1. Epley manoeuvre 2. Vestibular rehabilitation (Cawthorne-Cooksey exercises)

ENT & Ophthal & Derm Flashcards by Galvin Chiam

BPPV signs and symptoms

Vertigo lasting a minute
Dizziness after changing head position

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BPPV investigations

Hallpike test

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BPPV management

Epley manoeuvre
Vestibular rehabilitation (Cawthorne-Cooksey exercises)

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Ménière’s disease signs and symptoms

Vertigo lasting hours
Unilateral hearing loss with aural fullness and tinnitus
N+V

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Ménière’s disease management

Acute:
Vestibular sedatives e.g. prochlorperazine
Antihistamine e.g. cinnarizine

Long term:
Stress avoidance
Betahistine (reduces frequency and length of episodes)
Diuretics

Dont drive!
2nd line:
Grommet
Hearing aid
Intratympanic gentamicin/steroid injection

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Epistaxis management

Firm pressure on soft anterior nose for 15 min
Patient should sit forward

bleed is visible:
Cautery with silver nitrate

bleed isn’t visible:
nasal packing

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Infectious mononucleosis signs and symptoms

Triad:
Sore throat
Lymphadenopathy
Fever

Tonsillar enlargement
Splenomegaly (important)

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Infectious mononucleosis investigations

Gold standard: Heterophil antibody test (monospot test)

FBC: leukocytosis/lymphocytosis
Blood film: atypical lymphocytes

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Infectious mononucleosis management

Physical isolation
Avoid alcohol
Analgesia, hydration
Steroids if symptoms are severe

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Obstructive sleep apnoea signs and symptoms

Snoring
Sleep disruption/fragmentation

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Obstructive sleep apnoea management

Mild:
Lifestyle and sleep advice

Moderate/severe:
Lifestyle and sleep advice
Fixed level CPAP, auto CPAP if not working

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Rhinosinusitis signs and symptoms

Headache
Facial pain, worse when bending over/lying down
Thick nasal discharge (green/blood/pus)

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Rhinosinusitis management

Nasal congestion:
Nasal irrigation
Hydration

Allergic:
Antihistamine
Mometasone/fluticasone

Viral:
Will get better over 10 days

Bacterial:
Co-amoxiclav 500mg TDS 5/7
Penicillin allergy -> clarithromycin/doxycycline

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Tonsillitis signs and symptoms

Common cold: rhinorrhoea, nasal congestion, cough

Influenza: headache, weakness, fatigue, myalgia, fever, dry cough

Streptococcal: acute onset, fever, tonsil exudate, no cough

Glandular fever (inf mononucleosis): >7d sore throat, adenopathy, splenomegaly

Haem malignancy (rare): fatigue, weight loss, petechial rash, bruising, adenopathy, fever

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Tonsillitis indications for hospital admission

Drooling with respiratory distress
Severe dehydration
Per-tonsillitis abscess
Suspected Kawasaki disease

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Tonsillitis management

Calculate feverPAIN score:
2-3 -> delayed penicillin V 500mg QDS 10/7
4-5 -> immediate penicillin V 500mg QDS 10/7

Peri-tonsillar abscess:
Intraoral incision and drainage
Needle aspiration

> 7 well-documented episodes of tonsillitis in a year: tonsillectomy

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Optic neuritis signs and symptoms

Eye pain, worse on eye movement
Blurry vision and colour may be affected(red desaturation)
Related to MS

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Causes of abnormally large/small pupil

Large:
Third nerve palsy
Acute glaucoma
Pharmacological

Small:
Horner’s syndrome
Opioid overdose

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Optic neuritis investigations

MRI to rule out MS
Lumbar puncture to check for MS

Optic neuritis management

High dose steroids

Scleritis signs and symptoms

Severe eye pain, worse at night
Photophobia
Tearing
Visual acuity affected

Associations:
RA
SLE
Sarcoidosis
Granulomatosis with polyangiitis

Uveitis signs and symptoms

Pain and redness
Photophobia
Blurred vision
anterior uveitis associated with ankylosing spondylitis

Types of visual field defects and where are the lesions

Bitemporal hemianopia: optic chiasm
Homonymous hemianopia: optic tract contra
Unilateral vision loss: optic nerve ipsi
Homonymous superior quadrantanopia: temporal lobe contra
Homonymous inferior quadrantanopia: parietal lobe contra

Conjunctivitis signs and symptoms

Red eye, swelling, watering
Normal vision and reflexes
Viral conjunctivitis associated with URTI
Sticky discharge if bacterial

Conjunctivitis investigations

Swab if bacterial and not improving with topical antibiotics Patch test for allergen

Conjunctivitis management

Antihistamines Artificial tears Bacterial: topical chloramphenicol, topical fusidic acid if pregnant

Scleritis management

NSAIDs e.g. ibuprofen Prednisolone if NSAIDs contraindicated or scleritis is posterior/necrotising Immunosuppressants e.g. azathioprine/methotrexate Antibiotics if bacterial

Uveitis management

Topical/oral steroids Rule out corneal ulcers DMARDs if caused by RA

Eczema Signs and symptoms

Thickened and scaly skin on flexor surfaces

Eczema management

Reduce exposure to irritant emollient Moisturise Mild: hydrocortisone Moderate: betamethasone(betnovate)/clobetasone(eumovate) Potent: fluticasone(cutivate) Very potent: clobetasol(dermovate)

Cellulitis management

Flucloxacillin 1g QDS 7/7

Cellulitis signs and symptoms

Pain and swelling Blanching erythema

Psoriasis signs and symptoms

Scaly erythematous plaques on extensor surfaces Joint pain Exacerbations: Smoking/alcohol Stress Infection Medication Skin injury

Psoriasis management

1. emollients 2. potent corticosteroid + vit D 3. step up vit D 4. step up steroids 5. dithranol phototherapy methotrexate etanercept

Candidiasis signs and symptoms

Oral: White patches on tongue Vagina: Itching, burning White discharge

Candidiasis management

Oral: Topical nystatin Topical clotrimazole Vaginal: Topical clotrimazole

Necrotising fasciitis signs and symptoms

Red/purple skin in affected area Fever Pain Usually limbs or perineum

Necrotising fasciitis investigations

Surgical exploration (gold standard) FBC, CRP, U&E, glucose

Necrotising fasciitis management

Aggressive surgical debridement Co-amoxiclav IV fluid Analgesia

HSV signs and symptoms

Urinary retention Burning/tingling Lymphadenopathy, malaise, anorexia Painful vesicles on erythematous base

HSV diagnosis and management

Diagnosis: PCR Acyclovir IV antivirals

Orbital cellulitis signs and symptoms

Painful, limited eye movement Sudden vision loss Bulging eyes (proptosis) Eyelid redness, swelling

Orbital cellulitis management

IV Penicillins/vancomycin/clindamycin/doxycyline Surgical drainage of sinuses

Urticaria signs and symptoms

Red, raised itchy bumps Caused by medication, insect bites, food RF: asthma, hay fever

Urticaria management

Antihistamines (fexofenadine) Omalizumab

Viral exanthema signs and symptoms and causative organisms

Widespread rash, usually children Measles Rubella Parvovirus B19 HHV6

strawberry tongue presentation

kawasaki disease