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PANCE Practice > PANCE Prep- EENT > Flashcards

PANCE Prep- EENT Flashcards

1
Q

What is the number 1 chronic disease in children?

A

ECC

*greater than asthma

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2
Q

Components of ECC prevention:

A
  1. strengthen enamel- via fluoride (possible supp. after 6months)
  2. reduce oral sugars
  3. reduce transmission of Strep mutans- dont share utensils and binkys
  4. manual removal of biofilm.
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3
Q

sucking becomes non-nutritive at age __. Consequences of prolonged sucking habits results in:

A

6 months
*stop definitely by age 3

malocclusions

  1. Increased overjet
  2. anterior open bite
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4
Q

White curd-like plaques initially beginning on the buccal and/or labial mucosa and spreading to the tongue and finally to the lips that can be scraped but not off easily (leave behind erythema/bleeds if scraped)

A

oral candidiasis (thrush)

  • normal until age 2, after consider immunocompromised states
  • Remember to examine the diaper area as the fungus is swallowed and then excreted in the stool and often the infant has a candidial diaper dermatitis as well, which will also need treatment.

DX: clinical or KOB smear: budding yeast/pseudohyphae

Tx:

  1. vNystatin suspension orally for up to 4 weeks.
  2. Clean bottle nipples and pacifiers in the dishwasher cycle.
  3. Breastfeeding moms should apply a small amount of the Nystatin suspension to their nipples to prevent re-infection to the infant
  4. If treatment fails, consider oral Diflucan for 7 days.
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5
Q

a LOW GRADE fever, rhinorrhea and the vesicular/ulcerative lesion on the buccal, pharyngeal and/or labial mucosa

A

herpangina (caused by cocksackie virus)

Tx: supportive and encourage hydration

  1. oral ibuprofen dosed at 10mg/kg/dose given every 6hours until the symptoms are resolved- usually in 3-5 days.
  2. 3:1 mouth solution, KBX or magic mouthwash (20cc each of the following: 1. Benadryl-controls inflammation, 2. Maalox or Kaopectate- band-aid to keep salivary enzymes from irritating the lesions, and may or may not include viscous 3. lidocaine- numbing)
  3. good hand-washing to prevent spread

*highly contagious, mostly to young children, as adults likely have been infected before and have immunity.

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6
Q
  1. HIGH GRADE fever, often lasting 7-10 days, vesicles and ulcers to pharyngeal, buccal, labial mucosa, and gingival mucosa
  2. vesicular lesions may spread onto the skin around the mouth and nose
  3. Cervical lymphadenopathy*
A

herpetic gingivostomatitis- caused by HSVI
(herpetic whitlow if on fingers- minimally painful)

Tx: self-limited

  1. oral ibuprofen 7 days around the clock*
  2. KBX if appropriate
  3. +/- oral acyclovir if sx present <72 hours.
  4. encourage hydration (oral sores and high fever)
  5. Educate: herpes viruses all have the ability for recurrence, usually during times of illness or after sun exposure- usually consists of a solitary or possibly a few lip or lower face vesicular lesions, commonly known as a “cold sore” or “fever blister”. The recurrence is never as severe as the initial infection
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7
Q

Blisters superimposed on eczema rash on hands from sucking

A

eczema herpeticum

Tx: requires admission for IV anti-viral drugs due to the possibility of disseminated HSV infection

*if a child with HSV 1 infection should have a seizure, it is important to consider the complication of herpetic encephalitis or meningitis and the child will need appropriate work-up.

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8
Q

Areas of normal rough-appearing tongue mucosa with patches that appear denuded, smooth and shiny
-commonly after a viral illness, some medications, stress, and sensitizing foods such as citrus and tomatoes

A

Benign glossitis

Tx: benign and no tx needed
1. Reassurance

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9
Q

Tx of Apthous ulcers

A
  1. self-limiting in 7-10 days

2. OTC Zilactin or Orabase

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10
Q

Fluid-filled cysts on the labial or buccal mucosa, which develop following trauma

A

Mucocele

Tx: benign- often don’t need tx
*oral surgeon can remove if large enough to interfere with chewing

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11
Q

lingual frenum is attached very close to the tip of the tongue. This does not allow full mobility of the tongue, resulting in feeding problems and later speech problems

A

ankyloglossia (tongue-tied)

Tx:
referred to an ENT or oral surgeon for consideration of a frenectomy,

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12
Q

Differentiate between:

  1. Bohn’s nodules
  2. Dental lamina cysts
  3. Epstein Pearls
A
  1. Bohn’s nodules: occur along the buccal or lingual sides of the mandibular or maxillary gingival ridges as well as the hard palate
  2. Dental lamina cysts: occur also along the mandibular and maxillary gingival ridges, but are more cystic in appearance
  3. Epstein Pearls: occur only in the midline of the hard palate

Tx: self-limiting- resolve in a few weeks

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13
Q

Describe the different classes of tooth fractures

A

Class I: fx of enamel
Class II: fx of enamel + dentin (yellow)
Class III: fx of enamel + dentin + pulp (red)
Class IV: involves root

Tx: (both primary and secondary teeth)
Class I-II: DDS referral in 2-3 days
Class III-IV: immediate DDS referral

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14
Q

Dental Displacements:
___- tooth has been traumatically removed from socket
___- tooth has been pulled down in the socket
___- tooth has been pushed into the socket
___- tooth has been moved laterally in the socket

A

Avulsion- tooth has been traumatically removed from socket
Extrusion- tooth has been pulled down in the socket
Intrusion- tooth has been pushed into the socket
Luxation- tooth has been moved laterally in the socket

tx: immediate DDS referral (primary and secondary)

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15
Q

Tx of teeth avulsions

A

Primary- immediate DDS referral and DO NOT reinsert tooth

Secondary: immediate DDS referral and don’t touch or scrub root. Rinse and re-insert if <60 min. Can store in milk/saline

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16
Q

Tx of tongue and lip lacerations

A

Tongue: could suture but difficult- rinse their mouth with salt water after eating and expect closure by secondary intention in about a week

Lip: suture esp. if vermillion portion involved- oral antibiotic prophylaxis for in-to-out lac (higher risk to develop infection in the wound) Any mucosal laceration left open will need to be rinsed with salt water after eating

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17
Q

Tx of commissure burns

A
  1. dentist immediately so they can be fitted with a commissure splint which prevents the mucosal layers from touching together and healing with a fusion of the corner of the mouth
  2. PCP debridement
  3. oral prophylaxis Abx
  4. Tetanus immunization
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18
Q

When do you start performing different eye exams?

A

birth: red reflex, corneal light reflex (Hirschberg’s test), pupillary response to light

Age 2: cover/uncover

age 3: visual acuity (tumbling E then shapes in kindergarten and then typical Snellen)
*20/20 is not attained in children until age 6 years, so usually no need to refer unless they are 20/40 or a 2-line chart difference between eyes.

*the visual cortex of the brain is developing until ~9yo, so any visual deficit, whatever the cause, could cause the visual cortex to not develop properly which is an uncorrectable condition beyond the age of 9 years, even if the underlying disorder is identified and treated

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19
Q

when does conjugate gaze develope

A

5 months

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20
Q

Tx for horeolums and chalazions

A

Chalazions: steroid eye drops +/- surgery

Internal and external hordeolums: warm compresses to unplug the gland and antibiotic eye drops for the infection. Expect resolution within 2-3 days

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21
Q

Eye discharge in a neonate is most commonly caused by ___ and is treated with ___

A

chlamydia (erythromycin eye ointment) or gonorrhea (IV abx)
*culture eye discharge + gram stain

OR
dacryostenosis (message inner canthus, should resolve at 4-6 months, if not by 6 months refer to ophthalmology for tear duct probing)

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22
Q

Tx of allergic, viral and bacterial conjunctivitis

A

Allergic: antihistamine eye drops (Patanol or Pataday (QD formula), or Naphcon and Ketotifen which are OTC)

Viral: nothing (tx w/ abx drops for 2/2 bacterial infection)

Bacterial: abx eye drops (Polytrim, Vigamox or Ocuflox, and erythromycin ointment in infants)

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23
Q

Dx and Tx of corneal abrasion

A

Dx: woods lamp w/ fluoroscein stain

Tx:

  1. Cylogel for pain or Tylenol #3
  2. Abx eye drops (Polytrim, Vigamox or Ocuflox)
  3. return in 1 day as the corneal abrasion should heal overnight, and needs to be rechecked. If not healed, refer to ophthalmology for a slit lamp exam in case a FB or more extensive damage is present
    * if pt wears contact lens, tx w/ aminoglycoside eye drop or fluoroquinolone (Ciprofloxacin)***
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24
Q

Tx of periorbital cellulitis and orbital cellulitis

A

periorbital: outpt augmentinor cephalosporins and close f/u

orbital (septal): IV abx (cefotaxime or ceftriaxone and clindamycin) and surgical debridement

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25
Q

What is the number one cause of neonate retinopathy

A

prematurity
*Premature infants born at less than 32 wks gestation or less than 1500 gm are at risk for the retina to not develop appropriate blood vessels

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26
Q

How do you dx retinopathy of prematurity

A
  1. Initial Exam at 4-6 weeks after delivery
  2. Repeat screening every 1-2 weeks
  3. PCP’s job in evaluating a NICU graduate to follow-up on their ophthalmology rechecks and document the caregiver discussions about the importance of follow-up.
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27
Q

Who should you tx for AOM

A
  1. 6mon+ with moderate-severe otalgia + fever 39C or greater
  2. 6-23 months w/ mild otalgia + fever <39 C bilateral

Consider watchful waiting for those with mild ear pain and fever w/ f/u in 2-3 days

Tx w/ amoxicillin 80-90mg/kg divided into 2 doses (max 3g/day) for 10-14 days and ibuprofen for pain
-f/u 3-4 weeks for recheck

*those who do not resolve their MEE by 3 months, are losing language/not gaining language, or have a hx of speech delay/learning issues should be referred to ENT for consideration of myringotomy and pressure-equalization (PE) tubes.

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28
Q

MC causes of AOM

A

1 S. Pneumoniae

  1. haemophilus influenzae
  2. moraxella catarrhalis
  3. Strep pyogenes
  4. viruses

*MC preceded by viral URI

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29
Q

Kids less than 5y/o average about __ viral URI per year, especially if they have exposure to other children. That number tapers down as they get close to school age. The average URI lasts about ___ days, so these children have rhinorrhea about 1-2 weeks/month with closer spacing during winter months.

A

6-8

7-14days

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30
Q

Tx of allergic rhinitis

A

*supportive

1. Nasal steroids
Mometasone: >2 years
Fluticasone: > 4 years 
2. Oral Medications
Cetrizine: >6 months
Loratadine:  >2 years
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31
Q

Tx of sinusitis

A
  1. Nasal steroids
    Fluticasone
  2. ABX (if sx >10-14 days) amox. 45-90mg/kg
    Augmentin (45-90mg/kg)
    Cefdinir, Cefuroxime, Cefpodoxime
  3. 2nd line- doxycycline, bactrim, fluoroquinolone
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32
Q

Describe who should be tested for strep pharyngitis

A
  1. Age 5-15y,
  2. late fall to early spring presentation,
  3. pharyngeal erythema, edema or exudates on exam,
  4. tender, >1cm anterior cervical LAD,
  5. fever 101-103,
  6. absence of URI symptoms such as cough & rhinorrhea.

score of 5: culture only
scores of 6+: rapid strep tests

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33
Q

Tx of strep pharyngitis

A
  1. PCN, including amoxicillin, ampicillin, cephalosporins and macrolides for 10 d.
    * Expect rapid improvement and patients can return to school once they complete 24 hours of treatment.
  2. Stress the importance of completing the entire regimen
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34
Q
  • severe sore throat, fever, difficulty swallowing and talking -unilateral edema and erythema if still in the cellulitis phase.
  • stiff neck and lateral neck flexion due to the position of the mass near their neck muscles
A

peritonsillar vs retropharyngeal abscess

Tx: admit, IV abx, I&D

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35
Q

Risk factors for OSA

A
  1. obesity (BMI>97th percentile)
  2. tonsillar (3-4+)/adenoidal hypertrophy
  3. +FH of OSA
  4. Down’s syndrome
  5. cerebral palsy
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36
Q

Ear pain

  • Tenderness: Especially with movement of the pinna, especially tragus, and with chewing is particularly characteristic
  • Aural discharge*
  • NO FEVER OR HEARING LOSS
  • Auditory canal usually reveals inflamed lining with mild to severe erythema and edema.
  • Scant to copious discharge from the auditory canal may obscure the TM
  • Lobule is spared because no cartilage
  • Can be complicated by perichondritis
A

otitis externa (swimmers ear)

*Pseudomonal infection (MC) until proven otherwise

TX: Topical Abx/steroid

  1. Ofloxacin (ciprofloxacin/dexamethasone)
    * safe to use w/ TM perforation
  2. Aminoglycoside combo: Neomycin/polytrim-B/hydrocortisone otic
    * Don’t use aminoglycoside if TM is suspected
  3. Amphotericin B if fungal

***Malignant Otitis externa- osteomyelititis at skull base secondary to pseudomonas (MC seen in DM and immunocompromised)
TX: IV antispseudomonal abx (ex. ceftazidime + fluoroquinolone)

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37
Q
  • Pool of “goo” (infection)
  • salmon colored red thing (tissue)
  • anytime there is a defect the skin,(always a salmon red because full of blood vessels, if you touch it bleeds)
  • in the ear it is the tip of the iceberg (only the very beginning of the problem)
A

Granuloma

Tx: topical steroids
Ciprodex ear drops
Refer to eNT if cannot get rid

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38
Q
  • Benign bony growth, usually multiple
  • cold water exposure
  • if you touch these things, they are hard as a rock because they are bone
  • rarely cause any trouble
  • Hearing will be totally normal
  • They can get big enough, they can trap cerumen in there
  • if you touch with probe will hurt because it is bone
A

Exostosis (Surfer or Kayakers ear)

TX: nothing unless cerumen gets trapped will need to get surgery

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39
Q
  • Bright white
  • surrounded by normal appearing TM (no rim of normal TM)
  • Moves with pneumotoscopy
  • Calcified scar mass between layers of the membrane
  • No impact on hearing
  • Clear edges
A

Tympanosclerosis

No tx needed

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40
Q

Tx of TM perforation

A
  1. most heal spontaneously- f/u to ensure resolution +/- surgical repair
  2. AVOID water/moisture/topical aminoglycosides in the ear whenever TM is perforated***
  3. Refer to ENT if vertiginous after injury/infection

+/- Oxafloxacin if infected

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41
Q
  1. Painless otorrhea (brown/yellow discharge w/ STRONG ODOR)

Abnormal keratinized collection of desquamated squamous epithelium–> mastoid bony erosion

*MC due to chronic ET dysfunction: chronic neg. pressure inverts part of the TM –> Granulation tissue that erodes the ossicles over time resulting in conductive hearing loss**

A

Cholesteatoma

TX: surgical excision

*can lead to bony erosions or conductive hearing loss

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42
Q

S/S:

  1. Deep ear pain (usually worse at night), fever
  2. mastoid tenderness, may develop cutaneous abscess (flutuance)
  3. hearing loss, labyrinthitis, vertigo, CN VII paralysis, brain abscess
  4. posterior auricular tenderness
  5. Pinna displaced downward and outward
A

Mastoiditis

DX: CT scan

TX: IV abx + middle ear/mastoid drainage hallmark

  • Myringotomy w/ or w/o PE tubes
  • Abx: Augmentin
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43
Q

If bullae on TM suspect

A

Mycoplasma pneumoniae

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44
Q

What should you use to tx AOM in someone with a PCN allergy?

A

Erythromycin- Sulfisoxazole

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45
Q

Perforated TM + persistent or recurrent purulent otorrhea + pain
-may have varying degrees of conductive hearing loss +/- cholesteatoma

A

Chronic otitis media

TX: Topical Abx: Oflaxacin or ciprofloxacin

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46
Q

It is important to avoid _____ whenever TM rupture is suspected

A

water, moisture, topical aminoglycosides

47
Q

Ear fullness, popping of ears, underwater feeling, intermittent sharp ear pain, disequilibrium, fluctuating conductive hearing loss

*otoscopic findings usually normal +/- fluid behind TM

A

Eustachian tube dysfunction

TX:

  1. Decongestants (pseudoephedrine, phenylephrine)
  2. Autoinsufflation (swallwing, yawning,)
  3. Intranasal corticosteroids

Complications: acute serous otitis media, AOM

48
Q

Tx o f barotrauma

A

*rapid pressure change–> inability of ET to equalize pressure

TX: autoinsufflation (swallow, yawn)
2. decongestants or antihistamine)

49
Q

What do you expect the weber and rinne test to be with sensoorineural hearing loss

A

Weber: lateralizes to normal ear

Rinne: Normal AC>BC- difficulting hearing their own voice and deciphering words

**SensoriNeural lateralized to Normal ear + Normal rinne (think N or sensoriNeural)

50
Q

What do you expect the weber and rinne test to be with conductive hearing loss

A

Weber: Lateralizes to affected ear

Rinne: BC>/= AC (negative)

51
Q

Causes of sensorineural hearing loss

A

(inner ear disorder)- Presybacusis MC, CNS lesion, Meniere syndrome

52
Q

Best way for cerumen softening

A

hydrogen peroxide, carbamide peroxide

53
Q

Causes of dizziness

A
  1. stroke/TIA
  2. migraine
  3. MS
54
Q
  • Dizziness that lasts only seconds (10-60 sec)*

- sudden, episodeic peripheral vertigo provoked w/ changes of head positioning

A

BPPV (benign paroxysmal positional vertigo)
*MC cause of vertigo

DX: positive Dix-Hallpike test/Nylan Barany- DELAYED FATIGABLY horizontal nystagmus

TX:

  1. epley maneuver: canalith repositioning
    * may need to repeat the maneuver and no post-procedural instructions
  2. meds: antihistamines* anticholinergics (but strongly discouraged)
  3. FU in 1 month to reassess sx
55
Q

What is the cause of benign paroxysmal positional vertigo (BPPV)

A

displaced otoliths
*normally otoliths are attached to hair cells insdie the saccule and utricules (attached to the 3 semicircular canals.) head movements cause displaced otolith movements

56
Q
  • Sudden dizziness that lasts minutes to hours (1-8 hours)
  • horizontal nystagmus
  • N/V
  • Hearing loss in affected ear (low frequency)
  • Ear fullness/pressure
  • Tinnitus
A

Menieres Disease (idiopathic endolymphatic hydrops)

TX:

  1. symptomatic: antiemetics, antihistamines- (Meclizine), benzo
    * corticosteroids
  2. Surgical endolymphatic sac decompression if refractory to meds or severe
  3. Preventative: diuretics (HCTZ), avoid salt/caffeine/chocolate/ETOH
57
Q

What is the cause of menieres disease?

A

idiopathic distention of the endolymphatic compartment of the inner ear by excess fluid–> increased pressure within the inner ear

**Meniere SYNDROME is due to identifiable cause. Meniere DISEASE is idiopathic

58
Q
  • Sudden onset of dizziness for days to weeks (continuous)
  • N/V
  • gait disturbances
  • Often follows viral URI**
A

Vestibular neuritis (caused by inflammation of vestibular portion of CN 8)

Labyrinthitis (vestibular neuritis + hearing loss/tinnitus)

TX: corticosteroids**
2. antihistamine (Meclizine) if symptomatic

59
Q

Peripheral Vertigo

  1. Location of problem:
  2. Etiologies:
  3. Clinical manifestations:
A
  1. Location of problem: Labyrinth or vestibular nerve (CN 8)
  2. Etiologies: BPPV, Meniere, Vestibular neuritis, labyrinthitis
  3. Clinical manifestations: fatigable horizontal nystagmus (beats away from affected side)
60
Q

Central Vertigo

  1. Location of problem:
  2. Etiologies:
  3. Clinical manifestations:
A
  1. Location of problem: brainstem or cerebellar
  2. Etiologies: migraine, CVA, MS, vestibular neuroma
  3. Clinical manifestations: nonfatigable vertical nystagmus, pos. CNS signs
61
Q

How to treat N/V in patients with vertigo

A
  1. antihistamine: meclizine
  2. Dopamine blockers: metoclopramide, prochlorperazine (compazine)
  3. Anticholinergic: scopolamine
  4. Benzos: Lorazepam
62
Q

Ways to dx sinus infection

A
  1. clinical dx
  2. CT scan is test of choice
  3. Sinus radiographs: Water’s view
63
Q

MC cause of sinus infections

A
  • same as AOM
    1. S. pneumo
    2. H. flu
    3. M. Catarrhalis
    4. GABHS
64
Q
  1. Pale/violaceous, boggy turbinates

2. Erythematous turbinates

A
  1. allergic rhinitis

2. viral rhinitis

65
Q

What is samter’s triad?

A
  1. Asthma
  2. Nasal polyps
  3. ASA/NSAID sensitivity/allergy
66
Q

TX of nasal polyps

A
  1. intranasal corticosteroid treatment of choice

2. surgical removal

67
Q

compare anterior and posterior epistaxis

A

Anterior (MC)

  • RF: nose picking, ETOH, nose blowing)
  • Kiesselbach’s plexus

Posterior

  • RF: HTN, atherosclerosis
  • Palatine artery (may cause bleeding in both nares and posterior pharynx)
68
Q

TX for epistaxis

A
  1. Direct pressure (10-15min, leaning forward)
  2. Topical decongestants/vasoconstrictors (phenylephrine, oxymetazoline (afrin), cocaine
  3. Cauterization (silver nitrate)
  4. Nasal packing (consider abx if packing)
69
Q

Septal hematoma is associated with ___ if the hematoma is not removed

A

loss of cartilage

70
Q
  • dysphagia, pharyngitis
  • muffled, hot potato voice
  • difficulty handling oral secretions
  • trismus, uvula deviation to contralateral side
A

Peritonsillar abscess

DX: CT scan to diff. cellulitis vs drainage

TX: ABX + I&D
(ampicillin/sulbactam (unasyn), clindamycin)

71
Q

Oral hairy leukoplakia is caused by __

A

EBV (HHV-4)

*MC in immunocompromised

72
Q

Postprandial salivary gland pain and swelling

A

Sialolithiasis (salivary gland stones)

*MC in Wharton’s duct (submandibular gland duct) and Stensen’s duct (parotid gland duct)

TX: sialogogues (tart, hard candies, lemon drops- to increase salivary flow)

73
Q

Swelling and erythema of the upper neck and chin with pus on the floor of the mouth

A

Ludwig’s Angina

  • cellulitis of the sublingual and submaxillary spaces in teh neck
  • MC secondary to dental infections

DX: CT scan

TX: Abx (ampicillin/sulbactam- unasyn)

74
Q

eyelids and lashes turned outward (MC in elderly)

*due to relaxation of the orbicularis oculi muscle)

A

Ectropion

TX: surgery, lubricating eye drops

75
Q

What is a pterygium

A

fleshy, triangular-shaped “growing” fibrovascular mass (MC in inner corner/nasal side of eye and extends laterally)

TX: observation/remove if affects vision

76
Q

What is a pinguecula

A

yellow, elevated nodule on nasal side of SCLERA (fat/protein) DOES NOT GROW

77
Q

Blunt/penetrating trauma to the eye resulting in:

  • diplopia, ocular pain
  • misshaped eye w/ prolapse of ocular tissue from the sclera or corneal opening
  • enophthalmos
  • severe conjunctival
  • hemorrhage (360 bulbar)
  • teardrop or irregularly shaped pupil, hyphema
A

Globe rupture

TX:

  1. Rigid eye shield
  2. Immediate optho consult (impaled object should be left undisturbed)
  3. Hyphema- place at 45 degrees to keep RBCs from staining the cornea

*optho emergency!!

78
Q

Diplopia especially with upward gaze occurs with orbital floor blowout fractures because:

A

inferior rectus muscle entrapment

79
Q

DX and TX of orbital floor blowout fractures

A

DX: CT scan

TX:

  1. Nasal decongestants (decrease pain)
  2. Avoid blowing nose
  3. corticosteroids (reduce edema)
  4. Abx (clinda)
  5. Surgical repair
80
Q

MC cause of permanent legal blindness and visual loss in the elderly (75y/o+)

A

Macular degeneration

81
Q

___ is responsible for central vision as well as detail and color vision

A

macula

82
Q

types of macular degeneration

A
  1. Dry (atrophic) MC
    - gradual breakdown of macula- Drusen= small round yellow-white spots on the outer retina
  2. Wet (neovascular or exudative)
    -New, abnormal vessels (rarer)
    DX: fluorescein angiography
83
Q

TX of macular degeneration

A
  1. Dry: Amsler grid at home to monitor stability (vit, A, C, E, zinc may slow)
  2. Wet: intravitreal anti-angiogenics (ex. Bevacizumab)
    - laser photocoagulation
84
Q

MC cause of new, permanent vision loss/blindness 25-74y/o

A

diabetic retinopathy

85
Q

Grades of hypertensive retinopathy

A

I: arterial narrowing, copper wiring= moderate, silver-wiring= severe
II: AV nicking
III: flame shaped hemorrhage, cotton wool spots
IV: papilledema (malignant HTN)

86
Q
  • photopsia (flashing lights)–> floaters–> progressive unilateral vision loss
  • “shadow curtain” coming down in periphery initially–> loss of central visual field
  • no pain/redness
A

Retinal Detachment

DX: retinal tear on funduscopy
- Positive shafer’s sign= clumping of brown-colored pigment cells in the anterior vitreous humor resembling tobacco dust

TX: Optho emergency
*don’t use miotic drops

87
Q
  • eye FB sensation, erythema and itching
  • preauricular lymphadenopathy, copious watery eye discharge, scanty mucoid discharge
  • punctate staining on slit lamp exam
A

Viral conjunctivitis

  • MC adenovirus
  • Swimming pool MC source
88
Q
  • cobblestone mucosa- appearance to the inner/upper eyelid, itching, tearing redness, stringy discharge
  • chemosis
A

allergic conjunctivitis

TX: antihistamine eye drops: olopatadine (patanol)

89
Q 
MC cause of neonatal conjunctivitis at
Day 1:
Day 2-5:
Day 5-7:
Day 7-11:
A

Day 1: chemical cause (silver nitrate given)
Day 2-5: Gonococcal
Day 5-7: Chlamydia
Day 7-11: HSV

90
Q

Describe management of chemical eye burns

A
  • Ophtho emergency!
  • Alkali burns are WORSE than acidic burns (liquefactive necrosis)

TX:

  1. Irrigation immediately! (LR* or NS x30 min or at least 2L)
  2. check pH and visual acuity after irrigation
  3. Abx: moxifloxacin, ophtho fu
91
Q
  • Eye pain, photophobia, reduced vision, tearing, conjunctival erythema
  • ciliary injection (limbic flush), corneal ulceration/defect on slit lamp exam
A

Keratitis (corneal ulcer/inflammation)

Bacterial: hazy cornea
TX: fluoroquinolone drops (Moxifloxacin)
*DO NOT PATCH EYE

HSV: dendritic lesions: branching seen w/ fluorescein staining
TX: topical antivirals

92
Q
  • Ciliary injection (limbic flush) consensual photophobia

- inflammatory cells and flare** within the aqueous humor

A

Uveitis (iritis)

TX:

  • anterior (unilateral pain): topical corticosteroid
  • posterior (decreased vision, floaters, no pain): systemic corticosteroid
93
Q

Risk factors for cataracts

A
  • lens opacification (thickening)
  • blurred/loss of vision over months-years
  1. Aging >60yo
  2. Cig smoking
  3. corticosteroids
  4. DM
  5. UV lights
  6. TORCH infection

DX: absent RR, opaque lens

94
Q
  • loss of color vision, visual field defects (ex. central scotoma/blind spot), loss of vision over a few days (usually unilateral)
  • associated w/ ocular pain that is worse w/ eye movement
  • Marcus-gunn pupil
A

Optic Neuritis (optic nerve/CN 2 inflammation)

TX IV methylprednisolone followed by oral corticosteroids

95
Q

What is marcus gunn pupil

A
  • relative afferent pupillary defect
  • MC cause is optic neuritis

light in unaffected eye- both pupils constrict (normal)
light in affected eye- both pupils dilate

*relative afferent pupillary defect (RAPD) = Ray in Affected Pupil it Dilates (RAPD)

96
Q

What is argyll-robertson pupils

A

pupils constrict on accommodation but do not react to bright light.

ARP
—> accomodation reflex present

97
Q

MC cause of argyll-robertson pupils

A
  1. Neurosyphilis (MC)
  2. midbrain lesions
  3. diabetic neuropathy
98
Q

Describe where the lesion would be if you had:

  1. total blindness of ipsilateral eye
  2. Ipsilateral nasal hemianopsia
  3. Bitemporal heteronymous hemianopsia
  4. Contralateral homonymous hemianopsia
A
  1. total blindness of ipsilateral eye: optic nerve or retina*
  2. Ipsilateral nasal hemianopsia: if lesion is lateral* to optic chiasm
  3. Bitemporal heteronymous hemianopsia: if midline optic chiasm lesion (ex .pit. adenoma)
  4. Contralateral homonymous hemianopsia: if lesion at optic tract or in occipital lobe stroke
99
Q
  • Severe, sudden onset of unilateral ocular pain* +/- N/V, HA
  • Vision changes: halos around lights, peripheral vision loss (tunnel)
  • Conjunctival erythema “steamy cornea”= corneal epithelial edema or cloudiness shallow chamber, mid-dilated fixed, nonreactive pupil,
  • eye feels hard to palpation**
A

Acute narrow angle-closure glaucoma

DX: increased intraocular pressure by tonometry,
-“cupping” of optic nerve on funduscopy

100
Q

Tx of acute angle-closure glaucoma

A

*Ophtho emergency
2 steps: first lower IOP (acetazolamide, BB, mannitol), then open the angle (cholinergics)

  1. acetazolamide (decrease aqueous humor production and therefore decreases pressure)
  2. Topical BB (timolol) reduces IOP pressure w.o affecting visual acuity
  3. Miotics/cholinergics (pilocarpine, carbachol)

Peripheral iridotomy definitive treatment

**AVOID: anticholinergics, sympathomimetics

101
Q
  • Slow gradual BILATERAL PAINLESS peripheral vision loss (tunnel vision)
  • Cupping of optic discs, notching of the disc rim
A

Chronic (open angle) glaucoma

TX:

  1. prostaglandin analogs 1st line (Latanoprost- greater reduction in IOP),
  2. laser therapy
102
Q

What is amaurosis fagux

A

temporary monoocular vision loss (lasting minutes) with complete recovery

-vision loss described as a “temporary curtain that resolves (lifts up) usually within 1 hr

103
Q

Disorder associated with arthritis, conjunctivitis, and urinary tract symptoms

A

Reiter Syndrome (aka a reactive arthritis)

104
Q

how do you rule out globe perforation

A

Seidel test (fluorescein dye exam)- if present, the dye will be diluted by aqueous fluid from the injured site

105
Q

Gingival hyperplasia is a possible known complication of what medication

A

Dilantin

106
Q

facial palsy with otalgia and varicella or vesicular type lesions

A

Ramsay-Hunt Syndrome

TX: oral corticosteroids, antiviral meds, and pain meds.

107
Q

___ is progressive, familiar condition in which the bones of the middle ear soften and then harden at the joints. Results in impedance to passage of sound causing CONDUCTIVE hearing loss

A

Otosclerosis

108
Q

Nasal polyposis in a child is a red flag condition and should make you suspicious for ___

A

cystic fibrosis

109
Q

a nasal mass in a postpubescent male (13-21y/o) is typically _____. They tend to present in adolescent males and w/ complaint of severe unilateral epistaxis and obstruction

A

juvenile angiofibromas

110
Q

injuries to nasal bone may lead to fractuer through thte cribriform or ethmoid bones causes CSF leakage. This can be diagnosed by

A

urine glucose dipstick

111
Q

Most common cause of chronic cough in an adult

A

postnasal drip

#2= asthma, #3= GERD

112
Q

Routine audiology screening is recommended in all adults who have reached age __

A

65

113
Q
  • acute, sudden monoocular vision loss*

- funduscopy: extensive retinal hemorhages (“blood and thunder” appearance

A

central retinal vein occlusion (CRVO)

114
Q
  • acute sudden monoocular vision loss often preceded by amaurosis fugax
  • funduscopy: pale retina with cherry red macula, “box car” appearance
A

central retinal artery occlusion (CRAO)

PANCE Practice (26 decks)

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