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Special Senses Flashcards

1
Q

Complications of tonsillitis?

A

Peritonsillar abscess (quinsy) - sore throat, dysphagia, peritonsillar bulge, uvular deviation, trismus and muffled voice.

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1
Q

Causes of recurrent unilateral salivary gland symptoms?

A

Often from stones - 80% in submandibular. Pain/swelling worse on eating. Gland may be red, swollen and tender.

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2
Q

1st line treatment for eczema?

A

Emollients (topical, soap substitute, bath additives) Topical steroids

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3
Q

Infective causes of corneal ulcers?

A

Bacterial (pseudomonas), herpetic (simplex, zoster), funal (candida; aspergillus), protozoal or from vasculitis.

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4
Q

4 topical steroids and their potencies?

A

Mild - hydrocortisone Moderate - eumovate Potent - betnovate Very potent - dermovate

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4
Q

Definition of glue ear?

A

Otitis media with effusion

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5
Q

How does a cataract present/

A

Blurred vision; unilateral cataracts cause loss of steropsis which affects distance judgement. Bilateral loss of vision +/- dazzle +/- monocular diplopia.

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6
Q

What causes chicken pox?

A

Varicella zoster virus

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6
Q

Signs of nasopharyngeal cancer?

A

Diplopia, conductive deafness (Eustachian tube affected), CN palsy (not I, VII, VIII), nasal obstruction or neck lumps

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6
Q

Risk factors for oropharyngeal cancer?

A

Chewing or smoking tobacco, alcohol alone not a risk factor but is synergistic with smoking

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7
Q

Define basal cell carcinoma?

A

Slow growing, locally invasive malignant tumour of the epidermal keratinocytes.

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8
Q

What is episcleritis?

A

Infalammation below the conjunctiva - often seen with inflammatory nodule. Bilateral in 30%.

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9
Q

Causes of acute unilateral salivary gland symptoms?

A

Likely to be due to mumps. Acute parotitis may occur by ascending oral infections. Occurs post op but now rare unless dehydrated or poor oral hygeine.

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10
Q

Treatment of conjunctivitis?

A

Chloramphenicol drops

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11
Q

Management of psoriasis?

A

General measures Topical - vit d analogues, topical corticosteroids, coal tar preparations, keratolytics, scalp preparations Phototherapy Oral therapies - methotrexate, ciclosporin, biologics…

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11
Q

What causes impetigo?

A

Staph aureus/strep pyogenes

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12
Q

What is acne rosacea and who does it affect?

A

Chronic inflammatory dermatosis Usually affects 30-50 year olds, common in women

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13
Q

Treatment of choice for BCC?

A

surgical excision - allows histologcial examination of tumour and its margins

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13
Q

Arise from jugular lymph sac and transilluminate brightly. Treated by surgery or hypertonic saline sclerosant.

A

Cystic hygromas - anterior triangle

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14
Q

Treatment of candida?

A

Mouth treatment = nystatin, vagina treatment = imidazole cream.

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15
Q

Symptoms of nasal polyps?

A

Watery anterior rhinorrhoea, purulent postnasal drip, nasal obstruction, change in voice, anosmia/taste disturbance, sinusitis, headaches, mouth-breathing, snoring, mucocele, pain

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16
Q

Treatment of acne?

A

Retinoids - vit A derivatives Benzylperoxide - topical antimicrobial. Abx - erythromycin, tetracyclines, trimethorpim Hyfrecation - application of electrical energy to destroy small areas of soft tissue

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16
Q

Presentation, cause and management of erysipelas?

A

Sharply defined superficial infection caused by Strep Pyogenes. Often affects face unilaterally with fever and ↑WCC. Systemic penicillin.

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16
Q

If a lump is superoposterior in the anterior triangle…?

A

Parotid tumour - more likely in over 40s

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16
Q

What causes excess evaporation of tears?

A

Post exposure keratitis

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17
Q

Open angle glaucoma presentation?

A

Asymptomatic until fields badly impaired - central field intact so acuity maintained so presentation delayed.

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18
Q

Treatment for acute angle closure glaucoma?

A

Pilocarpine drops open the closed angle

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19
Q

Treatment for corneal ulcer?

A

Chloramphenicol ointment

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19
Q

Chief cause of registerable blindness?

A

Macular degeneration

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20
Q

How does molluscum contagiosum present?

A

Pink papules with an umbilicated (depressed) central punctum. Common in children. Resolve spontaneously, more common in atopic eczema.

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21
Q

Typical presentation of squamous cell laryngeal cancer?

A

Typical older patient = male smoker with progressive hoarseness, then stridor, difficulty or pain on swallowing +/- haemoptysis +/- ear pain (if pharynx involved)

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22
Q

What is cholesteatoma?

A

Active squamous otitis media

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23
Q

Presentation of malignant melanoma?

A

ABCDE symptoms rule: Asymmetrical shape Border irregularity Colour irregularity Diameter >6mm Evolution of lesion (change in size and/or shape) Symptoms (bleeding, itching)

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23
Q

Wet ARMD?

A

Occurs when aberrant vessels grow from the choroid into the neuro-sensory retina and leak. Vision deteriorates rapidly and distortion is a key feature. (treatment available)

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24
Q

Symptoms of allergic rhinosinusitis?

A

Sneezing, pruritis, rhinorrhoea (bilateral and variable)

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24
Q

Causes of fixed salivary gland swellings?

A

Malignant, idiopathic or due to sarcoidosis

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24
Q

How does open angle glaucoma present on opthalmoscopy?

A

Raised IOP. Cupping, nerve damage, scotoma. Disc pales (atrophy) and cup widens and deepens so vessels emerging from disc appear to have breaks in them as they disappear into the cup and then seen in base again.

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25
Q

Precipitating factors in psoriasis?

A

Trauma (Koebner phenomenon), infection, drugs, stress and alcohol

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26
Q

How does Lichen Planus present?

A

Itchy, shiny, purple plaques. Flat-topped with Whickham’s striae.

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26
Q

How is ambylopia caused?

A

Developmental failure of immature neuroretina during early childhood that occurs as a result of visual deprivation or abnormal binocular interaction.

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27
Q

What is a risk in orbital cellulitis?

A

Blindness from pressure on optic nerve or thrombosis of its vessels

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29
Q

Presentation of psoriasis?

A

 Well demarcated erythematous scaly plaques.  Lesions can be itchy, burning or painful.  Common on extensor surfaces and over scalp.  Auspitz sign (scratch and gentle removal of scales cause capillary bleeding)  Associated nail changes (pitting, oncholysis)  Associated psoratic arthropathy.

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30
Q

What is erythroderma/exfoliative dermatitis? Causes?

A

Widespread erythema and dermatitis. Sulfonamides, allopurinol, carbamezapine, gold

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31
Q

What is the corneal reflection test?

A

Reflection from bright light falls centrally and symmetrically on each cornea if no squint, asymmetrically if squint present.

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32
Q

Where is BCC most common?

A

Head and neck

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32
Q

Typical age/gender for nasal polyps?

A

Male >40

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32
Q

Management of squamous cell laryngeal cancer?

A

Total laryngectomy - patient must have permanent tracheostomy so must learn oesophageal speech.

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33
Q

Name some ototoxic drugs?

A

Streptomycin, vancomycin, gentamicin, chloroquine and hydroxychloroquine, vinca alkaloids

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34
Q

Presentation of uveitis?

A

Acute pain, photophobia, reduced acuity, lacrimation, circumcorneal redness, small pupil. White precipitations on back of cornea.

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35
Q

What aggravates eczema?

A

Dryness, stress, infection and allergy

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36
Q

What can be a sinister complication of persistent otitis externa?

A

Malignant/necrotising otitis externa (in diabetics/immunocompromised/elderly)

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37
Q

Causes of tonsillitis?

A

Group A streps (pyogenes). Staphs, moraxella, mycolplasma, chlamydia, haemophilus

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38
Q

Definition of eczema?

A

Inflammatory skin condition with itching, redness and scaling.

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39
Q

Pathophysiology of glue ear?

A

Dysfunction of eustachian tubes

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40
Q

Management of cholesteatoma?

A

Mastoid surgery

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41
Q

What is tinea

A

Ringworm. Round, scaly, itchy lesion whose edge is more inflamed than its centre.

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42
Q

Infections causing facial palsy?

A

Otitis media, cholesteatoma, necrotising otitis externa

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43
Q

Presentation of acute otitis media?

A

Rapid onset of pain, fever +/- irritability, anorexia or vomiting, often after a viral URTI.

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44
Q

Should you try to remove a large foreign object from the eye?

A

NO. Support it with padding, transport supine. Pad unaffected eye to prevent damage from conjugate movement.

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45
Q

Two groups of skin cancer?

A

Non-melanoma and melanoma

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47
Q

Bulla definition?

A

Large fluid filled lesion

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47
Q

What are you thinking if many small lumps in posterior triangle?

A

Nodes - TB or viruses

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47
Q

What is congenital blocked nasolacrimal duct called?

A

Dacyrostenosis

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48
Q

Macule definition?

A

small flat lesion

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48
Q

Risk factors for SCC?

A

Excessive UV exposure, pre-malignant skin condition (actinic keratosis), chronic inflammation (leg ulcers, wound scars), immunosuppression and genetic predisposition

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48
Q

Compression of optic tracts causes what

A

Homonomous hemianopia

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49
Q

Treatment of acne rosacea?

A

Topical abx - metronidazole/azelaic acid Systemic abx - macrolides/tetracycline

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50
Q

Compression of optic nerve causes what?

A

Monocular blindness

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51
Q

Most common type of squint in children?

A

Convergent (esotropia). Exotropia tends to be in older kids

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52
Q

What type of epistaxis can be seen easily with rhinoscopy and is easier to treat?

A

Anterior

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53
Q

What is a cataract?

A

Any opacity in the lens

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54
Q

Patch definition?

A

Diffuse flat lesion

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55
Q

What is pityriasis rosea?

A

Rash preceded by a herald patch (ovoid red scaly patch with a scaly edge, similar to but larger than later lesions. Affects neck, trunk and proximal limbs. Affects young adults.

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56
Q

Causes of chronic bilateral salivary gland symptoms?

A

May be associated with dry eyes and mouth +/- Sjogren’s or Mikulicz’s syndromes

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57
Q

Atrophy definition?

A

Loss of tissue

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57
Q

Define sensorineural deafness?

A

Results from defects central to oval window in cochlea (sensory), cochlear nerve (nerual) or, rarely, more central pathways

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57
Q

Management of posterior epistaxis?

A

Examination under anaesthesia. Gold standard = endoscopic ligation of maxillary/sphenopalatine artery around the sphenopalatine foramen.

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58
Q

How does facial palsy in brainstem lesions present?

A

Produce only muscle weakness and may be accompanied by VI nerve palsies

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59
Q

What is myopia?

A

Short-sightendness - Eyeball is too long. Only close objects focus on the retina unless CONCAVE lenses used.

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61
Q

Name some retinoids?

A

Tretinoin gel, adapalene, isotrenitoin,

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61
Q

What is the cover test?

A

Movement of uncovered eye to take up fixation as the other eye is covered demonstrates manifest squint: latent squint revealed by movement of the covered eye as cover is removed

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62
Q

First line treatment for rhinosinusitis?

A

Topical corticosteroids and oral abx.

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62
Q

Where are most malignant salivary gland tumours?

A

Mandibular (50% of them are malignant.

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63
Q

Presentation of episcleritis?

A

Eye aches dully and is tender. Acuity usually okay. No cause in 70%.

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63
Q

Most prevalent inherited degeneration in the retina?

A

Retinitis Pigmentosa

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65
Q

Atopic eczema usually associated with what?

A

Hayfever and asthma

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66
Q

Aetiology of acne?

A

Abnormal cell turnover, inflammation and host immune reaction, excessive sebum production, P.acnes colonisation

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66
Q

Causes of sensorineural deafness?

A

Ototoxic drugs, postinfective, cochlear vascular disease, Méniére’s disease, trauma, presbyacusis.

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66
Q

How does tonsillitis present?

A

Sore throat +/- lymphadenopathy

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68
Q

Risk factors for squamous cell laryngeal cancer?

A

Smoking, regular cannabis use, HPV +ve in young people

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68
Q

Risk from giant cell arteritis?

A

Anterior ischaemic optic neuropathy (AION) - optic nerve damaged if posterior ciliary arteries are blocked by inflammation or atheroma.

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69
Q

How do you test for and fix BPV?

A

Hallpike test, Epley manoeuvres

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70
Q

Associations of glue ear?

A

URTIs, oversized adenoids, narrow nasopharyngeal dimensions

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71
Q

What is Méniére’s disease?

A

Vertigo with prostration, nausea/vomiting +/- feeling of fullness in the ear; unilateral or bilateral tinnitus +/- sensorineural deafness

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71
Q

How does facial palsy present in UMN and LMN lesions

A

UMN - upper portion of face spared LMN - can paralyse all of one side of face

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71
Q

Presentation of conjunctivitis?

A

Conjunctiva red and inflamed, hyperaemic vessels may be moved by gentle pressure on the globe. Eyes itch, burn and lacrimate. May be photophobia. Often bilateral with discharge sticking eyes together. Acuity, pupillary response and corneal lustre unaffected.

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72
Q

Symptoms of chronic otitis media?

A

Discharge, reduced hearing, but little pain

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73
Q

What happens if secretions from chronic otitis media cannot drain?

A

Differentiation into squamous epithelium occurs –> retraction of pars tensa or flaccida

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74
Q

How does central retinal artery occlusion present?

A

Dramatic visual loss within seconds. Afferent pupil defect appears within seconds.

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74
Q

Risk factors for glaucoma

A

>35, +ve FH, afro-caribbean, myopia, diabetic/thyroid eye disease

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74
Q

Compression of optic chiasm causes what?

A

Heteronomous hemianopia

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75
Q

Recovery from optic neuritis?

A

2-6 weeks

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76
Q

Where does anterior epistaxis usually come from?

A

Invariably septal - Little’s area (Kiesselbach’s plexus) is an anterior anastamotic aracade.

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77
Q

Causes of facial pain?

A

Tooth pathology, sinusitis, TMJ dysfunction, salivary pathology, migraine, trigeminal neuraglia, atypical facial pain, trauma, cluster headache, angina, fontal bone myelitis, ENT tumours

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77
Q

What can happen as a consequence of posterior vitreous detachment?

A

Retinal tears

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78
Q

What happens in IVth nerve palsy?

A

Eye looks upward in addution and cannot look down (SO paralysed). Diplopia and patient may hold head tilted (ocular torticollis)

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79
Q

Main cause of salivary gland inflammation?

A

Usually due to obstructing calculus (Calcium phosphates and carbonates)

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80
Q

Symptoms of giant cell arteritis?

A

Malaise, jaw claudication (chewing pain), tender scalp and temporal arteries (thickened, absent pulses), neck pain. ESR and CRP raised.

82
Q

Pustule definition?

A

Raised and contains pus

83
Q

Causes of central vertigo?

A

Acoustic neruoma, MS, head injury, inner ear syphilis, vertebrobasilar insufficiency

85
Q

Key to treatment of otitis externa?

A

Aural toilet

86
Q

Define conductive hearing loss?

A

Impaired sound transmission via external canal and middle ear ossicles to foot of the stapes

88
Q

What is toxic epidermal necrolysis? Causes?

A
  • The bad end of erythema multiforme/SJS spectrum - Widespread erythema then necrosis of large sheets of epidermis. Mucoase severely affected/ - Risk 1000 fold higher in HIV patients. - Causes – sulfonamides, anticonvulsants, penicillins, allopurinol, NSAIDs.
88
Q

Management of Bell’s palsy?

A

Protect eye, artifical tears, ?prednisolone

89
Q

What is a squint?

A

Abnormality of co-ordinated movements of eyes.

90
Q

Signs and causes of Stevens Johnson Syndrome?

A
  • Signs – target lesions and polymorphic erythema, eg with blistering muscosae (conjunctivae, oral, labial, genital). - Mainly due to drugs (sulfonamides, anticonvulsants)
91
Q

How do patients describe posterior vitreous detachment?

A

Monochromatic photopsia in peripheral temporal field. More obvious in dim light and with eye movements. Increase in floaters but vision remains unchanged and no field defects.

92
Q

V.rare. Move from side to side but not up and down. Splay out to the carotid bifurcation. Firm and pulsatile but do not usually cause bruits. May be bilateral, familial and malignant. Treat by extirpation by vascular surgeons.

A

Carotid body paraganglioma

94
Q

How is headlice spread?

A

common in children, spread only by head to head contact. Itch and popular rash on the nape. Neurotoxic agents work in 70%.

95
Q

Differentials for midline neck lump?

A

If under 20, likely a dermoid cyst. If moves on tongue protrusion and below hyoid, thyroglossal cyst. If over 20, probably a thyroid mass - unless bony hard, may be a chondroma.

97
Q

Risk factors for BCC?

A

UV exposure, history of severe or frequent sunburn in childhood, skin type I, increasing age, male sex, immunosuppression, previous history of skin cancer, genetic predisposition.

99
Q

Where is eczema usually found?

A

Flexor surfaces

100
Q

Dry ARMD?

A

Shows mainly drusen and degenerative changes at the macula. Progresses slowly.

101
Q

What is candida?

A

common in immunocompromised. Affects mouth, vagina, glans, skin folds/toe web, nail areas. Often pink and moist +/- satellite lesions.

102
Q

What is ambylopia?

A

Lazy eye.

103
Q

When should you remove a salivary gland if swelling?

A

If swelling present for over 1 month

104
Q

Where do nasal polyps most commonly arise?

A

Middle turbinates, middle meatus, ethmoids.

105
Q

Management of epistaxis?

A

Resuscitate if needed. Vital signs often. Ask patient to apply pressure to lower part of nose. Fully decongest (ephedrine). Silver nitrate cautery - liodcaine and phenylephrine first (vasoconsriciton) Anterior nasal pack too (admit patients with packs and look for causes)

106
Q

Orophargyngeal cancer - M:F ratio and what type?

A

M:F 5:1, 85% sqaumous

106
Q

Association of optic neuritis?

A

45-80% go on to develop MS in next 10 years

108
Q

Retinal detachment may happen following what?

A

Separation of the vitreous leading to retinal tear and then detachment

109
Q

What makes up 90% of ocular carcinomas?

A

Basal cell carcinoma

110
Q

Complications of BCC?

A

Local tissue invasion and destruction

110
Q

What is allergic rhinosinusitis?

A

IgE mediated inflammation from allergen exposure to nasal mucosa causing inflammatory mediator release from mast cells - may be seasonal or perennial

111
Q

Esotropia =?

A

Convergent squint (one eye turned in)

112
Q

How does Bell’s palsy present?

A

Onset abrupt, mouth sags, dribbling, watering (or dry eyes), impaired brow wrinkling, blowing, whistling, lid closure, cheek-pouting, taste and speech

114
Q

What nasal polyp may be sinister?

A

Polyp causing unilateral nasal obstruction, esp if pain or bleeding

115
Q

What happens in VIth nerve palsy?

A

Eye medially deviated and cannot move laterally from midline (LR paralysed). Diplopia in horizontal plane.

117
Q

Management of malignant melanoma?

A

Surgical excision = definitive treatment Radiotherapy may sometimes be useful Chemotherapy for metastatic disease

119
Q

What is vertigo?

A

Illusion of movement - may be accompanied by nausea, vomiting, hearing loss, tinnitus and nystagmus (usually horizontal)

120
Q

2nd line treatment for eczema?

A

Antibiotics for secondary infection Phototherapy with UV Oral steroids Immunosuppressant

121
Q

Causes of conductive hearing loss?

A

External canal obstruction, drum perforation, problems with ossicular chain, inadequate Eustachian tube ventilation of middle ear

122
Q

Presentation of SCC?

A

Keratotic (scaly, crusty), ill-defined nodule which may ulcerate

123
Q

Uveal injury risks what in the other eye?

A

Sympathetic opthalmia

124
Q

Associations of nasopharyngeal cancer?

A

HLA A2 allele, HPV, EBV, tobacco, formaldehyde, wood dust exposure.

126
Q

Management of SCC?

A

Surgical excision = treatment of choice

126
Q

What do you need to think about when investigating a neck lump>

A

How long has it been there? -

127
Q

Extropia =?

A

Divergent squint (one eye turned out)

128
Q

What is an acute angle closure glaucoma?

A

Blocked flow of aqueous from anterior chamber via canal of schlemm. Intraocular pressure rises.

130
Q

What is pityriasis versicolor?

A

multi hypo- or hyperpigmented scaly macules on the upper trunk and back.

132
Q

Other treatments of BCC?

A

Mohs micrographic surgery, radiotherapy, cryotherapy, curettage and cautery, topical treatment

133
Q

Why do patients with sinus squamous cell cancer present late?

A

Because epistaxis, obstruction and headahce only occur with large tumours.

134
Q

Chief organisms involved in otitis externa?

A

Pseudomonas and Staph aureus

135
Q

Typical presentation of sinus squamous cell cancer?

A

Middle aged or elderly. Suspect when chronic sinusitis presents for first time in later life. Early signs = blood stained nasal discharge and nasal obstruction. Later = cheek swelling, swelling or ulcers of buccoalveolar plate or palate, epiphora due to blocked nasolacrimal duct, ptosis and diplopia as floor of orbit involved, and pain in maxillary division of trigeminal nerve.

136
Q

Differentials for lump in submandibular triangle?

A

If

138
Q

Treatment of tonsillitis?

A

Paracetamol +/- difflam - gargle if severe. Abx unlikely to help as most viral. If ill or centor criteria +ve –> penicillin or erythromycin if penicllin allergic. NOT amoxicillin - rash in EBV.

139
Q

Drugs that can cause vertigo?

A

Gentamicin, diuretics, co-trimoxazole, metronidazole

140
Q

Erythema definition?

A

Red

141
Q

Treatment for dry eyes?

A

Artificial tears give symptomatic relief

142
Q

Rare causes of sensorineural deafness?

A

Acoustic neuroma, B12 deficiency, MS, secondary carcinoma in brain

143
Q

Most common malignant skin tumour?

A

BCC

144
Q

Peak age for cholesteatoma?

A

5-15 years

145
Q

What is a corneal abrasion?

A

Epithelial breach. Causes pain, photophobia and decreased vision.

146
Q

Prognosis of Bell’s palsy?

A

1/3 full recovery 1/3 incomplete recovery of facial motor function Rest = permanent neurological and cosmetic abnormalities

148
Q

What do polyps look/feel like?

A

Pale, mobile and insensitive to gentle palpation

150
Q

Where does acne affect most?

A

Face, back, chest

151
Q

Vesicle definition?

A

Small fluid filled lesions

152
Q

Presentation of oropharyngeal cancer?

A

Often advanced at presentation. Typical older patient = smoker with sore throat, sensation of a lump, referred otalgia, local irritation by hot or cold foods, with risk factors.

153
Q

Causes of otitis externa?

A

Moisture (swimming), trauma (fingernails), high humidity, absence of wax, narrow ear canal and hearing aids

154
Q

Associations of paediatric cataracts?

A

Rubella, Down’s

156
Q

Cellulitis - cause, presentation and treatment?

A

acute infection of skin and soft tissues – deeper and less well-defined than erysipelas. Beta-haemolytic streps and staphs. Pain, swelling, erythema, warmth, systemic upset and lymphadenopathy. Benzylpenicllin + flucloxacillin or erythromycin if penicillin allergic.

157
Q

Risk factors for ARMD?

A

Age, smoking, sun exposrue, poor diet, alcohol

159
Q

Causes of external ear canal obstruction?

A

Wax, pus, debris, foreign body

160
Q

Types of malignant melanoma?

A

Superficial spreading melanoma - common on lower limbs in young and middle aged adults; related to intermittent high intensity UV exposure Nodular melanoma - common on trunk, in young and middle aged adults, related to intermittent high-intensity UV exposure Lentio malinga melanoma - common on face in elderly, related to long term cumulative UV exposure Acral lentiginous melanoma - common on palms, sole and nail beds, in elderly population, no clear relationship with UV exposure

161
Q

Plaque definition?

A

Diffuse raised lesion

163
Q

What is contact dermatitis?

A

Inflammatory response to chemical penetration of epidermis

164
Q

What is posterior vitreous detachment?

A

Degenerative changes in the vitreous lead to its eventual spearation from the retina (normal part of ageing)

166
Q

Two key processes in acne rosacea?

A

Chronic inflammation, vasodilation/vascular instability

167
Q

Causes of drum perforation?

A

Trauma, barotrauma, infection

168
Q

What virus causes warts?

A

HPV

169
Q

How does retinal detachment present?

A

4 Fs - floaters, flashes, field loss and fall in acuity. Painless and may be a curtain falling over the vision.

169
Q

Test for dry eyes?

A

Schirmer’s test - filter paper put overlapping lower lid; tears should soak.

170
Q

Common organisms for otitis media

A

Pneumococcus, haemophilus, moraxella, other streps and staphs

172
Q

Nodule definition?

A

Discrete raised lesion

172
Q

Causes of facial palsy?

A

Intracranial - brainstem tumours, strokes, polio, MS, cerebellopontine angle lesions (acoustic neuroma, meningitis) Intratemporal - otitis media, Ramsay Hunt syndrome, cholesteatoma Infratemporal - parotid tumours, trauma Others - Lyme disease, sarcoid, Guillain-Baré, herpes, diabetes, Bell’s palsy

173
Q

Definition of rhinosinusitis?

A

Inflammation in the nose and paranasal sinuses with >2 symptoms, one of which must be nasal congestion or nasal discharge

174
Q

Treatment for allergic rhinosinusitis?

A

Loratidine = antihistamine. Systemic decongestants, nasal sprays, nasal steroids, oral steroids.

175
Q

Generalised pustular psoriasis?

A
  • May cause severe systemic upset (fever, high WCC, dehydration) – also triggered by withdrawal of systemic steroids.
176
Q

What would you see on opthalmoscopy in cataracts?

A

No red reflex or visible fundus

178
Q

What are plane warts?

A

flat skin coloured or brown lesions.

179
Q

Pattern of visual loss in open angle glaucoma

A

Nasal and superior fields lost first, temporal last

180
Q

Define squamous cell carcinoma?

A

Locally invasive malignant tumour of the epidermal keratinocytes or its appendiges, which has the potential to metastasise.

181
Q

What is BPV?

A

Displacement of otoconia in semicircular canals. No persistent vertigo, no speech, visual, motor or sensory problems, no tinnitus, headache, ataxia, facial numbness or dysphagia, no vertical nystagmus.

183
Q

Tests for vertigo?

A

Romberg’s, provocation tests (hallpike test)

183
Q

An uncommon cause of lump in anterior triangle - painless, more common in males and made worse by blowing?

A

Laryngocele

183
Q

Causes of mucin deficiency in tears?

A

Avitaminosis A, Stevens-Johnson syndrome, pemphigoid, chemical burns

184
Q

Treatment of optic neuritis?

A

High dose methylprednisolone

185
Q

Signs of glue ear?

A

Retracted or bulging ear drum

186
Q

Compression of optic radiation causes what/

A

Homonomous hemianopia

188
Q

How does scabies present?

A

presents with little linear burrows, really itchy. Person to person spread. Very itchy papules, vesicles, pustules and nodules affecting finger webs, wrist flexures, axillae, abdomen, buttocks, groins. Permethrin is treatment.

189
Q

What is horner’s syndrome?

A

Disruption of sympathetic nerve fibres causing mitotic pupil, partial ptosis and unilateral anhydrosis.

191
Q

In whom do you see BCC?

A

Older people

192
Q

What do you see in ARMD on opthalmoscopy?

A

Pigment, drusen and sometimes bleeding at macula

194
Q

Indications for tonsillectomy?

A

Sore throat definitely caused by tonsillitis. 5 or more episodes per year Symptoms for at least a year Respiratory obstruction, suspicion of malignancy

195
Q

Presentation and mangement of impetigo?

A

Lesions usually start around nose and face with honey-coloured crusts on erythematous base. Topical abx, oral if more severe

196
Q

Where are malignant melanomas more common in men and women?

A

More common on legs in women and trunk in men

198
Q

Risk factors for malignant melanoma?

A

Excessive UV exposure, skin type I, history of multiple moles or atypical moles, and family or previous history of melanoma

199
Q

Usually present in acne rosacea?

A

Flushing, non-transient erythema, papules and pustules, telangiectasia

200
Q

How does retina appear in central retinal artery occlusion?

A

Appears white, with a cherry spot at the macula

200
Q

Causes of orbital cellulitis?

A

Staphs, strep pneumoniae, strep pyogenes or milleri

201
Q

What might a corneal abrasion result from?

A

Scratches from sharp objects, trauma, chemical injury or previous corneal disease.

202
Q

Presentation of cholesteatoma?

A

Foul discharge +/- deafness; headache, pain, facial paralysis and vertigo indicate impending CNS conditions

204
Q

How does nodular BCC present?

A

Small, skin coloured papule or nodule with surface talngiectasia, and a pearly rolled edge; may have a necrotic or ulcerated centre (rodent ulcer)

205
Q

Presentation of acne?

A

Comedones, papules, pustules and nodules/cysts. If untreated can lead to scarring

206
Q

Lichenification definition?

A

Thickening (if deeper = sclerosis)

207
Q

Name another type of ocular malignancy?

A

Choroidal melanoma and eyelid skin melanoma

209
Q

What is psoriasis?

A

Chronic inflammatory skin condition due to hyperproliferation of keratinocytes and inflammatory cell infiltration

211
Q

If over 20, what are you thinking about lumps in posterior triangle?

A

Lymphoma or metastases

212
Q

Management of giant cell arteritis?

A

Temporal artery biopsy within 1 week of starting prednisolone - other eye still at risk of AION until steroids given.

214
Q

How does retinal detachment present on opthalmoscopy?

A

Grey opalescent retina, ballooning forward

215
Q

What are nasal polyps?

A

Ciliated columnar epithelium with a thickened basement membrane and an avascular odematous stroma.

216
Q

Where does lichen planus affect?

A

Wrists and ankles. Can affect scalp causing scarring alopecia or mucuous membranes causing white streaks and ulceration

217
Q

How does optic neuritis present?

A

Unilateral loss of acuity over hours or days. Colour vision affected (dyschromatopsia): reds appear less red and eye movements hurt. Pupil shows an afferent defect.

218
Q

How does eyelid BCC present?

A

Nodular lumps with pearly edges +/- telangiectasia

219
Q

Main symptom of blocked nasolacrimal duct?

A

Excessive tearing.

221
Q

Causes of conjunctivitis?

A

Adenoviruses (small lymphoid aggregates appear as follicles on conjunctiva), bacteria (purulent discharge - staphs) or allergic.

222
Q

Treatment of glue ear?

A

Grommet insertion

223
Q

Define malignant melanoma?

A

Invasive malignant tumour of the epidermal melanocytes which has the potential to metastasise.

224
Q

What is Amaurosis fugax?

A

Painless transient monocular visual loss

225
Q

Symptoms of squamous H&N cancers? (13)

A

Neck pain/lump, hoarse voice >6 weeks, sore throat >6 weeks, mouth bleeding, mouth numbness, sinus congestion, sore tongue, painless ulcers, patches in mouth, earache/effusion, lumps (lip, mouth, gum), speech change, dysphagia, epistaxis

226
Q

Most common salivary gland tumour?

A

Pleomorphic adenoma (parotid).

227
Q

What happens in IIIrd nerve palsy?

A

Ptosis, proptosis (as recti tone reduced), fixed pupil dilatation, eye looking down and out

228
Q

Orbital cellulitis is typically spread via what?

A

A paranasal sinus infection (or eyelide, dental injury/infection or external ocular infection)

230
Q

Lymph spread of nasopharyngeal cancer?

A

usually early to upper deep cervical nodes. Local spread may involve cranial nerves via jugular foramen.

232
Q

Causes of red eye?

A

Conjunctivitis, corneal ulcers, acute angle closure glaucoma, uveitis, episcleritis/scleritis, loads more

233
Q

Sequelae of otitis externa?

A

Hearing loss and canal stenosis (making hearing aids harder to wear)

235
Q

Types of glaucoma surgery?

A

Laser - trebeculoplasty Surgery - trabeculectomy (establishes pressure valve at limbus so aqueous can flow into a conjunctival bleb)

236
Q

Presentation of acute angle closure glaucoma?

A

Acute uniocular attacks occur with headache, nausea, and a painful red eye.

237
Q

Papule definition?

A

Small raised lesion

238
Q

Symptoms of ARMD?

A

Disturbed central vision - blurring, scotoma, distortion. Difficulty reading fine print. Difficulty recognising faces. Difficulty appreciating fine detail.

239
Q

What are plantar warts?

A

Verucas

240
Q

Emerges under anterior border of SCM where upper 1/3 meets middle 1/3; age

A

Brachial cyst - anterior triangle

241
Q

What is hypermetropia?

A

Eye is too short. Distant objects focused behind retina. Can produce tiredness of gaze or a convergent squint in children. Corrected by CONVEX lenses.

242
Q

What is Centor criteria?

A

History of fever, tonsillar exudates, tender anterior cervical adenopathy, absence of cough.

243
Q

Causes of acute bilateral salivary gland symptoms?

A

Usually due to mumps (if young/unvaccinated)

244
Q

Where are eyelid squamous and meibomian gland carcinomas common?

A

Commoner on upper lid, in females and increase with age

246
Q

Primary sites of posterior triangle lymph mets in order of likelihood?

A

H&N, bronchus, gut, breast, gonad

247
Q

What is scleritis?

A

Rarer than epi. When sclera itself is inflamed and pain is significant. Generalized inflammation with oedema of the conjunctiva and scleral thinning. Associated with CT disorders and infection. Acuity may be reduced.

248
Q

Some infections that can give postinfective sesorineural deafness?

A

Meningitis, measles, mumps, flu, herpes, syphilis

249
Q

Crust definition?

A

Tissue fluid + debris

250
Q

Why retinoids only given in secondary care?

A

Teratogenic

251
Q

Glaucoma medications?

A
  1. Prostaglandins analogue - increase uveoscleral outflow. End in PROST - bimatoprost, travoprost etc 2. Beta-blockers - reduce aqueous production. Timolol. 3. Carbonic anhydrase inhibitors - reduces aqueous production (dorzolamide) 4. Selective alpha-2 receptor agonists - reduce aqueous production. (Brimonidine)
252
Q

Symptoms of otitis externa?

A

Minimal discharge, itch, pain and tragal tenderness (due to inflammation of skin of meatus)

253
Q

Causes/associations of epistaxis?

A

Trauma, local trauma or infection, hypertension, dyscrasia/haemophilia, high alcohol intake, septal perforation, neoplasm

255
Q

Morphological types of BCC?

A

Nodular (most common), superficial (plaque like), cystic, morphoeic (sclerosing), keratoic and pigmented

256
Q

Causes of peripheral vertigo

A

Méniére’s disease, BPV, vestibular failure, labyrinthitis, cholestatoma

257
Q

Typical causes of dry mouth?

A

Hypnotics and tricyclics, antipsychotics, beta blockers, diuretics, mouth breathing, ENT radiotherapy, Sjogren’s syndrome, SLE/scleroderma, sarcoidosis, HIV/AIDS, parotid sialoliths.

258
Q

Management of otitis media?

A

Analgesia - abx not usually needed If fails to resolve, amoxicillin +/- clavulanate for

259
Q

Causes of dry eyes?

A

Decreased tear production in old age. Sjogren’s syndrome, mumps, sarcoidosis, amyloidosis, lymphoma, lukaemia, haemochromatosis.

260
Q

What may intrude in posterior triangle?

A

Cervical ribs mate

261
Q

Cause of uveitis

A

Often none found, autoimmune

262
Q

Telangiectasia definition?

A

Blood vessel dilatation

263
Q

Keratin definition?

A

Scaly

264
Q

Symptoms of rhinosinusitis?

A

Facial pain or pressure, reduced olfaction, endoscopic signs of nasal polyps or musucs +/- pus discharged primarily from sinuses

265
Q

Herpes zoster aetiology and presentation?

A

varicella zoster becomes dormant in dorsal root ganglia. Recurrent infection affects one or more dermatomes. Polymorphic red papules, vesicles, pustules. Postherpetic neuralgia. Aciclovir or famciclovir.

266
Q

Most common type of psoriasis?

A

Chronic plaque psoriasis

267
Q

Sites of squamous cell laryngeal cancer? And which is best?

A

Supraglottic, glottic and subglottic. Glottic is best because it produces hoarseness earlier (and spreads to nodes late)

268
Q

Typical patient with orbital cellulitis?

A

Child with inflammation in the orbit, fever, lid swelling and reduced eye mobility

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