Shared Flashcard Set

Details

BOARDS II
Disease
113
Medical
Graduate
11/12/2011

Additional Medical Flashcards

 


 

Cards

Term
Risk Factors associated with Choriodal Nevi
Definition
1. thickness > 2mm
2. Size > 5mm
3. Proximity to ONH
4. Orange pigment on surface of tumor
5. (+) SRF
Term
Classic age of Dx of Gardner's Syndrome

Avg age of Dx for malignancy in colon
Definition
22 yo/ 39 yo
Term
Gardener's Syndrome Triad
Definition
1) multiple intestinal polyps
2) skeletal hamartomas
3) soft tissue tumors (cyts, neurofibromas, fibromas)

*** Over 50% of pts will have dental anomalies
Term
Goldenhar Syndrome Triad
Definition
1) Ocular dermoid (mostly on eyeball)
2) preauricular skin tages
3) vertebral dysplasia
Term
Crouzan's syndrome
Definition
DDX for PROPTOSIS AT BIRTH!!!
- craniofacial disorder
- shallow orbits with proptosis
- aniridia, blue sclera, strabismus, optic neuropathy, congenital cataracts
- hypertelorism
Term
Congenital Encephalocele. What is the tell tale sign?
Definition
PROPTOSIS that becomes pulsatile during crying
Term
Fabry's Disease
Definition
X-linked, AR lysosomal storage dx - CORNEAL VERTICILLATA (90% of cases!) - POSTERIOR SPOKE-LIKE LENS OPACITY (50% of cases) - episodes of excruciating pain in fingers and toes - premature death (40-50) from renal or cardiovascular complications
Term
Marfan's Syndrome
Mutation in which gene?
Definition
AD, connective tissue disorder
Mutation in the Fibrillin gene on chromosome 15
Term
Characteristics of Marfan's syndrome

CONNETIVE TISSUE DZ
Definition
1) Lens subluxation (ectopic lentis)
2) tall stature with disproportionately long arms, legs, and digits (arachnodactyly)
3) joint laxity with dislocation
4) CDVS abnormalities (aortic aneurysm, mitral valve prolopse)

*** Think: Michael Phelps***
Term
Ehler Danlos syndrome

COLLAGEN DZ
Definition
*** Think: Kevin Lam***
- AD, COLLAGEN DZ
- DEFICIENCY in Hydroxylysine
- lens subluxation, blue sclera, angiod streaks, keratoconus, megalcorena
- CDVS abnormalities
- Joint laxity with dislocation
(very similar to Marfan's syndrome, but this guy is not very tall)
Term
Homocystinuria
Definition
AR
DEFICIENCY in enzyme cystathionine synthase
- lens subluxation, GL
- tall stature with features similar to Marfans
- however, patients are BELOW INTELLIGENCE level, STIFF JOINTS
Term
Weill-Marchesani Syndrome
Definition
AD or AR
short stature with small shot stub
lens subluxation
microspherophakia
retinal detachment
Term
what is the most important ocular complication in collagen/connective tissue dz?
Definition
RD!!!
Term
Which type of carcinoma is commonly mistaken for a recurrent chalazion or chronic unilateral blepharitis?
Definition

Sebaceous Cell Carcinoma

 

Cardinal Signs:

- Eyelash involvement: madorosis, poliosis, thick red lid margin inflammation

- Lid adenopathy common

 

Poor Px:

- Sx > 6 months

- size > 2mm

- poor differentiation

- local vascular or lymphatic inflitration

 

Term
Which eyelid tumor arises from actinic keratosis?
Definition

Squamous Cell Carcinoma

  • second most common eyelid tumor BUT 40-50x less common than BCC
  • usually on lower lid with margin involvment
  • FASTER GROWTH THAN BCC
  • Px varies depending on tumor size, degree of differentiation, underlying etiology, and dept of tumor invastion
Term
What is the most common type of eyelid tumor?  Cardinal signs?
Definition

Basal cell carcinoma

  • older adults with male predilection
  • lower lid usually but can appear subsequently on upper lid
  • locally invasive but rarely metastatic
*** Think of pt at Woodhull whose eyelid lesion looks like a BCC!***
Term
What is the fastest growing eyelid tumor??
Definition

Keatoacanthoma

  • found in sun exposed areas with a central ulcerated, keratin killed crater and hyperkeratotic margins
  • older adults
Tx: COMPLETE sx excision.  Radiation, cryotherapy, chemo etc will NOT work!
Term
What medication to Rx for Gonorrhea?
Definition

Ceftriaxone; Cephalosporin family

 

Dosage:

If cornea is involved: 1g IV q12-24hrs (duration of tx depends on clinical response (3-5days usually)

If cornea is NOT involved, 1g IM

Term
Kawasaki's Disease
Definition

Mucocutaneous lymph node syndrome

  • children < 5 yo
  • Japanese more common
  • Dx based on 5/6 criteria
  1. fever (> 5 days)
  2. bilateral conjunctivitis
  3. strawberry tongue (oral mucosal changes)
  4. peripheral extremity changes (edemia, erythema)
  5. cervial lymphadenopathy
Term
T or F? Crohn's disease causes a granulomatous uveitis
Definition

F.  Non granulomatous uveitis

 

"Fat old crone skipping down a cobblestone road"

  • SKIP lesions in GI tract with rectal sparing
  • ulcers and fistulas, COBBLESTONE mucosa
  • wall thinkening
  • infectioous
Term
Two subsets of Inflammatory Bowel Disease
Definition

1) Crohn's Disease

2) Ulverative Collitis

Term
All Fluoroquinolones are approved for kids >1yo except _____, which is a ____ generation FQ
Definition
Levofloxacin (Quixin); 3rd
Term
Which "subset"of IBS is autoimmune? 
Definition

Ulcerative Colitis

  • Colon = RECTAL INVOLVEMENT
  • granulomatous uveitis
  • pseudopolyps abscess and ulcers
  • mucosal inflammation, colorectal carcinomas, stenosis, toxic megacolon
Term
Wilson's disease
Definition

d/t failure of coppor to enter circulation in form of ceuloplasmin 


Kayser-Fleisher Ring

 

Signs: tremor of wrise, basal ganglia degene, cirrhosis, corneal deposits, carcinoma, dementia

Tx: Pencillamine (Cuprimine): chelating agent that binds Cu.  Many SE (OMG, pemphigoid, optic neuritis)

Term
Cholecystitis (Gall Bladder Dz)
Definition

inflammation of gall bladder lining d/t cholesterol stones

Fat, Fertile Females over Forty


(+) Murphy's sign = pain on inspiration when the examiner's finger are placed under the rgiht costal region  next to the rectus abdominalis.  Think: "Black Swan"

Term
Succinylcholine
Definition

Cholingergic Antagonist used as a muscle relaxant prior to SX

 

CONTRAINDICATED in intraocular SX d/t rapid increase in IOP and expulsion of intraocular contents

Term
Which two antibiotic drugs are NEVER used alone but in combination?  Why? What part of the bacteria does the drug work on?
Definition

1) Polymyxin: not used along because very limited activity.  Gram (-) coverage only; affects cells MEMBRANE

 

2) Neomycin: toxic to ocular surface? affects PROTEIN SYNTHESIS

Term
What drug has the potential side effect of Red Man's Syndrome?
Definition

VANCOMYCIN


Red Man Syndrome is a reaction to the drug vancomycin. Patients typically develop symptoms within 5 or 10 minutes of receiving the drug, and they experience itching and flushing of the face, neck, & torso. They may also experience swelling of the lips, face, or eyes and/or a drop in blood pressure, but this is less frequent. Red Man Syndrome is not a true allergy, even though the symptoms look similar to an allergic reaction. 

When signs of red man syndrome appear, the first step is often to stop the vancomycin infusion. Some patients may receive antihistamine medications before the drug is restarted. It is common practice to infuse the vancomycin at a slower rate thereafter. If the drug is given again, Red Man Syndrome can usually be avoided by pre-treating the patient with antipyretic and antihistamine medications (like acetaminophen and diphenhydramine) and infusing the drug at the slower rate.

Term
Which drug can have the potential side effect of a Grey Baby Syndrome?
Definition

Choloramphenicol

  • works on 50S subunit in protein synthesis
  • rarely Rx'd d/t S/E: irreversible aplastic anemia, optic neuritis, Grey Baby Syndrome
Gray baby syndrome: A syndrome due to toxicity of the antibiotic chloramphenicol in the newborn, especially the premature newborn, because of lack the necessary liver enzymes to metabolize this drug. Chloramphenicol accumulates in the baby, causing hypotension (low blood pressure), cyanosis (blue coloring of lips, nail beds, and skin from lack of oxygen in the blood), and often death. Chloramphenicol is therefore usually not given to newborns or premature babies.
Term

Which drugs are safe during a pregnancy?

 

Which drugs are harmful? <-- These drugs are also the main BROAD spectrum drugs

 

Which drugs can you eat on an empty stomach?

Definition

" You never say FAT to a pregnant woman because they are just PACking a baby." 

" You PAT an empty stomach"


 Safe drugs (PAC)

- Penicillin

- Azithromycin/Erythromycin

- Cephalosporins


Harmful drugs (FAT)

- Flouroquinolone

- Aminoglycosides

- Tetracyclin


 

Drugs on Empty stomach (PAT)

-  Penicillin

- Azithromycin

- Tetracycline

Term

Which two drugs are given in IV form for an orbital cellulitis?

 

Definition

Naficillin; Penicillin family; penicillase resistant

 

Ceftriaxone: Cephalosporin; IV x 1 week

Term

Combo Drugs

What are the components of these drugs?

 

1) Polytrim

2) Polysporin

3) Neosporin

4) Tobradex

Definition

1) Polytrim: Polymixin B (cell membrane) and Trimethroprim (folate metabolism)

2) Polysporin: Polymixin B (cell membrane) and Neosporin (30S Protein Synthesis--> Aminoglycoside)

3) Neosporin: Neomycin (30S protein synthesis-->aminoglycosides) , Gramicidin (cell membrane), Polymixin B

4) TobraDex: Tobramycin (30S--> aminoglycosides) + Dexamethasone 0.1% 

Term

1) As Cephalosporins go from 1st --> 4th generation, it starts with more gram (+/-) coverage to more gram (+/-) coverage

 

2) As FQ go from 1st --> 4th generation, it starts with more gram (+/-) coverage to more gram (+/-) coverage

Definition

1) (+) --> (-)

2) (-) --> (+)

Term
Which drug can be given to provide prophylaxis of gonococcal ophthalmia neonatorum instead of silver nitrate?
Definition
Erythromycin ung
Term

Prescribing Tetracyclines for...


1) Meibomianitis

2) Acne Rosacea

3) Chlamydia Conjunctivitis

4) RCE

Definition

1) Meibomianitis: Doxycycline 100 mg PO bid x 1 month, then taper to qd x 3-6 mo

 

2) Acne Rosacea: Doxy 100mg PO BID (x until sx are relieved), then taper 100mg PO qd x several weeks after.  Long term tx: Periostat (20mg Doxy) tablet po qd

 

3) Chlamydia Conjunctivitis: Doxy 100mg PO bid x 10days 

OR

1g Zpack (Azithromycin) but this question doesn't warrant this answer

 

4) RCE: Doxy 50 mg bid x 2 months

Term
Pt comes in with a HSV Keratitis.  How do you treat TOPICALLY?
Definition

Tx choice #1:

  • 1 gtt Viroptic opth soln 9x/day (q2hr) until leasion heals (usually 5-7days), then taper to 5x/day x 5-7 days
Tx choice #2: = Gold Standard now
  • 1gtt Zirgan gel 5x/day unti lesion/ulcer heals, then taper to qgtt 3x/day x7 days
  • Zirgan gel = topical from of Ganciclovir
** if concomitant stromal keratits --> indicated immune rx, then give PF, but in a 2:1 ratio between antiviral and PF
Term

Pt comes in with a HSV Keratitis.  How do you treat SYSTEMICALY?'

 

How do you treat PROPHYLACTICALLY for recurrent HSV keratitis?

Definition

FAV


Famcyclovir: 250mg TID x 7 days

Acyvlovir: 400mg 5x/day x 7 days

Valacyclovir: 500mg TID x 7 days

 

Prophylactically

F: 125 mg bid

A: 400mg bid

V: 250mg bid


** all BID and 1/2 dosage of acute HSV, except for Acyclovir which is same dosage

Term
NIDDM drugs (4 categories)
Definition

1) Sulfonylureas: Glipizide (Glucotrol), Glyburide (Diabeta, Micronase), Chloropropamide (Diabenase), Tolbutamide (orinase)

-- increase secretion of insulin by beta cells, decrease glucagon release, increase sensitivity to insulin

 

2) Biguanides: Metoformin (glucophage): decreases liver glucose production, increases glucose uptake

 

3) The Zones: Thiazolidendiones (all end in -zones)

 

4) Juanuvia (commercials)

Term
S/E of HCTZ
Definition
HyperGLUC, hyperGLYCEMIA, hyperLipidemia, hyperUricemia, HyperCalcemia
Term
At which doses of Amiodarone will you get Whorl Keratopathy? Anterior Subcapsular lens deposits?
Definition

whorl keratopathy (corneal verticillata): inevitable at 400mg/day

 

ASC lens deposits: >600mg/day after 6 mo of tx (in 50% of cases)

Term

Mucomyst 10-20% = Acetylceysteine 

What are the indications of this drug ophthalmically, even though this is a respiratory drug?

Definition

severe DES, especially when filametns are present

 

also Tx for corneal burns

Term
What is the mechanism of action of Restasis?
Definition

inhibits T-cell ativation by stopping hte production of interleuki-2

Dosage: q12hrs or BID

S/E: stinging upon instillation

Term
How to treat benign essential blepharospasm?
Definition

1) Bromocriptine (Parlodel) : also for Parkinsons and prolactic secreting pituitary adenoma

2) Immunosuppressive agents: Cyclosporine (Sandi-immune), Azathiprine (Imuran)

Term

How to tx these following dz's with systemic steroids

 

1. Scleritis

2. GCA

3. Toxoplasmosis

4. Thyroid eye dz (optic neuropathy)

Definition

1. 60-100mg qd x 1 week, then taper to 20mg qd x 2-3wks

2, IV methylprednisolone x 3 days, then PO 800-1000 qd x 2-4 wks until sx resolve or ESR normal

3. 20-40mg qd - initiated 24-48 hrs after starting Ab therapy

4. 100mg qd x 2-14 days

Term

uthoff's sign

Definition

vision worse when body temperature raises

 

ddx - MS, congestive heart failure, pulmonary problems

Term
what are five in office diagnostic tests for myasthenia gravis?
Definition

1. Lid fatigue - have pt look upwards and fixate a target held in your hand. If your hand gets tired before they do, the test is negative. Impt  not to have pt blink, therefore administer a drop of proparicane prior to the test

2. Pseudo lid retraction - the other eye may look retracted d/t retrievable of equal innervation. Manually close the ptotic eye and see if the retracted eye comes done

3. Orbicularis weakness

4. Sleep test - for 30 mins

5. Ice pack test  - cold temperatures inhibit the action of AchE, therefore increasing Ach --> less pitied

Term
what tests would you order for a pt that you suspect MG? 
Definition

1. Tensilon test  in adults, Prostigmine in kids

2. Blood tests

  • AchR for MG dx
  • TSH to rule out autoimmune thyroid dz

ANA to rule out autoimmune dz such as RA

3. Mediastinal imaging bc 23% have thymomas

4. Electrophysiologic testing

 

Term
common etiologies of INO and Skew Deviation in kids, young adults, elderly
Definition

kids -think neoplasm

30 yo - MS

elderly - CVA

Term

GUNN'S SIGN

 

Definition
retinal vascular crossing changes found in HTN retinopathy
Term
KOCHER'S SIGN
Definition

stare appearance found in graves disease

 

think: "It is not kosher to stare at people"

Term

both discrete and confluent white to yellow dots

stationary night blindness

contracted visual field

markedly reduced ERG

Definition
RETINITIS PUCTATA ALBICENS
Term
two hereditary diseases that cause abnormal EOG, normal ERG
Definition

1. Best disease

2. Pattern dystrophy

Term

egg yolk or glial scar, central scotoma, rpe changes c Neovascular changes

 

abn EOG, normal ERG

Definition
BEST VITELLIFORM DYSTROPHY
Term
BULL'S EYE MACULOPATHY
Definition

CONE DYSTROPHY

CONE ROD DYSTROPHY

TAMOXIFEN TOXICITY

CHLOROQUINE

HYDROXYCHLOROQUINE

Term
PRIMARY DEVIATION
Definition
misalignment when the non-paretic eyenis fixating
Term
SECONDARY DEVIATION
Definition
amt of ocular deviation when the paretic eye is fixation
Term

You injected Tensilon into a patient's arm and they experience SLUD. You immediately think of administering this in office drug to help counter the effects of this drug.

 

The patient later arrives at the hospital in which they will administer which IV drug?

Definition
ATROPINE, PRALIDOXIME (PROTOPAM)
Term

percentages of MG pts with...

 

1. a thymoma

2. Thyroid disease

3. Initially presenting with OMG

4. Presenting with OMG at some point in their lives

Definition

1. 10

2. 5

3. 75

4. 90

Term
What is PSEUDOPAPILLEDEMA?
Definition

Think: disc at risk (very small) c buried drusen

 

- Nerves that are very small

- anomolous vascular branching patterns c multiple bifurcations and trifurcations

- Drusen may be a result of this small nerve.  This occurs d/t the prelaminar stasis of axoplasmic flow that results from crowding of axons as they pass through the narrowed scleral canal

- Drusen laetr makes the nerve look lumpy bumpy, which further confuses the clinician from TRUE papilledema

Term
Name 5 clinical differences between Psuedopapilledema vs True papilledema
Definition

MAJOR DISTINGUISHING FACTOR for ONH Drusen and Papilledema = Autofluressence and B scan U/S.  Drusen will Autoflluress, show calcific changes in B scan ultrasound

 

Also Pseudopapilledema has...

1) swelling in the middle of the nerve (True Papilledema is swelling around the borders of the nerve)

2) large disc vessels arise from a central cone and there is little to no physiologic cups.  Multiple trifurcations and bifurcations, but no real changes in microvasculature

3) (+) SVP intact

4) no flame hemes around the disc

5) Familial trait...family members will have similar looking nerves

 

 

 

Term
Optic Nerve Hypoplasia
Definition
  • subnormal # of axons in the ON
  • Disc: smaller disc, Peripapillary halo, Double ring sign (inner ring: where ON head, Outer ring: where RPE ends)
  • VA range from normal to severe
  • VF can be anything
  • CV: deficient
  • Nystagmus (not always)
  • Midline defects (absence of corpus collosum, septum pelludcidum, poorly developed nose bridge
  • Fetal Alcohol Syndrome
Tx: no Tx, monitoring of visual function, VF loss should remain stable over time. If not, look for another cause of this optic nerve dysfucntion
Term

Morning Glory Syndrome

 

What condition is associated with it?

Definition
Characteristics:
  • Unilateral, Dysplastic disc that resembles the morning glory flower
  • characterized by an excated funnel shape, spoke like vessels
  • elevated chorioreitnal pigmentary disturbance
Associated with nasal encephalocele: brain tissue that has herniated into sphenoid tissues --> to nose --> RUNNY NOSE! --> can get meningitis
 
Tx: NEUROIMAGE
Term

Tilted Discs

 

- Characteristics

- It's VF defect mimics which disease process? 

 

Definition

Characteristics:

  • oval shape, situs inversus, scleral crescent (usually IT or IN)
  • high myopic oblique astigmatism
  • causes amblyopia with guarded Px
VF = bitemporal VF loss (d/t IN tilt).
  • mimics chiasmal tumors!
Term

T or F: 

Vascular lesions respect the midline of a VF

Compressive lesions can involve both sides of a VF

Definition
T
Term
How many db difference in a VF will cause an RAPD?
Definition
3db
Term

Chiasmal Syndrome

Si/Sx

Definition

Sx: unilateral, asymmetric, or bilateral painless, progressive vision loss, HA (due to stretching of the diagphrama sella), and DIPL (if involvement of the cranial nerves)

 

Si: VF defect, Optic atrophy, APD, CV defect, Endocrine Dysfunction

 

Band pallor, diffuse palor

Term

Chiasmal Syndrome

Etiology

 

Name the 4 most common types of Neoplasms as well as the other causes


Definition

1. Neoplasms:

  • Pituaitary Adenoma
    • Most common 10% of all chiasmal; can be hormone secreting and non-hormone secreting, attacks chiasm from below
  • Craniopharygioma: attacks chiasm from above, benign, but can cause papilledema
  • Glioma: most impt infiltrative tumor in kids
  • Meningioma: looks like a pitutitary adenoma but with a less hyperintense signal
2. infilatrative dz (sarcoid)
3. inflammation/demylination
4. aneurysm
5. truama
6. infection (sphenoid sinus infection_
Term
Pituitary Hypoplexy
Definition

- MOST SEVERE HA ever

subarachnoid hemorrhage

- DIPL

poor thermal regulation d/t disruptions in cortisol levels

- EXTREME MEDICAL EMERGENCY

 

- enlarging pituitary gland becomes necrotic --> internal hemorrhage with rapid expansion of tumor 

- mechanism: the gland becomes strangulated by the diaphragma sella --> chokes off blood supply --> necrosis --> hemorrhage --> rapid expansion of tumor

 

 


Term
What are the four unique characteristics of CNIV?
Definition

1. Smallest of all cranial nerves

2. Only cranial nerve to decussate dorsally from the brainstem

3. Longest  intracranial course

4. Only nerve to completely decussate

Term

Pt c/o DIPL greater while reading.  

Pupils: No consensual or direct response.  (-) Anisocoria.  Near response intact.  Eyelids are retracted

Motilities: Vertical Gaze Palsy, Convergence Retraction Nystagmus

Ant seg: unremarkable

Post Seg: Papilledema

 

What does this pt have? What should you r/o?

Definition

Dorsal Midbrain Syndrome (this is a CN IV palsy!)

 

R/O:

Pineal gland tumor (Neuroimage)

Tentorial Meningioma (Neuroimage)

DM, HTN for vasculopathic age group (CBC/ESR)

Term
What is cavernous sinus syndrome? Where is the cavernous sinus located and what structures are involved?
Definition
  • definition: any neuro-ophthalmic presentation that involves more than one structure contained within the cavernous sinus
  • Cavernous Sinus: located lateral to the sella turcica.  It is a blood filled channel that completely surround intracvernous portions of the cranial nerves and the cartoid artery
  • Structures involved: ICA, CN III, IV, VI, V-1, Oculosympaththeics

 

Term
Important etiologies of Cavernous Sinus Syndrome
Definition

multiple cranial nerve pareses (CN 3, 4, V1, V2, 6, and sympathetic involvement (may have Horner's syndrome)

 

1. Aneurysm (rare because fortunately as aneurysm expalns, it is surrounded by the tough, dural walls of the sinus which prevents rupture)

2. Carotid Cavernous Fistula - see next slide

3. Neoplasm

4. Infection

5. Inflammation

Term
Carotid Cavernous Fistula characteristics
Definition
  • multiple cranial nerve pareses (CN 3, 4, V1, V2, 6, and sympathetic involvement (may have Horner's syndrome)
  • d/t rupture of ICA or one of its branches within the cavernous sinus
  • think: trauma or rupture of a pre-existing aneurysm
  • Result: arterial blood from a high pressure source empties into a low pressure venous structure --> extends into superior and inferior ophthalmic veins --> congestion of orbit --> pulsating proptosis, chemosis, epibulbar injection, and vascular tortuosity, increased IOP
  • PULSATING PROPTOSIS, AUIDBLE BRUIT = HIGH FLOW FISTULA
Term
What disease process usally causes Carotid Cavernous Sinus Fistula?
Definition
ATH, HTN causing rupture of ICA or one of its branches
Term
Why do you see vessel engorgment in carotid cavernous sinus syndrome?
Definition

In medicine, a fistula (pl. fistulas or fistulae) is an abnormal[1] connection or passageway between two epithelium-lined organs or vessels that normally do not connected

 

high pressure arterial blood is emptying into the low pressure system --> causes retrograde flow

Term
Tolosa Hunt Syndrome
Definition

most impt cause of cavernous sinus inflammation

  • granulomatous, idiopathic, PAINFUL ophthalmoplegia that results from dramage to the cranial nerves by the granulomatous inflammation
  • optic nerve can be compromised when the process occurs at the orbial apex
  • ptosis (d/t CN III involvement)
  • no proptosis because no pressure on CS like in carotid cavernous sinus fistula
  • rapidly respsonsive to high dose corticosteroids
Term

What is the calling card of a 6NP?

 

 

Definition

Horizontal DIPL greater at distance than near

Ipsi abduction deficit

Term

6NP - Where is the lesion located?

 

contralateral hemiglegia

ipsilateral facial palsy

ipsi facial analgesia

ipsi Horners

nystagmus. or ipsi hearing loss

Definition

Brainstem

 

(Nucleus and Fascicles of pons) of abducen's nerve

Term

6NP - Where is the lesion located? What are you suspecting as an etiology?


Bilateral 6NP

Papilledema

 


Definition

Subarachnoid

 

Clivus lesion d/t...

  1. neoplasm
  2. compression
  3. severe head trauma
  4. meningitis
  5. increased ICP!
Term

6NP - Where is the lesion located? What is another name of this condition?


Ipsi facial palsy

Ipsis facial pain

Otitis media (middle ear infection)

Definition

Subarachnoid

 

Petrous Apex

 

Gradenigo's Syndrome

Term

6NP - Where is the lesion located?


6NP with reduced tearing ispilaterally

possible favial pain (facial nerve involvment)

Definition

Subarachnoid 

 

Middle Cranial Fossa 

Term

1) Management of Isolated 6NP in ...

 

- children

- 15-40 yo

- >40yo

 

2) Is neoplasm a common cause of 6NP?

Definition

1)

  • children: neuro consult, monitor q2-6 weeks, r/o brainstem glioma and infection
  • 15-40: MRI, lumbar puncture, r/o trauma, idiopathic, ifectious, demyelinating dz (MS)
  • older adults: ischemia (ATH, GCA), increased ICP, infection, neoplasm
2) No, because will involve other structures and other CN.  You will not JUST see a 6NP
Term
Management of Complicated 6NP
Definition

Neuroimage! Contrast enhanced MRI is test of choice.

 

If petrous apex disease is suspected (Facial pain/palsy, otitis media), CT scan is test of choice because it will detect bony erosion

Term
What caues bilateral 6NP?
Definition

increase ICP

OUTSIDE brainstem (Clivus) 

papilledema

 

Think: MENINGEAL DISEASE! MUST NEURP-IMAGE

Term

Important causes of Horner's Syndrome


What do you suspect in First Order Lesions?

Definition

First order lesions = "Central" Sympathathtics in the hypothalamus


Therefore, suspect...

  • Brainstem disease (tumor, trauma, infection, hemorrhages)
  • ALWAYS has associated neurological signs such as CNP
Term

Important causes of Horner's Syndrome


What do you suspect in Second Order Lesions?

Definition

Second Order = "Preganglionic" = Spinal Cord (Cervical), Neck, and ICA

 

Therefore, suspect...

  • Spinal cord injuries
  • apical lung tumor!! RARE and very unlikely in the absense of arm or axillary pain
  • neck injury/SX
Term

Important causes of Horner's Syndrome


What do you suspect in Third Order Lesions?

Definition

Third Order = "Post-Ganglionic" = IVA, Cilary ganglion, Cavernous Sinus, Ear

 

Therefore, suspect...

  • Cavernous sinus disease (tumor, aneurysm, inflammation, infection)
  • Cluster HA
  • Otits media
Term
Locating the lesion in Horners by anhydrosis (sweating)
Definition

1st order: ipsi body

2nd order: ipsi face and neck

3rd order: ipsi brow

Term
Adie's Tonic Pupil Characteristics
Definition
  • Dilated pupil
  • LND 
  • Sector paralysis - under slit lamp, areas of intact (innervated sphincter) can be visualized
  • Sluggish near response c slow redilation
  • Irregular pupil - d/t flattening of the pupillary margin from the denervated iris
  • Impaired accommodation (can't relax acc)
Term
Three types of tonic pupils
Definition

1) Local tonic pupils: d/t truama, infection, CE

2) Neuropathic tonic pupils: bilateral.  DM!! Syphillis and chronic alcoholism

3) Adies's or Idiopathic Tonic Pupil:  most likey, idiopathic, healthy pts.  reduced or absent tendon reflexes

Term

Where is the lesion?

 

- Adies

- Argyl Robertson

- Dorsal Midbrain Syndrome

- APD

Definition

Adies: Ciliary Ganglion, Ciliary nerves, or iris sphincter

Argyl Roberston: Prectal Oculomotor tract

Dorsal Midbrain: Posterior Commisure

APD: Optic tract, nerve

 

Term
How do you differentiate a retinoschisis from a RD? Name 5 differences
Definition

1. in retinoschisis, the surface is very taut and typically does not move with eye movements (RD, undulates freely with eye movements).  Reason = the cavity of the retinoschisis is thought to be filled with hyaluronic acid

2. honeycomb appearance in RS d/t to the inner and outer layer breaks

3. RS usually does not have a pigmented line of demarcation (probably because the split is no where near the RPE)

4. RS ALWAYS has an area of cystoid degneration btw PRS (Peripheral RS) and Ora

5. Choroidal features are visible but dim in RS, but totally obscured in RD.  (This is bc in RS, you get a very thin splitting of the retina, wheareas RD you get a complete thick separation of sensory retina from RPE)

 

Term

Pt presents with facial paralysis of the entire half of the face.  

Ant Seg: SPK, Exposure Keratitis

 

1) What do you suspect?

2) Where is the lesion?

3) How to Tx?

4) How to manage as an OD

Definition

1. Bells Palsy

2. Peripheral, Isolated facial nerve lesion.  May be d/t ischemia involving the vasa nervorum or inflammatory dz but Dx'd by EXCLUSION

3. Possible help from corticosteroids

4. Ocular lubricants, patching, moisture chambers, tarsorrhaphy, eyelid weight implant

Term

Pt presents with paralysis of the lower facial muscles.  

Ant seg: normal

 

You suspect a facial nerve palsy and run the battery of tests.  You find the frontal muscls, orbicularis occuli are all functioning appropriately.  

 

What is the Dx? Where is the lesion? 

Definition
Supranuclear Palsy.  Lesion located in the cortex or the internal capsule
Term

Pt comes in complaining of DIPL.  

(+) ipsi horizontal gaze palsy to the right

(+) contralateral hemiparesis to the left

(+) difficulty abducting to the right (6NP) with facial analgesia

 

You suspect?... (there are 2 right answers)

Where is this lesion? (There are 2 right answers)

 

 

Definition

Facial Nerve palsy or 6NP

 

Lesion = (1) Brainstem or (2) Cerebellopontine Angle

 

 

Term
How do you evaluate Facial Nerve function?
Definition

Orbicularis oculi: ask pt to squeeze eyelids shut.  Look for inability to bury lashes or incomplete closure

Frontalis: raise and scrunch eyebrows

Orbicularis oris: smile then whistle

Buccinator: fill cheeks with air

Stapedus: if hear things louder on side of palsy

Term

 What is a nasal step?  Why do we see it in GL?


Definition

nerve fibers from the optic nerve spread out across the retina.  They stop on the temporal side of the optic nerve at the horizontal midline of the retina.  Therefore, damage above or below what is called the horizontal raphe produces asymmetric loss at the nasal mid-horizontal line. 

[image]

Term

What do these terms mean?

 

- plegia?

- paresis?

- palsy?

 

Definition

- plegia = paralysis

- paresis = weakness

- palsy = paralysis of a body part, often accompanied by loss of sensation and tremor

Term

CN III palsy with choreiform movements, temor, ataxia

 

1) Where is the lesion?

2) If this pt had hemiplegia on one side, what syndrome are you thinking of?

3) If this pt had hemiparesis on one side, now what syndrome are you thinking of?

Definition

CNIII Palsy:

 

1) Location: Fascicular in the red nucleus, sup.cereballar peduncl, cerebral peduncle


2) Weber's Syndrome (Think: if you are caught in a Web you will be unable to move and will be paralyzed)


3) Benedict's Syndrome: (Think: if you do not eat your egg's benedict in the morning, you will have muscle weakness)

Term

How do you treat Lyme Dz

 

Definition

Doxy 100mg BID x 3 weeks

 

Refer to infectious dz

Term
Cat-scratch fever 
Definition
  • caused by Bartonella henselae
  • Ocular conditions:
    • Parinaud Oculoglandular Syndrome: unilateral conjuncitivitis, (+) PAN
    • Neuroretinitis: stellate macular star and disc edema
Tx: Systemic antibiotics
Term
Tuberous Sclerosis
Definition

AD, Phakomatosis

 

  • buttery malar rash
  • cyst on toenails
  • ash leaf spots
  • reinal astrocytic hamartomas that start as noncalcified lesions and becomes calcified
  • mulberry lesion: bc multilobulated surface with intralesional calcium --> exudative RS or hemmorhhage
  • DDx: Retinoblastoma 
    • to differentiate, note that TS has smooth surface, not exophytic growth, no viteous seeding, or any vascular abnormalities
Term

Leber's Congenital Amaurosis 

 

Presentation, AR or AD?,

VA?

CV?

VF?

ERG/ EOG?

Tx?

 

Definition
  • Nystagmus one to the 5 A's
  • AR hereditary disorders onset at birth or early childhoos
  • SEVERE visual impairment.  Think: EVERYTHING is wrong
    • sluggish pupils
    • nyctalopia
    • light sensitivity
    • nystagmus
    • high hyperopia
    • keratoconus, PSC, high HYP, salt and pepper fundus, vasculopathy, attenuation, macular colobomas, chorioretinal atrophy
  • Systemic: MR, deafness, seizures, skeletal abnormalities, renal musclar abormalities
VA: varies
CV: abn
VF: constricted
ERG (Markedly reduced or absent); EOG (abn)
Term
Where in the lens is glaucomaflecken located?
Definition
anterior subcapsular 
Term
[image]
Definition

Salzmann nodular degeneration

 

blue/white elevated, midperipheral, subepithelial hylanie nodule

associated with trachoma, chronic DES/Bleph

 

 

Term
How do you treat a Disciform Stromal Keratitis in a pt with HSV keratitis?
Definition

- Cyclo

- PF 1% QID with slow taper

- Trifluridine 1% TID to QID OR Acyclovir 400mg BID

 

** Acyclovir po alone will not resolve the stromal keratitis!

Term
Long time oral antiviral prophylaxis in HSV
Definition
Acylcovir 400 mg bid
Term

Common causes of Angiod Streaks

Definition

PEPSI

 

Pseudoelasticum xanthoma

Ehler Danlos

Pagets

Sickle Cell 

Idiopathic (50%)

Term
Determining the Malingnancy potential for choroidal nevus
Definition

. “TFind Small OcularMelanomas, Use Helpful Hints.” 

  1. Thickness (elevation) > 2mm
  2. Fluid - any subretinal fluid
  3. Symptoms 
  4. Orange Pigment (lipofuscin on the surface of the tumor)
  5. Margins
  6. Ultrasonographic Hollowness (on B-scan)
  7. Halo absence
Term
[image]
Definition

This is a superficial brown to black tumor that has a "stuck-on" appearance and a cobble-stone surface. 
Unlike squamous carcinomas of the eyelid, seborrheic keratosis does not typically cause inflammation around its edges nor does it have a smooth reddened scaly surface. If it does become inflammed it can be mistaken for a basal or squamous cell carcinoma. 


BENIGN!

Term
Which one moves? Thrombus or emboli?
Definition

Emboli! 

 

Causes CRAO, BRAO

Supporting users have an ad free experience!