1
Q
infection of eyelid
A
blepharitis
2
Q
blepharitis treatment
A
- Hygiene: clean off scales, warm wet washcloth with mild shampoo
- Antibiotic ointment for acute exacerbations (Bacitracin or Erythromycin every 3 hrs)
3
Q
Staphylococcal abscess in the eyelid
A
Hordeolum (Sty)
4
Q
Internal vs external hordeolum/sty
A
Internal = meibomian gland abscess External = sty and usually on the margin of the eyelid
5
Q
Hordeolum (Sty) treatment
A
- Warm compress x 48 hours
- Antibiotic ointment may be necessary (Bacitracin or Erythromycin q3 hrs)
- I&D may be necessary
6
Q
How is sty different than chalazion?
A
Chalazion is usually painless while sty is tender
7
Q
Pathophysiology of Chalazion
A
Cyst of a clogged meibomian gland
8
Q
Chalazion treatment
A
- Steroid injection may be helpful
- Surgical excision definitive tx
9
Q
Entropion vs Ectropion
A
Entropion = eyelid folding inward Ectropion = eyelid folding outward
10
Q
What is a blowout fracture?
A
fracture of orbit
11
Q
How to treat foreign object in eye?
A
- Use sterile wet cotton tipped applicator or hypodermic needle to remove object
- Polymyxin-bacitracin ointment should be applied
- Do not apply an eye patch
- REFER intraophthalmic foreign body. Do not attempt to remove!
12
Q
How can a corneal abrasion be dx’d?
A
h/o trauma
Fluorescein stains abrasion darker than rest of cornea
13
Q
Corneal abrasion treatment
A
Polymyxin-bacitracin ointment
NSAIDS
14
Q
Infections that can cause Corneal Ulcer (Ulcerative Keratitis)?
A
Bacterial keratitis: Staph, Strep, E. coli, Pseudomonas
Viral keratitis: Herpes
Fungal keratitis
15
Q
Labs, Studies and Physical Exam Findings of Ulcerative Keratitis
A
Aqueous flare – protein in the aqueous humor
Small Pupil
Slit lamp is used for diagnosis
Fluorescein stain may help with visualization
Corneal scraping for Gram stain or KOH
16
Q
Inflammation of the nasolacrimal sac, commonly in newborns.
A
Dacryocystitis
17
Q
Typical infection of viral and bacterial conjunctivitis
A
viral: Adenovirus
bacterial: Strep pneumo, Staph Aureus, Haemophilus, Moraxella, Chlamydia (more rare, more severe), Neisseria
18
Q
Treatment of viral and bacterial conjunctivitis
A
viral: saline flush BID, hot compress
bacterial: fluoroquinolone, Polymyxin B drops
19
Q
Orbital cellulitis is usually secondary to a ______ or a _______ infection.
A
chronic sinus
dental
20
Q
Orbital cellulitis treatment
A
Patients will usually be admitted for IV antibiotic therapy to cover Staph and Strep (Vancomycin, clindamycin, or doxycylcine)
Surgical intervention may be necessary for abscess
21
Q
An opacification of the lens obstructing the flow of light to the retina
A
Cataracts
22
Q
Symptoms of acute angle glaucoma
A
* Halos around lights Pain N/V Blurred vision Photophobia
23
Q
What changes in vision seen in chronic (open angle) glaucoma?
A
gradual peripheral vision loss
24
Q
Pathophysiology of glaucoma
A
Increased intraocular pressure leading to damage to optic nerve. Aqueous humor is constantly being produced within the eye and constantly draining out through an area of eye called the angle.
25
open vs closed angle glaucoma
Open angle glaucoma which is a the chronic form
| Closed angle glaucoma which is an acute clogging of the drainage of aqueous humor
26
PE findings that indicate glaucoma
Tonometry: IOP > 21
Pupils unreactive to light
Visual field test: decreased peripheral vision
Fundoscopy: vessels bending over edge of disc, cup:disc ratio >0.5 (increasing cup size)
27
Glaucoma treatment
Meds:
- Prostaglandins to promote drainage
- Beta Blockers to decrease aqueous humor production
- Alpha Adrenergic agonists to decrease aqueous humor production and promote drainage
Surgical correction
Laser trabeculoplasty – open the clogged channels
Filtering trabeculectomy – removing a piece of the sclera to allow drainage
28
Optic DISC swelling secondary to intracranial pressure
papilledema
29
Blood in the anterior chamber of eye
hyphema
30
Signs of papilledema on PE
Fundoscopy: venous engorgement, hemorrhages, blurring of optic disc margins
Blurred vision, enlarged blind spot
31
hyphema treatment
```
SUPPORTIVE
Blood reabsorbed in a few days
Sleep with head of bed at 45 degrees
Recommend patient not read or watch television
Eye patch
```
32
Pterygium
A benign wedge shaped growth of conjunctiva which grows from the nasal side to over the cornea
33
Pinguecula
A yellowish deposit on the conjunctiva which does not grow over the cornea
34
65 yo patient comes in with loss of central vision (scotoma) and wavy vision (metamorphopsia)
Macular Degeneration
35
Hallmark finding on PE of macula in macular degeneration
Drusen (yellow deposits of debris)
36
2 types of age-related macular degeneration
dry (atrophy of retina) and wet (neovascular; only about 10%)
37
macular degeneration treatment
```
Laser photocoagulation
Dietary supplements (Vit A, C, E B6, B12, zinc copper, etc.)
```
Wet ARMD: intravitreal injection of vascular endothelial growth factor inhibitors
38
"curtain coming down" vision changes
retinal detachment
39
cotton wool spots on fundoscopic exam
DM retinopathy
40
Cherry red spot Central
| boxcarring of arterioles
Retinal artery occlusion
41
Vision pathology with curtain descends and then goes back up?
Amaurosis fugax
42
Involuntary eye movement - up and down, side to side, rotary
Nystagmus
43
Strabismus
cross-eyed
44
Amblyopia
A loss of vision in an otherwise normal eye.
| Most often this is secondary to a strabismu
45
How to describe direction of strabismus? (up, down, in, out)
Hypotropia – one eye goes down
Hypertropia – one eye goes up
Exotropia – one eye out
Esotropia – one eye goes in
46
PE tests to do for suspected strabismus
Cover/uncover test (look for movement)
| Hirschberg corneal reflex test (light reflection should be in same place on each eye)
47
Strabismus treatment
Children – the goal is to avoid amblyopia: glasses, eye patch, surgery
Adults: glasses, surgery
48
I came in to see my physician assistant today because of…
Acute painful vision loss or blurred vision
Loss of color vision
Pain with eye movement
optic neuritis
49
Causes of optic neuritis
Autoimmune – MS is #1 cause, scleroderma, lupus
Fungal infection
Bacterial infection – lyme, TB, syphilis
Viral infection – herpes zoster, mumps, rubella
Vitamin B deficiency
50
PE findings of retinal detachment
Retina may appear to be hanging
| Asymmetric red reflex
51
Treatment of retinal detachment
REFER for surgery
52
Causes of retinopathy
DM, HTN, premature birth, radiation damage (acute pain), Sickle Cell
53
Fundoscopy findings of diabetic retinopathy
Preproliferative
- hemorrhages
- exudates
- cotton wool spots
Proliferative
- neovascularization
- edema
54
Fundoscopy findings of HTN retinopathy
Arteriolar narrowing:
- copper wire
- silver wire sclerosis
- AV nicking
55
I came in to see my physician assistant today because of…
ACUTE vision loss
Partial
Complete
NO PAIN
Retinal Artery Occlusion
56
Fundal exam of Retinal Artery Occlusion
Boxcarring – narrowing of arterioles
Cherry red spot – its actually that the rest of the retina is pale
Optic atrophy
Pale disc
57
Retinal Artery Occlusion treatment
EMERGENCY
Referral
Intermittent pressure
tPA
58
Pathology with "blood and thunder fundus", dilated veins, exudates on fundus exam?
Central Vein Occlusion
59
I came in to see my physician assistant today because of…
Transient ACUTE vision loss
Curtain descends and then goes back up
Unilateral
Amaurosis Fugax
60
Amaurosis Fugax treatment
Treat underlying cause of ischemia
Heparin
* Think TIA of eyeball
61
Amsler grid
used to diagnose wavy vision in macular degeneration
62
Acute otitis media vs chronic organisms
acute: strep pneumo, strep pyogenes, H-flu
chronic: staph aureus, pseudomonas, proteus
63
PE findings of otitis media
- TM: erythema, decreased mobility with a pneumatic otoscope
| - Tenderness over mastoid
64
acute otitis media treatment
Amoxicillin x 10 days
| Erythromycin x 10 days
65
DDX of ear discharge
otitis externa, chronic otitis media, mastoiditis, perforated eardrum, cholesteatoma
66
Causes of chronic otitis media
Recurrent acute otitis media
| Rupture of tympanic membrane
67
Abx for chronic otitis media exacerbations
Cipro
68
Etiology of otitis externa
Trauma
Excessive moisture
Pseudomonas
Proteus
69
Pain with movement of the auricle
Tympanic membrane moves with a pneumatic otoscope
Eardrum is intact
otitis externa
70
otitis externa management
Behavior: don’t put things in ear canal, careful use of earplugs, drying agent after swimming may be helpful (50% alcohol or white vinegar)
Abx: Fluoroquinolones or Aminoglycosides
71
What is malignant otitis externa and how is it treated?
complication of otitis externa with osteomyelitis of the temporal bone
tx: IV cipro
72
I came in to see my physician assistant because of…
```
Redness and swelling behind the ear
High fever
Ear pain
Drainage from the ear
Loss of hearing
```
mastoiditis
73
Mastoiditis treatment
Prevention! treat ear infections with abx
IV abx – cefazolin is broad spectrum abx of choice
Surgery
- myringotomy (whole to drain the middle ear)
- removal of the mastoid may be necessary
74
I came in to see my physician assistant because of…
Sudden unilateral hearing loss
Episodic or continuous vertigo
Tinnitus
Acoustic Neuroma (Vestibular Schwannoma)
75
Acoustic neuroma is a slow growing benign tumor located where?
vestibulocochlear nerve, CN VIII
76
3 types of hearing loss
Conductive – sound waves can't get to ear structure
Sensory – damage to cochlea and usually related to loss of hair cells
Neural hearing loss – damage to vestibulocochlear nerve
77
Common causes of conductive hearing loss
Cerumen impaction
| Osteosclerosis
78
Common causes of sensory hearing loss
Age related hearing loss due to loss of the hair cells
Head trauma
Significant noise exposure
79
Common causes of neural hearing loss
Acoustic neuroma
| Multiple sclerosis
80
How are Weber and Rinne tests done?
Weber test – Tuning fork placed against the forehead equidistant from both ears. A patient without hearing loss will hear the tuning fork equally in both ears.
Rinne test – Place tuning fork on mastoid process and then remove it and place it next to the ear. Normal hearing or a positive test will be louder with air conduction rather than bone conduction
81
Conductive hearing loss findings on Weber and Rinne test
Weber test – Patient will report the sound louder in the affected ear.
Rinne test – The sound will be louder on the mastoid with bone conduction. This is referred to as a negative Rinne’s test
82
Sensory hearing loss findings on Weber and Rinne test
Weber test – Louder in unaffected ear
Rinne test – The sound will be louder off the mastoid with air conduction. This is referred to as a positive Rinne’s test
83
High pitched ringing in the ears is _______.
tinnitis
84
DDX of vertigo and their duration
BPPV (under several minutes)
Meniere’s disease (20 min to several hours)
Ototoxic drugs
Labyrinthitis
85
Meds for vertigo
Meclizine 1st line (anticholinergic)
Diazepam for acute phase
Anti-histamines
Compazine or zofran for nausea
86
I came in to see my physician assistant because of…
```
Acute onset of vertigo
Involuntary eye movements
Unilateral hearing loss
nausea and vomiting
Tinnitus
```
Labyrinthitis
87
Predisposing factors to labyrinthitis
```
Fatigue
Alcohol consumption
Allergies
Upper respiratory infection
Smoking
Stress
Drugs
```
88
I came in to see my physician assistant because of…
Episodic vertigo
Low frequency hearing loss
Tinnitus
Unilateral ear pressure
Meniere's Disease
89
Inflammation of the inner ear
Labyrinthitis
90
Meniere's disease treatment
Low salt diet
Diuretics
Intratympanic steroid injection
Labyrinthectomy or ablation
91
I came in to see my physician assistant because of…
Conductive hearing loss
Tinnitus
Earache
Discharge of fluids
perforated tympanic membrane
92
Treatment of perforated eardrum
Be careful of getting water in ear
Most heal within weeks
Surgery if needed (Tympanoplasty)
93
OTC meds that may help with barotrauma
Decongestants
94
I came in to see my physician assistant because of…
Fullness in the ears
Decreased hearing
Popping or crackling with yawning or swallowing
Eustachian tube dysfunction - tubes narrow
95
Narrow eustachian tube PE findings
- Retraction of TM
| - Decreased TM motility with pneumatic otoscope
96
A cyst in the middle ear which is filled with keratin
cholesteatoma
97
PE findings of cholesteatoma
Unilateral hearing loss
Ear discharge
Ear canal filled with debris
98
Cholesteatoma treatment
Surgical removal of the cyst
99
Ways to evaluate patient with suspected sinus infection?
Transillumination
Tender over sinuses
Nasal endoscopy may be helpful with chronic sinusitis
CT may be helpful with chronic sinusitis
100
Sinusitis treatment
Supportive: nasal irrigation with saline, steam, increased fluids, humidifier, Tylenol or ibuprofen, decongestants
Antibiotics after 10 days
Amoxicillin
Surgical correction
101
Allergic rhinitis treatment
```
Prevention! Avoid triggers
Best choice – intranasal corticosteroids (Beclomethasone or Flunisolide BID)
Antihistamines
Decongestants
Desensitization
```
102
Epistaxis treatment
Direct pressure – pinch the bridge of the nose for 15 minutes
Have patient lean forward to avoid swallowing blood leading to nausea and vomiting
Topical vasoconstrictor ie cocaine or oxymetazoline
If you can visualize the source silver nitrate may be used to cauterize the vessels
Packing for 24 hrs if necessary
Pneumatic tamponade
Surgical correction
103
What are 2 types of nosebleeds?
Anterior nosebleed - most common, originates from Kiesselbach’s plexus
Posterior nosebleed - less common, much more difficult to treat
104
Nasal polyps commonly exist with what other conditions?
allergic rhinitis and asthma
105
Nasal polyp treatment
Topical nasal steroid for 1-3 months
Oral steroid may be helpful
Surgical removal
106
Causes of acute pharyngitis
viral: EBV (mono), Adenovirus, cold viruses, Herpes
bacterial: **strep pneumo, Neisseria gonnorhea, Mycoplasma, Chlamydia
107
Acute pharyngitis treatment
MOST VIRAL
Symptomatic: NSAIDS or tylenol, increase fluids
abx if strep throat
Penicillin 500 mg BID
Amoxicillin 500 mg TID
108
hot potato voice =
peritonsillar abscess
109
Most common etiology of epiglottitis
Haemophilus influenzae
110
signs/sx's of epiglottitis
```
High fever
Difficulty swallowing
Drooling
Stridor
Cyanosis
```
111
XR hallmark of epiglottitis
Thumbprint sign
112
Treatment of epiglottitis
ABC's; be prepared for intubation
| IV abx may be necessary: Cephalosporins (ceftriaxone) or racemic epinephrine
113
Laryngitis treatment
```
Rest voice
Humidifier
Fluids
Treat for GERD if appropriate
Antibiotics if appropriate
```
114
Who is likely to get oral candidas?
```
Newborns
Uncontrolled Diabetes
HIV/AIDS
Chemotherpy
Side effect of inhaled steroids
Side effect of antibiotics
Dentures or poor hygiene
```
115
Thrush treatment
Address underlying cause
Fluconazole 100mg x 7 days for non-immunocompromised patients
½ hydrogen peroxide mouth rinse
116
thrush vs oral leukoplakia
thrush: patches painful/bleed when scraped off
| oral leukoplakia: patches cannot be scraped off
117
oral leukoplakia causes
HPV, smoking, alcohol
118
An inflammation of one or both salivary glands
parotitis
119
Infections that cause parotitis
```
Viral
- Historically, #1 cause was Mumps
- Parainfluenza and EBV now most common
- HIV
Bacterial
- Staph Aureus
```
120
aphthous ulcers commonly known as _______.
Canker sores
121
Treatment of aphthous ulcers
Self-limiting
½ hydrogen peroxide solution
Corticosteroids
122
Most common bugs that cause acute OM, chronic OM, and OE
acute OM: strep
chronic OM: Pseudo, H flu, staph, proteus
OE: E. coli, Aspergillus
123
Cause of amaurosis fagut
carotid artery disease
124
How to treat cauliflower ear?
evacuation + abx + splinting
125
Risk of leaving cauliflower ear untreated?
cartilage necrosis
126
When to refer child for poor vision?
less than 20/40 or +2 line difference in eyes
127
ototoxic meds
furosemide (Lasix), gentamycin, aspirin
128
What treatment is contraindicated if herpes simplex keratitis suspected?
ophthalmic corticosteroids
129
eye with dendritic/branching ulcers =
HSV keratitis
130
Painless vision loss with optic DISC edema?
retinal vein occlusion
PANCE review
flashcards
Decks in class (18)
# Cards
