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Stage 4 Semester 2 > ENT/Opthalmology > Flashcards

ENT/Opthalmology Flashcards

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1
Q

How do head and neck cancers typically present?

A

dysphagia
dysarthria
dysphonia
odynophagia
referred otalgia
globus

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2
Q

What are the diagnostic criteria for rhinosinusitis?

A

At least two sx + at least one sign

sx = blockage/congestion, anterior/posterior discharge, facial pain/pressure, hyposmia

signs = endoscopic signs, CT imaging confirming sinusitis, pus/obstruction in the middle meatus, mucosal changes

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3
Q

What reaction results in allergic rhinitis?

A

type 1 IgE mediated hypersentivity reaction

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4
Q

What are the complications of acute rhinosinusitis?

A

ophthalmologic = periorbital cellulitis

neurologic = meningitis, epidural abscess, brain abscess, cavernous sinus thrombosis

bone = OM

nasal = mucocele

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5
Q

Define periorbital cellulitis

A

infection of skin + soft tissue around the eye

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6
Q

Detail the presentation of periorbital cellulitis

A

emergent presentation
divided into:
pre-septal (infection anterior to orbital septum)
post septal (infection w/in orbital compartment)

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7
Q

When is periorbital cellulitis suspected?

A

reduced visual acuity, diplopia, proptosis (exophthalmos), lateral displacement of the eye

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8
Q

Define orbital cellulitis

A

infection behind the orbital septum

usually caused by sinusitisW

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9
Q

What are the signs/sx of orbital cellulitis?

A

systemically unwell
high CRP + WCC
signs of optic nerve dysfunction

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10
Q

What is orbital compartment syndrome + signs?

A

caused by orbital floor (blowout) fracture

proptosis (exophthalmos), RAPD, reduced visual acuity, high intraocular pressure

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11
Q

What is otitis externa associated with?

A

SPELD
- swimming
- pseudomonas
- ear pain
- loss of hearing
- discharge

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12
Q

What can develop from otitis media?

A

osteomyelitis of the mastoid process of the temporal bone

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13
Q

What are the key differences b/w conductive and sensorineural hearing loss?

A

conductive - decreased transmission of background noise
sensorineural - decreased transmission of all sound

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14
Q

What are the key differences b/w open angle and closed angle glaucoma?

A

OA = anterior chambre angle is open, associated w/ resistance to aqueous humor drainage through trabecular meshwork

CA = anterior chamber angle is closed, associated w/ anatomic abnormalities between anterior + posterior chamber

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15
Q

What are the red flag sx of acute angle closure glaucoma?

A

Hurts in a Hurry with Halos, Headache and a Half-dilated pupil
- pain
- acute presentation
- conuuctival erythema, halos around lights
- headache

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16
Q

What are the most common types of cancer in parotid glands?

A

adenocarcinoma (malignant)
pleiomorphic adenoma (benign)

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17
Q

List the differential diagnosis for ear pain

A

otitis media (acute, suppurative, chronic)
otitis interna
otitis externa
acute mastoiditis (complication from acute otitis media)

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18
Q

What is the differential dx involved in a sore throat?

A

pharyngitis (commonly viral in etiology)
epiglottitis
tonsillitis
retropharyngeal abscess
thyroiditis
Lemierre syndrome

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19
Q

What does the presentation of a facial nerve palsy with a new onset parotid lump indicate the possibility of?

A

Red Flag – the presentation of facial nerve palsy with a new onset parotid lump
should alert the clinician to the possibility of a tumour – direct ENT referral is
indicated

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20
Q

What is a drug iatrogenic cause of glaucoma?

A

Use of systemic corticosteroids such as prednisone is a risk factor for glaucoma.

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21
Q

_____ tumors typically occur in the apex and may compress the stellate ganglion.

A

Pancoast

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22
Q

_____ is a direct muscarinic receptor agonist used in the treatment of glaucoma. It decreases IOP by facilitating drainage of aqueous humor.

A

Pilocarpine

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23
Q

What are the pathological changes associated w/ hyperopia?

A

farsightedness
eye too short for refractive power of the lens –> light is focused behind the retina

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24
Q

What are the pathological changes associated w/ myopia?

A

nearsightedness
eye too long for refractive power of cornea = lens –> light is focused in the front of the retina

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25
____ is age related impaired accommodation of the lens
presbyopia
26
What causes a thyroglossal duct cyst?
incomplete obliteration of the thyroglossal duct
27
What nerve impairment causes internuclear ophthalmoplegia?
damage to the medial longitudinal fasciculus
28
What structure of the eye produces aqueous humor?
epithelial cells of the ciliary body
29
Ptosis is...
the drooping of the upper eyelid
30
Anisocoria refers to...
uneven pupillary size
31
RAPD is caused by lesions in the ____ limb of the pupillary reflex pathwayt
afferent
32
What are the causes of RAPD?
OPTIC DISEASE Optic neuritis Advanced glaucoma Ischaemic optic neuropathy (arteritic or non-arteritic) Traumatic optic neuropathy Tumour of the optic nerve (meningioma/glioma) RETINAL DISEASE Ischaemic retinal disease (CRAO, ischaemic CRVO) Large retinal detachment Severe macular degeneration
33
What are some systemic conditions which can affect the eye?
connective tissue: ankylosing spondylitis, GCA, Marfans, rheumatoid Genetics: NF, Down's Autoimmune: Thyroid eye disease, MG, Sjogrens, MS + optic neuritis Vascular: HTN, DM, IIH Neoplastic: choroidal melanoma
34
What are the differences in ocular manifestations of NF1 and NF2?
NF1: lisch nodules in the iris NF2: juvenile cataracts + meningioma
35
What are the effects of Marfans on the eye?
cataract lens dislocation retinal detachment glaucoma myopia astigmatism
36
What are the classic sx of Meniere's disease?
vertigo tinnitus unilateral sensorineural hearing loss
37
What is juvenile angiofibroma and what are its associated signs/sx?
benign growth of nasopharynx recurrent epistaxis, nasal obstruction, hearing loss (ET obstruction), tinnitus bulging palate, buccal mass
38
What are the most common causes of pharyngitis (sore throat)?
viral origin more commonly GAS if bacterial (but will not have cough or rhinorrhea)
39
What is a Quinsy?
peritonsillar abscess that can result from acute tonsillitis
40
What are the differences b/w Rinne and Weber test?
Rinne tests for air conduction > bone conduction (conductive hearing loss) Weber tests for sensorineural hearing loss
41
What are some iatrogenic causes of tinnitus?
loop diuretics aminoglycosides salicylates
42
What is benign paroxysmal position vertigo (BPPV)?
dislodging of otoconia and migrating into SCC, which disrupts endolymph dynamics and leads to vertigo on sudden head movement
43
What is Wegeners?
GPA necrotising granulomas of respiratory tract w/ vasculitis + GLN ANCA+
44
What are the most common causes of sialedenitis?
bacterial infection obstruction of the gland by a stone autoimmune (sjogrens)
45
What are the groups of head + neck tumours?
mucosal thyroid parathyroid skin salivary gland vascular neurogenic
46
Detail the features of oropharyngeal cancer?
HPV induced tumors Occurs due to previous lack of HPV vax for males younger mean age than squamous oro cancer 60% reduction in death risk when compared to squamous oropharyngeal cancers (smoking induced) presents w/ painless mass + odynophagia
47
What is a tracheostomy and what are its indications?
surgical formation of an opening into thetrachea through anterior neck - indicated if a laryngectomy is performed
48
What are some sx of parathyroid cancers?
neuropsychiatric --> depression, anxiety, headache, etc. MSK --> bone pain, muscle weakness + osteoporosis due to increased osteoclasts GI - Renal --> stones due to increased Ca++ cardiac --> HTN + arrhythmias due to increased Ca++
49
What does an RAPD suggest?
- An afferent pupil defect results from partial damage to the visual pathway anywhere from the retinal ganglion cell layer to the lateral geniculate body (LGN), thus causing a reduction in the input (afferent) signal reaching the brainstem when a light is directed at the affected eye. RAPD or pupillary light defects are not seen in lesions after the LGN.
50
Explain the Rationale Behind the Swinging Light Test
- In Afferent pupil defect, the affected pupil will not be able to elicit a full light reflex. - If a light is directed at the better eye, both pupils will constrict fully and equally. If it is then immediately swung over (the ‘swinging flash light test’) and directed at the affected eye (e.g. an eye with an optic nerve lesion), both pupils will appear to dilate—a relative afferent pupillary defect (RAPD). In fact, what has happened here is that both pupils are constricting but to a lesser degree than when the light was directed at the normal eye, hence they only appear to dilate. When the light is swung back to the better eye, the pupils will constrict.
51
How do we differentiate dry and wet AMD?
dry = non exudative, gradual vision loss, nonvascularized, blurry vision, wet = exudative, vascularized, wavy vision, rapid vision loss
52
What type of vision loss will result from AMD?
central vision loss
53
conductive hearing loss In the weber test, where will sound lateralize? In the rinne test, where will sound lateralize?
weber = affected ear negative air over bone
54
sensorineural hearing loss In the weber test, where will sound lateralize? In the rinne test, where will sound lateralize?
better ear positive air over bone
55
What are the top causes of conductive hearing loss?
cerumen impaction otitis media w/ effusion tympanic membrane perforation otosclerosis foreign body
56
What is the most common cause of sensorineural hearing loss?
idiopathic
57
Which drugs lead to ototoxic hearing loss?
salicylates aminoglycosides erythromycin cis-platinumn loop diuretics
58
What is leukoplakia?
white patch of plaque in the oral cavity which cannot be removed
59
What is erythroplakia?
red patch of plaque in the oral cavity that cannot be diagnosed as any other lresion
60
how do topical steroids work?
not completely understood; may be inhibition of arachidonic acid release from phospholipids
61
What landmarks are seen in the anterior chambre angle?
Schwalbe's line: the perpiheral termoneration of Descemet's membrane as the apex of the corneal light wedge Anterior TM Posterior (pigmented) TM Schlemms canal (faint red band) Scleral spur (narrow white band of sclera) CB band (marks the anterior face of the ciliary body Iris
62
What are the common visual sx associated w/ age related macular degeneration?
visual blur central scotoma metamorphopsia (visual distortion)
63
What is retinopathy of prematurity?
affects infants born prematurely development of abnormal vessels that proliferate, which can lead to detachment, macular ectopia and visual loss
64
How do we treat patients w/ stable epiglottitis?
Stable patients → are treated with IV steroid, antibiotics, nebulised adrenaline and are admitted to ICU for close airway monitoring
65
How do we treat patients w/ unstable epiglottitis??
immediate airway intervention via intubation or tracheostomy
66
/What is laryngomalacia
commonest cause of congenital stridor in babies weak laryngeal tone due to immature NM support sx: high inspiratory stridor that worsens during feeding
67
What is initial treatment for Meniere's disease?
lifestyle changes (low salt diet, reduced caffeine intake) and addition of thiazide diuretic
68
Meniere's disease involves a _____ hearing loss
sensorineural
69
The action of the inferior oblique muscle is...
elevation, extorsion + abduction
70
The action of the superior rectus muscle of the eye is...
elevation, intorsion, adduction
71
Is cupping of the disc found in papilloedema?
no
72
Facial palsy + vesicles in the ear =
Ramsay Hunt syndrome
73
What is Ramsay Hunt syndrome?
reactivation of chicken pox/shingles affecting the facial nerve
74
What type of cancer is characterized by elevated calcitonin + a thyroid nodule?
medullary thyroid cancer family history of MEN
75
Recurrent bilateral parotid swelling _ dry eyes =
Sjogrens syndrome
76
Recurrent severe epistaxis in teeange male =
juvenile angiofibroma
77

Stage 4 Semester 2 (5 decks)

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