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132 Cards in this Set
- Front
- Back
What is the time frame for the best prognosis of reimplanted avulsed teeth?
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30 mins
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what are the antibiotics given after reimplantation of avulsed teeth?
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PCN or Amox for 7-10 days
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what is the most common complication of bites?
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infection
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what type of bite are the biggest worry to parents?
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rabies
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when is infection most likely to occur following a bite?
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1. delay in treatment > 24 hours 2. puncture wounds 3. hand wounds
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what are the general management for bites?
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1. cleaning 2. moderate pressure irrigation 3. debride devitalized tissue 4. suturing: controversial 5. antibiotics 6. rabies 7. tetanus 8. careful follow up
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what are the agents to cause infection for human bites?
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Eikenella corrodens, staph aureas, strep species
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what are the pathogens to cause infection after cat/dog bite/
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s. aureaus, pastuerlla, strep, rabies
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what are the 2 drugs given for rabies protocol?
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1. Human Immune Globulin (HRIG) @ 20 IU/kg: .5 dose into the wound and .5 dose IM 2. Human diploid cell vaccine (HDCV): 1cc days 0,3,7,14 and 28
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what are the agents to cause conjunctivitis in neonates < 24 hours?
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chemical
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what is the common agent to cause conjunctivities in neonates < 1 week old? 1-2 weeks?
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N. gonorrhea; chlamydia
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what are the agents to cause conjuct in infants/toddlers w/o otitis
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h. flu, strep pneumo, b. catarrhals
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what are the agents to cause conjunct in school age?
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HSV, varicella, viral
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which age often get conjucntivitis from allergic causes?
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school age and adolescents
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what are the characteristics of bacterial conjunctivitis?
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neonates and toddlers; purulent discharge; 1+ to 3+ amount of dc;; 3+ injection; occasional lymphadenop; otitis media often seen; tx with abx
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what are the characteristics of viral conjunct?
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school age to adults; watery dc; 1+ to 2+ dc; 2+ injection; common lymphadenop; pharyngitis and URI associated; tx with artificial tears and acyclovir
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describe allergic conjunctivitis.
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seen in late childhood early adult; 1+ mucoid discharge; 1+ injection; no lymphadenop; associated with rhinitis, asthma, eczema; tx with antihistamines; decongest; mast cells; and NSAIDs
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what is the most common virus to cause conjunct?
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adenovirus
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which pathogen causes pre-auricular lymphaden?
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h. flu
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what are the characteristics of h. flu conjucnt?
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1. conjunctivitis and otitis 2. pre-auricular nodes 3. fever 4. URI
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what are the characteristics of bact conjunct?
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1. younger children 2. fever +/- 3. papillary response 4. bilateral 5. purulent dc
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what are the common adenoviruses to cause conjunct?>
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3,4, and 7
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what are the differentials for conjunctivitis?
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dacriostenosis, corneal abrasion, gluacoma, herpes blepharitis, iritis
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what are the anticipatory guidance for conjunct?
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contagion, spread, medication admin, SxS of periorbital cellulitis, ointment cause temp blurry vision
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what are the PE findings for allergic response in the eyes?
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intense itching; conjunctival chemosis and hyperemia, tearing, rhinnorhea, unliateral/bilateral signs
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what are the findings for a chemical reaction in the eye?
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hyperemia of conjunctivae; tearing; hx of exposure to the agent
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what are the management options for allergic conjunct?
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cool compress; ID and avoid allergen; topical anti-inflammatory agent (Acular); mast cell stabilizer (Alomide); systemic antihistoamines; zxyrtec, claritin, benadryl
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what is the tx for chlamydia conjunct in the neonate?
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PO erythro qid for 14 days, no eye ointment, same tx for chlamydial pneumonia
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what is the tx for GC conjunct in the neonate?
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admit; flushing out of the eyes, ceftriaxone IV
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which usually occurs within the first week of life, chlamydia or GC conjunct?
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GC
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what symptoms of conjunctivitis should have a ophthalmology referral?
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1. suspicion of herpes 2. no response to tx in 3-5 days 3. pain, severe photophobia, decrease in vision 4. pupillary abnormalities 5. unable to examine well
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___ account for almost 70% of all ocular injuries
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boys
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boys between ages 11 to 15 are the most vulnerable to occular injury with a __ to __ ratio compared to girls
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4 to 1
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what are the hx components to an eye injury?
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mechanism of injury; coexisting systemic disease?; allergy? Tetanus status
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what is the first goal of the eye exam with eye trauma?
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rule out open globe
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what are the signs of an open globe?
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chemosis, peaked pupil; vitreous hemorrhage
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the vision exam following an eye injury should occur ___ eye at a time
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one
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what does the lack of a red light reflex mean after an eye injury?
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possible retinal detachment
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what must occur if a chemical injury occurs to the eye?
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MUST provide copious irrigation before history and physical
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visual acquity is considered the __ __ of the eye
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vital signs
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describe the fluorescein exam
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use topical anesthetics, tetracaine (onset of action <1min) or proparacaine (<20secs); apply sterile fluourescein eye strips with saline or anesthetic used with woods light or cobalt blue light
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when is the slit lamp exam done?
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used for anterior chamber looking at the cornea, intraocular pressure and evaluating for foreign bodies
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what is the benefit of the dilated eye exam?
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allows the slit lamp exam to be used to view the posterior globe as well (the retina, optic nerve, blood vessels and the macula)
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what is the radiologic study of choice for an eye injury?
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ct scan
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what are the presenting symptoms of a corneal abrasion?
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pain, tearing, photophobia, FB sensation
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what is the tx for corneal abrasion?
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topcial abx drops; pain meds and NO PATCHING
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what is important to do if you suspect a conjuctival/corneal FB?
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evert the eyelid using a qtip
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what are the common corneal/conjunctival FBs?
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dust, dirt, or metallic silvers
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metallic FBs can leave a __ __ in the cornea
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rust ring
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what type of abrasion is characteristic of a FB under the eyelid?
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linear abrasion
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corneal/scleral lacerations are usually caused by?
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penetrating or blunt trauma
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what is the most important PE component with a corneal/scleral laceration?
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visual acuity
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what should be done in the ED for a scleral/corneal laceration?
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1. visual acuity 2. shield the eye and call optho 3. cycloplegics used to relieve ciliary muscle spasms (can cause tissue prolapse) 4. tetanus shot 5. IV antibiotics 6. CT if you think the FB pierced through the cornea
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what are the ED management for a lid laceration?
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1. eye exam 2. tetanus prophylax 3. wound closure if superficial lac
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what are the determinants for an ophtho referral from a lid lac?
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1. involves the medial 1/3 of the lid (canaliculi injury) 2. lid margins (tarsal plate) 3. levator palpebra muscle (ptosis may develop)
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what are the symptoms of a globe rupture?
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pain, decreased vision, diplopia
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what are the signs of a globe rupture?
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teardrop pupil, prolapsed iris, hyphema
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what are the PE steps for a possible globe rupture?
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Focused: visual acuity (how many fingers or light perception); EOMs examined for entrapment
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what is the goal of ED management of globe rupture?
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to prevent increased in IOP
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what is the management for globe rupture in the ED?
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1. shield the eye 2. pain relief 3. antiemetics 4. NPO 5. Tetanus 6. broad spec abx (ancef/ceftraz/vanco) 7. stool soft 8. ophtho consult
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what are the symptoms of orbital floor fractures?
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eyelid swelling and bruising; enophthlamos "sinking I" of the affected eye; ptosis; diplopia; anesthesia of the cheek; inability to move the eye upward
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what are the images done for orbital fracture?
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orbital CP and plain films may be helpful
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what are the 3 views used on plain film for an orbital fracture?
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Water's; caldwell and lateral views
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when is surgery most often done following an orbital fracture?
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after 7-14 days
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what are the indications for surgery following an orbital fracture?
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entrapment; facial hypoesthesia; symptomatic diplopia w/ minimal improvement over time; large floor fracture leading to enophthalmos
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what should you tell a pt do avoid after an orbital fracture?
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blowing their nose
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what is a hyphema?
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blood in the anterior chamber
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how do hyphemas usually occur?
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blunt, projectile or penetrating trauma
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the majority of hyphemas have less than 50% of the __ __ filled with blood
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anterior chamber
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what are the SxS of hyphema?
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pain, decreased vision, injection, irregular appearing pupil
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what is a grade 1 hyphema?
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layered blood occupying less than 1/3 of the anterior chamber
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what is the grade of a hyphema that have blood filling 1/3 - 1/2 of the anterior chamber?
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2
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what is a grade 3 hyphema?
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layered blood filling .5 to less than the total anterior chamber
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what is grade 4 hyphema? What are the other names?
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total clotted blood, often referred to as blackball or 8-ball hyphema
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what is the major complication of hyphema?
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secondary hemorrhage (rebleeding)
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what is the cause of rebleeeding in hyphema?
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lysis and retraction of the clot and fibrin aggregates
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when is the highest risk of rebleeding for hyphema?
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in the first 5 days
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what is the average rate of rebleeding for hyphema? Who is at greatest risk?
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25% and those under age 6
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ToF: 100% visual acuiity is regained following a hyphema?
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false: nearly 80% regain acuity to only 20/40
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what is the management for hyphemas>?
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1. elevate head of bed 2. eye shield 3. pain control 4. topical cycloplegics 5. topical miotics 6. topical vs systemic AMICAR 7. topical vs systemic steroids 8. sickle cell prep
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what are the SxS of retrobulbar hemorrhage?
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acute proptosis, subconjunctival hemo, decreased vision, pain limitation of ocular movement
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what is the management for retrobulbar hemorrhage?
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immediate ophtho consult, IV mannitol, IV steroids, lateral canthotomy (by experienced person)
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what is the key in the management of ocular chemical burns?
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No H&P…COPIOUS IRRIGATION until pH is neutral near 7. use 1 -2 liters of NS.
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why are chemical burns to the eye so bad? Describe acid and alkaline
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Acid burns cause coag necrosis and denature surface proteins but usuallys don't penetrate the eye. Alkaline are more serious becaues they rapidly penetrate the cornea and anterior chamber causing liquefication necrosis.
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what are examples of alkaline agents that can burn the eye?
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Lye, cement cleaner, drain cleaner, fertilieer, sparklers, and firecrackers.
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what is the name of the tool used to treat ocular chemical burns?
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the morgan lens
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where do chalazia often occur?
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in the lid
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which of the sinuses are presnet at birth?
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maxillary and ethmoid
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what is the most common site for sinusitis?
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ethmoid sinus
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the __ sinus moves to position at 5-6 years of age and not developed until late adolecsence.
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frontal
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the __ sinus are not a frequent site of infection but are common for CNS spread
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frontal
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what are the common organisms to cause sinusitis?
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strep pneumo, H. flu, M. Catarrhalis, strep aureas (chronic sinusitis)
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what are the 2 common presentations of acute sinusitis?
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persistent and severe
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what is the classification of persistent sinusitis?
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resp symptoms for > 10 days and < 30 days, 10 days of resp symptoms without improvement, any form of nasal discharge, cough worse at night, malodorous breath, rare facial pain and headache,+/- fever
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what are the characteristics of severe sinusitis?
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cold that is more severe than usual, combo of high fever and purulent nasal idscharge, and combo lasting 3-4 days= bacterial infection in paranasal sinuses
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what is the chronic sinusitis?
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nasal symptoms for > 30 days without getting better, cough: worse at night, sorethroat, nasal dc of any type, headache not common and fever is rare
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what are the criteria for CT scan for sinustis?
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toxic appearance, proptosis, impaired vision, limited eoms, severe facial pain, swelling of forehead or eyes, adolesecents with risk of frontal sinusitis
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what is the tx for sinusitis?
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amoxil 60-90 mg/kd, augment 45/10/mg/kd, Pediazole, Bactrim, Cefuroxime, 10 dyas vs 14 days- 10 days then until no more symtpomss for 7 more days
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do antihistamines work for sinusitis?
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they don't hurt but are controversial
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what is the #1 and 2 cause of preseptal and orbital cellulitis?
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1: sinusitis 2: eyelid lesion
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what age group is more common to have bacteremia from orbital cellulitis?
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< 2 yrs
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what is the #1 sinus to be involved with orbital cellulitis in children?
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ethmoid sinusitis
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what are the risk factors for orbital cellulitis?
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hx of sinusitis, periorbital inflammation, trauma, dacrycystisis, dental abscess
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__% of children with preseptal or obital cellulits will have fevers
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75
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ToF: chemosis is useful in differentiating preseptal from orbital cellulitis
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false, it occurs in both
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what are the infectious causes of preseptal cellulitis?
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1. conjunctivitis, 2. herdeolum 3. chalazion, 4. dacryocystisi, 5. bacerial cellulitis
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ToF: preseptal cellulits never has proptosis
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TRUE
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are the eoms in tact in preseptal cellulitis?
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yes
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does ptosis occur in preseptal cellulitis?
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yes
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what is the management of preseptal?
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must ro orbital, cbc, blood cx, < 3 yrs hospitalize, abx (cetriazone, ceuroxime, aug) *** dialy followup
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what is the age group of orbital?
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usually > 5 ys
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tof: orbital cell rarely spreads from adjacent sinuses
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false, nearly always
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what are the rare causes of orbital?
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trauma, eye surgery, dental infections
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what are the characteristics of orbital?
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mod to severe eyelid edema, ptosis, proptosis, conjunctiva hyperemia, chemosis, diplopia
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what are the Sxs of orbital?
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pain on movement, decrease eoms, altered visual acuity, dilated pupil, fever, toxic appearance
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what are the clinical findings that differentiate orbital from preseptal?
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decreased and painful eoms with proptosis
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what type of FB must be removed before returning home?
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nasal fb
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what are the causes of nasal bleeds?
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infection, dry heat, nose picking
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what is the management of nose bleeds?
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lean forward, mild pressure, do not use clothes pin or tongue blades
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what are the types of congenital masses of the neck?
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1. 1st, 2nd and 3rd branchial cleft cysts 2. thyroglossal, 3. cystic hygroma 4. hemangioma 5. dermoid cysts 5 venous malformation
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what are the common causes of cervical adenitis?
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usually bacterial: staph a. most common, then group a strep
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what is the tx for cervical adenitis?
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2 abx: systemic penicillin, and first gen ceph follow up 24-36 hours and admit if they get worse
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what is the definition of AOM?
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is an infectious process of the middle ear cleft and to a variable extent of the mastoid air cell system
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what are the most common causes of AOM?
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strep pneumo, H flu, morax catarrh, p hemolytic strep, psuedo aeruginosa
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what are the symps of AOM?
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fever, otalgia, fullness, hearing loss
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what is the management of AOM?
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abx therapy, traditional duration 10-14 days, now 5-7 days,
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what is the management for perfed TM?
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Floxicin otic drops OR PO abx, may take weeks
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what is the definition of acute mastoiditis?
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an infection of the mastoid characterized by diffuse osteitis followed by rarefaction and breakdown of the bony septae
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when is the mastoid bone mature?
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age 4
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what are the symptoms of acute mastoiditis?
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may follow AOM, otalgia, aural discharge, conductive hearing loss, fever
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what are the physical findings of mastoiditis?
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fever, otorrhea, pulsatile, tympanic perf, welling of superior TM, postauricular aura: erythema and tenderness, pitting edema, obliteration of the postauricular crease
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what is the management of acute mastoiditis?
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abx: IV therpary should be maintained for at least 24-48 hours after resolution of symptoms, then oral abx for 2 weeks, treated like an osteo, emergency surgery (simple mastoidectomy, + ventilation tube)
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