MedEd ENT and opthamology Flashcards
What is BPPV/
Recurrent and brief attacks of positional vertigo
What is the most common cause of vertigo?
BPPV
How does BPPV arise?
Canalith particles break loose and fall into the wrong part of the semicircular canals of the inner ear causing vertigo
How will BPPV present?
Recurrent brief (<1min) attacks of vertigo
Quick onset
Attacks related to body position change eg looking up
Nausea and vomitting
No precipitating event
How long are vertigo attacks in BPPV?
<1 min
What position of the head triggers BPPV?
Looking up
What invetsigations are done for BPPV?
Hallpike’s manourvere
How is Hallpike’s manourvere done?
Sit patient up
Slowly rotate their head to 45 degrees on one side
Liw the patient down and hold head at 20 degree angle on bed
See if they have vertigo
How is BPPV managed?
Canalith repositioning manoevures
What is menieres disease?
Disorder of inner ear caused by change in fluid volume in the labyrinth causing tinnitus and vertigo
What is the difference between meniere disease v syndrome?
Disease= idiopathic Syndrome= secondary to condition
What causes menieres disease?
Allergy
Viral infection
Lyme disease
Hypothyrodism
How does menieres disease present?
Vertigo that lasta mins or hrs
NV
Tinnitus
May have hearing loss in affected ear
How do you differentiate menieres disease and BPPV?
Menieres= vertigo lasts mins/hrs BPPV= vertigo lasts <1min
What test can you do for menieres disease?
Fukudas stepping test
Rombergs test
What investigations are done for menieres and what will you see?
Audiometry- will reveal sensorineural hearing loss
How is menieres disease managed?
No cure- manage acute attacks
Vestibular supressants- benzodiazipines and antihistamines
Prophylactic- limit salt, caffeine and alcohol, exercise to improve management
Maintenance- thiazide diuretics to reduce endolymph volume
What is thyroglossal cyst?
Epithelial lines cyst between adams apple and chin
What age is likely to get thyrogloassal cyst?
5 years
How will thyroglossal cyst present?
Lump in midline of neck
Compressible
Cyst moves up on swallowing and sticking out tongue
How is thryoglossal cyst managed?
Surgical removal
What is a cataract?
Opacification of lens
How will cataract present?
Cloudy lens visible
Gradual loss in visual acuity over years
How does cataract arise?
Normal proteins that make up lens of the eye degrade overtime and become opaque
What are RF for cataract?
ageing smoking alcohol UV exposure diabetes trauma uveitis
How do you investigate catarct and what will you see?
Slit lamp reveals cataract as black against red light reflex
Reduced red reflex on fundoscopy
reduced visual acuity
How is cataract managed?
Control RF
Surgical management when affects lifestyle- phaecomulsification with intraocular lens implant
What is conjuctivits?
Inflammtion of the conjunctiva
Where is the conjunctiva?
Inner eyelid and covers sclera
Who is conjunctivits most common in?
Children
What are causes of conjunctivits? What is most common? Include organisms
Viral most common- EBV, herpes, adenovirus
Bacterial- staph aureus, strep pneu, heam infl
Allergy
Wearing contacts
Mechanical- floppy eyelid syndrome
How will conjunctivits present?
Eye redness
Discharge
Itchy eye
Crust formation- especially in morning
Describe discharge in viral v bacterial v allergic conjunctivitis
Viral= clear Bacterial= thick, purulent, yellow Allergic= clear
Describe eye involvement in viral v bacterial v allergic conjunctivitis
Viral= first unilat then becomes bilat Bacterial= unilat, no bilat progression
What is glaucoma?
Increased intraocular pressure which results in damage ro retina and optic nerve
How is conjunctivits managed?
Viral= gets better with time, can give antihistamine drops
What are the types of glaucomona?
Open angle
Closed angle
What is open angle glaucoma?
Iridocorneal angle is unaffected
Defect in trabecular meshwork
What are RF for open angle glaucoma?
Over 40
DM
FHx
African descent
How will open angle glaucoma present?
Bilateral progressive visual field loss
Visual loss of peripheral to central
What investigations are done for open angle glaucoma? What will you see
Clinical diagnosis
Tonometry- may get IOP >21 mmHg
Fundoscopy- increase in cupping of optic disc
What is closed angle glaucoma?
Narrowing of iridocorneal angle- aqeuous flow into trabecular meshwork is disrupted
What type of glaucoma is and emergency?
Closed angle
What are RF for closed angle glauxoma
Old
Mydriasis (drug induced by anticholinergics)
How does closed angle glaucoma present?
Sudden onset Red eye NV Unilateral pain Dilated pupil in one eye
What inevstigations are done for closed angle glaucoma? What will you see?
Tonometry- IOP >21 mmHg
Slit lamp- narrowing of iridocorneal angle
Gonioscopy
Fundoscopy- increased cupping of optic disc
How is open agle glaucoma managed?
Prostaglandin analogues to increase aqeous humor flow (latanoprost and travoprost)
Topic beta blockers- decreas production of aqueous production
If bad surgical= trabeculectomy
How is closed angle glaucoma managed?
Topical beta blockers- timolol to decrease aqeous humor production
Carbon anhydrase production to decrease aqeous humor profuction- acetazolamide
Immediate surgery- high intensity laser treatment
What is anterior uveitis?
Inflammation of the iris and ciliary body
What is the most common type of uveitis?
Anterior
What are causes of anterior uveitis?
Idiopathic
What conditions is anterior uveitis associated with? Give examples
Non infectious, systemic autoimmune disease- HLA B27 pos eg ankylosing spondylitis
What is posterior uveitis?
Inflammation of retina, choroid, retinal vasculature, optic nerve
What causes posterior uveitis?
Viruses
Syphillis
How does anterior uveitis present?
Pain dull and progressive eye redness photopobia decreased visual acuity lacrimation flares
How is anterior uveitis investigated?
Clinical diagnosis
Can do slit lamp exam
What is seen on examination in anterior uveitis?
Keratic precipitates- white fluid in inferior part of anterior chamber
Protein in aqueous humor
Red eye
Hypopyon
How will post uveitis present?
Painless
Decreased visual acuity
Lacrimation
Floaters or flashers
What do you see on examination in post uveitis?
Leukocytes in vit humor
What are complications of uveitis?
Cataract
Glaucma
Synechiae
How is uveitis managed?
Steroid drops systemic or oral steroids Treat underlying inflammation cycloplegic eye drops Simple analgesia ABX or antiviral for post uveitis
What is optic neuritis?
inflammation of the optic nerve
Who is most likely to get optic neuritis?
20-40 yo females
What causes optic neuritis?
Demyelination of optic nerve- ofetn due to MS, can be encephalitis, meningitis, sinusitis, or drugs
How will optic neuritis present/
Visual loss Hours to days Decreased visual acuity Eye pain worse on movement Reduced colour vision Usually unilateral, can be bilateral
How is optic neuritis investigated?
Gadolinium enhanced MRI of orbit and brain- enlarged optic nerve may be seen
How is optic neuritis managed?
High dose steroids
What are complications of optic neuritis?
Decreased long term visual acuity
What is scleritis?
Inflammation of sclera
Who is more likely ot get scleritis?
40-60 y/o
What causes sleritis?
Systemic disorder eg RA SLE IBD Ankylosing spondylitis
Is sclerits uni or bilat?
Bi
How does scleritis present?
Dull boring eye pain May disturb slep Pain worse on eye movmeent Pain radiates to face Red eye- violet or blue tinge Over several days Photophobia Lacrimtion
How can you differentiate scleritis and episcleritis?
Scleritis= painful Episcleritis= painless
Why do you get violet/ blue tinge in scleritis?
Thinning of sclera
How is optic neuritis managed?
urgent referral ro opthamologist
NSAIDs if mild/moderate
Treat cause
Systemic steroids if necrotising
What are complications of optic neuritis?
cataract
