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Flashcards in 67-100 Deck (19)
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1
Q

67.S/S of central vs. branch retinal vein occlusion.

Retinal Vein Occlusions (Central and Branch)

Pathophysiology

  • Sudden ______ loss of vision (branch 4x more common)
  • Major predisposing factors are the etiologic factors associated with _______

S/S
No _____ or ______
Widespread or sectoral retinal _______
Visual impairment commonly first noticed upon _____
Widespread retinal hemorrhages, retinal venous dilation and tortuosity
Retinal ______l spots and optic disk ______
Branch occlusion:
-Sudden loss of vision at the time of occlusion if the _____ is involved
-Sometime after from vitreous hemorrhage due to retinal new _______
-More gradual loss with macular edema
-Retinal abnormalities are confined to the area drained by obstructed vein

Risk factors: check for __, tobacco smoking, estrogen therapy including OCPs

  • Screen for ___, hyperlipidemia, hyper viscosity
  • Antiphospholipid antibodies, lupus anticoagulant, inherit4ed thrombophilia and homocysteine levels

Prevention

Treatments

PPP – no consensus on optimal treatment 
 High risk of neo-vascular glaucoma with retinal ischemia 
photocoagulation 
Intravitreal \_\_\_\_\_\_
Intravitreal corticosteroids 
Misc.
A
monocular
arteriosclerosis
pain, redness
hemorrhages
waking
cotton wool
 swelling
fovea
vessels

BP
DM

VEGF

2
Q

Retinal Artery Occlusions (Central and Branch)

Pathophysiology
___, hyperlipidemia and systemic ____ are predisposing factors
Migraine, OCPs systemic vasculitis, thrombophilia and hyperhomocysteinemia

S/S 
Sudden \_\_\_\_\_\_ loss of vision 
No \_\_\_ or \_\_\_\_\_
Widespread or sectoral retinal \_\_\_\_\_\_\_: 
Sudden profound monocular visual loss 
Visual acuity substantial reduces 
Visual field restricted  

PE
Pallid swelling of the retina with _____ spot at the fovea
_____ segmentation of blood in the veins may be seen
_____ may be seen in the central artery or its branches
Retinal swelling subsides over a period of 4-6 weeks leaving a pale ______ and attenuated arterioles

Branch:
Sudden loss of vision if the ____ is involved
More commonly sudden loss of visual field is presenting complaint
Fundal signs of retinal swelling and adjacent ______ spots are limited to the area of _____ suppled by the occluded artery

Epidemiology

Patient 50 years or older consider Giant Cell arteritis

Tests

Elevated ESR, CRP in giant cell arteritis but may be normal
Screen for vasculitis
Screen for DM and hyperlipidemia
Duplex ultrasonography of carotid arteries, ECG, and echocardiography with transesophageal studies

Prevention

Treatments 
If seen few hours after onset
emergency treatment!
lay patient \_\_\_\_
\_\_\_\_\_ massage
high conc \_\_\_\_\_\_
IV \_\_\_\_\_\_\_\_

Misc.

A

DM, HTN

monocular
pain, redness
pallid swelling

cherry red
box car
emboli
optic disc

fovea
cotton wool
retina

flat
ocular
oxygen
acetazolamide

3
Q

69.S/S of hypertensive chorioretinopathy. Prevention of retinopathies.
Hypertensive Retinopathy - damage to the retinal blood vessels from longstanding high _______

Pathophysiology
Acute changes in BP
Most ____ ocular changes
Causes: pheochromocytoma, ______ hypertension, preeclampsia-eclampsia

S/S
Acute elevations in BP result in:
Loss of ______ in the retinal circulation
Leads to breakdown in the ______ integrity
Leads to _______ of precapillary arterioles and capillaries
________ (damage to nerve fibers; fluffy white patches)
Retinal _______
Retinal edema
Retinal exudates, often in stellate appearance at the macula (lipid residue from damaged capillaries)

Acute elevations of BP
Vasoconstriction and ischemia in the ______
-___________
-Retinal pigment epithelial infarcts
-May also affect the optic nerve head
–Ischemic optic neuropathy with optic disc swelling
_____ abnormalities are the hallmark of hypertensive crisis with retinopathy
–Previously known as malignant hypertension
-Marked fundal abnormalities are likely associated with permanent retinal, choroidal or optic nerve damages
–Precipitous reduction of blood pressure may exacerbate such damage

A

BP
florid

malignant

autoregulation
endothelial
occlusion
cotton wool spots 
hemorrhages

choroid
retinal detachments
fundal

4
Q

70.S/S of malignant otitis externa.
Malignant External Otitis (_______ of the skull base)

Patho
Caused by __________

S/S 
Persistent foul aural \_\_\_\_\_\_
Granulations in the ear canal  
Deep \_\_\_\_\_  
Advanced cases: progresive cranial nerve palsies VI, VII, IX, X, XI, or XII 

Epid
Diabetic or ________ patients

Diagnostics
Diagnosis confirmed by osseous erosion on ___ and _______ scanning

Treatment
Prolonged _____________
IV often required: _____
Some select patients may be treated with oral cipro

Misc

A

osteomyelitis

pseudomonas aeruginosa

discharge
otalgia

immunocompromised

CT
radionucleotide

antipseudomonal antibiotic
cipro

5
Q

71.Treatment of mastoiditis.

Mastoiditis

Patho
•Evolves following several weeks of inadequately treated acute _________

S/S
Postauricular _____ & _____ accompanied with spiking _______

Epid

Diagnostics

•__ scan reveals coalescence of the mastoid cells due to destruction of bony septa

Treatment

  • __________ directed against the most common offending agents (s.pneumoniae, H. influenzae, S pyogenes)
  • ______ 0.5-1.5 g every 6-8 hours

Myringotomy for C and S

Misc

A

otitis media
pain, erythema
fever

CT

IV antibiotics
Cefazolin

6
Q

72.Treatment of laryngitis.

Laryngitis

Patho
Acute ______ of the mucosa of the larynx
Avoid vigorous use of ____ (singing, shouting) until voice returns to normal
Persistent use may lead to formation of traumatic vocal fold ______, polyps and cysts

Etiologies: viral _______ infection most common – adenovirus, rhinovirus, influenza, RSV, parainfluenza

S/S
Most common cause of ______ - hallmark
Aphonia
Dry or _____ throat
May have _____ symptoms (rhinorrhea, cough, sore throat)

Epid

Diagnostics
Usually a clinical diagnosis

Treatment
PPP- Supportive care mainstay- _____, humidification, ____ rest, warm saline gargles, anesthetics, lozenges, and reassurance that is usually self-limited
PPP-ENT follow up if workup needed
______ may speed improvement of hoarseness at 1 week and cough at 2 weeks when measured subjectively
Oral or IM corticosteroids may be used in selected cases of professional vocalists to speed recovery and allow scheduled performances

A

inflammation
voice
hemorrhages

URI

hoarseness
scratchy
viral URI

hydration
vocal

erythromycin

7
Q

73.S/S of herpes zoster ophthalmicus.

Herpes Zoster Opthalmicus

Pathophysiology
Involves ophthalmic division of _____ nerve
Preceding eruption of ______
_____, ____ headache and _____ burning and itching

S/S 
Ocular signs 
\_\_\_\_\_\_\_\_
\_\_\_\_\_\_
Episcleritis 
Anterior \_\_\_\_

Optic neuropathy, cranial nerve palsies, acute retinal necrosis and cerebral angiitis are infrequent
Rash is initially vesicular becoming ____ then _____
Involvement of tip of the nose or lid margins involves the eye

Epidemiology
____ risk factor

Treatments

High dose oral:
____ 800mg 5x daily
Valaciclovir 1g TID
Famciclovir 500mg TID

Misc.
*Refer all cases to Ophthalmology

A

trigeminal
vesicles
malaise, fever
periorbital

conjuncitvitis
keratitis
uveitis
pustular, crusting

HIV

acyclovir

8
Q

75.Patho and S/S of viral labyrinthitis.

Labyrinthitis

Patho
Cause unknown
Inflammation of the vestibular and cochlear portion of CN ___
Acute onset of continuous, usually severe vertigo lasting ____ to a _____

S/S
_____ loss
______

Treatment
______ if patient is febrile
Vestibular suppressants (valium, meclizine)

Misc

A

VIII
several days, week
hearing
tinnitus

antibiotics

9
Q

Papilledema

Pathophysiology
Optic nerve (disc) _____ secondary to increased ___
Idiopathic

S/S
•Usually _____ and most commonly produces enlargement of the _____ without loss of acuity
Chronic papilledema or Severe acute papilledema – associated with visual field loss and occasionally with profound loss of _____

Treatments
____ loss
________

Chronic needs to be monitored carefully and CSF shunt or optic nerve sheath fenestration should be considered with progressive visual failure not medically controlled

A

Swelling
ICP

bilateral
blind spot
acuity

weight loss
acetazolamide

10
Q

82.Patho of hemotympanum.

_____ behind an ____ tympanic membrane (hemotympanum) may follow ____trauma or extreme ________

A

hemorrhage
intact
blunt
barotrauma

11
Q

88.S/S and causes of conductive hearing loss

Conductive hearing loss results from ____ or ______ ear dysfunction. Four mechanisms each result in impairment of the passage of sound vibrations to the inner ear: (1) ______(eg, cerumen impaction), (2) ____ loading (eg, middle ear effusion), (3) ______(eg, otosclerosis), and (4) _____ (eg, ossicular disruption). Conductive losses in adults are most commonly due to _____ impaction or transient _______ dysfunction from ____. Persistent conductive losses usually result from chronic ear infection, trauma, or otosclerosis. Conductive hearing loss is often correctable with medical or surgical therapy, or both.

A
external, middle
obstruction
mass
stiffness
discontuinity 

cerumen
eustachian tube
URI

12
Q

89.S/S and causes of tinnitus.

Tinnitus

Patho
Defined as the sensation of sound in the _____ of an exogenous sound source

S/S 
 Pulsatile tinnitus  
-Described as listening to one’s own \_\_\_\_\_ 
-May be more serious  
-May indicate a \_\_\_\_\_ abnormality  

Tonal Tinnitus
-____ in the ears

Staccato or “clicking”

  • ____ ear spasm sometimes associated with palatal myoclonus
  • Rapid series of ____ noises
  • Lasts ____ to a few _____
  • Accompanied by _____ feeling in the ear

Pulsatile: Magnetic resonance angiography and venography
Routine nonpulsatile: Audiometry
Unilateral: MRI to r/o a retro cochlear lesion

Treatment

Avoidance of excessive ____, ____ agents and other factors that may cause damage
oral antidepressants: ______
Misc

A

absence

heartbeat
vascular
ringing
middle
popping
seconds, mins
fluttering

noise
ototoxic
nortriptiyline

13
Q

92.S/S of trench mouth, herpes stomatitis, apthous ulcers

Herpes Stomatitis
Patho
-Common, mild, and ___ lived

S/S

  • Initial _____
  • Typical small ____ that rupture and form scabs
  • Most commonly found on the attached _____ and mucocutaneous junction of the ___
  • Lesions can also form on the tongue, buccal mucosa and soft palate

Diagnostics

Differential diagnosis: ___ ulcers, herpangina, ________ disease, coxsackievirus-caused lesions.

Treatment

Requires no intervention in most adults
_____, valacyclovir

Misc

A

short
burning
gingigiva
lip

apthous
hand and foot

acyclovir

14
Q

92.S/S of trench mouth, herpes stomatitis, apthous ulcers

Apthous Ulcers

Patho
Cause uncertain – ____
_____ is a major predisposing factor

S/S 
-single or \_\_\_\_\_ 
-Found on freely \_\_\_\_\_, nonkeratinized mucosa
–\_\_\_\_and labial mucosa 
–Not attached to \_\_\_\_ or palate 
-usually recurrent 

■____ small round ulcerations with _______ fibrinoid centers surrounded by ___halos

■Minor

–Less than 1 cm

–Heal 10-14 days

■Major

–Greater than 1 cm

–May be disabling due to degree of pain

Treatment

–Challenging: no single systemic tx has proven effective

–Topical ______

Misc

A
HHV6
stress
moving
buccal
gingiva

painful
yellow-grey
red

corticosteroids

15
Q

93.S/S and treatment of viral pharyngitis, diphtheria,

Diphtheria
Patho
pharyngeal diphtheria, the most common form

S/S
a tenacious_______ membrane covers the ____ and _____. Mild sore throat, ____ and____ are followed by toxemia and prostration.

Diagnostics

The diagnosis is made clinically but can be confirmed by ______ of the organism.

Treatment
Removal of membrane by direct ______ or bronchoscopy may be necessary to prevent or alleviate airway obstruction.
______, which is prepared from horse serum, must be given in all cases when diphtheria is suspected.

Misc

A
gray
tonsils, pharynx
fever, malaise
culture
laryngoscopy
antitoxin
16
Q

95.S/S, causative agents and treatment of acute otitis media and chronic otitis media.

Acute Otitis Media

Patho
_____, often with an ____
Erythema and ______ of tympanic membrane
Bacterial infection of the mucosally lined air containing spaces of the _____ bone
usually precipitated by viral URI
Infected by bacteria:
Most commonly _______ haemophilus Influenza, streptococcus pyogenes

S/S 
\_\_\_\_\_ material forms in \_\_\_\_ ear cleft and mastoid air cells and petrous apex 
Otalgia 
Aural pressure 
Decreased \_\_\_\_\_  
Often fever  
May have tenderness of the mastoid  

PE – erythema and decreased _____ of the TM, occasionally bullae on the TM

Epid
Infants and children

Treatment
Specific antibiotic therapy
First choice: _____ or _____plus sulfonamide

Misc

A

otalgia, URI
hypomobility
temporal
strep pneumoniae

purulent
middle
hearing

mobility

amoxcicillin, erythromycin

17
Q

Chronic Otitis Media

Patho
•Chronic infection of _____ ear and _____
•Generally develops as a consequence of recurrent ____ but may follow other disease and trauma

S/S
•Chronic _____ with or without otalgia
•Tympanic membrane _____ with _____ hearing loss
•Perforation of the tm is usually present

Clinical hallmark:
•_____ aural discharge
•Continuous or intermittent
•Increased severity during ____ or following _____ exposure
•Pain is uncommon except during acute exacerbations
•Conductive hearing loss results from destruction of the TM or ossicular chain or both

Treatment
The medical treatment of chronic otitis media includes regular removal of infected ___, use of _____ to protect against water exposure, and topical antibiotic drops (______ 0.3% or ciprofloxacin with dexamethasone) for exacerbations

Misc

A

middle, mastoid
acute OM

otorrhea
perforation
conductive

purulent
URI
water

debris
earplugs
ofloxcacin

18
Q

97.Diagnostic findings in Diabetic Retinopathy. Prevention of retinopathies.

Diabetic Retinopathy

Pathophysiology

S/S
•Nonproliferative: mild, moderate or severe. Microvascular changes are limited to the _____
•Mild: without visual loss
•Proliferative retinopathy: new retinal, optic nerve or iris _____
•Diabetic Macular edema: central retinal ______; can occur with any severity; reduces visual acuity if the center is involved
•Non-proliferative retinopathy
•Microaneurysms
•Retinal _____
•Venous beading
•Retinal edema
•Hard _____
•Reduction of ____ most commonly due to diabetic macular edema
•Focal or diffuse
May be associated with treatment with thiazolidinediones (glitazones)

Proliferative Retinopathy
•__________
•Arising from either the optic disk or the major vascular arcades
•_____ hemorrhage is a common sequela
•Proliferation of blood vessel into the vitreous may lead to _______

Epidemiology
•Present in about 35% of all diagnosed diabetic patients
•Present in about 20% of type 2 diabetic patients at diagnosis

Tests
•Visual ____ testing, stereoscopic examination of the retina, retinal imaging with optical coherence tomography and sometimes fluorescein angiography.

Prevention

Screening
•Undergo at least yearly screening by fundal photography
•More frequent monitoring
•Women during ______
•Those planning pregnancy
•Type 2 should be screened shortly after diagnosis

Treatments

  • Optimizing _______, ______, kidney function and serum lipids
  • Probably more important in preventing the development than in influencing its subsequent course.
  • Fenofibrate and renin-angiotensin system inhibitors are beneficial even in established retinopathy
  • Macular edema and exudates
  • Laser photocoagulation
  • Intravitreal administration of a ____ inhibitor (mainstay of treatment; vascular endothelial growth factor)
  • Corticosteroid implant
  • Fluocinolone implant
  • Vitrectomy
  • Intravitreal injection of a serine proteases to release vitreo-retinal retraction

Misc.

  • When to Refer
  • All diabetic patients with sudden loss of vision or retinal detachment should be referred emergently to an ophthalmologist
  • Proliferative retinopathy or macular involvement requires urgent referral to an ophthalmologist
  • Severe non-proliferative retinopathy or unexplained reduction of visual acuity requires early referral to an ophthalmologist.
A
retina
vessels
swelling
hemorrhages
exudates
vision

neovascularization
vitreous
retinal detachment

acuity

pregnancy

blood glucose
BP
VEGF for proliferative

19
Q

99.S/S and treatment of hordeolum

Hordeolum

Pathophysiology
Common ______ abscess

S/S
localized ___, _____, acutely tender area. Can be internal or external.

Treatments
______
Incision indicated if resolution does not begin within 48 hours
Use abx ointment (______ or _____)

Misc.
Internal stye can lead to _____ of the eyelid

A

staphylococcal
red, swollen

warm compresses
bacitracin
erythromycin
cellulitis