ENT Flashcards
Blatchford bleeding score is for what
Calculating Upper GI bleeding risk
Both corneal ulcers and corneal abrasions have the same symptoms, except an ulcer goes deeper/ is an open sore and therefore abrasions are much much milder in comparison. What are the symptoms?
Pain
Photophobia
Visual acuity
Meaning of this discharge:
Purulent
Vs
Watery/clear
Purulent = bacterial infection
Watery/clear = viral infection
What is a corneal ulcer?
Open sore of infection / ulcer of the cornea
Investigation for corneal ulcer
Causes green uptake at epithelial damage/defect following fluorescent drops under cobalt blue light
Treat corneal ulcer how? (2)
Based on infection:
Antivirals
Antibiotics
Antifungals
Also treat systemic symptoms with what?
Antiemetics
Analgesia- topical or oral
Complication of corneal ulcer?
Complete vision loss
What’s keratitis?
Inflammation of the cornea
Common in contact lens wearer
Why vision loss in glaucoma?
Optic nerve becomes damaged due to fluid build up, leading to pressure build up
What does aqueous humour do?
Provide nutrients to the cornea
Where does the aqueous humour travel in bullet points, from the posterior chamber and around the iris?
1) anterior chamber
2) trabecular meshwork
3) canal of schlemm
First line treatment for glaucoma?
Prostaglandin analogue eye drops like latanoprost
Which increases outflow of aqueous humour
Why might you give beta blockers in glaucoma?
They reduce production of aqueous humour
What surgery for glaucoma if all else fails?
Trabeculectomy surgery
How does glaucoma present?
Severely painful red eye
Halos around lights
Also associated with headache and nausea
Looks red, feels hard, can’t really see
First thing to do for someone with acute glaucoma?
Lie them down with no pillow
First med pre hospital to give for glaucoma?
Pilocarpine eye drops (muscarininc receptor) that causes pupil to constrict for more space)
What’s uveitis?
Inflammation of the uvea of the eye
What is the uvea made of (3)
Iris
Ciliary body
Choroid
What does uveitis occur? / why would your uvea of the eye, become inflamed.
Usually autoimmune
But
Can also be: trauma and infection
Symptoms of uveitis?
Red
Pain
Photophobia
And
Excessive lacrimation
Risk factors for uveitis? And give example
Anything inflammatory
Arthritis, sarcoidosis, IBD
How to treat uveitis? (2)
Steroid eye drops
And
Cycloplegics
What do cycloplegics do?
Act on ciliary muscles- paralyses them, dilates pupil
If bacterial conjunctivitis, what time of day are symptoms worse?
Morning when eyes stick together
Pain vision loss and photophobia: which red eye condition couldn’t this be?
Conjunctivitis
Symptoms of conjunctivitis? (3)
Red/pink eye
Gritty/itchy
Discharge (which might give blurry vision)
If there’s no vision loss with conjunctivitis, why might there be blurry vision?
Discharge might cause it
treatment of conjunctivitis?
self resolves, but can clean out.
however if due to allergy, use antihistamine or mast cell stabiliser
when would you have an urgent referral for conjunctivitis?
if it occurs under one month old, because it could be a gonococcal infection
pathology of stye?
infection of glands on eyelid near base of eyelashes (usually meibomian glands)
purpose of meibomian glands
secrete oil for your tears I’m pretty sure
treat stye how
maybe analgesia recommended
topical antibiotics e.g. chloramphenicol eye drops
how do we treat acute angle closure glaucoma (3)
Lie down
Pilocarpine- works on muscarinic receptors so pupil constricts therefore more space
Beta blockers like timolol
Why beta blockers like timolol in treating acute angle closure glaucoma?
Timolol reduces aqueous humour production
Corneal abrasion caused by chemicals- what treatment?
immediate irrigation
Red eye, loss of visual acuity, and photophobia.
Daughter was ‘helping’ mother put on makeup. What’s wrong?
corneal abrasion.
would you get photophobia with a corneal abrasion?
yes
Red eye, loss of visual acuity, and photophobia.
Daughter was ‘helping’ mother put on makeup.
Then the patient say’s it’s bilateral. What condition, that originally seemed very likely, now seems less likely?
corneal abrasion, just cuz of the chances of it being bilateral
Manage corneal abrasion how?
remove foreign bodies
simple analgesia
lubricating eye drops (carbomer)
diagnose corneal abrasion how?
fluorescein stain which highlights under blue light (though also collects in ulcers)
pathology of orbital cellulitis?
infection of muscles and fat of the orbit
usual cause of pathology of orbital cellulitis?
usually bacterial, source > from the sinuses.
pain with eye movement
proptosis
vision change
fever
reduced eye movement, swelling
What is this?
orbital cellulitis
You initially suspected orbital cellulitis, but now there are red flag symptoms, i.e. meningeal signs, and a couple others. What are these?
meningeal: neck stiffness, altered mental state.
altered colour vision
nausea/vomiting
abnormal pupil reaction
you kinda do the whole shebang of investigations for orbital cellulitis. When would you include a lumbar puncture?
if meningeal signs also
e.g. neck stiffness, altered mental state.
Treatment for orbital cellulitis
immediate admission for IV antibiotics for 7-10 days
what does having ‘cataracts’ actually mean?
lens go cloudy because proteins in the lens break down, start clumping together
what 2 conditions can cataracts hide?
diabetic retinopathy
macular degeneration
NB diabetes is a risk factor for cataracts
Horner’s: there is a lesion on the sympathetic chain supplying what?
the eye
why does the eye constrict in Horners?
It’s disruption in sympathetic innervation. So it constricts because we’ve lost dilator pupillae
Why droopy eyelid in horners? The LPS is innervated by the oculomotor nerve, which is parasympathetic. (all cranial nerves are parasympathetic).
because we’ve got loss of muscles that help LPS
what’s the name of the eyedrop you give in investigation for Horner’s, that reverses constriction by working on alpha 2 agonist receptors?
apraclonidine
Is the vision loss that age related macular degeneration causes, bilateral or unilateral?
often just unilateral
what is the pathology of age related macular degeneration
progressive condition of affecting the macula, where loads of drussen (yellow protein deposits) are found in the macula.
what’s the macula
part of retina found back of the eye that’s important for high definition colour vision in the centre
wet vs dry macular degeneration
wet (10%) = new vessels develop and grow into the retina, and can leak fluid or blood, causing faster vision loss
treatment for WET macula degeneration
ranibizumab (anti-VEGF)
anti vascular endothelial growth factor lol
what three investigations/tests do you do for age related macular degeneration?
1) drussen is seen in fundoscopy
2) amsler grid test causes distortion of straight lines in AMD
3) snellen chart for visual acuity
sudden painless loss of vision is a red flag symptom of what
ischaemic optic neuropathy
often due to giant cell arteritis
Tonsilitis is usually viral, but if it’s not viral, then what bacteria
strep A
When do you give antibiotics like penicillin or clarithromycin for tonsilitis
when centor score is above 3
what’s the centor score
used to assess likelihood sore throat or even like tonsilitis, is due to bacteria.
What treatment for tonsilitis
safety net and paracetamol
Optic neuritis treatment
It may go away on its own after a few weeks if no other conditions, but: give high dose of IV steroids. as urgent input.
Diagnose optic neuritis how
MRI scan of the brain
can see relevant afferent pupillary defect
and other symptoms
optic neuritis is central or peripheral vision loss
vision loss starts in the centre
two biggest bacterial causes of otitis externa
1) pseudomonas aeruginosa
2) staphylococcus aureus
treatment of otitis externa- mild vs severe
acetic acid (which is antibacterial AND anti-fungal)
if moderate:
topical antibiotic and steroid
if severe: oral antibiotics, maybe IV and admission to see extent of infection
which bacteria is often cause of swimmers ear/otitis externa, but is also seen colonising lungs of patients with cystic fibrosis?
pseudomonas aeruginosa
ear pain
itchiness
maybe conductive hearing loss
discharge
swimmer
otitis externa
which symptoms accompanying otitis externa suggests it’s become ‘malignant’?
headache
severe pain
and
fever
pathology of ‘malignant’ otitis externa
infection has spread to temporal bone
management of malignant otitis externa
admission
antibiotics
imaging e.g. CT or MRI
A fractured cribriform plate can lead to leakage of CSF how?
Because of penetration of meningeal linings of the brain, therefore meningitis, encephalitis, cerebral abscess etc.
Correct order of management of epistaxis
nasal packs
nasal cautery- silver nitrate sticks
naseptin nasal cream like neomycin, 4 times daily
what hypersensitivity reaction would be present in allergic rhinitis?
IgE mediated type 1 hypersensitivity reaction
for allergic rhinitis, obvs give antihistamine. What is the other treatment possible?
nasal corticosteroid spray like fluticasone or beclomethasone.
mastoiditis is common in children under the age of what
two years
mastoiditis is usually secondary to what
bacterial infection usually streptococcus pneumoniae
what’s the 4 step pathological pathway of mastoiditis?
exudate collects
increase in pressure
therefore bone necrosis
therefore abscess cavity
bulging behind the ear, and systemic upset such as- irritability, fever, lethargy, diarrhoea, headache, vertigo, hearing loss, otorrhoea.
what is this likely to be
mastoiditis
how do we diagnose mastoiditis
history of bacterial infection
hearing loss
+ non specific systems
+ actually seeing a bulge
First initial management of mastoiditis? (4)
ABCDE
nil by mouth in case we need to do something
analgesia
SEPSIS 6 with broad spectrum antibiotics
Your sepsis 6 management with broad spectrum antibiotics isn’t working in the patient with mastoiditis. What should you do next?
Give IV antibiotics
then potentially mastoidectomy with purulent middle ear fluid sent to microbiology.
Glue ear/otitis media with effusion management
grommet
why would you see discharge in otitis media?
Because tympanic membrane has perforated
why would you ever give antibiotics in otitis media? And what would it be?
If maybe bilateral, or immunocompromised. Consider delayed prescription.
5 days amoxicillin or erythromycin or clarithromycin
hearing loss
tinnitus
acute onset vertigo
what disease is this
labyrinthitis
labyrinthitis is a ‘peripheral cause of vertigo’. What is actually infected?
petrous part of the temporal bone
how to diagnose labyrinthitis?
exclude other causes of vertigo and look at clinical conditions
symptom difference between labyrinthitis and vestibular neuronitis
labyrinthitis has tinnitus, so like ‘hearing problems’ as well. the same management
what do we do in acute labyrinthitis? First step
3 days of tryna suppress chemoreceptor trigger zone with ‘prochlorperazine’
and treat underlying infections
if you have meningitis, WITH hearing loss, what might have you got now?
labyrinthitis
are nasal polyps bilateral or unilateral
bilateral. If unilateral, bad. think malignancy
what growths are associated with chronic rhinitis, sinusitis, cystic fibrosis and asthma?
nasal polyps
how should nasal polyps be treated?
nasal steroid drops or eventually polypectomy
exact definition of rhinosinusitis
inflammation of the mucous membrane of the nose
viral rhinosinusitis can include fever, true or false
true
for treating rhinosinusitis, it can be viral or autoimmune. so treatment, as well as nasal irrigation and antihistamine, is what?
decongestants
and
nasal corticosteroid sprays
method of action of phenylephrine (a decongestant)
causes blood vessels of the nasal mucous membrane to narrow/constrict
why would you only use nasal sprays for 3 days
it can cause rebound congestion/suddenly makes things worse after 3 days
lots of blood, thick foul smelling pus, crusting. Is this more likely in acute or chronic rhinitis
obviously chronic
NB infection requires culture
how to manage stridor after ABCDE, sitting patient upright and
CT if chance of abscess/tumour (4)
manage with broad spectrum antibiotics
nebulised adrenaline
IV high dose steroids
High flow oxygen
cleft lip/palate is usually picked up on what scan
20 week screening scan
