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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
Q

How do you manage a patient with angle closure glaucoma?

A

Combination of topical agents (Timolol, Apraclonidine, Pilocarpine) with systemic agent to lower pressure (PO or IV Acetazolamide or IV Mannitol)

26
Q

What is the definitive treatment for angle closure glaucoma?

A

Iridotomy (laser)

27
Q

What type of drug is Timolol and does it affect visual acuity?

A

Topical BB

No, it does not affect visual acuity

28
Q

Risk factors for chronic (open angle) glaucoma

A
  • African Americans
  • Age > 40
  • Family History
  • Diabetes Mellitus
29
Q

Pathophysiology of open angle glaucoma

A

-The increased IOP is due to reduced aqueous drainage through trabeculum which eventually damages the optic nerve

30
Q

Symptoms of chronic open angle glaucoma

A
  • Usually asymptomatic until later in disease

- Slow progressive painless bilateral peripheral vision loss progressing to central loss

31
Q

What is seen on physical exam in chronic open angle glaucoma?

A

Cupping of the optic disc
Increased cup to disc ration
Notching of the disc rim

32
Q

Management of chronic open angle glaucoma

A
  • Reduce IOP: Latanoprost (Prostaglandin) is first-line
  • Laser therapy (trabeculoplasty) if medical therapy fails
  • Surgery is last-line treatment
33
Q

What is Amaurosis Fugax?

A

Transient monocular vision loss (lasting minutes) with complete recovery

34
Q

What are some causes of Amaurosis Fugax?

A
  • Retinal emboli or ischemia
  • GCA
  • CRAO
  • Migraine (visual aura)
  • SLE
35
Q

Symptoms of Amaurosis Fugax

A
  • Vision loss descending over visual field

- Temporary curtain or shade comes down and lifts up within 1 hour

36
Q

What is common in the history of patient with a central retinal artery occlusion (CRAO)

A

50-80 years old

History of atherosclerotic disease

37
Q

MC etiology of a CRAO

A
  • Emboli from carotid artery atherosclerosis MC

- Cardiogenic emboli 2nd MC, but MC in young patients

38
Q

Symptoms of CRAO

A
  • Acute, sudden painless monocular vision loss (may be preceded by Amaurosis Fugax)
  • May have insulated carotid bruit (same side)
39
Q

What is seen on funduscopy of patient with a CRAO?

A
  • Pale retina with cherry-red macula
  • Boxcar appearance of retinal vessels (segmentation of retinal flow)
  • Emboli may be seen
40
Q

How do you manage a patient with a CRAO?

A
  • Co2 rebreathing
  • 100% oxygen
  • Ocular massage to dilate vessels and dislodge clot
  • Acetazolamide
  • Ophthalmology consult
41
Q

What is a CRVO?

A

Thrombus in the central retinal vein that leads to fluid backup in the retina

42
Q

Risk factors for CRVO?

A 
DM
HTN
Glaucoma
Hypercoagulable states (polycythemia vera)
Multiple Myeloma
Smoking
43
Q

Symptoms of a CRVO

A

Sudden painless monocular vision loss

44
Q

What is seen on a funduscopy in a CRVO?

A

Extensive retinal hemorrhages (blood and thunder appearance)

-Retinal vein dilation, macular edema, optic disc swelling may be seen

45
Q

True or False: There is no definitive treatment for a CRVO?

A

True

46
Q

Review Eye muscles and movements they make

A

PANCE 2.0 (62 decks)

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