Case Studies: HEENT Exam #1 with 100% complete solutions

A 65 year old Female with diabetes, a history of smoking, and history of UV exposure presents with progressive blurry vision over the past several years in both eyes. She also states difficulty with driving at night time. Upon physical exam you notice an absent red reflex and opaque lens. 1. What is the diagnosis? 2. What can cause this? 3. What is the tx? 1. Cataracts 2. UV light, age, diabetes, smoking, steroids, trauma, malnutrition 3. Observation if mild. Cataract surgery is elective. Extracapsular incision (larger) or Phacoemulsification (more common, smaller) A 50 year old African American M presents to the office today with slow, progressive painless bilateral peripheral vision loss. Upon physical exam you notice cupping of optic disc and notching of the disc rim. 1. What is the diagnosis? 2. Possible treatments? 1. Primary open angle glaucoma 2. LOWER THE IOP! * 1st = Prostaglandin analog eyedrops (latanoprost) * 2nd = Surgery such as Argon Laser Trabeculoplasty (ALT) or Trabeculectomy 00:00 01:51 A 65 y/o Asian F presents to the ED with sudden onset of severe unilateral ocular pain. She states nausea and headache, blurry vision, and halos around lights. She has a history of hyperopia. Upon PE you notice cloudy swollen cornea, conjunctival injection and intraocular inflammation. Tonometry shows increased IOP and fundoscopy reveals optic disc cupping. 1. What is the diagnosis? 2. What can cause this? 3. Treatments? 1. Closed angle Glaucoma 2. Mydriasis (dilation) can be caused by dim lights, sympathomimetics, anticholinergics. 3. Peripheral iridectomy = Definitive treatment. Consult ophthalmologist if constriction or dilation meds needed. Give pain meds and antiemetics. A 40 y/o male farmer from sunny Florida presents to the office today for his annual checkup. Upon PE you notice a triangular shaped growing fibrovascular mass that starts medially and extends laterally on the bulbar conjuctiva. The pt stated he has noticed some irritation and feels like there is something in his eye. 1. Diagnosis? 2. Treatment? 1. Pterygium 2. Treatment: - Artificial tears. - Steroid drops for inflammation. - Surgery is usually cosmetic or needed if growth affects vision. A 50 y/o F with a hx of ocular rosacea presents to the office with a painful, warm, pustule on the outer eyelid at the lash line. 1. What is the dx and bacteria that commonly causes this? 2. Treatment 1. Hodeolum (Stye) - Staph aureus 2. Treatment: - Mostly warm compresses - Topical antibiotic ointment - I&D if no spontaneous drainage after 48 hrs. A 25 y/o F presents with a large, firm, tender, painless nodule on the conjunctival surface of the eyelid. She has also noticed some redness associated with that eyelid. 1. What is the diagnosis? 2. Tx? 1. Chalazion 2. Treatment: - warm compress - Triamcinolone injection if no infection - Incision and curettage A 10 year old boy was violently struck from the left side while playing a football game. After he removed his helmet his teammates noticed a bright red patch on the white of his eyeball. He saw his family PCP the next day and the red patch was painless and no vision loss was noted. 1. Diagnosis? 2. Treatment? 1. Subconjuctival hemorrhage 2. No treatment will heal in about 1 week. Monitor BP just to be sure not elevated. A 65 y/o female presents with pain and swelling in the outer part of the upper lid with a S-shaped curve of its margin. Upon physical exam you notice a firm lobulated mobile mass felt under the upper rim of orbit and watery discharge. 1. Diagnosis? 2. Causes? 3. Treatment? 1. Dacryoadenitis 2. Acute - viral or bacterial, Chronic - inflammatory disease such as sarcoidosis, Grave's 3. Treatment: - Acute: warm compress + abx - Chronic: treat underlying disease