ENT and Ophthalmology Flashcards
Where can referred pain be from if a pt presents with earache (otalgia)?
Teeth, TMJ, tonsils, pharynx, cervical spine
How is an otoscopy performed?
Helix of ear pulled backwards and upwards - can see tympanic membrane
What is the Rinne tuning fork test?
Tuning fork vibrated on mastoid process and then when pt cant hear it its put to the side of ear canal. Air conduction > bone conduction = normal. BC>AC = abnormal. Careful - false negatives
What is the Webers tuning fork test?
Lateralises sound by putting vibration in midline. Conductive = ipsilateral (vibrations on same side)
Sensorineural = contralateral (vibrations on other side)
What does sensorineural mean?
Deafness where nerves affected (VIII -vestibular cochlear nerve)
What does conductive mean?
Sound waves not conducted properly down ear canal into ossicles
What is pure tone audiometry?
Air and bone conduction tested with different intensities of sound in a soundproof booth. Sensitivity more precise and measurable
What is electronic response audiometry?
Electrodes glued to scalp and sound stimuli given and cortical response measured - objective
For the external ear:
a) What is the outer 2/3 and inner 1/3 made up of
b) What cells are present
c) What cells are not present
a) Outer = cartilage Inner = bone
b) Specialised squamous epithelium, ceruminous glands, multiple sensory supply
c) Follicles, does not desquamate
What is otitis externa?
Inflammatory disorder of external ear where the tympanic membrane is inflamed causing pain, serous discharge and ‘blocked ear’. Infection with Pseudomonas, S.aureus, HSV, Candida, Aspergillus
What are the causes of otitis externa?
General = irritants, skin disorders Local = trauma, infection of the middle ear spreading
What is an auricular haematoma?
Blood fills between skin and cartilage usually when punched in the ear. Needs to be drained and pressure dressing or can develop perichondritis
What is perichondritis of the ear?
Infection of cartilage - skin can become necrotic
What is cauliflower ear?
Cosmetic defect and ear canal narrowed
What benign neoplasia’s can be present in the external ear?
Osteoma = lump in ear canal - can block
Keloid scarring = after trauma scarring that extends beyond original margins (hypertrophic scarring lies within margins of cut)
What malignant neoplasia’s can be present in the external ear?
Basil cell cancer
Squamous cell carcinoma
Where is the middle ear and what does it contain?
Medial to tympanic membrane
Contains ossicles - malleus, incus and stapes
What is acute suppurative otitis media?
Inflamed tympanic membrane seen in childhood causing pain, pyrexia, hearing loss, discharge and systemic illness. Can be from ascending URTI as children don’t have large enough draining tubes for secretion so becomes infected with S.pneumonia or H. influenzae
What are the complications of acute suppurative otitis media?
- Otitis externa
- Recurrent otitis media
- Perforation/chronic otitis media
- Mastoiditis (inflammation of mastoid process)
- Intracranial extension
What is the treatment of acute suppurative otitis media?
Antipyretics, antibiotics, decongestants, myringotomy (surgical incision in tympanic membrane)
What are the causes of chronic otitis media with effusion (‘glue ear’)?
- Eustachian insufficiency (tube between middle ear and pharynx gets blocked)
- Environmental (cold)
- Immunity (have enlarged adenoid tissue)
- Allergy
- Cleft palate
What is chronic otitis media with effusion (‘glue ear’)?
Fluid build up in the middle ear and eustachian tube that prevents the eardrum vibrating properly. This causes conductive hearing loss, language delay and behavioural issues in children and recurrent infections.
What is the management of chronic otitis media with effusion (‘glue ear’)?
Conservative, medical, myringotomy alone, autoinflation (pinch nose and blow), grommets (Teflon tube to maintain drainage)
What is cholesteatoma?
A complication of eustachian dysfunction - attic retraction pocket with debris lodging. Progressive and destructive. Presents with foul smell, conductive hearing loss, facial palsy, vertigo and intracranial extension
What is the management of cholesteatoma?
Treated surgically with post auricular incision
What forms the inner ear?
Semi-circular canals, cochlear, vestibular cochlear nerve supply, ampulla
What is an acoustic neuroma?
Rare, benign, locally compressive brain tumour (6%) in the cerebello pontine angle (confined space). Causes progressive unilateral deafness, less commonly vertigo, unsteadiness and deafness
What is the management of an acoustic neuroma?
Conservative - monitor with scans
Gamma knife - 14% recurrence - precisely focussed so minimal damage
Surgery - significant morbidity 3% recurrence
What is Meniere’s disease?
Episodic fullness, fluctuating deafness, tinnitus, vertigo, nausea and vomiting and drop attacks lasting 2-4 hours. Self-limiting but unpredictable
What is BPPV (benign paroxysmal positional vertigo)?
Loose ‘ear rocks’ (otoconia) cause position related ‘top shelf’ dizziness i.e. when rolling in bed or lying down. Rotatory nystagmus - eyes move rapidly. Managed with clinic and home manipulations
What is the treatment of otitis externa?
Gentamicin steroid eardrops - possible fungal infection
Where is head movement detected in the ear?
Inner ear - otolith sits on top of sensory hairlike structure to detect movement
Where is head movement detected in the ear?
Inner ear - otolith sits on top of sensory hairlike structure to detect movement
What is visual acuity? How is it measured?
An angular measurement of the ability to resolve the minimal separation of two objects. Measured using a Snellen chart one eye at a time, 6m from chart. A normal person VA 6/6 or better
What is in the macula and where is it positioned?
Rods and cones - focal point by optic nerve
What is the differential diagnosis of red eye?
Conjunctivitis, acute glaucoma, uveitis, corneal ulcer, cataracts, macular degeneration
In conjunctivitis, what is:
a) Visual acuity
b) Pain
c) Pupil
d) Photophobia
e) Other clinical features
a) Normal
b) Not severe, gritty sensation
c) Normal
d) No
e) Eye sticky and very contagious
In glaucoma, what is:
a) Visual acuity
b) Pain
c) Pupil
d) Photophobia
e) Other clinical features
f) Treatment
a) Decreased
b) Severe
c) Dilated and irregular shaped
d) Not prominent
e) Vomiting, red eye, sight threatening as increase intraocular pressure and damage to optic nerve
d) Drain fluid built up in intraocular compartment
In uveitis, what is:
a) Visual acuity
b) Pain
c) Pupil
d) Photophobia
e) Other clinical features
a) Normal or decreased
b) Moderate
c) Normal or constricted
d) Yes
e) Adhesions between iris and lens
In corneal ulcers, what is:
a) Visual acuity
b) Pain
c) Pupil
d) Photophobia
e) Other clinical features
a) Decreased
b) Severe
c) Normal or constricted
d) Tes
e) Corneal opacity/stain
In corneal ulcers, what is:
a) Visual acuity
b) Pain
c) Pupil
d) Photophobia
e) Other clinical features
a) Decreased
b) Severe
c) Normal or constricted
d) Yes
e) Corneal opacity/stain
What is cataracts, what are the risk factors and what is the treatment?
Slowly progressive clouding of lens
Age, trauma, UVB
Surgical (lens removed), phacoemulsification (ultrasonic to destroy lens), plastic lens
What is macular degeneration? What are the risk factors?
‘Dry’ or ‘wet’- blood vessels from choroud leak exudate and haemorrhage. Loss of central vision (scotoma)
Age, family history
Why should you never give steroid to an undiagnosed red eye?
Steroids - blood vessels can grow over visual part of eye
What may be the presenting symptoms for giant cell arteritis or temporal arteritis ?
Loss of vision in one eye
Headache fronto-temporal present all the time
Tender to touch scalp
Loss of weight
Pain in jaw
Shoulders ache and difficulty raising arms over head
Can’t read letters
Normal eye movements
Fundus - haemorrhagic appearance, inflamed blood vessels
Tender thickened temporal arteries
In giant cell arteritis or temporal arteritis, what investigations confirm diagnosis?
Erythrocyte sedimentation rate (ESR) = 90 or above
CRP = 20 or above
Temporal artery biopsy or ultrasound
For giant cell arteritis or temporal arteritis, what is the treatment?
Hospitalisation, 500mg IV methylprednisolone for 3 days, tapering dose oral steroids 2 years. Prophylaxis for peptic ulcer and osteoporosis (proton pump inhibitor or bisphosphonates), monitoring for diabetes and hypertension (side effects of steroids)
What does hypopyon and hyphaemia mean
Hypopyon = pus in anterior chamber of eye Hyphaemia = blood
If a patient presents with mouth ulcers, genital ulcers and an inflamed eye, what should you suspect?
Bechet’s disease
What are the signs and symptoms of Bechet’s Disease?
Oral ulceration, genital ulceration, uveitis, atypical pneumonia, venous occlusion, pathergy, mono arthritis, acne, retinal venous vasculitis
How do lacrimal gland tumours present?
Slow growing and painless
Bone erosions
Can cause compressive problems
Can become malignant
What are ‘blowout’ fractures?
Fracture of floor of orbit from localised trauma - often assocaited with fractures zygoma. Subconjunctival haemorrhage between sclera and conjunctiva.
What injuries to the eye are associated with ‘blowout’ fractures?
Retinal detachment
Lens dislocation
Describe the following signs that are indicative of a ‘blowout fracture’:
a) CT scan
b) Diplopia
c) Enopthalmus
d) Infraorbital anaesthesia
e) Surgical emphysema
f) Hypoglobus
a) contents in maxillary sinus
b) double vision
c) eyeball sinks backwards - not immediately due to swelling
d) Numbness of lip and cheek as infraorbital nerve runs through floor of orbit
e) Air blown into soft tissue from nose
f) Inferior displacement of globe in orbit
What are the signs and symptoms of orbital cellitus?
Unwell, pyrexial, white cell count, proptosis, restricted eye movement, pupil and vision affected
How is orbital cellulitis causes=d and what is the treatment?
Infection from maxillary tooth or paranasal sinuses
IV antibiotics, sinus drainage, subperiosteal abscess
What is Ramsay Hunt Syndrome and how is it treated?
Type 2 facial palsy (lower motor neurone). Develop vesicles in external ear due to reactivation of Varicella Zoster Virus that lays dormant in geniculate ganglion
Tx = IV acyclovir
