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Year 4 > special senses > Flashcards

special senses Flashcards

1
Q

symptoms/signs of otitis external

A
  • pain: sharp, starts in tracus, radiates to pinna
  • discharge: thick and scanty
  • irritation and itching
  • swelling
  • pre auricular enlarged nodes
  • impaired hearing if meatus is blocked
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2
Q

treatment of otitis externa

A
  • systemic analgesia+ hot pad
  • ear drops (aluminium acetate, topical antibiotics + steroids)
  • systemic antibiotics (if fever or lymphadenitis)
  • pope wick if meatus swelling
  • gentle micro suction of the ear (to remove debris)
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3
Q

complications of otitis external

A
  • facial cellulitis
  • otomycosis
  • osteomyelitis/malignant otitis externa
  • pericondritis
  • canal stenosis with hearing loss
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4
Q

risk factors in developing otitis external

A

skin conditions
instrumentation in ear canal
swimmers ear

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5
Q

pathogens responsible for otitis externa

A 
staph aureus 
aspergillus niger (fungal)
pseudomonas aeriguinosa
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6
Q

pathophysiology of glue ear/otitis media with effusion

A

blocked/narrowed eustachian tube: fluid build up in middle ear
no infection

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7
Q

symptoms of acute otitis media

A
  • deep seated pain
  • impaired hearing
  • systemic illness with fear
  • blocked feeling in the ear
  • discharge (if perforation)
  • child tugs ear
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8
Q

pathogens involved in otitis media

A

streptococcus pneumoniae

haemophilia influenzae

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9
Q

diagnosis of acute otitis media

A

inspect tympanic membrane

conductive hearing loss

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10
Q

treatment of acute otitis media

A
  • usually self limiting
  • pain relief with analgesia and hot pad
  • systemic antibiotics (ie amoxycillin)
  • antibiotic drops if perforation
  • if bulging ear drug: myringotomy
  • if perforation: myringoplasty
  • grommets (if recurrence)
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11
Q

complications of acute otitis media

A
  • mastoiditis
  • cholesteatoma
  • recurrent acute otitis media (4+ episodes in 6 months)
  • chronic suppurative otitis media (> 3m)
  • hearing loss
  • facial palsy
  • suppurative labyrinthitis
  • meningitis
  • extradural/subdural/brain abscess
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12
Q

cause of nasal obstruction

A
  • polyps
  • malignant tumours
  • septal deviation
  • foreign body
  • rhinosinusistis
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13
Q

when do you realign nose in trauma

A
  • immediately

- 5-14 days post trauma (with surgery)

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14
Q

red flags nose

A
  • unilateral nasal polyps
  • persistent nose bleeds
  • persistent glue ear
  • unilateral congestion
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15
Q

causes of septal deviation

A
  • Gradulomatosis polyangitis arteritis
  • sarcoidosis
  • infective septal haematoma
  • trauma
  • congenital
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16
Q

management of septal deviation

A

septoplasty

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17
Q

pathogens in rhino sinusitis

A
  • rhinovirus
  • influenza virus
  • parainfluenza virus
  • streptococcus pneumoniae
  • haemophilus influenza
  • staphylococcus aureus
  • moraxella catarrhalis
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18
Q

diagnosis acute rhinosinusitis

A
  • up to 4 weeks
  • purulent nasal drainage and nasal obstruction
  • facial pain pressure
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19
Q

diagnosis of chronic rhino sinusitis

A
    • 12 weeks of
      nasal obstruction, drainage, facial pain and decreases sense of smell

AND one of the following
- inflammation in sinuses (seen on imaging), purulent mucus, polyps in middle meatus

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20
Q

management of rhino sinusitis

A
  • saline nasal irrigation
  • topical nasal steroids 6 weeks
  • decongestants ‘max 10 days
  • antihistamines (if allergies)
  • sinus surgery (if does not respond to medical treatment)
  • for polyps: prednisolone + above
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21
Q

complications of sinusitis

A

brain abscess

orbital cellulitis

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22
Q

epistaxis types

A

90% anterior (Little’s area)

10% posterior (Woodruf’s plexus)

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23
Q

risk factors in developing epistaxis

A
  • trauma
  • hypertension
  • bleeding disorder
  • rhinitis
  • recent nasal surgery
  • carcinoma
  • recreational drugs
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24
Q

management of epistaxis

A
  • press cartilaginous part of the nose and head forwards for 15 min
  • nasal cautery w/ silver nitrate (one side only)
  • naseptin ointment (prescribe 1-2 weeks to keep nasal cavity free of crusts)
  • nasal packing (anterior, posterior packs and Foley catheter): must admitt for 24h + do bloods (FBC, G&S, coag profile)
  • surgery
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25
Q

red flags neck lumps

A 
persistent sore throat 
hoarseness 
dysphagia 
odynophagia 
weight loss 
fevers 
night sweat
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26
Q

differentials of midline lumps

A

dermoid cysts
thyroglossal cysts
thyroid lump
reactive lymphadenopathy

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27
Q

differentials for lateral neck lumps

A 
reactive lymphadenopathy 
branchial cyst
thyroid mass
cystic hygroma
cervical rib 
lipoma
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28
Q

lymphadenitis presentation

A
  • painful

- associated illness

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29
Q

dermoid cysts presentation

A
  • midline

- moves with skin

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30
Q

thyroglossal cyst presentation

A
  • unlikely painful
  • midline
  • moves with swallowing
  • moves on protruding tongue
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31
Q

branchial cyst presentation

A
  • possible painful
  • anterior to sternocleidomastoid (left side)
  • late childhood/early adulthood
  • slowly enlarging
  • may enlarge after RTI
  • male
  • smooth, soft, fluctuant
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32
Q

goitre/thyroid mass presentation

A
  • possible painful
  • associated symptoms (hypo/hyperthyroid)
  • moves with swallowing
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33
Q

thyroid mass differentials

A
  • follicular adenoma
  • hyperplastic nodules
  • thyroid cysts
  • carcinoma
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34
Q

red flag thyroid mass

A
  • stridor
  • unexplained hoarseness
  • thyroid nodule in a child
  • rapidly enlarging painless thyroid mass
  • enlarged cervical lymph nodes
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35
Q

pharyngeal pouch presentation

A
  • older men
  • dysphagia
  • regurgitation
  • halitosis
  • aspiration
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36
Q

risk factors for head and neck cancer

A

alcohol
smoking
HPV
betel nut chewing

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37
Q

investigations head an neck cancer

A

panendoscopy and biopsy

CT skull base to diaphragm

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38
Q

causes of swollen optic disc

A
  • raised intracranial pressure
  • space occupying lesion
  • optic neuritis
  • malignant hypertension
  • ischaemic optic neuropathy
  • central retinal vein occlusion
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39
Q

symptoms of cataracts

A
  • painless gradual loss of vision
  • glare (struggle with night vision)
  • halos around lights
  • changes in refraction
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40
Q

signs of cataracts

A
  • reduced visual acuity

- cataracts appear black against red reflex

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41
Q

risk factors for cataracts

A
  • age
  • smoking
  • UV radiation
  • elevated blood sugar levels
  • ocular conditions (uveitis, trauma, high myopia, steroids, intraocular tumours)
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42
Q

treatment of cataracts

A
  • tinted sunglasses to reduce glare
  • contrast enhancement around the house
  • magnifier for small print
  • cataract surgery (removal of the lens)
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43
Q

risk factors of age related macular degeneration

A 
age 
smoking 
obesity 
CVD 
UV radiation
FH 
hypermetropia 
female
44
Q

symptoms of ARMD

A
  • gradual loss of vision
  • blurred central vision (loss of detail, recognition of faces, reading, seeing signs)
  • metamorphopsia (distorted vision: micropsia, macropsia)
  • wet ARMD: quite a sudden loss of vision
45
Q

signs of ARMD

A
  • absent foveal reflex
  • drusen
  • areas of hypo and hyper pigmentation
  • haemorrhages can be seen in wet AMD
46
Q

treatment of ARMD

A
  • will not lose peripheral vision
  • stop smoking
  • anti VEGF injections for wet AMD (to stop it progressing)
47
Q

differentials sudden painless loss of vision

A
  • vascular occlusion
  • retinal or nitrous haemorrhage
  • retinal detachment
  • optic neuritis
48
Q

differentials sudden painful loss of vision

A
  • uveitis
  • trauma
  • temporal arteritis
  • optic neuritis
  • endophthalmitis
  • acute congestive glaucoma
49
Q

differentials gradual painless loss of vision

A
  • cataracts
  • optic atrophy
  • diabetic retinopathy
  • ARMD
  • refractive errors
50
Q

differentials gradual painful loss of vision

A
  • corneal ulceration

- chronic iridocyclitis

51
Q

symptoms of diabetic retinopathy

A
  • loss of peripheral vision (difficulty in the dark)
  • loss of visual acuity
  • blurred vision
  • loss of colour vision
  • fluctuating vision
  • floaters
52
Q

diabetic retinopathy ophthalmoscopy

A
  • micro aneurysms
  • blot and dot haemorrahge
  • hard exudate
  • cotton wool spots
  • proliferative changes ( new vessels, vitreous haemorrhage, retinal detachment)
53
Q

clinical classification of diabetic retinopathy

A

5 stages

  1. no retinopathy
  2. mild non proliferative retinopathy (micro aneurysms, dot and blot haemorrhage)
  3. moderate NPDR (as above+ progressive naemorrgas exudates
  4. severe/pre-proliferative NPDR (as above + venous changes, intraretinal microvascular anomalies)
  5. proliferative (new vessels, fibrous proliferation, vitreous haemorrhage, retinal detachment)
54
Q

management of diabetic retinopathy

A
  • screening for diabetic patients
  • hypertensive and glycemic control
  • if diabetic retinal oedema:
    • laser
    • anti VEGF injections
    • steroids (if can’t have aVEGF)
    • vitrectomy
55
Q

def glaucoma

A

chronic, progressive optic neuropathy

56
Q

different types of glaucoma

A
  • chronic open angle glaucoma (Primary open angle glaucoma, normal tension glaucoma)
  • acute angle closure glaucoma
  • developmental glaucoma
57
Q

presentation of infective conjunctivitis

A
  • red eye
  • discomfort/itch
  • discharge (watery or purulent)
  • crusting of eyelids
  • history of contact with people with red eye
  • generalised flu like symptoms in viral cases
  • mostly unilateral
58
Q

management of infective conjunctivitis

A
  • hygiene advice
  • in purulent cases; culture and sensitivity swab
  • topical antibiotics
59
Q

pathogenesis in acute bacterial conjunctivitis

A

S pneumoniae
S aureus
H influenza
Moraxella catarrhalis

60
Q

presentation of corneal ulcer

A
  • painful red eye
  • photophobia
  • decreased visual acuity
  • purulent discharge in bacterial cases
  • history of contact lens wearing, foreign material injuring the eye, facial cold sores or similar previous episodes
  • decreased corneal sensation with dendritic corneal ulcer
  • fluorescein staining reveals area of epithelial defect under cobalt blue light
61
Q

pathogens in corneal ulcers

A
  • herpes HSV
  • bacterial
  • acanthomoeba
62
Q

management of corneal ulcers

A
  • ophthalmological emergency
  • corneal scrape
  • antiviral ointment (if viral)
  • intensive antibiotic drops (if bacterial)
  • more?
63
Q

def uveitis

A

inflammation of the uveal tract (iris, ciliary body, choroid)

64
Q

presentation of uveitis

A
  • painful red eye
  • photophobia
  • history of autoimmune disease (ankylosing spondylitis, inflammatory bowel disease, sarcoidosis) or infection
  • blurred vision or floaters
  • reduced visual acuity
  • sluggish/irregular pupil
  • hazy iris (due to inflame cells)
  • ciliary/circumcorneal injction
65
Q

conditions associated with uveitis

A
  • HLAB27 gene
  • sarcoidosis
  • rheumatoid arthritis
  • MS
  • herpes zoster Infection
66
Q

management of uveitis

A

refer to ophthalmologist

  • topical steroids
  • cycloplegia and dilation drop for pain relief and synchiae formation prevention
67
Q

presentation of episcleritis

A
  • painless/dull red eye
  • localised or diffuse episcleral injection
  • non tender
  • normal vision
  • no discharge
  • associated with rheumatoid arthritis
68
Q

differentials to unilateral painful red eye

A
  • contact lens related microbial keratitis
  • acute anterior uveitis
  • acute angle closure glaucoma
  • herpes simplex keratitis
  • herpes zoster keratitis
  • scleritis
69
Q

presentation of scleritis

A
  • extremely painful red eye
  • blurred vision
  • gradual decrease in vision
  • watering and photophobia are common
  • intense injection of sclera and episcleral vessels
  • globe extremely tender
  • associated with rheumatoid arthritis
70
Q

what are the different ocular emergencies

A 
central retinal artery occlusion
orbital cellulitis 
retinal detachment 
acute angle closure glaucoma 
giant cell arthritis
71
Q

symptoms and signs of central retinal artery occlusion

A
  • sudden painless loss of vision (usually happens overnight)
  • fleeting or permanence
  • red cherry spot in macula
72
Q

management of central retinal artery occlusion

A
  • dilate arteriole
  • lower intraocular pressure
  • ocular massage
  • raise the blood CO2 (rebreathe into paper bag)
73
Q

cause of orbital cellulitis

A

usually arises form infection in ethmoid sinus (complication on sinusitis)
- staph aureus, strep pneumonia, haemophilia influenza, beta haemolytic streptococcus

74
Q

symptoms/signs of orbital cellulitis

A
  • painful, proposed eye
  • conjunctival injection
  • periorbital inflammation and swelling
  • reduced eye movement
  • possible visible loss
  • systemic pyrexia and illness
75
Q

investigations for orbital cellulitis

A
  • CT/MRI
  • optic nerve check (acuity, colour vision, RAPD)
  • bloods (FBC, WCC)
  • blood culture and swab of conjunctive
76
Q

complications of orbital cellulitis

A

brain abscess

cause blindness

77
Q

investigations for central retinal artery occlusion

A
  • vascular work up

- check for GCA in elderly

78
Q

risk factors of retinal detachment

A
  • myopia
  • FH
  • previous ocular surgery (cataracts)
  • ocular trauma
  • retinal vascular disease (diabetes)
79
Q

signs/symptoms of retinal detachment

A
  • floaters and flashing lights
  • peripheral shadow or curtain
  • tear appears reddish/pink
80
Q

investigations and management of retinal detachment

A
  • full eye exam and visual fields

- surgery

81
Q

risk factors for acute angle closure glaucoma

A
  • FH
  • hyperopia
  • age
  • female
  • diabetes or uveitis
82
Q

symptoms/signs of acute angle closure glaucoma

A
  • sudden onset of overly painful red eye
  • blurred vision
  • halos around lights
  • headache
  • nausea/vomiting
  • reduced visual acuity
  • brick red eye
  • hazy cornea
  • mid dilated fixed pupil
  • very high IOP
83
Q

management of acute angle closure glaucoma

A
  • emergency referral to ophthalmology
  • bring down IOP: IV mannitol, pilocarpine, beta blockers
  • laser iridotomy
  • prescribe phenylephrine and tropic amide long term
84
Q

signs/symptoms of giant cell arthritis

A
  • sudden painful loss of vision
  • scalp tenderness
  • jaw claudication
  • shoulder pain
  • malaise
  • headache
  • reduction in visual field
  • field defect (horizontal loss of vision)
  • swollen and haemorrhage disc with normal retina and retinal vessels)
  • tender temporal artsy
85
Q

investigations and management of GCA

A
  • ESR and CRP high
  • temporal artery biopsy
  • corticosteroids

(vision does not recover once it has been lost)

86
Q

signs/symptoms glaucoma

A

visual fields:

  • scatter visual loss
  • asymmetry between eyes
  • later: tunnel vision
optic disk:
- cupping 
- loss of disc rim $) vascular changes 
peripapillary atrophy 
- RNFL changes
87
Q

management of glaucoma

A

control IOP

maintain optic nerve

88
Q

CN III palsy presentation

A

eye ptosis
dilated, fixed pupil
‘down and out’ gaze

89
Q

CN IV palsy presentation

A

defective downward gaze (vertical diplopia)

90
Q

CN VI presentation

A

horizontal diplopia: defective abduction

91
Q

DVLA and eye problems

A

must tell if

  • retinopathy in both eyes
  • glaucoma if affects both eyes or can’t meet visual standards
  • macular degeneration (if affects both eyes)
  • optic neuritis
  • tunnel vision
  • visual field defect
  • reduced visual acuity
92
Q

sign of retinoblastoma

A

leukocoria (white glow in the eye/white pupil)

93
Q

when do you screen for retinopathy of prematurity

A
  • babies born before 31 weeks OR
  • babies weight <1500g

do it 4-7 weeks postnatal

94
Q

treatment of retinopathy of prematurity

A

laser photocoagulopathy

95
Q

causes of congenital cataracts

A
  • sporadic
  • genetic
  • chromosomal abnormalities
  • metabolic disorders
  • intrauterine infections
96
Q

causes of tinnitus

A
  • osteosclerosis
  • acoustic neuroma
  • hearing loss
  • drugs
97
Q

causes of vertigo

A
  • BPPV
  • vestibular neuronitis
  • Menieres disease
  • stroke
  • tumours
98
Q

menieures disease presentation

A

triad:

  • vertigo
  • hearing loss
  • tinnitus
  • sense of fullness in the ear
  • lasts hours
  • comes and goes
99
Q

labyrinthitis presentation

A
  • vertigo (days to weeks)
  • unilateral or bilateral hearing loss
  • profuse vomitting
  • sudden onset horizontal nystagmus
  • gait disturbances
  • preceding symptoms of resp tract infection
100
Q

presentation of cholesteastoma

A
  • chronic history of smelly discharging ear
  • no pain
  • decrease in hearing
101
Q

treatment of cholesteatoma

A

mastoidectomy

102
Q

Management of primary open angle glaucoma

A
  • First line: prostaglandin analigues eyedrop
  • Second line; beta blokcers, carbonic anhydrase inhibitors or sympathomimetic eye drops
  • If advanced: surgery or laser traient
103
Q

Presentation of optic neuritis

A
  • Unilateral loss of vision/ blurring of vision
  • pain on eye movement
  • red colour desaturation (red looks like pink)
  • Marcus Gunn pupil
  • lateral gaze palsy and ophthalmoplegia
104
Q

Investigations for optic neuritis

A
  • full eye exam + fundoscopy
  • bloods: CRP, ESR, FBC, B12, + antibodies (ANA, ANCA)
  • vision evoked potentials
105
Q

Investigations for acute angle closure glaucoma

A
  • full eye examination and funds copy
  • intraoculaire pressure
  • gonioscopy
  • slit lamp exam
  • OCT
  • Optic nerve evaluation
106
Q

Differentials of photophobia (eye and headache)

A

Meningitis
Uveitis
Scleritis
Corneal ulcer

Year 4 (13 decks)

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