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My step 1 mnemonics > Otology & Ophthalmology, and specific drugs > Flashcards

Otology & Ophthalmology, and specific drugs Flashcards

1
Q

Each frequency leads to vibration at specific location on basilar membrane (tonotopy):
• Low frequency heard at _____

A

apex near helicotrema (wide and flexible).

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2
Q

Each frequency leads to vibration at specific location on basilar membrane (tonotopy):

•High frequency heard best at______

A

the base of cochlea (thin and rigid).

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3
Q

Noise-induced hearing loss and Presbycusis lose hearing in _____frequency

A

Loss of high-frequency

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4
Q

Cholesteatoma

A

Overgrowth of desquamated keratin debris within the middle ear space;

may erode ossicles, mastoid air cells - conductive hearing loss.

Often presents with painless otorrhea

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5
Q

Peripheral vertigo Tx:

A

Treatment:

C - anticholinergics
H - antihistamines
A - antiemetics
S - low-salt diet
E - Epley maneuver (BPPV).
D - diuretics
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6
Q

Meniere disease triad:

A

sensorineural hearing loss

vertigo

tinnitus

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7
Q

Hyperopia corrects with:

A

Correct with convex (converging) lenses.

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8
Q

Myopia corrects with:

A

Correct with concave (d iverging) lens.

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9
Q

Cataract risk factors:

A

A - age
I - infection
D - diabetes mellitus

C - corticosteroid
A - alcohol
S - smoking
T - trauma
S - sunlight

3 - trisomies (13, 18, 21)
M - myotonic dystrophy
Torche - ToRCHeS infections

Milk - galactokinase deficiency /classic galactosemia

M - Marfan syndrome
A - Alport syndrome
N - neurofibromatosis 2

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10
Q

Open-angle glaucoma (Primary vs. secondary) causes:

A

Primary- cause unclear.

Secondary: blocked trabecular meshwork from

WBCs (eg, uveitis)

RBCs (eg, vitreous hemorrhage)

retinal elements (eg, retinal detachment).

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11
Q

Closed or narrow-angle glaucoma causes:

A

Primary- enlargement or anterior movement of the lens against central iris (pupil margin) - > obstruction of normal aqueous flow through the pupil.

Secondary- hypoxia from retinal disease (eg, diabetes mellitus, vein occlusion) induces vast proliferation in the iris that contracts angle.

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12
Q

Closed or narrow-angle glaucoma: Chronic vs. acute.

A

Chronic closure- often asymptomatic with damage to the optic nerve and peripheral vision.

Acute closure- true ophthalmic emergency. Very painful, red-eye, sudden vision loss, halos around lights, frontal headache, fixed and mid-dilated pupil, nausea, and vomiting.

Mydriatic agents contraindicated.

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13
Q

Uveitis - Posterior vs. anterior

A

Anterior uveitis: iritis;

posterior uveitis: choroiclitis and /or retinitis.

May have hypopyon

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14
Q

Age-related macular degeneration

A

Degeneration of macula (central area of the retina). It causes distortion (metamorphopsia) and eventual loss of central vision (scotomas).

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15
Q

Dry Age-related macular degeneration

% and cause

A

(nonexudative, > 80%)- Deposition of yellowish extracellular material (“Drusen”) in between Bruch membrane and retinal pigment epithelium with gradual dec. in vision. Prevent progression with a multivitamin and antioxidant supplements.

“Baruch (and pigment) the Druz”

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16
Q

Wet Age-related macular degeneration

% and cause

A

Wet (exudative, 10- 15%)-rapid loss of vision due to bleeding 2° to choroidal neovascularization. Treat with anti-VEGF (vascular endothelial growth factor) injections (eg, bevacizumab, ranibizumab).

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17
Q

Diabetic retinopathy - Nonproliferative

A

Damaged capillaries leak blood -> lipids and fluid seep into retina -> hemorrhages and macular edema.

Treatment: blood sugar control.

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18
Q

Diabetic retinopathy - Proliferative

A

Chronic hypoxia results in new blood vessel formation with resultant traction on the retina. Treatment: anti-VEGF injections, peripheral retinal photocoagulation, surgery

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19
Q

Hypertensive

retinopathy results in

A

Flame-shaped retinal hemorrhages
arteriovenous nicking
microaneurysms
macular star (exudate)

20
Q

Retinal vein occlusion cause:

A

due to compression from nearby arterial atherosclerosis

“blood and thunder appearance”;

21
Q

Retinal detachment pathology

A

Separation of the neurosensory layer of the retina (photoreceptor layer with rods and cones) from
outermost pigmented epithelium (normally shields excess light, supports retina)

22
Q

Central retinal artery

occlusion

A

Acute, painless monocular vision loss.

The retina is cloudy with attenuated vessels and “cherry-red” spot at the fovea (center of the macula).

Evaluate for embolic source

23
Q

Retinitis pigmentosa

A

progressive vision loss beginning with night blindness - rods in peripheral vision affected first

24
Q

Papilledema

A

Optic disc swelling (usually bilateral) due to inc. ICP

25
Q

Leukocoria

A

Loss (whitening) of the red reflex.

causes in children include

C - congenital cataract
a
R - retinoblastoma
T - toxocariasis.

26
Q

Retinal detachment risk factors:

A

May be 2° to retinal breaks, diabetic traction, inflammatory effusions.

more common with high myopia and/or history of head trauma.

Often preceded by posterior vitreous detachment (“flashes” and “floaters”) and eventual monocular loss of vision like a “curtain drawn down.”

Surgical emergency.

27
Q

Miosis pathway

A

Constriction, parasympathetic:

Short ciliary nerves shorten the pupil diameter.

Edinger-Westphal nucleus —(via CN III)—> ciliary ganglion—(short ciliary nerves)—>sphincter pupillae muscles

28
Q

Pupillary light reflex pathway

A

Light —(via CN II)—>pretectal nuclei in midbrain—>bilateral Edinger Westphal nuclei;

pupils constrict bilaterally (direct and consensual reflex).
Result: illumination of 1 eye results in bilateral pupillary constriction.

29
Q

Mydriasis pathway - 1st neuron

A

hypothalamus —> ciliospinal center of Budge at C8-T2

hypothalamus —> ciliospinal center of Budge at C8-T2 —(T1, along cervical sympathetic chain, lung apex, subclavians)—> superior cervical ganglion—(along internal carotid, cavernous sinus, enters orbit as long ciliary nerve)—> pupillary dilator muscles, smooth muscle of eyelids, sweat glands of forehead and face.

30
Q

Mydriasis pathway - 2nd neuron

A

ciliospinal center of Budge at C8-T2 —(T1, along cervical sympathetic chain, lung apex, subclavians)—> superior cervical ganglion

hypothalamus —> ciliospinal center of Budge at C8-T2 —(T1, along cervical sympathetic chain, lung apex, subclavians)—> superior cervical ganglion—(along internal carotid, cavernous sinus, enters orbit as long ciliary nerve)—> pupillary dilator muscles, smooth muscle of eyelids, sweat glands of forehead and face.

31
Q

Mydriasis pathway - 3rd neuron

A

superior cervical ganglion—(along internal carotid, cavernous sinus, enters orbit as long ciliary nerve)—> pupillary dilator muscles, smooth muscle of eyelids, sweat glands of forehead and face.

hypothalamus —> ciliospinal center of Budge at C8-T2 —(T1, along cervical sympathetic chain, lung apex, subclavians)—> superior cervical ganglion—(along internal carotid, cavernous sinus, enters orbit as long ciliary nerve)—> pupillary dilator muscles, smooth muscle of eyelids, sweat glands of forehead and face.

32
Q

Horner syndrome - Associated with lesions along the sympathetic chain:

A

Associated with lesions along the sympathetic chain:

  • 1st neuron: pontine hemorrhage, lateral medullary syndrome, spinal cord lesion above T1 (eg, Brown-Sequard syndrome, late-stage syringomyelia)
  • 2nd neuron: stellate ganglion compression by Pancoast tumor.
  • 3rd neuron: carotid dissection (painful)
33
Q

CN Ill damage

A

CN III has both motor (central) and parasympathetic (peripheral) components.
Common causes include:
PU(peripheral)CIM(central)

P - PCom aneurysm - sudden-onset headache
U - Uncal herniation - coma
C - Cavernous sinus thrombosis - proptosis, involvement of CNs IV, V1/V2, VI
I - Ischemia - pupil sparing (motor fibers affected more than parasympathetic fibers)
M - Midbrain stroke - contralateral hemiplegia

34
Q

Internuclear ophthalmoplegia

A

Medial longitudinal fasciculus (MLF): pair of tracts that allows for crosstalk between CN VI and CN III nuclei

Frontal eye field-> PPRF-> nuc VI—(MLF)—>nuc III

Directional term (eg, right INO, left INO) refers to the eye that is unable to adduct.

INO = ipsilateral adduction failure, Nystagmus Opposite.

35
Q

Suvorexant

A

Orexin (hypocretin) receptor antagonist - used for insomnia.

Contraindications:

narcolepsy
combination with strong CYP3A4 inhibitors.
patients with liver disease.

36
Q

Triptans

A

5-HT 1B/1D - agonists. Inhibit trigeminal nerve
activation, prevent vasoactive peptide release, induce vasoconstriction - used for Acute migraine, cluster headache attacks.

contraindicated in patients with CAD or vasospastic angina

37
Q

Memantine

A

NMDA receptor antagonist; helps prevent excitotoxicity
(mediated by Ca2+). - Used for moderate to advanced
dementia.

38
Q

Tetrabenazine

A

Inhibit vesicular monoamine transporter (VMAT)
- dec dopamine vesicle packaging and release.

used for Huntington chorea and tardive dyskinesia.

39
Q

Local anesthetics - Order of nerve blockade:

A

small-diameter fibers> large diameter. Myelinated fibers> unmyelinated fibers.

Overall, size factor predominates over myelination such that small myelinated fibers >small unmyelinated fibers> large myelinated fibers> large unmyelinated fibers.

40
Q

Baclofen

A

GABA-B receptor agonist in spinal cord.

Use: Muscle spasticity, dystonia, multiple sclerosis.

41
Q

Cyclobenzaprine

A

Centrally acting. Structurally related to TCAs. May cause anticholinergic side effects,
sedation.

Use: Muscle spasticity (works in BS).

42
Q

agonists at opioid receptors

A

μ = beta-endorphin, delta = enkephalin, K = dynorphin

43
Q

Pentazocine vs. Butorphanol MECHANISM

A

K-opioid receptor agonist (both)

Pentazocine - μ-opioid receptor weak antagonist OR partial agonist
Butorphanol - μ -opioid receptor partial agonist.

44
Q

Pentazocine vs. Butorphanol NOTES

A

Both can cause opioid withdrawal symptoms if a patient is also taking full opioid agonists.

Butorphanol - Causes less respiratory depression than full opioid agonists, Not easily reversed with naloxone.

45
Q

Glaucoma drugs - drugs that dec aqueous humor synthesis

A

B - beta bolckers (Timolol, betaxolol,carteolol)
A - alfa agonists (Epinephrine-a1, apraclonidine, brimonidine -a2)
D - Diuretics (Acetazolamide)

via vasoconstriction (Epinephrine)
via inhibition of carbonic anhydrase (Acetazolamide)
46
Q

Glaucoma drugs - drugs that inc outflow of aqueous humor

A

Prostaglandins - uveoscleraI pathway (Bimatoprost, latanoprost -PGF2a)

Cholinomimetics, M3 - contraction of the ciliary muscle and opening of the trabecular meshwork

Cholinomimetics-Direct: pilocarpine, carbachol
Cholinomimetics-indirect: physostigmine, echothiophate

My step 1 mnemonics (19 decks)

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