Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Phase 1c > ENT & Ophthalmology > Flashcards

ENT & Ophthalmology Flashcards

1
Q

BPPV definition

A

disorder of recurrent episodes of vertigo accounting half pts with peripheral vertigo associated with head movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

BPPV cause

A

most idiopathic but associated with head trauma, labyrinthitis, otological surgery and vestibular neuronitis

otoconia debris comes loose into semi-circular canals
debris causes endolymph movement in canals with head movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

BPPV signs and symptoms

A

recurrent vertigo episodes <1min
provoked by head movements
peripheral vertigo (neg HINTS)
no symptoms of hearing loss, tinnitus or neuro deficits
positive Dix-Hallpike test - latent and fatigable nystagmus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

BPPV mx

A

particle repositioning manoeuvres (Epley/Semont manoeuvre)

home exercises (Brandt-Daroff)

referral to balance specialist if sx unresolving and resistant to manouvres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Meniere’s disease pathophysiology

A

excess fluid production or impaired absorption of endolymph of inner ear
causes endolymph hypertension which causes symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Meniere’s disease presentation

A

onset 20-40 yrs maybe FHx

rotatory episodic vertigo (mins to hrs)
sensorineural hearing loss, progressive and episodic
tinitus

associated with ear fullness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Meniere’s disease IX

A

audiology
otoscopy
MRI head if asymmetrical tinnitus/hearing loss to exclude acoustic neuroma

positive Romberg’s
positive Fukuda stepping test
peripheral HINTS exam
difficulty in heel-to-toe walking
sensorineural Rinne and Weber

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Meniere’s mx

A

decrease salt, caffeine, alcohol, nicotine
avoid triggers

acute attack
- benzos +/- antiemetic

refractory symptoms
- try betahistine first as less SEs
- replace betahistine for thiazide diuretic (hydrochlorothiazide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

causes of conductive hearing loss

A

defects limiting sound conduction from auricle to ossicles

wax impaction
foreign bodies
otitis externa
tumour
otitis media
glue ear
cholesteatoma
ruptured TM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

causes of unilateral sensorineural hearing loss

A

MS, brainstem stroke, Meniere’s acoustic neuroma

needs MRI scan and ENT referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

causes of bilateral sensorineural hearing loss

A

age-related (presbycusis)
noise exposure
ototoxicity (aminoglycosides, tetracyclines, chemotherapy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how do you clinically differentiate sensorineural and conductive hearing loss

A

Conductive:
Rinne BC>AC
Weber localises to affected ear

Sensorineural loss:
Rinne AC>BC
Webber localises to unaffected ear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

hearing investigations

A

pure tone air and bone conduction testing
speech audiometry
impedance audiometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

clear, watery nasal discharge with coryza and maybe fever. consider …

A

… common cold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

clear, watery nasal discharge with Hx of head injury/surgery. consider …

A

… CSF rhinorrhoea!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

clear, watery nasal discharge with history of allergy/atopy maybe itchy eyes maybe itchy nose. consider …

A

… allergic rhinitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

clear watery nasal discharge with headache and unilateral neurology. consider …

A

… migraine or cluster headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

clear watery nasal discharge in elderly patient excluding serious pathology. consider …

A

… senile rhinorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

mucopurulent non-bloody nasal discharge with obstruction maybe anosmia maybe facial pain. less than a week. consider …

A

… acute rhinosinusitis (viral)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

mucopurulent non-bloody nasal discharge with obstruction maybe anosmia maybe facial pain. more than a week, less than 12 weeks. maybe fever. consider …

A

… acute rhinosinusitis (bacterial)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

mucopurulent non-bloody nasal discharge with obstruction maybe anosmia maybe facial pain. more than 12 weeks. consider …

A

… chronic rhinosinusitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

mucopurulent bloody discharge with unilateral nasal obstruction. consider…

A

… sinus/nasopharyngeal neoplasm

… nasal foreign body in a child or psychiatric adult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

mucopurulent bloody discharge with septal perforation maybe crusting maybe nasal collapse. consider …

A

granulomatosis with polyangiitis (Wegner’s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

most common causes of acute viral rhinosinusitits

A

rhinovirus, influenza, parainfluenza

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
common causes of acute bacterial rhinosinusitis
strep.pneumoniae h.influenzae moraxella catarrhalis
26
acute rhinosinusitis mx
analgesia/antipyretics (paracetamol, ibuprofen) nasal saline irrigation oral nasal decongestant phenylephrine 1 wk topical intranasal glucocorticoids ABs if high suspicion bacterial (Penicillin V or doxycycline or clarithromycin) if systemically unwell or high risk complications give co-amoxiclav
27
some chronic rhinosinusitis signs
inflammation nasal polyps anteriorly post nasal drip anosmia red flags: visual changes focal neurology blood-stained unilateral symptoms
28
chronic rhinosinusitis management
lifestyle: avoid triggers, stop smoking, dental hygiene, steaming nasal saline irrigation intranasal glucocorticoids up to 3mo specialist referral
29
when would you refer chronic rhinosinusitis patient to specialist
if: red flag symptoms symptoms despite 3mo intranasal steroids polyps complicating treatment significant impact on QoL
30
rhinosinusitis complications
orbital: - orbital/preseptal cellulitis - orbital abscess intracranial: - meningitis - cavernous sinus thrombosis
31
eye red flags
diplopia eye pain on movement decreased visual acuity loss of colour vision discrimination chemosis (oedema of sclera)
32
orbital, preseptal cellulitis ix
assess with ABCDE, look for sepsis, intracranial infection and assess for eye compromise nasendoscopy to inspect mucosa and neurological examination with cranial nerves if red flags: admit. urgent CT sinus and brain, broad spectrum antibiotics and keep NBM
33
which vessels affected in anterior epistaxis
Kisselbach's plexus (Little's area)
34
which vessels affected in posterior epistaxis
Sphenopalatine artery
35
epistaxis ix
ABCDE approach examine with thudicum speculum endoscopy
36
epistaxis mx
1) assess with ABCDE approach maybe manage any hypovolaemia (IV access and crystalloids) 2) lean forward, pinch anterior nares, hold 20mins 3) examine with thudicum and cauterise anterior bleeds with silver nitrate 4) anterior packing with nasal tampon or gauze in paraffin, refer to ENT for admission 5) bilateral anterior packing maybe posterior packing (Foley catheter) 6) unresolving bleeds need arterial ligation in theatre (eg SPA ligation)
37
allergic conjunctivitis signs and symptoms
watery discharge + itchy + nasal sx + bilateral disease
38
viral conjunctivitis causes and symptoms
adenovirus, HSV watery discharge + sticky eyes + bilateral disease +/- herpetic vesicular rash
39
bacterial conjunctivitis causes and symptoms
pneumococcus, stph.aureus, moraxella catarrhalis purulent discharge + sticky eyes + unilateral + pannus
40
conjunctivitis ix
slit lamp
41
conjunctivitis mx
dont touch things between eyes, dont itch, dont share household items wash hands and face and eyes regularly if suspect bacteria, topical BS abx to reduce symptom duration if given before day 6 if suspect viral or allergic give topical antihistamines if unresolving allergic try topical steroids or topical sodium cromoglycate
42
scleritis pathophysiology
painful destructive and vision threatening disorder of the sclera half of pts associated with systemic illness most cases are anterior scleritis posterior and necrotising anterior are most serious. posterior often delayed recognition and close to optic nerve
43
scleritis signs and symptoms
severe pain constantly exacerbated on eye movement may have photophobia look out for diplopia and reduced vision (compression of 2nd nerve) in posterior less likely to have redness than anterior
44
scleritis ix
use slit lamp and look for: scleral oedema and dilation deep episcleral vascular plexus (anterior) choroidal thickening and retinal detachment (posterior) may want B-scan ultrasonography to confirm scleral thickening may also want CT/MRI to exclude orbital lesions
45
mild-moderate scleritis mx
anterior subtype NSAIDs if no response to NSAIDs or moderate anterior then try high dose prednisolone (+ eventually tapering)
46
severe scleritis mx
aggressive mx with high dose prednisolone and rituximab (anti-CD20) if still not responding to rituximab try cyclophosphamide short as possible <3-6mo (high toxicity) if responsive to cyclophosphamide eventually switch to less toxic medication: azathioprine methotrexate mycophenolate mofetil
47
iritis signs
limbal redness (junction cornea and sclera) irregular pupil blurred vision photophobia throbbing and dull pain cells and flare in anterior chamber on split lamp examination
48
iritis (anterior uveitis) causes
occurs with systemic conditions seronegative spondyloarthropathies rheumatoid arthritis IBD Bechet's Sarcoidosis TB Herpes HIV
49
uveitis mx
if infectious use appropriate antimicrobial plus below topical corticosteroid for anterior peri/intra-ocular injections cycloplegic (atropine, cyclopentolate) to paralyse ciliary body if no response initial treatment, systemic glucocorticoids +/- immunosuppressants (MTX, azathioprine, mycophenolate)
50
transient acute visual loss. <24hrs. consider ...
TIA giant cell arteritis papilloedema seizure migraine
51
posterior uveitis is inflammation of
choroid retina
52
aetiologies posterior uveitis
herpes simples/ herpes zoster toxoplasmosis TB CMV lymphoma sarcoidosis Bechet's
53
posterior uveitis signs and symptoms
ACTIVE INFLAMMATION OF CHOROID OR RETINA + LEUCOCYTES IN VITREOUS HUMOUR painless and no redness eye floaters reduced visual acuity
54
unilateral ptosis with miosis?
Horner's syndrome
55
unilateral ptosis with opthalmoplegia
CN III palsy
56
ptosis with fatiguability
myasthaenia gravis
57
bilateral ptosis with midbrain signs
supranuclear CN III palsy
58
bilateral ptosis with chronic progressive opthalmoplegia
Myopathies
59
what does monocular diplopia suggest
monocular diplopia is present when only one eye is open suggests orbital pathology
60
what does binocular diplopia suggest
present when both eyes are open, absent when one is closed suggests neurological, NMJ or muscular pathology

Phase 1c (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions