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Clin Med Exam II > Eye trauma/ HEENT I > Flashcards

Eye trauma/ HEENT I Flashcards

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1
Q

Etiology of orbital fractures

A
  • blunt trauma
  • MVAs
  • industrial accidents
  • assaults
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2
Q

Who most commonly gets orbital fractures?

A

adolescent males

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3
Q

Bones of the orbit

hint: 7

A
  • sphenoid bone
  • zygoma
  • maxilla
  • ethmoid bone
  • palatine bone
  • lacrimal bone
  • frontal bone
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4
Q

What makes up the superior wall of the orbit?

A
  • frontal bone

- lesser wing of the spheniod bone

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5
Q

What makes up the inferior wall of the orbit?

A
  • maxilla
  • zygomatic bone
  • palatine bone
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6
Q

What makes up the medial wall of the orbit?

A

thinnest wall

  • ethmoid bone
  • maxilla
  • lacrimal
  • sphenoid
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7
Q

What makes up the lateral wall of the orbit?

A

thickest wall

  • zygomatic bone
  • sphenoid bone
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8
Q

Six extra ocular eye muscles and actions

A 
lateral rectus-abduction
medial rectus-adduction
superior rectus- up and in
inferior rectus- down and in
superior oblique-inferior and lateral
inferior oblique-superior and lateral
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9
Q

Three sinuses

A
  • maxilla
  • frontal
  • ethmoid
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10
Q

Where are the canthal ligaments

A

medial canthal- corner of the tarsal plate to the orbital wall
lateral canthal- lateral aspect of the orbit

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11
Q

What does the infraorbital nerve supply

A

lower eyelid, nose and upper lip

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12
Q

What does the supraorbital nerve supply?

A

upper eyelid, forehead and scalp

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13
Q

What are the four orbital fracture types?

A
  • orbital zygomatic fracture (tripod fracture)
  • nasoethmoid fracture
  • orbital roof fracture (rare)
  • orbital floor fracture (most common)
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14
Q

What is a blowout fracture

A

orbital floor fracture without fracture of the orbital rim with herniation of the contents

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15
Q

Complications of a blowout fracture

A
  • alteration of support mechanism for extra ocular muscles
  • EOM can become entrapped
  • entrapment of inferior rectus and damage to infraorbital nerve)
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16
Q

Pure blow out fracture

A

bone fragments involving the central area of bone

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17
Q

Impure blow out fracture

A

fracture line extends to orbital rim

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18
Q

Mechanism of blow out fracture

A

force of blow–>backward displacement of eyeball–>infraorbital pressure increases–>fracture in the weakest portion of the orbital wall

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19
Q

Symptoms of orbital fracture

A
  • facial pain
  • ocular pain on movement
  • neuropraxia
  • diplopia
  • color changes
  • floaters, hazy vision, fog
  • flashers, veil or curtain
  • foreign body sensation
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20
Q

Physical exam findings of an orbital fracture (inspection)

A
  • periorbital edema and ecchymosis
  • depression/defect of the orbit
  • epistaxis
  • CSF leakage
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21
Q

Physical exam findings of orbital fracture (palpation)

A
  • nerve neuropraxia
  • emphysema
  • pain
  • step off deformity
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22
Q

Initial Assessment of orbital fracture: what do you do/check?

A

EYE EXAM

  • visual acuity
  • pupils
  • cornea
  • funduscopic exam
  • EOMs
  • conjunctiva
  • eyelids
  • color perception
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23
Q

Eye examination findings with orbital fracture

A
  • lid laceration
  • periocular ecchymosis
  • hypoglobus
  • subconjunctival hemorrhage
  • hyphema
  • traumatic mydriasis
  • epipora
  • corneal abrasion
  • ruptured globe
  • vitreous hemorrhage
  • retinal detachment/tears
  • EOM entrapment
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24
Q

What xray views are you going to get for an orbital fracture?

A
  • AP
  • PA
  • Caldwell view
  • Waters view
  • Towne view
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25
Gold standard for orbital fracture diagnosis
CT scan | -axial and coronal view
26
Other diagnostic test for orbital fracture
- forced ductions test - fluorescein stain - Hertel Exophtalmometer
27
Major associated complications w/ orbital fracture
- blindness - long term diplopia - infection - EOM entrapment - orbital dystopia/cosmetic issures - neuropraxia - intracranial bleed
28
Non surgical treatment for orbital fractures
- ice - nasal decongestants - if sinus involved, broad spectrum abx - corticosteroids for orbital edema with diplopia * avoid aspirin and nose blowing
29
What are the indications surgical repair of an orbital fracture
- restrictive strabismus - CT evidence of muscle entrapment - enophthalmos <2mm - oculocardiac relfex - hypo ophthalmos - large floor fracture
30
When should you emergently consult ophthalmology with an orbital fracture
- rupture - retro orbital hematoma - retinal detachment
31
What requires a 24 hr follow up with a specialist when it comes to orbital fracture
- muscle entrapment - enopthalmos or orbital dystopia resulting in facial asymmetry - naso orbital ethoid fractures with injury to medial canthal ligament or lacrimal apparatus
32
What is hyphema
grossly visible blood in the anterior chamber d/t tears on the vessels of the cillary body or iris
33
Peak incidence of hyphema
10-20 years old | males>females
34
What causes hyphema
- trauma (blunt or penetrating) | - spontaneous (less common, usually underlying condition)
35
Hyphema symptoms
- decreased visual acuity - photophobia - pain
36
Hyphema physcial exam findings
- layer of blood in anterior chamber - decreased visual acuity - photophobia - anisocoria - elevated intraocular pressure
37
How to diagnose hyphema
-clinical diagnosis ophthalmoscope slit lamp tonopen
38
Treatment of hyphema
- eye shield on affecred eye - bed rest, dim lighting/limited activity - cyclopentolate or homatropine - PO pain control (avoid ASA and NSAIDs) - anti emetics for n/v
39
Complications of hyphema
- intractable glaucoma | - optic atrophy
40
Posterior Synechiae
iris adheres to lens
41
Peripheral Synechiae
iris adheres to cornes
42
Symptoms of corneal foreign body
- pain - foreign body sensation - photophobia - tear - red eye - blurred vision
43
What do you do on physcial exam for foreign body in the eye
- visual acuity - inspection of eye and eyelid - slit lamp - fluorescein stain
44
Corneal foreign body physical exam findings
- normal or decreased visual acuity - conjunctival/cilliary injection - VISIBLE FOREIGN BODY - rust ring - excessive tear production - corneal edema - corneal perforation with deep foreign body
45
Differential diagnosis for corneal foreign body
- keratitis - intraocular foreign body - corneal abrasion
46
Medical management for corneal foreign bodies
- topical abx (cipro,erythro) - topical cycloplegic - tetanus if not UTD
47
What is the layer most commonly involved in corneal abrasions?
endothelium
48
What nerve innervates the cornea
trigeminal
49
Symptoms of a corneal abrasion
- pain - foreign body sensation - photophobia - tears - red eye - blurred vision
50
Differentials for corneal abrasion
- acute globe rupture - retained foreign body - infectious keratitis - corneal ulcer - acute angle glaucoma
51
Physical exam for corneal abrasion
- visual acuity - slit lamp exam - fluorescein stain
52
Exam findings for corneal abrasion
- normal/decreased visual acuity - conjunctival/cilliary injection - visible foreign body - rust ring - excessive tear production - corneal edema
53
Treatment of corneal abrasion
- topical erythro ointment | - topical cipro drops for contact lens
54
Infectious causes of corneal ulcer
-bacterial VIRAL -fungal -amoebas
55
Non infectious causes of corneal ulcers
- exposure keratitis - severe allergic disease - severe dry eye - inflammatory/autoimmune - vit A deficiency
56
Bacterial cause of corneal ulcer
``` pseudomonas (contacts) moraxella liquefaciens (DM,alcoholic, immunosup) strep staph MRSA ```
57
Viral cause of corneal ulcer
HSV/ zoster
58
Amoeba cause of corneal ulcer
- acenthamoeba - contaminated water - contact lens with poor hygiene
59
Risk factors for corneal ulcers
- contacts - previous eye surgery - hx of HSV - immunocompromised - topical or systemic steriod use
60
Symptoms of corneal ulcer
- pain - photophobia - tearing - reduced vision - lid and ocular swelling - injected conjunctiva/eyelid - foreign body sensation - miotic pupil - clear or mucopurulent discharge
61
Exam findings for corneal ulcer
- punctate or diffuse branching dendritic lesions (HSV) - corneal ulceration - hypopyon - anterior cell/flare
62
Diagnosis of corneal ulcer
- slit lamp and fluorescein stain | - culture and gram stain or PCR
63
Bacterial corneal ulcer treatment
fluoroquinolone
64
Viral corneal ulcer treatment
acyclovir | always start if dendritic pattern
65
Pain management for corneal ulcers
- topical cycoplegics | - oral NSAID or analgesia
66
What will some corneal ulcer perforations require?
- cyanoacrylate glue - conjunctival graft - conjunctival flaps - corneal transplant
67
Complications of corneal ulcer
- corneal scarring - corneal perforation - anterior or posterior synechiae - glaucoma - cataracts - blindness
68
What is the semi circular canals function
organ for body movement
69
What is the cochlea for
organ for hearing
70
Which nerve relays info from the vestibular labyrinth to the cerebellum, ocular nuclei or spinal cord?
vestibular portion of CN VIII
71
What do the posterior semicircular canals detect?
head tilts down towards the shoulder
72
What do the lateral semicircular canals detect
head shakes side to side in a "no" motion
73
What do the superior semicircular canals detect?
head nods up and down in a "yes" motion
74
What do the otolith organs sense
gravity and linear acceleration
75
What does the utricle detect?
- horizonatal movement in the head | - registers accelerations in horizontal plane
76
What does the saccule detect?
- vertical | - registers acceleration in vertical plane
77
Where does the eustachian tube run?
anterior wall of the middle ear into the nasophasrynx
78
What is the wider part of the eustachian tube?
nasopharyngeal and tympanic ends
79
What is the narrowest portion of the eustachian tube?
bony isthmus
80
How is the eustachian tube different in children than in adults?
- shorter, more horizontal tubes - immature floppy elastic cartilage - larger adenoids
81
What happens when the eustachian tube is compromised?
air trapped in the middle gets absorbed creating negative pressure--> TM retraction
82
Normal function of the eustachian tube
- equalization of pressure across tympanic membrane - protection of middle ear from infection and reflux of nasopharyngeal contents - clearance of middle ear secretions
83
What causes blockage of the ET?
- ALLERGIC RESPONSE - URI - sinusitis - chronic OM - congenital/acquired stenosis - neoplasms
84
What causes dysfuntion of the ET?
- blockage | - failure of tube to open
85
What are the two types of ET tube dysfunction
- dilatory dysfunction | - patulous dysfunction
86
What causes dilatroy dysfunction of ET
- inflammation - pressure dysregulation - acquired anatomic abnormalities
87
What is dilatory dysfunction of ET
the tube does not dilate
88
What is patulous dysfunction of the ET
valve incompetency, chronic patency (stuck open)
89
What does pt complain of with ET dysfuntion
- fullness in the ear - mild to moderate decrease in hearing - possible "popping" sound during yawning or swallowing - ear pain
90
Exam findings of ET dysfunction
- retracted TM of affected side | - decreased TM mobility
91
Halmark of dilatory ET dysfuntion
- hearing loss | - abnormalities of TM (retraction, middle ear effusion)
92
Otoscope exam w/ dilatory ET dysfunction
- effusion - scarring - thickening of TM
93
What does weber test show w/ dialtory ET dysfunction
lateralization to affected ear (conductive hearing loss)
94
Hallmark of patulous ET dysfunction
autophony- pt hears own voice amplified
95
Physical exam findings of patulous ET dysfunction
- breathing induced excursions of the TM | - sensorineural hearing loss
96
Treatment of dilatory ET dysfunction
TREAT UNDERLYING ETIOLOGY - antihistamines - decongestants - nasal steriods - valsalva
97
Treatment of patulous ET dysfunction
- treat if severe sx >6 weeks - hydration, mucous thickening agents - ventilation tubes if severe
98
Treatment of ET dysfunction
- referral to ENT - nasal endoscopy - balloon dilation - surgery if mass or continued OM w/ effusion - CT or MRI w/contrast if >3 mnths unilateral sx or middle ear effusion with increased risk of malignant
99
What is vertigo
symptom of illusory movement
100
Dysfunction in peripheral input causes what sx in vertigo
- sudden onset - tinnitus - hearing loss - horizontal nystagmus
101
Dsyfunction in central input causes what sx in vertigo
- gradual onset | - no associated auditory sx
102
What are the two types of vertigo
- peripheral | - central
103
Causes of peripheral vertigo
More benign - BPPV - vestibular neuritis - Meniere's disease - Herpes zoster oticus - acoustic neuroma - aminoglycoside toxicity - superior semicurcular dehiscence syndrome
104
Causes of central vertigo
More serious - migraines - cerebral tumor on CN VIII - chiari malformation - brain ischemia - TIA - MS
105
Key to diagnosing vertigo
- duration | - hearing loss
106
What provokes BPPV
Specific head movements - turning in bed - tilting head backward to look up
107
What causes BPPV
calcium debris in semicircular canals (most common posterior)
108
Vertigo sensation in BPPV
- short in duration | - ear pain, hearing loss, tinnitus are absent
109
BPPV can be a residual affect of what
Meniere's disease
110
Epidemiology of BPPV
>60 y/o | females>males
111
Clinical presentation of BPPV
- rapid onset of dizziness or spinning - nystagmus (classic) - nausea/vomiting
112
Diagnosis of BPPV
- Dix Hallpike positional testing - electronystagmography - MRI/CT to rule out other causes
113
Treatment of BPPV
Symptomatic treatment - antihistamines - antiemetics - benzos - scopolamine
114
What does PT or neuro do for BPPV
vestibular rehab - gaze stimulation exercises - repositioning maneuvers - surgery: rare, only after 6 months
115
What causes vestiular neuritis
viral or postviral inflammatory disorder affecting the vestibular portion of CN VIII
116
Is vestibular neuritis benign and self limiting
YES
117
Vestibular neurities
vertigo without hearing loss
118
Labrynthitis
vertigo with unilateral hearing loss
119
Clinical presentation of vestibular neuritis
- rapid onset of severe, persistent vertigo - nausea and vomiting - gait instability (toward affected side) - nystagmus on affected side - + head thrust
120
Imaging for vestibular neuritis?
if concerned for lesion or stroke causing sx | -MRI/MRA for infarct
121
Treatment for vestibular neuritis
- corticosteriods - symptomatic treatment (antihistamines, antiemetics) - vestibular rehab
122
Prognosis of vestibular neuritis
- self limiting - usually a few days to 1 week - may have non specific dizziness and imbalance for months
123
Meniere's disease
peripheral vestibular disorder attributed to exces endolympathic fluid pressure
124
Another name for Meniere's disease
labyrinthine hydrops
125
What does Meniere's disease cause
episodic inner ear dysfunction
126
Risks for Meniere's disease
- allergies - stress - viral
127
Classic presenting sx of Meniere's
-vertigo -sensioneural hearing loss -tinnitus UNILATERAL
128
Audiometry in Meniere's disease
+ low frequency sensorineural hearing loss
129
Electronystagmography in Meniere's disease
+ unilateral reduced vestibular response
130
Caloric testing in Meniere's disease
loss/impairment of thermally induced nystagmus on affected side (nystagmus goes towards warm, away from cold)
131
Goals of Meniere's treatment
- reduced frequency and severity of vertigo attacks - reduced or eliminiate hearing loss and tinnitus - minimize disability - prevent disease progression (hearing loss and imbalance)
132
Acute Meniere's diease treatment
- antihistamines - antiemetics - benzos - anticholinergics (scopolamine)
133
Long term Meniere's treatment
- lifestyle adjustment - salt restriction - limit caffeine and nicotine - limit alcohol - diuretics
134
Nondestructive procedures for Meniere's
- surgery on endolymphatic sac - intratympanic glucocorticoids - postive pressure pulse generator
135
Destructive procedures for Meniere's
- intratympanic gentamicin injection - surgical labryinthectomy - vestibular nerve resection
136
Semicircular canal dehscence syndrome AKA...
Minor's syndrome
137
What is semicircular canal dehiscence sydrome
thinning of the bone that separates the superior semicircular canal from the middle cranial fossa
138
What provokes vertigo in semicircular canal dehiscence syndrome
coughing, sneezing, valsalva maneuver
139
What is Tullio phenomenon
vertigo induced by loud sounds
140
How is semicircular cana dehiscence syndrome diagnosed
high resolution CT of the temporal bone
141
What is tinnitus
perception of sound in proximity of head in the absence of external source
142
Pulsatile tinnitus
-like listening to your own heartbeat
143
What can cause pulsatile tinnitus
- vascular disorders - arteriovenous shunts - venus hums - ET dysfunction - arterial bruits
144
Non-pulsatile tinnitus
unilateral clicking tinnitus secondary to middle ear spasm
145
Presbycusis
sensorineural hearing loss with aging, or any acquired high frequency hearing loss commonly associated with tinnitus
146
Otosclerosis
condition of abnormal bone repair of the stapes footplate bone
147
Chiari Malformation
occurs when low lying cerebellar tonsils causes tension on the auditory nerve
148
Diagonistics for tinnitus
- audiometry to R/O associated hearing loss | - MRI if unilateral esp with hearing loss to R/O retrocochlear lesion

Clin Med Exam II (11 decks)

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