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CPD > Week 3 > Flashcards

Week 3 Flashcards

1
Q

How do you check near vision?

A

Rosenbaum chart at 14”

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2
Q

How do you check far vision?

A

Snellen chart at 20’

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3
Q

What does PERRLA mean?

A

Pupils are Equal Round and Reactive to Light

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4
Q

DDx: Vision loss (unilateral, gradual, painful)

A

neoplastic, inflammatory disease

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5
Q

DDx: Vision loss (unilateral/bilateral, gradual, painless)

A

refractive errors, cataracts, macular degeneration, glaucoma, diabetic retinopathy, compressive optic neuropathy, genetics (Leber’s optic atrophy, Forster-Fuchs ret spot), drugs (hydroxychloroquine, methanol, COX2 inhibitors, ethambutol), toxic agents (organophosphates), chronic eye strain (close work, excessive computer use)

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6
Q

What is hyperopia?

A

farsightedness

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7
Q

What is the most common refractive error?

A

hyperopia

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8
Q

What is myopia?

A

nearsightedness

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9
Q

What is astigmatism?

A

refraction is unequal in different meridians of the eye

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10
Q

What refractive error is often present at birth?

A

astigmatism

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11
Q

What causes astigmatism?

A

cornea or lens has a different surface curvature than the other

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12
Q

What is presbyopia?

A

slow loss of ability to see close object or small print

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13
Q

What is photophobia?

A

abnormal visual intolerance of light

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14
Q

Etiology: photophobia

A

eye infx, eye injury, conjunctivitis, allergies, uveitis, iritis, keratitis, acute glaucoma, cataracts, migraine, foreign body abrasion, ulcer

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15
Q

What is a scotoma?

A

area of partial or complete blindness within an otherwise normal or slightly impaired visual field, “blind spot”

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16
Q

What is a negative scotoma?

A

blind spot in visual field, not perceptible by patient

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17
Q

What is a positive scotoma?

A

blind spot perceived as a dark spot

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18
Q

What is a scintillating scotoma?

A

irregular outline around a luminous patch in the visual field following mental/physical work, eyestrain, migraine prodrome (visual aura)

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19
Q

What are floaters?

A

deposits of various size, shape, consistency, refractive index, and motility within the vitreous humor; appear as spots, threads, or cobwebs

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20
Q

How are floaters visible?

A

floaters cast shadows on the retina when light passes through them

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21
Q

What is myodesopsia?

A

the perception of floaters

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22
Q

Etiology: floaters

A

embryonic origin, degenerative changes of vitreous humor or retina

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23
Q

What is hemianopsia?

A

blindness or decreased vision in half of visual field of one or both eyes

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24
Q

What is homonymous hemianopsia?

A

same side of both eyes, ~30 minutes, loses pupillary reflexes, usually optic tract problem

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25
Q

What is crossed hemianopsia?

A

oppositie side, often at level of pituitary gland

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26
Q

What is quadrant hemianopsia?

A

level of brain, pupil reflex present as optic tract not affected

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27
Q

Etiology: dry eyes

A

aging, drugs (antihistamines, nasal decongestants), eye surgery, malpositioned eyes, climate, vitamin A deficiency, chemical burn

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28
Q

What is keratoconjunctivitis sicca?

A

bilateral dryness of eyes from lack of tears

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29
Q

Population: keratoconjunctivitis sicca

A

adult females

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30
Q

What is dacryoadenitis?

A

enlarged lacrimal gland on upper lateral aspect of eye

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31
Q

What is dacryocystitis?

A

inflammation of the lacrimal sac

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32
Q

Etiology: dacryocystitis

A

secondary to obstruction of nasolacrimal duct

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33
Q

Population: dacryocystitis

A

infants

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34
Q

Sx: dacryocystitis

A

tenderness, swelling, redness of lacrimal gland; may express pus from sac

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35
Q

What is dacryostenosis?

A

congenital narrowed lacrimal duct in neonates

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36
Q

Prognosis: dacryostenosis

A

usually resolves in 6 months

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37
Q

Sx: dacryostenosis

A

excess tearing, possible pus expressed

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38
Q

What is ectropion?

A

eyelid turns outward

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39
Q

Etiology: ectropion

A

tissue relaxation with aging, edema, spasming in MS

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40
Q

Sx: dacryoadnitis

A

tender lacrimal gland, red if acute, painless if chronic, possible abscess

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41
Q

What is entropion?

A

inversion of the eyelid

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42
Q

Entropion can lead to ____

A

corneal ulceration and scarring

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43
Q

What is a chalazion (meibomian cyst)?

A

chronic enlargement of meibomian gland

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44
Q

Morphology: chalazion

A

onset: painless stye, chronic: BCC or SCC; cyst found in the eyelid

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45
Q

Etiology: chalazion

A

infx and occlusion of meibomian gland duct, often following inflammation of the gland

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46
Q

Prognosis: chalazion

A

usually resolves within 2 months

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47
Q

What is an internal hordeolum?

A

acute inflammation of meibomian gland

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48
Q

Comparison (severity): internal vs external hordeolum

A

internal hordeolum are usually more severe

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49
Q

What is an external hordeolum?

A

acute, localized infection/inflammation of eyelid margin involving sebaceous gland near hair follicles of cilium; “stye”

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50
Q

Etiology: external hordeolum

A

staph. aureus (90-95%)

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51
Q

Population: external hordeolum

A

kids

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52
Q

Sx: external hordeolum

A

pain, redness, tenderness of lid margin, small/round induration, lacrimation, photophobia, foreign body sensation, pustule on lid margin

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53
Q

Prognosis: external hordeolum

A

rupture and spontaneously healing

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54
Q

Comparison (resolution): internal vs external hordeolum

A

external - rupture, spontaneous healing

internal - rupture is rare, recurrence is common, abscess can form

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55
Q

What is blepharitis?

A

inflammation of lid margins

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56
Q

What systemic conditions are associated with blepharitis?

A

rosacea, seborrheic dermatitis, allergic/contact dermatitis, ocular dz (keratitis, Sjogren’s, dry eye syndromes, chalazion, trichiasis, conjunctivitis)

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57
Q

Comparison (Sx): blepharitis caused by seborrheic dermatitis and rosacea

A

seborrheic dermatitis - scalp itching, flaking, oily skin

rosacea - rhinophyma, facial flushing, broken/distended vessels in face, pustules, oily skin, eye irritation

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58
Q

PE: blepharitis

A

loss of lashes, whitening of lashes, scarring/misdirection of lashes, crusting of lashes and meibomian orifices, eyelid margin ulcers, plugging/”pouting” of meibomian orifices, telangiectasia, lid irregularity

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59
Q

PE (corneal findings): blepharitis

A

punctate epithelial erosions, marginal infiltrates, marginal ulcers

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60
Q

What is madarosis?

A

loss of lashes

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61
Q

What is poliosis?

A

whitening of lashes

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62
Q

What is trichiasis?

A

scarring/misdirection of lashes

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63
Q

What is tylosis?

A

lid irregularity

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64
Q

Keratoconjunctivitis sicca can occur in conjunction with what systemic diseases?

A

rheumatoid arthritis, SLE, Sjogren’s

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65
Q

What are the two main causes of “red eye”?

A

hemorrhage of conjunctival vessels and injection (congestion of vessels)

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66
Q

Etiology: hemorrhage of conjunctival vessels

A

minor trauma (straining, sneezing, coughing)

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67
Q

Sx: hemorrhage of conjunctival vessels

A

red sclera, painless, does not affect vision

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68
Q

Age: hemorrhage of conjunctival vessels

A

any age

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69
Q

What are the two types of red eye caused by injection?

A

conjunctival (common) and ciliary (less common)

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70
Q

Comparison (Sx): conjunctival vs ciliary injection

A

conjunctival - blanch w/ pressure, fade toward iris

ciliary - doesn’t blanch w/ pressure, fade toward periphery

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71
Q

What is the most common etiology for acute conjunctivitis?

A

allergic

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72
Q

Predisposing factors: acute conjunctivitis

A

irritation from wind, dust, smoke, air pollution, common cold, measles, corneal irritation, welding arcs, reflection from snow

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73
Q

Sx: acute conjunctivitis

A

usu bilateral, superficial dilated vessels (conjunctival injection)

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74
Q

If acute conjunctivitis is unilateral, ___

A

toxic, chemical, mechanical and/or lacrimal etiologies should be suspected

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75
Q

PE: acute conjunctivitis

A

normal intraocular pressure, PERRLA, normal vision (unless exudate clouds eye)

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76
Q

Acute allergic conjunctivitis often recurs when?

A

spring/summer, often concomitant with hay fever

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77
Q

Sx: acute allergic conjunctivitis

A

bilateral swelling of conjunctiva and lids, pale conjunctiva with visible blood vessels, pruritus, clear/watery discharge

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78
Q

PE: acute allergic conjunctivitis

A

preauricular adenopathy is absent, chemosis common, discharge - clear, thin, stringy, sparse to moderate, injection is moderate, eosinophilic Wright stain

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79
Q

Chronic allergic conjunctivitis may be misdiagnosed as ____

A

dry eye syndrome

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80
Q

Comparison (Sx): acute vs chronic allergic conjunctivitis

A

chronic - velvety projections on palpebral conjunctiva, photophobia

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81
Q

Etiology: giant papillary conjunctivitis

A

autoimmune response to pt’s own protein or to trauma of contact lens wear

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82
Q

Sx: giant papillary conjunctivitis

A

excessive pruritus, mucous production, intolerance to contacts

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83
Q

PE: giant papillary conjunctivitis

A

inflamed conjunctiva, thick d/c, giant papillae usu on upper palpebral conjunctiva (cobblestone granulations)

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84
Q

Comparison (Sx): chronic allergic conjunctivitis vs giant papillary conjunctivitis

A

chronic - velvety projections on palpebral conjunctiva, giant papillary - papillae on palpebral conjunctiva

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85
Q

Etiology: viral conjunctivitis

A

adenovirus, esp. when associated with keratitis (epidemic keratoconjunctivitis - EKC)

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86
Q

Sx: viral conjunctivitis

A

pruritus, clear/thin/watery d/c, occ severe photophobia/foreign-body sensations

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87
Q

PE: viral conjunctivitis

A

pre-auricular adenopathy is common in EKC and herpes; chemosis - variable; d/c - mod to sparse/thin/seropurulent; injection - mod to marked; concomitants - sore throat, nasal d/c (rhinitis); lymphoid follicles on underside of eyelid

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88
Q

Comparison (PE): acute allergic conjunctivitis vs viral conjunctivitis

A

acute - pre-auricular LA absent, chemosis common
viral - pre-auricular LA present, chemosis variable, concomitants
d/c similar

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89
Q

Recurrent HSV conjunctivitis infxs usually take the form of ____

A

dendritic keratitis - raised lesion of the cornea, nodules at terminal end of each “branch”

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90
Q

Location: HSV conjunctivitis

A

cornea (herpes keratitis)

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91
Q

Comparison (PE): acute allergic vs viral vs HSV conjunctivitis

A

HSV usually is unilateral, allergic/viral bilateral

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92
Q

Sx (early): HSV conjunctivitis

A

foreign-body sensation, lacrimation, photophobia, conjunctival injection

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93
Q

DDx: patient experiences foreign-body sensations or photophobia with conjunctivitis

A

viral or HSV conjunctivitis

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94
Q

Sx (late): HSV conjunctivitis

A

anesthesia of cornea and dendritic keratitis lesion, ulceration and permanent corneal scarring, loss of vision/blindness

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95
Q

What is diagnostic for HSV conjunctivitis?

A

anesthesia of cornea and dendritic keratitis lesion

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96
Q

Triggers: HSV conjunctivitis

A

fever, stress, sunlight, trauma, immunosuppression (HIV, DM), zoster (shingles), oral/genital herpes

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97
Q

Etiology: bacterial conjunctivitis

A

staph and strep are most common pathogens

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98
Q

What can predispose you to bacterial conjunctivitis?

A

ocular surface dz (keratitis sicca, trichiasis, chronic blepharitis)

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99
Q

Sx: bacterial conjunctivitis

A

acute onset, minimal pain, occ pruritus

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100
Q

PE: bacterial conjunctivitis

A

pre-auricular LA sometimes, chemosis - common, d/c - thick, copious, purulent, injection - mod to marked

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101
Q

Comparison (PE): acute vs chronic bacterial conjunctivitis

A

chronic may produce little to no d/c exc crusting of eyelashes

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102
Q

Comparison (PE): acute allergic vs viral vs acute bacterial conjunctivitis

A

allergic, viral - thin, clear stringy d/c, mod to sparse

bacterial - thick, purulent, copius

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103
Q

Sx: neisseria gonorrhea (adults)

A

rare, 12-48 hr incubation, severe/purulent d/c, usu unilateral, lid edema

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104
Q

Sx: neisseria gonorrhea (neonate)

A

2-5 days after birth, purulent d/c, lid edema

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105
Q

Complications: neisseria gonorrhea (adult)

A

corneal ulceration, abscess, perforation, blindness

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106
Q

What is retinitis pigmentosa?

A

hereditary, slowly progressive, bilateral retinal degeneration

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107
Q

Sx: retinitis pigmentosa

A

loss of photoreceptors, blindness, night blindness/peripheral vision loss in early childhood, central island of vision constricts over time

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108
Q

What is the leading cause of visual loss in the elderly?

A

macular degeneration

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109
Q

Population: macular degeneration

A

more common in whites than blacks

110
Q

Sx: macular degeneration

A

slow/sudden, painless loss of central visual acuity

111
Q

Etiology: chlamydia trachomatis

A

exposure to genital secretions

112
Q

PE: chlamydia trachomatis

A

pre-auricular LA is occ, chemosis - rare, scant/seropurulent d/c, mod injection

113
Q

What is a pinguecula?

A

benign raised bumps under conjunctiva

114
Q

What is a pterygium

A

conjunctival thickening

115
Q

Comparison: pinguecula vs pterygium

A

pterygium can invade/grow over the cornea, affecting vision; pinguecula will not grow onto the cornea

116
Q

What is band keratopathy?

A

calcified plaques at 2, 5, 7, 10 o’clock of limbus

117
Q

Etiology: band keratopathy

A

hypercalcemia, 2nd to kidney dz

118
Q

What is arcus senilis?

A

whitish deposits around limbus, usu in elderly

119
Q

When might arcus senilis be seen in younger people?

A

those w/ hyperlipoproteinemia

120
Q

What is preseptal (periorbital) cellulitis?

A

inflammation/infx of eyelid and surrounding skin anterior to orbital septum

121
Q

Population: periorbital cellulitis

A

common in kids

122
Q

Etiology: periorbital cellulitis

A

trauma, infx spreading from nasal sinus/tooth, insect bite, bacteremia, conjunctivitis, chalazion, sinusitis

123
Q

Sx: periorbital cellulitis

A

tenderness/swelling/warmth/redness of eyelid

124
Q

Prognosis: periorbital cellulitis

A

typically mild, visual acuity not affected, complications rare

125
Q

What is hyphema?

A

hemorrhage into anterior chamber from trauma

126
Q

What is orbital cellulitis?

A

infx of orbital tissues (fat/muscle) posterior to orbital septum

127
Q

Etiology: orbital cellulitis

A

extension of infx from ethmoid sinus (~90%), local trauma, infx on face or teeth

128
Q

Sx: orbital cellulitis

A

swelling/redness of eyelid, proptosis, extreme orbital pain (unilateral), pain with movement, decreased motility, conjunctival hyperemia/chemosis, decreased visual acuity

129
Q

DDx: symptoms of orbital cellulitis with accompanying fever, malaise, HA

A

meningitis

130
Q

Outcomes: orbital cellulitis

A

EMERGENCY, retinal artery/vein thrombosis, increased intraocular pressure, retinal damage, brain abscess, meningitis, cavernous sinus thrombosis

131
Q

Comparison (Sx): periorbital vs orbital cellulitis

A

orbital - severe orbital pain, decreased visual acuity

132
Q

The longer the history of DM, the greater the risk for ___

A

diabetic retinopathy

133
Q

Sx (early): diabetic retinopathy

A

venous dilation, small/red/well-demaracated lesions, macular edema

134
Q

Sx (late): diabetic retinopathy

A

soft exudates (cotton-wool spots), microinfarcts, hard white-yellow exudates due to chronic edema, tortuous retinal neovascularization

135
Q

Refer (emergency) for diabetic retinopathy if ___

A

blurred vision develops over 2 days not assoc with elevated glucose, sudden loss of vision (unilateral/bilateral), black spots, cobwebs, flashing lights in vision field

136
Q

Sx: chlamydia trachomatis (neonate)

A

chemosis, mucopurulent d/c, bilateral, no corneal damage

137
Q

What is chemosis?

A

edema of the mucous membrane of the eyelid

138
Q

What is conductive hearing loss?

A

hearing loss due to physical/mechanical problems which limit movement of the sound wave through the ear

139
Q

Etiology: conductive hearing loss

A

obstructed ear canal, perforated ear canal/TM, dislocated ossicle, otitis media/externa, otosclerosis, congenital, cholesteatoma

140
Q

What is sensorineural hearing loss?

A

hearing loss due to damage to the hair cells or nerves that sense sound waves

141
Q

Etiology: sensorineural hearing loss

A

acoustic trauma, barotrauma (pressure trauma), head trauma, otoxic drugs (cocaine, ASA, antibiotics), vascular dz, kidney problems, Meniere dz, acoustic neuroma, infx, aging, MS

142
Q

What is presbycusis?

A

age-related hearing loss (progressive, bilateral)

143
Q

What is subjective tinnitus?

A

sound audible to patient only

144
Q

Etiology: subjective tinnitus

A

acoustic trauma, barotrauma, presbycusis, CNS tumors, Eustachian tube dysfunction, Meniere dz, obstruction, emotional, drugs

145
Q

What is objective tinnitus?

A

sound audible to both patient and doctor

146
Q

Is objective tinnitus usually bilateral or unilateral?

A

bilateral

147
Q

If objective tinnitus is unilateral, rule out ____

A

tumor (CT)

148
Q

Etiology: objective tinnitus

A

AV malformations, monoclonus, turbulent flow, tumor

149
Q

In a work-up for tinnitus, check for ___

A

carotid artery bruits, HTN, signs of bruxism, myofascial spasms, paraspinal/SCM spasms, TMJ dysfunction

150
Q

What are the two types of vertigo?

A

subjective (impression is “moving in space”) and objective (impression is “objects are moving”)

151
Q

What is trachoma?

A

chronic infx of cornea and conjunctiva caused by chlamydia

152
Q

Population: trachoma

A

preschool children, ages 3-5

153
Q

Sx: trachoma

A

often asymptomatic, bilateral mucopurulent keratoconjunctivitis, photophobia, eyelid edema, lacrimation, pain, follicles in upper eyelid

154
Q

PE: trachoma

A

follicular/inflammatory response on conjunctival surface of upper eyelid, limbal follicles on cornea, superior neovascularization, punctate keratitis

155
Q

What is the most common cause of corneal ulcer?

A

HSV

156
Q

Etiology: corneal ulcer

A

HSV, HZV, contacts, injury, steroids, bacterial infx

157
Q

What is Hutchinson’s sign?

A

vesicular eruptions on tip of nose in ophthalmic herpes zoster infx

158
Q

Sx: corneal ulcer

A

erythema of eyelid/conjunctiva, foreign body sensation, photophobia, mucopurulent d/c, blurred vision, pain

159
Q

Sx: UV keratitis

A

foreign-body sensation, irritation, pain, photophobia, tearing, blepharospasm, decreased visual acuity

160
Q

PE: UV keratitis

A

diffuse staining with fluorescein dye (loss of epithelium), lid edema

161
Q

What is acute uveitis?

A

inflammation of one or all parts of uveal tract (iris, ciliary body, choroids)

162
Q

Population: acute uveitis

A

adults, 20-50

163
Q

Etiology: acute uveitis

A

systemic dz (sarcoidosis, Reiter’s syndrome, infx, ankylosing spondylitis), idiopathic

164
Q

What is Reiter’s syndrome?

A

triad of arthritis, urethritis, conjunctivitis

165
Q

Acute uveitis can be classified one of three ways. What are they and which is the most dangerous?

A

anterior, intermediate, posterior (most dangerous)

166
Q

Sx: anterior uveitis

A

unilateral, painful ciliary flush, blurred vision, photophobia, tearing

167
Q

Sx: intermediate uveitis

A

painless, floaters, blurred vision

168
Q

Sx: posterior uveitis

A

blurred vision, floaters, eye pain, photophobia

169
Q

What are the two types of cataracts?

A

developmental and degenerative

170
Q

Sx: cataracts

A

decreased visual acuity, increased glare, no red reflex

171
Q

Sx: acute closed-angle glaucoma

A

peri-orbital pain, visual deficits, boring pain, ipsilateral HA, blurry vision,

172
Q

Population: acute closed-angle glaucoma

A

elderly, hyperopic

173
Q

PE: acute closed-angle glaucoma

A

medial crescent shadow, increased cup/disc ratio, increased IOP and ischemia, corneal/scleral injection, cloudy cornea

174
Q

DDx: acute closed-angle glaucoma

A

conjunctivitis, acute iritis

175
Q

Why is acute closed-angle glaucoma an emergency?

A

blindness can occur quickly due to pressure on optic nerve

176
Q

What accounts for 90% of all glaucoma cases?

A

chronic open-angle glaucoma

177
Q

Sx: chronic open-angle glaucoma

A

may be none, progressive peripheral vision loss, late loss of central vision

178
Q

What is the most common etiology for retinal detachment?

A

posterior vitreous detachment

179
Q

Sx: retinal detachment

A

painless, dark/irregular floaters, flashes of light, progressive blurred vision, no redness

180
Q

What is grade 1 hypertensive retinopathy?

A

narrowing of terminal branches of retinal arteries, straightening

181
Q

What is grade 2 hypertensive retinopathy?

A

general narrowing with signs of AV compression

182
Q

What is grade 3 hypertensive retinopathy?

A

grade 2 + hemorrhaging and soft exudates

183
Q

What is grade 4 hypertensive retinopathy?

A

grade 3 + hard exudates

184
Q

What are names for vascular changes?

A

copper wire, silver wire, AV nicking, humping, banking, tapering

185
Q

What is tympanosclerosis?

A

sclerosis of the TM, from chronic OM or post T-tube

186
Q

PE: tympanosclerosis

A

whitish plaques on TM

187
Q

What is otosclerosis?

A

genetic metabolic bone dz, leading to bone overgrowth at stapes/oval window

188
Q

Population: otosclerosis

A

F > M, more common in whites, 15-35 yo most commonly

189
Q

SSx: otosclerosis

A

progressive hearing loss, tinnitus, usu bilateral

190
Q

What is acute mastoiditis?

A

suppurative infx of the mastoid air cells

191
Q

Population: mastoiditis

A

young children, 6-13 yo

192
Q

what is the most common etiology for mastoiditis?

A

strep. pneumoniae

193
Q

SSx: mastoiditis

A

redness/swelling/tenderness behind ear, fever, hearing loss, profuse creamy ear d/c, throbbing pain

194
Q

PE: mastoiditis

A

erythema/tenderness/edema over mastoid area, post-auricular fluctuance, protrusion of auricle

195
Q

Complications: mastoiditis

A

abscess, CN 7 palsy, hearing loss, osteomyelitis, meningitis, venous sinus thrombosis

196
Q

SSx: cholesteatoma

A

painless otorrhea, conductive hearing loss, dizziness uncommon

197
Q

PE: cholesteatoma

A

canal filled with muco-pus and granulation tissue, TM perforation in > 90% of cases

198
Q

What is a cholesteatoma?

A

keratinizing squamous epithelium in middle ear and mastoid process

199
Q

What is myringitis?

A

inflammation/infx of TM

200
Q

SSx: myringitis

A

serosanguinous otorrhea, otalgia, fever, hearing impairment, sudden onset in acute

201
Q

PE: myringitis

A

vesicles on the TM in bullous form

202
Q

What is true vertigo?

A

true rotation movement of self or surroundings, most common classification of vertigo

203
Q

SSx: true vertigo

A

patient moving, postural instability, worse with head movements, nausea/vomiting, sweating, nystagmus

204
Q

Comparison (nystagmus): peripheral vs central vertigo

A

peripheral - unidirectional, horizontal w/ rotation

central - any direction

205
Q

Comparison (other neuro signs): peripheral vs central vertigo

A

peripheral - absent

central - present (ataxic gait, diplopia, slurred speech)

206
Q

Comparison (postural instability): peripheral vs central vertigo

A

peripheral - unidirectional instability, walking preserved

central - severe instability

207
Q

Comparison (hearing loss/tinnitus): peripheral vs central vertigo

A

peripheral - may be present

central - absent

208
Q

What is non-vertigo?

A

syncope, fainting, or sensation of impending fainting

209
Q

With non-vertigo, lightheadedness suggests _____ of the brain

A

hypoperfusion

210
Q

With non-vertigo, disequilibrium occurs only ___

A

when standing or walking

211
Q

Vertigo lasting hours or days probably caused by ____

A

Meniere dz or vestibular neuronitis

212
Q

Vertigo of sudden onset lasting minutes can be due to ___

A

brain or vascular dz

213
Q

What are RED FLAG concomitants when doing a PE for vertigo?

A

head/neck pain, ataxia, LOC, focal neurological deficit

214
Q

What tests are included in a work-up for vertigo?

A

general exam, otological exam, extraocular movements, hearing tests, sensory exam, vestibular imbalance

215
Q

What are RED FLAG concomitants for an earache?

A

diabetes, redness/pain over mastoid, severe swelling of canal meatus, chronic pain with head/neck symptoms

216
Q

Etiology: acute ear d/c

A

acute OM with TM perforation, serous OM, CSF leak from head trauma, OE, post-tympanostomy tube

217
Q

Etiology: chronic ear d/c

A

cancer of ear canal, cholesteatoma, chronic purulent OM, foreign body, mastoiditis, necrotizing OE, Wegener’s granulomatosis

218
Q

Diagnostic Criteria: AOM

A

acute onset AND middle ear effusion (bulging TM), limited/absent mobility of TM, air/fluid level behind TM AND SSx of middle ear inflammation (red TM, otalgia)

219
Q

Diagnostic Criteria: persistent AOM

A

persistent features of middle ear infx during antibiotic treatment OR relapse within one month of treatment completion

220
Q

Diagnostic Criteria: OME

A

fluid behind TM in absence of features of acute infx

221
Q

Diagnostic Criteria: COME

A

persistent fluid behind intact TM in absence of acute infx

222
Q

Diagnostic Criteria: CSOM

A

persistent inflammation of middle ear or mastoid cavity, recurrent/persistent otorrhea through perforated TM

223
Q

SSx: CSOM

A

hearing loss, chronic purulent d/c, painless

224
Q

PE: CSOM

A

perforation of TM, retraction pocket,

225
Q

DDx: CSOM

A

OE, cholesteatoma, myringitis, chronic mastoiditis, impacted cerumen, tympanosclerosis, Wegener granulomatosis

226
Q

Etiology: CSOM

A

acute OM w/ perforation, trauma, Eustachian tube blockage

227
Q

What is CSOM?

A

chronic inflammation of middle ear persisting at least 6 weeks with TM perforation and otorrhea

228
Q

What is OME?

A

effusion in the middle ear w/o infx

229
Q

SSx: OME

A

hearing impairment, mild otalgia, may have overlapping symptoms with common cold

230
Q

PE: OME

A

amber/gray TM, retracted or neutral; impaired mobility of TM, bubbles/air/fluid behind TM, chronic cervical LA

231
Q

What is the 1st and 2nd most common dz of childhood?

A

1st - URI, 2nd - AOM

232
Q

What are common bacterial etiologies for AOM?

A

S. pneumoniae, H. influenzae, M. catarrhalis

233
Q

Risk factors: AOM

A

daycare, bottle-feeding, smoker in household, FHx

234
Q

SSx: AOM

A

throbbing pain (or NO pain), fever, decreased hearing, nausea/vomiting, moodiness, irritability, dizziness, d/c if rupture of TM

235
Q

PE: AOM

A

bulging, red/cloudy TM, decreased mobility of TM

236
Q

What is perichondritis?

A

decreased blood supply to the ear cartilage d/t trauma/insect bites

237
Q

SSx: COE

A

pruritus, redness, d/c

238
Q

PE: COE

A

pinna/tragus pain, irritated external canal, TM usu not affected

239
Q

Etiology: COE

A

psoriasis, seborrheic dermatitis, eczema, allergies, fungus

240
Q

PE: AOE

A

pinna/tragus ttp, external canal red/swollen, fever, LA possible, TM is normal

241
Q

Pseudomonas infx in AOE produces ____

A

purulent green/yellow otorrhea

242
Q

Aspergillus infx in AOE looks like ____

A

fine white mat topped by black spheres

243
Q

Etiology: AOE

A

infx, swimming, forceful cleaning, trauma

244
Q

SSx: AOE

A

pruritus, otalgia, d/c, loss of hearing

245
Q

Etiology: Meniere dz

A

increase in volume/pressure of endolymph

246
Q

Age/Gender: Meniere dz

A

early to mid-adulthood, M=F

247
Q

SSx: Meniere dz

A

SN hearing loss, tinnitus, isolated attacks of vertigo

248
Q

What is a Tumarkin crisis?

A

severe vertigo of Meniere dz causing collapse

249
Q

Is Meniere dz usu bilateral or unilateral?

A

unilateral

250
Q

DDx: Meniere dz

A

migrain, labryinthitis, OM, SA hemorrhage, transient ischemic attack, acoustic neuroma, hypothyroidism, MS, ischemic stroke, salicylate toxicity, vestibular neuritis

251
Q

What is acoustic neuroma?

A

benign, slow-growing tumor derived from Schwann cells of CN VIII

252
Q

SSx: acoustic neuroma

A

unilateral, progressive SN hearing loss, HA, vertigo, tinnitus, facial numbness

253
Q

Consider any unilateral SN hearing loss an ____ until proven otherwise

A

acoustic neuroma

254
Q

What type of antibiotic can create bilateral vestibular damage?

A

aminoglycoside

255
Q

What is BPPV?

A

abnormal sensation of motion elicited by certain positions

256
Q

Pathophysiology: BPPV

A

canalithiasis - particles in canal of SCC, free-floating

cupolithiasis - particles in ampulla of SCC, not free-floating

257
Q

PE: BPPV

A

Dix-Hallpike maneuver standard for BPPV

258
Q

SSx: BPPV

A

sudden onset of vertigo, dizziness attacks triggered by head movements

259
Q

What is vestibular neuritis?

A

benign, self-limiting disorder of vestibular nerve

260
Q

SSx: vestibular neuritis

A

acute vertigo NOT assoc with hearing loss

261
Q

What often precedes vestibular neuritis and viral labrynthitis?

A

URI

262
Q

PE: vestibular neuritis

A

horizontal nystagmus, gait instability, NO hearing loss

263
Q

Comparison (bilateral/unilateral): meningitis vs otogenic infxs

A

meningitis - bilateral, otogenic - unilateral

264
Q

What condition is now rare in the post-antibiotic era?

A

bacterial labryinthitis

265
Q

SSx: viral labryinthitis

A

sudden unilateral hearing loss and vertigo, n/v

266
Q

Population: viral labrynthitis

A

30-60, rarely children

267
Q

PE: viral labrynthitis

A

spontaneous nystagmus toward normal side, hearing loss

268
Q

SSx: herpes zoster oticus (Ramsay-Hunt syndrome)

A

deep/burning/auricular pain followed by eruption of vesicular rash in external auditory canal and concha; vertigo/hearing loss/facial weakness follows

269
Q

What is caloric testing for vertigo?

A

cold water into external canal produces tonic eye deviation to side of cold water with simultaneous horizontal nystagmus to opposite side

270
Q

Positive caloric test

A

if asymmetry is > 20% with affected ear producing less severe/less prolonged nystagmus

CPD (8 decks)

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