Term
|
Definition
|
|
Term
| insufflation and tympanography help in dx of.... |
|
Definition
|
|
Term
|
Definition
| surgical puncture of the tympanic membrane for removal of fluid from the middle ear. |
|
|
Term
|
Definition
| diffuse inflammation of ear canal skin. |
|
|
Term
| pathogen of OE in immunocmpromised pts (such as with diabetes.) What is a name for this type of inf? |
|
Definition
- pseudomonas aeruginosa
- malignant external otitis |
|
|
Term
| What common pathogen would not cause purulent drainage? |
|
Definition
|
|
Term
| general antibiotic choice against pseudomonas aeruginosa |
|
Definition
| Two-drug combination therapy, such as an antipseudomonal beta-lactam with an aminoglycoside. |
|
|
Term
Drug class which can cause irreversible ototoxicity?
(suffix of most in this class) |
|
Definition
aminoglycosides
(-micin or -mycin) |
|
|
Term
pathogens associated with sinusitis
(drug of choice for sinusitis?) |
|
Definition
- streptococcus
- Haemophilus influenza
- Moraxella catarrhalis
(amoxicillin) |
|
|
Term
| what penicillin does not have good sinus penetration? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| sore throat, odynophagia, muffled voice, soft palate deviation, peritonsillar fold. |
|
Definition
|
|
Term
- initial tx of peritonsillar abscess
- followed by... |
|
Definition
- incision and drainage or aspiration.
- oral abx tx (PCN or E-mycin for PCN allergic) |
|
|
Term
| Common Organisms Associated with Peritonsillar Abscess |
|
Definition
Aerobic
- Streptococcus pyogenes
- Staphylococcus aureus
- Haemophilus influenzae
- Neisseria species
Anaerobic
- Fusobacterium
- Peptostreptococcus
- Prevotella
- Bacteroides |
|
|
Term
| nasal congestion, HA, clear watery (non-purulent) nasal discharge, sneezing, afebrile, edematous nasal mucosa. |
|
Definition
|
|
Term
| cheek pain and pressure, discolored nasal discharge. |
|
Definition
|
|
Term
| clear nasal drainage triggered by cold and emotions. |
|
Definition
|
|
Term
Minor infections at the opening of the nose may result from folliculitis.
(pathogen & tx?) |
|
Definition
- nasal vestibulitis
- Staphylococcus
- Bacitracin ointment |
|
|
Term
| 5 yo, red edematous eyelids, purulent nasal d/c, fever, lethargy, restricted extraocular motion. |
|
Definition
| orbital cellulitis or abscess. |
|
|
Term
| imaging for orbital cellulitis or abscess. |
|
Definition
|
|
Term
| abx route for orbital cellulitis or abscess. |
|
Definition
|
|
Term
| abx for orbital cellulitis or abscess. |
|
Definition
- ceftriaxone (rochephin) IV.
- broad spectrum 3rd gen Cephalosporin |
|
|
Term
abx class contraindicated in peds
(suffix) |
|
Definition
quinolones
(-floxacin, -quin) |
|
|
Term
- abx of choice for streptococcal pharyngitis
- alternative abx? |
|
Definition
- PCN is first line
- erythromycin is alternative for PCN allergic. |
|
|
Term
| weak abx against streptococcal species. |
|
Definition
sulfamethoxazole-trimethoprim
(inhibits < 50%) |
|
|
Term
| abx with potential cross-reactivity in PCN allergic pts |
|
Definition
|
|
Term
| routine hearing screen for a 4 yo |
|
Definition
|
|
Term
|
Definition
Play audiometry
These children are conditioned to respond to an auditory stimulus through play activities. |
|
|
Term
| fever, postauricular pain, erythema, forward displacement of the pinna, hx OM |
|
Definition
|
|
Term
| pain with auricular movement |
|
Definition
|
|
Term
| hot, edematous, and erythematous external ear w/o drainage |
|
Definition
|
|
Term
| most common complication of inadequately treated OM |
|
Definition
|
|
Term
Weber's test
(describe and explain results) |
|
Definition
- for differentiating between conduction deafness and sensorineural deafness.
- the stem of a vibrating tuning fork is placed on the vertex or midline of the forehead
- if the sound is heard best in the affected ear, the deafness is probably of the conductive type
- if heard best in the normal ear, it is probably of the sensorineural type. |
|
|
Term
Rinne test
(describe and explain results) |
|
Definition
- Tuning forks of 256, 512, and 1024 Hz placed on the mastoid process until it is no longer heard at one of these positions.
- When air conduction is greater than bone conduction (positive Rinne test), it indicates normal hearing or sensorineural hearing loss.
- When bone conduction is greater than air conduction (negative Rinne test), it indicates conductive hearing loss. |
|
|
Term
4 yo, acute fever, erythematous TM.
(suspect? confirmed by?) |
|
Definition
- OM
- confirmed by pneumatic otoscopty/insufflation to inspect TM mobility. |
|
|
Term
| Fullness in the ear, fever, malaise, hearing loss in the affected ear, immobile TM. |
|
Definition
|
|
Term
| What is postural drainage and when is it no longer recommended? |
|
Definition
| Not recommended for foreign body airway obstruction because it may cause the FB to become dislodged and obstruct a central airway.[image] |
|
|
Term
| dyspnea, inspiratory stridor and unilateral wheezing. |
|
Definition
| airway obstruction of a foreign body. |
|
|
Term
| how do you remove an airway obstruction from a foreign body? |
|
Definition
|
|
Term
| hearing loss, episodic vertigo lasting several hours, usually accompanied by tinnitus. |
|
Definition
|
|
Term
Meniere's disease
(describe) |
|
Definition
| Meniere's disease involves a swelling of part of the (endolymphatic sac). The endolymphic sac controls the filtration and excretion of the fluid in the semicircular canals.
[image] |
|
|
Term
Caloric stimulation
(What is it and why do I care?) |
|
Definition
- A test which uses differences in temperature to diagnose ear nerve damage.
- Positive = meniere's dz
- This test stimulates the inner ear and nearby nerves by delivering cold and warm water to the ear canal at different times.
- cold water enters the ear, it should cause nystagmus. The eyes should move away from the cold water and slowly back.
- Warm water is placed into the ear. The eyes should now move towards the warm water then slowly away.
- electrodes, placed around the eyes, detect the movements. A computer records all the results. |
|
|
Term
| vertigo triggered by head movement lasting 10-30 sec. |
|
Definition
- Benign Paroxysmal Positional Vertigo
- BPPV or BPV |
|
|
Term
|
Definition
Liberatory maneuvers
- modified Epley maneuver.
- Semont maneuver
- head is firmly moved into different positions, the calcium crystal (canalith) debris causing vertigo will slip out of the semicircular canal into an area of the inner ear where it will no longer cause symptoms. |
|
|
Term
|
Definition
| - modified Epley maneuver. (for BPV)
-- Turns pt's head 45 degrees horizontally toward the affected ear. Hold the pt's arms for support. Tilt the pt backward to a horizontal position with your head kept in place at a 45-degree turn, hanging. An attack of vertigo is likely as the debris moves toward the apex of the canal. Hold in this position until the vertigo stops, usually within a minute. Turn the pt's head 90 degrees toward the unaffected ear. Roll the pt to the side of the unaffected ear, so they are now looking at the floor. The debris should move in the canal again, possibly provoking another attack of vertigo. You should remain in this position until the vertigo subsides, usually within a minute. Help pt back to a seated position. Then tilt the pt's head down 30 degrees, which allows the debris to fall into the utricle of the canal where it will not cause vertigo.[image] |
|
|
Term
|
Definition
| - Semont maneuver (for BPV)
--Turn head 45 degrees horizontally toward the unaffected ear.Tilts pt 105 degrees so pt is lying on the side of the affected ear with your head hanging and your nose pointed upward. You remain in this position for 3 minutes. The debris should move to the apex of the canal. Then moves the pt quickly through the seated position, holding your head in place, until you are lying on the side of the affected ear with your nose pointed to the ground. You remain in this position for 3 minutes. The debris should move toward the exit of the canal. Then slowly move the pt back to the seated position. The debris should fall into the utricle of the canal, where it will not cause vertigo.[image] |
|
|
Term
| sudden vertigo that may last for weeks |
|
Definition
|
|
Term
|
Definition
- relief of symptoms.
- antivertiginous: (eg, meclizine, scopolamine, ephedrine, dimenhydrinate, diazepam)
- others are antiemetics (eg, promethazine, prochlorperazine).
- Meclizine, Dimenhydrinate, Scopolamine, Diazepam, Promethazine |
|
|
Term
| chronic vertigo, progressive unilateral hearing loss. |
|
Definition
|
|
Term
| Acoustic Neuroma is AKA... |
|
Definition
|
|
Term
|
Definition
| Intracranial tumor that arise from the Schwann cell sheath of the 8th cranial (vestibular or cochlear nerve). As they increase in size, they eventually occupy a large portion of the cerebellopontine angle.[image] |
|
|
Term
cerebellopontine angle
(Why do I care?) |
|
Definition
| Space that an acoustic neuroma can occupy. [image] |
|
|
Term
|
Definition
|
|
Term
| 20 month old, moderate fever, tachypnea, neck in hyperextended, hx URI |
|
Definition
| retropharyngeal space abscess[image] |
|
|
Term
| Imaging for retropharyngeal space abscess and what are you looking for? |
|
Definition
- lateral neck films
- widened retropharyngeal space (wider then C4 vertebral body) |
|
|
Term
| Why not get a CT or blood cultures for a retropharyngeal space abscess? |
|
Definition
- CT is not that specific
- Cx are not useful since abscesses are caused by anaerobic bacteria and take 24-48hrs to return. |
|
|
Term
- unresolved OE after appropriate therapy, not immunocompromised.
- Suspect? |
|
Definition
| Squamous cell carcinoma or other neoplasm. |
|
|
Term
|
Definition
| hemorrhage in the anterior chamber of the eye[image] |
|
|
Term
|
Definition
|
|
Term
| sudden, unilateral, painless eye with total or near total vision loss |
|
Definition
| central retinal artery occlusion |
|
|
Term
| tx central retinal artery occlusion |
|
Definition
- Immediate lowering of intraocular pressure includes acetazolamide 500 mg IV or 500 mg PO once.
- Topical medications to lower intraocular pressure.
Further treatments:
- Carbogen therapy (5% CO2, 95% O2): CO2 dilates retinal arterioles, and O2 increases oxygen delivery to ischemic tissues. Perform for 10 minutes every 2 hours for 48 hours.
- Hyperbaric oxygen (HBO) therapy may be beneficial if begun within 2-12 hours of symptoms. |
|
|
Term
| Optic neuritis (define and sx) |
|
Definition
- inflammation of the optic nerve.
- assumed autoimmune
- associated with MS
-- Acute loss of vision in one eye
-- Loss of color vision
-- Pain on movement of the eye
-- Changes in the pupil's reactions to bright light. |
|
|
Term
|
Definition
Controversial (ONTT trial)
- consult opthalmology and neurology
- IV steroids are good for acute cases but do not protect against MS
- DO NOT use of oral steroids because they increased rate of recurrence of Optic Neuritis. |
|
|
Term
| painless, monocular and transient visual loss lasting 5-30 minutes |
|
Definition
|
|
Term
| amaurosis fugax (define and give cause) |
|
Definition
- a clot of plaque in the carotid artery breaking off and traveling to the retinal artery in the eye.
- This blocks the artery for a time and causes loss of vision in that eye for as long as its blood supply is cut off.
- Atherosclerosis of the carotid arteries (in the neck) is the main risk factor for this condition. |
|
|
Term
| blurred vision, deep aching eye pain, photophobia and varying erythema. |
|
Definition
|
|
Term
| an inflammation of part or all of the uvea, commonly involving the other tunics of the eye (sclera, cornea, and retina). |
|
Definition
|
|
Term
| differences in presenting sx of optic neuritis vs central retinal artery occlusion. |
|
Definition
- central retinal artery occlusion
ACUTE VISION LOSS
- optic neuritis
PROGRESSIVE VISION LOSS
- central retinal artery occlusion
COMPLETELY PAINLESS
- optic neuritis
PAIN WITH EYE MOVEMENT |
|
|
Term
- acute unilateral visual loss
- Fundoscopy = venous dilation, intra retinal hemorrhages, cotton-wool spots |
|
Definition
|
|
Term
| retinal artery occlusion, Fundoscopy = |
|
Definition
|
|
Term
| Similarities and differences between retinal vein occlusion and hypertensive retinopathy. |
|
Definition
Similar: both present with intraretinal hemmorages, and cotton-wool spots.
Difference: HTN retinopathy has progressive visual loss, retinal vein occlusion has acute, unilateral visual loss. |
|
|
Term
| mottled appearance of macula. progressive vision loss and possibly central vision loss |
|
Definition
| Macular degeneration
[image] |
|
|
Term
difference between dry and wet macular degeneration.
(give alt. names and percents of each) |
|
Definition
- dry = nonexudative (90%)
- wet = exudative (10%)
- exudative form is associated with the development of choroidal neovascular membranes that result in the development of exudate, subretinal fluid, and hemorrhage.
- Dry AMD is an inherited autosomal dominant dz that appears to be affected by nutrition and environmental factors. |
|
|
Term
welder has something in her eye. red and watery eye. what is the VERY first step?
Then what? |
|
Definition
VISUAL ACUITY
Then irrigation, flourescein dye, and topical anesthetic drops |
|
|
Term
| eye exams for DM2 pts occur when? |
|
Definition
| At dx, annually and with any fundoscopic changes. |
|
|
Term
Does fam hx matter in dx of cataracts?
- contact lense use?
- acquired rubella? |
|
Definition
- No, fam hx indicates no sig increase risk.
- Not contact lense use.
- Not ACQUIRED rubella, but congenital rubella does. |
|
|
Term
| Congenital rubella syndrome |
|
Definition
| - Fetal infection occurs transplacentally during the maternal viremic phase, but the mechanisms by which rubella virus causes fetal damage are poorly understood. |
|
|
Term
| risk factors for developing cataracts. |
|
Definition
- congenital rubella
- trauma
- systemic or inhaled steroid use
- uveitis
- systemic dz such as
--- diabetes |
|
|
Term
uni- or bilateral, painless, fleshy, triangular shaped, conjunctival growth.
(risk factors? tx?) |
|
Definition
| - pterygium
- exposure to sunny, dusty, sandy, or windblown areas.
- tx: remove if vision is interfered.[image] |
|
|
Term
| granulomatous inflammation of the meibomian gland. hard, non-tender swelling on the LOWER lid. |
|
Definition
|
|
Term
a localized, purulent, inflammatory staphylococcal infection of one or more sebaceous glands (meibomian or zeisian) of the eyelids.
- AKA? |
|
Definition
|
|
Term
- inflammation of the lacrimal sac
- presentation? |
|
Definition
dacryocystitis
- pain, swelling, tenderness, and redness of tear sac area. |
|
|
Term
|
Definition
- The treatment of choice is a dacryocystorhinostomy whether the patient is symptomatic or not.
- Purulent infection of the lacrimal sac and skin should be treated similarly with oral antibiotics (Augmentin)
- Cultures of the lacrimal fluid should be obtained. |
|
|
Term
| tx hordeolum and chalazion |
|
Definition
| - daily use of warm compresses, eyelid hygiene, and topical anti-inflammatory medication in the acute inflammatory phase. Topical or oral abx. |
|
|
Term
| hallmark of age related macular degeneration |
|
Definition
|
|
Term
| clinical presentation of cataracts |
|
Definition
- decreased visualization of the retina
- obscure or absent red reflex |
|
|
Term
| slight cupping of the optic disk or changes in retinal nerve fiber layer. |
|
Definition
|
|
Term
| sudden loss of vision, floaters, bleeding within the eye. |
|
Definition
|
|
Term
|
Definition
| Impairment of aqueous outflow is caused by closure of the anterior angle[image] |
|
|
Term
| - glaucoma caused by closure of the anterior angle by contact between the iris and the inner surface of the trabecular meshwork |
|
Definition
| angle-closure (closed) glaucoma |
|
|
Term
| Difference between closed and open glaucoma |
|
Definition
| - closure of the anterior angle
angle-closure glaucoma - closed angle with apposition of the iris and trabecular meshwork.
- open-angle glaucoma - angle of the anterior chamber remains open, but filtration is gradually diminished because of the tissues of the angle [image] |
|
|
Term
any glaucoma in which the angle of the anterior chamber remains open, but filtration is gradually diminished because of the tissues of the angle.
- (AKA???) |
|
Definition
open-angle glaucoma
AKA: chronic glaucoma, simple glaucoma, and wide-angle glaucoma |
|
|
Term
| Stages of closed angle glaucoma |
|
Definition
- latent - the first phase, may be free of symptoms or have minor attacks of varying severity, duration, and frequency for months or years.
- intermittent - the second phase usually lasting for several months, and characterized by intermittent, transient attacks of glaucoma with rapidly rising intraocular pressure, edematous cornea, and dull or throbbing pain in or around the eye.
- acute - the third phase, a grave medical emergency.
-- intraocular pressure continues increasing
-- cornea becomes swollen and steamy;
-- iris fixes in mid-dilation;
-- excruciating ocular pain radiating to the other areas of the trigeminal distribution
-- eye may become red and congested; visual acuity fails rapidly
MUST LOWER IOP!!!!
- chronic - the fourth, irreversible increase of intraocular pressure resulting from progressive damage to the angle structures and from permanent. |
|
|
Term
| Tx goal for closed angle glaucoma |
|
Definition
| - Decrease IOP until iridotomy can be completed. |
|
|
Term
Rx options for glaucoma
(Class and examples) |
|
Definition
- Alpha-adrenergic agonists - decrease aqueous production and reduce resistance to aqueous outflow.
example: Brimonidine (Alphagan)
- Topical beta-adrenergic receptor antagonists decrease aqueous humor production by the ciliary body.
example: Levobunolol (Betagan, AKBeta),Betaxolol (Betoptic), Timolol maleate (Timoptic, Timoptic XE)
- Miotic agents (parasympathomimetics) - Contract ciliary muscle, tightening the trabecular meshwork and allowing increased outflow of the aqueous.
example: Pilocarpine (Pilocar, Pilagan)
- Prostaglandin analogs - Increase uveoscleral outflow of the aqueous. example: Latanoprost (Xalatan)
- Carbonic anhydrase inhibitors - Reduce secretion of aqueous humor by inhibiting carbonic anhydrase in ciliary body.
Example: Acetazolamide (Diamox), Methazolamide (GlaucTabs, Neptazane), Dorzolamide HCl (Trusopt), Brinzolamide (Azopt), Dorzolamide HCl/ timolol maleate (Cosopt) |
|
|
Term
| unilateral eye pain, N/V, halo around lights, red eye, pupil is nonreactive and steamy cornea. |
|
Definition
| acute angle-closure glaucoma |
|
|
Term
| acute angle-closure glaucoma |
|
Definition
| unilateral eye pain, N/V, halo around lights, red eye, pupil is nonreactive and steamy cornea. |
|
|
Term
| sx acute angle-closure glaucoma |
|
Definition
| unilateral eye pain, N/V, halo around lights, red eye, pupil is nonreactive and steamy cornea. |
|
|
Term
| decreased vision, unilateral pain, tenderness of the globe and orbit, visual field defects. |
|
Definition
|
|
Term
| inflamed eyelid and conjunctiva, mucopurulent drainage , foreign body sensation, eye pain and blurred vision. |
|
Definition
|
|
Term
| bilat inflammation of conjunctiva, excessive tearing, |
|
Definition
|
|
Term
|
Definition
|
|
Term
| flashing lights, large number of floaters and a 'shade' over the vision in one eye. |
|
Definition
|
|
Term
amaurosis fugax
(easy way to remember) |
|
Definition
| angina of the eye. Not retinal artery occlusion, more like plaque build-up and transient sx. |
|
|
Term
|
Definition
- Laser therapy and cryotherapy are ambulatory outpatient procedures.
- Use of intraocular gas (ie, pneumatic retinopexy) to tamponade the detachment can be an outpatient procedure with close follow-up of the intraocular pressure.
- Scleral buckling, in which a silicone band indents the eye to approximate the retina and RPE. |
|
|
Term
| Who is at greatest risk for hypertensive retinopathy? |
|
Definition
| those who undergo acute abrupt BP elevations such as pheochromocytoma, malignant HTN, acute renal failure or pre-eclampsia. |
|
|
Term
best visualization of orbital fx and extent of damage?
(Use _____ and not ______) |
|
Definition
CORONAL CT
(not orbital plain films) |
|
|
Term
| Possible entrapments from an orbital fx |
|
Definition
- "soft tissue"
- extraocular muscles
- orbital fat
POSSIBLE BLOWOUT FX |
|
|
Term
|
Definition
| Leads to damage to the optic nerve & vision loss/blindness. |
|
|
Term
|
Definition
- Fracture of the orbital floor caused by a sudden increase of intraorbital pressure due to traumatic force
- Orbital contents herniate into the maxillary sinus so that the inferior rectus or inferior oblique muscle may become incarcerated in the fracture site, producing DIPLOPIA ON LOOKING UP!! |
|
|
Term
|
Definition
| An instrument that registers intraocular pressure by direct application to the cornea. |
|
|
Term
| suspect gonococcal conjunctivitis, what is your abx of choice and why? |
|
Definition
- IV ceftriaxone (3rd gen, cephalosporin)
- (+/- topical erythromycin)
- for PCN-restssistant gonococcus. |
|
|
Term
Why is gonococcal conjunctivitis an ophthalmic emergency?
Tx? |
|
Definition
If it leads to corneal involvement, it may rapidly lead to perforation of the eye.
- Tx: IV ceftriaxone, topical gentamycin, frequent saline lavages. |
|
|
Term
What is doxycycline good for in conjunctivitis?
What is it NO good for? |
|
Definition
Chlamydia trachomatis (inclusion) conjunctivitis.
- NO GOOD for Gonnococcal conjunctivitis. |
|
|
Term
|
Definition
- caused by an organism (Chlamydia trachomatis)
- it affects primarily newborn infants, beginning as an acute purulent conjunctivitis that leads to papillary hypertrophy of the palpebral conjunctiva. |
|
|
Term
conjunctival dendritic plaques
(tx with?) |
|
Definition
Herpetic keratosis.
- oral acylovir |
|
|
Term
|
Definition
| deviation of the eye which the patient cannot overcome. |
|
|
Term
|
Definition
strabismus in which there is manifest deviation of the visual axis of an eye toward that of the other eye, resulting in diplopia.
(CROSS-EYED) |
|
|
Term
|
Definition
| strabismus in which there is permanent deviation of the visual axis of one eye away from that of the other, resulting in diplopia;
(WALLEYE)[image] |
|
|
Term
| Inability to gaze downward and inward with the left eye. |
|
Definition
| Left fourth cranial nerve |
|
|
Term
inability to gaze laterally with the left eye.
(What nerve and what is it called?) |
|
Definition
Left sixth cranial nerve
(maximal esotropia with leftward gaze) |
|
|
Term
inability to gaze laterally with the right eye.
(What nerve and what is it called?) |
|
Definition
Right sixth cranial nerve
(maximal esotropia with rightward gaze) |
|
|
Term
| Inability to gaze downward and inward with the right eye. |
|
Definition
| Right fourth cranial nerve |
|
|
