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CCFP(EM) Omar > Ophtalmology, ENT, Dental > Flashcards

Ophtalmology, ENT, Dental Flashcards

1
Q

“<span>Aside from historical features of the patient with epistaxix, what features of a nose bleed would be consistent a posterior source for the bleeding?</span>”

A

-No anterior bleeding site visible<br></br>-Failure to achieve hemostasis despite anterior source control<br></br>-Bleeding from both nares<br></br>-Unstable hemodynamics

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2
Q

“<span>The epistaxis persists. Along with adequate topical anesthesia, name 3 topical pharmacologic agents which could aid with hemostasis.</span>”

A

-Oxymetazoline<br></br>-Phenylephrine<br></br>-Epinephrine<br></br>-Cocaine<br></br>-Silver nitrate<br></br>-Tranexamic Acid

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3
Q

“<span>What is the next most appropriate step in management of refractory epistaxis?</span>”

A

-Posterior nasal packing. (double balloon nasal pack, foley tamponade, etc)

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4
Q

What are the potential complications of nasal packing?

A

-Septal necrosis<br></br>-Sinusitis/OM<br></br>-Septal hematoma/abscess (trauma from pack insertion)<br></br>-Dislodgement of packing/ packing failure/ rebleeding

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5
Q

“<span>26 year old female presents with a 1 day history of worsening dysphagia, odynophagia, and dyspnea that is worse while lying flat.<br></br></span><span>Name 5 diagnoses on your differential.</span><span><br></br></span>”

A

-Epiglottitis<br></br>-Pharyngitis<br></br>-Infectious Mononucleosis<br></br>-Diphtheria<br></br>-Deep space neck abscess<br></br>-Retropharyngeal abscess<br></br>-Laryngeal trauma<br></br>-Foreign body aspiration<br></br>-Laryngospasm

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6
Q

“<span>Name the 2 most likely etiologic organisms in this patient (adult)</span>”

A

-Streptococcus sp.<br></br>-Staphylococcus sp.<br></br><br></br>** note this question specifics “this” patient, ie an adult who is likely immunized against H influenzae type B. Therefore, although this a possible organism it is no longer the most likely offending organism in this age group.

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7
Q

Most common bacteria in orbital cellulitis

A

Staph aureus<br></br>strept pneumoniae

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8
Q

“<span>48 year old male presents with a 4hr history of increasingly severe right eye pain, blurred vision after a routine optometry appointment screening for diabetic retinal changes. Physical exam reveals the following:<br></br></span><img></img><span><br></br></span>”

A

-Cloudy appearance of the cornea<br></br>-Conjunctival injection<br></br>-Fixed mid-dilated pupil<br></br><br></br>* Note the stem should cue you to a common precipitant of acute angle closure glaucoma – administration of dilatory agents in those who are prone to this condition

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9
Q

“<span>Painless acute persistent loss of vision:</span>”

A

“<ul> <li><a>central retinal artery occlusion</a>(CRAO)</li> <li><a>central retinal vein occlusion</a>(CRVO)</li> <li><a>retinal detachment</a>or hemorrhage</li> <li><a>vitreous hemorrhage</a></li> <li><a>optic or retrobulbar neuritis</a></li> <li><a>internal carotid artery occlusion</a></li> </ul>”

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10
Q

Painful acute loss of vision:

A

“<ul><li><a>acute angle closure glaucoma</a></li><li>Temporal arteritis</li><li>Corneal ulcer</li><li><a>endophalmitis</a></li><li><a>uveitis</a>/irits</li><li>keratoconus</li></ul>”

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11
Q

Medication classes for Rx of Glaucoma

A

-Topical B-blocker (Timolol)<br></br>-Topical alpha-agonist (Apraclonidine)<br></br>-Carbonic anhydrase inhibitor IV/PO (Acetalzolomide)<br></br>-Osmotic IV (mannitol)<br></br>-Topical miotic (pilocarpine)

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12
Q

<p>What clinical signs would support temporal arteritis?</p>

A

<ul> <li>1. Retinal appearance</li> <li>2. Temporal artery tender</li> <li>3. Relative afferent pupillary defect (Marcus Gunn defect)</li> </ul>

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13
Q

“<img></img>”

A

“<img></img>”

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14
Q

“<img></img>”

A

<ul> <li>1. Macular Cherry red spot</li> <li>2. Retinal Pallor</li> </ul>

<p>Central retinal artery occlusion</p>

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15
Q

Rx of CRAO

A

<p>1.Consider Orbital massage (.5)</p>

<p>2.Emergent (immediate) Opth consult (1)</p>

<p>3.Lower IOP if increase (.5)</p>

<p>4.Consider intraarterial thrombolysis with IR(.5)</p>

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16
Q

“Describe<br></br><img></img>”

A

“<img></img>”

17
Q

Optic Neuritis

A

“<img></img>”

18
Q

“<img></img>”

A

Perilimbal Flush<br></br>Hypopyon<br></br><br></br>Most likely due to Iritis/uveitis

19
Q

Iritis/uveitis, what to ask further in Hx?

A

Arthritis<br></br>Urethritis<br></br>GI sym (IBD)

20
Q

Iritis/uveitis, what are other signs?

A

Contralateral photophobia<br></br>Cell in ant chamber by slit lamp

21
Q

Iritis/uveitis, Treatment

A

Cycloplegia/mydriatic<br></br>Topical steroids<br></br>Urgent ophth consult within 24 hrs

22
Q

What historic features are important in orbital cellulitis?

A

<b><u>Hx of:</u></b><br></br>URTI (sinusitis)<br></br>Trauma<br></br>Pain<br></br>Fever<br></br>

23
Q

What physical features are important in orbital cellulitis?

A

VA<br></br>EOM (painful)<br></br>Proptosis

24
Q

“<img></img>”

A

Teardrop sign (orbital floor #)<br></br>Air/fluid level in lt max sinus<br></br>Maxillary wall #

25
Q

<p>Orbital wall #, Describe 2 important physical exam that should be performed and why</p>

A

<p>1.Assess EOM specifically upper gaze(1) (entrapment of inferior rectus muscle)</p>

<p>2.Visual acuity (.5)</p>

<p>3.Slit lamp to rule out Hyphema (.5)</p>

26
Q

Ruptured globe immediate Mx

A

“<p>1.Apply Protective Fox eye shield (1)</p> <p>2.IV broad spectrum ABTS(.5)</p> <p>3.Emergent OPTH consult (1)</p> <ol> <li>Imaging of globe (CT or plain films)</li> </ol> <p>5.Assess Tetanus status, if unknown give TD (.5)</p>”

27
Q

Treatment of Hyphema

A

Elevation HOB (45)<br></br>Check IOP<br></br>Dilate the pupil<br></br>Urgent cons

28
Q

<p>Hyphema treatment</p>

A

<ul> <li>1 drop of 1% atropine</li> <li>1 drop of 1% prednisolone</li> <li>Fox shield</li> <li>If globe intact and Pressure>30 Timolol</li> <li>Acetazolamide ( exception sickle cell)</li> <li>If no response Mannitol</li> <li>Sickle Cell keep pressure<24</li> <li>Emergent Opth consult</li> <li>If 1/3< may be tx as outpatient</li> </ul>

29
Q

Most common causes of 3rd n palsy:

A

Post communicating a aneurysm<br></br>Tumor<br></br>DM

30
Q

Classical features of 3rd CN palsy:

A

Ptosis<br></br>Mydriasis<br></br>Failure of adduction and upward gaze (Down and out)

31
Q

“<span>Name 4 potential causes of epistaxis</span>”

A

-Local trauma: nose picking, FB, nasal or sinus infections, foreign bodies<br></br>-Environmental: dry cold conditions, prolonged inhalation of dry air (e.g. nasal cannula)<br></br>-Latrogenic: e.g. NG insertion<br></br>-Medicinal: topical steroids, antihistamines, solvent inhalation (huffing), snorting cocaine<br></br>-Coagulopathies<br></br>-Vascular anomalies: e.g. neoplasms

32
Q

“<span>Name 3 features on physical exam that would lead you to suspect a posterior bleed</span>”

A

-Brisk or pulsatile bleeds<br></br>-Cannot directly visualize source of bleeding<br></br>-++ fresh blood in posterior pharynx<br></br>-Ongoing bleeding despite bilateral anterior packing<br></br>-Hemodynamic instability

33
Q

ER Mx of posterior epistaxis

A

-Stop hemorrhage: bilateral posterior nasal packs, Balloon<br></br>-Administration of PRBC<br></br>-Administration of FFP (for resus and reversal of DOAC)<br></br>-Consider platelet infusion<br></br>-Consider PCC/octaplex<br></br>-Consider securing the airway<br></br>-Consider small IVF bolus (blood is better)<br></br>ENT consultation

34
Q

<p>Provide a differential diagnosis of painless vision loss</p>

A

<p>Central retinal artery occlusion</p>

<p>Central retinal vein occlusion</p>

<p>Vitreous detachment/hemorrhage</p>

<p>Retinal detachment</p>

<p>Pre-chiasmal space occupying lesion</p>

<p>Macular degeneration</p>

<p>Amarosis fugaux</p>

<p>Malingering</p>

<p>Conversion disorder</p>

35
Q

Some conditions that can cause a RAPD are the following

A

<ol> <li>Vitreous hemorrhage</li> <li>Retinal detachment</li> <li>Retinal ischemia</li> <li>Optic neuritis</li></ol>

36
Q

<b>List ten causes of increase intraocular pressure</b>

A

<ol> <li>Acute angle-closure glaucoma</li> <li>Open-angle glaucoma</li> <li>Vitreous hemorrhage</li> <li>Orbital cellulitis/abscess</li> <li>Retrobulbar hemorrhage</li> <li>Hyphema</li> <li>Iritis with hypopyon</li> <li>Chronic steroid eye drop use</li> <li>Enopthalmitis </li> <li>Incorrect measurement technique</li> <li>Ocular malignancy</li> <li>Vomiting</li> <li>Ocular trauma</li></ol>

37
Q

<b>List five causes for an absent red reflex</b>

A

<div>● Opacification of the cornea, most commonly by edema secondary to injury or infection</div>

<div>● Hyphema or hypopyon within the anterior chamber</div>

<div>● Extremely miotic pupil</div>

<div>● Cataract of the lens</div>

<div>● Blood in the vitreous or posterior eye wall</div>

Retinal detachment

38
Q

<b>What are the three most common causes of an irregularly shaped pupil?</b>

A

<ol> <li>Blunt or penetrating trauma</li> <li>Previous surgery</li> <li>Synechiae from prior iritis or other inflammatory conditions</li></ol>

39
Q

<b>4 non‐traumatic eye emergencies that require prompt ophthalmological consultation</b>

A

<ol> <li>Acute angle‐closure glaucoma</li> <li>severe uveitis</li> <li>acute loss of vision (from CRAO, temporal arteritis, retinal detachment or optic neuritis)</li> <li>significant corneal ulceration of >1mm in length</li></ol>

CCFP(EM) Omar (27 decks)

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