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Phase1c Medicine > ENT and Ophthalmology > Flashcards

ENT and Ophthalmology Flashcards

1
Q

Definition of BPPV

A

Inner ear disorder characterised by recurrent brief attacks of positional vertigo

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2
Q

What triggers vertigo episodes in BPPV?

A

Positional - change in had position

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3
Q

What is the average length of a vertigo period in BPPV?

A

10-20 seconds

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4
Q

What is a positive Dix-Hallpike manoeuvre?

A

patient experiences vertigo

rotatory nystagmus

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5
Q

What provides symptomatic relief for BPPV?

A

Epley manoeuvre

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6
Q

What is Meniere’s diseae?

A

Disorder of the inner ear caused by a change in fluid volume in the labyrinth causing tinnitus and vertigo

Endolymphatic hydrops (Excess fluid in the inner ear) due to impaired endolymph resorption

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7
Q

What are the aetiological agents of Meniere’s disase?

A 
Allergy
Viral infection
Syphillis
Lyme disease
Hypothyroidism
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8
Q

What are the features associated with Meniere’s disease?

A

Recurrent episodes of vertigo,

Tinnitus and hearing loss (sensorineural).

Vertigo

Aural fullness

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9
Q

What is vertigo length for Meniere’s disease?

A

Minutes to hours

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10
Q

What are the key signs for Meniere’s? (Two clinical tests)

A

Fukuda’s stepping test - turning towards the affected ear side

Romberg’s test

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11
Q

What are the investigations for Meniere’s diseae?

A

Audiometry - Presence of Sensorineural hearing loss

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12
Q

What is the management for acute vertigo attacks in Meniere’s diseae?

A

Vestibular suppressant drugs - Benzodiazepines, antihistamines

Recurrence prevention
-Limit salt, caffeine and alcohol consumption, smoking cessation and manage stress

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13
Q

What is the maintenance therapy for Meniere’s disease?

A

Diuretics

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14
Q

What is a thyroglossal cyst?

A

An epithelial lined cyst between Adam’s apple and chin

Median age 5 years

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15
Q

What are the main symptoms of a thyroglossal cyst?

A

Lump on the midline of the neck

Compressive

Moves upwards when tongue is protruded after swallowing

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16
Q

What is the management of a thyroglossal cyst?

A

Elective surgical excision

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17
Q

What is the definition of cataracts?

A

Opacification of the lens resulting in a gradual loss of visual acuity

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18
Q

What is the aetiology of cataracts?

A

The normal proteins that make up the lens of the eye degrade overtime and become opaque

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19
Q

What are the symptoms of cataracts?

A

Reduced vision

Faded colour vision: making it more difficult to distinguish different colours

Glare: lights appear brighter than usual

Halos around lights

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20
Q

What clinical sign is observed in cataracts?

A

A Defect in the red reflex: the red reflex is essentially the reddish-orange reflection seen through an ophthalmoscope when a light is shone on the retina. Cataracts will prevent light from getting to the retina, hence you see a defect in the red reflex.

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21
Q

What are the investigations for cataracts?

A

Slit-lamp examination - Reveals cataracts as black against a red reflex

loss of visual acuity - Snellen’s eye chart

Reduced red reflex on fundoscopy

Normal pupillary response

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22
Q

What is the definitive management for cataracts?

A

Phacoemulsification with an intraocular lens implant

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23
Q

What type of discharge is associated with bacterial conjunctivitis?

A

Purulent discharge

Eyes may be ‘stuck together’ in the morning

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24
Q

What type of discharge is associated with viral conjunctivitis?

A

Serous discharge

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25
What is the most common cause of viral conjunctivitis?
EBV, herpes and adenoviru s
26
What are the most common causes of bacterial conjunctivitis?
Staphylococcus aureus Streptococcus pneumoniae Haemophilus influenzae
27
What is the management of infective conjunctivitis?
Chloramphenicol drops | Topical fusidic acid
28
What are the general symptoms associated with conjuncivitis?
Eye redness Discharge Itchiness Crusty formation
29
What type of discharge is associated with allergic conjunctivitis?
Clear, watery discharge
30
What is the difference in terms of eye involvement for conjunctivitis (Infective v allergic)?
Viral - unilateral progressing to bilateral Bacterial - Unilateral Allergic - Bilateral
31
What is the conjunctival appearance in viral conjunctivitis?
Small swollen papules in the palpebral surface
32
What is the management for viral conjunctivitis?
Self-limiting Anti-histamine drops Topical antivirals (Acyclovir - if HSV is cause)
33
Management for allergic conjunctivitis?
Cold compress Allergen avoidance Anti-histamine drops
34
What is glaucoma?
Increased intraocular pressure which results in damage to the retina and optic nerve
35
What is open-angle glaucoma?
In primary open-angle glaucoma (POAG), the iris is clear of the meshwork. The trabecular network functionally offers an increased resistance to aqueous outflow, causing increased IOP.
36
What are the risk factors for open-angle glaucoma?
>40/year old Diabetes mellitus FHx African descent
37
What are the symptoms for open-angle glaucoma?
Bilateral progressive (chronic) visual field loss. Peripheral to central Nasal scotomas progressing to 'tunnel vision' decreased visual acuity optic disc cupping
38
What investigations are indicated in glaucoma?
Tonometry - measures intraocular pressure Fundoscopy (Gold-standard) - Increased in cupping of the optic disc.
39
What are the fundoscopy signs in open-angle glaucoma?
1. Optic disc cupping - cup-to-disc ratio >0.7 (normal = 0.4-0.7), occurs as loss of disc substance makes optic cup widen and deepen 2. Optic disc pallor - indicating optic atrophy 3. Bayonetting of vessels - vessels have breaks as they disappear into the deep cup and re-appear at the base 4. Additional features - Cup notching (usually inferior where vessels enter disc), Disc haemorrhages
40
What is the distinctive feature of open-angle glaucoma?
Pathological cupping of the optic disc
41
What is the management for open-angle glaucoma?
first line: prostaglandin analogue (PGA) eyedrop second line: beta-blocker, carbonic anhydrase inhibitor, or sympathomimetic eyedrop if more advanced: surgery or laser treatment can be tried2
42
What is the mechanism of action for prostaglandins analogues in open-angle glaucoma?
Increases uveoscleral outflow
43
How do beta-blockers work in the management of open-angle glaucoma?
Reduces aqueous production
44
What are the features of acute angle (closed) glaucoma?
severe pain: may be ocular or headache decreased visual acuity symptoms worse with mydriasis (e.g. watching TV in a dark room) hard, red-eye haloes around lights semi-dilated non-reacting pupil corneal oedema results in dull or hazy cornea systemic upset may be seen, such as nausea and vomiting and even abdominal pain
45
What is the aetiology of acute angle glaucoma?
Narrowing of the iridocorneal angle preventing aqueous flowing correctly into the trabecular meshwork
46
What are the two main risk factors for acute angle glaucoma?
Old age | Mydriasis (Drug-induced - atropine - anti-cholinergic)
47
What investigations are performed in acute angle glaucoma?
Tonometry -Raised IOP Slit-lamp - narrowing/closure of the iridocorneal angle Gonioscopy - Gold standard
48
What does fundoscopy reveal in acute angle glaucoma?
Increased cupping | Dilated pupil
49
Examples of prostaglandin analogues used in open-angle glaucoma
Latanoprost Travoprost -Increases aqueous humour outflow
50
What is the surgical management for open angle glaucoma?
Laser/surgical trabeculectomy
51
What is the first-line management for closed-angle (acute) glaucoma?
Emergency - need to lower IOP - referral to ophthalmologist Topical beta-blockers (Timolol) - decreases aqueous production Carbonic anhydrase inhibitors - decreases aqueous production
52
What is the definitive management for acute angle glaucoma?
laser peripheral iridotomy | creates a tiny hole in the peripheral iris → aqueous humour flowing to the angle
53
What is anterior uveitis?
Anterior uveitis is one of the important differentials of a red eye. It is also referred to as iritis. Anterior uveitis describes inflammation of the anterior portion of the uvea - iris and ciliary body.
54
Which part of the eye is inflamed in anterior uveitis?
Iris | Ciliary body
55
What is anterior uveitis is associated with?
HLA-B27 associated conditions - ankylosing spondylitis, SLE, reactive arthritis
56
What is the presentation of anterior uveitis?
acute onset ocular discomfort & pain (may increase with use) pupil may be small +/- irregular due to sphincter muscle contraction photophobia (often intense) blurred vision red eye lacrimation ciliary flush: a ring of red spreading outwards hypopyon; describes pus and inflammatory cells in the anterior chamber, often resulting in a visible fluid level visual acuity initially normal → impaired (Flares and pan)
57
What structures are affected in posterior uveitis?
Retina Choroid Retinal vasculature Optic nerve
58
What is the main cause of posterior uveitis?
Infections - Viruses - EBV, rubella, syphilis, TB
59
A slit-lamp examination in anterior uveitis reveals what?
Keratic precipitates - leukocytes in the anterior chamber Protein in the aqueous humour Red eye and hypopyon (Inflammatory cells in the anterior chamber in the eye)
60
Keratic precipitates are associated with what condition?
Anterior uveitis
61
What are the symptoms of posterior uveitiis?
Painless - Key Decreased visual acuity Lacrimation Floaters/flashes - marks found on vision
62
What is revealed on examination on a slit-lamp in posterior uveitis?
Leukocytes in the vitreous humour Inflammation of choroid and retina
63
What are the complications of uveitis?
Cataracts Glaucoma Syenchiae
64
What is the management of uveitis?
Corticosteroid drops -Use systemic/oral steroids Cycloplegic eye drops - relieves pain caused by the spasm of muscles
65
What are the features of optic neuritis?
unilateral decrease in visual acuity over hours or days poor discrimination of colours, 'red desaturation' pain worse on eye movement relative afferent pupillary defect central scotoma
66
What is the aetiology of optic neuritis?
Inflammatory demyelination of the optic nerve
67
What is the main cause of optic neuritis?
Multiple sclerosis - presenting manifestation of MS
68
What drugs can cause optic neuritis?
Quinine Arsenic Ethambutol -TB medication
69
What is the gold-standard investigation for optic neuritis?
Gadolinium-enhanced MRI of the orbit and brain - Enlarged optic nerve - Diagnose multiple sclerosis
70
What is the management of optic neuritis?
High dose corticosteroids
71
Define scleritis
Inflammation of the sclera
72
What is the aetiology of scleritis?
Underlying systemic disorder in 60% of cases - Rheumatoid arthritis - SLE - IBD - Ankylosing spondylitis
73
What are the symptoms of scleritis?
Dull eye pain Sleep disturbances Pain exacerbated by eye movements Pain radiates to the rest of the face Lacrimation Photophobia Eye redness Over several days
74
What is the key difference between scleritis and episcleritis?
Episcleritis is painless
75
What is the management for scleritis?
Urgent referral NSAIDs High-dose corticosteroids

Phase1c Medicine (11 decks)

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