EXAM 1 26-50 Flashcards Preview

Clin Med I > EXAM 1 26-50 > Flashcards

Flashcards in EXAM 1 26-50 Deck (25)
Loading flashcards...
1
Q

26.Causes and S/S of presbyacusis.
Presbyacusis

Patho:
-\_\_\_\_ related hearing loss 
-Most frequent cause of \_\_\_\_\_ hearing loss 
Causes: 
-\_\_\_\_trauma 
-\_\_\_\_ exposure 
Important role  
-Genetic predisposition 
-Prior noise exposure 
S/S 
-Loss of \_\_\_\_\_ discrimination pronounced in noisy environemnts 

Epid
25% of people between 65-75; 50% of those over 75

Diagnostics
Treatment
Misc

A
noise
sensory
noise
drug
speech
2
Q

27.Causes of rhinitis medicamentosa.

Rhinitis medicamentosa – _____ congestion
Cause: _______ used >3-5 days, so restrict use to 3 days

A

rebound

intranasal decongestions

3
Q

28.PE in Allergic Rhinitis. Treatment of allergic rhinitis. S/S allergic rhinosinusitis

Allergic Rhinitis
Patho
- Most common type overall – ___ mediated mast cell histamine release due to allergens

S/S

  • Clear ______
  • _____
  • Tearing
  • ____ irritation
  • Pruritus
  • _____
  • Bronchospasm
  • ______ dermatitis

Epid

Diagnostics

PE:

  • Mucosa of the turbinates is usually ___ or violaceous because of venous engorgement
  • Mucosa is ______ in viral rhinitis
  • ______ are associated with long-standing allergic rhinitis

Treatment
- __________ first line if allergic or nasal polyps
-Beclomethasone, Flunisolide, Mometasone furoate, Budesonide, Fluticasone propionate
Misc
Prevention

A
IgE
rhinorrhea
sneezing
eye
cough
eczamatous

pale
erythema
nasal polyps

intransal corticosteroid

4
Q

30.S/S and pathology of vestibular neuronitis.

Vestibular Neuronitis
Patho
-Inflammation of the vestibular portion of _____
-A paroxysmal, usually single attack of _____ without ______impairment. Persists several days to weeks before clearing
-Cause unclear – presumed ____

S/S
During acute phase:
Positive ______ (usually horizonal and rotary)
Continuous ______vertigo
Absent responses to ____ stimulation on one or both sides

Epid

Diagnostics

Treatment

_________: first line management
Supportive diazepam (5 mg) or meclizine (25 mg)
Vestibular therapy

Misc

A

CN VIII
vertigo
auditory
viral

nystagmus
peripheral
caloric

glucocorticoids

5
Q

31.Causes of BPPV.

Benign Paroxysmal Positioning Vertigo
Patho
-Vertigo induced by changes in _____ position
-_______ vertigo most commonly due to displaced otolith particles (_____ crystals) within the semicircular canals of the inner ear

S/S

  • Recurrent spells lasting a few _____ per spell
  • Provoked with specific ____ movements
  • May be accompanied by ____ and ____
  • Occur in _____ and last for several ______

Epid

Diagnostics
______ (nylen barany) test – produces fatigable nystagmus

Treatment
___ protocols

Misc

A

head
peripheral
calcium

minutes
head
nausea, vomiting
clusters, days

dix hallpike

PT

6
Q
  1. Length of vertiginous episodes in various forms of peripheral vertigo.
    - Endolymphatic Hydrops (______ Syndrome): Discrete vertigo spells lasting ___ mins to several ____
    - Labyrinthitis: Acute onset of continuous, usually severe vertigo lasting several ____ to a ____
    - BPPV: Occur in ____ and last for several ____
    - Vestibular Neuritis: ´usually ____ attack of vertigo without auditory impairment. Persists several ____ to ____ before clearing
A

Meniere’s syndrome
20, hours

days, week

clusters, days

single
days, weeks

7
Q
33.Treatment for Meniere’s Disease. S/S of Meniere’s disease 
Endolymphatic Hydrops (Meniere Syndrome) 

Patho
-Cause Unknown
-Distention of the endolymphatic compartment of the inner ear due to excess fluid is a pathologic finding
Two known causes: _____ and ______

S/S

  • Episodic ______ vertigo
  • Discrete vertigo spells lasting __ minutes to several ___
  • Fluctuating Low-frequency _____ hearing loss
  • _____
  • Ear fullness
  • ____ nystagmus
  • Symptoms wax and wane

Epid

Diagnostics

  • Caloric testing
  • Loss of impairment of thermally induced nystagmus on the involved side

Treatment

  • Low __ diet
  • _____
  • ______

Misc

A

syphillis, head trauma

peripheral
20 mins, hours
sensorineural
tinnitus
horizontal

salt
dieuretics
acetazolamide

8
Q

34.S/S of acute rhinosinusitis .Risk factors for the development of sinusitis. Treatment of viral rhinosinusitis. Treatment of bacterial rhinosinusitis

  • Symptomatic inflammation of the nasal cavity and paransal sinuses
  • Acute = 1-4 weeks

Acute Bacterial Rhinosinusitis/ Acute Viral Rhinosinusitis

Patho
Bacterial: _______ (most common) ______ , Moraxella catarrhalis, & group A Streptococcus
Viral: most cases are viral in etiology – ______, ______ & parainfluenza

PPP: Risk factor: most common in the setting of a viral ___, _____ infections, _____ , allergies cy

S/S
Major symptoms include
-______ nasal drainage
-nasal _______ or congestion
-facial ____/_____ with bending down & leaning forward
-altered _____
-Cough
- _____
Viral: nasal ________, _____ sense of smell, _______, sneezing, headache, throat discomfort
Minor symptoms include headache, otalgia, halitosis, dental pain, and fatigue.

“Double Sickening”
Worsening of symptoms within __ days after initial improvement OR ______ of symptoms more than 10 days after onset.

Epid

Diagnostics
-CT scan is the imaging test of choice if needed

Treatment 
-Bacterial: Symptomatic management:
\_\_\_\_\_\_\_\_(promote sinus drainage)  
-antibiotics:  symptoms should be present for >10-14 days 
-\_\_\_\_\_\_\_\_\_\_ is antibiotic of choice  
-Second line- doxycycline  

Viral: no specific treatment or prevention

Misc

A

Strep pneumoniae
Haemophilus influenzae
rhinovirus, influenza

URI, dental, smoking

purulent
obstruction
pain/pressure
smell
fever

nasal congestion, decreased, watery rhinorrhea

10
persistence

decongestants
amoxicillin-clavulanic acid

9
Q

35.S/S of hypopyon from anterior uveitis vs. infected corneal ulcer.

Anterior uveitis
Hypopyon (layered collection of white cells and fibrin within the ______chamber
Cells may also be seen on the corneal endothelium
Keratic precipitates (KPs)

Infected coneal ulcer:
´It is a primary infective ____ shaped paracentral corneal ulcer characterized by severe _____ (iris inflammation) with the formation of hypopyon (sterile pus at bottom of anterior chamber).

Corneal Ulcer

Pathophysiology

  • Most commonly due to infection by ____, _____, fungi or amoebas
  • Noninfectious causes which may be complicated by infection include:
  • neurotropic ____ (from loss of sensation)
  • exposure (due to inadequate eyelid closure)
  • severe ____ eye
  • severe _____ eye disease and inflammatory disorders

S/S

  • Complain of ____, _____, tearing and reduced vision
  • Eye is ___ with circumcorneal injection and _____ or watery discharge
  • Corneal appearance is based on cause
  • It is a primary infective disc shaped paracentral corneal ulcer characterized by severe iridocyclitis (iris inflammation) with the formation of hypopyon (sterile pus at bottom of anterior chamber).

Epidemiology

Tests

To find it:
_____ with woods lamp and/or slit lamp:
Area will glow green from dye uptake at area of injury

Prevention

Treatments
Topicals
-______ (especially in contact wearers)
Conflicting information about using corticosteroids

Must refer to ophthalmology if

  • Corneal Ulcer
  • contact wearers with acute eye pain, redness and decreased vision.

Misc.

A

anterior

disc
iridocyclitis

bacteria, viruses
keratitis
dry
allergic

pain
-photohphobia
red

purulent

Fluroscein Stain

Fluoroquinolines

10
Q

37.Drug reactions commonly seen with tx of strep throat and mono coexistence.
•Mononucleosis
•Marked lymphadenopathy an shaggy white-purple tonsillar exudate into the nasopharynx
•1/3 patients have secondary strept; _____ should be avoided because induces a rash that may be interpreted as a PCN allergy

A

ampicillin

11
Q

38.Types of epistaxis and anatomy involved.

Epistaxis

Patho
_____ from the unilateral anterior nasal cavity most common
Patients with epistaxis often have higher __ that returns to normal following treatment of acute bleeding

Anterior:
_______ plexus most common site
Associated with nasal ___ (picking most common in children, blowing nose forcefully, etc…), low humidity, hot environments, rhinitis, alcohol, cocaine use, antiplatelet meds, foreign body, deviated septum.

Posterior:
________ branches and woodruffs plexus most common site (may cause bleeding in both nares and posterior pharynx)
Risk factors: _______, older patients, nasal neoplasms

S/S

Epid

Diagnostics
Once acute episode has passed careful exam of the nose and paranasal sinuses to r/o ______ and hereditary hemorrhagic _______

Treatment
Anterior:
_______ is first line therapy in most cases
Pressure applied 5-15 mins with patient seated and leaning forward (to reduce vessel pressure)
PPP- Topical vasoconstrictors (sympathomimetics) may be adjunct therapy (oxymetazoline)
Short acting topical nasal decongestants act as vasoconstrictors
Phenylephrine

Posterior:
PPP- ______ most common initial management
PPP- foley catheter
PPP-Cotton packing

Misc

A

Bleeding
BP

Kiesselbach venous
trauma
Sphenopalatine artery
hypertension

neoplasms
telangiectasias

direct pressure
balloon catheters

12
Q

39.S/S and patho of candidiasis, erythroplakia, leukoplakia and oral lichen planus. Treatment for oral candida 3, Causes of candida in buccal mucosa. S/S and causes of leukoplakia.

Oral Candidiasis (Thrush)

Patho

  • Overgrowth of candida albicans.
  • Causes: systemic or local _______. ____, ____ use, abx use, chemo, diabetes, patients who wear dentures, inhaled corticosteroids without a spacer

S/S
____, looks like ____ whitish curd patches overlying erythematous mucosa. Patches easily ____ off. Underlying erythema is seen after rubbing off the white patches. Can have _____

Epid

Diagnostics
Wet preparation using _______ may show spores an nonseptate mycelia

Treatment
_____ (fluconazole 100 mg PO x 7 days)

Misc

A
immunosuppression, HIV
creamy
whitish
scraped
angular chelitis
potassium hydroxide
antifungals
13
Q

Nasal Foreign Body

Patho

S/S
PPP: Many are ______
-Classically presents with _____ associated with a mucopurulent discharge, ___ odor and nasal _____ (mouth bleeding)

Epid
Most commonly seen in ______

Diagnostics

  • Direct visualization (head light & otoscope)
  • Rigid or flexible fiberoptic endoscopy

Treatment
- Positive pressure technique: involves having the patient blow their nose while occluding the nostril ____ of the foreign body
Oral positive pressure – parent blows into mouth while occluding the ______ nostril

Misc

A
asymptomatic
epistaxis
foul
obstruction
children
opposite
unaffected
14
Q

Glossitis

Patho 
-Inflammation of the \_\_\_\_\_\_ with loss of filiform papillae 
Benign- no infection or tumor likely to be appreciated 
Secondary to:  
-Nutritional deficiencies 
-Drug reactions 
-Dehydration, irritants 
-Food and liquids 
-Autoimmune reactions or psoriasis 

S/S

  • ____, ____-surfaced tongue
  • Rarely _____

Epid

Diagnostics

Treatment
-_________ may be helpful even in cases where primary cause is unknown

Misc

A
tounge
red
smooth surface
painful
nutritional supplementation
15
Q

42.S/S Trench mouth.

Necrotizing Ulcerative Gingivitis (Trench Mouth)

Patho

  • Often caused by infection of both _______ and _____ bacilli
  • Underlyng systemic disease may also predispose this order

S/S
-Painful acute _____ inflammation and _____

Epid
-Common in young adults under stress

Diagnostics

Treatment
–War half-strength ____ rinses
-Oral _____

Misc

A

spirochetes
fulsiform

gingival
necrosis

peroxide
penicillin

16
Q

44.Treatment of oral herpes simplex

Oral herpes simplex
Patho
-Over 85% of adults have serologic evidence of herpes simplex type 1 (HSV-1) infections, most often acquired asymptomatically in ______. Occasionally, primary infections may be manifested as severe gingivostomatitis. Thereafter, the patient may have recurrent self-limited attacks, provoked by ___ exposure,____ surgery, fever, or a viral infection.

S/S
-Small, grouped _____ on an erythematous base that can occur anywhere but that most often occur on the vermilion border of the lips

Epid

Diagnostics

Treatment
-_____, its valine analog valacyclovir, and famciclovir

Misc

A
childhood
sun
orofacial
vesicles
acyclovir
17
Q

Acute Glaucoma/ Acute Angle-Closure Glaucoma

Pathophysiology

  • Primary: Closure of a pre-existing narrow ____ chamber. Angle closure can occur from pupillary ____
  • Secondary: Does not require pre-existing narrow angle. May occur with anterior uveitis, dislocation of the lens or due to various drugs.

S/S

  • Extreme ___ and ____ vision. N&V, ____ cornea, increased ___ pupil dilated and nonreactive. Untreated it leads to severe and permanent visual loss in 2-5 days.
  • Rapid onset of severe pain and profound visual loss with ________
  • Red eye, ____ cornea, dilated pupil
  • ___ eye on palpation
  • Subacute may present as a recurrent headache

Epidemiology
-Older age groups, particularly farsighted individuals (hyperopes), Asians, Inuits

Tests
-____ usually > 50 mmHg

-Prevention

Treatments

Primary:

  • Single IV dose of ______ followed by oral. In conjunction with topical medications that lower ___.
  • _____ drops
  • Long term prevention requires laser peripheral iridotomy or surgical peripheral iridectomy
  • Secondary: additional treatment is determined by the cause

Misc.

  • Differential diagnosis: conjunctivitis, acute uveitis, corneal disorders
  • Prognosis: Untreated will result in severe and permanent visual loss within 2-5 days after onset of the symptoms
A
anterior
dilation
pain
blurred
steamy
IOP
halo around lights
cloudy
hard
IOP
acetazolamide
IOP
pilocarpine
18
Q

47.Centor criteria for strep throat. Complications of strep pharyngitis. S/S and treatment strep pharyngitis

Streptococcal Pharyngitis
Patho

S/S 
•\_\_\_\_ Throat 
•\_\_\_\_ 
•Anterior cervical adenopathy 
•\_\_\_\_\_ exudate 
•Focus is to treat group A beta-hemolytic streptococcus infection to prevent rheumatic sequelae 
  • Centor criteria : when all four present strongly suggest GABHS; 3 of 4 intermediate; 1 of 4 unlikely
  • Fever over ___ degrees Celsius
  • Tender anterior cervical _____
  • Lack of a ____
  • _______ exudate

Epid

Diagnostics
•______ throat culture is 90-95% sensitive
•Rapid antigen detection testing (RADT) is 90-99% sensitive for GABHS
•Available in 15 minutes

Treatment
PPP:
-______ – first line treatment
-If penicillin allergy – macrolides, clindamycin, cephalosporins

Misc

Complications PPP:

  • Rheumatic fever (preventable with antibiotics)
  • Acute glomerulonephritis (not preventable with antibiotics)
  • Peritonsillar abscess
A
sore
fever
tonsillar
38
adenopathy
cough
pharyngotonsillar
single-swab
penicillin
19
Q

54.S/S of 3rd CN palsy.

A cranial nerve palsy of any of the three cranial nerves that supply the extraocular muscles can cause ______

Complete third nerve palsy, there is ____ with a divergent and slightly _____ eye _______ movements are restricted in all directions except ______ (preserved lateral rectus function). Pupillary involvement, manifesting as a relatively dilated pupil that does not ____ normally to light, usually means compression, which may be due to aneurysm of the posterior communicating artery or uncal herniation due to a supratentorial mass lesion. In acute painful isolated third nerve palsy with pupillary involvement, posterior communicating artery aneurysm must be excluded. Pituitary apoplexy is a rarer cause. Causes of isolated third nerve palsy without pupillary involvement include diabetes mellitus, hypertension, giant cell arteritis, and herpes zoster.

A
double vision
ptosis
depressed
extraocular
laterally
constrict
20
Q

Types of nystagmus with peripheral vs. central lesions.

-Fine rhythmic oscillations of the globe
-Caused by a variety of neurological conditions
-A few beats in extreme lateral gaze is normal
Types: _____, ____, ______

A

horizontal, rotary, vertical

21
Q

60.Causes of subconjunctival hemorrhage.
•_____ condition
•____ in well defined area
•Appears spontaneously after ____, sneeze, vomiting

A

benign
blood
cough

22
Q

63.Treatment of otitis externa. S/S of classic otitis externa.
External Otitis

Patho
History of ____ exposure or trauma. Caused by gram – (_______) or fungi

S/S
____ tenderness. Otalgia, pruritus, ______ discharge. Erythema, edema ____ movement of TM
•_____ and edema of the ear canal skin
•Often with a _____ exudate
•Manipulation of the auricle often elicits pain
•Lateral aspect of TM (made of ear canal skin), may be erythematous
•May be impossible to visualize __ if canal is significantly swollen

Epid

Diagnostics
-Clinical and otoscopy: edema of the external auditory canal

Treatment
•fundamental: protect ear from additional ______ and avoidance of further mechanical injury by scratching!
•Swimmer’s ear: acidification with a drying agent
•50/50 mixture of isopropyl alcohol and vinegar
•Treat infection:
•Acidic otic antibiotic drops with an ______ or fluoroquinolone with or without corticosteroids
•Purulent debris filling the ear canal should be gently ____ to permit entry of the topical medication.

Recalcitrant cases:
•Oral fluoroquinolones

Prevention
Dry ear especially after swimming, protect from further trauma

A

water
pseudomonas

tragal
purulent
erythema
purulent
TM

moisture
aminoglycoside
removed

23
Q

39.S/S and patho of candidiasis, erythroplakia, leukoplakia and oral lichen planus. Treatment for oral candida 3, Causes of candida in buccal mucosa. 61.S/S and causes of leukoplakia.

Leukoplakia
Patho
Oral potentially malignant disorder character by _______ due to chronic irritation
Up to 6% are dysplastic or squamous cell carcinoma

Risk factors: chronic irritation due to tobacco, cigarette smoking, alcohol, dentures, HPV infections

S/S
Most _______
Painless ____, _____lesions that cannot be scraped off (in comparison to Candida which is painful and can be scraped off

Epid

Diagnostics
Biopsy to rule out ________

Treatment
Cessation of irritants (____, _____)
Cryptherapy, laser ablation and surgical excision are options if increased risk for malignancy or malignant

A
hyperkeratosis
asymptomatic
white, patchy
squamous cell carcinoma
alcohol, smoking
24
Q

39.S/S and patho of candidiasis, erythroplakia, leukoplakia and oral lichen planus. Treatment for oral candida 3, Causes of candida in buccal mucosa. 61.S/S and causes of leukoplakia.

Oral lichen planus - idiopathic cell-mediated autoimmune response affecting the ____ & ___ membranes

Patho
Increased incidence with ______ infection

S/S
PPP:
Reticular: ___ reticular leukoplakia of the oral mucosa (_______). Usually ______. Most common type.
Erythematous: ___ patches (may accompany the reticular lesions). May be painful
Erosive: erosions or ulcers. Usually painful.

Epid
Most common middle-age range

Diagnostics

Treatment
Aimed at managing the pain and discomfort
_____ either topically or systemically

A

skin, mucus
hep C

lacy
Wickham striae
painless

red

corticosteroids

25
Q

39.S/S and patho of candidiasis, erythroplakia, leukoplakia and oral lichen planus. Treatment for oral candida 3, Causes of candida in buccal mucosa. 61.S/S and causes of leukoplakia.
Erythroplakia

Patho
Uncommon ______ with a high risk of malignant transformation
Usually dysplastic or shows evident of squamous cell carcinoma
Similar to leukoplakia except has a definite ______ component

Risk factors: chronic irritation due to _____, cigarette smoking

S/S
Most ______
_____ erythematous, soft, velvety, patch in the oral cavity, most commonly on the mouth ____ soft palate, and ventral aspect of the tongue

Epid
Age > __years

Diagnostics
Biopsy to rule out squamous cell carcinoma

Treatment
Complete excision may be needed depending on the biopsy results

Misc

A
oral lesion
erythmatous 
tobacco
asymptomatic
painless 
floor
65