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Phase 3b > ENT > Flashcards

ENT Flashcards

1
Q

Causes of a painless red eye

A

Conjunctivitis
Episcleritis
Subconjunctival haemorrhage

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2
Q

Causes of a painful red eye

A 
Glaucoma
Anterior uveitis
Scleritis
Corneal abrasion or ulceration
Keratitis
Foreign body
Traumatic or chemical body
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3
Q

Red flags for a red eye

A

Impaired vision
Pain/photophobia
Lack of ocular discharge

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4
Q

Define conjunctivitis

A

Inflammation and redness of the conjunctiva -> covers the inside of eyelids and sclera

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5
Q

Symptoms of conjunctivitis

A 
Red eyes
Unilateral or bilateral
Vision unaffected
Bloodshot
Itchy or gritty sensation
Discharge from the eye
Does NOT cause pain, photophobia or reduced visual acuity
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6
Q

Symptoms of bacterial conjunctivitis

A

Purulent discharge -> pus
Eyes may be stuck together in morning
Highly contagious
Starts in one eye and spreads to other

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7
Q

Causative organisms for bacterial conjunctivitis

A

Staph
Strep
Haemophilus
Neisseria

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8
Q

Symptoms of viral conjunctivitis

A 
Clear discharge (serous)
Dry cough
Sore throat
Blocked nose
Preauricular lymph nodes (in front of the ears)
Recent URTI
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9
Q

Common cause of viral conjunctivitis

A

Adenovirus

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10
Q

Features of allergic conjunctivitis

A 
Most frequent
Watery and serous discharge 
Itch
Caused by contact with allergens
Type 1 hypersensitivity
Antihistamines (oral or topical) used to reduce symptoms
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11
Q

Treatment for conjunctivitis

A

Reassurance (resolves after 1-2 weeks) + hygiene

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12
Q

Treatment for bacterial conjunctivitis

A

Chloramphenicol

Fuscidic acid

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13
Q

Features of chlamydial conjunctivitis

A

Trachoma is on the leading causes of blindness in the world

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14
Q

What is ophthalmia neonatorum

A

Conjunctivitis in the first three weeks of life

Purulent discharge

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15
Q

Causes of ophthalmia neonatorum

A

Chlamydia
Herpes simplex
Gonorrhoea
Staph/strep

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16
Q

Tests for ophthalmia neonatorum

A

Swab and microscopy

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17
Q

Treatment for ophthalmia neonatorum

A

Chlamydia - erythromycin/azithromycin

Gonorrhoea - cefotaxime and chloramphenicol

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18
Q

Define episcleritis

A

Thin vascular layer between sclera and conjunctiva

Common in young women

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19
Q

Symptoms of episcleritis

A 
Acute onset
Unilateral (bilateral in 30%)
Typically not painful
Segmental redness
Dilated episcleral vessels
Watering of eye
NO discharge
Visual acuity is normal
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20
Q

What is episcleritis associated with

A

Rheumatoid arthritis
Rheumatic fever
SLE
PAN

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21
Q

Treatment for episcleritis

A

Self-limiting and will recover in 1-4 weeks
Artificial tears
Topical or systemic NSAIDs (e.g. naproxen)

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22
Q

Define subconjunctival haemorrhage

A

Small blood vessel within the conjunctiva ruptures and releases blood into the space between the sclera and the conjunctiva

They often appear after episodes of strenuous activity such as heavy coughing, weight lifting or straining when constipated

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23
Q

Causes of subconjunctival haemorrhage

A

Hypertension
Bleeding disorders (e.g. thrombocytopenia)
Whooping cough
Medications (warfarin, NOAC’s, antiplatelets)
Trauma

24
Q

Symptoms of subconjunctival haemorrhage

A

Sudden onset
Painless - does not affect vision
Bright red covering white

25
Q

Management of subconjunctival haemorrhage

A

Resolves spontaneously - 2 weeks

26
Q

Define scleritis

A

Inflammation of the full thickness of the sclera

More serious than epscleritis

27
Q

What is the most severe type of scleritis

A

Necrotising scleritis

Causes visual impairment, can lead to perforation of sclera

28
Q

Associated conditions with scleritis

A 
Rheumatoid arthritis
SLE
IBD
Sarcoidosis
Granulomatosis with polyangiitis
29
Q

Symptoms of scleritis

A 
Constant, severe dull ache
Severe pain
Pain with eye movement
Photophobia
Eye watering -> no discharge
Reduced visual acuity
Headache 
Abnormal pupil reaction to light
Tenderness to palpation of the eye
30
Q

Management of scleritis

A

Urgent referral within 24 hours
Oral NSAIDs
Oral high dose prednisolone
Treat underlying condition - methotrexate for RA

31
Q

Define anterior uveitis

A

Inflammation in the anterior uvea which comprises of the iris and ciliary body

32
Q

Causes of anterior uveitis

A 
Ankylosing spondylitis
IBD
Reactive arthritis
Sarcoidosis
Syphilis
Lyme disease
TB
Herpes simplex
Behcet's disease
33
Q

Symptoms of anterior uveitis

A

Unilateral
Dull, aching painful red eye
Ciliary flush (ring of red spreading from cornea outwards)
Reduced visual acuity - blurred visual
Photophobia
Pain on movement
Lacrimation
Floaters and flashes
Sphincter muscle contraction causing miosis (constricted pupil)
Abnormally shaped pupil due to posterior synechiae (adhesions) pulling the iris into abnormal shapes

34
Q

Ask about in a history for anterior uveitis

A 
Headaches
Mouth ulcers (Behcet's)
Joint problems
Chest and skin disease
GU symptoms
35
Q

Investigations for anterior uveitis

A

Slit lamp with dilated pupil to visualise inflammatory cells

Fundus fluorescein and indocyanide green-angiography

36
Q

Treatment for anterior uveitis

A

Urgent same day referral to ophthalmologist
Topical prednisolone
Cyclopentolate or atropine (to dilate pupil)
DMARDs and TNF inhibitors for immunosuppression
Laser therapy/surgery (vitrectomy) in severe cases

37
Q

Define keratitis

A

Inflammation of the cornea

Breakdown of the epithelium = corneal ulcer

38
Q

Causes of keratitis

A

Viral - herpes simplex
Bacterial - psuedomonas or staph
Fungal infection with candida or aspergillus
Contact lens acute red eye (CLARE)
Exposure keratitis is caused by inadequate eyelid coverage (e.g. eyelid ectropian)

39
Q

Symptoms of herpes simplex keratitis

A 
Painful red eye
Photophobia
Vesicles around the eye
Watery discharge
Foreign body sensation
Reduced visual acuity
40
Q

Investigations for herpes simplex keratitis

A

Staining with fluorescein - shows dendritic corneal ulcer
Slit lamp examination
Corneal swabs or scrapings

41
Q

Management for herpes simplex keratitis

A

Aciclovir (topical or oral)

42
Q

Symptoms of bacterial keratitis

A

Painful red eye
Loss of vision
Hazy cornea with central abscess

43
Q

Management of bacterial keratitis

A

Requires specialist

Intense antibiotics

44
Q

Define corneal abrasions

A

Scratches or damage to the cornea

45
Q

Causes of corneal abrasions

A 
Contact lenses - may have psuedomonas infection
Foreign bodies
Finger nails
Eyelashes
Entropion (inward turning eyelid)
46
Q

Symptoms of corneal abrasions

A 
History of contact lenses/foreign body
Painful red eye
Foreign body sensation
Watering eye
Blurring vision
Photophobia
47
Q

Diagnosis of corneal abrasions

A

Staining with fluorescein -> yellow/orange colour

Slit lamp examination in more severe cases

48
Q

Management of corneal abrasions

A 
Same day referral
Analgesia - paracetamol
Lubricating eye drops
Antibiotic eye drops - chloramphenicol
Cyclophentolate eye drops - dilate pupil - improves photophobia

Usually heals over 2-3 days

49
Q

Bacterial causes of corneal ulcers

A

Pseudomonas

50
Q

Fungal causes of corneal ulcers

A

Candida

Aspergillus

51
Q

Protozoal causes of corneal ulcers

A

Acanthamoeba

52
Q

Vasculitic cause of corneal ulcers

A

Rheumatoid arthritis

53
Q

Management of corneal ulcers

A

Refer
Chloramphenicol drops (gram +ve)
Ofloxacin (gram -ve)

54
Q

Cause of herpes simplex corneal ulcers

A

Keratitis manifestation

55
Q

Symptoms of herpes simplex corneal ulcers

A

Pain
Photophobia
Watering

56
Q

Diagnosis of herpes simplex corneal ulcers

A

Slit lamp - fluorescein -> look for dendritic ulcers

57
Q

Treatment for herpes simplex corneal ulcers

A

Aciclovir

Phase 3b (18 decks)

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