Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 1c > ENT & Ophthalmology > Flashcards

ENT & Ophthalmology Flashcards

1
Q

BPPV definition

A

disorder of recurrent episodes of vertigo accounting half pts with peripheral vertigo associated with head movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

BPPV cause

A

most idiopathic but associated with head trauma, labyrinthitis, otological surgery and vestibular neuronitis

otoconia debris comes loose into semi-circular canals
debris causes endolymph movement in canals with head movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

BPPV signs and symptoms

A

recurrent vertigo episodes <1min
provoked by head movements
peripheral vertigo (neg HINTS)
no symptoms of hearing loss, tinnitus or neuro deficits
positive Dix-Hallpike test - latent and fatigable nystagmus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

BPPV mx

A

particle repositioning manoeuvres (Epley/Semont manoeuvre)

home exercises (Brandt-Daroff)

referral to balance specialist if sx unresolving and resistant to manouvres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Meniere’s disease pathophysiology

A

excess fluid production or impaired absorption of endolymph of inner ear
causes endolymph hypertension which causes symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Meniere’s disease presentation

A

onset 20-40 yrs maybe FHx

rotatory episodic vertigo (mins to hrs)
sensorineural hearing loss, progressive and episodic
tinitus

associated with ear fullness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Meniere’s disease IX

A

audiology
otoscopy
MRI head if asymmetrical tinnitus/hearing loss to exclude acoustic neuroma

positive Romberg’s
positive Fukuda stepping test
peripheral HINTS exam
difficulty in heel-to-toe walking
sensorineural Rinne and Weber

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Meniere’s mx

A

decrease salt, caffeine, alcohol, nicotine
avoid triggers

acute attack
- benzos +/- antiemetic

refractory symptoms
- try betahistine first as less SEs
- replace betahistine for thiazide diuretic (hydrochlorothiazide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

causes of conductive hearing loss

A

defects limiting sound conduction from auricle to ossicles

wax impaction
foreign bodies
otitis externa
tumour
otitis media
glue ear
cholesteatoma
ruptured TM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

causes of unilateral sensorineural hearing loss

A

MS, brainstem stroke, Meniere’s acoustic neuroma

needs MRI scan and ENT referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

causes of bilateral sensorineural hearing loss

A

age-related (presbycusis)
noise exposure
ototoxicity (aminoglycosides, tetracyclines, chemotherapy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how do you clinically differentiate sensorineural and conductive hearing loss

A

Conductive:
Rinne BC>AC
Weber localises to affected ear

Sensorineural loss:
Rinne AC>BC
Webber localises to unaffected ear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

hearing investigations

A

pure tone air and bone conduction testing
speech audiometry
impedance audiometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

clear, watery nasal discharge with coryza and maybe fever. consider …

A

… common cold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

clear, watery nasal discharge with Hx of head injury/surgery. consider …

A

… CSF rhinorrhoea!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

clear, watery nasal discharge with history of allergy/atopy maybe itchy eyes maybe itchy nose. consider …

A

… allergic rhinitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

clear watery nasal discharge with headache and unilateral neurology. consider …

A

… migraine or cluster headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

clear watery nasal discharge in elderly patient excluding serious pathology. consider …

A

… senile rhinorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

mucopurulent non-bloody nasal discharge with obstruction maybe anosmia maybe facial pain. less than a week. consider …

A

… acute rhinosinusitis (viral)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

mucopurulent non-bloody nasal discharge with obstruction maybe anosmia maybe facial pain. more than a week, less than 12 weeks. maybe fever. consider …

A

… acute rhinosinusitis (bacterial)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

mucopurulent non-bloody nasal discharge with obstruction maybe anosmia maybe facial pain. more than 12 weeks. consider …

A

… chronic rhinosinusitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

mucopurulent bloody discharge with unilateral nasal obstruction. consider…

A

… sinus/nasopharyngeal neoplasm

… nasal foreign body in a child or psychiatric adult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

mucopurulent bloody discharge with septal perforation maybe crusting maybe nasal collapse. consider …

A

granulomatosis with polyangiitis (Wegner’s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

most common causes of acute viral rhinosinusitits

A

rhinovirus, influenza, parainfluenza

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

common causes of acute bacterial rhinosinusitis

A

strep.pneumoniae
h.influenzae
moraxella catarrhalis

26
Q

acute rhinosinusitis mx

A

analgesia/antipyretics (paracetamol, ibuprofen)
nasal saline irrigation
oral nasal decongestant phenylephrine 1 wk
topical intranasal glucocorticoids

ABs if high suspicion bacterial (Penicillin V or doxycycline or clarithromycin)
if systemically unwell or high risk complications give co-amoxiclav

27
Q

some chronic rhinosinusitis signs

A

inflammation
nasal polyps anteriorly
post nasal drip
anosmia

red flags:
visual changes
focal neurology
blood-stained
unilateral symptoms

28
Q

chronic rhinosinusitis management

A

lifestyle: avoid triggers, stop smoking, dental hygiene, steaming
nasal saline irrigation
intranasal glucocorticoids up to 3mo

specialist referral

29
Q

when would you refer chronic rhinosinusitis patient to specialist

A

if:
red flag symptoms
symptoms despite 3mo intranasal steroids
polyps complicating treatment
significant impact on QoL

30
Q

rhinosinusitis complications

A

orbital:
- orbital/preseptal cellulitis
- orbital abscess

intracranial:
- meningitis
- cavernous sinus thrombosis

31
Q

eye red flags

A

diplopia
eye pain on movement
decreased visual acuity
loss of colour vision discrimination
chemosis (oedema of sclera)

32
Q

orbital, preseptal cellulitis ix

A

assess with ABCDE, look for sepsis, intracranial infection and assess for eye compromise
nasendoscopy to inspect mucosa and neurological examination with cranial nerves

if red flags:
admit. urgent CT sinus and brain, broad spectrum antibiotics and keep NBM

33
Q

which vessels affected in anterior epistaxis

A

Kisselbach’s plexus (Little’s area)

34
Q

which vessels affected in posterior epistaxis

A

Sphenopalatine artery

35
Q

epistaxis ix

A

ABCDE approach
examine with thudicum speculum

endoscopy

36
Q

epistaxis mx

A

1) assess with ABCDE approach maybe manage any hypovolaemia (IV access and crystalloids)

2) lean forward, pinch anterior nares, hold 20mins

3) examine with thudicum and cauterise anterior bleeds with silver nitrate

4) anterior packing with nasal tampon or gauze in paraffin, refer to ENT for admission

5) bilateral anterior packing maybe posterior packing (Foley catheter)

6) unresolving bleeds need arterial ligation in theatre (eg SPA ligation)

37
Q

allergic conjunctivitis signs and symptoms

A

watery discharge + itchy + nasal sx + bilateral disease

38
Q

viral conjunctivitis causes and symptoms

A

adenovirus, HSV

watery discharge + sticky eyes + bilateral disease +/- herpetic vesicular rash

39
Q

bacterial conjunctivitis causes and symptoms

A

pneumococcus, stph.aureus, moraxella catarrhalis

purulent discharge + sticky eyes + unilateral + pannus

40
Q

conjunctivitis ix

A

slit lamp

41
Q

conjunctivitis mx

A

dont touch things between eyes, dont itch, dont share household items
wash hands and face and eyes regularly
if suspect bacteria, topical BS abx to reduce symptom duration if given before day 6
if suspect viral or allergic give topical antihistamines
if unresolving allergic try topical steroids or topical sodium cromoglycate

42
Q

scleritis pathophysiology

A

painful destructive and vision threatening disorder of the sclera
half of pts associated with systemic illness
most cases are anterior scleritis

posterior and necrotising anterior are most serious. posterior often delayed recognition and close to optic nerve

43
Q

scleritis signs and symptoms

A

severe pain constantly
exacerbated on eye movement
may have photophobia

look out for diplopia and reduced vision (compression of 2nd nerve)

in posterior less likely to have redness than anterior

44
Q

scleritis ix

A

use slit lamp and look for:
scleral oedema and dilation deep episcleral vascular plexus (anterior)
choroidal thickening and retinal detachment (posterior)

may want B-scan ultrasonography to confirm scleral thickening
may also want CT/MRI to exclude orbital lesions

45
Q

mild-moderate scleritis mx

A

anterior subtype
NSAIDs
if no response to NSAIDs or moderate anterior then try high dose prednisolone (+ eventually tapering)

46
Q

severe scleritis mx

A

aggressive mx with high dose prednisolone and rituximab (anti-CD20)
if still not responding to rituximab try cyclophosphamide short as possible <3-6mo (high toxicity)

if responsive to cyclophosphamide eventually switch to less toxic medication:
azathioprine
methotrexate
mycophenolate mofetil

47
Q

iritis signs

A

limbal redness (junction cornea and sclera)
irregular pupil
blurred vision
photophobia
throbbing and dull pain

cells and flare in anterior chamber on split lamp examination

48
Q

iritis (anterior uveitis) causes

A

occurs with systemic conditions

seronegative spondyloarthropathies
rheumatoid arthritis
IBD
Bechet’s
Sarcoidosis
TB
Herpes
HIV

49
Q

uveitis mx

A

if infectious use appropriate antimicrobial plus below
topical corticosteroid for anterior
peri/intra-ocular injections
cycloplegic (atropine, cyclopentolate) to paralyse ciliary body

if no response initial treatment, systemic glucocorticoids +/- immunosuppressants (MTX, azathioprine, mycophenolate)

50
Q

transient acute visual loss. <24hrs. consider …

A

TIA
giant cell arteritis
papilloedema
seizure
migraine

51
Q

posterior uveitis is inflammation of

A

choroid
retina

52
Q

aetiologies posterior uveitis

A

herpes simples/ herpes zoster
toxoplasmosis
TB
CMV
lymphoma
sarcoidosis
Bechet’s

53
Q

posterior uveitis signs and symptoms

A

ACTIVE INFLAMMATION OF CHOROID OR RETINA + LEUCOCYTES IN VITREOUS HUMOUR
painless and no redness
eye floaters
reduced visual acuity

54
Q

unilateral ptosis with miosis?

A

Horner’s syndrome

55
Q

unilateral ptosis with opthalmoplegia

A

CN III palsy

56
Q

ptosis with fatiguability

A

myasthaenia gravis

57
Q

bilateral ptosis with midbrain signs

A

supranuclear CN III palsy

58
Q

bilateral ptosis with chronic progressive opthalmoplegia

A

Myopathies

59
Q

what does monocular diplopia suggest

A

monocular diplopia is present when only one eye is open

suggests orbital pathology

60
Q

what does binocular diplopia suggest

A

present when both eyes are open, absent when one is closed

suggests neurological, NMJ or muscular pathology

Phase 1c (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions