Diseases Group 3

Question 1

Opthalmia neonatorum

Answer 1

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

Question 2

Blepharitis

Answer 2

Infection of the eyelid

Question 3

Conjunctivitis

Answer 3

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.

Question 4

Keratoconjunctivitis

Answer 4

Infection of the conjunctiva and cornea

Question 5

Chorioretinitis

Answer 5

Infection of the choroid and retinal layers

Question 6

Endopthalmitis

Answer 6

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

Question 7

Stye/Hordeolum

Answer 7

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.

Question 8

Allergic rhinoconjunctivitis

Answer 8

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

Question 9

Viral conjunctivitis

Answer 9

Neonatal - HSV

Post natal - Adenovirus (most common) Coxsackie, HSV, VZV (pain before redness), EBV, rubella, mumps, influenze

Question 10

Acute bacterial conjunctivitis

Answer 10

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

Question 11

Hyperacute bacterial conjunctivitis

Answer 11

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.

Question 12

Chylmydia trachomatis

Answer 12

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.

Question 13

HSV - 1 keratoconjunctivitis

Answer 13

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.

Question 14

Keratitis

Answer 14

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

Question 15

Uveitis

Answer 15

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.

Question 16

Chorioretinitis

Answer 16

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

Question 17

Toxoplasma

Answer 17

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)

Question 18

Cauliflower Ear

Answer 18

shearing forces applied to anterior auricle which separates from underlying cartilage. Tears auricular blood vessels creating a hematoma and then stimulates new cartilage growth

Question 19

Conductive Hearing Loss

Answer 19

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

Question 20

Otosclerosis

Answer 20

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.

Question 21

Otitis media

Answer 21

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

Question 22

Choanal atresia

Answer 22

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.”

Question 23

Anterior lip and palate defects

Answer 23

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.

Question 24

Posterior palate defects

Answer 24

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

Question 25

Fetal Alcohol Syndrome (FAS)

Answer 25

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.

Question 26

Congenital coloboma

Answer 26

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

Question 27

Detached retina

Answer 27

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.

Question 28

Congenital cataracts

Answer 28

Lens becomes opaque during intrauterine life. ``` Etiologies: Rubella infx of mom at 4-9 months Heridiatry Malnutrition Chromosomal abnormalities Radiation Galactosemia ```

Question 29

Perilymphatic fistula

Answer 29

Rupture of bony labyrinth causing CSF to flow through the cochlear aqueduct.

Question 30

Benign Paroxysmal Positional Vertigo

Answer 30

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.

Question 31

Labrynthitis

Answer 31

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.

Question 32

Sensorineuronal hearing loss

Answer 32

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.

Question 33

Central Auditory Processing Disorder

Answer 33

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.

Question 34

Tinnitus

Answer 34

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

Question 35

Persbycusis

Answer 35

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.

Question 36

Tympanosclerosis

Answer 36

Calcium plaques from old old ear infx, perforation of drum, or tubes/surgery

Question 37

Serous otitis media

Answer 37

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

Question 38

Eustachian tube dysfunction

Answer 38

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.

Question 39

Cholesteatoma

Answer 39

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.

Question 40

Ear drum perforation

Answer 40

Not uncommon. Caused by Q-tip, loud noise, severe otitis media, or post tubes) Tx: generally heal, sometimes tympanoplasty needed.

Question 41

Hemotympanium

Answer 41

Blood in middle ear, generally post trauma. Order CT.

Question 42

Epistaxis

Answer 42

"The Goal is Control" Most common causes: Disruption of nasal mucosa, facial trauma, scars, intranasal medications/ recreational drugs, hypertension and/or arteriosclerosis, and anticoagulant meds (High INR) Most common areas are Kiesselbach's plexus on anterior septum (ethmoidal arteries) or Woodruff's plexus in posterior septum (sphenopalatine artery) Treatment: 1.) local pressure 2.) Silver nitrate cautery 3.)Absorbable hemostat 4.) Pack or Rhinorocket (antibiotics for TSS) for *Posterior epistaxis may need foley placement

Question 43

External Ear Malformation

Answer 43

Failure of first cleft to invaginate. Part of several syndromes: first arch syndromes, chromosomal abnormalities. Present as: - Auricular appendages/tags from excess hillock mesenchyme - Auricular cysts (fistulas) from incomplete fusion of hillocks - Microtia: abnormal shape or size of the ear which varies in severity. Can be unilateral or bilateral. - Anotia: agenesis, inner ear may be normal and individual may have normal hearing.

Question 44

Congenital Neurosensory deafness:

Answer 44

Neurosensory deafness: - abnormal development of cochlea, cranial nerve VIII, or brain stem - Rubella in first trimester can have defects in organ of Corti in 30% of cases - Neural Crest defect: migratory melanocytes from NC don't properly form stria vascularis

Question 45

Congenital conduction deafness:

Answer 45

- Persistence of meatal plug (seen in first arch syndrome) - Fixation of footplate of stapes - Abnormalities of malleus and incus often involved in first arch syndrome

Question 46

Microopthamia

Answer 46

Arrested development of optic vesicle; globe is small, lens does not form

Question 47

Anopthalmia

Answer 47

Arrested development of optic vesicle early in 4th week, usually accompanies severe craniocerebral defects.

Question 48

Congenital glaucoma

Answer 48

Cloudy cornea from abnormally high intraocular pressure, usually from malformed drainage apparatus. Genetic abnormalities account for 85% of cases and Rubella for rest Cupping of eye exam.

Question 49

Persistent hyaloid artery or pupillary membrane

Answer 49

failure of either structure to completely dissolve during development. Hyaloid artery: normal regression around 11 weeks and is complete by 8 months. Generally little or no visual defect if persists Pupillary membrane: may interfere with visual acuity

Question 50

CHARGE syndrome

Answer 50

Coloboma, heart defects, atresia of choanae, retarded growth/development, genital hypoplasia, ear abnormalities

Question 51

Congenital Ptosis

Answer 51

Does not affect vision and correctable via surgery by tightening LPS Autosomal dominant trait Can result from birth trauma, myasthenia gravis, abnormal CN III development, or dysgenesis of LPS

Question 52

Nasolacrimal groove atresia

Answer 52

Results in canalization failure, infection is common, and newborn may have constant tearing/mucuous drainage, and subsequent chapping of periocular skin

Question 53

Macular degeneration

Answer 53

Degeneration of RPE leading to blurry vision and loss of central vision first

Question 54

Vitamin A defeciency

Answer 54

Night blindness due to loss of 11-Cis-Retinal

Question 55

Marcus Gunn pupil or relative afferent pupillary defect (RAPD)

Answer 55

Monocular defect in cranial nerve 2 afferent for pupillary response. No consensual or ipsilateral pupillary constriction on affected eye, but consensual and ipsilateral reaction when testing normal eye.

Question 56

Argyll Robertson pupils

Answer 56

bilateral small pupils that reduce in size when the patient focuses on a near object (they “accommodate”), but do not constrict when exposed to bright light (they do not “react” to light). They are a highly specific sign of neurosyphilis, and might also be a sign of diabetic neuropathy

Question 57

Temporal Bone Fracture (hearing loss)

Answer 57

Post trauma Ssx: Headache, vertigo, SNHL, CHL, facial nerve paralysis, CSF leak RX: CT --> Neurosurgical

Question 58

Acoustic Neuroma

Answer 58

Ssx: asymmetric SNHL, vertigo, facial nerve paralysis, aural fullness, trigeminal numbness, diplopia Dx: MRI of IACs w/ contrast Rx: Observation vs. Surgery vs Radiation

Question 59

Vertigo

Answer 59

Illusion of movement. Commonly epidsodic

Question 60

Dysequilibrium

Answer 60

Sense of poor coordination with erect posture or movement, usually continuous

Question 61

Imbalance

Answer 61

Implies orthapedic or neuro problem

Question 62

Dizziness

Answer 62

All-encompassing term (i.e. light-headed, orthostatic, hypoglycemic, inability to concentrate)

Question 63

Meniere's Disease

Answer 63

Ssx: Fluctuating SNHL, Tinnitus, Episodic vertigo (min-hr), often totally asymptomatic between spells. Rx: R/O stroke, tumor, infx, trauma, hypothyroid. Salt restriction. Ppy: believed to be inflammatory

Question 64

Vestibular Neuronits

Answer 64

Ppy: viral infection of the vestibular nerve SSx: Vertigo lasts hours to days w/o hearing loss May last weeks to months and preceded by URI Rx: Meclizine, benzos, antiemetics

Question 65

Microtia

Answer 65

Grade I: Ear is slightly smaller than normal; surgery not needed Grade II: Auricle is half sized; surgery is sometimes beneficial Grade III: Small cartilage present; surgical repair at age 5-6.

Question 66

Lop Ear

Answer 66

Most common external abnormality. Absence of antihelical fold. Cosmetic surgery offered

Question 67

Preauricular pits and fistulas

Answer 67

Frequently infected pits in front of ear Rx with antibiotics and incision and drainage. Frequently bilateral

Question 68

Auricular appendages

Answer 68

Ppy: Arrested development of fusion of the Hillocks of His. Growth that contains cartilage and skin. Rx: Elective excision Note: facial nerve is quite superficial in infants and toddlers.

Question 69

Relapsing Polychondritis

Answer 69

Autoimmune disease of external ear that is episodic and inflammatory. Dx: elevated ESR and IgG Rx: Steroids and NSAIDS DDx: between cellulitis

Question 70

Nodularis Chornicus Helicus

Answer 70

Very painful benign growth on helix of old patients. Rx: Excisional biopsy

Question 71

Keloids of the ear

Answer 71

Avoid piercing. Early Rx: Steroids Late Rx: Excision

Question 72

Auricular Hematoma

Answer 72

Caused by trauma. Rx: Incison, drainage, and BOLSTER; if untreated results in cauliflower

Question 73

Cellulitis of the pinna

Answer 73

Key organisms: Staph, Strep, Psuedomonas

Question 74

Osteomas

Answer 74

Benigh projections in canal that is more common in norweigians. Linked to cold water exposure. Surgical removal is rarely indicated Looks like cholesteatoma

Question 75

Carcinoma of Ear Canal

Answer 75

Painful, bleeding, soft tissue mass in canal. Needs Biopsy. Rx: Excision and radiation. Can metastasize and kill.

Question 76

Otitis externa

Answer 76

Sx: Very painful red swollen canal with purulence. Painful to rotate or palpitate external ear. Risk factors: swimmers, Q tip users, diabetics, immunocompromised. Rx: AB drops and systemic ABs w/ topical suctioning and debridement (sever cases) Causative agents: Pseudomonas, E coli, Staph corynebacter. Also Candida and other fungal Hearing may be affected.

Question 77

Herpes Zoster Oticus

Answer 77

Sx: purulent ulcers in and around ear, decresed hearing, SEVERE pain, Facial nerve paralysis Rx: Antiviral and pain relief Risk factor: immunocompromised

Question 78

Otorrhea (Ear drainage)

Answer 78

Ddx: Otitis media, otitis externa, allergy, trauma, CSF leak Dx: culture, GM stain, beta 2 transferrin for CSF

Question 79

Ear canal stenosis

Answer 79

Can be congenital or secondary to trauma and infx. Small amt of cerumen clogs ear. Rx: canalplasty

Question 80

Otomycosis

Answer 80

Sx: itching painful ear drainage w/ decreased hearing. Secondary to antibiotic rx. Rx: Antifungal drops, pills, pain relief, debridement

Question 81

TM perforation

Answer 81

Ppy: Secondary to Otitis media, trauma, slag burns, indwelling PE tubes, etc. Rx: keep ear dry and consider tympanoplasty in severe or persistent cases. Often heal on own.

Question 82

Bullous myringitis

Answer 82

Inflamed TM w/ serous bullae. Associated w/ virus of mycoplasma post URI. Sx: otalgia, otorrhea, hearing loss Rx: analgesia, ABs, decompression of vesicle, steroids

Question 83

Dermoid Cyst

Answer 83

Cysts consist of squamous cell epithelium containing epidermal appendages. Several possible locations: fronto-temporal region, orbital region, or nasoglabellar region.

Question 84

Naso Encepahlocele

Answer 84

Extracranial protrusions of meninges, CSF fluid, and neural tissue. Meningoceles present similarly w/o herniation of brain tissue. Dx: CT scan (Looks like Jhonny!)

Question 85

Nasal Glioma

Answer 85

Congenital neoplasm on the nose. Varying theories on origin.

Question 86

Nonallergic Rhinitis

Answer 86

Rhinitis caused by virus, occupational exposures, abuse of antihistamines, and more.

Question 87

Sinusitis (Rhinosinusitis)

Answer 87

Complex group of disorders with inflammation as the major universal finding Affects almost 15% of US pop. Ppy: Bacterial: S. aureus, M Cat, H Influ --> biofilms Fungi, Allergic Dx: Head CT (gold standard) to visualize paranasal sinuses. Nasal endoscopy

Question 88

Chronic Sinusitis

Answer 88

Inflammatory not infectious sinusitis. Treatment = nasal saline lavage.

Question 89

Hoarse Voice

Answer 89

Many causes. The big ones that we can control are smoking, drinking, DM, GERD, and overuse. Other rarer causes such as tumors that can be ruled out via scoping.

Question 90

Cataracts

Answer 90

Opacity of the normally clear lens caused by age, metabolic disorder (hyperglycemia, hypergalactosemia etc.), trauma, or hereditary. Generally painless and bilateral. Indications for surgery: severity of visual loss, functional needs of patients, need to improve view of posterior eye to care for occular pathology Risk factors: age, smoking, EtOH, sunlight, DM, classic galactosemia, galactokinase deficiency, trauma, infx. Rx: Cataract surgery and lens replacement

Question 91

Dry Macular Degeneration

Answer 91

Degeneration of macula. Causes central vision loss (scotomas) that is slow, due to fat deposits and causes gradual decrease in vision. Age Related if after 50; usually over 70 Eye exam = Drusen around macula and atrophy of retina Rx: quit smoking, nutritional recommendations, AREDS (antioxidants and zinc in high levels) supplements, manage systemic diseases

Question 92

Wet (exudative) Macular Degeneration

Answer 92

Defects in deep retinal layers. Degeneration of macula. Causes central vision loss (scotomas) that is rapid due to neovascularization, edema, and hemorrhage. Eye exam = neovascularization, edema, hemorrhage, and eventual scarring and vision loss. Age Related if after 50; usually over 70 Rx: quit smoking, nutritional recommendations, AREDS (High amounts of zinc and antioxidants) supplements, manage systemic diseases. And conventional laser, photodynamic therapy, anti-vegf drugs.

Question 93

Open Angle Glaucoma

Answer 93

Increased ocular pressure causes optic nerve loss. Can be multifactorial. Caused by obstructed outflow (i.e. canal of schlemm) Painless with slow onset. More common over age 40 Risk factors: Age, African American, and myopia Treatment: Decrease production, increase outflow. Beta blockers, acetazolamide, prostaglandin analogs, topical cholinergic agonists, and topical alpha agonists and irodotomy surgery putting hole in iris. Eye exam: Monitor cupping and cupping ratio. 0.3 is the normal average (varies greatly between patients so progression is more important than numbers)

Question 94

Closed Angle Glaucoma

Answer 94

Increased ocular pressure causes optic nerve loss. Can be multifactorial. Obstruction of flow between iris and lens leading to pressure buildup behind iris. Symptoms: Red eye, +/- nausea, very painful, decreased vision, rock-hard eye (touch it!) frontal headache. Opthalmologic emergency! Give pilocarpine, acetazolomide, oral glycerine or isosorbide. Get to optho ASAP for laser iridotomy.

Question 95

Nonproliferative diabetic retinopathy (NPDR)

Answer 95

PPY: Diabetic induced vascular damage leading to neovascularization and other symptoms below. Eye exam: Blot hemorrhages, Cotton wool spots, microaneurysms, macular edema, hard exudates. Prevention by controlling blood sugars (use this as a motivator! Also can reverse minor retinopathy w/ sugar control. Steroid injection can be short term fix as well. Treat early and aggressively!

Question 96

Proliferative Diabetic Retinopathy (PDR)

Answer 96

PPY: Diabetic induced vascular damage leading to neovascularization and other symptoms below. Eye exam: Neovascular vitreoretinopathy with vietrous hemorrhage. Prevention by controlling blood sugars (use this as a motivator! Also can reverse minor retinopathy w/ sugar control. Steroid injection can be short term fix as well. Treat early and aggressively! Treatment: Panretinal Photocoagulation

Question 97

Hypertensive Retinopathy

Answer 97

Ppy: Narrowing and sclerosis of arterioles (sliver wired arterioles on eye exam) leading to flame hemorrhages within retina, cotton wool spots, and optic nerve edema Rx: Treat blood pressure! If significant occlusions and ischemia can use panretinal photocoagulation (PRP)

Question 98

Amuaurosis Fugax

Answer 98

Sudden loss of vision in one eye that lasts only minutes. Painless. Generally due to vascular insufficiency, so cardiac workup before optho work up.

Question 99

Retinal Cholesterol Emboli

Answer 99

Non occlusive emboli seen in occular vessels that is a warning sign of future disaster in vascular system. Workup with carotid ultrasound and echocardiogram.

Question 100

Opthalmic Migraine

Answer 100

Scintillating scotoma is hallmark (visual aura) Symptoms: painless and temporary, involves both eyes causing temporary hemianopsia. Time is key =20-30 min. Etiology: spasm of arteriole in occiptial cortex Rx:

Question 101

Retinal Arterial Occlusion

Answer 101

Sx: sudden severe loss of vision in one eye. Painless. Usually permanent unless caught quick! CHERRY RED SPOT on eye exam with pale retina. Treatment protocol: rebreathing CO2, Timolol, IV acetazolamide, massaging globe, refer to optho!

Question 102

Retinal Vein Occlusion

Answer 102

Central (CRVO), or Branch (BRVO) Symptoms are SQUASHED TOMATO on eye exam. Risk factors: HTN, DM

Question 103

Temporal Arteritis (Giant Cell Arteritis)

Answer 103

Sx: Headache and extreme scalp tenderness. Fever, weight loss, jaw claudication, polymyalgia rheumatica. Vision loss secondary to inflammatory vaso-occlusion. Vision loss can be severe involving one or both eyes. Often permanent. Dx: STAT ESR and CRP. Biopsy of artery. Rx: Start high dose steroids IMMEDIATELY. Pale and swollen optic nerve (acutely ischemic)

Question 104

Visual CVA

Answer 104

Sudden painles loss of vision causing bilateral hemianopsia. Usually involves occipital cortex.