Ophthalmology and ENT Flashcards
What is a Marcus Gunn pupil?
RAPD
What is an Agyll Robertson pupil?
Pupil constricts on accommodation but not to light
What is a Holmes Adie pupil?
Tonically dilate pupil that does not react to light (associated with PSNS damage)
What is normal IOP?
6-21mmHg
A positive finding in an Amsler grid (metamorphopsia) indicates what kind of disease?
Macular pathology
Abnormal EOM may indicate what disease?
- CN palsy (III, IV, VI) - Muscle entrapment - Muscle infiltrate (thyroid eye disease) - Muscle weakness - Gaze centre dysfunction (horizontal gaze palsy, INO)
What are causes of leukocoria (absent red reflex)?
- Cataract - Retinoblastoma - Coats disease - Retinal detachment - Retinopathy of prematurity
What is myopia and hypermetropia?
- Myopia: short-sighted - Hypermetropia: long-sighted
What are the causes of cataracts?
- Age-related - Drugs (steroids) - Trauma - DM - Myotonic dystrophy - Wilson’s disease - Uveitis, retinitis pigmentosa
What are the symptoms of cataracts?
- Gradual decrease in visual acuity - Increase in glare symptoms - Occurs over weeks to years
What are the 3 clinical features of primary open angle glaucoma?
- Progressive visual field loss (annular scotoma) - Progressive increase in cup-to-disc ratio of optic disease - Elevated IOP
What are the management optics for open angle glaucoma?
- Eye drops to reduced aqueous production or increase aqueous outflow - Tablets to decrease aqueous production - Selective laser trabeculoplasty - Trabeculectomy
What occurs in proliferative diabetic retinopathy?
- Neovascularisation - Vitreous haemorrhage
What causes diabetic maculopathy?
- Macular oedema - Macular ischaemia
How do you manage diabetic maculopathy?
- Intra-vitral anti-VEGF (for oedema) - BGL, BP and cholestrol control (for ischaemia)
What features are seen in dry age-related MD?
- Increasing age, smoker - Geographic atrophy, drusen
What is the management of dry age-related MD?
- Smoking cessation - Low vision aids
What feature is seen in wet age-related MD?
Choroidal neovascularisation
What is the management of wet age-related MD?
- Anti-VEGF agents - Photodynamic therapy - Macular laser
What is rhinitis medicamentosa?
Inflammation of the nasal mucosa secondary to prolonged alpha-agonist topical medications Associated with clear rhinorrhoea and marked nasal congestion
What are the features of anterior epistaxis?
- Through the nares - Controlled by direct pressure
What are the features of posterior epistaxis?
- Felt dripping down back of nose - May need nasal packing for control
What raises your suspicion of a base of skull fracture?
- CSF rhinorrhoea/otorrhoea - Raccoon eyes - Battle’s sign (mastoid bruising) - Haemotympanum - Subconjunctival haemorrhage with no posterior margin
Examination of the nares reveals the following, what is going on?
Septal haematoma
Patient has a 2 year history of clear rhinorrhoea, sneezing and bilateral nasal congestion. Worse in dusty environments
Allergic rhinitis
What is this nasal pathology?
Nasal polyp
A patient presents with 1 week of purulent rhinorrhoea, persistent nasal obstruction and a 2 day history of bilateral cheek and inter-orbital pain
Acute rhinosinusitis
57yo smoker presents with a 3 year history of post-nasal drip, facial pressure, nasal congestion and 3 weeks of purulent rhinorrhoea
Chronic rhinosinusitis
What’s FESS?
Functional endoscopic sinus surgery?
What kind of hearing loss is shown?
Sensorineural hearing loss (air and bone conduction are similar)
What kind of hearing loss is shown?
Conductive hearing loss: top = bone conduction, bottom = air conduction
14yo presents with a painful, blocked left ear and an itchy right ear. She swims in a river every day
Otitis externa
What is the management of otitis externa?
- Analgesia
- Ear toilet/cleaning
- Topical Abx
18mo has thick, purulent discharge from his ear; he is happy and rubs at his ear. He has had a cold
Acute otitis media with perforation
What organisms cause otitis media?
- Strep. pneumoniae
- H. influenzae
- Morazella catarrhalis
Who should be treated with Abx in otitis media?
- Child
- TM perforation
- Indigenous
- Known immunodeficiency
- Cochlear implant
- Only hearing ear infected
- Has a complication, eg/ mastoiditis, facial paralysis, cerebral infection or venous thrombosis
What antibiotics are used to treat otitis media?
- Amoxycillin for 5 days
- Cerufoxime if allergy to penicillin
- Amoxycllin + clavulanate if recurrent or no improvement after 48hrs
A 23mo presents with his mother who is concerned because he is not speaking. He occasionally rubs at his ear
Chronic otitis media with effusion (glue ear)
Which children should have middle era ventilation tubes?
- OME for 4 months at least with hearing loss
- Recurrent or persistent OME in an “at risk” child, eg/ cleft palate, visual impairment, developmental delay, autism spectrum
- OME and TM structural damage
64yo presents with intermittent unilateral discharge with a foul odour. Poor hearing on this side and some imbalance
Chronic suppurative otitis media with cholesteatoma
What are the features of chronic suppurative otitis media?
- Recurrent or persistent bacterial infection of the ear
- Destruction of the TM ± ossicles
- Irreversible
- No pain, usually have itchiness and discharge
- Conductive hearing loss
What are the complications of cholesteatoma?
- Conductive hearing loss
- Sensorineural hearing loss
- Vertigo
- Facial paralysis
- Intracranial complications
If there is conductive hearing loss, where will the sound localise on Weber’s?
In the worse hearing ear
If there is sensorineural hearing loss, in Weber’s where will the sound localise?
In the better ear
What is a positive Rinne’s?
Air conduction better than bone conduction
What is a Rinne’s negative?
Bone conduction better than air conduction = conductive hearing loss
What are some causes of otorrhoea?
- Wax
- Otitis externa
- Foreign body in the ear canal
- Acute otitis media with perforation
- Chronic suppurative otitis media ± cholesteatoma
44yo presents with right ear pain for 2 days, he also has a facial nerve palsy and vesicles in his concha
Herpes zoster oticus (Ramsay Hunt syndrome)
What are the features of vestibular neuritis?
- Abrupt onset vertigo
- No hearing loss or tinnitus
What are the features of Meniere’s disease?
At least 3 of:
- Vertigo: for at least half an hour, but less than a day
- Fullness in the ear
- Roaring tinnitus
- Initially low frequency SNHL that fluctuates but becomes worse and permanent
What is the management of Meniere’s disease?
- Vestibular suppressants (prochlorperazine, diazepam)
- Lifestyle: reversible stresses
- Low salt diet
- Medications if persistent: thiazides, betahistine
What is the definition of sudden SNHL?
- Occurs within 3 days
- In at least 3 frequencies
- Is at least 30dB
