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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
red flags neck lumps
``` persistent sore throat hoarseness dysphagia odynophagia weight loss fevers night sweat ```
26
differentials of midline lumps
dermoid cysts thyroglossal cysts thyroid lump reactive lymphadenopathy
27
differentials for lateral neck lumps
``` reactive lymphadenopathy branchial cyst thyroid mass cystic hygroma cervical rib lipoma ```
28
lymphadenitis presentation
- painful | - associated illness
29
dermoid cysts presentation
- midline | - moves with skin
30
thyroglossal cyst presentation
- unlikely painful - midline - moves with swallowing - moves on protruding tongue
31
branchial cyst presentation
- possible painful - anterior to sternocleidomastoid (left side) - late childhood/early adulthood - slowly enlarging - may enlarge after RTI - male - smooth, soft, fluctuant
32
goitre/thyroid mass presentation
- possible painful - associated symptoms (hypo/hyperthyroid) - moves with swallowing
33
thyroid mass differentials
- follicular adenoma - hyperplastic nodules - thyroid cysts - carcinoma
34
red flag thyroid mass
- stridor - unexplained hoarseness - thyroid nodule in a child - rapidly enlarging painless thyroid mass - enlarged cervical lymph nodes
35
pharyngeal pouch presentation
- older men - dysphagia - regurgitation - halitosis - aspiration
36
risk factors for head and neck cancer
alcohol smoking HPV betel nut chewing
37
investigations head an neck cancer
panendoscopy and biopsy | CT skull base to diaphragm
38
causes of swollen optic disc
- raised intracranial pressure - space occupying lesion - optic neuritis - malignant hypertension - ischaemic optic neuropathy - central retinal vein occlusion
39
symptoms of cataracts
- painless gradual loss of vision - glare (struggle with night vision) - halos around lights - changes in refraction
40
signs of cataracts
- reduced visual acuity | - cataracts appear black against red reflex
41
risk factors for cataracts
- age - smoking - UV radiation - elevated blood sugar levels - ocular conditions (uveitis, trauma, high myopia, steroids, intraocular tumours)
42
treatment of cataracts
- tinted sunglasses to reduce glare - contrast enhancement around the house - magnifier for small print - cataract surgery (removal of the lens)
43
risk factors of age related macular degeneration
``` age smoking obesity CVD UV radiation FH hypermetropia female ```
44
symptoms of ARMD
- 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
signs of ARMD
- absent foveal reflex - drusen - areas of hypo and hyper pigmentation - haemorrhages can be seen in wet AMD
46
treatment of ARMD
- will not lose peripheral vision - stop smoking - anti VEGF injections for wet AMD (to stop it progressing)
47
differentials sudden painless loss of vision
- vascular occlusion - retinal or nitrous haemorrhage - retinal detachment - optic neuritis
48
differentials sudden painful loss of vision
- uveitis - trauma - temporal arteritis - optic neuritis - endophthalmitis - acute congestive glaucoma
49
differentials gradual painless loss of vision
- cataracts - optic atrophy - diabetic retinopathy - ARMD - refractive errors
50
differentials gradual painful loss of vision
- corneal ulceration | - chronic iridocyclitis
51
symptoms of diabetic retinopathy
- loss of peripheral vision (difficulty in the dark) - loss of visual acuity - blurred vision - loss of colour vision - fluctuating vision - floaters
52
diabetic retinopathy ophthalmoscopy
- micro aneurysms - blot and dot haemorrahge - hard exudate - cotton wool spots - proliferative changes ( new vessels, vitreous haemorrhage, retinal detachment)
53
clinical classification of diabetic retinopathy
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
management of diabetic retinopathy
- screening for diabetic patients - hypertensive and glycemic control - if diabetic retinal oedema: - laser - anti VEGF injections - steroids (if can't have aVEGF) - vitrectomy
55
def glaucoma
chronic, progressive optic neuropathy
56
different types of glaucoma
- chronic open angle glaucoma (Primary open angle glaucoma, normal tension glaucoma) - acute angle closure glaucoma - developmental glaucoma
57
presentation of infective conjunctivitis
- 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
management of infective conjunctivitis
- hygiene advice - in purulent cases; culture and sensitivity swab - topical antibiotics
59
pathogenesis in acute bacterial conjunctivitis
S pneumoniae S aureus H influenza Moraxella catarrhalis
60
presentation of corneal ulcer
- 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
pathogens in corneal ulcers
- herpes HSV - bacterial - acanthomoeba
62
management of corneal ulcers
- ophthalmological emergency - corneal scrape - antiviral ointment (if viral) - intensive antibiotic drops (if bacterial) - more?
63
def uveitis
inflammation of the uveal tract (iris, ciliary body, choroid)
64
presentation of uveitis
- 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
conditions associated with uveitis
- HLAB27 gene - sarcoidosis - rheumatoid arthritis - MS - herpes zoster Infection
66
management of uveitis
refer to ophthalmologist - topical steroids - cycloplegia and dilation drop for pain relief and synchiae formation prevention
67
presentation of episcleritis
- painless/dull red eye - localised or diffuse episcleral injection - non tender - normal vision - no discharge - associated with rheumatoid arthritis
68
differentials to unilateral painful red eye
- contact lens related microbial keratitis - acute anterior uveitis - acute angle closure glaucoma - herpes simplex keratitis - herpes zoster keratitis - scleritis
69
presentation of scleritis
- 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
what are the different ocular emergencies
``` central retinal artery occlusion orbital cellulitis retinal detachment acute angle closure glaucoma giant cell arthritis ```
71
symptoms and signs of central retinal artery occlusion
- sudden painless loss of vision (usually happens overnight) - fleeting or permanence - red cherry spot in macula
72
management of central retinal artery occlusion
- dilate arteriole - lower intraocular pressure - ocular massage - raise the blood CO2 (rebreathe into paper bag)
73
cause of orbital cellulitis
usually arises form infection in ethmoid sinus (complication on sinusitis) - staph aureus, strep pneumonia, haemophilia influenza, beta haemolytic streptococcus
74
symptoms/signs of orbital cellulitis
- painful, proposed eye - conjunctival injection - periorbital inflammation and swelling - reduced eye movement - possible visible loss - systemic pyrexia and illness
75
investigations for orbital cellulitis
- CT/MRI - optic nerve check (acuity, colour vision, RAPD) - bloods (FBC, WCC) - blood culture and swab of conjunctive
76
complications of orbital cellulitis
brain abscess | cause blindness
77
investigations for central retinal artery occlusion
- vascular work up | - check for GCA in elderly
78
risk factors of retinal detachment
- myopia - FH - previous ocular surgery (cataracts) - ocular trauma - retinal vascular disease (diabetes)
79
signs/symptoms of retinal detachment
- floaters and flashing lights - peripheral shadow or curtain - tear appears reddish/pink
80
investigations and management of retinal detachment
- full eye exam and visual fields | - surgery
81
risk factors for acute angle closure glaucoma
- FH - hyperopia - age - female - diabetes or uveitis
82
symptoms/signs of acute angle closure glaucoma
- 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
management of acute angle closure glaucoma
- emergency referral to ophthalmology - bring down IOP: IV mannitol, pilocarpine, beta blockers - laser iridotomy - prescribe phenylephrine and tropic amide long term
84
signs/symptoms of giant cell arthritis
- 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
investigations and management of GCA
- ESR and CRP high - temporal artery biopsy - corticosteroids (vision does not recover once it has been lost)
86
signs/symptoms glaucoma
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
management of glaucoma
control IOP | maintain optic nerve
88
CN III palsy presentation
eye ptosis dilated, fixed pupil 'down and out' gaze
89
CN IV palsy presentation
defective downward gaze (vertical diplopia)
90
CN VI presentation
horizontal diplopia: defective abduction
91
DVLA and eye problems
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
sign of retinoblastoma
leukocoria (white glow in the eye/white pupil)
93
when do you screen for retinopathy of prematurity
- babies born before 31 weeks OR - babies weight <1500g do it 4-7 weeks postnatal
94
treatment of retinopathy of prematurity
laser photocoagulopathy
95
causes of congenital cataracts
- sporadic - genetic - chromosomal abnormalities - metabolic disorders - intrauterine infections
96
causes of tinnitus
- osteosclerosis - acoustic neuroma - hearing loss - drugs
97
causes of vertigo
- BPPV - vestibular neuronitis - Menieres disease - stroke - tumours
98
menieures disease presentation
triad: - vertigo - hearing loss - tinnitus - sense of fullness in the ear - lasts hours - comes and goes
99
labyrinthitis presentation
- vertigo (days to weeks) - unilateral or bilateral hearing loss - profuse vomitting - sudden onset horizontal nystagmus - gait disturbances - preceding symptoms of resp tract infection
100
presentation of cholesteastoma
- chronic history of smelly discharging ear - no pain - decrease in hearing
101
treatment of cholesteatoma
mastoidectomy
102
Management of primary open angle glaucoma
- First line: prostaglandin analigues eyedrop - Second line; beta blokcers, carbonic anhydrase inhibitors or sympathomimetic eye drops - If advanced: surgery or laser traient
103
Presentation of optic neuritis
- 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
Investigations for optic neuritis
- full eye exam + fundoscopy - bloods: CRP, ESR, FBC, B12, + antibodies (ANA, ANCA) - vision evoked potentials
105
Investigations for acute angle closure glaucoma
- full eye examination and funds copy - intraoculaire pressure - gonioscopy - slit lamp exam - OCT - Optic nerve evaluation
106
Differentials of photophobia (eye and headache)
Meningitis Uveitis Scleritis Corneal ulcer

Year 4 (13 decks)

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