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55 Cards in this Set
- Front
- Back
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What is a Hyphema? What disease is associated with it? |
rupture of iris or ciliary body vessels, into anterior chamber, which blocks the visual field. 1/3 will have temp rise in week, get IOP now. Tx: elevation of bed and Acetazolamide Sickle Cell ass'd with it. DON'T Give acetazolamide in sickle cell hyphema! (may worsen suckling in acidotic state) |
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What is a Hordeolm |
A stye An infection of the apocrine sweat glands. being. hot compresses |
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What hemorrhages exist in the eye? |
Vitreous Hemorrhage: more posterior, has floaters and vision loss Subconjunctiva: more anterior |
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What do you see physically in a Peritonsillar Abscess? What is the danger in lancing? |
Unilateral swelling in tonsil, shifting of uvula away from infection Internal Carotid Artery Runs 2-3 cm inferior&lateral to tonsil. Bad risk!!! Trim plastic needle tip to 2 cm |
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What is Lemierre's Disease |
Septic thrombophlebitis of Internal Jugular Vein 2/2 Fusobacterium Necrophorum Occurs once a peritonsillar abscess ruptures internally into Internal Jugular Vein |
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Epistaxis: What should patient do prior to treatment? How does silver nitrate work? what to avoid? What benefit of antibiotics? |
Have patient blow out nose first to clear out all the clots Silver nitrate forms nitric acid w/ water > coagulates tissue. Don't do bilateral on septum!!! cartilage blood supply is impaired Posterior Bleed Packing needs a monitor bed as danger of vagal stimulation No clear benefit of Abx to nasal packing. Toxic shock VERY rare |
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What are punctate corneal lesions? Who gets? |
Indicates UV light exposure to eye. Seen under fluorescein. Expect in significant outdoor time, tanning bed, welding. Topical Cycloplegics, Broad Abx and Optho |
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What is the difference between HSV keratitis and VZV infection on cornea |
HSV see dendritic lesions (rounded bulb tips) on fluorsceine VZV: shingles onto eyes, Hutchinson's sign, see psdeudo-dendritic lesions on fluorescein (no rounded tips). Also Hutchison's sign, nasocilliary n from facial N (CN V) |
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What is Otitis Externa? |
Inflammation of the external auditory canal. Usually 2/2 trauma or elevated pH water (freshwater pool). If can't see TM, assume punctured. TM punctured or can't see: topical cipro/dexamethasone TM intact: acetic acid drops If necrotizing OE, consider DM or Immunocompromised. Tx: oral augmentin |
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What is Bullous Myringitis? What is Zoster Oticus |
Direct Inflammation/Infection of the TM itself (not same as AOM!). Strept Pneumo` See Vesicles/bullae full of blood on TM. TM clear vesicles and usually w/ facial n (CN VIII paralysis) |
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What is the first sign of Syphillis? |
Painless Chancre |
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What is most common cause of Otitis Externa? Acute Otitis Media? |
OE: Pseudomonas AOM: Strept Pneumo |
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What is Ludwig's Angina |
Bilateral cellulitis/abscess in submandibular space or sublingual space. Tongue is elevated. 80% have preceding dental infection (2nd mandibular molar most). Acute Laryngospasm worse outcome |
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What is a periodical abscess? What is Alveolar osteitis |
infection of alveolar bone 3-4 days after a dental extract, blood clot falling out prematurely, causing local inflammation, foul smell. Pack w/ iodoform dental paste or oil of cloves |
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Where is a Peritonsillar Abscess loaded specifically? What do you seen in a Retropharyngeal Abscess? |
Between tonsillar capsule and superior constrictor and palatopharyngeus muscles. Most common in strept throat season: young people, winter, spring Swelling in retropharyngeal space, torticullis |
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What are the two main congenital neck masses? |
Branchial Cleft Cyst - epithelial, from branchial arches (should be gone). lateral, anterior to SCM near angle of mandible. Non-tender. Does not move w/ swallowing or tongue Thyroglossal cyst: 2/2 persistent thyroglossal duct, midline. DOES move with swallowing and tongue |
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What is a Scrofula? |
Cervical Lymphadenitis 2/2 Mycobacterium TB Literally TB of the neck |
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What is most sensitive sign of a AOM? |
Bulging and impaired TM mobility most sensitive for AOM (the puff of air!) |
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What is the most common intracranial complication of untreated AOM? extra-cranial? |
Intracranial: meningitis Extracranial: mastoiditis |
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Difference between a Chalazion and a Stye |
Chalazion: granuloma of Meibomian gland > hard & painless. Above eyelashes on upper eyelid, blocked oil gland. Granulomatous inflammatory response. More external Stye: more internal on lid and more painful. Eyelash follicle, bacterial infection at root of eyelash or oil gland of lids |
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What do you see in CRVO and CRAO? |
CRVO: see "Blood and Thunder" fundus, diffuse intraretinal hemorrhages (blood) and cotton wool spots (thunder). Needs Optho for topical steroid and photocoagulation. CRAO: See cherry red macula (separate blood supply from central retinal artery). Tx: orbital massage |
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What is a Pterygium and a Pinguecula? |
Both like a eye callus. Conjunctiva growth. Benign Pterygium: "Surfers Eye" growth from nasal side extends into the cornea. Pinguecula: on conjunctiva, does not extend into cornea |
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How do you treat a CRAO? |
Manual Massage of eyeball: 10 seconds on, 5 seconds off. have patient do to self to prevent damage. Should restore blood in 90 minutes. Also minimize internal pressure to help: mannitol, acetazolamide, topical timolol, sublingual nitro |
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What are complications of Sinusitis |
Usually Viral/Allergic at first. Decongest with Oxymetazoline or Sudafed. Can develop bacteria secondarily Fungal infection in sinus is Mucormycosis, from Rhizopus (DM complication!!) |
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Differentiate Orbital Cellulitis from Periorbital Cellulitis |
OC: Direct extension from Ethmoid Sinus. Proptosis, painful EOM. Emergency, may need lateral canthotomy POC: painless EOM |
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How does cartilage blood supply work? What is most common infection of cartilage? |
Diffuses from surroundings. This is why shouldn't use Silver Nitrate on both sides of nasal septum > compromise blood supply! Pseudomonas is most common (such as OE) Tx: Cipro, hits Pseudomonas, Staph, Strept |
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What is Endophthalmitis. What are the risk factors? |
Infection/Inflammation of Vitreous/Aqueous humor of globe. Usually sterile, so must be contacted recently: think recent surgery or penetrating trauma (metal workers, machinists). Often see a Hypopyon (leukocytes in anterior chamber) |
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what nerve is irritated in photophobia? |
Ophthalmic branch of V1 (not Cranial N 2!) CN2 only vision, can't carry sensation (same nerve damaged in Herpes Otiticus) |
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Which cranial nerve neuropathy most commonly hit? |
CN III. From DM. Damage is from intramural nutrient artery (tiny artery), which travels in middle of nerve. Peripheral n fibers get collateral perfusion. The parasympathetics are peripheral, thus the light reflex is spared even if EOM are not (constricts to light). This differentiates form aneurysm or tumor blocking CN III. |
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What is Ramsay Hunt syndrome: |
Herpes Zoster Oticus: CN V1 herpes. Hits cornea and ear drug and periaurical area. Get unilateral facial paralysis. Hutchison sign precedes worse infection. On fluorscein staining, see Pseudodendrites (no rounded tips) unlike HSV keratitis, where see true dendrites (rounded tips). Also, don't expect CN V1 distribution on HSV |
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What drugs cause ototoxicity? |
Aminocglycosides: Worse in renal failure and elderly. Can be irreversible, 2/2 destruction of outer cilia. Loop Diuretics: lasix can cause electrolyte changes that cause transient deafness. Platinum chemo (cisplatin/carboplatin) destroy outer sensory hair cells then inner |
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What should one consider in a Tracheostomy Bleed? |
>3 days - 6 weeks: Innominate Artery Fistula (R. Brachiocephalic Artery branch). See self-limiting sentinel bleed then hemorrhage Tx: place pressure to root of neck in sternal notch; inflate trach tube w/ 50 cc air. Place ET tube in airway! |
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What disease is associated with Peritonsillar Abscess? |
Mononucleosis common viral co-infection Lemierre's Syndrome: internal burst of peritonsillar abscess and leaking into internal jugular vein > thrombotic. Very bad |
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What is a viral cause of sudden hearing loss? |
Mumps! |
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What helps with removing an insect from the ear? |
pour in viscous lidocaine |
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What is a complication of AOM extracranially and what do you see? |
Mastoiditis periauricular erythema and tenderness |
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How do you treat Herpes Simplex Keratitis? |
Trifluridine (topical acyclovir-like drug). Q2hr x 3 weeks PO acyclovir makes sense but evidence not gathered yet |
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What is Hutchison's Sign? |
A cluster of vesicles on the tip of the nose, usually precedes a bad outbreak of Herpes Zoster Oticus. Indicates infection of the nasocilliary nerve, a branch of CN V1, which also innervates the cornea |
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What is Bacterial Tracheitis |
A secondary infection after a viral URI. Croup-like, worsening when stridor. Toxic appearing child. Airway obstructed 2/2 thick mucopurulent secretions on trachea. Intubate sitting up |
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Where is a Bezold Abscess found |
in the SCM muscle |
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What is most common cause of Conjunctivits? |
Viral: adenovirus (itchy, less discharge, periauricular adenopathy) Bacterial: staph/strep, lots of discharge. Consider pseudomonas in contact lens wearing |
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What disease puts one at risk for lens dislocations, retinal detachments? |
Marfan's disease. |
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What disease is associated with anterior uveitis? |
Lupus predisposes to this condition |
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What is Amaurosis Fugax? |
Painless acute vision loss, often monocular |
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What is the first symptom of Optic Neuritis? |
Dyschromatopsia (loss of color vision). Acute inflammation of optic n itself. Often get complete CENTRAL vision loss, but preserved peripheral vision. Marcus Gunn Pupil Multiple Sclerosis most common cause, however consider infectious (Lyme, Herpes, Syphilis); Autoimmune (sarcoid, Lupus); B12 deficiency and Methanol poisoning |
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What HIV common superinfection hits the eye? |
CMV Retinitis. Usually good indicator that CD4 < 50. AIDS defining illness. Fully white perivascular lesions Also consider in post-transplant or immunocompromised |
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Why should you look in the ears for a blast injury |
TM's usually first part damaged. If no damage to TM's, low risk of damage to other organs Pars Tensa most commonly perforated part |
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What is seen in a retropharyngeal abscess? |
usually after a sore throat, have trouble swallowing and difficulty hyperextending neck. Thickened pre vertebral space C2-C4, usually 2x thick as vertebral body. Most common in <4 years old since Lymph Nodes are bigger relatively |
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What are the two oral "white fluffy" lesions in HIV? |
Oral Thrush: thick flaky curds on tongue in mouth, scrape off. Benign, however Candidial Esophagitis life threatening risk of hemorrhage, perforation Hairy Leukoplakia: can't scrape off, painful (Epstein Barr Complication) |
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What is typical cause of Unilateral Obstructive Emphysema? |
Swallowed Foreign Body into trachea. R mainstream most common location. Lungs hyper expanded. Inhalation ok, exhalation hard. Creates a valve. In children usually caused by a vegetable while eating > Radiolucent |
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What is indicated in a Facial Nerve paralysis with an ear infection? |
Emergent Myringotomy! Pressure is compressing CN VII |
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What is the Seidel Sign? What is a Hypopyon? |
SS: fluorescein streaming away in teardrop patter from wound. Indicates leaking globe puncture Hypopyon: WBC's building up in anterior chamber, indicates endophthalmitis, infection of aqueuos/vitreous fluid. usually recent surgery or trauma. needs systemic and intra-ocular antibiotics |
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What is nosebleed sometimes the first sign of? |
Osler-Weber-Rendu Disease: (also called Hereditary Hemorrhage Telangiectasia). Autosomal dominant disease making faulty blood vessels |
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What is the rule of 80 in neck masses? |
80% of pediatric masses are benign (branchial cleft, thyroglossal cleft) 80% of adult (non-thyroid) masses are malignant |
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What is Dacryocystitis? |
Infection of the nasolacrimal duct. Inferior/medial to eye. Causes Epiphora (overflow of tears). Rubbing will cause purulent discharge. Real danger of Orbital Cellulits!! |
