EENT Emergencies - Exam 1 Flashcards
______ changes size to control how much light enters the eye
iris
_____ part of the eye lining which prevents light from reflecting all around the eye
retina
______ Helps focus an image on the back surface of the eye
lens
_____ the region with no light-sensitive cells, where blood vessels and the optic nerve join
optic disk
____ the hole in the center of the iris which dilates
in dark conditions
pupil
_____ the clear ‘window’ that allows light to enter
the eye
cornea
the ____ is the pigmented part of the retina located in the very center.
macula
_______ is the center of the macula. What is important to note about it? What does it contain?
fovea
area of the best visual acuity
contains large amount of cones (nerve cells that are photoreceptors with high acuity)
What 4 categories should eye complaints be classified as?
vision changes/loss
change in appearance of the eye
eye pain/discomfort
trauma
What oral medication drug classes increase risk for glaucoma?
dilating eye drops
TCA
MAOIs
antihistamines
antiparksonian drugs
antipsychotics
antispasmolytic agents
What type of eye injury does the intervention need to come before the PE?
chemical injuries!
need to irrigate first and ask questions second
How should visual acuity be assessed if the pt’s corrective lens are NOT available? What should you do if the visual acuity is less than 20/200?
using pinhole testing
use finger counting at 3 ft or hand motion perception at 1-2 ft. If they still cannot see that, then light perception
What should you think if the pt’s nystagmus when assessing while looking at a rotating wheel is NOT symmetric?
the cause is likely neurologic in nature
What is a Marcus- Gunn pupil? What is another name for it? What does it indicate?
when performing a swinging flashlight test, the pupils do not constrict as they should
afferent pupillary defect
Any pathology that prevents light from getting to the CNS, such as opacification of the vitreous with blood, retinal pathology, or optic nerve pathology
What is the best way to look at the conjunctiva, sclera, cornea, anterior chamber, iris, lens?
using a slit lamp because it provides a 3D view of the ocular structures
What is a normal intraocular pressure? When is it CI?
normal is 10-20mmHg
CI in globe rupture or suspected penetrating trauma
How do you determine the difference between preseptal and orbital cellulitis?
proptosis, fever, vision changes and pain EOM will be present in orbital cellulitis
Where is periorbital cellulitis affecting? Why does it usually arise? in pt or out pt?
infection anterior to the orbital septum
arises from sinusitis or contiguous infection due to local skin trauma, insect bite, or hordeolum
outpt
Where does orbital cellulitis affect? Where does it stem from? in pt or out pt?
infection extending behind the orbital septum
Often occurs as a complication of ethmoid or maxillary sinusitis
emergency! in pt therapy
What are red flag symptoms for orbital involvement?
chemosis, proptosis, increased IOP, decreased VA & pupillary response, pain with EOM
What testing is needed if you suspect orbital cellulitis?
Orbital CT WITH contrast if concern for orbital involvement or in young children who are not able to cooperate fully with exam
What is the tx for periorbital cellulitis in adults/older children with mild symptoms? In pt or out pt? When do they need to f/u?
outpatient
oral amoxicillin/clavulanic acid (Augmentin) or cephalexin (Keflex)
PCN allergy: clindamycin (Cleocin)
f/u in 24-48 hours with ophthalmology
What is the tx for young children or severe periorbital cellulitis? in pt or out pt?
in pt!
IV ceftriaxone (Rocephin) OR
ampicillin-sulbactam (Unasyn) PLUS vancomycin
PCN allergy: fluoroquinolone PLUS metronidazole (Flagyl) or clindamycin (Cleocin)
What is the tx for orbital cellulitis? in pt or out pt?
ADMIT, ophthalmology consult
IV ceftriaxone (Rocephin)
OR ampicillin-sulbactam (Unasyn) PLUS vancomycin
PCN allergy: fluoroquinolone PLUS metronidazole (Flagyl) or clindamycin (Cleocin)