PANCE Prep- EENT Flashcards
What is the number 1 chronic disease in children?
ECC
*greater than asthma
Components of ECC prevention:
- strengthen enamel- via fluoride (possible supp. after 6months)
- reduce oral sugars
- reduce transmission of Strep mutans- dont share utensils and binkys
- manual removal of biofilm.
sucking becomes non-nutritive at age __. Consequences of prolonged sucking habits results in:
6 months
*stop definitely by age 3
malocclusions
- Increased overjet
- anterior open bite
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)
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:
- vNystatin suspension orally for up to 4 weeks.
- Clean bottle nipples and pacifiers in the dishwasher cycle.
- Breastfeeding moms should apply a small amount of the Nystatin suspension to their nipples to prevent re-infection to the infant
- If treatment fails, consider oral Diflucan for 7 days.
a LOW GRADE fever, rhinorrhea and the vesicular/ulcerative lesion on the buccal, pharyngeal and/or labial mucosa
herpangina (caused by cocksackie virus)
Tx: supportive and encourage hydration
- oral ibuprofen dosed at 10mg/kg/dose given every 6hours until the symptoms are resolved- usually in 3-5 days.
- 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)
- good hand-washing to prevent spread
*highly contagious, mostly to young children, as adults likely have been infected before and have immunity.
- HIGH GRADE fever, often lasting 7-10 days, vesicles and ulcers to pharyngeal, buccal, labial mucosa, and gingival mucosa
- vesicular lesions may spread onto the skin around the mouth and nose
- Cervical lymphadenopathy*
herpetic gingivostomatitis- caused by HSVI
(herpetic whitlow if on fingers- minimally painful)
Tx: self-limited
- oral ibuprofen 7 days around the clock*
- KBX if appropriate
- +/- oral acyclovir if sx present <72 hours.
- encourage hydration (oral sores and high fever)
- 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
Blisters superimposed on eczema rash on hands from sucking
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.
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
Benign glossitis
Tx: benign and no tx needed
1. Reassurance
Tx of Apthous ulcers
- self-limiting in 7-10 days
2. OTC Zilactin or Orabase
Fluid-filled cysts on the labial or buccal mucosa, which develop following trauma
Mucocele
Tx: benign- often don’t need tx
*oral surgeon can remove if large enough to interfere with chewing
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
ankyloglossia (tongue-tied)
Tx:
referred to an ENT or oral surgeon for consideration of a frenectomy,
Differentiate between:
- Bohn’s nodules
- Dental lamina cysts
- Epstein Pearls
- Bohn’s nodules: occur along the buccal or lingual sides of the mandibular or maxillary gingival ridges as well as the hard palate
- Dental lamina cysts: occur also along the mandibular and maxillary gingival ridges, but are more cystic in appearance
- Epstein Pearls: occur only in the midline of the hard palate
Tx: self-limiting- resolve in a few weeks
Describe the different classes of tooth fractures
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
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
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)
Tx of teeth avulsions
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
Tx of tongue and lip lacerations
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
Tx of commissure burns
- 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
- PCP debridement
- oral prophylaxis Abx
- Tetanus immunization
When do you start performing different eye exams?
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
when does conjugate gaze develope
5 months
Tx for horeolums and chalazions
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
Eye discharge in a neonate is most commonly caused by ___ and is treated with ___
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)
Tx of allergic, viral and bacterial conjunctivitis
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)
Dx and Tx of corneal abrasion
Dx: woods lamp w/ fluoroscein stain
Tx:
- Cylogel for pain or Tylenol #3
- Abx eye drops (Polytrim, Vigamox or Ocuflox)
- 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)***
Tx of periorbital cellulitis and orbital cellulitis
periorbital: outpt augmentinor cephalosporins and close f/u
orbital (septal): IV abx (cefotaxime or ceftriaxone and clindamycin) and surgical debridement
What is the number one cause of neonate retinopathy
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
How do you dx retinopathy of prematurity
- Initial Exam at 4-6 weeks after delivery
- Repeat screening every 1-2 weeks
- 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.
Who should you tx for AOM
- 6mon+ with moderate-severe otalgia + fever 39C or greater
- 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.
MC causes of AOM
1 S. Pneumoniae
- haemophilus influenzae
- moraxella catarrhalis
- Strep pyogenes
- viruses
*MC preceded by viral URI
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.
6-8
7-14days
Tx of allergic rhinitis
*supportive
1. Nasal steroids Mometasone: >2 years Fluticasone: > 4 years 2. Oral Medications Cetrizine: >6 months Loratadine: >2 years
Tx of sinusitis
- Nasal steroids
Fluticasone - ABX (if sx >10-14 days) amox. 45-90mg/kg
Augmentin (45-90mg/kg)
Cefdinir, Cefuroxime, Cefpodoxime - 2nd line- doxycycline, bactrim, fluoroquinolone
Describe who should be tested for strep pharyngitis
- Age 5-15y,
- late fall to early spring presentation,
- pharyngeal erythema, edema or exudates on exam,
- tender, >1cm anterior cervical LAD,
- fever 101-103,
- absence of URI symptoms such as cough & rhinorrhea.
score of 5: culture only
scores of 6+: rapid strep tests
Tx of strep pharyngitis
- 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. - Stress the importance of completing the entire regimen
- 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
peritonsillar vs retropharyngeal abscess
Tx: admit, IV abx, I&D
Risk factors for OSA
- obesity (BMI>97th percentile)
- tonsillar (3-4+)/adenoidal hypertrophy
- +FH of OSA
- Down’s syndrome
- cerebral palsy
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
otitis externa (swimmers ear)
*Pseudomonal infection (MC) until proven otherwise
TX: Topical Abx/steroid
- Ofloxacin (ciprofloxacin/dexamethasone)
* safe to use w/ TM perforation - Aminoglycoside combo: Neomycin/polytrim-B/hydrocortisone otic
* Don’t use aminoglycoside if TM is suspected - 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)
- 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)
Granuloma
Tx: topical steroids
Ciprodex ear drops
Refer to eNT if cannot get rid
- 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
Exostosis (Surfer or Kayakers ear)
TX: nothing unless cerumen gets trapped will need to get surgery
- 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
Tympanosclerosis
No tx needed
Tx of TM perforation
- most heal spontaneously- f/u to ensure resolution +/- surgical repair
- AVOID water/moisture/topical aminoglycosides in the ear whenever TM is perforated***
- Refer to ENT if vertiginous after injury/infection
+/- Oxafloxacin if infected
- 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**
Cholesteatoma
TX: surgical excision
*can lead to bony erosions or conductive hearing loss
S/S:
- Deep ear pain (usually worse at night), fever
- mastoid tenderness, may develop cutaneous abscess (flutuance)
- hearing loss, labyrinthitis, vertigo, CN VII paralysis, brain abscess
- posterior auricular tenderness
- Pinna displaced downward and outward
Mastoiditis
DX: CT scan
TX: IV abx + middle ear/mastoid drainage hallmark
- Myringotomy w/ or w/o PE tubes
- Abx: Augmentin
If bullae on TM suspect
Mycoplasma pneumoniae
What should you use to tx AOM in someone with a PCN allergy?
Erythromycin- Sulfisoxazole
Perforated TM + persistent or recurrent purulent otorrhea + pain
-may have varying degrees of conductive hearing loss +/- cholesteatoma
Chronic otitis media
TX: Topical Abx: Oflaxacin or ciprofloxacin
It is important to avoid _____ whenever TM rupture is suspected
water, moisture, topical aminoglycosides
Ear fullness, popping of ears, underwater feeling, intermittent sharp ear pain, disequilibrium, fluctuating conductive hearing loss
*otoscopic findings usually normal +/- fluid behind TM
Eustachian tube dysfunction
TX:
- Decongestants (pseudoephedrine, phenylephrine)
- Autoinsufflation (swallwing, yawning,)
- Intranasal corticosteroids
Complications: acute serous otitis media, AOM
Tx o f barotrauma
*rapid pressure change–> inability of ET to equalize pressure
TX: autoinsufflation (swallow, yawn)
2. decongestants or antihistamine)
What do you expect the weber and rinne test to be with sensoorineural hearing loss
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)
What do you expect the weber and rinne test to be with conductive hearing loss
Weber: Lateralizes to affected ear
Rinne: BC>/= AC (negative)
Causes of sensorineural hearing loss
(inner ear disorder)- Presybacusis MC, CNS lesion, Meniere syndrome
Best way for cerumen softening
hydrogen peroxide, carbamide peroxide
Causes of dizziness
- stroke/TIA
- migraine
- MS
- Dizziness that lasts only seconds (10-60 sec)*
- sudden, episodeic peripheral vertigo provoked w/ changes of head positioning
BPPV (benign paroxysmal positional vertigo)
*MC cause of vertigo
DX: positive Dix-Hallpike test/Nylan Barany- DELAYED FATIGABLY horizontal nystagmus
TX:
- epley maneuver: canalith repositioning
* may need to repeat the maneuver and no post-procedural instructions - meds: antihistamines* anticholinergics (but strongly discouraged)
- FU in 1 month to reassess sx
What is the cause of benign paroxysmal positional vertigo (BPPV)
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
- 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
Menieres Disease (idiopathic endolymphatic hydrops)
TX:
- symptomatic: antiemetics, antihistamines- (Meclizine), benzo
* corticosteroids - Surgical endolymphatic sac decompression if refractory to meds or severe
- Preventative: diuretics (HCTZ), avoid salt/caffeine/chocolate/ETOH
What is the cause of menieres disease?
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
- Sudden onset of dizziness for days to weeks (continuous)
- N/V
- gait disturbances
- Often follows viral URI**
Vestibular neuritis (caused by inflammation of vestibular portion of CN 8)
Labyrinthitis (vestibular neuritis + hearing loss/tinnitus)
TX: corticosteroids**
2. antihistamine (Meclizine) if symptomatic
Peripheral Vertigo
- Location of problem:
- Etiologies:
- Clinical manifestations:
- Location of problem: Labyrinth or vestibular nerve (CN 8)
- Etiologies: BPPV, Meniere, Vestibular neuritis, labyrinthitis
- Clinical manifestations: fatigable horizontal nystagmus (beats away from affected side)
Central Vertigo
- Location of problem:
- Etiologies:
- Clinical manifestations:
- Location of problem: brainstem or cerebellar
- Etiologies: migraine, CVA, MS, vestibular neuroma
- Clinical manifestations: nonfatigable vertical nystagmus, pos. CNS signs
How to treat N/V in patients with vertigo
- antihistamine: meclizine
- Dopamine blockers: metoclopramide, prochlorperazine (compazine)
- Anticholinergic: scopolamine
- Benzos: Lorazepam
Ways to dx sinus infection
- clinical dx
- CT scan is test of choice
- Sinus radiographs: Water’s view
MC cause of sinus infections
- same as AOM
1. S. pneumo
2. H. flu
3. M. Catarrhalis
4. GABHS
- Pale/violaceous, boggy turbinates
2. Erythematous turbinates
- allergic rhinitis
2. viral rhinitis
What is samter’s triad?
- Asthma
- Nasal polyps
- ASA/NSAID sensitivity/allergy
TX of nasal polyps
- intranasal corticosteroid treatment of choice
2. surgical removal
compare anterior and posterior epistaxis
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)
TX for epistaxis
- Direct pressure (10-15min, leaning forward)
- Topical decongestants/vasoconstrictors (phenylephrine, oxymetazoline (afrin), cocaine
- Cauterization (silver nitrate)
- Nasal packing (consider abx if packing)
Septal hematoma is associated with ___ if the hematoma is not removed
loss of cartilage
- dysphagia, pharyngitis
- muffled, hot potato voice
- difficulty handling oral secretions
- trismus, uvula deviation to contralateral side
Peritonsillar abscess
DX: CT scan to diff. cellulitis vs drainage
TX: ABX + I&D
(ampicillin/sulbactam (unasyn), clindamycin)
Oral hairy leukoplakia is caused by __
EBV (HHV-4)
*MC in immunocompromised
Postprandial salivary gland pain and swelling
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)
Swelling and erythema of the upper neck and chin with pus on the floor of the mouth
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)
eyelids and lashes turned outward (MC in elderly)
*due to relaxation of the orbicularis oculi muscle)
Ectropion
TX: surgery, lubricating eye drops
What is a pterygium
fleshy, triangular-shaped “growing” fibrovascular mass (MC in inner corner/nasal side of eye and extends laterally)
TX: observation/remove if affects vision
What is a pinguecula
yellow, elevated nodule on nasal side of SCLERA (fat/protein) DOES NOT GROW
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
Globe rupture
TX:
- Rigid eye shield
- Immediate optho consult (impaled object should be left undisturbed)
- Hyphema- place at 45 degrees to keep RBCs from staining the cornea
*optho emergency!!
Diplopia especially with upward gaze occurs with orbital floor blowout fractures because:
inferior rectus muscle entrapment
DX and TX of orbital floor blowout fractures
DX: CT scan
TX:
- Nasal decongestants (decrease pain)
- Avoid blowing nose
- corticosteroids (reduce edema)
- Abx (clinda)
- Surgical repair
MC cause of permanent legal blindness and visual loss in the elderly (75y/o+)
Macular degeneration
___ is responsible for central vision as well as detail and color vision
macula
types of macular degeneration
- Dry (atrophic) MC
- gradual breakdown of macula- Drusen= small round yellow-white spots on the outer retina - Wet (neovascular or exudative)
-New, abnormal vessels (rarer)
DX: fluorescein angiography
TX of macular degeneration
- Dry: Amsler grid at home to monitor stability (vit, A, C, E, zinc may slow)
- Wet: intravitreal anti-angiogenics (ex. Bevacizumab)
- laser photocoagulation
MC cause of new, permanent vision loss/blindness 25-74y/o
diabetic retinopathy
Grades of hypertensive retinopathy
I: arterial narrowing, copper wiring= moderate, silver-wiring= severe
II: AV nicking
III: flame shaped hemorrhage, cotton wool spots
IV: papilledema (malignant HTN)
- photopsia (flashing lights)–> floaters–> progressive unilateral vision loss
- “shadow curtain” coming down in periphery initially–> loss of central visual field
- no pain/redness
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
- eye FB sensation, erythema and itching
- preauricular lymphadenopathy, copious watery eye discharge, scanty mucoid discharge
- punctate staining on slit lamp exam
Viral conjunctivitis
- MC adenovirus
- Swimming pool MC source
- cobblestone mucosa- appearance to the inner/upper eyelid, itching, tearing redness, stringy discharge
- chemosis
allergic conjunctivitis
TX: antihistamine eye drops: olopatadine (patanol)
MC cause of neonatal conjunctivitis at Day 1: Day 2-5: Day 5-7: Day 7-11:
Day 1: chemical cause (silver nitrate given)
Day 2-5: Gonococcal
Day 5-7: Chlamydia
Day 7-11: HSV
Describe management of chemical eye burns
- Ophtho emergency!
- Alkali burns are WORSE than acidic burns (liquefactive necrosis)
TX:
- Irrigation immediately! (LR* or NS x30 min or at least 2L)
- check pH and visual acuity after irrigation
- Abx: moxifloxacin, ophtho fu
- Eye pain, photophobia, reduced vision, tearing, conjunctival erythema
- ciliary injection (limbic flush), corneal ulceration/defect on slit lamp exam
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
- Ciliary injection (limbic flush) consensual photophobia
- inflammatory cells and flare** within the aqueous humor
Uveitis (iritis)
TX:
- anterior (unilateral pain): topical corticosteroid
- posterior (decreased vision, floaters, no pain): systemic corticosteroid
Risk factors for cataracts
- lens opacification (thickening)
- blurred/loss of vision over months-years
- Aging >60yo
- Cig smoking
- corticosteroids
- DM
- UV lights
- TORCH infection
DX: absent RR, opaque lens
- 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
Optic Neuritis (optic nerve/CN 2 inflammation)
TX IV methylprednisolone followed by oral corticosteroids
What is marcus gunn pupil
- 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)
What is argyll-robertson pupils
pupils constrict on accommodation but do not react to bright light.
ARP
—> accomodation reflex present
MC cause of argyll-robertson pupils
- Neurosyphilis (MC)
- midbrain lesions
- diabetic neuropathy
Describe where the lesion would be if you had:
- total blindness of ipsilateral eye
- Ipsilateral nasal hemianopsia
- Bitemporal heteronymous hemianopsia
- Contralateral homonymous hemianopsia
- total blindness of ipsilateral eye: optic nerve or retina*
- Ipsilateral nasal hemianopsia: if lesion is lateral* to optic chiasm
- Bitemporal heteronymous hemianopsia: if midline optic chiasm lesion (ex .pit. adenoma)
- Contralateral homonymous hemianopsia: if lesion at optic tract or in occipital lobe stroke
- 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**
Acute narrow angle-closure glaucoma
DX: increased intraocular pressure by tonometry,
-“cupping” of optic nerve on funduscopy
Tx of acute angle-closure glaucoma
*Ophtho emergency
2 steps: first lower IOP (acetazolamide, BB, mannitol), then open the angle (cholinergics)
- acetazolamide (decrease aqueous humor production and therefore decreases pressure)
- Topical BB (timolol) reduces IOP pressure w.o affecting visual acuity
- Miotics/cholinergics (pilocarpine, carbachol)
Peripheral iridotomy definitive treatment
**AVOID: anticholinergics, sympathomimetics
- Slow gradual BILATERAL PAINLESS peripheral vision loss (tunnel vision)
- Cupping of optic discs, notching of the disc rim
Chronic (open angle) glaucoma
TX:
- prostaglandin analogs 1st line (Latanoprost- greater reduction in IOP),
- laser therapy
What is amaurosis fagux
temporary monoocular vision loss (lasting minutes) with complete recovery
-vision loss described as a “temporary curtain that resolves (lifts up) usually within 1 hr
Disorder associated with arthritis, conjunctivitis, and urinary tract symptoms
Reiter Syndrome (aka a reactive arthritis)
how do you rule out globe perforation
Seidel test (fluorescein dye exam)- if present, the dye will be diluted by aqueous fluid from the injured site
Gingival hyperplasia is a possible known complication of what medication
Dilantin
facial palsy with otalgia and varicella or vesicular type lesions
Ramsay-Hunt Syndrome
TX: oral corticosteroids, antiviral meds, and pain meds.
___ 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
Otosclerosis
Nasal polyposis in a child is a red flag condition and should make you suspicious for ___
cystic fibrosis
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
juvenile angiofibromas
injuries to nasal bone may lead to fractuer through thte cribriform or ethmoid bones causes CSF leakage. This can be diagnosed by
urine glucose dipstick
Most common cause of chronic cough in an adult
postnasal drip
#2= asthma, #3= GERD
Routine audiology screening is recommended in all adults who have reached age __
65
- acute, sudden monoocular vision loss*
- funduscopy: extensive retinal hemorhages (“blood and thunder” appearance
central retinal vein occlusion (CRVO)
- acute sudden monoocular vision loss often preceded by amaurosis fugax
- funduscopy: pale retina with cherry red macula, “box car” appearance
central retinal artery occlusion (CRAO)
