Q5 - Optho, ENT, Derm Flashcards by Hannah Tuma'e

Which bone gets eroded with ethmoid sinusitis? Pathogens then spread

Lamina paparatia - medial wall of the orbit.

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Valve of Hasner - “one way” valve for tears.

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CN 7 “hooks the eyes closed” and CN 3 is like a column keeping it open.
CC bill of 7000 you close your eyes because you don’t want to look
CC bill of 3000 you open your eyes to look because you can’t believe it!

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Most common fracture of the eye bones?

Orbital floor

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Oculo-cardiac reflex

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Indications for urgent repair of the orbit (after trauma)

Occulo-cardiac reflex
Muscle entrapment.

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“5 and dime reflex”

CN 5 is connected to vagus somehow, so when muscles of the eye are pulled on, your HR can drop.

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What muscle could be damaged with a superior eye lid lac?

Levator Palpebral.

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What is obstructed in Peds nasolacrimal duct obstruction?
Usually ________ (congenital/acquired)
Prognosis?

Valve of hasner.
Congenital.
Self limiting by 1 year

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What is epiphora?

Acquired nasolacrimal duct obstruction (valve of Hasner)
Infection, trauma.

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What causes retrobulbar hemorrhage?
Prognosis?

Trauma - punch in the face.
Anesthesia needle to retrobulbar space.
Pressure builds - assess function (CN 2)
Perform a lateral Canthotomy and Cantholysis.

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Orbital compartment syndrome - cause?
Treatment?

Burns

Canthotomy+Cantholysis.

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Positive Sidel test means what?

Globe rupture. Where the intra ocular fluid oozes out and washes away the flouriscene.

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Globe rupture? What do you do?

Foxshield
Abx Moxifloxacin - 400mg z1
Radio graphic studies (CT Orbits w/wo contrast) check for FOB.
Tetanus.

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Retinoblastoma - deets!

Presents before age 4
60% Unilateral
15% germline mutations
RB1 gene on chromosome 13 = TSG check point for cellular growth cycle at G1 check point “2-hit hypothesis”
45% chance of passing on the gene due to 90% penetrance of gene.

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2-hit hypothesis

If the first mutation is a germline mutation (sperm or egg), then they only need 1 more mutation to cause the cancer
If the person does not have a germline mutation, then it takes 2 mutations for them to get cancer

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LR6 SO4

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Congenital CNIV (Trochlear) palsy

Looking straight, affected eye may rise up a little
Adducting affected eye - double vision. (Upshot with lateral gaze away from affected eye-ADduction)

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CN VI abducens nerve palsy.

More common in adults/peds?

No ABduction in affected eye (LR6SO4)
RARE in peds, most common in Adults with vascular problems - due to micro vascular insult.
MS, neoplasm, infiltrative cause.
Peds congenital
Look up pics!!

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Inter nuclear Ophthalmoplegia (INO)

Ipsilateral adduction deficit
On attempted base to contra-lesional side, abducting eye has horizontal gaze evoked nystagmus
Adults: MS or stroke
Peds: Neoplasm.

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CN III slide with pupil sparing or pupil involving.

“Down and out” of affected eye with PTOSIS
Pupil sparing = ischemic
Pupil involving = PCA aneurysm.

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Horner syndrome

Injury to SNS.
Ipsilateral ptosis, no pupil constriction, flushing

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1st order = ?
Pancoast tumor (2nd order)
Carotid dissection (3rd order)

1st order is tumor of hypothalamus, brainstem or spinal cord
2nd order = tumor of mediastinum, thoracic outlet or thoracic spinal cord
3rd order = superior cervical ganglion, internal carotid dissection, cavernous sinus.
Two common causes of Horner’s syndrome.

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Test for Horner’s in a very ________ room.

Dark.
Eyes are already dilated, and so there will be more of a change in constriction.

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What’s the difference between a corneal abrasion and a globe rupture with the dye?

Corneal abrasion just stays in one place and lights up. Globe rupture has fluid running out so it will wash the dye away like a trail (sidel).

What is the treatment for corneal abrasion?

Abx. Contact lens wearers - at risk for pseudomonas infection which can eat through the lens very quickly. Moxi for contact lens wearers or vegetative injury

Who is more prone to subconjunctival hemorrhage?

Old ladies on blood thinners.

Tx of subconjunctival hemorrhage

2 weeks - artificial tears. Coughing, valsalva.

Hyphema caused by (blunt/penetrating) injury

Blunt.

Where is a hypema located?

In the anterior chamber.

What things can cause spontaneous hyphema?

SCD, diabetes, coagulopathies, blood thinners.

DC instructions for hyphema?

Return for close f./u due to risk of re-bleed in 7-10 days.

Difference between glaucomas: Open angle Angle closure/narrow angle

Open angle - blockage of trabecular mesh network even in setting of adequate space for drainage. Inherited. Blindness with few preliminary symptoms - hours or days! Angle closure - iris presses agains cornea blocking flow, and the pressure behind it bows the iris out to block the trabecular mesh network. Pain and visual disturbances. Immediate treatment!

Pinhole occluder - if this corrects the vision, then the problem is with the lens, not the retina. (If patient c/o not seeing well).

VEGF injections DM related macular degeneration of the eye.

Vitreous detachment - 90% go unnoticed or with no symptoms. If retinal traction or tear involved, THEN there is an issue. Save the retina!

What causes a vitreous detachment?

Aging. It does not reattach.

Causes of nasoairway obstruction

Deviated nasal septum, bilateral inferior turbinate hypertrophy (BITH) Nasal valve collapse Chronic sinusitis Allergic rhinitis Nasal mass.

What part of the nose senses airflow?

The “valve” over the middle turbinate.

Polyp looks like a “water balloon”

S/s of coanal atresia

Unilateral - chronic runny nose from 1 side only Bilateral - noticed right away because baby can’t breathe while breastfeeding.

Type 2 response (allergenic) in Western cultures to allergens.

Antibodies to allergens - activates mast cells to trigger inflammation cascade.

Circular self-licking ice cream cone of interleukens

IL-25+33 are type 2 inducers. IL-4 - triggers Th2 cell (why it’s called a Type 2 reaction) Activates B cells to make IgE and activate more mast cells. IL-5 makes eosinophils IL-13 - cell recruitment, mucus response (goblet cells) and remodeling.

Other parts of the world have a Type 1 response in reaction to infective not allergens.

Astopro - topical antihistamine.

Signs of a Bacterial rhinosinusitis

No improvement past 10 days of initial symptoms OR (double worsening) worsening after 10 days after an initial improvement.

What water should be used for nasal saline rinse?

Distilled or boiled tap.

Beware of pressure/back flow into the eustatian tubes if nares are very congested - drop the soft palate and let the water rinse come out the mouth. If the nose is clear, and it easily comes out the other side, then that’s okay.

Isotonic - salt in the water. It doesn’t burn.

Kiesselbach’s plexus

Area most susceptible to nose bleeds

JNA. - pubescent boys with recurrent spontaneous bleeding from one side of the nose.

Loose high frequency cells first in blast injuries/chronic noise use and old age.

What is more concerning - unilateral or bilateral tinnitus?

Unilateral - tumor? Bilateral - aging or sound trauma.

BPPV - short, transient vertigo due to position change. Test with?

Eply’s maneuver.

What things can cause short, transient vertigo that only lasts seconds? Hours? Days? Constant?

BPPV, VBI, Epilepsy, Arrhythmia Meniere’s, Migrane Vestibular neuronitis, labrynthitis Central(white matter, dz, TBI, low B12, MS, etc)

“Describe your symptoms without using the word dizzy” how long does it last??

Labrynthitis - vertigo for days AND HEARING affected Vestibular neuronitis - vertigo for days, hearing NOT usually involved. Both of these are _______ infections.

Viral. Treat with antiviral and sterioids

Danger space is midline while others are unilateral.

____________ are the immune cells of the skin

Langerhans cells

Review phone pics of skin lesions.

Keloid. = abnormal___________ activity.

fibroblast

Hypertrophic scar vs keloid.

Keloid extends past the original site of injury.

Allergic contact dermatitis is delayed hypersensitivity (>24hrs after exposure) Irritant contact dermatitis = more immediate after exposure up until 24hrs.

Most common psoriasis? Most common in kids?

Plaque Glutatate

Herald patch associated with?

Pityriasis Rosea “Christmas tree pattern” on the trunk. Resolves spontaneously w/in 6 weeks.

Non-scaling purple (Violaceous) polygonal puritic papules (Wrist, ankles, lower legs, oral genitalia. What is this?

Lichen planus.

Difference between TEN and SJS

TEN >30% of BSA

HPV 16 and 18 with head/neck cancers HPV E6/E7 with cervical.

E6 inactivates p53 which makes it unable to activate p21 which makes the makes the cell progress through it’s cycle without proofreading. E7 inactivated pRB which allows E2F to elongate the DNA and allow for continued cell cycle progression.

A well child with a midline swollen area under the chin is probably? Lateral neck?

Thyroglossal duct cyst Branchial cleft.

Hashimoto’s and thyroperoxidase antibody caused by ________

Hypothyroidism

Graves and thyrotropin receptor antibody TRAb caused by ______

HYPERthyroidism.

Biopsy of a thyroid nodule is only recommended IF:

>1.5cm and Low suspicion US findings, Intermediate suspicion US findings and >1cm or high suspicion US findings and >1cm.

Clinical S/S of hypercalcemia

Stones (kidney) Bones (osteitis fibrosis cystica) Groans (gall stones) AMS (Psychiatric overtones)

Sleep Apnea >10seconds of no airflow Hypopnea >30-50% decrease in airflow with 3-4% drop in O2 salts RERA (resp event related arousal) - decreased airflow not meeting above criteria.

What increases your risk for sleep apnea?

HTN, Stroke, traffic accident.

Single greatest predictor of OSA?

Neck size >17 in men >16 in women

T/F: non-con neck CT appropriate to eval for salivary stones.

True. 80-90% of submandibular stones are radiopaque, 60% of parotid stones are.

How do cataracts form?

Lens proteins break down leading to opacification.

Glaucoma diagnosed with IOP >

12-20mmhg

Patho of most common type of glaucoma. Chronic use of these medications can predispose for glaucoma?

Corticosteroids and anticholinergics. Open angle is most common. Outflow obstruction of aqueous humor- adequate space for drainage, just not able to drain. Often painless,and blindness can occur in a matter of days or weeks.

Patho of narrow angle (angle closure) glaucoma.

PainFUL! Obstruction of outflow from anterior chamber due to iris displaced towards the cornea.

AMD- age related macular degeneration- 2 types:

Dry: accumulation of waste in macula, choriocapillary loss, accumulation of pigment residue in retinae and atrophy. S/s night vision loss and difficulty reading. No Treatement Wet: abnormal choroidal blood vessel growth in macula, leakage of blood, retinal tears, scarring loss of dental vision. Tx is intraoccular anti-VEGF injection.

A lesion prior to the optic chiasm will cause vision loss in one eye. Posterior the the chiasm, most will cause same-sided (homonymous) hemianopsia or quadrantanopia. Lesion at chiasm itself will cause bitemporal hemianopsia.

What is keratitis ?

Infx of the cornea.

What part of the ear is involved with hearing and equilibrium?

Inner ear.

Conductive hearing loss involves_______ Sensorineural hearing loss involves________ Which type would be caused by syphilis?

Conductive: physical anomalies in outer or middle ear SN:damage to organ of Corti or it’s central connections to the auditory cortex. SN.

Melanocytes are located in the _______

Epidermis, right on the border of the epidermis and dermis

Dermis contains:

Nerves, sweat glands, blood vessels, hair follicles, lymphatic vessels and sebaceous. Glands

What type of nerve fibers transmit itch?

Small, unmyelinated C type and thinly myelinated Agama fibers

Scalp dandruff is a mild example of?

Seborrheic dermatitis.

Psoriasis -IL-23 mediated activation of Th cell 17 pathway.

Hydradenitus suppurativa (inverse acne) involves the pilosebaceous follicular ducts - folds and hair follicles.

Auto-antibodies. And immune complexes infiltrate the dermal-epidermal junction and cause tissue damage and inflammation. Exacerbated by UV.

Cutaneous Lupus Erythematosus

Urticarial lesions are associated with type _____ hypersensitivity reactions

types of hypersensitivity reactions.

I - IgE mediated - Th2 cells IL4-> Bcell activation. Asthma., anaphylaxis, allergic rhinitis II - Tissue-specific - altered self-antigens on tissues - autoimmune hemolytic anemia, HIT, Graves and MG III - Immune complex-mediated - antibodies activate complement and neutrophils that destroy tissue (SLE, raynaud) IV - cell-mediated - Th1 activate macrophage and Tc. Poison Ivey, mycobacterial infx.

BCC - mutation of p53 TSG - loss of keratinocyte repair function and apoptosis resistance of DNA damaged class. Sonic hedgehog signalling access and disinhibition of PTCH1 gene

BCC - Surface epithelial tumor SCC - epidermis

Most common cause of lip cancer?

SCC

CTCL - Cutaneous T-Cell Lymphoma - pruritic.

Difference between allergic contact dermatitis and irritant contact dermatitis?

ACD is t-cell mediated delayed hypersensitivity ICD is not mediated by the immune system

Q5 - Optho, ENT, Derm Flashcards

(101 cards)