ENT & Opthalmology Flashcards
A person has a severe nose bleed, tried managing it with cautery, anterior and posterior packing yet it is still bleeding. The patient is on warfarin for A fib. What to do now?
Tried both 1st and 2nd line now:
Ligation of the sphenopalatine artery in theatre
What treatment options would there be in a px with chronic sinusitus and clear runny discharge?
clear discharge - not bacteria so no abx
INTRANASAL corticosteroid
and
Nasal irrigation with saline
A person has Meniere’s (vertigo, N&V, Hearing loss, tinnitus) how to treat their acute flare and prevent future cases?
Acute attack = Buccal or IM prochlorperazine
Prevention - betahistine
Epistaxis treatment for bleed from known source vs cannot find the source of bleed?
if you know it : Silver nitrate cautery
If cannot find it: Nasal packing
Having chronic sinusitis itself isn’t a red flag, but what key features would be red flags that would result in an ENT referral?
Unilateral chronic symptoms
Epistaxis
Blood stained discharge
Orbital features
Having chronic sinusitis itself isn’t a red flag, but what key features would be red flags that would result in an ENT referral?
Unilateral chronic symptoms
Epistaxis
Blood stained discharge
Orbital features
The dix-hallpike manouvre is the 1st line test to diagnose BPPV, what is seen?
would see
- patient experiencing vertigo
- rotatory nystagmus
acute maniere disease attacks medication?
Buccal or IM
Prochlorperazine
Scleritis summary
- episcleritis is a painless red eye in comparison
- underlying systemic e.g RA, SLE, IBD
- Deep eye pain worse on movement
- Red eye
- Photophobia
Ix = phenylephrine drops = if redness improves its episcleritis not scleritis
Mx = urgent referral due to threat to sight
NSAIDs 1st line if mild case
2nd line = systemic glucocortiods
3rd line = azathioprine/methotrexate
Uveitis summary
Anterior = HLAB27 linked
- dull pain
- red eye
- photophobia
- movement DOES NOT cause pain
- blurry vision
- lacrimation, hypopyon, small oval pupil
Posterior = Infections usually, same features + Floaters
referral + prednisolone drops
can give cycloplegic e.g atropine eye drops to dilate pupil and help relieve the pain and photophobia
Periorbital and orbital cellulitis summary
periorbital = superifical eyelid, insect bit = red swollen, oedema but no pain on movement
orbital = infection spread, sinusitis = red, oedema, severe pain + on movement, visual disturbance, proptosis, eyelid oedema
Ix = CT sinus + orbits with contrast, helps differentiate and assess for posterior spread
Mx
periorbital = oral abx co-amoxiclav and 2ndry care referal
Orbital = admission and review, IV vancomycin + ceftaxime
- risks cavernous sinus thrombosis
Optic neuritis summary
Commonly caused by MS (MS features)
Quick vision loss quickly or presents as decreased acquity with scotoma
Pain and on eye movement
colour desaturation
no red eye
RAPD
Papillitis
Ix - gadolinium enhanced MRI of orbit and brain
Mx - high dose prednisolone
Lesion to the superior optic radiation
inferior homonymous quadrantanopia
(cannot see between 6-9 oclock on both eyes)
Lesion to the inferior optic radiation
superior homonymous quadrantanopia
e.g. px can only see from 4-11 oclock on both eyes
what is the most likely source of orbital cellulitis infection?
Ethmoid sinus (sinusitis)
px has viral conjunctivitis, with pre auricular lymph nodes, how long to take off work?
Sign of adenovirus conjunctivitis, avoid contact up to 2 weeks
what is the epley manourvre?
A type of canalith repositioning manouvre - CRM
move the otoconia out of the semicircular canal and into the vestibule
Used in BPPV
whats tests may be done in menieres?
Fakudas stepping test
look for nystagmus
positive rombergs test
ix for meniere?
pure tone audiometry = rhinne + weber
will get unilateral sensourineal:
rhinne positive bilaterally
weber localising to normal ear
meniere accute attacks mx
meniere prevention
maintenance therapy
- IM prochlorperazine
- betahistine
- thiazide diuretic to redice endolymph fluid
epistaxis:
hereditary haemorrhagic telangiectasia ?
arteriovenous malformations
over skin and mucous membranes
spontaneous bleeding
first degree relative will have it too
epistaxis:
granulomatosis with polyangiitis (wegener’s)
px with epistaxis, sinusitis and saddle shaped nose
rapidly progressive glomerulonephritis (’pauci-immune’).
cANCA positive.
ITP vs TTP in epistaxis?
ITP = idiopathic
TTP = thrombotic (in sick patient
- thrombocytopaenic purpura
will get low platelets either in a well or unwell patient.
if ITP can tx with steroids
recurrent epistaxis mx?
Naseptin
