ENOT/Ophthalmology Flashcards
(73 cards)
1
Q
Sinus pain/pressure (worse with bending down and leaning forward). Facial tap elicits pain.
A
Acute sinusitis ; MC after URI
2
Q
MCC of sinusitis & what are the MC organisms
A
- Viral: Most common, symptoms < 7 days. Bacterial: Symptoms 7+ days and associated with bilateral purulent nasal discharge.
- Organisms: S. pneumoniae, H. influenzae, M.catarrhalis
3
Q
When would sinusitis be considered to be chronic
A
-
Chronic = lasts 12 weeks or longer
- Chronic: Plainview X-ray (waters view) is a good initial screening, CT is the Gold Standard
4
Q
Indications for abx for sinusitis
A
antibiotics in rhinosinusitis include the duration of symptoms >10 days without improvement. Treatment is for five to seven days
- Amoxicillin (500 mg orally three times daily or 875 mg orally twice daily) or amoxicillin-clavulanate (500 mg/125 mg orally three times daily or 875 mg/125 mg orally twice daily)
- Penicillin-allergic: Doxycycline 100 mg orally twice daily or 200 mg orally daily
- Macrolides (clarithromycin or azithromycin) and trimethoprim-sulfamethoxazole are not recommended for empiric therapy because of high rates of resistance of S. pneumoniae
- kids Amoxicillin x 10-14 days
5
Q
Dx of Blepharitis
A
DX is usually by slit-lamp examination
TX: Warm compresses, daily lid wash with diluted baby shampoo on cotton-tipped swabs; lid massage to express the gland; topical antibiotics used if infection suspected
7
Q
Causes of Cholesteatoma
A
- Caused by chronic eustachian tube dysfunction which results in chronic negative pressure and inverts part of the TM causing granulation tissue that over time, erodes the ossicles and leads to conductive hearing loss
TX: Surgical removal
8
Q
MCC of conjuncitivits
A
- MC caused by adenovirus; highly contagious, transmission via direct contact/swimming pools
9
Q
will present with purulent (yellow) discharge from both eyes (“glued shut”), crusting, usually worse in the morning; May be unilateral
A
Bacterial conjunctivitis
10
Q
Abx tx for bacterial conjunctivitis
A
- Gentamicin/tobramycin (Tobrex): aminoglycoside antibiotic used for gram-negative bacterial coverage. Most cases of bacterial conjunctivitis will respond to this agent
- Erythromycin ointment (E-Mycin) Chlamydia for newborns
- Trimethoprim and polymyxin B (Polytrim) This combination is used for ocular infections, involving cornea or conjunctiva, resulting from strains of microorganisms susceptible to this antibiotic.
- Ciprofloxacin (Ciloxan)
11
Q
Contact wearers abx for bacterial conjunctivitis
A
Contact lenses use = pseudomonas tx=fluoroquinolone (ciprofloxacin / Ciloxan drops)
- Neisseria conjunctivitis warrants prompt referral and topical + systemic antibiotics
- Chlamydial conjunctivitis systemic tetracycline or erythromycin x 3 weeks, topical ointments as well, assess for STD or child abuse
12
Q
Allergic conjunctivitis tx
A
epinastine (Elestat)
- azelastine (Optivar)
- Emedastine difumarate (Emadine)
- Levocabastine (Livostin)
13
Q
- White spot on the surface of the cornea that stains with fluorescein: round “ulceration” versus “dendritic” pattern like herpes
A
Corneral ulcer
14
Q
MCC of corneal ulcer
A
Contact lens wearers, caused by a deep infection in the cornea by bacteria, viruses or fungi
15
Q
- Inflammation of the nasolacrimal duct or the nasolacrimal gland (supratemporal)
A
Dacryoadenitis
17
Q
Tx of dacrocystitis
A
Tx: systemic antibiotics: Clindamycin + 3rd gen. cephalosporin
18
Q
(eversion of the eyelid) occurs when the eyelid turns outward exposing the palpebral conjunctiva, conjunctiva will appear red from air exposure and inflammation
A
Ectropion
19
Q
- Peripheral to central gradual visual loss (versus macular degeneration which is a central loss)
A
Open angle glaucoma
20
Q
Classic triad of acute narrow angle-closure glaucoma
A
- Classic triad: injected conjunctiva, steamy cornea, and fixed dilated pupil, this is an ophthalmic emergency
21
Q
- Sudden dull or severe eye pain (unilateral), worse in dark rooms
A
Acute narrow angle-closure glaucoma:
22
Q
Tx of Acute narrow angle-closure glaucoma
A
- Acetazolamide IV is the first-line agent - decrease IOP by decreasing aqueous humor production
- Topical beta-blocker (ex. timolol) reduces IOP without affecting visual acuity
- Miotics/cholinergics (ex. Pilocarpine, Carbachol)
- Peripheral iridotomy is the definitive treatment
23
Q
- A gradual loss of peripheral vision; Painless
A
Chronic open-angle glaucoma
24
Q
painful red infection in a gland at the margin of the eyelid
A
Hordeolum
25
Painful vs painless eyelid lesion
* [**Painful warm (hot)**](https://smartypance.com/wp-content/uploads/2015/09/Stye02_0.jpg)**,** swollen **red lump** on the eyelid = Hordeolum
* Chalazion which is painless
26
MC organism in Hordeolum
S.aureus
27
Hordeolum Tx
**Warm compress** and **topical antibiotics**
* A hordeolum that does not respond to hot compresses **can be incised** with a sharp, fine-tipped blade
* **Systemic antibiotics** (eg, dicloxacillin or erythromycin 250 mg PO QID) are indicated when **cellulitis accompanies a hordeolum**
28
**Trauma causes blood in the** [**anterior chamber of the eye**](https://smartypance.com/wp-content/uploads/2017/09/an-vitreouschamber.jpg) (between the cornea and the iris) and may cover iris
Hyphema
29
Dx of Hyphema
DX: **orbital CT if indicated** + ophthalmology consult
30
Tx of Hyphema
TX: usually, blood is **reabsorbed over days/weeks**
* **Elevate head at night at 30 degrees**, acetaminophen for pain, patch/shield
* May use beta-adrenergic blockers or carbonic anhydrase inhibitors
* Surgery if high pressure/persistent bleeding
* **NSAIDs contraindicated** (may increase bleeding)
31
**Acute onset, vertigo + hearing loss, tinnitus** of several days to a week
[**Labyrinthitis**](https://smartypance.com/lessons/ear-disorders/inner-ear-pearls/labyrinthitis/)
32
MCC of [**Labyrinthitis**](https://smartypance.com/lessons/ear-disorders/inner-ear-pearls/labyrinthitis/)
* Usually **viral**, an **absence of neurologic deficits**
* Associated with **nausea and vomiting**
33
**hoarseness** following a URI
Laryngitis
34
In Laryngitis, if hoarseness **persists \> 2 weeks**, history of ETOH and or smoking, laryngoscopy is required for symptoms persisting \> 3 weeks
Consider **squamous cell carcinoma**
35
Laryngitis tx
TX: Relax voice **(vocal rest)**, supportive therapy
* Oral or IM **corticosteroids** may also hasten recovery for performers but requires vocal fold evaluation before starting therapy
* Bacterial → erythromycin, cefuroxime, or Augmentin for cough or hoarseness
36
**Gradual painless** loss of **central vision****.** The macula is responsible for central visual acuity which is why macular degeneration causes gradual central field loss.
Macular degeneration
37
Difference between dry vs wet macular degeneration
* **Dry (85% of cases)**: atrophic changes with age – a slow gradual breakdown of the macula (macular atrophy), with [**DRUSEN (DRY)**](https://smartypance.com/wp-content/uploads/2018/04/macular_degeneration.jpg) = yellow retinal deposits
* **Wet**: an advanced form of dry age-related macular degeneration
* New blood vessels growing beneath the retina ([**neovascularization**](https://smartypance.com/wp-content/uploads/2018/04/macular_degeneration.jpg)) leak blood and fluid, damaging the retinal cells. These small hemorrhages usually result in rapid and severe vision loss
38
Tx of wet macular degeneration
* VEGF inhibitors (*e.g.,* bevacizumab)
* Photodynamic therapy
* Zinc and antioxidant vitamins
39
Tx of dry macular degeneration
**Dry** age-related macular degeneration
* Zinc and antioxidant vitamin
40
Meniere dz etiology
**Excessive endolymph fluid** in cochlea overstimulates hairs causing vertigo and sudden hearing loss with aural fullness - Unknown etiology
41
Sx of Meinere dz
* Vertigo attacks **lasting hours**, classic triad of **low-frequency hearing loss, tinnitus with aural (ear) fullness and vertigo**
42
Tx of meniere dz
TX: Low salt diet, diuretics (HCTZ + triamterene) to reduce aural pressure
43
Samters triad
Samter's triad for nasal polyps
1. **asthma**
2. **aspirin sensitivity**
3. **nasal polyps**
44
Otitis externa
[**Bacterial otitis externa**](https://smartypance.com/wp-content/uploads/2018/11/Otitis-Externa.jpg) "swimmer's ear"
45
* **Ear pain (**especially with **movement of tragus** or auricle), pain with eating, purulent **cheesy white discharge**, palpation of the tragus is painful
* Tuning fork ⇒ **bone conduction** \> air conduction
Bacterial otitis externa
46
Otitis externa organisms
* **Pseudomonas aeruginosa** (swimmer’s ear) vs. **S. aureus** (digital trauma)
47
Diabetic otitis externa
* **Malignant otitis externa** is commonly seen in **diabetics**
48
Tx of otitis externa
TX: **Antibiotic drops** ⇒ (aminoglycoside or fluoroquinolone +/- corticosteroids) + avoid moisture
* **If perforated or chance of perforation:** Ciprofloxacin 0.3% and dexamethasone 0.1% suspension: 4 drops BID × 7 days or ofloxacin: 0.3% solution 10 drops once a day × 7 days
* **Diabetic/immunocompromised:** malignant otitis externa ⇒ necrotizing infection ⇒ hospitalization with IV abx (caused by aspergillus)
49
1) [**bulging of the tympanic membrane**](https://smartypance.com/wp-content/uploads/2015/09/aom.jpg) or 2) other signs of acute inflammation (eg, **marked erythema** of the tympanic membrane, **fever, ear pain**) and **middle ear effusion**
Otitis media
50
MC bugs in otitis media
**S. pneumoniae 25%**, H. influenzae 20%, M. catarrhalis 10%
51
Dx of otitis media
otoscopic ⇒ [**bulging**](https://smartypance.com/wp-content/uploads/2015/09/aom.jpg), loss of landmarks, redness, TM injection
52
Otitis media tx
**first-line amoxicillin**, augmentin = 2nd line (PCN allergy = azithromycin, erythromycin, Bactrim)
* Treat **\< 2 y for 10 days** and **\> 2 y for 5-7 days**
* Recurrent: tympanostomy, tympanocentesis, myringotomy
* Complications: Mastoiditis and bullous myringitis
53
**Optic disc swelling** that is caused by **increased intracranial pressure**. The swelling is usually bilateral and can occur over a period of hours to weeks
Papilladema
54
Common causes of papilledema
* Causes include [**malignant hypertension**](https://smartypance.com/lessons/hypertension-pearls/hypertensive-emergencies/)**,** [**brain tumor/abscess**](https://smartypance.com/lessons/neurologic-system-intracranial-neoplasms/)**,** [**meningitis**](https://smartypance.com/lessons/infectious-disorders-3/meningitis-reeldx348/)**,** [**cerebral hemorrhage**](https://smartypance.com/lessons/vascular-disorders/intracracial-hemorrhage-reeldx744/)**,** [**encephalitis**](https://smartypance.com/lessons/infectious-disorders-3/encephalitis/), pseudotumor cerebri
55
Mumps parotitis MCC
* **Mumps** is caused by a **paramyxovirus****.**Likely in a**child without a complete vaccination series.**Transmitted via**respiratory droplets**
* Typically, it begins with a few days of **fever, headache, myalgia, fatigue,** and **anorexia, followed by** [**parotitis**](https://smartypance.com/wp-content/uploads/2017/09/parotitis.jpg)
* In adult males **look for an associated orchitis**
56
Viral parotitis mcc
* **Viral infections** associated with parotitis include influenza A virus, **parainfluenza**, adenovirus, coxsackievirus, Epstein-Barr virus (EBV), cytomegalovirus, herpes simplex virus, human immunodeficiency virus (HIV), and lymphocytic choriomeningitis virus
57
Peritonsillar abscess
* Presents with a **hot potato (muffled) voice,** **severe sore throat**, lateral [**uvula displacement**](https://smartypance.com/wp-content/uploads/2015/09/quinsy1.jpg), bulging tonsillar pillar
58
Tx of peritonsillar abscess
Aspiration, **incision** and **drainage, and/or antibiotics**
* **IV antibiotics ⇒** amoxicillin, amoxicillin-sulbactam, and clindamycin
* In less severe cases, **oral antibiotics** can be used for 7 to 10 days (i.e., amoxicillin, amoxicillin-clavulanate, clindamycin)
* **Tonsillectomy** may also be considered in about 10% of patients
59
Viral pharyngitis mcc
Usually [**viral**](https://smartypance.com/wp-content/uploads/2018/05/adenovirus.png) - **adenovirus** most common
* **Mononucleosis:** Epstein Barr virus, fever, sore throat, lymphadenopathy, splenomegaly, **atypical lymphocytes,** **+ heterophile agglutination test (monospot)**
* Consider **gonorrhea pharyngitis** in patients with recent sexual encounters, or with **non-resolving pharyngitis**
* [**Fungal**](https://smartypance.com/wp-content/uploads/2018/05/candidal-pharyngitis.png) in patients using **inhaled steroids**
60
Strep pharyngitis centor criteria
* Group A B-hemolytic streptococci **(GABHS)**
* **Centor criteria**: 1. Absence of a cough, 2. [**exudates**](https://smartypance.com/wp-content/uploads/2018/05/Exudative-Pharyngitis.png), 3. fever (\> 100.4 F), 4. cervical lymphadenopathy
* Not suggestive of strep - coryza, hoarseness, and cough
* If 3 out of 4 Centor criteria are met get a **rapid streptococcal test** (sensitivity \> 90%)
* **If negative → throat culture** is the gold standard
61
Elevated, superficial, [**fleshy, triangular-shaped**](https://smartypance.com/wp-content/uploads/2015/12/pterygium-510x304.png) **“growing” fibrovascular mass** (most common in the inner corner/nasal side of the eye)
Pterygium
62
**Pterygium tx**
Tx: Only surgically **remove when vision is affected**
63
Retinal detachment
**Separation of the retina** from the pigmented epithelial layer causing the detached tissue to appear as a [**flap in the vitreous humor**](https://smartypance.com/wp-content/uploads/2019/06/Retinal-Detachment.jpg)
64
Tx for retinal detachment
Stay **supine** (lying face upward) with head turned **towards the side of the detached retina**
* Consult ophthalmologist
* **Pneumatic retinopexy** is a procedure for the management of retinal detachment that involves cryoretinopexy followed by **injection of an air bubble in the vitreous**
65
Retinal vascular occlusion
⇒ Central **retinal artery** occlusion ([**cherry-red spot**](https://smartypance.com/wp-content/uploads/2017/09/Cherry-Red-Spot-Retinal-Vascular-Occlusion.jpg), ischemic retina)
66
* **Sudden, painless, unilateral,** and **usually severe vision loss** (Amaurosis fugax)
[**Retinal vascular occlusion**](https://smartypance.com/lessons/eye-disorders/retinal-vascular-occlusion/)
67
tx of retinal vascular occlusion
TX: **Emergent ophthalmologic consult** - Immediate treatment is indicated if occlusion occurred within 24 h of presentation
* **Reduction of intraocular pressure** with ocular hypotensive drugs (eg, topical timolol 0.5%, acetazolamide 500 mg IV or PO)
* **Intermittent digital massage** over the closed eyelid or anterior chamber paracentesis
* If patients present within the first few hours of occlusion, some centers **catheterize the carotid/ophthalmic artery** and selectively **inject thrombolytic drugs**
* Workup and management of atherosclerotic disease
* Irreversible damage to the retina after 90 min; Poor prognosis
68
Blood and thunder fundus
⇒ Central **retinal vein occlusion; blood and thunder retina** (dilated veins, hemorrhages, edema, exudates)
69
Tx of central vein occlusion
TX: **vision resolves with time (partially)**; workup for thrombosis
* Neovascularization treated with intravitreal injection of VEGF inhibitors
70
Prolonged hyperglycemia affects eyes
* Prolonged **hyperglycemia** causes basement membrane thickening, decreased pericytes (hyperproliferation), microaneurysms, and neovascularization
71
2 types of diabetic retinopathy
* Diabetic retinopathy falls into two main classes: **nonproliferative (early)** and **proliferative (late, advanced)**
72
pain, otorrhea, and **hearing loss/reduction**
[**_Tympanic membrane perforation_**](https://smartypance.com/wp-content/uploads/2018/11/Tympanic-Membran-Perforation.jpg)
73
[**Tympanic membrane perforation**](https://smartypance.com/wp-content/uploads/2018/11/Tympanic-Membran-Perforation.jpg)
TX: Usually, resolve on own; surgical repair may be necessary with persistent hearing loss
* Keep dry ⇒ water/moisture to the ear should be avoided to prevent secondary infection that impedes closure
* The only class of antibiotics that are non-ototoxic are the **Floxin drops** and should be used if you are going to be prescribing drops with a perforated TM
* **Surgery** if persists **past 2 months**
