Diseases Group 3 Flashcards
Opthalmia neonatorum
Conjunctivitis or keratoconjunctivitis occurring within first four weeks of birth.
Timing can help predict etiology.
Key organisms: N. gonorrhoeae, C. trachomatis, Staph, Strep. etc.
Treamtent: prophylactic erythromycin ointment.
Cultures and smears for diagnosis
Blepharitis
Infection of the eyelid
Conjunctivitis
Infection of the thin conjunctiva.
Symptoms: Discharge, red eye, irritation, and sensitivity to palpitation; caused by dilation and congestion of sub epithelial vessels.
DDX: Bacterial vs Viral vs Allergic (Other include Rhinoconjunctivitis, chemical reaction, meds, neoplasm, foreign body)
Bacterial: 50 to 74% bilateral, mucopurulent discharge, 32-39% acute otitis media.
Children: S. aureus, S. pneumoniae, H. influenza
Adults: S. aureus
Viral: 35% bilateral, mild watery discharge, redness, 10% acute otitis media
Neonates: HSV
Adults: Adenovirus (overall most common cause)
Allergic: Usually bilateral, discharge is rare, usually red, no otitis media, MAJOR PRURITIC
*AdenoPlus Test to test for viral vs. bacterial.
Keratoconjunctivitis
Infection of the conjunctiva and cornea
Chorioretinitis
Infection of the choroid and retinal layers
Endopthalmitis
Rare infection of the aqueous and vitreous humor.
Symptoms: Pain, redness, and decreased vision
Cause: Bacteria/Fungi
Exogenous - recent intraolcular eye surgery esp. cataract with agent coming from normal flora: Pseudomonas, Staph, and Candida
Endogenous - Hematogenous spread
Treatment - Fluoroquinolone
Stye/Hordeolum
Localized inflammation often on lower lid due to bacterial growth in eyelash.
Treatment - Keep lid clean. Warm compress or massage to open gland. Erythromycin ointment.
Allergic rhinoconjunctivitis
IgE response (Hay fever)
Affects 20% of US pop.
Onset: Rarely before 2; always before 20
Dx: HISTORY! Recurrent episodes of sneezing, rhinorrhea, nasal congestion, and lacrimation. Pruritis is highly suggestive.
Testing: Skin testing (anitgen exposure) In vitro testing - radioallergosorbent testing (RAST) and enzyme linked immunosorbent testing (ELISA)
Management - Antihistamines, mast cell stabilizers, NSAIDS, avoid antigen, and glucocorticoid
Viral conjunctivitis
Neonatal - HSV
Post natal - Adenovirus (most common) Coxsackie, HSV, VZV (pain before redness), EBV, rubella, mumps, influenze
Acute bacterial conjunctivitis
Mucopurulent
Children - Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae
Adults - Staphylococcus aureus
Self-limited, but decreased morbidity and transmission with treatment. Empiric w/ gram pos and negative coverage. Trimethoprim and polymixin opthalmic drops (Polytrim) or more expensive moxifloxacin drops
Hyperacute bacterial conjunctivitis
Causative agent: Neisseria gonorrhea
Symptoms: Copious yellow-green discharge (purulent), preauricular adenopathy
Gram negative intracellular diplococci that grows on chocolate agar.
Treat promptly with systemic ceftriaxone.
Chylmydia trachomatis
Inclusion conjunctivitis (serogroups D-K)
Trachoma (serotypes A-C) leading cause of blindness worldwide due to multiple infections since no long lasting immunity
Treatment - Azithromycin and improve hygeine; treat sexual partner. (widespread prophylaxis is being used to try to eliminate Trachoma by 2020.
HSV - 1 keratoconjunctivitis
Similar presentation to adenovirus although lesions can be painful especially if scarring of the cornea occurs and often only one eye.
Avoid corticosteroids since can facilitate corneal penetration.
If corneal involvement treat with trifluridine and systemic acyclovir. Consider prophylactic treatment with erythromycin to prevent bacterial superinfection.
Keratitis
Symptoms: Vison defects, photophobia, pain, and foreign body sensation
Risk factors: trauma, drying of epithelia, and hypoxia increase susceptibilty
Causative agents: HSV-1, S. aureus and epidermidis, P. aeriginosa, and Bacillus cereus, Acanthamoeba
Treatment - Moxifloxacin eye drops for bacteria; Acyclovir and trifluridine for HSV-1
Uveitis
Inflammation of uveal tract can lead to blurred vision and permanent vision loss.
Iritis (anterior uveitis) - often not infectious, photophobia, pain, and decreased visual acuity. Caused by Treponema pallidum, HSV, and VZA
Chorioretinitis (posterior uveitis) - most common, floaters, no pain.
Chorioretinitis
Symptoms - blurred vision and visual field defects
Pathophysiology: Blood borne route via retinal arteries, frequently manifestation of systemic disease
Congenital - Toxoplasma and CMV are most common (HIV +)
Two parasitic worm infections (Toxocara canis and Onchocerca volvulus) cause eye infx
Toxoplasma
Most common parasitic disease, late term congenital infections are more likely to produce progressive blindness, diagnose with IgM serology
Treatment: Pyrimethamine (blocks DHFR) and sulfadiazine (blocks pteridine synthetase)
Cauliflower Ear
shearing forces applied to anterior auricle which separates from underlying cartilage. Tears auricular blood vessels creating a hematoma and then stimulates new cartilage growth
Conductive Hearing Loss
increase in hearing thresholds due to decrease in sound transmission through external and/or middle ears. Air conduction is reduced but bone transmission is unaffected.
Positive Rinne and Weber lateralizes to affected ear.
Main causes: Otitis media, otosclerosis, ruptured TM
Otosclerosis
Pathophys: abnormal growth of bone in middle ear causing immobilization of stapes
Initially causes increase in stiffness (low freq) rapidly results in increased mass (high freq)
Bone growth can occur into cochlea sensorineural hearing loss
Common cause of bilateral, gradual hearing loss in adults (60-70% hereditary, females>males, Caucasians)
Low freq sounds affected first high freq almost always affected by time pt seeks tx
Treatment: Stapedectomy or hearing aids. Fluoride prevents.
Otitis media
Acute middle ear space infection. Tubes often blocked. fluid, inflammation under TM
Most or Second most common reason that children visit MD
Risk factors: Day care attendence, smoke exposure, bottle feeding (lack of maternal Anitibodies)
Common etiologic agents: Strep pneumo 25-50%, Haem infl. 15-30%, Moraxella catarrhalis 3-20%, Viral (RSV, rhinovirus) 5-22%, No pathogen identified
May cause tympanic membrane rupture
Sx: Otalgia, Aural fullness, hearing loss, tinnitus. Hearing loss temporary which can cause significant impact on speech development for kids.
Tubes are shorter and less slanted in children
Low freq sounds (speech) affected first – threshold elevations
High freq sounds not affected until mass of middle ear bones is increased –> both low and high frequency sounds are reduced = conductive hearing loss
Complications: Perforated TM, Acute mastoiditis, Abcess, labyrinthe fistula, facial nerve paralysis, meningitis, and more
Choanal atresia
Improper opening of choanae due to failure of apoptosis of oronasal membrane.
“My newborn is having difficulty breathing and can’t breastfeed.”
“My daughter’s nose is always running; she cannot breathe through it.”
Anterior lip and palate defects
Due to the failure of fusion of maxillary prominences with the fused medial nasal prominences.
Involve upper lip, alveolar part of maxilla, and primary palate.
1 in 1000 births and 60-80% males increasing with increasing maternal age.
Posterior palate defects
Due to failure of fusion of the palatine shelves with one another with the nasal septum and with the posterior margin of the primary palate.
Involves hard and soft palate (secondary palate)
1 in 2500 births and 2x as common in girls. No link with maternal age
Wide variation: all of hard and soft palate, only soft palate, only uvula (bifid uvula); unilateral or bilateral
Fetal Alcohol Syndrome (FAS)
Characteristic facial features. (Many FAS don’t show facial features) Classic signs are flat face, small palpebral fissures, small jaws
Majority of features are neurological.
Only 4-6% show physical signs.
Congenital coloboma
Defective closure of the choroid or optic fissure.
It is positioned in the infero-nasal quadrant, relective of the location of the optic fissure during fetal development
Detached retina
Failure of retinal layers to fuse and obliterate intraretinal space between neural retinal layer and retinal pigmented epithelium.
Presents as sudden partial vision loss in one eye. Painless, progressive, and often floaters.
Can occur congenitally (linked with Marfans and Down Syndrome), or later in life secondary to trauma or type II DM. Linked with myopia.
Surgical emergency = lasar demarcation of retinal tear, or scleral buckling procedure.
Congenital cataracts
Lens becomes opaque during intrauterine life.
Etiologies: Rubella infx of mom at 4-9 months Heridiatry Malnutrition Chromosomal abnormalities Radiation Galactosemia
Perilymphatic fistula
Rupture of bony labyrinth causing CSF to flow through the cochlear aqueduct.
Benign Paroxysmal Positional Vertigo
Most common cause of vertigo. Caused by otoconia displacement from utricle into semicircular canal post trauma/ viral infx.
Symptoms are recurrent brief vertigo and ipsilateral nystagmus.
Normal Hearing
Diagnosed via Dix-Hallpike maneuver and treated with epley maneuver to move otoconia back into semicircular canal.
Labrynthitis
Inflammation of inner ear, usually viral cause (1-2 weeks after flu or otitis media) that spreads through round or oval window.
Symptoms: Sudden vertigo and sometimes temporary hearing loss/ tinnitus.
Rx: IV antibiotics, symptomatic control –> antiemetics for nausea and vomitting.
Sensorineuronal hearing loss
Increase in thresholds and/or loss of ability to transduce specific freq. due to damage to cochlea, auditory nerve, or cochlear nucleus.
More commonly due to hair cell damage due to noise (brief high sounds most potential to damage, but all are important)
Exposure/toxic drugs (aminoglycosides cause sterocilia damage and furosemide blocks NKCC in stria vascularis)
Genetic problems w/ endolymph changes possible too (commonly due to connexin genes regualting gap junctions)
Weber lateralizes to normal ear. Normal or absent rinne.
Central Auditory Processing Disorder
Defeciency in central processing of auditory stimuli resulting in “cocktail party effect” in which a patient can’t filter out extra noise.
Generally old patients and will have normal audiograms when in isolated examination room.
Hearing aids often compound problem.
Tinnitus
PERCEPTION of sound when no external stimulus is present. “ringing in the ears”
Very common and can be debilitating.
Cause may be central or peripheal (likely multiple types)
Worsened by loud noises, alcohol, nicotine, caffeine, and many medications (NSAIDS, Antibiotics, and more)
Many treatments
Persbycusis
Loss of hearing that occurs gradually as people age. Affects 1/3 of people over 65.
Can be sensorineuronal, CAPD, or tinnitus
Both peripheral and central causes.
Tympanosclerosis
Calcium plaques from old old ear infx, perforation of drum, or tubes/surgery
Serous otitis media
negative pressure, clear fluid due to eustachian tube obstruction.
Symptoms: bubbles behind TM, do tympanogram if you can’t see fluid (expect flat line result)
Tx: Time/Tubes
Eustachian tube dysfunction
Leads to negatve pressure and eventual erosion of ossicles. More concave TM w/ obvious bony landmarks.
Tx: decongestants, plug nose and blow out to open tube. . Tubes if chronic.
Cholesteatoma
Skin cyst caused by long standing retraction pocket of eardrum into the middle ear. Cyst slowly erodes bone and can eventually cause facial paralysis, hearing loss, dizziness, and eventually erode into brain cavity
Tx: Mastoid operation.
Ear drum perforation
Not uncommon. Caused by Q-tip, loud noise, severe otitis media, or post tubes)
Tx: generally heal, sometimes tympanoplasty needed.
Hemotympanium
Blood in middle ear, generally post trauma. Order CT.
