ENT & Opthalmology Flashcards
Sx of Herpes Simplex Keratitis?
Red painful eye, photophobia, excessive tearing (epiphora) and decreased visual acuity?
Ix and Mx of Herpes Simplex Keratitis?
Ix = linear branching epithelial or corneal ulcer on fluorescein stain
Mx = topical aciclovir and referral to opthalmology
Sx of anterior uveitis?
Sx = acute onset pain and discomfort in the eye, red eye, photophobia, blurred vision and lacrimation. Pupil may appear small and irregular
Mx of anterior uveitits?
Steroid and cycloplegic eye drops (e.g. atropine), refer to opthalmology
What is endophthalmitis?
A complication of cataract surgery due to inflammation of the aqueous or vitreous humour. Presents with a painful red eye
Sx of age related macular degeneration?
Decreased visual acuity, especially for near objects
Deterioration in night vision
Flickering/flashing of lights and glare around objects
Distorted line perception
If sub acute = Wet, If gradual deterioration = Dry
Ix and Mx of ARMD?
Ix = amsler grid testing. Drusen yellow areas of pigment deposition seen. If Wet haemorrhages are seen secondary to neovascularisation
Mx = If Wet, vascular endothelial growth factor
If Dry, zinc with anti-oxidant vitamins A, C and E
What is a Branchial cyst
A benign cyst seen in children in young adults.
It is non tender and lies lateral and anterior to sternocleidomastoid. It will not move on tongue protrusion
On aspiration is filled with cholesterol crystals
When should you refer a mouth ulcer on the 2WW pathway?
If it lasts for >3 weeks as ?Squamous cell carcinoma
Sx and Mx of viral labyrinthitis?
Acute onset vertigo, nausea and vomiting, sensorineural hearing loss, tinnitus and horizontal nystagmus
Mx = prochlorperazine or antihistamines
What is otosclerosis?
An autosomal dominant condition typically affecting young adults
Sx = conductive hearing loss, tinnitus, normal TM and a positive family history
What is seen in retinal detachment?
Sudden onset painless but progressive vision loss (described as a shadow/curtain progressing from the peripheries to the centre). New onset flashes and floaters.
O/E = loss of red reflex and pale retinal folds
Sx of optic neuritis?
Unilateral decreased visual acuity, red desaturation, painful eye movements, RAPD and central scotoma (blind spot in the centre of the vision)
Ix and Mx of optic neuritis?
High dose steroids, MRI of the brain and orbits with contrast
Sx of vestibular neuronitis?
Vertigo lasting hours/days, nausea and vomiting and horizontal nystagmus.
Unlike viral labyrinthitis there will be NO hearing loss or tinnitus!
Mx of vestibular neuronitis?
IM prochlorperazine if severe
PO prochlorperazine or anti-histamines if less severe
What is seen in a central retinal artery occlusion?
Sudden painless unilateral vision loss with an RAPD and a cherry red spot seen on a pale retina
Ix and Mx of BPPV?
Ix = Dix-Hallpike Manoeuvre
Mx = Epley Manoeuvre
What is Blepharitis and how does it present?
Inflammation of the eyelid margins
Bilateral grittiness and discomfort of the eyes with red eyelid margins
Mx of Blepharitis?
Hot compress and mechanical removal of debris
What is seen in pre-proliferative diabetic retinopathy?
Microaneurysms, blot haemorrhages, cotton wool spots and venous bleeding
What is seen in proliferative diabetic retinopathy?
Retinal neovascularisation which may lead to vitreous haemorrhage
What can occur in those who overuse topical decongestants? How do we treat this?
Rhinitis Medicamentosa (return of symptoms of rhinitis)
Mx = stop all decongestants
What should you do if a Chinese or South-East Asian patient presents with a unilateral middle ear effusion (a dull and retracted TM)?
2WW pathway as may be presenting complaint of a nasopharyngeal carcinoma
How should you manage post-tonsillectomy bleeds?
All must be seen urgently by ENT
If primary (occurring withing hrs of surgery) - return immediately to theatre
Secondary bleeds (occurring after hours or days) are usually due to infection so Abx will be given
What is Herpes Zoster Opthalmicus?
Reactivation of VZV in the ophthalmic branch of the trigeminal nerve
Sx = vesicular rash around the eye. Involvement of a rash on the tip or side of the nose is a strong RF for ocular involvement
Mx of Herpes Zoster Opthalmicus?
PO aciclovir for 7-10 days
If ocular involvement give topical steroids and refer urgently to ophthalmology
Sx of vitreous detatchment?
Sudden appearance of flashes/floaters in the vision, burred vision or cobwebs across the vision WITHOUT dark curtain/shadow coming cross (differentiates between retinal and vitreous detachment)
How can you manage epistaxis?
First aid measure, if successful give topical Naseptin and self care advice. If unsuccessful and visible source of bleed do cautery. If no visible source of bleed do anterior packing. If this fails refer to ENT for posterior packing
How can we differentiate between Meniere’s Disease and Labyrinthitis?
Meniere’s causes a feeling of fullness in the ear and symptoms tend to come and go. There may also be diarrhoea.
In Labyrinthitis symptoms are generally constant
Mx of chronic rhinosiunsitis? What are the red flags that should warrant further investigation?
Avoid allergens, internasal corticosteroids and nasal irrigation with saline
Red flags = unilateral symptoms, epistaxis and symptoms which persist after 3/12 treatment
A question states that an “increased number of retinal blood vessels” are noted on fundoscopy, what is this describing? What is the diagnosis?
Neovascularisation = proliferative diabetic retinopathy = more common in T1DM
Which visual fields are affected in macular degeneration and primary open angle glaucoma?
ARMD = affects the central vision first
POAG = affects the peripheral vision first
Describe Primary Open Angle Glaucoma?
Increase intraocular pressure as the aqueous humour drainage becomes blocked. Myopia is a risk factor
Sx = peripheral visual field loss (tunnel vision), decreased visual acuity and optic disc cupping.
There will be gradual onset of symptoms, may also be fluctuating pain, headaches, blurred vision and halos around light
Ix of Primary Open Angle Glaucoma?
Fundoscopy shows optic disc cupping and pallor, bayonetting of vessels (there appears to be breaks in the vessels), cup notching and disc haemorrhages
Goldman Applanation Tonometry is the GS to measure raised IOP
Mx of Primary Open Angle Glaucoma?
1st line = Latanoprost eye drops
2nd line = Beta blocker (e.g. timolol), carbonic anhydrase inhibitors (e.g. dorzolamide) or sympathomimetics (e.g. brimonidine) eye drops
Sx of Acute Angle-Closure Glaucoma?
Rapid onset severe eye pain/headache which is worse with mydriasis (e.g. when in the dark), hard red eye, semi dilated non-reactive pupil, reduced visual acuity, halos around lights and dull/hazy cornea
Mx of Acute Angle-Closure Glaucoma?
Emergency referral to ophthalmology
Combination eye drops (pilocarpine, timolol, apraclonidine)
IV acetazolamide
Definitive Mx = laser peripheral iridotomy
What actually are cotton wool spots?
Pre-capillary arteriolar occlusion (retinal infarction)
Which drugs are known to cause tinnitus?
Aspirin, NSAIDs, aminoglycosides, loop diuretics and quinine
Mx of proliferative diabetic retinopathy? What are the compliations?
Mx = panretinal laser photocoagulation
Complications = vitreous haemorrhage or retinal detachment
What is retinitis pigmentosa?
Tunnel vision preceded by night blindness. On fundoscopy blackness in seen on the retina
Can be associated with Alport’s syndrome (alongside kidney disease and hearing loss
How do we differentiate between thyroglossal cysts and thyroid swellings?
Thyroglossal cysts move on tongue protrusion. Thyroid swellings move up on swallowing
Sx of a pharyngeal pouch?
Halitosis, throat infections, regurgitation of undigested food or night time cough
What is a cystic hygroma?
A neck swelling found in children <2 years old. It will transilluminate
What actually are Drunsen spots?
Extracellular material between Bruch’s membrane and the retinal pigment epithelium of the eye
Sx and Mx of Glue ear?
Otitis media with effusions
Sx = conductive hearing loss (commonest cause in children), loss of light reflex on TM and a fluid level
Mx = active observation unless the child has Down’s syndrome or a Cleft palate, then refer to ENT for grommits
How can we distinguish between vestibular neuronitis and a posterior cerebellar stroke?
HiNTs exam
How do Pancoast tumours present?
Horner’s syndrome (miosis, ptosis, enophthalmos and anhidrosis), shoulder pain and upper limb neurological signs
What should you do with a patient presenting with acute onset sensorineural hearing loss?
Refer to ENT for audiology assessment and brain MRI
Sx and Ix of BPPV?
Vertigo triggered by a change in head position associated with nausea and vomiting
Ix = Dix Hallpike manoeuvre (is positive if there is vertigo and rotatory nystagmus experienced)
How do we distinguish between 3rd nerve palsy and Horner’s syndrome?
3rd nerve palsy = ptosis and dialled pupil
Horner’s syndrome = ptosis and constricted pupil
What are the common causative organisms of otitis media?
Strep pneumoniae, H. influenzae, Moraxella Catarrhalis
What should you do with a patient with a non-resolving otitis media or with worsening pain?
Refer urgently to ENT - may be malignant (necrotising) otitis media!
Describe Scleritis?
Red, painful eye with watering and photophobia. Visual acuity decreases slowly over time so may be normal at presentation. Blue tinge to the sclarea and non-mobile vessels
Most commonly associated with RA but also SLE
Mx = same day opthal referral and oral NSAIDs
Describe episceritis?
Painful eye (less painful than in scleritis). Injected vessels which are mobile with gentle pressure
Ix and Mx of mastoiditis?
Diagnosed clinically (protruding ear with a boggy swelling behind the pinna).
Mx = IV Abx
Mx of unexplained persistent sore throat or hoarse voice?
2WW
What is characteristically seen in WET macular degeneration?
Choroidal neovascularisation
What is the cause of most sudden onset sensorineural hearing loss?
Idiopathic
Describe Holmes-Adie Pupil?
Unilateral dilated pupil which is slowly reactive to accommodation and not reactive to light.
It is often seen in women
If there is also absent ankle/knee reflexes = Holmes-Adie Syndrome
What should you do with a patient who you are referring down the 2WW pathway for a hoarse voice?
CXR to exclude apical lung lesion
When should you consider offering medical treatment for sinusitis? What should you offer?
Offer intranasal steroids if symptoms are present for more than 10 days
When should you immediately prescribe antibiotics in otitis media? What should you prescribe?
Offer 5-7 days of amoxicillin if:
Symptoms last for >4 days, patient is immunocompromised, systemically unwell, <2 years with bilateral otitis media or OM with perforation and/or discharge in the canal
When should you think of a posterior circulation stroke?
If there is vertigo, nystagmus, ipsilateral facial pain and contralateral loss of temperature
What should you suspect as the cause of vertigo in the elderly with dizziness on neck extension?
Vertebrobasilar ischaemia
Mx of sudden onset sensorineural hearing loss?
Urgent ENT refferal and high dose oral steroids
How does latanoprost work?
It increase uveoscleral outflow to manage open angle glaucoma
What is the name of the exercise which can be performed at home to relieve BPPV symptoms?
Brandt-Daroff exercise
Which type of drugs increase the risk of vitreous haemorrhoage?
Blood thinners
Mx of perforation secondary to barotrauma?
No Mx, is self-limiting and does not require Abx
True or false, anterior uveitis is associated with pus in the anterior chamber?
True! Also known as hypogyon
Ix of ?orbital cellulitis?
Contrast CT of the sinuses and brain
Mx of OE?
TOP Abx +/- TOP steroids
If poor response to steroids refer to ENT
