Eyes/Ears

Question 1

1. Nearsightedness (see better up close)
2. Farsightedness (see better far away)
3. Irregularity of lens/cornea (distance doesn’t affect vision)
4. Farsightedness of age (loss of lens)

Answer 1

1. Myopia
2. Hyperopia
3. Astigmatism
4. Presbyopia

Question 2

Most commonly caused by adenovirus

Often preceded by URI

Highly contagious

Ssx?

Answer 2

Viral conjunctivitis

Painless to mild irritation

CLEAR watery to thick d/c w/ crusting on lashes

Question 3

OFten from ocular injury, FB, poor contact lens care, spread from rhinosinusitis

Ssx?

Answer 3

Bacterial conjunctivitis

ssx = usually painless COPIOUS mucopurulent d/c (at risk for corneal ulceration)

Question 4

INfection involving the cornea typically with an ulcerative process

Answer 4

Keratitis (most cases are keratoconjunctivitis as an extension of conjunctivitis)

Question 5

Common keratitis in the US… HSV

From cold sores or zoster on ophthalmic branch CN V

Herpetic vesicles/ulcerations on corneal surface (may cause scarring/blindness)

Ssx?

Answer 5

ssx = unilateral, photophobia, dendritic pattern

Question 6

Outside of US, leading cause of blindness

Highly contagious from contact w/ infected secretions, contaminated objects, flies

ssx?

Answer 6

Chlamydia trachomatis (trachoma)

Mild itch/irritation progressing to purulent d/c

Scars cause lashes to turn inward

Ingrown lashes scratch eyelid leading to corneal inflammation/permanent clouding

Question 7

Infxn of eyelash follicle w/ small pustule at lash line (staph aureus)

Answer 7

Style (hordeolum)

Warm compresses (maybe abx)

Question 8

Blockage of meibomian gland

Answer 8

Chalazion

Acutely warm compresses, maybe referral to optho if no improvement

Question 9

Redness/swelling of eyelash and eyelash follicles (often staph aureus)

Answer 9

Blepharitis

Tx - maybe abx but careful daily cleansing of lids/eyelashes

Question 10

most common cause of vision loss in US

Opacification or clouding of lens, usually develops over years - decades

Answer 10

Cataracts

Question 11

Most common cataracts

Wear/tear on lens

Answer 11

Senile cataracts

Question 12

Cataracts as a consequence of trauma, burns, inflammation, radiation

Answer 12

Secondary cataracts

Question 13

Tx for cataracts?

Answer 13

Surgical removal/replacements of lens

Question 14

Increased IOP from disrupted flow of aqueous humor

Atrophy of optic nerve/retinal cells -> loss of central/peripheral visual fields

Answer 14

Glaucoma

Question 15

Impaired reabsoprtion for unknown reason

Progressive

Slowly increased IOPs

Answer 15

Open-angle

Question 16

Iris suddenly impedes flow

SUDDEN, RAPID rise in IOPs

INTENSELY PAINFUL RED EYE/BLURRED VISION

Answer 16

Closed-angle

Question 17

Tx for glaucoma?

Answer 17

STAT optometry referral

REDUCE IOP ( can use beta Bs, alpha agonist)

Pilocarpine to constrict pupil for angle closure crisis

Question 18

Progressive deterioration and loss of central vision

Dry is less aggressive, wet form progressives rapidly

Answer 18

Age-related macular degeneration

No tx

Question 19

Drusen bodies

Answer 19

Yellow lipid deposits on retina characteristic of ARMD

Question 20

Clinical features of ARMD?

Answer 20

Visual distortions (straight lines appear bent)

Need for brighter light for near vision

Difficulty at adapting to lowlight levels

Question 21

Copper wiring or silver wiring

Retinal hemorrhages (dot/flame hemorrhages)

Cotton wool spots (retinal edema and exudates0)

Answer 21

HTN retinopathy findings on exam

Question 22

Cotton wool spots

Neovascularization

Answer 22

Diabetic retinopathy

Question 23

Rare eye malignancy affecting CHILDREN (often involves both eyes)

Intraocular mss eventually fills entire globe and extends into optic (UNTREATED = LETHAL)

Answer 23

Retinoblastoma

Tumor recognized by WHITE PUPIL OR WHITE REFLEX during infant eye exam

Question 24

Primary eye tumor affecting adults

Tumor originates from pigmented cells uveal tract (enlarging growth distorts globe)

Answer 24

Malignant melanoma

Ssx - dark spot on iris or conjunctiva

Question 25

Both retinoblastoma and malignant melanoma get what tx?

Answer 25

Eye nucleation

Question 26

Cauliflower ear, “wrestler’s ear” Trauma causes hematoma to form w/ subsequent ischemia -> permanently deformed auricle

Answer 26

Auricular hematoma

Question 27

Tx for auricular hematoma?

Answer 27

Drain ear hematoma quickly Apply pressure dressing to sandwich skin against cartilage

Question 28

Most often associated w/ children w/ atopic dermatitis or adults w/ eczema Ssx - itching, erythema, flaking

Answer 28

Allergic OE

Question 29

swimmers ear Common in children but affects all age ranges Staph aureus/pseudomonas SSx?

Answer 29

Bacterial OE Ssx - pn, redness, swelling d/c, TENDERNESS W/ EAR MOTION

Question 30

Ssx are similar to bacterial OE but no d/c and HYPHAE in ear canal Associated w/ hot climates

Answer 30

Fungal OE

Question 31

Typically an extension of viral URI Common in 1-5 y/o SSx = ear pn, hearing loss, fever RED AND BULGING TM

Answer 31

Acute OM Tx - abx, fever mgmt

Question 32

Chronic/recurrent OM?

Answer 32

Repeated/failed abx Tx - ENT referral Myringotomy w/ PE tubes (no head immersio under water)

Question 33

Perf TM causes?

Answer 33

Mechanical trauma - FB Acoustic trauma - noise Barotrauma - sudden pressure change (divers/fliers) Infection - drainage from OM

Question 34

Tx for small perf TM?

Answer 34

Small perfs will heal spontaneously but no head immersion | large/non healing perfs may need ENT sx

Question 35

Benign (but erosive) tumor Common complication of chronic otitis media External canal epithelium grows inward through TM perforation into middle ear/mastoid

Answer 35

cholesteatoma | negative pressures in middle ear "pull" in squamous cells, forming cyst -> damage to ossicles/mastoid

Question 36

Ear drainage, vertigo, hearing loss PEARLY WHITE MASS IN MIDDLE EAR

Answer 36

cholesteatoma | tx = surgical excision/repair; abx

Question 37

Tiny floating debris in labyrinth, provoked by simple manuevers (usually self-limiting, but associated w/ infxn or head/neck trauma)

Answer 37

Benign positional vertigo

Question 38

Ssx = dizziness (not lightheadedness) Tx = antiemetics, drugs for motion sickness (also, home exercises to "fatigue" labyrinth receptors)

Answer 38

benign positional vertigo

Question 39

Fluid imbalance between inner ear compartments common in 40-60 y/o Tx?

Answer 39

Meniere's dz Tx = antiemetics (ENT for eval)

Question 40

What's the classic triad for meniere's dz?

Answer 40

Vertigo (lasting hours, then subsides then recurs w/ in days) Sensorineural hearing loss (especially low-freq sounds) Tinnitus

Question 41

What would the hearing loss in Meniere's dz look like on PE?

Answer 41

Weber lateralizes to affected ear Rhinne AC > BC

Question 42

Loss of conduction, usually external to middle ear problem FB, cerumen, TM perf, OM

Answer 42

conducitve hearing loss

Question 43

Cochlear damage, inner ear "receiver" is damaged

Answer 43

Sensory | repetitive noise trauma is most common cause, but also ppresbycusis = hearing loss of old age

Question 44

Least common hearing loss? Auditory/brain damage (MS, CVA, cranial nerve tumor)

Answer 44

Neural hearing loss

Question 45

Sounds great than ___ as sudden impulse/repetitive burst cause damage

Answer 45

85 decibels (heavy city traffic)

Question 46

How do loud noises affect hair cells?

Answer 46

Release of free radicals irreversibly damaging auditory hair cells (-> tinnitus)