Term
| What is marcus gunn pupil another name for? explain this phenomenon |
|
Definition
| relative afferent pupillary defect - when the good eye is stimulated with light both pupils will constrict fully, when the light is switched to the bad eye both pupils will dilate a bit because the stimulus carried through the optic nerve is weaker |
|
|
Term
| What eye pathology is associated with giant cell arteritis? |
|
Definition
| ischemic optic neuropathy |
|
|
Term
| what is the average tonometry reading for the eye? |
|
Definition
| 16 mm Hg (10-21 is the normal range) |
|
|
Term
| a patient complains of a painful eye with steamy vision with colored halos around light sources... you think....? |
|
Definition
| acute angle closure glaucoma |
|
|
Term
| A patient presents with acute onset of vision loss and explains it as a curtain being drawn from top to bottom... you think....? |
|
Definition
|
|
Term
| Name two drugs that can cause macular degeneration. |
|
Definition
| chloroquine or phenothiazine |
|
|
Term
| what is metamorphopsia? how can it be measured? |
|
Definition
| the phenomenon of wavy or distorted vision that is often seen in macular degeneration. it can be measured with an amsler grid |
|
|
Term
| What is one drug and one drug class that are known to cause cataracts? |
|
Definition
lovastatin
corticosteroids |
|
|
Term
| What is the immediate tx for a patient with acute angle closure glaucoma? |
|
Definition
start IV carbonic anhydrase inhibitor (acetazolamide, brinzolamide, dorzolamide, methazolamide..)
topical Beta blocker
and osmotic diuresis |
|
|
Term
| Describe what will be seen on a gram stain of an eye infected with gonorrhea and chlamydia |
|
Definition
chlamydia: no organisms seen
gonorrhea: intracellular gram-negative diplococci |
|
|
Term
| a blue or cyanotic sclera can be a normal finding or seen in children with ___________/___________ |
|
Definition
|
|
Term
| A lesion of the R optic nerve would cause |
|
Definition
| total blindness of the R eye |
|
|
Term
| a lesion at the optic chiasm would produce what visual defect? |
|
Definition
| bitemporal heteronymous hemianopsia |
|
|
Term
| A lesion of the R optic tract would produce what visual defects? |
|
Definition
| Left homonymous hemianopsia |
|
|
Term
| Describe the results of the Webber and Rinne test in conductive hearing loss |
|
Definition
Weber: lateralization to the affected ear
Rinne: bone conduction greater than air conduction |
|
|
Term
| Describe the results of the Weber and Rinne test in sensorineual hearing loss. |
|
Definition
Weber: sound will be louder in the ear that does not have SNHL
Rinne: impairment in both bone and air conduction but air conduction will remain greater than bone |
|
|
Term
| What are the clinical manifestations of menieres disease? What is the tx? |
|
Definition
hearing loss, tinnitus, and vertigo
diuretics and salt restriction (sx result from distention of the endolymphatic compartment) |
|
|
Term
| what class of abx can cause hearing loss? |
|
Definition
|
|
Term
| What is the difference between the nystagmus seen with central and peripheral vertigo? |
|
Definition
Peripheral: horizontal with a rotary component, fast-phase beats away from the diseased side and fixation inhibition
Central: nonfatigable nystagmus with vertical greater than horizontal plane, and no latency or suppression by fixation |
|
|
Term
| How do you differentiate thrush from leukoplakia? |
|
Definition
| Thrush can be scraped off, leukoplakia cannot |
|
|
Term
| What is the most common site of nosebleeds? Less common and more severe? |
|
Definition
Kiesselbach's plexus on the anterior aspect of the nose
Woodruff's plexus is a posterior bleed and requires emergency evaluation |
|
|
Term
| Describe vision loss in macular degeneration and what would be seen on the fundoscopic exam. |
|
Definition
gradual painless central vision loss
Drusen! |
|
|
Term
| Describe vision loss in macular degeneration and what would be seen on the fundoscopic exam. |
|
Definition
gradual painless central vision loss
Drusen! |
|
|
Term
| what is initial tx for epiglottitis? |
|
Definition
| IV abx (ceftizoxime or cefuroxime-- 3rd gen cephalosporins) and steroids (dexamethasone) |
|
|
Term
| what is initial tx for acute angle closure glaucoma? |
|
Definition
| IV acetazolamide (carbonic anhydrase inhibitor) |
|
|
Term
| When is MRI and when is CT indicated in diagnostic studies in a patient with sinusitis? |
|
Definition
MRI: if malignancy is suspected
CT: routine |
|
|
Term
| Name the organisms associated with chronic and acute otitis media |
|
Definition
chronic: pseudomonas, proteus, s aureus
acute: h flu, strep pneumonia, mycoplasma pneumoniae |
|
|
Term
| what is tx for herpes keratitis? |
|
Definition
|
|
Term
| cotton wool spots are seen in what eye problem |
|
Definition
|
|
Term
| What is presbycusis due to? is it sensorineural or conductive? |
|
Definition
loss of cochlear hair cells
sensorineural |
|
|
Term
| What is the examination of choice to examine a patient with suspected tracheoesopheageal fistula? What diagnosis in a pregnant mother would lead you to suspect this problem in her baby? |
|
Definition
-xray of the chest after inserting a nasogastric tube
-polyhydraminios |
|
|
Term
| stensons duct vs. whartons duct |
|
Definition
stensons- on the parotid gland
whartons- submandibular |
|
|
Term
| Acute sinusitis is usually due to viral etiology, only 0.2-2% are bacterial. What is the initial tx? When are abx implicated in adults and in children? |
|
Definition
nasal saline irrigation and APAP for pain
-abx in adults after a minimum of 7 days, in kids at 10-14 days |
|
|
Term
| what are 3 abx that are considered first line for acute sinusitis? |
|
Definition
amoxicillin
trimethoprim-sulfamethoxazole
doxycycline |
|
|
Term
| What is the pathophysiology behind vitamin A in visual health? |
|
Definition
| it is an important prosthetic group for visual pigments in the retina |
|
|
Term
| Define amblyopia and strabismus? |
|
Definition
Amblyopia- decreased acuity for non-anatomic reasons
Strabismus- type of amblyopia where one eye drifts off target |
|
|
Term
| What would be characteristic of vernal conjunctivitis on PE and on smear? |
|
Definition
| cobblestone papillae with milky exudates and eosinophils seen on smear |
|
|
Term
| A pt presents with acute angle closure glaucoma, what medication should be distributed immediately? |
|
Definition
| oral glycerin will reduce intraocular pressure rapidly |
|
|
Term
| a "boxcar" pattern seen on opthalmic exam signals what? |
|
Definition
| segmentation of the venous blood column- possibly a retinal artery occlusion |
|
|
Term
| Blepharitis can be anterior or posterior, differentiate the two. |
|
Definition
Anterior: affects the base of the eyelid
Posterior: usually due to meibomian gland dysfunction |
|
|
Term
| What rheumatic disease can initially present as blepharitis |
|
Definition
|
|
Term
| Name 6 of the top causes of blepharitis |
|
Definition
-staph infection
-dysfunction of the meibomian glands
-seborrheic dermatitis
-Demodex (parasite)
-rosacea
-Sjögren's |
|
|
Term
| Give the three steps to abx treatment of blepharitis, and how is a Demodex infection treated? |
|
Definition
-topical abx (erythromycin, e-mycin)
-topical abx/corticosteroid: sulfacetamide/prednisolone (blephamide)
-oral abx: tetracyclines
-domedex tx with ivermectin (PO) |
|
|
Term
|
Definition
| A firm nodular bulb that forms secondary to chronic inflammation of an internal hordeolum |
|
|
Term
| Will a chalazion be painful or tender to touch? |
|
Definition
| No, only if there is secondary infection and this would be the only instance in which topical abx would be appropriate in the tx of a chalazion |
|
|
Term
| What are the main tx options for a chalazion? |
|
Definition
-warm compress, baby shampoo, massage
-oral tetracyclines, no relief--> metronidazole
-oral corticosteroids |
|
|
Term
| Describe the differences beaten viral, bacterial, and allergic conjunctivitis |
|
Definition
Viral: watery dc
Bacterial: mucoid purulent dc
Allergic: mucoid dc that is stringy |
|
|
Term
| What is the most common cause of viral conjunctivitis ? What is also commonly seen? |
|
Definition
| Adenovirus and ipsilateral periauricular lymphadenopathy can be seen |
|
|
Term
| What are the treatments for non complicated bacterial conjunctivitis, gonococcal, chlamydial? |
|
Definition
Daytime: trimethoprim polymixin b (polytrim), at night erythromycin
Chlamydial: ees or azithromycin PO
Gonococcal: rocephin or penicillin IV |
|
|
Term
| Corneal involvement with conjunctivitis suggests which types of infection? |
|
Definition
Gonococcal or herpetic
HSV needs referral and tx with acyclovir |
|
|
Term
| What bacterial cause of conjunctivitis also commonly causes an ipsilateral OM |
|
Definition
|
|
Term
| A topical anesthetic is usually used in clinic to get a good exam on a pt with corneal abrasion, are these drops rx for the patient to use a home? |
|
Definition
| NO, pt can use APAP PO at home to help with pain |
|
|
Term
| Topical abx use is questionable as a staple in the tx of every corneal abrasion pt, but when are they a must? |
|
Definition
| When the abrasion is due to contact lenses |
|
|
Term
| Why is it so important to follow up with corneal abrasion patients? |
|
Definition
| Most corneal ulcers begin as abrasions |
|
|
Term
| Describe the difference in location between dacryocystitis and dacryoadenitis |
|
Definition
Cyst: medial base if the eye where the lacrimal duct is located
Adenitis: upper outer portion of the eye lid where the lacrimal gland is located |
|
|
Term
| What serious condition of the eye is sometimes seen with dacryocystitis |
|
Definition
| Orbital cellulitis- admit for IV abx |
|
|
Term
| What is the tx for acute and chronic dacryoadenitis and dacryocystitis |
|
Definition
Acute adenitis: keflex
Chronic adenitis: warm compress and symptomatic, biopsy if no improvement in 2 weeks
Acute cyst: augmentin
Chronic cyst: often requires surgery |
|
|
Term
| What are the 4 common types of ectropion? |
|
Definition
-senile: where aging relaxes the palpebral ligaments and causes the tarsus to sag outwards
-congenital: rare and associated with other developmental anomalies
-paralytic: 7th nerve palsy
-cicatricaial: formed after an infection or injury |
|
|
Term
|
Definition
| Eyelashes in contact with the cornea |
|
|
Term
| What autoimmune condition can cause entropion? |
|
Definition
| Ocular cicatricaial pemphigoid |
|
|
Term
| In the case of an intraocular impailment injury, the pupil may displace toward/away from the penetration site |
|
Definition
|
|
Term
| What can be done to exclude an intraocular or intraoribtal foreign body when a pt presents with what seems to be a superficial FB |
|
Definition
| CT scan, or X-ray if the FB is known to be metal |
|
|
Term
Which definition goes with the term horde old and which goes with chalazia:
-chronic non infectious granulomatous reaction
-acute focal infectious process |
|
Definition
Hordeola is acute
Chalazia is chronic |
|
|
Term
| What is the most common pathogen of causation in hordeola |
|
Definition
|
|
Term
| All non white pt's presenting with hyphema need to be screened for what |
|
Definition
|
|
Term
| IOP reduction is necessary for a sickle cell patient at what mmhg? A regular pt? |
|
Definition
|
|
Term
| If a hyphema patient has a normal or lower than normal IOP what is possible? |
|
Definition
|
|
Term
| What type of immunoglobulin is responsible for allergic rhinitis |
|
Definition
|
|
Term
| On a CBC of a patient with allergic rhinitis what will be seen? |
|
Definition
| Normal WBC with increased eosinophils |
|
|
Term
| What is the difference in the appearance of the nasal mucosa in a patient with seasonal allergic rhinitis and perennial allergic rhinitis ? |
|
Definition
Seasonal: mucosa looks bluish purplish in color
Perennial: bright red and shows inflammation |
|
|
Term
| What is the allergic triad? |
|
Definition
| Nasal polyps,, aspirin allergy, and asthma |
|
|
Term
| Antihistamines, in the tx of allergic rhinitis, are efficacious in treating most of she symptoms (sneezing, rhinorrhea, itching) but do not cause ignite ant improvement in wht? |
|
Definition
|
|
Term
|
Definition
| Ear discomfort due to pressure differences between the inside and outside of the ear drum. Most usually a negative pressure in the tympanic cavity |
|
|
Term
| What type of hearing loss ms be present with barotrauma? |
|
Definition
|
|
Term
| What are some tx options for barotrauma? |
|
Definition
| NSAIDs for pain, decongestant nose drops, steroids, then surgery if severe enough (paracentesis) |
|
|
Term
| The teed scale of severity is used to asses what? |
|
Definition
|
|
Term
| What is the first line antibiotic for Otitis media? Second line, if the first fails after three days? Second line, if pt is allergic to the class of the first line? |
|
Definition
Amoxicillin
Augmentin or rocephin (ESP if vomiting)
Macrolides (azithromycin, clarithromycin, clindamycin) |
|
|
Term
| What is the pathophysiology of otitis media? |
|
Definition
| Dysfunction of Eustachian tube drainage (could be due t a number of things) leaves air trapped in the middle ear which is eventually resorbed. It's creates a negative pressure and facilitates the reflux of nasopharyngeal bacteria into the Eustachian tube |
|
|
Term
| What is the most common pathogen for OM? Second? |
|
Definition
Strep pneumoniae
H flu ( different strain than meningitis so kids aren't protected by getting the vaccine) |
|
|
Term
| What is the most common pathogen in mastoiditis? |
|
Definition
|
|
Term
| A ct of the mastoid area in a pt with mastoiditis would show what? |
|
Definition
| Loss of mastoid air cells |
|
|
Term
| What cranial nerve is most often affected with mastoiditis |
|
Definition
|
|
Term
| When is it appropriate to treat mastoiditis with abx only, what abx? |
|
Definition
-in the early stages of disease when there is no sign of osteitis or peri osteitis
-rocephin
-ticarcillin (will cover pseudomonas in pt's with chronic mastoiditis ) |
|
|
Term
| What is the classical clinical triad for diagnosing mastoiditis? |
|
Definition
-prominent auricle with retroauricular swelling
-tenderness over the mastoid area
-otorrhea |
|
|
Term
| What are the 5 types of otitis externa? |
|
Definition
1. Acute diffuse: swimmers ear
2. Acute localized: usually an infected hair follicle
3. Chronic: pruritis more than pain and commonly due to drainage from a chronic OM
4. Invasive: in IC or diabetic patients, effects deep tissues of the ear canal and spread to the base of the skull
5. Eczematous |
|
|
Term
| Adults with otitis externa, especially if it is recurrent, should have what blood levels checked? |
|
Definition
| Glucose, because diabetes is a cause for recurrent and malignant otitis externa |
|
|
Term
| Describe the otorrhea seen in acute OE, chronic OE, fungal OE, acute perforated TM, chronic OM, fractured skull, allergy, and osteomyelitis... |
|
Definition
-acute OE: scant white
-chronic OE: more bloody, presence of granulomatous tissue
-fungus: small white or black florets with hyphae
-acute OM w. perf: mucus white yellow with pain
-chronic OM: same as above but no pain
-allergy: serous looking w. clear mucous
-osteomyelitis: foul odor
-fractured skull: CSF, high in glucose! |
|
|
Term
| What is the most common cause of otitis externa (OE)? |
|
Definition
| Pseudomonas aeruginosa (swimming pools and lakes) |
|
|
Term
| What bacteria is the cause of OE in IC adults and those with DM? |
|
Definition
|
|
Term
| What type of drug is the best to treat otitis externa? |
|
Definition
| An antibiotic steroid combo otic solution such as cortisporin (neomycin-polymyxinB-hydrocortisone) |
|
|
Term
| A perforated TM without associated infection or a legit MOA is a red flag for what in kids? |
|
Definition
|
|
Term
| When doing a weber test on a patient with TM perforation, which side will the sound lateralize? |
|
Definition
|
|
Term
| It's controversial to put otic abx drops into an ear with a perforated TM, but whwt class of abx should absolutely be avoided due to risk of sensorineural hearing loss? |
|
Definition
| Amino glycosides (gentamicin, neomycin, tobramycin) |
|
|
Term
| If a patient has a perforated TM and abuse is possible, what is a good way to verify ? |
|
Definition
| Look at the fluid coming from the ear, if its CSF from a ripped dura it will have a high glucose content and will leave a halo on a slide or cotton pad |
|
|
Term
| Which lymph nodes may be resent in a patient with GABHS pharyngitis |
|
Definition
|
|
Term
| Some pt's with GABHS pharyngitis present with symptoms of scarlet fever, give the three most prominent sx of this |
|
Definition
-circumpolar pallor
-white strawberry tongue turning to red strawberry tongue
-diffuse maculopapular rash that feels like goose flesh |
|
|
Term
| What is the gold standard for diagnosing GABHS pharyngitis |
|
Definition
| Throat culture, but RADT is often used in the clinical setting because its faster, but it's more expensive and has less sensitivity than a culture |
|
|
Term
| What abx is m own as the gold standard for GABHS pharyngitis? What does the peds book and dr. Jocher say is a better alternative and why? |
|
Definition
-penicillin
-cephalosporins (ESP keflex) because b-lactamase always present in the throat reduce the efficacy of penicillin and not cephalosporins |
|
|
Term
| What two abx should NOT be used in the tx of GABHS pharyngitis? |
|
Definition
| -tetracyclines and bactrim due to high levels of resistance |
|
|
Term
| How long should a pt stay out of work or school after startin abx to treat GABHS pharyngitis |
|
Definition
|
|
Term
| What complication of GABHS pharyngitis or an infection of the skin has not been shown to be preventable with abx? What are the three classic sx? |
|
Definition
Post strep glomerulonephritis
Hematuria, edema, HTN |
|
|
Term
| What is the common name for aphthous ulcers |
|
Definition
|
|
Term
| Describe what an aphthous ulcer looks like |
|
Definition
| Round or oval with yellow / white center and an erythema tours border and a gray floor |
|
|
Term
| What three nutritional deficiencies have been linked to aphthous ulcers |
|
Definition
|
|
Term
| When should a patient with laryngitis be referred to see a specialist? |
|
Definition
| If hoarseness is present >3 weeks |
|
|
Term
| Name five causes of oral candidiasis |
|
Definition
1. Breast fed infants
2. IC
3. Corticosteroid exposure (inhalers)
4. Abx use
5. DM |
|
|
Term
| How can one tell the difference between oral candidiasis and leukoplakia ? |
|
Definition
| Thrush can be scraped off to reveal an erythematous friable surface underneath |
|
|
Term
| What are 4 possible underlying etiologies in kids with chronic thrush |
|
Definition
-hypoparathyroidism
-Addison's disease
-hypothyroidism
-DM |
|
|
Term
| What are the three different types of dental abscesses? |
|
Definition
-peri apical: usually secondary to dental caries, originating in the pulp, MC in kids
-periodontal: involves the supporting structures of the teeth, MC in kids
-pericoronitis: infection of the gum flap that overlies the third molar |
|
|
Term
| Which tooth is MC effected in dental abscesses |
|
Definition
|
|
Term
|
Definition
| involuntary eye movements usually triggered by inner ear stimulation |
|
|
Term
| When it comes to central and peripheral causes of vertigo, which never has a vertical nystagmus and which may that finding be present? |
|
Definition
peripheral Never has a vertical nystagmus
a vertical nystagmus may be seen in central causes |
|
|
Term
| Tinnitus and deafness are often components of which type of vertigo- peripheral or central? |
|
Definition
|
|
Term
| Describe the difference in onset and severity between peripheral and central causes of nystagmus? |
|
Definition
peripheral is usually sudden and severe
central is usually slow onset and less severe |
|
|
Term
| What is pathognomonic for BPPV? |
|
Definition
|
|
Term
| what medication is often used to treat BPPV? what is a practice the patient can perform at home? |
|
Definition
meclizine (antivert)
epley manuever |
|
|
Term
| What associated finding in a pt with vertigo would lead you to believe it was central or cerebellar in origin? |
|
Definition
|
|
Term
| If a pt is suspected to have central causes of vertigo and MRI or CT of what structure is necessary? |
|
Definition
|
|
Term
| What is the most common form of labyrinthitis and name the mc causative organisms? |
|
Definition
Viral:
-Rubella and CMV prenatal
-Mumps and Measles: postnatal
-Herpes zoster oticus (Ramsay Hunt syndrome) |
|
|
Term
| What is a class of medications that are ototoxic and could be a potential cause of labyrinthitis? |
|
Definition
|
|
Term
| Does labyrinthitis occur with vertigo, nystagmus, or hearing loss? |
|
Definition
| It can occur with any of those, but not all need to be present for a dx |
|
|
Term
| What causes meneires disease? |
|
Definition
| the pathophys is not well understood- but the underlying cause is an overaccumulation of endolymph |
|
|
Term
| What are the guidelines for dx of Meneires dz? |
|
Definition
-recurrent spontaneous episodic vertigo (> or equal to 2 episodes of vertigo of at least 20 min duration must have occured)
-hearing loss
-aural fullness OR tinnitus |
|
|
Term
| What type of hearing loss is affected with Meneires disease? |
|
Definition
|
|
Term
| IF you preformed a Weber and Rinne test on a Meneires dz pt, what would be the results? |
|
Definition
-Rinne shows that air conduction remains > than bone
-Weber: the sound is more pronounced on the UNaffected side
*Normally the sound should be heard equally on both sides, in conductive hearling loss (NOT a meneiers pt) the sound is greater on the affected side, in sensorineural (MENEIRES pt) is is greater on the unaffected side |
|
|
Term
| What are some tx option for Meneires dz |
|
Definition
-meclizine
-salt restriction
-diuretics (AVOID LOOP because of ototoxicity potential)
-Aminoglycosides are a last resort bc they will destroy hearing in the process of releiving sx
-surg if all else fails |
|
|
Term
| What sinuses are the MC sites of sinusitis in children and in adults |
|
Definition
Maxillary is MC across the board
ehtmoid is most common in children |
|
|
Term
| What are the three factors that contribute to the development of a sinusitis? |
|
Definition
-obstruction of sinus drainage pathways (sinus ostia)
-ciliary impairment
-altered mucus quality and quantity |
|
|
Term
| How long should you wait before rx abx in a patient with sx of sinusitis |
|
Definition
-7-10 days
-sometimes a pt will think they are starting to feel better, and then the sx worsen around day 7 |
|
|
Term
| Name some abx that can be used to treat a sinusitis |
|
Definition
| -amoxicillin, augmentin, bactrim... |
|
|
Term
| What types of complications are common with sinusitis |
|
Definition
|
|
Term
| What sinusitis pt is a CT indicated in? |
|
Definition
| chronic sinusitis resistant to other tx, other complications, or an IC host |
|
|
Term
| What is the most common bleeding site in epistaxis |
|
Definition
|
|
Term
| What are some tx options for epistaxis |
|
Definition
-position the pt forward to keep blood from collecting posterior and obstructing the airway
-apply pressure to septum for 15-20 mins
-Decongest the mucosa with Afrin or lidocaine
-if necessary localize the clot and cauterize with silver nitrate |
|
|
Term
| Who are some pts you would suspect nasal polyps in |
|
Definition
-atopic: aspirin allergic, asthma pts
-pts with chronic sinus infections
-CF PATIENTS! |
|
|
Term
| What would a CT scan show for a nasal polyp? |
|
Definition
| cloudy opaque spots in the sinuses, and possible broken down bone from long standing polyps |
|
|
Term
| What are some tx options for nasal polyps? |
|
Definition
-nasal steroid sprays for blockages (nasonex, flonase, nasacort)
-oral corticosteroids if sx persist
-ABX if infection present
-SURG if necessary |
|
|
Term
| The initial manifestation of children and adults with HSV 1 often appears as what? |
|
Definition
-Kids: acute herpetic ginigivostomatitis
-Adults: acute herpetic pharyngotonsillitis |
|
|
Term
| What type of test is ordered to reveal a HSV infection? |
|
Definition
| tzank smear which will show multinucleated giant cells |
|
|
Term
| WHat is herpetic whitlow? |
|
Definition
| often seen in healthcare workers exposed to saliva of pts with HSV- infxn of the fingers at or near the cuticle or other site assoc with trauma |
|
|
Term
| What are some treatments for HSV1 |
|
Definition
magic mouthwash
antivirals- acyclovir etc |
|
|
Term
| what is the most common precancerous lesion of the lips and oral cavity? |
|
Definition
|
|
Term
| what is oral hairy leukoplakia associated with> |
|
Definition
| HIV- thought to be caused by EBV |
|
|
Term
| Which oral lesion can be scraped off- candidiasis or oral leukoplakia? |
|
Definition
| CANDIDIASIS- leukoplakia cannot be scraped off |
|
|
Term
| is oral hairy leukoplakia associated with malignancy? |
|
Definition
|
|
Term
| What social factors are directly related to the development of oral leukoplakia? |
|
Definition
|
|
Term
| what is the necessary eval for oral leukoplakia?? |
|
Definition
|
|
Term
| what is uveitis- what parts of the eye are involved |
|
Definition
| inflammation of the uveal tract of which the anatomy includes: iris, ciliary body, and choroid plexus |
|
|
Term
| what is the MC form of uveitis often seen in primary care or EDs? |
|
Definition
|
|
Term
| what is the causative agent of uveitis? |
|
Definition
often idiopathic
can be due to autoimmune diseases, too (IBD, RA, SLE, sarcoid, TB, syphilis, AIDS) |
|
|
Term
| What are two ways to differentiate uveitis from conjunctivitis |
|
Definition
-COnjunctival exam: perilimbal injection is present and increases in intensity as you approach the limbus. this is the opposite in conjunctitis
-Photophobia will be direct and consensual in uveitis, it will just be direct in conjunctivitis |
|
|
Term
| What is the #1 tx for a PA to remember for uveitis? |
|
Definition
|
|
Term
| What nerve and what muscle are most often associated with an orbital blowout fx- how do you test each |
|
Definition
infraorbital nerve (touch below the lower eyelid on both sides of face)
inferior rectus muscle (have the patient look up, they either wont be able to do it or they may have diplopia when they look up) |
|
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Term
| what is the most common site of orbital blowout fracture? what site will put the pt at increased risk of orbital cellulitis? |
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Definition
orbital floor (superior aspect of the maxillary bone)
medial wall fractures (ethmoid bone) |
|
|
Term
| What do you check for by palpating the bony rim of the orbit in a pt with a possible orbital wall fx? |
|
Definition
|
|
Term
| What is the imaging used to eval an orbital wall fx? |
|
Definition
|
|
Term
|
Definition
| defined as increased IOP with optic nerve damage |
|
|
Term
| What race is most often affected with glaucoma? |
|
Definition
|
|
Term
| What is the 2nd MCC of blindness in the US |
|
Definition
|
|
Term
| Describe the hx and PE of a pt with acute angle glaucoma (narrow angle) |
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Definition
| -develops over hours, painful red eye with vision loss, pupils tend to be fixed mid-dilated, may see a "halo", may describe vision as "cloudy" or "steamy" |
|
|
Term
| Describe the vision loss of a pt with primary, open angle, glaucoma |
|
Definition
| peripheral first, then central |
|
|
Term
| Describe the open angle glaucoma- sex it affects most, and eye sx |
|
Definition
men > women
Incr. IOP
optic neuropathy |
|
|
Term
|
Definition
|
|
Term
| What is Ramsay Hunt Syndrome. what part of the body does it affect |
|
Definition
VZV infection of the head and neck that involves the facial nerve
-gives rise to vesiculation and ulceration of the external ear, ipsilateral ant 2/3 of tongue and soft palate, ipsilateral facial neuropathy |
|
|
Term
| how does a ramsay hunt pt typically present |
|
Definition
| deep pain within the inner ear that eventually radiates out to the pinna. pain can be present for hours to days before rash occurs |
|
|
Term
| what are the two drugs used to tx ramsay hunt |
|
Definition
| corticosteroids (prednisone) and acyclovir (zovirax) |
|
|
Term
| when does a ramsay hunt patient need to follow up with their PCP |
|
Definition
| 2 weeks, 6 weeks, and 3 months |
|
|
Term
| What is a peritonsillar abscess? |
|
Definition
| unilateral inflammatory process that is in tonsilar parenchyma and the peritonsilar tissue |
|
|
Term
| what are some signs and sx of a peritonsilar abscess |
|
Definition
| unilateral swelling and erythema of soft palate, hot potato voice, dysphagia, fever, drooling, uvular deviation |
|
|
Term
| the pathophysiology of peritonsillar abscess is unknown, what is a proposed theory |
|
Definition
| progression of an episode of exudative tonsillitis first into peritonsillitis and then into frank abscess formation |
|
|
Term
| what is the tx for a peritonsillar abscess |
|
Definition
| aspiration or incision and drainage followed by abx (augmentin or clindamycin) |
|
|
Term
| what are the sx of a retropharyngeal abscess |
|
Definition
| sore throat, fever, neck stiffness, and stridor |
|
|
Term
| what is the tx for retropharyngeal abscess |
|
Definition
-protect airway, O2, intubate if necessary
-call ENT
-admit with IV abx!!!! |
|
|
Term
| what is the tx for retropharyngeal abscess |
|
Definition
-protect airway, O2, intubate if necessary
-call ENT
-admit with IV abx!!!! |
|
|
Term
| What is another name for Ludwigs angina |
|
Definition
|
|
Term
|
Definition
| an oral floor abscess that can become potentially life threatening if the inflammatory process spreads to the deep cervical soft tissues and mediastinum |
|
|
Term
| Where does the inflammation of ludwig's angina usually begin? |
|
Definition
|
|
Term
| What will be seen clinically with ludwig's angina? what will the pt be complaining of? |
|
Definition
-edematous expansion with a firm, erythematous expansion in the submental and submandibular areas
-pt c/o difficulty swallowing and speaking
-high fever |
|
|
Term
| what needs to be done to make a dx of ludwigs angina |
|
Definition
|
|
Term
| What is the tx for Ludwig's angina |
|
Definition
ADMIT
consult ENT- they can I and D the abscess
IV abx |
|
|
Term
|
Definition
| opacity of the natural lens of the eye |
|
|
Term
| What are the two major types of cataracts? What are some risk factors for cataracts? |
|
Definition
-acquired and congenital
-DM, UV rays, smoking, excessive ETOH use, trauma, aging, hypothyroidism, down syndrome |
|
|
Term
| what will a cataract look like on fundoscopic exam? |
|
Definition
| black on a red background |
|
|
Term
| Mild cataracts that are not interfering with a patients ADLs can be treated with what? |
|
Definition
|
|
Term
| what is the most common tx of cataracts that are affecting a patients ADLs |
|
Definition
|
|
Term
| What are 4 diseases that can cause congenital cataracts |
|
Definition
Rubella
Mumps
Hepatitis
Toxoplasmosis |
|
|
Term
| Name some visual complaints that a pt with cataracts may have |
|
Definition
-yellow vision
-cloudy or foggy vision
-glare
-trouble driving at night
-reduced color perception
-double vision |
|
|
Term
| What is the leading cause of vision loss in patients older than 65? In patients younger than 65? |
|
Definition
age related macular degeneration
diabetic retinopathy |
|
|
Term
| Does ARMD effect central or peripheral vision? |
|
Definition
|
|
Term
| What are some RFs for ARMD? |
|
Definition
advancing age
white race
female gender
tobacco!!!!
UV rays |
|
|
Term
| What are the two types of ARMD? |
|
Definition
-wet, neovascular, exudative
-dry, non-neovascular, non-exudative |
|
|
Term
| What are some visual complaints in a patient with ARMD |
|
Definition
| blurred vision, distortion, peripheral vision is PRESERVED |
|
|
Term
| describe the pathophysiology of dry ARMD and what may be seen on fundoscopic exam |
|
Definition
-atrophy and degeneration of the retina
-drusen (debris within the retinal basement membrane) form and are seen as yellow spots on the retina on exam
-gradual visual acuity loss
-can at any moment change to the wet form.... |
|
|
Term
| describe the pathophysiology of wet ARMD and what may be seen on fundoscopic exam |
|
Definition
- less common that dry, but causes more severe visual loss
-causes sudden visual loss due to leakage of serous fluid into the retina, followed by abnormal vessel formation under the retinal pigment epithelium
-see serous fluid and intraretinal hemorrhages on exam |
|
|
Term
| What is the most important lifestyle modification that can be made in the tx of ARMD |
|
Definition
|
|
Term
|
Definition
-none has shown to be totally effective
-lutein and other vitamin supplements
-there are laser treatments and photodynamic therapy available |
|
|
Term
|
Definition
-none has shown to be totally effective
-lutein and other vitamin supplements
-there are laser treatments and photodynamic therapy available |
|
|
Term
| What is the most common cause of orbital cellulitis |
|
Definition
| bacterial ethmoid (occasionally frontal) sinusitis extension into the involved orbit |
|
|
Term
| What are the MC s/sx of orbital cellulitis |
|
Definition
-malaise and fever
-pain with eye movement
-limited ocular mobility, "CEMENTED GLOBE"! |
|
|
Term
| What imaging tests should be ordered of the orbit in a case of orbital cellulitis? |
|
Definition
|
|
Term
| What is the tx of orbital cellulitis? |
|
Definition
| ADMIT the pt and put on IV abx, MC oxacillin with a second agent depending on age |
|
|
Term
| What is the major DDX for orbital cellulitis? |
|
Definition
| paraseptal cellulitis which is more common but is anterior to the orbital septum so chemosis and limited mobility are absent |
|
|
Term
| What are two major complications of orbital cellulitis? |
|
Definition
-orbital inflammation leads to optic neuritis with atrophy and vision loss
-purulent thrombophlebitis of the orbital veins can lead to a cavernous sinus thrombosis |
|
|
Term
| What is the difference between a pterygium and a pinguecula? |
|
Definition
histologically they are the same: they are non-cancerous growth of tissue in the conjunctiva.
-a pinguecula does NOT grow onto the cornea
-a pterygium does grow onto the cornea! |
|
|
Term
| What is the treatment for a pterygium? |
|
Definition
none, let them be
they can be surgically excised if they start to interfere with vision, but they often recur unless the diseased bowman's layer is also removed |
|
|
Term
| What is the major risk factor for pterygium? |
|
Definition
|
|
Term
| The common presenting complaint in an emergency situation of "I can't see, and I feel like a curtain fell over my eye" is pathognomonic for what diagnosis? |
|
Definition
|
|
Term
| What are some other common visual symptoms of retinal detachment besides "curtain falling" |
|
Definition
| seeing flashing lights, floaters, blurred or blackening vision |
|
|
Term
| What is the treatment for a retinal detachment? |
|
Definition
emergency consult to ophthalmology--> surgery
patient should lay supine with head turned the direction of the affected eye |
|
|
Term
| What will be seen on fundoscopic exam of retinal detachment |
|
Definition
| often nothing, but possibly the rugous retina flapping in the vitreous humor |
|
|
Term
| what are some RFs for retinal detachment |
|
Definition
-can be spontaneous
-trauma
-extreme myopia
-older age |
|
|
Term
| Does every break in a retina lead to a retinal detachment? |
|
Definition
| No- detachment occurs when the liquefied vitreous body separates and vitreous humor penetrates beneath the retina through the tear and the forces of adhesions can no longer withstand the pressure |
|
|
Term
| What is more common, a retinal artery or retinal vein occlusion? |
|
Definition
| retinal vein occlusions are much more common |
|
|
Term
| What is the common presentation of a retinal vascular occlusion? |
|
Definition
| sudden painless marked unilateral vision loss |
|
|
Term
| What are common fundoscopic findings of a retinal artery occlusion |
|
Definition
| a pale or ground glass retina with a cherry red spot at the fovea. |
|
|
Term
| what is the name for the glistening yellow orange flakes of emboli that are seen on fundoscopic exam in a patient with retinal artery occlusion |
|
Definition
|
|
Term
| What are some risk factors for a retinal artery occlusion |
|
Definition
|
|
Term
| in retinal artery occlusion either the central retinal artery is occluded or a branch of it, what is the difference in pt presentation |
|
Definition
complete visual field defect in CRAO
sectional visual field defect in BRAO |
|
|
Term
| When is boxcar segmentation seen on fundoscopic exam |
|
Definition
| this is a sign of severe occlusion and slowing of the circulation.... often seen with branch retinal artery occlusion |
|
|
Term
| What is a beta blocker often used to lower IOP? |
|
Definition
|
|
Term
| what is the tx for retinal vascular occlusions? |
|
Definition
| immediate optho consult and lower IOP |
|
|
Term
| what is a risk factor for retinal vein occlusion that was not mentioned for RAO |
|
Definition
| glaucoma increases risk by 5x |
|
|
Term
| what is a risk factor for retinal vein occlusion that was not mentioned for RAO |
|
Definition
| glaucoma increases risk by 5x |
|
|
Term
| What are some findings on fundoscopic exam that are characteristic of a retinal vein occlusion |
|
Definition
| "BLOOD AND THUNDER RETINA": flame hemorrhages, edematous optic disk, edematous retinal vein, macular edema, possibly cotton wool spots |
|
|
Term
| What are the two types of diabetic retinopathy? What will you see on fundoscopic exam with each? |
|
Definition
-non-proliferative: venous dialtion, microaneurysms, retinal hemorrhages, retinal edema, hard exudates, and cotton wool spots
-proliferative: neovascularization, vitreous hemorrhage |
|
|
Term
| When should a newly diagnosed type 1 and type 2 diabetic get their first ophthalmic exam? then how often after that? |
|
Definition
-type 1: within 5 years of diagnosis, then annually
-type 2: at diagnosis, then annually |
|
|
Term
| Patients with diabetic retinopathy will be asymptomatic until what happens? |
|
Definition
| when the macula becomes involved or if their is vitreous hemorrhage |
|
|
Term
| What are cotton wool spots? What diagnosis are they most often associated with? Other dx's? |
|
Definition
-infarction of the nerve fiber layer of the retina
-DIABETIC RETINOPATHY!
-also retinal vein occlusion and htn retinopathy |
|
|
Term
| In hypertensive retinopathy and sclerotic changes in the eye, what is the basis behind each formation |
|
Definition
-htn: arterial changes primarily caused by vasospasm
-arteriosclerosis: changes due to thickening of the wall of the arteriole |
|
|
Term
| WHat may be seen on fundoscopic exam in a patient with htn retinopathy or sclerotic changes? |
|
Definition
arteriovenous nicking (discontinuity in the retinal vein secondary to thickened arterial walls) and cotton wool spots.
-in more serious disease you may see hemorrhages and exudates
-papilledema is an ominous finding seen in pts with severely elevated BP |
|
|
Term
| what is optic neuritis usually associated with? s /sx? |
|
Definition
-MS
-decreased vision, pain with movement, decr color perception |
|
|
Term
| dx and tx for optic neuritis? |
|
Definition
MRI can visualize the optic nerve very well
usually resolves on its own, color vision loss can be permanent, steroids can help sx and make healing faster |
|
|
Term
| what is the hallmark of intracranial HTN |
|
Definition
|
|
Term
| what is the main tx to remember when dealing with a pt with a hyphen? Why? |
|
Definition
-REFER punt to ophtho.
-bc the RBCs can block the trabecular meshwork and cause high IOPs. Give them an eye shield and do an emergent consult to ophtho |
|
|
Term
| an acoustic neuroma is a rare benign tumor affecting what nerve? |
|
Definition
| The 8th cranial nerve (auditoy/vestibulocochlear) this nerve functions in balance and in hearing |
|
|
Term
| when a patient has an acoustic neuroma, what other CN might be affected due to trauma during surgery or growth of the tumor? |
|
Definition
|
|
Term
| Explain the results of the webber and rinne test |
|
Definition
-Weber is normal if the sound does not lateralize. If it materializes to one side there is either conductive hearing loss on the side it lateralized to, or sensorineural hearing loss on the contralateral side.
-The Rinne test is positive if AC>BC. If there was lateralization towards the left in the Weber, then the Rinne was pos. on the left, this means there is sensorineural hearing loss on the contralateral side. If Rinne neg. in this instance, then there is conductive hearing loss on that Left side |
|
|
Term
| What are the s/sx of acoustic neuroma? |
|
Definition
| Gradual or sudden onset of hearing loss, ataxia, nystagmus, tinnitus, vertigo |
|
|
Term
| what is the number one concern for a DM patient with chronic OM? Tx? |
|
Definition
| Cholesteatoma, referral to ENT for surgery d/t bone destruction |
|
|
Term
| If a bug is the foreign body inside an ear canal, what must be done first before trying to remove? |
|
Definition
| kill it with rubbing alcohol, this goes for any live object in the ear |
|
|
Term
| what will dissolve styrofoam or super glue if in the ear canal? |
|
Definition
|
|
Term
| if a foreign body seems to far to grasp in the ear with a tool, what can be done first (if the tympanic membrane is intact)? |
|
Definition
|
|
Term
| what should be ruled out if the patient has sudden onset of hearing loss? |
|
Definition
|
|
Term
| What causes conductive hearing loss? |
|
Definition
| impaired transmission of sound along the external canal, across the ossicles and through the oval window. Can be due to cerumen, otosclerosis, OE or OM |
|
|
Term
| What is sensorineural hearing loss and what is the MCC |
|
Definition
| hearing loss secondary to disruption of the nerves or mechanics of hearing. MCC is presbycusis |
|
|
Term
| What class of drugs is asssoc with hearing loss? |
|
Definition
| aminoglycosides (-mycins-- gentamycin, streptomycin, neomycin, tobramycin) |
|
|
Term
What is the common name for hematoma of the external ear?
tx? |
|
Definition
cauliflower ear
drain the hematoma, then compress the skin against the cartilage, the hematoma will reform if the skin is not pressed between the cartilage |
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