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Year 3 > ENT/Opthal > Flashcards

ENT/Opthal Flashcards

1
Q

What is vertigo?

A

The sensation that the environment is spinning around relative to oneself or vice versa

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2
Q

WHat is tinnitus?

A

Hearing noises that are not caused by sounds from outside e.g. ringing, buzzing, whooshing, humming, hissing

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3
Q

What is BPPV?

A

Peripheral vestibular disorder characterised by sudden short lived vertigo

1) idiopathic 50-70%
2) secondary to trauma, labryinthitis, vestibular neuronitis, Menieres, migraines

50-70YO
Migraine and head trauma common in younger

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4
Q

Rfs for BPPV?

A

Hx, recent head trauma, viral infection URTI, viral labryinthitis, or vestibular neuronitis, migraines, inner ear surgery and MENIERES

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5
Q

Pathophysiology of BPPV?

A

Freefloating endolymph canalith (CaCO2) particles (displaced otoconia) in the psoterior (most common) semicircular canals in inner ear

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6
Q

BPPV presentation?

A

nausea, imbalance and lightheadedness

Nystagmus

1) slow phase
2) fast phase correction

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7
Q

BPPV canals and nystagmus?

A

Posterior (common) = fatigued and torsional + weak upbeat position R side eye rotates anticlockwise in fast phase and L clockwise

Anterior = rare and torsional + vertical down beat

Lateral = less common, no fatigues and horizontal nystagmus

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8
Q

BPPV diagnosis and Mx?

A

Dix-hallpike manouevre

Supine test procedure

Repositioning manouvres or surgery in severe intractable

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9
Q

What is Menieres?

A

Episodic auditory and vestibular disease with sudden onset vertigo, hearing loss, tinnitus and sensation of fullness in the affected ear

1) idiopathic
2) secondary to inner ear pathology

epi = 40YO, 50% have FHx

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10
Q

Pathophysiology of menieres?

A

Raised endolymphatic pressure -> reissners mebrane herniation -> mixing of K+ rich endloymph and K+ low perilymph -> abnormal vestibular nerve firing = symptoms

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11
Q

Presentation of menieres?

A

Hearing loss , roaring tinnitus, sensation of fullness

+ VERTIGO

Drop attacks = sudden loss of balance, no LOC

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12
Q

IX for Menieres?

A 
\+ve rombergs
poor tandem walking
Fukuda/unterberger test (cannot hold position and turns to affected side)
audiometry
\+ exclusion MRI
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13
Q

Mx for Menieres?

A

Lifestyle = salt restriction, reduce caffeine and ETOH, smoking cessation and stress management

Diuretics to reduce endolymph volume e.g hydroclorothiazide

Sx = Vertigo = anti-emetics, e.g. antihistamine, denzo, anticholernergics, corticosteroids

Tinnitus = white noise generation, counselling. 2nd line = antidepressants

Hearing loss = cortiocsteroids + hearing devices

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14
Q

What causes opacification of lens?

A

Normal ageing, trauma, metabolic disoders, infection e.g. rubella, corticosteroids, congenital conditions

RFS: UV radiation and smoking cause progression

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15
Q

What metabolic conditions cause cataracts?

A

Wilsons, galactosaemia, myotonic dystrophy and Marfasn

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16
Q

Presentation and Ix of cataracts?

A

Gradual blurry or cldy vision, glare when night driving and decreased colour (blues)

Red relex defect by direct opthalmoscopy

Lens opacity with pupillary dilation and slit lamp exam

Vidsual acuity with eye chart

Normal intraocular pressure

17
Q

Mx for cataracts?

A

Surgery = phacoemulsification + IOL implant

Nd:YAG laser

18
Q

What is open angle glaucoma?

A

Neurodegenerative condition caused by dysfunction in aqueous humour outflow

Most common type 70%

GLC1A locus and myocilin mutations are RF

19
Q

presentation of open angle glaucoma?

A

Usually asymptomatic

CUP:disc ratio = >0.6 suspicious, >0.2 asymetry

Normal corneal thickness and gongioscopy

Raised IOP>23mmHg (goldmann tonometry)

Painless vision loss

Loss of nerve fibre layer

optic cup changes = inferior NOTCH, flame haemorrhage

20
Q

Mx for open angle glaucoma?

A

Monitoring of optic disce, retinal nerve fibre layer, visual field and IOP tracking

Topical opthalmic medication = beta blockers

Laser therapy = trabeculoplasty 1st line or 2nd to eye drop

Surgery = trabeculotomy, aqueous shunt, new microsurgery

21
Q

Causes of acute eye pain?

A

Angle closure glaucoma and anterior uveitis

ACG: inuit and asian, female, 55-65,primary or secondary to ocular disease, hyperopia

AU: children and adults, primary/idiopathic, HLA-B27 and viral ocular disease

22
Q

Presentation of CAG?

A

Blurring of vision, headache, N+V, halos around lights, redness of affected eye

23
Q

Anterior uveitis presenation?

A

Dull eye/orbit pain, photophobia, blurred vision, tearing,

Bilateral = systemic causes
IBD/arthritis, oral lesions

24
Q

CAG O/E?

A

High IOP
Corneal oedema
Fixed, dilated pupil

vascular congestion
Gonioscopy = closed angle and shallow chamber

Slit lamp = large optic cup, nerve fibre loss

25
Q

Anterior uveitis O/E?

A

Circumlimbal redness
Small, irregular pupil
Ciliary flush /conjunctival injection

Anteriro chamber WBCs and flare - hypopyon
Synechia

Granulomatous: Large, yellow KPs
Cell clusters

26
Q

Breakdown of CAG?

A

Acute = sudden pain, Nausea, bluured vision, corneal oedema, fixed dilated pupil, elevated IOP, anterior chamber angle closure on gonioscopy

Subacute = sudden but self limiting, may recur

CHronic = no symptoms, incidental with elevatedIOP and normal otpic head

27
Q

MX for Glaucoma?

A

Acute = topical carbonic anhydrase inhibitors, beta blockers, topical alpha 2 adrenergic agonists

Suergey 24-48hours : laser peripheral iridotomy +- prior anteior chamber paracentesis

28
Q

Anterior uveitis Mx?

A

acute = high dose corticosteroids

Long term = corticosteroids, injections, implants, immunosuppresives

29
Q

What is conjunctivitis?

A

Inflammation of eyeball and eyelid lining

Bacterial children > adults

Viral adlts> children
42-80% bacterial, 13-70% viral

Viral = adensovirus, HSV, EBV, VSV, molloscum, coxsackie, entervirus
bacterial - pneumococcus/S.Aureus, moraxella, haemophilus
mechanical, chemical, allergic, medication induced

30
Q

Allergic conjunctivits Px?

A

Watery mucoid dischagre + itching, often seasonal
Hx = atopic dermatitis, hay fever , asthma
Vernal conjunctivits = young asian, mediterrenian males

31
Q

Viral conjunctivitis Px?

A

Starts in one eye/ spreads
Recent URTI or infection
RED EYE + itching, burning, foreign body sensation
Watery dischargee + pre-auricular lymphadenopathy
+- cornal subepithelial infiltrates

32
Q

Bacterial conjunctivitis Px?

A

Bilaterl > unilateral

REd eye + burning or foreign body sensation
Ithcing uncommon
Papillar conjunctival reaction, eyelid matting, PURULENT discharge
+- concurrent #otitis media

33
Q

Features of chlamydia conjunctivitis?

A

3% infectious cases

Stringy or mucous discharge
Conjucntival follicles + corneal pannus
+- corneal infiltrates
PRE_AURICULAR LYMPHADENOPATHY

Becomes chronic

34
Q

Features of neisseria conjunctivitis?

A

Young, sexually active
lots of purulent discharge, eyelid swelling, chemosis
Develops 12-24 hours
+- peripheral corneal ulcers, pre-auricula lymphadenopathy

Progressises to blindness

35
Q

Conjunctivitis Mx?

A

Allergic = topical mast cell stabilisers and antihistamines

bacterial = topical Abx

Viral = symptomatic Tx

36
Q

What are thyoglossal cysts?

A

Congential fibrous cysts formed from a persistent thryoglossal duct

Infrahyoid(most common)
Suprhyoid
Juxtahyoid, inraingual

37
Q

Thyroid cysts presentation?

A

Swelling = fluctuant, moves with tongue protrusion, mobile, non tender

Infection = tender, increasing size, malaise, dysphagia, dysphonia and airway obstruction

38
Q

thyroid cysts clinical Dx?

A

USS neck = well circumscribed, anechoic mass and above thyroid

TFTs to exclude ectopic thryoids

Year 3 (38 decks)

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