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NP 801 NP Theory 2 > HEENT > Flashcards

HEENT Flashcards

1
Q

What are cataracts?

A

Opacificaiton + clouding of lens

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2
Q

5 D’s

Cataracts clinical manifestations

A
  • Vision is hazy, blurred, or dimmer
  • Photosensitivity
  • See “halos” around lights + Glare
  • See a progressive decline in vision over months to years
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3
Q

Cataracts Objective findings
What PE assessments and findings?

A
  • NO conjunctiva REDNESS
  • PAINLESS
  • Full eye + neuro exam
  • Pupil exam NORMAL (PERRLA)
    • ABNORMAL red reflex
      • Dull, extinct, or shady
  • Test visual acuity
Abnormal red reflex
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4
Q

What do you need to rule out first?

Cataracts differentials?

A

Macular degeneration
Diabetic retinopathy

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5
Q

RF?

What are cataracts commonly A/w

A

↑ AGE

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6
Q

Cataract Risk Factors

A
  • Age
  • Diabetes
  • UV exposure
  • Systemic steroid use
  • HTN, CKD, HIV
  • Eye trauma Hx
  • EtOH use
  • Tobacco use
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7
Q

Cataracts Patient Education
Cataract surgery contraindication

A
  • Avoid night time driving
  • Surgery is low-risk
    • NO SRG if have active URI/coughing, or poorly controleld BP
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8
Q

Cataract Surgery
What to do pre-op?
What to do post-op?

A
  • Med reconcilliation pre-op
    * Alpha-adrenergic antagonist - Flomax → Floppy Iris Syndrome
  • Post-op:
    • No heavy lifting, no straining
    • Eye drop administration
    • Wear sunglasses
    • Go to urgent care if experiencing abrupt changes
Cataracts Surgery
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9
Q

Three things

Eyes complication signs/symptoms → ED

A
  • ONLY IF ABRUPT CHANGES
  • Sudden vision changes
  • Darkening of vision
  • Eye pain!
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10
Q

Definition

What is macular degeneration?
Types?

A

Degenerative disease of central portion of retina
Dry (non-exudative) + Wet (exudative)

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11
Q

Macular degeneration clinical manifestations (BOTH)

A
  • Change in central vision
  • Difficulties adapting to the dark
  • Dark spots in vision
  • Distorted straight lines
  • Colors may appear less vivid or darker
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12
Q

Dry macular degeneration clinical manifestations

A
  • Retinal atrophy
  • Build-up of drusen (yellow deposits)
  • Gradual central vision loss
  • Fuzzy or distorted vision
  • Scarring + thinning of retina
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13
Q

Wet macular degeneration clinical manifestations

A
  • New blood vessels forming → swelling + bleeding into retina
  • Sudden OR gradual central vision loss
  • Blindspot in central vision
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14
Q

Macular degeneration PE techniques

A

Full eye + neuro exam
Test visual acuity

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15
Q

DX test for macular degeneration and purpose

A

Amsler grid
ID central cision defects - used for monitoring progression

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16
Q

Dry macular degeneration Pharmacologic txs

A

AREDs or AREDs2 for non-smokers only
These carry risk for lung cancer

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17
Q

Wet macular degeneration pharmacological txs

A

Intravitreous INJs w/VEGF inhibitors

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18
Q

Dry macular degeneration Nonpharmacological Txs

A

Risk modification
* Tobacco cessation
* UV protection
* BP + lipid control

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19
Q

Wet macular degeneration Nonpharmacologic txs

A

Photodynamic therapy
Laser coagulation txs d/t vessel changes

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20
Q

Macular degeneration Risk Factors + Referral education

A
  • Age
  • Tobacco Usage
  • FMHx → Should see opthamology
  • HTN
  • HLD

Referral + regular F/U + Monitor w/Amsler grid

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21
Q

Definition

What is glaucoma?
Types?

A
  • Condition resulting in progressive damange to optic nerve → vision loss
    • peripheral → central vision loss
  • Causing dysfunctional drainage of aqueous humor
  • Types
    • Primary angle-closure (ACUTE)
    • Primary open-angle
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22
Q

Acute-angle closure glaucoma: clinical manifestations

A
  • ↑ IOP (not definitive as this can still happen w/normal pressure)
  • ABRUPT CHANGES
  • Redness
  • Eye PAIN
  • Vision loss
  • H/A
  • Halos (as opposed to painless halos in cataracts)

VISION EMERGENCY DO NOT MISS
TX W/IN HRS

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23
Q

Primary open-angle glaucoma: clinical manifestations

A
  • GRADUAL ↑ IOP d/t dysfunctional drainage → peripheal vision loss → central vision loss
  • Bilateral s/s
  • Painless = silent blinder
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24
Q

Glaucoma Objective findings
Glaucoma PE techniques

A
  • Full eye exam
  • Optic cupping
    • Look at ratio of cup size to disk (see a clear circle)
  • Optic nerve fibers to brain damaged + destroyed from ↑ IOP on nerve cells → axon loss
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25
Q

Glaucoma differentials

A

Macular degeneration
Severe open-angle glaucoma

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26
Q

Angle-closure glaucoma pharmacologic txs

A
  • Eye drops
  • Systemic meds to ↓ IOP (short term)
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27
Q

Open-angle glaucoma pharmacologic txs

A
  • Eye drops
    • Prostaglandin analogs
    • Lantoprost
    • BBs (timolol)
    • Combo products
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28
Q

Meds that will interact with glaucoma meds
Why avoid these?

A

SSRIs
Antihistamines
Decongestants
These will ↑ IOP

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29
Q

Angle-closure glaucoma nonpharmacological txs

A

Iridotomy to ↓ pressure
* Drill small hole in iris to allow drainage
* Acute occlusion of anterior chamber angle

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30
Q

Open-angle glaucoma nonpharmacological txs

A
  • Laser txs
  • Surgery - trabulectomy
    • creating. ashunt to allow drainage
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31
Q

Glaucoma risk factors

A
  • ↑ age
  • FMHx
  • Tobacco usage
  • HTN
  • Nearsightedness (myopia)
  • ↑ IOP
  • ↑ Prevalence in black, Latinx pop
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32
Q

Glaucoma referral management
Monitoring

A
  • Routine testing of visual acuity
  • Measuring IOP + visual field testing + dilated exam
  • Ask about medication adherence
  • Opthamology visits
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33
Q

Diabetic retinopathy

A
  • Resulting from chronic effects of DM
  • ↑ A1c = ↑ DM retinopathy risk
  • Damanged blood vessels d/t hypergylcemia
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34
Q

Diabetic retinopathy clinical manifestations

A
  • May be asymptomatic
  • Floaters or light flashes
  • Sudden vision loss if hemorrhage occurs
DM retinopathy vision
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35
Q

(overall) Diabetic retinopathy objective findings on exam

A
  • Microaneurysms
  • Dot-blot hemorrhages
  • Cotton wool spots
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36
Q

Non-proliferative DM retinopathy objective findings

A
  • Microaneurysms
  • Hemorrhages
  • Blockages
  • Dilation of larger vessels
  • Macular edema
  • NO NEW BLOOD VESSEL GROWTH
37
Q

Proliferative diabetic retinopathy objective findings

A
  • Presence of abnormal blood vessels
  • Likely to leak → bleed
  • ↑ scar tissue on retina
  • ↑ retinal detachment
  • ↑ fluid → glaucoma
  • ↑ risk of optic nerve damange
  • CAN CAUSE BLINDNESS
38
Q

Diabetic reitnopathy DX

A
  • Dx on fundal exam
  • Retinal scanning
    • Can take retinal photo early in disease process
39
Q

Diabetic retinopathy pharmacological interventions

A
  • Fenofibrate to slow progression
  • VEGF INJs little evidence
  • Intravitreal corticosteroids amin for macular edema
40
Q

Diabetic retinopathy nonpharmacological interventions

A

Tx managed by opthamology
* Address poor glycemic control
* Pan-retinal photocoagulation

41
Q

Diabetic retinopathy Risk Factors

A
  • Poor gylcemic control
  • Duration of dx
  • HTN
  • HLD
  • Pregnancy
42
Q

Best treatment(s) for DM retinopathy

A

PREVENTION
* Control BS, BP, Lipid level
* Monitor A1c%
* Early detection prevention
* Screening eye exams
* DM II should have opthalmologic exam at time of dx + annually

43
Q

Definition

Dry eye syndrome
Two types and conditions with each

A
  • Tear film deficiency
  • Ocular surface disease
  • Dysfunction teaar sydnrome
  • Aqueous:
    • Sjogren’s hyposecretion
  • Evaporative:
    • Meioban gland dysfunction
    • Poor eyelid disclosure
    • Insufficient blinking
44
Q

Dry eye syndrome clinical manifestations

A
  • Paradoxical XS tearing
  • Dryness
  • Foreign body sensation
  • Burning or stinging
  • Itchiness
  • Ocular fatigue (screen)
  • Blurriness relieved by blinking

symptoms worsened in extended periods of visual concentration + low-humidity

45
Q

Dry eye syndrome PE findings

A

Unremarkable

46
Q

Dry eye syndrome Diagnostic tests
Which meds aggravate this condition?
Which med to AVOID?

A
  • Fluoresein dye for corneal abrasion
  • Shirmer test
  • Complete PE for systemic causes
    • Complete ROS
  • Review med history
    • Diuretics
    • Anti-histamines
    • TCAs
  • Avoid VASOCONSTRICTORS
47
Q

Dry eye syndrome differentials

A

Trichiasis, Conjunctivitis, Corneal abrasion, Systemic causes

48
Q

Dry eye syndrome pharmacological txs

A
  • Artificial tears 6x/day
  • Fish oil, vitamin D
  • Specialist (short course topical steroid - Cyclosporine); Low dose PO abx
49
Q

Dry eye syndrome nonpharmacological txs

A
  • Avoid extended periods of visual concentration
  • Avoid direct drying effect of A/C or fan
  • Lid hygiene
50
Q

Hearing loss types
Most common hearing type

A

Conductive
Sensorineural (age-related) - presbycusis

51
Q

Concerning hearing loss signs/symptoms

A

All rapid onset
* Severe vertigo
* Ataxia
* Fevers
* Head trauma
* Neurological deficits: H/A dizziness, imbalance

52
Q

Hearing loss exam tests

A

Finger rub
Whispered Voice test
Weber and Rinne

53
Q

bone condution vs air conduction

Weber vs. Rinne test
How does each show conductive vs. sensorineural hearing loss?
Where would each localize to?

A
54
Q

Conditions of external ear

A
  • Cerumen impaction
  • Otitis externa
  • Foreign body
55
Q

Conditions of middle ear

A
  • Cholesteatoma
  • Otitis media w/effusion
  • Otosclerosis
  • TM rupture
  • Eustachian tube dysfunction
56
Q

Systemic labs for hearing loss

A
  • CBC w/diff
  • Syphilis
  • ESR
  • ANA
  • RF
  • TSH
  • CT or MRI for structure cause
57
Q

Hearing loss nonpharmacological txs/patient education

A

Cochlear implants (moderate to profound sensorineural hearing loss)
Hearing aides
* Face patient when speaking
* Minimize background noise

58
Q

Hearing loss referrals

A

Referral for formal audiometry
Referral to ENT/neuro
Referral to ED if abrupt onset of s/s

59
Q

Definition

Tinnitus

A

Perception of hearing sound when there’s no sound in environment

60
Q

Tinnitus etiologies

A
  • Toxins
  • Noise or barotrauma
  • Eustachian tube dysfunction
  • Acoustic neuroma
  • Vascular abnormality
60
Q

Tinnitus etiologies

A
  • Toxins
  • Noise or barotrauma
  • Eustachian tube dysfunction
  • Acoustic neuroma
  • Vascular abnormality
61
Q

Tinnitus clinical manifestations
What do the different sounds heard indicate?

A
  • Hearing buzzing, ringing, hissing, whistling
  • UNL or BL
  • Constant or intermittent
  • High pitched, continuous → sensorineural hearing loss
  • Low-pitched → idiopathic or Meniere disease
  • Pulsating/rushing → vascular cause
  • Clicking → TMJ
  • Any neuro s/s: ear pain, dizziness, discharge, etc
  • Insomnia
62
Q

Tinnitus PE exams

A

Ear + neuro exam
TMJ assess
Auscultate for bruits

63
Q

Tinnitus differentials

A
  • CNS lesion
  • MS
  • Vestibular schwannoma (DO NOT MISS)
64
Q

Tinnitus diagnostics

A
  • Systemic labs: CBC w/diff, ESR, glucose, TSH
    ** MRI + CT to R/o CNS lesion**
65
Q

Tinnitus nonpharmacological tx

A

Earplugs
White noise machine

66
Q

Tinnitus Risk factors
Referrals

A

Risk Factors
* Syphilis
* Lyme Disease
* Referral to audiogram, ENT, or neuro

67
Q

Cerumen impaction wax description

A

Dry, dark, immobile, malodorous

68
Q

Cerumen clinical manifestations

A
  • UNL or BL s/s
  • Fullness
  • Hearing loss
  • Ear pain + discomfort
  • Tinnitus
  • Vertigo or dizziness
69
Q

2 things

How is cerumen impaction DX

A

When patient has s/s and cannot assess ear d/t cerumen

70
Q

Objective finding cerumen impaction
PE assessments

A
  • Wax partially or full occludes TM
  • Assess for bleeding + drainage
  • PE preauricular, posterior auricular lymph nodes
71
Q

Cerumen impaction differentials

A
  • Foreign body
  • Otitis media
  • Otitis externa
  • TM perforation
  • Eustachian tube dysfunction
72
Q

Cerumen impaction pharmacological txs

A

Ear wax removal drops:
* Carbamide peroxide drops x 3-5d
* Cortisporin drops x 2-3d after irrigation if risk for otitis externa

73
Q

Cerumen impaction nonpharmacologic txs

A

Using currette or irrigation for removal

74
Q

Cerumen impaction risk factors

A

Q-tip usage
Ear plug usage
Hearing aides
Earbuds

75
Q

Hx questions to ask if patient has cerumen impaction

A

Ask about…
* Hx of tympanostomy tube
* Surgery
* TM rupture (irrigation)
* Immunocomp: excoriation

76
Q

Cerumen impaction patient education

A
  • Clean external ear only
  • Avoid ear swabs/small objects inot ear
  • May use debrox drops 1-2x/week
  • Individuals who use hearing aides are at higher risk for impaction
77
Q

Definition

Cholesteatoma
What kind of hearing loss

A
  • Collection of skin cells in middle ear or mastoid → benign tumor
  • Middle ear issue; congential/acquired
  • Conductive hearing loss
78
Q

Cholesteatoma
Primary vs secondary

A

Primary: eustachian tube dysfunction
Secondary: post TM perforation

79
Q

Cholesteatoma clinical manifestations

A

These can recur
* Erosion
* Hearing loss
* Malodorous drainage
* Tinnitus
* Vertigo

80
Q

PE exams cholesteatoma

A

External/internal ear exam
Neuro exam

81
Q

Cholesteatoma differentials

A
  • Squamous cell carinoma
  • Adenocarcinoma
  • Acoustic neuroma
  • Otitis externa
  • Chronic otitis media
  • Foreign body
82
Q

Cholesteatoma definitive treatment

A

SURGERY
* F/U w/ENT post-op
* Referral to ENT + audiogram

83
Q

Cholesteatoma pharmacological tx if otitis externa/AOM present

A

Antibacterial agent

84
Q

Chronic inflammation of cholesteatoma →

A
  • Balance issues
  • Meningitis
  • Brain injury
  • Tinnitus
  • Vertigo
85
Q

Low vision parameters

A

20/70 or <

86
Q

Legal blindness parameters

A

20/200 or <

87
Q

Vision screening

A

USPSTF has no recommendations BUT
AAO: > 65y.o. comprehensive eye exam Q1-2yrs

NP 801 NP Theory 2 (7 decks)

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