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Family Medicine EOR > ENOT/Ophthalmology > Flashcards

ENOT/Ophthalmology Flashcards

1
Q

What is acute/chronic sinusitis?

A

After URI, sinus pain/pressure (worse with bending down and leaning forward), facial tap elicits pain

  • viral: more common, symptoms < 7 days, bacterial: symptoms 7+ days and associated with bilateral purulent nasal discharge
  • organisms: S. pneumoniae, H. influenzas, M. catarrhalis
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2
Q

How is acute/chronic sinusitis dx?

A
  • clinical, XR not recommended, MRI indicated if malignancy or intracranial spread of infection is suspected
  • chronic = lasts 12 weeks or longer
  • chronic: plain view X-ray (waters view) is a good initial screening, CT is the gold standard
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3
Q

What is the tx for acute/chronic sinusitis?

A

NSAIDs for pain, saline washes, steam, oral/nasal decongestants - improvement in 2 weeks
-Indications for antibiotics in rhino sinusitis include the duration of symptoms >10 days without improvement
Treatment is for five to seven days
-amoxicillin (500 mg orally three times daily or 875 mg orally twice daily) or amoxicillin-clavulanate (500 mg/125 mg orally three times daily or 875 mg/125 mg orally twice daily)
-penicillin-allergic: doxycycline 100 mg orally twice daily or 200 mg orally daily
-Macrolides (Clarithromycin or azithromycin) and trimethoprim-sulfamethoxazole are not recommended for empiric therapy because of high rates of resistance of S. pneumoniae
-kids amoxicillin x 10-14 days

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4
Q

What is the tx for chronic sinusitis?

A

therapy is typically given for at least three weeks and may be extended up for ten weeks in refractory causes

  • Amoxicillin-clavulanate: 875 mg twice daily or two 1000 mg extended-release tablets twice daily
  • Pen allergic: clindamycin 300 mg four times daily or 450 mg three times daily
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5
Q

What is allergic rhinitis?

A

clear nasal discharge, rhinorrhea, itchy, watery eyes, sneezing nasal congestion, pale, bluish, boggy mucosa

  • allergic shiners (blue discoloration below eyes), transverse nasal crease
  • IgE mediated mast cell histamine reease
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6
Q

What is the tx of allergic rhinitis?

A

avoid any known allergens and use antihistamines, cromolyn sodium, nasal or systemic corticosteroids, nasal saline drops or washes, immunotherapy
-intranasal decongestants not to be used more than 3-5 days may cause rhinitis medicamentosa

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7
Q

What is aphthous ulcers?

A

single of multiple, shallow ulcers with a yellow-gray fibrinoid center with red halos, a biopsy should be considered for ulcers lasting more than 3 weeks

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8
Q

What is the tx of aphthous ulcers?

A

viscous lidocaine 2-5% applied to ulcer QID after meals until healed

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9
Q

What is blepharitis?

A

chronic inflammation of lid margins caused by seborrhea, staph, or strep = dysfunction of Meibomian glands

  • anterior blepharitis: eyelid skin, eyelashes; may be ulcerative (S. aureus) or seborrheic
  • posterior: inflammation of Meibomian glands; may be infectious (S. aureus) or caused by glandular dysfunction
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10
Q

What are the signs and symptoms of blepharitis?

A

-crusting, scaling, red-rimming of eyelid and eyelash flaking, adherent eyelashes, hyperemic lid margins, dandruff-like deposits (scurf) and fibrous scales (collarettes); clear or slightly injected conjunctiva; thick cloudy discharge visible when Meibomian glands obstructed

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11
Q

How is blepharitis dx?

A

is usually by slit-lamp examination

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12
Q

What is the tx of blepharitis?

A

warm compresses, daily lid wash with diluted baby shampoo on cotton-tipped swabs; lid massage to express the gland; topical antibiotics used if infection suspected

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13
Q

What is cholesteatoma?

A

presents with painless otorrhea, brown/yellow discharge with a strong odor

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14
Q

What is cholestatoma caused by?

A

chronic Eustachian tube dysfunction which results in chronic negative pressure and inverts part of the TM causing granulation tissue that over time, erodes the ossicles and leads to conductive hearing loss

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15
Q

What is the tx of cholestatoma?

A

surgical removal

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16
Q

What is viral conjunctivitis?

A

acute onset unilateral or bilateral erythema of conjunctiva, copious watery discharge, tender preauricular lymphadenopathy, scant mucoid discharge

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17
Q

What is the MC cause of viral conjunctivitis?

A

caused by adenovirus, highly continuous, transmission via direct contact/swimming pools

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18
Q

What is bacterial conjunctivitis?

A

will present with purulent (yellow) discharge from both eyes (“glued shut”), crusting, usually worse in the morning, may be unilateral

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19
Q

What are the common causes of bacterial conjunctivitis?

A
  • S. pneumonia, S. aureus (common) - acute mucopurulent
  • M. catarrhalis, Gonococcal - copious purulent discharge, in a patient who is not responding to conventional treatment
  • Chlamydia - newborns, Giemsa stain - inclusions body, scant mucopurulent discharge
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20
Q

What is allergic conjunctivitis?

A

red eyes, itching, and tearing, usually bilateral, cobblestone mucosa on the inner/upper eyelid

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21
Q

What is the tx for allergic conjunctivitis?

A

hand washing, avoid contamination

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22
Q

What is the tx of bacterial?

A

treatment(s) in order of suggested use - the dose is 0.5 inch (1.25 cm) of ointment (preferable in children) deposited inside the lower lid or 1 to 2 drops instilled four times daily for five to seven days

  • Gentamicin/tobramycin (Tobrex): amino glycoside antibiotic used for gram-negative bacterial coverage, most cases of bacterial conjunctivitis will respond to this agent
  • Erythromycin ointment (E-Mycin) chlamydia for newborns
  • Trimethoprim and polymyxin B (polytrim) this combination is used for ocular infections, involving cornea or conjunctiva, resulting from strains of microorganisms susceptible to this antibiotic
  • ciprofloxacin (Ciloxan)
  • Contact lenses use = pseudomonas tx = fluoroquinolone (ciprofloxacin/ciloxan drops)
  • neisseria conjunctivitis warrants prompt referral and topical + systemic antibiotics
  • chlamydial conjunctivitis systemic tetracycline or erythromycin x 3 weeks, topical ointments as well, assess for STD or child abuse
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23
Q

What is the tx of viral?

A

eye lavage with normal saline bid 7-14 days; antihistamine drops, warm to cool compresses

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24
Q

What is the tx of allergic conjunctivitis?

A

systemic antihistamines and topical antihistamines or mast cell stabilizers (Naphcon-A, Ocuhist, generics)

  • epinastine (Elestat)
  • azelatine (optivar)
  • emedastine difumarate (Emadine)
  • levocabastine (livostin)
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25
Q

What is a corneal abrasion?

A

sudden onset of eye pain, photophobia, tearing, foreign body sensation, blurring of vision, and/or conjunctival injection
-fluorescein dye demonstrates increased absorption in the devoid area

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26
Q

What is the tx of a corneal abrasion?

A

antibiotic eye ointment, no patching

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27
Q

What is a corneal ulcer?

A

also known as ulcerative keratitis, is an inflammatory or infective disease of the cornea leading to disruption of the epithelial layer and the corneal stroma

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28
Q

What are the characteristics of corneal ulcers?

A
  • contact lens wearers, caused by deep infection in the cornea by bacteria, viruses, or fungi
  • white spot of the surface of the cornea that stains with fluorescien: round “ulceration” versus “dendritic” pattern like herpes
  • in developing countries, children with vitamin A deficiency are at high risk for developing corneal ulcers
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29
Q

What is the tx of corneal ulcers?

A

immediate referral - if an immediate referral is not possible, it is reasonable to start topical ophthalmic antibiotics without delay

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30
Q

What is dacryoadenitis?

A

inflammation of the nasolacrimal duct or the nasolacrimal gland (supra temporal)

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31
Q

What is the tx of dacryoadenitis?

A

cannulation of the duct, stunting, surgery

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32
Q

What is dacryocystitis?

A

infectious obstruction of nasolacrimal duct (inferomedial region)

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33
Q

What is the tx of dacryocystitis?

A

systemic antibiotics: Clindamycin + 3rd gen cephalosporin

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34
Q

What is an ectropion?

A

(eversion of the eyelid) occurs when the eyelid turns outward exposing the palpebral conjunctiva, conjunctiva will appear red from air exposure and inflammation

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35
Q

What is the tx of ectropion?

A

tear supplements and ocular lubricants at night

-definitive treatment is surgery

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36
Q

What is an entropion?

A

(inversion of an eyelid) occurs when the eyelid turns inward, it is most commonly caused by age-related tissue relaxation, surgical correction is definitive

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37
Q

What is the tx of entropion?

A

tear supplements and ocular lubricants at night

-definitive treatment is surgery

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38
Q

What is epistaxis?

A

nasal trauma, dryness, HTN, nasal cocaine, alcohol

  • Kiesselbach’s Plexus or Little’s Area is the most common site for anterior bleeds
  • posterior bleed = less frequent (woodruff plexus)
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39
Q

What is the tx of epistaxis?

A

most nosebleeds are anterior and stop with direct pressure

  • apply direct pressure at least 10-15 minutes, seated leaning forward
  • short-acting topical decongestant (Afrin, phenylephrine, cocaine)
  • anterior nasal packing
  • patients with nasal packing must be treated with antibiotics (cephalosporin) to prevent toxic shock syndrome and the patient has to return to take the packing out
  • if there is no packing in the nose, place a small amount of petroleum jelly or antibiotic ointment inside the nostril 2 times a day for 4-5 days
  • cauterize if able to visualize bleeding source
  • posterior balloon packing is used to treat posterior epistaxis
  • high-risk for complications - specialist eval and inpatient monitoring; nasal arterial supply ligation via surgery in some cases
  • recurrent epistaxis: must rule out hypertension of hyercoagulable disorder
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40
Q

What is open-angle glaucoma?

A

most common, aqueous outflow obstruction

  • > 40 y/o, African Americans, often asymptomatic
  • peripheral to central gradual visual loss (versus macular degeneration which is a central loss)
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41
Q

What is acute narrow angle-close glaucoma?

A

iris again lens, dark environment, acute loss of vision, nausea, and vomiting

  • classic triad: injected conjunctiva, steamy cornea, and fixed dilated pupil, this is an ophthalmic emergency
  • sudden dull or severe eye pain (bilateral), worse in dark rooms
  • IOP acutely elevated
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42
Q

What is the tx for acute narrow angle-closure glaucoma?

A
  • acetazolamide IV is the first-line agent - decrease IOP by decreasing aqueous humor production
  • topical beta-blocker (ex. timolol) reduces IOP without affecting visual acuity
  • miotics/cholinergics (ex. pilocarpine, carbachol)
  • peripheral iridotomy is the definitive treatment
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43
Q

What is chronic open-angle glaucoma?

A
  • a gradual loss of peripheral vision

- painless

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44
Q

What is the tx of chronic open-angle glaucoma?

A
  • prostaglandin analogs are the 1st line (ex. latanoprost), beta-blocker (timolol), alpha-agonist, a carbonic anhydrase inhibitor to decrease production
  • laser or surgical treatment
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45
Q

What is a hordeolum?

A

a painful red infection in a gland at the margin of the eyelid

  • painful, warm (hot), swollen red lump on the eyelid (different from a chalazion which is painless)
  • think “H” for Hot = hordeolum, most common organism S. aureus
46
Q

What is the tx for a hordeolum?

A

warm compress and topical antibiotics

  • a hordeolum that does not respond to hot compresses can be incised with a sharp, fine-tipped blade
  • systemic antibiotics (eg, dicloxacillin or erythromycin 250 mg PO QID) are indicated when cellulitis accompanies a hordeolum
47
Q

What is a hyphema?

A

trauma causes blood in the anterior chamber of the eye (between the cornea and the iris) and may cover iris

  • the blood may cover part of all of the iris (the colored part of the eye) and the pupil, and may partly or totally block vision in that eye
  • usually from blunt/penetrating trauma = ensure no other type of injury (skull fracture, orbital fracture)
48
Q

How is hyphema dx?

A

orbital CT if indicate + ophthalmology consult

49
Q

What is the tx of a hyphema?

A

usually, blood is reabsorbed over days/weeks

  • elevate head at night at 30 degrees, acetaminophen for pain, patch/shield
  • may use beta-adrenergic blockers or carbonic anhydrase inhibitors
  • surgery if high pressure/persistent bleeding
  • NSAIDs contraindicated (may increase bleeding)
50
Q

What is labyrinthitis?

A

acute onset, vertigo + hearing loss, tinnitus of several days to a week

  • usually viral, an absence of neurologic deficits
  • associated with nausea and vomiting
51
Q

What is the tx of labyrinthitis?

A
  • diazepam or meclizine for vertigo, promethazine for nausea

- symptoms regress after 3-6 weeks

52
Q

What is laryngitis?

A

almost always viral, hoarseness following a URI

  • M. cat, H. flu
  • consider squamous cell carcinoma if hoarseness persists > 2 weeks, history of ETOH and or smoking, laryngoscopy is required for symptoms persisting > 3 weeks
  • absence of pain or sore throat
53
Q

What is the tx of laryngitis?

A

relax voice (vocal rest), supportive therapy

  • Oral or IM corticosteroids may also hasten recovery for performers but requires vocal fold evaluation before starting therapy
  • bacterial = erythromycin, cefuroxime, or Augmentin for cough or hoarseness
54
Q

What is macular degeneration?

A

gradual painless loss of central vision

  • the macula is responsible for central visual acuity which is why macular degeneration causes gradual central field loss
  • metamorphopsia: wavy or distorted vision, measured with Amsler grid (distortion on Amsler grid)
55
Q

What is dry macular degeneration?

A

atrophic changes with age - a slow gradual breakdown of the macula (macular atrophy), with drusen (dry) = yellow retinal deposits

56
Q

What is wet macular degeneration?

A
  • an advanced form of dry age-related macular degeneration
  • new blood vessels growing beneath the retina (neovascularization) leak blood and fluid, damaging the retinal cells
  • these small hemorrhages usually result in rapid and severe vision loss
57
Q

What is the tx of wet age-related macular degeneration?

A
  • VEGF inhibitors (bevacizumab)
  • photodynamic therapy
  • zinc and antioxidant vitamins
58
Q

What is the tx of dry age-related macular degeneration?

A

zinc and antioxidant vitamin

59
Q

What is meniere disease?

A

excessive endolymph fluid in cholera overstimulates hair causing vertigo and sudden hearing los with aural fullness - unknown etiology
-vertigo attacks lasting hours, classic triad of low-frequency hearing loss, tinnitus with aural (ear) fullness and vertigo

60
Q

What is the tx of meniere disease?

A

low salt diet, diuretics (HCTZ + triamterene) to reduce aural pressure

61
Q

What are nasal polyps?

A

teardrop-shaped growths that form in the nose or sinuses

  • usually benign, often with allergic rhinitis, consider cystic fibrosis when multiple polyps are seen
  • chronic congestion, decreased sense of smell
62
Q

What is the Samter’s triad?

A
  • asthma
  • aspirin sensitivity
  • nasal polyps
63
Q

What is the tx of nasal polyps?

A

topical nasal corticosteroid (3-month course) is the intimal treatment choice, this is effective for small polyps and can reduce the need for surgical intervention

  • oral steroids ( 6-day taper) can also help reduce the size
  • surgical removal may be necessary if therapy is unsuccessful or if polys are large
64
Q

What is bacterial otitis externa?

A

“swimming ears”

  • ear pain (especially with movement of tragus or auricle), pain with eating, purulent cheesy white discharge, palpation of the trigs is painful
  • tuning fork = bone conduction > air conduction
  • Pseudomonas aeruginosa (swimmer’s ear), S. aureus (digital trauma)
  • malignant otitis externa is commonly seen in diabetics
65
Q

What is the tx of bacterial otitis externa?

A

antibiotics drops = (amino glycoside or fluoroquinolone +/- corticosteroids) + avoid moisture

  • if perforated or chance of perforation: ciprofloxacin 0.3% and dexamethasone 0.1% suspension: 4 drops BID x 7 days or ofloxacin: 0.3% solution 10 drops once a day x 7 days
  • diabetic/immunocompromised: malignant otitis externa = necrotizing infection = hospitalization with IV abx (caused by aspergillus)
66
Q

What is fungal otitis externa?

A
  • prititus, weeping, pain, hearing loss
  • swollen, moist, wet appearance
  • aspergillus niger (black), A. flavus (yellow) or A. fumigates (gray), candida albicans
67
Q

What is the tx of fungal otitis externa?

A

-topical therapy, anti-yeast for Candida or yeast: 2% acetic acid 3-4 drops QID, clotrimazole 1% solution; itraconazole oral

68
Q

What is otitis media?

A

the clinical diagnosis of AOM requires 1) bulging of the tympanic membrane or 2) other signs of acute inflammation (eg, marked erythema of the tympanic membrane, fever, ear pain) and middle ear effusion

  • bugs: S. pneumoniae 25%, H. influenzas 20%, M. catarrhalis 10%
  • acute: <3 weeks, chronic: > 3 months, recurrent: 3 episodes in 6 months or 4 in 12 with clearing between
  • chronic > 3 months: clear serous fluid in the middle ear without s/sx of ear infection (may have hearing loss/asymptomatic) - no abx
69
Q

How is otitis media dx?

A

otoscopic = bulging, loss of landmarks, redness, TM injection
-a key findings is limited mobility of the TM with pneumotoscopy

70
Q

What is the tx of otitis media?

A

first-line amoxicillin, augmentin = 2nd line (PCN allergy = azithromycin, erythromycin, Bactrim)

  • treat < 2 y for 10 days and >2 y for 5=7 days
  • recurrent: tympanostomy, tympanocentesis, myringotomy
  • complictions: mastoiditis and bullies myringitis
71
Q

What is papilledema?

A

optic disc swelling that is caused by increased intracranial pressure
-the swelling is usually bilateral and can occur over a period of hours to weeks

72
Q

What are the causes of papilledema?

A

malignant hypertension, brain tumor/abscess, meningitis, cerebral hemorrhage, encephalitis, pseudotumor cerebri

73
Q

What are the signs and symptoms of papilledema?

A
  • asymptomatic or may present with transient visual alterations (seconds)
  • bilateral, develops over hours to weeks, the disc appears swollen, margins blurred, obliteration of the vessels, ICP: increased
  • immediate neuroimaging to rule out mass lesion, then CSF analysis
74
Q

What is the tx of papilledema?

A

treat the underlying cause

75
Q

What are the characteristics of mumps parotitis?

A
  • mumps is caused by paramyxovirus, likely in a child without a complete vaccination series, transmitted via respiratory droplets
  • typically, it begins with a few days of fever, headache, myalgia, fatigue, and anorexia followed by parotitis
  • in adult males look for an associated orchitis
76
Q

What are the characteristics of viral parotitis?

A

viral infections associated with parotitis include influenza A virus, parainfluenza, adenovirus, coxsackievirus, Epstein-barr virus (EBV), cytomegalovirus, herpes simplex virus, human immunodeficiency virus (HIV), and lymphocytic choriomeningitis virus

77
Q

What is the tx of parotitis?

A

self-limiting treat with hydration and rest

  • vaccintion is effective for prevention
  • contagious for 9 days after onset of parotid swelling
78
Q

What is a peritonsillar abscess?

A

results from penetration of infection through tonsillar capsule and involvement of neighboring tissue

  • presents with a hot potato (muffled) voice, severe sore throat, lateral uvula displacement, bulging tonsillar pillar
    • streptococcus pyogenes
79
Q

What is the tx of a peritonsillar abscess?

A

aspiration, incision and drainage, and/or antibiotics

  • IV antibiotics = amoxicillin, amoxicillin-sulbactam, and clindamycin
  • in less severe cases, oral antibiotics can be used for 7 to 10 days (i.e., amoxicillin, amoxicillin-clavulanate, clindamycin)
  • tonsillectomy may also be considered in about 10% of patients
80
Q

What is pharyngitis?

A

usually viral - adenovirus most common

  • mononucleosis: Epstein Barr virus, fever, sore throat, lymphadenopathy, splenomegaly, atypical lymphocytes + heterophile agglutination test (mono spot)
  • consider gonorrhea pharyngitis in patient with recent sexual encounters, or with non-resolving pharyngitis
  • fungal in patient using inhaled steroids
81
Q

What is strep pharyngitis?

A
  • group A B-hemolytic streptococcus (GABHS)
  • centor criteria: 1. Absence of a cough, 2. exudates, 3. fever (>100.4 F), 4. cervical lymphadenopathy
  • not suggestive of strep - coryza, hoarseness, and cough
  • if 3 out of 4 center criteria are met a rapid streptococcal test (sensitivity >90%)
  • if negative = throat culture is the gold standard
82
Q

What is the tx of group A strep?

A

penicillin is first line, azithromycin if penicillin-allergic
-complications: rheumatic fever and post-strep glomerulonephritis

83
Q

What is the tx of viral strep?

A

supportive

84
Q

What is the tx of mononucleosis?

A

symptomatic and void contact sports, antibiotics such as amoxicillin or ampicillin may cause a rash

  • for athlete planning to resume non-contact sports three weeks from symptoms onset
  • for strenuous contact sports four weeks after illness onset
85
Q

What is the tx of fungal strep?

A

clotrimazole, miconazole, or nystatin

86
Q

What is the tx of gonorrhea pharyngitis?

A

follows the same principles for the approach to therapy of uncomplicated urogenital gonococci infection, with a preferred regiment of intramuscular ceftriazone (250 mg) and azithromycin as a second agent

87
Q

What is a pterygium?

A

elevated, superficial, fleshy, triangular-shaped “growing” fibrovascular mass ( most common in the inner corner/nasal side of the eye)
-pterygium is associated with increased sun exposure and climates where there is wind, sand, and dust

88
Q

What is the tx of a pterygium?

A

only surgically remove when vision is affected

89
Q

What is a retinal detachment?

A

separation of the retina from the pigmented epithelial layer causing the detached tissue to appear as a flap in the vitreous humor

90
Q

What are the characteristics of a retinal detachment?

A
  • can occur spontaneously or secondary to trauma or extreme myopia
  • vertical curtain coming down (curtain of darkness) across the filed of vision may sense floaters or flashes at the onset, loss of vision over several hours (acute and painless)
  • fundoscopic exam: asymmetric red reflex
  • myopia (nearsightedness) is a risk factor for the development of retinal detachment
  • retinal detachment usually presents with defects in the peripheral visual field
91
Q

What is the tx of retinal detachment?

A

stay supine (lying face upward) with head turned towards the side of detached retina

  • consult ophthalmologist
  • pneumatic retinopexy is a procedure for the management of retinal detachment that involves cryoretinopexy followed by injection of an air bubble in the vitreous
92
Q

What is a retinal vascular occlusion?

A

central reninal artery occlusion (cherry-red spot, ischemic retina)

  • flow-through CRA occluded
  • atherosclerotic thrombosis, embolism from the same side (ipsilateral) carotid artery, ophthalmic artery, and heart, or giant cell arteritis
93
Q

What are the fundoscopy findings of retinal vascular occlusion?

A
  • look for peritoneal atrophy (cherry-red spot) and pale opaque fundus with red fovea and arterial attenuate
  • anteriolar narrowing, separation of arterial flow, retinal edema, ganglionic death to optic atrophy and pale retina
  • rule out carotid artery stenosis by carotid ultrasound
94
Q

What are the signs and symptoms of retinal vascular occlusion?

A

sudden, painless, unilateral, and usually severe vision loss (amaurosis fugax)

95
Q

What is the tx of retinal vascular occlusion?

A
  • emergent ophthalmologic consult - immediate treatment is indicated if occlusion within 24 h of presentation
  • reduction of intraocular pressure with ocular hypotensive drugs (eg topical timolol 0.5%, acetazolamide 500 mg IV or PO)
  • intermittent digital message over the closed eyelid or anterior chamber paracentesis
  • if patients present within the first few hours of occlusion, some centers catheterize the carotid/ophthalmic artery and selectively inject thrombolytic drugs
  • workup and management of atherosclerotic disease
  • irreversible damage to the retina after 90 min, poor prognosis
96
Q

What is a central retinal vein occlusion?

A

blood and thunder fundus

  • sudden, painless, unilateral vision loss, blurred vision or complete visual loss
  • most common in ages 50+, associated with HTN, primary open-angle glaucoma (POAG), diabetes, hyperlipidemia, hyper viscosity states (polycythemia, leukemia)
  • usually occurs secondary to a thrombotic event
97
Q

How is a central retinal vein occlusion dx?

A

funuscopy: retinal hemorrhages in all quadrants, optic disc swelling; blood and thunder retina (dilated veins, hemorrhages, edema, exudates)

98
Q

What is the tx of a central retinal vein occlusion?

A

vision resolved with time (partially), workup for thrombosis
-neovascularization treated with intravitreal injection of VEGF inhibitors

99
Q

What is retinopathy?

A

caused by systemic disorders, including diabetes, hypertension, preeclampsia-eclampsia, blood dycrasias, and HIV disease - may affect the retina

100
Q

What are the characteristics of retinopathy?

A
  • diabetic retinopathy falls into two main classes: nonproliferative (early) and proliferative (late, advanced)
  • prolonged hyperglycemia causes basement membrane thickening, decreased pericytes (hyper proliferation), micro aneurysms, and neovascularization
  • leading cause of blindness in adults
101
Q

What are the characteristics of nonproliferative type?

A

an early form of the disease

  • non-proliferative diabetic retinopathy (NPDR) is the early stage of the disease in which symptoms will be mild or nonexistent
  • in NPDR, the blood vessels in the retina are weakened
  • fundoscopy: micro aneurysms, hard exudates, cotton wool spots, blot and dot hemorrhages, and venous dilation
102
Q

What are the characteristics of proliferative type?

A

most severe, abnormal blood vessel growth

  • proliferative diabetic retinopathy (PDR) is the more advanced form of the disease
  • at this stage, circulation problems deprive the retina of the oxygen, as a result new, fragile blood vessels can begin to grow in the retina and into the vitreous, the new blood vessels may leak blood into the vitreous, clouding vision
  • fundoscopic exam (abnormal growth of vessels) neovascularization
  • complications: pre-retinal and vitreous hemorrhages, retinal tears, retinal detachments, neovascular glaucoma, and blindness
103
Q

What is the tx of retinopathy?

A

control of blood glucose and BP

  • ocular treatments: retinal laser photocoagulation, intravitreal injection of anti vascular endothelial growth factor drugs (eg. ranibizumab, bevacizumab), intraocular corticosteroids, vitrectomy, or a combination
  • if diabetic get yearly dilated ophthalmoscopic examination
104
Q

What is sialdenitis?

A

a bacterial infection of a salivary gland usually caused by sialolithiasis which is an obstruction stone in the salivary gland

105
Q

What are the characteristics of sialadenitis?

A
  • acute swelling of the cheek which worsens with meals
  • etiology: S. aureus
  • affects the parotid or submandibular gland, occurs with dehydration or chronic illness (Sjogren syndrome) ductal obstruction
  • diagnose with CT, ultrasonography, or MRI
106
Q

What is the tx of sialadenitis?

A
  • IV antibiotics: nafcillin
  • hydration, warm compresses, sialogogues (lemon drops), massage gland
  • oral antibiotics for less severe cases - dixloxacillin, 1st gen cephalosporin, or clindamycin
  • resolves in 2-3 weeks
107
Q

What is tinnitus?

A

ringing or buzzing noise in one or both ears the may be constant or come and go, often associated with hearing loss

108
Q

What are the characteristics of tinnitus?

A
  • common causes include age-related hearing loss, exposure to loud noise, ceruminosis, otosclerosis
  • other causes include Meniere’s disease, TMJ disorders, head or neck injuries, acoustic neuroma, Eustachian tube dysfunction, muscle spasms of the inner ear, atherosclerosis, AVMs, medications (antibiotics, diuretics, quinine medications, certain antidepressants, ASA)
  • comprehensive audiologic examination for unilateral persistent tinnitus or associated hearing impairment
  • imaging (CT or MRI) for unilateral tinnitus, pulsatile tinnitus, asymmetric hearing loss, or focal neuro deficits
109
Q

What is the tx of tinnitus?

A
  • hearing aids for tinnitus with hearing loss
  • CBT or sound therapy (white noise machines) for persistent, bothersome tinnitus
  • medications (TCAs such as amitriptyline and nortriptyline, Xanax)
  • alternative therapies include acupuncture, hypnosis, melatonin
110
Q

What is tympanic membrane perforation?

A

presents with pain, otorrhea, and hearing loss/reducation

-can occur from infection (acute otitis media) or trauma (barotrauma, direct impact, explosions)

111
Q

What is the tx of tympanic membrane perforation?

A

usually, resolve on own; surgical repair may be necessary with persistent hearing loss

  • keep dry = water/moisture to the ear should be avoided to prevent secondary infection that impedes closure
  • the only class of antibiotics that are non-ototoxic are the floxin drops and should be used if you are going to be prescribing drops with a perforated TM
  • surgery if persists past 2 months

Family Medicine EOR (14 decks)

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