Eye, Ear, Nose, Throat Flashcards
0
Q
Optic Neuritis is the most common etiology of what condition?
A
Multiple Sclerosis (MS)
1
Q
Inflammation of the optic nerve is call what?
A
Optic Neuritis
2
Q
Optic Neuritis present with what symptoms?
A
- Sudden loss of vision or Blurry vision
* Pain with eye movement
3
Q
If Optic Neuritis is what you suspect, what would you find on a Funduscopic exam?
A
- Normal or some swelling
- Maybe some loss of Pupil reaction to light
- Some loss of find color vision
4
Q
What is the Treatment for Optic Neuritis?
A
Corticosteriods
5
Q
Fleshy, triangular encroachment of the conjunctiva onto the nasal side of the cornea. This is see in Tropical climates. Name this condition?
A
Pterygium
6
Q
What is the treatment for Pterygium?
A
Excision is indicated if vision is threaten
7
Q
A nodule that is yellow, elongated conjunctival, on the nasal side in area of palpebral fissure. The Pt is over the age of 35 and is exposed to wind, sun, sand, and dust. What is this condition called?
A
Pinguecula
8
Q
What is the treatment for Pinguecula?
A
No treatment typically indicated
9
Q
What is the difference between Pterygium and Pinguecula?
A
The nodule is on the cornea for Pterygium and not on the cornea for Pinguecula.
10
Q
A Pt come in, who is 58 year old with blurred vision in one eye. It is progressively getting worse. Pt states, when I look out of my bad eye it seems that a curtain is coming down over it. Their is no pain or redness to the bad eye. What condition should I be thinking about?
A
Retinal Detachment
11
Q
Is Hypertension related to Retinal Artery Occlusion?
A
No
12
Q
Is a history of carotid artery disease related to Retinal Artery Occulusion
A
Yes
13
Q
What is the treatment for Retinal Detachment?
A
- Refer to Ophthalmology
- Place Pt in a supine position and place the head so that the retinal falls back with the help of gravity.
- Surgery
14
Q
A Pt who has Retinal Artery Occlusion, what would I find on a Funduscopic exam?
A
- The retinal arteries are swollen
- “Box-car” arteries, meaning the arteries are attenuated
- A pale retina with a cherry red spot (commonly used on exam)
15
Q
How do you treat Retinal Artery Occlusion?
A
- Immediately refer to Ophthalmology
- Digital global massage
- Lower IOP
16
Q
In Retinal Artery Occlusion, do you have retinal hemorrhages?
A
NO
Retinal hemorrhages are seen in Retinal Vein Occlusion, NOT in Retinal Artery Occlusion.
17
Q
What would you see on a Funduscopic exam in a Diabetic Pt who you suspect having Retinophathy (non-proliferative, early)?
A
- Dilation of veins
- Micro-aneurysms
- Retinal hemorrhage
- Hard exudate
18
Q
What would you see on a Funduscopic exam in a Diabetic Pt who you suspect having Retinophathy (Proliferative, late)?
A
- Neovascularization
- Vitreous hemorrhage
- Cotton-wool spots (soft exudate)
19
Q
What would you see on a Funduscopic exam in a Hypertensive Pt who you suspect having Retinophathy?
A
- Retinal arteries become tortuous and narrow
- Abnormal light reflex (silver-wire, copper-wire)
- AV nicking
- Flame-shaped hemorrhages in the nerve layer of the retina
20
Q
How do you treat Retinopathy in Diabetic and/or Hypertensive Pts?
A
- Refer to Ophthalmology
* Control both the conditions
21
Q
what is the leading cause of blindness in the United States?
A
Diabetic Retinopathy
22
Q
Scotoma
A
An island-like blind spot in the visual field.
23
Q
Amblyopia
A
Unilateral or bilateral decrease of best corrected vision in an otherwise healthy eye, commonly due to asymmetric refractive error or strabismus.
24
Strabismus
A disorder of the eye in which optic axes cannot be directed to the same object. This is due to ocular muscle being weak or imbalance. This disorder presents in about 4% of children under the age of 3 months.
25
Retinoblastoma is what?
Congenital Malignancy: lack of tumor suppressor gene
26
On examination of a Retinoblastoma, you would find what?
* Absent red reflex
| * White pupil (sometimes call the cat eye)
27
How would you treat Retinoblastoma?
Immediate referral to an Ophthalmology, this is Life-threatening!!!
28
What is Retinitis Pigmentosa?
A hereditary degenerative retinal diseases marked by defective night vision starting by the second decade followed by a progressive loss of the field of vision (tunnel vision) and blindness by the age 40-50 years old
29
How would you treat Retinitis Pigmentosa?
Their is no treatment, but vitamin A may be helpful.
30
Infection of the middle ear between Eustachian tube and tympanic membrane is what condition?
Acute Otitis Media
31
Remember for the exam, when you are given signs & symptoms for Acute Otitis Media what usually precede it?
A viral upper respiratory infection (URI)
32
Name the pathogens that cause Acute Otitis Media?
* S. pneumoniae
* H. Influenzae
* M. Catarrhalis
* Viral (most common etiology)
These pathogen are the same for Acute Bronchitis & Sinusitis
33
Acute Otitis Media is most common in what demographic?
Infants and children, peak age 6-18 month
34
What are the risk factors for Acute Otitis Media (AOM)?
* Daycare attendance
* Sibling with AOM
* Parental smoking
* Bottle drinking
35
What are the symptoms of Acute Otitis Media?
* Ear pain
* Fever
* URI symptoms
* Irritability
* Tugging at the ear
36
What kind of things would I find on a Physical exam for Acute Otitis Media?
* TM erythema
* Decrease mobility of TM
* Fever
* Decrease hearing
37
If I am examining a patient who I think has Acute Otitis Media and I find bullae on the TM, what pathogen is causing the problem?
Mycoplasma pneumoniae
38
How would I treat Acute Otitis Media?
* 1st line: Amoxicillin (PCN-allergic use Azithromycin)
* 2nd line: Amoxicillin/Clavulanate, Cefaclor, Cefixime, erythromycin
TMP/Sulfa (poor activity against S. pneumoniae)
* Pain control
39
How would you treat Chronic Otitis Media
```
* Remove debris, avoid water,
use antibiotic drops (Cipro)
* Antibiotics to use:
Amoxicillin or Sulfamethoxazole
* Possible surgery
```
40
What is a common find on physical exam for Chronic Otitis Media?
Perforation of the TM
41
What pathogens cause Chronic Otitis Media?
* P. aeruginosa & S. aureus
42
With Chronic Otitis Media, I could find what on clinical examination?
* Purulent ear drainage
| * Conductive hearing loss
43
A shingle lesion on the tip of the nose means what?
Herpes Zoster Ophthalmicus, the ophthalmic branch of the Trigeminal nerve is affected.
44
A rash that is erythematous or maculopapular following a dermatomal pattern.
The rash evolves into vesicles and pustules and then crusting.
Name this rash.
Herpes Zoster
45
On exam the patient has a red eye and on fluorescein stain, dendritic ulcers are noted. What condition should I be thinking?
Herpes Simplex infection
46
When treatment for Corneal Abrasion is prescribed when should follow-up occur?
Follow up in 24 hours and avoid contracts for 1 week after healing
47
Dacryocystitis?
Infection of lacrimal sac
48
Ectropion
Outward turning of the lower lid (Basset-hound look)
49
What is the Treatment for Optic Neuritis?
Corticosteriods
50
A patient has an eye that produce excessive tearing, but the eye is typically dry. What condition is it and how do you treatment it?
Ectropion
Treatment is surgery
51
Entropion
Inward turning of the lower lid toward the eye
52
what is the 1st step of intervention with a patient with a foreign body?
Test visual acuity 1st.
53
Blepharospasm
A twitching or spasmodic contraction of the eyelid
54
Blepharo-
Eyelid
55
What is normal Inner Ocular Pressure (IOP)
8 to 21 mm Hg
56
What are the two types of Glaucoma
Primary angle-closure
| Primary open-angle
57
TQ: What TRIGGERS Acute Glaucoma
1) Pupillary dilation
2) Pharmacologic Mydriasis (dilation of the pupil)
3) Anticholinergic medication
58
What are the clinical signs of acute Glaucoma
Extreme pain, blurred vision (halos around lights), N/V, & HA
59
On Physical examination of Acute Glaucoma what would you find?
* Eye is red,
* Cornea steamy,
* Pupils moderately dilated,
* Nonreactive to light.
60
Treatment of Glaucoma
Primary: IV acetazolamide (Diamox) to lower pressure;
Once lowered start Pilocarpine 2%
Secondary: systemic Acetazolamide
Laser Trabeculoplasty
61
What happens if Acute Glaucoma is untreated?
Vision loss in 2-5 days
62
Due to abnormal drainage of aqueous through trabecular meshwork should lead you to think what?
Primary Open-Angle Glaucoma
63
Due to increase intraocular pressure, which results in nerve damage and loss of vision is called what?
Glaucoma
64
Occurs only with closure of peexisting narrow anterior chamber angle
Acute Glaucoma
65
What are the treatments of Primary Open-Angle Glaucoma
1) Beta-adrenergic blocking agents: decrease fluid production
* Timolol or Betaxolol
2) Prostaglandin analog: increase fluid drainage
3) Carbonic anhydrase inhibitors: decrease fluid production
4) Laser trabeculoplasty surgery
66
Staph infection of the meibomian gland (internal) or glands of Zeis or Moll (external) are called what?
Hordeolum
| Infection of the external glands are called a Stye.
67
How do you treat a Hordeolum
* Warm compresses
* Antibiotic ointment: E-mycin, Bacitracin
* if no improvement in 2 days, may have to I&D
68
Hemorrhage into the anterior chamber
Hyphema
69
If you see Hyphems in a child you should be thinking what?
Child abuse
70
Patients with sickle cell anemia has an increase risk of what eye condition
Hyphema
71
How do you treat a Hyphema
Fox shield and place patient in a 45 degree, to keep the red blood cells staining the cornea
72
What is the difference between Acute Iritis vs Conjunctivitis
Acute Iritis has NO dicharge
73
What is the treatment of Acute Iritis
Since this is an inflammation of the Iris
* Topical steroids,
* Analgesics, and
* Refer to Ophthalmology
74
Gradual progressive vision loss of moderate severity, retinal pigment atrophy, yellow deposits (drusen). Name this this eye condition.
Atrophic (Dry) Macular Degeneration
75
Rapid onset and greater severity of vision loss, hemorrhage, and neovascularization. Name this eye condition.
Exudative (Wet) Macular Degeneration
76
Their are two types of Orbital Cellulitis, Periorbital (preseptal) and Orbital (postseptal). Name what is associated with each of them.
Periorbital (preseptal): URI
| Orbital (postseptal): Sinusitis that has spread from paranasal
77
Periorbital (preseptal) and Orbital (postseptal) name the organisms that cause these two problems
Periorbital (preseptal): S. aureus, S. epidermis, & Step sp
| Orbital (postseptal): S. aureus, S. pneumoniae, & anaerobes
78
Periorbital (preseptal) & Orbital (postseptal) share the same symptoms, what are they?
Tearing, fever, erytherma, warmth, & tenderness for both
79
What would you see on a Physical exam for Periorbital (preseptal) vs Orbital (postseptal) cellulitis
Periorbital (preseptal): Normal !!! Visual acuity, pupillary reaction, & EOM
Orbital (postseptal): Pain with eye movement, decreased visual acuity, proptosis (eye bulging forward)
80
How would you treat Periorbital (preseptal)
* Amoxicillin/Clavulanic acid (Augmentin)
| * 1st generation cephalosporin
81
How would treat Orbital (postseptal) cellulitis
* Hosiptalization with IV antibiotics
* 2nd or 3rd generation cephalosporin
* Ampicillin-sulbactam (Unasyn)
* Carbapenems
* Clindamycin
82
The big difference between Periorbital (preseptal) and Orbital (postseptal) Cellulitis is what and how would you confirm your diagnosis
Physical Exam and order a CT to confirm the diagnosis
83
Half of patient with MS will develop this eye problem
Optic Neuritis (inflammation of the optic nerve)
84
Optic neuritis is present, what would you find on physical exam and funduscopic exam
PE: * Sudden loss of vision or blurry vision,
* Pain with eye movement
* Loss of pupil reaction to light
* Loss of color vision
Funduscopic exam: Normal or show swelling
85
What is Leukocoria
a white reflex in the pupil, sometimes referred to as cat's-eye pupil
86
Most common complication of acute otitis media
Mastoiditis
87
What are the symptoms for Mastoiditis
* Post-auricular pain
* Erythema
* Fever
* Bulging
* The area behind the ear is very red and swollen
88
What causes Mastoiditis
Inadequately treated Acute Otitis Media
89
What is the test of choice for Mastoiditis
CT scan
90
How do you treat Mastoiditis and what are the complications
* IV antibiotics (ampicillin, Ceftriaxone)
* Myringotomy (tubes in the TM)
* Mastoidectomy (surgical drainage)
* Hearing loss, labyrinthitis, vertigo, facial nerve paralysis
91
Otitis Externa is commonly seen do to what conditions
* History of water exposure (swimmer ear)
| * Mechanical trauma (pencil in the ear)
92
Malignant Otitis externa is commonly seen in what type of patients
Diabetics
93
Name the pathogens that cause Otitis Externa
* Pseudomonas
* Staph
* Proteus
* Fungi (aspergillus)
94
Otitis Externa has what type of clinical findings
* Otalgis (ear pain)
* Pruitus (itchy ear)
* Purulent drainage (if brown/yellow discharge with strong odor think cholesteatoma)
* Erythema, edema of the ear canal skin
* Pain with movement of auricle
* Periauricular lymphadenopathy
95
What is the treatment of Otitis Externa
* Otic aminoglycoside (Neomycin sulfate, Polymyxin B sulate)
* Corticosteroids
* Ear wick
* Oral or Otic Quinolones
* Fungal: Amphottericin B
As in immunocompromise, cancer, HIV, Chronic steroid users
96
What is the classic Triad for Meniere's Syndrome
1) Episodic vertigo, lasting 1-8 hours, rarely longer than 24 hrs
2) Sensorineural hearing loss, Low-frequency
3) Tinnitus (ringing in the ear)
97
How would you test for Meniere's Syndrome
1) Caloric testing, checking the horizontal nystagmus
2) Audiometry, Low-frequency = sensorineural loss
3) Otoscopy is normal
98
How would you treat Meniere's Syndrome
1) Low-salt diet
2) Anti-vertigo medication
* Dimenhydrinate (Dramamine)
* Meclizine (Antivert)
* Diazepam (Valium)
3) Diuretics (hydrochlorothiazide)
4) Surgical decompression of the endolymphatic sac
99
If you are considering Meniere's Syndrome, what other condition have the same symptoms or clinical picture.
Acoustic Neuroma, it is a benign tumor of the myelin-forming cells of the vestibulocochlear nerve (CN VIII)
100
Pt comes in with unilateral hearing loss (low-frequency), episodes of vertigo lasting 1-8 hrs, ringing in the ear, decreased speech discrimination and disequilibrium. What do you think is the problem and how would you diagnose it
1) Acoustic neuroma
| 2) MRI of the head
101
What clue would help you distinguish Labyrinthitis from Meniere's
Labyrinthitis has continuous vertigo
| Meniere's has episodic vertigo
102
What is Labyrinthitis
Inflammation of the vestibular labyrinth
103
Pt comes in complaining of hearing loss, ringing in the ear, and severe vertigo that is continuous. When asked if he had an URI recently, he answered yes a few weeks ago. What is the problem and how would you treat it.
1) Labyrinthitis
2) Treatment: is self-limiting, but may need some anti-vertigo medication like;
* Diazepam,
* Meclizine,
* Dimenhydrinate
104
What is a very common cause of dizziness. Makes up 20% of all cases, especially in older patients who are over the age of 50. Also common in head traumas.
Benign Paroxysmal Positional Vertigo
105
73 year old female comes in complaining of dizziness, vertigo, lighthradness, imbalance, and nausea. Symptoms are brought on by changing position of the head (mostly tipping the head backwards). The episode can last about a minute or so. Patient has noticed that when she lays down or rolls over can cause her to be come dizzy. What is the likely cause and how would you diagnosis it.
1) Benign Paroxysmal Positional Vertigo
2) Dix-Hallpike Test
* Pt in a supine position, turn head to 45 degress to one side and 20 degress backwarm. Positive, if a burst of nystagmus occurs.
106
How would you treat Benign Paroxysmal Positional Vertigo
1) Wait and see (may last up 2 months)
2) Epley Maneuver (called particle repositioning)
* involves moving the head into 4 positions and staying at each for 30 seconds. May cause weakness, numbness, and visual changes.
107
Name the types of hearing loss and what area of the ear is affected
1) Conduction (middle ear):
* Problems with mechanical reception or amplification of sound
* Disease in the auditory canal, TM, or ossicles.
2) Sensonineural (inner ear):
* Degeneration/destruction of hair cells or CN VIII
* Disease in the cochlea, semicircular canal, and neuron
108
What are some good screening test for hearing
1) Weber test (tuning fork on top of head)
2) Rinne test (tuning fork on mastoid process)
3) Whisper test
109
Examination for hear loss, Conductive vs Sensorineural. What would you find in each
```
Conductive:
1) Decreased perception of sound
2) Loss of low-frequency tones
3) Weber sound, heard in the ear with loss
4) Rinne: BC>AC
Sensorineural:
1) Difficulty deciphering words
2) Tinnitus common
3) Rinne: AC>BC
```
110
What are some causes of conductive hearing loss
1) Otosclerosis - bones in the ear fuses. F > M
2) Cerumen impaction
3) Middle ear fluid
111
What causes sensorineural hearing loss
1) Presbycusis: aging, hair cell loss
2) Noise-induced: job related, chronic exposure
3) Drug-induced:
* Aminoglycosides (tobermycin, glenomycin)
* Lasix
* Cisplatin
4) Acoustic tumor or neuroma
5) Meniere disease
6) Viral
112
Does Aspirin cause hearing loss
No, it causes ringing in the ear
113
Tympanic membrane perforation occurs secondary to what
1) Middle ear infection,
2) Barotrauma, due to pressure increase in middle ear. Like high altitude or scuba diving.
3) Trauma
114
How would a tympanic membrane perforation presents itself
1) Acute onset of pain and hearing loss
2) Bloody Otorrhea is possible
3) Vertigo and/or tinnitus is also possible but transient
4) PE reveals a perforated TM
115
How would you treat a perforated tympanic membrane
1) Most heal spontaneously
2) Antibiotics not needed
* NO, under water diving
