Task Trainers Flashcards
How would you describe a normal eye?
● Optic disc is orange/yellow/pink with clear margins and bright optic cup
● Optic cup ratio to optic disc 1:3
● Vessels are well defined and show no apparent nicks, hemorrhages or occlusions
● Retina shows no hemorrhages, exudates, or plaques
● Optic disc is the anatomic blind spot where nerves and blood vessels enter the retina.
what causes aortic stenosis
- degeneration if less than 70y/o
- Congenital if less than 70
- Congenital bicuspid valve,
- Rheumatic heart dz,
- Atherosclerosis
- may be the cause of sudden death, particularly in children and adolescents, either at rest or during exercise; risk related to degree of stenosis
Describe these findings
TM retraction
● Increased visualization of bone landmarks
● If light reflex present at >100 degree of malleus
● Sign of eustachian tube dysfunction
● Immediate referral to ENT—can cause sudden deafness
Describe a pulmonary stenosis murmur
- Grade I-IV, systolic harsh diamond shaped murmur, heard loudest over 2nd ICS and radiates to the back. Increased splitting of S2
Diagnose
Papilloedema (chronic phase)
- caused by increased intracranial pressure
- boundary of the papilla and surrounding retina are unclear
- small exudate and hemorrhage
Describe these findings
● Calcifications with distinct edges and surrounded by margins of normal TM are normal finding
● Seen with hx of TM trauma or PE tubes
Diagnose
Serious Otitis Media (SOM)
What causes Wheezes
Asthma, fibrotic diseases (Farmer’s lungs, silicosis,etc), bronchiolitis,
What murmur is commonly seen with a narrow pulse pressure and a bounding WIDE pulse pressure
- narrow pulse pressure: Aortic stenosis
- Bounding, wide pulse pressure: Aortic regurgitation, PDA
Describe these findings
Abnormal Findings
● Erythema
● Bulging: light reflex at <90 degrees of malleus
● No visualization of incus
Describe an ASD murmur
- Grade I-IV, widely split fixed S2, systolic ejection, diamond-shaped, and early diastolic diamond-shaped murmur heard loudest at 2nd ICS no radiation_._ Heard loudest over pulmonic area.
what causes Mitral stenosis
- Rheumatic heart disease (Most common by far)
- cardiac infection
**Also seen w R-sided HF, PHTN, and Afib
Where is a VSD murmur best heard?
Tricuspid (35th ICS)
Supine
Diagnose
Simple/Background Diabetic Retinopathy
- microaneurysms
- spotty hemorrhages
- hard exudates
Diagnose
Traumatic Perforations
Diagnose
Age-Related Macular Degeneration
-macular exudates and subretinal hemorrhages
(severe level of visual impairment occurs after repeated hemorrhage from newly formed blood vessels)
Describe these abnormal findings
Hollenhorst plaques
● Cholesterol embolus in the vessels of the retina
● Sign of severe atherosclerosis
● Common finding in geriatric population
Diagnose
Acute Suppurative Otitis Media
Normal Eye documentation
Lashes and brows symmetric, conjunctivae are pink and sclera are without injection or jaundice. No discharge. Cornea and lens clear. Pupils equal, round and reactive to light and accommodation (PERRLA). Extraocular movements intact (EOMI). Ophthalmoscopic exam: Optic disc visualized with sharp disc margins. No hemorrhages. Vessels smooth, no nicking. (Note cup:disc ratio if pertinent).
Diagnose
Retinal Vein Occlusion (after retinal laser photocoagulation)
- scar from retinal photocoagulation seen as white spots
- after bleeding, retinal veins form white lines
Describe these abnormal findings
Exudates
● Hard exudates fat spots in the retina
o Related to hyperlipidemia
● Cotton wool spots(soft exudates), illdefined yellow areas caused by infarction of nerve layer, indicate vascular dz
Well defined, associated with a vessel
● Signs of diabetes
● Sign of wet macular degeneration
(age related)
What murmur is associated with a paradoxically split S2, Prominent S1 (clsing snap), widely split S2, and widely split, fixed S2
- paradoxically split S2: severe aortic stenosis
- Prominent S1 (closing snap): Mitral stenosis
- widely split S2: Mitral regurgitation
- Widely split, fixed S2: ASD
Name these areas
Abnormal Eye Findings Documentation
External examination: erythema, purulent discharge, clear discharge, injected palpebral or bulbar conjunctiva, corneal abrasion, corneal ulcer, foreign body present, unequal size of pupils
Ophthalmoscopic exam: papilledema, glaucomatous cupping, cotton wool spots, hemorrhage, papilledema, drussen bodies
Diagnose
Cerumen Blockage
Treatment for aortic regurgitation
- vasodilators (decrase afterlaod increase forward flow)
- surgery
Diagnose
Toxoplasmosis
- localized exudative retinochoroiditis
- white and gray lump can be seen at the macula
Describe these abnormal findings
- Glaucomatous cupping: Optic cup is widened >1/3 of optic disc
● Glaucoma is due to increased intraocular pressure from vitreous humour, producing additional pathologic cupping.
● Cup:disc ratioNormal is 0.3 or 3/10.
● The pink rim of disc contains nerve fibers, the white cup is a pit with no nerve fibers. As glaucoma worsens, cupping increases.
What causes VSD
- Congenital, post MI
Diagnose
Hypertensive Retinopathy
- spotty hemorrhages
- cotton wool spots (soft exudates)
- arterial vasoconstriction
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