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Clinical Medicine > Test 4 ENT > Flashcards

Test 4 ENT Flashcards

1
Q

Anterior blepharitis

A

Inflammation of the eyelid
S. aureus or epidermidis
Seborrheic

From direct bacterial infection & response against bacterial toxins
Delayed hypersensitivity rxns to bacterial antigens

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2
Q

Posterior blepharitis

A

Inflammation of eyelids

Dysfunction of meibomian glands

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3
Q

S/S blepharitis

A
  1. Burning
  2. Itching
  3. Foreign body senstaion
  4. Crusting of the eye lashes
  5. Erythematous lid margins
  6. Scaling lids
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4
Q

Risk factors of blepharitis

A
  1. Rosacea
  2. Eczema
  3. Prior lid injury
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5
Q

What would you see with slit lamp exam of blepharitis?

A

Usually bilateral may be asymmetric

  1. Lid erythema
  2. Lid telangiectasia
  3. Oily collerettes base of lashes
  4. Papules
  5. Pustules w/ rosacea
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6
Q

Tx blepharitis

A
  1. Warm compresses 2x/day
  2. Eyelid scrubs after compresses
  3. Anterior - Topical abx if infected (erythromicin/bacitracin)
    Posterior - oral doxycyline
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7
Q

What is the most common orbital Fx?

A

Blowout Fx

Occurs with blunt force trauma to globe or orbital rim

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8
Q

What is the weakest area for orbital Fx?

A

Medial wall & orbital floor

-lamina papyracea

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9
Q

S/S Blowout Fx

A

Blunt trauma

  1. Diplopia on upgaze
  2. Periorbital ecchymosis & edema
  3. Anesthesia of maxillary teeth & upper lip
  4. Step off deformity over infraorbital ridge
  5. Orbital crepitus
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10
Q

How to Dx blowout Fx?

A
  1. Plain skull XR w/ Waters & Caldwell views
  2. Teardrop sign
    CT scan needed to Dx & determine extent of damage (coronal & sagittal views)
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11
Q

Tx blowout Fx

A

Surgery for persistent diplopia & endopthalmitis

Refer

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12
Q

MCC of cataracts & other causes ?

A

Aging

  1. Trauma
  2. Metabolic disorders
  3. Infections (rubella)
  4. Medications
  5. Congenital problems
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13
Q

What is the MCC of blindness in the world?

A

cataracts

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14
Q

What causes cataracts?

A

Changes in the lens protein affects how the lens refracts light, reducing clarity & visual acuity
May cause color to turn yellow, green, brown or white

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15
Q

S/S cataracts

A
  1. Painless blurry vision or vision loss
  2. Glare
  3. Myopia
  4. Monocular diplopia
  5. Absent red reflex
  6. Leukoria
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16
Q

How to Tx cataracts?

A
  1. Surgery w/ intraocular lens implant
    May just remove it w/o implant
    Refer
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17
Q

What is a chalazion?

A

Idiopathic, sterile chronic granulomatous inflammation of the meibomian gland caused by a foreign body reaction to sebum

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18
Q

What causes chalazion?

A
  1. Chronic process of that results from an inflammatory foreign body reaction to sebum
  2. Blockage of normal drainage glands, especially at at the eyelid margin
  3. Blepharitis, acne rosacea or hordeolum may contribute to development
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19
Q

Dx chalazion

A
  1. Nontender, palpable localized swelling
  2. Swelling points to the conjunctival surface
  3. No signs of inflammation
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20
Q

Tx chalazion

A
  1. Warm compresses and lid scrubs

If recurrent - refer for incision & curettage

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21
Q

What is the MCC of acute conjunctivitis, & others?

A

Adenovirus

1. Bacterial
Streptococcus pneumoniae
Haemophilus influenza
Staphloccus aureus
Neisseria gonorrhea
Chlamydia trachomatis
2. Viral
Herpes simplex virus type 1 and 2
Picornaviruses
3. Allergies
4. Chemical
5. Irritative
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22
Q

Who more commonly gets bacterial conjunctivitis?

A

Kids

Adults usually get viral

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23
Q

S/S Conjuncitivits

A
  1. Foreign body sensation
  2. Burning
  3. Itching
  4. Photophobia
  5. URI
  6. Family member with same symptoms
  7. Tearing
  8. H/o cold sores
  9. Crusting
  10. Lids stuck shut in the morning
  11. Hyperemia
  12. Pseudoptosis
  13. Preauricular LAD
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24
Q

Dx conjuncitivitis

A
  1. Rapid adenovirus immunoassay kit

2. Bacterial or viral culture

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25
Q

Tx of bacterial conjuncitivits

A

Self limiting 10-14 days
If Tx - 1-3 days
Broad specturm topical abx

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26
Q

Tx of chlamydial conjuncitivitis

A

Oral tetracylcine, doxycylcine, erythromicin or azithromycin
Topical ointments of drops used

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27
Q

Tx of viral conjuncivitis

A
  1. Artificial tears
  2. Cool compresses
    Acyclovir if herpes
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28
Q

Tx of allergic conjunctivitis

A
  1. Topical antihistamines

2. Short course of topical steroids

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29
Q

Good sign for bacterial conjunctivitis

A

Lid stuck shut in morning

Less itching

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30
Q

Good signs for viral conjuncitivitis

A
  1. Preauricular LAD
  2. Subconjunctival hemorrhage
  3. Punctate keratopathy
  4. Photophobia
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31
Q

Good signs for allergic conjuncitivitis

A
  1. Intense itching
  2. Chemosis
  3. Thick stringy mucus
  4. Conjunctival papilla
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32
Q

S/S corneal abrasion

A
  1. Sudden onset
  2. Foreign body sensation
  3. Photophobia
  4. Excessive tearing
  5. Blepharospasm
  6. Blurry vision
  7. Pain worse with eye movement
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33
Q

Tx corneal abrasion

A
  1. Remove foreign body
  2. Anesthetic eye drop
  3. Topical abx (Tobramycin)
  4. NSAID
    No patching, no contacts
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34
Q

What ulcers can contacts cause?

A

P. aeruginosa

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35
Q

Risk factors for corneal ulcers

A
  1. Contact lenses
  2. HIV
  3. Trauma
  4. Ocular surface disease
  5. Ocular surgery
  6. Age
  7. Gender
  8. Smoking
  9. Low socioeconomic class, poor hygiene
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36
Q

Common causes of corneal ulcers

A
  1. Staphylococcus sp, Pseudomonas
  2. Fungi - Fusarium
  3. Amoeba - Acanthamoeba
  4. Herpes simplex, Varicella-Zoster
  5. Idiopathic
  6. Neurotrophic keratitis
  7. Exposure keratitis
  8. Severe dry eyes
  9. Severe allergic disease
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37
Q

S/S corneal ulcer

A
  1. Pain
  2. Photophobia
  3. Tearing
  4. Decreased/blurred vision
  5. Erythema of eyelid and conjunctiva
  6. Circum-corneal injection
  7. Purulent or watery discharge
  8. Foreign body sensation
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38
Q

Tx of corneal ulcer

A
  1. Broad spectrum abx - usually cipro
    If contact lens wearer - fluoroquinolone
  2. Cycloplegic eye drops
    Refer
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39
Q

Dacryoadenitis & when is it commonly seen in kids?

A 
Inflammation of lacrimal gland
May be primary inflammatory condition of secondary
1. Mumps
2. Measles
3. Influenza
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40
Q

Causes of dacryoadenitis

A
  1. Autoimmune diseases - Sjorgen syndrome, Sarcoidosis, Tumor
  2. Rare caused by staphyloccus, aures, Nesseria gonorrhea or streptococci
  3. Mumps, mononucleosis, influenza and herpes zoster
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41
Q

S/S dacryoadenitis

A
  1. Unilateral eye pain
  2. Redness
  3. Swelling over lateral 1/3 upper eyelid
  4. Tearing or discharge
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42
Q

Tx of dacryoadenitis

A
  1. Inflammatory - Refer to ophthalmologist for treatment pseudo tumor cerebri
  2. Viral - Cool compresses to swelling, NSAIDs PRN
  3. Bacterial or infectious
    mild to moderate amoxicillin/clavulanate or cephalexin
    Moderate to severe
    Hospitalize treat according to causative organism
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43
Q

What is ectropion caused by?

A

Eversion of lower eyelid

Relaxation of the orbicularis oculi muscle or degeneration of the lid fascia

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44
Q

S/S ectropion

A
  1. Previous surgery, trauma, chemical burn or seventh nerve palsy
  2. Excessive tearing
  3. Corneal abrasion from eyelashes
  4. Foreign body sensation
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45
Q

Tx of ectropion

A
  1. Artificial tears & lubricant
  2. Bacitracin/erythromycin
  3. Warm compress
  4. Tape lid into place
    Refer for surgery
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46
Q

What is entropion caused by?

A

Onward turning of the lower eyelid

  1. Due to age related laxity of the lower eyelid muscles and degeneration of the lid fascia
  2. Can also be caused by birth defect (Down’s Syndrome), facial palsy & scar tissue of conjunctiva and tarsus
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47
Q

S/S entropion

A
  1. Eye irritation
  2. Foreign body sensation
  3. Tearing redness
  4. Conjunctival injection
  5. Blepharospasm
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48
Q

Tx of entropion

A
  1. Artificial tears & lubricants

2. Surgical repair

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49
Q

What can happen w/ corneal foreign body?

A
  1. Small particles lodge in the corneal epithelium or stroma
  2. Foreign body may start inflammatory cascade dilation of vessels, eyelid edema, conjunctiva and cornea
  3. WBC’s may be released resulting in anterior chamber causing inflammation and/or corneal infiltration
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50
Q

S/S corneal foreign body

A
  1. Pain, worse with eye movement (significant relief with topical anesthetic)
  2. Foreign body sensation (relieved by topical anesthetic)
  3. Photophobia
  4. Tearing
  5. Redness
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51
Q

Tx corneal foreign body

A
  1. Topical anesthetic
  2. Remove FB
  3. If rust ring is present must completely removed
  4. Tx w/ abx
    Pts w/ intraocular foreign body need immediate referral
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52
Q

What is the 2nd leading cause of blindness?

A

Glaucoma

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53
Q

Cause of glaucoma

A

Inc. intraocular pressure causing optic nerve damage
Open- angle: Neurodegenerative condition from dysfunction of aqueous humor

Angle closure: restricted flow of aqueous humor

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54
Q

S/S open angle glaucoma

A
  1. Usually asymptomatic early
  2. FH diabetes or glaucoma
  3. Halos around lights
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55
Q

S/S closed angle glaucoma

A
  1. Halos around lights
  2. Aching eye/brow pain
  3. HA
  4. N&V
  5. Dec. vision
  6. Eye redness
  7. Use of sulfa based drugs
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56
Q

Dx open angle glaucoma

A
  1. IOP >21
  2. Loss of rim tissue on optic disc
  3. Enlarged cup to disc ratio or asymmetric cup to disc
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57
Q

Dx closed angle glaucoma

A
  1. Reduced visual acuity
  2. Hyperemia
  3. Elevated IOP
  4. Corneal edema
  5. Dilated fixed pupil
  6. Shallow anterior chamber
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58
Q

Tx of open angle glaucoma

A
  1. Reduction of aqueous production
    beta-adrenergic drops timolol or levobunolol contraindicated in asthma and cardiac conduction defects.
    Alpha-adrenergic agonists apraclonidine and brimonidine.
  2. Laser trabeculectomy
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59
Q

Tx closed angle glaucoma

A

Medical Emergency!!!
1. Reduce IOP and break the angle closure
Beta-adrenergic drops
Topical Streoids drops Prednisilone acetate 1%
Alpha-adrenergic agonists
Carbonic anhydrase inhibitor acetazolamide 500 mg
2. Hyperosmotic agents when pressures are very high
3. Laser peripheral iridotomy used to relieve pressure in iris

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60
Q

Tx glaucoma caused by Topiramate or sulfonamide

A 
Angle closure 
1. Cycloplegia (atropine 1% BID to TID
2. IV hyperosmotic agents
3. IV steroids (methylprednisione250 mg QID) 
Refer - emergency
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61
Q

What bacteria causes Hordeolum & what is infected?

A

S. aureus
Meibomian gland
Tx w/ warm compress

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62
Q

Who is at inc. risk of Hordeolum?

A

Adults

  1. Diabetes
  2. Blepharitis
  3. Seborrhea
  4. High serum lipids
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63
Q

S/S hordeolum

A
  1. Acute pain or tenderness eyelid
  2. Erythematous eyelid
  3. Pustule on eyelid
  4. Hyperemia
  5. Eyelid bump
  6. Eyelid swelling
  7. Previous eye surgery or eyelid surgery
  8. Rosacea or blepharitis
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64
Q

Dx hordeolum

A
  1. Palpate lid for eyelid nodule
  2. Visual examination for blocked meibomian gland
  3. Eyelid swelling
  4. Localized eyelid tenderness
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65
Q

What should you consider if there is periorbital erythema & warm edema?

A

preseptal cellulitis

Tx w/ cephalexin & refer

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66
Q

Tx hordeolum

A
  1. Warm compresses 10 minutes QID with lid massage over nodule
  2. Eyelid scrubs
  3. Abx maybe
    If no improvement after 3-4 weeks refer to an ophthalmologist curettage and drainage
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67
Q

Hyphema

A

Post injury accumulation of blood in the aqueous humor of the anterior chamber
Inc. intraocular pressures

REFER - Medical Emergency

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68
Q

What is the most common site of bleeding w/ hyphema?

A

anterior aspect of ciliary body

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69
Q

S/S hyphema

A
  1. Blunt or penetrating trauma, intraocular surgery
  2. Vision loss
  3. Eye pain
  4. N&V
  5. Blurry vision
  6. Vision loss (is it changing over time?)
  7. Medications w/ anticoagulation properties
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70
Q

Dx hyphema

A
  1. Blood/clot in anterior chamber
  2. R/O ruptured globe
  3. Measure IOP
    Screen black & mediterranean Pts for sickle cell
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71
Q

Tx of hyphema

A
  1. Avoid ASA & NSAIDS
  2. Bedrest or limited activity
  3. Elevate head of head to allow blood to settle
  4. Eye shield either metal or plastic (do not patch)
  5. Atropine 1% BID to TID
  6. Acetaminophen only
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72
Q

What is the leading cause of blindness in industrialized nations?

A

Macular Degeneration

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73
Q

Risk Factors of Macular Degeneration

A
  1. Age
  2. FH
  3. Smoking
  4. Previous cataract surgery
  5. ARMS2/HTRA1
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74
Q

S/S non-exudative macular degeneration

A
  1. Gradual loss of central vision
  2. Drusen’s
  3. Macular retinal pigment epithelial changes
  4. Variable vision loss
  5. Amsler Grid changes
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75
Q

S/S exudative macular degeneration

A
  1. Severe vision loss
  2. Choroidal neovascularization noted on fundus examination
  3. Drusen and subretinal fluid or retinal pigment epithelium detachment
  4. Disciform scar
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76
Q

Tx non-exudativee macular degeneration

A
  1. AREDS formula vitamins
  2. Monitor with Amsler Grid
  3. Smoking cessation
77
Q

Tx exudative macular degeneration

A
  1. Laser photocoagulation

2. Intraocular injections of anti-vegf drug

78
Q

Nystagmus

A

Fast uncontrollable mvmts of the eye
Can be in one or both eyes
Acquired/Congenital
Usually asymptomatic unless developed after 8y/o

79
Q

Causes of congenital nystagmus

A
  1. Idiopathic
  2. Albinoism
  3. Aniridia
  4. Leber congenital amaurosis
80
Q

Causes of acquired nystagmus

A
  1. Vision loss
  2. Toxic or metabolic causes
  3. CNS disorders
  4. Non-physiologic
  5. Trauma
  6. Labyrinth’s/Meniere’s disease
  7. Thiamine/Vit B12 deficiency
  8. Drugs/alcohol
  9. Vertigo
  10. MS
81
Q

Tx congenital nystagmus

A
  1. Maximize vision by refraction
  2. Treat amblyopia
  3. Prism glasses maybe
  4. Muscle surgery maybe
82
Q

Tx acquired nystagmus

A
  1. Treat underlying etiology

2. Periodic alternating nystagmus treat baclofen (not for use in children)

83
Q

Optic neuritis & Causes

A 
Inflammation of the optic nerve 
1. Epstein-barr Virus
Other viruses - demyelinating disease
2. Autoimmune
SLE, Sarcoidosis, Sjogren, Behcet & MS
84
Q

S/S Optic Neuritis

A
  1. Monocular periorbital pain/retro-ocular pain
  2. Eye pain worse w/ eye mvmt
  3. Loss of visual acuity w/ scotoma
  4. Color desaturation/loss of color vision
  5. Relative afferent papillary defect
  6. Uhthoff phenomenon
  7. Pulfrich phenomenon
  8. Phosphenes (see light with sight being present)
85
Q

What is Uhthoff phenomenon?

A

Worsening of symtoms w/ inc. in body temps

Seen w/ Optic neuritis

86
Q

What is Pulfrich phenomenon?

A

Altered depth perception of moving objects

Seen w/ optic neuritis

87
Q

Dx optic neuritis

A
  1. Visual acuity
  2. Optic disc swelling
  3. Color perception
  4. Contrast sensitivity
  5. Visual field - APD (90% pts)
  6. Optic disc pallor (optic atrophy from previous
    ON)
  7. MRI brain/orbits
  8. Labs -CBC, RPR, FTA-ABS, ESR & CRP
88
Q

Tx optic neuritis

A
  1. MRI w/ 1 demyelinating lesion - steoids for 14 days
  2. Antiulcer meds - ranitidine 150 mg BID
  3. MRI w/ >3 demyelinating lesions - steroids then refer for interferon Tx
89
Q

Why is periorbital cellulitis concerning in kids?

A

Could be underlying bacterial sinusitis

90
Q

Orbital cellulitis

A

Infective process occurring in the eyelid tissues superficial to the orbital septum
Affects muscles & fat w/in orbit but not the globe
Commonly spread & causes other infections

91
Q

Causes of orbital cellulitis

A
  1. Superficial inoculation - insect bite, chalazion, epidermal inclusion cyst, folliculitis
  2. Local spread from respiratory tract
  3. Orbital injury, Tx, dacryocystitis, endophthalmitis, dental infections
92
Q

What organisms commonly cause cellulitis?

A
  1. S. aureus
  2. S. epidermidis
  3. Strep & anaerobes
  4. Fingal seen in immunosuppressed/diabetics…very aggressive
93
Q

S/S orbital cellulitis

A
  1. Ocular pain
  2. Proptosis
  3. Ophthaloplegia (paralysis of extraocular muscles)
  4. Eyelid edema
  5. Vision loss
  6. Chemosis
  7. Eyelid erythema
  8. Elevated intraocular pressure
  9. HA
  10. Decreased eye motility
  11. N&V
94
Q

Dx orbital cellulitis

A
  1. Complete dilated eye examination with visual acuity
  2. Head and neck examination
  3. Oral examination (tissue necrosis and black eschar)
  4. Check for +APD
  5. CT scan
95
Q

Tx orbital cellulitis

A
  1. Empiric oral or IV antibiotics
  2. Incision and drainage of abscess
  3. Culture for causative organism
  4. Antifungal therapy with amphoteracin-B (for immunosuppressed or ketoacidosis pts)
96
Q

Papilledema

A

Optic disc swelling that is secondary to elevated intracranial pressure
No dec. vision***
Usually bilat
Caused by infection, infiltration or inflammation

97
Q

Causes of papilledema

A
  1. Primary and metastatic intracranial tumors
  2. Hydrocephalus
  3. Pseudotumor cerebri
  4. Subdural and epidural hematomas
  5. Subarchnoid hemorrhage
  6. Arteriovenous malformation
  7. Brain abscess
  8. Meningitis
  9. Encephalitis
  10. Cerebral venous sinus thrombosis
98
Q

S/S papilledema

A
  1. HA (worse on awakening, exacerbated by coughing or other types of Valsalva maneuver)
  2. N&V
  3. LOC, pupillary dilation and death
  4. Pulsatile tinnitus
  5. Blurry vision, constriction visual field & decreased color vision
  6. Diplopia (6th nerve palsy)

No visual disturbances

99
Q

Dx papilledema

A
  1. Full dilated eye examination
  2. Automated visual field test (detect blind spot or constriction of field)
  3. Color vision testing
  4. Optic disc photos
  5. BP
  6. MRI head with gadolinium and MRV head
  7. Lumbar puncture with CSF analysis and opening pressure msmt
100
Q

Tx papilledema

A

Fix cause

  1. Diuretics-carbonic anhydrase inhibitors (idiopathic intracranial hypertension)
  2. Weight reduction (idiopathic intracranial hypertension)
  3. Corticosteroids (inflammatory disorders)
101
Q

Pterygium & Risk factors

A

Fleshy, fibrovascular overgrowth from the conjunctiva onto the corneal surface

  1. UV
  2. Irritation from wind
  3. Genetics
102
Q

S/S Pterygium

A
  1. Ocular irritation and burning
  2. Redness
  3. Tearing
  4. Blurred vision
  5. Diplopia
  6. Altered ocular cosmesis
103
Q

Dx Pterygium

A
  1. Wing shaped, vascular, conjunctival overgrowth

2. Increased tear lakes

104
Q

Tx Pterygium

A
  1. Protect eyes from direct sun and wind
  2. Topical steroid drop to reduce irritation
  3. Refer to ophthalmologist for surgical excision if overgrowth encroaches into the pupillary area
105
Q

Retinal Detachment

A

Acute or progressive condition where the neuroretina separates from the retinal pigment epithelium with accumulation of subretinal fluid and loss of visual function

106
Q

S/S Retinal Detachment

A
  1. Flashes of light
  2. Floaters
  3. A curtain or shadow moving over the field of vision
  4. Peripheral or central vision loss
107
Q

Causes of Retinal Detachment

A

Traction

  1. Diabetes
  2. Trauma
  3. Previous surgery
108
Q

Dx retinal detachment

A
  1. Full dilated eye examination
  2. Confrontational fields
  3. Indirect ophthalmoscopy with scleral depression
  4. B-scan (ultrasound) is used if media problem
109
Q

Tx Retinal Detachment

A
  1. Pneumatic retinopexy

2. Surgical-vitrectomy and/or scleral buckle

110
Q

Causes of Retinal Artery Occlusion

A

Embolus

  1. Cholesterol - Hollenhorst plaque from carotid artery bifurcation
  2. Calcium - from heart valves
  3. Fibrin - from atheromas in carotids
  4. Thrombosis
  5. Giant cell arteritis
  6. Collagen-vascular disease
  7. Hypercoag. disorders
111
Q

S/S Retinal Artery Occlusion

A
  1. Acute persistent vision loss
  2. Visual acuity finger count to light perception
  3. H/O HA, weight loss, jaw claudication, scalp tenderness, fever, proximal joint pain
  4. H/O atrial fibrillation, endocarditis, coagulopathies, atherosclerotic disease
  5. Direct pressure to the globe or drug induced stupor
112
Q

Dx Retinal Artery Occlusion

A
  1. Whitening of the retina on the posterior pole
  2. Cherry red spot macula
    • APD
  4. Narrowed retinal arterioles
  5. Boxcaring or segmentation of the blood columns in the arterioles
113
Q

Tx Retinal Artery Occlusion

A

Tx underlying medical problems

114
Q

Retinal Vein Occlusion

A

Non-ischemic - milder

Ischemic

115
Q

Causes of retinal vein occlusion

A
  1. Atherosclerosis of the adjacent central retinal artery causing thrombosis
  2. HTN
  3. Optic disc edema
  4. Glaucoma
  5. Optic disc drusen
  6. Hypercoagulable states
  7. Vasculitis
  8. Drugs
116
Q

S/S Retinal Vein Occlusion

A
  1. Unilateral painless vision loss
117
Q

Dx Retinal Vein Occlusion

A
  1. Diffuse retinal hemorrhages, dilated, tortuous retinal veins
  2. Cotton-wool patches, disc edema, retinal hemorrhages, retinal edema, optociliary shunt vessels on the disc, neovascularization of the optic disc, retina and/or angle
  3. Intravenous fluorescein angiography
  4. Labs-FBS, HgbA1c, CBC with diff, platelets, PT/PTT, ESR, lipid profile, homocystine, ANA, FTA-ABS
  5. Medical eval CV disease and hypercoagulability
118
Q

Tx Central Retinal Vein Occlusion

A
  1. Chronic macular edema-focal laser or anti-VEGF intraocular injections
  2. Retinal neovascularization-panretinalphotocoagulation laser
119
Q

S/S Diabetic Retinopathy

A 
Non-proliferative
1. Venous dilation
2. Microaneurysms
3. Retinal hemorrhages
4. Edema
5. Hard exudates
6. Cotton-wool patches
Proliferative
7. Neovascularization
8. Hemorrhage in the vitreous body
9. May lead to retinal detachment
10. Fibrosis
120
Q

Dx Diabetic Retinopathy

A
  1. Based on history and funduscopic examination
  2. Optical coherence tomography scanning of the macula
  3. Fluorescein angiography
121
Q

Tx Diabetic Retinopathy

A
  1. Management of blood glucose, BP & lipids
  2. Yearly dilated eye examination
  3. Neovascularization of the retina and disc is treated with panphotocoagulation laser
  4. Neovascularization of the angle is treated with PRP laser, cryotherapy and/or topical glaucoma medications
  5. Macular edema use intraocular injectable
122
Q

Strabismus

A

Deviation from perfect ocular alignment

Congenital or defective nerves

123
Q

S/S Strabismus

A
  1. Diplopia
  2. Scotoma
  3. Amblyopia
  4. Abnormal eye movements
  5. Visual confusion
  6. Asthenopia (weakness or fatigue of the eyes with headache)
  7. Intermittent closure of the eye
  8. Cranial nerve palsy
124
Q

Dx Strabismus

A
  1. Full dilated eye examination with cycloplegics
  2. Cover test
  3. Forced duction testing
  4. MRI of bra if needed to r/o mass lesion
  5. CT chest if needed to r/o possible thyoma
  6. CT or MRI orbit if needed to orbital fracture, entrapment of extraocular muscle or tissue or Graves disease
125
Q

Tx Strabismus

A

Primary and secondary strabismus

  1. Correct refraction
  2. Treat amblyopia or diplopia
  3. Extraocular muscle surgery
  4. Chemodenerviation
  5. Over-minus prescription or occlusion

Paralytic and restrictive strabismus
1.Botulinum toxin injections

126
Q

What type of glaucoma is a medical emergency?

A

Acute Closure

127
Q

When is a cherry red spot macula seen?

A

Retinal Artery Occlusion

128
Q

Common organisms w/ otitis externa & sinusitis

A

aka swimmer’s ear

  1. Pseudomonas Sp.
  2. Enterobacteriaceae
  3. Proteus Sp
  4. Fungi sometimes

or contact dermatitis

129
Q

S/S otitis externa

A
  1. Pain in ear
  2. Tenderness w/ palpation of tragus/auricle
  3. Grayish discharge in canal
130
Q

What is otomycosis?

A

Fungal infection due to excessive use of abx

greenish drainage

131
Q

Tx otitis externa

A
  1. Abx drops - Quinolone
  2. Keep canal clean & dry

Maybe steroid & acetic acid

132
Q

Cause of otitis media

A
  1. Poor drainage from eustachian tubes
  2. Inflammation & edema
  3. Congenital deformity (Down’s)
    Most common in 4-24 months
133
Q

Organisms w/ otitis media

A
  1. S pneumoniae
  2. H. influenzae
  3. Moraxella catarrhais
  4. Strep pyogenes
  5. S. aureus
134
Q

S/S otitis media

A
  1. Fever (rare)
  2. Pressure
  3. Pain
  4. Hearing loss
  5. Immobile, erythematous, bulging TM
135
Q

Complications w/ otitis media

A
  1. TM rupture - otorrhea & dec. pain

2. Mastoiditis - spiking fevers, postauricular pain, erythema

136
Q

Tx otitis media

A

> 2 y/o or 6mo-2y/o w/o middle ear effusion - watch & wait for 48-72 hrs

If effusion/more severe Sx - Amoxicillin

If fever + otalgia - Amoxicillin + Clavulanate

137
Q

Choleseatoma Sx & Tx

A

Destruction & expanding growth of keratinizing squamous epithelium in the middle ear &/or mastoid process

Sx - discharge & hearing loss

Tx - Surgery

138
Q

What is barotrauma & cause?

A

inability to equalize barometric stress on the middle ear causing pain
Caused by auditory tube dysfunction from congenital narrowing or acquired mucosal edema

TM may rupture if not equalized

139
Q

Causes of conductive hearing loss

A
  1. Cerumen impaction
  2. Acute otitis externa
  3. Otosclerosis
  4. Otitis media
140
Q

What is the MCC of sensorineural hearing loss?

A

Presbycusis

High frequency hearing loss
May be assoc. w/ tinnitus

Tx - hearing aids

141
Q

Causes of vertigo

A
  1. Labyrinthitis
  2. Meniere’s disease
  3. Vestibular neuritis
  4. Obstructing anatomic abnormalities
  5. Brain stem vascular disease
  6. Arteriovenous malformations
  7. Tumors of the brain stem or cerebellum
  8. MS
  9. Vertebrobasilar migraine syndrome
142
Q

Benign Paroxysmal Position Vertigo Dx & Tx

A

Predicted type of vertigo in certain positions

Dx - Dix-Halpike maneuver

Tx - Epley maneuver

143
Q

Vestibular Neuritis Labyrinthitis Cause S/S & Tx

A

Viral/post-viral affecting the vestibular portion of the 8th nerve
Need thorough neuro exam
Worse w/ rolling over in bed & quick head turning
1. Severe persistent vertigo
2. N&V
3. Gait instability

Dx - Hallpike maneuver
Tx - Meclizine

144
Q

What should you consider in an old person w/ labryinthitis?

A

Cerebellar/posterior stroke

145
Q

Who gets malignant otitis externa & what do you need to get?

A

elderly/immunocompromised

Get CT to rule out osteomyelitis

146
Q

Herpes Zoster Oticus S/S

A

aka Ramsay Hunt Syndrome
CN VII

  1. Acute vertigo & hearing loss
  2. Facial paralysis
  3. Ear pain
  4. Vesicules in the auditory canal
147
Q

If a Pt has vertigo, what must you document?

A
  1. Chronic hearing loss
  2. Tinnitus
  3. Dizziness/vertigo

If yes to all 3 = Meniere’s

148
Q

Meniere’s disease S/S & Tx

A

Excess endolymphatic fluid pressure

  1. Hearing loss
  2. Tinnitus
  3. Vertigo
  4. N&V

Tx - diuretics & salt restriction

149
Q

Acoustic neuroma & Dx

A

aka vestibular shwannoma

More common in females

  1. Unilateral hearing loss
  2. Tinnitus
  3. Vertigo
  4. Ataxia
  5. Brain stem dysfunction

Dx - CT/MRI
TX- Surgery

150
Q

TM Perforation

A

Traumatic or w/ OM
Small ones heal in 4-6 wks
Large may need surgery

151
Q

Mastoiditis

A

Rare but serious
Tender in mastoid area
FEVER

152
Q

What it the most common nosebleed?

A

Anterior
From Keisselbach’s plexus

Causes:

  1. Trauma
  2. Irritation
  3. Low moisture
  4. Infection, allergy
  5. Foreign body
153
Q

Tx of posterior epistaxis

A

From Woodruff’s plexus

  1. Packing
  2. Surgery
  3. Embolization
154
Q

Tx of allergic rhinitis

A

Pale stringy mucus

  1. Antihistamine (Beclomethasone-spray, or benadryl)
  2. Steroid
  3. Avoid exposure
  4. Allergy testing
155
Q

Viruses assoc. w/ sinusitis

A

Usually follows a URI - usually viral

  1. Rhinovirus
  2. Parainfluenza virus
  3. Influenza
156
Q

S/S acute sinusitis

A
  1. Nasal drainage & congestion
  2. Facial pain or pressure worse w/ bending over
  3. HA
  4. Thick, purulent or discolored nasal discharge
  5. Cough
  6. Sneezing
  7. Fever

Tooth pain & halitosis may be bacterial

157
Q

When do you get a CT scan w/ sinusitis?

A

persistent, recurrent, or chronic sinusitis

158
Q

Tx of acute sinusitis

A

If 10 days, facial pain or fever = amoxicillin

Symptom Tx

159
Q

Complications of sinusitis

A
  1. Fungal in immunocompromised
    2 . Osteomyelitis
  2. Cavernous sinus thrombosis
  3. Orbital cellulitis
160
Q

Centor Criteria

A

For Dx acute pharyngitis

  1. Fever
  2. Tonsillar exudates
  3. NO cough
  4. Tender anterior cervcal chain LAN

0-1 = low possibility of strep - no abx
2 or + = RST but only Tx positive Pts
4 = Tx

161
Q

Organisms of pharyngitis

A

Viral more common - supportive Tx

  1. Rhinovirus
  2. Coronavirus
  3. Influenza
  4. Parainfluenza
  5. Adenovirus
  6. Herpes, Coxsackie, CMV, EBV
  7. S. pyogenes
  8. Group A Strep
162
Q

S/S pharyngitis

A
  1. Sore throat
  2. Difficulty swallowing
  3. Fever
  4. Erthema of tonsils & posterior pharynx
  5. LAD
  6. Rhinitis
  7. Cough
163
Q

Tx Strep

A

Penicillin/erythromicin

164
Q

When is strep most common?

A

Nov-Dec
April-May

Incubation 2-5 days

Once on abx for 24 hours, risk of transmission greatly dec.

165
Q

Secondary disorders from EBV

A
  1. HIV-related lymphomas
  2. Nasopharyngeal carcinoma
  3. Burkitt lymphoma
  4. Oral hairy leukoplakia
  5. Posttransplant lymphoproliferative disorder
166
Q

S/S mono

A
  1. Fever, sore throat
  2. Malaise, anorexia, myalgia
  3. LAD
  4. Transient bilateral upper-lid edema (Hoagland sign)
  5. Splenomegaly
  6. Maculopapular rash uncommon (15%), except in patients receiving ampicillin (90%)
  7. Exudative pharyngitis, uvular edema, tonsillitis, or gingivitis may occur and soft palatal petechiae may be noted
167
Q

Who commonly gets mono?

A

Age 10-35

168
Q

What is the common triad w/ nasal polyps?

A
  1. Nasal polyps
  2. Asthma
  3. ASA sensitivity
169
Q

Organisms of epiglottitis

A
  1. Group A strep
  2. Pneumococci
  3. Staph
  4. H. influenza
170
Q

S/S epiglottitis

A

Abrupt onset

  1. High fever
  2. Difficulty swallowing
  3. Sore throat
  4. Drooling
  5. Sitting in tripod/sniffing position in kids
  6. Stridor
  7. Hoarseness
  8. Neck tenderness
171
Q

Dx & Tx epiglottitis

A

Thumb sign X-ray, intubation
NO tongue depressor
IV fluids & abx, steroids
Prophylactic rifampin

172
Q

Peritonsillar abscess S/S & Tx

A

These areRED FLAGS for no sore throat

  1. Fever >39.4
  2. Severe unilateral pain
  3. Trismus
  4. Drooling
  5. Muffled “hot potato” voice

Tx - surgical drainage

173
Q

Laryngitis causes

A

Usually viral - sometimes bacterial

Chronic

  1. GERD
  2. Chronic sinusitis vocal strain
  3. EtOH
  4. Smoking
174
Q

Laryngitis S/S & Tx

A

Hoarseness, cough maybe

Voice rest & Tx underlying cause

175
Q

Sialadenitis Causes, S/S & Tx

A

Inflammation of salivary glands
Causes - Dehydration, poor oral hygiene

S - Painful welling redness, fever, purulent exudate

Tx - hydration, analgesics, abx

176
Q

Sialolithiasis

A

Calculi in salivary gland ducts
More common in Wharton duct
Must clamp duct so it doesn’t go back into gland
Shock wave therapy

177
Q

Parotitis Causes

A
  1. Mumps
  2. EBV
  3. CMV
  4. Influenza
  5. S. aureus
  6. Mixed oral flora

Bilateral firm, erythematous swelling
Elevated amylase but not lipase
Symptomatic Tx

178
Q

Aphthous ulcers

A

May be caused by HHV6

Topical steroids provide Sx relief

179
Q

Necrotizing gingivitis causes S/S & Tx

A
  1. Spirochetes
  2. Fusiform bacilli
  3. Acute gingival inflammation & necrosis
  4. Bleeding
  5. Halitosis
  6. Fever
  7. Cervical LAD

warm peroxide rinses & penicillin

180
Q

Leukoplakia

A

A white lesion that cannot be removed by rubbing the mucosal surface

181
Q

Erythroplakia

A

Similar to leukoplakia except that it has a definite erythematous component

182
Q

Oral Lichen Planus

A

Most commonly presents as lacy leukoplakia but may be erosive; definitive diagnosis requires biopsy

183
Q

Hairy leukoplakia

A

occurs on the lateral border of the tongue and is a common early finding in HIV infection

184
Q

Oral Cancer

A

SCC
Early lesions appear as leukoplakia or erythroplakia; more advanced lesions will be larger, with invasion into tongue such that a mass lesion is palpable. Ulceration may be present.

185
Q

What is a DDx of oral herpes simplex?

A

Hand, foot & mouth disease

186
Q

Oral candidiasis Risk Factors & Tx

A

aka thrush
Usually painful and looks like creamy-white curd-like patches overlying erythematous mucosa
Can be scraped off

  1. Dentures
  2. Debilitated & have poor oral hygiene
  3. Diabetics
  4. Anemics
  5. Pts doing chemo or radiation
  6. corticosteroids or broad-spectrum abx

Tx = fluconazole

187
Q

What is angular cheilitis & when is it seen?

A

Form of candidiasis seen w/ nutritional deficiencies

188
Q

S/S laryngeal CA

A
  1. New & persistent hoarseness in a smoker
  2. Persistent throat or ear pain, especially with swallowing
  3. Neck mass
  4. Hemoptysis
  5. Stridor or other symptoms of a compromised airway

Clinical Medicine (11 decks)

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