ENT + fundoscopy + endocine Flashcards by Sarah Solliman

Hypertensive retinopathy causes changes in the blood vessels supplying the eye - what are these?

Silver wiring or copper wiring (arterioles wall become thickened and sclerosed causing increased reflection of the light)
Arteriovenous nipping is where the arterioles cause compression of the veins where they cross (due to sclerosis and hardening of the arterioles)
Cotton wool spots are caused by ischaemia and infarction in the retina causing damage to nerve fibres.
Hard exudates are caused by damaged vessels leaking lipids into the retina.
Retinal haemorrhages are caused by damaged vessels rupturing and releasing blood into the retina.
Papilloedema is caused by ischaemia to the optic nerve resulting in optic nerve swelling (oedema) and blurring of the disc margins.

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Keith-Wagener Classification of hypertensive retinopathy

Stage 1: Mild narrowing of the arterioles

Stage 2: Focal constriction of blood vessels and AV nicking

Stage 3: Cotton-wool patches, exudates and haemorrhages

Stage 4: Papilloedema

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Whats this?

Eye showing treatment with laser photocoagulation

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Diagnosis

Diabetic retinopathy (mild) - haemorrhages and microaneurysms can be seen

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Diabetic retinopathy - hard exudates + evidence of macula involvement

* Compared to hypertensive retinopathy DR has more exudates, extensive oedema and multiple haemorrhages

* Hypertensive R has moire cotton wool spots and flame shaped haemorrhages

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Papillodema - disc is swollen + disc margin has dissapeared + veins are congested

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Hypertensive retinopathy

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Hypertensive retinopathy

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landmarks of inside the ear

pars flaccida
pars tensa
handle of the malleous
Umbo

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What is this and its symptoms

Cholesteatoma

hearing loss
Malodorous discharge
Possibly dizziness

** not an emergency but needs to referrred

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Septal haematoma - usually bilateral + patient will usually complain of a blocked nose

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How to manage a nose bleed

pinch the nasal alar (most bleeding comes form Little’s Area)
Lean FORWARD (protect the airway)
Once holding the nose don’t let go (allow a clot to form)
Cool the head by Sucking on an ice cube (encourage vasoconstriction)

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Managment of tonsillitis?

Usually viral but do centor criteria

if 0-2: rest and fluid
if 3-4 then give antibiotics: Phenoxymethylpenicillin 500mg for 5-10 days (if allergic clarithromycin/erythromycin)

** avoid amoxicillin -risk of glandular fever

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Management of leucoplakia

Referral to ENT
Oral surgery for assessment

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Mouth cancer

When taking the history what are the important aetiological factors to consider?

Smoking

Alcohol consumption

Betel nut

Family history of mouth cancer

Immunosuppression

HPV infection

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Management of hypothyroidism

Levothyroxine 50 mcg then repeat blood in 6 months

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Management of iron deficienncy anaemia

Prescribe iron tablets: ferrous fumarate/ sulphate

What can
B12 deficiency cause? and what investigation would you do

anaemia due to impaired RBC production
pins and needles
visual disturbance
memory loss

**FBC, vitamin b 12: would show raised MCV, HB and B12

Patient presents assymptomatic with Hba1c 44mmol/L? what is he and next steps

Pre-diabetic

give lifestyle advise
recheck hba1c in a year

if pre-diabetic patient presents a year after still assymptomatic with hba1c 57 - what to do?

Repeat Hba1c and offer lifestyle advise

**pt comes back and still high -

give metformin 500 mg once daily
Refer for structured education/ diabetic awareness programme
Assess for complications of diabetes.
Inform DVLA abotu condition

If continues to rise (>58 mmol/l - aim 53) - 2nd line

consider dual therapy so add: DPP4i (sitagliptin)/pioglitazone or Sulfylurea
(gliclazide)

if unsuccessful: triple therapy with metformin

Or metformin + insulin

Treatment targets for diabetic patients

SIGN Guidelines 2017 and NICE Guideline 2015 recommend the following HbA1c treatment targets:

48 mmol/mol for new type 2 diabetics
53 mmol/mol for diabetics that have moved beyond metformin alone

Diabetic meds

What does diabetic year check up involve

foot check
eye check (not in GP)
BMI
BP
Bloods for HbA1c, Renal function, Lipids
Urinary ACR

if patient blood test showed:

eGFR 50ml/min + •ACR 2.9mg/mmol?

what does this mean

CKD stage 3

other evidence of chronic kidney damage may be one of the following:

persistent microalbuminuria
persistent proteinuria
persistent haematuria (after exclusion of other causes, e.g. urological disease)
structural abnormalities of the kidneys demonstrated on ultrasound scanning or other radiological tests, e.g. polycystic kidney disease

Labryinthitis management

Fluids + Prochloroperazine

Otitis externa treatment

1. mild: Topical acetic acid 2% spray is also a safe and effective treatment and can be used for mild cases. 2. more severe: topical antibiotic +/- topical steroids for 7 days 3. if canal swollen: oral abx

Diagnostic test for BPPV treatment test/meds for BPPV

1. Hallpike test 2. Epley manouvre / prochlorperazine (acute) or betahistine (prevention -chronic) or vestibular physiotherapy

Management of Chronic otitis media – with effusion

* Otherwise known as glue ear * Watch and wait for 3 months - self limiting * if speech impaired then refer to ent \*\* Refer of cases of repeated Otitis media/chronically discharging ear

whats 1.2.3.4

1. frontal 2. ethmoids 3. sphenoid 4. Maxillary

Management of acute sinusitis for \<10 days

* usually viral and takes 2-3 weeks to resolve * can recommend analgesia * Consider nasal saline or nasal decongestants. (sterimar/otrivine)

if acute sinusitis with symptoms \> 10 days

* Likely to be bacterial * Consider prescribing a high-dose nasal corticosteroid for 14 days for adults e.g. **mometasone 200 micrograms** twice a day _•Consider antibiotics :_ phenoxymethylpenicillin 500 mg four times a day for 5 days **OR** _•If systemically very unwell_ — co-amoxiclav 500/125 mg three times a day for 5 days. •_If allergic penicillin_ — doxycycline 200 mg on the first day, then 100 mg once daily for 4 days (a 5-day course in total) OR clarithromycin 500 mg twice a day for 5 days.

Management of allergic rhinitis

* Advise:use of **nasal irrigation with saline** – _sterimar/Neil Med douche_ **_If mild to moderate intermittent or persistent symptoms:_** * Advise use of intranasal antihistamine PRN e.g. _azelastine_ (first-line) * OR non sedating oral histamine e.g._loratadine or cetirizine_

if acute epistaxis + patient haemodynamically unstable - whats ur next steps?

refer to a&e

•Group A beta-haemolytic streptococcus (GABHS) is most common bacterial cause in

tonsillitis, or scarlet fever.

Apthous ulcers

Acoutic neuroma is a shwannoma of acoustic nerve - what is it symptoms

Triad of 1. •unilateral tinnitus, 2. •unilateral hearing loss (SNHL) that’s on same side as tinnitus 3. • vertigo

initial treatment of menieres

Beta histine Symptoms 1. Episodic of vertigo 2. Fluctuating hearing loss 3. Tinnitus 4. is associated with a feeling of fullness in the affected ear If suspected refer routinely to ENT.

Manamgement of suspected Acoustic neuroma

•Refer ENT for MRI IAM

use of Ear Calm (2% acetic acid) – uses AND moa

mild otitis externa. * How it works – vinegar inhibits growth of bacterial and fungi