Eyes/Ears Flashcards
- Nearsightedness (see better up close)
- Farsightedness (see better far away)
- Irregularity of lens/cornea (distance doesn’t affect vision)
- Farsightedness of age (loss of lens)
- Myopia
- Hyperopia
- Astigmatism
- Presbyopia
Most commonly caused by adenovirus
Often preceded by URI
Highly contagious
Ssx?
Viral conjunctivitis
Painless to mild irritation
CLEAR watery to thick d/c w/ crusting on lashes
OFten from ocular injury, FB, poor contact lens care, spread from rhinosinusitis
Ssx?
Bacterial conjunctivitis
ssx = usually painless COPIOUS mucopurulent d/c (at risk for corneal ulceration)
INfection involving the cornea typically with an ulcerative process
Keratitis (most cases are keratoconjunctivitis as an extension of conjunctivitis)
Common keratitis in the US… HSV
From cold sores or zoster on ophthalmic branch CN V
Herpetic vesicles/ulcerations on corneal surface (may cause scarring/blindness)
Ssx?
ssx = unilateral, photophobia, dendritic pattern
Outside of US, leading cause of blindness
Highly contagious from contact w/ infected secretions, contaminated objects, flies
ssx?
Chlamydia trachomatis (trachoma)
Mild itch/irritation progressing to purulent d/c
Scars cause lashes to turn inward
Ingrown lashes scratch eyelid leading to corneal inflammation/permanent clouding
Infxn of eyelash follicle w/ small pustule at lash line (staph aureus)
Style (hordeolum)
Warm compresses (maybe abx)
Blockage of meibomian gland
Chalazion
Acutely warm compresses, maybe referral to optho if no improvement
Redness/swelling of eyelash and eyelash follicles (often staph aureus)
Blepharitis
Tx - maybe abx but careful daily cleansing of lids/eyelashes
most common cause of vision loss in US
Opacification or clouding of lens, usually develops over years - decades
Cataracts
Most common cataracts
Wear/tear on lens
Senile cataracts
Cataracts as a consequence of trauma, burns, inflammation, radiation
Secondary cataracts
Tx for cataracts?
Surgical removal/replacements of lens
Increased IOP from disrupted flow of aqueous humor
Atrophy of optic nerve/retinal cells -> loss of central/peripheral visual fields
Glaucoma
Impaired reabsoprtion for unknown reason
Progressive
Slowly increased IOPs
Open-angle
Iris suddenly impedes flow
SUDDEN, RAPID rise in IOPs
INTENSELY PAINFUL RED EYE/BLURRED VISION
Closed-angle
Tx for glaucoma?
STAT optometry referral
REDUCE IOP ( can use beta Bs, alpha agonist)
Pilocarpine to constrict pupil for angle closure crisis
Progressive deterioration and loss of central vision
Dry is less aggressive, wet form progressives rapidly
Age-related macular degeneration
No tx
Drusen bodies
Yellow lipid deposits on retina characteristic of ARMD
Clinical features of ARMD?
Visual distortions (straight lines appear bent)
Need for brighter light for near vision
Difficulty at adapting to lowlight levels
Copper wiring or silver wiring
Retinal hemorrhages (dot/flame hemorrhages)
Cotton wool spots (retinal edema and exudates0)
HTN retinopathy findings on exam
Cotton wool spots
Neovascularization
Diabetic retinopathy
Rare eye malignancy affecting CHILDREN (often involves both eyes)
Intraocular mss eventually fills entire globe and extends into optic (UNTREATED = LETHAL)
Retinoblastoma
Tumor recognized by WHITE PUPIL OR WHITE REFLEX during infant eye exam
Primary eye tumor affecting adults
Tumor originates from pigmented cells uveal tract (enlarging growth distorts globe)
Malignant melanoma
Ssx - dark spot on iris or conjunctiva
Both retinoblastoma and malignant melanoma get what tx?
Eye nucleation
Cauliflower ear, “wrestler’s ear”
Trauma causes hematoma to form w/ subsequent ischemia -> permanently deformed auricle
Auricular hematoma
Tx for auricular hematoma?
Drain ear hematoma quickly
Apply pressure dressing to sandwich skin against cartilage
Most often associated w/ children w/ atopic dermatitis or adults w/ eczema
Ssx - itching, erythema, flaking
Allergic OE
swimmers ear
Common in children but affects all age ranges
Staph aureus/pseudomonas
SSx?
Bacterial OE
Ssx - pn, redness, swelling d/c, TENDERNESS W/ EAR MOTION
Ssx are similar to bacterial OE but no d/c and HYPHAE in ear canal
Associated w/ hot climates
Fungal OE
Typically an extension of viral URI
Common in 1-5 y/o
SSx = ear pn, hearing loss, fever
RED AND BULGING TM
Acute OM
Tx - abx, fever mgmt
Chronic/recurrent OM?
Repeated/failed abx
Tx - ENT referral
Myringotomy w/ PE tubes (no head immersio under water)
Perf TM causes?
Mechanical trauma - FB
Acoustic trauma - noise
Barotrauma - sudden pressure change (divers/fliers)
Infection - drainage from OM
Tx for small perf TM?
Small perfs will heal spontaneously but no head immersion
large/non healing perfs may need ENT sx
Benign (but erosive) tumor
Common complication of chronic otitis media
External canal epithelium grows inward through TM perforation into middle ear/mastoid
cholesteatoma
negative pressures in middle ear “pull” in squamous cells, forming cyst -> damage to ossicles/mastoid
Ear drainage, vertigo, hearing loss
PEARLY WHITE MASS IN MIDDLE EAR
cholesteatoma
tx = surgical excision/repair; abx
Tiny floating debris in labyrinth, provoked by simple manuevers
(usually self-limiting, but associated w/ infxn or head/neck trauma)
Benign positional vertigo
Ssx = dizziness (not lightheadedness)
Tx = antiemetics, drugs for motion sickness (also, home exercises to “fatigue” labyrinth receptors)
benign positional vertigo
Fluid imbalance between inner ear compartments
common in 40-60 y/o
Tx?
Meniere’s dz
Tx = antiemetics (ENT for eval)
What’s the classic triad for meniere’s dz?
Vertigo (lasting hours, then subsides then recurs w/ in days)
Sensorineural hearing loss (especially low-freq sounds)
Tinnitus
What would the hearing loss in Meniere’s dz look like on PE?
Weber lateralizes to affected ear
Rhinne AC > BC
Loss of conduction, usually external to middle ear problem
FB, cerumen, TM perf, OM
conducitve hearing loss
Cochlear damage, inner ear “receiver” is damaged
Sensory
repetitive noise trauma is most common cause, but also ppresbycusis = hearing loss of old age
Least common hearing loss?
Auditory/brain damage
(MS, CVA, cranial nerve tumor)
Neural hearing loss
Sounds great than ___ as sudden impulse/repetitive burst cause damage
85 decibels (heavy city traffic)
How do loud noises affect hair cells?
Release of free radicals irreversibly damaging auditory hair cells
(-> tinnitus)
