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Question | Answer |
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How long to rinse chemical burns to eyes? | 30 minutes with normal saline |
How to detect corneal abrasion? | stain with fluorescein and observe area of uptake with wood's lamp. |
What bones make up the orbital floor? | maxillary, palatine, and zygomatic |
How does a blow-out orbital fracture present? | swelling, misalignemtn, restricted globe movement (especially looking up), double vision, sub-q emphysema and exopthalmos. Should be sent immediately. |
How does a corneal abrasion present? | painful eye, photophobia, tearing, injection, and blepharospasm. Make sure you record visual acuity before. Can use anestetic in office. Give abx ointment and f/u 1-2 days is a must. |
How does a retinal detachment present? | partial to complete monocular blindness; curtain from top to bottom. Emergency consult is needed with good prognosis. |
How does macular degeneration present? | gradual loss of central vision. Amslers grid may be helpful in diagnosis. Drusen deposits on Bruch's membrane. Wet and dry types. laser therapy may help early on. |
How does retinal artery occlusion present? | sudden painless unilateral loss of vision often caused by embolism. This is an emergency with poor prognosis. Vessel dilation and paracentesis are emergent therapies. Cholesterol mgmt is long term. |
How does central retinal vein occlusion present? | usually secondary to thrombotic event. Similar sudden, unilateral, painless blurred vision or complete visual loss. Blood and thunder retina on examination. |
What drugs are linked to macular degeneration? | chloroquine and phenothiazine |
What drugs are linked to causing cataracts? | corticosteroids and lovastatin |
How do cataracts present? | opacification of lens of eye which is often due to old age. Complaints of double vision, fixed spots, or reduced color perception. Lens appears yellowish and cataract appears black on red background of fundo exam. Tx is lens replacement. |
How does closed-angle glaucoma present? | painful unilateral loss of vision with steamy cornia, fixed mid-dilated pupil and decreased visual acuity. IOP is elevated and patients often n/v. Emergency consult needed. Give IV carbonic anhydrase inhibitor, topical b-blocker and osmotic diuresis. |
What should you NOT give to closed-angle gluacoma patients? | mydriatics |
What causes closed-angle glaucoma? | increased IOP leading to optic nerve damage caused by blockage of canal of Schlemm. |
How does open-angle glaucoma present? | chronic, usually over 40 and AA. Asymptomatic but can cause blinding in long run. Typical take topical meds to keep pressures down. |
How does orbital cellulitis present? | ptosis, eyelid edema, exophthalmos, purulent discharge and conjunctivitis. Usually -12 yo with fever and decreased ROM of EOM. This is an emergency requiring hospit. |
What are the leading bugs of orbital cellulitis? | strept pneumoniae, staphylococcus aureus, HIB, and MRSA in adults. |
What is dacrostenosis? | lacrimal duct is narrow in 1st month of life often leading to obstruction. Treate with warm compress. Can lead to dacrocystitis which is more painful, swollen and purulent. |
What is blepharitis? | chronic inflammation of lid margins with dandruff-like deposits (scurf) and adhering red rims. Lid scrubs are helpful. |
What is a hodeolum? | small painful nodule or pustule within a gland in upper or lower eyelid. External hordeola is also known as a STY. Usually caused by Staph aureus. Use warm compresses for 48 hours and possibly abx. |
What is a chalazion? | usually painless induration lesion deep from the palpebral margin. Use warm compresses then consider referral. |
What is entropion? | eyelids and lashes roll inward |
What is extropion? | eyelids and lashes roll outward, associated with age and bells palsy. Keep eye nice and hydrated. |
What usually causes viral conjunctivitis? | adenovirus 3, 8, or 19 |
How does viral conjunctivitis present? | acute uni or bilateral erythema of conjunctiva, watery discharge, and preauricular lymphadenopathy. Very contagious. Treat with BID NS washes and antihistamine drops. |
How does bacterial conjunctivitis present? | acute copious, purulent discharge from both eyes. Eyelids difficult to open in mornings. Treat with topical abx. |
What bugs cause bacterial conjunctivitis? | strep pneumonia, staph aureus, Hemophilus aegyptius, and moraxella sp. |
What is a pinguecula? | elevated yellowish flshy conjunctival mass on sclera adjacent to cornia usually caused by chronic exposure to wind, trauma. No treatment necessary. |
What is a pterygium? | slow growing thickening of bulbar conjunctiva growing from nasal to cornea. Consider operating whn interferring with vision. Comes back. |
What is papilledema a sign of? | increased ICP. Disc appears swollen with blurred margins and obliteration of vessels. |
Disruption of right optic nerve causes what sort of blindness? | right complete blindness |
Disruption of optic chiasm causes what sort of blindness? | bitemporal heteronymous hemianopsia (bilateral loss of peripheral fields) |
Disruption of right outer optic nerve causes what sort of blindness? | Right nasal emianopsia (loss of right nasal field) |
Disruption of right optic tract causes what sort of blindness? | left homonymous hemianopsia (loss of left/nasal visual fields in both right and left eye) |
What is strabismus? | misalignment of eyes that needs addressed before patients turn two else it will cause amblyopia (reduced visual acuity not correctable by glasses) |
What can a blue or cyanotic sclera be a sign of in infants? | osteogenesis imperfecta |
What is a key clinical sign of uveitis? | pain in affected eye when light is shined ipsilaterally |
What is the Weber test? | tuning fork on top of head. Lateralization to affected ear indicative of conductive hearing loss or contralateral sensorineural hearing loss. Must combine with Rinne. |
What is Rinne sign? | tuning fork on mastoid process until patient can no longer hear, then put beside ear and patient should be able to hear (conduction). If cannot hear, then suspect ipsilateral conduction loss. A POSITIVE Rinne = normal conductive hearing |
What are the most common causes of conductive hearing loss? | cerumen, otitis externa, otosclerosis, or OM |
What are common causes of sensorineural hearing loss? | presbyscusis, Meniere's dz, acoustic trauma, or acoustic neuroma |
What is presbycusis? | most common cause of sensorineural hearing loss. Genetic loss of high frequency associated with tinnitis. May be helped with hearing aids. |
What is Meniere's disease? | hearing loss accompained by episodes of tinnitus, vertigo, n/V. Attacks are minutes to hours. Cause is unknown but is treated with diuretics and salt restriction. |
What are examples of acoustic trauma? | shotgun, explosion, or chronic noise exposure leading to sensorineural hearing loss. |
What are signs of acoustic neuromas (vestibular schwannoma)? | insidious unilateral hearing loss that is progressive. |
What are commonly asked ototoxic drugs? | streptomycin, kanamycin, neomycin, ethacrynic acid, chloramphenical. Often high frequency loss which may or may not be reversible. |
What are common acquired causes of hearing loss? | measles, mumps, pertussis, meningitis, influenza, and labryinthitis |
What are common bugs of OM? | streptococcus pneu, HIB, moraxella catarrhalis, staph aureus, strep pyogenes |
what can OM lead to? | TM rupture, mastoiditis, rarely cellulitis |
What are 1st line treatments for OM? | amoxicillin, augmentin, erytab, bactrim, cefaclor |
What is the usual bug in OE? | pseudomonas, occ enterobacteriaceae or proteus. Treat topically with abx. |
How does peripheral vertigo present? | sudden onset of n/V, tinnitis, decreased hearing, horizontal nystagmus with beats away from diseased side. |
What are causes of peripheral vertigo? | labyrinthitis, Meniere's dz, positioning, vestibular neuronitis |
How does central vertigo present? | slower-onset, nonfatigable nystagmus usually vertical. |
What is the Hallpike or Nylen-Barany maneuver? | test for vertigo. Rotate pateint's head 90 degrees while patient is supine. Usually positive with peripheral vertigo. |
What are causes of central vertigo? | brain stem dz, tumors, MS, AV malformations. |
How is vertigo treated? | acute attacks of diazepam. Mild vertigo can try meclizine. Severe try scopolamine. |
TM ruptures? | small ruptures heal on own over time but larger ones may require tympanoplasty. Keep ear dry in meantime. |
What is allergic rhinitis? | IG-E mediated reaction to airborne antigens with symptoms similar to common cold. Allergic shiners common. Discharge is clear/watery. Treat with antihistamins or cromolyn sodium |
What is Vasomotor rhinitis? | increased secretion of mucus from nose due to changes in temp/humidity/odor/etoh. Just avoidance. |
What is Rhinitis medicamentosa? | rebound congestion, often due to oxymetazoline or phenylephrine use. Often painful. Those meds are mala! |
What is Centor criteria? | fever >100.4, tender anteriaor cervical adenopathy, lack of cough, and pharyngotonsillar exudates. Score of 3+ highly suggestive of group A strep. |
What to treat strept infections with? | PCN, erytab. Complications included rheumatic fever, Ludwig's angina, and tonsillar abcesses if not treated properly. |
What are aphthous ulcers? | canker sores, often on buccal mucosa. Red painful ulcers with red halo's. Topical steroids and anesthetics are helpful. |
How does oral candidiasis present? | burning in affected areas with white scrapable areas with raw erythematous friable bases. Treat with nystatin swish and swallow. |
How does Leukoplakia present? | painless white area of tongue, cheek/lip. Common in smokers, tobacco chewers, HIV, or etOH |
How does Epiglottitis present? | abrupt high fever, difficulty swallowing, sore throat, drooling, and child sitting in tripod/sniffing position. Most commonly caused by HIB, group a strep. Diabetics are higher risk. Thumbprint sign on lateral neck x-ray. Admit, intubate. |
What is the most common location of a nosebleed? | anterior: Kiesselbach's plexus. Hold pressure on nares for 10 minutes seated upright...then look for source. Numb and use silver nitrate to cauterize. May pack anteriorly for 24 hours. |
Where does a posterior bleed come from? | Woodruff's plexus: uncommon and often result of signifcant trauma. Bleeding is arterial and blood is seen in posterior pharynx. May pack posteriorly while awating immediate consult. |