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NURP 532 > Week 2 Ophthalmology and ENT > Flashcards

Week 2 Ophthalmology and ENT Flashcards

1
Q

non painful red eye conditions

A

conjunctivitis (allergic, viral, bacterial, chemical)

dry eye syndrome

subconjunctival hemorrhage

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2
Q

If acute otitis media is associated with conjunctivitis, that’s commonly due to _____ bacteria. So treat with ____

A

haemophilius influenza

Amoxicillin clavulanate

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3
Q

Viral conjunctivitis key findings

A

Adenovirus

  • redness, itchy, swollen conjunctiva
  • tearing, clear watery discharge
  • fever, headache, anorexia, malaise
  • blepharitis
  • pharyngitis with enlarged preauricular nodes
  • concurrent URI
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4
Q

Adenoviral conjunctivitis management

A
  • Cool compresses
  • Lubricating drops
    • Good handwashing
    • avoid touching the eyes,
    • don’t share any towels
    • wash pillowcases
    • resolves in 1-2 weeks
    • NO prophylaxis antibiotics
  • Antihistamine ophthalmic for sx relief
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5
Q

If non responsive conjunctivitis in sexually active adults, suspect

A

chlamydial conjunctivitis

  • concurrent genital infection
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6
Q

Bacteria conjunctivitis key findings

A
  • Yellow - green purulent discharge
  • Encrusted and matted eyelid on awakening
  • injected conjunctiva
  • photophobia
  • petechiae on bulbar conjunctiva
  • normal vision
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7
Q

bacterial conjunctivitis: what organisms?

A

haemophilus influenzae, strep pneumoniae, and staph aureus.

H flu more common in children (dec-april)

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8
Q

Bacterial conjunctivitis: adult management vs children

A

adult: conservatively if not immunocompromised = observe or empiric antibiotic x 1 week
- if Chlam/gon = refer CDC

children: empiric (trimethoprim + polymyxin B sulfate ophthalmic soln, erythromycin 0.5% ointment to cover H influ),

Older children/teens = watch and wait! resolves in 1 week no matter what

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9
Q

Allergic conjunctivitis results from ____ and is associated with ___

A

igE mediated hypersensitivity

a/s with atopic disorders, asthma, atopic dermatitis, seasonal, perennial plant

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10
Q

allergic conjunctivitis sx’s and on exam

A
  • bilateral severe eye itching, teary
  • rhinitis
  • clear, white stringy mucoid discharge
  • teary boggy conjunctiva
  • allergic shriners/dark circles
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11
Q

allergic conjunctivitis management

A

Identify/avoid the allergen
Cold compresses and artificial tears
Oral antihistamines if systemic allergy sx’s

  • NO antibiotics/steroids
  • eye drops:
    • Ketotifen (antihistamine)
    • Patanol or Olopatadine (prescription); Used > 3 yrs old
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12
Q

how does chemical conjunctivitis occur

A

Benign: fumes, smoke, chlorine or toxic

  • if causes severe pain, vision disturbances = refer!
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13
Q

vernal conjunctivitis

A

type of allergic conjunctivitis
common in childhood and spring
bilateral
more severe

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14
Q

atopic conjunctivitis

A

common in >50 yrs old
bilateral itchy, burning, tearing
tx w mass stabilizer eye drop or refer

refer!

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15
Q

dry eye syndrome sx’s

A
  • foreign body sensation
  • scratchy gritty feeling stinging, tearing
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16
Q

what test to do for dry eye vs lacrimal problem? Explain.

A

schirmer test

assesses aqueous production. using filter paper and placing it in the inferior culdesac, measure tear production after 5 mins. < 5 mm = tear deficiency

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17
Q

dry eye management and treatment

A

Avoid causative medications
anticholinergics or diuretics
Avoid air conditioners or fans

1st line: preservative-free lubricants (OTC) if not work refer and cyclosporin rx

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18
Q

Subconjunctival hemorrhage

A
  • benign
  • from increased intrathoracic pressure (coughing sneezing, straining)
  • no pain
  • common in HTN or blood thinner pts
  • resolves in 2 weeks
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19
Q

what are ocular adnexal disorders? Name them.

A

disorders of structures that surround the eye

Blepharitis
Hordeolum (stye)
Chalazion
Nasolacrimal duct obstruction
Preseptal and orbital cellulitis

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20
Q

flakey, yellow scaly debris over eyelid margins on awakening

inflammation of eyelid or follicles

A

Blepharitis

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21
Q

blepharitis management (3)

A
  1. 1st line: warm compresses x 10 mins several times a day
  2. dilute baby shampoo with warm water and just cleanse the eyelid every day
  3. Topical antibiotic is only needed if due to a staph infection.
    usu resolves with conservative treatment.
    If it’s persistent or severe, doxycycline often not needed.
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22
Q

Define hordeolum (stye) and symptoms

A

Acute infection and inflammation of eyelid gland d/t to a blocked meibomian gland

Staph aureus

  • contact lens use
  • painful furuncle/nodules
  • NO injection, NO discharge, NO redness
  • foreign body sensation

resolves 1-2 weeks (ruptures from compresses or I&D)

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23
Q

Define chalazion and management

A

Chronic, inflammation of eyelid from lipogranuloma of meibomian

non-painful, non-infectious nodule; results from hordeolum

Warm compresses, gentle massage, weeks to resolve, I&D if persistent

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24
Q

Hordeolum vs Chalazion

A

chalazion results from a hordeolum

Chalazion: located AWAY from the eyelid margin, more firm, and it’s non-tender, deeper in eyelid

Hordeolum: closer to the eyelid margin

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25
Nasolacrimal duct obstruction (dacryostenosis) symptoms and management
* tearing, mucoid discharge * blepharitis * painful, tenderness/swelling over duct * elevated WBC from exudate manage: * Daily massage of the lacrimal duct. If it doesn't resolve by 12 months = refer for probing procedure. * ![]()
26
Complications from dacryostenosis (2)
Dacryocystitis (inflammation of duct = infection) ![]() I&D or systemic antibiotics Peri/orbital cellulitis
27
preseptal cellulitis aka periorbital cellulitis sx's and treatment
* **NOREFER!** * staph aureus * superficial infection * **NO** painful eye movement, eye is spared, no fever * infection that's **ANTERIOR** to orbital septum * tx \< 1 yrs: hospitalization, IV antibiotics * \>2 yrs: mild (no vision changes, eye moves, no ptosis): * oral amoxicillin, cefdinir, cefpodoxime 1-2 weeks * warm soaks 2-4 hrs x 15 mins * f/u 24 hrs
28
what is orbital cellulitis and how does it affect the eye?
* IMMEDIATE CT SCAN! Can go blind * severe infxn of soft tissue **POSTERIOR** to orbital septum * affects eye: PAIN with eye movement or restricted eye movement, chemosis, ptosis (late), dec visual acuity
29
Painful red eye conditions
* URGENT REFERRAL! * Severe eye pain * Loss of visual acuity * Loss pupillary reactivity * Hypopyon * Neutrophils and fibrin in anterior chamber * Hyphema * Blood in aqueous anterior chamber
30
pain, photophobia, conjunctiva hyperemia, hypopyon, cloudy appearance, pupil constriction, blurred vision, epiphora ciliary flush, pupil constriction
uveitis inflammation of middle layer (choroid, ciliary body, iris) ![]()
30
inflammation of cornea affecting visual acuity * can progress to corneal ulceration and blindness * Severe pain, foreign body * Photophobia * Erythema * Spasms of eyelid
keratitis
31
keratitis major risk factor and diagnostic
trauma: contact lens seen using a slit lamp, stained green with a fluorescent strip
32
Herpes zoster ophthalmicus's classic symptom is called \_\_\_
hutchinson sign lesion at tip/right side of nose (but absent does not r/o it) vesicular eruption along trigeminal nerve causing conjunctivitis ![]()
33
severe eye pain, tenderness, blurred vision, tearing, photophobia pain radiates into the brow bone or jaw occurs in autoimmune disorder disorders (uveitis, IBD, lupus)
**scleritis** inflammation of sclera
34
episcleritis superficial inflammation not painful, resolves w/o tx
35
severe pain, photophobia, decreased vision, disrupted tear film over corneal epithelium uses fluorescein stain (woods lamp) from trauma to eye like fingers, lens, airbags, job
corneal abrasion
36
corneal abrasion management
* topical antibiotic ointment. * ibuprofen * Eye patch does NOT improve healing but if must wear, max 24-48 hrs * Educate it’ll heal within 1-3 days. If not improving after 3 days, refer * if have these, refer: * purulent discharge, worsening eye pain, photophobia = refer !
37
Severe pain; nausea, vomiting; halos around lights; photophobia; conjunctival hyperemia; pupil mid-dilated and fixed; firm globe; shallow anterior chamber
acute angle closure glaucoma abrupt increase in intraocular pressure REFER!!!!
38
sudden onset of visual field defects, floaters, photopsia/flashing lights
retinal detachment refer! need surgery and NPO
39
1 eye, dyschromatopsia (abnormal color vision), pain with eye movement, vision loss worse with exercise and heat, central scotoma (blind spot in center) preceding viral infection objects appear curved
optic neuritis
40
optic neuritis management
REFER! IV then oral steriods brain MRI (demyelinating lesions for MS)
41
transient **monocular** loss of vision grey curtain peripheral vision 30 seconds
**amaurosis fugax** form plaque buildup in carotid artery refer! get cardio workup, assess carotid
42
otitis media risk factors
* allergies * upper respiratory infection * cleft palate * adenoid hypertrophy * tobacco exposure.
43
otitis media sx's
* ear pain * pulling at ear * fever (otitis externa has NO fever) * TM erythema and pain * worse when child lying down * otorrhea
44
mild vs severe otitis media
mild: \< 102.2F, sx's \< 48 hrs severe: \>102.fF, sx's \> 48 hrs
45
otitis media management
Pain control (Tylenol) Only treat **amoxicillin(-clavulanate) or cephalosporin** if healthy children (no Down S, cleft palate, tubes): * severe sx's \> 6 months, then f/u 48-72 hrs of onset of sx's * no severe sx's, \< 24 months, bilateral * if sx's persist after 48-72 hrs of sx onset DON'T treat if: * \< 24 months, no severe sx's, unilateral * \> 24 months, not severe sx's
46
Complications of otitis media
* mastoiditis (fever, pain behind ear, swelling posterior ear over mastoid process) * perforation of TM * otorrhea * effusion (fluid; hearing test if \> 3 months; refer if \> 6 months or hearing lost but watch and wait 48 hrs if mild) * **cholesteatoma** (cyst in ear; pearly white lesion = refer!)
47
acute otitis externa risk factors and sx's
inflammation of external canal aka swimmers ears * foreign bodies (q tips, ear buds) * sx's (pain when palpate tragus/auricle, otorrhea, fullness/clogged, hearing loss, intense itching) * TM normal * infection with edema, discharge, erythema * furuncles or small abscesses at hair follicles * infection of epidermis
48
otitis external differentials and treatment
* acute otitis media * TMJ because sometimes the pain can refer into the jaw. * fungal infection (uncommon) * tx (topical antibiotic drops)
49
Otitis externa education
* educate cerumen = protective mechanism * NO Q-tips * Keep their ears dry. * NO swimming or submerging their head until the infection has cleared. * Use hair dryer when they come out of the pool or shower = ears dry * If 1st episode, use earplug or cap when swimming * **improve in 5 to 7 days**. * come back if they're not improving or if their symptoms are worse
50
Persistent AOM vs Recurrent AOM
Persistent AOM: does not resolve when finished antibiotic therapy or recurs within days of treatment Recurrent AOM: 3 separates bouts of AOM w/in 6 month period or 4 within 12 month period * often positive hx of otitis media and other ENT dz
51
AOM with perforation treatment
if mild, wait and watch. Tylenol/motrin, hydration if no improvements within 48 hours, amoxicillin
52
Peripheral vertigo conditions
* benign paroxysmal vertical * vestibular neuritis * bacterial labryinthinis * viral * meniere's disease * neuroma
53
central vertigo conditions
* Brain stem PIA * Infarcts * Neurological tumors * Multiple Scerlosis * Basilar migraines or vestibular migraines * Cardiac - bradycardia, tachy, anemia, medications, toxins, hypotension
54
episodic dizziness/vertigo, triggered, nausea, nystagmus confirm with what test and what treatment
dix hall pike to confirm benign paroxysmal positional vertigo and treat with epley maneuver, meclizine, antiemetic refer to vestibular rehab if epley doesn't work
55
vestibular neuritis
viral or post inflammatory disorder affecting vestibular portion of 8th CN or from otitis media
56
persistent continuous vertigo/dizziness, occurs spontaneously, horizontal nystagmus, nausea/vomiting, instability gait, tinnitus what is it? & treatment?
vestibular neuritis 1st line: anticholinergics and antihistamines(Meclizine), antiemetics, vestibular rehab
57
episodic, spontaneous vertigo, unilateral hearing loss, unilateral tinnitus, ear fullness, nausea, vomiting
meniere's disease
58
meniere's disease management
excessive fluid putting pressure and swelling distorts sound and balance * referral to ENT * limit sodium, alcohol, caffeine * H1 receptor agonist (beta histamine, diuretics)
59
herpes zoster oticus (Ramsay Hunt) symptoms
herpes zoster activation affecting geniculate ganglion severe ear pain and vertigo, ipsilateral facial paralysis vesicles in auditory canal and auricle
60
Bell's palsy vs Ramsay hunt
both have ipsilateral facial paralysis and vessel in auditory canal/aurical as typical features BUT Ramsay hunt has severe ear pain and vertigo
61
labyrinthe concussion
from traumatic peripheral vestibular injury after concussion vertigo, n/v, imbalance, **hearing loss/issues**
62
vestibular neuritis vs labyrinthine concussion
labyrinthine has hearing loss vestibular neuritis has tinnitus but hearing intact
62
vestibular neuritis vs labyrinthine concussion
labyrinthine has hearing loss
63
vertigo, migraine, h/a, photophobia, nausea photophobia
vestibular migraine
64
What does the HINTS exam do?
diagnose vestibular neuritis vs stroke in pt with hrs/days of ongoing vertigo and nystagmus 1. nystagmus 2. vertigo skew test 3. head impulse (want rapid movement in both eyes = vestibular neuritis)
65
yellow raised growth on conjunctiva -usu on side near nose; deposit of fat, protein, calcium
pinguecula from UV (sun), wind, dust wear sunglasses, glasses/goggles
66
growth of fleshy tissue (blood vessels) that may start as pinguecula
pterygium from UV (sun), wind, dust wear sunglasses, glasses/goggles
67
corneal arcus
blue or gray crescent shape (arc) made of lipid (fatty) deposits that curves around the outer edges of the cornea of the eye. from high blood pressure, high cholesterol, and atherosclerosis

NURP 532 (13 decks)

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