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5. ENT Flashcards

1
Q
  1. Otoscopy shows cerumen impacted - type of hearing loss/Tx?
  2. Perforated TM - Tx?
A
  1. MC Conduction hearing loss
    • Tx: Hydrogen peroxide 3%, Carbamide peroxide
  2. Heal its own
  • Avoid water/mositure/aminoglycosides if TM rupture
  • only abx is ofloxacin can be use
  • Surgery may need if past two month
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2
Q

Pt complains Pain on traction of the ear canal/tragus

ID/Pathogen/Patient/Presentation/PE/Tx/Complication

A

Name: OE (Otitis externa)

Pathogen: Pseudomonas

Patient: Swimming or exposure moisture

Presentation: malodorous discharge and pruritus

PE: tenderness with tragus or pinna

Tx: Cipro (ofloxacin safe to use TM perforation), Hydrocortisone

Complication: Osteomyelitis at skull (Necrotizing)

  • often cause due to DM or immunocompromised
  • Tx: IV piperacilin or ceftazidime + FQ
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3
Q

Pt’s ear cartilage thickening which looks like cauliflower ear. Pt had hx of blunt trauma.

ID/Patho/Tx

A

ID: Auricular hematoma

Patho: blunt trauma

Tx

  • Evacuate blood < 7days, abx (cephalexin)
  • ENT referral >7days
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4
Q

Pt complains of Gradually Unilateral sensorineural hearing loss and Tinnitis over months. Other result pending at this time.

ID(other name)/Involve nerve/Dx/Tx

A

ID: Acoustic neuroma (CN8) - other name: Vestibular schwannoma

Involve nerve

  • hearing loss - cochlear nerve
  • ataxia - vestibular nerve
  • facial - Facial nerve

Dx: MRI

Tx: Surgery

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5
Q

Pt recently had airplane trip. Pt complains of ear fullness after get off airplane.

ID/Patho/Patient/Tx

A

ID: Barotrauma

Patho: rapid pressure change due to eustachian tube closer -> inability of ET to equalize pressure

Patient: diver or flying

Tx: Autoisufflation (swallowing, yawning), decongestant or antihistamine

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6
Q

Vertigo

  1. No hearing loss + episodic vertigo - ID/Patho/Dx/Tx
  2. hearing loss + episodic vertigo - ID/Patho/Extra sx/Tx
  3. No hearing loss + Cont’ Vertigo - ID/Patho/Tx
  4. Hearing loss + Cont’ Vertigo - ID/Patho/Patient/Extra sx/Tx
A
  1. BPPV (benign paroxymal positional vertigo
    • Patho: displaced otolith
    • Dx: Dix-hallpike test - Place 30 degree head -> quick move 90 degree of one side -> check delayed nystagmus (POSITIVE)
    • Tx: Epley maneuver (reposition to put otolith back to normal)
  2. Meniere
    • Patho: Inner ear distention by excessive fluid
    • Extra sx: Tinnitus
    • Tx: vestibular rehabilitation(Main), Low salt diet and diuretic, Meclizine(vertigo)
  3. Vestibular neuronitis
    • Patho: inflammation of vestibular (MC after viral infection)
    • Tx: Corticosteriod + Meclizine (for vertigo)
  4. Labyrinthitis (라베리나이티스)
    • Patho: cochlear hearing loss
    • Patient: recent URI
    • Extra sx: Tinnitus
    • Tx: Corticosteriod + Meclizine (for vertigo)
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7
Q

Central vs Peripheral vertigo

Onset/effect position/direction nystagmus/Neurologic

A

Central

  • Onset: gradual or sudden
  • Head position: Do not effect
  • Direction nystagmus: bidirection horizon or vertical
  • Neruologic finding: yes

Peripheral

  • Onset: Sudden
  • Head position: worsened by position
  • Direction nystagmus: Unidirection (never vertical)
  • Neurologic finding: No
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8
Q

Pt complain of painless brown/yellow discharge with strong order and granulation tissue

ID/Patient/Dx/Tx

A

ID: Cholesteatoma

Patient: MC has hx of Chronic ET

Dx: Otoscopy (granulation tissue)

Tx: Tympanomastoid surgery

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9
Q

Pt had hx of URI few days ago. Pt complain of ear pain. PE reveals bulging and red TM w/ effusion

ID/Pathogen/PE/Dx/Tx

A

ID: AOM (acute otitis media)

Pathogen: S. Pneumo, H.flu, Moraxella catarrhalis, Strep pyogenes

Presentation: URI sx

PE: Bulging, red TM (decreased TM mobility)

Dx: Otoscopy

Tx:

  • One time - AMOX, if PCN allergy Cefixime or cefidinir
  • recurrent - Augmentine, if PCN allergy -> Clinda + cefixime or cefidinir
  • acetic acid drops - someone who can’t afford medication
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10
Q

Sensory vs conduct hearing loss

Result of hearing test/MC cause

A

Sensory normal ear to lateralization + AC >BC

  • Presbyacusis(Aging) MC

Conduct: Affected ear to lateralization + BC >AC

  • Cerumen impaction MC
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11
Q

Pt had hx of OM. Pt present mastoid tenderness and deep ear pain

ID/Patient/Dx/Tx

A

ID: Mastoiditis

Patient: hx of Otitis Externa

Dx: CT scan

Tx: IV abx + drainage + admission

  • Refractory - mastoidectomy
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12
Q

Pt states his ear continues Perforated TM and recurrent purulent otorrhea for months

ID/Pathogen/Tx

A

ID: Chronic otitis media

Pathogen: Pseudomonas, S. Aureus

Tx: Oflaxacin

  • no water, aminoglycosides in the ear if TM rupture
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13
Q

Pt had Ear fullness, poping of ears. But PT reveals normal otoscopy exam. No pain.

ID/Patient/Dx/Tx

A

ID: Eustachian tube dysfunction

Patient: hx of URI or allergy rhnitis

Dx: Normal otoscopy exam

Tx: Decongestants

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14
Q

bugs in ear

ID/MC risk/Tx

A

ID: Foreign body in the ear

MC risk: 6y> children

Tx: kill bug first by using mineral oil -> remove

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15
Q

Pt present with nose area tenderness. PE revealed Sinus pain with pressure and worse with bending down & leaning forward

ID/Pathogen/MC site/Duration/PE/Dx/Tx

A

ID: Acute Sinusitis

Pathogen: S. Pneumo, H flu, GABHS, M catarrhalis

MC site: Maxillary

Duration: 1-4 weeks (if more than 10-14 days bacterial)

PE: Opacification with transillumination, tenderness nose area

Dx: CT scan

Tx: Symptomatic therapy (1st)

  • Abx use only if presistant more than 10 days or faicial swelling - AMOX, augmentin
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16
Q

Pt has long hx of facial pressure pain x 12wks. Upon PE, revealed black eschar on palate, face.

ID/Complication/Tx

A

ID: Chronic sinusitis

Complication: Mucormycosis

Tx: IV amphotericin

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17
Q

Pt complain of Clear rhinorrhea and Nasal polyps. Pt states nasal congestion worse in the morning

ID/Patho (2 type)/Patient(triad)/PE/Dx/Tx

A

ID: Rhinitis

2 type

  • Allergy - MC type - IgE mediated mast cell histamine release
  • Infection - Rhinovirus MC infection

Patient: hx of asthma, dermatitis and rhinitis altogether make up atopy

PE

  • Transverse nasal crease/infraorbita edema/cobblestone - allergy
  • Erythmatous turbinates - viral

Dx: elevated IgE

Tx

  • Intranasal steriod (flonase) Best option for seasonal allergic rhinitis
  • If Failed Flonase then use antihistamine - Azaletine
  • Decongestant - 3-5 days use only (rebound congestion)
    • DO not use it for allergic rhinitis monotherapy
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18
Q

Pt present for annual exam. PE shows nasal polyp but otherwise normal exam

ID/Patient/Triad/Tx

A

ID: Nasal polyps

Patient: allergic MC

Triad: Samter Triad: asthma + allergy/NSAID/ASA sensitivity + nasal polyps

Tx: Flonase

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19
Q

Nasal bleeding

ID/2 type/Risk/Tx/Prevention/Special consideration

A

Name: Epistaxis

2 type

  • Anterior - Kiesselbach’s plexus MC site
  • Posterior - Palatine artery MC site

Risk

  • Anterior - nasal trauma MC
  • Posterior - HTN, atherosclerosis

Tx

  • Direct pressure (1st) - Compress the Kiesselback plexus with the child in an upright position and head tilted forward
  • Decongestant or cocain 4% helpful
  • Continue bleeding posterior - may consider hospitalization

Prevention: avoid exercise, spicy food

Special consideration: Septal hematoma - consider loss of cartilage if hematoma not removed

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20
Q

Children + foul odor in nose

Name/Dx/Tx

A

Name: Nasal Foreign body

Dx: Rigid or flexible fiberoptic endoscopy

Tx: Remove

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21
Q

Strep throat

Pathoge/4 sx/Criteria interpretation/Dx/Tx/Complication

A

Pathogen: GAS

Strep throat 4 sx

  • Fever (101.5)
  • Lymadenopathy (neck)
  • Absent of cough
  • Pharyngotonsillar exudate

Criteria interpretation

  • 0-1 point - No abx No culture
  • 2 - Rapid test(1st) if Neg do culture
  • 3-4 - Rapid test(1st) and culture + Abx

Dx

  • Rapid strep test (1st screening) if negative should do culture
  • Culture (Definitive)

Tx

  • PCN
  • Macrolide if PCN allergy

Complication: Glomerulonephritis, Rheumatic fever

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22
Q

Muffle (hot potato voice) + Uvula deviation to contralateral side

Name/Pathogen/Dx/Tx

A

Name: Quinsy (peritonsillar abscess)

Pathoge: GAS

Dx: CT

Tx: I&D followed by augmentin,

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23
Q

Vocal abuse (singers, screaming) + hoarseness

Name/Patho/MC cause/Tx

A

Name: Laryngitis

Patho: Inflammation of the larynx

MC cause: Viral infection MC

Tx: Supportive

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24
Q

White curd like plaque able to scrape and bleeding after scrape

Name/Pathogen/Risk/Dx/Tx

A

Name: Oral Candidiasis (thrush)

Pathogen: Candida albicans

Risk: often hx of DM (check glucose)

Dx: KOH smear (budding yeast/pseudohyphae)

Tx: Nystatin liquid, Oral fluconazole

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25
Painless white patchy lesion that cannot scraped off Name/Patho/Dx/Tx
Name: Oral leukoplakia Patho: Precancerous hyperkeratosis Dx: Biopsy Tx: Cryotherapy, laser ablation
26
Painless white plaque along the lateral tongue borders or buccal mucosa (irregular hairy or feathery) Name/Risk/Tx
Name: Oral hairy leukoplakia Risk: Epstein-Barr virus, HIV related Tx: No specific tx, Acyclovir
27
Yellow centered surrounded by red halo Name/Tx
Name: Aphthous ulcers (Canker sore, ulcerative stomatitis) Tx: Viscous Lidocaine 2-5%, topical oral steriod
28
Postprandial(after food) salivary gland pain & swelling + No trismus + No ductal discharge Name/Gland duct/Tx
Name: Sialolthiasis Gland duct: Wharton (submandibular), Stensen (parotid) Tx: sialogogues (tart, hard candies, lemon drop)
29
Postprandial gland swelling and pain + tenderness at the duct opening + Trismus + ductal discharge Name/Pathogen/patho/Dx/Tx
Name: Sialadenitis Pathogen: S. Aureus Patho: Infection of parotid or submandibular (salivery gland) Dx: CT scan Tx * Sialogogues (Tart hard candies or lemon drop) * IV dicloxacillin or nafcillin + Metronidazole or Clindamycin if severe
30
Lacy leukoplakia of the oral mucosa (Wickham striae) Name/Risk/Tx
Name: Oral lichen planus Risk: Hep C infection Tx: Corticosteroids
31
Sudden onset fever and gum swelling or bleeding (gingivitis) Name/Risk/Tx
Name: Acute herpetic gingivostomatitis Risk: HSV 1 infection children (6month - 5y) Tx: self limited
32
vesicles that rupture and become ulcerative lesion with grayish exudates + fever Name/Tx
Name: Acute herpetic pharyngotonsillitis Risk: HSV 1 children Tx: Oral hygiene - resolve within 7-14 days
33
Swelling & erythema of the upper neck & chin with PUS on the floor of the mouth + Phonation is muffled and tongue protrusion Name/Patho/PE/Dx/Tx
Name: Ludwig's angina Patho: cellulitis of the sublingual & submaxillary spaces in the neck PE * upwardly displaced tongue as cellulitis and pus gather in the floor of the mouth * Phonation is muffled and tongue protrusion Dx: CT Tx: AMP/sulbactam, pen + Metro or clinda
34
swelling angle of mendible + Trismus Name/Pathogen/Risk/Tx
Name: Pariotitis Cause: S Aureus Risk: hx of dehydration or intubation Tx: IV abx
35
Stridor + Trismus + neck rigidity + muffle voice Name/Patho/Risk/Pathogen/Dx/Tx
Name: Retropharyngeal abscess Patho: infection and thickened prevertebral space Risk: 3-5 y children Pathogen: S. Aureus, GAS Dx: Lateral neck x-ray (widened retropharyngeal space twice the size of the vertebral body in C2-4) Tx: IV Abx, I & D
36
1. Shine on unaffected eye both constrict but shine on affected eye both dilate = Name/MC cause 2. Accomodation but does not react to light = Name/MC cause 3. Bitemporal heteronymous hemianopsia = MC cause 4. Vision curtain lift up usually within 1 hour called as?
1. Marcus gunn pupil - MC Optic neuritis (MS) 2. argyll-robertson pupil - MC neurosyphilis 3. Pituitary adenoma 4. Amaurosis fugax
37
Prulent and yellow discharge + Worst in the morning, hard to open eye due to cursting. Name/Patho(2 case)/PE/TX (2 case)
Name: Bacterial conjunctivitis Patho * MC case: infection (Staph A) * Lens wearers: Pseudomonas PE: Prulent, yellow discharge Tx * General infection: Erythromycin, Polymix B meds * Lens wearer: FQ (moxifloxacin)
38
Pt complaining of itch eye and tearing. No prulent discharge. ID/Presentation/PE/Tx
ID: Allergic conjuctivitis Presentation: itching PE: Cobblestone mucosa Tx: H1 blocker (olopatadine)
39
Pt complaining of Copious watery discharge and bilateral pink or red eye. ID/Patho/Presentation/PE/Tx
ID: Viral conjunctivitis Presentation: red or pink eye PE: Corpious watery discharge, preauricular lymphadenopathy Tx: Cool compress, artificial tear, antihistamine if itch
40
New born baby less than 14 days comes with eyelid swelling and discharge ID/Patho/Patient/PE/Dx/Tx
ID: Chlamydial conjunctivitis Patho: Chlamydia trachomatis Patient: Neonate 5-14 days PE: Eye swelling and mucoprulent discharge Dx: Culture Tx: **Oral** erythromycin
41
New born baby less than 5 days comes with swelling and discharge ID/Patho/Patient/Dx/Tx
ID: N. Gonorrhoea conjunctivitis Patho: N. Gonorrhoea Patient: Neonate 0-5 days PE: Eye swelling and mucoprulent discharge Dx: Culture Tx: **Ointment** erythromycin
42
61 y pt present to clinic for gradual blurre vision over few months ID/Patho/Patient/Presentation/PE/Tx/Differential
ID: Cataract Patho: Lens opacification (thicken) Patient: OLD Presentation: Gradual blurreness or double vision PE: Clouding lens (NO red light reflex) Tx: Surgical removal Differential: Retinoblastoma - white pupil + Absent red reflex
43
Pt used extensive contact lens uses. Oval ulcer with ragged edge reveals upon test. Patient complain of pain and foreign body senation. ID/Patho/Patient/PE/Dx/Tx
ID: Corneal ulcer Patho: Staph A (if lens - Pseudomona) Patient: hx of lens use or trauma PE: Oval ulcer with ragged edges Dx: Fluorescein dye test Tx: Emergent ophthalmo consult
44
Pt who is welder comes to clinic for bilateral decreased vision acuity and pain. ID/Patient/Presentation/PE/Dx/Tx
ID: Ultraviolet Keratitis Patient: Welder or skier Presentation: bilateral vision acuity decreased PE: Multiple punctate lesion Dx: fluorescein staining Tx: NSAID
45
Pt present to clinic for foregin body sensation. Upon exam, revealed dendritic lesion on cornea. ID/Colonized/Presentation/PE/Dx/Tx
ID: Herpes simplex keratitis Colonized: trigeminal ganglion (V1) Presentation: Unilateral pain, Foregin body sesation PE: Cillary flush Dx: Slit lamp (dendritic) Tx: Acyclovir
46
Pt has hx of prolong exposure to sunlight. PE reveals triangular-shaped growth on medial aspect of eye. ID/Patient/Presentation/PE/Tx
ID: Pterygium Patient: prolong exposure of sunlight, Sand wind Presentation: foreign body sensation PE: Triangular-shaped growth on medial aspect of eye (Corneal involved) Tx: Artificial tear, sunglasses, surgical excision
47
Pt has yellow, brown fleshy mess on the conjunctiva. Do not involve corneal. ID/PE/Tx
ID: Pinguecula PE: Nasal side of Sclera (No involve Corneal) Tx: Observe
48
Pt present with Unilateral tender and swelling at inframedial of eye. ID (2 case)/Involved gland/Presentation(2 case)/Complication/Tx
ID: Dacryocystitis vs dacryoadenitis Involve gland: lacrimal Presentation * Cystitis (infection) - **inframedial,** **overflow tearing** * Adenitis (inflammation) - **supratemporal** Complication: preseptal or orbital cellulitis Tx: * Mild - clindamycin * Severe - Vanco
49
Pt woke up in the morning with crusting, scaling, red-rimming of eyelid. Also able to see eyelash flaking. ID/Patho/Presentation/PE/Dx/Tx/Associated with other Dz
ID: Blepharitis Patho: MC caused by dysfuntional of meibomian gland Presentation: eyelash flaking PE: Crusting, scaling, red-rimming of eye Dx: Slit exam Tx * Supportive: warm compress * Abx for flare up: erythromycin Associated with other Dz: seborrhea, and Rosacea
50
Hordeolum vs Chalazion Patho/Presentation/Location/Tx
Hordeolum * Patho: **infection** * Presentation: **Tender** * Location: Near follicle * Tx: warm compress + I&D Chalazion * Patho: **Obstruction** of meibomian gland * Presenation: **nontender** * Location: upper lid * Tx: Warm compress (if prolong I&D)
51
Entropion vs Ectropion Patho/Presentation/PE/Tx
Ectropion * Patho: caused by aging * Presentation: Dry eye * PE: eyelid outward * Tx: Surgical correction Entropion * Presentation: foreign body sensation * PE: eyelid inward * Tx: Surgical correction
52
1. eye rapidly moves called as? 2. if eye movement up and down caused by what? 3. if eye movement horizontal caused by what? 4. Gaze-evoked caused by what?
1. Nystagmus 2. CNS dysfunction 3. Labyrinth or vestibular 4. MC and benign
53
Pt complains of monocular vision loss and pain worse with eyemovement ID/Patho/Associated Dz/Medication/Presentation/PE/Dx/Tx
ID: Optic Neuritis Patho: Demyelinating inflammation of the optic nerve Associated dz: Multiple sclerosis Medication: Ethambutal Presentation * Monocular vision loss * eye pain with move * loss of color vision * Transient vision loss due to increased body temp (uhthoff's phenomenon) PE: Marcus-gunn pupil Dx: MRI (confirm) Tx: IV methylprednisolone (will return if tx)
54
Pt present to urgent care for acute onset of HA and blurred vision. PE revealed ICP increased and optic disc swelling. ID/Patho/Presentation/PE/Dx/Tx
ID: Papilledema Patho: ICP increased Presentation: Acute onset of HA, blurred vision PE: Optic disc swelling Dx: Fundoscopy Tx: Acetazolamide
55
Pt presents with painful eye swelling and limited extraocular movement. ID/Patient/Presentation/PE/Dx/Tx/Comparable dz
ID: Orbital cellulitis Patient: Children, bacterial rhinosinusitis Presentation: swelling eye PE: Painful eye and limited extraocular movement, proptosis Dx: Clinically Tx: Vanco + piperacillin Comparable dz: pre-orbital cellulitis (eye movement doesn't cause pain)
56
70 y pt present with gradual central field vision loss with Scotoma (blind spot) and Metamorphopsia (line bent) ID/Patient/Presentation/PE/Dx/Tx
ID: Macular degeneration Patient: 50y\< (MC blindness in elderly) Presentation * Dry - **Drusen** - accumulation of waste products(breakdown of retina) from the retinal pigment * Wet - **Sudden** Abnormal vessel PE: Dry (**Gradual** vision loss), Wet (**Sudden** vision loss) Dx: Amsler grid (dry), Fluorescein angiography (wet) Tx * Dry - Zinc, Vitamin A,C,E (slow down progression) * Wet - - Zumab meds
57
Pt complain with Flash light, floater, and Unilater vision loss (curtain down) ID/Patho/Presentation/Dx/Tx/Avoid/Confused w/ other
ID: Retinal detachment Patho: Retinal tear Presentation: **Painless** loss of vision, floaters, flashing light, **curtain down** Dx: Funduscopy - flapping (haze gray w/ white fold) Tx: Ophtho Emergency Avoid: **DO NOT USE MIOTIC DROP** Confused with other: Amaurosis fugax - **Curtain lifts up**
58
Pt reports progressive central vision loss. Pt has hx of DM. ID/Patient/Presentation/PE/Tx
ID: Diabetic retinopathy Patient: DM Presentation: Progressive central vision loss, Red spot and floaters PE: Microaneurysms (cotton-wool spot, hemorrhages) Tx: DM control (1st), Laser surgery or Vitrectomy
59
Children loss of red reflex upon exam. ID/Patho/PE/Special comment
ID: Retinoblastoma Patho: MC loss function of the retinoblastoma gene PE: white pupil (leukocoria) Special comment: MC eye tumor in children
60
Pt had hx of trauma to the orbit. Upon PE, revealed that pt unable to upward gaze and enophthalmos (eyeball socket inward) ID/Presentation/PE/Mc site/Muscle entraped/Dx/Tx
ID: Orbital floor fx Presentation: Limited upward gaze PE: Enophthalmos MC site: Maxillary Muscle entrapt: inferior rectus Dx: CT scan (tear drop) Tx * Nasal decongestants (decrease pain) * Avoid blowing nose * Corticosteriod (reduce edema) * Abx * Surgical repair
61
Pt recently had penetrating eye injury. ID/Patho/Patient/PE/Dx/Tx
ID: Globe rupture Patho: Full thickness injury to the sclera Patient: Recent penetrating injury or trauma, blunt trauma PE: teardrop pupil, seidel sign (aqueous flows on fluorescain test) Dx: CT Tx: Emergency ophthalmology consult + eye shield + elevated head 45 degree
62
Pt had hx of blunt trauma. Pt complains of blurre vision and PE revealed blood in the anterior chamber. ID/Patient/Presentation/PE/Tx
ID: Hyphema Patient: hx of trauma Presentation: blurred vision PE: Blood in the anterior chamber Tx: eye protection + rest with head elevated 30-45 degrees all the time + opthalmology consultation
63
CRAO vs CRVO Risk/Presentation/Dx/Tx
CRAO * Risk: Atherosclerotic disease (**Ophtho ER**) * Sx: sudden Mono vision loss + amurosis fugax * Dx: fundoscopy - Cherry red macula (red spot) * Tx: Lower IOP (mannitol IV) + ophtalmology consult CRVO * Risk: DM, HTN * Sx: sudden Mono vision loss * Dx: fundoscopy - Thunder & blood appearance (extensive retinal hemorrhage) + tortorus vein seen * Tx: Opthalmology consult
64
Pt has Foregin body sensation, tearing, and painful eye ID/Presentation/Dx/Tx (1st thing first)
ID: Ocular foreign body & Corneal abrasion Presentation: foreign body sensation Dx: Fluorescein staining Tx: visual acutiy check 1st * If foreign body - remove with irrigation + ABX * if abrasion - small no patch, larger then 5mm Patch it but no longer than 24hours + ABX * if contact lens - NO PATCH, use CIPRO drop * if Rust ring - remove rust ring at 24 hour
65
Chemical burn Type/Tx
Ophtho Emergency Type * Alkali burn - worse than acid, denature protein * Acid burn - coagulative necrosis Tx * Irrigation with Lactaed ringers or Normal saline * PH & visual acuity after irrigation * ABX - moxifloxacin
66
Acute closed vs open Glaucoma Sx/PE/Dx/Tx/Contraindication (closed only)
Acute (closed) * Sx: Sudden painful unilateral eye (halo around light) * PE: Cloudiness + fixed nonreactive pupil * Dx: Tonometry (IOP high 30 * Tx: Timolol (reduce IOP, 1st) + Pilocarpine +Acetazolamide (severe case) * Dilation of the pupils is contraindicated in acute closed-angle glaucoma. Chronic (open) * Sx: Painless bilateral peripheral vision loss (tunnel vision) * PE: Cupping of optic disk * Tx: Prostaglandin * Laser therapy if failed meds
67
Esotropia vs exotropia ID/Patho/Dx/Tx
ID: Strabismus Patho: misalignment of the eyes (Newborn - stable ocular alignment not present until 2-3month of life) * Esotropia - Deviated inward * Exotropia - Deviated outward * Hypertropia - Upward * Hypotropia - Down Dx: Hirschberg Corneal light reflex test (cover/uncover test) Tx: Patchy therapy, corrective surgery
68
Pt has hx of HLA-B27. PE reveals cilliary injection and inflammatory cells & flare ID/Patient/Location/Tx
Name: Uveitis (iritis) Patient: hx of HLA B27 Location * Anterior - unilater eye pain + redness * Posterior - decreased vision Tx * Anterior - topical corticosteriod (scopolamine) * Posterior - systemic corticosteriod

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