ENT/Opthal Flashcards
What is vertigo?
The sensation that the environment is spinning around relative to oneself or vice versa
WHat is tinnitus?
Hearing noises that are not caused by sounds from outside e.g. ringing, buzzing, whooshing, humming, hissing
What is BPPV?
Peripheral vestibular disorder characterised by sudden short lived vertigo
1) idiopathic 50-70%
2) secondary to trauma, labryinthitis, vestibular neuronitis, Menieres, migraines
50-70YO
Migraine and head trauma common in younger
Rfs for BPPV?
Hx, recent head trauma, viral infection URTI, viral labryinthitis, or vestibular neuronitis, migraines, inner ear surgery and MENIERES
Pathophysiology of BPPV?
Freefloating endolymph canalith (CaCO2) particles (displaced otoconia) in the psoterior (most common) semicircular canals in inner ear
BPPV presentation?
nausea, imbalance and lightheadedness
Nystagmus
1) slow phase
2) fast phase correction
BPPV canals and nystagmus?
Posterior (common) = fatigued and torsional + weak upbeat position R side eye rotates anticlockwise in fast phase and L clockwise
Anterior = rare and torsional + vertical down beat
Lateral = less common, no fatigues and horizontal nystagmus
BPPV diagnosis and Mx?
Dix-hallpike manouevre
Supine test procedure
Repositioning manouvres or surgery in severe intractable
What is Menieres?
Episodic auditory and vestibular disease with sudden onset vertigo, hearing loss, tinnitus and sensation of fullness in the affected ear
1) idiopathic
2) secondary to inner ear pathology
epi = 40YO, 50% have FHx
Pathophysiology of menieres?
Raised endolymphatic pressure -> reissners mebrane herniation -> mixing of K+ rich endloymph and K+ low perilymph -> abnormal vestibular nerve firing = symptoms
Presentation of menieres?
Hearing loss , roaring tinnitus, sensation of fullness
+ VERTIGO
Drop attacks = sudden loss of balance, no LOC
IX for Menieres?
\+ve rombergs poor tandem walking Fukuda/unterberger test (cannot hold position and turns to affected side) audiometry \+ exclusion MRI
Mx for Menieres?
Lifestyle = salt restriction, reduce caffeine and ETOH, smoking cessation and stress management
Diuretics to reduce endolymph volume e.g hydroclorothiazide
Sx = Vertigo = anti-emetics, e.g. antihistamine, denzo, anticholernergics, corticosteroids
Tinnitus = white noise generation, counselling. 2nd line = antidepressants
Hearing loss = cortiocsteroids + hearing devices
What causes opacification of lens?
Normal ageing, trauma, metabolic disoders, infection e.g. rubella, corticosteroids, congenital conditions
RFS: UV radiation and smoking cause progression
What metabolic conditions cause cataracts?
Wilsons, galactosaemia, myotonic dystrophy and Marfasn
Presentation and Ix of cataracts?
Gradual blurry or cldy vision, glare when night driving and decreased colour (blues)
Red relex defect by direct opthalmoscopy
Lens opacity with pupillary dilation and slit lamp exam
Vidsual acuity with eye chart
Normal intraocular pressure
Mx for cataracts?
Surgery = phacoemulsification + IOL implant
Nd:YAG laser
What is open angle glaucoma?
Neurodegenerative condition caused by dysfunction in aqueous humour outflow
Most common type 70%
GLC1A locus and myocilin mutations are RF
presentation of open angle glaucoma?
Usually asymptomatic
CUP:disc ratio = >0.6 suspicious, >0.2 asymetry
Normal corneal thickness and gongioscopy
Raised IOP>23mmHg (goldmann tonometry)
Painless vision loss
Loss of nerve fibre layer
optic cup changes = inferior NOTCH, flame haemorrhage
Mx for open angle glaucoma?
Monitoring of optic disce, retinal nerve fibre layer, visual field and IOP tracking
Topical opthalmic medication = beta blockers
Laser therapy = trabeculoplasty 1st line or 2nd to eye drop
Surgery = trabeculotomy, aqueous shunt, new microsurgery
Causes of acute eye pain?
Angle closure glaucoma and anterior uveitis
ACG: inuit and asian, female, 55-65,primary or secondary to ocular disease, hyperopia
AU: children and adults, primary/idiopathic, HLA-B27 and viral ocular disease
Presentation of CAG?
Blurring of vision, headache, N+V, halos around lights, redness of affected eye
Anterior uveitis presenation?
Dull eye/orbit pain, photophobia, blurred vision, tearing,
Bilateral = systemic causes
IBD/arthritis, oral lesions
CAG O/E?
High IOP
Corneal oedema
Fixed, dilated pupil
vascular congestion
Gonioscopy = closed angle and shallow chamber
Slit lamp = large optic cup, nerve fibre loss
Anterior uveitis O/E?
Circumlimbal redness
Small, irregular pupil
Ciliary flush /conjunctival injection
Anteriro chamber WBCs and flare - hypopyon
Synechia
Granulomatous: Large, yellow KPs
Cell clusters
Breakdown of CAG?
Acute = sudden pain, Nausea, bluured vision, corneal oedema, fixed dilated pupil, elevated IOP, anterior chamber angle closure on gonioscopy
Subacute = sudden but self limiting, may recur
CHronic = no symptoms, incidental with elevatedIOP and normal otpic head
MX for Glaucoma?
Acute = topical carbonic anhydrase inhibitors, beta blockers, topical alpha 2 adrenergic agonists
Suergey 24-48hours : laser peripheral iridotomy +- prior anteior chamber paracentesis
Anterior uveitis Mx?
acute = high dose corticosteroids
Long term = corticosteroids, injections, implants, immunosuppresives
What is conjunctivitis?
Inflammation of eyeball and eyelid lining
Bacterial children > adults
Viral adlts> children
42-80% bacterial, 13-70% viral
Viral = adensovirus, HSV, EBV, VSV, molloscum, coxsackie, entervirus
bacterial - pneumococcus/S.Aureus, moraxella, haemophilus
mechanical, chemical, allergic, medication induced
Allergic conjunctivits Px?
Watery mucoid dischagre + itching, often seasonal
Hx = atopic dermatitis, hay fever , asthma
Vernal conjunctivits = young asian, mediterrenian males
Viral conjunctivitis Px?
Starts in one eye/ spreads
Recent URTI or infection
RED EYE + itching, burning, foreign body sensation
Watery dischargee + pre-auricular lymphadenopathy
+- cornal subepithelial infiltrates
Bacterial conjunctivitis Px?
Bilaterl > unilateral
REd eye + burning or foreign body sensation
Ithcing uncommon
Papillar conjunctival reaction, eyelid matting, PURULENT discharge
+- concurrent #otitis media
Features of chlamydia conjunctivitis?
3% infectious cases
Stringy or mucous discharge
Conjucntival follicles + corneal pannus
+- corneal infiltrates
PRE_AURICULAR LYMPHADENOPATHY
Becomes chronic
Features of neisseria conjunctivitis?
Young, sexually active
lots of purulent discharge, eyelid swelling, chemosis
Develops 12-24 hours
+- peripheral corneal ulcers, pre-auricula lymphadenopathy
Progressises to blindness
Conjunctivitis Mx?
Allergic = topical mast cell stabilisers and antihistamines
bacterial = topical Abx
Viral = symptomatic Tx
What are thyoglossal cysts?
Congential fibrous cysts formed from a persistent thryoglossal duct
Infrahyoid(most common)
Suprhyoid
Juxtahyoid, inraingual
Thyroid cysts presentation?
Swelling = fluctuant, moves with tongue protrusion, mobile, non tender
Infection = tender, increasing size, malaise, dysphagia, dysphonia and airway obstruction
thyroid cysts clinical Dx?
USS neck = well circumscribed, anechoic mass and above thyroid
TFTs to exclude ectopic thryoids
