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43 Cards in this Set

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  • Back
Inflammation of the eyelid margins.
usually involves eyelid skin, eyelashes, and associated glands.
Two main types: Seborrheic and Staphylococcal.
S&S: irritation, burning, redness, and itching of eyelid margins
TX: careful cleaning, topical AB as needed
Anterior Blepharitis
Inflammation of the eyelids involving the meibomian glands.
Cause: May result from bacterial inf. Mainly Staph. or a dysfunctional gland in which there is a strong association w Acne Rosacea.
S&S: Lid margins often rolled inward, redness and infammation, tears may be frothy and greasy.
TX: may involve systemic AB, and short term steroids as needed.
Posterior Blepharitis
Infection of the sebaceous glands of the eyelid, and can be internal or external.
S&S: pain, redness, swelling.
TX: similar to abscess, heat, warm compresses, AB ointment, I&D as needed.
Hodeolum, or stye
A granulomatous inflammation of a meibomian gland that may follow and internal hordeolum.
S&S: small nontender nodule on the upper or lower lid, area around conjunctiva is red, and elevated.
TX: Sx excision
Infection of the Lacrimal Sac.
Most often in infants, and older >54.
S&S: usually unilateral, and most often 2nd. to obstructed nasolacrimal duct. Tearing and discharge, swelling, pain and tenderness.
TX: Warm compress, Topical AB's and if Chronic may need Sx.
Infection of the lacrimal sac.
Usually caused by Staph. and Strep.
S&S: Pain, redness, and edema around the lacrimal sac. Pressure over lacrimal sac causes reflux of mucoid material through the puncta.
TX: Warm compresses,and oral AB's for mild cases ie.(Cephalexin), and IV AB for more severe(Cefzolin). I&D may be necessary. Usually accompanied by Chronic Conjunctivitis, and if so may requie SX.
Loss of Lens ability to Change shape to focus on near objects due to aging.
Corrected by Convex Lens
Farsightedness, the point of focus is behind the retina because the cornea is too flatly curved of axial length is too short.
Convex lens used to correct
Nonspherical curvature of the lens causes light to focus at different points.
Cylindrical lens used to correct. (no refractive power along one axis, and concave or convex along the other.)
Significant difference between the refractive errors of the 2 eyes. (Usually >2 diaopters)
Nearsightedness, the point of focus is in front of the retina because the cornea is too steeply curved or the axial length is too long.
Visual Field Deficits.
Positive results in light spots or scintillating flashes(results from abnormal stimulation of some portion of visual system, ie from migranes.)
Negative results in blind spots. (can result from hemorrhage, edema, or detachment, as well as optic nerve dysfunction.)
light sensitivity or intolerance.
an anatomic misalignment of the eyelashes, which rub against the eyeball.
S&S: Foreign body Sensation, tearing, red eye.
DDX: rule out corneal abrasion or ulceration using flourescein staining.
TX: eyelash removal with forcepts, or electrolysis.
Highly contagious acute conjunctival infection.
S&S: Unilateral but spreads, irritation, lacrimation, photphobia, and Mucoid discharge (~watery). Enlarged Pre Auricular LN's
Usually caused by Adenovirus
(sometimes Herpes Simplex)
TX: Mostly Self limiting, If severe use topical Corticosteroids. UNLESS HERPES SIMPLEX BECAUSE CORTICOSTEROIDS CAN EXACERBATE
Viral Conjunctivitis
Very contagious infection of the conjunctiva.
S&S: ~ Unilateral but often spreads, Hyperemia, lacrimation, irritation, an discharge. (thick mucopurluent)
Usually due to Staph aureus, Strep. pneumoniae, H. influenzae, M. catarrhalis, C. Trachomatis
TX: AB's Moxifloxacin drops, or Trimethoprim/polymixn B.
If Adult Gonnococcal -Single Dose Ceftriaxone, or Ciprofloxacin
Bacterial Conjuntivitis
Chronc Conjunctivitis caused by C. trachomatis.
Leading Cause of Preventable Blindness Worldwide.
S&S: ~ Bilaterally, Initially Hyperemia, eyelid edema, photophobia, and lacrimation.
Secondarily, Corneal neovascularization and scarring of the conjuntiva, cornea, and eyelids. Lymphoid follicles on tarsal plate.
TX: Azithromycin orally single dose, doxycycline or tetracycline.
Acute, Intermittent, or Chronic conjuntival inflammation.
S&S: Bilateral intense Pruritis, lacrimation, discharge(watery to stringy Mucoid with numerous esinophils), and hyperemia. photophobia.
TX: Avoidance, Tear supplements, Topical antihistamines ad mast cell stabilizers.
Allergic Conjunctivitis
Benign growth of conjunctiva that can result from chronic actinic irritation.
~ at 3:00 and 9:00 positions.
Raised yellow-white mass on bulbar conjunctiva adjacent to cornea, but does not tend to grow on cornea.
TX: can easily be removed.
Fleshy Triangular growth of bulbar conjunctive that may spread across and distort the cornea, induce astigmatism
S&S: Decreased vision, Foreign Body Sensation.
Predisposed by HOT, DRY climates.
TX: Removal
Optic nerve damage usually accompanied by and increase in Intraoccular pressure(normal 10-21mmHg). More prevalent in blacks, elderly, HTN, DM, Myopia, positive family history.
S&S: usually occur late involving visual field loss. Both eyes affected but ~ not equally.
Upon exam increased cup:disk ratio, nerve fiber layer hemorrhage that crosses optic margin (Drance hemorrhage). Nasal-septal defects.
TX: Goal is to prevent further loss of vision. B-Blockers(timolol), Cholinergic agonists(rare now, Carbonic anhydrase inhibitors(acetazolamide which reduces Aqueuous Humor Secretion). SX to relieve IOP
Open Angle Glaucoma
Although mainly chronic development, The rarely Acute version is an occular Emer.
If Acute- Severe occular pain, redness, decreased central vision, colored halos, headache, N&V, Elevated Intraoccular Pres.
On exam: Conjunctival injection, hazy cornea, fixed mid-dialated pupil.
Risk factors include Asians, hyperopia, family history, elderly.
TX: Emergency, Acetazolamide po, Laser iridotomy to open another path. Often the other eye is treated prophylactically.
Closed Angle Glaucoma
Degenerative opacity of the lens.
S&S: Gradual, Painless loss of vision (blurring), Halos esp. around lights
DX: best with pupil dialated, Yellow-brown opacities on lens, loss or red reflex.
Risks: elderly, smoking, EtOH, x-rays & UV, systemic corticosteroids.
TX: surgical removal and replacement of the lens
Inflammation of the Uveal Tract. (iris, Cilliary body, Choroid).
S&S: Pain, redness, photophobia, and floaters.
Causes: ~ mostly idiopathic, trauma, infections. Association with Juvenile Arthritis, and Herpes virus.
Forms: Anterior, Posterior, Intermediate, and Diffuse
TX: referral, Corticosteroids
Leading cause of vision loss in the elderly, more prevalent in whites vrs blacks.
Two forms exsist: Atrophic (Dry)
S&S: irregular pigmentation of macular region w/o elevation or scarring. Drusen, gradual progressive loss of central vision.
Exudative (wet)
Hyperpigmentation of Macula and soft drusen, neovascularizaton, Rapid loss of central vision (This form ~leads to blindness if untreated).
TX: Laser Coagulation
Macular Degeneration
Bacterial infection of the mastoid air cells usually following AOM.
S&S: otalgia, purulent otorrhea, redness, tederness, swelling over mastoid, displacement of pinna lateral and inferiorly
Complications: Subperiosteal abcess, lateral sinus thrombosis
TX: C&S(tympanocentesis), initial IV AB's (Ceftriaxone or oral quinilones w good CNS Penetration)
form of AOM in which vesicles develop on the tympanic membrane. Can be viral or bacterial(esp S. pneumoniae) or mycoplasma
S&S: sudden pain for 24-48hrs,. hearing loss and fever suggest bacterial.
dificult to differentiate cause.
TX: AB's, oral analgesics, May require rupture of vesicles with myringotomy knife.
Infection of the middle ear causing pain and may lead to hearing loss. Three forms exist, Acute, Secretory, and Chronic.
Eti: Many times viral, IF BACTERIAL includes Strep. pneumoniae, H. Influenzae, M. catarrhalis, Staph aureus, E.coli
S&S: Onset 3mo-3yr for acute, Otalgia, NV&D, Constant crying, irritablility, bulging TM.
TX: Amoxicillin x10days or bactram (timethoprim-Sulfamethoxzasole). Ibuprofen
Acute Otitis Media
Effusion of the middle ear resulting from incomplete resolution of AOM, or eustacion tube obstruction.
S&S: Hearing loss, fullness or pressure, Considered chronic if effusion >3mo., Usually painless.
TX: Watchful waiting, if allergies are clearly involved then topical corticsteroids and antihistamines
Secretory Otitis Media
Persitent, Chronically draining >6wk, suppurative perforation of TM.
ETI: can result from AOM Staph. aureus or Gram neg bacilli, eustachion tube obstruction, trauma, blasts, and thermal or chemical burns.
Defined as recurrent if >3x/6mo or >4x/yr
S&S: includes painless otorrhea(purulent foul smelling) with conductive hearing loss.
Chronic (recurrent) Otitis Media
Most common cause of hearing loss in the elderly.
TX: Irrigation HOOH+H20, or manual removal
Cerumen Impaction
~Heals by self over weeks, if a large perforation refer to ENT for tympanoplasty
Perforated Eardrums
Painful posterior throat w or w/o swallowing and if severe many patients refuse oral intake.
Etiology: ~infectious mostly as Tonsillopharyngitis, either viral or bacterial(esp GABHS, less common is abscess (peritonsillar, parapharyngeal) and epiglottitis.
S&S: Coryza suggests viral, but NN throat culture to diferentiate. Hot-potato voice suggests peritonsillar abscess, whereas stridor an sitting upright leaning forward suggests epigottitis,(IN WHICH CASE NO PHARYNGEAL EXAM)
TX: Varies greatly Dependant on cause. AB shorten course if GABHS, Warm Saltwater gargles and Topical anesthetics (benzocaine, lidocaine, dyclonine)
Acute Pharyngitis
Acute infection of the pharnyx or pallatine tonsils or both.
S&S: Pain w swallowing and often reffered to ears, dysphagia, cervical lymphadenopathy, fever.
ETI: ~viral (adenovirus, RSV, rhinovirus, influenza, coronavirus) also epstien barr, herpes simplex, and CMV. IF BACTERIAL, GABHS, Then Staph aureus, S. pneumoniae, Mycoplasma pneumoniae, and Chlamydia pneumoniae. Rarely pertussis, fusobacterium, diphteria, syphilis, and gonorrhea.
GABHS most common 5-15yrs. and uncommon <3yrs
TX: Supportive, analgesics, hydration, rest, PEN V for GABHS.
Consider tonsillectomy if GABHS reocurrs >6x/yr or >4/yr for 2 years or >3/yr for 3 yrs.
Acute Tonsillitis
Inflammation of the Larynx usually due to virus or overuse.
S&S: decreased vol. and Hoarsness. Tickling, rawness, IF >3wks then Laryngoscopy.
ETI:~result of viral URI, Can be induced by cough from bronchitis, pneumonia, perussis, or due to excessive use, smoking, allergies, gerd, irritants.
TX: ~supportive cough suppresants, voice rest, smoking cessation, Tx's aimed at underlying causes
Bacterial infection of the salivary glands due to obstructing stone or hyposecretion.
S&S: Swelling, redness, pain, gland is frim w tenderness, most common in parotid, fever, chills, unilateral swelling, ~50-60yrs, or those with xerostomia, or who have had radiation Tx in oral cavity.
ETI: ~S. aureus, Streps, colifroms, and anerobes.
CT, Ultrasound, and MRI may help ID cause.
TX: initially aimed at S. aureus dicloxacillin, 1st gen cephalosporins, clindamycin and modify based on C&S. I&D if abcess, warm compresses and gland massage, lemon juice and hard candy to stimulate secretions
S&S:~ Unilateral sore throat w gradual onset, dyspagia, fever, otalgia, asymmetric cervical adenopathy, trismus, hot-potato voice, drooling, severe halitosis, uvular deviayion
ETI: ~multiple bact. Staph, Strep, and anaerobic Bacteroides.
Needle Aspiration of PUS differentiates Abscess from Cellulitis.
TX: Hydration, High-dose PEN, or 1st gen cephs, or clindamycin. I&D done in ER, airway monitoring
Peritonsillar Abscess & Cellulitis
S&S:Short bursts of vertigo ~<60secs w tends to peak in the am, nystagmuus, nausea, abscense of hearing loss or tinnitus.
TX: exercises (Epley manuever), ~self limiting but often long lasting, Drugs not reccomended
ETI: OM, trauma, recent viral infections, or degeneragtion of utricular otolithic membranes.
Benign Positional Vertigo
-Rhegmtogenous- Most common, ~>60yrs, Posterior vitreous detachment leads to tearing or flap formation.
-Tractional- ~due to previous retinal detachment, surgey, trauma, or proliferative neuropathy.
-Exudative- ~due to accumulation of serous or hemorrhagic fluid, severe Acute HTN, neoplastic effusions, or inflammation
3 types of retinal detachments
S&S: Sudden, painless, profound vision loss. Cherry red spot at fovea, pupil may repond poorly to direct light but exhibits consensual response, arteries may appear bloodless.
ETI: atherosclerotic plaques, cholesterol emboli(Hollenhorst plaques) endocarditis, thrombosis
TX: if<24hrs Reduce IOP by hypotensives acetazolamide, if 2nd to temporal arteritis give systemic corticosteroids, Intermittent digital massage to loosen and move to smaller branch.
Central Retinal Artery Occlusion
S&S: Sudden or gradual, but painless loss of vision. Superficial and deep intraretinal hemorhages, Looks red and angry, macular edema, optic disk,swelling, Iris neovasularization over time, cotton-wool spots.
TX: prognosis much better than CRAO. Normal vision may be restored, if <20/40 at time of presentation good prognosis but if >20/200 poor in 80%.
No real accepted treatment but may use Photocoagulation if neovascularization
Central Retinal Vein Occlusion
Includes microaneurysms, hemorrhages, exudates, and macular edema occuring w Diabetes over several years. vision rarely decreases until late in the disease. Non-proliferative develops first and see fluid leaking from capillaries, dot and blot hemorrhages, cotton-wool spots, and hard exudates~yellow.
Progresses to proliferative w neovasculaization on retina, and may extend into vitreous cavity. blurred vision and black spots,flashing lights in field of vision.
TX: Control underlying diabetes, Intra-vitreal Corticosteroids for Macular edema. Photocoagulation for neovascularization.
Diabetic Retinopathy
S&S: arteriolar constriction, arteriovenous nicking, Flame shaped hemorrhages, cotton-wool spots, yellow-hard exudates, usually asymptomatic until well advanced. vascular wall changes ie, silver and/or copper wiring.
TX: Manage HTN
Hypertensive Retinopathy