ENT Geriatrics Flashcards
MC type of blepharitis
posterior
what is posterior blepharitis due to
meibomian gland dysfunction
sx blepharitis
eyelid crusting, scaling, red-rimming of the eyelid
tx blepharitis
eyelid hygiene
what is ectropion
eyelid and lashes are turned outward (everted)
tx ectropion
lubricating eye drops and moisture shields for sx relief
surgery if needed
what is entropion
eyelid and lashes are turned inward (inverted)
tx entropion
lubricating eye drops and moisture shields for sx
surgery is needed
what is pterygium
slow-growing thickening of the bulbar conjunctiva that may extend onto the corneal surface
RF pterygium
UV light exposure in sunny climates
sand, wind, dust
tx pterygium
observation for most
surgical removal if growth affects vision
what is the MCC of permanent legal blindness and vision loss in older adults in the US
macular degeneration
types of macular degeneration
dry - MC
wet - choroidal neovascularization
sx macular degeneration
bilateral progressive CENTRAL vision loss (includes detailed and colored vision)
metamorphopsia (straight lines appear bent)
funduscopic exam macular degeneration
dry - druse bodies - small, round yellow-white spots
wet - choroidal neovascularization
what grid can you use to help dx macular degeneration
amsler grid
tx macular degeneration
dry - zinc and vitamins C & E
wet - intravitreal VEGF inhibitors (Bevacizumab)
RF retinal detachment
myopia
previous cataract surgery
sx retinal detachment
photopsia (flashing lights)
floaters
progressive unilateral peripheral vision loss
shadow or curtain coming down
dx retinal detachment
funduscopy:
retinal tear - detached tissue flapping in the vitreous humor
positive shakers sign - clumping of brown-colored pigment resembling tobacco dust
tx retinal detachment
emergency - keep pt supine with head turned toward side of detachment
MCC blindness in the world
cataracts
RF cataracts
aging
cigarette smoking
steroid use
DM
sx cataracts
painless, slow, progressive blurred or vision loss over months to years
PE cataracts
absent red reflex
opaque lens
tx cataract
observe if mild
cataract surgery if visual changes affect ADL
what is chronic open angle glaucoma
slow progressive painless bilateral peripheral vision loss
RF chronic open angle glaucoma
AA
A > 40
FHx
DM
sx chronic open angle glaucoma
asx until late
slow, progressive painless bilateral peripheral vision loss (tunnel vision)
PE chronic open angle glaucoma
cupping of optic discs
increased cup to disc ratio
notching of disc rim
tx chronic open angle glaucoma
prostaglandin analogs (latanoprost)
laser therapy
surgery
tx cerumen impaction
3% hydrogen peroxide
6.5% carbide peroxide
irrigation
what is BPPV
a type of peripheral vertigo MC due to displaced otolith particles within semicircular canals
sx BPPV
sudden episodic peripheral vertigo (60 s or less); provoked with certain changes in head position
not associated with hearing loss or tinnitus
dx BPPV
dix hallpike - produces nystagmus and vertigo
tx BPPV
carnality repositioning - Epley maneuver
vestibular neuronitis and labyrinthitis is due to
viral/postviral inflammation
sx vestibular neuronitis and labyrinthitis
continuous peripheral vertigo
vestibular - no hearing loss
labyrinthitis - hearing loss
dx vestibular neuronitis and labyrinthitis
clinical
MRI > CT
tx vestibular neuronitis and labyrinthitis
steroids
sx relief - meclizine
what is menieres dz
idiopathic distention of the endolymphatic compartment of the inner ear due to excess fluid
sx menieres dz
episodic peripheral vertigo
unilateral fluctuating sensorineural hearing loss
tinnitus
ear fullness
what should you rule out w menieres dz
syphilis
tx menieres dz
sodium and caffeine restriction
can use HCTZ
MCC sialadenitis
S aureus
sx sialadenitis
sudden onset firm and tender gland swelling w purulent discharge (may be able to express pus if the duct is massaged)
dysphagia
trismus
fever and chills
dx sialadenitis
CT scan
tx sialadenitis
dicloxacillin or nafcillin
metronidazole can be added for anaerobic coverage
