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124 Cards in this Set
- Front
- Back
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what is the most common secondary cause of HTN in young women?
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birth control pills
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what is the most common cause of secondary HTN?
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renal artery stenosis
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what are 2 early retinal changes seen in HTN?
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1. arteriovenous nicking - discontinuity in retinal vein secondary to thickened arterial walls
2. cotton wool spots - infarction of nerve fiber layer in retina |
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what are the systolic and diastolic BPs for the different classifications of htn?
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Prehypetension - 120-139/80-89
Stage 1 - 140-159/90-99 lifestyle mod, drug therapy Stage 2 - >160/100 lifestyle mod AND drug therapy (usually 2 drugs) |
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what are the requirements for establishing the diagnosis of HTN?
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at least 2 readings over a span of 4 or more weeks
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What diet has been shown to lower BP?
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DASH diet - low sat fat rich in fruits, veggies, and low-fat dairy products
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What BP medications are safe in pregnancy?
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B blockers and hydralazine
(ACEi, ARBs, CCB's, thiazides contraindicated) |
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what anti-HTN class is particularly useful in diabetics?
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ACE inhibitors and ARBs
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what anti-HTN class may be of benefit in a patient w/ concurrrent BPH?
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b-blockers
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What are the characteristics of a tension headache?
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- steady, aching, encircles entire head (tight band-like pain) --> usualy generalized but may be most intense around neck or back of head
- tightness in posterior neck muscles - usually worsens throughout day |
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what are the characteristics of cluster headaches?
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- excrutiating periorbital pain (behind the eye) - ALMOST ALWAYS UNILATERAL
- deep, burning, stabbing pain - accomp by ipsilateral lacrimation, facial flushing, nasal stuffiness/discharge - usually begin a few hours after pt goes to bed and lasts 30-90min, awakens from sleep - daytime headaches can occur - attacks occur nightly for 2-3 mo then diappear |
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what is the drug of choice for acute cluster headache attacks?
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sumatriptan (contraindicated in CAD or Prinzmetal's angina)
- also very helpful in combo w/ o2 therapy |
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What is the drug of choice for prophylactic treatment of cluster headaches?
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verapamil
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what are some first line agents for migraine prophylaxis?
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1. TCAs (amitriptyline)
2. propanolol |
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what type of condition does pain of maxillary sinusitis mimic?
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pain over cheeks --> dental caries
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what diagnosis should be considered if have cold where symptoms improve, then worsen after a few days
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acute bacterial sinusitis (secondary bacterial infection after primary viral illness)
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how long do symptoms need to be present for sinusitis to be considered chronic?
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2-3 months
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what is the problem w/ using antihistamines in treating sinusitis?
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want to facilitate drainage and antihistamines can have drying effect --> make secretions thicker; sometimes worsens congestion
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what is the next course of treatment if there is no improvement after 2 weeks of sinusitis treatment (antibiotics + decongestants)?
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sinus films (CT more reliable than XRay) and pencilinase resistant antibiotics
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How is the diagnosis of non-ulcer dyspepsia (functional dyspepsia) made?
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dyspepsia symtpoms must be present for at least 4 weeks; diagnosis of exclusion after appropriate tests don't reveal specific cause
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What is the primary mechanism of GERD and the other factors that can contribute?
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1. inappropriate relaxation of lower esophageal sphincter --> retrograde flow of stomach contents into esophagus
Other factors - decreased esoph motility to clear refluxed fluid - gastric outlet obstruction - hiatal hernia - dietary --> alcohol, tobacco, chocolate, high fat foods, coffee (can decrease LES pressure) |
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GERD associated with dysphagia is suggestive of what diagnosis?
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peptic stricture
(motility disorder and cancer are other considerations) |
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What is the test of choice for diagnosing GERD? When is it indicated?
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endoscopy
- indicated if cancer or complication of GERD suspected - if persistent, atypical, anemia, weight loss, dysphagia present |
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what is the GOLD STANDARD (aka most sensitive and specific) for GERD diagnosis?
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24-HR ph monitoring (usually not necessary)
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what use does upper gi series (barium contrast study) have in the workup for GERD?
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only helpful in ID'ing complications of GERD (strictures/ulcerations), can't diagnose GERD itself
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What are the complications of GERD?
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1. erosive esophagitis
2. peptic stricture 3. esophageal ulcer (poss cause of upper GI bleeding) 4. barrett's esophagus 5. recurrent pneumonia (due to recurrent pulmonary aspiration) 6. pitting of dental enamel (dental erosion) 7. laryngitis, pharyngitis |
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peptic stricture
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complication of GERD
fibrotic rings that narrow the lumen and obstruct passage of food - presents w/ dysphagia, usually difficulty w/ solid foods only and is progressive - can be diagnosed w/ endoscopy - treat by dilation |
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When should GERD patients be screened for Barrett's? What is the clinical management if they have Barret's?
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- if have symptomatic GERD for at least 5 years
- requires endoscopy w/ biopsy - if Barrett's --> periodic surveillance every 3 years |
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what is the GOLD STANDARD (aka most sensitive and specific) for GERD diagnosis?
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24-HR ph monitoring (usually not necessary)
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what is the next course of treatment if there is no improvement after 2 weeks of sinusitis treatment (antibiotics + decongestants)?
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sinus films (CT more reliable than XRay) and pencilinase resistant antibiotics
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what use does upper gi series (barium contrast study) have in the workup for GERD?
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only helpful in ID'ing complications of GERD (strictures/ulcerations), can't diagnose GERD itself
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How is the diagnosis of non-ulcer dyspepsia (functional dyspepsia) made?
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dyspepsia symtpoms must be present for at least 4 weeks; diagnosis of exclusion after appropriate tests don't reveal specific cause
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What are the complications of GERD?
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1. erosive esophagitis
2. peptic stricture 3. esophageal ulcer (poss cause of upper GI bleeding) 4. barrett's esophagus 5. recurrent pneumonia (due to recurrent pulmonary aspiration) 6. pitting of dental enamel (dental erosion) 7. laryngitis, pharyngitis |
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What is the primary mechanism of GERD and the other factors that can contribute?
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1. inappropriate relaxation of lower esophageal sphincter --> retrograde flow of stomach contents into esophagus
Other factors - decreased esoph motility to clear refluxed fluid - gastric outlet obstruction - hiatal hernia - dietary --> alcohol, tobacco, chocolate, high fat foods, coffee (can decrease LES pressure) |
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GERD associated with dysphagia is suggestive of what diagnosis?
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peptic stricture
(motility disorder and cancer are other considerations) |
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peptic stricture
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complication of GERD
fibrotic rings that narrow the lumen and obstruct passage of food - presents w/ dysphagia, usually difficulty w/ solid foods only and is progressive - can be diagnosed w/ endoscopy - treat by dilation |
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When should GERD patients be screened for Barrett's? What is the clinical management if they have Barret's?
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- if have symptomatic GERD for at least 5 years
- requires endoscopy w/ biopsy - if Barrett's --> periodic surveillance every 3 years |
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What is the test of choice for diagnosing GERD? When is it indicated?
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endoscopy
- indicated if cancer or complication of GERD suspected - if persistent, atypical, anemia, weight loss, dysphagia present |
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what is the GOLD STANDARD (aka most sensitive and specific) for GERD diagnosis?
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24-HR ph monitoring (usually not necessary)
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what use does upper gi series (barium contrast study) have in the workup for GERD?
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only helpful in ID'ing complications of GERD (strictures/ulcerations), can't diagnose GERD itself
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What are the complications of GERD?
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1. erosive esophagitis
2. peptic stricture 3. esophageal ulcer (poss cause of upper GI bleeding) 4. barrett's esophagus 5. recurrent pneumonia (due to recurrent pulmonary aspiration) 6. pitting of dental enamel (dental erosion) 7. laryngitis, pharyngitis |
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peptic stricture
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complication of GERD
fibrotic rings that narrow the lumen and obstruct passage of food - presents w/ dysphagia, usually difficulty w/ solid foods only and is progressive - can be diagnosed w/ endoscopy - treat by dilation |
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When should GERD patients be screened for Barrett's? What is the clinical management if they have Barret's?
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- if have symptomatic GERD for at least 5 years
- requires endoscopy w/ biopsy - if Barrett's --> periodic surveillance every 3 years |
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What are the 6 phases in GERD treatment?
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1. behavior modfication (diet, sleeping position, smoking cessation), and use anacids after meals/bedtime
2. Add H2 blocker (ranitidine, famotidine, cimetidine) instead of or in addition to antacid 3. switch to PPI if above fails or if have erosive esphagitis 4. Add promotility agent (metoclopramide most commonly used - D2 antagonist) 5. a. Combo therapy - H2 or PPI plus promotility agent b. increase H2 blocker or PPI dose 6. Antireflux surgery - if severe or resistant case |
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What are the indications for surgery in GERD?
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1. intractability - failure of medical rx
2. respiratory problems due to reflux and aspiration of gastric contents 3. severe esophageal injury (ulcer, hemorrhage, stricture, Barrett's) |
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What types of diarrhea-causing organisms will show fecal leukocytes?
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- campylobacter
- salmonella - shigella - EIEC - C diff |
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What organisms show blood and fecal leukocytes in diarrhea?
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campylobacter, salmonella, shigella, EIEC
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what is the most common electrolyte/acid-base disturbance w/ severe diarrhea?
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metabolic acidosis and hypokalemia
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in what situations of acute diarrhea are antibiotics recommended?
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- high fever, bloody stools, or severe diarrhea (quinolones)
- stool culture grows one of the pathogenic organisms - traveler's diarrhea (ETEC) - C diff infection --> metronidazole |
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What is the treatment of choice for shigella?
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TMP/SMX (Bactrim)
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Is treatment usually required for salmonella infection?
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No, except in immunocompromised or in case of enteric fever (Salmonella typhi)
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What is the main mode of transmission of campylobacter? What is the treatment?
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fecal oral more than food
- rx = erythromycin |
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What are common clinical features of IBS and how is it diagnosed?
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clinical Dx of exclusion; symptoms must be present for at least 3 months
- change in frequency/consistency of stool --> diarrhea, constipation, or alternating - cramping abdom pain relieved by defecation - bloating or feeling of abdom distension |
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What are common clinical features of IBS and how is it diagnosed?
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clinical Dx of exclusion; symptoms must be present for at least 3 months
- change in frequency/consistency of stool --> diarrhea, constipation, or alternating - cramping abdom pain relieved by defecation - bloating or feeling of abdom distension |
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what are complications of severe or prolonged vomiting?
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1. electrolyte abnorm's --> metabolic alkalosis, hypokalemia
2. dental caries 3. aspiration pneumonitis 4. GI - mallory weiss, boerhaave's syndrome |
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Low back pain --> musculoligamentous strain
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most common cause of lower back pain
- tear/strain of muscle fibers/ligaments in paraspinal muscles around iliac crest/lower lumbar regions - usually recalls episode of bending/twisting or of back giving way when lifting heavy object, w/ immediate onset of pain - radiation of pain across low back, usually doesn't radiate distal to knee since no nerve root injury has occurred |
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Causes of low back pain
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1. musculoligamentous strain
2. degenerative disc disease (osteoarthritis) 3. Facet arthritis (facet joints of lumbar spine) 4. lumbar disc herniation 5. lumbar spinal stenosis 6. vertebral compression fracture 7. neoplasms 8. infection (osteomyelitis) 9. Anklyosing spondylitis 10. Cauda equina syndrome 11. Spinal deformity (kyphosis, scoliosis) 12. spondylolsethesis - forward slipping of cephalad vertebra on caudad vertebra (usually due to advanced degen changes in disc and facet joints that have progressed to instability) |
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What levels do most cases of lumbar disc herniation occur?
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L5-S1 or L4-L5 levels
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What is the difference in pain patterns between disc herniation vs. spinal stenosis?
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HERNIATION - pain exacerbated by coughing/sneezing (increase intraspinal pressure)
forward flexion (sitting, driving, lifting) worsens leg pain SPINAL STENOSIS leg pain on back extension (walking, standing) relief w/ bending or sitting |
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pattern of pain in vertebral compression fracture (low back pain)
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acute; due to minor stress in elderly patients
- pain at level of fracture w/ local radiation across back and around trunk - rarely into legs (unlike disc herniation or spinal stenosis) |
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What types of patients are at risk of vertebral compression fracture?
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- elderly with severe osteoporosis
- long term steroid therapy - cancer patients w/ lytic bony mets, or multiple myeloma |
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Lower back pain that is considered night pain is suspicious of what cause?
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neoplasm (usually metastatic carcinoma)
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Cauda equina syndrome
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occurs after spinal trauma or central lumbosacral disc herniations, causing compression to multiple S1, S2, S3, S4 nerve roots
- bilateral sciatica, saddle anesthesia over buttocks/perineum - bowel or bladder dysfn (freq, retention, incontinence) - impotence, perianal anesthesia, lax anal sphincter --> can display by loss of anocutaneous reflex (contraction of anal sphincter when pinprick perianal area) - SURGICAL EMERGENCY |
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Straight leg raising test
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Produces radicular pain if a compressed L5 or S1 root is stretched (sensitive for nerve root compression)
- Positive test = radiculopathy when leg elevated 30 degrees to 60 degrees w/ patient supine - earlier the pain onset, the more specific and the greater severity of herniation - If get contralateral leg pain is more specific for herniated disc |
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pattern of pain in vertebral compression fracture (low back pain)
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acute; due to minor stress in elderly patients
- pain at level of fracture w/ local radiation across back and around trunk - rarely into legs (unlike disc herniation or spinal stenosis) |
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What types of patients are at risk of vertebral compression fracture?
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- elderly with severe osteoporosis
- long term steroid therapy - cancer patients w/ lytic bony mets, or multiple myeloma |
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Lower back pain that is considered night pain is suspicious of what cause?
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neoplasm (usually metastatic carcinoma)
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Cauda equina syndrome
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occurs after spinal trauma or central lumbosacral disc herniations, causing compression to multiple S1, S2, S3, S4 nerve roots
- bilateral sciatica, saddle anesthesia over buttocks/perineum - bowel or bladder dysfn (freq, retention, incontinence) - impotence, perianal anesthesia, lax anal sphincter --> can display by loss of anocutaneous reflex (contraction of anal sphincter when pinprick perianal area) - SURGICAL EMERGENCY |
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Straight leg raising test
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Produces radicular pain if a compressed L5 or S1 root is stretched (sensitive for nerve root compression)
- Positive test = radiculopathy when leg elevated 30 degrees to 60 degrees w/ patient supine - earlier the pain onset, the more specific and the greater severity of herniation - If get contralateral leg pain is more specific for herniated disc |
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What tests examine the function of L4, L5, S1?
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L4 - ankle dorsiflexion, patellar tendon reflex
L5 - ankle and big toe dorsiflexion against resistance S1 - ankle plantar flexion; achilles reflex |
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patellofemoral pain
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common cause of anterior knee pain
worse w/ climbing and descending stairs - physical therapy used to stretch/strengthen quads/hamstrings |
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patellar tendinitis
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aka "jumper's knee"
- common cause of anterior knee pain (inferior pole) - overuse injury, common in jumping and running sports - Rx = activity modification and quads/hamstring rehab (stretching/strengthing) |
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Osteochondritis dissecans
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Cause of knee pain
area of necrotic bone and degenerative changes in the overlying cartialge - bone/cartilage piece may separate from underlying bone and become loose body in joint --> cause symptoms of pain, catching, popping |
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Baker's cyst
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cause of knee pain, caused by intra-articular pathology (eg meniscus tear)
- rupture can cause pain/swelling - if extends into calf, may mimic thrombophlebitis or acute DVT - ultrasound can help diagnosis - more common in pt's w/ osteoarthritis or rheumatoid disease - most resolve spontaneously |
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Meniscus tear
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due to specific injury or secondary to degenerative process
- recurrent knee effusions - tenderness along medial or lateral join lines - positive McMurray test (extends and rotates leg; positive if click heard/felt at 90 degrees) surgery effective if no arthritic changes present |
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In cases of knee pain, what would you be looking for in radiographs vs. MRI?
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radiograph - if degenerative disease or history of trauma/acute injury
MRI - if any ligamentous instablity is apparent or meniscus tear is suspected |
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What is the most commonly injured ankle ligament?
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anterior talofibular ligament (ATFL)
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What are the Ottawa rules (for ankle radiographs)?
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used to avoid unnecessary ankle radiographs and prevent missing clinically significant fractures
Ankle radiographs not necessary if the following conditions are met: - able to walk 4 steps at time of injury and time of evaluation - no bony tenderness over distal 6cm of either malleolus |
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What is the treatment for ALL acute ankle sprains?
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1. RICE (rest, ice, compression, elevation)
2. physical therapy (peroneal tendon strengthening and proprioceptive training) |
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what is the most common cause of shoulder pain? What are the features?
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supraspinatus (rotator cuff) tendinitis
- pain subacromially and on lateral aspect of shoulder w/ arm abduction - poorly localized pain w/ insidious onset, usually over lateral deltoid - see in elderly patients (tendon degeneration) and young patients w/ a lot of overhand lifting/throwing |
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if there is weakness on shoulder abduction, what should be suspected? what's the best test?
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rotator cuff tear; MRI
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Impingement syndrome (shoulder)
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common cause of shoulder pain (occurs w/ overhead activity)
- due to impingement of greater tuberosity on acromion - temp relief w/ steroid injections - surgery (acromioplasty) very effective |
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Lateral epicondylitis at elbow (cause, treatment)
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aka "tennis elbow"
inflammation/degen of extensor tendons of forearm, which originate from lateral epicondyle - due to excessive supination/pronation Initial rx = splinting forearm (counterforce brace) DON'T SPLINT OR WRAP ELBOW ITSELF physical therapy |
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Medial epicondylitis
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aka "golfer's elbow"
- pain distal to medial epicondyle (origin of flexor muscles of forearm) - exacerbated by wrist flexion - due to overuse of flexor pronator muscle group |
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De Quervain's disease (clinical features, cause, treatment)
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pain at radial aspect of wrist (especialy w/ pinch gripping) just distal to thumb, commonly radiates to elbow or into thumb
- due to inflammation of abductor pollicus longus and extensor pollicis brevis tendons from repetive grasping, gripping, wringing - Positive Finkelstein test (patient clenches thumb under other fingers while making fist; positive if pain upon ulnar deviation of wrist) RX = thumb spica splint and NSAIDS |
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what conditions are associated with carpal tunnel syndrome?
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- hypothyroidism
- diabetes - rheumatoid arthritis - repetitive use of hands in certain activities - pregnancy - recent trauma/fracture of wrist - |
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What are the 2 physical exam tests that can be used to diagnose carpal tunnel syndrome?
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1. Tinel sign - tap over median nerve at wrist crease, causes parasthesia in median nerve distribution
2. Phalen's test - palmar flexion of wrist for 1 minute causes paresthesias in median nerve distribution |
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3 other differentials for hand numbness besides carpal tunnel syndrome
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1. cervical radiculopathy (nerve root compression in cervical spine; C7 mostly)
2. peripheral neuropathy (diabetes) 3. median nerve compression in forearm |
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What are the key findings on radiographs in osteoarthritis?
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1. joint space narrowing (due to loss of cartilage)
2. osteophytes (bony enlargements of joints) 3. sclerosis of subchondral bony end-plates adjacent to diseased cartilage (most severe at points of max pressure) 4. subchondral cysts - due to increased transmission of intra-articular pressure to subchondral bone |
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If a cane is used for osteoarthritis for the left knee or hip, what hand should the cane be placed in?
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right hand
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where can pain sometimes be felt in osteoarthritis of the hip?
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groin region and sometimes radiation to anterior thigh
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what is the first line pharmacologic treatment for osteoarthritis? why?
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acetaminophen; better side effect profile than NSAIDS (GI effects; although are just as effective)
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Are corticosteroid injections useful for osteoarthritis treatment? what is the limitation?
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yes; provide up to 3 mo of pain relief per injection; more than 3-4/year not recommneded
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Name 6 causes of secondary osteoporosis?
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1. excess steroid therapy/Cushing's syndrome
2. immobilization 3. hyperthyroidism 4. long-term heparin 5. hypogonadism in men (low testosterone) 6. vitamin D deficiency |
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What are the most common fractures in osteoporosis?
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vertebral body compression fractures (middle and lower thoracic and upper lumbar spine most common)
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Colles fracture
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distal radius fracture, usually due to fall on outstretched hand; more commmon in post-menopausal women; a common fracture occuring in osteoporosis patients
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What is the gold standard for osteoporosis diagnosis?
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DEXA - very precise for measuring bone density
- perform at menopause - take bone samples from hip and lumbar verterae; compare density of bone w/ standard control (bone density of healthy 30-year old person) |
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What is the mechanism of action of biphosphonates in osteoporosis treatment? What are their side effect?
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decrease osteoclastic activity by binding to hydroxapetite) and thus decrease risk of fractures
- Corrosive esophagitis = major side effect - have poor gi absorp so must admin in fasting state w/ lots of H2O, and patient must stay upright for 30min afterwards |
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What did the PROOF trial show in regards to calcitonin in osteoporosis treatment?
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- no effect at hip
- shown to decrease risk of vertebral fractures by as much as 40% - slight increase in bone density at lumbar vertebrae |
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What is the most common cause of visual impairment/loss in adults <65 yo? >65 yo?
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< 65 yo --> diabetic retinopathy
>65 yo --> age-related macular degeneration |
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ARMD is characterized by what type of vision loss?
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central loss of vision, because macula is affected (complete loss almost never occurs)
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What are the major risk factors for age-related macular degeneration?
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1. age
2. female gender 3. caucasian 4. smoking 5. HTN 6. fam hx |
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What are the two categories of macular degeneration?
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1. Wet (exudative) - less common
- resp for most cases of severe vision loss causes sudden loss due to leakage of serous fluid into retina, followed by neovascularization under the retinal pigment epithelium 2. Dry - atrophy and degeneration of central retina Drusen (yellowish white deposits) form under pigment epithelium, visible w/ opthalmoscope |
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Clinical features of open angle vs closed angle glaucoma
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OPEN ANGLE
- painless, increased IOP (may be only sign) - progressive and insidious visual field loss, usually sparing central vision until end stage disease CLOSED ANGLE - red, painful eye - sudden decrease in visual acuity, seeing "halos", markedly elevated IOP - nausea and vomiting comon - involved pupil dilated and non-reactive |
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What are the different treatments for open and closed angle glaucoma?
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OPEN
1. topical meds - usually beta blocker, alpha agonist, carbonic anhydrase inhibitor, and/or PG analogue singly or in combo 2. laser or surgical rx for refractory cases CLOSED opthalmic emergency - opthamologist referral, must lower IOP immediately - Medical rx = pilocarpine drops, IV azetazolamide, oral glycerin - definitive rx = laser or surgical iridectomy |
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blepharitis
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inflammation of eyelid usually due to Staph species
- dx via careful exam of eyelid margins (red and often swollen w/ crusting that sticks to lashes) - Rx = lid scrubs and warm compresses; topical AB's for severe cases |
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"second sight" phenomenon
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seen in some cataracts patients
- become increasingly near-sighted and may no longer require reading glasses - due to increased refractive power of lens of eye caused by the cataract |
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episcleritis
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inflammation of vessels lining episclera (lining just beneath conjunctiva)
- poss autoimmune cause; may be seen w CT disease - redness, irritation, dull ache, poss watery discharge - sclera may be blotchy w/ areas of redness over episcleral vessels - Rx = NSAIDS symptomatic relief; self-limited optho eval |
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Scleritis
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inflammation of sclera associated w/ systemic immunologic disease (ex RA)
- significant deep eye pain; ocular redness and pain on eyeball palpation - can cause visual impairment - req's prompt eval by opthamologist RX = topical or systemic corticosteroids |
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Acute anterior uveitis
|
inflamm of iris and ciliary body; more common in young and middle-aged
- assoc w/ CT diseases (sarcoid, ank spond, reiters, JRA, IBD) CLIN - circumcorneal injection (most prom around cornea) - blurred vision, pain, photophobia - constricted pupil comp w/ contralat eye |
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What dangerous finding in HSV keratitis needs to be looked for and why?
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classic dendrite on cornea of fluorescein staining --> indicates dendritic ulcer; can result in irrev vision loss if untreated
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What distinguishes HSV keratitis from viral conjunctivitis?
|
HSV - usually unilateral
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What type of infection should be inquired about when taking history for viral conjunctivitis?
|
recent URI - often precedes or simultaneously causes viral conjunctivitis
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What are the 2 forms of chlamydia conjunctivitis?
|
1. trachoma (serotypes A-C) - most common cause of blindness worldwide due to chronic scarring
- less common in developed countries 2. Inclusion (D-K) - mainly genital-hand-eye contract in patients w/ STD - sim sx to bact conjunct - usually doesnt lead to scarring/blindness |
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What is a rapid onset of copious purulent conjunctival exudate consistent w/ ?
|
Hyperacute bacterial conjunctivitis - N. gonorrhea
- IMMED RX FROM OPTHO - corneal scarring and blindness if left untreated |
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What is the RX for acute and hyperacute bacterial, and chlamydial conjunctivitis?
|
1. Bacterial acute - broad spec topical (erythro, cipro, sulfacetamide)
2. Hyperacute (gonorrhea) - 1-time dose of ceftriaxone IM as well as topical therapy 3. Chlam (oral tetracycline, doxycycline, or erythromycine for 2 weeks) |
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Amaurosis Fugax
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sudden, transient monocular loss of viison
- due to embolization of cholesterol plaque from carotid arterial system w/ retinal ischemia - vision returns when reperfusion is spontaneously established MGMT: - carotid ultrasonography and cardiac workup (lipid profile, ECG, etc) |
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most common cause of conductive hearing loss
|
cerumen impaction (buildup obstructing auditory canal)
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most common cause of sensorineural hearing loss
|
presbycusis
- gradual symmetric hearing loss assoc w/ aging - due to degen of sensory cells and nerve fibers at base of cochlea - hearing loss most marked at high frequencies w/ slow progression to lower frequencies |
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What type of hearing loss is noise-induced? what is the mech?
|
sensorineural
- damage to hair cells in organ of corti - chronic, prolonged exposure to sound levels >85dB |
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Meniere's disease
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fluctuating, unilat hearing loss
sensorineural sense of pressure/fullness in ear, tinnitus, vertigo - due to increased volume and pressure of endolymph in vestibular apparatus (prob defective absorption - often episodic w/ exacerbations and remissions RX - meclizine and salt restriction for vertigo hearing loss is progresive |
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Clinical Features of conductive vs sensorineural hearing loss?
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CONDUCTIVE
- Abnormal Rinne (bone conduction > air) - Weber - sound lateralizes to affected side decreased perception of sound, esp low-freq sounds can hear loud noises well SENSORINEURAL Normal Rinne - air conduction>bone conduction Weber - sound lateralized to unaffected side - difficulty hearing louid noises; annoyed by loud speech poor speech discrimination more difficulty w/ high freq sounds - tinnitus often present SENSORINEURAL |
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What is normal residual urine volume? volumes greater than this indicate what?
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50mL
if >50mL --> urinary obstruction or hypotonic bladder |
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Features of urge vs. stress vs. overflow vs reflex incontinence
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1. Urge
MECH = involuntary and uninhibited detrusor contractions --> involuntary loss of urine CLIN = urgency, loss of lg volumes of urine w/ small postvoid residual nocturnal wetting 2. Stress (usually in multi-parous women) MECH = weakness of pelvic floor --> loss of bladder support and hypermobility of bladder neck; prox urethra descends below pelvic floor; increases in intra-abdom P transmitted mostly to bladder CLIN = involuntary urine loss in spurts during activities that increase intra-abdom P (cough, laugh, sneeze, etc); small post-void vol 3. Overflow (common in diabetics and neurolog d/o's) MECH = inadeq bladder contraction or bladder outlet obstruction leading to urinary retention and subseq overdistention of bladder; P eventually exceeds urethral resistance; urine leakage CLIN = nocturnal wetting, freq loss of small urine amts; large postvoid residual 4. Reflex - can't sense urge to urinaate usually from spinal cord injury |
