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Neuro (ENT, Derm, Opthal) Flashcards

1
Q

Otitis Ext Sx

A

Painful, Itchy, Inflamm,
Discharging Ear
(esp in swimmers/adults)

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2
Q

Otitis Ext Mx

A

Micro-suction pus/debris,
(If Bact: Top Gentamicin)
(If Fungal: Top Anti-fungal)

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3
Q

Acute Otitis Med Sx + Ex

A

Dull Pain (w/ ear pulling),
Discharge (once pain stops),
Fever,
(Preceeding Viral Inf)

Otoscope:
Bulging, non-mobile tympanic membrane with yellow/red discolouration

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4
Q

Acute Otitis Med Mx, Admission criteria + Surg

A

Analgesia, Delay Abx
(If confirmed/Otorrhoea or < 2yo w/ Bilat Inf: Amox)

Admit if:
< 3mo w/ fever > 38,
< 6mo w/ fever > 39

(If recurrent/ET dysfunction: Grommet Surg),
(If TM Perf: Myringoplasty)

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5
Q

Glue Ear Patho + Sx

A

(Otitis Media w/ Effusion):
Dysfunctional ET following OM causes build-up of Fluid w/in Middle Ear

(CN) Hearing loss,
Ear Pain w/ fullness,
Discharge,
Recurrent ENT Inf

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6
Q

Glue Ear Ix + Mx

A

Otoscopy (Normal Ex does not Excl)

Mx:
Act Observation for 6-12wks
Assess hearing w/ Pure Tone Audiometry x2 before Refer
Surg (Grommets, Hearing Aid)

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7
Q

Otosclerosis Features

A

Early, progressive (CN) hearing loss w/
(+) FHx,
Tinnitus

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8
Q

Otosclerosis Mx

A

Hearing aids,

Stapedectomy

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9
Q

TM Perforation Sx + Mx

A

Pain​
Conductive hearing loss​

Mx:
Watch and wait (w/ water caution)​
(If > 6 months: Myringoplasty)​

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10
Q

BPPV Patho + Sx

A

Otoliths within semicircular canals​
​
Transient (secs/mins), Positional (occurs with head movements)​ Vertigo
(no tinnitus/hearing loss)​

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11
Q

BPPV Diagnosis + Mx

A

Diagnosis:
Dix-Hallpike Test​

Mx:
Epley and Brandt-Daroff Manouvres​

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12
Q

Menieres D Patho + Sx

A

Excess Fluid w/in Inner Ear​

Sx:​
Episodic vertigo (mins - hours) w/ N+V​
Tinnitus, 
Aural fullness​
Fluctuating SN hearing loss (progress -> permanent)​
(Gen Imbalance)​
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13
Q

Menieres D Mx​:
Diet
Med - 3
Surg - 5

A

Diet (Reduce salt, chocolate, alcohol, caffeine)​

Med: ​
Thiazide diuretics,
Betahistine​
Prochlorperazine (vestibular sedative)​

Surgery: ​
Grommets​
Dexamethasone middle ear injection​
Endolymphatic sac decompression​
Gentamicin injection (causes vestibular destruction)​
Surg Labryninthectomy ​
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14
Q

Vestibular Neuritis Patho + Sx

A

Inflamm of Vestibular Nerve​

Sx:​
Severe Vertigo (days) w/ N+V​
Horizontal nystagmus​​

​(If Hearing affected, Tinnitus: Labyrinthitis)

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15
Q

Vestibular neuritis Mx​

A

Vestibular Sedatives (Prochlorperazine)​

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16
Q

Sudden-onset hearing loss Ix

A

Tuning fork (Weber + Rinnes)
Pure Tone Audiogram​
Tympanogram​
MRI (excl. Acoustic neuroma)​

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17
Q

Acute Rhinosinusitis Org + Length/Timing

A

Viral (RhinoV, InfluenzaV): Sx resolve w/in 5 days

Bact (S.Pneum, H.Influenzae): Sx persist > 5 days

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18
Q

Acute Rhinosinusitis Mx

A

Analgesia, Nasal decongestants​
If > 10 days:
- Top/Nasal Steroid
- Delayed PO Abx (wait 1wk for Sx to resolve: Phenoxymethylpenicillin 5 days)

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19
Q

Chronic Rhinosinusitis Def + Ix

A

Def: > 12wks​

Skin prick (Allergy) test​
(If Unilat: Biopsy)​
(If Atypical features/Surg planned: CT sinuses)​

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20
Q

Chronic Rhinosinusitis Mx:
Conservative
Med
Surg

A 
Conservative​:
Allergy avoidance, 
Nasal douching (IN saline sol)​

Med:​
Antihistamines​
Top nasal steroids, PO steroids (1wk)​
PO Abx​
ImmunoTx (for Severe Allergies)​

Surg:​
Nasal Polypectomy​
Funct Endoscopic Sinus Surg​

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21
Q

Allergic Rhinosinusitis Classification:
Duration
Severity

A

Duration:​
Intermittent: Sx < 4 days a week, < 4 wks​
Persistant: Sx > 4 days a week, > 4 wks​

Severity:​
Mild: No Impairment of Daily Activities​
M2S: Troublesome Sx​

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22
Q

H+N Lumps Red Flags - 5

A 
Hard, Fixed, Irreg Lumps 
Associated Otalgia, Dysphagia, Stridor or Hoarse voice 
Epistaxis, Unilat nasal congestion 
Cranial N palsies 
B Sx
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23
Q

H+N Lumps Ix

A

USS +/- FNA

CT/MRI

(If Lymphoma suspected: Core biopsy, Open LN biopsy)

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24
Q

BCC Features

A 
Skin coloured (Clear/Pink), rolled borders​
Surface Telangiectasia (+/- ulcer in centre)​
Slowly evolves (non-healing scab)
(Found on H+N​)
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25
Q

BCC Mx

A

Surgical excision​

Radiotherapy (when surgery not appropriate)​

Micrographic surgery (progressive excision until specimen free) – for High risk, recurrent tumours

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26
Q

SCC Features

A

In situ: Erythematous + Scaly,
Invasive: Exophytic Ulcer (w/ Ill-defined border)
Grows quickly + Easily Friable

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27
Q

SCC Mx

A

Surgical excision,
Micrographic surgery​
Radiotherapy (large, nonresectable tumours)​
Chemotherapy (metastatic disease)​

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28
Q

Melanoma Features

A 
Asymmetrical​
Irregular border​
Deeply pigmented (Brown)​
> 6mm​
Evolving (+ Metastasises)​
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29
Q

Melanoma Mx

A

Surgical excision​

Immunotherapy/chemotherapy (metastatic disease)​

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30
Q

Eczema Sx

A

Itchy, erythematous, dry, scaly patches​
w/ Lichenification

Infants (Face and Limb extensors), Adults (Limb Flexures)​

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31
Q

Eczema Ix

A

Allergy (patch) testing​

Serum IgE​

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32
Q

Eczema Mx

A

Avoid triggers (pets, soaps, infections)​
Emollients​
Acute flareups: Top Steroids
Severe Pruritus: Antihistamines (Piriton)​

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33
Q

Psoriasis Sx

A

Itchy/Painful, Erythematous, Scaly, Well-defined patches/plaques (Adults: Ext)

Koebner Phenomen (new skin lesions at sites of skin injury)
Auspitz sign (Excoriation => Bleeding)

(Nail changes: pitting, onchyolysis)​

34
Q

Psoriasis Mx

A

Emollients (Reduce scales)​

Vitamin D analogues​

Topical steroids​ (8wks max)

35
Q

Acne Mx

A

Mild: Top Abx/Retinoid + BPO ​
Mod: Oral antibiotics​ (Tetracyclines)
Severe: Oral retinoids (Isotretinoin)​
(PCOS: antiandrogens – COCP/Spironolactone)

(Epiduo: Top Adapalene + BPO, Duac: Top Clindamycin + BPO)

36
Q

Steroid SE:
Local - 5
Systemic - 6

A 
Local:​
Skin thinning, 
striae, 
telangiectasia, 
acne, 
allergic contact dermatitis​
​

Systemic:​
Cushing’s, 
immunosuppression, 
hypertension, 
diabetes, 
osteoporosis, 
cataracts​
37
Q

Retinoids SE

A

Dry lips/skin/eyes​
Myalgia, arthralgia​
Hypercholesteraemia, hypertriglyceridaemia​
Teratogenic (require contraception before prescribing)​
Suicidal Ideation

38
Q

Pupil Reflexes:
Afferent
Efferent

A

Afferent:​
CN-II -> Pre-tectal Nucleus​
Pre-tectal N -> EWN (Bilat)​

Efferent:​
EWN -> CN-III ->
Ciliary Ganglion​ - >
Sphincter Pupillae (+ Ciliary muscles)

39
Q

Pupil Defects:
Complete
Partial

A

Complete Optic N:​
Light shone in eye -> No direct/consensual response​
Light shone in other eye -> Consensual response​

​

Partial Optic N: (RAPD)​
Slowed direct response, normal consensual response​
Swinging light test: Constriction (Light shone contralaterally), Dilation (Light shone ipsilaterally)​

40
Q

Blepharitis Patho, Sx + Mx

A

Inf eyelids (Inflamm w/ yellow crust)

Mx:
Lid hygiene, Abx

41
Q

Chalazion vs Stye

A

Chalazion: (Blocked Meibomian glands):
Painless, Above lash line

Stye: (Inf Meibomian glands):
Painful, Edge of lash line

42
Q

Ant Uveitis Sx

A 
(Iris + ciliary body): 
Red, painful eye (w/ irreg pupil), 
Reduced VA, 
Floaters, 
Photophobia
43
Q

Ant Uveitis Mx

A

Mx:
Steroid drops (Reduce Inflamm),
Cyclopentolate (Anti-musc) drops
(Prevent adhesions + reduce pain: Cycloplegia/Ciliary paralysis)

44
Q

Inf Keratitis Sx

A 
(Cornea): 
Red, painful eye 
w/ hypopyon (Pus w/in Ant chamber), 
Reduced VA (Corneal oedema), 
Photophobia, 
(HSV keratitis: Dendrite pattern w/ Fluoroscein)
45
Q

Inf Keratitis Mx

A

Mx:
Remove contacts, Steroid drops
IV Abx/Antivirals/Antifungals,
(Avoid steroid drops w/ HSV keratitis)

46
Q

Scleritis Sx, Associations + Mx

A

Red, tender, painful eye
(Pain => Headache => Waking at night)

(Associated w/ RA, GCA/Vasculitis, Ank Spondylo, SLE, IBD)

Mx:
Urgent referral

47
Q

Subconjunctival Haem Sx

A

Unilateral, localised, discrete bleed​
No inflammation, pain, discharge​
Normal vision​

(Pt may be on anticoags/antiplatelets)​

48
Q

Subconjunctival Haem Mx

A

Reassure​

Check BP, clotting/INR​

49
Q

Hyphema Def + Sx

A

Bleed within anterior chamber (following trauma)​ =>

Red eye​ (w/ Meniscus)
Severely reduced vision​
Stained cornea (with increased IOP)​

50
Q

Hyphema Mx

A

Urgent referral​

Bedrest and eyepatch​

51
Q

Amarosis Fugax Sx, Ix + Mx

A

Temp monocular vision loss (returns to normal w/in hrs) +/- Focal Neuro Def

Carotid Doppler
Normal Fundoscopy

Mx:
Aspirin 300mg + Referral

52
Q

CRVO Sx + Ex

A

Sudden painless vision loss w/ RAPD

Blood + Thunder:
Dil torturous V, Cotton-wool spots, Swollen Optic disc, Retinal Oedema + Haem

53
Q

CRAO Sx + Ex

A

Sudden painless vision loss w/ RAPD

Cherry-Red
Pale retina w/ red spot on fovea

54
Q

Optic Neuritis Patho + Sx + Ex

A

(CN-II Inflamm):

Sudden vision loss w/ RAPD (+/- Blur/Haze/Central Scotoma, Desaturated colours)
Orbital pain (esp w/ eye movements)

O/E:
Swollen optic disc
(If normal: Retrobulbar neuritis)

55
Q

Optic Neuritis Mx

A

IV steroids + Urgent referral

56
Q

Ischaemic Optic Neuropathy Sx + Ex

A

Temp painless vision loss w/ RAPD,
(GCA Sx + B Sx)

O/E:
Swollen, pale optic disc

57
Q

Ischaemic Optic Neuropathy Ix + Mx

A

Fundoscopy
CRP/ESR
Temporal artery biopsy (GCA)​

IV Methylpred 1g

58
Q

ARMD Patho:
Dry
Wet

A

Dry AMD: ​
Gradual Accumulation of waste products/fatty deposits (Drusen) bilaterally​

Wet AMD: ​
Sudden Choroidal neovascularisation (w/ macular oedema and haemorrhage)
(+/- Retinal detachment)​

59
Q

ARMD Features

A 
Painless (central) vision loss​ (Normal peripheral and colour vision)​
​
Dry: ​
Progressive (years), 
Bilateral, 
(+/- progress to Wet AMD)​

Wet: ​
Rapid,
Unilateral,
(Visual distortion: Scotomas, Metamorphopsia)​

60
Q

Retinal Detachment Patho + Sx

A

Separation of Sensitive Retina layer from RPE​

Painless loss of vision​
Recent history of floaters/flashes/shadows​

61
Q

Fundoscopic changes in HT
Mild - 2
Mod - 4
Severe - 1

A

Mild: ​
Gen/focal arteriolar narrowing ​
AV nicking​

​
Moderate: ​
Retinal haemorrhage​
Micro-aneurysms​
Cotton wool spots​
Hard exudates​

​
Severe: ​
Optic disc swelling​

62
Q 
Fundoscopic changes in DM
Background - 2
Pre-proliferative - 2
Proliferative - 1
(Diabetic Maculopathy)
A

Background: ​
Microaneurysms,
Retinal haemorrhages​

Preproliferative: ​
Cotton wool spots,
Exudates​

Proliferative: ​
Retinal neovascularisation​

(Diabetic maculopathy: Macular oedema)​

63
Q

Diabetic Retinopathy Mx

A

Pan-retinal photocoagulation (PRP): Reduce VEGF​

64
Q

Aqueous Humour Prod Control

A

A2-Adren-R:
Decrease production of Aqueous Humour ​

B2-Adren-R:
Increase production of Aqueous Humour​

65
Q

Drugs affecting IOP

A

Alpha-Agonists, Beta-Blockers
(Decrease Production of Aqueous Humour)​

Carbonic Anhydrase Inhibitors (Acetazolamide)
(Decrease Production of Aqueous Humour)​

Prostaglandins (Latanoprost)
(Increase Outflow of Aqueous Humour)​

Parasympathomimetic (Pilocarpine)
(Increase Outflow of Aqueous Humour)​

​

66
Q

Glaucoma Features :
Open-angle, Chronic Closed
Acute Closed

A

Open-angle/Chronic Closed:
Initially asymptomatic
Bilat, progress visual field loss
(Periph -> centre)

Acute Closed:
Unilat, painful, Inflamm eye (w/ Irreg, semi-dilated + unresponsive pupil)
Blurry vision, Haloes,
(Frontal headache, N+V, Photophobia)

67
Q

Glaucoma Ix

A

Tonometry (Raised IOP)

Fundoscopy (Cupping, Optic disc pallor/Haem)

Gonioscopy (Reduced Iridocorneal angle)

68
Q

Open angle glaucoma Mx ​

A

Top Prostaglandins (Latanoprost)​

Surg (Improve drainage):​
Laser trabeculoplasty
Surg Trabeculectomy

69
Q

Chronic Closed angle glaucoma Mx

A

Laser (Periph) Iridotomy​
Surg Trabeculectomy​

(Top Lantanoprost/PG’s: Maintenance)​

70
Q

Acute Closed angle Mx:
Supp
Med
Surg

A

Supportive:​
Urgent referral, Analgesia and anti-emetic​

Med:​
Parasympathomimetic (Pilocarpine)​
A2-Adren-R Agonist (Apraclonidine)​
Beta-blocker (Timolol)​
Carbonic anhydrase inhibitor (Acetazolamide)​
Diuretic (IV Mannitol – esp if N+V)​

Surg:​
Ant chamber Paracentesis​
Laser (Periph) Iridotomy​

71
Q

Retinoblastoma Sx

A 
Lack of red reflex (Abnormal white reflection), 
Change in colour of Iris​
Red, inflamed (painless) Eye
Squint/Poor vision,
Diff controlling EOM
72
Q

Retinoblastoma Ix + Mx

A

Fundoscopy​, USS

Mx:
Urgent referral,
Small: Laser Photocoag/ThermaTx, CryoTx
Large: Radio/ChemoTx + Removal of Eye

73
Q 
Def:
Myopia
Hyperopia
Astigmatism
Anisometropia
A

Myopia: (Short-sightedness):
Long eye, Wide Lens (Cataracts)
=> (-) Biconcave Lens (Divergence)

Hyperopia: (Long-sightedness):
Short eye, Lack of Lens (Aphakia)
=> (+) Biconvex Lens (Convergence)

Astigmatism (Assymetrical Eyeball):
Mx: Cyclindrical Lens

Anisometropia (Different refractive powers btw 2 eyes)

74
Q

Allergic Conjunctivitis Sx

A

Itchy, painful, red eye​s (Bilat) w/ watery discharge
Swollen conjunctiva​
History of Atopy (pruritus, eczema, asthma)

75
Q

Allergic Conjunctivitis Mx

A

Remove allergen​
Topical antihistamines, cool compresses​
(If no change in 3 days: refer)​

76
Q

Bact Conjunctivitis Sx

A

Bilateral, red, painful eye with purulent discharge​

Systemically well

77
Q

Bact Conjunctivitis Mx

A 
Topical antibiotics (5 days)​ w/ Regular eye hygiene
(If vision affected or worsens: refer)
78
Q

Viral Conjunctivitis Sx

A

(Recent Eye/URTI infection)​
Burning sensation and watery discharge (Increased lacrimation)​
Swollen conjunctiva​
Preauricular lymphadenopathy

79
Q

Viral Conjunctivitis Mx

A

(Self resolving – weeks)​
Cool compresses, Lubrication fluid, Top ABx drops​ (Secondary Bact Inf)
(If reduced VA, photophobia, > 3wks: refer)​

80
Q

Sarcoidosis Features

A

Purple rash/lesions on face

(Tender) Bilat Lymphadenopathy

81
Q

Acne Rosaecea Feature indicating Severe + Mx

A

(If Plaques: Severe)

M2M: Top Metronidazole
Severe/Resistant: PO Tetracyclines

Medicine (13 decks)

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