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CPD I > The Ear and Eye > Flashcards

The Ear and Eye Flashcards

1
Q

Types of hearing loss (2)

A
  1. Conductive hearing loss - from (physical/mechanical) problems that limit the movement of the sound wave through the external and middle ear.
  2. Sensorineural hearing loss - damage in the inner ear or nerves that sense sound.
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2
Q

What can cause conductive hearing loss?

A
  1. Obstructed external ear canal
  2. Perforated tympanic membrane
  3. Dislocated ossicle
  4. Otitis media
  5. Otitis externa
  6. Osteosclerosis
  7. Congenital
  8. Cholesteatoma - squamous epithelial overgrowth
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3
Q

What can cause sensorineural hearing loss?

A
  1. Acoustic trauma - exposure to loud noises
  2. Barotrauma - pressure trauma
  3. Head trauma
  4. Ototoxic drugs
  5. Infection
  6. Aging
  7. Acoustic neuroma
  8. SSNHL - unilateral hear loss over 72hrs
  9. Meniere dz - hearing loss, vertigo and tinnitus
  10. Vascular dz
  11. MS
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4
Q

What are the two types of tinnitus?

A

Subjective - most common, audible only to pt, due to damage of fine hair cells.
Objective - rare, can be heard with stethoscope over pt’s ear due to vascular issues.

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5
Q

What are the two types of vertigo?

A

Subjective - pt has the impression they are moving

Objective - pt feels that objects are moving around them

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6
Q

True vertigo

A

Sensation of movement caused by asymmetry in the vestibular system.

Peripheral vertigo - labyrinth or CN VIII
Central vertigo - cerebellum, vestibular cortex in temporal lobe

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7
Q

Non-vertigo

A

Lightheadedness - hypoperfusion of the brain

Disequilibrium - only feel unsteady when they are walking

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8
Q

Work-up for vertigo

A

Hx: Onset (sudden or gradual), Duration (episodic or long-lasting)
PE: general exam, otological exam, extraocular movements (H in space test), hearing tests, proprioception, vestibular imbalance

RED FLAG: head or neck pain, ataxia, loss of consciousness, focal neurological deficit

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9
Q

Ear pain

A

Otalgia
Causes: external (impacted cerumen or foreign body, local trauma, otitis externa), middle (eustacian tube obstruction, OM, neoplasms), referred pain from TMJ, wisdom teeth, local infection, tumors, neuralgia

RED FLAG: DM, immunocompromised, red or pain over mastoid, severe swelling, chronic pain

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10
Q

Ear discharge

A

Otorrhea
Acute d/c causes: otitis media with TM perforation, post-tympanostomy tube, otitis externa
Chronic d/c causes: cancer, cholesteatoma, chronic purulent OM, foreign body, mastoiditis

RED FLAG: same as otalgia

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11
Q

Acute otitis externa (AOE)

A

Etiology: infections, swimmer’s ear, forceful cleaning of the ear, trauma
S/Sx: itching, pain, ,discharge possible, loss of hearing
PE: pinna and tragus painful when pressed or tugged on, TM is normal, fever, LA

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12
Q

Chronic otitis externa (COE)

A

Etiology: often follows psoriasis, seborrheic dermatitis, eczema, allergy, fungus
S/Sx: same as AOE
PE: same as AOE but tragus and pinna may be less painful

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13
Q

Perichondritis

A

Etiology: trauma, insect bites

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14
Q

Tumors

A

Etiology: sebaceous cysts, gouty deposits, BCC, SCC

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15
Q

Acute otitis media (AOM)

A

Etiology: infection
S/Sx: pain, fever, dec hearing, moodiness, irritability
PE: bulging red TM, no visual of bony landmarks
Complications: progresses to OME, bilateral infection can lead to hearing loss and speech development issues, mastoiditis, rupture of the TM

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16
Q

Otitis media with effusion (OME)

A

fluid behind TM, may be unresolved AOM or inflammation

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17
Q

Chronic OM with effusion (COME)

A

S/Sx: hearing impairment, mild otalgia, overlapping sx of common cold
PE: amber or gray, TM is intact bubbles or air/fluid level may be seen, chronic cervical LA

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18
Q

Chronic suppurative otitis media (CSOM)

A

Chronic inflammation of the middle ear that persists at least 6 wks with TM perforation and otorrhea
Etiology: AOM, trauma
S/Sx: hearing loss, chronic purulent d/c, painless

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19
Q

Cholesteatoma

A

Growth of keratinizing squamous cell epithelium that invades the inner ear
Etiology: congenital, primary acquired, secondary acquired
S/Sx: painless otorrhea, either unremitting or frequently recurrent, conductive hearing loss

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20
Q

Myringitis

A

Inflammation or infection of the TM.
Etiology: primary and secondary causes
S/Sx: serosanguinous otorrhea, otalgia, hearing impairment, if acute: sudden onset of ear pain that lasts 24-48hrs

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21
Q

Acute mastoiditis

A

Suppurative infection in the mastoid air cells
Etiology: complication of severe AOM
S/Sx: redness, swelling, tenderness behind ear, fever, hearing loss, profuse creamy ear d/c, throbbing pain
PE: bulging TM, tenderness, postauricular fluctuance
REFER!! Serious complication

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22
Q

Ostosclerosis

A

Genetic metabolic bone dz affecting otic capsule and ossicles, leads to overgrowth of footplate in stapes/dysfunction
S/Sx: progressive bilateral, hearing loss and tinnitus

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23
Q

Tympanosclerosis

A

Sclerosis of the TM from COM that leads to stiffening of the TM and impaired conductive hearing
S/Sx: progressive hearing loss
PE: whitish plaques on TM

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24
Q

Viral labyrinthitis

A

URI precedes the onset of sx in up to 50% of cases, sudden unilateral hearing loss and severe vertigo, assoc. with nausea and vomiting. Age 30-60 most common
Etiology: potentially Herpes Zoster Oticus
PE: spontaneous nystagmus towards the normal side with diminished or absent caloric response.

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25
Q

Bacterial labyrinthitis

A

Bacterial infection of the inner ear. Can further develop into meningitis.
S/Sx: vertigo, ataxia, hearing loss, N/V

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26
Q

Vestibular neuritis

A

Benign and temporary disorder of the vestibular nerve with vertigo but NO hearing loss. URI precedes. Self-limiting.
S/Sx: sudden acute vertigo without hearing loss in an otherwise healthy patient.

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27
Q

Benign paroxysmal positional vertigo (BPPV)

A

Sudden vertigo elicited by provocative positions, triggering nystagmus. 90% of the time it is due to posterior semicircular canal canalithiasis.
Etiology: major surgery, caffeine, alcohol, CNS dz, etc.
S/Sx: sudden onset, very sudden sx but usually dissipate within 20-30s. N/V.
PE: Full work-up with Dix-Hallpike maneuver - considered pathognomonic

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28
Q

Acoustic neuroma

A

Benign, slow-growing tumor derived from Schwann cells of CN VIII.
S/Sx: Consider ANY unilateral sensorineural hearing loss an acoustic neuroma until proven otherwise. May present with vertigo, tinnitus, HA in 50-60%, facial numbness in 25%.

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29
Q

Meniere disease

A

Increase in volume and pressure of the endolymph in the inner ear canals.
Age: middle-aged
S/Sx: Triad (SN hearing loss, tinnitus, vertigo), prodrome with a sense of fullness in one ear, tinnitus followed by a decrease in hearing, vertigo that lasts min to hours and possibly days (Tumarkin crises - severe vertigo attack that they fall to the ground), HA, gait unsteadiness.
PE: complete neurological exam

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30
Q

Toxic vestibulopathy

A

Toxic agent ingestion that is toxic to the vestibular structures of the ear.

31
Q

Errors of Refraction

A

Vision is becoming blurry
Hyperopia (far-sightedness) - most common; distant objects are clear, and close-up objects are blurry
Myopia (near-sightedness) - faraway objects will appear blurry
Astigmatism - refraction is unequal in different meridians of the eye; cornea has a slightly different curvature.
Presbyopia - slow loss of ability to see close objects or small print. With age, the lens becomes less pliable.

32
Q

Scotoma

A

Area of partial or complete blindness usually within the central 30-degree area. From damage to nerve fiber layer in retina.
“Scintillating scotoma” - an irregular outline around a luminous patch in the visual field following mental or physical work, eyestrain, or a migraine prodrome.

33
Q

Hemianopsia

A

Blindness or decreased vision in half of visual field of one or both eyes.
Homonymous - same side, both eyes. Usually optic tract problem
Crossed - opposite side, often pituitary problem
Quadrant - level of brain, pupil reflex present as optic tract not affected.

34
Q

Hemorrhage of conjunctival vessels

A

Sclera gets very red; due to minor trauma - straining, sneeze or cough; not painful, no vision change, not pathologically sig.

35
Q

Injection

A

Congestion of vessels
Conjunctival - common, peripheral, brick-red, tortuous superficial vessels that fade toward the iris; move with conjunctiva; usually assoc. with allergies, etc. Blanches.
Ciliary - less common, violet or rose colored; fine, straight, deep vessels that radiate out from iris and fade towards the periphery, doesn’t blanch.

36
Q

Acute allergic conjuctivitis

A

Recurs in spring and lasts through summer.

S/Sx: sudden, mild to moderate bilateral severe swelling of conjunctiva and lids, pruritus is common

37
Q

Chronic allergic conjunctivitis

A

Non-seasonal, little evidence of inflammation but itching, burning and photophobia are present.

38
Q

Giant papillary conjunctivitis

A

Allergy to soft contact lenses; may be slow to develop
S/Sx: excessive pruritus, mucous production, increasing intolerance to contact use
PE: inflamed conjunctiva, sticky discharge, worse in morning

39
Q

Viral conjunctivitis

A

Usually adenovirus, common lasts 1-2wks.
S/Sx: pruritus, minimal pain; clear, thin, watery discharge is typical. Occasionally severe photophobia and foreign-body sensation occurs, usually caused by adenovirus when assoc. with keratitis.

40
Q

Herpes simplex virus conjunctivitis

A

Affects only 1 eye, most often occurs on the cornea which results in herpes kereatitis. Recurring infection takes form in dendritic keratitis.
S/Sx: EARLY: foreign body sensation, lacrimation, photophobia. LATE: anesthesia of cornea and dendritic keratitis lesion. Assoc with immunocompromised pts

41
Q

Bacterial conjunctivitis

A

Staph and Strep are the most common.
S/Sx: acute onset, minimal pain
PE: preauricular adenopathy; chemosis is common

42
Q

Neisseria gonorrhea

A

Adult - rare, 12-48hr incubation, severe purulent discharge, usually unilateral, lids swollen
Neonate - purulent discharge, 2-5 days after birth, may be severe lid edema

43
Q

Chlamydia trachomatis

A

Adult - swimming pool with infected individuals

Neonatal - exposure during birth

44
Q

Trachoma

A

Endemic to Africa, Asia, Middle East, Latin America, Pacific Islands, Australia
S/Sx: often asymptomatic, bilateral, photophobia, lacrimation, pain 7-10d follicles develop in upper lid

45
Q

Pinguecula

A

Harmless slight raised bumps, fatty deposits under the conjunctiva on the nasal side

46
Q

Pterygium

A

Conjunctival thickening from chronic inflammation from wind, dust. Often distinct triangular lesion which may grow over cornea and affect vision.

47
Q

Corneal trauma

A

Etiology: foreign body and/or abrasion
S/Sx: pain, photophobia, spasm
PE: evert lid to inspect for foreign body, check cornea for damage, check PERRLA

48
Q

Corneal ulcer

A

Etiology: HSV most common, contact lens, trauma, VZV

S/Sx: erythema of eyelid and conjunctiva, foreign body sensation, photophobia, pain, blurred vision

49
Q

Band keratopathy

A

Hard, white calcified plaques at 2, 5, 7, 10 o’clock of limbus. May be secondary to kidney dz

50
Q

Arcus senilis

A

Whitish deposits around limbus, usually in the elderly. May be related to hyperlipoproteinemia

51
Q

UV Keratitis

A

Etiology: exposure to UV lights, welding arcs, radiation to the corneal epithelium is cumulative
S/Sx: onset of foreign body sensation, irritation, pain, photophobia, tearing
PE: diffuse staining with fluorescein dye

52
Q

Acute uveitis

A

Inflammation of the uveal tract most common in adults’
Anatomically classified:
1) anterior, ciliary body, or both
2) intermediate
3) posterior, rare, serious
Etiology: underlying systemic dz, may be idiopathic
S/Sx: anterior uveitis - acute unilateral, painful ciliary flush, blurred vision, photophobia. Intermediate - painless, floaters, blurred vision
Posterior - blurred vision, floaters, eye pain, RA, Sjorgren’s
PE: 360 peri-limbal injection which increases in intensity as it approaches the limbus

53
Q

Cataract

A

Opacity of the lens with painless, progressive, gradual visual loss.
Etiology: developmental - juvenile, congenital or early life from poor diet. Degenerative - senile degeneration, DM, x-ray, cortisone
S/Sx: decreased visual acuity, increased glare, no red reflex

54
Q

Acute closed angle glaucoma

A

EMERGENCY
Etiology: mechanical blockage of outflow channels, drugs
S/Sx: elderly, hyperopic, hx of glaucoma. Most commonly present with peri-orbital pain and visual deficits, ipsilateral HA, Halos
PE: blurred vision, can see movement but not letters or numbers, increased IOP, pain upon movement

55
Q

Chronic open angle glaucoma

A

NO red eye
90% of all glaucoma; caused by a malfunction of the drainage system
Etiology: decreased rate of flow, bilateral, genetic predisposition
S/Sx: gradual loss of peripheral vision, can lead to blindness

56
Q

Hyphema

A

hemorrhage into anterior chamber from trauma, danger of recurrent bleeding which may cause glaucoma and visual loss

57
Q

Preseptal cellulitis

A

Inflammation/infection of eyelid and surrounding skin anterior to the orbital septum
Etiology: trauma, infection
S/Sx: tenderness, swelling warmth, redness of eyelid
Typically mild condition. Difficult to distinguish from ???

58
Q

Orbital cellulitis

A

EMERGENCY
Infection of the orbital tissues posterior to the orbital septum. Common in kids
Etiology: infection from ethmoid sinus
S/Sx: swelling, redness of eyelid and surrounding tissues, proptosis, extreme orbital pain, conjunctival hyperemia and chemosis, decreased visual acuity, fever, malaise, HA

59
Q

Exopthalomos

A

bulging of the eyes, also known as proptosis

Etiology: orbital inflammation, edema, injuries, hyperthyroid, leukemia, meningioma

60
Q

Retinal detachment

A

EMERGENCY
Etiology: trauma, diabetes, inflammatory disorder, posterior vitreous detachment
S/Sx: painless, dark irregular floaters, flashes of light, blurred vision, curtain over field of vision

61
Q

Posterior vitreous detachment

A

With age, the vitrious gel can collapse and pull forward

S/Sx: painless, floaters, flashes of light. Might see a “rice ring”

62
Q

Macular degeneration

A

Leading cause of visual loss in the elderly from a hemorrhagic disturbance in the macular region of the eye.
S/Sx: slow or sudden, painless loss of central visual acuity

63
Q

Diabetic retinopathy

A

Major cause of blindness in diabetics
S/Sx: early - venous dilation and small, red well demarcated lesions. Late - soft exudates caused by anoxia, or hard yellow exudates
REFER if suddenly develops

64
Q

Hypertensive retinopathy

A

Vascular changes with extent and persistence of hypertension.

1) copper wire - brightening and widening of central strip artery
2) silver wire - central light reflex is entire width of arteriole from thickened walls
3) AV nicking - arteriole crossing venule, thickened arteriole walls compress and obscure the vein
4) Hemorrhages
5) Soft exudates - fuzzy, gray-white, irregular borders
6) Hard exudates - well defined yellow-white deposits
7) Papilledema

65
Q

Retinitis pigmentosa

A

Inherited, slowly progressive, bilateral, retinal degeneration. Loss of photoreceptors and blindness.

66
Q

Blepharitis

A

Inflammation of the lid margins causing irritation, itching, occasionally red eye
S/Sx: eye irritation, itching and erythema of the lids, lacrimation, photophobia, blurred vision, crusting and matting of eyelashes
PE: loss of lashes, whitening of lashes, scarring and misdirection of lashes, crusting of the lashes and meibornian orifices, lid irregularity

67
Q

Hordeolum (external)

A

A stye. Localized infection or inflammation of the eyelid margin involving a sebaceous gland
S/Sx: begins with pain, redness, tenderness of lid margin followed by small, round, tender, induration. Lacrimation, photophobia, foreign body sensation, pustule on lid margin, ruptures and heals spontaneously

68
Q

Hordeolum (internal)

A

Acute inflammation of meibomian gland, usually more severe.

S/Sx: pain, redness, edema more localized, abscess can form.

69
Q

Entropion

A

Lid inversion, lid area atrophic or scarred, then lashes grow inward, causing irritation, blepharospasm, may lead to corneal ulceration and scarring

70
Q

Ectropion

A

Lid turns outward, tissue relaxation with aging, leads to poor drainage of tear, excess tearing, redness, irritation

71
Q

Dacryoadenitis

A

Enlarged lacrimal gland on upper lateral aspect of eye. Tender, red if acute; painless if chronic. Can abscess.

72
Q

Dacryocystitis

A

Inflammation of the lacrimal sac, usually secondary to obstruction of nasolacrimal duct, tenderness, swelling, redness; may express pus from sac

73
Q

Dacryostenosis

A

Congenital narrowed lacrimal duct in neonate; excess tearing, may be pus expresses, usually resolves in 6mo.

CPD I (7 decks)

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