MISC Flashcards
Cataracts & macular degeneration?
Common in the elderly population and often result in visual impairment. Elderly patients should be thoroughly evaluated for the severity of macular degeneration, as they may not benefit from cataract surgery.
Anterior uveitis?
Pain, redness, variable visual loss, and a constricted and irregular pupil. Visualization of leukocytes in the anterior segment confirms the diagnosis.
Herpes simplex virus keratitis?
Dendritic corneal ulcerations, usually present with eye pain, in addition to other classic findings (eg, blurry vision, tearing, redness), but can occur without pain due to decreased corneal sensation from trigeminal nerve (CN V) involvement.]
Management is topical or oral antiviral therapy (eg, acyclovir)
Diabetic retinopathy?
Requires some years to develop. Poor glycemic control and blurry vision can be due to the swelling in the optical lens secondary to osmotic changes.
Corneal laceration?
Open globe injury if it extends through the full thickness of the cornea. A positive Seidel sign (ie, concentrated fluorescein uptake with subsequent clearing in a waterfall pattern) indicates full-thickness corneal laceration, an ophthalmologic emergency that requires immediate ophthalmologic consultation.
Central retinal artery occlusion?
Carotid atherosclerosis and presents with acute, painless, monocular vision loss. Patients typically have an afferent pupillary defect on examination and funduscopy may show a pale, ischemic fundus with a “cherry red spot.
Bacterial keratitis?
Acute presentation; mucopurulent eye discharge; and a round, white corneal opacity. Contact lens wearers are at increased risk, and treatment is topical antibiotics (eg, moxifloxacin) to treat the most common cause (Pseudomonas).
Hyphema? Blood in eyes
Management of hyphema involves preventing complications such as rebleeding and intraocular hypertension, which can result in permanent vision loss. Patients should have an eye shield placed and be admitted to the hospital for strict bed rest with 30-degree head of bed elevation and serial intraocular pressure measurements.
Foreign bodies?
Common cause of corneal abrasion. Treatment requires complete removal of any foreign bodies with eyelid eversion and saline irrigation. Topical antibiotics and follow-up with ophthalmology are also indicated.
Candida endophthalmitis?
Common in hospitalized patients with indwelling central catheters on parenteral nutrition and those with immunocompromise or recent gastrointestinal surgery/perforation. Manifestations typically include floaters, decreased visual acuity, eye pain (late), and funduscopic evidence of fluffy, yellow-white chorioretinal lesions.
Candida endophthalmitis with vitreous involvement is typically treated with systemic antifungal medication (eg, voriconazole), intravitreal antifungal injection, and vitrectomy.
Sudden hearing loss?
Sudden sensorineural hearing loss should be evaluated urgently by otolaryngology with a formal audiogram, MRI, and corticosteroid therapy.
Sensori-neural hearing loss?
AC > BC in both ears
Malignant otitis externa?
Invasive infection of the external ear canal, usually caused by Pseudomonas aeruginosa. It is typically seen in elderly, diabetic patients and is characterized by severe pain and granulation tissue at the floor of the canal at the osseocartilaginous junction.
Otitis externa (“swimmer’s ear”)
Discomfort, erythema, edema, and discharge at the external ear canal. Mild cases can be managed with topical acidifying agents (eg, acetic acid). Moderate cases should be treated with topical antibiotics. Severe cases with edema that blocks antibiotic penetration may require placement of a wick.
Hearing loss due to presbycusis
Frequent causes of social withdrawal and isolation in the elderly. It must be differentiated from depression and dementia. Screening can be accomplished through simple hearing tests performed in the office.
Peritonsillar abscess?
Acute infection between the tonsil and pharyngeal muscles. Inflammation and spasm of the nearby pterygoid muscles lead to trismus, one of the most specific findings that differentiates tonsillitis from peritonsillar abscess
Presbuysis environment?
The decreased ability to discriminate speech in patients with presbycusis is especially obvious in a noisy, distracting environment.
Nonallergic rhinitis?
After age 20 with nasal blockage, rhinorrhea, and postnasal drip. Patients have limited eye symptoms, are unable to identify a clear trigger, and can have symptoms throughout the year. Treatment includes topical intranasal glucocorticoids (eg, fluticasone) or intranasal antihistamines (eg, azelastine).
Ménière disease
inner ear characterized by increased volume and/or pressure of endolymph (endolymphatic hydrops).
Clinical features include episodic vertigo, sensorineural hearing loss, and tinnitus or aural fullness.
Medicare part A
covers primarily inpatient services. Part B covers outpatient services. Part C (Medicare Advantage) allows enrollment in private insurance plans. Part D covers prescription drugs.
Ichthyosis vulgaris
is a chronic, inherited disorder characterized by rough, dry skin with fish-like scales. Treatment includes long baths to remove the scales and frequent moisturizing with products containing keratolytics such as urea, alpha-hydroxy acid (eg, lactic acid), and salicylic acid to soften the skin and loosen the scales.
Tinea versicolor
is a non-invasive fungal infection of the skin characterized by multiple, often coalescing, small circular maculae that may vary in color (white, pink, or brown). It is often more apparent in the spring and summer months. Diagnosis is confirmed by potassium hydroxide preparation of skin scrapings showing yeast and hyphae.
Porphyria cutanea tarda
is a condition characterized by painless blisters, hypertrichosis, and hyperpigmentation. It is often associated with Hepatitis C infection and can be triggered by the ingestion of certain substances (e.g., ethanol, estrogens), which should be discontinued if suspect.
Onychomycosis
may occur in patients with preexisting tinea pedis and manifests as thickened, discolored, and dystrophic nails. Oral antifungals (eg, terbinafine, itraconazole) are needed for patients with moderate to severe onychomycosis, and prolonged treatment (eg, 12 weeks) is required.
