Special Senses

Abnormal Fundoscopic Findings

Finding Diseases
Cherry-red spots Retinal artery occlusion
Lysosomal storage diseases (LSD)
Cotton-wool spots Diabetic retinopathy
Hypertensive retinopathy
Retinal vein occlusion
CMV retinitis
Drusen Age-related macular degeneration (AMD)
Optic nerve cupping Open-angle glaucoma

Etiology of Ophthalmoplegia & Nystagmus

Lesion Presention Etiology
Inner ear Peripheral vertigo Vestibular disorders
CN VIII Bruns nystagmus Cerebellopontine angle tumors
Superior colliculus Vertical gaze palsy Parinaud syndrome
Frontal eye fields (FEF)
Paramedian pontine reticular formation (PPRF)
Horizontal gaze palsy -
Medial longitudinal fasciculus (MLF) Internuclear ophthalmoplegia (INO) Multiple sclerosis
CN III Down-and-out gaze Cavernous sinus thrombosis
Posterior communicating artery aneurysm
Uncal herniation
Extraocular muscles - Myasthenic syndrome
Thyroid ophthalmopathy
Mammillary body - Wernicke encephalopathy
- - Epilepsy
Stroke
Migraine
Chiari malformation

Presentation of Parinaud Syndrome

  • Vertical gaze palsy
  • Convergence-retraction nystagmus
  • Light-near dissociation
  • Collier sign

Etiology of Miosis

  • Drug-induced
    • ACh esterase inhibitors
    • M agonists
    • α2 agonists
    • Opioids
  • Cluster headaches
  • Horner syndrome

Etiology of Mydriasis

  • Drug-induced
    • M antagonists
    • NDRIs
  • CN III damage
    • Cavernous sinus thrombosis
    • Posterior communicating artery aneurysm
    • Uncal herniation
  • ↑ Intracranial pressure (ICP)
    • Intracranial hemorrhage
    • Cerebral edema
  • ↑ Intraocular pressure (IOP)

Presentation of Glaucoma

  • Headache
  • Nausea ± vomiting
  • Visual disturbances
  • Non-reactive pupil
  • Mydriasis

Medications for Glaucoma

Mechanism Medication
ACh esterase inhibitors Organophosphate
Sarin
M agonists Carbachol
Pilocarpine
α2 agonists Brimonidine
β antagonists Timolol
PGF2 agonists Latanoprost
Carbonic anhydrase inhibitors Acetazolamide

Treatment of Dry Eye Disease (DED)

  • Cyclosporine :: topical
  • Lifitegrast :: topical
  • Corticosteroids :: topical
  • Pilocarpine
  • Punctal occlusion
  • Autologous serum tears

Abnormal Physical Examination Findings in Hearing Loss

Hearing Loss Rinne Test Weber Test
Normal AC > BC Left = Right
Sensorineural AC > BC Lesion < Normal
Conductive AC < BC Lesion > Normal
  • Air conduction (AC)
  • Bone conduction (BC)

Abnormal Audiographic Findigs

Conductive Hearing Loss

Sensorineural Hearing Loss

Mixed Hearing Loss

Noise-induced Hearing Loss

Presbycusis

Meniere Disease

Osteosclerosis

Abnormal Findings on Tympanometry

Type Interpretation
A Normal
Ad Ossicular chain dislocation
As Tympanosclerosis
B Perforation
C Eustachian tube dysfunction

Etiology of Peripheral Vertigo

  • Benign paroxysmal positional vertigo (BPPV)
  • Labyrinthitis
  • Labyrinthine concussion
  • Meniere disease
  • Vestibular neuritis
  • Vestibular schwannoma

Pathogens of Otitis Externa

  • Enterobacter
  • Pseudomonas

Pathogens of Otitis Media {SHM}

  • Streptococcus pneumonia
  • Haemophilus influenzae
  • Moraxella catarrhalis

Treatment of Allergic Rhinitis

  • Allergen avoidance
  • Intranasal H1 antagonists
  • Oral H1 antagonists
  • Intranasal corticosteroids

Treatment of Nonallergic Rhinitis (NAR)

  • Intranasal H1 antagonists
  • Intranasal corticosteroids

Pathogens of Sinusitis {SHM}

  • Streptococcus pneumonia
  • Haemophilus influenzae
  • Moraxella catarrhalis
  • Mucor and Rhizopus

Pathogens of Pharyngitis & Tonsillitis

  • Group A streptococcus (GAS)
  • Adenovirus
  • HSV
  • EBV
  • CMV
  • HIV
  • Parainfluenza virus
  • Influenza virus