cranial and ophtalmology Flashcards
Conjuctivitis
- causes
- Symptoms
- Causes: – Bacterial, Viral or Allergic
-
Symptoms:
- Conjunctival Hyperaemia – “pink eye”
- Chemosis - oedema of the eyelid
- Crust and Discharge
- “Foreign body sensation”
- Photophobia
How do differentiate between viral & bacterial & allergic conjunctivitis?
-
Bacterial
- unilateral
- thick discharge
- reduced vision
- urethtitis/ vaginal discharge (STD)
-
Viral:
- bilateral watery discharge
- Normal vision
- signs of viral infection (fever and Lymphadenopathy)
-
Allergic: (type 1 hypersensitivity )
- triggers such as pollen, dust, chemical scent
- Conjunctivitis symptoms
- plus: Itching Sneezing Red, watery and oedematous eye
Cataract
- causes
- Symptoms
- signs
- causes: clouding of the lens of the eye over 90% is due to age other can be due to (congenital, diabetes, drug induced, trauma)
-
Symptoms:
- Visual impairment
- glare, halos around lights
- Painless
-
Sign:
- reduced red reflex
- clouding of the lens
Glaucoma
causes
Types
Symptoms
Investigations
- causes: optic nerve damage due to raised intraocular pressure
-
Types:
- Primary Open Angle Glaucoma (Commonest type):
- presents acutely with a painful red eye
- due to dysfunction with Trabecular Meshwork
- Closed Angle Glaucoma
- can be acute or chronic
- Increased pressure pushing the iris/lens complex forwards, blocking the trabecular meshwork – vicious cycle
- Risk factors - small eye (hypermetropia), narrow angle at trabecular meshwork
- Treated with peripheral laser iridotomy (creates drainage hole on iris)
- Primary Open Angle Glaucoma (Commonest type):
-
Symptoms:
- progressive peripheral visual loss
- IF acute red painful eye signs
-
Investigations:
- Fundoscopy - disc cupping
- Gonioscope – look at the angle of the iris to determine if closed or open angle glaucoma
- Slit lamp examine whole eye closely
- Tonometry- measures intraocular pressure
How do differentiate between closed and open angle glaucoma?
-
Open:
- bilateral
- progressive vision loss
- initially asymptomatic
- mild non specific symptoms
-
Closed:
- unilateral
- sudden onset
- severely painful
- N&V, cloudy cornea, headache, dilated pupil
Uveitis
causes
Associations:
Types
Investigations
- What is it? inflammation of uvea (iris, ciliary body and choroid)
- causes: Systemic Inflammation Infection
-
Types:
- Anterior
- Posterior
- Complete
- Intermediate
-
Investigations:
- fundoscopy
- slit lamp examination
How do you differentiate between anterior and posterior uveitis?
-
Anterior
- autoimmune condition (seronegative spondyloarthropathies, RA, sarcoidosis, SLE, IBD and Bechet’s)
- painful
- ocular hyperaemia
- blurry vision
- increased lacrimation and photophobia
-
posterior:
- infective causes (viruses like CMV, EBC, HSC, VZV. Bacteria like syphilis and TB, and Lyme disease)
- painless
- blurry vision
- floaters and Scotomata
A 24 year old woman presents to her GP with a red painful eye with blurry vision. She has noticed a lot of clear discharge coming from her eye. She has otherwise been well, apart from some recent diarrhoea. What is the most likely diagnosis?
Viral Conjunctivitis
Bacterial Conjunctivitis
Anterior Uveitis
Posterior Uveitis
Closed angle glaucoma
Viral Conjunctivitis
Bacterial Conjunctivitis
Anterior Uveitis -
Posterior Uveitis
Closed angle glaucoma
What are the different calssification of vision affecting conditions you can get?
What lesions could cause such symptoms?
-
Prechiasmal: ISCHAEMIA (TIA) and INFLAMATION (MS, temporal arteritis)
- One eye only
- Ipsilateral
-
Chiasmal: PITUITARY TUMOUR AND CRANIOPHARYNGIOMA
- Bitemporal hemianopia
-
Post chiasmal tumours, MS, strokes
- Homonymous contrallateral - optic tracts
- homonymous superior quadrantanopia - inferior optic radiation
- homonymous inferior quadrantanopia -superior optic radiation
- Macula sparing - cortex
Neglect syndrome
Cause
Symptoms
Diagnosis
Cause: damage to the right parietal lobe
Symptoms: patient ignores that side- eat only food from one side, shave only one side, wash only one side
Diagnosis: finger wigling
A lack of the direct pulliary reflex would indicate a lesion to which cranial nerve
CN 2- optic
A lack of the consensual pulliary reflex would indicate a lesion to which cranial nerve
CN 3 - oculomotor
What is relative afferent pupillary defect?
What condition causes it?
medical sign observed during the swinging-flashlight test whereupon the patient’s pupils constrict less (therefore appearing to dilate) when a bright light is swung from the unaffected eye to the affected eye
Seen in optic neuritis and MS
What is the horner triad?
What are the differentials for it? (benign and malignant)
Investigation for Horner?
- What is the horner triad? Ptosis, Miosis, anhidrosis
- What are the differentials for it? (benign and malignant) - anything that pushes on sympathic nerve
-
Benign:
- migraine
- goitre
- cluster headache
- multiple sclerosis
- syringomyelia
-
Malignant:
- Pancoast’s tumour on the lung apex,
- thyroid carcinoma
- cavernous sinus
- thrombosis and carotid artery dissection -artery expands it will compress the nerve
- brainstem stroke -
- Investigations:
- CXR
- CT Head
- MRI/ MR Angiography
describe the difference between mediacl and surgical third nerve palsy?
To understand: parasympathetic nerve is on the periphary and the oculomotor in the center with blood supply
medical third nerve palsy (DM(blood suuply problem)): Pupil sparing - because the blood will first affect the more deeper strucure, as superificial have another blood supply
surgical third nerve palsy: mor liquely to involve the pupil because cut goes superficial and then deep
Typical appearance of a 3rd nerve palsy?
eye down and out
-> could involve the pupil as well
What does a trochlear nerve palsy look like?
What muscle does it supply
What is the most common cause of it?
What does a trochlear nerve palsy look like? looks up and in
What muscle does it supply? superior oblique,
What is the most common cause of it?
- idiopathic
- head trauma
- skull based tumor
- Microvasculopathy secondary to diabetes, atherosclerosis, or hypertension
What does a abducens nerve palsy look like?
What muscle does it supply
What is the most common cause of it?
What does a abducens nerve palsy look like? failure to abduct eye
What muscle does it supply? lateral rectus
What is the most common cause of it? In chilren: head trauma , in adults: stroke (viral illness, brain tumor, inflammation, infection, migraine headache and high ICT
what is an Internuclear opthtalmoplegia?
How does it happen?
what is an Internuclear opthtalmoplegia?
- lesion to the medial longitudinal fasciculus - connects cranial nerve 3 and 6- so they don’t move together
How does it happen?
CAUSE: In young people: MS in older people stroke
A 50 year old patient presents to A&E with diplopia. The doctor examines their cranial nerves and finds a palsy in the oculomotor nerve. Peripheral nerve exam demonstrated a length dependent sensory neuropathy. What did the doctor most likely see during the cranial nerve examination:
A.Internuclear ophthalmoplegia
B.Anhidrosis, miosis and ptosis
C.Down and out pupil
D.Mydriasis
E.Down and out pupil with mydriasis
A.Internuclear ophthalmoplegia
B.Anhidrosis, miosis and ptosis
C.Down and out pupil
D.Mydriasis
E.Down and out pupil with mydriasis
What are causes for a lack of trigeminal palsy? and where would they manifest?
- •Higher central (MCA)
- •Contralateral
- •Brainstem (Stroke (middle cerebral infarct), raised ICP)
- •ipsilateral
- •Peripheral (trauma and raised ICP) (Craniofacial trauma, skull base fracture, Maxillary sinusitis, Tumour, Aneurysm of internal carotid artery, cavenous sinus thrombosis)
- •Branch distribution
- •Lesion beyond trigeminal ganglion
What is Bells palsy?
What muscles are affected?
WHat are causes for Bell’s palsy?
What are investigaitons for Bell’s palsy?
What is the management of Bell’s palsy?
What is Bells palsy? Lower motor neurone lesion of the facial nerve
What muscles are affected? inability to wrinkle brow, drooping of the eyelid, inability to close the eye, inability to puff out the cheek, inability to smile or pucker
WHat are causes for Bell’s palsy?
- •idiopathic
- •compression of facial nerve within the facial canal
- •inflammation, e.g. viral infection
- •herpes simplex type 1 or varicella zoster
What are investigaitons for Bell’s palsy?
- •Serology - lyme, herpes, zoster
What is the management of Bell’s palsy?
- •Prevent corneal abrasions
- •Steroids - prednisolone
What is Ramsey hunt syndrome?
What muscles are affected?
WHat are causes ?
What are investigaitons ?
What is the management ?
What is Ramsey hunt syndrome? type of bell’s of the LMN facial nerve palsy due to Varicella Zoster
What muscles are affected? not forhead sparing
WHat are causes? varicella zoster
What are symptoms?
- •Pain often a prominent feature
- •other cranial nerves can be affected
- •vesicles in the ipsilateral ear, hard palate or the anterior two thirds of the tongue
- •can include deafness and vertigo
Whch part of the motor neurone system is affect in forhead sparing and non- sparing bell’s palsy?
- damage to upper motor neuron, such as in a stroke, then forehead is spared. This is because cranial nerve 7 has double innervation from each hemisphere, but only for forehead. So if supply from one hemisphere is knocked out, there is still supply from the other side.
- damage to lower motor neurone results in the forehead being affected as well
A 28 year old lady presents to A&E thinking she is having a stroke, worried as she cannot move the right side of her face. On examination, the patient cannot smile, puff up her cheeks or wrinkle her forehead on the right side. Serology comes back positive for herpes simplex virus 1. What is the most likely diagnosis?
A.Stroke
B.Bell’s Palsy
C.MS
D.Ramsay Hunt syndrome
E.Horner’s
A.Stroke
B.Bell’s Palsy
C.MS
D.Ramsay Hunt syndrome
E.Horner’s
FIll out the table out
What are causes of conductive hearing loss (state the place and an example of the condition)?
What are causes of sensory motorneurone loss (state the place and an example of the condition)?
What are causes of conductive hearing loss ?
- •External Auditory Canal
- •Wax
- •Foreign body
- •Otitis externa
- •Drum
- •Perforation – infection/trauma
- •Middle ear
- •Acute otitis media
- •Serous otitis media
- •Oval window
- •Otosclerosis
What are causes of sensory motorneurone loss?
- •Inflammation
- •Meningitis
- •Viral - MMR
- •Tumour
- •Acoustic neuroma
- •Ototoxic drugs
- •Aminoglycoside antibiotics
- •Aspirin (overdose)
- •Loop diuretics
- •Trauma
- •Meniere’s disease
Fill out the table about Neurofibromatosis type 1 and type 2
NF1 more common
How to remember: NF1 associated with problems with body as a whole (you only have 1 body), whereas NF2 associated with ear problems (you have 2 ears)’
Both have increased risk of CNS cancers
What is the condition seen on this image and what are the names these things
NF1 on examination, top left is café-au-lait spots, bottom left is neurofibromas, bottom right is lisch nodules
A 20 year old lady sees her GP after having some hearing difficulties in the last week. On examination, Weber’s test lateralises to her left ear. Rinne’s test is negative in her left ear also, but positive in the right ear. She reported having a cold at the start of the month. Which of these is most likely?
A.Meningitis
B.Otitis media
C.Foreign body
D.Meniere’s disease
E.Neurofibromatosis type 2
A.Meningitis
B.Otitis media
C.Foreign body
D.Meniere’s disease
E.Neurofibromatosis type 2
What are the differences between a pseudobulbar palsy and a bulbar palsy?
Is it upper or lower motor neurone
Which nerves does it affect
what are tehe symptoms
what conditions are they associated with
what is the speech like
what about their emotion?
A 60 year old man presents to his GP with dysphagia. The GP notices he speaks with a nasally voice. Examination demonstrates a reduced gag reflex, as well as fasciculations and wasting of the tongue. Jaw jerk is normal. Which of these is the most likely cause of their dysphagia?
A.Stroke
B.Parkinson’s
C.Motor neuron disease
D.MS
E.Achalasia
A.Stroke
B.Parkinson’s
C.Motor neuron disease
D.MS
E.Achalasia
