HEENT PANCE ? Flashcards
A pt presents to office with the dx of retinal detachment. What is the recommended tx until pt can receive opthalamic care?
Remain supine with head turned to the side of the detachment
A 55 yo pt presents with gradual loss of central vision. Upon fundoscopic examination, Drusen spots and hemorrhaging are seen. What is the most likely diagnosis?
Age related macular degeneration
A 25 yo pt presents with gradual loss of central vision. Upon fundoscopic examination, Drusen spots and hemorrhaging are seen. What is the most likely cause of this diagnosis?
Chloroquine
Phenothiazine
What tx can be used to slow the progress of ARMD?
IV monoclonal antibodies,
Vitamin, antioxidants. Zn, Cu, omega 3
What disorder is associated with metamorphopsia?
ARMD;
Phenomena of wavy or distorted vision
A pt presents with sudden, painless, unilateral vision loss. The pt has a hx of a fib and atherosclerosis. Pt denies jaw claudication. Exam reveals Pallor of retina, perifoveal atropy (cherry red spot), retinal edema, and arteriolar narrowing. What is the most likely dx?
Central arterial occlusion
A pt presents with sudden, painless, unilateral vision loss. The pt has a hx of a fib and atherosclerosis. Pt denies jaw claudication. Diagnosis is Central arterial occlusion What can be done while waiting for emergent opthalamic care?
Recumbent position and gentle ocular massage
A pt with a hx of diabetes presents with sudden, unilateral, painless, blurred vision. Exam reveals optic disc swelling, and “blood and thunder “ retina . What is the most likely diagnosis?
Central retinal vein occlusion
Blood and thunder retina- dilated veins, hemorrhages, edema, exudates
A pt with a hx of diabetes presents with sudden, unilateral, painless, blurred vision. Exam reveals optic disc swelling, and “blood and thunder “ retina . What tx can be done for this diagnosis?
Vascular endothelial growth factor- neovascularization
What is the difference btw proliferative and nonproliferative retinopathy?
Proliferative- more severe, will see neovascularization on exam, and vitreous humor
Nonproliferative- venous dilation, micro aneurysm, retinal hemorrhages, retinal edema, hard exudates
A pt 85 yo pt presents with bilateral, insidious vision loss. She also complains of double vision and reduced color perception. Exam shows translucent, yellow discoloration of the lens. What causes this disease state?
Progressive increase in the proportion of insoluble protein
A pt 85 yo pt presents with bilateral, insidious vision loss. She also complains of double vision and reduced color perception. Exam shows translucent, yellow discoloration of the lens. What is the tx?
Extraction and lens replacement
A pt presents with bilateral, insidious vision loss. She also complains of double vision and reduced color perception. Exam shows translucent, yellow discoloration of the lens. What drugs may cause this disease?
Statins and steroids
A pt presents with sudden onset of dizziness, tinnitus, and hearing loss, and horizontal nystagmus. Dicks hallpike maneuver produces delayed Fatigable nystagmus. What is the most likely diagnosis?
Benign pp v
A pt presents with gradual onset vertigo and vertical nystagmus. Pt denies hearing loss or tinnitus. What may be some common causes of this?
Central vertigo.
Think vascular disease, arteriovenous malformation, tumors MS, or vertebrobasilar migraines
A pt presents with painful vision loss. Fundoscopic exam reveals a steamy cornea, fixed mid dilated pupil, and tearing. The pt also complains of nausea and diaphoresis. What is the most concerning differential?
Acute angle closure glaucoma
A pt presents with painful vision loss. Fundoscopic exam reveals a steamy cornea, fixed mid dilated pupil, and tearing. The pt also complains of nausea and diaphoresis. What is the first line to for the suspected diagnosis?
IV carbonic anhydride inhibitor (acetazolamide)
Topical B.B.
Mannitol (osmotic diuresis)
A pt presents with painful vision loss. Fundoscopic exam reveals a steamy cornea, fixed mid dilated pupil, and tearing. The pt also complains of nausea and diaphoresis. What medication is contraindicated in the suspected diagnosis?
Mydriatics
A 55 yo AA pt presents with loss of peripheral vision. Fundoscopic exam reveals and increased disc to cup ratio. What medication is indicated for the suspected diagnosis?
Topical/oral BB, Alpha agonists (brimonidine)
How do B.B. work in open angle glaucoma?
Decrease aqueous production
How do anticholinergic, prostaglandin like agents, and epi work in open angle glaucoma?
Increases outflow
A 9 yo pt with a recent hx of a sinus infection, presents with ptosis, eyelid edema and surrounding skin, purulent dc. PE shows fever, decreased EOM, and decreased pupillary response. What diagnostic study is recommended to determine the extent of disease? And what may it show?
CT; broad infiltration into orbital soft tissue
A 9 yo pt with a recent hx of a sinus infection, presents with ptosis, eyelid edema and surrounding skin, purulent dc. PE shows fever, decreased EOM, and decreased pupillary response. WBC are 22,000. What is the recommended first line tx for the suspected diagnosis?
Nafcillin and metro or clindamycin, 2/3 gen cephalosporins, and FQ
IV until fever stops, then oral for 2-3 weeks
A 9 yo pt with a recent hx of a sinus infection, presents with ptosis, eyelid edema and surrounding skin, purulent dc. PE shows fever, decreased EOM, and decreased pupillary response. What are some causative agents of the suspected diagnosis?
Staph aureus, strep pneumonia, h flu, or gram neg
A newborn presents with pooling and excessive draining tears and eye redness. What is the suspected diagnosis?
Dacryostenosis
A newborn presents with pooling and excessive draining tears and eye redness. What is the tx for the suspected diagnosis?
Usually resolves by 9 months; warm compresses, massage
A pt presents with pain, swelling, tenderness, redness, and excessive tearing/purulent dc. Pt is diagnosed with dacryostitis. What is a potential complication of this disorder?
Abscess
What is dacryostitis?
Inflammation of lacrimal gland
A pt presents with red-rimmed eyes, scurf, and collarettes. PE shows a slightly erythematous conjunctiva and a thick, cloudy discharge is noted. What is the most likely cause is the suspected diagnosis?
Blocked meibomian gland.
A pt presents with red-rimmed eyes, scurf, and collarettes. PE shows a slightly erythematous conjunctiva. scaling of the scalp
is noted as well. What is the tx for the suspected diagnosis?
Lid scrubs with baby shampoo, massage to express meibomian glands
A pt presents with red-rimmed eyes, scurf, and collarettes. PE shows a slightly erythematous conjunctiva. What is the suspected dx?
Blepharitis
A pt presents with acute onset of pain and edema involving the eyelid. PE finds a palpable, indurated area on the eyelid that has a central area of purulence with surrounding erythema. What is the most likely causative agent of the suspected diagnosis?
Staph aureus
A pt presents with acute onset of pain and edema involving the eyelid. PE finds a palpable, indurated area on the eyelid that has a central area of purulence with surrounding erythema. The pustule is located deep from the palpebral margin. What is the most like diagnosis?
Internal hordeola
What is an internal hordeola caused by?
Inflammation of the meibomian gland.
A pt presents with acute onset of pain and edema involving the eyelid. PE finds a palpable, indurated area on the eyelid that has a central area of purulence with surrounding erythema. The pustule is located immediately adjacent to the edge of the palpebral margins. What is the suspected dx and what is it caused by?
External hordeola, inflammation/infection of the glands of Moll or Zeis
A pt presents with acute onset of pain and edema involving the eyelid. PE finds a palpable, indurated area on the eyelid that has a central area of purulence with surrounding erythema. What is the first line tx?
Warm compresses
A pt presents with a painless, indurated lesion deep from the palpebral margin. Pt reports that is is occasionally pruritic. It appears white/Grayish. What is the most likely diagnosis?
Chalazion
What can cause entropion?
Lids and lashes turned inward. Secondary to scar tissue or a spasm of the orbicularis oculus
