Ophtho, Dentistry, Otolaryngology Flashcards
(132 cards)
1
Q
what is a strabismus?
A
misalignment of the visual pathway
2
Q
strabismus defects always present are called?
A
tropias
3
Q
strabismus defects found on provocative testing?
A
phorias
4
Q
the majority of strabismus cases occur bet. the ages of?
A
18 months & 6 yo
5
Q
what will the developing brain do if it is receiving poor-quality visual information from one side (strabismus, cataract, etc)?
A
it will suppress the information from the abnormal side
6
Q
visual sensory deprivation leads to what?
A
chronic visual loss on the affected side
7
Q
what do you call a chronic visual loss related to dz of visual pathways?
A
amblyopia
8
Q
amblyopia leads to what?
A
reduction in central visual acuity
accounts for 20-70% of visual loss in adults
9
Q
40% of children w/ strabismus will develop what?
A
amblyopia
10
Q
vision screening is subjectively screened up to what age?
A
3 months of age
11
Q
vision screening in infancy
A
red reflex fixation & tracking (approp. for age) test of pupillary refelx corneal light reflex blink to threat
12
Q
what do you assess for when checking red reflex?
A
cataracts & intraglobular tumors
13
Q
vision screening between 6 months to 3 years of age
A
fixation & tracking
test of pupillar reflex (if child allows)
corneal light replex
strabismus screening
14
Q
what is the test fro strabismus screening?
A
cover-uncover test
15
Q
esotropia
A
one eye correctly looks straight, one looks inward
16
Q
exotropia
A
one eye looks straight, the other looks outward
17
Q
hypertropia
A
one eye looks straight, other looks up
18
Q
objective vision screening test begins at what age?
A
3 yo
19
Q
objective visual acuity testing consists of what?
A
Allen object recognition
E test
Snellen chart (letters)- when developmentally able
*failed tests require ophthalmologist referral
20
Q
typical visual acuity at 6 months old
A
20/60
21
Q
typical visual acuity at 3 years old
A
20/20 to 20/30
22
Q
typical visual acuity at 3.5 years old
A
20/20 to 20/25
23
Q
examples of ocular trauma
A
ecchymosis burn corneal abrasion hyphema globe rupture
24
Q
examples of eyelid d/o’s
A
Blephritis
pediculosis
hoerdeolum (stye)- gland of Zeiss
chalazion- meibomian gland
25
Horner's syndrome
miosis
ptosis
anhidrosis
26
corneal abrasion
abrasion causing corneal epithelium defect
painful
hx of FB (absent in newborns, whose hands are the culprit)
27
how do you check for a corneal abrasion?
fluorescein test
28
how do you tx a corneal abrasion?
Abx ointment
patching
cycoplegics
29
how do you prevent newborn corneal abrasions?
file down fingernails
30
what is the name given to bleeding in the anterior chamber of the eye?
hyphema
31
what is the typical cause of hyphemas?
direct trauma
| also seen in coagulopathy
32
rise in intraocular pressure d/t hyphema raises the risk of what?
vision loss & optic n. atrophy
33
how to manage hyphema?
sickle cell status VERY important
immed. referral to ophthalmologist
serial anterior chamber pressure measurements
therapies include steroids, ocular O2, operative evacuation
34
most concerning syndrome when you see a retinal hemorrhage?
shaken baby syndrome
35
retinal hemorrhages may also be seen in?
coagulopathies
cardiopulmonary resuscitation
sudden changes in intracranial pressure
changes in intracranial pressure during delivery
36
hordeolum
acute, localized infxn of the eyelash follicles (glands of Zeiss, external) or meibomian glands (internal)
37
MCC of hordeolum
S. aureus
38
Hordeolum tx
warm compesses
referral to ophthalmologist if not improving in 2-3 days for drainage
Abx if inflammation appears to be spreading or w/ pre-auricular adenopathy or signs of bacteremia
39
chalazion
painless chronic inflammation (granuloma) of the lid involving tarsal sebaceous gland (meibomian gland)
40
a chalazion typically starts as a what?
hordeolum
41
how do you tx a chalazion?
warm compresses for up to 6 wks
| referral to ophtho after 6 wks for removal
42
nasolacrimal duct obstruction
frequent-6% of infants
may open spontaneously
refer to ophtho if persistent to 1 yer of age, or w/ constant eye tearing & drainage
43
dacryocystocele
blue nodule inferior & medial to inner canthus
44
dacrocystitis
infected dacryocystocele
45
ophthalmia neonatorum
purulent conjunctivitis starting 1st 10 days of life
silver nitrate causes neonatal conjunctivitis (ack)
E. coli & other enteric gram-negative rods, HSV, others discussed separately
46
opthalmia neonatorum d/t Chlamydiae
high suspicion based on prenatal hx
risk is 25-50% if mother infected (risk of pneumonitis is 5-10%)
2 wks oral erythromycin
47
ophthalmia neonatorum d/t N. gonorrhoeae
copious eye d/c
ophthalmologic emergency
irrigate, systemic Abx (single dose ceftriaxone)
48
what Abx do you use to tx ophtalmia neonatroum d/t N. gonorrhoeae
single does ceftriaxone
49
bacterial conjunctivitis
purulent eye d/c
| may be unilateral or bilateral
50
bacterial conjunctivitis causative pathogens
Streptococcus pneumoniae
nontypable Haemophilus influenzae
Psuedomonas aeurginosa
51
Pseudomonas aeurginosa is associated w/ what?
extended wear contact lenses
52
tx of bacterial conjunctivitis
topical: ciprofloxacin, trimethoprim-polymyxin B, sulfacetamide (stings), erythromycin
systemic tx depends on severity
53
viral conjunctivitis ("pink eye")
watery to purulent eye d/c
sometimes difficult to distinguish from bacterial
*very contagious!!!
hand washing, often limits CH from school attendance
54
very common causes of viral conjunctivitis
enteroviruses
| adenoviruses
55
tx of viral conjunctivitis
resolves usually w/ minimal intervention; refrain/limit use of Abx if viral conjunctivitis suspected (no pus, no fever, localized)
56
varicella & herpes simplex I & II may cause what?
viral conjunctivitis
keratitis
*refer for any cases of infxn around globe & concern for corneal involvement; also to r/o keratitis
57
sx's of corneal ulcer
```
decreased vision
pain
scleral injection
white corneal infiltrate
*refer to ophtho d/t greater chance of scarring
```
58
what might you see in allergic conjunctivitis
boggy turbinates
Dennie-Morgan lines
transverse nasal crease
allergic shiners
59
allergic shiners
dark discoloration under eyes
| swollen eyelids
60
associated sx's w/ allergic conjunctivitis
allergic rhinitis
allergic sx's
usually very itchy eyes
61
tx for allergic conjunctivitis
mast cell stabilizer
| H1 receptor antagonist
62
what are some systemic causes of conjunctivitis
```
Kawasaki's dz
SJS
Reiter syndrome
various auto-immune d/o's:
SLE
juvenile RA (causes anterior uveitis-iridocyclitis)
Behcet dz
Sjorgen's syndrome
IBD
```
63
primary teeth begin to erupt when?
~6 months
64
early age for primary teeth to erupt
3-4 months
65
late age for primary teeth eruption
12-16 months
66
when should kid visit dentist for 1st time?
6 months after 1st teeth erupt
67
what do you call teeth present at birth?
supernumerary teeth
| "real" primary teeth
68
why do you usually remove supernumerary teeth/ "real" primary teeth?
facilitate nursing
prevent ulceration, occlusion issues
eliminate risk of aspiration
69
what can you use for teething pain?
teething rings & biscuits
cold rag massage
systemic analgesia
topical "teething gel" discouraged
70
systemic analgesia for teething pain
acetaminophen
| ibuprofen (over 6 months of age)
71
why is topical teething gel discouraged?
may cause excessive numbness & impair gag reflex and airway protection
overdose may lead to methemoglobinemia
72
what are some of the causes of dental caries?
bacteria
simple carbs (substrate for bacteria)
acidic environment
73
name some of the bacteria responsible for dental caries?
viridans streptococci
streptococcus mutans
others
74
strategies to prevent dental caries
fluoride- in H2O, direct application
minimizing oral flora
eliminate carbs (simple & complex-amylase)
75
how do you minimize oral flora?
gently rub teeth
brushing-2 min, at least 1x/day
flossing- start before preschool period to acclimate CH to habit
76
acceptable level of fluoride in drinking water for age 6 month to 3 yo
0.25 mg/d if < 0.3 ppm
77
acceptable level of fluoride in drinking water for age 3-6 yo
0. 5 mg/d if < 0.3 ppm
| 0. 25 mg/d if 0.3-0.6 ppm
78
acceptable level of fluoride in drinking water for age 6-16 yo
1 mg/d if <0.3 ppm
| 0.5 mg/d if 0.3-0.6 ppm
79
dental trauma- avulsion
primary dentition not replanted
| permanent dentition may be replaced (save tooth in cold milk or NS; replace in alveolar bone in 1 hr)
80
evaluating fractured teeth
enamel- tooth cleaned & shaped
enamel & dentin- tooth protected
exposed pulp- pulpotomy or pulpectomy
81
dental Abx prophylaxis
certain pt groups require prophylactic Abx coverage during invasive dental procedures
-CH w/ heart dz, immunocompromised
82
what is the MCC of viral URI?
rhinoviruses (10-40%)
| coronaviruses (~20%)
83
CH < 6 yo typically have how many colds/yr?
6-8
| w/ avg sx duration of 14 days
84
URI infnxs are most contagious when?
1st 2-4 days
85
T or F: a child may have cold sx's up to 1/2 of all days between Sept & April & sitll have a nml frequency & duration of colds
TRUE
86
what are the most effective means of preventing URI's?
hand washing
| alcohol gels
87
fluids in URI
not extra fluids, but encourage fluids to prevent dehydration
88
no ibuprofen under what age?
6 months
89
no aspirin under what age?
18 yo
90
what can you do for nasal passages in URI?
nasal bulb suction or wash
91
Complications of URI that need to be watched
otitis media (viral or bacterial)
bacterial conjunctivitis, sinusitis, pneumonia
asthma exacerbation
dehydration
92
have zinc, vitamin C or echinacea been proven effective in the tx of URI?
no
93
FDA recommends against the use of what in CH < 6yo w/ URI?
decongestants
expectorants
cough suppressants
*no definitive proof of efficacy
94
what may be of slight benefit to CH > 12 months old w/ URI?
antihistamines
95
AAP policy statement against the use of what in URI?
dextromethorphan
| codeine
96
causes of bacterial pharyngitis
Group A strep (~10%)
other beta-hemolytic strep (groups C,D,G)
gonococcus
97
general causes of pharyngitis
```
viral
bacterial
allergic
chemical
traumatic (bulimia)
weird: PFAPA
```
98
classic sx's of S. pyogenes (GAS) pharyngitis
```
fever
beefy red pharyngitis
+/- palatal petechiae
+/- tonsillar exudate
+/- strawberry tongue
tender cervical adenopathy
H/A
abdominal pain +/- vomiting
lasts 3-5 days w/o tx
```
99
complications of S. pyogenes (GAS) pharyngitis
bacterial cervical lymphadenitis
peritonsillar or retropharyngeal abscess
scarlet fever
100
s/sx of scarlet fever
sandpaper rash 1-2 days after start of pharyngitis
| Pastia's lines- intense erythema of axillae & groin
101
immune complications of S. pyogenes (GAS) pharyngitis several wks later
acute rheumatic fever
| glomerulonephritis
102
various scoring systems use criteria to predict chance that GAS is causative of pharyngitis
```
age 5-15
season late fall, winter, early spring
evidence of acute pharyngitis
tender, enlarged, cervical lymph nodes
middle grade fever
absence of usual S&S assoc. w/ viral URTI (no cough, rhinorrhea, nasal congestion)
```
103
reasons to ID & tx S. pyogenes (GAS) pharyngitis
```
prevents suppurative complications
prevents streptococcal toxic shock
prevents acute rheumatic fever (post-streptococcal glomerulonephritis is not prevented by Abx)
prevents transmission
prevents overuse of Abx
```
104
what tests can you use to test for S. pyogenes (GAS) pharyngitis
rapid antigen detection test (75-85% sensitive)
| beta-hemolytic strep throat cx- higher sensitivity, results may take 1-2 days
105
tx for S. pyogenes (GAS) pharyngitis is?
PCN or IM benzathine PCN
| other beta-lactams, azithromycin & clindamycin also used
106
when should a formal hearing eval be done in kids w/ hx of AOM
OM w/ effusion for more than 3 months
| 4+ episodes of AOM in 6 months
107
ethmoid & maxillary sinuses are present & pneumatized when?
at birth
108
frontal & sphenoid sinuses form & pneumatize when?
in preschool or early school age
109
what do you call inflammation of the paranasal sinuses that can have a viral, allergic, or bacterial origin?
sinusitis
110
what are the s/sx of sinusitis
severe cold sx's: fever +/- mucopurulent nasal d/c
| persistent (> 2wks) respiratory sx's: +/- nasal d/c, H/A, facial pressure, tooth pain on heelstrike, cough, halitosis
111
how do you typically dx sinusitis?
typically clinically
| though sinus films or CT may have some role in equivocal cases
112
tx of sinusitis
nearly 50% will resolve on own
tx reserved for persistant sx's/ worsening severity
tx Rx for 2-3 wks
recurrent/chronic may require surgical intervention, consideration of fungal causes
113
preseptal (periorbital) & postseptal (orbital) cellulitis MC presention is?
eye swelling
114
DDx for periorbital & orbital cellulitis
```
infxn- preseptal & postseptal cellulitis
trauma- "black eye"
edema- angioedema, CHF, hypoalbuminemia
allergy- allergic conjunctivitis
tumor- neuroblastoma, retinoblastoma, rhabdomysarcoma
```
115
preseptal (periorbital) cellulitis caused by?
```
extension of localized infxn:
conjunctivitis
hordeolum
dacryoadenitis
dacrocystitis
*often a complication of acute sinusitis/ trauma
```
116
postseptal (orbital) cellulitis is a complication of?
acute sinusitis or trauma
| hematogenous spread
117
orbital infxn can cause permanent?
visual impairment
118
postseptal cellulitis suspected w/ signs of orbital infiltration...
proptosis
impairment of extra-ocular eye mvnts
pain w/ eye mvnt (ophthalmoplegia)
loss of visual acuity
119
organisms to consider for tx in preseptal & postseptal cellulitis
```
S. aureus
S. pyogenes
S. pneumonia
H. influenzae
M. catarrhalis
with abscess-anaerobes
postpartum- gonococcus & C. trachomatis
```
120
otits externa is aka?
swimmer's ear
121
otitis externa is associated w/?
swimming
diving
tympanostomy tubes
122
s/sx of otitis externa
typically fever
tenderness w/ mvnt of pinna, esp. tragus
swollen, tender external auditory canal, often w/ purulent d/c: easily confused w/ otitis media w/ TM perforation. Malignant OE may have granulomatous tissue in EAC; occasionally w/ facial n. palsy
123
malignant OE caused by?
P. aeurignosa
124
typical tx for OE?
topical quinolone, 2% acetic acid irrigation
125
malignant OE tx w/?
systemic IV Abx
126
mngt of OE
avoidance of cause: earlplugs, special diving equipment
| drying the EAC after swimming/diving may be used as prophylaxis- isopropanol, 2% acetic acid, or Burow soln
127
mastoiditis
inflammation of the air cells & tissue surrounding the mastoid process of the temporal bone
128
classic findings of mastoiditis
fever, post-auricular pain
presence or recent hx of AOM
anterior, downward, lateral displacement of pinna
129
mastoiditis etiologies
S. pneumoniae
S. pyogenes (Group A beta-hemolytic strep)
S. aureus
Haemophilus influenzae
130
tx of mastoiditis
hospitalization
IV Abx- ceftriaxone, clindamycin
may require mastoidectomy
131
complications of mastoiditis
meningitis
facial n. palsy
cavernous sinus thrombosis
thrombophlebitis
132
clinical sx's of URI
fever for up to 3 days
cough, nasal & pharyngeal sx's for 7-21 days
color of nasal mucus is not important
