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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
Q

What is the most common cause of viral conjunctivitis?

A

EBV, herpes and adenoviru s

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26
Q

What are the most common causes of bacterial conjunctivitis?

A

Staphylococcus aureus
Streptococcus pneumoniae
Haemophilus influenzae

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27
Q

What is the management of infective conjunctivitis?

A

Chloramphenicol drops

Topical fusidic acid

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28
Q

What are the general symptoms associated with conjuncivitis?

A

Eye redness
Discharge
Itchiness
Crusty formation

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29
Q

What type of discharge is associated with allergic conjunctivitis?

A

Clear, watery discharge

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30
Q

What is the difference in terms of eye involvement for conjunctivitis (Infective v allergic)?

A

Viral - unilateral progressing to bilateral

Bacterial - Unilateral

Allergic - Bilateral

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31
Q

What is the conjunctival appearance in viral conjunctivitis?

A

Small swollen papules in the palpebral surface

32
Q

What is the management for viral conjunctivitis?

A

Self-limiting
Anti-histamine drops
Topical antivirals (Acyclovir - if HSV is cause)

33
Q

Management for allergic conjunctivitis?

A

Cold compress
Allergen avoidance
Anti-histamine drops

34
Q

What is glaucoma?

A

Increased intraocular pressure which results in damage to the retina and optic nerve

35
Q

What is open-angle glaucoma?

A

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
Q

What are the risk factors for open-angle glaucoma?

A

> 40/year old
Diabetes mellitus
FHx
African descent

37
Q

What are the symptoms for open-angle glaucoma?

A

Bilateral progressive (chronic) visual field loss.

Peripheral to central

Nasal scotomas progressing to ‘tunnel vision’
decreased visual acuity
optic disc cupping

38
Q

What investigations are indicated in glaucoma?

A

Tonometry - measures intraocular pressure

Fundoscopy (Gold-standard) - Increased in cupping of the optic disc.

39
Q

What are the fundoscopy signs in open-angle glaucoma?

A
  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
Q

What is the distinctive feature of open-angle glaucoma?

A

Pathological cupping of the optic disc

41
Q

What is the management for open-angle glaucoma?

A

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
Q

What is the mechanism of action for prostaglandins analogues in open-angle glaucoma?

A

Increases uveoscleral outflow

43
Q

How do beta-blockers work in the management of open-angle glaucoma?

A

Reduces aqueous production

44
Q

What are the features of acute angle (closed) glaucoma?

A

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
Q

What is the aetiology of acute angle glaucoma?

A

Narrowing of the iridocorneal angle preventing aqueous flowing correctly into the trabecular meshwork

46
Q

What are the two main risk factors for acute angle glaucoma?

A

Old age

Mydriasis (Drug-induced - atropine - anti-cholinergic)

47
Q

What investigations are performed in acute angle glaucoma?

A

Tonometry -Raised IOP

Slit-lamp - narrowing/closure of the iridocorneal angle

Gonioscopy - Gold standard

48
Q

What does fundoscopy reveal in acute angle glaucoma?

A

Increased cupping

Dilated pupil

49
Q

Examples of prostaglandin analogues used in open-angle glaucoma

A

Latanoprost
Travoprost

-Increases aqueous humour outflow

50
Q

What is the surgical management for open angle glaucoma?

A

Laser/surgical trabeculectomy

51
Q

What is the first-line management for closed-angle (acute) glaucoma?

A

Emergency - need to lower IOP - referral to ophthalmologist

Topical beta-blockers (Timolol) - decreases aqueous production

Carbonic anhydrase inhibitors - decreases aqueous production

52
Q

What is the definitive management for acute angle glaucoma?

A

laser peripheral iridotomy

creates a tiny hole in the peripheral iris → aqueous humour flowing to the angle

53
Q

What is anterior uveitis?

A

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
Q

Which part of the eye is inflamed in anterior uveitis?

A

Iris

Ciliary body

55
Q

What is anterior uveitis is associated with?

A

HLA-B27 associated conditions - ankylosing spondylitis, SLE, reactive arthritis

56
Q

What is the presentation of anterior uveitis?

A

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
Q

What structures are affected in posterior uveitis?

A

Retina
Choroid
Retinal vasculature
Optic nerve

58
Q

What is the main cause of posterior uveitis?

A

Infections - Viruses - EBV, rubella, syphilis, TB

59
Q

A slit-lamp examination in anterior uveitis reveals what?

A

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
Q

Keratic precipitates are associated with what condition?

A

Anterior uveitis

61
Q

What are the symptoms of posterior uveitiis?

A

Painless - Key

Decreased visual acuity

Lacrimation

Floaters/flashes - marks found on vision

62
Q

What is revealed on examination on a slit-lamp in posterior uveitis?

A

Leukocytes in the vitreous humour

Inflammation of choroid and retina

63
Q

What are the complications of uveitis?

A

Cataracts
Glaucoma
Syenchiae

64
Q

What is the management of uveitis?

A

Corticosteroid drops
-Use systemic/oral steroids

Cycloplegic eye drops - relieves pain caused by the spasm of muscles

65
Q

What are the features of optic neuritis?

A

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
Q

What is the aetiology of optic neuritis?

A

Inflammatory demyelination of the optic nerve

67
Q

What is the main cause of optic neuritis?

A

Multiple sclerosis - presenting manifestation of MS

68
Q

What drugs can cause optic neuritis?

A

Quinine
Arsenic
Ethambutol -TB medication

69
Q

What is the gold-standard investigation for optic neuritis?

A

Gadolinium-enhanced MRI of the orbit and brain

  • Enlarged optic nerve
  • Diagnose multiple sclerosis
70
Q

What is the management of optic neuritis?

A

High dose corticosteroids

71
Q

Define scleritis

A

Inflammation of the sclera

72
Q

What is the aetiology of scleritis?

A

Underlying systemic disorder in 60% of cases

  • Rheumatoid arthritis
  • SLE
  • IBD
  • Ankylosing spondylitis
73
Q

What are the symptoms of scleritis?

A

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
Q

What is the key difference between scleritis and episcleritis?

A

Episcleritis is painless

75
Q

What is the management for scleritis?

A

Urgent referral
NSAIDs
High-dose corticosteroids

Phase1c Medicine (11 decks)

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