ENOT - 7% Flashcards

Question

**Acute Angle Closure** Glaucoma

Answer 1

Women, China, eskimo Increased IOP w/ optic n damage - A**queous humor blockage t**hrough trabecular meshwork **Canal of Schlemm** - increasing pressure in anterior chamber Sxs: * **Opthalmic EMERGENCY** * Triad * Injected conjunctiva * Fixed dilated pupil * Steamy cornea * painful eye/loss of vision, tearing, N/V, diaphoresis * **IOP \>50** Tx: * REFER to ophthal * start MEDS * IV Carbonic anhydrase inhibitor (acetazolamide) * topical B blocker - timolol * osmotic diuresis * **laser/surgical iridotomy** * **mydriatics - dilate pupils - do not administered**

Answer 2

Chronic, asymptomatic, insidious; older black myopic (nearsighted) Sxs: * Increased IPO * incr cup to disc ratio * asymptomatic until late - **loss of peripheral vision** = main symptoms - TUNNEL vision Dx: * elevated IOP w/o optic disc damage or * optic n damage w/o increased IOP Tx * Refer to opthalmologist * **Prostaglandin analogs - latanoprost - 1st line** * **B blocker timolol** * **carbonic anhydrase Inhibitor - Acetazolamide** to decr production * Laser or surgical treatment * Mydriatics c/i - atropine\*

Answer 3

Blunt or penetrating trauma (face punch, or acid) = vitreous and/or aqueous humour drain through site of rupture (**eye deflate)** full thickness injury to cornea, sclera or both Sxs * Decreased visual acuity * afferent pupillary defect * eccentric or teadrop pupil * Incr anterior chamber * low intraoccular pressure Dx * CT scan non contrast Tx * **Ophthal emergency - Surgery!** * Begin IV Ancef or FQ * **fox/rigid eye shield** over affected eye, avoid pressure examinations * Sedation, analgesics, antiemetic * **keep head elevated 30-40 degrees**

Answer 4

HSV1 - above the waist; HSV 2 - below the waist Sxs * Primary infx - fever, irritability * Severe pain/burning of oral mucosa * Vesicular and ulcerative lesion on lips, gingiva and tongue * lasts for 2-3 weeks, viral shedding continue for several more weeks Dx * clinical, confirm with culture * PCR, direct immunofluorescence Tx * First episode - **PO Acyclovir** 400 mg TID x 7-10d, if started within 72 hrs of onset * Recurrent episode - **Acyclovir** 400 mg TID x 5, Valacyclovir 1g PO BID x 1d or Famciclovir 1g PO BID x 1d * Suppressive * Acyclovir 400 TID * Famciclovir 500 mg BID * Valacyclovir 1g BID

Answer 5

Stye; infection of glands of the eyelid - **meibomian gland** Sxs * painful, warm/hot, swollen red lum on eyelid * Staph abscess Dx - clinical Tx * **warm compress** and topical antibiotics * I &D * Systemic abx if + cellulitis - **dicloxacillin or erythromycin 250 mg PO QID**

Answer 6

Trauma causing blood acc in **anterior chamber of eye** (btwn cornea and iris) Dx: * orbital CT + ophthal consult Tx * blood reabsorbed over days/wks * ele head 30d at night * NSAID c/i * patch/shield

Answer 7

Inflammation of the cornea; Eti - Infectious keratitis caused by fungi, parasites, or * Virus - HSV - **dendritic ulcer** * Bacteria - **pseudomonas -** improper contact lens wear Sxs * pain, impaired eyesight * photophobia, red eye * foreign body sensation Dx * Fluorescein staining - dendritic lesion for virus * bacterial keratitis - **corneal opacity or infiltrate** - round white spot Tx * topical antivirals for herpetic keratitis - **idoxuridine, vidarabine, trifluridine** * bacterial keratitis = **urgent ophthal ref + topical bactericidal abx**

Answer 8

Preceded by viral respiratory illness Sxs: * Acute Severe vertigo, **hearing loss (days to a week)** * vertigo can resolve but not hearing loss (Sensorineural) * Tinnitius * Imbalance Dx - clinical, no neuro deficit * Vestibular Sx - peripheral vertigo w/ **vertical nystagmus (away from affected side)** Tx - Vestibular suppresants - **diazepam or** **meclizine (anticholinergic)** **Resolves in 3-6 wks**

Answer 9

Inflammation of Larynx - usu Viral following URI or change in voice * Consider Squamous Cell Caricinoma if hoarseness \> 2wks + hx of ETOH and smoking * consider GERD if no viral eti * M. Cat or H. flu Sxs * no pain or sore throat Dx - clinical, laryngoscopy if sx \> 3wk * Deviation of soft palate -\> abscess Tx * Symptomatic - cough suppressant, voice rest, steam inhalant * Viral - self limited, oral or IM steroids for vocal performers * Bacterial - erythromycin, cefuroxime, or augmentin

Answer 10

Benign and asymptomatic condition but can progress to **squamous cell carcinoma;** RF - **smoking**, etoh, HPV infx Sxs * White patches of oral mucosa - can't be wiped off Dx - biopsy and surgical excision Tx * surgical excision * laser ablation * cryosurgery **Oral hairy Leukoplakia** - a/w EBV in HIV pts, lateral tongue, not to progress to SCC * Tx w/ Zidovudine, acyclovir, etc.

Answer 11

Gradual loss of **central vision; non reversible** advanced form of dry age-related macular degeneration Dry - Drusen - daily amsler grid * PO antioxidants, carotenids * **rapid and severe vision loss** Wet - Neovasculization * new blood vessel growth beneath retina (neovascularization) leak blood and fluid -\> damage retinal cells * VEGF Inhibitors - **bevacizumab** * photodynamic therapy * Zinc and antioxidant vitamin

Answer 12

Complication of AOM - Suppurative infx of mastoid air cells; MC Down Syndrome MC S. pneumo, H. influ, M. cat, S. aureus, S. pyogenes Sxs: * Fever * otalgia * pain * Erythema posterior to ear and **fwd displacement of external ear** Dx * Clinical * **CT scan temporal bone w/ contrast** for complicated - toxic appearing Tx * Simple - **PO or IV Ceftriaxone/Vanco** * ENT referral in more complicated * Drainage of middle ear fluid

Answer 13

Sxs * **Episodic vertigo** - 20 mins to 24 hrs * **Sensorineural hearing loss** - fluctuating + varying in severity * **Tinnitus** - in affected ear and fullness * **aural fullness** Dx - MRI of head to r/o other eti Tx - Na, caffeine, nicotine, and etoh restriction Benzo, antihistamines, antiemetics for acute symptoms

Answer 14

Dx * **Caloric reflex** - ear canal irrigated with warm or cold waterl stimulate horizontal semicircular * eye movement then recorded by **electronystagmography (ENG**) [external electrodes) or **videonystagmograph** (VNG) [small cameras built into head masks * Optokinetic drum, or electrooculography - assess pt eye movements Tx * Congenital - untreatable * Baclofen - stop periodic alt nystagmus * gabapentin * Tenotomy * Acupuncture * PT * Contacts and low vision rehab

Answer 15

Involuntary, rapid, repetitive movement of eyes Two types 1. **Congenital nystagmus** - infancy btwn 6 wks and 3 mos of age * sensory nystagmus + poor vision from cataracts, strabismus, optic nerve hypoplasia, will develop less clear vision 2. **Acquired nystagmus** - later in life * a/w med conditions, adults may see world as shaky Sxs * Down/Up beat - CNS dysfunction * Vestibular (horizontal) - labyrinth or vestiular n dysfx * Gaze evoked - MC and often benign

Answer 16

Acute inflammation and demyelination of optic n. leading to * acute **monocular vision loss**/blurriness * loss of color vision * **pain on EOM** * **a/w Multiple Sclerosis** - MCC and initial presenting Sxs * eti - ethambutol (TB drug) Dx * fundoscopy - inflammation of optic disc, confirmed by MRI Tx * Corticosteroids - methylpredinsolone IV * r/o MS * Recovery in 2-3 wks

Answer 17

Hx of blunt trauma, **muscle entrapment**, eyelid swelling Sxs * vertical gaze restriction (inferior rectus muscle) * **pain with EOM,** double vision - **diplopia** * **ecchymosis\*** * Anesthesia or paresthesia in gums, upper lips and cheek = **infraorbital n damage** Dx - CT scan **Tx - opthalmic referral = surgery** abx for infx

Answer 18

Infx of orbital muscles and fat behind eye MC in children 7-12yo Sxs: * **decreased EOM** * pain w/ mvmt of eye * Proptosis * Signs of infx * a/w with sinusitis dx - **CT scans of orbits** - confirmatory tx - hospitalization with IV broad spectrum abx - **Vanco** **EMERGENCY** **Surgery**

Answer 19

**Swimmer's ear** infx of auditory canal 2/2 trauma or consistently moist env MCC - Pseudomonas (green dc), S aureus malignant OE in DM - MC aspergillus -fluffy white black dots Sxs: * Ear pain w/ tragus or auricle movement * purulent cheesy white dc * erythematous canal Dx * clinical * tuning form - bone conduction \> air conduction Tx * **Ofloxacin 0.3% solution** 10 drops QD x 7d * if perforated or chance of - ciprofloxacin 0.3% and dexamethasone 0.1% 4 drops BID x 7 days * **Clotrimazole for Aspergillus**

Answer 20

Optic disc swelling d/t **increased ICP** - bilateral & occurs over period of hrs to wks ## Footnote Eti - **malignant HTN,** brain tumor/abscess, meningitis, pseudotumor cerebri, encephalitis Sxs - asymptomatic or present with transient visual alterations (seconds) Dx - neuroimaging to r/o lesions, CSF analysis Tx underlying cause EMERGENT Meds

Answer 21

Inflammation of parotid glands; Eti * DeH2O, eldery post op * Autoimmune - Sjogren's and Sarcoidosis * Infectious * Bacterial - S aureus * Viral - **Mumps** - paramyxovirus (no immunization) * Fever, HA, mylagia, fatigue, anorexia, =\> parotitis * Self limited * Look for associated **orchitis** Sxs * Fever, chills * Periauricular, mandibular pain, and swelling * trismus, dysphagia, purulent drainage Dx * Clinical * Sample purulent exudate * US and CT for surrounding tissue assessment * Viral - IgM against mumps Tx * Self limited with Hydration and rest * vaccination * contagious 9d after onset of parotid swelling

Answer 22

Penetration of infx through tonsillar capsule-\> tonsillitis -\> cellulitis -\> abscess formation **MC GABHS\***, S aureus * Hot potato/muffled voice * medial deviation of soft palate * Uvula deviation to contralat side * Dysphagia * trismus Dx - CT to diff btwn cellulitis and abscess Tx * I&D * IV abx - **Amoxicillin**, Amox-Sulbactam (Unasyn), Clinda * Tonsillectomy

Answer 23

Usu GAS **Centor Criteria** - if +3/4, get rapid strep test * Fever \> 100.4 or 38C * Absence of cough * Pharyntonsillar Exudate * Tender anterior cervical lymphadenopathy Dx - throat culture - gold std Tx * Symptomatic - fluids, NSAIDs, saline gargles, CS * Bacterial - Penicillin or Amoxicillin

Answer 24

Less likely exudative (CMV, EBV, adenovirus) Mononucleosis - EBV, rash w/ penicillin Dx * atypical lymphocytes * + **Heterophile agglutination tests (monospot)** * Splenomegaly - splenic rupture * non contact sports - 3 wks after sxs onset * contact sport - 4 wks Tx supportive

Answer 25

a/w increased sun exposure and climate where there is wind, sand, and dust Sxs * elevated, superficial, fleshy, triangular-shaped "growing" **fibrovascular mass** * mc in inner corner/nasal side of eye Dx - clinical Tx * Observation - artificial tears * Surgically remove only if **central vision** affected

Answer 26

Central **retinal artery** occlusion eti - a/w Afib, carotid dz, or giant cell arteritis _Sxs:_ * Sudden, painless, **unilat,** and severe vision loss - **Amaurosis fugax** _Dx:_ * Fundoscopy - **perifoveal atrophy - Cherry red spots on pale macula** * R/o carotid artery stenosis w/ carotid US _Tx:_ * EMERGENT OPTHAL consult - immediate tx if occlusion \<24 hrs * Reduce IOP w/ ocular hypotensive drugs - **topical timolol 0.5% & acetazolamide 500 mg IV or PO** * Intermittent digital massage over closed eyelid * irreversible damage to retina if \> 90 mins

Answer 27

Separation of retina from pigmented epithelial layer; usu from **choroid, lens implant** Sxs: * acute onset **painless blurred or blackened vision** * monoccular blindness * **vertical curtain coming down - vision does not return** * Floaters and flashes Dx: * Fundoscopic - asymmetric red reflex * IOP is decreased Tx * **Stay supine**- lying face upward - head turned towards detached retina * **Pneumatic retinopexy - air bubbles in vitreous**

Answer 28

**Blood and thunder fundus** MC \>50yo, HTN, **DM\*\*\***, primary open angle glaucoma, HLD, hyperviscosity (polycythemia and leukemia) Occurs 2/2 to thrombotic event Sxs: * Sudden, **painless**, **unilat** vision loss * blurred vision or complete loss of vision Dx: * Fundoscopy - **retinal hemorrhages in all quadrants** * optic disc swelling * **blood and thunder retina** Tx: * vision resolves with time * tx neovascularization w. intravitreal injections of **VEGF inhibitors**

Answer 29

Eti - fam hx of atopy, IgE mediated mast cell histamine release Sxs: * clear nasal dc * rhinorrhea * itchy, watery eyes * allergic shiners - blue discoloration under eye * Transverse nasal crease Tx * Avoid allergens * nasal CS - beclomethasone, mometasone * Intranasal decongestants dont use more than 3-5 days --\> causes **rhinitis medicamentosa**

Answer 30

Inflammation of sclera; usu from **systemic immunologic dz (RA)** Sxs * **bilateral** Significant eye pain * worsen at night * radiates to face and periorbital region Dx * PE - ocular redness and pain on palpation of eyeball * can cause visual impairment * Labs for syst immunologic dz - ANCAs, ANA, CRP, ESR, Lyme, RA, ACE\< RPR Tx * Prompt eval to opth * Topical vs syst CS

Answer 31

bacterial infection of salivary **(parotid or submandibular**) gland; caused by sialolithiasis (obstructing stone) **MCC S aureus,** mumps Sxs * Swelling, pain, redness, tenderness * a/w with Sjogren syndrome Dx - clinical, CT or MRI can help Tx - * **IV or PO Nafcillin/dicloxaciilin 250 mg QID, 1st gen ceph or Clinda** * dilation of salivary duct; sialogogues for incr salivary flow

Answer 32

Ca salt stones obstructing salivary glands; MC in **Wharton's duct** (submandibular gland) and **Stenson's (parotid)** Sxs * post prandial salivary gland pain and swelling Dx - clinical , non-contrast CT Tx * Cephalosporin * dilation of salivary gland duct * Incr PO hydration + sialogogues

Answer 33

Viral \> bacterial - adenovirus MC Eti: * Mononucleosis * EBV, fever, sore throat, lymphadenopathy * atypical lymphocytes * + Heterophile agglutination test/ monospot * Gonorrhea pharyngitis for recent sexual encounters or **non resolving pharyngitis** * Fungal in pts **Inhaled steroids** **GABHS** * Fever, tender anterior cervical adenopathy, no cough, pharyngo tonsillar exudate * 3/4 Centor - rapid strep test, only 1/4 Centor - not likely strep Dx * Rapid strep - if negative * Throat culture is confirmatory Tx * IM PCN if pt incompliance * PO PCN/ Cefuroxime * Erythromycin if pcn allergy

Answer 34

"Lazy eye" Ocular misalignment; can be intermittent or constant Sxs * Exotropia - out turning eyes * Esotropia - in turning eyes Dx * Cover/uncover test * asymmetrical corneal light reflex tx * **Glasses\***, occlusion therapy * Eye exercises - ortho exercises

Answer 35

ETi - infx (AOM) or trauma (barotrauma, direct impact, or explosions) Sxs: * pain * otorrhea * hearing loss/reduction Tx * Resolves on own, surgery if persistent hearing loss * keep dry -\> water 2ry to infx * Floxin drops * Surgery if \> 2mos

Answer 36

Sensation of Movement in the absence of movement -Spinning Sensorineural HL **_Peripheral_ -** Inner ear --\> labyrinthitis, BPPV, Meniere, vestibular neuritis, head injury -\> sudden onset, n/v, tinnitus, hearing loss, **horizontal nystagmus** **_Central_** - brainstem vascular dz, AVM, tumor, MS -\> gradual onset/**Rotary +** **vertical nystagmus**, no auditory symptoms (vertigo+symptom = vertebrobasilar insufficiency ) **_BBPV_ -** positional, **no hearing loss**, tinnitus, ataxia * dx - Dix Hallpike, tx with Epley's manuveur **Vestibular Neuritis:** not positional, no hearing loss/tinnitus **Labyrinthitis:** acute, self-resolving episode; vertigo, hearing loss, tinnitus * tx - meclizine + steroids **Meniere's Disease:** chronic, relapsing, remitting; vertigo + **hearing loss** + tinnitus * tx - diuretics, salt restriction, CN VIII ablation for severe cases **Perilymph fistula:** a history of trauma; vertigo from trauma * tx - fix damage surgically **Acoustic neuroma:** ataxia, neurofibromatosis type II, MRI findings. Hearing loss, tinnitus, and ataxia; * tx - surgery

Answer 37

Schwann cell derived tumor - from **CN VIII** (growth as a fetus) Sxs - unilateral SNHL + tinnitus Dx - MRI is gold Tx - surgery, radiation for older ppl

ENOT - 7% Flashcards

(61 cards)