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2a. OPHTHO / ENT > Disease > Flashcards

Disease Flashcards

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1
Q

What are the main local indications and side effects of steroid eye drops?

A

Indicated - post-op cataracts, uveitis, temporal arteritis, and corneal graft (prevent rejection)
S/E: cataract, glaucoma, exacerbation of viral conjunctivitis (exclude dendritic ulcers)

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2
Q

Define glaucoma and describe how it is treated.

A

Group of diseases characterized by progressive optic neuropathy, with increased IOP.
Treatment: prostanoids 1st line, then carbonic anhydrase inhibitors / beta-blocker, then alpha agonists / parasympathomimetics

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3
Q

What is the main diagnostic medium used for eye disease?

A

Fluorescein drops

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4
Q

Name the three systemic main drugs seen that can cause effects to the eye, and name these effects.

A

Ethambuol - yellow-blue colour defects
Chloroquine - bulls eye maculopathy
Amiodarone - corneal verticulata

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5
Q

Define cataract and give some risk factors.

A

Progressive opacification of the lens. Contents are diminished and replaced with maturation of the epithelium and loss of the nucleus. Causes scattering or blockage of light
Risks - UVB, hypertension, smoking, post-op surgery, contact lenses, diabetes etc.

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6
Q

Define glaucoma, briefly describe the two main types, and name the main sign on fundoscopy.

A

Abnormal increased IOP, leading to optic disc/nerve damage. Open-angle means abnormal drainage (of aqueous humour), angle-closure means build-up of pressure acutely
Main sign: cupping (note; papilloedema is caused by ICP, while cupping is IOP)

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7
Q

Briefly describe macular degeneration, the two main types, and signs on fundoscopy.

A

Damage to the macula, most often caused by age (AMD, also ARMD). Dry (no neovascularisation) and wet (neovascularisation, mediated by VEGF).
Fundoscopy can show haemorrhage (dark spot), atrophy (dark spot surrounded by light ring), and drusen (spots of protein, lipid etc.)

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8
Q

Name the types and causes of vascular eye disease.

A

Central retinal artery/vein occlusion (CRAO/CRVO) by atherosclerosis, inflammation, thromboembolism etc.
Argyll-Robertson pupil caused by neurosyphillis, retinopathy by diabetes

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9
Q

Name the main types of eye tumour.

A 
BCC, SCC, adnexal, melanoma (mostly related to the large amount of skin around the eye)
Internal melanoma (acts and appears differently to cutaneous melanoma)
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10
Q

Describe the presentation, diagnosis, likely pathogens, and management of conjunctivitis (bacterial and viral).

A

Acute, red eye. Mucopurulent discharge (bacterial) or profuse watery discharge (viral), Hutchison’s sign (nose lesions, viral)Diagnosis is usually in GP by swab.
Bacterial: (neonate: neisseria gonorrhoeae, chlamydia); staph/strep etc., pseudomonas
Viral: adenovirus, herpes (zoster, simplex)
Management: chloramphenicol (4/d), gentamycin (pseudomonas), fusidic acid (s aureus), ganciclovir (viral), oxytetracycline (chlamydial)

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11
Q

What is keratitis? Describe the key signs and treatment.

A

Infection of the cornea (not subtle, usually avascular). Hypopyon may develop, dendritic ulcers if viral.
Fluoroscein drops used to diagnose, or scraping and culture.
Avoid steroids (risk of melting); drops needed to sterilize the surface.

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12
Q

Name the two types of cellulitis pertinent to the eye. Describe the associated symptoms and signs and possible treatments.

A

Preseptal (blockage of glands in the eyelid), orbital (painful eye movement, proptosis, may be sight threatening)
Symptoms/signs: pain on eye movement, double vision, inability to open eye, paranasal sinusitis (needs CT)
Broad-spec abx, ENT drainage if sinuses involved.

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13
Q

What is endophthalmitis? How does it usually arise? How is it treated?

A

Infection of the whole eyeball which can devastate it within 24h. Most are post-surgical (careful air management and post-op iodine covered abx should be given as preventative). Sample take from the vitreous and abx are given intravitreously.

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14
Q

Describe the MOA and side effects of chloramphenicol.

A

Inhibits peptidyl transferase, stopping bacterial protein being made. S/E include allergy, aplastic anaemia (very, very rare) and grey baby syndrome.

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15
Q

Describe the main features and management of orbital blow-out fracture.

A

Clinical signs - emphysema, paraesthesia, limitation of eye movement, enophthalmos
Give local anaesthetic (drops; lidocaine or amethocaine) to observe the upper eyelid
Most do not need surgery as swelling resorbs, but take CT to assess potential eye content herniation

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16
Q

How should foreign bodies be treated in the eye?

A

Slit lamp -> anaesthetic -> CT/Xray -> needle scrape/scoop, followed by chloramphenicol. Burr for iron contents

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17
Q

How should lacerations be treated in the eye?

A

Apposition and suture. Always attempt to repair bilateral damaged canaliculi

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18
Q

How should uveitis be treated?

A

Steroid drops, dilatory drops. Observe for raised IOP.

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19
Q

What are the four golden rules of ocular trauma management?

A
  1. take a good history, visual acuity (medico-legal), and use fluorescein
  2. handle (suspected/) globe rupture with care (USS/MRI), avoid pressure
  3. with foreign bodies, always X-ray/CT
  4. irrigate chemical injuries (remove lime/cement)
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20
Q

Describe the fundoscopy signs of pathological myopia. What are the dimensions required for diagnosis?

A

Irregular shaped disc, progressive atrophy, Fuchs spot (macular haemorrhage) and lacquer cracks (seperation of retinal layers). >26mm axial length, >-8.00 spherical equivalent

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21
Q

Describe the key features of central serous (chorio-)retinopathy.

A

Stress + poor pump function causes fluid to leak out of the hypervascular hyperpermeable choroid causes fluid/blood to accumulate between the ILM (internal limiting membrane) and choroid
Typically male, 30-50 years
3-4month observation, stress reduction (80-90% spontaneous reduction)
(verteporfin 693nm laser can be used after this)

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22
Q

What is posterior vitreous detachment (PVD)? What are the two main types?

A

Solidifying of vitreous (normal with age) can pull the retina forward. If a retinal tear occurs this is referred to as rhegmatomatous (otherwise non-).

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23
Q

What are the two main pathological signs found on Amsler grid examination? What do they indicate?

A

Metamorphopsia - macular pathology (e.g. traction)

Scotoma (aka blind spot) - lack of ganglia (e.g. ARMD)

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24
Q

Briefly describe the three associated conditions of PVD.

A

Epiretinal membrane - decreased acuity, retinal striae, metamorphopsia
Vitreomacular traction - accumulation of fluid around macula as vitreous pulls it. Vitrectomy - never causes blindness
Macular hole - tear caused by vitreous pulling. If symptomatic give vitrectomy and keep patient prone 1-3days

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25
What are the four main causes of sudden visual loss?
ABCD - ARMD, bleed, closed-angle glaucoma, detachment ARMD - rapid central visual loss; painless. Metamorphopsia and scotoma Bleed - especially with Virchow's. pale if CRAO, dark if CRVO. others include ION, temporal arteritis, vitreous haemorrhage close-angle glaucoma: painful acute red eye, nausea, vomiting etc. drops/oral meds to reduce IOP. detachment: painless, flashers/floaters
26
What are the five main causes of gradual visual loss?
ABCDG - ARMD, 'blur', cataract, diabetes, glaucoma Dry ARMD - atrophy, drusen, haemorrhage. no treatment blur - refractive error, astigmatism cataract - replacement of contents, loss of lens nuclei. cloudy lens with difficulty seeing in night or bright light. if symptomatic - intraocular lens replacement. glaucoma - open-angle. cupping (larger -> more damage). central vision preserved, deterioration in peripheral vision
27
Describe CN III palsy and inter-nuclear ophthalmoplegia (CN III and VI).
down and out, with ptosis and mydriasis (loss of LPS and constrictor pupillae muscles, respectively) ino - nystagmus in abduction
28
Describe CN IV palsy.
cannot depress in adduction. eye is up and medial (loss of superior oblique)
29
Describe CN VI palsy.
eye turns medially, cannot abduct (hence name of nerve, abducens). patients turn head to compensate.
30
Describe how herpes simplex viruses differ, and link this to how they cause latent infection.
HSV-1 (oral infection); HSV-2 (genital infection). HSV-1 -> infects the sensory ganglion of the trigeminal nerve by retrograde travel HSV-2 -> infects the sacral ganglia by retrograde travel
31
Give the spectrum of herpes simplex virus presentation.
Oral - lesions ('cold sores'). Primary gingivostomatitis. Herpetic keratitis, encephalitis --------- Fingers - herpetic whitlow. Can be associated with dentistry, anaesthetics
32
Give the diagnosis and management options for herpes simplex virus.
PCR taken for new mucosal/cutaneous lesions, or if recurrent, is the diagnostic test of choice. Tzanck smear with Wright's stain is less specific, showing multinucleated giant cells -------------------- In those with primary gingivostomatitis, presenting within 72 hrs, antivirals are recommended (acyclovir, famciclovir, valaciclovir)
33
Apart from HSV and aphthous ulcers, name the main causes of oral ulceration and the main pathogen responsible.
Coxsackie A virus - herpangina, hand-foot-and-mouth disease | Treponema pallidium - syphillis (painless ulceration, requires IM insulin to prevent progression)
34
Recurrent aphthous ulcers should raise suspicion of which autoimmune diseases?
Coeliac's, IBD SLE, reactive arthritis (Reiter's) Acute HIV, neutropenia of any cause, methotrexate
35
What are the primary diagnostic signs for Behcet's disease?
Recurrent oral ulcers (i.e. >3/year), + 2 of - eye lesions - skin lesions - genital ulcers - +ve pathergy test (e.g. arthritis)
36
Give the key considerations for throat infection, including - when to refer as an emergency - when to refer urgently - how to treat - when to perform tonsilitis
emergency: stridor, clinical dehydration, or a life threatening condition (e.g. acute epiglottitis, Kawasaki) urgent: suspected cancer, HIV treat: paracetamol/ibuprofen, very rarely non-viral - tonsilectomy: >7/year, >5/year over 2yr, >3/year over 3yr
37
Describe the two scoring systems used to guide probability of a tonsilitis being bacterial rather than viral.
``` Centor score: - tonsilar exudate - tender anterior cervical lymph nodes - hx of fever - lack of cough/coryza FeverPAIN score: - fever - purulence - attended <3 days - inflamed tonsils - no cough/coryza ```
38
Give an overview of agranulocytosis.
Neutropenia, which is associated with DMARDs, carbimazole (thyroid disease), and other conditions (leukemia, aplastic anaemia, immunosuppression) Patients should be advised to report to GP if throat infection arises Conduct a FBC and withhold the offending drug until the results have returned.
39
Give an overview of diphtheria.
Caused by corynebacterium diphtheriae. Grey psuedomembrane develops causing a sore throat, lymphadenopathy, fever, and/or myocarditis If early, treat with antitoxin If late, treat with IV erythromycin or procaine penicillin; then, when oral intake possible, give oral penicillin V
40
Regarding infectious mononucleosis (aka glandular fever), describe the classic triad of symptoms, diagnosis, and aspects of management.
Caused by Epstein-Barr virus (EBV). - fever, pharyngitis, lymphadenopathy (with atypical lymphocytes) - (other symptoms: hepatitis/jaundice, rash, palatal petechiae, splenomegaly) - diagnosis preferred with heterophile antibodies (e.g. Paul-Bunnel (sheep RBCs), Monospot (horse RBCs) - other diagnostic options: IgM, IgG VCA, EBNA - treatment is non-specific (bedrest, paracetamol) but due to RISK OF SPLENIC RUPTURE, SPORT MUST BE AVOIDED FOR 6 WEEKS
41
Describe the key management of otitis externa and media.
Externa (redness, itch, pain, discharge) treated with thorough cleaning. If not responsive send swab to micro and treat with clotrimazole/canesten - bacterial: neomycin, gentamycin, polymixin B, framycetin - fungal: clotrimazole, nystatin If externa worsens, systemic/topical antibiotics may be required, +/- wicks/dressings ---------------- Media (usually viral) resolves in 4days for 80%, so usually watch-and-wait. If effusion present take swab. Treat with amoxicillin (clarithromycin if allergic) if under 2yrs and bilateral, or if TM bulging
42
What is the main cause of necrotizing otitis? In which group of patients is this most likely? What is the diagnosis?
P aeruginosa Diabetics/those with HIV Plasma viscosity/CRP, imaging, biopsy and culture
43
Define AOM and OME, and describe how they should be treated.
AOM - inflammation of middle ear with symptoms of acute inflammation OME - no signs of acute inflammation Tx - Usually transient (review 3/12). If recurrent, consider grommets and/or adenoidectomy (especially if nasal disease is involved)
44
Describe the pathology, risks, and treatment of cholesteatoma of the ear.
Keratin (dead skin cells) build up and are trapped in the ear, allowing a growth medium for bacteria Risks: - medial spread (tinnitus, vertigo, facial palsy) - superior spread (meningitis, abscess) - posterior spread (venous sinus thrombosis) Treatment: excise and reconstruct
45
What is otosclerosis? How should it be treated?
Genetic cause of gradual constructive hearing loss, forms bone/cartilage on TM - treat with fixation of the stapes, or stapoidectomy
46
What are the main causes of conductive and sensorineural hearing loss?
Conductive - otitis externa, media, perforation of TM, cholesteatoma, otosclerosis Sensorineural - prebycusis, drugs (gentamicin, chemotherapy (cisplatin, vinchristine), overdose of NSAIDs), vestibular schwannoma, skull fracture
47
Dizziness is caused by inputs to central pathways, which impact in two main reflexes. What are the inputs and reflexes?
Inputs: Cardiovascular (arrythmia, postural hypotension) Neurological (stress, migraine, SOL, MS) Vestibular (BPPV, Meniere's, vestibular neuritis) Other (visual, DM, arthritis) ---------- Outputs: - vestibulo-ocular reflex (test with nystagmus) - vestibulospinal tract (via dynamic, static, and tonic reflexes)
48
What are the five key investigations to narrow down causes of vertigo?
``` otoscopy neurological exam blood pressure (including postural) balance screen pure tone audiometry ```
49
The four main causes of vestibular vertigo are BPPV, Meniere's, vestibular neuritis/labyrinthitis, and migraine-associated vertigo. Describe briefly the pathology, how they are differentiated, and management.
Differentiated by time of spells. (seconds, hours, days, variable) - BPPV: otoconia displace from the utricle with specific movements. Dix-Hallpike test diagnostic -> Epley manouvres - Meniere's: endolymphatic hydrops (high pressure) with aural fullness. supportive (reduce salt, caffeine, alcohol, stress) - Vestibular neuritis / labyrinthitis (former -vertigo, nausea, vomiting; latter - vertigo + hearing loss, tinnitus). self-limiting, rule of 3 (3 days bed, 3 weeks off work, 3 months recovery) - migraine: triptans acutely, propranolol/ amitriptyline prophylaxis
50
When should nasal fracture be reviewed in ENT clinic?
5-7 days after the fracture
51
Describe the management of epistaxis.
1. First aid (external pressure to nose, ice, cautery, and nasal packing (e.g. rapid rhino pack)). 2. Resus on arrival if needed with local anaesthetic (adrenaline, lignocaine), then clot suction / nose blowing. 3. If unresponsive, consider arterial ligation (90% will be the sphenopalatine artery) 4. Pre-surgery management: tranexamic acid, reversal of anticoagulation, platelet transfusion, treatment of hypertension etc.
52
Describe the borders and contents of the three trauma zones of the neck.
Zone 1 - sternal notch to cricoid cartilage - trachea, oesophagus, thyroid, great vessels of the neck, and spinal cord Zone 2 - cricoid cartilage to angle of mandible - larynx, hypopharynx, CN X - XII, carotid arteries, internal jugular vein, spinal cord Zone 3 - superior to angle of mandible - pharynx, cranial nerves, carotids, IJV, spinal cord
53
Describe the immediate examination and investigation of neck trauma.
1. Examination: ABCDE, inspection (does the trauma pass through the platysma? which neck zone? injuries or bleeding present?) 2. Investigations: CXR (subcutaneous emphysema, pneumothorax), CT angiogram, urgent exploration
54
What are the signs of deep neck space infection? What are the main deep neck spaces? What is the management of deep neck space infection?
- febrile, trismus (inability to open mouth fully), red tender neck, restriction of movement - retropharyngeal, parapharyngeal, prevertebral - IV access, blood/fluid resus, IV antibiotics (co-amoxiclav, or clindamycin if allergic)
55
What are the main differences between the child and the adult airway? What are the two terms used to describe harsh inspiratory effort?
``` children have: - large heads, small nares, larger tongue, and weaker neck muscles - they are obligate nasal breathers terms for harsh inspiration: - stridor: high pitched - stertor: sonorous (snoring) ```
56
Describe the monitoring and treatment of airway obstruction.
Triad of observation (appearance, work of breathing, circulation - especially capillary refill in children) 1. Pre-endoscopy, give local anaesthetic (fluvorane) or IV anaesthetic (propofol, remifentanil) 2. ABCDE approach, heliox (80 He/20 O2), then - nebulised budesonide (2mg) - dexamethasone (0.15 - 0.6 mg/kg) - nebulized adrenaline (5ml, 1:10,000) 3. Secure the airway with a definitive airway (endotracheal tube, ET, or tracheostomy).
57
What is the divine proportion of facial symmetry? Give the aesthetic ladder of treatment and give key indications related to rhinoplasty and otoplasty.
- divine proportion = 1.612 - anaesthetic ladder: healing by secondary intervention (e.g. watch-wait), facelift, skin rejuvination, blepharoplasty, fillers, then botox. - rhinoplasty: ensure no recent changes to mental health - otoplasty (pinning ears back): consider the 1-2-3 technique; 1cm from top of pinna to mastoid, 2cm from tragus to mastoid, and 30 deg between pinna and mastoid.
58
Describe the classification of rhinitis (e.g. non-infective, infective causes) and give key considerations/treatment.
Non-infective -> allergic / non-allergic - allergic (persistent (dog, cat, house dust mites), or intermittent (tree, grass pollen, fungal spores) - non-allergic (vasomotor -> anticholinergics), (polyps -> oral, then topical, steroids) Infective -> rhinosinusitis (98% are viral) - treat with analgesia/decongestants, then progress to antibiotics. emergency referral for orbital cellulitis
59
What are the 4 S's of rhinitis, and what is the initial management of allergic rhinitis?
Stuffy, sore, snot, smell (e.g. blockage, pain, discharge, change to sense of smell) -> allergen avoidance (e.g. pillow cover for HDMs), then antihistamines, topical steroids, then both
60
Describe the WHO pain ladder, and define/describe adjuvant therapy.
1. Paracetamol/NSAIDs -> 2. Mild opioid (codeine) -> 3. Severe opioid (morphine sulfate). Adjuvants may be used at any stage of the ladder. These are drugs used that aren't for the primary intention of pain relief. - anticonvulsants: pregablin, gabapentin - antidepressants: amitriptyline, duloxetine.
61
Name and describe the most common neoplasms of the parotid salivary gland.
Pleomorphic adenoma (most common) - slow growing, low risk of malignant transformation (carcinoma ex pleomorphic adenoma). Chondromyxoid stroma is pathognomonic Warthin tumour - oncocytic epithelium, lymphoid stroma, germinal centres, cystic areas, papillary projections. Rarer - mucoepidermoid carcinoma, adenoid cystic carcinoma
62
What are the two main side effects of eardrop application?
Dizziness (occurs when drops are not same as room temperature) Ototoxicity (aminoglycosides). Risk of infection must be > than risk of hearing loss from drugs
63
Give the terms for short-sightedness and long sightedness and the lenses used to correct them.
Short; myopia, diverging | Long; hyperopia, converging

2a. OPHTHO / ENT (3 decks)

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