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PANCE 2.0 > EENT #3 > Flashcards

EENT #3 Flashcards

1
Q

In allergic conjunctivitis, contact of the allergen with the eye causes ______ and ______

A

Mast cell degranulation and release of histamine

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2
Q

Symptoms of allergic conjunctivitis

A
  • Conjunctival erythema (red eyes)
  • Normal vision
  • Allergic symptoms (nasal congestion, sneezing)
  • Marked pruritus (hallmark)
  • Atopic history (hay fever)
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3
Q

Name some physical exam findings of a patient with allergic conjunctivitis

A 
Cobblestone mucosa to inner upper eyelid
Watery or mucoid discharge
Erythema
Chemosis (conjunctival edema)
No visual deficits
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4
Q

Treatment for allergic conjunctivitis

A
  • Symptomatic Treatment is mainstay
  • -Topical antihistamines: Olopatadine, Pheniramine-Naphazoline
  • -Topical NSAIDs: Ketorolac
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5
Q

True or False: Alkali ocular burns are worse than acid burns?

A

True

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6
Q

What happens in an alkali ocular burn?

A

-Causes liquefactive necrosis, denatures proteins and collagen, causes thrombosis of vessels

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7
Q

What happens in an acidic ocular burn?

A

Coagulative necrosis (cleaners, batteries)

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8
Q

Symptoms of an ocular chemical burn

A
  • Ocular pain
  • Decreased vision
  • Blepharospasm (inability to open eyelid)
  • Photophobia
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9
Q

Management for an ocular chemical burn

A
  • Immediate irrigation until neutral pH (7.0-7.4) with lactated ringers or normal saline for 30 minutes
  • Topical Antibiotic: Polymyxin-Trimethoprim, Erythromycin ointment or Moxifloxacin
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10
Q

What is strabismus?

A

Misalignment of one or both eyes

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11
Q

Stable ocular alignment is not usually present until age _______

A

2-3 months

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12
Q

When is a referral needed for strabismus?

A

If it persists > 4-6 months of age to reduce incidence of amylopia

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13
Q

What is esotropia?

A

Convergent strabismus (deviated inward/nasally) - cross eyed

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14
Q

What is exotropia?

A

Divergent strabismus (deviated outward) - temporally

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15
Q

Symptoms of strabismus?

A

Diplopia
Scotomas
Amblyopia
Asymmetric corneal reflex

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16
Q

What is often used as the initial screening for strabismus?

A

Hirschberg corneal light reflex testing: asymmetric deflection of the corneal light reflex in one eye

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17
Q

What other diagnostic can be done to diagnose strabismus?

A

Cover-uncover test

Convergence testing

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18
Q

Management of strabismus

A

Patch (occlusive) therapy is first-line: normal eye covered to strengthen the affected eye
Eyeglasses
Corrective surgery if unresponsive to patching

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19
Q

What is orbital (septal) cellulitis?

A

Infection of the orbit posterior to the orbital septum

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20
Q

Orbital cellulitis is often polymicrobial. What are some common causes?

A
  • S. Aureus
  • Streptococci
  • GABHS
  • H. Influenzae
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21
Q

MC etiology of orbital cellulitis

A

Secondary to sinus infections (Ethmoid)

22
Q

Symptoms of orbital cellulitis

A
  • Ocular pain with eye movement
  • Ophthalmoplegia (EOM weakness)
  • Diplopia
  • Proptosis
  • Visual changes
  • Eyelid edema and erythema
23
Q

What diagnostic can be done for orbital cellulitis?

A

High resolution CT scan

24
Q

Management of orbital cellulitis

A

-Admission + IV ABX (Vancomycin + Ceftriaxone/Cefotaxime) (Ampicillin-Sulbactam), Piperacillin-Tazobactam), (Clindamycin) are all options

25
Q

What is preseptal cellulitis?

A

Infection of the eyelid and orbit anterior to orbital septum

26
Q

MCC of preseptal cellulitis

A

Staph A (including MRSA), Streptococci, and anaerobes

27
Q

Symptoms of preseptal cellulitis

A
  • Unilateral ocular pain
  • Eyelid erythema
  • Edema
  • Absence of proptosis, ophthalmoplegia, ocular pain with EOM movements
28
Q

How do you distinguish orbital cellulitis from preseptal cellulitis?

A

Orbital has ocular pain with eye movement, ophthalmoplegia and proptosis
Preseptal does not have any of these symptoms

29
Q

What is the best test to distinguish between preseptal and postseptal cellulitis?

A

CT scan

30
Q

Management of preseptal cellulitis?

A
  • Outpatient if > 1 year of age and mild
  • -MRSA coverage: Oral Clindamycin
  • -Other options: Bactrim + Amoxicillin/Augmentin (Amox-Clav)
31
Q

What exactly is keratitis?

A

Corneal inflammation

32
Q

What are the common causes of bacterial keratitis?

A
  • Staph Aureus
  • Streptococci
  • Pseudomonas in contact lens wearers
33
Q

Risk factors for bacterial keratitis

A
  • Improper contact lens wear (greatest risk factor)
  • Dry ocular surfaces (such as inability to close eye with Bell palsy)
  • Topical corticosteroid use
34
Q

Symptoms of bacterial keratitis

A
  • Ocular pair
  • Photophobia
  • Eye Redness
  • Vision changes
  • Discharge
  • FBS
  • Difficulty keeping eye open
35
Q

What is seen on physical exam with a patient with bacterial keratitis?

A
  • Conjunctival erythema
  • Ciliary injection (limbal flush)
  • Hazy cornea (opacification and ulceration)
  • Increased fluorescein uptake on slit lamp
36
Q

Management for bacterial keratitis

A

Fluoroquinolone topical: Moxifloxacin, Gatifloxacin

  • Do not patch the eye
  • Same day ophthalmology consult
37
Q

Herpes Keratitis is from

A

reactivation of herpes simplex virus in the trigeminal ganglion

38
Q

Although the herpes keratitis symptoms are the same as bacterial keratitis, what is hallmark on fluoroscein staining?

A

-Dendritic (branching) corneal ulceration

39
Q

Treatment for herpes keratitis

A
  • Topical antivirals: Trifluridine, Ganciclovir ointment
  • PO Acyclovir
  • Corneal transplant may be needed in severe cases
40
Q

Common etiologies of Uveitis (Iritis)

A
  • Systemic inflammatory and autoimmune diseases: HLA-B27, Sarcoidosis, IBD
  • Infectious: CMV, Toxoplasmosis, Syphilis, TB
  • Trauma
41
Q

Symptoms of iritis (uveitis)

A

Anterior: unilateral severe ocular pain and photophobia, redness, blurriness, decreased vision, tearing

Posterior: blurry or decreased vision, floaters. May not be painful.

42
Q

What is the difference between anterior and posterior uveitis?

A

Anterior: inflammation of iris and ciliary body
Posterior: choroid inflammation

43
Q

What is seen on examination in a patient with uveitis (iritis)?

A
  • Conjunctival erythema
  • Ciliary injection (limbal flush)
  • Consensual photophobia
  • Constricted pupil (miosis)
44
Q

On slit lamp, what is seen in a patient with uveitis (iritis)?

A
  • Inflammatory “cells and flare”

- WBCs and proteins in the vitreous humor

45
Q

Management of uveitis (iritis)

A
  • Anterior: Topical glucocorticoids. Cyclopentolate or Homatropine relieves spasm
  • Posterior: Systemic glucocorticoids
46
Q

What is a cataract?

A

Lens opacification (thickening)

47
Q

True or False: Cataract is the MCC of blindness in the world?

A

True

48
Q

Risk Factors for cataracts

A
  • Aging (MC > 60)
  • Cigarette Smoking
  • Glucocorticoid Use
  • Diabetes Mellitus
  • UV Light
  • Malnutrition
  • Trauma
49
Q

Symptoms of cataracts

A

Painless, slow, progressive blurred vision loss over months to years
Difficulty with night driving, reading signs

50
Q

What is seen on physical exam in a patient with a cataract?

A

Absent red reflex, opaque lens

51
Q

How to treat a cataract

A
  • Observation if mild

- Surgery if vision changes are affecting everyday life

PANCE 2.0 (62 decks)

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