ENT Flashcards
Otitis externa
- what bacteria
- mild vs infected treatment
Why urgent referral for malignant OE
P.aeruginsomas
Acetic acid
Abx + steroid drops
Risk of osteomyelitis
Drugs that cause HL
Aminoglycosides (gentamicin, neomycin) - irreversible
Loop diuretics (furosemide, bumetamide) - largely reversible
Chemotherapeutic agents (cisplatin, carboplatin) - irreversible
Aspirin, NSAIDs- reversible
Causes of congenital hearing loss
- special baby care unit x 10 more likely earring loss than peers
Toxoplasmosis
Rubella
CMV
Herpes
Syphilis
Neonatal hypoxia
Rhesus incompatibility
Hearing test
- at birth
- At 6-9months
Oto-acoustic emissions
Distraction testing
Audiometery >5years
OM effusion
- period of observation
- concerns for urgent referral
3months
- <61, hearing concerns or downs
Risks for Cholesteatoma
ET dysfunction
FHx
Bisphosphates
Description of Rennes and Webber’s
Rinnes = AC is > BC
Webbers - lateralised to good ear in SL, bad ear in conductive
Criteria for immediate ENT referral in hearing loss
<3days, 3fre 30db
Within 30days, any neurological symptoms or post-trauma
Start def after discussion with ENT
If HL is >30days ago - what is referral
2WW urgent
Also if ?NPC or cholesteroma
What tinnitus symptoms warrant urgent ENT referral
Unilateral, pulstaile, neuro symptoms
Tx for reducing frequency of menires
- avoid in
Betahistime (asthma, PU)
Also bendrufthaize, low salt, vest rehab
Differentiation between Thyroglossal cyst and brachial
T = moves up on tongue protrusion, midline, 15-30 years (common!)
B = at junction of sternmastoid, Fluctant lump, 16-30
Chronic sinusitis
- main stay of treatment
- if blocked nose
- water eyes
- asthma
- doesn’t want steroid
Nasal saline irrigiatation
Antihistamines
Intranasal steroid (fluticasone, momestasone)
Decongestants (Xylometazole’ ‘Pseudoperfi’)
- only 7 days
Ipratium bromide drops
LTRA
Sodium cromoglicate
Hay fever topical eye drops ‘Chromil’ like Nedocromil
When would a sore throat require urgent FBC
DMARD
Carbimazole
Criteria for ?PEN V in sore throat for 10days (>4)
- if allergic
Fever within 24hours
Pus on tonsils
Attends within 3 days
Inflamed tonsils
No cough/corzyal
Erythromycin or Clari
What might you seen in back ground retinopathy
Microaneurysms (lots of cappillaries)
Dot and blot haemorrhages (bleeding cappilaries)
what indicaties the progression from background o pre-porliferaive retinopathy
Reinal ischaemia
- coton wool spots (dead nerve cells)
- venous changes
–> routine opthal referral
changes indicating proliferative retinopathy
what our pathology does this lead the risk to
treatment
neovascularisation
- urgent opthal referral
advanced this can cause
- viterous haemorrhage
- retinal detachements
- rubeosisis (gluacoma)
pan-retinal photocoagulation
what occurs in diabetic maculatoapthy
now present of hard exudates + macular oedema
- routine referral
what are the 3 grades of hypertensive retinopathy
1 = ateriolar narrowing
2 - AV nippinh (narrowing + compression)
3 = like diabetic retinopathy- retinal haemorrhages, hard exudaes and coton wool spots
4 (malignat) - as 3 but also with optic disc swelling
- will have symptms of reduced acuity, headaches
what will optic cuppig indicate
swollen optic disc
gluacoma
raised ICP
recommended treatent for a small FB in eye
Local anaesthetic eye drops act for about 15 minutes, so an eye pad to prevent injury is not required.
Chomplemhicol eye drops for 5 days
She should not replace the contact lenses until 24 hours after the antibiotic course has been completed.
discussion with an ophthalmologist in view of the history of contact lens use.
re-examine after 24 hours using fluorescein stain, to ensure the corneal abrasion is healing.
Treatment for primary (chronic) open angle gluacoma
First-line treatment is with prostaglandin analogues (Latanoprost) which increase aqueous humour drainage.
If prostaglandin analogues are not tolerated then topical beta-blockers can be used. Third-line treatment includes alpha adrenoreceptor agonists or carbonic anhydrase inhibitors.
treatment for acute open angle glaucome
pilocarpine hydrochloride - Miotic eye drops
then reduce production of aqueous humour - , Topical prostaglandin analogues - lanatonprost, caution in COPD
BB
carbonic anhydrase - Oral acetazolamide or Topical brinzolamide
Brimonidine - caution in CVD
what might pain and reduce acuity 2 weeks after cataract surgey indicate
endophthalmitis
- urgent referral
crystaloid macular oedema migh just show reduced acuity
- topical NSAIDs
The most common postoperative complication of cataract
Posterior capsular opacification — this is a consequence of proliferation of remnants of lens epithelial cells.
This proliferative opaque membrane causes decreased visual acuity, blurred vision, or glare. It occurs gradually months or years after surgery. It can be corrected by laser treatment.
Posterior vitreous detachment vs retinal detachement
Flashes of light (photopsia) - in the peripheral field of vision
Floaters, often on the temporal side of the central vision
Dense shadow that starts peripherally progresses towards the central vision
A veil or curtain over the field of vision
Straight lines appear curved
Central visual loss
