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PANCE 2.0 > EENT #2 > Flashcards

EENT #2 Flashcards

1
Q

What is the MC type of macular degeneration?

A

Dry (progressive, over decades)

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2
Q

True or False: Wet macular degeneration is not as common as dry, but is more aggressive?

A

True. It progresses within months

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3
Q

Symptoms of macular degeneration

A
  • Bilateral, progressive central vision loss including detailed and colored vision
  • Metamorphopsia (straight lines appear bent)
  • Micropsia (objects seem smaller in the affected eye)
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4
Q

What is seen on funduscopic examination for dry macular degeneration?

A

Drusen bodies: small round yellow white spots on the outer retina

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5
Q

What is seen on funduscopic exam for wet (exudative) macular degeneration?

A

-New abnormal vessels that can cause retinal hemorrhages and scarring

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6
Q

What are three ways to diagnose and monitor macular degeneration?

A
  • Funduscopy
  • Fluorescein angiography
  • Amsler grid
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7
Q

Management of dry macular degeneration

A
  • Zinc and antioxidant vitamins (C&E) may slow progression

- Amsler grid to monitor stability

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8
Q

Management of wet macular degeneration

A
  • Intravitreal VEGF Inhibitors (Bevacizumab, Ranibizumab, Aflibercept)
  • laser photocoagulation
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9
Q

What is the MCC of new, permanent vision loss in 20-74 year olds

A

Diabetic retinopathy

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10
Q

What are the two types of diabetic retinopathy?

A

Nonproliferative and proliferative

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11
Q

What are some exam findings of a patient with nonproliferative (background) Diabetic retinopathy?

A
  • Microaneurysms
  • Cotton wool spots (soft, white grey fluffy spots)
  • Hard exudates: yellow spots with sharp margins that circinate (circular)
  • Blot and dot hemorrhages (bleeding into deep retinal layer)
  • Flame shaped hemorrhages
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12
Q

What are some exam findings of a patient with proliferative diabetic retinopathy?

A

-Neovascularization: growth of new abnormal blood vessels that can lead to vitreous hemorrhage

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13
Q

Treatment for nonproliferation diabetic retinopathy?

A

Strict glucose control, laser treatment

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14
Q

Treatment for proliferative diabetic retinopathy

A
  • VEGF inhibitors intravitreal injection
  • Laser photocoagulation treatment
  • Strict glucose control
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15
Q

How often are diabetic eye exams performed to detect retinopathy?

A

Annually

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16
Q

What is hypertensive retinopathy?

A

Damage to retinal blood vessels from longstanding high blood pressure

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17
Q

Explain the difference in severity in a patient with copper wiring and silver wiring with hypertensive retinopathy?

A

Copper wiring: moderate narrowing

Silver wiring: severe narrowing

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18
Q

What is seen with severe (Grade IV) hypertensive retinopathy?

A
  • Copper wiring
  • AV nicking
  • Flame hemorrhages
  • Cotton wool spots
  • Papilledema
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19
Q

What are some risk factors for a retinal detachment

A
  • Myopia (nearsightedness)
  • previous cataract surgery
  • Advancing age
  • Trauma
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20
Q

MC type of retinal detachment

A

Rhegmatogenous: full thickness tear causes retinal inner sensory layer to detach from choroid plexus

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21
Q

What type of retinal detachment is a result of proliferative diabetic retinopathy, sickle cell disease, or trauma?

A

Tractional: adhesions separate the retina from its base

22
Q

Symptoms of a retinal detachment

A
  • Photopsia (flashing lights)
  • Floaters
  • Progressive unilateral peripheral vision loss
  • Shadow or curtain/veil coming down in periphery
  • Followed by central vision loss
  • No ocular pain
23
Q

What diagnostic study is done to detect a retinal detachment?

A

Funduscopy

24
Q

What is seen on funduscopy with a retinal detachment?

A

Shafer’s Sign: clumping of brown pigment vitreous cells in the anterior vitreous humor resembling “tobacco dust”

25
Q

A retinal detachment is an ophthalmologic emergency. What recommendations should you give the patient?

A

-Keep patient supine with head turned toward side of detachment

26
Q

What is ophthalmia neonatorum?

A

Neonatal Conjunctivitis

27
Q

If the neonatal conjunctivitis occurs on Day 1, what is the most likely cause?

A

Chemical conjunctivitis due to silver nitrate

-Artificial tears may be helpful once it occurs

28
Q

If the neonatal conjunctivitis occurs on Days 2-5, what is the most likely cause?

A

Gonococcal most likely cause

-Purulent conjunctivitis with exudate and swelling of the eyelids

29
Q

If gonococcal in nature, what is the treatment and prophylaxis for neonatal conjunctivitis?

A
  • Prophylaxis: Topical erythromycin to prevent infection

- Treatment: IM or IV Ceftriaxone

30
Q

If the neonatal conjunctivitis occurs on Days 5-7, what is the most likely cause?

A

Chlamydia Trachomatis may occur up to 23 days after birth

31
Q

What is the treatment for chlamydia neonatal conjunctivitis?

A

Oral erythromycin

32
Q

Standard neonatal prophylaxis against gonococcal conjunctivitis given immediately after birth is

A

Erythromycin ointment 0.5%

33
Q

True or False: Neonatal ocular prophylaxis is NOT effective in preventing neonatal chlamydial conjunctivitis

A

True

34
Q

What is seen on fluorescein staining with a corneal abrasion?

A

Ice rink/linear abrasions

evert eyelid to look for it

35
Q

What is the management for ocular foreign body and corneal abrasions?

A
  • Antibiotic drops
  • -Non contact lens wearers: Erythromycin ointment, Polymyxin-Trimethoprim, Sulfacetamide
  • -Contact lens wearers: Pseudomonal coverage (Topical Ciprofloxacin or Ofloxacin)
36
Q

What if a rust ring is present with a corneal abrasion

A

Remove at 24 hours using rotating burr by an ophthalmologist

37
Q

What contraindication must be remembered if the patient is a contact lens wearer and Pseudomonas is suspected?

A

Do not patch!

38
Q

True or False: Antibiotics containing corticosteroids are not used in corneal abrasions or foreign bodies because they can prolong healing and open the patient up to superinfection?

A

True

39
Q

MCC of bacterial conjunctivitis in adults

A

Staph Aureus

40
Q

What are other causes of bacterial conjunctivitis?

A 
Strep Pneumo
H. Influenzae
M. Catarrhalis
N. Gonorrhoeae
Chlamydia Trachomatis
41
Q

Symptoms of bacterial conjunctivitis

A
  • Purulent discharge
  • Lid crusting (eye stuck shut in the morning)
  • Conjunctival erythema with no ciliary injection (limbal flush)
  • No significant visual changes
42
Q

What diagnostic should be done to determine what bacteria is at play with the conjunctivitis?

A

Culture and gram stain of the discharge

43
Q

If the patient is not a contact lens wearer, what is the treatment for bacterial conjunctivitis?

A

-Erythromycin ointment, Trimethoprim-Polymyxin B, Fluoroquinlones (Ofloxacin)

44
Q

If the patient is a contact lens wearer, what treatment should be given for bacterial conjunctivitis?

A

-Cover Pseudomonas (Topical Ciprofloxacin or Ofloxacin)

Alternatives are: Topical Aminoglycosides (Tobramycin or Gentamicin)

45
Q

MCC of viral conjunctivitis?

A

Adenovirus

46
Q

Viral conjunctivitis is high contagious from

A

direct contact

47
Q

What is the MC source during outbreaks of viral conjunctivitis?

A

Swimming pools

48
Q

Symptoms of viral conjunctivitis

A
  • Foreign body or gritty sensation
  • Itching
  • Normal vision
  • Starts unilateral and progresses to bilateral in 1-2 days
  • Accompanying viral symptoms
49
Q

What are some physical exam findings of a patient with viral conjunctivitis?

A
  • Ipsilateral preauricular LAD
  • Copious watery tearing
  • Punctate staining on slit lamp
50
Q

What is the treatment for viral conjunctivitis?

A
  • Supportive is mainstay
  • Warm to cool compresses
  • Artificial tears
  • Antihistamines for itching (Olopatadine)

PANCE 2.0 (62 decks)

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