HEENT Exam 1 Cards Flashcards
1
Q
Part of the eye that controls the lens shape
A
Ciliary body
2
Q
Substance in the back of the eye
A
Vitreous humor
3
Q
Substance in the front of the eye
A
Aqueous humor
4
Q
Pigmented part of the retina located in the very center of the eye
A
Macula
5
Q
Area of greatest visual acuity in the eye
A
Fovea
6
Q
The lens in our eye is a _____________ lens
A
Convex
7
Q
What does the lens do when we want to see something that is near?
A
The ciliary muscles contract, suspensory ligaments slacken, making the lens thicker and the focal length shorter
8
Q
What does the lens do when we want to see something far away?
A
Ciliary muscles relax, suspensory ligaments tighten, making the lens thinner and the focal length longer
9
Q
2 things that can cause myopia
A
Too curved cornea, too long eyeball
10
Q
Correction for myopia
A
Use a concave lens to diverge light rays and make objects look smaller
11
Q
2 things that can cause hyperopia
A
Not enough curvature of the cornea, Eye too short
12
Q
Correction for hyperopia
A
Use a convex lens to converge light rays and make objects look larger
13
Q
An irregular shape of the cornea or lens leading to multiple focal points
A
Astigmatism
14
Q
Presbyopia
A
Age related farsightedness
15
Q
Cornea becomes cone shaped causing blurred vision
A
Keratoconus
16
Q
Purpose of aqueous humor
A
Maintains intraocular pressure
17
Q
Where does aqueous humor come from and where does it go
A
Produced in ciliary body and absorbed by trabecular meshwork
18
Q
Purpose of vitreous humor
A
Maintain shape of eyeball and hold retina in place
19
Q
Result of a lesion before the optic chiasm
A
Blindness in one eye
20
Q
Result of a lesion at the optic chiasm
A
Bitemporal hemianopsia
21
Q
Result of lesion in the optic tract (after optic chiasm)
A
Homonymous hemianopsia (left or right visual field loss in both eyes) on the opposite side as the lesion
22
Q
Parasympathetic pupillary effect
A
Constriction
23
Q
Sympathetic pupillary effect
A
Dilation
24
Q
One pupil being naturally larger that the other
A
Anisocoria
25
Cotton wool spots
Yellow-white lesions that look like clouds on the retinal surface - Caused by micro ischemia and nerve infarction
26
Physiologic anisocoria
The pupillary difference is the same in the light and dark
27
MCC of cotton wool spots (2)
Diabetic retinopathy, hypertensive retinopathy
28
Anisocoria that is more pronounced in the dark
The small pupil is abnormal
29
Anisocoria that is more pronounced in the light
Large pupil is abnormal
30
Marcus Gunn Pupil
Pupil only reacts to consensual light, not direct - indicates an optic nerve lesion
31
Horner syndrome triad
Ptosis, Anhydrosis, Miosis,
PAM Horner
32
Horner syndrome triad
Ptosis, Anhydrosis, Miosis,
PAM Horner
33
Cause of horner syndrome
Loss of sympathetic innervation to the eye
34
Adie's pupil
Sluggish direct and consensual reaction to light couples with diminished DTRs
35
Accommodation reflex
The pupils get smaller looking at closer objects and larger looking at far away objects
36
Agyll Robertson pupil
Pupils have an accommodation reflex but NO pupillary reflex (to light)
ARP - Accommodation Reflex Present
Pupillary reflex Absent
37
Patient complains of a "curtain coming down over 1 eye"
Retinal detachment
38
Swelling of the optic nerve
Papilledema
39
4 signs of papilledema
Disc elevation
Venous distension and tortuosity
Obscured disk margin
Absent venous pulsations
40
Blood and thunder fundus
Widespread retinal hemorrhages with venous dilation and tortuosity
41
Cause of a cherry red spot on the fovea
Central retinal artery occlusion
42
Cause of blood and thunder fundus
Retinal vein occlusion
43
Cause of retinal boxcar segmentation
Retinal artery occlusion
44
A-V Nicking
A small artery crosses and small vein and compresses it - seen in hypertensive retinopathy and atherosclerosis
45
Silver and Copper wiring
Seen in hypertensive retinopathy and atherosclerosis - Silver is more serious
46
Hard exudates
Yellow/white spots with distinct borders - caused by a breakdown of blood retina border and due to diabetes
47
Flame hemmorhages
Caused by necrotic blood vessels bleeding into the retina caused by diabetes or hypertension
48
Dot-Blot hemmorhages
Caused by micro aneurism rupture in the deeper retinal layers
49
Optic cupping
Blood flow to the optic nerve is diminished because of damage to the nerve, the optic cup grows larger
50
2 conditions in which we might see fundoscopic neovascularization
DM retinopathy and macular degeneration
51
Retinal Drusen
Yellow deposits under the retina - dead retinal epithelial cells caused by age-related macular degeneration
52
What does a slit lamp look at?
The anterior portion of the eye
53
Use of fluorescence staining
Helps us highlight corneal abrasions and foreign bodies
54
Presentation of bacterial conjunctivitis (3 things)
Purulent discharge, conjunctival injection, mild discomfort
55
3 MCCs of Bactierial conjunctivitis
S. aureus - Adults
Strep Pneumo - Children (followed by other OM causes)
Pseudomonas - Contact wearers
56
Treatment for mild bacterial conjunctivitis
Polymixin B/Trimethoprim (Polytrim)
57
3 treatments for severe bacterial conjunctivitis or pseudomonal conjunctivitis
Moxifloxacin (vigamox), Ofloxacin opthalmic (Ocuflox) Ciprofloxacin
58
Treatment for gonococcal conjunctivitis
Rocephin (ceftriaxone) with Erythromycin or bacitracin
59
Treatment for chlamydial conjunctivitis
1 dose azithromycin PO
60
Presentation of gonococcal conjunctivitis
Perfuse purulent exudate
61
Presentation of trachoma
Chlamydial conjunctivitis - Yellow follicle spots on inner eyelid
62
Clinical presentation of viral conjunctivitis
Usually bilateral, watery discharge, foreign body sensation, preauricular lymphadenopathy
63
MCC of viral conjunctivitis
Adenovirus from eye clinics or swimming pools
64
Treatment for viral conjunctivitis
Supportive care
65
Presentation of allergic conjunctivitis
May be seasonal. stringy discharge with cobblestone papillae on inner eyelid (big bumps), pruritis
66
Chemosis
Swelling of the conjunctiva - seen in allergic conjunctivitis
67
Treatment for allergic conjunctivitis
2 drugs
Topical antihistamines such as Ketotifen or Olopatadine
68
Uvea
Structures of the eye beneath the sclera
The iris
The ciliary body
The choroid
69
MC type of uveitis
Acute, nongranulomatous, anterior uveitis
70
Posterior Uvea
Choroid
71
Anterior Uvea
Iris and Ciliary body
72
1 thing NOT to do with opthalmic herpes
DONT give steroids
73
Non-granulomatous uveitis
Inflammation with predominantly polymorphonuclear cells rather than giant cells - usually presents acutely
74
Granulomatous uveitis
Inflammation where macrophages are the predominant cell - usually indolent with blurred vision
75
Causes of non-granulomatous anterior uveitis
Often linked to autoimmune condition such as UC or arthritis
76
Causes of anterior granulomatous uveitis
Syphillis, TB, Toxoplasmosis, Herpes
77
Fundus of ocular syphillis
Salt and pepper fundus
78
Diagnosis and clinical presentation of anterior uveitis
Use a slit lamp - Hypopyon or collection of pus in the cornea, Keratitic deposits seen - larger with granulomatous inflammation
79
General presentation of uveitic eyes
Red and painful with redness around the cornea
80
Old v New Posterior Uveitic lesions
New have less defined borders and are yellow, old have more definite margins
81
Clinical presentation of posterior uveitis
Gradual vision loss with floaters and often bilateral
82
Cause of posterior uveitis
Idiopathic, autoimmune, pars plantis, or agents that cause anterior granulomatous uveitis
83
Treatment for anterior uveitis
Topical corticosteroid with pupil dilation - treat agent if identified
84
Treatment for posterior uveitis
Corticosteroid therapy given more invasively - treat agent if identified
85
Keratitis
Inflammation of the cornea
86
Causes of bacterial keratitis
Most common in contact lenses worn overnight - most commonly pseudomonas, moraxella, staph or strep
87
Presentation of bacterial keratitis
Hazy cornea with ulcer, hypopyon, difficulty keeping eye open
88
Treatment for bacterial keratitis
Emergent referral and fluoroquinolone drops
89
Cause of viral keratitis
HSV
90
Key sign of herpes simplex keratitis
Dendritic (branching) lesion of the cornea
91
Treatment for viral keratitis
Urgent referral with topical or oral acyclovir or valacyclovir
92
Hutchinsons sign
Involvement of the tip of the nose or lid margins in HSV predicts eye involvement
93
Fungal kerititis
Candida, aspergillis, fusarium
Often from injury in an agricultural setting or with contacts and the immune compromised
94
Presentation of fungal keratitis
Feathery corneal infiltrate with satellite lesions and multiple stromal abscesses
95
Treatment for fungal keratitis
Natamycin, Amphotericin, Voriconazole
96
Acanthamoeba keratitis
Severe pain with ring shaped corneal infiltrate
97
Treatment for acanthamoeba keratitis
Needs long term treatment with topical biguamide (Polyhexamethylene or chlorahexadine)
98
Why does acanthamoeba keratitis need long term treatment
It can encyst with the corneal stroma
99
Subconjunctival hemmorhage
Well defined area of hemorrhage under the conjunctiva - usually self limiting and caused by HTN or trauma
100
How long does a subconjunctival hemorrhage usually last?
Resorbs within 2 weeks
101
Dacryoadenitis
Inflammation or infection of the lacrimal gland
102
Dacryocystitis
Infection of the lacrimal sac/duct
103
Clinical Presentation of dacryoadenitis
Unilateral rapid onset swelling in the supratemporal region
104
Dacryocystitis clinical presentation
epiphora(overflow of tears), rapid unilateral onset, and inframedial swelling
105
2 potential causes of dacryoadenitis
Mumps, and autoimmune inflammatory
106
MC organisms for acute and chronic dacryocystitis
Acute - Staph aureus
Chronic - Staph epidermidis
107
Treatment for dacryoadenitis
Treat underlying cause and use systemic antibiotics if bacterial
108
Treatment for acute dacryocystitis
Lacrimal sac massage
Topical Tobramycin and Moxifloxacin if discharge only
Augmentin systemic if other s/s of infection are present
109
Treatment for chronic dacryocystitis
Can be kept latent with antibiotics - Surgery to relieve obstruction is definitive treatment
110
Anterior blepharitis
Involves the eyelids skin and eyelashes, may be associated with ulcers or seborrhea of the scalp, brows, and ears
111
Posterior blepharitis
Inflammation of meibomian glands at inner portion of the eyelid can be cause by infection, dysfunction, or skin conditions
112
Meibomian glands
Located in eyelids - secrete oily substance used to lubricate eyeball and prevent tear evaporation
113
Clinical presentation of anterior blepharitis
Red rimmed eyes with scales seen on eyelashes
114
Clinical presentation of posterior blepharitis
Greasy or frothy tears with rolled in lid margin with telangiectasia and hyperemesis - Waxy, congealed meibomian glands
115
Treatment for anterior blepharitis
Remove scales with a hot washcloth use bacitracin or erythromycin for an antistaph ointment
116
Treatment for mild poterior blepharitis
Meibomian gland expresseion and lid massage
117
Treatment for conjunctival and corneal inflammation
Tetracycline long term, Prednisolone short term
118
Hordeolum
Localized red, tender area of the eyelid caused by a staphylococcal abcess
119
External Hordeolum
Usually smaller and on the margin of the eyelid
120
Internal hordeolum
Often a Meibomian gland abscess pointing into the conjunctival surface of the lid, can cause lid cellulitis
121
Treatment for Hordeolum
May need to change any cosmetics, warm compress, and I&D if no progress
Antibiotics NOT indicated
122
I&D
Incision and Drainage
123
Chalazion
Hard, Non-tender swelling with redness of adjacent conjunctiva
124
Chalazion treatment
Often resolves on own with warm compress etc, may need to refer refractory for incision or steroids
125
Cause of Orbital cellulitis
Caused my OM pathogens and S. Aureus - often connected with a sinus infection (cause the sinuses are nearby)
126
Orbital cellulitis or Preseptal cellulitis - which one is an emergency
Orbital - think - it's closer to the brain!!
127
Orbital cellulitis pathology
Infection of the fat and soft tissue that holds the eye in its socket
128
Clinical presentation of orbital cellulitis
Fever, Painful swelling, Proptosis, Ptosis, Limited movement
129
One thing you should do to assess for severity of preorbital cellulitis
Check pupillary reaction to light to assess ocular nerve involvement
130
Treatment for orbital cellulitis
Immediate IV Vanc and a later gen cephalosporin
May add metronidazole or Clinda for anaerobes
131
Orbital cellulitis treatment after symptoms are under control
Switch to oral Bactrim, Augmentin, or FQone for 2-3 weeks
132
Preseptal/Periorbital cellulitis
Bacterial infection superficial to the orbital septum - Usually secondary to another eyelid infection such as conjunctivitis
133
2 common agents of preseptal cellulitis
S. Aureus and S. Pneumo
134
Clinical presentation of preseptal/periorbital cellulitis
NO fever, NO proptosis, Eyelid swelling, Erythema, No vision impairment
135
Treatment for Preseptal/Periorbital cellulitis
PO - Augmentin or Omnicef with Bactrim or Clinda
136
Ciliary flush
Definitive for corneal pathology - red/violet streaks spreading out from the edges of the cornea
137
4 clinical presentations of a corneal ulcer
Ciliary flush, Irregular pupil, dendritic ulcer, mucopurulent discharge
138
Characteristics of Psudomonas Corneal ulcer
Gray/Yellow infiltrate at a break in the cornea, Contact lens wearing hx,
139
Treatment for corneal ulcer with pseudomonas
FQone or Tobra/Gentamycin
140
Characteristics of group A strep corneal ulcer
May include a hypopyon, Edematous corneal stroma, not as specific
141
Characteristic of a staph infected corneal ulcer
Ulcer bed feels firm when scraped
142
3 drugs to treat staph infected corneal ulcers
Cefazolin, Moxifloxacin, Gatifloxacin
143
Characteristics of Fungal corneal ulcers
Gray, irregular edged infiltrate with satellite lesions -slow growing
144
Treatment for fungal corneal ulcer
Amphotericin B, Voriconazole, Posaconazole
145
Characteristics of viral corneal ulcers
Hx of fever or blisters, Dendritic ulcer, photophobia
146
Treatment for viral corneal ulcer
Acyclovir PO or Idoxuridine/Gancyclovire Topical
147
Corneal ulcer placement and size
Can be a small dot at the EDGE of the cornea
148
Entropion
Inward turning of the eyelid - often in elderly patients
149
Treatment for entropion
Surgery if eyelashes rub against the cornea
Botulinum toxin injections may be used
150
Ectropion
Outward turning of the lower eyelid - associated with tear leakage
151
Blepharospasm and treatment
Abnormal eyelid muscle contraction (eye twitching) - treated by alleviating stress and possibly botox
152
3 Neurological diseases that can cause Ptosis
Horner's syndrome
3rd nerve palsy
Myasthenia gravis
153
Mild, Moderate, and Severe Ptosis
2, 3, and 4 mm drop
154
Treatment for Ptosis
Oxymetazoline eye drops (alpha adrenergic stimulators)
Surgery usually reserved for those with an obscured visual field
155
Pterygium
Encroachment of the conjunctiva onto the nasal side of the cornea - often due to prolonged exposure to wind, sand, dust, etc.
156
Treatment for pterygium
Artificial tears, NSAIDS and steroid can be used, surgery in extreme cases
157
Pinguecula
Yellow/orange raised conjunctival lesion that DOES NOT cross into the cornea - exposure or dust caused
158
Clinical findings of dry eye
Itching, Absence of tear meniscus on lower lid, Excess mucous production, blurred vision
159
Tests to detect dry eye
Fluorescence staining to find dry spots
Rose Bengal and Lissamine Green for epithelial defects
Schirmer's tear production test
Tear breakup time
160
3 complications of dry eye
Corneal scarring and vascularization, Corneal ulceration, Impaired vision
161
First line treatment for dry eye
Artificial tears 3-4 times a day and ointment, Plugs, Cyclosporine for immune inhibition
162
Cataract
Lens opacity usually resulting from age, can also be related to smoking and alcohol use
163
Clinical presentation of cataracts
Progressive blurring of vision, monocular double vision, cloudy lens, Glare with bright lights
164
Cataract treatment
Refer to ophthalmology for surgery
165
Part of the eye effected by cataracts
Lens not the cornea
166
Clinical presentation of macular degenerations
Loss of central vision first that is usually bilateral
167
Atrophic macular degeneration (dry)
Atrophy and degeneration of the retina and retinal pigment with retinal drusen
168
Retinal drusen
Hard, discrete, yellow retinal deposits
169
Neovascular (wet) macular degeneration
Excess growth of vasculature under the retina leads to fluid accumulateion, hemorrhage, and fibrosis - more rapid vision loss
170
Narrow angle glaucoma
Acute glaucoma - a medical emergency
171
Open angle glaucoma
Chronic glaucoma - less emergent
172
Glaucoma
Neuropathy of the optic nerve with or without intraocular pressure, also with cupping of the optic disk
173
Creation and drainage of aqueous humor
Made by ciliary body, drained by trabecular meshwork
174
Etiology of acute angle closure glaucoma
Lens is pushed forward leading to closure of the angle between the cornea and the iris and impaired drainage of aqueous humor
175
3 risk factors for narrow angle glaucoma
Asian descent
Female, 40-50 years old
Farsightedness
176
Primary angle closure glaucoma
Lens located too far forward anatomically, leading to closed angle
177
Secondary angle closure glaucoma
Conditions that push the ciliary body forward or pull on the iris creating a closed angle
178
Clinical presentation of acute angle closure glaucoma
Halo's around lights, with onset more common when it is dark, Red steamy cornea with sluggish dilated pupils and IOP over 50mmg
179
Gold standard diagnostic for narrow angle glaucoma
Gonioscopy is the gold standard for diagnosis - views the irideocorneal angle
180
Initial treatment for angle closure glaucoma
Place the patient supine and refer to opthalmology urgently
181
Pharmacology for Narrow angle glaucoma
First line: Acetazolamide (CAI) PO or IV
Pilocarpine drops administered later
Recheck IOP every 30-60 minutes
182
3 Non-first line topicals for acute angle closure glaucoma
Latanoprost, Timolol, Apraclonidine
183
Definitive treatment for angle closure glaucoma
Laser peripheral iridotomy, creates a hole in the peripheral iris to releive the pupillary block
184
5 things to give someone with Angle closure glaucoma while waiting for the ambulance
Lie on back
Acetazolamide
Pilocarpine
Anagesia
Antiemetic
185
Clinical presentation of open angle glaucoma
Gradual peripheral vision loss with high IOP (over 40mmHg)
186
Screening recommendations for glaucoma
every 5-10 years for under 40
to ever 1-2 years over 65
Refer any pt with cupping!
187
IOP at which to refer
30-40 is Urgent, anything higher is emergent
188
3 types of therapy for open angle glaucoma
Pharm - acetazolamide
Laser therapy
Surgery
189
4 drugs for open angle glaucoma
Topical prostaglandins - Lataprost
Topical beta blockers - Timolol
Topical Alpha 2 agonists - Apraclonidine
(reduces aqueous humor production by dilating eyes)
Cholinergic agonists - Pilocarpine
190
Surgical therapy for any glaucoma
Laser periperal iridotomy - put a hole in the peripheral iris for drainage
191
Cause of a corneal abrasion
Often from trauma - fingernail, contact lens, paper, etc.
192
Clinical presentation of a corneal abraision
Tearing, Foreign body sensation, may have ciliary flush or change in visual acuity, photophobia
193
Complications for a corneal abrasion
Bacterial keratitis leading to ulcers and hypopyon
194
Diagnostics for a corneal abraision
Evert eyelid to rule out foreign body, check visual acuity, stain to find abrasion
195
3 treatments for corneal abrasions
Antibiotics - bactrim-polymixin
NSAID eye drop
Cycloplegic to stop ciliary spasms and pain
196
Are alkali or acidic burns worse?
Alkali
197
4 factors effecting the severity of a chemical eye injury
Toxicity
Length of exposure
Depth of penetration
Area of involvement
198
Treatment for chemical eye injury
Irrigate with pH monitoring
May use a cycloplegic
199
Presentation of welder's flash photophobia
6-12 hours after exposure to UV radiation, Staining reveals corneal speckles
200
Treatment for welder's flash potophobia
Binocular patching with Cyclopentolate (cycloplegic drug)
201
What MUST you do when you suspect a foreign body?
Always evert the eyelid
202
Rust ring
formed by an iron containing foreign body - remove if not resolved in 2-3 days
203
Hyphema
Injury causing a hemorrhage into the anterior chamber of the eye causing pain, photophobia and blurred vision
204
Non-pharm management for a hyphema
Prevent further bleeding, keep patient supine with head elevated 45 degrees and a hard eye shield
205
Pharm management of hyphema
NO NSAIDs or Aspirin
Pain meds and antiemetics
206
Bone at the top of the orbit
Frontal bone
207
2 Bones on the outside edge of the orbit
Zygomatic bone and sphenoid bone
208
2 Bones on the bottom of the orbit
Maxilla and zygomatic bone
209
2 Bones on the inside edge of the orbit
Maxilla and ethmoid bone
210
Bones in back of the orbit (4)
Sphenoid, Palatine, Ethmoid, Maxilla
211
Action of the inferior oblique
Moves the eye upwards and inwards
212
Action of superior oblique
Moves the eye downwards and inwards
213
Most common bone injured in an orbital blowout fracture
Maxilla
214
Clinical presetation of an orbital blowout fracture
Pain and ecchymosis around the eye
Decreased movement - especially looking upwards due to trapped inferior rectus
Localized facial anesthesia (trigeminal nerve)
Enopthalmos (sunken in eyes - indicates inferior displacement of orbital contents through the orbital floor)
215
3 Evaluation steps for an orbital blowout
Obtain mechanism of injury
Examine eye contents and check visual acuity
CT of the orbit
216
4 things to look for on an orbital CT from an orbital blowout fracture
Emphysema (air in the orbit) with crepitus
Fracture of floor or medial wall of orbit
Soft tissue extending into maxillary sinus (could become ischemic)
Opacification of maxillary sinus from blood or edema
217
3 things we do not want someone with an orbital blowout fracture doing
Throwing up
Sneezing
Blowing nose
(or anything like unto it)
218
2 pharm treatments for orbital blowout
Systemic antibiotics and steroids for swelling
219
3 symptoms that are indicative of a ruptured globe in penetrating trauma
Teardrop shaped pupil, eyeball appears deflated, afferent pupillary defect
220
Afferent pupillary defect
Response to light is more sluggish in one eye
221
3 treatment points for penetrating trauma or ruptured globe
Protective eye shield
Elevate head 45 degrees
Vancomycin and Ceftazidime or FQone
222
Amaurosis fujax
Transient monocular blindness, symptom not a diagnosis
223
3 things that might cause amaurosis fujax
Migraine, Retinal emboli, giant cell arteritis
224
Clinical presentation of amaurosis fujax
Described as a curtain coming down over the visual field with a few minutes of complete vision loss
225
Monocular ischemia pattern and mechanism
Monocular rapid onset due to a retinal embolism
226
Giant cell arteritis vision loss pattern and mechanism
Usually monocular w/ headache, due to optic nerve ischemia
227
Papilledema vision loss pattern and mechanism
Monocular graying or blurring with diplopia from elevated intercranial pressure
228
Idiopathic retinal vasospasm
Accompanied by a headache and monocular vision loss
229
Migraine vision loss
Binocular due to cortical depression and possible retinal vasospasm
230
Vision loss of vertebrobasilar ischemia
Homonymous hemianopia caused by an embolism
231
Vision loss of an ictal seizure
Binocular and lateralized due to epileptic discharge
232
Postictal vision loss
lasts 20+ minutes, binocular visual field loss due to cortical inhibition
233
Clinical presentation of central retinal artery occlusion
Sudden profound painless monocular loss of vision with a cherry red spot and afferent pupillary defect and boxcar segmentation
234
Management for central retinal artery occlusion
Lay patient flat, give acetazolamide and vasodilators and ocular massage with O2. Thrombolysis given CAREFULLY
235
Treatment for giant cell arteritis
High dose corticosteroids
236
~Pexy
Root for fixation of something
237
Clinical presentation of Central retinal vein occlusion
Painless monocular vision loss often first noticed upon awakening with a blood and thunder fundus - starts out blurry
238
Treatment for retinal vein occlusion
Anti VEGF first line
Intravitreal corticosteroids second line
Laser photocoagulation
239
Laser photocoagulation
Uses lasers to seal leaky vessels and prevent VEGF formation
240
2 common risk factors for retinal detachment
Nearsighted (longer eyeball)
Cataract extraction
241
Clinical findings of a retinal detachment
Monocular decreased vision, Eye pain, Central vision is last to go
Flashing lights and floaters
242
Treatment of retinal detachment
Can often be cured surgically, prognosis depends upon length of time and extent of detachment
243
Optic neuritis
Strongly associated with MS - inflammation of the optic nerve can also be HSV or autoimmune
244
Clinical presentation of optic neuritis
Pain behind the eye with loss of color vision/perception andcentral field loss
Unilateral w/ pupillary defect
245
Fundoscopic findings for optic neuritis
Swollen disc with diffuse borders and a few homrrhages
246
Treatment for Optic neuritis
IV methylprednisone for 3 days and then oral prednisone
May need more prolonged therapy for chronic/non-acute cases
247
Optic disk swelling due to intercranial pressure
Papilledema
248
Clinical presentation of papilledema
Bilateral with blurred margins and flame hemorrhages - may have NO visual symptoms
249
Treatment for Papilledema
DONT perform a lumbar puncture!!
MRI for diagnostics and treat underlying cause
250
Why no lumbar puncture for papilledema
Risk of herniation
251
Ischemic optic neuropathy
Inadequate perfusion of ciliary arteries leading to infarction of the optic disk
252
Clinical presentation of Ischemic optic neuropathy
PAINLESS monocular vision loss usually affecting the superior and inferior visual field
Treated with HIGH dose corticosteroids and referral
253
Fundoscopic exam for ischemic optic neuropathy
Optic disk swelling, central cotton with flame shaped hemorrhage (nonarteric) Large central palor/cotton wool spot (Arteric)
254
6 eye complaints that can be treated in primary care w/o urgent follow up
Hordeolum
Chalazion
Blepharitis
Subconjuntival Hemorrhage
Conjunctivitis
Dry eye syndrome
255
3 eye complaints that can be treated in primary care BUT need urgent follow up
Corneal Abrasion
Corneal foreign body
Contact lens over wear
256
3 ophthalmic signs of hypertension
Cotton wool spots, Open angle glaucoma, Copper and silver wiring
257
3 signs of diabetic retinopathy
Hard exudates, Neovascularization, Ischemic optic neuropathy
258
3 ophthalmic signs of thyroid disease
Protruding eyes, Color dullness, difficulty moving eyes
259
2 ophthalmic signs of hyperlipidemia
Macular degeneration, Blood and thunder fundus from venous occlusion
260
2 ophthalmic signs of sarcoidosis
Granulomatous anterior uveitis
Optic neuritis
261
Ophthalmic signs of myasthenia gravis
Diplopia and ptosis due to muscle weakness
262
Ocular signs of HIV/AIDS (4)
Patchy salmon appearance from conjunctival lymphoma
Opportunistic fungal infections
Cytomegalovirus with yellow around vascular distribution
Something w/ blue sclera in newborns
263
4 things that need to be determined in a hearing loss evaluation
Nature of impairment
Severity of impairment
Anatomy of impairment
Etiology of impairment
264
3 times that we screen hearing
Within 1 month of birth
Kindergarten
Pre-employment/Military service
265
2 screening tests for infants
Otoacoustic emissions (bounces sound waves off of the tympanic membrane)
Auditory brainstem responses
266
Otoacoustic emissions
Tests the ears response to sound - can tell if sound is responded to or not - should be an echo if hearing is intact
267
Auditory brainstem response
Uses electrodes to detect whether or not the brain is receiving sound information in a clear manner
268
What do you do is a baby does not pass initial hearing screenings?
Obtain a full hearing evaluation before 3 months of age
269
Full infant hearing eval
Repeat ABR
See how baby reacts to sounds
See how ears respond to sound
270
5 signs of hearing loss in a baby
Not being startled by loud sounds
Not turning towards a sound after 6 months of age
Not saying single words at 1 year
Turns head it they see you but not if you call out their name
Seems to hear some sounds but not others
271
When should children at risk for hearing loss be retested
By 2.5 years
272
Visual reinforcement audiometry
6 months to 2 years - Child is trained to look towards the source of a sound
273
Conditioned play audiometry
2-5 years old - child is trained to perform and activity when a sound is heard
274
3 hearing tests for children and adults
Tuning fork, Whisper testing, Audiometric screening (with headphones)
275
Pure tone audiogram
Determines the faintest a tones a person can hear at pitches from low to high
276
X axis of audiogram
Frequency in Hertz
277
Y axis of audiogram
Hearing threshold level in decibels
278
6 hearing loss categories with dB number
Slight, Mild, Moderate, Moderately severe, Severe, Profound - start at 10 dB for slight and add 15 each time
279
Symbol for left ear
X
280
Symbol for right ear
O
281
2 symbols used for bone conduction on the right
[ or <
282
2 symbols used for bone conduction on the left
] or >
283
Tympanogram
Measures the motility of the tympanic membrane
Types A B and C
284
5 things that can be diagnosed with a tympanogram
Otitis Media, Fluid in middle ear space, Eustachian tube dysfunction, Indirectly diagnose hearing loss, Tympanic membrane perforation
285
How does a tympanogram work
It introduces pressure into the ear canal while emitting sound waves to see how the TM is responding - measures pressure and flexibility
286
Type A tympanogram
Normal finding - central peak
287
Type B tympanogram
Gentle decline - No compliance
288
Type C tympanogram
Early peak with rapid decline - Eustachian tube dysfunction (negative pressure in the ear space)
289
3 Rinne test results and what they mean
Air>Bone - No loss or sensoneurial
Bone>Air - Conductive hearing loss
290
3 Weber test results and what they mean
Hearing in both ears -Normal
Hearing in good ear - Sensorineural
Hearing in Affected ear - Conductive
291
Conductive hearing loss
Sound is not conducted efficiently through the outer or middle ear leading to better bone conductivity than air conductivity
292
Sensorineural hearing loss
Occurs because of damage to the inner ear or auditory nerve - may hear unclear or only low pitched sound
293
Correction of sensorineural hearing loss
Permanent loss usually
294
Infectious causes of hearing loss
TORCH
Toxoplasmosis
Other agents (Syphillis, Parvovirus, Listeria)
Rubella
Cytomegalovirus
Herpes Simplex Virus
295
Ototoxic drugs - what do they cause?
Cause BILATERAL tinnitus or hearing loss
296
List of ototoxic drugs (7)
Medications neglected can loss auditory vestibular system
M - Malaria and Macrolide
N - Nsaid
C - Cisplatin
L - Loop diuretic
A - Aminoglycoside
V - Vancomycin and Vincristine
S - Salcilic acid (ASA)
297
Otosclerosis
Stapes affixes to the oval window causing conductive hearing loss - autosomal dominant
298
Clinical presentation of otosclerosis
Slow uni or bilateral hearing loss with possible improved hearing of background noise
299
Treatment for otosclerosis
surgical with stapedectomy
300
Otoscopy findings of otosclerosis
Flamingo flush over the tympanic membrane or normal tympanic membrane
301
Otoscopy finding for tympanosclerosis
White chalky patches on tympanic membrane
302
Presbyacusis
Sensorineural - Bilateral age related hearing loss that is most remarkable at high frequencies - most severe in males
303
Age-related change to the cochlea
Degeneration of outer and inner hair cells
304
Ossicular change related to age
Joint between bones calcify and become thinner
305
Treatment for presbyacusis
Hearing aids, cochlear implants if severe, OTC CoQ may help
306
2 clinical signs of presebyacusis
Increased wax production with decreased TM compliance
307
Acoustic neuroma
Benign tumor of schwann cells on nerve VIII causing UNILATERAL sensorineural hearing loss (rarely affects CN VII)
308
Clinical presentation of acoustic neuroma
Progressive unilateral hearing loss with tinnitus, dizziness, and balance problems
309
Diagnostic and treatment for acoustic neuroma
MRI to diagnose
Depending on severity, monitoring, radiation, or surgery
310
Noise induced hearing loss
Permanent hearing impairment cause by hair cell death that results from prolonged exposure to high levels of noise
311
Decibel level that causes noise induced hearing loss and frequencies usually lost
85+ decibels
2000-4000 hertz
312
Decibels of a vacuum cleaner
70
313
2 causes of hearing loss that may not need a referral
Cerumen impaction and OM
314
What patient needs an urgent referral for hearing problems
Idiopathic, sudden sensorineural hearing loss - can use corticosteroids
315
People who should have routine audiologic screenings
Prior exposure to injurious noise and over 65
316
Gold standard for auditory rehabilitation
Cochlear implant
317
Dizziness
Imprecise symptom that can describe many conditions
318
Vertigo
Sensation of movement when there is none - can be caused by spinning or by vestibular dysfunction
319
Lightheadedness
Feeling like one is about to loose consciousness
320
Disequlilibrium
Feeling off balance may be CNS lesion or vestibular
321
Peripheral vertigo
Vertigo that originates OUTSIDE of the CNS
322
Central Vertigo
Vertigo that originates INSIDE the CNS - can be mixed (ie. migraines)
323
General presentation of peripheral vertigo
Often sudden with hearing symptoms
324
General presentation of central vertigo
Often gradual with no hearing symptoms or bilateral ones
325
Nystagmus
Involuntary back and forth movement of the eyes - can be suppressed by
326
Eye movement indication of cerebellar pathology
Abnormal pursuit/saccades
327
Head impulse test
Patient looks forward and their head is turned to the side
328
Positive head impulse test
Patient's eyes move WITH the head - they can't keep their gaze on the examiner or take time returning their gaze to the examiner after returning of head to its position - PATHOLOGICAL
329
Dix-Hallpike test
Patient sits upright with head turned 45 degrees, patient is layed down so that their head is 30 degrees below horizontal
330
Positive Dix-Hallpike test
Nystagmus upon performance
331
What does the Dix-Hallpike test test for
Benign Paroxysmal Positional Vertigo
332
What does the head impulse test test for?
Vestibulo-occular reflex
333
Normal caloric testing result
Warm beats ipsilateral
Cold beats contralateral
334
Abnormal caloric testing result
Lack of any nystagmus
335
Medications that can interfere with the caloric reflex
Antihistamines, anxiolytics, antidepressants
336
ENG or VNG testing
Uses electrodes to trace eye movements and record the presence of nystagmus
337
VEMP testing
Vestibular evoked myogenic potential
looks at the reaction time between a sound and muscle response
338
Cervical VEMP
Assesses Saccule
339
Ocular VEMP
Assess Utricle
340
Etiology of BPPV
Canalithiasis - calcium deposits in SCC can also be from a free floating otoconia
341
Presentation of BPPV
Vertigo appears upon changes in head position and presents with no other neurological deficits
342
BBPV of posterior canal
Upward rotary nystagmus
343
BBPV of anterior canal
Downward rotary nystagmus
344
Horizonal canal BBPV
Beating towards the floor
345
Otolith repositioning for BPPV
Epley maneuver
346
2 deconditioning exercises for BPPV
Brandt-Daroff and Sermont
347
Vestibular neuronitis
Viral or post viral inflammatory response only affecting that vestibular division of CN VIII
348
Vestibular labyrinthitis
Viral or post viral inflammatory response that effects the vestibular AND cochlear division of CN VIII
349
Clinical presentation of Vestibular neuronitis or labrynthitis
Sudden onset vertigo
Nystagmus AWAY from the affected side
Normal head impulse test for central lesion
350
Treatment for vestibular neuronitis/labrynthitis
Corticosteroids - prednisone or methyl prednisone for 10 days to 3 weeks
May try antivirals or antimicrobials if suspected
351
2 drugs for vertigo suppression and 2 for nasuea
Antihistamines and Benzodiazepines
Promethazine and Ondansetron
352
Meniere's disease (endolymphatic hydrops)
Thought to be related to excessive fluid in the inner ear may be due to syphillis and blocked endolymphatic ducts
353
Classic meniere's disease triad
Episodic vertigo, Unilateral hearing impairment, Tinnitus w/ low tone blowing
Aural fullness is also a symptom
354
Testing for meniere's disease
2 spontaneous episodes lasting at least 20 minutes
Abnormal caloric testing
Hearing normal between attacks
355
Treatment for meniere's disease
Restrict salt, alcohol, and caffeine
356
Medication for acute Meniere's disease
Meclizine, diazepam, promethazine
357
Medication for chronic meniere's disease
Acetazolamide - Diuretic to remove salt water
358
Perilymphatic fistula
Leakage of fluid from the inner to the middle ear
359
Perilymphatic dehiscence
Abnormal thinning or asence of bone above the superior semicircular canal
360
Clinical presentation of peri lymphatic fistula or semicircular canal dehiscence
Sensorineural hearing loss
Brief recurrent episodes of vertigo with specific triggers
Physical exam usually unremarkable
361
Treatment for peri lymphatic fistula or semicircular canal dehiscence
Referral, Bed rest with head elevation, meds for symptoms, may need a surgical patch if refractory
362
Barotrauma
Buildup of pressure between the middle and inner ear due to eustachian tube dysfunction, flight, SCUBA, etc.
363
Type of pressure usually present in barotrauma
Negative pressure in the middle ear
364
Presentation of Barotrauma
Pain, Pressure, Tinnitus, Hearing loss
Hemorrhage behind TM or perforation may be seen
365
Treatment for barotrauma
Most heal over time, refractory may need myringoplasty or tympanoplasty
366
Prevention of barotrauma
Decongestants, slow depth/altitude changes, Chewing gum or pacifier, frequent swallowing
367
Tinnitus
Sounds in the absence of an exogenous source - pulsatile or non-pulsatile. Continuous or intermittent
368
Pulsatile tinnitus
Can result from carotid bruits, Muscle spasms or open Eustachian tube (loud breath sounds)
369
Non-pulsatile tinnitus
Due to sensorineural hearing loss, otosclerosis, meniere's disease, etc.
TL/DR - More directly ear related
370
Paragnaglioma
Tumor of the middle ear - causes pulsatile tinnitus and can be removed surgically
Look for high vascularity
Treat sugically
371
Patulous eustachian tube
Tube stays open leading to roaring from breath sounds and unusually loud hearing of one's own voice
372
Treatment for patulous eustachian tube
Premarin (mucosal irritant)
Surgery
373
Exacerbating factors of tinnitus
Depression and insomnia
21% suicide rate
374
Therapy for tinnitus
Noise reducing generators with retraining therapy, Stress reducing CBT
375
Other interventions for tinnitus
BZD, Intra TM steroids, Misoprostol, Transcranial magnetic stimulation
