EarEyes-Table 1 Flashcards
- What is the process by which muscle contraction protects the cochlea from loud noises? What is it called?
Tensor tympani pulls eardrum inward, tightening it; stapedius reduces mobility of stapes
Tympanic reflex
How is sound produced?
Vibration of ossicles by tympanic membrane, transmitted through oval window and then vibration of basilar membrane under hair cells
An older patient is no longer able to hear the tea kettle whistling when it is done, what type of hearing loss is this associated with? What is this hearing loss called where high frequency is lost first?
Sensorineural hearing loss (AC>BC)
Presbycusis
What are the three types of hearing loss?
Conductive, sensorineural, mixed
A patient has received a treatment of gentamycin, what may he/she come back with complaints of? Specifically, what type?
Ototoxicity, sensorineural hearing loss
A patient has come into your office complaining of dizziness x2 weeks and an occasional hearing loss of low-frequency sounds. He also states that there seems to be a sense of fullness and ringing in his ear. What are you thinking this may be? Treatment/plan?
Meniere’s Disease
Low Na diet; restricted water intake, caffeine, chocolate, alcohol restriction for prevention
Can use Diazepam zonk for an acute phase…as well as so many other things
Surgery may be end result (shunt/decompression, nerve resection)
A patient comes in to your office complaining of suddenly not being able to hear out of his left ear. Upon inspection the canal is patent, clear of cerumen, and no significant findings seen…what should you do with this patient?
Refer to otolaryngology
True or False: Tympanometry can be utilized as a screening test for middle ear dysfunction and requires patient response.
False…it is a screening test, but no patient response required
Patient is complaining of ear pain and frequently swims. What is most likely going on? What is the most likely organism? How do you treat it? What happens if it is fungal? Most common fungal cause?
Otitis externa Staph aureus/maybe pseudomonas aeruginosa Oflaxacin most common, analgesia Acidification and consider clotrimazole Aspergillus
A 24 year old patient returns to your clinic after an ear ache has now moved to “behind her ear” and really hurts when she touches it. She is an avid swimmer and recently had an otitis externa infection. What would be on the differential for this and why is this so worrisome?
Mastoiditis/necrotizing or malignant OE
Mastoiditis is continuous with the brain; high mortality rate, even with treatment (surgical debridement and prolonged abx)
A 30 year old man comes into the office in January complaining of ear pain and some hearing loss. His vitals show a low grade fever, bulging TM, and opaque fluid seen behind it. What is this patient experiencing and how would you treat it?
Acute otitis media
Primary treatment = Amoxicillin 500 mg PO TID x10days
Secondary Augmentin 875/125 PO BID x10 days
2nd or 3rd gen cephalo x10 days
The 30 year old patient above also brought his 4 year old son in experiencing identical symptoms, but just finished a 10 day course of Amoxicillin 90mg/kg/day. PE shows TM perforation and a fever. How should you manage this patient?
Refer…(emergency ENT?)
In regards to the macula (in vestibular apparatus), what does it do?
Perceive linear acceleration for dynamic equilibrium
True/False: Otoliths add to the density and inertia and enhance the sense of gravity and motion.
True
True/False: The crista ampullaris, located in the semicircular ducts of the cochlea, can be stimulated by rotation in different planes. This shows angular movement.
True
What is the Dix-Hallpike maneuver useful for?
Benign positional paroxysmal vertigo by moving the head through different planes and thus checking the semicircular ducts…patients eyes will remain open so also looking for nystagmus
What is the most common cause of a “red eye”?
Conjunctivitis
Patient comes into the office with a complaint of a red eye and not being able to open their eyes very easily in the mornings, have to wipe “gunk” off. PE shows conjunctival injection and mucopurulent discharge. What is the most likely diagnosis and cause?
Bacterial conjunctivitis and pneumococcus most common in temperate zone
Treat with topical antibiotics
You have an 18 year old male patient come into your office complaining of a red eye and painful urination. What are we thinking and what is the eye component associated with it?
Reiter’s (Reactive) arthritis and bilateral sterile conjunctivitis
A frequent boater comes into your office complaining of a red “thing” on the side of his eye near his nose and slightly impaired vision in that eye. He wants to know what it is. PE shows a vascular lesion on the medial side of the eye that is encroaching on the cornea. What do you tell him it is and what should be done?
Pterygium
Surgical excision; can lead to blindness
A patient comes in with pain in the eye, photophobia, and ocular redness. His history is positive for juvenile idiopathic pauciarthritis. PE shows iritis with pupillary contraction and abnormal visual exam. Fundoscopic results show a slightly cloudy anterior chamber. What is the most likely cause?
Uveitis
PS, 25 year old male, comes into your office with complaints of painful bump on their left eye around the lashes. What is on the differential and what is the organism usually associated? What
Hordeolum
Staph infection of the Meibomian glands or Glands of Zeis or Moll
What is a complication of an untreated hordeolum? What happens?
Orbital cellulitis
Swollen, red eyelids with chemosis, pain, exophthalmos, fever, leukocytosis
Refer ophthalmologist where it is treated aggressively
DD, 23 year old female, comes into the office complaining of pain and redness in her right eye with cloudy vision. PE shows ciliary flush in the right eye, with a mid-dilated and fixed pupil. Tonometry shows IOP of 22 mmHg. What is the most likely cause?
Acute glaucoma Note: can treat with Acetazolamide (PO or IV), topical ß-blockers, pilocarpine to induce miosis. Laser can be used at treatment failure to create a hole in the peripheral iris
True/False. Myopia is the most common cause of refractive error in the older population.
False; myopia is most common in teens/early 20s; prespyopia most common over 40 (accommodation)
All of the following, except which, are criteria for glaucoma? Appearance of nerve heads Visual field determinations Degree of discomfort Level of intraocular pressure Genetic history
Degree of discomfort
A patient with history of ocular trauma is complaining of increased cloudiness in vision. PE shows an abnormal red-reflex. What is the most likely possibility and only treatment option?Cataract
Keratitis
Retinal detachment
Retinoblastoma
Cataract—Surgery excision of lens and placement of plastic or silicone intraocular lens in the empty lens capsule
A diabetic patient with sickle cell disease comes into the office complaining of hazy vision. On ophthalmoscopy it is difficult to see through the vitreus humor due to a dark haze of blood. What is the most likely cause?
Cataract
Iritis
Hemorrhage due to secondary neovascularization
Glaucoma
Hemorrhage due to secondary neovascularization
A patient with history of ocular trauma and subsequent cataract extraction comes to the office complaining of floaters and flashing lights in the peripheral visual field with a blind spot in the far left peripheral field area. PE shows a small hole in the vitreus chamber of the eye and a flap where vitreus fluid has gone behind. What is the most likely cause?Another cataract
Retinal detachment
Macular degeneration
Papilledema
Retinal detachment
A 76 year old male patient is in for a routine annual physical exam with a comment that his vision has gotten worse. Fundoscopic exam shows multiple spots of drusen in the macula bilaterally. What is the most likely cause? Exudative macular degeneration Amaurosis fugax Non-exudative macular degeneration Glaucoma
Non-exudative macular degeneration
Treatment is vitamin C and E, ß-carotene, and zinc to retard dry macular degeneration
Treatment for exudative includes direct injection into the vitreus cavity on a monthly basis of antagonists to vascular endothelial growth factor (Bevacizumab, Ranibizumab, or aflibercept).
A patient has come into the ED by EMS after falling off a platform onto the concrete. CT shows a subdural hematoma on the right fronto-temporal region and the patient is now complaining of vision loss in the right eye as well. What is the most likely cause of his vision loss?
Optic neuririts
Optic disc edema-papilledema secondary to ICP
Glioma
Pituitary adenoma
Optic disc edema-papilledema secondary to ICP
A 30 year old patient with complaint of eye pain with movement, altered vision, and sudden “color blindness”. PE shows abnormal visual field exam and funduscopic exam shows a normal ocular fundus. What imaging should be done and then what is the most likely course of treatment?
Imaging
CT
MRI
US
Nuc Med scan
Looking for plaque deposits indicative of demyelinating lesions on optic nerve
Treatment
Topical glucocorticoids
IV methylprednisolone followed by PO prednisone
IV Antibiotics
Immunoglobulins to treat infection
High dose steroid treatment has been shown to increase recovery time of vision
MRI and IV methylprednisolone followed by PO prednisone
A patient comes in with severe anxiety and hysterical account of vision loss. No significant findings on PE, unchanged since last visit. Patient seems to be remaining and insisting something is wrong with increasing anxiety and hysteria. What is the most likely cause of this malingering? Psychogenic Optic neuritis Papilledema Acute angle closure glaucoma
Psychogenic
The most common cause of exophthalmos is: Graves’ disease Meningioma Increased intracranial pressure Diabetic retinopathy
Graves’ disease
A diabetic patient should have routine eye exams with a baseline eye exam done at diagnosis of diabetes for which of the following reasons: Retinopathy Flame hemorrhages Retinal detachment Cataract
Retinopathy
What is the hallmark of diabetic retinopathy seen on funduscopic exam? Flame hemorrages Drusen Neovascularization Copper wiring
Neovascularization
TE, a sweet 66 year old grandmother comes into the office for her annual physical exam. She has history significant for longstanding hypertension and has shown difficulty finding a regimen that can maintain an optimal blood pressure. All of the following changes are being observed for during a funduscopic exam, except: Flame hemorrhages AV-nicking Papilledema Arterioloar narrowing Increased vascular toruosity
Papilledema
