ENT and Ophthalmology Flashcards
Where are your tonsils located and what ring do they collectively form?
Tonsils are located within pharynx
They form Waldeyer’s ring:
Pharyngeal tonsil
Tubal tonsils
Palatine tonsils - where we see tonsilitis
Lingual tonsil
What is the role of tonsils?
Fighting infection against pathogens entering naso or oro pharynx - contain T cells, B cells, and macrophages
Main cx of tonsillitis
Viral - EBV
Bacterial:
1. Group A streptococcus - (streptococcus pyogenes)
2. Streptococcus pneumoniae
Acute tonsilitis Sx
- Sore throat
- Fever >38
- Pain on swallowing
- red, inflamed, enlarged tonsils + can have exudates (bacterial white patches of pus)
- Anterior cervical lymphadenopathy (space between jaw and jugular vein)
What is the centor criteria?
Used to estimate the probability that tonsilitis is due to bacterial infection and therefore can be treated with abx
What are the features of centor criteria?
1 point for each of:
1. Fever >38
2. Tonsillar exudates
3. Absence of cough
4. Tender anterior cervical lymphadenopathy
Score 3 or more = 40-60% probability bacterial cause
What is a fever pain score?
An alternative for the centor criteria to determine whether tonsilitis is caused by bacteria
What is the criteria for Fever pain score?
1 point for each:
1. Fever in past 24hrs
2. Exudates on tonsil
3. Attended within 3 days
4. Inflamed tonsils
5. No cough or coryza (cold sx)
Tx of tonsilitis
Viral = simple analgesia, education, safety net
Bacterial = Abx if:
centor score 3 or more
Fever pain 4 or more
High risk of sever infection (i.e. immunocompromised)
What Abx should be used if px has bacterial tonsillitis?
- Penicillin V - against strep pyogenes
- Clarithromycin - penicillin allergy
Complications of tonsillitis?
- Quinsy - peritonsillar abscess (serious)
- Otitis media
- Scarlet fever
- Rheumatic fever
What are sinuses and what are the different types?
They’re air-filled extensions of the nasal cavity. Produce mucus and drain into nasal cavity through ostia (hole). Blockage of ostia causes sinusitis.
Paranasal sinuses:
Frontal sinus
Ethmoid sinus
Maxillary sinus
Sphenoid sinus
What is the role of a sinus?
- Lightening the weight of the head
- Supporting immune defence of the nasal cavity
- Humidifying inspired air
- Increasing resonance of the voice
Cx of sinusitis
- Infection - Following viral upper resp tract infx
- Allergies
Sinusitis Sx
- Nasal congestion
- Nasal discharge
- Facial pain/ headache
- Facial pressure and swelling
- Loss of smell
- Systemic - fever
Sinusitis Tx
NICE CKS (May 2023) recommend for patients with symptoms that are not improving after 10 days, the options of:
High-dose steroid nasal spray for 14 days
A delayed antibiotic prescription, used if worsening or not improving within 7 days (phenoxymethylpenicillin first-line)
What is conjunctiva?
A thin layer of tissue that covers the inside of the eyelids and the sclera.
What are the 3 different types of conjunctivitis?
- Allergic
- Bacterial
- Viral
Sx of conjunctivitis
- Red, bloodshot eye
- Itchy or gritty sensation
- Discharge
Describe discharge and specific Sx in each of the following conjunctivitis:
1. Allergic
2. Bacterial
3. Viral
- Clear, watery discharge. Conjunctival chemosis, itchy, photophobic.
- Purulent discharge (white, green or yellow). Worse in the morning when eyes may be stuck together. It usually starts in one eye. It’s contagious.
- Clear discharge. Associated with other Sx of a viral infection: dry cough, sore throat and blocked nose.
Tx of bacterial/viral conjunctivitis
Usually self-limiting within 1-2 wks
Broad spectrum abx eye drops - bacterial conjunctivitis.
Tx of allergic conjunctivitis
Antihistamines (oral or topical) can help symptoms.
What kind of infection usually causes neonatal conjunctivitis?
Gonococcal infection
What is otitis externa?
Inflammation of the skin in the external ear canal. It can spread to the external ear (pinna) or tympanic membrane. It can be acute (less than three weeks) or chronic
RF for otitis externa?
- “swimmers ear”, as exposure to water whilst swimming can lead to inflammation
- Trauma from the ear canal (e.g., from cotton buds or earplugs)
- removal of ear wax
What causes the inflammation in otitis externa?
Bacterial infection
Fungal infection (e.g., aspergillus or candida)
Eczema
Seborrheic dermatitis
Contact dermatitis
The two most common bacterial causes of otitis externa?
Pseudomonas aeruginosa
Staphylococcus aureus
Sx of otitis externa?
Ear pain
Discharge
Itchiness
Conductive hearing loss (if the ear becomes blocked)
Erythema and swelling in the ear canal
Tenderness of the ear canal
Pus or discharge in the ear canal
Lymphadenopathy (swollen lymph nodes) in the neck or around the ear
Tx of otitis externa?
Mild:
Acetic acid 2% - antifungal and antibacterial
Moderate:
Topical antibiotic and steroid
i.e. Neomycin, dexamethasone and acetic acid (e.g., Otomize spray)
Severe:
Oral antibiotics (e.g., flucloxacillin or clarithromycin)
If fungal:
Clotrimazole ear drops
What is the risk of using Aminoglycosides (e.g., gentamicin and neomycin) for tx of otitis externa?
They are potentially ototoxic, rarely causing hearing loss if they get past the tympanic membrane. Therefore, it is essential to exclude a perforated tympanic membrane before using topical aminoglycosides in the ear.
What is malignant otitis externa?
Life-threatening form of otitis externa. The infection spreads to the bones surrounding the ear canal and skull. It progresses to osteomyelitis of the temporal bone of the skull.
What is otitis media? and how does infection happen?
Infection in the middle ear.
The middle ear is the space that sits between the tympanic membrane (eardrum) and the inner ear. This is where the cochlea, vestibular apparatus and nerves are found.
Bacteria enter from the back of the throat through the eustachian tube. A viral upper respiratory tract infection often precedes bacterial infection of the middle ear.
Common bacterial cause of otitis media?
MC - Streptococcus pneumoniae
Others:
Haemophilus influenzae
Staphylococcus aureus
Sx of otitis media?
Ear pain
Reduced hearing in the affected ear
Feeling generally unwell, for example with fever
Symptoms of an upper airway infection such as cough, coryzal symptoms and sore throat
Balance issues and vertigo
Discharge (if tympanic membrane perforated)
Tx of otitis media
Acute: self limiting - simple analgesia
If significantly unwell or immunocompromised: Abx-
Amoxicillin for 5-7 days first-line
Clarithromycin (in penicillin allergy)
Erythromycin (in pregnant women allergic to penicillin)
What is benign paroxysmal positional vertigo (BPPV)?
Peripheral cause of vertigo, meaning the problem is located in the inner ear rather than the brain.
Sx of benign paroxysmal positional vertigo (BPPV)
Head movements can trigger attacks of vertigo - (e.g. turning over in bed)
Sx lasts around 20 – 60 seconds
ASx between attacks
DOES NOT cx hearing loss or tinnitus
Describe pathophysiology of benign paroxysmal positional vertigo (BPPV)
Calcium carbonate crystals called otoconia become displaced into semi-circular canals (most commonly in the posterior one)
Disrupts normal flow of endolymph through the canals = confuse vestibular system
Therefore head movement = flow of endolymph = vertigo triggered
What manoeuvre can be used to diagnose BPPV?
The Dix-Hallpike manoeuvre
What manoeuvre can be used to tx BPPV?
The Epley manoeuvre
Define Xanthelasma
Yellowish plaques that develop on the eyelids, often near the inner corners. They are caused by the accumulation of fat deposits.
Define ptosis
Drooping of the upper eyelid, which can occur due to age, muscle weakness, or neurological conditions.
Define stye
A red, painful lump that forms on the eyelid, typically near the base of the eyelashes.
It’s caused by a bacterial infection of the oil glands or hair follicles in the eyelid and usually resolves on its own or with warm compresses.
What are Sx of scleritis? and which MSK cdtn is an example of a RF that causes scleritis?
A painful, red eye with tenderness on movement, photophobia and reduced visual acuity strongly suggests the diagnosis of scleritis.
Risk factors for scleritis include connective-tissue diseases such as rheumatoid arthritis.
