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Rotation 2: IM Outpatient > HEENT Portion > Flashcards

Flashcards in HEENT Portion Deck (17):
1

Glaucoma

 

what is this?

what are the 2 types?

1 RF?

eye conditions that cause progressive optic nerve damage, leading to irreversible loss of vision

 

Types:

1. open angle

2. closed angle

 

RF:

elevated intraocular pressure

2

Closed angle glaucoma

 

what is this caused by? IOP?

5 key sxs?

3 tx options?

2

3

1

acutre rise in IOP due to  the trabecular meshwork being occluded with IOP over 50

 

SXS:

PAINFUL 

STEAMY CORNEA

FIX MID DILATED PUPIL

NAUSEA AND VOMITING

INFLAMMED EYE

 

TX: get pressure down ASAP

1. Decrease aqueous production WITH BB or barconic anhydrase inhibitor

2. increase outflow with Prostaglandin, cholinergi, epi

***ALPHA AGONISTS DO BOTH OF THESE***

3. Ultimately need laser (YAG periphreal iridotomy**)

3

Open angle glaucoma

 

what is this?

3 ways to dx?

3 tx options?

most often asymptomatic and chronic with IOP over 22, but can still have damage less than 22

 

DX:

1. tonometry: tells IOP

2. optic nerve eval through dilated pupil

3. pachymetry: measure central corneal thickness

 

TX:

1. pharmocological first then consider surgery

A. BB or carbonic anyhdrase inhibitor

B. Laser Trabeculoplasty

4

secondary glycoma

7 causes

1. inflammation
2. hyphema-blood in the anterior chamber
3. angle recession-caused by blunt trauma to the TM
4. neovascular- complication of diabetic retinopathy or vascular occlusion, BV can grow into the angle
5. phacolytic
6. pseudoexfoliation syndrome-white flakey material from the anterior surface clogs the TM
7. pigment disruption-part of the iris flakes off and clogs the TM

5

Cataract

 

what is this?

patho?

3 sxs

3 types

opacity of the lens caused by insoluble protein caused by age, medication, illness, sun exposure

 

Patho: the lense is make of proteins arranged in a certain fashion but over time they can clump together and cloud the lense

 

SXS:

1. gradual loss of vision

2. increased glare

3. decreased color preception

 

Types:

nuclear sclerosis

cortical

posterior subscapular

6

Nuclear sclerosis cataract

ellow or brown discoloration
of the central lens; even distribution;
distance vision blurred myopic shift (second sight)

A image thumb
7

cortical cataract

radial or spoke like opacities

A image thumb
8

posterior subscapular cataracts

 

plaque-like opacities
on the posterior aspect of the lens. Greater affect
on acuity and often in younger patients

 

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9

whta are the reasons for doing cataract surgery?

1. increase activitis of daily living
2. prevent secondary glaucoma
3. permit fundus visulization

10

what is a secondary cataract that is a complication of cataract surgery?

-The posterior capsule can become opacified
of varying degrees, weeks to months later.

 

-The symptoms can range from blurring vision
to glare -similar to the initial cataract.
 


Txed with YAG laser in office procedure

11

presbyopia

what is this?

fix it?

age?

The natural loss of accommodation
due to thickening of the lens 
secondary to age.


Typically occurs after age 40

Corrected with near reading rx

12

Dry Macular degeneration

 

what is this?

age?

2 key findings?

tx considerations? 3 things

Q image thumb

painless and progressive  CENTRAL vision loss, OVER 50

 

FINDINGS:

1. drusen-small yellow deposits lead to degenerative changes and atrophy

2. changes on amsler grid

 

TX:

AREDS trial-tx with high antioxidants plus zinc can reduce up to 25%

(b-caretene, vit C, E, zinc)

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13

Wet macular degeneration

 

what are the two things the contribut to this?

patho?

2 findings?

1 tx?

Q image thumb

neovascular (new growth) and exudative (hemmorage), 10% of those with macular dengen but 90% of blindness

 

patho: subretinal fluid accumulation from neovascularization or fragile vessels that rupture

 

FINDINGS:

1. metamorphopsia-hemmorage causing wavy and distorted vision with paracentral scotomas "blind spots"

 

TX: ANTI-VEGF (vascular endothelial growth factor), 9/10 stabilize

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14

Sensory presbycusis

 

what causes this?

3 characterisitcs? 

1 tx?

Loss of sensory hair cells in basal end of cochlea

1. Slowly progressive loss

2. beginning with higher frequencies

3. Difficulty hearing in presence of background noise

 

 

Treatment: amplification..assisted listening or hearing aids

15

strial presbycusis

 

what is this?

what is lost?

1 tx?

A metabolic form of hearing loss

Cochlear dysfunction; atrophy of ≥30% of the stria vascularis

 

1. Mild to moderate hearing loss in most frequencies

 

 

 

Treatment: amplification...assisted listening or hearing aids

16

neural presbycusis

 

what is this?

what makes this unique that is lost?

what doesn't work?!

Cochlear neuronal loss of 50% or more

Poor speech discrimination

 

Amplification is usually not successful...TX cochlear implant

17

cochlear conductive presbycusis

 

what is this? 

what happens?

what doesn't work as well?

Changes in stiffness or mass; spiral ligament atrophy

Audiogram descends gradually over at least 5 octaves

 

 

**Speech discrimination impaired**