Exam 2: [ENT & Eyes] Flashcards
What are Tears composed of?
Water, Oil & Mucus
What is the Center of the Fiel of VIsion?
Fovea Centralis
Innervation of the Eye Muscles
Superior Oblique: CN 4
Lateral Rectus: CN 6
Inferior Oblique, Medial Rectus, Superior Rectus, Inferior Rectus: CN 3
Presbyopia Definition
Farsightedness caused by loss of elasticity of the lens of the eye
SNellen Chart
[Distance Vision]
- has to get more than 1/2 letters correct
- stands 20 feet away
- 20/70 = what pt reads from 20, normal eye can read from 70.
What reading on the SNellen chart is legally blind?
20/200 or worse
Rosenbaum Chart
[Near Vision]
- 14 inches from face
Ishihara Plates
[Color blindness]
- stands 75cm from plates
- must read within 3 seconds
- less than or equal to 9 correct = deficient color vision
Blind spot is where?
15 degrees temporal to the line of gaze
Anopsia Definition
[Visual Field Defect]
-hemianopia
- quadrantic defect
- mononuclear defect
Sparing of the Macula is seen when?
In Infarction of Occipital lobes due to PCA occlusion.
May be caused by collateral vascular supply to the macular region
If the Posterior cerebral artery is occulted…
Contralateral homonymous hemianopia with macular sparing
What types of light to use for Cornea & Lens, Iris & Corneal Reflection
Cornea & Lens: Oblique light
Iris: Tangenital light
Corneal Reflection: direct light
One eye vs both eyes protruding
One Eye: Cancerous growth in the eye
Both Eyes: abnormality of the thyroid
Strabismus definition
Eyes will not look straight ahead together
Lateral sparseness of the eyebrows indicates:
Hypothyroidism
Scaliness of the eyebrows indicates
Seborrheic dermatitis (dandruff)
Ptosis of the eyelids
[upper eye lid droop] (lazy eye)
NORMAL MAD = 4-4.5MM
- Upper eye lid should not cover the pupil
Myasthenia Gravis: CN III
Horner Syndrome: Congenital
Entropion of Eyelid
[Inward turning of lid margin]
- irritates conjunctiva & sclera
- MC in elderly
Ectropion of eyelid
[Outward turning of lid margin]
- If punctum turns outward, eye cant drain well
- MC in elderly
Lid Lag vs. Von Grafe’s Sign
Lid Lag: Static situation (lid higher than normal in downgaze)
Von Grafe’s: Dynamic sign (lid descends during downgaze)
Blepharitis
Chronic inflammation of eyelids at the base of the hair follicles
- S. Aureus
- Seborrheic dermatitis
- clogged sebaceous gland
- rosacea
Lesions of the Eye: Stye vs. Chalazion
Stye: Infection of margin, Ext = lash, Int = Obstructed Meibomian gland
Chalazion: Painless Obstructed Meibomian gland
Xanthelasma
Raised, yellowish cholesterol plaque on nasal portion of eyelid
- Hyperlipidemia
- Primary Biliary Cirrhosis
Pinguecula
[harmless yellow nodule in the bulbar conjunctiva]
- deposition of protein, fat or calcium
- nasal then temporal
Corneal Arcus (Arcus senilis)
- Gray/white arc around cornea
- usually benign
Kayser-Fleischer Ring
Red/brown ring shading to green or blue from Copper deposition in cornea
-Genetic OR Copper accumulation in Liver
Keratoconus
[assymetric thinning results in cone-shaped cornea]
- weakening of central cornea
Keratoconus Results In:
Myopia & Astigmatism
What CN Opens & Closes the Eye Lid?
Opens: CN 3
Closes: CN 7
Can’t close the eyes -> suspect what?
Hyperthyroidism
Bells Palsy
Loss of Conscoiusness
Corneal Injury or Infection Causes
Abrasion
Viral
Bacterial
Acute Iritis Causes
Herpes
TB
Autoimmune
Acute Angle Glaucoma Causes
Increased introcular pressure
Hyphema
[polling of blood in anterior chamber of eye]
- Results from: trauma, hemophilia
What do you inspect to cornea and lens for?
Cataracts (lens opacity)
Corneal Scars (superficial grayish white opacity of cornea)
Pterygium
Pterygium
Triangular thickening of bulbar conjunctiva that grows across the cornea
Increased introcular pressure results in a
Bulging Iris (shadow on medial iris w/ tangential lighting)
Ciliary Injecton of the Iris
Dilation of deeper vessels radiating from limbus
Glaucoma definition
Set of irreversible progressive optic neuropathies that can lead to severe visual field lass & bblindness
2 MC forms of Glaucoma
Primary open angle: family Hx, DM, Black, Hispanic
Primary angle closure: Asian, female
With treatment of glaucoma…
1 in 7 patients will be blind in 20 years
Glaucoma exam findings
- Optic Disc cupping
- Pain w/ eyelid palpation
- medial shadow
- halos around lights
- loss of peripheral vision (tunnel vision)
Exam finding during an acute episode of angle closure glaucoma include:
- Mid-dilated pupil
- conjunctival (ciliary) injection
- cloudy cornea
What does PERRLA stand for?
[Pupil observation]
Pupils
Equal
Round
React to
Light
Accommodate
Normal pupil size in adults:
2-4mm in diameter (bright light)
4-8mm in diameter (dark)
Coloboma
- Congenital
- Pupil loos like its drooping down the iris
Anisocoria
[defect in contraction or dilation of one pupil]
- “Unequal pupil size”
When anisocoria is greater in bright light pupil cant constrict
When anisocoria is greater in dim light pupil cant dilate
Pupillary constriction vs. Dilation
Constriction: Parasympathetic
Dilation: Sympathetic
Blindness is a problem with what CN?
CN 2
Light reaction in a blind eye
- Unilateral blindness does not cause anisocoria.
- light directed into the blind eye causes no response in either eye
Convergence, Consteiction & Accommodation of the pupil are controlled by:
CN 3
Mydriasis vs. Miosis
Mydriasis: dilation of the pupil
Miosis: excessive constriction of the pupil
Parasympathetic Anisocoria
[failure of larger pupil to constrict]
- CN 3 Paralysis
- Tonic (Adie) Pupil
Sympathetic Anisocoria
[failure of smaller pupil to dilate]
- Horner syndrome
- Argyll Roberson (small irregular pupils)
What might cause an absent red reflex?
- Detached retina
- Corneal Abrasion
- Cataract
- Tumor/retinoblastoma
3 C’s of the Optic Disc
1) Cup
2) Color
3) COntour
Glaucomatous Cupping
- Increased introcular pressure from glaucoma
- Increased cupping due to nerve fiber loss
Optic Atrophy
Optic cup occupies the entire optic disc
Entire disc appears pale/white
- Optic neuritis
- MS
- Temporal aretitis
Papilledema
Engorgement & swelling of optic disc
Intracranial pressure causes edema along optic nerve
- blurred disc margins
- cup not visible
A/V Nicking
“Apparent nicking at arteriovenous crossings”
Vein appears to taper down on either side of the artery
- Hyoertension
Cotton Wool Patches
White ovoid lesion with soft edged
Extruded Axoplasm
- HTN
- DM
Flame Hemorrhages
Superficial bundles of nerve fibers
- HTN
- Papillaedema
- Occlusion of retinal vein
Drusen
Yellow spots between optic disc & macula
Dead retinal pigment epithelial cells
- age related macular degeneration
- Scotsman vs. loss of peripheral vision
Conduction phase of the ear
External & Middle ear
(Air & Bone Conduction)
Sensorineural Phase of the ear
Inner Ear
Causes of Conductive External Ear hearing loss
- Ceruman impaction
- Infection (otitis external)
- Trauma
- foreign objects
- squamous cell carcinoma
- Benign bony outgrowths (exostosis & osteomas)
Causes of Conductive Middle Ear hearing loss
- otitis media
- congenital
- cholesteatomas
- otoscleosis
- tumors
- perforation of tympanic membrane
Causes of Sensorineural Inner Ear hearing loss
- congenital & hereditary
- presbycusis
- viral infections
- Meniere disease
- noise exposure
- ototoxic drug exposure
- acoustic neuromas
How many decibels is dangerous/painful?
120db (ambulance siren)
Whisper voice test at how many decibels?
20-40
Weber test
- In patients w/ unilateral hearing loss
- on top of head
Sound louder in bad ear = conductive hearing loss
Sound louder in good ear = Sensorineural loss
Sound lateralizes toward what ear?
Bad ear w/ conduction loss
Good ear w/ sensorineural loss
Rinse test
Normal: Air conduction (AC) > Bone conduction (BC)
Conductive Loss: AC < BC OR AC = BC
Sensorineural Loss: AC > BC
Causes of Sinus Obstruction
- Allergies
- Infections
- Deviated septum
- Environmental/chemical irritants
Abnormal Nasal Passage findings
- Swelling
- Bleeding
- Exudates
- Growths (polyps, tumors, ulcers)
- Deviated septum
- Perforated septum
Viral Rhinitis vs. Allergic RHinitis
Viral: red & swollen mucosa
Allergic: mucosa pale or grayish
Deviated vs perforated septum
Deviated: congenital, trauma
Perforated: trauma surgery, cocaine, anphetamines
What is Epistaxis & where does it occur?
Nose bleed
- Occurs in anterior portion of septum (children) Kiesselbach’s plexus
- Occurs in Posterior portion of septum (adults) in the, HTN & ASVD
Exudates
CSF Leak (Salty, Unilateral, copious, clear)
Typically follow head trauma
Thyroglossal Duct Cyst
Will rise when tongue is protruded AND when a patient swallows
The tongue deviates __________ the side of a CN 12 Lesion
Toward
CN X Inspection in the throat includes:
Soft palate rise
(Soft palate will not rise on side of the lesion)
Gag reflex tests
CN 9 by touching the posterior pharynx
What is Horseness?
Change in voice quality, described as husky, rough, harsh or lower pitched than usual
MC Causes of Hoarseness
Voice overuse
Viral Laryngitis
Neck Trauma
If hoarseness lasts more than 2 weeks…
Refer to larynoscopy
Attrition of teeth
Teeth worn down by repetitive use
(Dentin exposed)
Recession of gums
Exposes roots
Infection, genetics, brushing
Erosion of teeth
Chemical action
Dentin exposed
Hutchinson teeth
Congenital syphilis
Widely spaced teeth taper toward the biting surface
Abrasion of teeth w/ notching
Repetitive trauma
Bobby pin in mouth
Gingivitis (gum disease)
Red, swollen gingival margins
Poor oral hygeine
Actinic Chelitis
Predisposes to squamous cell carcinoma
Carcinoma of te lip
Squamous cell carcinoma
Scaly plaque or ulcer
Angular chelitis
B2, no teeth, poor fitting dentures
Exudative Tonsilitis
Fever & Enlarged anterior cervical nodes
Strep = anterior nodes
Mono = Posteriorr nodes
