EXAM 1 26-50 Flashcards
26.Causes and S/S of presbyacusis.
Presbyacusis
Patho: -\_\_\_\_ related hearing loss -Most frequent cause of \_\_\_\_\_ hearing loss Causes: -\_\_\_\_trauma -\_\_\_\_ exposure Important role -Genetic predisposition -Prior noise exposure S/S -Loss of \_\_\_\_\_ discrimination pronounced in noisy environemnts
Epid
25% of people between 65-75; 50% of those over 75
Diagnostics
Treatment
Misc
noise sensory noise drug speech
27.Causes of rhinitis medicamentosa.
Rhinitis medicamentosa – _____ congestion
Cause: _______ used >3-5 days, so restrict use to 3 days
rebound
intranasal decongestions
28.PE in Allergic Rhinitis. Treatment of allergic rhinitis. S/S allergic rhinosinusitis
Allergic Rhinitis
Patho
- Most common type overall – ___ mediated mast cell histamine release due to allergens
S/S
- Clear ______
- _____
- Tearing
- ____ irritation
- Pruritus
- _____
- Bronchospasm
- ______ dermatitis
Epid
Diagnostics
PE:
- Mucosa of the turbinates is usually ___ or violaceous because of venous engorgement
- Mucosa is ______ in viral rhinitis
- ______ are associated with long-standing allergic rhinitis
Treatment
- __________ first line if allergic or nasal polyps
-Beclomethasone, Flunisolide, Mometasone furoate, Budesonide, Fluticasone propionate
Misc
Prevention
IgE rhinorrhea sneezing eye cough eczamatous
pale
erythema
nasal polyps
intransal corticosteroid
30.S/S and pathology of vestibular neuronitis.
Vestibular Neuronitis
Patho
-Inflammation of the vestibular portion of _____
-A paroxysmal, usually single attack of _____ without ______impairment. Persists several days to weeks before clearing
-Cause unclear – presumed ____
S/S
During acute phase:
Positive ______ (usually horizonal and rotary)
Continuous ______vertigo
Absent responses to ____ stimulation on one or both sides
Epid
Diagnostics
Treatment
_________: first line management
Supportive diazepam (5 mg) or meclizine (25 mg)
Vestibular therapy
Misc
CN VIII
vertigo
auditory
viral
nystagmus
peripheral
caloric
glucocorticoids
31.Causes of BPPV.
Benign Paroxysmal Positioning Vertigo
Patho
-Vertigo induced by changes in _____ position
-_______ vertigo most commonly due to displaced otolith particles (_____ crystals) within the semicircular canals of the inner ear
S/S
- Recurrent spells lasting a few _____ per spell
- Provoked with specific ____ movements
- May be accompanied by ____ and ____
- Occur in _____ and last for several ______
Epid
Diagnostics
______ (nylen barany) test – produces fatigable nystagmus
Treatment
___ protocols
Misc
head
peripheral
calcium
minutes
head
nausea, vomiting
clusters, days
dix hallpike
PT
- Length of vertiginous episodes in various forms of peripheral vertigo.
- Endolymphatic Hydrops (______ Syndrome): Discrete vertigo spells lasting ___ mins to several ____
- Labyrinthitis: Acute onset of continuous, usually severe vertigo lasting several ____ to a ____
- BPPV: Occur in ____ and last for several ____
- Vestibular Neuritis: ´usually ____ attack of vertigo without auditory impairment. Persists several ____ to ____ before clearing
Meniere’s syndrome
20, hours
days, week
clusters, days
single
days, weeks
33.Treatment for Meniere’s Disease. S/S of Meniere’s disease Endolymphatic Hydrops (Meniere Syndrome)
Patho
-Cause Unknown
-Distention of the endolymphatic compartment of the inner ear due to excess fluid is a pathologic finding
Two known causes: _____ and ______
S/S
- Episodic ______ vertigo
- Discrete vertigo spells lasting __ minutes to several ___
- Fluctuating Low-frequency _____ hearing loss
- _____
- Ear fullness
- ____ nystagmus
- Symptoms wax and wane
Epid
Diagnostics
- Caloric testing
- Loss of impairment of thermally induced nystagmus on the involved side
Treatment
- Low __ diet
- _____
- ______
Misc
syphillis, head trauma
peripheral 20 mins, hours sensorineural tinnitus horizontal
salt
dieuretics
acetazolamide
34.S/S of acute rhinosinusitis .Risk factors for the development of sinusitis. Treatment of viral rhinosinusitis. Treatment of bacterial rhinosinusitis
- Symptomatic inflammation of the nasal cavity and paransal sinuses
- Acute = 1-4 weeks
Acute Bacterial Rhinosinusitis/ Acute Viral Rhinosinusitis
Patho
Bacterial: _______ (most common) ______ , Moraxella catarrhalis, & group A Streptococcus
Viral: most cases are viral in etiology – ______, ______ & parainfluenza
PPP: Risk factor: most common in the setting of a viral ___, _____ infections, _____ , allergies cy
S/S
Major symptoms include
-______ nasal drainage
-nasal _______ or congestion
-facial ____/_____ with bending down & leaning forward
-altered _____
-Cough
- _____
Viral: nasal ________, _____ sense of smell, _______, sneezing, headache, throat discomfort
Minor symptoms include headache, otalgia, halitosis, dental pain, and fatigue.
“Double Sickening”
Worsening of symptoms within __ days after initial improvement OR ______ of symptoms more than 10 days after onset.
Epid
Diagnostics
-CT scan is the imaging test of choice if needed
Treatment -Bacterial: Symptomatic management: \_\_\_\_\_\_\_\_(promote sinus drainage) -antibiotics: symptoms should be present for >10-14 days -\_\_\_\_\_\_\_\_\_\_ is antibiotic of choice -Second line- doxycycline
Viral: no specific treatment or prevention
Misc
Strep pneumoniae
Haemophilus influenzae
rhinovirus, influenza
URI, dental, smoking
purulent obstruction pain/pressure smell fever
nasal congestion, decreased, watery rhinorrhea
10
persistence
decongestants
amoxicillin-clavulanic acid
35.S/S of hypopyon from anterior uveitis vs. infected corneal ulcer.
Anterior uveitis
Hypopyon (layered collection of white cells and fibrin within the ______chamber
Cells may also be seen on the corneal endothelium
Keratic precipitates (KPs)
Infected coneal ulcer:
´It is a primary infective ____ shaped paracentral corneal ulcer characterized by severe _____ (iris inflammation) with the formation of hypopyon (sterile pus at bottom of anterior chamber).
Corneal Ulcer
Pathophysiology
- Most commonly due to infection by ____, _____, fungi or amoebas
- Noninfectious causes which may be complicated by infection include:
- neurotropic ____ (from loss of sensation)
- exposure (due to inadequate eyelid closure)
- severe ____ eye
- severe _____ eye disease and inflammatory disorders
S/S
- Complain of ____, _____, tearing and reduced vision
- Eye is ___ with circumcorneal injection and _____ or watery discharge
- Corneal appearance is based on cause
- It is a primary infective disc shaped paracentral corneal ulcer characterized by severe iridocyclitis (iris inflammation) with the formation of hypopyon (sterile pus at bottom of anterior chamber).
Epidemiology
Tests
To find it:
_____ with woods lamp and/or slit lamp:
Area will glow green from dye uptake at area of injury
Prevention
Treatments
Topicals
-______ (especially in contact wearers)
Conflicting information about using corticosteroids
Must refer to ophthalmology if
- Corneal Ulcer
- contact wearers with acute eye pain, redness and decreased vision.
Misc.
anterior
disc
iridocyclitis
bacteria, viruses
keratitis
dry
allergic
pain
-photohphobia
red
purulent
Fluroscein Stain
Fluoroquinolines
37.Drug reactions commonly seen with tx of strep throat and mono coexistence.
•Mononucleosis
•Marked lymphadenopathy an shaggy white-purple tonsillar exudate into the nasopharynx
•1/3 patients have secondary strept; _____ should be avoided because induces a rash that may be interpreted as a PCN allergy
ampicillin
38.Types of epistaxis and anatomy involved.
Epistaxis
Patho
_____ from the unilateral anterior nasal cavity most common
Patients with epistaxis often have higher __ that returns to normal following treatment of acute bleeding
Anterior:
_______ plexus most common site
Associated with nasal ___ (picking most common in children, blowing nose forcefully, etc…), low humidity, hot environments, rhinitis, alcohol, cocaine use, antiplatelet meds, foreign body, deviated septum.
Posterior:
________ branches and woodruffs plexus most common site (may cause bleeding in both nares and posterior pharynx)
Risk factors: _______, older patients, nasal neoplasms
S/S
Epid
Diagnostics
Once acute episode has passed careful exam of the nose and paranasal sinuses to r/o ______ and hereditary hemorrhagic _______
Treatment
Anterior:
_______ is first line therapy in most cases
Pressure applied 5-15 mins with patient seated and leaning forward (to reduce vessel pressure)
PPP- Topical vasoconstrictors (sympathomimetics) may be adjunct therapy (oxymetazoline)
Short acting topical nasal decongestants act as vasoconstrictors
Phenylephrine
Posterior:
PPP- ______ most common initial management
PPP- foley catheter
PPP-Cotton packing
Misc
Bleeding
BP
Kiesselbach venous
trauma
Sphenopalatine artery
hypertension
neoplasms
telangiectasias
direct pressure
balloon catheters
39.S/S and patho of candidiasis, erythroplakia, leukoplakia and oral lichen planus. Treatment for oral candida 3, Causes of candida in buccal mucosa. S/S and causes of leukoplakia.
Oral Candidiasis (Thrush)
Patho
- Overgrowth of candida albicans.
- Causes: systemic or local _______. ____, ____ use, abx use, chemo, diabetes, patients who wear dentures, inhaled corticosteroids without a spacer
S/S
____, looks like ____ whitish curd patches overlying erythematous mucosa. Patches easily ____ off. Underlying erythema is seen after rubbing off the white patches. Can have _____
Epid
Diagnostics
Wet preparation using _______ may show spores an nonseptate mycelia
Treatment
_____ (fluconazole 100 mg PO x 7 days)
Misc
immunosuppression, HIV creamy whitish scraped angular chelitis potassium hydroxide antifungals
Nasal Foreign Body
Patho
S/S
PPP: Many are ______
-Classically presents with _____ associated with a mucopurulent discharge, ___ odor and nasal _____ (mouth bleeding)
Epid
Most commonly seen in ______
Diagnostics
- Direct visualization (head light & otoscope)
- Rigid or flexible fiberoptic endoscopy
Treatment
- Positive pressure technique: involves having the patient blow their nose while occluding the nostril ____ of the foreign body
Oral positive pressure – parent blows into mouth while occluding the ______ nostril
Misc
asymptomatic epistaxis foul obstruction children opposite unaffected
Glossitis
Patho -Inflammation of the \_\_\_\_\_\_ with loss of filiform papillae Benign- no infection or tumor likely to be appreciated Secondary to: -Nutritional deficiencies -Drug reactions -Dehydration, irritants -Food and liquids -Autoimmune reactions or psoriasis
S/S
- ____, ____-surfaced tongue
- Rarely _____
Epid
Diagnostics
Treatment
-_________ may be helpful even in cases where primary cause is unknown
Misc
tounge red smooth surface painful nutritional supplementation
42.S/S Trench mouth.
Necrotizing Ulcerative Gingivitis (Trench Mouth)
Patho
- Often caused by infection of both _______ and _____ bacilli
- Underlyng systemic disease may also predispose this order
S/S
-Painful acute _____ inflammation and _____
Epid
-Common in young adults under stress
Diagnostics
Treatment
–War half-strength ____ rinses
-Oral _____
Misc
spirochetes
fulsiform
gingival
necrosis
peroxide
penicillin
44.Treatment of oral herpes simplex
Oral herpes simplex
Patho
-Over 85% of adults have serologic evidence of herpes simplex type 1 (HSV-1) infections, most often acquired asymptomatically in ______. Occasionally, primary infections may be manifested as severe gingivostomatitis. Thereafter, the patient may have recurrent self-limited attacks, provoked by ___ exposure,____ surgery, fever, or a viral infection.
S/S
-Small, grouped _____ on an erythematous base that can occur anywhere but that most often occur on the vermilion border of the lips
Epid
Diagnostics
Treatment
-_____, its valine analog valacyclovir, and famciclovir
Misc
childhood sun orofacial vesicles acyclovir
Acute Glaucoma/ Acute Angle-Closure Glaucoma
Pathophysiology
- Primary: Closure of a pre-existing narrow ____ chamber. Angle closure can occur from pupillary ____
- Secondary: Does not require pre-existing narrow angle. May occur with anterior uveitis, dislocation of the lens or due to various drugs.
S/S
- Extreme ___ and ____ vision. N&V, ____ cornea, increased ___ pupil dilated and nonreactive. Untreated it leads to severe and permanent visual loss in 2-5 days.
- Rapid onset of severe pain and profound visual loss with ________
- Red eye, ____ cornea, dilated pupil
- ___ eye on palpation
- Subacute may present as a recurrent headache
Epidemiology
-Older age groups, particularly farsighted individuals (hyperopes), Asians, Inuits
Tests
-____ usually > 50 mmHg
-Prevention
Treatments
Primary:
- Single IV dose of ______ followed by oral. In conjunction with topical medications that lower ___.
- _____ drops
- Long term prevention requires laser peripheral iridotomy or surgical peripheral iridectomy
- Secondary: additional treatment is determined by the cause
Misc.
- Differential diagnosis: conjunctivitis, acute uveitis, corneal disorders
- Prognosis: Untreated will result in severe and permanent visual loss within 2-5 days after onset of the symptoms
anterior dilation pain blurred steamy IOP halo around lights cloudy hard IOP acetazolamide IOP pilocarpine
47.Centor criteria for strep throat. Complications of strep pharyngitis. S/S and treatment strep pharyngitis
Streptococcal Pharyngitis
Patho
S/S •\_\_\_\_ Throat •\_\_\_\_ •Anterior cervical adenopathy •\_\_\_\_\_ exudate •Focus is to treat group A beta-hemolytic streptococcus infection to prevent rheumatic sequelae
- Centor criteria : when all four present strongly suggest GABHS; 3 of 4 intermediate; 1 of 4 unlikely
- Fever over ___ degrees Celsius
- Tender anterior cervical _____
- Lack of a ____
- _______ exudate
Epid
Diagnostics
•______ throat culture is 90-95% sensitive
•Rapid antigen detection testing (RADT) is 90-99% sensitive for GABHS
•Available in 15 minutes
Treatment
PPP:
-______ – first line treatment
-If penicillin allergy – macrolides, clindamycin, cephalosporins
Misc
Complications PPP:
- Rheumatic fever (preventable with antibiotics)
- Acute glomerulonephritis (not preventable with antibiotics)
- Peritonsillar abscess
sore fever tonsillar 38 adenopathy cough pharyngotonsillar single-swab penicillin
54.S/S of 3rd CN palsy.
A cranial nerve palsy of any of the three cranial nerves that supply the extraocular muscles can cause ______
Complete third nerve palsy, there is ____ with a divergent and slightly _____ eye _______ movements are restricted in all directions except ______ (preserved lateral rectus function). Pupillary involvement, manifesting as a relatively dilated pupil that does not ____ normally to light, usually means compression, which may be due to aneurysm of the posterior communicating artery or uncal herniation due to a supratentorial mass lesion. In acute painful isolated third nerve palsy with pupillary involvement, posterior communicating artery aneurysm must be excluded. Pituitary apoplexy is a rarer cause. Causes of isolated third nerve palsy without pupillary involvement include diabetes mellitus, hypertension, giant cell arteritis, and herpes zoster.
double vision ptosis depressed extraocular laterally constrict
Types of nystagmus with peripheral vs. central lesions.
-Fine rhythmic oscillations of the globe
-Caused by a variety of neurological conditions
-A few beats in extreme lateral gaze is normal
Types: _____, ____, ______
horizontal, rotary, vertical
60.Causes of subconjunctival hemorrhage.
•_____ condition
•____ in well defined area
•Appears spontaneously after ____, sneeze, vomiting
benign
blood
cough
63.Treatment of otitis externa. S/S of classic otitis externa.
External Otitis
Patho
History of ____ exposure or trauma. Caused by gram – (_______) or fungi
S/S
____ tenderness. Otalgia, pruritus, ______ discharge. Erythema, edema ____ movement of TM
•_____ and edema of the ear canal skin
•Often with a _____ exudate
•Manipulation of the auricle often elicits pain
•Lateral aspect of TM (made of ear canal skin), may be erythematous
•May be impossible to visualize __ if canal is significantly swollen
Epid
Diagnostics
-Clinical and otoscopy: edema of the external auditory canal
Treatment
•fundamental: protect ear from additional ______ and avoidance of further mechanical injury by scratching!
•Swimmer’s ear: acidification with a drying agent
•50/50 mixture of isopropyl alcohol and vinegar
•Treat infection:
•Acidic otic antibiotic drops with an ______ or fluoroquinolone with or without corticosteroids
•Purulent debris filling the ear canal should be gently ____ to permit entry of the topical medication.
Recalcitrant cases:
•Oral fluoroquinolones
Prevention
Dry ear especially after swimming, protect from further trauma
water
pseudomonas
tragal purulent erythema purulent TM
moisture
aminoglycoside
removed
39.S/S and patho of candidiasis, erythroplakia, leukoplakia and oral lichen planus. Treatment for oral candida 3, Causes of candida in buccal mucosa. 61.S/S and causes of leukoplakia.
Leukoplakia
Patho
Oral potentially malignant disorder character by _______ due to chronic irritation
Up to 6% are dysplastic or squamous cell carcinoma
Risk factors: chronic irritation due to tobacco, cigarette smoking, alcohol, dentures, HPV infections
S/S
Most _______
Painless ____, _____lesions that cannot be scraped off (in comparison to Candida which is painful and can be scraped off
Epid
Diagnostics
Biopsy to rule out ________
Treatment
Cessation of irritants (____, _____)
Cryptherapy, laser ablation and surgical excision are options if increased risk for malignancy or malignant
hyperkeratosis asymptomatic white, patchy squamous cell carcinoma alcohol, smoking
39.S/S and patho of candidiasis, erythroplakia, leukoplakia and oral lichen planus. Treatment for oral candida 3, Causes of candida in buccal mucosa. 61.S/S and causes of leukoplakia.
Oral lichen planus - idiopathic cell-mediated autoimmune response affecting the ____ & ___ membranes
Patho
Increased incidence with ______ infection
S/S
PPP:
Reticular: ___ reticular leukoplakia of the oral mucosa (_______). Usually ______. Most common type.
Erythematous: ___ patches (may accompany the reticular lesions). May be painful
Erosive: erosions or ulcers. Usually painful.
Epid
Most common middle-age range
Diagnostics
Treatment
Aimed at managing the pain and discomfort
_____ either topically or systemically
skin, mucus
hep C
lacy
Wickham striae
painless
red
corticosteroids
39.S/S and patho of candidiasis, erythroplakia, leukoplakia and oral lichen planus. Treatment for oral candida 3, Causes of candida in buccal mucosa. 61.S/S and causes of leukoplakia.
Erythroplakia
Patho
Uncommon ______ with a high risk of malignant transformation
Usually dysplastic or shows evident of squamous cell carcinoma
Similar to leukoplakia except has a definite ______ component
Risk factors: chronic irritation due to _____, cigarette smoking
S/S
Most ______
_____ erythematous, soft, velvety, patch in the oral cavity, most commonly on the mouth ____ soft palate, and ventral aspect of the tongue
Epid
Age > __years
Diagnostics
Biopsy to rule out squamous cell carcinoma
Treatment
Complete excision may be needed depending on the biopsy results
Misc
oral lesion erythmatous tobacco asymptomatic painless floor 65
