ENT/Opthalmology Flashcards
How do head and neck cancers typically present?
dysphagia
dysarthria
dysphonia
odynophagia
referred otalgia
globus
What are the diagnostic criteria for rhinosinusitis?
At least two sx + at least one sign
sx = blockage/congestion, anterior/posterior discharge, facial pain/pressure, hyposmia
signs = endoscopic signs, CT imaging confirming sinusitis, pus/obstruction in the middle meatus, mucosal changes
What reaction results in allergic rhinitis?
type 1 IgE mediated hypersentivity reaction
What are the complications of acute rhinosinusitis?
ophthalmologic = periorbital cellulitis
neurologic = meningitis, epidural abscess, brain abscess, cavernous sinus thrombosis
bone = OM
nasal = mucocele
Define periorbital cellulitis
infection of skin + soft tissue around the eye
Detail the presentation of periorbital cellulitis
emergent presentation
divided into:
pre-septal (infection anterior to orbital septum)
post septal (infection w/in orbital compartment)
When is periorbital cellulitis suspected?
reduced visual acuity, diplopia, proptosis (exophthalmos), lateral displacement of the eye
Define orbital cellulitis
infection behind the orbital septum
usually caused by sinusitisW
What are the signs/sx of orbital cellulitis?
systemically unwell
high CRP + WCC
signs of optic nerve dysfunction
What is orbital compartment syndrome + signs?
caused by orbital floor (blowout) fracture
proptosis (exophthalmos), RAPD, reduced visual acuity, high intraocular pressure
What is otitis externa associated with?
SPELD
- swimming
- pseudomonas
- ear pain
- loss of hearing
- discharge
What can develop from otitis media?
osteomyelitis of the mastoid process of the temporal bone
What are the key differences b/w conductive and sensorineural hearing loss?
conductive - decreased transmission of background noise
sensorineural - decreased transmission of all sound
What are the key differences b/w open angle and closed angle glaucoma?
OA = anterior chambre angle is open, associated w/ resistance to aqueous humor drainage through trabecular meshwork
CA = anterior chamber angle is closed, associated w/ anatomic abnormalities between anterior + posterior chamber
What are the red flag sx of acute angle closure glaucoma?
Hurts in a Hurry with Halos, Headache and a Half-dilated pupil
- pain
- acute presentation
- conuuctival erythema, halos around lights
- headache
What are the most common types of cancer in parotid glands?
adenocarcinoma (malignant)
pleiomorphic adenoma (benign)
List the differential diagnosis for ear pain
otitis media (acute, suppurative, chronic)
otitis interna
otitis externa
acute mastoiditis (complication from acute otitis media)
What is the differential dx involved in a sore throat?
pharyngitis (commonly viral in etiology)
epiglottitis
tonsillitis
retropharyngeal abscess
thyroiditis
Lemierre syndrome
What does the presentation of a facial nerve palsy with a new onset parotid lump indicate the possibility of?
Red Flag – the presentation of facial nerve palsy with a new onset parotid lump
should alert the clinician to the possibility of a tumour – direct ENT referral is
indicated
What is a drug iatrogenic cause of glaucoma?
Use of systemic corticosteroids such as prednisone is a risk factor for glaucoma.
_____ tumors typically occur in the apex and may compress the stellate ganglion.
Pancoast
_____ is a direct muscarinic receptor agonist used in the treatment of glaucoma. It decreases IOP by facilitating drainage of aqueous humor.
Pilocarpine
What are the pathological changes associated w/ hyperopia?
farsightedness
eye too short for refractive power of the lens –> light is focused behind the retina
What are the pathological changes associated w/ myopia?
nearsightedness
eye too long for refractive power of cornea = lens –> light is focused in the front of the retina
____ is age related impaired accommodation of the lens
presbyopia
What causes a thyroglossal duct cyst?
incomplete obliteration of the thyroglossal duct
What nerve impairment causes internuclear ophthalmoplegia?
damage to the medial longitudinal fasciculus
What structure of the eye produces aqueous humor?
epithelial cells of the ciliary body
Ptosis is…
the drooping of the upper eyelid
Anisocoria refers to…
uneven pupillary size
RAPD is caused by lesions in the ____ limb of the pupillary reflex pathwayt
afferent
What are the causes of RAPD?
OPTIC DISEASE
Optic neuritis
Advanced glaucoma
Ischaemic optic neuropathy (arteritic or non-arteritic)
Traumatic optic neuropathy
Tumour of the optic nerve (meningioma/glioma)
RETINAL DISEASE
Ischaemic retinal disease (CRAO, ischaemic CRVO)
Large retinal detachment
Severe macular degeneration
What are some systemic conditions which can affect the eye?
connective tissue: ankylosing spondylitis, GCA, Marfans, rheumatoid
Genetics: NF, Down’s
Autoimmune: Thyroid eye disease, MG, Sjogrens, MS + optic neuritis
Vascular: HTN, DM, IIH
Neoplastic: choroidal melanoma
What are the differences in ocular manifestations of NF1 and NF2?
NF1: lisch nodules in the iris
NF2: juvenile cataracts + meningioma
What are the effects of Marfans on the eye?
cataract
lens dislocation
retinal detachment
glaucoma
myopia
astigmatism
What are the classic sx of Meniere’s disease?
vertigo
tinnitus
unilateral sensorineural hearing loss
What is juvenile angiofibroma and what are its associated signs/sx?
benign growth of nasopharynx
recurrent epistaxis, nasal obstruction, hearing loss (ET obstruction), tinnitus
bulging palate, buccal mass
What are the most common causes of pharyngitis (sore throat)?
viral origin more commonly
GAS if bacterial (but will not have cough or rhinorrhea)
What is a Quinsy?
peritonsillar abscess that can result from acute tonsillitis
What are the differences b/w Rinne and Weber test?
Rinne tests for air conduction > bone conduction (conductive hearing loss)
Weber tests for sensorineural hearing loss
What are some iatrogenic causes of tinnitus?
loop diuretics
aminoglycosides
salicylates
What is benign paroxysmal position vertigo (BPPV)?
dislodging of otoconia and migrating into SCC, which disrupts endolymph dynamics and leads to vertigo on sudden head movement
What is Wegeners?
GPA
necrotising granulomas of respiratory tract w/ vasculitis + GLN
ANCA+
What are the most common causes of sialedenitis?
bacterial infection
obstruction of the gland by a stone
autoimmune (sjogrens)
What are the groups of head + neck tumours?
mucosal
thyroid
parathyroid
skin
salivary gland
vascular
neurogenic
Detail the features of oropharyngeal cancer?
HPV induced tumors
Occurs due to previous lack of HPV vax for males
younger mean age than squamous oro cancer
60% reduction in death risk when compared to squamous oropharyngeal cancers (smoking induced)
presents w/ painless mass + odynophagia
What is a tracheostomy and what are its indications?
surgical formation of an opening into thetrachea through anterior neck
- indicated if a laryngectomy is performed
What are some sx of parathyroid cancers?
neuropsychiatric –> depression, anxiety, headache, etc.
MSK –> bone pain, muscle weakness + osteoporosis due to increased osteoclasts
GI -
Renal –> stones due to increased Ca++
cardiac –> HTN + arrhythmias due to increased Ca++
What does an RAPD suggest?
- An afferent pupil defect results from partial damage to the visual pathway anywhere from
the retinal ganglion cell layer to the lateral geniculate body (LGN), thus causing a
reduction in the input (afferent) signal reaching the brainstem when a light is directed at
the affected eye. RAPD or pupillary light defects are not seen in lesions after the LGN.
Explain the Rationale Behind the Swinging Light Test
- In Afferent pupil defect, the affected pupil will not be able to elicit a full light reflex.
- If a light is directed at the better eye, both pupils will constrict fully and equally. If it is
then immediately swung over (the ‘swinging flash light test’) and directed at the affected
eye (e.g. an eye with an optic nerve lesion), both pupils will appear to dilate—a relative
afferent pupillary defect (RAPD). In fact, what has happened here is that both pupils are
constricting but to a lesser degree than when the light was directed at the normal eye,
hence they only appear to dilate. When the light is swung back to the better eye, the
pupils will constrict.
How do we differentiate dry and wet AMD?
dry = non exudative, gradual vision loss, nonvascularized, blurry vision,
wet = exudative, vascularized, wavy vision, rapid vision loss
What type of vision loss will result from AMD?
central vision loss
conductive hearing loss
In the weber test, where will sound lateralize?
In the rinne test, where will sound lateralize?
weber = affected ear
negative air over bone
sensorineural hearing loss
In the weber test, where will sound lateralize?
In the rinne test, where will sound lateralize?
better ear
positive air over bone
What are the top causes of conductive hearing loss?
cerumen impaction
otitis media w/ effusion
tympanic membrane perforation
otosclerosis
foreign body
What is the most common cause of sensorineural hearing loss?
idiopathic
Which drugs lead to ototoxic hearing loss?
salicylates
aminoglycosides
erythromycin
cis-platinumn
loop diuretics
What is leukoplakia?
white patch of plaque in the oral cavity which cannot be removed
What is erythroplakia?
red patch of plaque in the oral cavity that cannot be diagnosed as any other lresion
how do topical steroids work?
not completely understood; may be inhibition of arachidonic acid release from phospholipids
What landmarks are seen in the anterior chambre angle?
Schwalbe’s line: the perpiheral termoneration of Descemet’s membrane as the apex of the corneal light wedge
Anterior TM
Posterior (pigmented) TM
Schlemms canal (faint red band)
Scleral spur (narrow white band of sclera)
CB band (marks the anterior face of the ciliary body
Iris
What are the common visual sx associated w/ age related macular degeneration?
visual blur
central scotoma
metamorphopsia (visual distortion)
What is retinopathy of prematurity?
affects infants born prematurely
development of abnormal vessels that proliferate, which can lead to detachment, macular ectopia and visual loss
How do we treat patients w/ stable epiglottitis?
Stable patients → are treated with IV steroid, antibiotics, nebulised adrenaline and
are admitted to ICU for close airway monitoring
How do we treat patients w/ unstable epiglottitis??
immediate airway intervention via intubation or tracheostomy
/What is laryngomalacia
commonest cause of congenital stridor in babies
weak laryngeal tone due to immature NM support
sx: high inspiratory stridor that worsens during feeding
What is initial treatment for Meniere’s disease?
lifestyle changes (low salt diet, reduced caffeine intake) and addition of thiazide diuretic
Meniere’s disease involves a _____ hearing loss
sensorineural
The action of the inferior oblique muscle is…
elevation, extorsion + abduction
The action of the superior rectus muscle of the eye is…
elevation, intorsion, adduction
Is cupping of the disc found in papilloedema?
no
Facial palsy + vesicles in the ear =
Ramsay Hunt syndrome
What is Ramsay Hunt syndrome?
reactivation of chicken pox/shingles affecting the facial nerve
What type of cancer is characterized by elevated calcitonin + a thyroid nodule?
medullary thyroid cancer
family history of MEN
Recurrent bilateral parotid swelling _ dry eyes =
Sjogrens syndrome
Recurrent severe epistaxis in teeange male =
juvenile angiofibroma
