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NP 801 NP Theory 2 > HEENT > Flashcards

HEENT Flashcards

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1
Q

What are cataracts?

A

Opacificaiton + clouding of lens

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2
Q

5 D’s

Cataracts clinical manifestations

A
  • Vision is hazy, blurred, or dimmer
  • Photosensitivity
  • See “halos” around lights + Glare
  • See a progressive decline in vision over months to years
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3
Q

Cataracts Objective findings
What PE assessments and findings?

A
  • NO conjunctiva REDNESS
  • PAINLESS
  • Full eye + neuro exam
  • Pupil exam NORMAL (PERRLA)
    • ABNORMAL red reflex
      • Dull, extinct, or shady
  • Test visual acuity
Abnormal red reflex
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4
Q

What do you need to rule out first?

Cataracts differentials?

A

Macular degeneration
Diabetic retinopathy

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5
Q

RF?

What are cataracts commonly A/w

A

↑ AGE

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6
Q

Cataract Risk Factors

A
  • Age
  • Diabetes
  • UV exposure
  • Systemic steroid use
  • HTN, CKD, HIV
  • Eye trauma Hx
  • EtOH use
  • Tobacco use
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7
Q

Cataracts Patient Education
Cataract surgery contraindication

A
  • Avoid night time driving
  • Surgery is low-risk
    • NO SRG if have active URI/coughing, or poorly controleld BP
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8
Q

Cataract Surgery
What to do pre-op?
What to do post-op?

A
  • Med reconcilliation pre-op
    * Alpha-adrenergic antagonist - Flomax → Floppy Iris Syndrome
  • Post-op:
    • No heavy lifting, no straining
    • Eye drop administration
    • Wear sunglasses
    • Go to urgent care if experiencing abrupt changes
Cataracts Surgery
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9
Q

Three things

Eyes complication signs/symptoms → ED

A
  • ONLY IF ABRUPT CHANGES
  • Sudden vision changes
  • Darkening of vision
  • Eye pain!
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10
Q

Definition

What is macular degeneration?
Types?

A

Degenerative disease of central portion of retina
Dry (non-exudative) + Wet (exudative)

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11
Q

Macular degeneration clinical manifestations (BOTH)

A
  • Change in central vision
  • Difficulties adapting to the dark
  • Dark spots in vision
  • Distorted straight lines
  • Colors may appear less vivid or darker
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12
Q

Dry macular degeneration clinical manifestations

A
  • Retinal atrophy
  • Build-up of drusen (yellow deposits)
  • Gradual central vision loss
  • Fuzzy or distorted vision
  • Scarring + thinning of retina
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13
Q

Wet macular degeneration clinical manifestations

A
  • New blood vessels forming → swelling + bleeding into retina
  • Sudden OR gradual central vision loss
  • Blindspot in central vision
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14
Q

Macular degeneration PE techniques

A

Full eye + neuro exam
Test visual acuity

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15
Q

DX test for macular degeneration and purpose

A

Amsler grid
ID central cision defects - used for monitoring progression

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16
Q

Dry macular degeneration Pharmacologic txs

A

AREDs or AREDs2 for non-smokers only
These carry risk for lung cancer

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17
Q

Wet macular degeneration pharmacological txs

A

Intravitreous INJs w/VEGF inhibitors

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18
Q

Dry macular degeneration Nonpharmacological Txs

A

Risk modification
* Tobacco cessation
* UV protection
* BP + lipid control

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19
Q

Wet macular degeneration Nonpharmacologic txs

A

Photodynamic therapy
Laser coagulation txs d/t vessel changes

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20
Q

Macular degeneration Risk Factors + Referral education

A
  • Age
  • Tobacco Usage
  • FMHx → Should see opthamology
  • HTN
  • HLD

Referral + regular F/U + Monitor w/Amsler grid

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21
Q

Definition

What is glaucoma?
Types?

A
  • Condition resulting in progressive damange to optic nerve → vision loss
    • peripheral → central vision loss
  • Causing dysfunctional drainage of aqueous humor
  • Types
    • Primary angle-closure (ACUTE)
    • Primary open-angle
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22
Q

Acute-angle closure glaucoma: clinical manifestations

A
  • ↑ IOP (not definitive as this can still happen w/normal pressure)
  • ABRUPT CHANGES
  • Redness
  • Eye PAIN
  • Vision loss
  • H/A
  • Halos (as opposed to painless halos in cataracts)

VISION EMERGENCY DO NOT MISS
TX W/IN HRS

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23
Q

Primary open-angle glaucoma: clinical manifestations

A
  • GRADUAL ↑ IOP d/t dysfunctional drainage → peripheal vision loss → central vision loss
  • Bilateral s/s
  • Painless = silent blinder
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24
Q

Glaucoma Objective findings
Glaucoma PE techniques

A
  • Full eye exam
  • Optic cupping
    • Look at ratio of cup size to disk (see a clear circle)
  • Optic nerve fibers to brain damaged + destroyed from ↑ IOP on nerve cells → axon loss
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25
Glaucoma differentials
Macular degeneration Severe open-angle glaucoma
26
Angle-closure glaucoma pharmacologic txs
* Eye drops * Systemic meds to ↓ IOP (short term)
27
Open-angle glaucoma pharmacologic txs
* Eye drops * Prostaglandin analogs * **Lantoprost** * BBs (timolol) * Combo products
28
Meds that will interact with glaucoma meds Why avoid these?
SSRIs Antihistamines Decongestants These will ↑ IOP
29
Angle-closure glaucoma nonpharmacological txs
Iridotomy to ↓ pressure * Drill small hole in iris to allow drainage * Acute occlusion of anterior chamber angle
30
Open-angle glaucoma nonpharmacological txs
* Laser txs * Surgery - trabulectomy * creating. ashunt to allow drainage
31
Glaucoma risk factors
* ↑ age * FMHx * Tobacco usage * HTN * Nearsightedness (myopia) * ↑ IOP * ↑ Prevalence in black, Latinx pop
32
Glaucoma referral management Monitoring
* Routine testing of visual acuity * Measuring IOP + visual field testing + dilated exam * Ask about medication adherence * Opthamology visits
33
Diabetic retinopathy
* Resulting from chronic effects of DM * ↑ A1c = ↑ DM retinopathy risk * Damanged blood vessels d/t hypergylcemia
34
Diabetic retinopathy clinical manifestations
* May be **asymptomatic** * **Floaters or light flashes** * Sudden vision loss if hemorrhage occurs
35
(overall) Diabetic retinopathy objective findings on exam
* Microaneurysms * Dot-blot hemorrhages * Cotton wool spots
36
Non-proliferative DM retinopathy objective findings
* Microaneurysms * Hemorrhages * Blockages * Dilation of larger vessels * Macular edema * NO NEW BLOOD VESSEL GROWTH
37
Proliferative diabetic retinopathy objective findings
* Presence of **abnormal blood vessels** * Likely to leak → bleed * ↑ scar tissue on retina * ↑ retinal detachment * ↑ fluid → glaucoma * ↑ risk of optic nerve damange * CAN CAUSE BLINDNESS
38
Diabetic reitnopathy DX
* Dx on fundal exam * Retinal scanning * Can take retinal photo early in disease process
39
Diabetic retinopathy pharmacological interventions
* **Fenofibrate** to slow progression * VEGF INJs little evidence * Intravitreal corticosteroids amin for macular edema
40
Diabetic retinopathy nonpharmacological interventions
Tx managed by opthamology * Address poor glycemic control * Pan-retinal photocoagulation
41
Diabetic retinopathy Risk Factors
* Poor gylcemic control * Duration of dx * HTN * HLD * Pregnancy
42
Best treatment(s) for DM retinopathy
PREVENTION * Control BS, BP, Lipid level * Monitor A1c% * Early detection prevention * Screening eye exams * DM II should have opthalmologic exam at time of dx + annually
43
# Definition Dry eye syndrome Two types and conditions with each
* **Tear film deficiency** * Ocular surface disease * Dysfunction teaar sydnrome * Aqueous: * Sjogren's hyposecretion * Evaporative: * Meioban gland dysfunction * Poor eyelid disclosure * Insufficient blinking
44
Dry eye syndrome clinical manifestations
* **Paradoxical XS tearing** * Dryness * Foreign body sensation * Burning or stinging * Itchiness * Ocular fatigue (screen) * Blurriness relieved by blinking symptoms worsened in extended periods of visual concentration + low-humidity
45
Dry eye syndrome PE findings
Unremarkable
46
Dry eye syndrome Diagnostic tests Which meds aggravate this condition? Which med to AVOID?
* Fluoresein dye for corneal abrasion * Shirmer test * Complete PE for systemic causes * Complete ROS * Review med history * Diuretics * Anti-histamines * TCAs * Avoid VASOCONSTRICTORS
47
Dry eye syndrome differentials
Trichiasis, Conjunctivitis, Corneal abrasion, Systemic causes
48
Dry eye syndrome pharmacological txs
* Artificial tears 6x/day * Fish oil, vitamin D * Specialist (short course topical steroid - Cyclosporine); Low dose PO abx
49
Dry eye syndrome nonpharmacological txs
* Avoid extended periods of visual concentration * Avoid direct drying effect of A/C or fan * Lid hygiene
50
Hearing loss types Most common hearing type
Conductive **Sensorineural (age-related) - presbycusis**
51
Concerning hearing loss signs/symptoms
All rapid onset * Severe vertigo * Ataxia * Fevers * Head trauma * Neurological deficits: H/A dizziness, imbalance
52
Hearing loss exam tests
Finger rub Whispered Voice test Weber and Rinne
53
# bone condution vs air conduction Weber vs. Rinne test How does each show conductive vs. sensorineural hearing loss? Where would each localize to?
54
Conditions of external ear
* Cerumen impaction * Otitis externa * Foreign body
55
Conditions of middle ear
* Cholesteatoma * Otitis media w/effusion * Otosclerosis * TM rupture * Eustachian tube dysfunction
56
Systemic labs for hearing loss
* CBC w/diff * Syphilis * ESR * ANA * RF * TSH * CT or MRI for structure cause
57
Hearing loss nonpharmacological txs/patient education
Cochlear implants (moderate to profound sensorineural hearing loss) Hearing aides * Face patient when speaking * Minimize background noise
58
Hearing loss referrals
Referral for formal audiometry Referral to ENT/neuro Referral to ED if abrupt onset of s/s
59
# Definition Tinnitus
Perception of hearing sound when there's no sound in environment
60
Tinnitus etiologies
* Toxins * Noise or barotrauma * Eustachian tube dysfunction * Acoustic neuroma * Vascular abnormality
60
Tinnitus etiologies
* Toxins * Noise or barotrauma * Eustachian tube dysfunction * Acoustic neuroma * Vascular abnormality
61
Tinnitus clinical manifestations What do the different sounds heard indicate?
* Hearing buzzing, ringing, hissing, whistling * UNL or BL * Constant or intermittent * **High pitched, continuous** → sensorineural hearing loss * **Low-pitched** → idiopathic or Meniere disease * **Pulsating/rushing** → vascular cause * Clicking → TMJ * Any neuro s/s: ear pain, dizziness, discharge, etc * Insomnia
62
Tinnitus PE exams
Ear + neuro exam TMJ assess Auscultate for bruits
63
Tinnitus differentials
* CNS lesion * MS * Vestibular schwannoma (DO NOT MISS)
64
Tinnitus diagnostics
* Systemic labs: CBC w/diff, ESR, glucose, TSH ** MRI + CT to R/o CNS lesion**
65
Tinnitus nonpharmacological tx
Earplugs White noise machine
66
Tinnitus Risk factors Referrals
Risk Factors * Syphilis * Lyme Disease * Referral to audiogram, ENT, or neuro
67
Cerumen impaction wax description
Dry, dark, immobile, malodorous
68
Cerumen clinical manifestations
* UNL or BL s/s * Fullness * Hearing loss * Ear pain + discomfort * Tinnitus * Vertigo or dizziness
69
# 2 things How is cerumen impaction DX
When patient **has s/s** and **cannot assess ear d/t cerumen**
70
Objective finding cerumen impaction PE assessments
* Wax partially or full occludes TM * Assess for bleeding + drainage * PE preauricular, posterior auricular lymph nodes
71
Cerumen impaction differentials
* Foreign body * Otitis media * Otitis externa * TM perforation * Eustachian tube dysfunction
72
Cerumen impaction pharmacological txs
Ear wax removal drops: * Carbamide peroxide drops x 3-5d * Cortisporin drops x 2-3d after irrigation if risk for otitis externa
73
Cerumen impaction nonpharmacologic txs
Using currette or irrigation for removal
74
Cerumen impaction risk factors
Q-tip usage Ear plug usage Hearing aides Earbuds
75
Hx questions to ask if patient has cerumen impaction
Ask about... * Hx of tympanostomy tube * Surgery * TM rupture (irrigation) * Immunocomp: excoriation
76
Cerumen impaction patient education
* Clean external ear only * Avoid ear swabs/small objects inot ear * May use debrox drops 1-2x/week * Individuals who use hearing aides are at higher risk for impaction
77
# Definition Cholesteatoma What kind of hearing loss
* Collection of skin cells in middle ear or mastoid → benign tumor * Middle ear issue; congential/acquired * Conductive hearing loss
78
Cholesteatoma Primary vs secondary
Primary: eustachian tube dysfunction Secondary: post TM perforation
79
Cholesteatoma clinical manifestations
These can recur * Erosion * Hearing loss * Malodorous drainage * Tinnitus * Vertigo
80
PE exams cholesteatoma
External/internal ear exam Neuro exam
81
Cholesteatoma differentials
* Squamous cell carinoma * Adenocarcinoma * Acoustic neuroma * Otitis externa * Chronic otitis media * Foreign body
82
Cholesteatoma definitive treatment
SURGERY * F/U w/ENT post-op * Referral to ENT + audiogram
83
Cholesteatoma pharmacological tx if otitis externa/AOM present
Antibacterial agent
84
Chronic inflammation of cholesteatoma →
* Balance issues * Meningitis * Brain injury * Tinnitus * Vertigo
85
Low vision parameters
20/70 or <
86
Legal blindness parameters
20/200 or <
87
Vision screening
USPSTF has no recommendations BUT AAO: > 65y.o. comprehensive eye exam Q1-2yrs

NP 801 NP Theory 2 (7 decks)

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