MedEd ENT and opthamology

Question 1

What is BPPV/

Answer 1

Recurrent and brief attacks of positional vertigo

Question 2

What is the most common cause of vertigo?

Answer 2

BPPV

Question 3

How does BPPV arise?

Answer 3

Canalith particles break loose and fall into the wrong part of the semicircular canals of the inner ear causing vertigo

Question 4

How will BPPV present?

Answer 4

Recurrent brief (<1min) attacks of vertigo
Quick onset
Attacks related to body position change eg looking up
Nausea and vomitting
No precipitating event

Question 5

How long are vertigo attacks in BPPV?

Answer 5

<1 min

Question 6

What position of the head triggers BPPV?

Answer 6

Looking up

Question 7

What invetsigations are done for BPPV?

Answer 7

Hallpike’s manourvere

Question 8

How is Hallpike’s manourvere done?

Answer 8

Sit patient up
Slowly rotate their head to 45 degrees on one side
Liw the patient down and hold head at 20 degree angle on bed
See if they have vertigo

Question 9

How is BPPV managed?

Answer 9

Canalith repositioning manoevures

Question 10

What is menieres disease?

Answer 10

Disorder of inner ear caused by change in fluid volume in the labyrinth causing tinnitus and vertigo

Question 11

What is the difference between meniere disease v syndrome?

Answer 11

Disease= idiopathic
Syndrome= secondary to condition

Question 12

What causes menieres disease?

Answer 12

Allergy
Viral infection
Lyme disease
Hypothyrodism

Question 13

How does menieres disease present?

Answer 13

Vertigo that lasta mins or hrs
NV
Tinnitus
May have hearing loss in affected ear

Question 14

How do you differentiate menieres disease and BPPV?

Answer 14

Menieres= vertigo lasts mins/hrs
BPPV= vertigo lasts <1min

Question 15

What test can you do for menieres disease?

Answer 15

Fukudas stepping test

Rombergs test

Question 16

What investigations are done for menieres and what will you see?

Answer 16

Audiometry- will reveal sensorineural hearing loss

Question 17

How is menieres disease managed?

Answer 17

No cure- manage acute attacks
Vestibular supressants- benzodiazipines and antihistamines
Prophylactic- limit salt, caffeine and alcohol, exercise to improve management
Maintenance- thiazide diuretics to reduce endolymph volume

Question 18

What is thyroglossal cyst?

Answer 18

Epithelial lines cyst between adams apple and chin

Question 19

What age is likely to get thyrogloassal cyst?

Answer 19

5 years

Question 20

How will thyroglossal cyst present?

Answer 20

Lump in midline of neck
Compressible
Cyst moves up on swallowing and sticking out tongue

Question 21

How is thryoglossal cyst managed?

Answer 21

Surgical removal

Question 22

What is a cataract?

Answer 22

Opacification of lens

Question 23

How will cataract present?

Answer 23

Cloudy lens visible

Gradual loss in visual acuity over years

Question 24

How does cataract arise?

Answer 24

Normal proteins that make up lens of the eye degrade overtime and become opaque

Question 25

What are RF for cataract?

Answer 25

``` ageing smoking alcohol UV exposure diabetes trauma uveitis ```

Question 26

How do you investigate catarct and what will you see?

Answer 26

Slit lamp reveals cataract as black against red light reflex Reduced red reflex on fundoscopy reduced visual acuity

Question 27

How is cataract managed?

Answer 27

Control RF | Surgical management when affects lifestyle- phaecomulsification with intraocular lens implant

Question 28

What is conjuctivits?

Answer 28

Inflammtion of the conjunctiva

Question 29

Where is the conjunctiva?

Answer 29

Inner eyelid and covers sclera

Question 30

Who is conjunctivits most common in?

Answer 30

Children

Question 31

What are causes of conjunctivits? What is most common? Include organisms

Answer 31

Viral most common- EBV, herpes, adenovirus Bacterial- staph aureus, strep pneu, heam infl Allergy Wearing contacts Mechanical- floppy eyelid syndrome

Question 32

How will conjunctivits present?

Answer 32

Eye redness Discharge Itchy eye Crust formation- especially in morning

Question 33

Describe discharge in viral v bacterial v allergic conjunctivitis

Answer 33

``` Viral= clear Bacterial= thick, purulent, yellow Allergic= clear ```

Question 34

Describe eye involvement in viral v bacterial v allergic conjunctivitis

Answer 34

``` Viral= first unilat then becomes bilat Bacterial= unilat, no bilat progression ```

Question 35

What is glaucoma?

Answer 35

Increased intraocular pressure which results in damage ro retina and optic nerve

Question 36

How is conjunctivits managed?

Answer 36

Viral= gets better with time, can give antihistamine drops

Question 37

What are the types of glaucomona?

Answer 37

Open angle | Closed angle

Question 38

What is open angle glaucoma?

Answer 38

Iridocorneal angle is unaffected | Defect in trabecular meshwork

Question 39

What are RF for open angle glaucoma?

Answer 39

Over 40 DM FHx African descent

Question 40

How will open angle glaucoma present?

Answer 40

Bilateral progressive visual field loss | Visual loss of peripheral to central

Question 41

What investigations are done for open angle glaucoma? What will you see

Answer 41

Clinical diagnosis Tonometry- may get IOP >21 mmHg Fundoscopy- increase in cupping of optic disc

Question 42

What is closed angle glaucoma?

Answer 42

Narrowing of iridocorneal angle- aqeuous flow into trabecular meshwork is disrupted

Question 43

What type of glaucoma is and emergency?

Answer 43

Closed angle

Question 44

What are RF for closed angle glauxoma

Answer 44

Old | Mydriasis (drug induced by anticholinergics)

Question 45

How does closed angle glaucoma present?

Answer 45

``` Sudden onset Red eye NV Unilateral pain Dilated pupil in one eye ```

Question 46

What inevstigations are done for closed angle glaucoma? What will you see?

Answer 46

Tonometry- IOP >21 mmHg Slit lamp- narrowing of iridocorneal angle Gonioscopy Fundoscopy- increased cupping of optic disc

Question 47

How is open agle glaucoma managed?

Answer 47

Prostaglandin analogues to increase aqeous humor flow (latanoprost and travoprost) Topic beta blockers- decreas production of aqueous production If bad surgical= trabeculectomy

Question 48

How is closed angle glaucoma managed?

Answer 48

Topical beta blockers- timolol to decrease aqeous humor production Carbon anhydrase production to decrease aqeous humor profuction- acetazolamide Immediate surgery- high intensity laser treatment

Question 49

What is anterior uveitis?

Answer 49

Inflammation of the iris and ciliary body

Question 50

What is the most common type of uveitis?

Answer 50

Anterior

Question 51

What are causes of anterior uveitis?

Answer 51

Idiopathic

Question 52

What conditions is anterior uveitis associated with? Give examples

Answer 52

Non infectious, systemic autoimmune disease- HLA B27 pos eg ankylosing spondylitis

Question 53

What is posterior uveitis?

Answer 53

Inflammation of retina, choroid, retinal vasculature, optic nerve

Question 54

What causes posterior uveitis?

Answer 54

Viruses | Syphillis

Question 55

How does anterior uveitis present?

Answer 55

``` Pain dull and progressive eye redness photopobia decreased visual acuity lacrimation flares ```

Question 56

How is anterior uveitis investigated?

Answer 56

Clinical diagnosis | Can do slit lamp exam

Question 57

What is seen on examination in anterior uveitis?

Answer 57

Keratic precipitates- white fluid in inferior part of anterior chamber Protein in aqueous humor Red eye Hypopyon

Question 58

How will post uveitis present?

Answer 58

Painless Decreased visual acuity Lacrimation Floaters or flashers

Question 59

What do you see on examination in post uveitis?

Answer 59

Leukocytes in vit humor

Question 60

What are complications of uveitis?

Answer 60

Cataract Glaucma Synechiae

Question 61

How is uveitis managed?

Answer 61

``` Steroid drops systemic or oral steroids Treat underlying inflammation cycloplegic eye drops Simple analgesia ABX or antiviral for post uveitis ```

Question 62

What is optic neuritis?

Answer 62

inflammation of the optic nerve

Question 63

Who is most likely to get optic neuritis?

Answer 63

20-40 yo females

Question 64

What causes optic neuritis?

Answer 64

Demyelination of optic nerve- ofetn due to MS, can be encephalitis, meningitis, sinusitis, or drugs

Question 65

How will optic neuritis present/

Answer 65

``` Visual loss Hours to days Decreased visual acuity Eye pain worse on movement Reduced colour vision Usually unilateral, can be bilateral ```

Question 66

How is optic neuritis investigated?

Answer 66

Gadolinium enhanced MRI of orbit and brain- enlarged optic nerve may be seen

Question 67

How is optic neuritis managed?

Answer 67

High dose steroids

Question 68

What are complications of optic neuritis?

Answer 68

Decreased long term visual acuity

Question 69

What is scleritis?

Answer 69

Inflammation of sclera

Question 70

Who is more likely ot get scleritis?

Answer 70

40-60 y/o

Question 71

What causes sleritis?

Answer 71

``` Systemic disorder eg RA SLE IBD Ankylosing spondylitis ```

Question 72

Is sclerits uni or bilat?

Answer 72

Bi

Question 73

How does scleritis present?

Answer 73

``` Dull boring eye pain May disturb slep Pain worse on eye movmeent Pain radiates to face Red eye- violet or blue tinge Over several days Photophobia Lacrimtion ```

Question 74

How can you differentiate scleritis and episcleritis?

Answer 74

``` Scleritis= painful Episcleritis= painless ```

Question 75

Why do you get violet/ blue tinge in scleritis?

Answer 75

Thinning of sclera

Question 76

How is optic neuritis managed?

Answer 76

urgent referral ro opthamologist NSAIDs if mild/moderate Treat cause Systemic steroids if necrotising

Question 77

What are complications of optic neuritis?

Answer 77

cataract