High Yield Diseases Block 3 Flashcards
Defects in deep retinal layers. Degeneration of macula. Causes central vision loss (scotomas) that is rapid due to neovascularization, edema, and hemorrhage. Eye exam = neovascularization, edema, hemorrhage, and eventual scarring and vision loss. Age Related if after 50; usually over 70 Rx: quit smoking, nutritional recommendations, AREDS (High amounts of zinc and antioxidants) supplements, manage systemic diseases. And conventional laser, photodynamic therapy, anti-vegf drugs.
Wet (exudative) Macular Degeneration
Degeneration of RPE leading to blurry vision and loss of central vision first
Macular degeneration
Conjunctivitis
Infection of the thin conjunctiva. Symptoms: Discharge, red eye, irritation, and sensitivity to palpitation; caused by dilation and congestion of sub epithelial vessels. DDX: Bacterial vs Viral vs Allergic (Other include Rhinoconjunctivitis, chemical reaction, meds, neoplasm, foreign body) Bacterial: 50 to 74% bilateral, mucopurulent discharge, 32-39% acute otitis media. Viral: 35% bilateral, mild watery discharge, redness, 10% acute otitis media Allergic: Usually bilateral, discharge is rare, usually red, no otitis media, MAJOR PRURITIC *AdenoPlus Test to test for viral vs. bacterial.
Infection of the thin conjunctiva. Symptoms: Discharge, red eye, irritation, and sensitivity to palpitation; caused by dilation and congestion of sub epithelial vessels. DDX: Bacterial vs Viral vs Allergic (Other include Rhinoconjunctivitis, chemical reaction, meds, neoplasm, foreign body) Bacterial: 50 to 74% bilateral, mucopurulent discharge, 32-39% acute otitis media. Viral: 35% bilateral, mild watery discharge, redness, 10% acute otitis media Allergic: Usually bilateral, discharge is rare, usually red, no otitis media, MAJOR PRURITIC *AdenoPlus Test to test for viral vs. bacterial.
Conjunctivitis
Macular degeneration
Degeneration of RPE leading to blurry vision and loss of central vision first
Shearing forces applied to anterior auricle which separates from underlying cartilage. Tears auricular blood vessels creating a hematoma and then stimulates new cartilage growth. Rx: Excise, drain, and bolster
Cauliflower Ear
Degeneration of macula. Causes central vision loss (scotomas) that is slow, due to fat deposits and causes gradual decrease in vision. Age Related if after 50; usually over 70 Eye exam = Drusen around macula and atrophy of retina Rx: quit smoking, nutritional recommendations, AREDS (antioxidants and zinc in high levels) supplements, manage systemic diseases
Dry Macular Degeneration
Cauliflower Ear
Shearing forces applied to anterior auricle which separates from underlying cartilage. Tears auricular blood vessels creating a hematoma and then stimulates new cartilage growth. Rx: Excise, drain, and bolster
Viral conjunctivitis
Neonatal - HSV Neonatal - HSV Post natal - Adenovirus (most common) Coxsackie, HSV, VZV (pain before redness), EBV, rubella, mumps, influenze
Sensorineuronal hearing loss
Increase in thresholds and/or loss of ability to transduce specific freq. due to damage to cochlea, auditory nerve, or cochlear nucleus. More commonly due to hair cell damage due to noise (brief high sounds most potential to damage, but all are important) Exposure/toxic drugs (aminoglycosides cause sterocilia damage and furosemide blocks NKCC in stria vascularis) Genetic problems w/ endolymph changes possible too (commonly due to connexin genes regualting gap junctions) Weber lateralizes to normal ear. Normal or absent rinne.
Otitis media
Acute middle ear space infection. Tubes often blocked. fluid, inflammation under TM Most or Second most common reason that children visit MD Risk factors: Day care attendence, smoke exposure, bottle feeding (lack of maternal Anitibodies) Common etiologic agents: Strep pneumo 25-50%, Haem infl. 15-30%, Moraxella catarrhalis 3-20%, Viral (RSV, rhinovirus) 5-22%, No pathogen identified May cause tympanic membrane rupture Sx: Otalgia, Aural fullness, hearing loss, tinnitus. Hearing loss temporary which can cause significant impact on speech development for kids. Tubes are shorter and less slanted in children Low freq sounds (speech) affected first – threshold elevations High freq sounds not affected until mass of middle ear bones is increased –> both low and high frequency sounds are reduced = conductive hearing loss Complications: Perforated TM, Acute mastoiditis, Abcess, labyrinthe fistula, facial nerve paralysis, meningitis, and more
Dry Macular Degeneration
Degeneration of macula. Causes central vision loss (scotomas) that is slow, due to fat deposits and causes gradual decrease in vision. Age Related if after 50; usually over 70 Eye exam = Drusen around macula and atrophy of retina Rx: quit smoking, nutritional recommendations, AREDS (antioxidants and zinc in high levels) supplements, manage systemic diseases
Acute bacterial conjunctivitis
Mucopurulent Children - Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae Adults - Staphylococcus aureus Self-limited, but decreased morbidity and transmission with treatment. Empiric w/ gram pos and negative coverage. Trimethoprim and polymixin opthalmic drops (Polytrim) or more expensive moxifloxacin drops
Causative agent: Neisseria gonorrhea Symptoms: Copious yellow-green discharge (purulent), preauricular adenopathy Gram negative intracellular diplococci that grows on chocolate agar. Treat promptly with systemic ceftriaxone.
Hyperacute bacterial conjunctivitis
Detached retina
Failure of retinal layers to fuse and obliterate intraretinal space between neural retinal layer and retinal pigmented epithelium. Presents as sudden partial vision loss in one eye. Painless, progressive, and often floaters. Can occur congenitally (linked with Marfans and Down Syndrome), or later in life secondary to trauma or type II DM. Linked with myopia. Surgical emergency = lasar demarcation of retinal tear, or scleral buckling procedure.
Benign Paroxysmal Positional Vertigo
Most common cause of vertigo. Caused by otoconia displacement from utricle into semicircular canal post trauma/ viral infx. Symptoms are recurrent brief vertigo and ipsilateral nystagmus. Normal Hearing Diagnosed via Dix-Hallpike maneuver and treated with epley maneuver to move otoconia back into semicircular canal.
Increase in thresholds and/or loss of ability to transduce specific freq. due to damage to cochlea, auditory nerve, or cochlear nucleus. More commonly due to hair cell damage due to noise (brief high sounds most potential to damage, but all are important) Exposure/toxic drugs (aminoglycosides cause sterocilia damage and furosemide blocks NKCC in stria vascularis) Genetic problems w/ endolymph changes possible too (commonly due to connexin genes regualting gap junctions) Weber lateralizes to normal ear. Normal or absent rinne.
Sensorineuronal hearing loss
Hyperacute bacterial conjunctivitis
Causative agent: Neisseria gonorrhea Symptoms: Copious yellow-green discharge (purulent), preauricular adenopathy Gram negative intracellular diplococci that grows on chocolate agar. Treat promptly with systemic ceftriaxone.
IgE response (Hay fever) Affects 20% of US pop. Onset: Rarely before 2; always before 20 Dx: HISTORY! Recurrent episodes of sneezing, rhinorrhea, nasal congestion, and lacrimation. Pruritis is highly suggestive. Testing: Skin testing (anitgen exposure) In vitro testing - radioallergosorbent testing (RAST) and enzyme linked immunosorbent testing (ELISA) Management - Antihistamines, mast cell stabilizers, NSAIDS, avoid antigen, and glucocorticoid
Allergic rhinoconjunctivitis
Otitis externa
Sx: Very painful red swollen canal with purulence. Painful to rotate or palpitate external ear. Risk factors: swimmers, Q tip users, diabetics, immunocompromised. Rx: AB drops and systemic ABs w/ topical suctioning and debridement (sever cases) Causative agents: Pseudomonas, E coli, Staph corynebacter. Also Candida and other fungal Hearing may be affected.
Acute middle ear space infection. Tubes often blocked. fluid, inflammation under TM Most or Second most common reason that children visit MD Risk factors: Day care attendence, smoke exposure, bottle feeding (lack of maternal Anitibodies) Common etiologic agents: Strep pneumo 25-50%, Haem infl. 15-30%, Moraxella catarrhalis 3-20%, Viral (RSV, rhinovirus) 5-22%, No pathogen identified May cause tympanic membrane rupture Sx: Otalgia, Aural fullness, hearing loss, tinnitus. Hearing loss temporary which can cause significant impact on speech development for kids. Tubes are shorter and less slanted in children Low freq sounds (speech) affected first – threshold elevations High freq sounds not affected until mass of middle ear bones is increased –> both low and high frequency sounds are reduced = conductive hearing loss Complications: Perforated TM, Acute mastoiditis, Abcess, labyrinthe fistula, facial nerve paralysis, meningitis, and more
Otitis media
Increased ocular pressure causes optic nerve loss. Can be multifactorial. Caused by obstructed outflow (i.e. canal of schlemm) Painless with slow onset. More common over age 40 Risk factors: Age, African American, and myopia Treatment: Decrease production, increase outflow. Beta blockers, acetazolamide, prostaglandin analogs, topical cholinergic agonists, and topical alpha agonists and irodotomy surgery putting hole in iris.
Open Angle Glaucoma
Neonatal - HSV Neonatal - HSV Post natal - Adenovirus (most common) Coxsackie, HSV, VZV (pain before redness), EBV, rubella, mumps, influenze
Viral conjunctivitis
Failure of retinal layers to fuse and obliterate intraretinal space between neural retinal layer and retinal pigmented epithelium. Presents as sudden partial vision loss in one eye. Painless, progressive, and often floaters. Can occur congenitally (linked with Marfans and Down Syndrome), or later in life secondary to trauma or type II DM. Linked with myopia. Surgical emergency = lasar demarcation of retinal tear, or scleral buckling procedure.
Detached retina
Closed Angle Glaucoma
Increased ocular pressure causes optic nerve loss. Can be multifactorial. Obstruction of flow between iris and lens leading to pressure buildup behind iris. Symptoms: Red eye, +/- nausea, very painful, decreased vision, rock-hard eye (touch it!) frontal headache. Opthalmologic emergency! Give pilocarpine, acetazolomide, oral glycerine or isosorbide. Get to optho ASAP for laser iridotomy.
Ppy: Secondary to Otitis media, trauma, slag burns, indwelling PE tubes, etc. Rx: keep ear dry and consider tympanoplasty in severe or persistent cases. Often heal on own.
TM perforation
Cataracts
Opacity of the normally clear lens caused by age, metabolic disorder (hyperglycemia, hypergalactosemia etc.), trauma, or hereditary. Generally painless and bilateral. Indications for surgery: severity of visual loss, functional needs of patients, need to improve view of posterior eye to care for occular pathology Risk factors: age, smoking, EtOH, sunlight, DM, classic galactosemia, galactokinase deficiency, trauma, infx. Rx: Cataract surgery and lens replacement
Mucopurulent Children - Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae Adults - Staphylococcus aureus Self-limited, but decreased morbidity and transmission with treatment. Empiric w/ gram pos and negative coverage. Trimethoprim and polymixin opthalmic drops (Polytrim) or more expensive moxifloxacin drops
Acute bacterial conjunctivitis
Wet (exudative) Macular Degeneration
Defects in deep retinal layers. Degeneration of macula. Causes central vision loss (scotomas) that is rapid due to neovascularization, edema, and hemorrhage. Eye exam = neovascularization, edema, hemorrhage, and eventual scarring and vision loss. Age Related if after 50; usually over 70 Rx: quit smoking, nutritional recommendations, AREDS (High amounts of zinc and antioxidants) supplements, manage systemic diseases. And conventional laser, photodynamic therapy, anti-vegf drugs.
Allergic rhinoconjunctivitis
IgE response (Hay fever) Affects 20% of US pop. Onset: Rarely before 2; always before 20 Dx: HISTORY! Recurrent episodes of sneezing, rhinorrhea, nasal congestion, and lacrimation. Pruritis is highly suggestive. Testing: Skin testing (anitgen exposure) In vitro testing - radioallergosorbent testing (RAST) and enzyme linked immunosorbent testing (ELISA) Management - Antihistamines, mast cell stabilizers, NSAIDS, avoid antigen, and glucocorticoid
TM perforation
Ppy: Secondary to Otitis media, trauma, slag burns, indwelling PE tubes, etc. Rx: keep ear dry and consider tympanoplasty in severe or persistent cases. Often heal on own.
Sx: Very painful red swollen canal with purulence. Painful to rotate or palpitate external ear. Risk factors: swimmers, Q tip users, diabetics, immunocompromised. Rx: AB drops and systemic ABs w/ topical suctioning and debridement (sever cases) Causative agents: Pseudomonas, E coli, Staph corynebacter. Also Candida and other fungal Hearing may be affected.
Otitis externa
Opacity of the normally clear lens caused by age, metabolic disorder (hyperglycemia, hypergalactosemia etc.), trauma, or hereditary. Generally painless and bilateral. Indications for surgery: severity of visual loss, functional needs of patients, need to improve view of posterior eye to care for occular pathology Risk factors: age, smoking, EtOH, sunlight, DM, classic galactosemia, galactokinase deficiency, trauma, infx. Rx: Cataract surgery and lens replacement
Cataracts
Most common cause of vertigo. Caused by otoconia displacement from utricle into semicircular canal post trauma/ viral infx. Symptoms are recurrent brief vertigo and ipsilateral nystagmus. Normal Hearing Diagnosed via Dix-Hallpike maneuver and treated with epley maneuver to move otoconia back into semicircular canal.
Benign Paroxysmal Positional Vertigo
Increased ocular pressure causes optic nerve loss. Can be multifactorial. Obstruction of flow between iris and lens leading to pressure buildup behind iris. Symptoms: Red eye, +/- nausea, very painful, decreased vision, rock-hard eye (touch it!) frontal headache. Opthalmologic emergency! Give pilocarpine, acetazolomide, oral glycerine or isosorbide. Get to optho ASAP for laser iridotomy.
Closed Angle Glaucoma
Open Angle Glaucoma
Increased ocular pressure causes optic nerve loss. Can be multifactorial. Caused by obstructed outflow (i.e. canal of schlemm) Painless with slow onset. More common over age 40 Risk factors: Age, African American, and myopia Treatment: Decrease production, increase outflow. Beta blockers, acetazolamide, prostaglandin analogs, topical cholinergic agonists, and topical alpha agonists and irodotomy surgery putting hole in iris.
