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MSRA- my cards > ENT and Opthalmology > Flashcards

ENT and Opthalmology Flashcards

1
Q

How does Labyrinthitis present?

A

Horizontal nystagmus/ Vertigo/ Vomiting/ Sensioneural hearing loss/ Acute onset- may follow viral illness

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2
Q

Rinnes test- what is normal?

A

Rinnes test is when the probe is tested in front and behind ear. In normal situation AC is louder than BC

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3
Q

What is the finding in Rinnes test for conductive hearing problem?

A

Conductive hearing problem: BC> AC on affected side

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4
Q

Webers test- what is normal?

A

Webers test is normal when it is heard is the midline

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5
Q

Webers test- what happens in conductive hearing loss?

A

Webers lateralises to the bad ear.

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6
Q

Webers test- what happens in SNHL ?

A

Webers in loudest in the non affected ear (good ear)

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7
Q

What visual change do you get with acute closed angle glaucoma?

A

Unilateral peripheral visual loss

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8
Q

What drugs can cause tinnitus?

A

Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine

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9
Q

What is seen in Argll Robinson pupils?

A

Bilaterally small pupils that accommodate but don’t react to bright light. Causes include neurosyphilis and diabetes mellitus

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10
Q

What is seen in Holmes Adie?

A

Tonically dilated pupil, slowly reactive to light with more definite accommodation response. Caused by damage to parasympathetic innervation of the eye due to viral or bacterial infection. Commonly seen in females, accompanied by absent knee or ankle jerks.

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11
Q

How would an RAPD be described? eg seen in optic neuritis

A

Swinging light test- when light is shone into the eye it appears to dilate bilaterally (constricts less than normal).

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12
Q

How does otosclerosis present?

A

Conductive hearing loss/ family history and tinnitus

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13
Q

How does Retinitis Pigmentosa present?

A

Young people
Loss of peripheral vision
Loss of night time vision

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14
Q

What is the treatment of otitis externa?

A

Topical antibiotic +/- steroid ear drops

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15
Q

How does age related macular degeneration present?

A

Reduction in visual acuity (gradual/ subacute). Difficulties with night vision

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16
Q

What are the mx options for dry macular degeneration

A

Nothing

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17
Q

How does a retinal vein occlusion present?

A

Painless loss of vision and retinal haemorrhages

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18
Q

How to treat a corneal abrasion?

A

Topical antibiotic.

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19
Q

How does vitreous detatchement present?

A

Peripheral visual loss + floaters/ flashers.
Associated with HTN and diabetes

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20
Q

Drusen are seen in which eye condition?

A

Macular degeneration- in particular DRY macular degeneration

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21
Q

Treatment of herpes simplex keratitis? (Dendritic ulcer)

A

Topical aciclovir

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22
Q

What does a bulging tympanic membrane suggest?

A

Otitis media

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23
Q

What does a retracted tympanic membrane suggest?

A

Otitis media with effusion

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24
Q

How does a acoustic neuroma present?

A

Sensioneural hearing loss, loss of corneal reflex and the neuroma grows into the 5th cranial nerve

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25
Q

Retinitis pigmentosa - how does it present?

A

Can be young patients with a family history
TUNNEL vision

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26
Q

Treatment of Ramsey Hunt?

A

Aciclovir AND steroids

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27
Q

How does Retinal detachment present?

A

Curtain falling down, straight lines appear curved and CENTRAL visual loss.

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28
Q

What is the treatment of herpes zoster opthalmicus

A

Oral aciclovir - can use topical steroids

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29
Q

Presentation of Menieres

A

Aural fullness/ vertigo/ nystagmus/ sensioneural hearing loss

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30
Q

Prophylaxis for Menieres?

A

Betahistine

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31
Q

What is a branchial cyst and how would it present?

A

Fluctuant cyst, present from birth but may flare up following LRTI. Does not transilluminate

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32
Q

What neck swelling moves up on swallowing or tongue protrusion?

A

Thyroglossal cyst.

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33
Q

How does central retinal artery occlusion present?

A

Painless unilateral vision loss. Can also present RAPD. Fundoscopy cherry red spot

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34
Q

Punctate fluorescein staining of the cornea is seen in which condition?

A

DRY EYES

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35
Q

Menieres management

A
  1. Refer to ENT
  2. Acute attacks- prochlorperazine
  3. Prophyalxis- betahistine
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36
Q

How may orbital lymphoma present?

A

Painless red eye that is resistant to usual conjuctivitis management
UNILATERAL

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37
Q

What is the difference between episcelritis and scleritis?

A

Scleritis is painful and episcleritis is not painful

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38
Q

Ptosis and a constricted pupil is seen in..?

A

Horners syndrome

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39
Q

How does optic neuritis present?

A

Pain on eyemovement, unilateral decrease in vision over a couple of days, pain on eye movements

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40
Q

How does argyll Robinson pupil present?

A

Bilaterally small (think neurosyphilis)

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41
Q

Retinal detachment presents how?

A
  • Non painful
    -CENTRAL visual loss
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42
Q

Management of open angle glaucoma?

A

1st line- surgery
2nd line - prostaglandin analogue eg lantoprost

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43
Q

Optic neuritis presents with what type of visual loss?

A

Central visual loss

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44
Q

What is the finding in DRY macular degeneration?

A

Drusen

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45
Q

How does Keratitis present?

A

Red eye, painful, photophobia.

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46
Q

How does retinal detachment present?

A

Painless loss of vision, gradual. straight lines appear curved and more common in myopes (short sighted)

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47
Q

How does a vitreous haemorrhage present?

A

Sudden painless loss of vision, floaters in vision. Patients with DM/ bleeding disorders.

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48
Q

Management of acute angle closure glaucoma?

A

First line- eye drops to reduce pressure/ pilocarpine and azetolamide
2nd line- iriodotmy

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49
Q

What is seen on fundoscopy in non proliferative diabetic retinopathy?

A

Cotton wool spots, beading of new vessels.

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50
Q

How would a corneal ulcer present?

A

Green fluorescin staining, common in contact lenses users.

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51
Q

Management of acute uveitis/ iritis?

A

Steroid eye drops and cyclopentalate or atropine (dilate the pupil to relieve pain)

52
Q

What causes a dendritic corneal ulcer? and what is the treatment?

A

Herpes simplex. Acyclovir drops (NOT STEROID DROPS)

53
Q

What is found in the posterior neck triangle?

A

Mostly lymph nodes

54
Q

How do branchial cysts present?

A

Present in 3rd decade and need surgical removal

55
Q

Malignant/ necrotising otitis externa- presents how and in who?

A

Otitis externa into temporal bone osteomyelitis.
Common in diabetes/ immunocompromised.

56
Q

How does an acoustic neuroma present?

A

SNHL/ Tinnitus/ vertigo/ facial nerve palsies eg dry eyes. UNILATERAL SNHL

57
Q

Is an acoustic neuroma unilateral or bilateral hearing loss?

A

UNILATERAL

58
Q

BPPV vs Menieres?

A

Both present with vertigo. Menieres has hearing loss. bppv - no affect to hearing.

59
Q

What is Schwartz sign?

A

Flamingo pink area on tympanic membrane.
Sign of Otosclerosis

60
Q

Management of Otitis Externa ?

A

Topical antibiotic or
a combined topical antibiotic with a steroid

61
Q

What is the management of septal haematoma?

A
  1. surgical evacuation 2. Abx
62
Q

What are the borders of the anterior neck triangle?

A

Sternocleidomastoid,
Midline
Mandible

63
Q

What is the most common thyroid cancer?

A

Papillary

64
Q

What is the triad of congenital rubella?

A

PDA, Cataracts, Microcephaly

65
Q

What is Rhinoscleroma?

A

Infection with Klebsiella.
Tropical disease
Granulomas

66
Q

What are the causes of painless loss of vision?

A

Retinal Detachement
Vitreous detachment
Retinal artery occlusion
Retinal vein occlusion
Anterior ischaemic neuropathy (amaurosis fugax)

67
Q

What are the defining features on examination of each of these conditions:

Retinal Detachement
Vitreous detachment
Retinal artery occlusion
Retinal vein occlusion
Anterior ischaemic neuropathy (amaurosis fugax)

A

Retinal Detachment - abnormal red reflex. (floaters and flashers in vision)
Vitreous detachment - vitreous floaters o/e and decreased or absent red reflex.
Retinal artery occlusion - cherry red spot.
Retinal vein occlusion - stormy sunset, cotton wool spot and haemorrhages.

Anterior ischaemic neuropathy (amaurosis fugax)- Pale, swollen optic disc.

68
Q

What antibiotic for otitis media with penicillin allergy?

A

Erythromycin or Clarithromycin

69
Q

What do these eye drops do in chronic open angle glaucoma?
- Lantoprost
- Brimonidine
- Dorzolamide
- Pilocarpine
- Timolol

A

Lantoprost - prostaglandin analogue (2nd line after operative management)- increased outflow

Brimonidine- Alpha agonist - reduces aqueous production

Dorzolamide- Carbonic anhydrase inhibitor reduce aqueous production

Pilocarpine - Musclarinic R agonist - increases uveoscleral outflow

Timolol- BB (avoid in asthmatics)

70
Q

How does CMV affect the eyes? and how does it present?

A

CMV Retinitis
Floaters and flashers
Common in HIV pos patients

71
Q

Classic cause of vitreous haemorrhage?

A

DIABETES!!

72
Q

Dry macular degeneration classic feature and treatment?

A

Drusen and NO TREATMENT :(

73
Q

Abducens nerve innervates which muscle? and what is the presentation of a palsy?

A

Lateral rectus
Palsy= cannot abduct eye. therefore diplopia.

74
Q

What are the pupil changes in an oculomotor palsy?

A

Dilated pupil- mydratic because oculomotor also controls pupillary constriction

75
Q

What is an eso/ exophoria?

A

Esophoria - eye squint inwards
Exophoria- eye squints outwards (laterally)

Phoria- meaning its only there some of the time
Cover/ uncover test.

76
Q

What are the categories of squint?

A

Paralytic and non paralytic (imbalance in extra ocular muscles)

Non paralytic (convergent and divergent). Convergent = inwards.

77
Q

How would a sebaceous cell carcinoma present?

A

Like a chazloin that doesn’t heal/ respond to abx.
Feature of losing eye lashes.

78
Q

Features of Holmes Adie pupil?

A

Tonically dilated
Slow reaction to light

79
Q

Myopia is a risk factor for?

A

Primary open angle glaucoma, retinal detachment, cataracts.

80
Q

Otosclerosis affects which bone in the ear?

A

Stapes
(Conductive hearing loss/ family history)

81
Q

What is the hearing test done for newborns vs at school entry?

A

Newborns- otoacoustic test
At school entry >3 years- Pure tone audiometry

82
Q

What are some complications of Tonsillitis ? (3)

A

Quinsy
Obstructive sleep apnoea
Febrile convulsions

83
Q

Treatment of Ramsey Hunt?

A

Steroids and antivirals (Acyclovir)

84
Q

What is a Marcus Gunn Pupil?

A

RAPD defect
Dilation of a pupil in response to light!

85
Q

How does Chorioretinits present and what are the causes?

A

Gradual loss of vision

Tuberculosis
CMV
Sarcoidosis
Syphillis

86
Q

Onchocercal keratitis- what is it?

A

River blindness - keratitis caused by a parasite.
(Major cause of blindness in developing world)

87
Q

What are some causes of Blepharospasm?

A

Tourettes, Cerebral palsy, Trauma, Parkinsons, Multiple sclerosis

88
Q

What is a normal IOP?
What is a normal cup to disc ratio?

A

11-21
0.4-0.7 (normal cup to disc ratio)

89
Q

What are some features of primary open angle glaucoma?

A

Raised IOP
Increased cup to disc ratio. >0.7
Optic disc pallor
Peripheral visual loss

90
Q

Complication of central vein occlusion?

A

Neovascular glaucoma

91
Q

How does Globe rupture present?

A

Low IOP, Blood in anterior chamber, trauma to eye, irregular pupil.

92
Q

What is Hutchinson’s sign?

A

Herpes zoster infection of Trigeminal nerve. Vesicles eruption at tip of nose.

93
Q

What is Trachoma?

A

Leading cause of infection related blindness.
Caused by Chalymidia
Treated with azithromycin eye drops
Entropian, eye lids fold inwards and corral abrasions from eye lashes

94
Q

Presentation of Cataracts?

A

Halos around bright lights
Faded colour vision
Glare
Vision improves with pinhole test

95
Q

When should antibiotics be given for Otitis media?

A

Bilateral symptoms and under 2
Ottohorea

96
Q

What does Pilocarpine do to the pupil?

A

Constricts the pupil

97
Q

What does Atropine do to the pupil?

A

Dilates pupil

98
Q

What condition gives the sign of curved lines appearing straight?

A

Retinal detatchement

99
Q

How do distinguish between Retinal detatchement and vitreous haemorrhage/detatchement

A

Vitreous haemorrhage/ detachment- more common in diabetics! FLOATERS AND FLASHERS. Decreased or absent red reflex.

Retinal detatchment- curved lines appear straight. Abnormal red reflex

100
Q

What is the clinical presentation of age related macular degeneration?

A

Central visual loss
Curved lines appear straight

101
Q

What is the treatment for allergic conjuctivitis in primary care?

A

Topical antihistamine (Antazoline) +/- mast cell stabiliser eg (Sodium cromoglicate)

102
Q

What is a positive Rinnes test?

A

Positive= normal test result
AC> BC

103
Q

What is a negative Rinnes test?

A

BC> AC

104
Q

What happens to Rinnes test in a SNHL ?

A

Normal test result ‘Positive’
AC> BC

105
Q

How does Presbycusis present?

A

Bilateral SNHL
Elderly individuals
High frequency hearing loss

106
Q

Retinitis pigmentosa - presentation and inheritance?

A

Tunnel vision
Problems with night time vision
Autosomal dominant and recessive forms

107
Q

Bacterial keratitis is caused by which organism?

A

Psudomonas aurgenisoa

108
Q

How does tobacco-alcohol amblyopia present?

A

loss of central colour vision

109
Q

Pinna cellulitis vs Pinna perichondritis?

A

Pinna cellulitis= whole ear
Pinna perichondritis= only the cartilage therefore ear lobe is spared

110
Q

Keratoconjunctivitis sicca is associated with which disease?

A

Dry eyes - associated with sjogrens

111
Q

Uveitis/ Anterior uveitis is associated with which other conditions?

A

Sjogrens and HLA B27 conditions (ank spond/ reactive arthritis etc)

112
Q

How does a dendritic ulcer present?

A

Red, painful eye
Reduced visual acuity
Dendritic ulcer is a common presentation of herpes simplex keratitis

113
Q

Macular degeneration - gives which type of visual loss?

A

Central visual loss

114
Q

Choroidal neovascularisation occurs in which disease?

A

Wet macular degeneration

115
Q

Homogoenous hemiaponia caused by a defect where?

A

Defect is behind the optic chasm

Superior: temporal
Inferior: parietal

116
Q

Bullous myringitis - what is it?

A

Painful pus filled vesicles ON tympanic membrane
Often a/w otitis media

117
Q

What is hordeolum externum?

A

Stye (external)- Hot compress/ and analgesia. Abx only if additional conjuctivitis.

118
Q

Open angle glaucoma- first line is SLT (laser therapy) what are the next line topical agents?

A

Topical prostaglandin analogue
Topical beta blocker

119
Q

Corneal abrasion presents how and management?

A

Photophobia/ gritty sensation/ reduced visual acuity in affected eye
Yellow stained abrasion
Management chloampenicol ointment (Topical Abx)

120
Q

What is the difference between abducens palsy and oculomotor palsy?

A

Oculomotor (3RD) DOWN AND OUT
CANNOT ADDUCT EYE
DILATED PUPIL

Abducens
6th nerve
Lateral rectus palsy
Eye rests adducted. Cannot Abduct

121
Q

Management of Menieres

A

Acute-Prochlorperazine
Prophylaxis- Betahistine

122
Q

How to diagnose BPPV?

A

Dix Hallpike

123
Q

Otits external caused by which bacteria ?

A

Psudeomonas auerginosa

124
Q

Features of acute angle closure glaucoma?

A

Acute pain
Red eye
Loss of Vision/ blurred vision
Fixed, semi dilated pupil (NON REACTING)
Raised IOP

125
Q

What drugs constrict vs dilate the pupil?

A

Constrict- opiates + musclarinic AGONISTS (pilocarpine)

Dilate- atropine, antimusclarinics (cyclopentolate), TCAs, adrenaline, ecstasy.

126
Q

What is first line mx for acute angle glaucoma?

A

acetazolamide and pilocarpine are first line.

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