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MD2 lectures > Ophthalmology and ENT > Flashcards

Ophthalmology and ENT Flashcards

1
Q

What is a Marcus Gunn pupil?

A

RAPD

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2
Q

What is an Agyll Robertson pupil?

A

Pupil constricts on accommodation but not to light

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3
Q

What is a Holmes Adie pupil?

A

Tonically dilate pupil that does not react to light (associated with PSNS damage)

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4
Q

What is normal IOP?

A

6-21mmHg

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5
Q

A positive finding in an Amsler grid (metamorphopsia) indicates what kind of disease?

A

Macular pathology

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6
Q

Abnormal EOM may indicate what disease?

A
  • CN palsy (III, IV, VI) - Muscle entrapment - Muscle infiltrate (thyroid eye disease) - Muscle weakness - Gaze centre dysfunction (horizontal gaze palsy, INO)
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7
Q

What are causes of leukocoria (absent red reflex)?

A
  • Cataract - Retinoblastoma - Coats disease - Retinal detachment - Retinopathy of prematurity
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8
Q

What is myopia and hypermetropia?

A
  • Myopia: short-sighted - Hypermetropia: long-sighted
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9
Q

What are the causes of cataracts?

A
  • Age-related - Drugs (steroids) - Trauma - DM - Myotonic dystrophy - Wilson’s disease - Uveitis, retinitis pigmentosa
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10
Q

What are the symptoms of cataracts?

A
  • Gradual decrease in visual acuity - Increase in glare symptoms - Occurs over weeks to years
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11
Q

What are the 3 clinical features of primary open angle glaucoma?

A
  • Progressive visual field loss (annular scotoma) - Progressive increase in cup-to-disc ratio of optic disease - Elevated IOP
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12
Q

What are the management optics for open angle glaucoma?

A
  • Eye drops to reduced aqueous production or increase aqueous outflow - Tablets to decrease aqueous production - Selective laser trabeculoplasty - Trabeculectomy
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13
Q

What occurs in proliferative diabetic retinopathy?

A
  • Neovascularisation - Vitreous haemorrhage
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14
Q

What causes diabetic maculopathy?

A
  • Macular oedema - Macular ischaemia
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15
Q

How do you manage diabetic maculopathy?

A
  • Intra-vitral anti-VEGF (for oedema) - BGL, BP and cholestrol control (for ischaemia)
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16
Q

What features are seen in dry age-related MD?

A
  • Increasing age, smoker - Geographic atrophy, drusen
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17
Q

What is the management of dry age-related MD?

A
  • Smoking cessation - Low vision aids
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18
Q

What feature is seen in wet age-related MD?

A

Choroidal neovascularisation

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19
Q

What is the management of wet age-related MD?

A
  • Anti-VEGF agents - Photodynamic therapy - Macular laser
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20
Q

What is rhinitis medicamentosa?

A

Inflammation of the nasal mucosa secondary to prolonged alpha-agonist topical medications Associated with clear rhinorrhoea and marked nasal congestion

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21
Q

What are the features of anterior epistaxis?

A
  • Through the nares - Controlled by direct pressure
22
Q

What are the features of posterior epistaxis?

A
  • Felt dripping down back of nose - May need nasal packing for control
23
Q

What raises your suspicion of a base of skull fracture?

A
  • CSF rhinorrhoea/otorrhoea - Raccoon eyes - Battle’s sign (mastoid bruising) - Haemotympanum - Subconjunctival haemorrhage with no posterior margin
24
Q

Examination of the nares reveals the following, what is going on?

A

Septal haematoma

25
Q

Patient has a 2 year history of clear rhinorrhoea, sneezing and bilateral nasal congestion. Worse in dusty environments

A

Allergic rhinitis

26
Q

What is this nasal pathology?

A

Nasal polyp

27
Q

A patient presents with 1 week of purulent rhinorrhoea, persistent nasal obstruction and a 2 day history of bilateral cheek and inter-orbital pain

A

Acute rhinosinusitis

28
Q

57yo smoker presents with a 3 year history of post-nasal drip, facial pressure, nasal congestion and 3 weeks of purulent rhinorrhoea

A

Chronic rhinosinusitis

29
Q

What’s FESS?

A

Functional endoscopic sinus surgery?

30
Q

What kind of hearing loss is shown?

A

Sensorineural hearing loss (air and bone conduction are similar)

31
Q

What kind of hearing loss is shown?

A

Conductive hearing loss: top = bone conduction, bottom = air conduction

32
Q

14yo presents with a painful, blocked left ear and an itchy right ear. She swims in a river every day

A

Otitis externa

33
Q

What is the management of otitis externa?

A
  • Analgesia
  • Ear toilet/cleaning
  • Topical Abx
34
Q

18mo has thick, purulent discharge from his ear; he is happy and rubs at his ear. He has had a cold

A

Acute otitis media with perforation

35
Q

What organisms cause otitis media?

A
  • Strep. pneumoniae
  • H. influenzae
  • Morazella catarrhalis
36
Q

Who should be treated with Abx in otitis media?

A
  • Child
  • TM perforation
  • Indigenous
  • Known immunodeficiency
  • Cochlear implant
  • Only hearing ear infected
  • Has a complication, eg/ mastoiditis, facial paralysis, cerebral infection or venous thrombosis
37
Q

What antibiotics are used to treat otitis media?

A
  • Amoxycillin for 5 days
  • Cerufoxime if allergy to penicillin
  • Amoxycllin + clavulanate if recurrent or no improvement after 48hrs
38
Q

A 23mo presents with his mother who is concerned because he is not speaking. He occasionally rubs at his ear

A

Chronic otitis media with effusion (glue ear)

39
Q

Which children should have middle era ventilation tubes?

A
  • 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
40
Q

64yo presents with intermittent unilateral discharge with a foul odour. Poor hearing on this side and some imbalance

A

Chronic suppurative otitis media with cholesteatoma

41
Q

What are the features of chronic suppurative otitis media?

A
  • Recurrent or persistent bacterial infection of the ear
  • Destruction of the TM ± ossicles
  • Irreversible
  • No pain, usually have itchiness and discharge
  • Conductive hearing loss
42
Q

What are the complications of cholesteatoma?

A
  • Conductive hearing loss
  • Sensorineural hearing loss
  • Vertigo
  • Facial paralysis
  • Intracranial complications
43
Q

If there is conductive hearing loss, where will the sound localise on Weber’s?

A

In the worse hearing ear

44
Q

If there is sensorineural hearing loss, in Weber’s where will the sound localise?

A

In the better ear

45
Q

What is a positive Rinne’s?

A

Air conduction better than bone conduction

46
Q

What is a Rinne’s negative?

A

Bone conduction better than air conduction = conductive hearing loss

47
Q

What are some causes of otorrhoea?

A
  • Wax
  • Otitis externa
  • Foreign body in the ear canal
  • Acute otitis media with perforation
  • Chronic suppurative otitis media ± cholesteatoma
48
Q

44yo presents with right ear pain for 2 days, he also has a facial nerve palsy and vesicles in his concha

A

Herpes zoster oticus (Ramsay Hunt syndrome)

49
Q

What are the features of vestibular neuritis?

A
  • Abrupt onset vertigo
  • No hearing loss or tinnitus
50
Q

What are the features of Meniere’s disease?

A

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
51
Q

What is the management of Meniere’s disease?

A
  • Vestibular suppressants (prochlorperazine, diazepam)
  • Lifestyle: reversible stresses
  • Low salt diet
  • Medications if persistent: thiazides, betahistine
52
Q

What is the definition of sudden SNHL?

A
  • Occurs within 3 days
  • In at least 3 frequencies
  • Is at least 30dB

MD2 lectures (13 decks)

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