Opthalmology And ENT Flashcards
What type of neck lump is usually indicative of inflammatory/infective process?
A neck lump that has come about suddenly over hours
What type of neck lump is usually indicative of malignancy?
Neck lump that has been present for many weeks/months
Name the 5 sets of superficial lymph nodes that receive lymph from the scalp, face and neck?
- Post-auricular
- Pre-auricular
- Parotid
- Submental
- Submandibular
What features would be suggestive of head and neck cancer?
- oral lump/erythroplakia
- unexplained oral ulceration lasting >3 weeks
- persistent or unexplained neck lump
- persistent hoarseness
- persistent throat pain or painful swallow
- stridor
What is the reason for increasing incidence of oropharnygeal malignancies?
HPV-related tumours
What is odynophagia?
Pain when swallowing
What are the three main features of orophyarngeal malignancy presentation?
- Odynophagia
- Throat pain often unilateral
- Unilateral ear pain without ear symptoms
Define, inflammation of the salivary gland.
Sialadenitis
What are the common causes of sialadenitis?
- obstruction
- infection
- poor OH
- auto-immune
A patient presents to you with sudden swelling and pain in their salivary glands. They also complain of feeling generally unwell. What might be the diagnosis?
Acute infective sialadenitis
What might suggest that sialadenitis is caused by obstruction (e.g. sialolith, tumour)?
Episodic swelling at mealtimes
What childhood disease is associated with bilateral sialadenitis?
Mumps
What is the conservative management of salivary gland pathology?
- oral hydration
- analgesia
- oral antibiotics
- sour sweets/drink
- warm/cold compress
- gland massage
What are the complications of salivary gland pathology?
- sepsis
- abscess
- deep neck space infection
If facial palsy occurs alongside salivary gland swelling what does this indicate?
A malignant tumour
What are the diagnostic features of TMJ disorder?
- pain around TMJ and MOM
- pain provoked by palpation or jaw movement
- reproducible joint noises (e.g. clicking)
- jaw locking or limited opening
- temporal headache
- otalgia/tinnitus without ear disease
What ear disorders can mimic TMD?
- Acute otitis media
- Otitis media with effusion
- Otitis externa (swimmers ear)
Symptoms of what ear disorder are described:
- systemically unwell
- increasing pain over 2-3 days followed by resolution/discharge
Acute otitis media
Symptoms of what ear disorder are described:
- fluid in the middle ear
- not acutely infected
Otitis media with effusion
Symptoms of what ear disorder are described?
- ear discharge/pain
- reduced hearing
Otitis externa (swimmers ear)
What are casues of otitis externa?
- swimming
- wearing ear phones/hearing aids
- eczema
- trauma (e.g. cotton buds)
- narrow ear canals
What is the treatment of Otis externa?
- topical antibiotics +/- steroid
- keep ears dry and don’t use headphone/aids
What are the four paired paransal sinuses?
- Maxillary
- Ethmoid
- Sphenoid
- Frontal
What are the symptoms of acute sinusitis?
- nasal blockage
- mucopurulent discharge
- pain/pressure around cheek and peri-orbital region
- smell loss
When is acute sinusitis considered chronic?
If it lasts >12 weeks
What is chronic unilateral maxillary sinusitis commonly secondary to?
Dental pathology (dental pain absent)
What radiograph is best taken to view sinuses?
CT scan
What are the three features of sinonasal + nasopharyngeal cancer?
- unilateral nasal discharge
- unilateral middle ear effusion
- orbital complications (e.g. proptosis)
What are the three phases of swallowing?
- Voluntary
- Pharyngeal
- Oesophageal
What are the main considerations a dentist has to make for a patient with dysphagia?
- essential to maintain good OH to prevent oral bacteria aspiration
- risk during dental procedures, may not produce cough/ gag
- limit chair tilt
- use of hand instruments so to avoid use of water/suction
- well fitted denture plates essential to prevent aspiration
Name 4 mild eye conditions that cause red/sore eye?
- Conjunctivitis
- Subconjuctival haemorrhage
- Dry eyes
- Episcleritis
Name 5 moderate eye conditions that cause red/sore eye?
- Corneal abrasion
- Corneal foreign body
- Iritis
- Scleritis
- Facial nerve palsy
Name 5 severe eye conditions that cause red/sore eye?
- Corneal ulcer (keratitis)
- Penetrating injury
- Chemical injury
- Acute glaucoma
- Orbital cellulitis
What are the common signs/symptoms of bacterial conjunctivitis?
- sticky, purulent discharge
- bilateral, sequential
- gritty, uncomfortable
What are the common signs/symptoms of viral conjunctivitis?
- watery, “streaming”
- bilateral
- pre-auricular lymphadenopathy
What is conjunctiva?
Thin translucent layer of skin that covers the white of the eye (sclera)
What eye condition, is effectively a bruise, that looks bad (blood in sclera of eye) but is asymptomatic and will have no effect on vision?
Subconjuctival haemorrhage
What factors put you at higher risk of Subconjuctival haemorrhage?
- high blood pressure
- taking anticoagulants
What hallmark feature identifies an eye condition involving the cornea?
Light sensitivity (severe eye pain from bright light)
What is a common cause of corneal ulcer?
Contact lenses
What is another word for corneal ulcer?
Keratitis
What is the term used to describe light sensitivity of the eye?
Photophobia
What eye condition is urgent and requires treatment in less than 24 hours, if left to get worse the patient may be left with a scar to the cornea that affects vision. Common symptom: photophobia.
Corneal ulcer (keratitis)
What is bells phenomenon?
A medical sign that allows observers to notice a defensive movement of the eye from damage (upward movement), when an attempt is made to close the eye.
What is the first aid management of an individual with facula nerve palsy who cannot close their eye on affected side of face?
- tape eye closed
- generous lubrication (eye drops)
- optometrist
- safety net advice
What anatomical feature of the eye is the most useful and important barrier to intra-orbital infection?
Orbital septum
When does the orbital septum form in young children?
5-6years old
What eye condition should we be aware of in children, especially as their orbital septum doesn’t fully from till 5-6years old?
Peri orbital cellulitis
What is one of the most severe eye conditions that is characterised by the pupil being fixed and unable to dilate or restrict?
Acute glaucoma
If the pupil of an eye is of irregular shape what would this indicate?
Infection
What eye conditions cause pain?
- Corneal abrasion
- Corneal foreign body
- Iritis
- Scleritis
- Corneal ulcer (keratitis)
- Penetrating injury
- Chemical injury
- Acute glaucoma
- Orbital cellulitis
What eye conditions cause vision to be affected?
- Conjunctivitis
- Dry eyes
- Corneal abrasion
- Iritis
- Facial nerve palsy
- Coronal ulcer
- Penetrating injury
- Chemical injury
- acute glaucoma
- Orbital cellultis
What eye conditions affect the pupil of the eye?
- iritis
- penetrating injury
- acute glaucoma
- orbital cellulitis
What part of the eye has highest concentration of retinal cells and is the most important part for vision?
Macula
What is cataract?
When the lens, a small transparent disc in your eye starts to develop cloudy/hazy patches
What is the treatment for cataracts?
Phacoemulsification surgery
What does the eye condition ARMD stand for?
Age-related macular degeneration
What part of your vision is affected by ARMD?
Central vision
What are the two types of ARMD?
- Dry type
- Wet type
What type of ARMD is described?
- gradual, slowly progressive over many years
- no specific treatment
Dry type
What type of ARMD is described?
- Faster onset and progression
- treatable with anti-VEGF injections
Wet type
What does VEGF stand for?
Vascular endothelial growth factor
What is a condition of the optic nerve which is characterised by gradual, progressive loss of axons from the nerve inside the eye?
Glaucoma
What are the two types of glaucoma?
- chronic open angle glaucoma
- acute closed angle glaucoma
What type of glaucoma is described?
- peripheral vision affected first
- central vision lost very late
- mostly asymptomatic
Chronic open angle glaucoma
What type of glaucoma is described?
- red
- painful
- unreactive pupil
- severe headache
Acute closed angle glaucoma
What symptoms would indicate retinal detachment?
- flashing lights
- floaters
- shadow in the corner of vision
Is retinal detachment treatment urgent?
Yes, must be treated in less than 2 days to salvage vision
Why can inhalation sedation never be used on a patient who has had surgery for retinal detachment?
Acute eye pressure would rise and permanent site loss can occur
What eye condition is a medical emergency, and is a result of inflammatory problem with arteries around the eye?
Giant cell arteritis
What are the consequences of giant cell arteritis if not spotted and treated quickly?
Complete blindness can occur due to necrosis of the retina
What are the common signs/symptoms of giant cell arteritis to look out for?
- individuals >50 years
- jaw/tongue claudication
- tender scalp skin
- headache
- feeling rotten
- losing weight
- transient vision disturbance
What is treatment for giant cell arteritis?
High dose steroid
What two eye probelms are associated with diabetes?
- Retinopathy
- Maculopathy
How does diabetic retinopathy cause clouding of vision?
The vessels that form are faulty and substandard due to sugary blood damage. This damage causes a vitreous haemorrhage which causes clouding of vision.
How would you treat diabetic retinopathy?
Laser treatment
What are two cause of vision loss from diabetic retinopathy?
- Vitreous haemorrhage (bleeding)
- Retinal detachment (scarring)
What is orbital compartment syndrome?
High pressure in eye socket
What radiograph is best at conforming orbital fractures?
CT scan
What are signs of orbital floor fracture?
- bruising
- peri-orbital oedema
- pain
- double vision
- numbness in upper cheek
- sunken eye
What is a specific type of orbital fracture that tends to occur in children as their bones are more flexible so when they break the can spring back?
Orbital entrapment
What can be the consequence of undetected orbital entrapment in a child?
Long term double vision
What are symptoms of orbital entrapment?
Little outward evidence
Bradycardia
Nausea
Syncope
What condition can develop from orbital compartment syndrome due to an increase in pressure and sudden bleeding behind the eye?
Retrobulbar haemorrhage
What is the site saving procedure for orbital compartment syndrome?
Lateral canthotomy and cantholysis
What is a hyphema?
Where blood collects at the bottom of the eye (meniscus of blood)
What type of chemical injury is worse for the eye? Alkali or acid?
Alkali
