Test 4 Reverse Flashcards
(188 cards)
1
Q
Inflammation of the eyelidS. aureus or epidermidisSeborrheicFrom direct bacterial infection & response against bacterial toxins Delayed hypersensitivity rxns to bacterial antigens
A
Anterior blepharitis
2
Q
Inflammation of eyelidsDysfunction of meibomian glands
A
Posterior blepharitis
3
Q
- Burning2. Itching3. Foreign body senstaion4. Crusting of the eye lashes5. Erythematous lid margins6. Scaling lids
A
S/S blepharitis
4
Q
- Rosacea2. Eczema3. Prior lid injury
A
Risk factors of blepharitis
5
Q
Usually bilateral may be asymmetric1. Lid erythema2. Lid telangiectasia3. Oily collerettes base of lashes4. Papules5. Pustules w/ rosacea
A
What would you see with slit lamp exam of blepharitis?
6
Q
- Warm compresses 2x/day2. Eyelid scrubs after compresses3. Anterior - Topical abx if infected (erythromicin/bacitracin)Posterior - oral doxycyline
A
Tx blepharitis
7
Q
Blowout FxOccurs with blunt force trauma to globe or orbital rim
A
What is the most common orbital Fx?
8
Q
Medial wall & orbital floor-lamina papyracea
A
What is the weakest area for orbital Fx?
9
Q
Blunt trauma1. Diplopia on upgaze2. Periorbital ecchymosis & edema3. Anesthesia of maxillary teeth & upper lip4. Step off deformity over infraorbital ridge5. Orbital crepitus
A
S/S Blowout Fx
10
Q
- Plain skull XR w/ Waters & Caldwell views2. Teardrop sign CT scan needed to Dx & determine extent of damage (coronal & sagittal views)
A
How to Dx blowout Fx?
11
Q
Surgery for persistent diplopia & endopthalmitisRefer
A
Tx blowout Fx
12
Q
Aging1. Trauma2. Metabolic disorders3. Infections (rubella)4. Medications5. Congenital problems
A
MCC of cataracts & other causes ?
13
Q
cataracts
A
What is the MCC of blindness in the world?
14
Q
Changes in the lens protein affects how the lens refracts light, reducing clarity & visual acuityMay cause color to turn yellow, green, brown or white
A
What causes cataracts?
15
Q
- Painless blurry vision or vision loss2. Glare3. Myopia4. Monocular diplopia5. Absent red reflex6. Leukoria
A
S/S cataracts
16
Q
- Surgery w/ intraocular lens implantMay just remove it w/o implantRefer
A
How to Tx cataracts?
17
Q
Idiopathic, sterile chronic granulomatous inflammation of the meibomian gland caused by a foreign body reaction to sebum
A
What is a chalazion?
18
Q
- Chronic process of that results from an inflammatory foreign body reaction to sebum2. Blockage of normal drainage glands, especially at at the eyelid margin3. Blepharitis, acne rosacea or hordeolum may contribute to development
A
What causes chalazion?
19
Q
- Nontender, palpable localized swelling2. Swelling points to the conjunctival surface3. No signs of inflammation
A
Dx chalazion
20
Q
- Warm compresses and lid scrubsIf recurrent - refer for incision & curettage
A
Tx chalazion
21
Q
Adenovirus1. BacterialStreptococcus pneumoniaeHaemophilus influenzaStaphloccus aureusNeisseria gonorrheaChlamydia trachomatis2. ViralHerpes simplex virus type 1 and 2Picornaviruses3. Allergies4. Chemical5. Irritative
A
What is the MCC of acute conjunctivitis, & others?
22
Q
KidsAdults usually get viral
A
Who more commonly gets bacterial conjunctivitis?
23
Q
Bacterial/viral1. Reduced host defenses & external contamination2. Leukocyte or lymphocytic inflammatory cascade leading to an attraction of read and white blood cells to the area. Allergic 1. Type 1 immune response to an allergen2. The allergen binds to a mast cell and crosslinking to IgE occurs3. Mast cell degranulation and initiation of the inflammatory cascade4. Releases histamines from mast cells and other mediators5. Histamine and bradykinin stimulate nociceptors resulting in itching, vasodilation, rednessand conjunctical injection.
A
Pathophysiology of Conjunctivitis
24
Q
- Foreign body sensation2. Burning3. Itching4. Photophobia5. URI6. Family member with same symptoms7. Tearing8. H/o cold sores9. Crusting10. Lids stuck shut in the morning11. Hyperemia12. Pseudoptosis13. Preauricular LAD
A
S/S Conjuncitivits
25
1. Rapid adenovirus immunoassay kit2. Bacterial or viral culture
Dx conjuncitivitis
26
Self limiting 10-14 daysIf Tx - 1-3 daysBroad specturm topical abx
Tx of bacterial conjuncitivits
27
Oral tetracylcine, doxycylcine, erythromicin or azithromycin Topical ointments of drops used
Tx of chlamydial conjuncitivitis
28
1. Artificial tears2. Cool compressesAcyclovir if herpes
Tx of viral conjuncivitis
29
1. Topical antihistamines2. Short course of topical steroids
Tx of allergic conjunctivitis
30
Lid stuck shut in morningLess itching
Good sign for bacterial conjunctivitis
31
1. Preauricular LAD 2. Subconjunctival hemorrhage 3. Punctate keratopathy4. Photophobia
Good signs for viral conjuncitivitis
32
1. Intense itching2. Chemosis3. Thick stringy mucus4. Conjunctival papilla
Good signs for allergic conjuncitivitis
33
1. Sudden onset 2. Foreign body sensation3. Photophobia4. Excessive tearing5. Blepharospasm6. Blurry vision7. Pain worse with eye movement
S/S corneal abrasion
34
1. Remove foreign body2. Anesthetic eye drop3. Topical abx (Tobramycin)4. NSAIDNo patching, no contacts
Tx corneal abrasion
35
P. aeruginosa
What ulcers can contacts cause?
36
1. Contact lenses2. HIV3. Trauma4. Ocular surface disease5. Ocular surgery6. Age7. Gender 8. Smoking9. Low socioeconomic class, poor hygiene
Risk factors for corneal ulcers
37
1. Staphylococcus sp, Pseudomonas2. Fungi - Fusarium3. Amoeba - Acanthamoeba4. Herpes simplex, Varicella-Zoster5. Idiopathic6. Neurotrophic keratitis7. Exposure keratitis8. Severe dry eyes9. Severe allergic disease
Common causes of corneal ulcers
38
1. Pain2. Photophobia3. Tearing4. Decreased/blurred vision5. Erythema of eyelid and conjunctiva6. Circum-corneal injection7. Purulent or watery discharge8. Foreign body sensation
S/S corneal ulcer
39
1. Broad spectrum abx - usually ciproIf contact lens wearer - fluoroquinolone 2. Cycloplegic eye dropsRefer
Tx of corneal ulcer
40
Inflammation of lacrimal glandMay be primary inflammatory condition of secondary1. Mumps2. Measles3. Influenza
Dacryoadenitis & when is it commonly seen in kids?
41
1. Autoimmune diseases - Sjorgen syndrome, Sarcoidosis, Tumor2. Rare caused by staphyloccus, aures, Nesseria gonorrhea or streptococci3. Mumps, mononucleosis, influenza and herpes zoster
Causes of dacryoadenitis
42
1. Unilateral eye pain2. Redness3. Swelling over lateral 1/3 upper eyelid4. Tearing or discharge
S/S dacryoadenitis
43
1. Inflammatory - Refer to ophthalmologist for treatment pseudo tumor cerebri2. Viral - Cool compresses to swelling, NSAIDs PRN3. Bacterial or infectiousmild to moderate amoxicillin/clavulanate or cephalexinModerate to severeHospitalize treat according to causative organism
Tx of dacryoadenitis
44
Eversion of lower eyelid Relaxation of the orbicularis oculi muscle or degeneration of the lid fascia
What is ectropion caused by?
45
1. Previous surgery, trauma, chemical burn or seventh nerve palsy2. Excessive tearing3. Corneal abrasion from eyelashes4. Foreign body sensation
S/S ectropion
46
1. Artificial tears & lubricant2. Bacitracin/erythromycin3. Warm compress4. Tape lid into placeRefer for surgery
Tx of ectropion
47
Onward turning of the lower eyelid 1. Due to age related laxity of the lower eyelid muscles and degeneration of the lid fascia2. Can also be caused by birth defect (Down’s Syndrome), facial palsy & scar tissue of conjunctiva and tarsus
What is entropion caused by?
48
1. Eye irritation2. Foreign body sensation3. Tearing redness4. Conjunctival injection5. Blepharospasm
S/S entropion
49
1. Artificial tears & lubricants2. Surgical repair
Tx of entropion
50
1. Pain, worse with eye movement (significant relief with topical anesthetic)2. Foreign body sensation (relieved by topical anesthetic)3. Photophobia4. Tearing5. Redness
S/S corneal foreign body
51
1. Topical anesthetic2. Remove FB3. If rust ring is present must completely removed4. Tx w/ abxPts w/ intraocular foreign body need immediate referral
Tx corneal foreign body
52
Glaucoma
What is the 2nd leading cause of blindness?
53
Inc. intraocular pressure causing optic nerve damageOpen- angle: Neurodegenerative condition from dysfunction of aqueous humor Angle closure: restricted flow of aqueous humor
Cause of glaucoma
54
1. Usually asymptomatic early2. FH diabetes or glaucoma3. Halos around lights
S/S open angle glaucoma
55
1. Halos around lights2. Aching eye/brow pain3. HA4. N&V5. Dec. vision 6. Eye redness7. Use of sulfa based drugs
S/S closed angle glaucoma
56
1. IOP >212. Loss of rim tissue on optic disc3. Enlarged cup to disc ratio or asymmetric cup to disc
Dx open angle glaucoma
57
1. Reduced visual acuity2. Hyperemia3. Elevated IOP4. Corneal edema5. Dilated fixed pupil6. Shallow anterior chamber
Dx closed angle glaucoma
58
1. Reduction of aqueous production beta-adrenergic drops timolol or levobunolol contraindicated in asthma and cardiac conduction defects.Alpha-adrenergic agonists apraclonidine and brimonidine.2. Laser trabeculectomy
Tx of open angle glaucoma
59
Medical Emergency!!!1. Reduce IOP and break the angle closureBeta-adrenergic dropsTopical Streoids drops Prednisilone acetate 1% Alpha-adrenergic agonistsCarbonic anhydrase inhibitor acetazolamide 500 mg2. Hyperosmotic agents when pressures are very high3. Laser peripheral iridotomy used to relieve pressure in iris
Tx closed angle glaucoma
60
Angle closure 1. Cycloplegia (atropine 1% BID to TID2. IV hyperosmotic agents3. IV steroids (methylprednisione250 mg QID) Refer - emergency
Tx glaucoma caused by Topiramate or sulfonamide
61
S. aureusMeibomian glandTx w/ warm compress
What bacteria causes Hordeolum & what is infected?
62
Adults1. Diabetes2. Blepharitis 3. Seborrhea4. High serum lipids
Who is at inc. risk of Hordeolum?
63
1. Acute pain or tenderness eyelid2. Erythematous eyelid3. Pustule on eyelid4. Hyperemia5. Eyelid bump6. Eyelid swelling7. Previous eye surgery or eyelid surgery8. Rosacea or blepharitis
S/S hordeolum
64
1. Palpate lid for eyelid nodule2. Visual examination for blocked meibomian gland3. Eyelid swelling4. Localized eyelid tenderness
Dx hordeolum
65
preseptal cellulitisTx w/ cephalexin & refer
What should you consider if there is periorbital erythema & warm edema?
66
1. Warm compresses 10 minutes QID with lid massage over nodule2. Eyelid scrubs3. Abx maybeIf no improvement after 3-4 weeks refer to an ophthalmologist curettage and drainage
Tx hordeolum
67
Post injury accumulation of blood in the aqueous humor of the anterior chamber Inc. intraocular pressures REFER - Medical Emergency
Hyphema
68
anterior aspect of ciliary body
What is the most common site of bleeding w/ hyphema?
69
1. Blunt or penetrating trauma, intraocular surgery2. Vision loss3. Eye pain4. N&V5. Blurry vision6. Vision loss (is it changing over time?)7. Medications w/ anticoagulation properties
S/S hyphema
70
1. Blood/clot in anterior chamber2. R/O ruptured globe3. Measure IOPScreen black & mediterranean Pts for sickle cell
Dx hyphema
71
1. Avoid ASA & NSAIDS2. Bedrest or limited activity3. Elevate head of head to allow blood to settle4. Eye shield either metal or plastic (do not patch)5. Atropine 1% BID to TID6. Acetaminophen only
Tx of hyphema
72
Macular Degeneration
What is the leading cause of blindness in industrialized nations?
73
1. Age2. FH3. Smoking4. Previous cataract surgery5. ARMS2/HTRA1
Risk Factors of Macular Degeneration
74
1. Gradual loss of central vision2. Drusen's3. Macular retinal pigment epithelial changes4. Variable vision loss 5. Amsler Grid changes
S/S non-exudative macular degeneration
75
1. Severe vision loss2. Choroidal neovascularization noted on fundus examination3. Drusen and subretinal fluid or retinal pigment epithelium detachment4. Disciform scar
S/S exudative macular degeneration
76
1. AREDS formula vitamins 2. Monitor with Amsler Grid3. Smoking cessation
Tx non-exudativee macular degeneration
77
1. Laser photocoagulation2. Intraocular injections of anti-vegf drug
Tx exudative macular degeneration
78
Fast uncontrollable mvmts of the eyeCan be in one or both eyesAcquired/CongenitalUsually asymptomatic unless developed after 8y/o
Nystagmus
79
1. Idiopathic2. Albinoism3. Aniridia4. Leber congenital amaurosis
Causes of congenital nystagmus
80
1. Vision loss2. Toxic or metabolic causes3. CNS disorders4. Non-physiologic5. Trauma 6. Labyrinth's/Meniere's disease7. Thiamine/Vit B12 deficiency8. Drugs/alcohol9. Vertigo10. MS
Causes of acquired nystagmus
81
1. Maximize vision by refraction2. Treat amblyopia3. Prism glasses maybe4. Muscle surgery maybe
Tx congenital nystagmus
82
1. Treat underlying etiology2. Periodic alternating nystagmus treat baclofen (not for use in children)
Tx acquired nystagmus
83
Inflammation of the optic nerve 1. Epstein-barr VirusOther viruses - demyelinating disease2. AutoimmuneSLE, Sarcoidosis, Sjogren, Behcet & MS
Optic neuritis & Causes
84
1. Monocular periorbital pain/retro-ocular pain2. Eye pain worse w/ eye mvmt3. Loss of visual acuity w/ scotoma4. Color desaturation/loss of color vision5. Relative afferent papillary defect6. Uhthoff phenomenon7. Pulfrich phenomenon8. Phosphenes (see light with sight being present)
S/S Optic Neuritis
85
Worsening of symtoms w/ inc. in body tempsSeen w/ Optic neuritis
What is Uhthoff phenomenon?
86
Altered depth perception of moving objects Seen w/ optic neuritis
What is Pulfrich phenomenon?
87
1. Visual acuity2. Optic disc swelling3. Color perception4. Contrast sensitivity5. Visual field - APD (90% pts)6. Optic disc pallor (optic atrophy from previous ON)7. MRI brain/orbits8. Labs -CBC, RPR, FTA-ABS, ESR & CRP
Dx optic neuritis
88
1. MRI w/ 1 demyelinating lesion - steoids for 14 days2. Antiulcer meds - ranitidine 150 mg BID3. MRI w/ >3 demyelinating lesions - steroids then refer for interferon Tx
Tx optic neuritis
89
Could be underlying bacterial sinusitis
Why is periorbital cellulitis concerning in kids?
90
Infective process occurring in the eyelid tissues superficial to the orbital septumAffects muscles & fat w/in orbit but not the globeCommonly spread & causes other infections
Orbital cellulitis
91
1. Superficial inoculation - insect bite, chalazion, epidermal inclusion cyst, folliculitis2. Local spread from respiratory tract 3. Orbital injury, Tx, dacryocystitis, endophthalmitis, dental infections
Causes of orbital cellulitis
92
1. S. aureus2. S. epidermidis3. Strep & anaerobes4. Fingal seen in immunosuppressed/diabetics...very aggressive
What organisms commonly cause cellulitis?
93
1. Ocular pain2. Proptosis3. Ophthaloplegia (paralysis of extraocular muscles)4. Eyelid edema5. Vision loss6. Chemosis7. Eyelid erythema8. Elevated intraocular pressure9. HA10. Decreased eye motility11. N&V
S/S orbital cellulitis
94
1. Complete dilated eye examination with visual acuity2. Head and neck examination3. Oral examination (tissue necrosis and black eschar) 4. Check for +APD5. CT scan
Dx orbital cellulitis
95
1. Empiric oral or IV antibiotics2. Incision and drainage of abscess3. Culture for causative organism4. Antifungal therapy with amphoteracin-B (for immunosuppressed or ketoacidosis pts)
Tx orbital cellulitis
96
Optic disc swelling that is secondary to elevated intracranial pressureNo dec. vision***Usually bilatCaused by infection, infiltration or inflammation
Papilledema
97
1. Primary and metastatic intracranial tumors2. Hydrocephalus3. Pseudotumor cerebri4. Subdural and epidural hematomas5. Subarchnoid hemorrhage6. Arteriovenous malformation7. Brain abscess8. Meningitis9. Encephalitis10. Cerebral venous sinus thrombosis
Causes of papilledema
98
1. HA (worse on awakening, exacerbated by coughing or other types of Valsalva maneuver)2. N&V3. LOC, pupillary dilation and death4. Pulsatile tinnitus5. Blurry vision, constriction visual field & decreased color vision6. Diplopia (6th nerve palsy)No visual disturbances
S/S papilledema
99
1. Full dilated eye examination2. Automated visual field test (detect blind spot or constriction of field)3. Color vision testing4. Optic disc photos5. BP6. MRI head with gadolinium and MRV head7. Lumbar puncture with CSF analysis and opening pressure msmt
Dx papilledema
100
Fix cause1. Diuretics-carbonic anhydrase inhibitors (idiopathic intracranial hypertension)2. Weight reduction (idiopathic intracranial hypertension)3.Corticosteroids (inflammatory disorders)
Tx papilledema
101
Fleshy, fibrovascular overgrowth from the conjunctiva onto the corneal surface1. UV 2. Irritation from wind 3. Genetics
Pterygium & Risk factors
102
1. Ocular irritation and burning2. Redness3. Tearing4. Blurred vision5. Diplopia6. Altered ocular cosmesis
S/S Pterygium
103
1. Wing shaped, vascular, conjunctival overgrowth2. Increased tear lakes
Dx Pterygium
104
1. Protect eyes from direct sun and wind2. Topical steroid drop to reduce irritation3. Refer to ophthalmologist for surgical excision if overgrowth encroaches into the pupillary area
Tx Pterygium
105
Acute or progressive condition where the neuroretina separates from the retinal pigment epithelium with accumulation of subretinal fluid and loss of visual function
Retinal Detachment
106
1. Flashes of light2. Floaters3. A curtain or shadow moving over the field of vision4. Peripheral or central vision loss
S/S Retinal Detachment
107
Traction1. Diabetes2. Trauma 3. Previous surgery
Causes of Retinal Detachment
108
1. Full dilated eye examination2. Confrontational fields3. Indirect ophthalmoscopy with scleral depression4. B-scan (ultrasound) is used if media problem
Dx retinal detachment
109
1. Pneumatic retinopexy2. Surgical-vitrectomy and/or scleral buckle
Tx Retinal Detachment
110
Embolus1. Cholesterol - Hollenhorst plaque from carotid artery bifurcation 2. Calcium - from heart valves3. Fibrin - from atheromas in carotids4. Thrombosis5. Giant cell arteritis6. Collagen-vascular disease7. Hypercoag. disorders
Causes of Retinal Artery Occlusion
111
1. Acute persistent vision loss2. Visual acuity finger count to light perception3. H/O HA, weight loss, jaw claudication, scalp tenderness, fever, proximal joint pain4. H/O atrial fibrillation, endocarditis, coagulopathies, atherosclerotic disease5. Direct pressure to the globe or drug induced stupor
S/S Retinal Artery Occlusion
112
1. Whitening of the retina on the posterior pole2. Cherry red spot macula3. + APD4. Narrowed retinal arterioles5. Boxcaring or segmentation of the blood columns in the arterioles
Dx Retinal Artery Occlusion
113
Tx underlying medical problems
Tx Retinal Artery Occlusion
114
Non-ischemic - milder Ischemic
Retinal Vein Occlusion
115
1. Atherosclerosis of the adjacent central retinal artery causing thrombosis2. HTN3. Optic disc edema4. Glaucoma 5. Optic disc drusen6. Hypercoagulable states7. Vasculitis8. Drugs
Causes of retinal vein occlusion
116
1. Unilateral painless vision loss
S/S Retinal Vein Occlusion
117
1. Diffuse retinal hemorrhages, dilated, tortuous retinal veins2. Cotton-wool patches, disc edema, retinal hemorrhages, retinal edema, optociliary shunt vessels on the disc, neovascularization of the optic disc, retina and/or angle3. Intravenous fluorescein angiography4. Labs-FBS, HgbA1c, CBC with diff, platelets, PT/PTT, ESR, lipid profile, homocystine, ANA, FTA-ABS5. Medical eval CV disease and hypercoagulability
Dx Retinal Vein Occlusion
118
1. Chronic macular edema-focal laser or anti-VEGF intraocular injections2. Retinal neovascularization-panretinalphotocoagulation laser
Tx Central Retinal Vein Occlusion
119
Non-proliferative1. Venous dilation2. Microaneurysms3. Retinal hemorrhages4. Edema5. Hard exudates6. Cotton-wool patchesProliferative7. Neovascularization8. Hemorrhage in the vitreous body9. May lead to retinal detachment10. Fibrosis
S/S Diabetic Retinopathy
120
1. Based on history and funduscopic examination2. Optical coherence tomography scanning of the macula3. Fluorescein angiography
Dx Diabetic Retinopathy
121
1. Management of blood glucose, BP & lipids2. Yearly dilated eye examination3. Neovascularization of the retina and disc is treated with panphotocoagulation laser4. Neovascularization of the angle is treated with PRP laser, cryotherapy and/or topical glaucoma medications5. Macular edema use intraocular injectable
Tx Diabetic Retinopathy
122
Deviation from perfect ocular alignment Congenital or defective nerves
Strabismus
123
1. Diplopia2. Scotoma3. Amblyopia4. Abnormal eye movements5. Visual confusion6. Asthenopia (weakness or fatigue of the eyes with headache)7. Intermittent closure of the eye8. Cranial nerve palsy
S/S Strabismus
124
1. Full dilated eye examination with cycloplegics2. Cover test3. Forced duction testing4. MRI of bra if needed to r/o mass lesion5. CT chest if needed to r/o possible thyoma6. CT or MRI orbit if needed to orbital fracture, entrapment of extraocular muscle or tissue or Graves disease
Dx Strabismus
125
Primary and secondary strabismus1. Correct refraction2. Treat amblyopia or diplopia3. Extraocular muscle surgery4. Chemodenerviation5. Over-minus prescription or occlusionParalytic and restrictive strabismus1.Botulinum toxin injections
Tx Strabismus
126
Acute Closure
What type of glaucoma is a medical emergency?
127
Retinal Artery Occlusion
When is a cherry red spot macula seen?
128
aka swimmer's ear1. Pseudomonas Sp.2. Enterobacteriaceae3. Proteus Sp4. Fungi sometimesor contact dermatitis
Common organisms w/ otitis externa & sinusitis
129
1. Pain in ear2. Tenderness w/ palpation of tragus/auricle 3. Grayish discharge in canal
S/S otitis externa
130
Fungal infection due to excessive use of abxgreenish drainage
What is otomycosis?
131
1. Abx drops - Quinolone2. Keep canal clean & dry Maybe steroid & acetic acid
Tx otitis externa
132
1. Poor drainage from eustachian tubes 2. Inflammation & edema3. Congenital deformity (Down's)Most common in 4-24 months
Cause of otitis media
133
1. S pneumoniae2. H. influenzae3. Moraxella catarrhais4. Strep pyogenes5. S. aureus
Organisms w/ otitis media
134
1. Fever (rare)2. Pressure3. Pain4. Hearing loss 5. Immobile, erythematous, bulging TM
S/S otitis media
135
1. TM rupture - otorrhea & dec. pain2. Mastoiditis - spiking fevers, postauricular pain, erythema
Complications w/ otitis media
136
>2 y/o or 6mo-2y/o w/o middle ear effusion - watch & wait for 48-72 hrsIf effusion/more severe Sx - AmoxicillinIf fever + otalgia - Amoxicillin + Clavulanate
Tx otitis media
137
Destruction & expanding growth of keratinizing squamous epithelium in the middle ear &/or mastoid process Sx - discharge & hearing lossTx - Surgery
Choleseatoma Sx & Tx
138
inability to equalize barometric stress on the middle ear causing pain Caused by auditory tube dysfunction from congenital narrowing or acquired mucosal edema TM may rupture if not equalized
What is barotrauma & cause?
139
1. Cerumen impaction2. Acute otitis externa3. Otosclerosis 4. Otitis media
Causes of conductive hearing loss
140
Presbycusis High frequency hearing loss May be assoc. w/ tinnitus Tx - hearing aids
What is the MCC of sensorineural hearing loss?
141
1. Labyrinthitis2. Meniere's disease3. Vestibular neuritis4. Obstructing anatomic abnormalities 5. Brain stem vascular disease6. Arteriovenous malformations7. Tumors of the brain stem or cerebellum8. MS9. Vertebrobasilar migraine syndrome
Causes of vertigo
142
Predicted type of vertigo in certain positionsDx - Dix-Halpike maneuverTx - Epley maneuver
Benign Paroxysmal Position Vertigo Dx & Tx
143
Viral/post-viral affecting the vestibular portion of the 8th nerveNeed thorough neuro examWorse w/ rolling over in bed & quick head turning 1. Severe persistent vertigo2. N&V3. Gait instability Dx - Hallpike maneuverTx - Meclizine
Vestibular Neuritis Labyrinthitis Cause S/S & Tx
144
Cerebellar/posterior stroke
What should you consider in an old person w/ labryinthitis?
145
elderly/immunocompromised Get CT to rule out osteomyelitis
Who gets malignant otitis externa & what do you need to get?
146
aka Ramsay Hunt SyndromeCN VII 1. Acute vertigo & hearing loss2. Facial paralysis3. Ear pain4. Vesicules in the auditory canal
Herpes Zoster Oticus S/S
147
1. Chronic hearing loss2. Tinnitus3. Dizziness/vertigoIf yes to all 3 = Meniere's
If a Pt has vertigo, what must you document?
148
Excess endolymphatic fluid pressure 1. Hearing loss2. Tinnitus3. Vertigo4. N&V Tx - diuretics & salt restriction
Meniere's disease S/S & Tx
149
aka vestibular shwannoma More common in females1. Unilateral hearing loss 2. Tinnitus3. Vertigo4. Ataxia5. Brain stem dysfunctionDx - CT/MRI TX- Surgery
Acoustic neuroma & Dx
150
Traumatic or w/ OM Small ones heal in 4-6 wks Large may need surgery
TM Perforation
151
Rare but seriousTender in mastoid areaFEVER
Mastoiditis
152
AnteriorFrom Keisselbach's plexusCauses:1. Trauma2. Irritation3. Low moisture4. Infection, allergy5. Foreign body
What it the most common nosebleed?
153
From Woodruff's plexus1. Packing2. Surgery3. Embolization
Tx of posterior epistaxis
154
Pale stringy mucus1. Antihistamine (Beclomethasone-spray, or benadryl)2. Steroid3. Avoid exposure4. Allergy testing
Tx of allergic rhinitis
155
Usually follows a URI - usually viral1. Rhinovirus2. Parainfluenza virus3. Influenza
Viruses assoc. w/ sinusitis
156
1. Nasal drainage & congestion2. Facial pain or pressure worse w/ bending over3. HA4. Thick, purulent or discolored nasal discharge5. Cough6. Sneezing7. FeverTooth pain & halitosis may be bacterial
S/S acute sinusitis
157
persistent, recurrent, or chronic sinusitis
When do you get a CT scan w/ sinusitis?
158
If 10 days, facial pain or fever = amoxicillin Symptom Tx
Tx of acute sinusitis
159
1. Fungal in immunocompromised2 . Osteomyelitis3. Cavernous sinus thrombosis4. Orbital cellulitis
Complications of sinusitis
160
For Dx acute pharyngitis1. Fever2. Tonsillar exudates3. NO cough4. Tender anterior cervcal chain LAN 0-1 = low possibility of strep - no abx2 or + = RST but only Tx positive Pts 4 = Tx
Centor Criteria
161
Viral more common - supportive Tx 1. Rhinovirus2. Coronavirus3. Influenza4. Parainfluenza5. Adenovirus 6. Herpes, Coxsackie, CMV, EBV7. S. pyogenes8. Group A Strep
Organisms of pharyngitis
162
1. Sore throat2. Difficulty swallowing3. Fever4. Erthema of tonsils & posterior pharynx5. LAD6. Rhinitis7. Cough
S/S pharyngitis
163
Penicillin/erythromicin
Tx Strep
164
Nov-DecApril-MayIncubation 2-5 days Once on abx for 24 hours, risk of transmission greatly dec.
When is strep most common?
165
1. HIV-related lymphomas2. Nasopharyngeal carcinoma3. Burkitt lymphoma4. Oral hairy leukoplakia5. Posttransplant lymphoproliferative disorder
Secondary disorders from EBV
166
1. Fever, sore throat2. Malaise, anorexia, myalgia 3. LAD4. Transient bilateral upper-lid edema (Hoagland sign)5. Splenomegaly 6. Maculopapular rash uncommon (15%), except in patients receiving ampicillin (90%)7. Exudative pharyngitis, uvular edema, tonsillitis, or gingivitis may occur and soft palatal petechiae may be noted
S/S mono
167
Age 10-35
Who commonly gets mono?
168
1. Nasal polyps2. Asthma3. ASA sensitivity
What is the common triad w/ nasal polyps?
169
1. Group A strep2. Pneumococci3. Staph4. H. influenza
Organisms of epiglottitis
170
Abrupt onset1. High fever2. Difficulty swallowing3. Sore throat4. Drooling5. Sitting in tripod/sniffing position in kids 6. Stridor7. Hoarseness8. Neck tenderness
S/S epiglottitis
171
Thumb sign X-ray, intubationNO tongue depressor IV fluids & abx, steroids Prophylactic rifampin
Dx & Tx epiglottitis
172
These areRED FLAGS for no sore throat1. Fever >39.42. Severe unilateral pain3. Trismus4. Drooling5. Muffled "hot potato" voiceTx - surgical drainage
Peritonsillar abscess S/S & Tx
173
Usually viral - sometimes bacterialChronic1. GERD2. Chronic sinusitis vocal strain3. EtOH4. Smoking
Laryngitis causes
174
Hoarseness, cough maybeVoice rest & Tx underlying cause
Laryngitis S/S & Tx
175
Inflammation of salivary glands Causes - Dehydration, poor oral hygiene S - Painful welling redness, fever, purulent exudateTx - hydration, analgesics, abx
Sialadenitis Causes, S/S & Tx
176
Calculi in salivary gland ductsMore common in Wharton duct Must clamp duct so it doesn't go back into glandShock wave therapy
Sialolithiasis
177
1. Mumps2. EBV3. CMV4. Influenza5. S. aureus6. Mixed oral flora Bilateral firm, erythematous swellingElevated amylase but not lipaseSymptomatic Tx
Parotitis Causes
178
May be caused by HHV6Topical steroids provide Sx relief
Aphthous ulcers
179
1. Spirochetes 2. Fusiform bacilli1. Acute gingival inflammation & necrosis2. Bleeding3. Halitosis4. Fever5. Cervical LADwarm peroxide rinses & penicillin
Necrotizing gingivitis causes S/S & Tx
180
A white lesion that cannot be removed by rubbing the mucosal surface
Leukoplakia
181
Similar to leukoplakia except that it has a definite erythematous component
Erythroplakia
182
Most commonly presents as lacy leukoplakia but may be erosive; definitive diagnosis requires biopsy
Oral Lichen Planus
183
occurs on the lateral border of the tongue and is a common early finding in HIV infection
Hairy leukoplakia
184
SCCEarly lesions appear as leukoplakia or erythroplakia; more advanced lesions will be larger, with invasion into tongue such that a mass lesion is palpable. Ulceration may be present.
Oral Cancer
185
Hand, foot & mouth disease
What is a DDx of oral herpes simplex?
186
aka thrushUsually painful and looks like creamy-white curd-like patches overlying erythematous mucosaCan be scraped off 1. Dentures2. Debilitated & have poor oral hygiene3. Diabetics4. Anemics5. Pts doing chemo or radiation6. corticosteroids or broad-spectrum abxTx = fluconazole
Oral candidiasis Risk Factors & Tx
187
Form of candidiasis seen w/ nutritional deficiencies
What is angular cheilitis & when is it seen?
188
1. New & persistent hoarseness in a smoker2. Persistent throat or ear pain, especially with swallowing3. Neck mass4. Hemoptysis5. Stridor or other symptoms of a compromised airway
S/S laryngeal CA
