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141 Cards in this Set

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Xanthelasma
-Slightly raised irregular flat yellow lesions 
-Secondary to abnormality in lipid metabolism
-Localizes to upper/lower eyelids and around canthus
-Slightly raised irregular flat yellow lesions
-Secondary to abnormality in lipid metabolism
-Localizes to upper/lower eyelids and around canthus
Periorbital edema
-Swelling around eye
-Always abnormal
-Causes include: allergic rxns, thyroid disease, mono, conjunctivitis, renal disease, insect bites, trauma, cellulitis
-Swelling around eye
-Always abnormal
-Causes include: allergic rxns, thyroid disease, mono, conjunctivitis, renal disease, insect bites, trauma, cellulitis
Preseptal cellulitis (periorbiral cellulitis)
-Infection of anterior soft tissues of eye
-Usually staph or strep
-No fever or leukocytosis
-No restriction in eye motility
-No pupillary defect
-Tx w/ oral antibiotics
-Infection of anterior soft tissues of eye
-Usually staph or strep
-No fever or leukocytosis
-No restriction in eye motility
-No pupillary defect
-Tx w/ oral antibiotics
Orbital cellulitis
-Infection of deep soft tissues of eye
-Usually staph or strep
-Fever, leukocytosis, proptosis
-Dec EOM
-Afferent pupillary defect
-Tx w/ admission and IV antibiotics
-Infection of deep soft tissues of eye
-Usually staph or strep
-Fever, leukocytosis, proptosis
-Dec EOM
-Afferent pupillary defect
-Tx w/ admission and IV antibiotics
Orbital ecchymosis
-AKA raccoon eyes
-Periorbital edema
-Indicates basilar skull fracture from trauma
-If no trauma has occurred, suspect bleeding disorder
-AKA raccoon eyes
-Periorbital edema
-Indicates basilar skull fracture from trauma
-If no trauma has occurred, suspect bleeding disorder
Fracture of orbit
-Direct blow to eye
-Impaired ocular movement due to inferior rectus entrapment
-Periorbital edema, diplopia, epistaxis
-Direct blow to eye
-Impaired ocular movement due to inferior rectus entrapment
-Periorbital edema, diplopia, epistaxis
Proptosis
-Fwd displacement of globe that implies orbital soft tissues are distended by inflammation or tumor
-In peds, rapid onset may indicate rhabdomyosarcoma
-Fwd displacement of globe that implies orbital soft tissues are distended by inflammation or tumor
-In peds, rapid onset may indicate rhabdomyosarcoma
Exophthalmos
-Represents a bilateral protrusion of eyeballs
-Think hyperthyroid
-Represents a bilateral protrusion of eyeballs
-Think hyperthyroid
Eyebrow irregularities
-Scaling and redness = seborrheic dermatitis
-Loss = chemo, plucking, burns, alopecia
-Coarse or do NOT extend past temporal canthus = hypothyroid
Rosenback sign
-Tremors of lids
-Suspect hyperthyroidism
Lid lag (Von Graefe sign)
-Strip of sclera above upper lid visible during superior/inferior eye tracking
-Indicates spasm and/or hyperthyroidism
Blepharitis
-Inflammation of lid margins w/ greasy flakes on lashes and redness of lid margin
-Irritation, blurring, itching
-May also be due to bacterial invasion (acute) 
-Tx w/ antibiotic eye ointment, eyelid scrubs, warm compresses
-Present: red eyes
-Chronic irritation of lids and lashes
-Telangectatic lid margins w/ greasy flakes on lashes
-Irritation, blurring, itching
-Causes include inflammatory, infectious, autoimmune
-Tx w/ antibiotic eye ointment, eyelid scrubs, warm compresses
Ptosis
-When superior eyelid covers more of iris than other or extends over pupil in primary gaze
-Can be congenital or acquired
-Weakness of levator muscle or palsy of CN III
-Other causes: MG, trauma, edema of lids, old age, DM
-When superior eyelid covers more of iris than other or extends over pupil in primary gaze
-Can be congenital or acquired
-Weakness of levator muscle or palsy of CN III
-Other causes: MG, trauma, edema of lids, old age, DM
Ectropion
-Present when lower lid is turned away from eye
-May result in excessive tearing
-Causes: congenital, scarring, surgery, trauma, aging, Bell's palsy
-Present when lower lid is turned away from eye
-May result in excessive tearing
-Causes: congenital, scarring, surgery, trauma, aging, Bell's palsy
Entropion
-Present when lid is turned inward toward the globe
-More threatening to sight
-May cause corneal and conjunctival irritation
-Present when lid is turned inward toward the globe
-More threatening to sight
-May cause corneal and conjunctival irritation
Acute hordeolum of upper eyelid
-AKA sty
-Caused by inflamed meibomian gland resulting in pustule
-Position is ON lash margin
-PAINFUL, red
-Tx w/ warm packs, antibiotic eye ointment
-AKA sty
-Caused by inflamed meibomian gland resulting in pustule
-Position is ON lash margin
-PAINFUL, red
-Tx w/ warm packs, antibiotic eye ointment
Chalazion
-Chronic cyst of a sebaceous gland
-Localized swelling or protrusion ABOVE lid margin
-NONTENDER and enlarges slowly
-Tx w/ hot packs and massage
-Chronic cyst of a sebaceous gland
-Localized swelling or protrusion ABOVE lid margin
-NONTENDER and enlarges slowly
-Tx w/ hot packs and massage
Dacryocystitis
-Infection of lacrimal sac usually due to congenital or acquired obstruction of nasolacrimal system
-Due to staph aureus or hemolytic strep in acute and S epidermdis, anaerobic strep, or Candida albicans in chronic
-Pain, swelling, redness in tear sac a
-Infection of lacrimal sac usually due to congenital or acquired obstruction of nasolacrimal system
-Due to staph aureus or hemolytic strep in acute and S epidermdis, anaerobic strep, or Candida albicans in chronic
-Pain, swelling, redness in tear sac area w/ possible purulence
-Tx w/ antibiotics or surgery
Allergic conjunctivitis
-Non painful eye irritation that does NOT affect vision or pupils
-Allergic (bilateral): pruritic, cobblestone appearance w/ clear d/c as well as chemosis or edema of conjunctiva
-Viral (bilateral): usually adenovirus w/ enlarged preauricular node and c
-Non painful eye irritation that does NOT affect vision or pupils
-Bilateral, pruritic, cobblestone appearance w/ clear d/c as well as chemosis or edema of conjunctiva
Subconjuctival hemorrhage
-Caused by straining, mild trauma, bleeding disorder
-Painless
-No tx needed
-Present: red eye, no pain
-Caused by straining, mild trauma, bleeding disorder
-Painless
-No tx needed
Pterygium
-Benign fleshy, triangular encroachment of bulbar conjunctiva OVER cornea at 3 or 9 o'clock
-Usually bilateral and caused by excessive wind, sun and dust exposure
-Irritation, redness, tearing
-Tx w/ eye lubricants, steriods, possibly surgery
-Benign fleshy, triangular encroachment of bulbar conjunctiva OVER cornea at 3 or 9 o'clock
-Usually bilateral and caused by excessive wind, sun and dust exposure
-Irritation, redness, tearing
-Tx w/ eye lubricants, steriods, possibly surgery
Pinguecula
-Benign raised yellow/white lipid deposit on bulbar conjunctiva extending TO cornea at 3 and 9 o'clock
-Thought to be due to sun, dirt and dryness over long period of time
-No tx required
-Benign raised yellow/white lipid deposit on bulbar conjunctiva extending TO cornea at 3 and 9 o'clock
-Thought to be due to sun, dirt and dryness over long period of time
-No tx required
Scleral icterus
-May be apparent when sclera is yellow
-Usually indicates liver disease
Episcleritis
-Localized inflammation of episcleral vessels
-Self limiting and idiopathic; little discomfort
-In some cases associated w/ collagen vascular disease
-Localized inflammation of episcleral vessels
-Self limiting and idiopathic; little discomfort
-In some cases associated w/ collagen vascular disease
Scleritis
-Markedly dilated vessels that do not extend onto underside of lower lid
-May appear purplish w/ deep pain and photophobia that can threaten vision
-Often in women w/ associated connective tissue disease
-Markedly dilated vessels that do not extend onto underside of lower lid
-May appear purplish w/ deep pain and photophobia that can threaten vision
-Often in women w/ associated connective tissue disease
Miosis
-Pupillary constriction to less than 2mm
-Pupil fails to dilate in dark
Mydriasis
-Pupillary dilation of more than 6 mm
-Pupil fails to constrict w/ light
-Associated w/ state of coma
Anisocoria
-Inequality between diameters of pupils
-Up to 1 mm difference is ok
-Can be normal variant from drops, iritis, 3rd nerve palsy, glaucoma, intracranial mass, artificial eye, etc
-Inequality between diameters of pupils
-Up to 1 mm difference is ok
-Can be normal variant from drops, iritis, 3rd nerve palsy, glaucoma, intracranial mass, artificial eye, etc
Ciliary flush (injection)
-Indicated inflammation of iris and ciliary body
-Produces pink band surrounding corneal limbus
-NOT seen in conjunctivitis
-Commonly seen in acute glaucoma, iritis
-Indicated inflammation of iris and ciliary body
-Produces pink band surrounding corneal limbus
-NOT seen in conjunctivitis
-Commonly seen in acute glaucoma, iritis
Acute narrow angle glaucoma
-Acute increase in IOP
-Severe, aching deep pain
-Dec vision
-Dilated, fixed pupil
-Steamy, cloudy cornea
-Widespread injection
-Tx w/ IV acetazolamide
-Present: red, painful eye, dec vision, N/V
-Acute increase in IOP
-Severe, aching deep pain
-Dec vision
-Dilated, fixed pupil
-Steamy, cloudy cornea
-Widespread injection
-Tx w/ IV acetazolamide
Acute iritis or anterior uveitis
-Mod, aching deep pain from iris spasms
-Dec vision and photophobia
-Small, irregular pupil
-Cornea clear or slightly clouded
-Injection confined to corneal limbus
-Sarcoidosis, RA, Reiters, ankylosing spondyltis
-Mod, aching deep pain from iris spasms
-Dec vision and photophobia
-Small, irregular pupil
-Cornea clear or slightly clouded
-Injection confined to corneal limbus
-Sarcoidosis, RA, Reiters, ankylosing spondyltis
Arcus senilis
-Hazy ring at edge of cornea where meets iris
-Composed of lipids deposited in periphery of cornea
-Common after 60, lipid disorder before 40
-Hazy ring at edge of cornea where meets iris
-Composed of lipids deposited in periphery of cornea
-Common after 60, lipid disorder before 40
Corneal abrasion
-May be secondary to infection, contacts, UV light, drugs, or blepharitis
-PAIN, photophobia, FB sensation, lacrimation, injection, possible dec vision
-Dx w/ fluorescein staining
-Tx / antibiotics (controversial), artificial tears
-May be secondary to infection, contacts, UV light, drugs, or blepharitis
-PAIN, photophobia, FB sensation, lacrimation, injection, possible dec vision
-Dx w/ fluorescein staining
-Tx / antibiotics (controversial), artificial tears
Corneal ulcer
-Red eye w/ predominantly circumcorneal injection
-May be purulent or watery d/c
-Pain, photophobia, tearing, reduced vision
-Tx w/ antibiotic eye drops, steroids if NOT bacterial
Herpes keratosis
-Viral infection of eye caused by herpes simplex virus
-Dendritic (branching) ulcer most characteristic manifestation
-Tx w/ debridement, patch, topic antivirals
Herpes zoster ophthalmicus
-Occurs when varicella-zoster virus reactivated in ophthalmic division of trigeminal nerve
-Malaise, fever, HA and periorbital burning and itching
-Tip of nose involvement predicts involvement of eye
-Tx w/ high dose acyclovir, valcyclovir w/in 72 hrs
-Occurs when varicella-zoster virus reactivated in ophthalmic division of trigeminal nerve
-Malaise, fever, HA and periorbital burning and itching
-Tip of nose involvement predicts involvement of eye
-Tx w/ high dose acyclovir, valcyclovir w/in 72 hrs of appearance
Kayser-Fleischer ring
-Circular band of brown pigment near limbus
-Associated w/ Wilson's disease, a disorder of copper metabolism
-Circular band of brown pigment near limbus
-Associated w/ Wilson's disease, a disorder of copper metabolism
Hyphema
-Layer of BLOOD visible in anterior chamber
-Caused by blunt trauma
-Refer immediately
-Layer of BLOOD visible in anterior chamber
-Caused by blunt trauma
-Refer immediately
Hypopyon
-PUS in anterior chamber
-May accompany corneal ulcer
-Refer immediately
-PUS in anterior chamber
-May accompany corneal ulcer
-Refer immediately
Astigmatism
-Type of refractive error of eye
-Front surface of cornea is curved more in one direction than other causing blurred vision
-Corrected by toric lens
Cataracts
-Gradually progressive blurred vision
-Clear lens becomes thicker, yellow and cloudy
-May see slight haze or blur over visual field w/ glare, halo or starburst
-Risks include aging, DM, HTN, sun, smokers, steroids
-Tx w/ removal using ultrasound devic
-Gradually progressive blurred vision
-Clear lens becomes thicker, yellow and cloudy
-May see slight haze or blur over visual field w/ glare, halo or starburst
-Risks include aging, DM, HTN, sun, smokers, steroids
-Tx w/ removal using ultrasound device
Strabismus
-Disorder in which eyes do not line up in same direction when focusing
-Involves lack of coordination between extraocular muscles
-Prevents bringing gaze of each eye to same point in space which affects binocular vision and depth perception
-Disorder in which eyes do not line up in same direction when focusing
-Involves lack of coordination between extraocular muscles
-Prevents bringing gaze of each eye to same point in space which affects binocular vision and depth perception
Esotropia
-Excessively convergent or medially deviated
-Most common type
-Tx w/ glasses, amblyopia tx, and sometimes surgery
Exotropia
-Excessively divergent or lateral deviation
-Tx w/ surgery, patch, glasses
Amblyopia
-Unilateral or bilateral impairment in visual acuity
-Affected during development and uncorrected by optics
-Leads to damage in visual pathway and visual loss
-Leading cause of monocular vision loss in people between 20-70
-Tx w/ patch
Presbyopia
-Farsightedness (impaired near vision)
-Defect in advancing years involving loss of accomodatio or recession of near point
-Due to loss of elasticity of lens
Myopia
-Nearsightedness (impaired far vision)
-Defect in vision in which parallel rays come to focus in front of retina
-Objects can only be seen distinctly when very close to eyes
Refractive error
-One corrected by glasses/lenses
Extraocular movements
-Controlled by integrated functions of CN III (oculomotor), IV (trochlear), VI (abducens)
-LR6SO4
Nystagmus
-Fast, uncontrollable movements of eyes
-May be side to side, up and down, or rotary
-Causes of acquired include MS, stroke, head trauma, Meniere's dz, labyrinthitis, brain tumor, drugs, etc
Hemianopia
-Decreased vision or blindness in half the visual field of one or both eyes
-Damage can result from acquired brain injuries caused by stroke, tumor, or trauma
-Occurs b/c of direct insult to eye via trauma or disease, damage to optic nerve, or damage to
-Decreased vision or blindness in half the visual field of one or both eyes
-Damage can result from acquired brain injuries caused by stroke, tumor, or trauma
-Occurs b/c of direct insult to eye via trauma or disease, damage to optic nerve, or damage to brain itself
Bitemporal hemianopia
-Visual loss involving temporal half of both fields
-Defect at optic chiasm (pituitary tumor)
Homonymous hemianopia
-Visual loss on same side of both eyes
-From tumor or stroke in occipital lobe
Glaucoma
-Third leading cause of blindness
-Optic nerve damage due to increased IOP 
- Pathologic cupping of optic disc 
-Insidious progressive bilateral loss of peripheral vision, resulting in tunnel vision but preserved visual acuities
-Tx w/ prostaglandin a
-Third leading cause of blindness
-Optic nerve damage due to increased IOP
- Pathologic cupping of optic disc
-Insidious progressive bilateral loss of peripheral vision, resulting in tunnel vision but preserved visual acuities
-Tx w/ prostaglandin analogs, laser therapy and surgery
Crescents
-Often seen around optic disc
-Normal developmental variations that appear as either white sclera, black retinal pigment, or both, especially along temporal border of disc
-Not part of disc itself and should not be included in estimate of disc diameter
-Often seen around optic disc
-Normal developmental variations that appear as either white sclera, black retinal pigment, or both, especially along temporal border of disc
-Not part of disc itself and should not be included in estimate of disc diameter
Retinal drusen
-Small, yellowish deposits that form w/in layers of retina
-Represents breakdown of photoreceptors
-May concentrate at posterior pole between optic disc and macula
-Increase in size or number raises risk of developing AMD
-Small, yellowish deposits that form w/in layers of retina
-Represents breakdown of photoreceptors
-May concentrate at posterior pole between optic disc and macula
-Increase in size or number raises risk of developing AMD
Diabetic retinopathy
-Microaneurysms, hemorrhages, exudates, and edema of retina
-Types include background, maculopathy, proliferative
-Tx w/ lasers to block development of new vessels and stop leaking vessels 
-Tight glucose control is best
-Microaneurysms, hemorrhages, exudates, and edema of retina
-Types include background, maculopathy, proliferative
-Tx w/ lasers to block development of new vessels and stop leaking vessels
-Tight glucose control is best
AV nicking
-Tapering of edges of vein as approaches artery
-Due to compression of vein at arteriovenous crossing
-Think HTN!!
-Tapering of edges of vein as approaches artery
-Due to compression of vein at arteriovenous crossing
-Think HTN!!
Papilledema
-Condition in which increased pressure in or around brain causes optic nerve to swell where enters eye
-Disc is swollen and margins blurred
-Caused by brain tumor or abscess, head injury, bleeding in brain, severe HTN, infection of brain
-Condition in which increased pressure in or around brain causes optic nerve to swell where enters eye
-Disc is swollen and margins blurred
-Caused by brain tumor or abscess, head injury, bleeding in brain, severe HTN, infection of brain
Cotton wool spots
-White or grayish, ovoid lesions w/ irregular "soft" borders
-Moderate in size but usually smaller than disc
-Result from infarcted nerve fibers
-Seen in HTN, DM, AIDS
-White or grayish, ovoid lesions w/ irregular "soft" borders
-Moderate in size but usually smaller than disc
-Result from infarcted nerve fibers
-Seen in HTN, DM, AIDS
Hard exudates
-Creamy or yellowish, often bright, lesions w/ well-defined "hard" borders
-Small and round but may coalesce into larger irregular spots
-Often occur in clusters or in circular, linear, or star-shaped patterns
-Causes include DM and HTN
-Creamy or yellowish, often bright, lesions w/ well-defined "hard" borders
-Small and round but may coalesce into larger irregular spots
-Often occur in clusters or in circular, linear, or star-shaped patterns
-Causes include DM and HTN
Central retinal vein occlusion
-Caused by hardening of vessels
-Blood and thunder fundus
-Caused by hardening of vessels
-Blood and thunder fundus
Central retinal artery occlusion
-Caused by embolisms
-Cherry red fovea
-Caused by embolisms
-Cherry red fovea
Retinal detachment
-Separation of light-sensitive membrane in back of eye (retina) from supporting layers
-PAINLESS, sudden loss of vision
-Flashing lights and new floaters may be sign of impending detachment
-Separation of light-sensitive membrane in back of eye (retina) from supporting layers
-PAINLESS, sudden loss of vision
-Flashing lights and new floaters may be sign of impending detachment
Macular degeneration
-Leading cause of blindness over age 60
-Progressive disease of retina wherein light-sensing cells in central area of vision (macula) stop working and eventually die
-Loss of detail vision, contrast sensitivity, relative/absolute scotoma
-Two types:
-Leading cause of blindness over age 60
-Progressive disease of retina wherein light-sensing cells in central area of vision (macula) stop working and eventually die
-Loss of detail vision, contrast sensitivity, relative/absolute scotoma
-Two types:
-Neovascular or "wet": more severe, some treatment
-Atrophic or "dry": most common, no treatment
-Tx w/ vitamins, drugs (AVEGF), surgery, rehab
Viral conjunctivitis
-Present: red, itchy eye w/ FBS x 1 week
-Adenovirus is the most common cause
       - Bilateral infection with copious watery d/c often with
         marked FBS and a follicular conjunctivitis
       -There may be pharyngitis, fever, malaise, and
-Present: red, itchy eye w/ FBS x 1 week
-Adenovirus is the most common cause
- Bilateral infection with copious watery d/c often with
marked FBS and a follicular conjunctivitis
-There may be pharyngitis, fever, malaise, and
preauricular adenopathy
-May also be due to herpes simplex virus (HSV)
– Usually unilateral infection
– May be associated with lid vesicles, and enterovirus
70 or coxsackievirus A24
-Tx w/ artificial tears
Bacterial (gonococcal) conjunctivitis
-Present: acute onset swollen eye, copious drainage
-Rapid onset of purulent drainage
-Tx w/ antibiotics such as topical fluoroquinolone or IM Ancef and poazithromycin
-Present: acute onset swollen eye, copious drainage
-Rapid onset of purulent drainage
-Tx w/ antibiotics such as topical fluoroquinolone or IM Ancef and poazithromycin
Traumatic iritis
-Present: eye pain, photophobia after bumping eye
-Ciliary flush, pupil asymmerty, pain, photophobia after trauma
-Tx w/ topical corticosteroic
-Present: eye pain, photophobia after bumping eye
-Ciliary flush, pupil asymmerty, pain, photophobia after trauma
-Tx w/ topical corticosteroic
Caput succedaneum
-Condition involving subcutaneous, extraperiosteal fluid collection w/ poorly defined margins
-Between scalp and periosteum
-Caused by pressure of presenting part of scalp against dilating cervix during delivery
-Condition involving subcutaneous, extraperiosteal fluid collection w/ poorly defined margins
-Between scalp and periosteum
-Caused by pressure of presenting part of scalp against dilating cervix during delivery
Cephalohematoma
-Hemorrhage of blood between skull and periosteum of newborn
-Between periosteum and skull bones
-Secondary to rupture of blood vessels crossing periosteum
-Hemorrhage of blood between skull and periosteum of newborn
-Between periosteum and skull bones
-Secondary to rupture of blood vessels crossing periosteum
Acute otitis media
-Bacterial infection of the mucosally lined air-containing spaces of the temporal bone
-Usually precipitated by a viral URI that causes eustachian tube obstruction, resulting in accumulation of fluid and mucus, which become secondarily infected by bacter
-Bacterial infection of the mucosally lined air-containing spaces of the temporal bone
-Usually precipitated by a viral URI that causes eustachian tube obstruction, resulting in accumulation of fluid and mucus, which become secondarily infected by bacteria
-Bacteriology: S pneumo, H flu, M catarrhalis
-Most commonly occurs 6 mths - 5 yrs
-Sx include fever, otalgia, irritability, otorrhea, red/bulging TM, cervical adenopathy
-Complications of TM perforation, mastoiditis, facial paralysis, hearing loss, impaired speech development
-Tx w/ high dose Amoxicillin, Amoxicillin/Clavulanate
Chronic otitis media
-Chronic infection of middle ear and mastoid as a consequence of recurrent acute otitis media
-Bacteriology: P aeruginosa, Proteus species, mixed anaerobes
-Purulent d/c with or without otalgia
-TM perforation with conductive hearing loss
-Tx w/ debri
-Chronic infection of middle ear and mastoid as a consequence of recurrent acute otitis media
-Bacteriology: P aeruginosa, Proteus species, mixed anaerobes
-Purulent d/c with or without otalgia
-TM perforation with conductive hearing loss
-Tx w/ debridement and topical antibiotic drops
Recurrent acute OME
-Repeted episodes of AOME w/ disease free intervals
-Tx w/ BMT
Chronic nonsuppurative OME
-Persistent non-infected middle ear fluid w/ hearing loss
-Tx w/ BMT
Acute otitis media w/ tympanostomy tubes
-Infection of inner ear in children w/ BMT tubes
-Risk factors include URI, EAC contamination, retained tubes
-Bacteriology: S aureus, P aeruginosa, a-hemolytic strep
-Sx include purulent otorrhea (no pus = no infection)
-Tx w/ ototopical antibiotics
-Infection of inner ear in children w/ BMT tubes
-Risk factors include URI, EAC contamination, retained tubes
-Bacteriology: S aureus, P aeruginosa, a-hemolytic strep
-Sx include purulent otorrhea (no pus = no infection)
-Tx w/ ototopical antibiotics such as fluoroquinolones (Ciprodex)
Acute otitis externa
-Inflammation of EAC
-Often hx of recent water exposure ("swimmer's ear") or mechanical trauma (eg, scratching, cotton applicators)
-Bacteriology: staph,  gram-negative rods (eg, Pseudomonas, Proteus) or fungi (eg, Aspergillus), which grow in the presen
-Inflammation of EAC
-Often hx of recent water exposure ("swimmer's ear") or mechanical trauma (eg, scratching, cotton applicators)
-Bacteriology: staph, gram-negative rods (eg, Pseudomonas, Proteus) or fungi (eg, Aspergillus), which grow in the presence of excessive moisture
-Painful erythema and edema of ear canal skin often with a purulent exudate
-Tx w/ removal of debris, reacidification, antibiotics, ototopicals
Chronic eczematoid otitis externa
-Flackey, itchy, weepy/moist EAC
-Usually related to eczema/psoriasis, too frequent q-tipping, astringents
-Tx w/ steroid containing ointment, lotion, or emollient
Fungal otitis externa
-White cheesy debris in EAC
-Often result of overuse of ototopical drops
-Tx w/ debridement, antifungals such as Lotrimin or Lotrisone
-White cheesy debris in EAC
-Often result of overuse of ototopical drops
-Tx w/ debridement, antifungals such as Lotrimin or Lotrisone
Malignant otitis externa
-Skull base osteomyelitis seen in immunocompromised pts
- Persistent foul aural discharge, granulations in the ear canal, deep otalgia
-Tx w/ prolonged antipseudomonal antibiotic administration
-Skull base osteomyelitis seen in immunocompromised pts
- Persistent foul aural discharge, granulations in the ear canal, deep otalgia
-Tx w/ prolonged antipseudomonal antibiotic administration
Herpes zoster oticus
-Shingles of the ear
-If associated w/ facial nerve paralysis called Ramsey Hunt Syndrome
-Tx w/ antivirals or corticosteroids
-Shingles of the ear
-If associated w/ facial nerve paralysis called Ramsey Hunt Syndrome
-Tx w/ antivirals or corticosteroids
Acute rhinosinusitis
-Defined as up to 4 weeks of purulent nasal drainage accompanied by nasal obstruction, facial pain, facial pressure, or fullness
-Bacteriology: S pneumo, H flu, M catarrhalis
-Must then distinguish between viral rhinosinusitis (VRS) and acute bacterial rhinosinusitis (ABRS)
-Viral Rhinosinusitis
-Sx present less than 10 days
-Sx are not worsening
-Acute Bacterial Rhinosinusitis
-Sx present 10 days or more beyond onset of
upper respiratory symptoms
-Sx worsen within 10 days after an initial
improvement
-Tx w/ decongestants/mucolytic, humidification/saline irrigation, antibiotic (AM/CL, cefuroxime 1 wk course)
Chronic rhinosinusitis
-Inflammatory condition of nasal cavity and paranasal sinuses lasting for longer than 12 weeks
-Believed to be multifactorial, resulting from interactions between host anatomy, genetics, and the environment
-Bacteriology: S aureus, gram negs, anaerobic, polymicrobial, fungal
-Sx include nasal obstruction, facial congestion-pressure-fullness, discolored nasal d/c, fatigue and myalgias
-Tx w/ antibiotics (4-6 wks) + nasal steroid, humidification/mucolytic
Pediatric sinusitis
-Sx include coryza, congestion, LGFs, poor sleep
-Usually an acute nasopharyngitis (adenoiditis) or URI
-Tx w/ nasal suctioning and irrigation, decongestants, mucolytics, surgery if failure to improve
Darwin's tubercle
-Thickening along upper ridge of helix
-A normal variation
-Thickening along upper ridge of helix
-A normal variation
TOPHI
-Small whitish uric acid crystals along peripheral margins of auricles
-Associated w/ gout
-Small whitish uric acid crystals along peripheral margins of auricles
-Associated w/ gout
Keloid
-Progressive enlargement of scar by xs collagen formation during healing
-Deformations of ear have high correlation to renal anomalies
-Progressive enlargement of scar by xs collagen formation during healing
-Deformations of ear have high correlation to renal anomalies
Cauliflower ear (perichondral hematoma)
-Initially caused by blunt trauma to ear and left untreated, turns to scar tissue and calcifies
-Starts as hematoma--if not drained, necrose then scar
-Initially caused by blunt trauma to ear and left untreated, turns to scar tissue and calcifies
-Starts as hematoma--if not drained, necrose then scar
Seborrheic dermatitis
-Dry scales and underlying erythema behind ear
-Caused by pityrosporum ovale
-Tx w/ shampoos containing salicylic acid, coal tar, zinc, resorcin, ketoconazole, or selenium
-Dry scales and underlying erythema behind ear
-Caused by pityrosporum ovale
-Tx w/ shampoos containing salicylic acid, coal tar, zinc, resorcin, ketoconazole, or selenium
Mastoiditis
-Postauricular pain, fever and outwardly displaced pinna
-Mastoid often appears swollen and red
-Consequence of middle ear infection
-Tx w/ myringotomy and IV antibiotics
-Postauricular pain, fever and outwardly displaced pinna
-Mastoid often appears swollen and red
-Consequence of middle ear infection
-Tx w/ myringotomy and IV antibiotics
Battle's sign
-Periauricular ecchymoses
-Seen several days after basilar skull fracture
-Periauricular ecchymoses
-Seen several days after basilar skull fracture
TM perforations
-Small holes in TM membrane
-Caused by direct trauma, infection, loud noise, flying, diving
-Never irrigate and avoid swimming and getting water in ears
-Small holes in TM membrane
-Caused by direct trauma, infection, loud noise, flying, diving
-Never irrigate and avoid swimming and getting water in ears
Bullous myringitis
-Painful hemorrhagic vesicles on TM, canal, or both
-Associated earache, blood tinged d/c, and conductive hearing loss
-Caused by mycobacterium pneumonia
-Tx is primarily pain control
-Painful hemorrhagic vesicles on TM, canal, or both
-Associated earache, blood tinged d/c, and conductive hearing loss
-Caused by mycobacterium pneumonia
-Tx is primarily pain control
Serous effusion
-Air bubbles in middle ear w/ or w/o hearing impairment, pain
-Caused by Eustachian tube dysfunction, resolving bacterial OM, allergies, large adenoids
-Tx w/ antibiotics, antihistamines, decongestants
-Air bubbles in middle ear w/ or w/o hearing impairment, pain
-Caused by Eustachian tube dysfunction, resolving bacterial OM, allergies, large adenoids
-Tx w/ antibiotics, antihistamines, decongestants
Cholesteatoma
-Squamous epithelium in middle ear or mastoid
-Most often result of untreated OM
-Purulent otorrhea, conductive hearing loss, tinnitus, mild vertigo
-Retraction of TM with a squamous debris collection or a whitish mass behind an intact TM
-Tx w/ debri
-Squamous epithelium in middle ear or mastoid
-Most often result of untreated OM
-Purulent otorrhea, conductive hearing loss, tinnitus, mild vertigo
-Retraction of TM with a squamous debris collection or a whitish mass behind an intact TM
-Tx w/ debridement and ototopical antibiotics
Conductive hearing loss
-Results from dysfunction of external or middle ear
-Loss of air conduction
-There are four mechanisms, each resulting in impairment of the passage of sound vibrations to inner ear:
(1) obstruction (eg, cerumen impaction, foreign body)
(2) mass loading (eg, middle ear effusion, OM)
(3) stiffness effect (eg, otosclerosis)
(4) discontinuity (eg, ossicular disruption, TM perforation)
-Weber test: sound lateralizes to impaired ear
-Tx w/ cleaning, myringotomy w/ tubes, bone conduction hearing aid
Sensorineural hearing loss
-Results from deterioration of cochlea, usually due to loss of hair cells from organ of Corti
-Loss of bone AND air conduction
-Loss may be congenital (present at birth) or acquired
-In both congenital and acquired categories, hearing loss may be either hereditary (due to a genetic mutation) or nonhereditary
-Most common form is a gradually progressive, predominantly high-frequency loss with advancing age (presbyacusis)
-Additional common causes include Connexin 24 & 26, meningitis, aminoglycosides
-Weber test: sound lateralizes to unaffected ear
-Tx w/ amplification, cochlear implant (direct stim of cochlea)
Rhinophyma
-Hypertrophy of nose w/ follicular dilation
-Results from hyperplasia of sebaceous glands w/ fibrosis and increased vascularity
-End stage of roscea
-Hypertrophy of nose w/ follicular dilation
-Results from hyperplasia of sebaceous glands w/ fibrosis and increased vascularity
-End stage of roscea
Nasal hematoma
-Potentially serous complication of nasal fracture
-Can cause necrosis of septum secondary to pressure and low vascularity of septum
-Tx w/ immediate drainage by ENT and antibiotics to prevent septal abscess
-Untreated can lead to saddle nose deformity
-Potentially serous complication of nasal fracture
-Can cause necrosis of septum secondary to pressure and low vascularity of septum
-Tx w/ immediate drainage by ENT and antibiotics to prevent septal abscess
-Untreated can lead to saddle nose deformity
Nasal fracture
-Most common facial fracture
-Sx include deformity, tenderness, hemorrhage, edema (can mask underlying deformity, crepitation, instability)
-Untreated can lead to cosmetic deformity and impaired nasal function
Sudden onset HL
-Unilateral sensorineural HL of greater than 30 dB over 3 contiguous pure tone frequencies
-Caused by labyrinthine viral infection, labyrinthine vascular compromise, intracochlear membrane rupture, idiopathic
-No standart treatment; spontaneous recovery in 47-63%
Noise induced HL
-Most common preventable cause of hearing loss
-Occurs when 25-30% of hair cells are lost
-Can be caused by one time event or continued/repetitive exposure
Presbycusis
-Most common type of sensorineural hearing loss
-Progressive bilateral symmetrical age-related sensorineural hearing loss
-Tends to affect high frequencies more
-Tx w/ hearing aids, cochlear implants, portable amplifiers, etc
Vestibular deficits
-Associated condition of hearing loss
-Low muscle tone, "snuggly" baby, arching of back, delayed disappearance of newborn reflexes
Angioedema
-Swelling of lips
-Allergic rxn, meds, etc
-Swelling of lips
-Allergic rxn, meds, etc
Cheilitis
-Dry, cracked lips
-Due to dehydration, dentures/braces, excessive lip licking, sun/wind exposure
-Angular (only on corners) or perl'eche (fungal or vitamin deficiency)
-Dry, cracked lips
-Due to dehydration, dentures/braces, excessive lip licking, sun/wind exposure
-Angular (only on corners) or perl'eche (fungal or vitamin deficiency)
Chelosis
-Deep fissures at corners of mouth
-Can be seen w/ poorly fitting dentures, lip licking, rarely Riboflavin deficiency
-Deep fissures at corners of mouth
-Can be seen w/ poorly fitting dentures, lip licking, rarely Riboflavin deficiency
Herpes labialis
-Painful recurrent vesicular and ulcerative lesions of mouth and tongue
-Caused by herpes virus, usually type 1 
-Tx w/ acyclovir or valcyclovir
-Painful recurrent vesicular and ulcerative lesions of mouth and tongue
-Caused by herpes virus, usually type 1
-Tx w/ acyclovir or valcyclovir
Peutz Jegher syndrome
-Melanin spots on lip
-Associated w/ multiple polyps of intestine
-High risk for colon and small bowel cancer
-Melanin spots on lip
-Associated w/ multiple polyps of intestine
-High risk for colon and small bowel cancer
Pyogenic granuloma
-Frequently appear following injury, during prego, while taking OCPs
-Can bleed easily
-Tx w/ electrocautery, lasers, freezing, excision
-Frequently appear following injury, during prego, while taking OCPs
-Can bleed easily
-Tx w/ electrocautery, lasers, freezing, excision
Strawberry hemangioma
-Swelling or growth of endothelial cells lining blood vessels
-Children are born with
-May resorb or can be excised
-Swelling or growth of endothelial cells lining blood vessels
-Children are born with
-May resorb or can be excised
Cleft lip
-Congenital deformity caused by abnormal facial development
-Can affect muscles in nasopharynx and Eustachian tube
-Multifactorial inheritance
Squamous cell cancer
-Most common form of oral cancer
-Thickened plaque, ulcer, or warty growth usually involving lower lip
-Most common form of oral cancer
-Thickened plaque, ulcer, or warty growth usually involving lower lip
Mucocele
-Painless, thin sac on the inner surface of the lips containing clear fluid
-Caused by traumatic rupture of mucous gland
-Tx w/ laser ablation or total excision
-Painless, thin sac on the inner surface of the lips containing clear fluid
-Caused by traumatic rupture of mucous gland
-Tx w/ laser ablation or total excision
Aphthous ulcer
-AKA canker sore 
-Most common oral mucosa lesion
-Shallow, recurrent white, round or oval ulcerative lesion w/ red halo and pseudomembrane
-Tx w/ tetracycline rinse, kenalog, lidocaine, zine lozenges
-AKA canker sore
-Most common oral mucosa lesion
-Shallow, recurrent white, round or oval ulcerative lesion w/ red halo and pseudomembrane
-Tx w/ tetracycline rinse, kenalog, lidocaine, zine lozenges
Salivary gland tumor
-80% involve parotid and are benign (pleomorphic adeomas)
-Slow growing, painless masses
-Malignant masses most commonly Mucoepidermoid carcinomas
-80% involve parotid and are benign (pleomorphic adeomas)
-Slow growing, painless masses
-Malignant masses most commonly Mucoepidermoid carcinomas
Candidiasis
-Creamy white, curdlike patches which rub/scrape off w/ friable base
-Caused by Candida albicans
-More common after antibiotic use, immunosuppresses, infants, DM, chronic steriods
-Tx w/ nystatin oral suspension or chlotrimazole troches
-Creamy white, curdlike patches which rub/scrape off w/ friable base
-Caused by Candida albicans
-More common after antibiotic use, immunosuppresses, infants, DM, chronic steriods
-Tx w/ nystatin oral suspension or chlotrimazole troches
Lichen planus
-White, reticulated or lacelike lesions
-Can be painful, bilateral
-Autoimmune
-Tx w/ steroids
-White, reticulated or lacelike lesions
-Can be painful, bilateral
-Autoimmune
-Tx w/ steroids
Koplik spots
-White specks w/ redbase opposite 1st/2nd molars
-Associated w/ measles (ribeola)
-White specks w/ redbase opposite 1st/2nd molars
-Associated w/ measles (ribeola)
Torus palatinus
-Bony protuberance at midline
-No clinical significance unless not midline
-Bony protuberance at midline
-No clinical significance unless not midline
Palatal lesions
-Adenocarcinoma of palate
-Palatal cyst
-Adenocarcinoma of palate
-Palatal cyst
Kaposi sarcoma
-Red to purple nodules, macules or papules
-Type of CA
-Increased incidence secondary to AIDS
-Red to purple nodules, macules or papules
-Type of CA
-Increased incidence secondary to AIDS
Strep pharyngitis
-Abrupt onset of sore throat, fever, malaise, nausea, and headache
-Throat red and edematous, with or without exudate; cervical nodes tender
-Caused by group A beta-hemolytic strep
-Tx w/ penicillin, macrolide, cephalosporin
-Abrupt onset of sore throat, fever, malaise, nausea, and headache
-Throat red and edematous, with or without exudate; cervical nodes tender
-Caused by group A beta-hemolytic strep
-Tx w/ penicillin, macrolide, cephalosporin
Peritonsillar abscess
-Infection of tissue between tonsils and pharynx
-Trismus and "hot potato" voice
-Red swollen tonsils, tonsillar pillars and soft tissue adjacent to soft palate
-Tx w/ I&D or tonsillectomy
-Infection of tissue between tonsils and pharynx
-Trismus and "hot potato" voice
-Red swollen tonsils, tonsillar pillars and soft tissue adjacent to soft palate
-Tx w/ I&D or tonsillectomy
Mononucleosis
-Fever, sore throat, exudative pharyngitis, uvular edema, tonsillitis, or gingivitis may occur and soft palatal petechiae may be noted
-Caused by EBV
-Tx is symptomatic
-Fever, sore throat, exudative pharyngitis, uvular edema, tonsillitis, or gingivitis may occur and soft palatal petechiae may be noted
-Caused by EBV
-Tx is symptomatic
Epstein pearls
-Retention cysts
-Small whitish, yellow masses on alveolar gingiva or junction of hard/soft palates
-Found in infants and disappear w/in few weeks after birth
-Retention cysts
-Small whitish, yellow masses on alveolar gingiva or junction of hard/soft palates
-Found in infants and disappear w/in few weeks after birth
Gingivitis/periodontitis
-Erythematous, bleeding, bulbous, edematous
-Most common cause is plaque
-Also phenytoin, OCs, calcium channel blockers
-Erythematous, bleeding, bulbous, edematous
-Most common cause is plaque
-Also phenytoin, OCs, calcium channel blockers
Gingival hyperplasia
-Enlargement of gingiva
-Can be due to leukemia, dilantin therapy
-Enlargement of gingiva
-Can be due to leukemia, dilantin therapy
Caries
-Discoloration or erosion of crown or base of teeth
-Often painful to percussion
-Discoloration or erosion of crown or base of teeth
-Often painful to percussion
Notched teeth
-Hutchinson's teeth from congenital syphilis
-Hutchinson's teeth from congenital syphilis
Dental abscess
-Red, fluctuant tender swelling of gingiva
-Starts w/ infection of pulp that can occur in one of three ways:
(1) Defect in enamel and dentin
(2) Periodontal pocket
(3) Hematogenous seeding of pulp that has been irritated mechanically
-Tx w/ antibioti
-Red, fluctuant tender swelling of gingiva
-Starts w/ infection of pulp that can occur in one of three ways:
(1) Defect in enamel and dentin
(2) Periodontal pocket
(3) Hematogenous seeding of pulp that has been irritated mechanically
-Tx w/ antibiotics to fight infection
Meth mouth
-Characterized by broken, discolored and rotting teeth
-Drug causes salivary glands to dry out, which allows mouth's acids to eat away to tooth enamel
-Vasoconstriction and tissue necrosis in moutn
-Characterized by broken, discolored and rotting teeth
-Drug causes salivary glands to dry out, which allows mouth's acids to eat away to tooth enamel
-Vasoconstriction and tissue necrosis in moutn
Geographic tongue/benign migratory glossitis
-Scattered smooth red areas that are denuded papillae
-Condition is benign
-Scattered smooth red areas that are denuded papillae
-Condition is benign
Leukoplakia
-Painless, white plaques that will NOT rub off
-Pre-cancerous
-Painless, white plaques that will NOT rub off
-Pre-cancerous
Varicosities
-Usually seen on ventral surface of tongue
-Blanche w/ pressure
-Usually seen on ventral surface of tongue
-Blanche w/ pressure
Glossitis
-Tongue swelling.
-Smooth appearance to the tongue due to pernicious anemia (Vitamin B12 Deficiency).
-Tongue color changes (usually dark "beefy" red).
-Sore and tender tongue.
-Difficulty with chewing, swallowing, or speaking
-Tongue swelling.
-Smooth appearance to the tongue due to pernicious anemia (Vitamin B12 Deficiency).
-Tongue color changes (usually dark "beefy" red).
-Sore and tender tongue.
-Difficulty with chewing, swallowing, or speaking
Condyloma
-Oral lesion (wart) on tongue
-HPV virus
-Oral lesion (wart) on tongue
-HPV virus
Hairy tongue
-Yellow-brown to black elongated filliform papillae on dorsum
-Overgrowth of yeast of bacteria
-Can be associated w/ antibiotic therapy, malnutrition, Pepto bismol, smoking, excess coffee
-Yellow-brown to black elongated filliform papillae on dorsum
-Overgrowth of yeast of bacteria
-Can be associated w/ antibiotic therapy, malnutrition, Pepto bismol, smoking, excess coffee
Oral hairy leukoplakia
-Corrugated or hairy raised nonpainful white lesions on lateral sides of tongue
-Associated w/ EBV
-Corrugated or hairy raised nonpainful white lesions on lateral sides of tongue
-Associated w/ EBV
Strawberry tongue
-Enlarged red papillae on tongue
-Associated w/ Scarlet fever
-Enlarged red papillae on tongue
-Associated w/ Scarlet fever
Fissured (scrotal) tongue
-Benign condition characterized by deep grooves (fissures) in the dorsum of the tongue
-Appears w/ advanced age, benign
-Benign condition characterized by deep grooves (fissures) in the dorsum of the tongue
-Appears w/ advanced age, benign
Macroglossia
-Enlargement, hypertrophy of tongue
-Associated w/ hypothyroidism, Down syndrome
-Enlargement, hypertrophy of tongue
-Associated w/ hypothyroidism, Down syndrome