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Opthamology and Otolaryngology
Terms in this set (48)
90% are squamous cell carcinomas. SSX: sores on lips mouth or cheeks that do not improve in 2 weeks. lingering white or red patches on gingiva. difficulty swallowing or chewing, hoarseness, lump in mass or neck, numbness of tongue. 50% survival in 5 years. if confined to mucosa it can respond to radiation. REFER.
Laryngeal Cancer, Throat Cancer
ALSO SCC. males 60-70 most common. SSX: persistent hoarseness more than 14 days with dysphasia, odynophagia, chronic cough, hemoptysis, weight loss, mass, tenderness. Order laryngoscopy and biopsy consider liver function tests to rule out metastatic disease. 90% cure with early detection and treatment. yearly chest X-ray LFT. if dysphagia order barium or endoscopy.
small lump thick white or red patch on tongue that becomes indurated and may spread to gums lymph nodes and neck. SSX: stiff and rigid tongue muscles, problems speaking or swallowing, difficulty eating, halitosis and pain.
most common malignancy of salivary glands. SSX: elevation of earlobe, cervical lymph node metastasis, ulceration, facial nerve palsy. ANY retromolar swelling needs to be considered. 95% cure rate with low grade if high grade 50% 5 year
adenoid cystic carcinoma/ cylindroma
MC malignant tumor of minor salivary glands. BAD prognosis. local reoccurrence common after excision. metsisis to lung and death is likely. SSX: mass in adenoid, elevation of earlobe, pain, ulceration facial nerve palsy. trigeminal numbness and tingling.
inflammation fo conjunctiva. DDX: keratitis, iritis, closed angle glaucoma. CAUSES: infection, allergy, irritation, systemic disease. BACTERIAL: profuse d/c and swelling unilateral. VIRAL: clear d/c often bilateral. less swelling. CHLAMYDIAL: moderate to profuse tearing bilateral. ALLERGIC: pruritic clear white d/c moderate to severe swelling......bacterial cause can lead to blindness important to treat. but nonbacterial is typically self limiting. refer if ulceration keratitis or if it worsens in 24 hours or no response.
uveitis (iritis=un-reactive pupil), acute/closed angle glaucoma (severe pain, cloudy cornea, dilated uncreative pupil). culture of exudate only necessary if bacterial infection or blepharitis.
symptoms duration of different forms of conjuntivitis
BACTERIAL 10-14 days shortened to 2-4 days with tx. VIRAL 10 days to 4 week. self limiting. TRACH: 3-9 months with tx 3-5 weeks
Lacrimal sac inflammation. SSX of ACUTE: fever, pain swelling, conjunctivitis. ORDER CBC, inspect check vital and LAD. culture discharge. WORST CASE: leads to abscess and secondary corneal infection eventual blindness. refer if it does not improve quickly with ABX.
MC organism in adults: Staph Aureus, Strep progenies, Strep pneumonia. In children H flu. usually unilateral can effect conjunctiva and orbit. In children consider rhabdomyosarcoma and child abuse since normally unilateral. ORDER blood cultures, CT scan. WORST CASE: death, blindness, central retinal artery or retinal vein thrombosis, meningitis. right therapy should lead to improvement in 24 to 48 hours....REFER!!!
iritis acute glaucoma
Iritis has constricted pupil with some light reponse normal depth on slit lamp normal IOP but AGG has a dilated unreactive pupil with no light reponse very shallow slit lamp and elevated IOP.
lens opacity. SSX: gradual painless visual loss with halo around lights. absence of red reflex. not reversible may need surgery. is 20/30 vision and not corrected by glasses refer.
Chalazion VS Hordeolum
Meibomian Cyst (enlargement of this gland from duct occlusion). can mimic stye (hordeolum) but is painless. will self resolve but rule out dacrocysitis.
STYE: infection of glands of Zeis or Moll in eyelash follicles (external) or meibomain gland (internal). PAINFUL....chalazion is a granulomatous non painful enlargement
retinal capillary closure and micro aneurysms, ischemia and neovascularization of retina. optic nerve or iritis three stages: background--preproliferative--proliferative. can see cotton wool spots and macular edema. associated with glaucoma, cataracts and rental detachment.
increased IOP. classified as primary (10%) and secondary. if closed angle the person may be asx for long periods and then have acute attacks with ocular redness, pain , mild headache, blurred vision. if optic nerve is effected there would be ciliary injection N/V halo around and more pain. Mydriasis and steamy cornea. OPEN: gradual bilateral vision loss with mild HA poor night vision or loss of peripheral vision. NO pain. EXAM: slit lap, tonometry (IOP), gonioscopy (angle) and vision. WORST case for closed angle glaucoma (corneal edema, corneal fibrosis, cataracts, lens subluxation, blindness) NO mydiratic drugs/anticholinergics or antidepressants.
SSX: focal arteriolar constriction in retina-->flame hemorrhages and white ischemic spots/cotton wool spots-->star shaped exudates around macula-->papilla edema. REFER for eye exam
atrophy or denigration of macula leading to loss of central vision. ATROPHIC (dry): common w/o scarring or hemorrhage EXUDATIVE (wet): uncommon form with choroidal neo-vascularization hyper pigmentation and scarring.....RF: smoking, aging, low micronutrients, atherosclerosis, sedentary. SSX: insidious onset with slow painless bilateral central vision loss. DRUSEN BODIES visible before loss. EXAM: acuity, optyamoscopic, slit lamp, Amslers chart and fluorescing angiography. LEADING cause of elderly blindness in developed world. Wet form can have laser while dry cannot. often progress to blindness but maintain peripheral and color vision. TX: vitamin C, E, carotenoids, zn, Cu.
benign yellow-white neoplasm of conjunctiva due to degeneration and thickening of bulbar conjunctiva. usually ASX but may become infected inflamed or ulcerate. does not invade cornea jut monitor for progression or visual changes.
EMERGENT. separation of neural retinal from RPE. RFs: myopia, eye trauma, iritis, cataract surgery. PAINLESS flashes of light blurred vision with curtain/veil loss of visual field. loss of central vision. REFER to ED
benign neoplasm of cornea with thickening of bulbar conjunctiva that may protrude into cornea. may be visual loss or change or irritation, photophobia, injection, tearing.
Inflammation of iris, ciliary body and choroid. ANTERIOR: iris and ciliary body INTERMEDIATE: structure behind lens DIFFUSE: choroid retina and vitreous
RFs: crohns, Reiters syndrome, RA, CMV, TB, syphilis, Behcets syndrome, AKSP, histoplasmosis. SSX: diminished vision with black floating spots and severe pain, redness or photophobia, miosis and injection around limbus, hypopyn, macular edema. WORST CASE: glaucoma, loss of vision, cataract, retinal detachment. Slit lamp is DX. REFER to EYE DOCTOR
infection and inflammation of labyrinth. occurs when bacterial infection from severe AOM spreads to inner ea. SSX: rapid onset of severe vertigo and nystagmus, fluctuating hearing loss n/v tinnitus fever pain and gait instability. EXAMS: neuro with HENT, Weber Rinne and blood culture CT MRI possible lumbar puncture. EMERGENCY GO TO ED. can lead to permanent hearing loss and vestibular dysfunction.
complication of bacterial OM. SSX: otalgia, bulging erythmetous TM, otorrhea. swelling and pain over mastoid. fever possible. EMERGENT. may lead to subperiosteal abscess, gradenigos syndrome, sigmoid sinus thrombosis, meningitis, intracranial abscess. ER will order CT or MRI to rule out abscess
inflammation of EAC. FIVE types. acute diffuse, acute circumscribed, chronic (>6 weeks), eczematous, malignant (deeper tissues may be osteomyelitis or cellulitis). SSX: pain, pruritus, discharge, inflamed canal, pinna and trigs are painful unlike OM. CN's that may be involved include: VII, IX, XI, XII, rule out cellulitis. WORST CASE: malignant OE, mastoiditis, perichondritis. topical tx if fever do oral abx. if cellulitis refer. acute in 48 hours at end of tx and one week later to look at TM. chronic every 2-3 weeks.
inflammation of middle ear. four types: AOM, Recurrent AOM, OME (MC form not infectious due to inflammation or inflammation), Chronic OM/serous OM. SSX: pain, fever, inflamed TM with obscured landmarks. Viral AOM alleviated by warm compress bacterial needs tx.
MC form of OM. not infectious due to inflammation or inflammation. less pain than AOM w/o fever, hearing affected unlike AOM.CRP and WBC normal unlike AOM. TM has fluid line with low mobility may have bubbles and be opaque (AOM is cloudy, inflamed). alleviated by warm compress. EXAM: otoscope, tympanometry, acoustic reflex, Weber (lateralized to bad ear), Rinne. MC in 6-36 months and 4-7 months. amoxicillin is first line
AOM: TM rupture, otorrrhea, labrinthitis, acute mastoiditis, brain abscess, hearing loss, facial herve paralysis, meningitis, hydrocephalus.
OME: Hearing loss and or speech language disabilities, ear tubes
recurrent AOM: scarring of TM, perforation, cholesteotoma, hearing loss, chronic mastoid
7-10 days. persistent nystagmus to side. no hearing loss, no tinnitus no visual changes.
thrush vs leukoplakia
triple abx therapy
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