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Clin Med Exam II > Eye trauma/ HEENT I > Flashcards

Eye trauma/ HEENT I Flashcards

1
Q

Etiology of orbital fractures

A
  • blunt trauma
  • MVAs
  • industrial accidents
  • assaults
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2
Q

Who most commonly gets orbital fractures?

A

adolescent males

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3
Q

Bones of the orbit

hint: 7

A
  • sphenoid bone
  • zygoma
  • maxilla
  • ethmoid bone
  • palatine bone
  • lacrimal bone
  • frontal bone
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4
Q

What makes up the superior wall of the orbit?

A
  • frontal bone

- lesser wing of the spheniod bone

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5
Q

What makes up the inferior wall of the orbit?

A
  • maxilla
  • zygomatic bone
  • palatine bone
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6
Q

What makes up the medial wall of the orbit?

A

thinnest wall

  • ethmoid bone
  • maxilla
  • lacrimal
  • sphenoid
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7
Q

What makes up the lateral wall of the orbit?

A

thickest wall

  • zygomatic bone
  • sphenoid bone
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8
Q

Six extra ocular eye muscles and actions

A 
lateral rectus-abduction
medial rectus-adduction
superior rectus- up and in
inferior rectus- down and in
superior oblique-inferior and lateral
inferior oblique-superior and lateral
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9
Q

Three sinuses

A
  • maxilla
  • frontal
  • ethmoid
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10
Q

Where are the canthal ligaments

A

medial canthal- corner of the tarsal plate to the orbital wall
lateral canthal- lateral aspect of the orbit

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11
Q

What does the infraorbital nerve supply

A

lower eyelid, nose and upper lip

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12
Q

What does the supraorbital nerve supply?

A

upper eyelid, forehead and scalp

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13
Q

What are the four orbital fracture types?

A
  • orbital zygomatic fracture (tripod fracture)
  • nasoethmoid fracture
  • orbital roof fracture (rare)
  • orbital floor fracture (most common)
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14
Q

What is a blowout fracture

A

orbital floor fracture without fracture of the orbital rim with herniation of the contents

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15
Q

Complications of a blowout fracture

A
  • alteration of support mechanism for extra ocular muscles
  • EOM can become entrapped
  • entrapment of inferior rectus and damage to infraorbital nerve)
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16
Q

Pure blow out fracture

A

bone fragments involving the central area of bone

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17
Q

Impure blow out fracture

A

fracture line extends to orbital rim

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18
Q

Mechanism of blow out fracture

A

force of blow–>backward displacement of eyeball–>infraorbital pressure increases–>fracture in the weakest portion of the orbital wall

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19
Q

Symptoms of orbital fracture

A
  • facial pain
  • ocular pain on movement
  • neuropraxia
  • diplopia
  • color changes
  • floaters, hazy vision, fog
  • flashers, veil or curtain
  • foreign body sensation
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20
Q

Physical exam findings of an orbital fracture (inspection)

A
  • periorbital edema and ecchymosis
  • depression/defect of the orbit
  • epistaxis
  • CSF leakage
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21
Q

Physical exam findings of orbital fracture (palpation)

A
  • nerve neuropraxia
  • emphysema
  • pain
  • step off deformity
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22
Q

Initial Assessment of orbital fracture: what do you do/check?

A

EYE EXAM

  • visual acuity
  • pupils
  • cornea
  • funduscopic exam
  • EOMs
  • conjunctiva
  • eyelids
  • color perception
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23
Q

Eye examination findings with orbital fracture

A
  • lid laceration
  • periocular ecchymosis
  • hypoglobus
  • subconjunctival hemorrhage
  • hyphema
  • traumatic mydriasis
  • epipora
  • corneal abrasion
  • ruptured globe
  • vitreous hemorrhage
  • retinal detachment/tears
  • EOM entrapment
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24
Q

What xray views are you going to get for an orbital fracture?

A
  • AP
  • PA
  • Caldwell view
  • Waters view
  • Towne view
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25
Q

Gold standard for orbital fracture diagnosis

A

CT scan

-axial and coronal view

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26
Q

Other diagnostic test for orbital fracture

A
  • forced ductions test
  • fluorescein stain
  • Hertel Exophtalmometer
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27
Q

Major associated complications w/ orbital fracture

A
  • blindness
  • long term diplopia
  • infection
  • EOM entrapment
  • orbital dystopia/cosmetic issures
  • neuropraxia
  • intracranial bleed
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28
Q

Non surgical treatment for orbital fractures

A
  • ice
  • nasal decongestants
  • if sinus involved, broad spectrum abx
  • corticosteroids for orbital edema with diplopia
  • avoid aspirin and nose blowing
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29
Q

What are the indications surgical repair of an orbital fracture

A
  • restrictive strabismus
  • CT evidence of muscle entrapment
  • enophthalmos <2mm
  • oculocardiac relfex
  • hypo ophthalmos
  • large floor fracture
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30
Q

When should you emergently consult ophthalmology with an orbital fracture

A
  • rupture
  • retro orbital hematoma
  • retinal detachment
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31
Q

What requires a 24 hr follow up with a specialist when it comes to orbital fracture

A
  • muscle entrapment
  • enopthalmos or orbital dystopia resulting in facial asymmetry
  • naso orbital ethoid fractures with injury to medial canthal ligament or lacrimal apparatus
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32
Q

What is hyphema

A

grossly visible blood in the anterior chamber d/t tears on the vessels of the cillary body or iris

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33
Q

Peak incidence of hyphema

A

10-20 years old

males>females

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34
Q

What causes hyphema

A
  • trauma (blunt or penetrating)

- spontaneous (less common, usually underlying condition)

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35
Q

Hyphema symptoms

A
  • decreased visual acuity
  • photophobia
  • pain
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36
Q

Hyphema physcial exam findings

A
  • layer of blood in anterior chamber
  • decreased visual acuity
  • photophobia
  • anisocoria
  • elevated intraocular pressure
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37
Q

How to diagnose hyphema

A

-clinical diagnosis
ophthalmoscope
slit lamp
tonopen

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38
Q

Treatment of hyphema

A
  • eye shield on affecred eye
  • bed rest, dim lighting/limited activity
  • cyclopentolate or homatropine
  • PO pain control (avoid ASA and NSAIDs)
  • anti emetics for n/v
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39
Q

Complications of hyphema

A
  • intractable glaucoma

- optic atrophy

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40
Q

Posterior Synechiae

A

iris adheres to lens

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41
Q

Peripheral Synechiae

A

iris adheres to cornes

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42
Q

Symptoms of corneal foreign body

A
  • pain
  • foreign body sensation
  • photophobia
  • tear
  • red eye
  • blurred vision
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43
Q

What do you do on physcial exam for foreign body in the eye

A
  • visual acuity
  • inspection of eye and eyelid
  • slit lamp
  • fluorescein stain
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44
Q

Corneal foreign body physical exam findings

A
  • normal or decreased visual acuity
  • conjunctival/cilliary injection
  • VISIBLE FOREIGN BODY
  • rust ring
  • excessive tear production
  • corneal edema
  • corneal perforation with deep foreign body
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45
Q

Differential diagnosis for corneal foreign body

A
  • keratitis
  • intraocular foreign body
  • corneal abrasion
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46
Q

Medical management for corneal foreign bodies

A
  • topical abx (cipro,erythro)
  • topical cycloplegic
  • tetanus if not UTD
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47
Q

What is the layer most commonly involved in corneal abrasions?

A

endothelium

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48
Q

What nerve innervates the cornea

A

trigeminal

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49
Q

Symptoms of a corneal abrasion

A
  • pain
  • foreign body sensation
  • photophobia
  • tears
  • red eye
  • blurred vision
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50
Q

Differentials for corneal abrasion

A
  • acute globe rupture
  • retained foreign body
  • infectious keratitis
  • corneal ulcer
  • acute angle glaucoma
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51
Q

Physical exam for corneal abrasion

A
  • visual acuity
  • slit lamp exam
  • fluorescein stain
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52
Q

Exam findings for corneal abrasion

A
  • normal/decreased visual acuity
  • conjunctival/cilliary injection
  • visible foreign body
  • rust ring
  • excessive tear production
  • corneal edema
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53
Q

Treatment of corneal abrasion

A
  • topical erythro ointment

- topical cipro drops for contact lens

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54
Q

Infectious causes of corneal ulcer

A

-bacterial
VIRAL
-fungal
-amoebas

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55
Q

Non infectious causes of corneal ulcers

A
  • exposure keratitis
  • severe allergic disease
  • severe dry eye
  • inflammatory/autoimmune
  • vit A deficiency
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56
Q

Bacterial cause of corneal ulcer

A 
pseudomonas (contacts)
moraxella liquefaciens (DM,alcoholic, immunosup)
strep
staph
MRSA
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57
Q

Viral cause of corneal ulcer

A

HSV/ zoster

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58
Q

Amoeba cause of corneal ulcer

A
  • acenthamoeba
  • contaminated water
  • contact lens with poor hygiene
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59
Q

Risk factors for corneal ulcers

A
  • contacts
  • previous eye surgery
  • hx of HSV
  • immunocompromised
  • topical or systemic steriod use
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60
Q

Symptoms of corneal ulcer

A
  • pain
  • photophobia
  • tearing
  • reduced vision
  • lid and ocular swelling
  • injected conjunctiva/eyelid
  • foreign body sensation
  • miotic pupil
  • clear or mucopurulent discharge
61
Q

Exam findings for corneal ulcer

A
  • punctate or diffuse branching dendritic lesions (HSV)
  • corneal ulceration
  • hypopyon
  • anterior cell/flare
62
Q

Diagnosis of corneal ulcer

A
  • slit lamp and fluorescein stain

- culture and gram stain or PCR

63
Q

Bacterial corneal ulcer treatment

A

fluoroquinolone

64
Q

Viral corneal ulcer treatment

A

acyclovir

always start if dendritic pattern

65
Q

Pain management for corneal ulcers

A
  • topical cycoplegics

- oral NSAID or analgesia

66
Q

What will some corneal ulcer perforations require?

A
  • cyanoacrylate glue
  • conjunctival graft
  • conjunctival flaps
  • corneal transplant
67
Q

Complications of corneal ulcer

A
  • corneal scarring
  • corneal perforation
  • anterior or posterior synechiae
  • glaucoma
  • cataracts
  • blindness
68
Q

What is the semi circular canals function

A

organ for body movement

69
Q

What is the cochlea for

A

organ for hearing

70
Q

Which nerve relays info from the vestibular labyrinth to the cerebellum, ocular nuclei or spinal cord?

A

vestibular portion of CN VIII

71
Q

What do the posterior semicircular canals detect?

A

head tilts down towards the shoulder

72
Q

What do the lateral semicircular canals detect

A

head shakes side to side in a “no” motion

73
Q

What do the superior semicircular canals detect?

A

head nods up and down in a “yes” motion

74
Q

What do the otolith organs sense

A

gravity and linear acceleration

75
Q

What does the utricle detect?

A
  • horizonatal movement in the head

- registers accelerations in horizontal plane

76
Q

What does the saccule detect?

A
  • vertical

- registers acceleration in vertical plane

77
Q

Where does the eustachian tube run?

A

anterior wall of the middle ear into the nasophasrynx

78
Q

What is the wider part of the eustachian tube?

A

nasopharyngeal and tympanic ends

79
Q

What is the narrowest portion of the eustachian tube?

A

bony isthmus

80
Q

How is the eustachian tube different in children than in adults?

A
  • shorter, more horizontal tubes
  • immature floppy elastic cartilage
  • larger adenoids
81
Q

What happens when the eustachian tube is compromised?

A

air trapped in the middle gets absorbed creating negative pressure–> TM retraction

82
Q

Normal function of the eustachian tube

A
  • equalization of pressure across tympanic membrane
  • protection of middle ear from infection and reflux of nasopharyngeal contents
  • clearance of middle ear secretions
83
Q

What causes blockage of the ET?

A
  • ALLERGIC RESPONSE
  • URI
  • sinusitis
  • chronic OM
  • congenital/acquired stenosis
  • neoplasms
84
Q

What causes dysfuntion of the ET?

A
  • blockage

- failure of tube to open

85
Q

What are the two types of ET tube dysfunction

A
  • dilatory dysfunction

- patulous dysfunction

86
Q

What causes dilatroy dysfunction of ET

A
  • inflammation
  • pressure dysregulation
  • acquired anatomic abnormalities
87
Q

What is dilatory dysfunction of ET

A

the tube does not dilate

88
Q

What is patulous dysfunction of the ET

A

valve incompetency, chronic patency (stuck open)

89
Q

What does pt complain of with ET dysfuntion

A
  • fullness in the ear
  • mild to moderate decrease in hearing
  • possible “popping” sound during yawning or swallowing
  • ear pain
90
Q

Exam findings of ET dysfunction

A
  • retracted TM of affected side

- decreased TM mobility

91
Q

Halmark of dilatory ET dysfuntion

A
  • hearing loss

- abnormalities of TM (retraction, middle ear effusion)

92
Q

Otoscope exam w/ dilatory ET dysfunction

A
  • effusion
  • scarring
  • thickening of TM
93
Q

What does weber test show w/ dialtory ET dysfunction

A

lateralization to affected ear (conductive hearing loss)

94
Q

Hallmark of patulous ET dysfunction

A

autophony- pt hears own voice amplified

95
Q

Physical exam findings of patulous ET dysfunction

A
  • breathing induced excursions of the TM

- sensorineural hearing loss

96
Q

Treatment of dilatory ET dysfunction

A

TREAT UNDERLYING ETIOLOGY

  • antihistamines
  • decongestants
  • nasal steriods
  • valsalva
97
Q

Treatment of patulous ET dysfunction

A
  • treat if severe sx >6 weeks
  • hydration, mucous thickening agents
  • ventilation tubes if severe
98
Q

Treatment of ET dysfunction

A
  • referral to ENT
  • nasal endoscopy
  • balloon dilation
  • surgery if mass or continued OM w/ effusion
  • CT or MRI w/contrast if >3 mnths unilateral sx or middle ear effusion with increased risk of malignant
99
Q

What is vertigo

A

symptom of illusory movement

100
Q

Dysfunction in peripheral input causes what sx in vertigo

A
  • sudden onset
  • tinnitus
  • hearing loss
  • horizontal nystagmus
101
Q

Dsyfunction in central input causes what sx in vertigo

A
  • gradual onset

- no associated auditory sx

102
Q

What are the two types of vertigo

A
  • peripheral

- central

103
Q

Causes of peripheral vertigo

A

More benign

  • BPPV
  • vestibular neuritis
  • Meniere’s disease
  • Herpes zoster oticus
  • acoustic neuroma
  • aminoglycoside toxicity
  • superior semicurcular dehiscence syndrome
104
Q

Causes of central vertigo

A

More serious

  • migraines
  • cerebral tumor on CN VIII
  • chiari malformation
  • brain ischemia
  • TIA
  • MS
105
Q

Key to diagnosing vertigo

A
  • duration

- hearing loss

106
Q

What provokes BPPV

A

Specific head movements

  • turning in bed
  • tilting head backward to look up
107
Q

What causes BPPV

A

calcium debris in semicircular canals (most common posterior)

108
Q

Vertigo sensation in BPPV

A
  • short in duration

- ear pain, hearing loss, tinnitus are absent

109
Q

BPPV can be a residual affect of what

A

Meniere’s disease

110
Q

Epidemiology of BPPV

A

> 60 y/o

females>males

111
Q

Clinical presentation of BPPV

A
  • rapid onset of dizziness or spinning
  • nystagmus (classic)
  • nausea/vomiting
112
Q

Diagnosis of BPPV

A
  • Dix Hallpike positional testing
  • electronystagmography
  • MRI/CT to rule out other causes
113
Q

Treatment of BPPV

A

Symptomatic treatment

  • antihistamines
  • antiemetics
  • benzos
  • scopolamine
114
Q

What does PT or neuro do for BPPV

A

vestibular rehab

  • gaze stimulation exercises
  • repositioning maneuvers
  • surgery: rare, only after 6 months
115
Q

What causes vestiular neuritis

A

viral or postviral inflammatory disorder affecting the vestibular portion of CN VIII

116
Q

Is vestibular neuritis benign and self limiting

A

YES

117
Q

Vestibular neurities

A

vertigo without hearing loss

118
Q

Labrynthitis

A

vertigo with unilateral hearing loss

119
Q

Clinical presentation of vestibular neuritis

A
  • rapid onset of severe, persistent vertigo
  • nausea and vomiting
  • gait instability (toward affected side)
  • nystagmus on affected side
    • head thrust
120
Q

Imaging for vestibular neuritis?

A

if concerned for lesion or stroke causing sx

-MRI/MRA for infarct

121
Q

Treatment for vestibular neuritis

A
  • corticosteriods
  • symptomatic treatment (antihistamines, antiemetics)
  • vestibular rehab
122
Q

Prognosis of vestibular neuritis

A
  • self limiting
  • usually a few days to 1 week
  • may have non specific dizziness and imbalance for months
123
Q

Meniere’s disease

A

peripheral vestibular disorder attributed to exces endolympathic fluid pressure

124
Q

Another name for Meniere’s disease

A

labyrinthine hydrops

125
Q

What does Meniere’s disease cause

A

episodic inner ear dysfunction

126
Q

Risks for Meniere’s disease

A
  • allergies
  • stress
  • viral
127
Q

Classic presenting sx of Meniere’s

A

-vertigo
-sensioneural hearing loss
-tinnitus
UNILATERAL

128
Q

Audiometry in Meniere’s disease

A

+ low frequency sensorineural hearing loss

129
Q

Electronystagmography in Meniere’s disease

A

+ unilateral reduced vestibular response

130
Q

Caloric testing in Meniere’s disease

A

loss/impairment of thermally induced nystagmus on affected side (nystagmus goes towards warm, away from cold)

131
Q

Goals of Meniere’s treatment

A
  • reduced frequency and severity of vertigo attacks
  • reduced or eliminiate hearing loss and tinnitus
  • minimize disability
  • prevent disease progression (hearing loss and imbalance)
132
Q

Acute Meniere’s diease treatment

A
  • antihistamines
  • antiemetics
  • benzos
  • anticholinergics (scopolamine)
133
Q

Long term Meniere’s treatment

A
  • lifestyle adjustment
  • salt restriction
  • limit caffeine and nicotine
  • limit alcohol
  • diuretics
134
Q

Nondestructive procedures for Meniere’s

A
  • surgery on endolymphatic sac
  • intratympanic glucocorticoids
  • postive pressure pulse generator
135
Q

Destructive procedures for Meniere’s

A
  • intratympanic gentamicin injection
  • surgical labryinthectomy
  • vestibular nerve resection
136
Q

Semicircular canal dehscence syndrome AKA…

A

Minor’s syndrome

137
Q

What is semicircular canal dehiscence sydrome

A

thinning of the bone that separates the superior semicircular canal from the middle cranial fossa

138
Q

What provokes vertigo in semicircular canal dehiscence syndrome

A

coughing, sneezing, valsalva maneuver

139
Q

What is Tullio phenomenon

A

vertigo induced by loud sounds

140
Q

How is semicircular cana dehiscence syndrome diagnosed

A

high resolution CT of the temporal bone

141
Q

What is tinnitus

A

perception of sound in proximity of head in the absence of external source

142
Q

Pulsatile tinnitus

A

-like listening to your own heartbeat

143
Q

What can cause pulsatile tinnitus

A
  • vascular disorders
  • arteriovenous shunts
  • venus hums
  • ET dysfunction
  • arterial bruits
144
Q

Non-pulsatile tinnitus

A

unilateral clicking tinnitus secondary to middle ear spasm

145
Q

Presbycusis

A

sensorineural hearing loss with aging, or any acquired high frequency hearing loss commonly associated with tinnitus

146
Q

Otosclerosis

A

condition of abnormal bone repair of the stapes footplate bone

147
Q

Chiari Malformation

A

occurs when low lying cerebellar tonsils causes tension on the auditory nerve

148
Q

Diagonistics for tinnitus

A
  • audiometry to R/O associated hearing loss

- MRI if unilateral esp with hearing loss to R/O retrocochlear lesion

Clin Med Exam II (11 decks)

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