Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neuro Diseases / Disorders > Week 3 - Neuro Diseases / Disorders > Flashcards

Week 3 - Neuro Diseases / Disorders Flashcards

1
Q

Graves disease (hyperthyroid)

A

eyes bulging out of head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Horner Syndrome

A

sympathetic superior cervical ganglion compressed, miosis (constricted pupil), ptosis (drooping eyelid), anhidrosis (no sweat), if present for a long time there will be less pigment in effected iris/eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cranial Nerve III palsy / compression

A

always associated with ptosis (drooping of eyelid), nonreactive pupil to light (will not constrict), and/or extraocular muscle palsy - often caused by vascular problems like aneurysms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Adie’s Tonic pupil

A

benign lesion of ciliary ganglion, young women, pupil reacts slightly to light and slowly to convergence - pupil nonreactive to light

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

pharmacological

A

pupil nonreactive to light, mydriatics (pupil dilators), scopalamine patch, farm chemicals, sympathetic stimulators (pseudoephedrine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

trauma

A

can cause pupil unreactive to light

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

physiologic

A

1mm difference is pupil dilation in light and dark is found in 20% of people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

nonreactive pupil to light

A

dilated pupil, will not constrict

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

drugs, narcotics

A

cause constricted pupil - miotics (pupil constrictors)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Argyll Robertson Pupil

A

constricts poorly to light, but reacts with constriction to convergence, syphilis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

iritis

A

eye pain, redness, anterior chamber inflammation, constricted pupils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Horner’s syndrome - first order neuron disorder

A

central lesion on hypothalamospinal tract, ex: transection of cervical spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Horner’s syndrome - second order neuron disorder

A

most common, preganglionic lesion, ex: compression along sympathetic chain by lung tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Horner’s syndrome - third order neuron disorder

A

postganlionic lesion at level of internal carotid artery, ex: tumor of cavernous sinus or carotid artery dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

causes of CN III palsy with dilated pupils

A

vascular disorders (diabetes, heart disease, atherosclerosis, aneurysm of posterior communicating artery), space occupying lesion or tumor, inflammation, infection, physical trauma, demyelinating disease (MS), autoimmune disease (myasthenia gravis), post operative neurosurgery complication, cavernous sinus thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

pupil-sparing CN III palsy

A

commonly microvascular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

pupil-involving CN III palsy

A

serious / urgent differential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CN III, CN IV, CN V1, CN VI, CN V2, internal carotid artery

A

pass through cavernous sinus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

CN III palsy

A

down (superior oblique still working) and out (lateral rectus still working) position of affected eye, ptosis (drooped eyelid), mydriasis (pupil dilation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

CN III palsy - parasympathetic fibers

A

run on outside of nerve (motor on inside of nerve), parasympathetic symptoms before motor symptoms, ptosis (drooping eyelid) and mydriasis (dilated pupil) before down and out eye position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

testing CN III function

A

movement of eye in 6 cardinal fields (H), look for limitation of movement in either eye (-ductions), look for limited gaxe (-versions), nystagmus (uncontrolled movement of the eye), strabismus (ocular misalignment)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

causes of isolated ocular muscle weakness / palsy

A

cranial nerve palsy (VI, IV, III), grave’s disease (hyperthyroid), trauma, giant cell arteritis (inflammation of blood vessels), MS, stroke, mass, myasthenia, sarcoidosis, meningeal infection, meningeal inflammation (lymes) - often adult presenting with double vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

microvascular ocular muscle abnormality

A

diabetes screen, blood pressure, sed rate for temporal arteritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

thyroid ocular muscle abnormality

A

weight loss, hair loss, heart palpitations, proptosis, lid lag, red eyes - middle aged with eyes that stick out (proptosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

neuroimaging ocular muscle abnormality

A

CT - for muscle size / entrapment / boney abnoramlity / sinus disease; MRI - brain abnormalities / tumors; MRA - angiography for vascular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

other causes of ocular muscle abnormality

A

tensilon test (myasthenia gravis), CBC, lymes, rheumatologic work up (eyes tired with double vision by end of day)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

orbital floor fracture

A

trauma / hydraulic force, fracture in orbital floor/medial orbit, swelling and hemorrhage in orbit affect eye movement, entrapped inferior rectus restricts upward gaze - often shows orbital bone flap with blood in sinus or air in orbit and trapped inferior rectus on CT, Tx surgery (2 wk window) and antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

visual field evaluation

A

pt sitting in front of you, test eyes individually, pt looks at you, compare their field to yours, if detected - not horizontal or vertical midline - 1/2 or 1/4 of field missing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

scotoma

A

area of abnormal / absent vision within otherwise intact vision field

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

hemianopia

A

loss of right or left half of visual field in either eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

homonymous hemianopia

A

loss of right or left half of vision field in both eyes, lesion on right or left optic tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

bitemporal hemianopia

A

loss of right half of field in right eye and left half of field in left eye, lesion at optic chiasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

altitudinal defect

A

loss of superior or inferior half of field

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

monocular vision loss

A

lesion on one optic nerve blocking afferent and efferent paths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

lower homonymous quadrantopia

A

lesion on left or right parietal radiation - meyer’s loop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

upper homonymous quadrantopia

A

lesion on left or right temporal radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

complete vision loss in one eye

A

compressive tumor, inflammation, neuritis, anterior ischemia, optic neuropathy, vasculitis, idiopathic intracranial hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

vision loss in left 1/2 left eye and right 1/2 right eye

A

parasellar mass - aneurysm, pituitary, adenoma, meningioma, craniopharyngioma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

vision loss in left or right halves of both eyes

A

neoplasm, inflammatory, ischemia, infections - encephalitis, arteriovenous malformation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

vision loss in upper right or left quadrant or both eyes

A

neoplasm, inflammation, ischemia, infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

vision loss in lower right or left quadrant of both eyes

A

neoplasm, inflammation, ischemia, infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

junctional scotoma (chiasm)

A

loss of central vision in one eye and temporal field in other eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

visual hallucinations

A

repeated, formed, faces, animals, people, in color, stereotyped - pt know images aren’t real, elderly, with vision loss, possible early dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

tunnel vision

A

loss or peripheral vision, late stage glaucoma, central retinal degeneration, retinal photocoagulation, nonphysiological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

retinitis pigmentosa

A

hereditary degeneration of rods and then cones, bone spicule appearance on retina, restricted to 10-20% of field of vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

panretinal photocoagulation

A

laser spots, diabetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

examination of optic disc

A

ophthalmoscope, close to pt, pt looks up, use right eye for right and left eye for left, focus on nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

optic nerve appearance

A

disc with central depression (cup), veins - larger / darker, arteries - smaller / lighter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

glaucoma

A

increasing pressure from accumulating aqueous humor, physiologic cup in optic disc gets larger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

optic neuritis

A

vision loss over hours / days, worst in one week, unilateral, 18-45, pain with eye movement, loss of color vision (intensity), decreased light intensity, focal neurological symptoms, flu-like - marcus gunn pupil (RAPD), decreased color vision, visual field defects, swollen disc (1/3 cases) that bulges outward into eye, blurred disc edges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

causes of optic neuritis

A

idiopathic, MS (initial), measles, mumps, chickenpox, mono, zoster, lymes, orbital infection, granulomatous disease (TB, lues, scaroid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

optic neuritis labs

A

BP, visual field test, sed rate, MRI (shows enlarged optic nerve, inflammed areas on brain - demylination), CBC, RPR, FTA-ABS, CRP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

optic neuritis Tx

A

IV methylprednisolone (1 gm for 3 days) -> oral prednisone (1mg/kg/day for 11 days) -> taper over 4 days -> antiulcer meds, consult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

optic neuritis relation to MS

A

negative MRI = risk of MS low 20% over 10 years - give pulsed IV steroids, pt with 1+ positive MRI spots 50% change of MS over 10 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

ischemic optic neuropathy

A

sudden, painless, nonprogressive vision loss, over 60, unilateral, RAPD, disc swelling, flame hemorrhages, differentiate between arteritic and non-arteritic -> check sed rate and CRP, headache, jaw claudication, scalp tenderness, joint aches, anorexia, weight loss, fever, biopsy of temporal artery, caused by vascular occlusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

papilledema

A

optic nerve swelling due to increased intracranial pressure, transient vision loss after rising up, headache, diplopia, nausea, vomiting - optic disc bugles out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

bilateral papilledema

A

intracranial mass, pseudo tumor cerebri, intracranial bleed, hypertensive crisis, hyrocephalus, meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

unilateral papilledema

A

optic neuritis, central retinal vein occulsion, ischemic optic neuropathy, orbital mass, juvenile diabetes, thyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

spina bifida with meningocele

A

cyst-like protrusion of dura and arachnoid, detected inutero with ultrasound, failure of caudal end of neural tube to close and induce formation of neural arches in lumbar vertebra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

multiple sclerosis

A

demyelinating disease, decreases axonal transmission due to increased capacitance and loss of saltatory conduction from node to node where Na / K channels are concentrated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

closed angle glaucoma

A

acute, sudden, blockage of aqueous humor outflow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

open angle glaucoma

A

chronic, gradual, overproduction of aqueous humor, more common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

hyperopia

A

far sighted, axial length < focal length = image behind retina, convex lens (+D) correction brings image forward, axial hyperopia = eyeball too short, refractive hyperopia = cornea / lens weak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

myopia

A

near sighted, axial length > focal length, image in front of retina, concave lens (-D) correction pushes image back, axila myopia = eyeball too long, refractive myopia = cornea / lens too strong

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

presbyopia

A

aging, decreased malleability of lens -> decreased accommodation, like hyperopia, correct with reading glasses (+D)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

astigmatism

A

uneven lens/cornea, part of visual field out of focus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

cataracts

A

opacity of lens, trauma/radiation/high glucose (diabetes)/age, Tx surgery to replace lens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

glaucoma

A

IOP > 30mmHg, aqueous humor flow problem, loss of vision, 1. cornea with halos, edema, decreased transparency; 2. loss of photoreceptors from periphery to fovea; 3. optic nerve; 4. loss of arterial supply -> necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

retinitis pigmentosa

A

decreased response of photoreceptors, rods first (night blindness), tunnel vision, central color vision, variable age / progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

retinopathy

A

damage to retina, often from lack of blood supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

vit A deficiency

A

vit a = retinol (fat soluble vit), affects retinal pigment epithelium, night blindness because rod photopigment can’t be recycled, also immune / bone or skin growth and repair / embryonic development problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

macular degeneration

A

age, yellow drusen pigments between retinal pigment epithelium and choroid, 2 forms -> dry and wet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

dry macular degeneration

A

atrophy of RPE, loss of photoreceptors, blurry vision, bad night vision, Tx slo with vit A sup, can progress to wet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

wet macular degeneration

A

abnormal growth of blood vessels in choroid, loss of photoreceptors in central vision, Tx angiogenesis inhibitor (anti-VEGF antibodies)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

noise induced hearing loss

A

primarily from damage to hair cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

benign paraphysinal positional vertigo

A

usually posterior canals of vestibular apparatus effected, can tell which canal and which side, determines therapy given

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

homonymous defect

A

visual defect in either right or left visual field, post-chiasmatic defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

heteronymous defect

A

visual defect of parts of both left and right visual field

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

hemianopsia

A

defective vision in 1/2 of a visual field

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

quadrantanopsia

A

defective vision in 1/4 of visual field

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

blindness in right eye

A

right eye optic nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

blindness in left eye

A

left eye optic nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

bitemporal heteronymous hemianopsia (loss of left and right lateral fields)

A

lesion on optic chiasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

left homonymous hemianopsia (loss of vision in lateral left and medial right fields)

A

lesion on right optic tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

left upper homonymous quadrantanopsia (loss of vision in left upper quadrant of both fields)

A

lesion on lateral right Meyer’s loop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

left homonymous hemianopsia with macular sparing (loss of left half of both fields with center spared)

A

lesion (often of posterior cerebral artery) in medial calcarine cortex, excluding most caudal portion which may have some middle cerebral artery supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

damage anterior to optic chiasm

A

only affects ipsilateral eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

damage at optic chiasm

A

produces heteronymous defects because nasal optic fibers can’t cross over

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

damage posterior to chiasm

A

produces homonymous defects in visual field opposite to side of lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

strabismus (squint)

A

failed coordination of extraocular muscles, deviation of affected eye and diplopia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

diplopia

A

double vision, failure of image to be alinged on same point on each retina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

amblyopia (lazy eye)

A

decreased visual acuity secondary to strabismus, brain avoids diplopia by suppressing vision of one eye in cortex, can occur in kids 3-8, Tx with therapy to train less dominant eye to operate by putting patch over dominant eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

scotoma

A

island of vision loss, ex: stroke effecting specific part of visual pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

case - tumor in right visual cortex

A

loss of left half of visual field, with calcifications on pineal gland and choroid plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

common causes of red eyes

A

conjunctivitis (bacterial, viral, allergic), corneal abrasion, foreign body, dry eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

five red eye symptoms that need ophthalmologic consultation

A

vision change, sluggish pupillary reflex, dendritic corneal lesion (herpes - newborn with HSV mother), pain, vesicular lesions around eye (zoster)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

signs of narrow angle glaucoma

A

diminished / blurred vision, halo, tunnel vision, sudden onset, acute, light shine shows increased ant chamber, globe feels rock hard, KEY - tenometer measures IOP >30mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

risk factors of narrow angle glaucoma

A

40+, African American / Asian / Mexican American, family Hx, diabetes, hypothyroid, heart disease, high BP, other eye conditions, longterm corticosteroid use (esp as eye drops)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

viral conjunctivitis

A

unilateral, tearing, less itch and exudate, possible upper respiratory infection, preauricular adenopathy common, adenovirus common, enterovirus, HSV, zoster

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

bacterial conjunctivitis

A

unilateral becoming unilateral, some tear, little itch, lots of purulent discharge, preauricular adenopathy uncommon, pneumococcus common cause, h. inf., staph aureus, N. gonorrhoeae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

allergic conjunctivitis

A

bilateral, itching, tearing, watery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

corneal abrasion

A

can see with blue scope lens and flurosine stain, check under lid for foreign body, heal 24 hours, if large antibiotic drops, no patch unless indicated, trauma, FB sensation, visible FB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

foreign body

A

often under lens, may be imbedded in eye = x-ray, use lid eversion to look

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

dry eye

A

feels like foreign body, overuse of antihistamines, common in elderly, check meds, lack of tearing, Tx artificial tears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

hyphema

A

blood in anterior chamber, trauma, need to drain, refer to ophthamologist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

iritis

A

whole eye red, less swelling, abnormal vision, more pain, see ophthamologist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

subconjunctival hemorrhage

A

patch of blood up top of white sclera, looks bad but harmless, common with labor strain / extreme pushing / weight lifting, spontaneous, will reabsorb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

tonsilitis

A

large red palatine tonsils, can be in adults too, usually kids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

black hairy tongue

A

benign, hypertrophy of papillae, smokers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

malignant melanoma

A

dark asymmetrical spot on gums

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

cancer under tongue

A

tobacco chewers, hard as a rock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

torus / tori

A

midline bump on palate, smooth, hard as bone, benign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

minor salivary gland malignancy

A

off midline, roof of mouth, firm but spongy, more common than malignancy of larger salivary glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

localized plasmacytoma

A

lymphoma variant, on gums, fatigue, anemia, Tx radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

pharyngeal cancer

A

progressive sore throat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

unilateral vocal cord paralysis

A

poor voice on phonation with over compensation of intact side, good airway on inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

bilateral vocal cord paralysis

A

voice good on phonation because chords are similarly affect, airway poor on inspiration because neither side will spread

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

vocal cord nodule

A

benign, hoarseness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

vocal cord polyps

A

swollen vocal cords

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

vocal cord cancer

A

warty looking, Tx success is stage dependent, Tx radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

laryngeal cancer

A

hoarseness, can cause pain in ears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

case - 69, progressive hoarseness, throat pain, no response to antibiotics, neg strep test, smoker, drinker, hemoptysis, dysphagia

A

vocal cord cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

pack / years

A

packs per day x number of years smoked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

cancer of the larynx

A

40+, drinker, smoker, chronic cough, weight loss, ear ache, neck lump, short of breath, hoarse, tickle, pain with swallow, hemoptysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

laryngectomy

A

removes larynx, preserve plane of platysmal (save nerves/vessels), remove muscles, split thyroid, lay nerves laterally, cut away from pharynx and close pharynx, ***if person with stoma from laryngectomy needs air it must go through stoma - no connection between airway and mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

case - 57, progressive hoarseness, no meds, healthy, nonsmoker, nondrinker, small paramedian neck mass

A

invasive thyroid cancer the is compressing recurrent laryngeal nerve to the larynx -> vocal cord paralyzed on one side, thyroid masses are mostly benign, workup -> ultrasound and needle biopsy, in surgical removal must take care to leave parathyroid glands and recurrent laryngeal nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

case - 42, teacher, past smoker, nondrinker, variable hoarseness

A

vocal cord nodule, common in singers / speakers / teachers / lawyers, speech therapy, voice hygeine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

signs of airway obstruction

A

stridor, respiratory effort, chest retraction, tracheal tug, intercostal retraction - little positive pressure will help breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

stridor

A

laryngeal sound with airway obstruction, high pitch, inspiratory, then inspiratory and expiratory, 90% compromised airway, drop chest and raise abdomen = airway gone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

sturdor

A

upper pharyngeal, gurgling, caused by swollen tonsils, pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

croup

A

acute infection of larynx, slow onset 24-48 hrs, subglottic inflammation, viral / parainfluenza / RSV, inspiratory stridor, seal bark cough, rarely need intubation, Tx humidified air and steroids, steeple sign on PA film due to extended narrowing of airway below vocal cords

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

epiglottotis

A

WBC, blood culture, urine antigens, abrupt onset (hours), endoscopy with intubation, sit upright, hurts to swallow, intercostal and suprasternal retraction, lateral film shows thumbprint sign inflammed epiglotis, Tx antibiotics and intubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

vocal cord nodule

A

benign, hoarseness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

vocal cord polyps

A

swollen vocal cords

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

vocal cord cancer

A

warty looking, Tx success is stage dependent, Tx radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

laryngeal cancer

A

hoarseness, can cause pain in ears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

case - 69, progressive hoarseness, throat pain, no response to antibiotics, neg strep test, smoker, drinker, hemoptysis, dysphagia

A

vocal cord cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

pack / years

A

packs per day x number of years smoked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

cancer of the larynx

A

40+, drinker, smoker, chronic cough, weight loss, ear ache, neck lump, short of breath, hoarse, tickle, pain with swallow, hemoptysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

laryngectomy

A

removes larynx, preserve plane of platysmal (save nerves/vessels), remove muscles, split thyroid, lay nerves laterally, cut away from pharynx and close pharynx, ***if person with stoma from laryngectomy needs air it must go through stoma - no connection between airway and mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

case - 57, progressive hoarseness, no meds, healthy, nonsmoker, nondrinker, small paramedian neck mass

A

invasive thyroid cancer the is compressing recurrent laryngeal nerve to the larynx -> vocal cord paralyzed on one side, thyroid masses are mostly benign, workup -> ultrasound and needle biopsy, in surgical removal must take care to leave parathyroid glands and recurrent laryngeal nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

case - 42, teacher, past smoker, nondrinker, variable hoarseness

A

vocal cord nodule, common in singers / speakers / teachers / lawyers, speech therapy, voice hygeine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

signs of airway obstruction

A

stridor, respiratory effort, chest retraction, tracheal tug, intercostal retraction - little positive pressure will help breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

stridor

A

laryngeal sound with airway obstruction, high pitch, inspiratory, then inspiratory and expiratory, 90% compromised airway, drop chest and raise abdomen = airway gone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

sturdor

A

upper pharyngeal, gurgling, caused by swollen tonsils, pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

croup

A

acute infection of larynx, slow onset 24-48 hrs, subglottic inflammation, viral / parainfluenza / RSV, inspiratory stridor, seal bark cough, rarely need intubation, Tx humidified air and steroids, steeple sign on PA film due to extended narrowing of airway below vocal cords

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

epiglottotis

A

WBC, blood culture, urine antigens, abrupt onset (hours), endoscopy with intubation, sit upright, hurts to swallow, intercostal and suprasternal retraction, lateral film shows thumbprint sign inflammed epiglotis, Tx antibiotics and intubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

ophthalamic zoster

A

prodrome, vesicular rash of C1 dermatome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

subconjunctival hemorrhage

A

blood between conjunctiva and sclera, benign, trauma, coughing, labor, vomiting, valsalva, hypertension, diabetes mellitus, anticoagulants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

eye globe pain

A

problem inside eye, iritis, uveitis, glaucoma, ophthalmologic consult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

decreased visual acuity

A

risk of permanent vision loss, ophthalmologic consult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

sluggish pupillary reflex

A

retinal or CNS problem, ophthalmologic consult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

dendritic corneal lesion

A

HSV keratitis, ophthalmologic consult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

vesicular lesions around eye

A

herpes zoster, ophthalmologic consult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

signs of narrow angle glaucoma

A

sudden, pain, blurred vision, halos, subconjunctival hyperemia, corneal clouding, pupil dilation with absent / sluggish light response, increased IOP, risk factors: family hx, hyperopia, older, female, Asian / Inuit, pupil dilation with meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

correct use of ophthalmoscope

A

dark room, lens at 0 D, R hand/eye for R eye, L hand/eye for L eye, brace against your eye brow, pt looks over shoulder distantly, start 15 inches away and at 15 degrees off middle, look for red reflex, hand on pt forehead, advance toward pt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

nose bleeds

A

most from ant nasal septum, called Kiesselbach’s area, terminal branches of sphenopalatine, ethmoidal, and superior labial arteries, posterior nose bleeds on septum or lateral wall supplies by sphenopalatine artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

Treacher Collins syndrome

A

first arch syndrome, deficient neural crest cell migration into arch, mandibulofacial dysostosis, abnormal dev of 1st arch structures - hypoplasia of upper and lower jaw, ext and middle ear deformation, palate and eyelid defects, conductive hearing loss, autosomal dominant or teratogenic, normal cognitive ability, mutation of TCOF1 gene on chromosome 5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

Pierre Robin Syndrome

A

1st arch syndrome, deficient neural crest cell migration into arch, micrognathia, posterior tongue (airway obstruction - glossoptosis), U shaped palate, genetic/environmental, Tx tracheostomy and mandibular distraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

DiGeorge Syndrome

A

genetic / environmental, no thymus and parathyroid glands, causing diminished immunity and hypocalcemia, failure of neural crest cell migration causes failure of 3rd and 4th pouches and hypoplsia of 1st arch - cleft palate, low ears, poor feeding, delayed speech, heart defects, poor circulation, poor muscle tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

accessory or ectopic parathyroid glands

A

variable # and location, inferior may fail to descend or may be found in thorax with thymus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

accessory or ectopic thymic tissue

A

found embedded in thyroid, near inferior parathyroid glands, or in isolated nests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

lateral cervical or branchial cyst

A

ant edge of SCM, below angle of jaw, due to incomplete overgrowth of pharyngeal clefts by 2nd pharyngeal arch, epi inside may produce secretions causing cyst between 10-20 years old, may have a draining fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

thyroglossal dust cyst of fistula

A

midline near hyoid, migrating thyroid that got caught up, epi secretions form cyst, infection likely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

ectopic or accessory thyroid tissue

A

pieces of thyroid found anywhere along path of migration of thyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

lingual thyroid

A

thyroid fails to descend from the base of the tongue, gland still works even though it is not in the right spot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

blepharitis

A

infection of eye lid, stye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

conjunctivitis

A

infection of conjunctiva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

kerititis

A

infection of cornea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

keratoconjunctivitis

A

infection of conjunctiva and cornea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

uveitis

A

infection of iris, ciliary body, and choroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

chorioretinitis

A

infection of choroid and retina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

endophthalmitis

A

infection of aqueous and vitreous humor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

eye infections

A

outer surface protects, trauma, immunocompromised, dry eye, warm/moist under eyelid, deep layers invaded from brain/blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

eye defenses

A

sclera / cornea = physical barrier, tears with IgA and lysozyme, conjunctiva with lymphocytes/plasma cells/neutrophils/mast cells, blinking blocks attachment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

conjunctivitis

A

discharge, red eye, irritation, sensitivity, no pain, no blurred vision, dilation of subepithelial vessels, can be viral, bacterial, allergic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

bacterial conjunctivitis

A

mostly bilateral (spreads), thick discharge, red in older kids, occur with otitis media, no itchy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

viral conjunctivitis

A

mostly unilateral, watery discharge, redness, little co-occurrance with otitis media, not itchy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

allergic conjunctivitis

A

bilateral, little discharge, redness, no otitis media, very itchy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

causes of neonatal viral conjunctivitis

A

herpes simplex virus, tx or will spread to cornea and affect vision

181
Q

causes of post-natal viral conjunctivitis

A

adenovirus (common), coxsackie, HSV, VSV, EBV, rubella, mumps, influenza

182
Q

causes of neonatal bacterial conjunctivitis

A

Niesseria gonorrhea

183
Q

causes of child bacterial conjunctivitis

A

Staph aureus, Strep pneumonia, Heamophilus influenzae, Moraxella

184
Q

causes of adult bacterial conjunctivitis

A

Staph aureus, Strep pneumonia, Corynebacterium, E.coli, Pseudomonas aeroginosa and Moraxella

185
Q

cause of neonatal and adult inclusion conjunctivitis

A

Chlamydia trachomatis (serotypes D-K)

186
Q

cause of trachoma

A

Chlamydia trachomatis (serotypes A-C)

187
Q

causes of allergic conjunctivitis

A

IgE mediated sensitivity from allergens, chemicals, ocular medications (prolonged use), neoplasm, foreign body, contact lens

188
Q

viral conjunctivitis (pink eye)

A

90% adenovirus, upper respiratory tract infection, preauricular adenopathy, contagious, benign, self limiting, Tx cold compress and topical vasoconstrictors, test with AdenoPlus that detects hexon protein in viral capsid

189
Q

adenovirus

A

naked, d.s., infects epi cells, can cause necrosis, can integrate into host genome and have latent infection

190
Q

herpes simplex virus

A

can cause keratoconjunctivitis, looks like adenovirus, lesion is painful, can scar cornea with recurrent infections, avoid corticosteroids that help corneal penetration, Tx topical trifluridine and systemic acyclovir and proph erythromycin

191
Q

action of acyclovir and ganciclovir

A

prodrugs, inhibit viral DNA synthesis, competitive substrate for DNA polymerase, causes chain termination, viral thymadine kinase phosphorylates but has no sugar, guanine analogue

192
Q

action of trifluridine

A

pyrimidine analogue, DNA chain termination and competitive inhibition of DNA polymerase, good for acyclovir resistant viruses, host kinases phosphorylate making more toxic

193
Q

hyperacute bacterial conjunctivitis

A

Neisseria gonorrhoeae (meningitidis less often), copious green discharge, preauricular adenopathy, gram - intercellular diplococci on choclate agar, Tx systemic ceftriaxone and topical antibiotic/irrigation - ca progress to corneal ulceration and systemic level

194
Q

action of ceftriaxone (3rd gen cephalosporin)

A

cell wall inhibitor, binds penicillin binding proteins, CNS penetration, Tx for N. gonorrhoeae conjunctivitis, empiric for bacterial meningitis with vancomycin, definitive and prophylactic for N. meningitis, empiric for brain abscess with metronidazole

195
Q

acute bacterial conjunctivitis

A

kids - staph aureus, strep pneumoniae, haemophilus influenza; adults - staph aureus; tx decreases spread, broad empiric tx of moxifloxacin solution / bacitracin-polymyxin B ointment / trimethoprim-polymyxin B, if recurrent culture

196
Q

action of moxifloxacin

A

DNA synthesis inhibitor, binds DNA gyrase and topoisomerase, broad Tx for conjunctivitis

197
Q

action of polymyxin B

A

cationic molecules disrupt cell membranes of gram -, with trimethoprim for conjunctivitis, with neomycin and hydrocortisone for otitis externa

198
Q

opthalmia neonatorum

A

conjunctivitis or keratoconjunctivitis in the week of life, N. gon / C. trachomatis / staph / strep / E. coli / H. inf / H simplex, proph tx erythromycin ointment, culture

199
Q

action of erythromycin

A

protein synthesis inhibitor, binds 50S ribosomal subunit, proph tx for ophthalmia neonatorum

200
Q

vertical transmission

A

mother to fetus, through placenta via blood, during vaginal birth in cervix (group B strep, C. trachomatis, N. gon, HSV2), through breast milk

201
Q

perinatal

A

infections around birth, can include CMV spread in nurseries

202
Q

chronic bacterial conjunctivitis

A

> 3 wks, Chlamydia trachomatis, inclusion serotypes D-K in US, trachoma serotypes A-C worldwide, basophilic inclusion bodies / EIA dipstick / PCR, coinfection with N. gon, Tx azithromycin, Tx sexual partners

203
Q

action of azithromycin

A

protein synthesis inhibitor, binds 50S ribosomal subunit, tx Chlamydia trachomatis conjunctivitis

204
Q

macrolides - erythromycin and azithromycin

A

inhibit protein synthesis, bind rRNS subunits, broad tx, resistance via increased efflux, drug hydrolysis by esterases, methylation of drug, adverse effects - GI, hepatic failure, prolonged QT, inhibits cytochrome p450

205
Q

Chlamydia trachomatis

A

elementary body - small, spreads, taken up b epi of uterus and eye, reticular body - forms inclusion body, multiplies inside cell and releases elementary body, interferon-gamma can create a persistent form

206
Q

chronic conjunctivitis associated with blepharitis

A

staph aureus, stye - in eyelid, chalazion - below eyelid in meibomian gland, tx - lid clean, warm compress, massage gland, erythromycin ointment

207
Q

keratitis

A

vision defects, photophobia, pain in cornea, foreign body like sensation, with trauma / drying / hypoxia, viral - HSV1, bacterial - Staph a and e / Pseudo aeurgrunosa / B cereus; acanthamoeba (contact lens case/fluid), tx - bacterial moxifloxacin drops, viral trifluridine and acyclovir

208
Q

pseudomonas aeroginsoa

A

gram -, aerobic, rod, flagella, water, soil, contact lens wearers, opportunistic with trauma, resistance with biofilms, tx pepercillian and ticarcillin, adherence factors, secretes cytoxins elastase and alklaine protease to destroy corneal epi -> immune response further scars cornea = loss of vision

209
Q

rubella

A

deep eye infection in utero, cataracts, microphthalmia

210
Q

CMV - cyclomegalovirus

A

in utero or with HIV, causes chorioretinitis in deep eye

211
Q

toxoplasma gondii

A

in utero, chorioretinitis deep eye infection

212
Q

uveitis

A

inflammed uveal, blurred vision, vision loss, anterior and posterior types

213
Q

anterior uveitis (iritis)

A

not infectious, photophobia, pain, decreased vision, Treponema pallidum, HSV, VZV

214
Q

posterior uveitis (chorioretinitis)

A

common, floaters, no pain

215
Q

posterior uveitis (chorioretinitis)

A

blood to retina, systemic disease, toxoplasma and CMV in neonates and HIV, parasitic worms (Toxocara canis, Onchocerca volvulus), begins in periphery and spread with CMV

216
Q

river blindness

A

parasitic worm, spread by sand flies, causes chorioretinitis

217
Q

endophthalmitis

A

infection of vitreous and aqueous humor, rare, pain, red, vision loss, bacterial/fungal, exogenous from cataract surgery (Staph or Candida), endogenous - blood, tx vancomycin or -floxacin (fluoroquinolones)

218
Q

action of vancomycin

A

cell wall inhibitor, binds D-ala-D-ala shielding it from transpeptidation reaction, good for gram + including MRSA, proph for meningitis with ceftriaxone

219
Q

otitis media

A

most common, middle ear infection

220
Q

otitis externa

A

fairly common, external ear infection, swimmers ear

221
Q

labrinthitis

A

inner ear infection, vestibular defects, rare

222
Q

otitis media

A

otalgia, erythema of TM, fluid in middle ear, can be acute / effusion / chronic / serous

223
Q

acute otitis media

A

often with upper resp infection or allergies, narrowing of eustachian tubes preventing ventilation and drainage, enlarged adenoids, secretions accumulate and pathogen grows, e tubes in young kids narrower and flatter, males, native americans

224
Q

causes of acute bacterial otitis media

A

strep pneumo, H. influ, Moraxella catarrhalis

225
Q

causes of acute viral otitis media

A

RSV, rhinovirus

226
Q

otitis media - strep pneumo

A

gram +, diplococci, alpha-hemolysis, secretion transmission, colonize naso-oropharynx, spread to middle ear, seen with alcoholism / diabetes mellitus / renal disease, 91 serotypes, unique surface capsule (oval), vaccine

227
Q

strep pneumo virulence factors

A

capsule blocks phagocytosis, choline-binding proteins bind epi carbs, neuraminidases cleave mucin sialic acid, autolysin A degrades peptidoglycan -> alpha hemolysis of RBC and bacteria, pneumolysin pore forming that disrupts cilia, iron acquisition A and uptake A

228
Q

Haemophilus influenzae

A

small, gram -, coccobacillus, nonmotile, biofilm, only humans, X and V chocolate agar, nonencapsulated, colonize nasopharynx, possible betalactamases, genital tract and conjunctivitis, vaccine does not cover because it is for encapsulated kind (has increased with Hib vaccine)

229
Q

Moraxella catarrhalis

A

gram -, aerobic, diplococcus, oxidase, nonmotile, pili, chocolate agar, upper resp tract in infants, betalactamases, hockey puck test

230
Q

acute otitis media dx

A

pneumatic otoscopy for TM, tympanometry to detect fluid in middle ear, aspirate and culture if not responding to Tx - recurrent can lead to hearing loss

231
Q

empiric tx acute otitis media

A

amoxicillin (strep p and h infl), if not improvement in 48 hrs add clavulanate, if pen allergy azithromycin, pain management with acetominophen and ibu, resp viral vaccine?

232
Q

action of amoxicillin

A

cell wall inhibitor, binds penicillin binding proteins, tx for otitis media

233
Q

action of clavulanate

A

inactivates betalactamase enzymes that would degrade drug, added to amoxicillin to include moraxella catarrhalis and H. influ coverage

234
Q

ear tube or incision

A

in TM, with recurrent ear infections, allows ear to drain

235
Q

complications of otitis media

A

conductive hearing loss/delayed speech due to perforation of TM and degraded ossicles, cholesteatoma epi cyst due to pressure change, spread to mastoid, inner ear, temporal bone, meninges

236
Q

otitis externa

A

inflammed canal, pain, ear drainage, risk factor - maceration of tissue/excessive moisture/middle ear infection, cerumen is acidic and has lysozymes (= no q tips)

237
Q

acute localized otitis externa

A

staph, pustule or furuncle of hair follicle

238
Q

acute diffuse otitis externa

A

pseudomonas aeroginosa, swimmers ear, itch, red, pain, tx ofloxacin

239
Q

chronic otitis externa

A

drainage from perforated TM form otitis media, tx polymyxin B and neomycin

240
Q

malignant otitis externa

A

pseudomonas aeroginosa, invades bone and cartilage, to CN, death, elderly with diabetes, tx imipenem

241
Q

fungal otitis externa

A

aspergillus and candida, gray fuzzy canal

242
Q

staphylcoccus aureus

A

cluster, gram +, cocci, anterior nares, protein A binds Fc on IgG preventing opsinization, coagulase binds prothrombin slowing migration of phagocytes, alpha toxin forms transmembrane pores lysing cells, resistant for MRSA

243
Q

general tx otitis externa

A

topical cleansing with low pH (acetic acid) kills gram - bac, flush if TM intact

244
Q

action imipenem

A

tx malignant pseudamonas chronic otitis externa

245
Q

action -ofloxacin

A

fluoroquinolones, DNA syn inhibitor, binds DNA gyrase / topoisomerase, tx acute pseudamonas otitis externa

246
Q

action polymyxin B

A

tx chronic otitis externa, with neomycin, cationic disruption of cell membrane in gram -

247
Q

action neomycin

A

tx chronic otitis externa, with polymyxin B

248
Q

stenosis (narrowing) /atresia (closure) problems

A

ear canal, nasal passage, larynx, esophagus, trachea

249
Q

clefts (opening, fissure, indentation)

A

ear pit, nasal masses, face, lip, palate, larynx, tracheal-esophageal

250
Q

persistent structures (that should have gone away)

A

thyroglossal duct, branchial clefts

251
Q

preauricular pits / tags / cysts

A

tx observation, antibiotics, excision, rule out sensorineuronal hearing loss

252
Q

prominent ears

A

tx otoplasty, cosmetic, creates antihelical fold, remove excess conchal cartilage

253
Q

microtia

A

small, malformed ear, functional and cosmetic problem, pinna small / cut off, canal small / cut off, tx surgery to put in bone anchored hearing aid or repair atresia, soft band hearing aid

254
Q

choanal atresia

A

problems breathing or breast feeding, nose running, can’t breathe, can be membranous, mostly bony

255
Q

bilateral choanal atresia neonatal

A

babies are obligate nasal breathers, resp distress improved with crying, difficulty feeding, can’t pass 8fr catheter, neonatal presentation, rule out CHARGE syndrome (coloboma eye, heart defect, retarded dev, urogen defect, ear problems)

256
Q

unilateral choanal atresia

A

delayed presentation, newborn - trisomy 21 or laryngomalacia, kid - chronic rhintis and adenoidectomy

257
Q

tx choanal atresia

A

bilateral - secure airway (oral, tracheotomy), endoscopic / transpalatal surgery, postop stents, high recurrence in infants (restenosis)

258
Q

congenital nasal masses

A

failure of foramen cecum closure, dermoid cyst along sinus tract, dimple in nasal skin with hair, dx imaging neurosurgery consult, tx excision of entire tract

259
Q

nasal glioma

A

type of congenital nasal mass, failure of dural regression through foramen cecum, possible intracranial connection, dx imaging and neurosurgery consult, tx excision

260
Q

frontanasal encephalocele

A

type of congenital nasal mass, does not involve foramen cecum, patent fonticulus frontalis, dx imaging and neurosurgery consult, tx resection

261
Q

nasoethmoidal encephalocele

A

type of congenital nasal mass, intranasal/prenasal, nasal obstruction, dx imaging and neurosurgery consult, tx excision

262
Q

ankyloglossia

A

ant tongue attached to floor of mouth, can’t latch to suck, neonatal, dysarthria, dental issues, cut it

263
Q

cleft lip and palate

A

show on ultrasound, cleft lip -/+ palate more common than cleft palate alone, palate and lip form at separate times during embryo development, risk factors - heredity, nutritional def (folate), drugs (valium, dilantin, cortisone), primary palate = alveolar ridge, secondary palate = hard / soft palate

264
Q

cleft lip surgery

A

10 wks old, Hb of 10, weighs 10 pounds

265
Q

cleft palate surgery

A

18 months, speech, facial growth

266
Q

cleft lip/palate secondary surgery

A

pharyngeal flap (4-8), cleft rhinoplasty (14-18), revisions

267
Q

cleft lip / palate surgery

A

id vermillion, measure, incise flaps, suture lin near philtral ridge, close palate based on palatine arteries and growing palatine flaps

268
Q

branchial cleft cyst / sinus / fistula

A

lateral on neck where 2nd pharyngeal arch overgrew pharyngeal clefts, preceding upper resp infection, if in 1st arch get external auditory canal duplication, 2nd arch fistula - starts ant SCM (deep to facial nerve and platysma, superficial to 3rd arch) opens into tonsil fossa

269
Q

thyroglassal duct cyst

A

midline on neck, preceding upper resp infection, elevates with tongue protrusion / swallowing, CT with contrast

270
Q

branchial and thyroglossal duct cyst tx

A

tx infection first, avoid incision/drainage, excision of entire tract/cyst, remember nerves, with thyroglossal resect part of hyoid and follow tract to base of tongue

271
Q

goldenhar syndrome

A

1st/2nd arch, vascular insult?, hypoplastic maxilla/mandible/temporal bone, ear may be absent, vertebra abnor, dermoid eye tumor, one side of face

272
Q

Treacher Collins

A

eyelid malform, hypoplastic cheek / jaw, low set and malform external ear, “fishmouth”

273
Q

branchiootorenal syndrome

A

autosomal dominant on 8th chromosome, branchial cycts, renal abnorm, ear malform and hearing loss (conductive, sensorineuronal, both)

274
Q

micrognathia

A

small lower jaw and mouth, seen with Pierre-Robin Sequence

275
Q

glossoptosis

A

tongue at back of mouth, seen with Pierre Robin Sequence

276
Q

anterior palate defects (cleft lip and incomplete cleft palate)

A

failed fusion of maxillary prominences with fused medial nasal prominences, upper lip, alveolar part of maxilla, primary palate

277
Q

posterior palate defects

A

failed fusion of palatine shelves and nasal septum and primary palate, palatine shelves are from maxillary prominence, involves hard and soft palate

278
Q

choanal atresia

A

narrowed choanae, babies are obligate nasal breathers, only breathe through mouth when crying, cycles of cyanosis with crying that re-oxygenates the blood - failed oronasal membrane rupture

279
Q

FAS facial development

A

disrupted migration of cells-neurons in CNS and neural crest cells in head, short palpebral fissures, flat midface, short nose, flat philtrum, thin upper lip, microagnathia, ear abnorm, low nasal bridge, epicanthal folds

280
Q

hyaloid artery

A

runs in optic fissure to supply optic cup and lens placode, hyaloid artery usually regresses by 8 mnths, if it persists in adult eye it might interfere with vision

281
Q

congenital coloboma

A

defective closure of optic fissure, pupil is positioned in infero-nasal quadrant where fissure was and pupil has odd shape, usually only affect iris but can involve all eye structures behind iris

282
Q

retinal detachment

A

separation of neural and pigmented retina, recreating intraretinal space, usually from trauma, medical emergency, floaters, flashes of light, can also be congenital from failed fusion of retinal layers

283
Q

congenital cataracts

A

lens opaque in utero, can be balloon like or central, causes: rubella, hereditary, malnutrition, chromosomal, radiation, galactosemia

284
Q

rubella congenital defects

A

eye (blindness), ear (deafness), cardiac defects

285
Q

congenital ptosis

A

autosomal dominant, surgically corrected, does not affect vision, unilateral, appears in first year, from birth trauma, abnormal CN III, or dysgenesis of levator palpebrae superioris

286
Q

congenital external ear malformation

A

often with 1st arch syndromes and chromosomal abnorm

287
Q

minor appendages / preauricular tags

A

from supernumerary hillocks or bits of tissue left behind, congenital malformation of external ear

288
Q

preauricular cysts

A

from incomplete fusion of hillocks, congenital malformation of external ear

289
Q

microtia

A

abnormal shape or size of external ear, unilateral more common, congenital malformation of external ear

290
Q

anotia

A

agenesis of the external ear, inner ear may be normal and hearing may be close to normal, congenital malformation of external ear

291
Q

reconstruction of external ear

A

uses rib cartilage placed under the skin

292
Q

rubella and hearing loss

A

1st trimester infection has high rate of defects, hearing loss, hearing defects, neurologic problems

293
Q

neurosensory deafness

A

abnormal development of cochlea, CN VIII, or brainstem, damage to organ of Corti in 30% of 1st trimester rubella

294
Q

conductive deafness

A

persisting meatal plug (1st arch syndromes), poor fixation of footplate of stapes, malleus and incus problems (1st arch syndrome) - hereditary and environmental causes

295
Q

tongue cancer lymphatic spread

A

bilateral from tongue down neck, ant tongue drains to submental nodes

296
Q

epiglottic valleculae

A

indentation in hyoepiglottic ligament between lateral and median glossoepiglottic folds - area where cancer can hide

297
Q

median glossoepiglottic fold

A

fold on midline superior hyoid bone, from epiglottis to tongue

298
Q

lateral glossoepiglottic folds

A

folds on lateral superior hyoid bone, from epiglottis to tongue

299
Q

epiglottis

A

cartilage extension off thyroid cartilage that extends superior to hyoid, covers larynx when swallowing

300
Q

thyroid cartilage

A

large cartilage inferior to hyoid and superior to cricoid

301
Q

cricoid cartilage

A

thinner cartilage inferior to thyroid cartilage

302
Q

arytenoid cartilage

A

small cartilages that sit on superior cricoid lamina, muscular process extends posterior laterally and vocal process extends anteriorly to thyroid cartilage, vocal processes connect vocal ligament with lamina of thyroid cartilage

303
Q

aryepiglottic folds

A

connects arytenoid cartilages with epiglottis

304
Q

piriform fossa

A

fossa created on either side of larynx, thryoid cartilage is lateral to it and cricoid cartilage is medial, pierced by the superior laryngeal artery and the internal branch of the superior laryngeal nerve (vagus) with sensory to larynx above vocal folds

305
Q

vestibular folds

A

false vocal cords, superior to true vocal cords, vestibule between aryepiglottic fold and vestibular fold

306
Q

vocal folds

A

true vocal cords, inferior to vestibular fold, middle part is the space between the vestibular fold and vocal fold

307
Q

vestibule

A

space between aryepiglottic fold and vestibular fold

308
Q

ventricle

A

space between vestibular and vocal folds

309
Q

infraglottic region

A

space inferior to vocal folds down to inferior edge of cricoid cartilage

310
Q

Rima glottidis

A

space between the vocal folds,

311
Q

glottis

A

vocal folds and rima glottidis

312
Q

vocal ligament

A

from vocal process of arytenoid cartilage to back of thyroid lamina

313
Q

posterior cricoarytenoid muscle

A

wraps around cricoid lamina, adbucts rima glottidis, swings vocal process of arytenoid cartilage laterally, from posterior cricoid to muscular process of arytenoid cartilage, recurrent branch of the laryngeal nerve (vagus)

314
Q

recurrent branch of the laryngeal nerve

A

all muscles of larynx, runs superiorly along trachea, dives under constrictor muscles, branch of vagus

315
Q

referred pain from middle ear infection to tonsilar fossa

A

glossopharyngeal nerve

316
Q

tongue deviation

A

hypoglossal nerve, tongue will deviate toward the side of the lesion due to unopposed normal side, ipsilateral muscles will atrophy and fasciculate

317
Q

512 tuning fork

A

for Weber and Rinne test

318
Q

Rinne test

A

tuning fork on mastoid and in air by ear, AC > BC is normal, BC > AC conductive hearing loss

319
Q

Weber test

A

tuning fork on midline of skull, symmetrical is normal, lateralizes - to conductive hearing loss side, away from sensorineuronal side

320
Q

audiogram

A

freq increases l-r, higher on the graph is better

321
Q

speech discrimination score

A

50%+ is ok, 80% is normal, how well are they hearing speech

322
Q

tympanometry

A

finds impedence of the middle ear (normal = 0), would tell you if there is fluid, tumor, or other behind ear drum making it stiffer

323
Q

otoacoustic emission test

A

for newborn, outerhair cell noise, good for kids <2yrs

324
Q

auditory brainstem response

A

sound into ear, follow through brainstem into teomporal bone, electrodes

325
Q

sensorineural hearing loss

A

old, progressive, 50% of >75, infectious (peds), trauma, ototoxic drugs, autoimmune, congenital, meurolgic, neoplastic

326
Q

conductive hearing loss

A

ear wax, otitis media, TM perforation, cholesteatoma

327
Q

aging of inner ear

A

high freq, progressive, symmetric, multifactorial, hearing aid, assistive device, cochlea implants, rehab - pharmthereapy, PT, surgery

328
Q

otosclerosis

A

autosomal dominant, bone deposistion at foot plate of stapes, fluoride prevents, family Hx, tx - hearing aids or stapedectomy

329
Q

noise induced hearing loss

A

exposure of life, audiogram with normal and then drop off at high freq

330
Q

temporal bone fracture

A

head trauma, headache, vertigo, SNHL, CHL, facial nerve para, CSF leak, tx - neurosurgical, reconstruction - is facial nerve working hardest to fix - it facial nerve is out immediately and you can fix it you should - if facial nerve goes away gradually will probably come back

331
Q

acoustic neuroma

A

unilateral SNHL, vertigo, facial nerve para, aural fullness, trigeminal numbness, diplopia, MRI with contrast, obs / surg

332
Q

tinnitus

A

subjective - perceived sound without sound, objective - perceived sound of internal body, more men, >50, 15% of pop

333
Q

subjective tinnitus

A

SNHL, pt perceives sound when there is none outside body, NSAIDS, aminoglycosides, antidep, anticancers, trauma, systemic disease (HTN,depression, anxiety, MS, stroke, meningitis), metabolic (hyper-hypothyroid, hyperlipidemia, vit A, vit B, zinc def)

334
Q

objective tinnitus

A

pt hears sound produced inside the body, doc can hear it too, vascular (bruits, hums, tumors), eustachian tube, myoclonus, tensor tympani/stapedius, spont otoacoustic emission

335
Q

vertigo

A

vestibular, illusion of movement

336
Q

dysequilibrium

A

vestibular, poor coordination,

337
Q

dizziness

A

vestibular, all encompassing

338
Q

imbalance

A

vestibular, orthopedic or neuro

339
Q

vestibular work up

A

HP, MRI/CT, LP?, electronystagmography, rotary chair, comp dynamic posturography, vest evoked myogenic potential

340
Q

ddx for peripheral vertigo

A

inner ear, benign paroxysmal positional vertigo - dizzy when head in certain position/repeatable, Meniere’s disease, neuronitis, labyrinithitis, ototoxicity, otitis media, fistula

341
Q

ddx for central vertigo

A

inner ear, MS, stroke, cerebellar lesions, daibetes, migraines

342
Q

benign paroxysmal positional vertigo

A

peripheral vertigo, post trauma/viral, brief positional vertigo with latency and fatigability, Dix-Hallpike manuver, hormal hearing

343
Q

Meniere’s disease

A

tinnitus, fluctuating SNHL, episodic vertigo, unilateral, progressive, tx - salt restriction, spaced meals, H2O, diuretics, steroids, vestibular suppressants, allergy, surgery - r/o stroke, tumor, infection, trauma

344
Q

vestibular neuronitis

A

viral infect of vestibular nerve, hours to days, no hearing loss, prodrome viral URI, weeks - months, tx - meclizine, benzos, antiemetics

345
Q

labyrinthitis

A

viral, bacterial, sudden hearing loss and vertigo, tinnitis, from middle ear through round or oval window, audiogram (SNHL), tx - IV antibiotics, vestibular suppressants, surgery, steriods

346
Q

facial nerve para

A

birth, mobious syndrome, herpes zoster, tumor, stroke, surgery, Guillain-Barre, myesthenia gravis

347
Q

anotia

A

more unilateral, canal atresia and middle ear, reconstruction, bone anchored hearing aid

348
Q

microtia grade I

A

slightly smaller, conchal bowl cupped, all parts present, no surgery

349
Q

microtia grade II

A

1/2 size auricle, all structures present, soft tissue def, surgery sometimes

350
Q

microtia grade III

A

small cartilage piece, ant deflected lobule, surgery 5-6yrs, prostheses, use rib cartilage

351
Q

lop ear

A

common, ears stick out, absent antihelical fold, royal lineages, teasing, low self esteem, surgery - otoplasty

352
Q

preauricular pits / fistulas

A

infected, antibiotics, incision, drain, excise after infection, bilateral

353
Q

auricular appendages

A

arrested hillock fusion, xxxx47

354
Q

relapsing polychondritis

A

autoimmune, episodic, nose/joints/airway/heart valves, ESR, IgG high, tx - steroids and NSAIDs, entire upper cartilage inflammed

355
Q

xxxx 50

A

xxxx 50

356
Q

keloids

A

scar, avoid peircing, steroids, pressure dressing, excision

357
Q

auricular hemotoma

A

trauma, wrestlers, incision and drain, then bolster that pushes skin to cartilage, causes cauliflower ear

358
Q

cellulitis of pinna

A

pain, swollen, red entire ear, staph, strep, pseudomonas, tx - antibiotic and pain meds, risk - diabetes, foreign body, piercing, trauma

359
Q

ear canal osteoma / exostosis

A

benign into canal, norwegians, cold water exposure, no surgery, looks like cholesteatoma, observe

360
Q

carcinoma of ear canal

A

pain, bleeding, soft tissue mass in canal, biopsy, excision and radiation, can metastasize, fatal

361
Q

otitis externa

A

painful red canal, swimmers, diabetics, immunosupressed, tx - antibiotic drops / systemic, cheesy, wet moist canal, suctioning, pseudomonas, e coli, staph, hearing may be affected - put sponge in to pull meds into canal and absorb secretions

362
Q

herpes zoster oticus

A

vesicular purulent ulcers, around ear, low hearing, pain, facial nerve para, tx - antiviral and pain meds, immunocompromised

363
Q

otorrhea (ear drainage)

A

pain, hearing loss, vertigo, trauma, previous surgery / infection, otitis media / externa, allergy, trauma, CSF, culture if recurrent, beta 2 transferrin for CSF

364
Q

psoriasis of external ear

A

red, itchy, flakes, no Q tips, in other places, tx - topic steriod and antibiotic for secondary otitis externa

365
Q

canal stenosis

A

congenital, trauma, xxxxx62

366
Q

otomycosis

A

fungal, pain, itch, hearing low, prior antibiotic, antifungal drops and pain meds, debride, alcohol, vinegar, peroxide tx - underlying immunocompromised?, fruiting bodies

367
Q

ear canal foreign body

A

flies, cerumen - in canal

368
Q

cerumen

A

protective against viruses/fungus/bacteria, can plug canal, canal sensitive, can cause vertigo or temp hearing loss, removal tricky

369
Q

cerumenectomy

A

removes ear wax, irrigation with syringe / water pick / suctioning / curetting / alligators, complication - pain, lacerates canal, perforation of TM, perilymph fistula, vertigo, deafness

370
Q

TM perforation

A

cause?, hearing loss, otorrhea, tinnitis, keep dry, tympanoplasty for large hearing loss, often heal with time if not chronic

371
Q

bullous myringitis

A

TM with serous bullae, virus, mycoplasma, URI, otalgia, otorrhea, hearing loss, tx - pain meds, antibiotics, decompression of vesicle, steroids

372
Q

tympanosclerosis

A

white plaque on TM, hyalin or calcium, otitis media or trauma, normal hearing, if middle ear - then conductive hearing loss

373
Q

cholesteatoma

A

ball of keratin from skin in the middle ear, bone erosion, surgery to prevent destruction of ear, can get to brain, must operate!!!

374
Q

middle ear choesteatoma

A

squ epi, bone and soft tissue destruction, then infection, no pain, otorrhea, pearly mass, hearing loss, vertigo, tympanomastoidectomy

375
Q

acute otitis media

A

middle ear, <3wks, kids, ear tube neg middle ear pressure causing retracted ear drum and fluid collection, strep pneumo, H. influenza, mor. catarrhalis, irritable, ear tugging, hearing loss, tinnitis, fever, red/yellow TM that bulges, TM turns red with crying, tx - resolve, antibiotics, topical drops if TM perforated, pain meds, proph antibiotics,

376
Q

serous otitis media

A

dark amber TM, serous fluid behind TM, use tympanogram

377
Q

otitis media - risk factors

A

day care, smoke, bottle feeding, food/nasal allergies, URIs, skull base ab, adenoid hypertrophy, GI reflux, immune disorder, ciliary dysfuction, nasal intubation, nasopharyngeal tumor, cholesteatoma, genetics

378
Q

myringotom and tubes for AOM

A

recurrent om, >3 in 3 mnths / >4 in 12 mnths, chronic effusion, poor response to antibiotics, cleft palate, TM retraction, immunocompromised, barotitis media, ear tube dysfunction

379
Q

mastoidectomy

A

irradicates infection, removing cholesteatoma, keep hearing and vestibular function

380
Q

complications of AOM

A

mastoiditis, abscess, petrous apiculitis, labyrinthine fistula, facial nerve para, meningitis, sinus thrombosis, hydrocephalus

381
Q

ddx for otalgia

A

infection, inflammatory, trauma, tumor, TMJ, dental, tonsil, cancer, post herpetic, cervical arthritis

382
Q

Q tips

A

promote infection, push wax deeper, makes ear itch, promotes stenosis, perforates TM

383
Q

case - 23, male, 6wks red eyes, discharge, tearing, blurred, swollen, already tx with polymyxin B/neomycin, started unilateral to bilateral, preauricular lymph nodes, multiple sexual partners

A

labs - chlamydia DNA probe positive = chlamydia trachomatis

384
Q

allergic conjunctivitis

A

itches, bilateral from start, serous / mucoid discharge, hay fever, itch / red / eyelid swelling, seasonal, Tx - vasoconstrictors and topical antihistamine drops

385
Q

viral conjunctivitis

A

unilateral at start, serous discharge, preauricular lymph nodes, contageous, eyes red / watery / foreign body sense, recent URI, adenovirus / herpes / zoster, Tx - cold compress and topical vasoconstrictors

386
Q

bacterial conjunctivitis

A

unilateral at start, mucopurulent discharge

387
Q

not conjunctivitis

A

pain, photophobia, blurred vision

388
Q

chlamydial conjunctivitis

A

mucoid / mucopurulent discharge, preauricular lymph nodes

389
Q

hyperacute bacterial conjunctivitis

A

severe, sight threatening, abrupt, lots of yellow discharge, red, tender, lid swelling, adenopathy, N/ gonorrhoeae or N. meninigitidis, neonates and sexually active young adults, Tx - ceftriaxone IM/topical antibiotic/irrigation

390
Q

acute bacterial conjunctivitis

A

tearing, mucopurulent / purulent, matted eyelid on waking, slower onset, less severe, Tx - topical antibiotic

391
Q

causes of acute bacterial conjunctivitis in kids

A

strep pneumo, H. influ, staph

392
Q

causes of acute bacterial conjuctivitis in adults

A

staph, strep, e. coli, pseudomonas, morazella

393
Q

chronic bacterial conjunctivitis

A

staph, eyelid findings swelling, debris, eyelash loss, Tx - warm compresses and topical antibiotic

394
Q

ocular chlamydial bacterial conjunctivitis

A

trachoma - serotyples A-C (worldwide), inclusion - serotypes D-K (US), Tx - oral tetracycline/doxycycline/erythromycin for 2-3 wks

395
Q

trachoma conjunctivitis

A

chronic keratoconjunctivitis, preventable blindness, Africa, Asia, Middle East, immigrants to US

396
Q

inclusion conjunctivitis in newborn

A

chlamydia, STD, to newborn via infected cervix, tearing, discharge, eyelid swelling 5-12 days after birth

397
Q

inclusion conjunctivitis in adult

A

chlamydia, STD, sexually active 18-30, infected genital secretion to the eye, subacute/chronic, red, mucopurulent, FB sense, adenopathy

398
Q

conjunctivitis test

A

hyperacute/chronic - culture, DNA probe, ELISA, PCR

399
Q

conjunctivitis

A

discharge and no pain

400
Q

steroid eye drops

A

do not use in eye drops alone or with antibiotic/antiviral

401
Q

case - 17 mnth boy, clear nasal discharge, cough, fever, fussy, not sleeping, father smokes, bottle fed, bulging TM, red TM, ear tugging, nodes on neck, nasal cold prior, mom chronic ear infections, TM no cone of light and can’t see malleus

A

acute otitis media not viral very often, labs - none needed, possible causes strep pneumo, staph, H. influ non-typable, Moraxella catterhalis

402
Q

acute otitis media article

A

strep pneumo, H influ, moraxella catarrhalis, fever, otalgia, headache, irritability, cough, listless, anorexia, vomiting, diarrhea, pulling ears, middle ear effusion detected with pneumatic otoscopy, tx amoxicillin with macrolides(erythro/azythro)/clindamycin/cephalosporin to penicillin allergy, hearing and language testing if hearing loss or effusion >3 mnths, sure signs - bulging TM, nonmobile TM, and red TM, smooth tympanogram = effusion, pointed neg pres tympanogram = retracted TM, tx - pain (aceto/ibu), spont resolution common, antibiotics if <6mnths, certain, or serious over 2yrs, tubes if recurrent

403
Q

if resistant otitis media

A

add clavulanate to amoxicillin

404
Q

chlamydial conjunctivitis, serotypes A-C

A

trachoma, conjunctival scarring, decreased tear adherence, corneal ulceration, blindness

405
Q

chlamydial conjunctivitis, serotypes D-K

A

genital infection, conjunctivitis, conjunctival scarring - not blindness, cervical cell inclusion body

406
Q

chlaymdial conjunctivitis

A

follicles, scarring, corneal opacity (serotypes A-C), cervical cell inclusion body (serotypes D-K)

407
Q

PBL - 15, male, peripheral vision loss, bad night vision, bad balance, pat grandpa blind and deaf, pallor in optic disc, attentuated retinal blood vessels, drusen, no vestibular reflexes

A

Usher syndrome - retinosis pigmentosa and congenital deafness, progressive blindness, MYO7A mutation, tx - vit A, docosaheaenoic acid (enhances vit A), field-expanding lenses

408
Q

conductive hearing loss audiogram

A

bone conduction greater than air conduction

409
Q

sensorineural hearing loss audiogram

A

air and bone conduction are the same, there is a drop off in hearing at higher freq

410
Q

cochlear implant

A

controversy because are deaf normal and can function with ASL, microphone -> speech processor -> transmitter -> receiver/stimulator -> electrode array in cochlea into nerve, very successful, not like normal hearing, good to implant during critical speech learning period, therapy to learn sounds

411
Q

retinal implant

A

camera -> transmitter -> wire -> chip in retina, new, narrow applications (must have healthy retinal cells - retinitis pigementosa and macular degeneration), low resolution image, newly approved

412
Q

risk factors for vision loss

A

African American, Hispanic, 40+, family Hx, nearsighted, longterm steriods, diabetes, eye trauma, hypertension, high IOP

413
Q

risk factors for hearing loss

A

babies - infection during pregnancy (CMV, rubella, toxo), ototoxic meds during pregnancy, neonatal infections (CMV, herpes, rubella, toxo), premature, genetics, malformation

414
Q

nystagmus

A

fast, uncontrolled eye movements side to side or up and down or circular, slow and fest phases, named for direction of fast phase

415
Q

vestibulo-cochlear reflex

A

head moves in one direction and eyes move in opposite direction, lateral semicircular canal -> vestibular nucleus -> interneuron -> abducens and oculomotor nucleus -> reticular formation (medial fibers only) -> lateral and medial recti (inhibited or excited to moves eye oppisite head), slow phase = smooth pursuit, fast phase = saccadic

416
Q

caloric testing

A

irritate external auditory canal with warm/cold water or air, stimulates lateral semicircular canals, causes nystagmus

417
Q

rotational testing

A

turning chair intended to induce nystagmus

418
Q

Usher syndrome Type I

A

3-6% of kids who are deaf or hard of hearing, 4/100,000 babies, MYO7A mutation, autosomal recessive

419
Q

why vit A for retinitis pigmentosa

A

combines with opsin to form rhodopsin - a light absorbing molecule

420
Q

papilledema

A

optic nerve - bulging / blurred, blood vessels - engorged

421
Q

macular degeneration

A

optic nerve - pits, blood vessels - lacey, drusen speckling in macula

422
Q

glaucoma

A

optic nerve - cupped inward, blood vessels - baring makes them look larger

423
Q

drusen diseases

A

optic exam - looks like light and dark speckling on the retina, found with macular degeneration, retinitis pigmentosa, Usher syndrome

424
Q

normal ear drum

A

white, clear, cone of light, malleus

425
Q

tympanosclerosis

A

calcium plaques from old infections, bumpy white spots on TM

426
Q

serous otitis media

A

neg pressure, clear fluid behind TM, from eustachian tube obstruction, ear drum still looks pretty clear, eventually erosion of osicles, retracted TM

427
Q

cholesteatoma

A

skin cyst, retraction pocket of TM into middle ear, erodes bone, possible facial paralysis, hearing loss, dizziness, Tx mastoid operation

428
Q

ear drum perforation

A

watch, may heal, tympanoplasty

429
Q

otitis media

A

bulging TM, red, inflamed

430
Q

hemotypanium

A

blood in middle ear, looks dark

431
Q

abrasion of ear drum

A

Q tips, can lead to otitis externa

432
Q

cause of primary otalgia

A

otitis media or otitis externa

433
Q

cause of secondary otalgia

A

referred pain from TMJ, pharyngitis, dental disease, cervical spine arthritis

434
Q

ear pain that needs further evaluation

A

hx or px of smoking, drinking, >50, diabetes

435
Q

evaluation of continuing ear pain after Tx

A

MRI, fiberoptic nasolaryngoscopy, ESR

436
Q

ear pain exam

A

traction on auricle, press on tragus, palpate TMJ

437
Q

epistaxis (nose bleed)

A

most often from anterior nasal cavity, compression usually stops bleeding

438
Q

if compression does not stop epitaxis

A

topical vasoconstriction, chemical cautery (silver nitrate), electrocautery, nasal packing, posterior gauze packing, balloon system, artierial ligation

439
Q

amicyasin (aminoglycosides)

A

antiobiotic that can be ototoxic in utero

440
Q

rubella

A

can cause deafness in utero

441
Q

defect of MYO7a

A

not all defects of myosin 7a cause usher syndrome, some just cause deafness

442
Q

neg pressure tympanogram

A

retracted TM, eustachian tube obstruction

443
Q

lower peak at normal pressure tympanogram

A

otitis serous (otitis media would have obvious other symptoms), often with URI

444
Q

epistaxis

A

unilateral = anterior (Kisselbach’s), bilateral = posterior, pressure 15 min (clamp), lean forward, pack if can’t see/stop bleeding, pack more post bleeds than ant, use lidocaine with vasoconstrictor (epi)

445
Q

DiGoerge Syndrome

A

failure of 3rd and 4th pharyngeal pouch formation, no thymus or parathyroid glands, immunosuppressed and hypocalcemic

446
Q

narrow angle glaucoma

A

sudden, pain, blurred vision, Asian, halo around light, anisocoria, sluggish pupil light reaction

447
Q

optic neuritis

A

loss of vision for hour-few hours, pain with eye movement, loss of color vision, altered pupil reaction to bright light, associated with future MS diagnosis

448
Q

trochlear nerve dysfunction

A

eye can’t look down and inward (intortion) on convergence, superior oblique not working

449
Q

base of cochlear membrane not working

A

can’t hear high frequencies as well

Neuro Diseases / Disorders (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions