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Neuro (ENT, Derm, Opthal) Flashcards

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1
Q

Otitis Ext Sx

A

Painful, Itchy, Inflamm,
Discharging Ear
(esp in swimmers/adults)

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2
Q

Otitis Ext Mx

A

Micro-suction pus/debris,
(If Bact: Top Gentamicin)
(If Fungal: Top Anti-fungal)

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3
Q

Acute Otitis Med Sx + Ex

A

Dull Pain (w/ ear pulling),
Discharge (once pain stops),
Fever,
(Preceeding Viral Inf)

Otoscope:
Bulging, non-mobile tympanic membrane with yellow/red discolouration

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4
Q

Acute Otitis Med Mx, Admission criteria + Surg

A

Analgesia, Delay Abx
(If confirmed/Otorrhoea or < 2yo w/ Bilat Inf: Amox)

Admit if:
< 3mo w/ fever > 38,
< 6mo w/ fever > 39

(If recurrent/ET dysfunction: Grommet Surg),
(If TM Perf: Myringoplasty)

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5
Q

Glue Ear Patho + Sx

A

(Otitis Media w/ Effusion):
Dysfunctional ET following OM causes build-up of Fluid w/in Middle Ear

(CN) Hearing loss,
Ear Pain w/ fullness,
Discharge,
Recurrent ENT Inf

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6
Q

Glue Ear Ix + Mx

A

Otoscopy (Normal Ex does not Excl)

Mx:
Act Observation for 6-12wks
Assess hearing w/ Pure Tone Audiometry x2 before Refer
Surg (Grommets, Hearing Aid)

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7
Q

Otosclerosis Features

A

Early, progressive (CN) hearing loss w/
(+) FHx,
Tinnitus

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8
Q

Otosclerosis Mx

A

Hearing aids,

Stapedectomy

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9
Q

TM Perforation Sx + Mx

A

Pain​
Conductive hearing loss​

Mx:
Watch and wait (w/ water caution)​
(If > 6 months: Myringoplasty)​

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10
Q

BPPV Patho + Sx

A

Otoliths within semicircular canals​
​
Transient (secs/mins), Positional (occurs with head movements)​ Vertigo
(no tinnitus/hearing loss)​

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11
Q

BPPV Diagnosis + Mx

A

Diagnosis:
Dix-Hallpike Test​

Mx:
Epley and Brandt-Daroff Manouvres​

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12
Q

Menieres D Patho + Sx

A

Excess Fluid w/in Inner Ear​

Sx:​
Episodic vertigo (mins - hours) w/ N+V​
Tinnitus, 
Aural fullness​
Fluctuating SN hearing loss (progress -> permanent)​
(Gen Imbalance)​
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13
Q

Menieres D Mx​:
Diet
Med - 3
Surg - 5

A

Diet (Reduce salt, chocolate, alcohol, caffeine)​

Med: ​
Thiazide diuretics,
Betahistine​
Prochlorperazine (vestibular sedative)​

Surgery: ​
Grommets​
Dexamethasone middle ear injection​
Endolymphatic sac decompression​
Gentamicin injection (causes vestibular destruction)​
Surg Labryninthectomy ​
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14
Q

Vestibular Neuritis Patho + Sx

A

Inflamm of Vestibular Nerve​

Sx:​
Severe Vertigo (days) w/ N+V​
Horizontal nystagmus​​

​(If Hearing affected, Tinnitus: Labyrinthitis)

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15
Q

Vestibular neuritis Mx​

A

Vestibular Sedatives (Prochlorperazine)​

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16
Q

Sudden-onset hearing loss Ix

A

Tuning fork (Weber + Rinnes)
Pure Tone Audiogram​
Tympanogram​
MRI (excl. Acoustic neuroma)​

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17
Q

Acute Rhinosinusitis Org + Length/Timing

A

Viral (RhinoV, InfluenzaV): Sx resolve w/in 5 days

Bact (S.Pneum, H.Influenzae): Sx persist > 5 days

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18
Q

Acute Rhinosinusitis Mx

A

Analgesia, Nasal decongestants​
If > 10 days:
- Top/Nasal Steroid
- Delayed PO Abx (wait 1wk for Sx to resolve: Phenoxymethylpenicillin 5 days)

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19
Q

Chronic Rhinosinusitis Def + Ix

A

Def: > 12wks​

Skin prick (Allergy) test​
(If Unilat: Biopsy)​
(If Atypical features/Surg planned: CT sinuses)​

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20
Q

Chronic Rhinosinusitis Mx:
Conservative
Med
Surg

A 
Conservative​:
Allergy avoidance, 
Nasal douching (IN saline sol)​

Med:​
Antihistamines​
Top nasal steroids, PO steroids (1wk)​
PO Abx​
ImmunoTx (for Severe Allergies)​

Surg:​
Nasal Polypectomy​
Funct Endoscopic Sinus Surg​

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21
Q

Allergic Rhinosinusitis Classification:
Duration
Severity

A

Duration:​
Intermittent: Sx < 4 days a week, < 4 wks​
Persistant: Sx > 4 days a week, > 4 wks​

Severity:​
Mild: No Impairment of Daily Activities​
M2S: Troublesome Sx​

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22
Q

H+N Lumps Red Flags - 5

A 
Hard, Fixed, Irreg Lumps 
Associated Otalgia, Dysphagia, Stridor or Hoarse voice 
Epistaxis, Unilat nasal congestion 
Cranial N palsies 
B Sx
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23
Q

H+N Lumps Ix

A

USS +/- FNA

CT/MRI

(If Lymphoma suspected: Core biopsy, Open LN biopsy)

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24
Q

BCC Features

A 
Skin coloured (Clear/Pink), rolled borders​
Surface Telangiectasia (+/- ulcer in centre)​
Slowly evolves (non-healing scab)
(Found on H+N​)
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25
BCC Mx
Surgical excision​ Radiotherapy (when surgery not appropriate)​ Micrographic surgery (progressive excision until specimen free) – for High risk, recurrent tumours
26
SCC Features
In situ: Erythematous + Scaly, Invasive: Exophytic Ulcer (w/ Ill-defined border) Grows quickly + Easily Friable
27
SCC Mx
Surgical excision, Micrographic surgery​ Radiotherapy (large, nonresectable tumours)​ Chemotherapy (metastatic disease)​
28
Melanoma Features
``` Asymmetrical​ Irregular border​ Deeply pigmented (Brown)​ > 6mm​ Evolving (+ Metastasises)​ ```
29
Melanoma Mx
Surgical excision​ | Immunotherapy/chemotherapy (metastatic disease)​
30
Eczema Sx
Itchy, erythematous, dry, scaly patches​ w/ Lichenification Infants (Face and Limb extensors), Adults (Limb Flexures)​
31
Eczema Ix
Allergy (patch) testing​ Serum IgE​
32
Eczema Mx
Avoid triggers (pets, soaps, infections)​ Emollients​ Acute flareups: Top Steroids Severe Pruritus: Antihistamines (Piriton)​
33
Psoriasis Sx
Itchy/Painful, Erythematous, Scaly, Well-defined patches/plaques (Adults: Ext) ``` Koebner Phenomen (new skin lesions at sites of skin injury) Auspitz sign (Excoriation => Bleeding) ``` (Nail changes: pitting, onchyolysis)​
34
Psoriasis Mx
Emollients (Reduce scales)​ Vitamin D analogues​ Topical steroids​ (8wks max)
35
Acne Mx
Mild: Top Abx/Retinoid + BPO ​ Mod: Oral antibiotics​ (Tetracyclines) Severe: Oral retinoids (Isotretinoin)​ (PCOS: antiandrogens – COCP/Spironolactone) (Epiduo: Top Adapalene + BPO, Duac: Top Clindamycin + BPO)
36
Steroid SE: Local - 5 Systemic - 6
``` Local:​ Skin thinning, striae, telangiectasia, acne, allergic contact dermatitis​ ​ ``` ``` Systemic:​ Cushing’s, immunosuppression, hypertension, diabetes, osteoporosis, cataracts​ ```
37
Retinoids SE
Dry lips/skin/eyes​ Myalgia, arthralgia​ Hypercholesteraemia, hypertriglyceridaemia​ Teratogenic (require contraception before prescribing)​ Suicidal Ideation
38
Pupil Reflexes: Afferent Efferent
Afferent:​ CN-II -> Pre-tectal Nucleus​ Pre-tectal N -> EWN (Bilat)​ Efferent:​ EWN -> CN-III -> Ciliary Ganglion​ - > Sphincter Pupillae (+ Ciliary muscles)
39
Pupil Defects: Complete Partial
Complete Optic N:​ Light shone in eye -> No direct/consensual response​ Light shone in other eye -> Consensual response​ ​ Partial Optic N: (RAPD)​ Slowed direct response, normal consensual response​ Swinging light test: Constriction (Light shone contralaterally), Dilation (Light shone ipsilaterally)​
40
Blepharitis Patho, Sx + Mx
Inf eyelids (Inflamm w/ yellow crust) Mx: Lid hygiene, Abx
41
Chalazion vs Stye
Chalazion: (Blocked Meibomian glands): Painless, Above lash line Stye: (Inf Meibomian glands): Painful, Edge of lash line
42
Ant Uveitis Sx
``` (Iris + ciliary body): Red, painful eye (w/ irreg pupil), Reduced VA, Floaters, Photophobia ```
43
Ant Uveitis Mx
Mx: Steroid drops (Reduce Inflamm), Cyclopentolate (Anti-musc) drops (Prevent adhesions + reduce pain: Cycloplegia/Ciliary paralysis)
44
Inf Keratitis Sx
``` (Cornea): Red, painful eye w/ hypopyon (Pus w/in Ant chamber), Reduced VA (Corneal oedema), Photophobia, (HSV keratitis: Dendrite pattern w/ Fluoroscein) ```
45
Inf Keratitis Mx
Mx: Remove contacts, Steroid drops IV Abx/Antivirals/Antifungals, (Avoid steroid drops w/ HSV keratitis)
46
Scleritis Sx, Associations + Mx
Red, tender, painful eye (Pain => Headache => Waking at night) (Associated w/ RA, GCA/Vasculitis, Ank Spondylo, SLE, IBD) Mx: Urgent referral
47
Subconjunctival Haem Sx
Unilateral, localised, discrete bleed​ No inflammation, pain, discharge​ Normal vision​ (Pt may be on anticoags/antiplatelets)​
48
Subconjunctival Haem Mx
Reassure​ | Check BP, clotting/INR​
49
Hyphema Def + Sx
Bleed within anterior chamber (following trauma)​ => Red eye​ (w/ Meniscus) Severely reduced vision​ Stained cornea (with increased IOP)​
50
Hyphema Mx
Urgent referral​ | Bedrest and eyepatch​
51
Amarosis Fugax Sx, Ix + Mx
Temp monocular vision loss (returns to normal w/in hrs) +/- Focal Neuro Def Carotid Doppler Normal Fundoscopy Mx: Aspirin 300mg + Referral
52
CRVO Sx + Ex
Sudden painless vision loss w/ RAPD | Blood + Thunder: Dil torturous V, Cotton-wool spots, Swollen Optic disc, Retinal Oedema + Haem
53
CRAO Sx + Ex
Sudden painless vision loss w/ RAPD | Cherry-Red Pale retina w/ red spot on fovea
54
Optic Neuritis Patho + Sx + Ex
(CN-II Inflamm): ``` Sudden vision loss w/ RAPD (+/- Blur/Haze/Central Scotoma, Desaturated colours) Orbital pain (esp w/ eye movements) ``` O/E: Swollen optic disc (If normal: Retrobulbar neuritis)
55
Optic Neuritis Mx
IV steroids + Urgent referral
56
Ischaemic Optic Neuropathy Sx + Ex
Temp painless vision loss w/ RAPD, (GCA Sx + B Sx) O/E: Swollen, pale optic disc
57
Ischaemic Optic Neuropathy Ix + Mx
Fundoscopy CRP/ESR Temporal artery biopsy (GCA)​ IV Methylpred 1g
58
ARMD Patho: Dry Wet
Dry AMD: ​ Gradual Accumulation of waste products/fatty deposits (Drusen) bilaterally​ Wet AMD: ​ Sudden Choroidal neovascularisation (w/ macular oedema and haemorrhage) (+/- Retinal detachment)​
59
ARMD Features
``` Painless (central) vision loss​ (Normal peripheral and colour vision)​ ​ Dry: ​ Progressive (years), Bilateral, (+/- progress to Wet AMD)​ ``` Wet: ​ Rapid, Unilateral, (Visual distortion: Scotomas, Metamorphopsia)​
60
Retinal Detachment Patho + Sx
Separation of Sensitive Retina layer from RPE​ Painless loss of vision​ Recent history of floaters/flashes/shadows​
61
Fundoscopic changes in HT Mild - 2 Mod - 4 Severe - 1
Mild: ​ Gen/focal arteriolar narrowing ​ AV nicking​ ``` ​ Moderate: ​ Retinal haemorrhage​ Micro-aneurysms​ Cotton wool spots​ Hard exudates​ ``` ​ Severe: ​ Optic disc swelling​
62
``` Fundoscopic changes in DM Background - 2 Pre-proliferative - 2 Proliferative - 1 (Diabetic Maculopathy) ```
Background: ​ Microaneurysms, Retinal haemorrhages​ Preproliferative: ​ Cotton wool spots, Exudates​ Proliferative: ​ Retinal neovascularisation​ (Diabetic maculopathy: Macular oedema)​
63
Diabetic Retinopathy Mx
Pan-retinal photocoagulation (PRP): Reduce VEGF​
64
Aqueous Humour Prod Control
A2-Adren-R: Decrease production of Aqueous Humour ​ B2-Adren-R: Increase production of Aqueous Humour​
65
Drugs affecting IOP
Alpha-Agonists, Beta-Blockers (Decrease Production of Aqueous Humour)​ Carbonic Anhydrase Inhibitors (Acetazolamide) (Decrease Production of Aqueous Humour)​ Prostaglandins (Latanoprost) (Increase Outflow of Aqueous Humour)​ Parasympathomimetic (Pilocarpine) (Increase Outflow of Aqueous Humour)​ ​
66
Glaucoma Features : Open-angle, Chronic Closed Acute Closed
Open-angle/Chronic Closed: Initially asymptomatic Bilat, progress visual field loss (Periph -> centre) Acute Closed: Unilat, painful, Inflamm eye (w/ Irreg, semi-dilated + unresponsive pupil) Blurry vision, Haloes, (Frontal headache, N+V, Photophobia)
67
Glaucoma Ix
Tonometry (Raised IOP) Fundoscopy (Cupping, Optic disc pallor/Haem) Gonioscopy (Reduced Iridocorneal angle)
68
Open angle glaucoma Mx ​
Top Prostaglandins (Latanoprost)​ Surg (Improve drainage):​ Laser trabeculoplasty Surg Trabeculectomy
69
Chronic Closed angle glaucoma Mx
Laser (Periph) Iridotomy​ Surg Trabeculectomy​ (Top Lantanoprost/PG's: Maintenance)​
70
Acute Closed angle Mx: Supp Med Surg
Supportive:​ Urgent referral, Analgesia and anti-emetic​ ``` Med:​ Parasympathomimetic (Pilocarpine)​ A2-Adren-R Agonist (Apraclonidine)​ Beta-blocker (Timolol)​ Carbonic anhydrase inhibitor (Acetazolamide)​ Diuretic (IV Mannitol – esp if N+V)​ ``` Surg:​ Ant chamber Paracentesis​ Laser (Periph) Iridotomy​
71
Retinoblastoma Sx
``` Lack of red reflex (Abnormal white reflection), Change in colour of Iris​ Red, inflamed (painless) Eye Squint/Poor vision, Diff controlling EOM ```
72
Retinoblastoma Ix + Mx
Fundoscopy​, USS Mx: Urgent referral, Small: Laser Photocoag/ThermaTx, CryoTx Large: Radio/ChemoTx + Removal of Eye
73
``` Def: Myopia Hyperopia Astigmatism Anisometropia ```
Myopia: (Short-sightedness): Long eye, Wide Lens (Cataracts) => (-) Biconcave Lens (Divergence) Hyperopia: (Long-sightedness): Short eye, Lack of Lens (Aphakia) => (+) Biconvex Lens (Convergence) Astigmatism (Assymetrical Eyeball): Mx: Cyclindrical Lens Anisometropia (Different refractive powers btw 2 eyes)
74
Allergic Conjunctivitis Sx
Itchy, painful, red eye​s (Bilat) w/ watery discharge Swollen conjunctiva​ History of Atopy (pruritus, eczema, asthma)
75
Allergic Conjunctivitis Mx
Remove allergen​ Topical antihistamines, cool compresses​ (If no change in 3 days: refer)​
76
Bact Conjunctivitis Sx
Bilateral, red, painful eye with purulent discharge​ | Systemically well
77
Bact Conjunctivitis Mx
``` Topical antibiotics (5 days)​ w/ Regular eye hygiene (If vision affected or worsens: refer) ```
78
Viral Conjunctivitis Sx
(Recent Eye/URTI infection)​ Burning sensation and watery discharge (Increased lacrimation)​ Swollen conjunctiva​ Preauricular lymphadenopathy
79
Viral Conjunctivitis Mx
(Self resolving – weeks)​ Cool compresses, Lubrication fluid, Top ABx drops​ (Secondary Bact Inf) (If reduced VA, photophobia, > 3wks: refer)​
80
Sarcoidosis Features
Purple rash/lesions on face | (Tender) Bilat Lymphadenopathy
81
Acne Rosaecea Feature indicating Severe + Mx
(If Plaques: Severe) M2M: Top Metronidazole Severe/Resistant: PO Tetracyclines

Medicine (13 decks)

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