Neurology Flashcards
1
Q
How can a gallstone obstruct the normal propulsive ability of the bowel?
A
Gallstone ileus via biliary enteric fistula
2
Q
Anterior cerebral artery
A
- Supply
- Medial cortex (frontal and parietal lobes)
- Result of stroke
- Motor/sensory deficit of LE and trunk
3
Q
Middle cerebral artery
A
- Region supplied
- Lateral cortex
- parietal and temporal lobes
- Lateral cortex
- Results of stroke
- Motor/sensory deficit of Face and UE
- Aphasia
4
Q
Posterior cerebral artery
A
- Region supplied
- occipital lobe
- Results of stroke
- impaired vision
5
Q
Broca Aphasia
A
- Expressive aphasia
- able to understand language but are not able to generate language.
- D/t disruption of MCA
6
Q
Wernicke aphasia
A
Receptive aphasia; able to generate words but are not able to understand what is said to them.
7
Q
Wallenburg Syndrome
A
Occlusion of the Posterior Inferior Cerebellar artery (PICA)
- Loss of pain and temp - contralateral body
- Loss of pain and temp - ipsilateral face
- Cerebellar deficit - ataxia, past-pointing.
8
Q
Hemispatial neglect
A
Damage to Nondominant parietal lobe (right)
because the left lobe controls right side of body
9
Q
Gerstmann syndrome
A
- Agraphia - inability to write.
- Acalculia - inability to perform math
- Finger agnosia - inability to distinguish the fingers of the hand
Damage to the Dominant Parietal Lobe
10
Q
Personality changes and the associated brain lesion site
A
Frontal lobe
11
Q
Klüver-Bucy Syndrome
A
- Disinhibition
- loss of fear
- hyperorality/hyperphagia
- hypersexuality.
damage to the Bilateral Amygdale
12
Q
Hemiballismus
A
Constant varying, large amplitude involuntary movements of proximal limbs.
damage to the Subthalamic Nucleus
13
Q
Amyotrophic Lateral Sclerosis
A
- Tracts
- cotricospinal
- anterior horn cells
- Findings
- spastic paralysis (UMN lesion)
- flaccid paralysis (LMN lesion)
14
Q
Poliomyelitis
A
- Lesion
- anterior horn cells
- Findings
- flaccid paralysis (LMN lesion)
15
Q
Syringomyelia
A
- Lesion
- Anterior white commissure
- +/- anterior horn cells
- Findings
- Cape-like loss of pain and temperature over the shoulders and arms
- +/- flaccid paralysis of arms and hands
16
Q
Tabes Dorsalis
A
Complication of tertiary syphilis.
- Lesion
- dorsal column
- Findings
- Imparied proprioception
- gait/balance issues
17
Q
Brown-Séquard syndrome
A
- Lesion
- Spinal cord hemisection
- Findings
- Ipsilateral loss of vibration and two-point discrimination
- Contralateral loss of pain and temperature
- Ipsilateral motor weakness or paralysis.
18
Q
Organisms causing bacterial meningitis < 1 month and treatment
A
- Organism
- Listeria monocytogenes
- GBS
- E.coli
- Tx
- Ampicillin + gentamycin
- +/- cefotaxime
19
Q
Organisms causing bacterial meningitis 1-3 months old and treatment
A
- Organisms
- GBS
- E.coli
- Streptococcus pneumonia
- Neisseria meningitidis
- Tx
- 3rd gen cephalosporin + vancomycin
20
Q
Organisms causing bacterial meningitis 3m - 50yo and treatment?
A
- Organisms
- S. Pneumonia
- N. meningitis (college)
- Tx
- 3rd gen cephalosporin + vancomycin
21
Q
Organisms causing bacterial meningitis > 50yo and treatment
A
- Organisms
- S. pneumoniae
- N. meningitidis
- L.monocytogenes
- Tx
- 3rd gen cephalosporin + vancomycin + ampicillin
22
Q
Pathogen suspected with meningitis and following situation:
- College student of military recruit
- Head trauma + clear nasal discharge
- Preceding sinus or ear infection
- Recent neurosurgery w/ artificial implantation
A
- College student of military recruit
- N. meningitidis
- Head trauma + clear nasal discharge
- S. pneumoniae
- Preceding sinus or ear infection
- S. pneumoniae
- Recent neurosurgery w/ artificial implantation
- S. aureus, pseudomonas
23
Q
What medication should be given to close contacts of N. meningitidis meningitis?
A
- Ciprofloxacin
- Rifampin
- Ceftriaxone
24
Q
Encephalitis
A
Inflammation of the brain parechyma
- Pt
- nuchal rigidity, HA, photophobia, fever, AMS
- FND, seizures, behavior changes.
- Dx
- CSF
- elevated opening pressure
- perform viral Cx, PCR, antibody studies.
- CSF
25
Brain Abscess
Pt
Dx
Tx
Bacterial infection of brain parenchyma resulting from extension of local infection _mastoiditis, sinusitis_ Or a hematogenous spread.
* Pt
* HA, Fever, Papilledema, Seizures.
* Dx
* MRI = ring enhancing lesion
* requires aspiration to guide Abx therapy
* Tx
* Vanco + ceftriaxone + metronidazole
26
What substances cause hemolysis with G6PD deficiency?
Spleen Purges Nasty Inclusions From Damaged Cells
* Sulfonamides
* Primaquine
* Nitrofurantoin
* Isoniazide
* Fava beans
* Dapsone
* Chloroquine
27
Treatment for a tension HA
1. NSAIDs
2. Dihydroergotamine or sumatriptan.
avoid vasoconstrictors (triptans) if pregnant, prinzmetal angina, or CAD.
28
What is the treatment for Migraine HA
1. NSAID / acetaminophen
2. Oral sumatriptan
3. Dihydroergotamine
Antiemetics : chlorpromazine, prochlorperazine, metoclopramide. *these do not need to be given last. Often give with #1, or #2.*
29
What agents are used as prophylaxis for migraine HA
1. TCA (amitriptyline, notriptyline)
2. Bblocker (propranolol, metoprolol)
3. Anticonvulsants (valproic acid, topiramate, gabapentin)
4. Verapamil
5. Naproxen
30
What are red flag features of a HA
* Mild w/ progressive worsening over days/weeks
* new onset \>50yo
* Papilledema
* Seizures, confusion, AMS
* FND
* Disruption of sleep. HA presents immediately when waking up
* Vomiting before HA
* Underlying systemic illnesses.
31
Features of idiopathic intracranial hypertension?
* Young, obese female
* papilledema, ICP
* Vision changes.
* Retroocular pain worse w/ eye movement
## Footnote
* CT = normal appearance*
* CSF pressure \> 200mmH2O.*
32
Treatment of idiopathic intracranial hypertension
* weight loss
* 1st line
* Acetazolamide
* 2nd line
* serial lumbar punctures
* optic nerve sheath decompression
* lumboperitoneal shunting.
33
Trigeminal Neuralgia
Compression of the trigeminal nerve root
* Pt
* electrical like unilateral face pain
* worse w/ stimulation/touch.
* Tx
1. Carbamazepine
2. oxcarbazepine, lamotrigine, baclofen
3. last line = rhizotomy
34
What is the recommended treatment for a TIA
* Antiplatelet therapy
* clopidogrel and aspirin
* Anti-lipid
* High intensity statin (rosuvastatin, atorvastatin)
* Blood pressure
* **treat all patient with BP \> 140/90. Lower the BP**
* Embolic TIA
* Warfarin + heparin (dabigatran, rivaroxaban, apixaban)
35
What are surgical indications for carotid endarterectomy?
* Symptomatic pt w/ \>70% occlusion
* Symptomatic Men w/ narrowing 50-69%
* Asymptomatic pt w/ narrowing of 60-90% w/ life expectancy \> 5years and \< 3% risk of complication
36
Anterior cerebral artery stroke
Contralateral LE and trunk weakness.
37
Middle cerebral artery stroke
Face and upper extremity weakness, aphasia, neglect, and inability to perform learned actions.
38
Posterior cerebral artery stroke
Vision changes.
39
Basilar artery stroke will present with...
* Contralateral weakness if only one of the branches occludes
* Complete basilar artery occlusion leads to bilateral long tract signs.
* Unilateral weakness followed by wide spread/diffuse weakness.
40
Treatment for hemorrhagic stroke
1. stop any anticoagulants (FFP and Vit K if needed)
2. Control BP
1. SBP \< 200. DBP \< 180.
3. Control ICP
1. Elevated HOB
2. Analgesia and sedation
3. Mannitol to reduce ICP
4. Hyperventilate to help ICP
5. surgical decompression if required.
41
What are the 5 most common lacunar strokes?
* Pure motor hemiparesis
* Pure sensory stroke
* Ataxic Hemiparesis
* Sensorimotor stroke
* Dysarthria clumsy hand syndrome
42
Describe the features of the lacunar stroke type: **Pure motor hemiparesis**
* Weakness in face, arm, and leg on one side of body
* Lack of sensory or cortical signs (No aphasia, neglect, apraxia)
* Most common stroke type
43
Describe the features of the lacunar stroke type: **Pure sensory stroke**
* Sensory defect of face, arm, and leg on 1 side of body.
* No motor or cortical signs
44
Describe the features of the lacunar stroke type: **Ataxic Hemiparesis**
* Ipsilateral weakness and limb ataxia out of proportion to motor defect.
* Gait deviation to affected side
* NO cortex signs
45
Describe the features of the lacunar stroke type: **Sensorimotor stroke**
* Weakness and Numbness on one side of body
46
Describe the features of the lacunar stroke type: **Dysarthria Clumsy Hand Syndrome**
* Facial weakness, dysarthria, dysphagia, slight weakness and clumsiness of one hand.
* Least common
47
What is a unique feature of all the lacunar strokes?
None of the lacunar stroke subtypes consist of having **cortical signs/symptoms**
behavior changes, speech problems, vision problems = cortical problem.
48
Diagnosis and Management of a **Subarachnoid Hemorrhage**
* Dx
* Non-contrast Head CT.
* LP shows bloody CSF
* Xanthochromia = yellowing of CSF = recent bleed.
* MR angiography to locate specific location of bleed
* Tx
* stop all anticoagulants.
* SBP \< 150 if cognition is intact.
* Labetalol
* Nimodipine (CCB to prevent vasospasm)
* Ultimately needs surgical clipping
49
Parenchymal brain hemorrhage. Presentation, diagnosis, treatment
* Most commonly d/t HTN.
* Pt
* FND, NV, HA, AMS
* Dx
* CT head w/o contrast.
* MR angiogram if pt is stable.
* Tx
* supportive care
* control ICP
* SBP \< 200
* Surgical decompression to prevent uncal herniation.
50
Simple partial seizure
Localized to one area of the brain, paresthesias, purposeless movement.
No LOC, EEG shows a localized abnormality
51
Complex partial seizure
Hallucinations, automatisms, LOC, postictal state, EEG w/ focal abnormalities.
Occurs most common in temporal lobe.
52
Absence (petit mal) seizure
Staring spell, no postictal state
## Footnote
**EEG = 3 cycles/sec spike and wave pattern.**
53
Generalized seizure (myotonic, tonic-clonic, tonic, atonic)
Full body muscle contration/relaxation
Postictal state
EEG = generalized abnormalities
54
Status epilepticus
Life threatening state of seizures.
Seizure lasting \> 5min.
Recurrent seizures w/o regaining consciousness in between
55
Medication used to treat absence seizure
1. Ethosuximide
2. Valproic Acid
56
Medication to treat status epilepticus
1. Benzo's
1. IV diazepam, lorazepam
2. Phenobarbital
3. Phenytoin/Fosphenytoin
57
Typical side effects of Phenytoin?
**Phenytion Has Given MDs Frustration**
* Peripheral neuropathy
* Hirsutism
* Gingival hyperplasia
* Megaloblastic anemia (poor folate absorption)
* Drug-induced lupus
* Stevens-Johnson Syndrome
* Fetal hydantoin syndrome
* IUGR, microcephaly, mental retardation, hypoplastic limbs and nails.
* Methemoglobinemia
58
Which antiepileptics are teratogenic?
* Carbamazepine
* Phenytoin
* Valproic Acid
59
Which drugs cause Steven-Johnson Syndrome?
* Ethosuximide
* Lamotrigine
* Carbamazepine
* Phenytoin
* Phenobarbital
* sulfonamides
* penicillins
* allopurinol
60
Which drugs cause agranulocytosis
* Carbamazepine
* Clozapine
* Colchicine
* PTU + methimazole
61
Clinical features and management of Parkinson's Disease
* Pt
* decreased mobility
* Cogwheel rigidity
* resting tremor
* mask-like facies
* orthostatic HoTN
* Festinating gait, instability
* Dementia, depression, apathy
* Management
* Levodopa/Carbidopa
* Selegiline (MAO-Binhibitor)
* COMT (entacapone, tolcapone)
* Dopamine agonist (bromocriptine, pramipexole, ropinirole)
* Anticholingergics- treat tremor (benztropine)
* Amantadine
62
Features of Huntington Disease
* CAG repeat on chr 4.
* aCetylcholine and GABA are reduced
* Choreiform motion
* Cognitive decline
* Caudate nucleus atrophy
* age 40 onset.
63
Diagnostic testing and treatment for amyotrophic lateral sclerosis
* Dx
1. Clinical exam
2. EMG - widespread acute and chronic muscular denervation and reinnervation
* Tx
* Riluzole
* slows progression of ALS and prolongs survival by reducing glutamate-induced excitotoxicity
ALS - mixed UMN and LMN symptoms
* UMN: slow, stiff movement w/ lack of coordination. Hyperreflexia.
* LMN: weakness, gait abnormality, flaccid paralysis, muscle atrophy, Fasciculations.
64
What medication is most often used to treat Huntington Disease?
Tetrabenazine
65
Internuclear ophthalmoplegia
* Damaged medial longitudinal fasciculus.
* Ipsilateral eye is unable to ADDuct
* Contralateral eye has Horizontal nystagmus
* Convergence is normal
Indicates Multiple sclerosis
66
Best evaluation of multiple sclerosis
* CSF
* High protein
* Leukocytosis
* **(+) Oligoclonal bands**
* MRI
* brain, orbtis, and spinal cord = demyelinated white matter w/ various stages.
67
Treatment for multiple sclerosis
1. acute attacks
1. High dose steroids (methylprednisolone 500-1000mg QD x5d)
2. Long term
1. IFN-beta
2. glatiramer
3. natalizumab
4. dimethyl fumarate
5. teriflunomide
68
Diagnosis and treatment of Alzheimer disease
Slowly progressive loss of memory and cognitive decline.
* Testing to r/o reversible causes of dementia
* CBC, CMP, UA, BG, Vit B12, TSH, RPR, HIV, CT/MRI for brain lesion
* Tx
* **Cholinesterase inhibitor**
* donepezil
* galantamine
* rivastigmine
* Memantine
Tx will only work to help slow Dz progression and will not help reverse.
69
Unique features of dementia w/ Lewy bodies
* Dementia
* Parkinson like features
* **Visual Hallucinations**
70
What features are unique to frontotemporal dementia (Pick disease)?
* Dementia with **Behavioral changes that are inappropriate for public/social interaction.**
71
Normal Pressure Hydrocephalus
Define
Pt
Dx
Tx
Inflammation and fibrosis of the arachnoid granulations impair CSF absorption and lead to CSF accumulation in ventricles.
* Pt: Wet, Wacky, Wobbly
* Incontinence
* Unsteady gait
* cognitive impairment.
* Dx
* MRI = ventricular dilation of cerebral ventricles.
* No elevated CSF pressure
* Tx
* ventricular shunt
72
Which medications can induce Delirium?
* Benzos
* Atnicholingergics (especially elderly)
* Antihistamines
* Glucocorticoids
* Alcohol/illicit drugs
73
Causes of Coma
AEIOU TIPS
* Alcohol
* Epilepsy
* Insulin (high or low)
* Overdose/ Opioids
* Uremia
* Trauma
* Infection
* Psychogenic
* Stroke
74
How do you Approach a patient with Coma??
75
A patient comes to the ER after being found unconscious on the street. What should be one of the first considerations for initial treatment?
* Give **Thiamine before giving Glucose**
* Consider Naloxone for opioid overdose.
76
Stages of sleep
* Awake: beta waves
* Relaxed: alpha waves
* N1: theta waves (high frequency, low amplitude)
* N2: sleep spindles and K complexes. (+) bruxism.
* N3: delta waves. (+) night terrors, sleepwalking, bedwetting.
* REM: beta waves. (+) Loss of motor tone, erections.
77
Unique features of drug for sleep: **Melatonin**
+/- efficacy. Non-addictice. Safe and OTC
78
Unique features of drug for sleep: **diphenhydramine**
1st line used by patients.
Poor sleep quality and fatigue next day
79
Unique features of drug for sleep: **trazodone**
antidepressant, anticholinergic, antihistamine effects
80
Unique features of drug for sleep: TCA (amitriptyline, doxepin)
antidepressant, anticholinergic side effects.
81
Unique features of drug for sleep: Benzos
Bind to GABA receptors.
High addictive.
**Increase N2, Decrease N3 and REM**
82
Unique features of drug for sleep: NonBenzodiazepines (zolpidem, zaleplon, eszopiclone)
Act at the GABA-A receptor.
## Footnote
* Rebound insomnia when stopped.*
* (+) sleepwalking induced.*
83
Restless Leg Syndrome
Define
Tx
Unpleasant paresthesias which cause *voluntary, spontaneous, continuous leg movement temporarily relieve symptoms.*
* Tx
1. Pramipexole
2. Ropinirole
3. Gabapentin, pregabalin, carbidopa/levodopa.
* Associated Dz
* iron deficiency
* ESRD
* diabetic neuropathy
* Parkinson disease
* pregnancy
* varicose veins
* caffeine intake
*The associated are all dz that can lead to secondary RLS*
84
Treatment for OSA
1. weight loss
2. no alcohol or hypnotics
3. CPAP
4. oral appliances to hold mouth open and forward
5. Uvulopalatopharyngoplasty
6. Modafinil, armodafinil, amphetamines
85
Most common primary brain tumors of adults
MGM Studios
* Metastasis (most common)
* Glioblastoma
* Meningioma
* Schwannoma
86
Glioblastoma
Most common PRIMARY brain tumor of adults
* 6mo -12mo prognosis
* Located in cerebral hemisphere
* Irregular mass w/ **necrotic center** w/ surrounding edema
* Tx
* resection + chemotherapy + radiation
87
Meningioma
2nd most common primary adult brain tumor
* Slow growing w/ good prognosis
* Asymptomatic
* Located near surfaces of brain, typically in periphery at parasagital location.
* Tx
* resection
F\>\>\>M
88
Schwannoma
* 3rd most common
* Localizes to the CN 8
* Pt
* tinnitus, hearing loss
* Tx
* resection
## Footnote
*bilateral schwannoma = neruofibromatosis II*
89
Infratentorially located pediatric brain tumors
Animal kingdom, Magic kingdom, Epcot
* Astrocytoma
* Medulloblastoma
* Ependymoma
90
Pilocytic astrocytoma
Most common primary brain tumor in children
* Located in posterior fossa
* Slow growth
* Tx: resection
91
Medulloblastoma
* 2nd most common primary brain tumor of pediatrics.
* HA and ataxic gait
* Pt
* HA and ataxic gait.
* compression of 4th ventricle and **noncommunicating hydrocephalus.**
* Tx
* resection
* chemotherapy
* radiation
92
Ependymoma
3rd most common primary brain tumor (rare)
* high rate of 4th ventricle compression leading to non-communicating hydrocephalus
* Tx
* resection
* chemotherapy
* radiation
93
Which cancers commonly metastasize to the brain?
Lots of Bad Stuff Kills Glia
* Lungs
* Breast
* Skin (**melanoma**)
* Kidney (renal cell carcinoma)
* GI
94
Neurofibromatosis Type I
* Pt
* café-au-lait spots (\>6)
* axillary/inguinal freckling
* Lisch nodules (iris)
* Neurofibroma of the peripheral nerves
* **Optic glioma** - vision loss, color changes, pupillary dysfunction.
* Tx
* supportive.
95
Neurofibromatosis type II
* (+) Bilateral schwannoma
* Intracranial meningioma and spinal tumors
* Pt
* Bilateral tinnitus, hearing loss, balance dysfunction.
* Tx
* resection
* monitor small tumors.
* *resection should lead to improved hearing along w/ reduced risk of brainstem compression.*
96
Myasthenia gravis: Dx and Tx
* Dx
* (+) Ach receptor Ab.
* Edrophonium test
* EMG
* Chest Ct to evaluate for **Thymoma**
* Tx
1. acetylcholinesterase inhibitor (neostigmine, pyridostigmine)
2. Thymectomy
3. immunosuppresants
4. plasmapheresis
5. IVIG
97
Lambert-Eaton Syndrome Dx and Tx
* Dx
* Muscle weakness which improves w/ use of muscle.
* Tx
1. Treat underlying **(small cell carcinoma)**
2. Ach inhibitors (neostigmine)
3. immunosuppressants
4. plasmapheresis
60% have small cell lung cancer.
98
Gullain-Barré Syndrome
Pt
Dx
Tx
Polyradiculopathy demyelination.
* Pt
* Symmetric mm weakness that starts in feet and ascends
* autonomic dysfunction. Absent/depressed DTR
* Dx
* CSF = **albuminocytologic dissociation (**high protein, Nml WBC)
* EMG
* Tx
* Hospitalize if resp failure.
* Plasmapheresis or IVIG.
* No steroids
99
Treatment of Bell's Palsy ?
Eye care (due to high risk of drying out and being scratched)
Glucocorticoids
Valacyclovir if severe
Most cases are d/t HSV, HZV, Lyme disease.
100
Hemiballismus
Flinging movement of extremities.
**stroke of subthalamic nucleus.**
Tx: haloperidol
101
Essential tremor
Fixed oscillation of hands/head
Tx: alcohol, Bblock(propranolol), Benzos, primidone, thalamotomy.
102
Dystonia
Sustained contraction of proximal limbs and trunk
Assoc: neuroleptic drugs, wilsondz, huntington, parkinson, cerebral palsy, encephalitis.
Tx: levodopa, carbidopa, botulinum toxin.
103
Tics
Involuntary movement. Blinking, sniffing, grunting, throat clearing.
Tourette syndrome, OCD, ADHD
Tx: fluphenazine, pimozide, tetrabenazine.
104
Astigmatism
Warped/ asymmetrical cornea causing blurred distal vision.
105
Myopia
Axial length of eye is too long. Nearsighted
106
Hyperopia
Eye is too small. Far-sighted
107
Amblyopia
Severe refractory error d/t eye misalignment (Strabismus). Leads to unilateral vision loss.
108
Presentation and treatment of Cataracts
* Pt
* Bilateral.
* Painless progressive vision loss. **Difficult night driving, reading fine print**.
* Tx
* surgical removal of opacified lens and replacement w/ synthetic lens.
109
Wet age related macular degeneration
* Neovascularization that causes hemorrhage, **sudden vision loss.**
* Dx
* fluoroscein angiography
* Tx
* injection of anti-VEGF drugs (ranibizumab)
110
Dry age relatedmacular degeneration
* Accumulation of cell debris on retina.
* Dx
* slit lamp examination
* Tx
* smoking cessation
* anti-oxidants.
111
Treatment for retinal detachment
Laser photocoagulation
Cryotherapy
Surgical reattachment
112
Retinal Vessel Occlusion
* Artery
* ***acute*** painless vision loss. Pale retina and cherry red spot.
* Tx: thrombolytics, acetazolamide, anterior chamber paracentesis
* Vein
* ***gradual*** painless vision loss
* retinal edema, retinal hemorrhage, venous dilation, cotton wool spots.
* Tx: VEGF-inhibitors, laser photocoagulation.
113
Acute angle-closure glaucoma
* Pt
* unilateral eye pain. sudden onset
* blurred vision and colored halos
* fixed pupil.
* Tx
* Referral to ophthalmologist for **laser iridotomy**.
* timolol, aproclonidine, pilocarpine.
* acetazolamide
114
Open angle glaucoma
* Pt
* slow onset, bilateral, **Loss of peripheral vision**
* Tx
1. Prostaglandins (latanoprost) - increases outflow
2. Bblock (timolol) - reduces aqueous humor production
3. A2-agonist (apraclonidine) - reduce aqeous humor production
4. Cholinergic agonist (pilocarpine) - miosis and open trabecular mesh.
5. Topical acetazolamide - reduce humor production
6. laser trabeculoplasty - last resort.
115
Orbital cellulitis
Proptosis, pain with eye movement, Eye weakness, Diplopia.
116
Chalazion
* Inflammation of internal Meibomian sebaceous gland.
* Tx:
* self limited but can treat with surgical excision and/or intralesional steroid injection
117
Horeolum (stye)
* Infection of external sebaceous gland of Zeiss.
* Tx
* warm compresses 3-4xd.
* Antibiotic ointment if present after 4 days.
118
Anterior blepharitis
* Infection of eyelids and lashes secondary to seborrhea.
* Tx
* wash lids daily wish shampoo
* remove scales w/ cotton ball
* antibiotic ointment
119
Viral conjunctivitis
* adenovirus
* Pt
* watery discharge w/ sealed in morning.
* Tx
* supportive care.
\*\**highly contagious. (+) fever, URI, LAD, pharyngitis.*
120
Bacterial conjunctivitis
* Most common in kids.
* Pt
* S.aureus, S. pneumonia, N. gonorrhea, C. trachomatis.
* Purulent, copious drainage 24/day
* Tx
* erythromycin eye drops.
121
Allergic Conjunctivitis
* Anything that can cause allergies.
* Pt
* bilateral, watery discharge.
* Pruritus and other allergy symptoms.
* Tx
* antihistamines.
122
Anterior uveitis
* Common in systemic inflammatory diseases
* HLA-B27 dz
* juvenile idiopathic arthritis
* sarcoidosis
**Painful**, red iris.
Treat underlying inflammatory process.
123
Posterior Uveitis
Commonly d/t infections.
* HSV
* CMV
* Toxoplasma
* Treponema
**Painless**, mild vision changes.
Tx topical antibiotics.
124
Complications of acute otitis media
* Hearing loss
* Bullous Myringitis
* painful bulla on TM
* Acute mastoiditis
125
Pt has horizontal nystagmus that is suppressed with visual fixation. After rapidly turning the head they are unable to maintain a visual fixation.
Dx??
Vestibular neuritis.
* Tx
* corticosteroid taper.
If pt has hearing loss = *labyrinthitis.*
126
Dx criteria of Meniere Disease?
* Vertigo lasting \>20min.
* Fluctuating hearing loss
* Tinnitus.
Tx.
1. limit salt intake, caffeine, nicotine, EtOH
2. HCTZ
3. Gentamicin
127
Cholesteatoma
Overgrowth of desquamated keratin debris in middle ear.
* Pt
* gray, pearly lesion behind or on TM.
* Conductive hearing loss
* Vertigo
* Tx
* surgical removal along w/ reconstruction of ossicular components
