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Boards 2 > Neurology > Flashcards

Neurology Flashcards

1
Q

How can a gallstone obstruct the normal propulsive ability of the bowel?

A

Gallstone ileus via biliary enteric fistula

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2
Q

Anterior cerebral artery

A
  • Supply
    • Medial cortex (frontal and parietal lobes)
  • Result of stroke
    • Motor/sensory deficit of LE and trunk
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3
Q

Middle cerebral artery

A
  • Region supplied
    • Lateral cortex
      • parietal and temporal lobes
  • Results of stroke
    • Motor/sensory deficit of Face and UE
    • Aphasia
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4
Q

Posterior cerebral artery

A
  • Region supplied
    • occipital lobe
  • Results of stroke
    • impaired vision
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5
Q

Broca Aphasia

A
  • Expressive aphasia
    • able to understand language but are not able to generate language.
  • D/t disruption of MCA
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6
Q

Wernicke aphasia

A

Receptive aphasia; able to generate words but are not able to understand what is said to them.

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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.
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8
Q

Hemispatial neglect

A

Damage to Nondominant parietal lobe (right)

because the left lobe controls right side of body

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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

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10
Q

Personality changes and the associated brain lesion site

A

Frontal lobe

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11
Q

Klüver-Bucy Syndrome

A
  1. Disinhibition
  2. loss of fear
  3. hyperorality/hyperphagia
  4. hypersexuality.

damage to the Bilateral Amygdale

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12
Q

Hemiballismus

A

Constant varying, large amplitude involuntary movements of proximal limbs.

damage to the Subthalamic Nucleus

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13
Q

Amyotrophic Lateral Sclerosis

A
  • Tracts
    • cotricospinal
    • anterior horn cells
  • Findings
    • spastic paralysis (UMN lesion)
    • flaccid paralysis (LMN lesion)
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14
Q

Poliomyelitis

A
  • Lesion
    • anterior horn cells
  • Findings
    • flaccid paralysis (LMN lesion)
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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
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16
Q

Tabes Dorsalis

A

Complication of tertiary syphilis.

  • Lesion
    • dorsal column
  • Findings
    • Imparied proprioception
    • gait/balance issues
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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.
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18
Q

Organisms causing bacterial meningitis < 1 month and treatment

A
  • Organism
    • Listeria monocytogenes
    • GBS
    • E.coli
  • Tx
    • Ampicillin + gentamycin
    • +/- cefotaxime
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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
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20
Q

Organisms causing bacterial meningitis 3m - 50yo and treatment?

A
  • Organisms
    • S. Pneumonia
    • N. meningitis (college)
  • Tx
    • 3rd gen cephalosporin + vancomycin
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21
Q

Organisms causing bacterial meningitis > 50yo and treatment

A
  • Organisms
    • S. pneumoniae
    • N. meningitidis
    • L.monocytogenes
  • Tx
    • 3rd gen cephalosporin + vancomycin + ampicillin
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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
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23
Q

What medication should be given to close contacts of N. meningitidis meningitis?

A
  1. Ciprofloxacin
  2. Rifampin
  3. Ceftriaxone
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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.
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25
Q

Brain Abscess

Pt

Dx
Tx

A

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
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26
Q

What substances cause hemolysis with G6PD deficiency?

A

Spleen Purges Nasty Inclusions From Damaged Cells

  • Sulfonamides
  • Primaquine
  • Nitrofurantoin
  • Isoniazide
  • Fava beans
  • Dapsone
  • Chloroquine
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27
Q

Treatment for a tension HA

A
  1. NSAIDs
  2. Dihydroergotamine or sumatriptan.

avoid vasoconstrictors (triptans) if pregnant, prinzmetal angina, or CAD.

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28
Q

What is the treatment for Migraine HA

A
  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.

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29
Q

What agents are used as prophylaxis for migraine HA

A
  1. TCA (amitriptyline, notriptyline)
  2. Bblocker (propranolol, metoprolol)
  3. Anticonvulsants (valproic acid, topiramate, gabapentin)
  4. Verapamil
  5. Naproxen
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30
Q

What are red flag features of a HA

A
  • 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.
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31
Q

Features of idiopathic intracranial hypertension?

A
  • Young, obese female
  • papilledema, ICP
  • Vision changes.
  • Retroocular pain worse w/ eye movement

  • CT = normal appearance*
  • CSF pressure > 200mmH2O.*
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32
Q

Treatment of idiopathic intracranial hypertension

A
  • weight loss
  • 1st line
    • Acetazolamide
  • 2nd line
    • serial lumbar punctures
    • optic nerve sheath decompression
    • lumboperitoneal shunting.
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33
Q

Trigeminal Neuralgia

A

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
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34
Q

What is the recommended treatment for a TIA

A
  • 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)
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35
Q

What are surgical indications for carotid endarterectomy?

A
  • 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
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36
Q

Anterior cerebral artery stroke

A

Contralateral LE and trunk weakness.

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37
Q

Middle cerebral artery stroke

A

Face and upper extremity weakness, aphasia, neglect, and inability to perform learned actions.

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38
Q

Posterior cerebral artery stroke

A

Vision changes.

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39
Q

Basilar artery stroke will present with…

A
  • 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.
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40
Q

Treatment for hemorrhagic stroke

A
  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.
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41
Q

What are the 5 most common lacunar strokes?

A
  • Pure motor hemiparesis
  • Pure sensory stroke
  • Ataxic Hemiparesis
  • Sensorimotor stroke
  • Dysarthria clumsy hand syndrome
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42
Q

Describe the features of the lacunar stroke type: Pure motor hemiparesis

A
  • 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
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43
Q

Describe the features of the lacunar stroke type: Pure sensory stroke

A
  • Sensory defect of face, arm, and leg on 1 side of body.
  • No motor or cortical signs
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44
Q

Describe the features of the lacunar stroke type: Ataxic Hemiparesis

A
  • Ipsilateral weakness and limb ataxia out of proportion to motor defect.
  • Gait deviation to affected side
  • NO cortex signs
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45
Q

Describe the features of the lacunar stroke type: Sensorimotor stroke

A
  • Weakness and Numbness on one side of body
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46
Q

Describe the features of the lacunar stroke type: Dysarthria Clumsy Hand Syndrome

A
  • Facial weakness, dysarthria, dysphagia, slight weakness and clumsiness of one hand.
  • Least common
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47
Q

What is a unique feature of all the lacunar strokes?

A

None of the lacunar stroke subtypes consist of having cortical signs/symptoms

behavior changes, speech problems, vision problems = cortical problem.

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48
Q

Diagnosis and Management of a Subarachnoid Hemorrhage

A
  • 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
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49
Q

Parenchymal brain hemorrhage. Presentation, diagnosis, treatment

A
  • 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.
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50
Q

Simple partial seizure

A

Localized to one area of the brain, paresthesias, purposeless movement.

No LOC, EEG shows a localized abnormality

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51
Q

Complex partial seizure

A

Hallucinations, automatisms, LOC, postictal state, EEG w/ focal abnormalities.

Occurs most common in temporal lobe.

52
Q

Absence (petit mal) seizure

A

Staring spell, no postictal state

EEG = 3 cycles/sec spike and wave pattern.

53
Q

Generalized seizure (myotonic, tonic-clonic, tonic, atonic)

A

Full body muscle contration/relaxation

Postictal state

EEG = generalized abnormalities

54
Q

Status epilepticus

A

Life threatening state of seizures.

Seizure lasting > 5min.

Recurrent seizures w/o regaining consciousness in between

55
Q

Medication used to treat absence seizure

A
  1. Ethosuximide
  2. Valproic Acid
56
Q

Medication to treat status epilepticus

A
  1. Benzo’s
    1. IV diazepam, lorazepam
  2. Phenobarbital
  3. Phenytoin/Fosphenytoin
57
Q

Typical side effects of Phenytoin?

A

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
Q

Which antiepileptics are teratogenic?

A
  • Carbamazepine
  • Phenytoin
  • Valproic Acid
59
Q

Which drugs cause Steven-Johnson Syndrome?

A
  • Ethosuximide
  • Lamotrigine
  • Carbamazepine
  • Phenytoin
  • Phenobarbital
  • sulfonamides
  • penicillins
  • allopurinol
60
Q

Which drugs cause agranulocytosis

A
  • Carbamazepine
  • Clozapine
  • Colchicine
  • PTU + methimazole
61
Q

Clinical features and management of Parkinson’s Disease

A
  • 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
Q

Features of Huntington Disease

A
  • CAG repeat on chr 4.
  • aCetylcholine and GABA are reduced
  • Choreiform motion
  • Cognitive decline
  • Caudate nucleus atrophy
  • age 40 onset.
63
Q

Diagnostic testing and treatment for amyotrophic lateral sclerosis

A
  • 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
Q

What medication is most often used to treat Huntington Disease?

A

Tetrabenazine

65
Q

Internuclear ophthalmoplegia

A
  • Damaged medial longitudinal fasciculus.
  • Ipsilateral eye is unable to ADDuct
  • Contralateral eye has Horizontal nystagmus
  • Convergence is normal

Indicates Multiple sclerosis

66
Q

Best evaluation of multiple sclerosis

A
  • CSF
    • High protein
    • Leukocytosis
    • (+) Oligoclonal bands
  • MRI
    • brain, orbtis, and spinal cord = demyelinated white matter w/ various stages.
67
Q

Treatment for multiple sclerosis

A
  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
Q

Diagnosis and treatment of Alzheimer disease

A

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
Q

Unique features of dementia w/ Lewy bodies

A
  • Dementia
  • Parkinson like features
  • Visual Hallucinations
70
Q

What features are unique to frontotemporal dementia (Pick disease)?

A
  • Dementia with Behavioral changes that are inappropriate for public/social interaction.
71
Q

Normal Pressure Hydrocephalus

Define

Pt

Dx

Tx

A

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
Q

Which medications can induce Delirium?

A
  • Benzos
  • Atnicholingergics (especially elderly)
  • Antihistamines
  • Glucocorticoids
  • Alcohol/illicit drugs
73
Q

Causes of Coma

A

AEIOU TIPS

  • Alcohol
  • Epilepsy
  • Insulin (high or low)
  • Overdose/ Opioids
  • Uremia
  • Trauma
  • Infection
  • Psychogenic
  • Stroke
74
Q

How do you Approach a patient with Coma??

A
75
Q

A patient comes to the ER after being found unconscious on the street. What should be one of the first considerations for initial treatment?

A
  • Give Thiamine before giving Glucose
  • Consider Naloxone for opioid overdose.
76
Q

Stages of sleep

A
  • 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
Q

Unique features of drug for sleep: Melatonin

A

+/- efficacy. Non-addictice. Safe and OTC

78
Q

Unique features of drug for sleep: diphenhydramine

A

1st line used by patients.

Poor sleep quality and fatigue next day

79
Q

Unique features of drug for sleep: trazodone

A

antidepressant, anticholinergic, antihistamine effects

80
Q

Unique features of drug for sleep: TCA (amitriptyline, doxepin)

A

antidepressant, anticholinergic side effects.

81
Q

Unique features of drug for sleep: Benzos

A

Bind to GABA receptors.

High addictive.

Increase N2, Decrease N3 and REM

82
Q

Unique features of drug for sleep: NonBenzodiazepines (zolpidem, zaleplon, eszopiclone)

A

Act at the GABA-A receptor.

  • Rebound insomnia when stopped.*
  • (+) sleepwalking induced.*
83
Q

Restless Leg Syndrome

Define

Tx

A

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
Q

Treatment for OSA

A
  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
Q

Most common primary brain tumors of adults

A

MGM Studios

  • Metastasis (most common)
  • Glioblastoma
  • Meningioma
  • Schwannoma
86
Q

Glioblastoma

A

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
Q

Meningioma

A

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
Q

Schwannoma

A
  • 3rd most common
  • Localizes to the CN 8
  • Pt
    • tinnitus, hearing loss
  • Tx
    • resection

bilateral schwannoma = neruofibromatosis II

89
Q

Infratentorially located pediatric brain tumors

A

Animal kingdom, Magic kingdom, Epcot

  • Astrocytoma
  • Medulloblastoma
  • Ependymoma
90
Q

Pilocytic astrocytoma

A

Most common primary brain tumor in children

  • Located in posterior fossa
  • Slow growth
  • Tx: resection
91
Q

Medulloblastoma

A
  • 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
Q

Ependymoma

A

3rd most common primary brain tumor (rare)

  • high rate of 4th ventricle compression leading to non-communicating hydrocephalus
  • Tx
    • resection
    • chemotherapy
    • radiation
93
Q

Which cancers commonly metastasize to the brain?

A

Lots of Bad Stuff Kills Glia

  • Lungs
  • Breast
  • Skin (melanoma)
  • Kidney (renal cell carcinoma)
  • GI
94
Q

Neurofibromatosis Type I

A
  • 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
Q

Neurofibromatosis type II

A
  • (+) 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
Q

Myasthenia gravis: Dx and Tx

A
  • 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
Q

Lambert-Eaton Syndrome Dx and Tx

A
  • 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
Q

Gullain-Barré Syndrome

Pt

Dx

Tx

A

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
Q

Treatment of Bell’s Palsy ?

A

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
Q

Hemiballismus

A

Flinging movement of extremities.

stroke of subthalamic nucleus.

Tx: haloperidol

101
Q

Essential tremor

A

Fixed oscillation of hands/head

Tx: alcohol, Bblock(propranolol), Benzos, primidone, thalamotomy.

102
Q

Dystonia

A

Sustained contraction of proximal limbs and trunk

Assoc: neuroleptic drugs, wilsondz, huntington, parkinson, cerebral palsy, encephalitis.

Tx: levodopa, carbidopa, botulinum toxin.

103
Q

Tics

A

Involuntary movement. Blinking, sniffing, grunting, throat clearing.

Tourette syndrome, OCD, ADHD

Tx: fluphenazine, pimozide, tetrabenazine.

104
Q

Astigmatism

A

Warped/ asymmetrical cornea causing blurred distal vision.

105
Q

Myopia

A

Axial length of eye is too long. Nearsighted

106
Q

Hyperopia

A

Eye is too small. Far-sighted

107
Q

Amblyopia

A

Severe refractory error d/t eye misalignment (Strabismus). Leads to unilateral vision loss.

108
Q

Presentation and treatment of Cataracts

A
  • Pt
    • Bilateral.
    • Painless progressive vision loss. Difficult night driving, reading fine print.
  • Tx
    • surgical removal of opacified lens and replacement w/ synthetic lens.
109
Q

Wet age related macular degeneration

A
  • Neovascularization that causes hemorrhage, sudden vision loss.
  • Dx
    • fluoroscein angiography
  • Tx
    • injection of anti-VEGF drugs (ranibizumab)
110
Q

Dry age relatedmacular degeneration

A
  • Accumulation of cell debris on retina.
  • Dx
    • slit lamp examination
  • Tx
    • smoking cessation
    • anti-oxidants.
111
Q

Treatment for retinal detachment

A

Laser photocoagulation

Cryotherapy

Surgical reattachment

112
Q

Retinal Vessel Occlusion

A
  • 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
Q

Acute angle-closure glaucoma

A
  • 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
Q

Open angle glaucoma

A
  • 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
Q

Orbital cellulitis

A

Proptosis, pain with eye movement, Eye weakness, Diplopia.

116
Q

Chalazion

A
  • Inflammation of internal Meibomian sebaceous gland.
  • Tx:
    • self limited but can treat with surgical excision and/or intralesional steroid injection
117
Q

Horeolum (stye)

A
  • Infection of external sebaceous gland of Zeiss.
  • Tx
    • warm compresses 3-4xd.
    • Antibiotic ointment if present after 4 days.
118
Q

Anterior blepharitis

A
  • Infection of eyelids and lashes secondary to seborrhea.
  • Tx
    • wash lids daily wish shampoo
    • remove scales w/ cotton ball
    • antibiotic ointment
119
Q

Viral conjunctivitis

A
  • adenovirus
  • Pt
    • watery discharge w/ sealed in morning.
  • Tx
    • supportive care.

**highly contagious. (+) fever, URI, LAD, pharyngitis.

120
Q

Bacterial conjunctivitis

A
  • Most common in kids.
  • Pt
    • S.aureus, S. pneumonia, N. gonorrhea, C. trachomatis.
    • Purulent, copious drainage 24/day
  • Tx
    • erythromycin eye drops.
121
Q

Allergic Conjunctivitis

A
  • Anything that can cause allergies.
  • Pt
    • bilateral, watery discharge.
    • Pruritus and other allergy symptoms.
  • Tx
    • antihistamines.
122
Q

Anterior uveitis

A
  • Common in systemic inflammatory diseases
    • HLA-B27 dz
    • juvenile idiopathic arthritis
    • sarcoidosis

Painful, red iris.

Treat underlying inflammatory process.

123
Q

Posterior Uveitis

A

Commonly d/t infections.

  • HSV
  • CMV
  • Toxoplasma
  • Treponema

Painless, mild vision changes.

Tx topical antibiotics.

124
Q

Complications of acute otitis media

A
  • Hearing loss
  • Bullous Myringitis
    • painful bulla on TM
  • Acute mastoiditis
125
Q

Pt has horizontal nystagmus that is suppressed with visual fixation. After rapidly turning the head they are unable to maintain a visual fixation.

Dx??

A

Vestibular neuritis.

  • Tx
    • corticosteroid taper.

If pt has hearing loss = labyrinthitis.

126
Q

Dx criteria of Meniere Disease?

A
  • Vertigo lasting >20min.
  • Fluctuating hearing loss
  • Tinnitus.

Tx.

  1. limit salt intake, caffeine, nicotine, EtOH
  2. HCTZ
  3. Gentamicin
127
Q

Cholesteatoma

A

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

Boards 2 (10 decks)

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