
Widespread retinal hemorrhages, retinal venous dilation and tortuosity
Retinal ______l spots and optic disk ______
Branch occlusion:
-Sudden loss of vision at the time of occlusion if the _____ is involved
-Sometime after from vitreous hemorrhage due to retinal new _______
-More gradual loss with macular edema
-Retinal abnormalities are confined to the area drained by obstructed vein
Risk factors: check for __, tobacco smoking, estrogen therapy including OCPs
- Screen for ___, hyperlipidemia, hyper viscosity
- Antiphospholipid antibodies, lupus anticoagulant, inherit4ed thrombophilia and homocysteine levels
Prevention
Treatments
PPP – no consensus on optimal treatment High risk of neo-vascular glaucoma with retinal ischemia photocoagulation Intravitreal \_\_\_\_\_\_ Intravitreal corticosteroids Misc.
monocular arteriosclerosis pain, redness hemorrhages waking cotton wool swelling fovea vessels
BP
DM
VEGF
Retinal Artery Occlusions (Central and Branch)
Pathophysiology
___, hyperlipidemia and systemic ____ are predisposing factors
Migraine, OCPs systemic vasculitis, thrombophilia and hyperhomocysteinemia
S/S Sudden \_\_\_\_\_\_ loss of vision No \_\_\_ or \_\_\_\_\_ Widespread or sectoral retinal \_\_\_\_\_\_\_: Sudden profound monocular visual loss Visual acuity substantial reduces Visual field restricted
PE
Pallid swelling of the retina with _____ spot at the fovea
_____ segmentation of blood in the veins may be seen
_____ may be seen in the central artery or its branches
Retinal swelling subsides over a period of 4-6 weeks leaving a pale ______ and attenuated arterioles
Branch:
Sudden loss of vision if the ____ is involved
More commonly sudden loss of visual field is presenting complaint
Fundal signs of retinal swelling and adjacent ______ spots are limited to the area of _____ suppled by the occluded artery
Epidemiology
Patient 50 years or older consider Giant Cell arteritis
Tests
Elevated ESR, CRP in giant cell arteritis but may be normal
Screen for vasculitis
Screen for DM and hyperlipidemia
Duplex ultrasonography of carotid arteries, ECG, and echocardiography with transesophageal studies
Prevention
Treatments If seen few hours after onset emergency treatment! lay patient \_\_\_\_ \_\_\_\_\_ massage high conc \_\_\_\_\_\_ IV \_\_\_\_\_\_\_\_
Misc.
DM, HTN
monocular
pain, redness
pallid swelling
cherry red
box car
emboli
optic disc
fovea
cotton wool
retina
flat
ocular
oxygen
acetazolamide
69.S/S of hypertensive chorioretinopathy. Prevention of retinopathies.
Hypertensive Retinopathy - damage to the retinal blood vessels from longstanding high _______
Pathophysiology
Acute changes in BP
Most ____ ocular changes
Causes: pheochromocytoma, ______ hypertension, preeclampsia-eclampsia
S/S
Acute elevations in BP result in:
Loss of ______ in the retinal circulation
Leads to breakdown in the ______ integrity
Leads to _______ of precapillary arterioles and capillaries
________ (damage to nerve fibers; fluffy white patches)
Retinal _______
Retinal edema
Retinal exudates, often in stellate appearance at the macula (lipid residue from damaged capillaries)
Acute elevations of BP
Vasoconstriction and ischemia in the ______
-___________
-Retinal pigment epithelial infarcts
-May also affect the optic nerve head
–Ischemic optic neuropathy with optic disc swelling
_____ abnormalities are the hallmark of hypertensive crisis with retinopathy
–Previously known as malignant hypertension
-Marked fundal abnormalities are likely associated with permanent retinal, choroidal or optic nerve damages
–Precipitous reduction of blood pressure may exacerbate such damage
BP
florid
malignant
autoregulation endothelial occlusion cotton wool spots hemorrhages
choroid
retinal detachments
fundal
70.S/S of malignant otitis externa.
Malignant External Otitis (_______ of the skull base)
Patho
Caused by __________
S/S Persistent foul aural \_\_\_\_\_\_ Granulations in the ear canal Deep \_\_\_\_\_ Advanced cases: progresive cranial nerve palsies VI, VII, IX, X, XI, or XII
Epid
Diabetic or ________ patients
Diagnostics
Diagnosis confirmed by osseous erosion on ___ and _______ scanning
Treatment
Prolonged _____________
IV often required: _____
Some select patients may be treated with oral cipro
Misc
osteomyelitis
pseudomonas aeruginosa
discharge
otalgia
immunocompromised
CT
radionucleotide
antipseudomonal antibiotic
cipro
71.Treatment of mastoiditis.
Mastoiditis
Patho
•Evolves following several weeks of inadequately treated acute _________
S/S
Postauricular _____ & _____ accompanied with spiking _______
Epid
Diagnostics
•__ scan reveals coalescence of the mastoid cells due to destruction of bony septa
Treatment
- __________ directed against the most common offending agents (s.pneumoniae, H. influenzae, S pyogenes)
- ______ 0.5-1.5 g every 6-8 hours
Myringotomy for C and S
Misc
otitis media
pain, erythema
fever
CT
IV antibiotics
Cefazolin
72.Treatment of laryngitis.
Laryngitis
Patho
Acute ______ of the mucosa of the larynx
Avoid vigorous use of ____ (singing, shouting) until voice returns to normal
Persistent use may lead to formation of traumatic vocal fold ______, polyps and cysts
Etiologies: viral _______ infection most common – adenovirus, rhinovirus, influenza, RSV, parainfluenza
S/S
Most common cause of ______ - hallmark
Aphonia
Dry or _____ throat
May have _____ symptoms (rhinorrhea, cough, sore throat)
Epid
Diagnostics
Usually a clinical diagnosis
Treatment
PPP- Supportive care mainstay- _____, humidification, ____ rest, warm saline gargles, anesthetics, lozenges, and reassurance that is usually self-limited
PPP-ENT follow up if workup needed
______ may speed improvement of hoarseness at 1 week and cough at 2 weeks when measured subjectively
Oral or IM corticosteroids may be used in selected cases of professional vocalists to speed recovery and allow scheduled performances
inflammation
voice
hemorrhages
URI
hoarseness
scratchy
viral URI
hydration
vocal
erythromycin
73.S/S of herpes zoster ophthalmicus.
Herpes Zoster Opthalmicus
Pathophysiology
Involves ophthalmic division of _____ nerve
Preceding eruption of ______
_____, ____ headache and _____ burning and itching
S/S Ocular signs \_\_\_\_\_\_\_\_ \_\_\_\_\_\_ Episcleritis Anterior \_\_\_\_
Optic neuropathy, cranial nerve palsies, acute retinal necrosis and cerebral angiitis are infrequent
Rash is initially vesicular becoming ____ then _____
Involvement of tip of the nose or lid margins involves the eye
Epidemiology
____ risk factor
Treatments
High dose oral:
____ 800mg 5x daily
Valaciclovir 1g TID
Famciclovir 500mg TID
Misc.
*Refer all cases to Ophthalmology
trigeminal
vesicles
malaise, fever
periorbital
conjuncitvitis
keratitis
uveitis
pustular, crusting
HIV
acyclovir
75.Patho and S/S of viral labyrinthitis.
Labyrinthitis
Patho
Cause unknown
Inflammation of the vestibular and cochlear portion of CN ___
Acute onset of continuous, usually severe vertigo lasting ____ to a _____
S/S
_____ loss
______
Treatment
______ if patient is febrile
Vestibular suppressants (valium, meclizine)
Misc
VIII
several days, week
hearing
tinnitus
antibiotics
Papilledema
Pathophysiology
Optic nerve (disc) _____ secondary to increased ___
Idiopathic
S/S
•Usually _____ and most commonly produces enlargement of the _____ without loss of acuity
Chronic papilledema or Severe acute papilledema – associated with visual field loss and occasionally with profound loss of _____
Treatments
____ loss
________
Chronic needs to be monitored carefully and CSF shunt or optic nerve sheath fenestration should be considered with progressive visual failure not medically controlled
Swelling
ICP
bilateral
blind spot
acuity
weight loss
acetazolamide
82.Patho of hemotympanum.
_____ behind an ____ tympanic membrane (hemotympanum) may follow ____trauma or extreme ________
hemorrhage
intact
blunt
barotrauma
88.S/S and causes of conductive hearing loss
Conductive hearing loss results from ____ or ______ ear dysfunction. Four mechanisms each result in impairment of the passage of sound vibrations to the inner ear: (1) ______(eg, cerumen impaction), (2) ____ loading (eg, middle ear effusion), (3) ______(eg, otosclerosis), and (4) _____ (eg, ossicular disruption). Conductive losses in adults are most commonly due to _____ impaction or transient _______ dysfunction from ____. Persistent conductive losses usually result from chronic ear infection, trauma, or otosclerosis. Conductive hearing loss is often correctable with medical or surgical therapy, or both.
external, middle obstruction mass stiffness discontuinity
cerumen
eustachian tube
URI
89.S/S and causes of tinnitus.
Tinnitus
Patho
Defined as the sensation of sound in the _____ of an exogenous sound source
S/S Pulsatile tinnitus -Described as listening to one’s own \_\_\_\_\_ -May be more serious -May indicate a \_\_\_\_\_ abnormality
Tonal Tinnitus
-____ in the ears
Staccato or “clicking”
- ____ ear spasm sometimes associated with palatal myoclonus
- Rapid series of ____ noises
- Lasts ____ to a few _____
- Accompanied by _____ feeling in the ear
Pulsatile: Magnetic resonance angiography and venography
Routine nonpulsatile: Audiometry
Unilateral: MRI to r/o a retro cochlear lesion
Treatment
Avoidance of excessive ____, ____ agents and other factors that may cause damage
oral antidepressants: ______
Misc
absence
heartbeat vascular ringing middle popping seconds, mins fluttering
noise
ototoxic
nortriptiyline
92.S/S of trench mouth, herpes stomatitis, apthous ulcers
Herpes Stomatitis
Patho
-Common, mild, and ___ lived
S/S
- Initial _____
- Typical small ____ that rupture and form scabs
- Most commonly found on the attached _____ and mucocutaneous junction of the ___
- Lesions can also form on the tongue, buccal mucosa and soft palate
Diagnostics
Differential diagnosis: ___ ulcers, herpangina, ________ disease, coxsackievirus-caused lesions.
Treatment
Requires no intervention in most adults
_____, valacyclovir
Misc
short
burning
gingigiva
lip
apthous
hand and foot
acyclovir
92.S/S of trench mouth, herpes stomatitis, apthous ulcers
Apthous Ulcers
Patho
Cause uncertain – ____
_____ is a major predisposing factor
S/S -single or \_\_\_\_\_ -Found on freely \_\_\_\_\_, nonkeratinized mucosa –\_\_\_\_and labial mucosa –Not attached to \_\_\_\_ or palate -usually recurrent
■____ small round ulcerations with _______ fibrinoid centers surrounded by ___halos
■Minor
–Less than 1 cm
–Heal 10-14 days
■Major
–Greater than 1 cm
–May be disabling due to degree of pain
Treatment
–Challenging: no single systemic tx has proven effective
–Topical ______
Misc
HHV6 stress moving buccal gingiva
painful
yellow-grey
red
corticosteroids
93.S/S and treatment of viral pharyngitis, diphtheria,
Diphtheria
Patho
pharyngeal diphtheria, the most common form
S/S
a tenacious_______ membrane covers the ____ and _____. Mild sore throat, ____ and____ are followed by toxemia and prostration.
Diagnostics
The diagnosis is made clinically but can be confirmed by ______ of the organism.
Treatment
Removal of membrane by direct ______ or bronchoscopy may be necessary to prevent or alleviate airway obstruction.
______, which is prepared from horse serum, must be given in all cases when diphtheria is suspected.
Misc
gray tonsils, pharynx fever, malaise culture laryngoscopy antitoxin
