Ophthalmology/ ENT Flashcards
What is conjunctivitis
inflammation of the conjunctiva which is a thin layer of tissue that covers the inside of the eyelids and the sclera
What are the features of bacterial conjunctivitis
- purulent discharge
- worse in the morning, eyes may be stuck together
Give 2 causes of bacterial conjunctivitis
- Staphylococcus aureus
- Pneumococcus
What are the features of viral conjunctivitis
- clear, serous discharge
- recent URTI
- tender, preauricular lymph nodes (in front of ears)
Give 2 causes of viral conjunctivitis
- adenovirus
- herpes simplex
How is infective conjunctivitis managed
- usually resolves in 1-2 weeks without treatment
- hygiene - don’t share towels, hand washing etc
- topical antibiotics (eyedrops/ ointment) - e.g. Chloramphenicol or fusidic acid (pregnant women)
- contact lenses should not be worn during an episode
What causes allergic conjunctivitis
contact with allergens, most commonly seen in context of hay fever
Describe the features of allergic conjunctivitis
- Bilateral symptoms: conjunctival erythema and swelling (chemosis)
- watery eyes
- prominent itch
- swollen eyelids
How is allergic conjunctivitis managed
- 1st line: topical or systemic antihistamines, e.g. epinastine
- 2nd line: topical mast-cell stabilisers, e.g. Sodium cromoglicate and nedocromil
Give 5 differentials for an acute painful red eye
- Acute angle closure glaucoma
- Anterior uveitis
- Scleritis
- corneal abrasions
- traumatic or chemical injury
Give 5 features of anterior uveitis
- acute onset
- painful, red eye
- blurred vision
- photophobia
- small, fixed oval pupil, ciliary flush (ring of red)
Give 5 features of acute angle closure glaucoma
- severe pain (may be ocular or headache)
- decreased visual acuity, patient sees haloes around lights
- fixed, semi-dilated non-reacting pupil
- hazy cornea
- red eye
Give 3 differentials for an acute painless red eye
- conjunctivitis
- episcleritis
- subconjunctival haemorrhage
Give 3 features of scleritis
- red, inflamed sclera
- severe pain that may be worse of movement
- tenderness to palpation
- systemic conditions: rheumatoid arthritis, granulomatosis with polyangiitis
What typically precedes subconjunctival haemorrhages
episodes of strenuous activity
* heavy coughing
* trauma
* weight lifting
* straining when constipated
What is the most common cause of tonsilitis
a viral infection
What are the 2 most common causes of bacterial tonsilitis
- group A streptococcus (Streptococcus pyogenes)
- Streptococcus pneumoniae
Give 5 features of acute tonsillitis
- Sore throat
- Fever (above 38°C)
- Pain on swallowing
- red, inflamed and enlarged tonsils, with or without exudates
- anterior cervical lymphadenopathy
What criteria is used to estimate the probability that tonsilitis is due to bacterial infection
Centor criteria or FeverPAIN score
How is tonsillitis managed
- viral: safety net (3d) , simple analgesia
- bacterial: antibiotics - penicillin V for 10 days or clarithromycin if CI
Give some complications of tonsillitis
- peritonsillar abscess (quinsy)
- otitis media
- rheumatic fever
- glomerulonephritis
What are the indications for tonsillectomy
- the person has had: 7 or more episodes in 1 year, 5 per year for 2 years, or 3 per year for 3 years
- recurrent peritonsillar abscess
- obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils
complications of tonsillectomy
- Primary (<24 hours): haemorrhage commonly due to haemostasis, pain
- Secondary (24hrs - 10d): haemorrhage commonly due to infection, pain
How are post-tonsillectomy haemorrhages managed
- assessed by ENT
- Primary haemorrhage within hours after surgery requires immediate return to theatre
- admit and give antibiotics if wound infection
What is acute sinusitis
inflammation of the mucous membranes of the paranasal sinuses
What are the most common infectious agents seen in acute sinusitis
- Streptococcus pneumoniae
- Haemophilus influenzae
- rhinoviruses.
Give 4 predisposing factors to acute sinusitis
- nasal obstruction e.g. septal deviation or nasal polyps
- recent local infection e.g. rhinitis or dental extraction
- swimming/diving
- smoking
Describe the presentation of acute sinusitis
- facial pain - worse on bending forward
- nasal discharge: usually thick and purulent
- nasal obstruction
- ‘double-sickening’ may sometimes be seen, where an initial viral sinusitis worsens due to secondary bacterial infection
How is acute sinusitis managed
- analgesia
- intranasal corticosteroids may be considered if the symptoms have been present for more than 10 days
- oral antibiotics are not normally required but may be given for severe presentations.
- phenoxymethylpenicillin first-line, co-amoxiclav if systemically very unwell
What is otitis externa
Inflammation of the skin in the external ear canal
Causes of otitis externa
- infection: S.aureus, Pseudomonas aeruginosa, candida
- seborrhoeic dermatitis
- contact dermatitis (allergic and irritant)
- recent swimming is a common trigger
Features of otitis externa
- ear pain
- itchiness
- discharge
Findings of otitis externa on otoscopy
red, swollen, or eczematous canal
How is otitis externa initially managed
- topical antibiotic +/- steroid (e.g. neomycin + betamethasone)
- if tympanic membrane is perforated, aminoglycosides are not used as they’re potentially ototoxic
- if there is canal debris then consider removal
- if the canal is extensively swollen then an ear wick is sometimes inserted
What are the second line options for managing otitis externa
- oral antibiotics (flucloxacillin) if the infection is spreading
- taking a swab inside the ear canal
- poor response to topical antibiotics should be referred to ENT
- empirical use of an antifungal agent
What is malignant otitis externa
severe form of otitis externa where there is extension of infection into the bony ear canal and the soft tissues deep to the bony canal
What does malignant otitis externa progress to
temporal bone osteomyelitis
RFs of malignant otitis externa
- diabetics - 90%
- immunocompromised
What organism most commonly causes malignant otitis externa
Pseudomonas aeruginosa
Features of malignant otitis externa
- Severe, unrelenting, deep-seated otalgia
- Temporal headaches
- Purulent otorrhea
- Possibly dysphagia, hoarseness, and/or facial nerve dysfunction
How is malignant otitis externa managed
- CT typically done
- admission for IV antibiotics (ciprofloxacin)
- non-resolving otitis externa with worsening pain should be referred urgently to ENT
