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Finals > Ophthalmology and ENT > Flashcards

Ophthalmology and ENT Flashcards

1
Q

Acoustic neuroma

Presentation and the cranial nerves involved

A

V: Absent corneal reflex

VII: Facial nerve palsy - if tumour grows big enough to compress facial nerve

VIII:

  • Unilateral hearing loss
  • Unilateral tinnitus
  • Dizziness/imbalance
  • Fullness in the ear
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2
Q

Describe HiNTs test and implications

A

HI = Head Impulse

  • Peripheral = abnormal
  • Central = normal

N = Nystagmus

  • Peripheral = unidirectional or none (fast component is away from the affected side)
  • Central = vertical, bidirectional, gaze-evoked

TS = Test of Skew

  • Peripheral = no skew deviation
  • Central = skew deviation
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3
Q

Ototoxic drugs

A

Permanent:

  • Vancomycin, Gentamicin, Streptomycin
  • Cisplatin

Temporary:

  • Quinine
  • Macrolides (clari, eryth, azithro)
  • NSAIDs
  • Aspirin
  • Loop diuretics

All cause BILATERAL hearing loss and tinnitus

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4
Q

Otosclerosis

  • genetics
  • what is it
  • when do people get it
  • treatment
A
  • Autosomal dominant
  • New bone forms around stapes footplate –> fixation
  • Accelerated by PREGNANCY
  • Tx = hearing aid, surgery
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5
Q

Investigation for sudden sensorineural hearing loss

A
  • MRI scan to exclude schwannoma

- Audiology –> Loss of 30 decibels in 3 consecutive frequencies

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6
Q

BPPV

Management

A
  • Self-limiting usually
  • Epley maneuver
  • Betahistine
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7
Q

Acoustic neuroma

Management
Risk of Tx

A
  • Conservative: monitoring
  • Surgery: partial or total removal
  • Radiotherapy

Tx risks : vestibulocochlear nerve damage, facial nerve damage

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8
Q

Vestibular neuronitis

Management

A

Acute:

  • Prochlorperazine (PO) or antihistamine for milder symptoms
  • Prochlorperazine (buccal/IM) for severe
  • For up to 3 days - any longer may slow recovery

Chronic:

  • Refer if not improving after 1 week or does not resolve after 6 weeks
  • May need vestibular rehabilitation
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9
Q

Labyrinthitis

Management

A

Acute:

  • 3 days of Prochlorperazine or antihistamines
  • If bacterial –> Abx

Offer audiology after recovery
Generally only have long-lasting symptom if post-bacterial meningitis

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10
Q

Meniere’s Disease

Management

A
  • Inform the DVLA

Acute:

  • Prochorperazine (buccal/IM)
  • Antihistamines

Prophylaxis:
- Betahistine

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11
Q

Nasal polyps

Samters triad

A
  • Nasal polyps
  • Asthma
  • Aspirin sensitivity
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12
Q

Nasal polyps

Red flags

A
  • Unilateral

- Bleeding

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13
Q

Nasal polyps

Management

A
  • Refer to ENT to exclude malignancy
  • Topical corticosteroids - drops or spray
  • Surgery:
    • Intranasal polypectomy if visible and close to nostril
    • Endoscopic intranasal polypectomy if further in or sinuses
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14
Q

Mastoiditis

Management

A
  • IV Ceftriaxone OD + IV Metronidazole TDS
  • Consider topical therapy, e.g. Ciprofloxacin ear drops
  • Myringoplasty (repair of tympanic membrane - if ruptured)
  • Mastoidectomy (eradicated cause of chronic infection, removes mastoid air cells, retains posterior canal wall)
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15
Q

Otitis media

Management

A
  • Usually self-limiting

Immediate Abx IF:

  • Immunocompromised
  • Significant co-morbidities
  • Systemic features
  • Bilateral and < 2 yrs
  • < 3 months of age
  • Perforation +/- discharge
  • > 4 days of symptoms with no improvement

Abx = Amoxicillin
If penicillin allergy -> Clarithromycin
If Pregnant and allergy –> Erythromycin

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16
Q

Otitis media

Most common cause

A
  • Strep pneumonia
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17
Q

Tonsillitis

Management

A

If viral:
- Analgesia, safety net, consider delayed prescription

If Abx required:

  • 7-10 days of phenoxymethylpenicillin (penicillin V)
  • Clarithromycin if PA
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18
Q

Tonsillitis

FeverPAIN score

A 
Fever (> 38)
P: Purulent exudate
A: Attended within 3 days of onset
I: Inflamed tonsils (severely)
N: No cough/coryza
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19
Q

Tonsillitis

CENTOR criteria

A
  • Fever > 38
  • Exudative tonsils
  • TENDER cervical lymphadenopathy
  • No cough
20
Q

Quinsy

Management

A
  • Urgent ENT referral
  • Needle aspiration and drainage
  • IV Abx
  • Consider tonsillectomy if recurrence
21
Q

Otitis externa

Management

A

Mild:

  • Acetic acid (Ear Calm) = antifungal and antibacterial
  • Can be used prophylactically pre-swim

Mod:

  • Topical Abx and steroid
  • e.g. Otomize = Neomycin, dexamethasone and acetic acid
  • Alternatives: gentamicin and hydrocortisone, ciprofloxacin and dexamethasone, neomycin and betamethasone
  • Do NOT use in perforation tympanic membrane (higher risk of ototoxicity)

Severe:

  • Ear wick with aluminum acetate
  • Oral Abx: Flucloxacillin/clarithromycin

Fungal –> clotrimazole

22
Q

Malignant otitis externa

Pathophysiology

A
  • Extension of infection into bony ear canal and soft tissues deep in bony canal
23
Q

Malignant otitis externa

Risk factors

A
  • Diabetes
  • Immunosupressants
  • HIV
  • Old age
24
Q

Malignant otitis externa

Symptoms

A
  • Severe otitis externa pain
  • Headaches
  • Fever
25
Q

Malignant otitis externa

Key finding

A

Granulomatous tissue at the junction between bone and cartilage

26
Q

Malignant otitis externa

Management

A
  • Admission to hospital under ENT
  • IV Abx
  • In diabetes: CIPROFLOXACIN to cover pseudomonas
  • Imaging: CT/MRI
27
Q

Most likely location of anterior nosebleed?

A
  • Kiesselbach’s plexus in LITTLE’S AREA

little fingers picking noses

28
Q

Nosebleeds

Management
Haemodynamically stable

A
  1. Basic first aid, lean forward, mouth open, hold cartilaginous area for 10-20 mins. Spit out any blood
  2. Naseptin (chlorhexidine and neomycin) QDS for 10 days to reduce crusting, inflammation and infection
    (CI in peanut, soy or neomycin allergy)
29
Q

Nosebleeds

Management
When to admit to hospital

A
  • Not stopped after 10-15 mins
  • Bleeding from both nostrils
  • Haemodynamically unstable
  • Comorbidity (CAD, severe HTN)
  • Underlying cause is suspected
  • < 2 yrs old - leukaemia/haemophilia more likely
30
Q

Nosebleeds

Hospital management

A

CAUTERY - If the source of bleed is visible

  • Anaesthetic spray
  • Silver nitrate for 3-5 seconds
  • Only cauterize one sign
  • Dab clean and use naseption

PACKING - If the source of bleed is not visible

  • Or used if cautery is not viable
  • Topical anesthetic spray
  • Pack nose with head forward

If fail all above:
- Surgical sphenopalatine ligation

31
Q

Obstructive sleep apnoea

RFs

A
  • Macroglossia (acromegaly, hypothyroidism, anyloidosis)
  • Large tonsils
  • Marfan’s Syndrome
  • Middle age, male, obesity, smoking, alcohol
32
Q

Obstructive sleep apnoea

Investigations

A
  • Epworth sleepiness scale
  • Multiple sleep latency test - time to fall asleep in dark room
  • Sleep studies - polysomnography
33
Q

Infectious mononucleosis

Investigation

A
  • Heterophile antibody test (monospot test)
    • FBC
  • Do in 2nd week of illness
  • 100% specific but 70-80% sensitive as not everyone with IM produces these antibodies and can take up to 6 weeks to build up
34
Q

Infectious mononucleosis

Management

A
  • Usually self-limiting
  • No contact sports for 8 weeks - risk of splenic rupture
  • No drinking alcohol (EBV affects livers ability to process)
35
Q

Differentiating tonsillitis and infectious mononucleosis?

A
  • Tonsillitis: anterior lymphadenopathy

- IM: anterior AND posterior lymphadenopathy

36
Q

Infectious mononucleosis

Reaction to be aware of

A
  • Itchy maculopapular rash in response to Amoxicillin or Cephalosporin or Ampicillin
37
Q

Rhinosinusitis

Management

A

Acute (< 12 weeks):

  • If not improving after 10 days offer MOMETASONE (high dose steroid nasal spray)
  • Delayed Abx if worsening/not improving within 7 days

Chronic (> 12 weeks):

  • Saline nasal irrigation
  • Avoid allergen
  • Functional endoscopic sinus surgery
  • Steroid nasal sprays - mometasone or fluticasone
38
Q

Rhinosinusitis

Red flags

A
  • Unilateral
  • Persistent symptoms despite compliance with 3 months of Tx
  • Epistaxis

Refer to ENT

39
Q

What should you do when referring someone for hoarseness?

A
  • Arrange a CXR to rule out apical lung lesion
40
Q

Adie pupil

A

Tonically dilated pupil, slowly reactive to light with more definite accommodation response. Caused by damage to parasympathetic innervation of the eye due to viral or bacterial infection. Commonly seen in females, accompanied by absent knee or ankle jerks.

41
Q

Marcus-Gunn pupil

A

Relative afferent pupillary defect, seen during the swinging light examination of pupil response. The pupils constrict less and therefore appear to dilate when a light is swung from unaffected to affected eye. Most commonly caused by damage to the optic nerve or severe retinal disease.

42
Q

Horner’s Syndrome (pupil)

A

Miosis (pupillary constriction), ptosis (droopy eyelid), apparent enophthalmos (inset eyeball), with or without anhidrosis (decreased sweating) occurring on one side. Caused by damage to the sympathetic trunk on the same side as the symptoms, due to trauma, compression, infection, ischaemia or many others.

43
Q

Hutchinson’s sign

A

Unilaterally dilated pupil which is unresponsive to light. A result of compression of the occulomotor nerve of the same side, by an intracranial mass (e.g. tumour, haematoma)

44
Q

Argyll-Robertson pupil

A

Bilaterally small pupils that accommodate but don’t react to bright light. Causes include neurosyphilis and diabetes mellitus

45
Q

Gingival hyperplasia

Causes

A
  • Phenytoin
  • Ciclosporin
  • CCBs - esp nifedipine
  • AML

Finals (21 decks)

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