Week 3 Flashcards
1
Q
How do you check near vision?
A
Rosenbaum chart at 14”
2
Q
How do you check far vision?
A
Snellen chart at 20’
3
Q
What does PERRLA mean?
A
Pupils are Equal Round and Reactive to Light
4
Q
DDx: Vision loss (unilateral, gradual, painful)
A
neoplastic, inflammatory disease
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)
6
Q
What is hyperopia?
A
farsightedness
7
Q
What is the most common refractive error?
A
hyperopia
8
Q
What is myopia?
A
nearsightedness
9
Q
What is astigmatism?
A
refraction is unequal in different meridians of the eye
10
Q
What refractive error is often present at birth?
A
astigmatism
11
Q
What causes astigmatism?
A
cornea or lens has a different surface curvature than the other
12
Q
What is presbyopia?
A
slow loss of ability to see close object or small print
13
Q
What is photophobia?
A
abnormal visual intolerance of light
14
Q
Etiology: photophobia
A
eye infx, eye injury, conjunctivitis, allergies, uveitis, iritis, keratitis, acute glaucoma, cataracts, migraine, foreign body abrasion, ulcer
15
Q
What is a scotoma?
A
area of partial or complete blindness within an otherwise normal or slightly impaired visual field, “blind spot”
16
Q
What is a negative scotoma?
A
blind spot in visual field, not perceptible by patient
17
Q
What is a positive scotoma?
A
blind spot perceived as a dark spot
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)
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
20
Q
How are floaters visible?
A
floaters cast shadows on the retina when light passes through them
21
Q
What is myodesopsia?
A
the perception of floaters
22
Q
Etiology: floaters
A
embryonic origin, degenerative changes of vitreous humor or retina
23
Q
What is hemianopsia?
A
blindness or decreased vision in half of visual field of one or both eyes
24
Q
What is homonymous hemianopsia?
A
same side of both eyes, ~30 minutes, loses pupillary reflexes, usually optic tract problem
25
What is crossed hemianopsia?
oppositie side, often at level of pituitary gland
26
What is quadrant hemianopsia?
level of brain, pupil reflex present as optic tract not affected
27
Etiology: dry eyes
aging, drugs (antihistamines, nasal decongestants), eye surgery, malpositioned eyes, climate, vitamin A deficiency, chemical burn
28
What is keratoconjunctivitis sicca?
bilateral dryness of eyes from lack of tears
29
Population: keratoconjunctivitis sicca
adult females
30
What is dacryoadenitis?
enlarged lacrimal gland on upper lateral aspect of eye
31
What is dacryocystitis?
inflammation of the lacrimal sac
32
Etiology: dacryocystitis
secondary to obstruction of nasolacrimal duct
33
Population: dacryocystitis
infants
34
Sx: dacryocystitis
tenderness, swelling, redness of lacrimal gland; may express pus from sac
35
What is dacryostenosis?
congenital narrowed lacrimal duct in neonates
36
Prognosis: dacryostenosis
usually resolves in 6 months
37
Sx: dacryostenosis
excess tearing, possible pus expressed
38
What is ectropion?
eyelid turns outward
39
Etiology: ectropion
tissue relaxation with aging, edema, spasming in MS
40
Sx: dacryoadnitis
tender lacrimal gland, red if acute, painless if chronic, possible abscess
41
What is entropion?
inversion of the eyelid
42
Entropion can lead to ____
corneal ulceration and scarring
43
What is a chalazion (meibomian cyst)?
chronic enlargement of meibomian gland
44
Morphology: chalazion
onset: painless stye, chronic: BCC or SCC; cyst found in the eyelid
45
Etiology: chalazion
infx and occlusion of meibomian gland duct, often following inflammation of the gland
46
Prognosis: chalazion
usually resolves within 2 months
47
What is an internal hordeolum?
acute inflammation of meibomian gland
48
Comparison (severity): internal vs external hordeolum
internal hordeolum are usually more severe
49
What is an external hordeolum?
acute, localized infection/inflammation of eyelid margin involving sebaceous gland near hair follicles of cilium; "stye"
50
Etiology: external hordeolum
staph. aureus (90-95%)
51
Population: external hordeolum
kids
52
Sx: external hordeolum
pain, redness, tenderness of lid margin, small/round induration, lacrimation, photophobia, foreign body sensation, pustule on lid margin
53
Prognosis: external hordeolum
rupture and spontaneously healing
54
Comparison (resolution): internal vs external hordeolum
external - rupture, spontaneous healing
| internal - rupture is rare, recurrence is common, abscess can form
55
What is blepharitis?
inflammation of lid margins
56
What systemic conditions are associated with blepharitis?
rosacea, seborrheic dermatitis, allergic/contact dermatitis, ocular dz (keratitis, Sjogren's, dry eye syndromes, chalazion, trichiasis, conjunctivitis)
57
Comparison (Sx): blepharitis caused by seborrheic dermatitis and rosacea
seborrheic dermatitis - scalp itching, flaking, oily skin
| rosacea - rhinophyma, facial flushing, broken/distended vessels in face, pustules, oily skin, eye irritation
58
PE: blepharitis
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
59
PE (corneal findings): blepharitis
punctate epithelial erosions, marginal infiltrates, marginal ulcers
60
What is madarosis?
loss of lashes
61
What is poliosis?
whitening of lashes
62
What is trichiasis?
scarring/misdirection of lashes
63
What is tylosis?
lid irregularity
64
Keratoconjunctivitis sicca can occur in conjunction with what systemic diseases?
rheumatoid arthritis, SLE, Sjogren's
65
What are the two main causes of "red eye"?
hemorrhage of conjunctival vessels and injection (congestion of vessels)
66
Etiology: hemorrhage of conjunctival vessels
minor trauma (straining, sneezing, coughing)
67
Sx: hemorrhage of conjunctival vessels
red sclera, painless, does not affect vision
68
Age: hemorrhage of conjunctival vessels
any age
69
What are the two types of red eye caused by injection?
conjunctival (common) and ciliary (less common)
70
Comparison (Sx): conjunctival vs ciliary injection
conjunctival - blanch w/ pressure, fade toward iris
| ciliary - doesn't blanch w/ pressure, fade toward periphery
71
What is the most common etiology for acute conjunctivitis?
allergic
72
Predisposing factors: acute conjunctivitis
irritation from wind, dust, smoke, air pollution, common cold, measles, corneal irritation, welding arcs, reflection from snow
73
Sx: acute conjunctivitis
usu bilateral, superficial dilated vessels (conjunctival injection)
74
If acute conjunctivitis is unilateral, ___
toxic, chemical, mechanical and/or lacrimal etiologies should be suspected
75
PE: acute conjunctivitis
normal intraocular pressure, PERRLA, normal vision (unless exudate clouds eye)
76
Acute allergic conjunctivitis often recurs when?
spring/summer, often concomitant with hay fever
77
Sx: acute allergic conjunctivitis
bilateral swelling of conjunctiva and lids, pale conjunctiva with visible blood vessels, pruritus, clear/watery discharge
78
PE: acute allergic conjunctivitis
preauricular adenopathy is absent, chemosis common, discharge - clear, thin, stringy, sparse to moderate, injection is moderate, eosinophilic Wright stain
79
Chronic allergic conjunctivitis may be misdiagnosed as ____
dry eye syndrome
80
Comparison (Sx): acute vs chronic allergic conjunctivitis
chronic - velvety projections on palpebral conjunctiva, photophobia
81
Etiology: giant papillary conjunctivitis
autoimmune response to pt's own protein or to trauma of contact lens wear
82
Sx: giant papillary conjunctivitis
excessive pruritus, mucous production, intolerance to contacts
83
PE: giant papillary conjunctivitis
inflamed conjunctiva, thick d/c, giant papillae usu on upper palpebral conjunctiva (cobblestone granulations)
84
Comparison (Sx): chronic allergic conjunctivitis vs giant papillary conjunctivitis
chronic - velvety projections on palpebral conjunctiva, giant papillary - papillae on palpebral conjunctiva
85
Etiology: viral conjunctivitis
adenovirus, esp. when associated with keratitis (epidemic keratoconjunctivitis - EKC)
86
Sx: viral conjunctivitis
pruritus, clear/thin/watery d/c, occ severe photophobia/foreign-body sensations
87
PE: viral conjunctivitis
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
88
Comparison (PE): acute allergic conjunctivitis vs viral conjunctivitis
acute - pre-auricular LA absent, chemosis common
viral - pre-auricular LA present, chemosis variable, concomitants
d/c similar
89
Recurrent HSV conjunctivitis infxs usually take the form of ____
dendritic keratitis - raised lesion of the cornea, nodules at terminal end of each "branch"
90
Location: HSV conjunctivitis
cornea (herpes keratitis)
91
Comparison (PE): acute allergic vs viral vs HSV conjunctivitis
HSV usually is unilateral, allergic/viral bilateral
92
Sx (early): HSV conjunctivitis
foreign-body sensation, lacrimation, photophobia, conjunctival injection
93
DDx: patient experiences foreign-body sensations or photophobia with conjunctivitis
viral or HSV conjunctivitis
94
Sx (late): HSV conjunctivitis
anesthesia of cornea and dendritic keratitis lesion, ulceration and permanent corneal scarring, loss of vision/blindness
95
What is diagnostic for HSV conjunctivitis?
anesthesia of cornea and dendritic keratitis lesion
96
Triggers: HSV conjunctivitis
fever, stress, sunlight, trauma, immunosuppression (HIV, DM), zoster (shingles), oral/genital herpes
97
Etiology: bacterial conjunctivitis
staph and strep are most common pathogens
98
What can predispose you to bacterial conjunctivitis?
ocular surface dz (keratitis sicca, trichiasis, chronic blepharitis)
99
Sx: bacterial conjunctivitis
acute onset, minimal pain, occ pruritus
100
PE: bacterial conjunctivitis
pre-auricular LA sometimes, chemosis - common, d/c - thick, copious, purulent, injection - mod to marked
101
Comparison (PE): acute vs chronic bacterial conjunctivitis
chronic may produce little to no d/c exc crusting of eyelashes
102
Comparison (PE): acute allergic vs viral vs acute bacterial conjunctivitis
allergic, viral - thin, clear stringy d/c, mod to sparse
| bacterial - thick, purulent, copius
103
Sx: neisseria gonorrhea (adults)
rare, 12-48 hr incubation, severe/purulent d/c, usu unilateral, lid edema
104
Sx: neisseria gonorrhea (neonate)
2-5 days after birth, purulent d/c, lid edema
105
Complications: neisseria gonorrhea (adult)
corneal ulceration, abscess, perforation, blindness
106
What is retinitis pigmentosa?
hereditary, slowly progressive, bilateral retinal degeneration
107
Sx: retinitis pigmentosa
loss of photoreceptors, blindness, night blindness/peripheral vision loss in early childhood, central island of vision constricts over time
108
What is the leading cause of visual loss in the elderly?
macular degeneration
109
Population: macular degeneration
more common in whites than blacks
110
Sx: macular degeneration
slow/sudden, painless loss of central visual acuity
111
Etiology: chlamydia trachomatis
exposure to genital secretions
112
PE: chlamydia trachomatis
pre-auricular LA is occ, chemosis - rare, scant/seropurulent d/c, mod injection
113
What is a pinguecula?
benign raised bumps under conjunctiva
114
What is a pterygium
conjunctival thickening
115
Comparison: pinguecula vs pterygium
pterygium can invade/grow over the cornea, affecting vision; pinguecula will not grow onto the cornea
116
What is band keratopathy?
calcified plaques at 2, 5, 7, 10 o'clock of limbus
117
Etiology: band keratopathy
hypercalcemia, 2nd to kidney dz
118
What is arcus senilis?
whitish deposits around limbus, usu in elderly
119
When might arcus senilis be seen in younger people?
those w/ hyperlipoproteinemia
120
What is preseptal (periorbital) cellulitis?
inflammation/infx of eyelid and surrounding skin anterior to orbital septum
121
Population: periorbital cellulitis
common in kids
122
Etiology: periorbital cellulitis
trauma, infx spreading from nasal sinus/tooth, insect bite, bacteremia, conjunctivitis, chalazion, sinusitis
123
Sx: periorbital cellulitis
tenderness/swelling/warmth/redness of eyelid
124
Prognosis: periorbital cellulitis
typically mild, visual acuity not affected, complications rare
125
What is hyphema?
hemorrhage into anterior chamber from trauma
126
What is orbital cellulitis?
infx of orbital tissues (fat/muscle) posterior to orbital septum
127
Etiology: orbital cellulitis
extension of infx from ethmoid sinus (~90%), local trauma, infx on face or teeth
128
Sx: orbital cellulitis
swelling/redness of eyelid, proptosis, extreme orbital pain (unilateral), pain with movement, decreased motility, conjunctival hyperemia/chemosis, decreased visual acuity
129
DDx: symptoms of orbital cellulitis with accompanying fever, malaise, HA
meningitis
130
Outcomes: orbital cellulitis
EMERGENCY, retinal artery/vein thrombosis, increased intraocular pressure, retinal damage, brain abscess, meningitis, cavernous sinus thrombosis
131
Comparison (Sx): periorbital vs orbital cellulitis
orbital - severe orbital pain, decreased visual acuity
132
The longer the history of DM, the greater the risk for ___
diabetic retinopathy
133
Sx (early): diabetic retinopathy
venous dilation, small/red/well-demaracated lesions, macular edema
134
Sx (late): diabetic retinopathy
soft exudates (cotton-wool spots), microinfarcts, hard white-yellow exudates due to chronic edema, tortuous retinal neovascularization
135
Refer (emergency) for diabetic retinopathy if ___
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
Sx: chlamydia trachomatis (neonate)
chemosis, mucopurulent d/c, bilateral, no corneal damage
137
What is chemosis?
edema of the mucous membrane of the eyelid
138
What is conductive hearing loss?
hearing loss due to physical/mechanical problems which limit movement of the sound wave through the ear
139
Etiology: conductive hearing loss
obstructed ear canal, perforated ear canal/TM, dislocated ossicle, otitis media/externa, otosclerosis, congenital, cholesteatoma
140
What is sensorineural hearing loss?
hearing loss due to damage to the hair cells or nerves that sense sound waves
141
Etiology: sensorineural hearing loss
acoustic trauma, barotrauma (pressure trauma), head trauma, otoxic drugs (cocaine, ASA, antibiotics), vascular dz, kidney problems, Meniere dz, acoustic neuroma, infx, aging, MS
142
What is presbycusis?
age-related hearing loss (progressive, bilateral)
143
What is subjective tinnitus?
sound audible to patient only
144
Etiology: subjective tinnitus
acoustic trauma, barotrauma, presbycusis, CNS tumors, Eustachian tube dysfunction, Meniere dz, obstruction, emotional, drugs
145
What is objective tinnitus?
sound audible to both patient and doctor
146
Is objective tinnitus usually bilateral or unilateral?
bilateral
147
If objective tinnitus is unilateral, rule out ____
tumor (CT)
148
Etiology: objective tinnitus
AV malformations, monoclonus, turbulent flow, tumor
149
In a work-up for tinnitus, check for ___
carotid artery bruits, HTN, signs of bruxism, myofascial spasms, paraspinal/SCM spasms, TMJ dysfunction
150
What are the two types of vertigo?
subjective (impression is "moving in space") and objective (impression is "objects are moving")
151
What is trachoma?
chronic infx of cornea and conjunctiva caused by chlamydia
152
Population: trachoma
preschool children, ages 3-5
153
Sx: trachoma
often asymptomatic, bilateral mucopurulent keratoconjunctivitis, photophobia, eyelid edema, lacrimation, pain, follicles in upper eyelid
154
PE: trachoma
follicular/inflammatory response on conjunctival surface of upper eyelid, limbal follicles on cornea, superior neovascularization, punctate keratitis
155
What is the most common cause of corneal ulcer?
HSV
156
Etiology: corneal ulcer
HSV, HZV, contacts, injury, steroids, bacterial infx
157
What is Hutchinson's sign?
vesicular eruptions on tip of nose in ophthalmic herpes zoster infx
158
Sx: corneal ulcer
erythema of eyelid/conjunctiva, foreign body sensation, photophobia, mucopurulent d/c, blurred vision, pain
159
Sx: UV keratitis
foreign-body sensation, irritation, pain, photophobia, tearing, blepharospasm, decreased visual acuity
160
PE: UV keratitis
diffuse staining with fluorescein dye (loss of epithelium), lid edema
161
What is acute uveitis?
inflammation of one or all parts of uveal tract (iris, ciliary body, choroids)
162
Population: acute uveitis
adults, 20-50
163
Etiology: acute uveitis
systemic dz (sarcoidosis, Reiter's syndrome, infx, ankylosing spondylitis), idiopathic
164
What is Reiter's syndrome?
triad of arthritis, urethritis, conjunctivitis
165
Acute uveitis can be classified one of three ways. What are they and which is the most dangerous?
anterior, intermediate, posterior (most dangerous)
166
Sx: anterior uveitis
unilateral, painful ciliary flush, blurred vision, photophobia, tearing
167
Sx: intermediate uveitis
painless, floaters, blurred vision
168
Sx: posterior uveitis
blurred vision, floaters, eye pain, photophobia
169
What are the two types of cataracts?
developmental and degenerative
170
Sx: cataracts
decreased visual acuity, increased glare, no red reflex
171
Sx: acute closed-angle glaucoma
peri-orbital pain, visual deficits, boring pain, ipsilateral HA, blurry vision,
172
Population: acute closed-angle glaucoma
elderly, hyperopic
173
PE: acute closed-angle glaucoma
medial crescent shadow, increased cup/disc ratio, increased IOP and ischemia, corneal/scleral injection, cloudy cornea
174
DDx: acute closed-angle glaucoma
conjunctivitis, acute iritis
175
Why is acute closed-angle glaucoma an emergency?
blindness can occur quickly due to pressure on optic nerve
176
What accounts for 90% of all glaucoma cases?
chronic open-angle glaucoma
177
Sx: chronic open-angle glaucoma
may be none, progressive peripheral vision loss, late loss of central vision
178
What is the most common etiology for retinal detachment?
posterior vitreous detachment
179
Sx: retinal detachment
painless, dark/irregular floaters, flashes of light, progressive blurred vision, no redness
180
What is grade 1 hypertensive retinopathy?
narrowing of terminal branches of retinal arteries, straightening
181
What is grade 2 hypertensive retinopathy?
general narrowing with signs of AV compression
182
What is grade 3 hypertensive retinopathy?
grade 2 + hemorrhaging and soft exudates
183
What is grade 4 hypertensive retinopathy?
grade 3 + hard exudates
184
What are names for vascular changes?
copper wire, silver wire, AV nicking, humping, banking, tapering
185
What is tympanosclerosis?
sclerosis of the TM, from chronic OM or post T-tube
186
PE: tympanosclerosis
whitish plaques on TM
187
What is otosclerosis?
genetic metabolic bone dz, leading to bone overgrowth at stapes/oval window
188
Population: otosclerosis
F > M, more common in whites, 15-35 yo most commonly
189
SSx: otosclerosis
progressive hearing loss, tinnitus, usu bilateral
190
What is acute mastoiditis?
suppurative infx of the mastoid air cells
191
Population: mastoiditis
young children, 6-13 yo
192
what is the most common etiology for mastoiditis?
strep. pneumoniae
193
SSx: mastoiditis
redness/swelling/tenderness behind ear, fever, hearing loss, profuse creamy ear d/c, throbbing pain
194
PE: mastoiditis
erythema/tenderness/edema over mastoid area, post-auricular fluctuance, protrusion of auricle
195
Complications: mastoiditis
abscess, CN 7 palsy, hearing loss, osteomyelitis, meningitis, venous sinus thrombosis
196
SSx: cholesteatoma
painless otorrhea, conductive hearing loss, dizziness uncommon
197
PE: cholesteatoma
canal filled with muco-pus and granulation tissue, TM perforation in > 90% of cases
198
What is a cholesteatoma?
keratinizing squamous epithelium in middle ear and mastoid process
199
What is myringitis?
inflammation/infx of TM
200
SSx: myringitis
serosanguinous otorrhea, otalgia, fever, hearing impairment, sudden onset in acute
201
PE: myringitis
vesicles on the TM in bullous form
202
What is true vertigo?
true rotation movement of self or surroundings, most common classification of vertigo
203
SSx: true vertigo
patient moving, postural instability, worse with head movements, nausea/vomiting, sweating, nystagmus
204
Comparison (nystagmus): peripheral vs central vertigo
peripheral - unidirectional, horizontal w/ rotation
| central - any direction
205
Comparison (other neuro signs): peripheral vs central vertigo
peripheral - absent
| central - present (ataxic gait, diplopia, slurred speech)
206
Comparison (postural instability): peripheral vs central vertigo
peripheral - unidirectional instability, walking preserved
| central - severe instability
207
Comparison (hearing loss/tinnitus): peripheral vs central vertigo
peripheral - may be present
| central - absent
208
What is non-vertigo?
syncope, fainting, or sensation of impending fainting
209
With non-vertigo, lightheadedness suggests _____ of the brain
hypoperfusion
210
With non-vertigo, disequilibrium occurs only ___
when standing or walking
211
Vertigo lasting hours or days probably caused by ____
Meniere dz or vestibular neuronitis
212
Vertigo of sudden onset lasting minutes can be due to ___
brain or vascular dz
213
What are RED FLAG concomitants when doing a PE for vertigo?
head/neck pain, ataxia, LOC, focal neurological deficit
214
What tests are included in a work-up for vertigo?
general exam, otological exam, extraocular movements, hearing tests, sensory exam, vestibular imbalance
215
What are RED FLAG concomitants for an earache?
diabetes, redness/pain over mastoid, severe swelling of canal meatus, chronic pain with head/neck symptoms
216
Etiology: acute ear d/c
acute OM with TM perforation, serous OM, CSF leak from head trauma, OE, post-tympanostomy tube
217
Etiology: chronic ear d/c
cancer of ear canal, cholesteatoma, chronic purulent OM, foreign body, mastoiditis, necrotizing OE, Wegener's granulomatosis
218
Diagnostic Criteria: AOM
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
Diagnostic Criteria: persistent AOM
persistent features of middle ear infx during antibiotic treatment OR relapse within one month of treatment completion
220
Diagnostic Criteria: OME
fluid behind TM in absence of features of acute infx
221
Diagnostic Criteria: COME
persistent fluid behind intact TM in absence of acute infx
222
Diagnostic Criteria: CSOM
persistent inflammation of middle ear or mastoid cavity, recurrent/persistent otorrhea through perforated TM
223
SSx: CSOM
hearing loss, chronic purulent d/c, painless
224
PE: CSOM
perforation of TM, retraction pocket,
225
DDx: CSOM
OE, cholesteatoma, myringitis, chronic mastoiditis, impacted cerumen, tympanosclerosis, Wegener granulomatosis
226
Etiology: CSOM
acute OM w/ perforation, trauma, Eustachian tube blockage
227
What is CSOM?
chronic inflammation of middle ear persisting at least 6 weeks with TM perforation and otorrhea
228
What is OME?
effusion in the middle ear w/o infx
229
SSx: OME
hearing impairment, mild otalgia, may have overlapping symptoms with common cold
230
PE: OME
amber/gray TM, retracted or neutral; impaired mobility of TM, bubbles/air/fluid behind TM, chronic cervical LA
231
What is the 1st and 2nd most common dz of childhood?
1st - URI, 2nd - AOM
232
What are common bacterial etiologies for AOM?
S. pneumoniae, H. influenzae, M. catarrhalis
233
Risk factors: AOM
daycare, bottle-feeding, smoker in household, FHx
234
SSx: AOM
throbbing pain (or NO pain), fever, decreased hearing, nausea/vomiting, moodiness, irritability, dizziness, d/c if rupture of TM
235
PE: AOM
bulging, red/cloudy TM, decreased mobility of TM
236
What is perichondritis?
decreased blood supply to the ear cartilage d/t trauma/insect bites
237
SSx: COE
pruritus, redness, d/c
238
PE: COE
pinna/tragus pain, irritated external canal, TM usu not affected
239
Etiology: COE
psoriasis, seborrheic dermatitis, eczema, allergies, fungus
240
PE: AOE
pinna/tragus ttp, external canal red/swollen, fever, LA possible, TM is normal
241
Pseudomonas infx in AOE produces ____
purulent green/yellow otorrhea
242
Aspergillus infx in AOE looks like ____
fine white mat topped by black spheres
243
Etiology: AOE
infx, swimming, forceful cleaning, trauma
244
SSx: AOE
pruritus, otalgia, d/c, loss of hearing
245
Etiology: Meniere dz
increase in volume/pressure of endolymph
246
Age/Gender: Meniere dz
early to mid-adulthood, M=F
247
SSx: Meniere dz
SN hearing loss, tinnitus, isolated attacks of vertigo
248
What is a Tumarkin crisis?
severe vertigo of Meniere dz causing collapse
249
Is Meniere dz usu bilateral or unilateral?
unilateral
250
DDx: Meniere dz
migrain, labryinthitis, OM, SA hemorrhage, transient ischemic attack, acoustic neuroma, hypothyroidism, MS, ischemic stroke, salicylate toxicity, vestibular neuritis
251
What is acoustic neuroma?
benign, slow-growing tumor derived from Schwann cells of CN VIII
252
SSx: acoustic neuroma
unilateral, progressive SN hearing loss, HA, vertigo, tinnitus, facial numbness
253
Consider any unilateral SN hearing loss an ____ until proven otherwise
acoustic neuroma
254
What type of antibiotic can create bilateral vestibular damage?
aminoglycoside
255
What is BPPV?
abnormal sensation of motion elicited by certain positions
256
Pathophysiology: BPPV
canalithiasis - particles in canal of SCC, free-floating
| cupolithiasis - particles in ampulla of SCC, not free-floating
257
PE: BPPV
Dix-Hallpike maneuver standard for BPPV
258
SSx: BPPV
sudden onset of vertigo, dizziness attacks triggered by head movements
259
What is vestibular neuritis?
benign, self-limiting disorder of vestibular nerve
260
SSx: vestibular neuritis
acute vertigo NOT assoc with hearing loss
261
What often precedes vestibular neuritis and viral labrynthitis?
URI
262
PE: vestibular neuritis
horizontal nystagmus, gait instability, NO hearing loss
263
Comparison (bilateral/unilateral): meningitis vs otogenic infxs
meningitis - bilateral, otogenic - unilateral
264
What condition is now rare in the post-antibiotic era?
bacterial labryinthitis
265
SSx: viral labryinthitis
sudden unilateral hearing loss and vertigo, n/v
266
Population: viral labrynthitis
30-60, rarely children
267
PE: viral labrynthitis
spontaneous nystagmus toward normal side, hearing loss
268
SSx: herpes zoster oticus (Ramsay-Hunt syndrome)
deep/burning/auricular pain followed by eruption of vesicular rash in external auditory canal and concha; vertigo/hearing loss/facial weakness follows
269
What is caloric testing for vertigo?
cold water into external canal produces tonic eye deviation to side of cold water with simultaneous horizontal nystagmus to opposite side
270
Positive caloric test
if asymmetry is > 20% with affected ear producing less severe/less prolonged nystagmus
