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PANCE 2.0 > EENT #4 > Flashcards

EENT #4 Flashcards

1
Q

What is papilledema?

A

Optic nerve swelling secondary to increased intracranial pressure (usually bilateral)

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2
Q

Symptoms of papilledema

A
  • Vision often preserved
  • Headache
  • Nausea
  • Vomiting
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3
Q

Diagnostics for papilledema

A
  • Funduscopy: swollen optic disc with blurred margins
  • MRI or CT scan of the head to rule out mass
  • Then Lumbar Puncture (increased CSF pressure)
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4
Q

How do you manage papilledema?

A

Acetazolamide: decreases production of aqueous humor

Treat underlying cause

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5
Q

True or False, in papilledema, there is no Marcus-Gunn pupil present?

A

True

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6
Q

What is optic neuritis?

A

CN II Inflammation

Acute inflammatory demyelination of the optic nerve

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7
Q

Optic Neuritis is MC in ______ and young patients ______

A

Women

Aged 20-40 years old

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8
Q

Etiologies of optic neuritis

A
  • Multiple Sclerosis
  • Autoimmune
  • Ethambutol, Chloramphenicol
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9
Q

Symptoms of optic neuritis

A
  • Painful loss of vision
  • Decrease in color vision (desaturation)
  • Visual field defects: central scotoma (blind spot)
  • Usually unilateral
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10
Q

What is seen on physical exam in a patient with optic neuritis?

A
  • Ocular pain worse with movement
  • Marcus-Gunn Pupil: relative affarent pupillary defect
  • Optic disc swelling, blurring
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11
Q

What is a Marcus-Gunn Pupil?

A

During swinging flashing test from unaffected eye to affected eye, pupils appear to dilate

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12
Q

What confirms the diagnosis of optic neuritis when MS is suspected?

A

MRI

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13
Q

Management of optic neuritis

A
  • IV Methylprednisolone initially followed by oral corticosteroids
  • Vision usually returns to normal without treatment
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14
Q

MCC of Marcus-Gunn Pupil

A

Optic neuritis

-Other causes: CRVO, CRAO, retinal detachment

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15
Q

What is an Argyll-Robertson Pupil?

A

Near-light dissociation

Pupil constricts on accommodation but does not react to bright light

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16
Q

MCC of Argyll-Robertson Pupil

A

Neurosyphilis

-Other causes: Diabetic neuropathy, Midbrain lesions

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17
Q

What kind of visual field defect would be present if there is lesion in the midline optic chiasm (pituitary adenoma)?

A

Bitemporal Heteronymous Hemianopsia

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18
Q

What is the leading cause of preventable blindness in the US?

A

Acute narrow angle closure glaucoma

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19
Q

Risk factors for an acute angle closure glaucoma attack?

A
  • Narrow angle or large lens
  • Age > 60
  • Hyperopes (farsightedness)
  • Females
  • Asians
20
Q

What is the pathophysiology of acute narrow angle closure glaucoma?

A

-Decreased drainage of aqueous humor via trabecular meshwork and canal of Schlemm

21
Q

What are precipitants of angle closure attacks?

A
  • Mydriasis (pupillary dilation) closes the angle further
  • -Dim lights
  • -Sympathomimetics
  • -Anticholinergics
22
Q

Symptoms of an acute angle closure glaucoma attack

A
  • Sudden onset of severe, unilateral ocular pain
  • Halos around lights and loss of peripheral vision
  • Nausea
  • Vomiting
  • Headache
23
Q

What is seen on exam of a patient with an angle closure glaucoma attack?

A

-Conjunctival erythema
-Cloudy, steamy cornea
-Mid-dilated fixed pupil (reacts poorly to light)
Eye hard on palpation

24
Q

How do you diagnose a patient with an angle closure glaucoma attack?

A
  • Tonometry: increased IOP > 21

- Funduscopy: optic disc blurring or cupping (thin outer rim)

25
How do you manage a patient with angle closure glaucoma?
Combination of topical agents (Timolol, Apraclonidine, Pilocarpine) with systemic agent to lower pressure (PO or IV Acetazolamide or IV Mannitol)
26
What is the definitive treatment for angle closure glaucoma?
Iridotomy (laser)
27
What type of drug is Timolol and does it affect visual acuity?
Topical BB No, it does not affect visual acuity
28
Risk factors for chronic (open angle) glaucoma
- African Americans - Age > 40 - Family History - Diabetes Mellitus
29
Pathophysiology of open angle glaucoma
-The increased IOP is due to reduced aqueous drainage through trabeculum which eventually damages the optic nerve
30
Symptoms of chronic open angle glaucoma
- Usually asymptomatic until later in disease | - Slow progressive painless bilateral peripheral vision loss progressing to central loss
31
What is seen on physical exam in chronic open angle glaucoma?
Cupping of the optic disc Increased cup to disc ration Notching of the disc rim
32
Management of chronic open angle glaucoma
- Reduce IOP: Latanoprost (Prostaglandin) is first-line - Laser therapy (trabeculoplasty) if medical therapy fails - Surgery is last-line treatment
33
What is Amaurosis Fugax?
Transient monocular vision loss (lasting minutes) with complete recovery
34
What are some causes of Amaurosis Fugax?
- Retinal emboli or ischemia - GCA - CRAO - Migraine (visual aura) - SLE
35
Symptoms of Amaurosis Fugax
- Vision loss descending over visual field | - Temporary curtain or shade comes down and lifts up within 1 hour
36
What is common in the history of patient with a central retinal artery occlusion (CRAO)
50-80 years old | History of atherosclerotic disease
37
MC etiology of a CRAO
- Emboli from carotid artery atherosclerosis MC | - Cardiogenic emboli 2nd MC, but MC in young patients
38
Symptoms of CRAO
- Acute, sudden painless monocular vision loss (may be preceded by Amaurosis Fugax) - May have insulated carotid bruit (same side)
39
What is seen on funduscopy of patient with a CRAO?
- Pale retina with cherry-red macula - Boxcar appearance of retinal vessels (segmentation of retinal flow) - Emboli may be seen
40
How do you manage a patient with a CRAO?
- Co2 rebreathing - 100% oxygen - Ocular massage to dilate vessels and dislodge clot - Acetazolamide - Ophthalmology consult
41
What is a CRVO?
Thrombus in the central retinal vein that leads to fluid backup in the retina
42
Risk factors for CRVO?
``` DM HTN Glaucoma Hypercoagulable states (polycythemia vera) Multiple Myeloma Smoking ```
43
Symptoms of a CRVO
Sudden painless monocular vision loss
44
What is seen on a funduscopy in a CRVO?
Extensive retinal hemorrhages (blood and thunder appearance) | -Retinal vein dilation, macular edema, optic disc swelling may be seen
45
True or False: There is no definitive treatment for a CRVO?
True
46
Review Eye muscles and movements they make

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