HEENT Flashcards
1
Q
Angioedema
A
Non-pitting edema of subcutaneous or submucosal tissues on lips, face, neck, extremities, larynx, gut
2
Q
Hereditary angioedema cause
A
Mutation in C1-INH gene
3
Q
Allergic angioedema pathophys
A
Histamine mediated.
More common
4
Q
Non-allegic angioedema pathophys
A
Bradykinin-mediated
Less common
C1-INH deficiency
Can be caused by ACE-INH
5
Q
Histamine-mediated angioedema clinical manifestatons
A
Urticaria
Flushing
Pruitus
Bronchospasm
ABD pain
Vomiting
Onset within 60 mins and could last 1-2 days
6
Q
Bradykinin-mediated angioedema
A
No urticaria
More severe and longer duration
Usually within a week of exposure
Takes one day to peak and resolves in 2-3 days
Recurrent episodes
7
Q
Angioedema physical exam focus
A
Head, neck. resp, abd
Monitor cardiac and O2 sat
8
Q
Angioedeme diagnosis/lab
A
Good history
C4-INH level (cheaper)
C1-INH level
Tryptase if anaphylaxis
Laryngoscopy
9
Q
Histamine mediated angiodema treatment
A
Epinephrine
Steroids
Histamine blockers (H1+H2)
10
Q
Hereditary angioedema treatment
A
C1 esterase INH
11
Q
ACE-INH induced angioedema treatment
A
Discontinue ACE-INH
Never use ACE-INH again
12
Q
Aphthous Ulcer
A
Canker sours
Common
13
Q
Aphthous ulcer cause
A
Stress
Human herpes virus 6
Can be in healthy
14
Q
Aphthous ulcer clinical presentation
A
Painful
Recurrent
Localized, shallow, small, round, oval
Found on freely moving nonkeratinized oral mucous membrane
Yellow-gray fibrinid centers surrounded by red halos
15
Q
Aphthous ulcer diagnosis
A
Biopsy to rule out squamous cell carcinoma.
If large rule out HIV, HSV, drug allergies, autoimmune
16
Q
Aphthous ulcer management
A
Topical corticosteroid (triamcinolone acetonide)
Oral prednisone for severe
Cimetidine or thalidomide for recurrent
17
Q
Glossitis
A
Inflammation of tongue
18
Q
Glossitis cause
A
Anemia
Vitamin deficiency
Infections
Medication
Dehydrated
19
Q
Oral thrush
A
Oral candidiasis albicans (yeast)
Common normal flora, but opportunistic pathogen.
20
Q
Oral candidiasis risk factors
A
Diabetes mellitus
Broad Abx
Corticosteroids
Dentures
21
Q
Oral candidiasis clinical presentation
A
Erythema
Painful creamy-white curd-like patches on tongue easily rubbed off with tongue blade.
22
Q
Angular cheilitis
A
Oral candidiasis
Painful erythematous fissured patches in mouth
Can be sign of HIV
Seen in nutritional deficiencies
23
Q
Oral candidiasis diagnosis
A
KOH
Spores and nonseptate mycelia
Biopsy
HIV
24
Q
Oral candidiasis treatment
A
Fluconazole (antifungal)
0.12% chlorhexidine or H2O2 for relief
Nystatin powder on dentures
25
Leukoplakia
Potentially malignant (squamous cell carcinoma)
White lesions on oral mucosa
Hyperkeratosis
Can't be removed by rubbing
26
Leukoplakia risk
Tobacco use
Alcohol use
27
Homogenous leukoplakia
Uniformly white, thin plaque with well defined margins
28
Nonhomogenous leukoplakia
White lesions speckled with red
Granular, nodular, verrucuous white lesions.
Higher risk of cancer
29
Leukoplakia diagnosis
Biopsy
Cytologic exam
30
Leukoplakia treatment
No real treatment.
Surveillance
Take out carcinogenics
31
Erythroplakiia
Erthematois placks
Can't be removed
Usually dysplasia or carcinoma
32
Erythroplakia treatment
Refer to oral surgeon.
Eliminate carinogenic irritants
33
Oral hairy leukoplakia
Associated with EBV
More common in HIV pts
Not malignant
34
Oral hairy leukoplakia clinical presentation
Develop quickly
Slightly raised leukoplakic areas with hairy surface
Can't be scraped off
35
Oral hairy leukoplakia labs
HIV test
Peripheral blood smear.
EBV test (hererophile antibody test)
36
Oral hairy leukoplakia treatment
Refer to HIV specialist and oral surgeon
Acyclovir
Valacyclovir
Famciclovir
37
What is majority of oral cancers
Squamous cell carcinoma (90%)
38
Oral cancer clinical presentation
Raised, firm, white lesions with lesions at base.
Painful
39
Oral cancer treatment
MRI and PET scan
Refer to oral surgeon
Quit tobacco and drinking
40
Oropharynx cancer
Cancer of tonsil, base and posterior one third of tongue, soft palate, posterior and laterla pharangial walls.
Usually squamous cell carcinoma
Linked to HPV
41
Oropharynx cancer oral presentation
Unilateral throat masses
Odynophagia
Weight loss
Ipsilateral cervical lymphadenopathy
42
oropharynx cancer diagnosis
Refer to otolaryngologist-head-neck surgeon
CT shows enhancing mass at lingual tonsils
43
Oropharynx cancer treatment
Radiation
Chemo
Therapy
44
Acute laryngitis
Cause of hoarseness
Usually URTI or acute vocal strain
45
Acute laryngitis presentation
Rough, low pitched voice
Hoarseness
Cough
Rhinorrhea
Sore throat
Constantly clearing throat
Edema of mucous membrane
Vascular engorgement of vocal folds
46
Acute laryngitis diagnosis
Clinical
Laryngoscopy
CXR
pH testing to test for reflux
47
Viral laryngitis treatment
Corticosteroids
48
Bacterial laryngitis treatment
Abx
Erythromycin can help hoarseness and cough
49
Vocal cord polypoid changes treatment
Treat underlying cause
50
GERD treatment
Proton pump inhibitor (-prazole)
51
Recalcitrant nodules or polyps on larynx treatment
Surgery
52
Chronic laryngitis
>3 weeks
Persistent inflammation
53
Chronic laryngitis red flags for malignancy
SOB
Stridor
Hemoptysis
Throat pain
Dysphagia and odynophagia
Weight loss
Chronic cough
54
Chronic laryngitis diagnosis
Refer to ENT
Laryngoscopy
Imaging
Rule out laryngeal cancer
55
Chronic laryngitis treatment
Remove irritants and treat underlying cause
56
Laryngeal cancer
Usually Squamous cell carcinoma
Associated with HPV
57
Laryngeal cancer presentation
Persistent throat or ear pain
weight loss
neck mass
emotysis
Visible mass
Palpable mass at base of tongue or tonsil
neck adenopathy
58
Laryngeal cancer diagnosis
Refer to ENT oncology
Laryngoscopy and biopsy
CT or MRI
59
Laryngeal cancer treatment
Radiation and surgery
60
Herpes labialis cause
HSV-1 mostly
Some HSV-2
61
Herpes labialis presentation
Pain, burning, itching at site of eruption (cold sores)
Small, grouped, painful vesicles on erythematous base usually perioral
Lesions crust and heal in one week
Enlarged lymph nodes
62
Herpes labialis in immunocompromised
Much larger eruptions
63
Herpes labialis diagnosis
PCR
Viral culture
64
Primary episode herpes labialis treatment
Famciclovir
Acyclovir (severe)
Valacyclovir
for 7-10 days or until lesions healed
Start within 72 hours
65
Recurrent herpes labialis treatment
Famciclovir
Acyclovir
Valacyclovir
for 4-5 days or until lesions healed
Continue until healed for immunocompromised
66
Acute sialadenitis
Inflammation or infection of salivary glands (usually parotid or submandibular)
67
Acute sialadenitis pathophysiology
Ductal obstruction caused by mucous pug.
Followed by salivary stasis and secondary infection.
Usually caused by Staph or H. infuenzae
68
Acute bacterial sialadenitis risk factors
Sjogren syndrome (dry mouth and eyes)
Dehydration
Peridontitis
69
Acute bacterial sialadenitis presentation
Sudden painful swelling of gland that increases with meals or anticipation of meals.
Edema and tenderness of overlying gland
Tenderness and erythema of duct opening.
Pus in duct
70
Acute bacterial sialadenitis management
Naficillin (IV) for severe
Oral abx for less severe
Measure salivary flow
Give candy to stimulate salivary flow
If it becomes abscess refer to ENT
71
Supurrative sialadenitis
Severe acute bacterial sialadenitis
Life threatening
Usually staph
Refer to ENT
72
Mumps (parotitis) cause
Paramyxovirus
Inflammation and swelling of parotid glands (angle of mandible)
73
Mumps (parotitis) presentation
Fever, headache, myalgia, fatigue, anorexia
Parotid gland swelling in 48 hours
Most cases unilateral
Swelling can last up to 10 days
Erythema and edema at orifice of stensen's duct
74
Mumps (parotitis) diagnosis
PCR
Viral culture
IgM and IgG
Lymphocytosis
Elevated serum amylase
75
Mumps (parotitis) complications
Orchitis
Sterility
Oophoritis
76
Mumps (parotitis) treatment
No specific antiviral
Supportive care (antipyretics, fluids, analgesics)
Warm or cold packs'
Isolate
MMR vaccine
77
Dental caries pathophys
Tooth decay from streptococcus mutans
78
Dental caries presentation
Soft rubbery defect on tooth
Rapidly progressive
Tooth pain
Tooth decay
Tooth sensitivity
79
Dental caries risk factors
High oral bacteria count.
High sugar intake
Inadequate fluoride exposure
80
Dental caries treatment
Refer to dentist
Remove tooth structure
Root canal
Or take out whole tooth if its bad
81
Dental caries prevention
Brush teeth
Floss
82
Dental abscess presentation
red, tender, focal or diffuse swelling of gingiva
Pus
83
Dental abscess treatment
Abx
Pain control
Refer to dentist to drain abscess or care for infected tooth
84
Ginigivitis
Bacteria in dental plaque causing inflammation of gums
85
Periodontitis
Gingivitis and involvement of soft tissue and bone supporting teeth (tooth gets loose)
86
Gingivitis and periodontitis risk factors
Poor hygiene
Smoking
Diabetes
Obesity
Alcohol
HIV
Steroids
87
Gingivitis presentation
Gingival redness, swelling, bleeding.
Halitosis
Provoked by brushing or flossing.
ONLY effects gums
88
Plaque Associated Gingivitis if left untreated
Turns into peridontitis
89
Non-plaque induced gingivitis
Less common
Caused by hormonal changes, HIV, gingival fungal infection, meds
90
Gingivitis treatment
Refer to dentist for debridement.
Better hygeine
91
Periodontitis presentation
gingivitis plus loss of connective tissue and bone support.
Plaque covering calculus destroys bone
Tooth mobility and loss.
Halitosis, gingival redness, swelling, bleeding
92
Periodontitis treatment
Refer to dentist for debridement
Topical abx
Chlorhexidine orla rinse
93
Ludwig angina
Rapidly spreading bilateral cellulitis of submandibular and sublingual spaces with tongue elevation
Dental infection of mandibular molars.
Strep, staph, or bacteroides
94
Ludwig angina clinical presentatoin
Paingul, brawny induration of floor of mouth.
Trismus
Drooling
Dysphonia
Can lead to compromised airway
95
Ludwig angina treatment
Secure airway
IV broad specrum abx.
I+D of abscess
96
Most common cause of sore throat
Group A strep
97
Beta hemolytic streptococci on blood agar
Complete hemolysis
98
Alpha hemolytic streptococci on blood agar
Incomplete hemolysis
99
Gamma hemolytic streptococci on blood agar
Nonhemoytic
100
Most common bacterial cause of exudative tolsillopharyngitis.
GAS strep pyogenes
Transmitted by droplets
101
GAS pharyngitis clinical presentation
Fever
Sore throat
Odynophagia
Tender swollen lymph nodes
Usually NO hoarseness, cough, coryza
102
GAS pharyngitis oral exam findings
Pharyngeal erythema (beefy red pharynx)
Erythematous soft palate
Enlarged erythematous tonsils
Palatal petachiae
103
GAS pharyngitis 4 point criterea
FALE
Fever
Absence of cough
Lymph nodes tender anterior cervical
Exudates
104
GAS pharyngitis diagnosing
Confirmatory bacterial testing
Rapid antigen detection testing (RADT)
Swab throat culture
105
GAS pharyngitis treatment
Oral penicillin or amoxicillin
Oral cephalosporins
Azithromycin if allergic to penicillin
Analgesics and anti-inflammatory
Salt water gargling
Tonsillectomy for recurrent
106
What to give person with GAS pharyngitis that is allergic to penicillin
Azithromycin
107
Scarlet fever (scarlatina)
Children
Common in winter and early spring
Group A strep producing erythrogenci toxins
108
Scarlet fever presentation
Abrupt prodrome with pharyngitis, headache, vomiting, abd pain, fever,
nonpruritic rash 1-2 days after illness
109
Scarlet fever physical exam findings
Orally similar to GAS pharyngitis
White strawberry tongue or red strawbettery tongue
Flushed face
Non-pruritic red rash feels like sandpaper
Pastia's lines in skin folds
Skin peels after few days
110
Lemierre syndrome
Supurrative complication of GAS pharynitis
Suppurative thrombophlebitis of jugular vein.
111
Lemierre syndrome cause
Fusobacterium necrophorum
Gram negative anaerobe
112
Lemierre syndrome treatment
CT of neck
Broad spectrum ABx (metronidazole + ceftriaxone or piperacillin-tazobactam)
113
Viral pharyngitis causes
Adenovirus, rhinovirus, coronavirus, enterovirus, flu A and B
114
Viral pharyngitis symptoms
Fatigue
Congestion
Cough
Coryza
115
Viral pharyngitis treatment
Supportive cair (NSAIDs)
116
Infectious mononucleosis cause
Epstein Barr Virus
Herpes Virus 4
117
How is infectious mononucleosis transmitted
Saliva
118
Infectious mononucleosis presentation
Fever
Sore throat
Fatigue
Posterior cervical LAD
Can be confused with GAS pharyngitis
119
Infectious mononucleosis oral exam
Erythema and exudative pharyngitis-tonsillitis
Soft platal petechiae
Uvular edema
120
Infectious mononucleosis physical exam
Palpable spleen (Splenomegaly)
Posterior cervical LAD
121
Hoagland sign
Conjunctival hemorrhage (eyes)
sign of infectious monoucleosis
122
Infectious mononucleosis skin
Maculopapular or petechial rash
123
Infectious mononucleosis diagnosis
Positive mono spot test.
Heterophile antibody test
Atypical lymphocytes in blood smear.
Rule out GAS infection
124
Infectious mononucleosis treatment
NSAID.
If culture grows GAS give penicillin or azithromycin.
Ampicillin and amoxicillin BAD because rash
125
Infectious mononucleosis complications
Secondary infection of GAS
Splenic rupture
126
Epiglottitis
Inflammation of epiglottis and nearby structures
Viral or bacterial
Common in diabetics
MEDICAL EMERGENCY
127
Epiglottitis cause
Haemophilius influenzae type B
or S. pyogenes, Staph (MSSA, MRSA)
Either candidia or pseudomonas in immunocompromised
128
Epiglottitis symptoms
Dysphagia
Drooling
Dysphonia
Distress
129
Epiglottis physical exam findings
Inflammation and edema of epiglottis
Redness of epiglottis
130
Epiglottitis diagnosis
Direct laryngoscopy
If suspected DO NOT check or test for infection
Secure airway is first priority
131
Epiglottitis treatment
Maintain airway
Admit to ICU
IV abx like 3rd gen cephalasporin and antistaph
IV corticosteroid
132
Peritonsillar abscess pathophys
Contiguous spread of infection from pharyngitis or tonsilitis
Usually polymicrobial
S. pyogenes
S. aureus (MRSA)
Fusobacterium necrophorum
Prevotella
133
Peritonsilar abscess symptoms
Sore throat
Fever
Muffled speech
Unable to open mouth
134
Peritonsillar abscess exam findings
Bulge on soft palate and tonsil
Tonsils pushed downward and medially
Uvula is edematous and pushed to opposite side
135
Peritonsillar abscess diagnosis
Culture pus.
CT neck
136
Peritonsillar abscess treatment
Drain pus
Abx that covers Group A strep, staph, respiratory anaerobes
137
Retropharyngeal abscess pathophys
Uncommon
Deadly
Retropharyngeal space infected--> Retropharyngeal lymph nodes infected--> RPA
Polymicrobial
Staph, group A strep, haemophus species
138
Retropharyngeal abscess risk factors
Children 2-4
Trauma to pharynx
Poor hygiene
139
Retropharyngeal abscess symptoms
Sore throat
Dysphagia
Drooling
Dysphonia
Neck stiffness (won't extend neck)
Resp destress
Chest pain
140
Retropharyngeal abscess diagnosis
CT scan of neck with contrast
CXR
Retropharyngeal tissues wider than C4 vertibral body
141
Retropharyngeal abscess treatment
Secure airway and drain abscess in OR
Admit to ICU
IV ampicillin-sulbactam or clindamycin
142
Diptheria pathophys
Corynebacterium diptheriae that makes toxins that inhibit cellular protein synthesis.
Toxins spread throughout bloodstream
143
Diptheria transmission
Air droplets
144
Cutaneous diptheria
Scaling rash or ulcers with clearly demarcated edges and membrane
145
Respiratory diptheria symptoms
Sore throat
Fever
Erythema and isolated spots of gray and white
Colescing pseudomembrane that can go from nasal passages to tracheobronchial tree.
Bull neck
146
Diptheria diagnosis
Culture and Elek test
147
Diptheria treatment
Dyptheria antitoxin DAT (hyperimmune antiserum from horse)
Erythromycin or penicillin
148
Diptheria prevention
Vaccine
Prophylactic antibiotic (erythromycin or penicillin) for close contact with confirmed case
149
Diptheria complications
Myocarditis
Nerve weakness or paralysis
Respiratory obstruction
150
Most common cause of reversible hearing loss
Cerumen impaction
151
Cerumen impaction causes
Self induced
Overproduction
narrow EAC
152
Cerumen impaction presentation
Asymptomatic or hearing loss (conduction)
153
Cerumen diagnostic tests
Otoscopy
Whisper or finger rub test
Weber and Rinne tests (BC>AC negative test)
154
Cerumen impaction treatment
Ear drops (H2O2 or carbamide peroxide)
Manual removal
Suction
Irrigation (not with severe pain)
155
When to refer someone with cerumen to specialty
Recurrent
Chronic otitis media
TM perforation
156
Acute Otitis Externa
Inflammation of EAC
Swimmer's ear
157
Acute otitis externa cause
Pseudomonas aeuruginosa (G- rods)
158
Acute otitis externa presentatino
Otalgia
Discharge
159
Acute otitis externa physical exam findings
Pain with movement of auricle
Erythema and Edema
TM is mobile
Possibly hearing loss
160
Acute otitis externa diagnosis
Otoscopy
Culture
161
Acute otitis externa treatment
Fluorquinolone (ciprofloxacin)
Aminoglycoside (ototoxic so don't use in pt with tubes)
162
Malignant otitis externa
Necrotizing infection of EAC and temporal bone
Causes osteomyelitis
163
Malignant otitis externa cause
Pseudomonas aeruginosa
164
Malignant otitis externa presentation
Smells bad
Persistent otorrhea
Granulation in ear canal
TMJ pain
Possible palsies of Vi, VII, IX, X, XI, XII
165
malignant otitis externa blood work
Increased WBC
Blood glucose check
Gram stain
Culture drainage
166
Malignant otitis externa diagnosis
CT can of temporal bone with contrast
Bone erosion shown
Increase in fat content of marrow in MRI
167
Malignant otitis externa mortality
50%
167
Malignant otitis externa treatment
Refer to otolaryngology for culture.
Give IV antipseudomonas (ciprofloxacin) then switch to oral once better
Stop treatment one week after normal Ga 67 scan
168
Acute auricular hematoma
Accumulation of blood in subperichondrial space after trauma to ear
169
Acute auricular hematoma presentatoin
Pain, bruising, swelling of ear
Edematous, fluctant, ecchymotic pinna, and loss of cartilaginous landmarks of auricle
Tender
170
Acute auricular hematoma treatment
Consult ENT for needle aspiration I&D or copious irrigaton with saline
Abx against Pseudomonas aeruginosa
171
Acute auricular hematoma diagnosis
CT to check bone integrity
MRI to check brain for injury
Coagulation studies
Culture
172
Acute auricular hematoma post-procedure
Evaluate every 24 hours for 3-5 days
Avoid ASA and NSAIDs
Consult hematologist
173
Complications of untreated acute auricularhematoma
Cauliflower ear
Necrosis of cartilage
174
Acute otitis media
Bacterial infection middle ear
Usually Strep pneumoniae
Or H. influenza, Strep pyogenes
Most common in children
175
Acute otitis media exam findings
IMMOBILE TM is bulging, opaque, yellowish-white or red.
Bullae on TM
176
Acute otitis media complications
TM perforation, pt will think they are getting better bc pressure is relieved but now there is hole in TM.
177
Other findings that come with acute otitis media
Otitis-conjunctivitis syndrome
178
Acute otitis media diagnosis if Abx fails
Tympanocentesis (puncture TM) with culture
179
Acute otitis media treatment
Amoxicillin
Amoxicillin-clavulanate if had amox in last 30 days or if have conjunctivitis
Cephalosporin
IM ceftriaxone if unable to tolerate oral atibiotics.
Macrolide (azithromycin) if allergic to penicillin
Consider tympanostomy tubes
180
Bullous myringitis
Bullae on TM
More painful than acute otitis media but treated the same way
181
Otitis media with effusion (Serous OM)
Most common presentation following acute otitis media
Fluid in middle ear causes loss of hearing
182
Otitis media with effusion (Serous OM) presentation
Hearing loss
Aural fullness/ear drops
Child behavioral changes or speech issue
183
Otitis media with effusion exam findings
TM opacified and thickened, amber colored
184
Otitis media with effusion diagnosis
Pneumatic otoscopy shows TM not mobile
Flat tympanogram
185
Otitis media with effusion treatment
ENT referral
186
Chronic otitis media cause
Pseudomonas aeruginosa
187
Chronic otitis media symptoms
Chronic painless purulent otorrhea.
Conductive hearing loss
TM perforation usually
188
Chronic otitis media treatment
Fluroquinolone (ciprofloxacin) drops
Surgery for TM perforations
189
TM perforation symptoms
Otalgia and hearing loss
Bloody otorrhea
Possible vertigo and tennitis
190
TM perforation causes
Pressure
Trauma
Infection
191
TM perforation diagnosis
Otoscopy
Weber sound lateralizes to affected ear
Rinne BC>AC
192
TM perforation treatment
Remove foreign bodies
Systemic ABx if otitis media, penetrating injury, water injury
AVOID topical steroids, ototoxic, water in ear
Maringoplasty if not healed in three months (rare)
193
Cholesteatoma
Keratinized collection of squamous epithelial cells in middle ear or mastoid process.
194
Cholestoma causes
Usually prolonged eustachian tube dysfunction with inward migraton of upper flaccid portion of TM.
TM perforation
Frequent OME
195
Cholestoma pathophys
Can erode bone into inner ear and involve facial nerve.
Can spread intracranially
196
Cholestoma symptoms
Painless or prurulent foul smelling otorrhea.
Hearing loss
Can cause vertigo, tinnitus, CN VII palsy
197
Cholesteatoma appearance
Greasy white pearly or yellow keratinous mass in retraction pocket.
Foul smelling discharge
198
Cholesteatoma diagnosis
Audiogram
CT scan to see bone erosion
199
Cholesteatoma treatment
ENT referral for surgical removal
200
Ostosclerosis
Hardening of ear
AKA Otospongiosis
Abnormal bone remodeling of middle ear
201
Otosclerosis pathophys
Normal bone replaced with sclerotic or spongiotic bone
202
Otosclerosis presentation
Hearing loss getting worse over years
Normal TM
Schwartz sign (see vasculature through TM)
203
Otosclerosis diagnosis
Weber sound lateralizes to affected ear
Rinne BC>AC
Audiometry and tympanometry can be normal at first
Flattened curve in tympanometry
Carhart notch in audiometry
CT of temporal bone
204
Otosclerosis treatment
No curative therapy
Hearing aid
Stapedectomy with replacement
205
Acoustic neuroma
AKA vestibular schwannoma
CN VIII
Most common intracranial tumor.
Unilateral usually
206
Acoustic neuroma pathophys
Overproduction of schwann cells causes tumor
Grows to involve cerebellopontine angle
207
Neurofibromatosis type 2
Acoustic neuroma
Mutation of NF2 gene
BILATERAL CN8 tumors
208
Acoustic neuroma symptoms
Unilateral hearing loss
CONTINUOUS vertigo
Tinnitus
CN V sensory problems (no corneal reflex or facial touch)
CN VII facial weakness or paralysis
N/V and BP drops if tumor large from pressing on brainstem and cerebellum
209
Acoustic neuroma diagnosis
MRI with contrast looking for mass (ice cream cone)
Audiogram for heating loss at higher frequencies
210
Acoustic neuroma treatment
Observation if small and nonsymptomatic
Surgical excision or radiotherapy if large or symptomatic
VEGF blocker in NF2
211
Eustachian tube
Connects middle ear to nasopharynx
Provides ventilatoin and drainage for middle ear
212
Hypofunctoning eustachian tube cause
Viral URTI and allergies (diseases with edema of tubal lining
213
Hypofunctioning eustachian tube presentation
Aural fullness
Negative pressure from air trapped in tube
Popping or crackling sound
Hearing loss
214
Hypofunctioning eustachian tube diagnosis
Otoscopy shows retracted TM and decreased TM mobility from pneumatic otoscope
215
Hypofunctioning eustachian tube treatment
INtranasal decongestants and intranasla corticosteroid if rhinitis history
Autoinflation (popping ears by holding nose and blowing. NOT for pts with intranasal infection)
Tympanostomy tube
216
Ear barotrauma
Unable to equalize barometric stress on middle ear.
Caused by air travil, rapid altitude change, diving, blast injury
217
Barotrauma symptoms
Ear pain
Pressure
Neuro hearing loss
Tinnitus
Vertigo
N/V
218
Barotrauma diagnosis
Otoscopy findingHemotympanum with dark blood in ear
TM perforation
Perilymphatic fistula (rupture of oval or round window
219
Ear barotrauma treatment
Myringotomy
Ventilation tubes for recurrent
220
Ear barotrauma prevention
Chewing gum or yawning .
Oral decongestant several hours before arrial
Nasal decongestant spray one hour before arrival
221
Labyrinthitis
Inflammatory disorder of labyrinth
Vestibular and cochlear portion of CN VIII
222
Acute labyrinthitis symptoms
Sudden neural hearing loss
Vertigo
Nystagmus
N/V
Maybe tinnitus
223
Acute labyrinthitis Physical exam findings
Possible nystagmus
Romberg
Non-blanching rash
Webber and rinne
224
Labyrinthitis treatment
Symptomatic care with vestibular suppressants
Antiemetics
Abx if febrile or history of AOM
225
Vertigo
Feels like room is spinning
226
Peripheral vertigo
Sudden onset
Unidirectional (usually horizontal)
Associated with tinnitus and hearing loss
227
Central vertigo
Gradual onset.
Multidirectional
NO auditory symptoms
Diplopia, ataxia, dysarthria, dysphagia, lateralized weakness usually present
Requires STAT workup including imaging of brain
228
Central vertigo causes
Stroke or tumor of brain stem or cerebellum
229
Vertebrobasilar stroke
Central vertigo with dysarthria, dysphagia, diplopia, weakness, numbness
230
Cerebelar infarct
Vertigo with gait or truncal ataxia or vertigo alone
231
Central vertigo diagnosis
MRI for ischemic
Non contrast CT can detect hemorrhagic stroke
232
Peripheral vertigo most common cause
Benign paroxysmal positional vertigo (BPPV)
233
Benign paroxysmal positioning vertigo (BPPV)
Provoked by moving head.
Free floating canalith/otoconia messed up
Usually posterior semicircular canal
234
Bening paroxysmal positioning vertigo presentation
Only when changes of head position
Subsides within 10-60 seconds
Nausea
235
BPPV peripheral
Severe
walking preserved
Hearing loss or tinnitus
No neurologic symptoms
Can be fixed with repetition
236
BPPV central
Less severe
Can't walk without falling
No tinnitis or hearing loss
Usually diplopia, ataxia, dysarthria, dysphagia, weaknss
237
Vertigo diagnosis
Neuroimaging (MRI and CT)
Dix-Hallpike meneuver
238
BPPV treatment
Canalith repositioning procedure.
Epley maneuver (lay down and rotate head around) or Brandt-Daroff (lay down on one side then sit up then lay down on other side) exercises
No pharm therapy
239
Acute mastoiditis
Complication of acute otitis media
240
Acue mastoiditis pathogen
Strep pneumoniae mostly
Strep pyogenes
H. influenza
Bc its complication of otitis media
241
Acute mastoiditis symptoms
Pain and postauricular cellulitis
Fever
242
Acute mastoiditis clinical findings
Postauriular erythema, tenderness, warmth, fluctuance.
Proptosis/protrusion/forward placement of pinna
243
Acute mastoiditis diagnosis
CT of temporal bone with contrast.
Disruptino of bony septation in mastoid air cells and potential intracranial extension of infection.
Myringotomy for culture and drainage
244
Acute mastoiditis treatment
ENT referral
IV abx
mastoidectomy
245
Meniere disease
Idiopathic
Excess fluid endolymph within cochlea and labyrinth
Endolymphatic hydrops
246
Meniere disease symptoms
episodic fluctuating of HL, tinnitus, spontaneous vertigo
Unilateral mostly
Symptoms wax and wane
low frequency neural hearing loss
247
Meniere disease diagnosis
Diagnosis of exclusion.
Audiometry, caloric, vestibular tests
248
Meniere disease treatment
Thiazide diuretics and low Na diet
No cure
Refer to ENT
Avoid triggers
Intratympanic corticosteroid for. refractory cases
249
Tinnitus
Ringing of ears
250
Clicking tinnitus cause
Could be from middle ear spasm
251
Low pitched tinnitus cause
Meniere disease
Cerumin impactoin
Venous hum
252
High pitched tinnitus cause
Noise induced hearing loss
Prebyscusis
253
Tinnitus diagnosis
Audiometry
MRI to rule out acoustic neuroma.
MRA
MRV
CT of temporal bone
254
Tinnitus treatment
Treat underlying cause.
Avoid excessive noise or ototoxic agents
Retraining therapy to mask tinnitus ewith music or hearing aide
antidepressants
255
Most common cause of sensorineural hearing loss
Presbycusis (age-related)
256
Sensorineural hearing loss
Hearing loss from damage to inner ear or auditory pathway.
Loss of hair cells
Noise exposure
Head trauma
Ototoxicity
Tumor
Systemic
257
Imaging for sensorineural hearing loss
MRI with gadolinium to determine location of defect or tumor
CT of temporal
258
Positive rinne test
AC>BC
259
Negative rinne test
BC>AC
260
Presbycusis
Age-related hearing loss
Most frequent cause of Sensorineural hearing loss
261
Presbycusis symptoms
Loss of speech discrimination.
More pronounced in noisy environment.
Can't hear high frequency
262
Presbycusis diagnostic test
Whisper/finger rub.
Webber-rinne
Hearing loss
Audiometry
263
Prebyscusis treatment
Hearing aid or cochlear implant
264
Second most common cause of sensorineural hearing loss
Noise induced
Begins in high frequencies
265
Epistaxis
Nosebleeds
266
Anterior epistaxis
More common
Bleeding from anterior septum
From Kiesselbach plexus
267
Posterior epistaxis
Less common
Bleeding from posterior half of inferior turbinate or top of naval cavity.
From Woodruff plexus
More common in stherosclerotic disease and HTN
268
Risk factors of epistaxis
Nasal trauma
Dry nasal mucosa
Rhinitis
Inhaled corticosteroid
Cocaine
Alcohol
269
Anterior epistaxis symptoms
Unilateral bleeding
270
Posterior epistaxis symptoms
Bleeding seen in posterior pharynx.
Usually bilateral
Can be significant hemorrhage
271
Epistaxis lab work
If recurrent cases
Platelet count
Coagulation studies
272
Anterior epistaxis management
Pinch tip of nose and lean forward in sitting position for 15 minutes
May use short asking topical nasal decongestants
273
What to do if anterior epistaxis won't stop
Find where bleeding is coming from and cauterize with silver nitrate
NEVER cauterize both sides of septum in same session (causes necrosis)
274
What to do if anterior epistaxis won't stop and can't see bleeding site
Consult ENT
Apply hemostatic sealant
275
Posterior epistaxis treatment
Double balloon packs
Admit to monitor airway
Posterior nasal packing
Opioids for pain
Topical nasal saline to keep packing moist
O2 supplementation
Anti-staph antibiotic prophylaxis to avoid toxic shock
Surgery (ENDOSCOPIC LIGATION)
Endovascular epistaxis control is last resort
276
Post control of epistaxis
No strenuous exercise for several days
No spicy food or tobacco
No nose picking
Use petroleum jelly
Increase home humidity
277
Nasal polyps physical exam
Pale, edematous, boggy, mucosally covered masses.
Common in pts with allergic rhinitis
Can cause nasal obstruction
278
What pts commonly have nasal polyps
Allergic rhinitis
Rhinosinusitis
Cystic Fibrosis
Asperin-exacerbated respiratory disease (AERD)
279
What to avoid in patients with nasal polyps
Aspirin bc may cause bronchospasm
280
Nasal polyps symptoms
Sneezing
Nasal congestion
Obstruction
Drainage fluid down throat
Facial pain
Excessive discharge from nose
Loss of smell
Chronic sinus infection
281
Nasal polyps diagnosis
Allergen testing
Nasal endoscopic exam
Mucosal biopsy
CT scan
282
Nasal polyps treatment
Intranasal corticosteroids for 1-3 months
283
Large nasal polyps treatment
Refer to ENT
Intranasal corticosteroids
Short course oral corticosteroids
Surgery for massive ones and continue intranasal corticosteroids after polypectomy to prevent recurrence
284
Three types of rhinitis
Allergic
Vasomotor
Rhinitis medicamentosa
285
Rhinosinusitis
disorders affecting nasal passages and paranasal sinuses
286
Allergic rhinitis
IgE mediated
Allergen causes release of inflammmatory mediators from mast cells
Common with atopic diseases (asthma, eczema, atopic dermatitis)
287
Seasonal allergic rhinitis
IgE mediated
Usually caused by pollens and spores
288
Perennial allergic rhinitis
Year round
IgE mediated
Usually caused by molds,, spores, animal dander, dust mites
289
Allergic rhinitis presentation
Clear rhinorrhea
Sneezing
Nasal congestion
Tearing eye
Pruritus
290
Allergic rhinitis common exam findings
Horizontal nasal crease (allergic salute)
Bluish discoloration below eye (allergic shiner)
291
Allergic rhinitis diagnosis
Allergen testing (RAST or skin test)
292
Allergic rhinitis treatment
Avoid allergens
Intranasal glucocorticoids
Oral antihistamine
Nasal spray antihistamine
Intranasal anticholinerginic
Mast cell stabilizer
Antileukotriene
293
Oral antihistamines
Loratidine (claritin)
Fexofenadine (allegra)
Cetirizine (zyrtec) (minimally sedating)
294
Nasal spray antihistamines
Azelastine (2 sprays per nostril)
295
Intranasal anticholinergic agents
Ipatropium bromide sprays
296
Mast cell stabilizer meds
Cromolyn sodium
Sodium nedocromil
297
Antileukotriene meds
Montelukast
298
Vasomotor rhinitis causes
Change in temp, light, odor, dust
299
Vasomotor rhinitis symptoms
Nasal congestion (clear discharge)
More intense than allergic
300
Vasomotor rhinitis physical exam
Bogginess of nasal mucosa
Clear discharge
301
Vasomotor rhinitis treatment
Avoid irritant
Saline nasal rinse
Intranasal corticosteroid if unable to avoid
302
Rhinitis medicamentosa cause
Overuse of decongestant sprays that have oxymetazoline or pheylephrine.
Why we don't prescribe nasal sprays for more than three days
303
Rhinitis medicamentosa symptoms
Severe congestion and pain
Minimum nasal discharge
304
Rhinitis medicamentosa treatment
Discontinue irritant
Intranasal corticosteroids through withdrawal
Short use of oral corticosteroid for severe cases
305
Viral rhinosinusitis symptoms
Nasal congestion
Rhinorrhea
Sneezing
Facial pressure
Hyposmia
Watery discharge
Lasts LESS than 10 days
306
Viral sinusitis treatment
Rest and hydration
OTC analgesics and decongestants
Nasal irrigation
307
Bacterial rhinosinusitis cause
Impaired mucocilliarly clearance
Usually Strep pneumoniae
308
Bacterial rhinosinusitis symptoms
Lasts MORE than 10 days.
Can worsen 10 days after initial improvement
Purulent (green) dranange
Facial pain/pressure
Fever
Cough
309
Acute maxillary sinusitis clinical presentation
< 4 weeks
Facial pain/pressure
Unilateral facial. fullness
Nasal aireay obstruction
tenderness over cheek
Purulent nasal drainage
Dental pain
310
Acute ethmoiditis
< 4 weeks
Usually comes with maxillary sinusitis
Pain and pressure over lateral wall of nose between eyes
311
Acute frontal sinusitis
< 4 weeks
Pain and tenderness in forehead
312
Acute sphenoid sinusitis
< 4 weeks
Seen in pansinusitis or infection of paranasal sinuses on at least one side
313
Hospital associate sinusitis
May present without typical symptoms.
Consider if fever in critically ill
Prolonged nasoastric or nasotracheal tube at risk
314
Acute bacterial sinusitis diagnosis
< 4 weeks
Tenderness over sinus
endoscopy and noncontrast CT scan if Sx last longer than 4 weeks to find mucosal edema, opacification, air fluid level, thick secretions
315
Acute bacterial sinusitis treatment
Amoxicillin-clavulanate
High dose for 7-10 days for severe
Also NSAIDs for pain and Intranasalcorticosteroids for inflammation
Doxy for PCN allergy
316
Acute bacterial sinusitis cause
Strep pneumonia
317
Acute bacterial sinusitis treatment if allergic to penicillin
Doxycycline
318
Hospital associated sinusitis treatment
Broad spectrum antibiotics that can target Pseudomonas and MRSA
319
Acute bacterial sinusitis complications
Orbital cellulitis and abscess
Osteomyelitis
INtracranial extension
Cavernous sinus thrombosis
320
Chronic rhinosinusitis
Lasts longer than 12 weeks
Usually bacterial (polymicrobial) or fungal (aspergillus, mucormycosis)
321
Chronic rhinosinusitis red flags
High fever
Double/reduced vision
Proptosis
Periorbital edema
Severe headache
Meningeal signs
Recurrent epistaxis
322
Chronic rhinosinusitis diagnosis
Nasal endoscopy
CT without contrast to find mucosal edema, opacification, air fluid level, thick secretions, polyps
323
Chronic rhinosinusitis treatment
Abx or antifungal depending on cause
Nasal saline irrigation
Intranasal steroids
Endoscopic sinus surgery
324
Nasal fractures physical exam
Examine orbits and midface.
Examine for septal hematomas
325
Septal hematomas
Can be infected with Staph aureus
Drain ASAP and start antibiotic prophylaxis
Necrosis of septum if left untreated
326
Nasal fractures diagnosis
X-rays not necessary (it won't change treatment) unless needed for legal reasons or suspect foreign body.
CT best if lots of facial trauma
327
Nose fracture management
Control epistaxis
Observation with surgical intervention if cosmetic deformity.
Consult ENT
Drain septal hematomas
328
Saddle nose deformity
When cartilage in nose dies and disintegrates after fracture
329
Pediatric vision screening
Birth: red reflex
3 months: alignment and conjugate gaze
6 months: tracking 180
3 years: alignment, tracking, acuity, corneal light reflex
330
Normal intraocular pressure
8-21 mmHg
331
Amblyopia
Visual acuity is unequal
Causes "lazy eye"/strabismus
332
Refractive amblyopia
Asymmetric refractive errors are source of visual discrepancies between eye
333
Strabismic amblyopia
Misalignment of eye causes input from "wandering" eye to be ignored
334
Deprivational amblyopia
Vision loss is secondary to pathology like congenital cateract or retinoblastoma
335
Amblyopia presentation
Blurry vision in affected eye
Cover/uncover test (strabismus)
Suspect if child protest covering good eye or if child turns head to better see
336
Amblyopia treatment
Patching
Opaque lenses
337
Cataract formation
Accumulation of nonviable cells in lens causing losss of transparency.
Trauma and aging accelerates it
338
How to prevent cataracts
Don't smoke
Don't drink
Wear sunglasses
Eat healthy
Avoid glucocorticoid
Control blood sugar
339
Cataract presentation
No early signs
Progressive visual loss (usually bilateral)
Increased light sensitivity
Complaining about headlights at night
340
Cataract treatment
Referral for complete eye exam
Surgical removal
Artificial lens
341
Cataract surgery complications
Retinal detachment
Endopthalmitis
342
Glaucoma
Increased intraocular pressure (>21mmHg)
Unable to manage outflow of aqueous humor.
Pressure damages weakest point (optic nerve) causing cupping and nasal displacement of vessels
343
Open-angle glaucoma
Most common
Increased intraocular pressure due to decreased drainage of aqueous fluid
344
Acute angle closure glaucoma
Flow of aqueous fluid into anterior chamber is obstructed causing increased intraocular pressure
345
Normal-tension glaucoma
Vascular insufficiency at optic nerve head, metabolic, or neurodegenerative disorders, oxidative stress, or abnormal biomechanics of lamina cribrosa
346
Acute angle closure glaucoma presentation
PAINFUL monocular vision lost
Red eye and fixed pupil
Vomiting
Halos around lights
Sudden onset
347
Normal tension glaucoma presentation
Asymptomatic until visual loss.
Peripheral visual loss as progresses
IOP not elevated or only slightly elevated.
Some nerve damage
348
Chronic open-angle glaucoma treatemtn
Long term opthalmic drops
349
Acute angle closure glaucoma treatment
EMERGENCY
IV acetazolamide to lower IOP
350
Strabismus
Weak extraocular muscles prevent eyes from working together.
Chromosome 21
Abnormal development of CN VI
351
Astigmatism
Curving of cornea or lens causing light to bend
Horizontal means globe is wider than tall
Vertical means eye is taller than wide
352
Conjunctivitis
Major cause of "red eye"/"pink eye"
353
Conjunctivitis cause
Staph and strep
Pseudomonas for contact wearers
Could be viral or irritation
354
Prevention of conjunctivitis in newborns
Put erythromycin on eyes to prevent STI transfer
355
Allergic conjunctivitis symptoms
Cobblestone
Inflammation in corner of eye
Very itchy
356
Bacterial conjunctivitis symptoms
Prurulent discharge
Lymphadenopathy
357
Viral conjunctivitis symptoms
Watery discharge
Not much eyelid edema
Lymphadenopathy
358
Bacteral conjunctivitis treatment
erythromycin
Tobramycin
Fluoroquinalones for contact wearers
359
Bacterial conjunctivitis treatment for CONTACT WEARERS
Fluoroquinolones (-floxacin)
360
Viral conjunctivitis treatment
Warm compress
Topical antihistamines
361
Allergic conjunctivitis treatment
Topical antihistamines
Topical mast cell stabilizer
362
Chemical conjunctivitis
From meds, smoke, chems.
Irrigate eyes with normal saline
Fluorescein stain evaluation after irrigation
363
Conjunctivitis pt education
Take contacts out
Wash hands
Don't share wash cloths
364
Conjunctivitis red flags
Pain with extraocular movements
Foreign body sensation
Change in vision
Photophobia
365
What to do if conjunctivitis has lots of stuff leaking out
Culture bc it could be STI
366
Bacterial keratitis presentation
Rapid onset of eye redness, photophobia, foreign body sensation
Purulent drainage
Lid edema and redness
Hypopyon
367
Keratitis
Inflammation of cornea
Prompt treatment and referral to ophthalmologist
368
Bacterial keratitis cause
Pseudomonas aeruginosa
369
Bacterial keratitis treatment
Topical antibiotics
Untreated will cause scarring with vision loss
370
Viral keratitis peresentation
Red eye
Dendritic lesion
photophobia
Foreign body sensation
371
Viral keratitis cause
HSV or VZV
372
Viral keratitis treatment
Acyclovir
Referral
373
Periorbital celllulits
Skin and soft tissue infection around eye anterior to orbital septum
374
Periorbital cellulitis cause
Trauma
Sinusitis
Staph aureus, Strep pneumoniae, or strep pyogenes
375
Periorbital cellulitis presentation
Fever
Leukocytosis
Eye pain and tenderness
376
Periorbital cellulitis treatment
Oral Abx
377
Orbital cellulitis comes from wha sinus
Ethmoid sinusitis in children
Frontal sinusitis in adults.
378
Orbital cellulitis presentation
fever
leukocytosis
Eyelid swelling and erythema
Eye pain and tenderness
Pain with EOM
Proptosis
379
Orbital cellulitis treatment
Broad IV abx (vancomycin+piperacillin-tazobactam)
380
Conjunctival foreign body symptoms
FB sensation
Pain
Tearing
Photophobia
Excessive blinking
381
Corneal foreign body
Something big gets in eye.
Usually from doing stuff without eyewear
382
Intraocular foreign body
Vitreous cavity
383
Conjunctival foreign body treatment
Evert eyelids
Remove contacts
Eye magnet for metal
Topical anestesia
Irrigate
Fluroscein dye
Abx ointment
Tetanus vaccine
384
Corneal abrasion cause
Scratching eye
Improper contaft lense wear
Trauma
FB
Chemical splash
385
Corneal abrasion symptoms
Pain
FB sensation
Tearing
Red eye
Excessive blinking
386
Corneal abrasion physical exam
Pupil exam
Rule out foreign body
Fluorescein staining
CT scan
387
Corneal abrasion treatment
Abx ointment
Patch for 12-24 hours if comfort needed
Tell pt to NOT flush eye at home
Refer if no healing in 72 hours
388
Corneal ulcer cause
Pseudomonas
Trauma
Nutritional deficiency (vitamin A)
389
Corneal ulcer symptoms
Pain/irritation
FB sensation
Tearing
Red eye
Photophobia
390
Corneal ulcer diagnosis
Confirm with fluorescein staining and slit lamp
Referral
Culture
Do not patch
391
Intraocular foreign body in anterior chamber treatment
Removal vai paracentesis
392
Intraocular foreign body in lens treatment
Lens can be left if no siderosis
Siderosis FB then lens is removed
393
Intaocular foreing body in posterior segment (vitreous chamber) treatment
Vitrectomy likely unless minimal tissue damage
394
Hyphema
Blood in anterior chamber from injury to blood vessels of iris or ciliary body
395
Hyphema presntation
Pain
Blurred vision
Pain with pupillary constriction
Photophobia
396
Hyphema diagnostic studies
CT of head
Ultrasound eye
397
Hyphema treatment
Bedrest with head at 30-45º
IOP monitoring
Avoid eyestrain (no screens or reading)
Avoid NSAIDs
Patch
398
Vitreous hemorrhage
Vessel rupture from trauma, retinal disorders, or aneurysm
399
Vitreous hemorrhage presentation
Hazy vision
Floaters
"shadows" or "cobwebs"
Usually no pain
400
Vitreous hemorrhage physical exam
Visual acuity
IOP
Normal pupil reaction
401
Vitreous hemorrhage treatment
Refer
Keep head elevated
Vision loss in 6-15%
402
Globe rupture
Usually from foreign body
EMERGENCY (consult)
403
Globe rupture presentation
Teardrop pupil
Soft eye
Retained FB
Flat anterior chamber
404
Glob e rupture treatment
Secure impaled object
Elevate head of bed
Avoid tonometry
Abx
Antiemetics
405
Seidel's sign
"waterfall" that shows globe rupture.
Emergent referall
406
Subconjuntival hemorrhage
Quick rise in venous pressure breaks capillaries
Common as we age
407
Subconjunctival hemorrhage physical exam
Flat with no change in vision
Painless
Does not pass limbus
Blood red eye
408
Subconjunctival hemorrhage treatment
Artificial tears if eye irritated
Should resolve itself in few days to week
409
Complicated subconjunctival hemorrhage
Not flat
CT and referral to opthalmologist
Stop anticoagulant
refer
410
Most common midfacial fracture
1. nasal
2. orbital floor fractures
411
Pterygium
Benign superficial mass of cornea
Corneal degernerative disorder.
Looks like wing of pterodactyl.
reaches over into iris/pupil
Grows
Probably will return after removal
412
Pinguecula
Benign superficial mass
Corneal degeneratice disorders
Mostly on sclera not on iris/pupil
Doesn't usually grow
413
Uveitis
Iritis or Posterior uveitis (choroiditis or retinitis)
Drug induced (fluoroquinolones or bisponates)
Trauma
Infection
414
Iritis presentation
Red eye around limbus
Pinful
Photophobia
Epiphora (excessive eye watering)
Constricted pupil
Cell and flare
Hypopyon (white cells within anterior chamber shoes sever inflammation)
415
Iritis treatment
Abx
antiviral
antifungal
steroid eyedrops
NSAIDs
416
Posterior uveitis (retinitis, choroiditis, optic disc) presentation
Painless
Floaters
Phototopsia (flashing lights)
Visual impairment
Leukocytes in vitreous humour seen on slit lamp
Chlorioretinal inflammation
417
Scleritis presentation
Intense deep eye pain worse with movement and at night or in morning.
Can follow trauma or retinal surgery
418
Scleritis diagnosis
Slit lamp exam
Smear or biopsy if suspect infectious
419
Scleritis treatment
Control inflammation with NSAIDs
More severe need glucocorticoids
420
Macular degeneration
Causes pt to see straight lines as bent
421
Atrophic macular degeneration
AKA dry/geographic
Slowly progressive
Lipid deposits and retinal atrophy
may progress to "wet"
422
Atrophic macular degeneration symptoms
Diff reading, driving, watching TV.
Need more light or magnification
423
Atrophic macular degeneration treatment
Eye vitamins
Syfovre
Stop smoking
424
Neovascular macular degeneration
aka Wet/exudative
Formation of new blood vessels beneath retina separation from choroid
Vessels fragile and dleacky
Acute central visual loss
Distortion of straight lines
425
Neovascular macular degeneration treatment
Eye vitamins
Eye injections anti-VEGf inhibitors
426
Retinopathy
Cotton/wool spots
Diabetic or hypertensive
427
Diabetic retinopathy
Hyperglycemia damages retinal blood vessels.
Leaking
Swelling
Neovasculization
428
Hypertensive retinopathy
HTN causes damage to tissues and blood vessels of retina.
Risk increases with diabetes, smoking, heavy alcohol use
429
Retinopathy presentation
Floaters
Dark spots
Blurry/double vision
Eye pain
Cotton wool spots
Blot hemorrhages
Hard exudates
Arteriole narrowing
430
Retinopathy treatment
Laser surgery
Vitrectomy
Anti-ceramide immunotherapy
431
Retinal detachment presentation
Monocular vision loss
Usually rapid spreading across visual field
No pain or redness
432
Retinal detachment treatment
Laser photocoagulaton
Cryotherapy
Vitrectomy
433
Central retinal artery occlusion
Cherry red spot (fovea)
Pale retina
Box car appearance of vessels
434
Amaurosis fugax
Ischemic attack of the retina
Vision loss in seconds to minutes then complete recovery.
Warns of a stroke
Symptom of Central retinal vein occlusion
435
Amaurosis fugax pathophys
Hypoperfusion of retina or optic nerve from hypotension, thrombus, embolus, arteritis, or vasospasm
436
Amaurosis fugax physical exam
Complete opthalmic evaluation
Neuroimaging
Cardiac evaluation
Vascular imaging
437
Amaurosis fugax treatment
Depends on what's causing it
438
Dacryostenosis
Lacrimal duct obstruction
439
Dacryostenosis treatment
Some newborns get conservative treatment of fluorescein on eye.
Nasolacrimal duct massage TID to QID
440
Dacryocysitis
Complicaton of dacryostenosis
Staph aureus
Strep pneumoniae
H. influenzae
Neonates and females over 40
441
Acute dacryocystitis symptoms
Medial canthal swelling lower eyelid
Erythema
Tenderness
442
Acute dacryocystitis treatment
Ampicillin-sulbactam or cephalosporins
443
Acute dacryocystitis red flag
Fever or AMS check for septic workup
444
Acute Dacryoadenitis treatment
Amoxicillin-clavulanate
IV ampicilllin-sulbactam
If viral, warm compress
445
Chronic dacryoadenitis treatment
Treat underlying disorder
446
Blepharitis risks
Contact lenses
Inflammation or damage to eyelid
447
Anterior blepharitis
Involves skin, eyelashes, associated glands
Maybe associated with seporrhea of scalp, brows, ears
Ulcerative if secondary staph infections
448
Posterior blepharitis
Inflammation of meibomian glands
Associated with acne rosacea
Secondary staph infections can occur
Mild entropion
449
Blepharitis treatment
Lid hygiene
Warm compress with lid massage
erythromycin for secondary infection
450
Entropion
Eyelid turns in
Tendons relax
Usually bilateral
Sagging of skin around eye
451
Ectropion
Eyelid turns out
452
Ectropion cause
Post surgery complication
Trauma
Eyelid laxation from aging
Facial nerve palsy
453
Diplopia
Double vision
454
Diplopia red flag signals
Strabismus
CN III palsy for near objects
CN VI palsy for far objects
455
Optic neuritis
Demyelination (usually MS)
Monocular vision loss oover few days
MRI with contrast needed
456
Optic neuritis treatment
Referral
