ENT & Ophthal & Derm Flashcards
BPPV signs and symptoms
Vertigo lasting a minute
Dizziness after changing head position
BPPV investigations
Hallpike test
BPPV management
- Epley manoeuvre
- Vestibular rehabilitation (Cawthorne-Cooksey exercises)
Ménière’s disease signs and symptoms
Vertigo lasting hours
Unilateral hearing loss with aural fullness and tinnitus
N+V
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
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
Infectious mononucleosis signs and symptoms
Triad:
Sore throat
Lymphadenopathy
Fever
Tonsillar enlargement
Splenomegaly (important)
Infectious mononucleosis investigations
Gold standard: Heterophil antibody test (monospot test)
FBC: leukocytosis/lymphocytosis
Blood film: atypical lymphocytes
Infectious mononucleosis management
Physical isolation
Avoid alcohol
Analgesia, hydration
Steroids if symptoms are severe
Obstructive sleep apnoea signs and symptoms
Snoring
Sleep disruption/fragmentation
Obstructive sleep apnoea management
Mild:
Lifestyle and sleep advice
Moderate/severe:
Lifestyle and sleep advice
Fixed level CPAP, auto CPAP if not working
Rhinosinusitis signs and symptoms
Headache
Facial pain, worse when bending over/lying down
Thick nasal discharge (green/blood/pus)
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
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
Tonsillitis indications for hospital admission
Drooling with respiratory distress
Severe dehydration
Per-tonsillitis abscess
Suspected Kawasaki disease
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
Optic neuritis signs and symptoms
Eye pain, worse on eye movement
Blurry vision and colour may be affected(red desaturation)
Related to MS
Causes of abnormally large/small pupil
Large:
Third nerve palsy
Acute glaucoma
Pharmacological
Small:
Horner’s syndrome
Opioid overdose
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
- emollients
- potent corticosteroid + vit D
- step up vit D
- step up steroids
- 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
