ENT and Opthalmology Flashcards
How does Labyrinthitis present?
Horizontal nystagmus/ Vertigo/ Vomiting/ Sensioneural hearing loss/ Acute onset- may follow viral illness
Rinnes test- what is normal?
Rinnes test is when the probe is tested in front and behind ear. In normal situation AC is louder than BC
What is the finding in Rinnes test for conductive hearing problem?
Conductive hearing problem: BC> AC on affected side
Webers test- what is normal?
Webers test is normal when it is heard is the midline
Webers test- what happens in conductive hearing loss?
Webers lateralises to the bad ear.
Webers test- what happens in SNHL ?
Webers in loudest in the non affected ear (good ear)
What visual change do you get with acute closed angle glaucoma?
Unilateral peripheral visual loss
What drugs can cause tinnitus?
Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine
What is seen in Argll Robinson pupils?
Bilaterally small pupils that accommodate but don’t react to bright light. Causes include neurosyphilis and diabetes mellitus
What is seen in Holmes Adie?
Tonically dilated pupil, slowly reactive to light with more definite accommodation response. Caused by damage to parasympathetic innervation of the eye due to viral or bacterial infection. Commonly seen in females, accompanied by absent knee or ankle jerks.
How would an RAPD be described? eg seen in optic neuritis
Swinging light test- when light is shone into the eye it appears to dilate bilaterally (constricts less than normal).
How does otosclerosis present?
Conductive hearing loss/ family history and tinnitus
How does Retinitis Pigmentosa present?
Young people
Loss of peripheral vision
Loss of night time vision
What is the treatment of otitis externa?
Topical antibiotic +/- steroid ear drops
How does age related macular degeneration present?
Reduction in visual acuity (gradual/ subacute). Difficulties with night vision
What are the mx options for dry macular degeneration
Nothing
How does a retinal vein occlusion present?
Painless loss of vision and retinal haemorrhages
How to treat a corneal abrasion?
Topical antibiotic.
How does vitreous detatchement present?
Peripheral visual loss + floaters/ flashers.
Associated with HTN and diabetes
Drusen are seen in which eye condition?
Macular degeneration- in particular DRY macular degeneration
Treatment of herpes simplex keratitis? (Dendritic ulcer)
Topical aciclovir
What does a bulging tympanic membrane suggest?
Otitis media
What does a retracted tympanic membrane suggest?
Otitis media with effusion
How does a acoustic neuroma present?
Sensioneural hearing loss, loss of corneal reflex and the neuroma grows into the 5th cranial nerve
Retinitis pigmentosa - how does it present?
Can be young patients with a family history
TUNNEL vision
Treatment of Ramsey Hunt?
Aciclovir AND steroids
How does Retinal detachment present?
Curtain falling down, straight lines appear curved and CENTRAL visual loss.
What is the treatment of herpes zoster opthalmicus
Oral aciclovir - can use topical steroids
Presentation of Menieres
Aural fullness/ vertigo/ nystagmus/ sensioneural hearing loss
Prophylaxis for Menieres?
Betahistine
What is a branchial cyst and how would it present?
Fluctuant cyst, present from birth but may flare up following LRTI. Does not transilluminate
What neck swelling moves up on swallowing or tongue protrusion?
Thyroglossal cyst.
How does central retinal artery occlusion present?
Painless unilateral vision loss. Can also present RAPD. Fundoscopy cherry red spot
Punctate fluorescein staining of the cornea is seen in which condition?
DRY EYES
Menieres management
- Refer to ENT
- Acute attacks- prochlorperazine
- Prophyalxis- betahistine
How may orbital lymphoma present?
Painless red eye that is resistant to usual conjuctivitis management
UNILATERAL
What is the difference between episcelritis and scleritis?
Scleritis is painful and episcleritis is not painful
Ptosis and a constricted pupil is seen in..?
Horners syndrome
How does optic neuritis present?
Pain on eyemovement, unilateral decrease in vision over a couple of days, pain on eye movements
How does argyll Robinson pupil present?
Bilaterally small (think neurosyphilis)
Retinal detachment presents how?
- Non painful
-CENTRAL visual loss
Management of open angle glaucoma?
1st line- surgery
2nd line - prostaglandin analogue eg lantoprost
Optic neuritis presents with what type of visual loss?
Central visual loss
What is the finding in DRY macular degeneration?
Drusen
How does Keratitis present?
Red eye, painful, photophobia.
How does retinal detachment present?
Painless loss of vision, gradual. straight lines appear curved and more common in myopes (short sighted)
How does a vitreous haemorrhage present?
Sudden painless loss of vision, floaters in vision. Patients with DM/ bleeding disorders.
Management of acute angle closure glaucoma?
First line- eye drops to reduce pressure/ pilocarpine and azetolamide
2nd line- iriodotmy
What is seen on fundoscopy in non proliferative diabetic retinopathy?
Cotton wool spots, beading of new vessels.
How would a corneal ulcer present?
Green fluorescin staining, common in contact lenses users.
Management of acute uveitis/ iritis?
Steroid eye drops and cyclopentalate or atropine (dilate the pupil to relieve pain)
What causes a dendritic corneal ulcer? and what is the treatment?
Herpes simplex. Acyclovir drops (NOT STEROID DROPS)
What is found in the posterior neck triangle?
Mostly lymph nodes
How do branchial cysts present?
Present in 3rd decade and need surgical removal
Malignant/ necrotising otitis externa- presents how and in who?
Otitis externa into temporal bone osteomyelitis.
Common in diabetes/ immunocompromised.
How does an acoustic neuroma present?
SNHL/ Tinnitus/ vertigo/ facial nerve palsies eg dry eyes. UNILATERAL SNHL
Is an acoustic neuroma unilateral or bilateral hearing loss?
UNILATERAL
BPPV vs Menieres?
Both present with vertigo. Menieres has hearing loss. bppv - no affect to hearing.
What is Schwartz sign?
Flamingo pink area on tympanic membrane.
Sign of Otosclerosis
Management of Otitis Externa ?
Topical antibiotic or
a combined topical antibiotic with a steroid
What is the management of septal haematoma?
- surgical evacuation 2. Abx
What are the borders of the anterior neck triangle?
Sternocleidomastoid,
Midline
Mandible
What is the most common thyroid cancer?
Papillary
What is the triad of congenital rubella?
PDA, Cataracts, Microcephaly
What is Rhinoscleroma?
Infection with Klebsiella.
Tropical disease
Granulomas
What are the causes of painless loss of vision?
Retinal Detachement
Vitreous detachment
Retinal artery occlusion
Retinal vein occlusion
Anterior ischaemic neuropathy (amaurosis fugax)
What are the defining features on examination of each of these conditions:
Retinal Detachement
Vitreous detachment
Retinal artery occlusion
Retinal vein occlusion
Anterior ischaemic neuropathy (amaurosis fugax)
Retinal Detachment - abnormal red reflex. (floaters and flashers in vision)
Vitreous detachment - vitreous floaters o/e and decreased or absent red reflex.
Retinal artery occlusion - cherry red spot.
Retinal vein occlusion - stormy sunset, cotton wool spot and haemorrhages.
Anterior ischaemic neuropathy (amaurosis fugax)- Pale, swollen optic disc.
What antibiotic for otitis media with penicillin allergy?
Erythromycin or Clarithromycin
What do these eye drops do in chronic open angle glaucoma?
- Lantoprost
- Brimonidine
- Dorzolamide
- Pilocarpine
- Timolol
Lantoprost - prostaglandin analogue (2nd line after operative management)- increased outflow
Brimonidine- Alpha agonist - reduces aqueous production
Dorzolamide- Carbonic anhydrase inhibitor reduce aqueous production
Pilocarpine - Musclarinic R agonist - increases uveoscleral outflow
Timolol- BB (avoid in asthmatics)
How does CMV affect the eyes? and how does it present?
CMV Retinitis
Floaters and flashers
Common in HIV pos patients
Classic cause of vitreous haemorrhage?
DIABETES!!
Dry macular degeneration classic feature and treatment?
Drusen and NO TREATMENT :(
Abducens nerve innervates which muscle? and what is the presentation of a palsy?
Lateral rectus
Palsy= cannot abduct eye. therefore diplopia.
What are the pupil changes in an oculomotor palsy?
Dilated pupil- mydratic because oculomotor also controls pupillary constriction
What is an eso/ exophoria?
Esophoria - eye squint inwards
Exophoria- eye squints outwards (laterally)
Phoria- meaning its only there some of the time
Cover/ uncover test.
What are the categories of squint?
Paralytic and non paralytic (imbalance in extra ocular muscles)
Non paralytic (convergent and divergent). Convergent = inwards.
How would a sebaceous cell carcinoma present?
Like a chazloin that doesn’t heal/ respond to abx.
Feature of losing eye lashes.
Features of Holmes Adie pupil?
Tonically dilated
Slow reaction to light
Myopia is a risk factor for?
Primary open angle glaucoma, retinal detachment, cataracts.
Otosclerosis affects which bone in the ear?
Stapes
(Conductive hearing loss/ family history)
What is the hearing test done for newborns vs at school entry?
Newborns- otoacoustic test
At school entry >3 years- Pure tone audiometry
What are some complications of Tonsillitis ? (3)
Quinsy
Obstructive sleep apnoea
Febrile convulsions
Treatment of Ramsey Hunt?
Steroids and antivirals (Acyclovir)
What is a Marcus Gunn Pupil?
RAPD defect
Dilation of a pupil in response to light!
How does Chorioretinits present and what are the causes?
Gradual loss of vision
Tuberculosis
CMV
Sarcoidosis
Syphillis
Onchocercal keratitis- what is it?
River blindness - keratitis caused by a parasite.
(Major cause of blindness in developing world)
What are some causes of Blepharospasm?
Tourettes, Cerebral palsy, Trauma, Parkinsons, Multiple sclerosis
What is a normal IOP?
What is a normal cup to disc ratio?
11-21
0.4-0.7 (normal cup to disc ratio)
What are some features of primary open angle glaucoma?
Raised IOP
Increased cup to disc ratio. >0.7
Optic disc pallor
Peripheral visual loss
Complication of central vein occlusion?
Neovascular glaucoma
How does Globe rupture present?
Low IOP, Blood in anterior chamber, trauma to eye, irregular pupil.
What is Hutchinson’s sign?
Herpes zoster infection of Trigeminal nerve. Vesicles eruption at tip of nose.
What is Trachoma?
Leading cause of infection related blindness.
Caused by Chalymidia
Treated with azithromycin eye drops
Entropian, eye lids fold inwards and corral abrasions from eye lashes
Presentation of Cataracts?
Halos around bright lights
Faded colour vision
Glare
Vision improves with pinhole test
When should antibiotics be given for Otitis media?
Bilateral symptoms and under 2
Ottohorea
What does Pilocarpine do to the pupil?
Constricts the pupil
What does Atropine do to the pupil?
Dilates pupil
What condition gives the sign of curved lines appearing straight?
Retinal detatchement
How do distinguish between Retinal detatchement and vitreous haemorrhage/detatchement
Vitreous haemorrhage/ detachment- more common in diabetics! FLOATERS AND FLASHERS. Decreased or absent red reflex.
Retinal detatchment- curved lines appear straight. Abnormal red reflex
What is the clinical presentation of age related macular degeneration?
Central visual loss
Curved lines appear straight
What is the treatment for allergic conjuctivitis in primary care?
Topical antihistamine (Antazoline) +/- mast cell stabiliser eg (Sodium cromoglicate)
What is a positive Rinnes test?
Positive= normal test result
AC> BC
What is a negative Rinnes test?
BC> AC
What happens to Rinnes test in a SNHL ?
Normal test result ‘Positive’
AC> BC
How does Presbycusis present?
Bilateral SNHL
Elderly individuals
High frequency hearing loss
Retinitis pigmentosa - presentation and inheritance?
Tunnel vision
Problems with night time vision
Autosomal dominant and recessive forms
Bacterial keratitis is caused by which organism?
Psudomonas aurgenisoa
How does tobacco-alcohol amblyopia present?
loss of central colour vision
Pinna cellulitis vs Pinna perichondritis?
Pinna cellulitis= whole ear
Pinna perichondritis= only the cartilage therefore ear lobe is spared
Keratoconjunctivitis sicca is associated with which disease?
Dry eyes - associated with sjogrens
Uveitis/ Anterior uveitis is associated with which other conditions?
Sjogrens and HLA B27 conditions (ank spond/ reactive arthritis etc)
How does a dendritic ulcer present?
Red, painful eye
Reduced visual acuity
Dendritic ulcer is a common presentation of herpes simplex keratitis
Macular degeneration - gives which type of visual loss?
Central visual loss
Choroidal neovascularisation occurs in which disease?
Wet macular degeneration
Homogoenous hemiaponia caused by a defect where?
Defect is behind the optic chasm
Superior: temporal
Inferior: parietal
Bullous myringitis - what is it?
Painful pus filled vesicles ON tympanic membrane
Often a/w otitis media
What is hordeolum externum?
Stye (external)- Hot compress/ and analgesia. Abx only if additional conjuctivitis.
Open angle glaucoma- first line is SLT (laser therapy) what are the next line topical agents?
Topical prostaglandin analogue
Topical beta blocker
Corneal abrasion presents how and management?
Photophobia/ gritty sensation/ reduced visual acuity in affected eye
Yellow stained abrasion
Management chloampenicol ointment (Topical Abx)
What is the difference between abducens palsy and oculomotor palsy?
Oculomotor (3RD) DOWN AND OUT
CANNOT ADDUCT EYE
DILATED PUPIL
Abducens
6th nerve
Lateral rectus palsy
Eye rests adducted. Cannot Abduct
Management of Menieres
Acute-Prochlorperazine
Prophylaxis- Betahistine
How to diagnose BPPV?
Dix Hallpike
Otits external caused by which bacteria ?
Psudeomonas auerginosa
Features of acute angle closure glaucoma?
Acute pain
Red eye
Loss of Vision/ blurred vision
Fixed, semi dilated pupil (NON REACTING)
Raised IOP
What drugs constrict vs dilate the pupil?
Constrict- opiates + musclarinic AGONISTS (pilocarpine)
Dilate- atropine, antimusclarinics (cyclopentolate), TCAs, adrenaline, ecstasy.
What is first line mx for acute angle glaucoma?
acetazolamide and pilocarpine are first line.
