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Z IPE > Special Senses > Flashcards

Special Senses Flashcards

1
Q

Causes of dry eyes

A

Causes:
• Excess tear loss - blepharitis, contact lens wear, drugs
• Insufficient production - sjogrens, allergic conjunctivitis
Abnormalities of eyelids and blinking - parkinsons

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2
Q

S&S of dry eyes

A

S&S:
• Gritty irritation and FB sensation
• Mild pain aggravated by reading, dry air, PC work
• Worse at end of day

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3
Q

Tx of dry eyes

A

Tx:
• Review meds
• Tear substitutes
• Avoid contact lenses where possible

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4
Q

Differentials of a red eye

A 
Differentials:
	• Conjunctivitis
	• Corneal ulcer
	• Iritis
Foreign body
	• Episcleritis
	• Scleritis
	• Acute angle closure glaucoma
	• Age related macular degeneration
	• Diabetic Retinopathy
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5
Q

S&S of conjunctivitis

A

S&S:
• Mucopurulent discharge on eyelashes
• Dilated red blood vessels on sclera
• Acute onset often bilateral red eyes

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6
Q

Tx of conjunctivitis

A

Tx:
• Topical chloramphenicol or topical fusidic acid
• Don’t wear contacts
• Don’t share towels

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7
Q

Allergic conjunctivitis S&S and tx

A 
Allergic conjunctivitis:
	• Bilateral sx
	• Prominent itch
	• History of atopy
	• Tx - Antihistamines or sodium cromoglicate
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8
Q

corneal ulcer S&S

A 
S&S:
	• Pain
	• Photophobia
	• Blurred vision
	• Sensation of foreign body
	• Signs - Red eye, corneal stain with fluorescein, hypopyon
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9
Q

Causes of corneal ulcer

A

Aetiology:
• Infections - herpes, streptococcus
• Contact lens wear
• Blepharitis

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10
Q

Tx of corneal ulcer

A

Tx:
• Herpes - aciclovir ointment
• Bacterial - topical abx
• Topical steroids

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11
Q

Tx of corneal FB

A

Tx:
• Topical NSAID
• Topical abx
• Tetanus ppx to prevent secondary infection if rust
• Refer if not healed in 72 hrs or worsening sx

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12
Q

Open angle glaucoma S&S

A

Open angle Glaucoma:
• Develops slowly over time, no pain
• Side vision begins to decrease followed by central
• Optic disc cupping (see pic)

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13
Q

Tx of closed angle glaucoma

A

Tx:
• Urgent admission
• Acetazolamide (reduces aqueous secretions) and topical pilocarpine (pupillary constriction)

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14
Q

S&S of acute angle closed glaucoma

A 
S&S:
	• Female over 50 usually
	• Unilateral eye pain
	• Eye watering
	• Headache
	• Progresses to N&V
	• May collapse
	• Reduced vision
	• Red eye
	• Fixed mid dilated pupil
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15
Q

Causes of homonymous Quadrantanopia

A

Homonymous quadrantanopia:
• Lesion of temporal lobe - superior
• Lesion of Parietal lobe - Inferior
PITS - Parietal Inferior Temporal Superior

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16
Q

Wet AMD tx

A

Anti-VEGF injection

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17
Q

S&S of cataracts

A 
S&S:
	• Slowly progressive visual loss or blurring
	• Glare
	• Reduced colour sensitivity
	• Reduced night vision
	• Double vision
	• No red reflex with opthalmoscope
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18
Q

Tx of cataracts

A

Tx:

• Lens extraction and intraocular lens implant surgery

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19
Q

Classification of diabetic retinopathy

A

Background - microaneurysms, blot hemorrhages <3, hard exudates

Pre-proliferative - cotton wool spots, >3 blot hem, cluster hemorrhages

Proliferative - Fibrous tissue anterior to retinal disc, retinal neovascularisation

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20
Q

Tx of diabetic retinopathy

A

Tx:
• Preproliferative - Laser photocoagulation
• Proliferative - Anti VEGF injection
• Glycemic control, lower BP, lower lipids

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21
Q

S&S of HTN retinopathy

A 
S&amp;S:
	• Headache
	• +/- visual disturbance
	• Underlying causes may be present eg pain
BP >200/130
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22
Q

Tx of HTN retinopathy

A

Management:
• Use oral therapy with short half life so you can monitor the drop in BP without taking ages
• Reduce BP by not more than 25% to avoid stroke risk

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23
Q

Optic neuritis S&S

A 
S&amp;S:
	• Unilateral decrease in visual acuity over hours or days
	• Red desaturation
	• Pain worse on eye movement
	• Central scotoma (blindness)
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24
Q

Causes of optic neuritis

A

Causes:
• MS
• Diabetes
• Syphilis

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25
Q

Patho of stye and tx

A

Infection of glands of eyelids

Tx:
• Hot compress
• Analgesia
• Abx if associated conjunctivitis

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26
Q

Differentials of sudden painless loss of vision. S&S of each

A

Central retinal artery occlusion:
• Sudden painless loss of vision
• Cherry red spot on a pale retina

Central retinal vein occlusion:
• Causes - glaucoma, polycythemia, HTN
• Severe retinal hemorrhages on fundoscopy

Retinal detachment:
• Flashes of light
• Floaters
• Curtain being drawn, tunnel vision to central vision.

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27
Q

Blepharitis patho and S&S and tx

A

Inflammation of eyelid margins

S&amp;S:
	• Bilateral
	• Discomfort around eyelid margins
	• Eyes sticky in morning
	• Eyelid margins red
	• Secondary conjunctivitis may occur

Tx:
• Hot compresses
• Mechanical removal of debris from lid margins with cotton wool buds dipped in hot water

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28
Q

Tx of pinna haematoma

A

urgent drainage and pressure dressing

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29
Q

S&S of otitis externa

A

S&S:
• Painful discharging ear
• History of itchy ear
• Hearing muffled by discharge

30
Q

Tx of otitis externa

A

Tx:
• Topical eardrops empirically - gentamicin
• Swab discharge in resistant cases
• Microsuction of pus to enable drops to get to source

31
Q

Acute otitis media S&S

A

S&S:
• Ear pain - due to Increased pressure
• Discharge - if tymp membrane ruptures. Pain settles
• Fever

32
Q

Tx of acute otitis media

A 
Tx:
	• Most managed with analgesia
	• Medical - abx prescribed if:
		○ Sx >4days
		○ Systemically unwell
		○ Immunocompromised
		○ <2 yrs old
		○ Perforation in tymp membrane
	• Surgery - Recurrent requires grommet
33
Q

Chronic otitis media classify

A

Divided into:
• Mucosal:
○ Active - chronic discharge through tymp perforation
○ Inactive - tymp perforation but no discharge
• Squamous - develops when keratinisied squamous cells introduced into middle ear via perforation:
○ Active - cholesteatoma
○ Inactive

34
Q

S&S of active COM

A

Active COM - S&S:
• Chronic ear discharge
• Conductive hearing loss
• Cx of temporal bone and intracranial infection

35
Q

S&S of cholesteatoma. ix

A 
Cholesteatoma S&amp;S:
	• Hearing loss
	• Foul smelling discharge
	• Invasion leads to:
		○ Vertigo
		○ Facial nerve palsy
	• Ix - Otoscopy shows attic crust
36
Q

Tx of COM

A

Tx:
• Cholesteatoma - surgery to clear
• Mucosal disease - topical abx and aural toilet

37
Q

S&S of otitis media with effusion

A

S&S:
• Middle ear effusion on otoscopy
• Conductive hearing loss - associated with speech delay and problems at school
• No pain

38
Q

Ix of OME

A

Ix:
• Tympanogram
• Pure tone audiogram - conductive hearing loss

39
Q

Tx of OME

A

`Tx:
• Self limiting in most cases
• Hearing aid
• Surgery if prolonged hearing loss - grommets

40
Q

S&S of otosclerosis. ix

A

S&S:
• Progressive hearing loss
• Tinnitus
• FHx

ix - pure tone audiogram - conductive hearing loss and carhart notch

41
Q

Causes of vertigo

A 
Central causes:
	• Stroke
	• Migraine
	• Neoplasms
	• Demyelination eg MS
	• Drugs

Peripheral causes:
• BPPV
• Menieres
• Vestibular Neuronitis

42
Q

Patho of BPPV

A

Patho - otoliths in semicircular canals causing abnormal stimulation of hair cells

43
Q

S&S of BPPV

A

S&S:

• Benign and short lasting but can be very distressing

44
Q

Ix and Tx of BPPV

A

Ix:
• Dix-hallpike test

Tx:
• Epley manoeuvre

45
Q

S&S of Menieres

A

S&S:
• Tinnitus in affected ear
• Episodic vertigo lasting minutes to hours with N&V
• Fluctuating sensorineural hearing loss which becomes permanent
• Aural fullness

46
Q

Tx of Menieres

A

Tx:
• Dietary - reduce salt, chocolate, alcohol, caffeine
• Medical:
○ Thiazide diuretics, bendrofluazide
○ Betahistine
○ Vestibular sedative, prochlorperazine, for acute attacks
• Surgical:
○ Grommet insertion
○ Dexamethasone middle ear injection
○ Endolymphatic sac decompression
○ Vestibular destruction using middle ear injection of gentamicin

47
Q

S&S of vestibular neuronitis

A

S&S:
• Severe vertigo lasting several days
• N&V
• Horizontal nystagmus

48
Q

Tx of vestibular neuronitis

A

Tx:
• Prochlorperazide during acute episode
• Vestibular rehab exercises eg cawthorne-cooksey exercises

49
Q

Explain Rinnes and webers

A

Rinne and Webers:
• Normally air conduction louder than bone
• Rinne - which sounds louder bone or air conduction:
○ Tests for conductive hearing loss
• Weber - which ear sounds louder
○ Sensorineural loss localises to good ear
○ Conductive localises to bad ear

50
Q

Causes of epistaxis

A 
Causes:
	• Local
		○ Idiopathic
		○ Trauma
		○ Iatrogenic
		○ Foreign body
		○ Inflammatory
		○ Neoplastic
	• Systemic
		○ HTN
		○ Coagulopathy
		○ Vasculopathy
51
Q

Tx of Epistaxis

A 
Tx:
	• ABCDE
	• First aid:
		○ Pinch soft part of nose
		○ Head forward
		○ Spit out blood
	• Conservative:
		○ Cautery - silver nitrate
			§ If anterior - anterior rhinoscopy
			§ If posterior - rigid endoscope
		○ Nasal packing if cautery fails
	• Surgical:
		○ Ligate or embolise vessels:
			§ Sphenopalatine
			§ External carotid last resort
52
Q

S&S of rhinosinusitis. CT changes?

A

S&S:
• Nasal congestion
• Facial pain or pressure
• Reduction in smell
• + endoscopic signs of polyps, discharge or oedema In middle meatus and/or:
○ CT changes - mucosal changes in sinus or osteomeatal complex

53
Q

Tx of acute rhinosinusitis

A

• Tx:
○ Analgesia
○ Nasal decongestants
>5 days - consider nasal steroids and oral abx

54
Q

Tx of chronic rhinosinusitis

A 
• Tx:
		○ Conservative:
			§ Nasal douching
			§ Avoid allergens
		○ Medical:
			§ Antihistamines
			§ Topical nasal steroids
			§ Oral steroids if severe
			§ Oral abx
		○ Surgery:
			§ Nasal polypectomy
Functional endoscopic sinus surgery to improve drainage
55
Q

S&S of retropharyngeal abscess

A 
S&amp;S:
	• Common in young children post URTI
	• Neck held rigid and upright
	• Systemically unwell
	• Airway compromise
	• Dysphagia
	• Widening of retropharyngeal space on lateral xray
56
Q

Tx of retropharyngeal abscess

A

Tx:
• Secure airway
• IV abx
• Surgery - incision and drainage

57
Q

Epiglottitis S&S and tx

A 
S&amp;S:
	• Rapidly progressive
	• Stridor
	• Drooling
	• Pyrexia

Tx:
• Secure airway immediately - DO NOT EXAMINE
• IV abx
• Take child to theatre immediately for intubation

58
Q

Causes of obstructive sleep anpoea

A

Causes:
• Adult - obesity
• Children - adenotonsillar hypertrophy

59
Q

Ix of obstructive sleep apnoea

A 
Ix:
	• BMI
	• TFT - ?hypothyroidism
	• CXR - ?Signs of obstructive lung disease
	• ECG - ?RV failure
	• Sleep study
60
Q

Tx of obstructive sleep apnoea

A

Tx:
• Advice - weight loss
• CPAP
• Surgery - adenotonsillectomy in children

61
Q

Tonsillitis S&S

A 
S&amp;S:
	• Pyrexia
	• Dysphagia
	• Lymphadenopathy
	• Odynophagia - pain swallowing
	• Trismus - reduced jaw movement
	• Swollen tonsils
	• Otalgia (referred ear pain)
62
Q

Tx of tonsillitis

A 
Tx:
	• Analgesia
	• Abx - Avoid Amoxicillin
	• Drainage if abscess
	• Tonsillectomy if recurrent
63
Q

S&S of H&N cancer

A 
S&amp;S:
	• Dysphonia - hoarseness
	• Dysphagia
	• Dryspnoea
	• Neck mass
	• Pain
	• Bleeding from nose or mouth
	• Nasal blockage
64
Q

Goitre differentials

A

Non neoplastic:
• Single nodule - colloid, cyst
• Multinodular goitre:
Neoplasm:
• Benign:
○ Adenoma
• Malignant:
○ Papillary adenocarcinoma - hx of irradiation
○ Follicular carcinoma - mets to bone and lungs
Medullary carcinoma - seen in MEN syndrome

65
Q

Cx of thyroid surgery

A 
Complications of thyroid surgery:
	• Post op hemorrhage
	• Airway obstruction
	• Vocal cord palsy
	• Hypocalcemia
66
Q

Sialolithiasis S&S

A

pain and swelling worse during meals

67
Q

Tx of sialolithiasis

A 
Tx:
	• Conservative:
		○ Analgesia
		○ Hydration
		○ Sialogogues
	• Endoscopy
	• Radiological removal
	• Surgery:
		○ Removal of gland
		○ Removal of stones
68
Q

Centor critera for URTI

A

Centor Criteria - LEAF:
• presence of tonsillar exudate - E
• tender anterior cervical lymphadenopathy or lymphadenitis - L
• history of fever - F
• absence of cough - A
3+ means sore throat likely due to bacteria.

69
Q

S&S of Post nasal drip and tx

A

S&S:
• Excess mucus accumulates in throat
• Chronic cough
• Bad breath

Tx - decongestants and antihistamines

70
Q

Neck lump differentials

A

Reactive lymphadenopathy - hx of local infection

Lymphoma - rubbery + painless, night sweats

Thyroid swelling - moves up on swallowing

Thyroglossal cyst - midline. Moves upwards with protrusion of tongue

Branchial cyst - mobile cyst between SCM and pharynx

Cervical rib - adult females

Carotid aneurysm - pulsatile mass, doesnt move on swallow

Z IPE (15 decks)

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