Part 3 Flashcards
Small, linear, flmae-shaped, red streaks in the fundi, shaped by the superficial bundles of nerve fibers that radiate from the optic disc. Sometimes the hemorrhages occur in clusters and look like a larger hemorrhage but can be identified by the linear streaking at the edges.
Superficial Retinal Hemorrhage
Small, rounded, slightly irregular red spots that are sometimes called dot or blot hemorrhage. They occur in a deeper lyer of the retina than flame-shaped hemorrhages. Diabetes is a common cause.
Deep Retinal Hemorrhage
Develops when blood escapes into the potential space between the retina and vitreous. This hemorrhage is typically larger than retinal hemorrhages because it is anterior to the retina, it obscures any underlying retinal vessels.
Preretinal Hemorrhage
Tiny, round, red spots commonly seen in and around the macular area. They are minute dilatations of very small retinal vessels; the vascular connections are too small to be seen with ophthalmoscope. A hallmark of diabetic retinopathy.
Microaneurysms
Refers to the formation of new blood vessels. They are more numerous, more tortuous, and narrower than neighboring blood vessels in the area and form disorderly looking red arcades. A common feature of the proliferative stage of diabetic retinopathy
Neovascularization
Are white or grayish, ovoid lesions with irregular soft borders. They are moderate in size but usually smaller than the disc. They result from extruded axoplasm.
Soft Exudates: Cotton-Wool Patches
Are creamy or yellowish, often bright, lesions with well-defined hard borders. They are small and round but may coalesce into larger irregular spots.
Hard Exudates
Inflammation has destroyed the superficial tissues to reveal a well-defined, irregular patch of white sclera marked with dark pigment.
Healed Chorioretinitis
Are yellowish round spots that vary from tiny to small. The edges may be soft or hard. They are haphazardly distributed but may concentrare at the posterior pole between the optic disc and the macula
Drusen
Movement of the auricle up and down. Painful in acute otitis externa.
Tug test
Tenderness by pressing firmly just behind the ear
Occurs in otitis media
A firm, nodular, hypertrophic mass of scar tissue extending beyond the area of injury. It may develop in any scarred area but is most common on the shoulders and upper chest.
Keloid
This chronic inflammatory lesion starts as a painful, tender papule on the helix
or antihelix. Here the upper lesion is at a later stage of ulceration and crusting.
Chondrodermatitis Helicis
This raised nodule shows the lustrous surface and telangiectatic vessels of basal cell carcinoma, a common slow-growing malignancy that rarely metastasizes.
Basal Cell Carcinoma
A deposit of uric acid crystals characteristic of chronic tophaceous gout. It appears as hard nodules in the helix or antihelix and may discharge chalky white crystals through the skin.
Tophi
Formerly called a sebaceous cyst,a dome-shaped lump in the dermis forms a benign closed firm sac attached to the epidermis.
Cutaneous Cyst
In chronic rheumatoid arthritis, look for small lumps on the helix or antihelix and additional nodules elsewhere on the hands and along the sur-face of the ulna distal to the elbow, and on the knees and heels.
Rheumatoid Nodules
Skin of the ear canal is thickened, red, and itchy
Chronic otitis externa
- Red bulging drum
- Amber drum of a serous effusion.
- Decreased mobility
Acute purulent otitis media
Unusual prominent short process and a prominent handle that looks more horizontal.
Retracted drum
No mobility of the ear drum
Ear drum perforation
The tympanic membrane, is pinkish gray. Note the malleus lying behind the upper part of the drum. Above the short process lies the pars flaccida. The remainder of the drum is the pars tensa
Normal Eardrum (Right)
Are holes in the eardrum, usually from purulent infections of the middle ear. They may be central, if not involving the margin of the drum, or marginal, when the margin is involved.
Perforation of the Eardrum
Is a scarring process of the middle ear from otitis media that involves deposition of hyaline and calcium and phosphate crystals in the eardrum and middle ear. When severe it may entrap the ossicles and cause conductive hearing loss.
Tympanosclerosis
Are usually caused by viral upper respiratory infections (otitis media with serous effusion) or by sudden changes in atmospheric pressure as from flying or diving (otitic barotrauma)
Serous Effusion
Is commonly caused by bacterial infection from S. pneumoniae or H. influenzae. Symptoms include earache, fever, and hearing loss. The eardrum reddens, loses its landmarks, and bulges laterally, toward the examiner’s eye.
Acute Otitis Media with Purulent Effusion
Painful hemorrhagic vesicles appear on the tympanic membrane, the ear canal, or both. Symptoms include earache, blood-tinged discharge from the ear, and conductive hearing loss.
Bullous Myringitis
Testing for Conductive Versus Neurosensory Hearing Loss
Tuning Fork Test
Test for lateralization (Weber test).
•Normal
• the vibration is_____.
- Unilateral hearing loss
- Bilateral conductive or sensorineural deficits
Normal
• the vibration is heard in the midline or equally in both ears.
Unilateral hearing loss
• Lateralize to the ear with normal hearing
Bilateral conductive or sensorineural deficits
• No lateralization
Describes the normal first phase in the hearing pathway.
Air conduction (AC)
- Alternative pathway
- Bypasses the external and middle ear
- Used for testing purposes.
Bone conduction (BC)
A vibrating tuning fork placed on the head stimulates
stimulates the cochlea directly
AC is more sensitive than BC (AC > BC).
Normal hearing
- External or middle ear disorder impairs sound conduction to inner ear. Causes include foreign body, otitis media, perforated eardrum, and otosclerosis of ossicles
- Childhood and young adulthood, up to age 40 years
- Abnormality usually visible, except in otosclerosis
- Little effect on sound
Hearing seems to improve in noisy environment
Voice remains soft because inner ear and cochlear
nerve are intact - Tuning fork at vertex
Sound lateralizes to impaired ear—room noise not well heard, so detection of vibrations improves - Tuning fork at external auditory meatus; then on mastoid bone
BC longer than or equal to AC (BC ≥ AC).
Conductive Loss
- Inner ear disorder involves cochlear nerve and neuronal impulse transmission tothe brain. Causes include loud noise exposure, inner ear infections, trauma, acoustic neuroma, congenital and familial disorders, and aging.
- onset: Middle or later years
- Problem not visible in the ear canal and drum
- Higher registers are lost, so sound may be distorted
Hearing worsens in noisy environment
Voice may be loud because hearing is difficult - Tuning fork at vertex
Sound lateralizes to good ear—inner ear or cochlear nerve damage impairs transmission to affected ear. - Tuning fork at external auditory meatus; then on mastoid bone
AC longer than BC (AC > BC).
Sensorineural Loss
Measures the distance between the lateral angle of the orbit and an imaginary line across the most anterior point of the cornea.
Exophthalmometer
Present in 60% of patients with Graves ophthalmopathy
Common symptoms • diplopia and tearing. • Grittiness • Pain from corneal exposure. • Eyelid retraction (91%), • Extraocular muscle dysfunction (43%), • Ocular pain (30%) • Lacrimation (23%)
Exophthalmos
Discharge of mucopurulent fluid from the puncta
Nasolacrimal Duct Obstruction
Reaction when the left-sided optic nerve is damaged in swinging flashlight test
Light reaction
Defect on the afferent pupil
Marcus Gunn pupil
