Special Senses Flashcards
Causes of dry eyes
Causes:
• Excess tear loss - blepharitis, contact lens wear, drugs
• Insufficient production - sjogrens, allergic conjunctivitis
Abnormalities of eyelids and blinking - parkinsons
S&S of dry eyes
S&S:
• Gritty irritation and FB sensation
• Mild pain aggravated by reading, dry air, PC work
• Worse at end of day
Tx of dry eyes
Tx:
• Review meds
• Tear substitutes
• Avoid contact lenses where possible
Differentials of a red eye
Differentials: • Conjunctivitis • Corneal ulcer • Iritis Foreign body • Episcleritis • Scleritis • Acute angle closure glaucoma • Age related macular degeneration • Diabetic Retinopathy
S&S of conjunctivitis
S&S:
• Mucopurulent discharge on eyelashes
• Dilated red blood vessels on sclera
• Acute onset often bilateral red eyes
Tx of conjunctivitis
Tx:
• Topical chloramphenicol or topical fusidic acid
• Don’t wear contacts
• Don’t share towels
Allergic conjunctivitis S&S and tx
Allergic conjunctivitis: • Bilateral sx • Prominent itch • History of atopy • Tx - Antihistamines or sodium cromoglicate
corneal ulcer S&S
S&S: • Pain • Photophobia • Blurred vision • Sensation of foreign body • Signs - Red eye, corneal stain with fluorescein, hypopyon
Causes of corneal ulcer
Aetiology:
• Infections - herpes, streptococcus
• Contact lens wear
• Blepharitis
Tx of corneal ulcer
Tx:
• Herpes - aciclovir ointment
• Bacterial - topical abx
• Topical steroids
Tx of corneal FB
Tx:
• Topical NSAID
• Topical abx
• Tetanus ppx to prevent secondary infection if rust
• Refer if not healed in 72 hrs or worsening sx
Open angle glaucoma S&S
Open angle Glaucoma:
• Develops slowly over time, no pain
• Side vision begins to decrease followed by central
• Optic disc cupping (see pic)
Tx of closed angle glaucoma
Tx:
• Urgent admission
• Acetazolamide (reduces aqueous secretions) and topical pilocarpine (pupillary constriction)
S&S of acute angle closed glaucoma
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
Causes of homonymous Quadrantanopia
Homonymous quadrantanopia:
• Lesion of temporal lobe - superior
• Lesion of Parietal lobe - Inferior
PITS - Parietal Inferior Temporal Superior
Wet AMD tx
Anti-VEGF injection
S&S of cataracts
S&S: • Slowly progressive visual loss or blurring • Glare • Reduced colour sensitivity • Reduced night vision • Double vision • No red reflex with opthalmoscope
Tx of cataracts
Tx:
• Lens extraction and intraocular lens implant surgery
Classification of diabetic retinopathy
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
Tx of diabetic retinopathy
Tx:
• Preproliferative - Laser photocoagulation
• Proliferative - Anti VEGF injection
• Glycemic control, lower BP, lower lipids
S&S of HTN retinopathy
S&S: • Headache • +/- visual disturbance • Underlying causes may be present eg pain BP >200/130
Tx of HTN retinopathy
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
Optic neuritis S&S
S&S: • Unilateral decrease in visual acuity over hours or days • Red desaturation • Pain worse on eye movement • Central scotoma (blindness)
Causes of optic neuritis
Causes:
• MS
• Diabetes
• Syphilis
Patho of stye and tx
Infection of glands of eyelids
Tx:
• Hot compress
• Analgesia
• Abx if associated conjunctivitis
Differentials of sudden painless loss of vision. S&S of each
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.
Blepharitis patho and S&S and tx
Inflammation of eyelid margins
S&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
Tx of pinna haematoma
urgent drainage and pressure dressing
S&S of otitis externa
S&S:
• Painful discharging ear
• History of itchy ear
• Hearing muffled by discharge
Tx of otitis externa
Tx:
• Topical eardrops empirically - gentamicin
• Swab discharge in resistant cases
• Microsuction of pus to enable drops to get to source
Acute otitis media S&S
S&S:
• Ear pain - due to Increased pressure
• Discharge - if tymp membrane ruptures. Pain settles
• Fever
Tx of acute otitis media
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
Chronic otitis media classify
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
S&S of active COM
Active COM - S&S:
• Chronic ear discharge
• Conductive hearing loss
• Cx of temporal bone and intracranial infection
S&S of cholesteatoma. ix
Cholesteatoma S&S: • Hearing loss • Foul smelling discharge • Invasion leads to: ○ Vertigo ○ Facial nerve palsy • Ix - Otoscopy shows attic crust
Tx of COM
Tx:
• Cholesteatoma - surgery to clear
• Mucosal disease - topical abx and aural toilet
S&S of otitis media with effusion
S&S:
• Middle ear effusion on otoscopy
• Conductive hearing loss - associated with speech delay and problems at school
• No pain
Ix of OME
Ix:
• Tympanogram
• Pure tone audiogram - conductive hearing loss
Tx of OME
`Tx:
• Self limiting in most cases
• Hearing aid
• Surgery if prolonged hearing loss - grommets
S&S of otosclerosis. ix
S&S:
• Progressive hearing loss
• Tinnitus
• FHx
ix - pure tone audiogram - conductive hearing loss and carhart notch
Causes of vertigo
Central causes: • Stroke • Migraine • Neoplasms • Demyelination eg MS • Drugs
Peripheral causes:
• BPPV
• Menieres
• Vestibular Neuronitis
Patho of BPPV
Patho - otoliths in semicircular canals causing abnormal stimulation of hair cells
S&S of BPPV
S&S:
• Benign and short lasting but can be very distressing
Ix and Tx of BPPV
Ix:
• Dix-hallpike test
Tx:
• Epley manoeuvre
S&S of Menieres
S&S:
• Tinnitus in affected ear
• Episodic vertigo lasting minutes to hours with N&V
• Fluctuating sensorineural hearing loss which becomes permanent
• Aural fullness
Tx of Menieres
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
S&S of vestibular neuronitis
S&S:
• Severe vertigo lasting several days
• N&V
• Horizontal nystagmus
Tx of vestibular neuronitis
Tx:
• Prochlorperazide during acute episode
• Vestibular rehab exercises eg cawthorne-cooksey exercises
Explain Rinnes and webers
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
Causes of epistaxis
Causes: • Local ○ Idiopathic ○ Trauma ○ Iatrogenic ○ Foreign body ○ Inflammatory ○ Neoplastic • Systemic ○ HTN ○ Coagulopathy ○ Vasculopathy
Tx of Epistaxis
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
S&S of rhinosinusitis. CT changes?
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
Tx of acute rhinosinusitis
• Tx:
○ Analgesia
○ Nasal decongestants
>5 days - consider nasal steroids and oral abx
Tx of chronic rhinosinusitis
• 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
S&S of retropharyngeal abscess
S&S: • Common in young children post URTI • Neck held rigid and upright • Systemically unwell • Airway compromise • Dysphagia • Widening of retropharyngeal space on lateral xray
Tx of retropharyngeal abscess
Tx:
• Secure airway
• IV abx
• Surgery - incision and drainage
Epiglottitis S&S and tx
S&S: • Rapidly progressive • Stridor • Drooling • Pyrexia
Tx:
• Secure airway immediately - DO NOT EXAMINE
• IV abx
• Take child to theatre immediately for intubation
Causes of obstructive sleep anpoea
Causes:
• Adult - obesity
• Children - adenotonsillar hypertrophy
Ix of obstructive sleep apnoea
Ix: • BMI • TFT - ?hypothyroidism • CXR - ?Signs of obstructive lung disease • ECG - ?RV failure • Sleep study
Tx of obstructive sleep apnoea
Tx:
• Advice - weight loss
• CPAP
• Surgery - adenotonsillectomy in children
Tonsillitis S&S
S&S: • Pyrexia • Dysphagia • Lymphadenopathy • Odynophagia - pain swallowing • Trismus - reduced jaw movement • Swollen tonsils • Otalgia (referred ear pain)
Tx of tonsillitis
Tx: • Analgesia • Abx - Avoid Amoxicillin • Drainage if abscess • Tonsillectomy if recurrent
S&S of H&N cancer
S&S: • Dysphonia - hoarseness • Dysphagia • Dryspnoea • Neck mass • Pain • Bleeding from nose or mouth • Nasal blockage
Goitre differentials
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
Cx of thyroid surgery
Complications of thyroid surgery: • Post op hemorrhage • Airway obstruction • Vocal cord palsy • Hypocalcemia
Sialolithiasis S&S
pain and swelling worse during meals
Tx of sialolithiasis
Tx: • Conservative: ○ Analgesia ○ Hydration ○ Sialogogues • Endoscopy • Radiological removal • Surgery: ○ Removal of gland ○ Removal of stones
Centor critera for URTI
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.
S&S of Post nasal drip and tx
S&S:
• Excess mucus accumulates in throat
• Chronic cough
• Bad breath
Tx - decongestants and antihistamines
Neck lump differentials
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
