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Holibobs Revision of all Semester 1 (yr 2) diseases > ENT > Flashcards

ENT Flashcards

1
Q

Blatchford bleeding score is for what

A

Calculating Upper GI bleeding risk

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2
Q

Both corneal ulcers and corneal abrasions have the same symptoms, except an ulcer goes deeper/ is an open sore and therefore abrasions are much much milder in comparison. What are the symptoms?

A

Pain
Photophobia
Visual acuity

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3
Q

Meaning of this discharge:
Purulent
Vs
Watery/clear

A

Purulent = bacterial infection
Watery/clear = viral infection

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4
Q

What is a corneal ulcer?

A

Open sore of infection / ulcer of the cornea

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5
Q

Investigation for corneal ulcer

A

Causes green uptake at epithelial damage/defect following fluorescent drops under cobalt blue light

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6
Q

Treat corneal ulcer how? (2)

A

Based on infection:
Antivirals
Antibiotics
Antifungals

Also treat systemic symptoms with what?
Antiemetics
Analgesia- topical or oral

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7
Q

Complication of corneal ulcer?

A

Complete vision loss

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8
Q

What’s keratitis?

A

Inflammation of the cornea
Common in contact lens wearer

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9
Q

Why vision loss in glaucoma?

A

Optic nerve becomes damaged due to fluid build up, leading to pressure build up

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10
Q

What does aqueous humour do?

A

Provide nutrients to the cornea

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11
Q

Where does the aqueous humour travel in bullet points, from the posterior chamber and around the iris?

A

1) anterior chamber
2) trabecular meshwork
3) canal of schlemm

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12
Q

First line treatment for glaucoma?

A

Prostaglandin analogue eye drops like latanoprost
Which increases outflow of aqueous humour

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13
Q

Why might you give beta blockers in glaucoma?

A

They reduce production of aqueous humour

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14
Q

What surgery for glaucoma if all else fails?

A

Trabeculectomy surgery

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15
Q

How does glaucoma present?

A

Severely painful red eye
Halos around lights

Also associated with headache and nausea
Looks red, feels hard, can’t really see

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16
Q

First thing to do for someone with acute glaucoma?

A

Lie them down with no pillow

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17
Q

First med pre hospital to give for glaucoma?

A

Pilocarpine eye drops (muscarininc receptor) that causes pupil to constrict for more space)

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18
Q

What’s uveitis?

A

Inflammation of the uvea of the eye

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19
Q

What is the uvea made of (3)

A

Iris
Ciliary body
Choroid

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20
Q

What does uveitis occur? / why would your uvea of the eye, become inflamed.

A

Usually autoimmune
But
Can also be: trauma and infection

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21
Q

Symptoms of uveitis?

A

Red
Pain
Photophobia
And
Excessive lacrimation

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22
Q

Risk factors for uveitis? And give example

A

Anything inflammatory
Arthritis, sarcoidosis, IBD

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23
Q

How to treat uveitis? (2)

A

Steroid eye drops
And
Cycloplegics

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24
Q

What do cycloplegics do?

A

Act on ciliary muscles- paralyses them, dilates pupil

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25
Q

If bacterial conjunctivitis, what time of day are symptoms worse?

A

Morning when eyes stick together

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26
Q

Pain vision loss and photophobia: which red eye condition couldn’t this be?

A

Conjunctivitis

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27
Q

Symptoms of conjunctivitis? (3)

A

Red/pink eye
Gritty/itchy
Discharge (which might give blurry vision)

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28
Q

If there’s no vision loss with conjunctivitis, why might there be blurry vision?

A

Discharge might cause it

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29
Q

treatment of conjunctivitis?

A

self resolves, but can clean out.
however if due to allergy, use antihistamine or mast cell stabiliser

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30
Q

when would you have an urgent referral for conjunctivitis?

A

if it occurs under one month old, because it could be a gonococcal infection

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31
Q

pathology of stye?

A

infection of glands on eyelid near base of eyelashes (usually meibomian glands)

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32
Q

purpose of meibomian glands

A

secrete oil for your tears I’m pretty sure

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33
Q

treat stye how

A

maybe analgesia recommended

topical antibiotics e.g. chloramphenicol eye drops

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34
Q

how do we treat acute angle closure glaucoma (3)

A

Lie down
Pilocarpine- works on muscarinic receptors so pupil constricts therefore more space
Beta blockers like timolol

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35
Q

Why beta blockers like timolol in treating acute angle closure glaucoma?

A

Timolol reduces aqueous humour production

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36
Q

Corneal abrasion caused by chemicals- what treatment?

A

immediate irrigation

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37
Q

Red eye, loss of visual acuity, and photophobia.

Daughter was ‘helping’ mother put on makeup. What’s wrong?

A

corneal abrasion.

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38
Q

would you get photophobia with a corneal abrasion?

A

yes

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39
Q

Red eye, loss of visual acuity, and photophobia.

Daughter was ‘helping’ mother put on makeup.
Then the patient say’s it’s bilateral. What condition, that originally seemed very likely, now seems less likely?

A

corneal abrasion, just cuz of the chances of it being bilateral

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40
Q

Manage corneal abrasion how?

A

remove foreign bodies
simple analgesia
lubricating eye drops (carbomer)

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41
Q

diagnose corneal abrasion how?

A

fluorescein stain which highlights under blue light (though also collects in ulcers)

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42
Q

pathology of orbital cellulitis?

A

infection of muscles and fat of the orbit

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43
Q

usual cause of pathology of orbital cellulitis?

A

usually bacterial, source > from the sinuses.

44
Q

pain with eye movement
proptosis
vision change
fever
reduced eye movement, swelling

What is this?

A

orbital cellulitis

45
Q

You initially suspected orbital cellulitis, but now there are red flag symptoms, i.e. meningeal signs, and a couple others. What are these?

A

meningeal: neck stiffness, altered mental state.

altered colour vision
nausea/vomiting
abnormal pupil reaction

46
Q

you kinda do the whole shebang of investigations for orbital cellulitis. When would you include a lumbar puncture?

A

if meningeal signs also
e.g. neck stiffness, altered mental state.

47
Q

Treatment for orbital cellulitis

A

immediate admission for IV antibiotics for 7-10 days

48
Q

what does having ‘cataracts’ actually mean?

A

lens go cloudy because proteins in the lens break down, start clumping together

49
Q

what 2 conditions can cataracts hide?

A

diabetic retinopathy
macular degeneration

NB diabetes is a risk factor for cataracts

50
Q

Horner’s: there is a lesion on the sympathetic chain supplying what?

A

the eye

51
Q

why does the eye constrict in Horners?

A

It’s disruption in sympathetic innervation. So it constricts because we’ve lost dilator pupillae

52
Q

Why droopy eyelid in horners? The LPS is innervated by the oculomotor nerve, which is parasympathetic. (all cranial nerves are parasympathetic).

A

because we’ve got loss of muscles that help LPS

53
Q

what’s the name of the eyedrop you give in investigation for Horner’s, that reverses constriction by working on alpha 2 agonist receptors?

A

apraclonidine

54
Q

Is the vision loss that age related macular degeneration causes, bilateral or unilateral?

A

often just unilateral

55
Q

what is the pathology of age related macular degeneration

A

progressive condition of affecting the macula, where loads of drussen (yellow protein deposits) are found in the macula.

56
Q

what’s the macula

A

part of retina found back of the eye that’s important for high definition colour vision in the centre

57
Q

wet vs dry macular degeneration

A

wet (10%) = new vessels develop and grow into the retina, and can leak fluid or blood, causing faster vision loss

58
Q

treatment for WET macula degeneration

A

ranibizumab (anti-VEGF)

anti vascular endothelial growth factor lol

59
Q

what three investigations/tests do you do for age related macular degeneration?

A

1) drussen is seen in fundoscopy
2) amsler grid test causes distortion of straight lines in AMD
3) snellen chart for visual acuity

60
Q

sudden painless loss of vision is a red flag symptom of what

A

ischaemic optic neuropathy

often due to giant cell arteritis

61
Q

Tonsilitis is usually viral, but if it’s not viral, then what bacteria

A

strep A

62
Q

When do you give antibiotics like penicillin or clarithromycin for tonsilitis

A

when centor score is above 3

63
Q

what’s the centor score

A

used to assess likelihood sore throat or even like tonsilitis, is due to bacteria.

64
Q

What treatment for tonsilitis

A

safety net and paracetamol

65
Q

Optic neuritis treatment

A

It may go away on its own after a few weeks if no other conditions, but: give high dose of IV steroids. as urgent input.

66
Q

Diagnose optic neuritis how

A

MRI scan of the brain
can see relevant afferent pupillary defect
and other symptoms

67
Q

optic neuritis is central or peripheral vision loss

A

vision loss starts in the centre

68
Q

two biggest bacterial causes of otitis externa

A

1) pseudomonas aeruginosa
2) staphylococcus aureus

69
Q

treatment of otitis externa- mild vs severe

A

acetic acid (which is antibacterial AND anti-fungal)

if moderate:
topical antibiotic and steroid

if severe: oral antibiotics, maybe IV and admission to see extent of infection

70
Q

which bacteria is often cause of swimmers ear/otitis externa, but is also seen colonising lungs of patients with cystic fibrosis?

A

pseudomonas aeruginosa

71
Q

ear pain
itchiness
maybe conductive hearing loss
discharge
swimmer

A

otitis externa

72
Q

which symptoms accompanying otitis externa suggests it’s become ‘malignant’?

A

headache
severe pain
and
fever

73
Q

pathology of ‘malignant’ otitis externa

A

infection has spread to temporal bone

74
Q

management of malignant otitis externa

A

admission
antibiotics
imaging e.g. CT or MRI

75
Q

A fractured cribriform plate can lead to leakage of CSF how?

A

Because of penetration of meningeal linings of the brain, therefore meningitis, encephalitis, cerebral abscess etc.

76
Q

Correct order of management of epistaxis

A

nasal packs
nasal cautery- silver nitrate sticks
naseptin nasal cream like neomycin, 4 times daily

77
Q

what hypersensitivity reaction would be present in allergic rhinitis?

A

IgE mediated type 1 hypersensitivity reaction

78
Q

for allergic rhinitis, obvs give antihistamine. What is the other treatment possible?

A

nasal corticosteroid spray like fluticasone or beclomethasone.

79
Q

mastoiditis is common in children under the age of what

A

two years

80
Q

mastoiditis is usually secondary to what

A

bacterial infection usually streptococcus pneumoniae

81
Q

what’s the 4 step pathological pathway of mastoiditis?

A

exudate collects
increase in pressure
therefore bone necrosis
therefore abscess cavity

82
Q

bulging behind the ear, and systemic upset such as- irritability, fever, lethargy, diarrhoea, headache, vertigo, hearing loss, otorrhoea.

what is this likely to be

A

mastoiditis

83
Q

how do we diagnose mastoiditis

A

history of bacterial infection
hearing loss
+ non specific systems
+ actually seeing a bulge

84
Q

First initial management of mastoiditis? (4)

A

ABCDE

nil by mouth in case we need to do something

analgesia

SEPSIS 6 with broad spectrum antibiotics

85
Q

Your sepsis 6 management with broad spectrum antibiotics isn’t working in the patient with mastoiditis. What should you do next?

A

Give IV antibiotics

then potentially mastoidectomy with purulent middle ear fluid sent to microbiology.

86
Q

Glue ear/otitis media with effusion management

A

grommet

87
Q

why would you see discharge in otitis media?

A

Because tympanic membrane has perforated

88
Q

why would you ever give antibiotics in otitis media? And what would it be?

A

If maybe bilateral, or immunocompromised. Consider delayed prescription.

5 days amoxicillin or erythromycin or clarithromycin

88
Q

hearing loss
tinnitus
acute onset vertigo

what disease is this

A

labyrinthitis

89
Q

labyrinthitis is a ‘peripheral cause of vertigo’. What is actually infected?

A

petrous part of the temporal bone

90
Q

how to diagnose labyrinthitis?

A

exclude other causes of vertigo and look at clinical conditions

91
Q

symptom difference between labyrinthitis and vestibular neuronitis

A

labyrinthitis has tinnitus, so like ‘hearing problems’ as well. the same management

92
Q

what do we do in acute labyrinthitis? First step

A

3 days of tryna suppress chemoreceptor trigger zone with ‘prochlorperazine’

and treat underlying infections

93
Q

if you have meningitis, WITH hearing loss, what might have you got now?

A

labyrinthitis

94
Q

are nasal polyps bilateral or unilateral

A

bilateral. If unilateral, bad. think malignancy

95
Q

what growths are associated with chronic rhinitis, sinusitis, cystic fibrosis and asthma?

A

nasal polyps

96
Q

how should nasal polyps be treated?

A

nasal steroid drops or eventually polypectomy

97
Q

exact definition of rhinosinusitis

A

inflammation of the mucous membrane of the nose

98
Q

viral rhinosinusitis can include fever, true or false

A

true

99
Q

for treating rhinosinusitis, it can be viral or autoimmune. so treatment, as well as nasal irrigation and antihistamine, is what?

A

decongestants
and
nasal corticosteroid sprays

100
Q

method of action of phenylephrine (a decongestant)

A

causes blood vessels of the nasal mucous membrane to narrow/constrict

101
Q

why would you only use nasal sprays for 3 days

A

it can cause rebound congestion/suddenly makes things worse after 3 days

102
Q

lots of blood, thick foul smelling pus, crusting. Is this more likely in acute or chronic rhinitis

A

obviously chronic

NB infection requires culture

103
Q

how to manage stridor after ABCDE, sitting patient upright and
CT if chance of abscess/tumour (4)

A

manage with broad spectrum antibiotics

nebulised adrenaline

IV high dose steroids

High flow oxygen

104
Q

cleft lip/palate is usually picked up on what scan

A

20 week screening scan

105
Q
A

Holibobs Revision of all Semester 1 (yr 2) diseases (5 decks)

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