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35 Cards in this Set
- Front
- Back
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give a dd for sudden loss of vision
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Central retinal artery occlusion
Central retinal vein occlusion retrobulbar neuritis amaurosis fugax retinal detachment |
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pt presents with sudden monocular painless, complete loss of vision. FUndoscopic exam shows pale retina with macular red spot. What is this and what should you do?
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Central retinal artery occlusion
macular red spot= cherry red spot STAT optho consult; increase CO2 (carbonic anhydrase inhibitor) definitive tx: paracentesis of the anterior chamber (surgery) |
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Sudden monocular painless and near complete loss of vision. Fundoscopic eam: chaotic, blood streaked retina. What is this and what should you do?
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Central Retinal Vein Occlusion
blood streaked retina=blood and thunder STAT optho consult |
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Progressive loss of central vision. May be painful, scotoma, flashing lights. Peripheral vision preserved. What is this? Associated with?
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Optic neuritis
associated with MS in 25% of cases |
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Fleeting painless loss of monocular vision due to minute emboli of the central retinal artery. What is this? What should your workup include
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Amaurosis Fugax
Consult neuro for TIA workup |
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Painless vision loss, prodromal floaters or flashing lights followed by "lowering curtain" What is this? What should you do?
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Retinal detachment
Optho consult, this is requiring surgery |
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give a quick DD of red eye
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Acute angle closure glaucoma
Acute iritis Conjuctivitis Herpes simplex keratitis corneal ulceration chemical conjunctivitis corneal abrasions |
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sudden severe unilateral ocular pain. decreased visual acuity. HA, nausea, blurred vision or rainbow halos. What is this? What should you do?
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Acute angle glaucoma
precipitous increased IOP-->blindness if untreated pupil dilation is often precipitant event think of the person in the movie theater |
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What is the normal IOP? What is IOP in acute angle glaucoma
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Normal < 20
AAG: 60-90 |
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Treatment for glaucoma? (definitive and what you should do)
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stat optho consult for iridectomy (definitive)
Timilol (B-B; decreases aqueous humor formation) Pilocarpine (parasympathomimetic, produces miosis) Acetazolamide (Carbonic anhydrase inhibitor; inhibits aqueous humor formation) Mannitol (increases blood osmolality, creating a gradient that draws water from vitreous cavity) |
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pt presents with blurred vision, photophobia, ocular pain. Exam shows ciliary flush, anterior chamber cells and flare (on slit lamp), constricted pupil, decreased visual acuity, lower IOP, consensual photophobia. What is this? What should you do?
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Acute Iritis
medications that dilates the eyes (cycloplegics, homatropine); optho followup |
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nonpainful red eye, bacterial, viral, or allergic
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conjunctivitis
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red eye with foreign body sensation. Dendritic fluorescein uptake. What is this? What should you do?
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Herpes Simplex Keratitis
acyclovir drops, cycloplegics |
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What is absolutely contraindicated in Herpes simplex keratitis
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Steroids--worsen condition
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red painful eye. Slit lamp shows: white flocculent infiltrate of the cornea, hypopyon (anterior chamber exudate; white layering in lower portion of iris)What is this? What should you do?
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Corneal Ulceration
Admit/ IV abx |
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which is more dangerous to the eye, Acidic or Alkali burns?
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Alkali
cause liquefactive necrosis this is the only optho emergency in which visual acuity is not checked until after therapy has begun get pH to 7 |
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what is the "ice rink sign" on slit lamp exam? what does it suggest
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Linear abrasions in upper 1/3 of cornea
due to foreign body this is why you should evert the lid to look for foreign body |
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on exam you see a tear shaped pupil (prolapse of the iris); small black fragments representing iris pigment may be seen and initially mistaken for a foreign body. What is this? What should you do?
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Corneal laceration
metal shield, STAT optho consult for surgical repair |
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what is Sidel's Sign?
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after floroscene staining you can see fluid draining out of the globe itself
this is a sign of perforated globe this is a surgical emergency |
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patient was mowing his law when he ran over a metal sprinkler head. Something flew towards his eye but he is unsure if it hit him or not. This was initially painless, but then the pt developed monocular pain and decreased visual acuity. No wound is visible on exam. What is this? What should you do?
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Intraocular Foreign Body
dg: CT scan, US, x-ray of globe tx: optho consult for surgical removal |
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Hemorrhage into the anterior chamber=
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Hyphema
tx: bed rest, head of bed elevation, optho consult, steroids, miotics |
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pt gets blunt trauma to the ear leading to an auricular hematoma. What should be done? What if its not?
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Needle aspiration and compression dressing
can lead to cartilage necrosis ("cauliflower ear") if untreated |
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deep pain with movement of the TMJ, granulation tissue on floor of the auditory canal at bony-cartilage junction. Seen in immunocompromised patient. What is this? What should you do?
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Malignant Otitis Externa
caused by pseduomonas aeruginosa can cause facial nerve paralysis--> multiple CN involvement --> meningitis tx: Stat ENT consult, surgical debridement, IV Abx |
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vesicular ras of ext auditory canal and auricle. Usually with sensorineural hearing loss and facial nerve paralysis. What is this? What should you do?
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Ramsey Hunt (herpes)
Admit, acyclovir |
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most common cause of epistaxis? (what blood supply)
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anterior Kiesselbach's plexus damage
note: posterior are often seen in older pts with HTN |
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What is Pott's Puffy Tumor?
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Osteitis of anterior frontal sinus wall
frontal lobe abscess can develop if not treated |
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orbital cellulitis vs periorbital?
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orbital: pain with extraoccular movements, protrusion of the eye, pain on the eye
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pt with high fever, toxic appearance, CN 3 & 6 palsy with papilledema. Dg made with CT or MRI
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Cavernous Sinus Thrombosis
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what most commonly causes pharyngitis?
why do we treat readily? will Abx prevent glomerulonephritis? |
Group A Strep
RHD Nope |
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pt has pharyngitis, fever, cervical lymphadenopathy. He is treated with ampicillin and gets a rash. What is this? What should you do?
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This was actually Mononucleosis
gluid, rest, steroids, avoid contact sports (potential splenic rupture) |
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Elderly debilitated alcoholic with brawny edema of submandibular area, febrile, protruding elevated tongue, respiratory distress.... due to bilateral cellulitis of the floor of the mouth. What is this? What should you do?
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Ludwig's Angina
Airway protection and IV abx (clinda/unasyn/PCN/MTZ) |
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adolescent presents with fever, trismus, dysphagia. Enlarged inflamed tonsil extending medially. Displaces uvula to opposite side. What is this? What should you do?
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Peritonsillar abscess
ENT for I & D (if too difficult to drain yourself) |
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children 6mo-3yr with fever, neck pain, muffled voice, dysphagia. Child likes to lie down. X-ray shows prevertebral edema on lateral soft tissue. What is this? What should you do?
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Retropharyngeal Abscess
muffled voice=hot potato voice tx: ICU admit, IV abx, ENT surgical drainage |
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abrupt high fever, sore throat, stridor, dysphagia. Child is drooling, stidrous, muffled voice, sittinug up wiht chin forward and neck extended. What is this? What should you do?
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Epiglottis (HiB, group A strep, B. Catarrhalis)
Dx: thumb print sign on lateral neck x-ray tx: cricothyrotomy set up at bedside, intubation by ENT in OR if possible admit to ICU for IV Abx, humidified O2 and IV fluids |
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2-3 days of URI sx, worsening to a barking cough, hoarse voice and stridorous. What is this? What should you do?
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Croup (parainfluenza most common)
dg: steeple or pencil sign on AP soft tissue neck xray Steroids, humidified O2, racemic epi |
