Ophthalmology and ENT Flashcards
(52 cards)
1
Q
What is a Marcus Gunn pupil?
A
RAPD
2
Q
What is an Agyll Robertson pupil?
A
Pupil constricts on accommodation but not to light
3
Q
What is a Holmes Adie pupil?
A
Tonically dilate pupil that does not react to light (associated with PSNS damage)
4
Q
What is normal IOP?
A
6-21mmHg
5
Q
A positive finding in an Amsler grid (metamorphopsia) indicates what kind of disease?
A
Macular pathology
6
Q
Abnormal EOM may indicate what disease?
A
- CN palsy (III, IV, VI) - Muscle entrapment - Muscle infiltrate (thyroid eye disease) - Muscle weakness - Gaze centre dysfunction (horizontal gaze palsy, INO)
7
Q
What are causes of leukocoria (absent red reflex)?
A
- Cataract - Retinoblastoma - Coats disease - Retinal detachment - Retinopathy of prematurity
8
Q
What is myopia and hypermetropia?
A
- Myopia: short-sighted - Hypermetropia: long-sighted
9
Q
What are the causes of cataracts?
A
- Age-related - Drugs (steroids) - Trauma - DM - Myotonic dystrophy - Wilson’s disease - Uveitis, retinitis pigmentosa
10
Q
What are the symptoms of cataracts?
A
- Gradual decrease in visual acuity - Increase in glare symptoms - Occurs over weeks to years
11
Q
What are the 3 clinical features of primary open angle glaucoma?
A
- Progressive visual field loss (annular scotoma) - Progressive increase in cup-to-disc ratio of optic disease - Elevated IOP
12
Q
What are the management optics for open angle glaucoma?
A
- Eye drops to reduced aqueous production or increase aqueous outflow - Tablets to decrease aqueous production - Selective laser trabeculoplasty - Trabeculectomy
13
Q
What occurs in proliferative diabetic retinopathy?
A
- Neovascularisation - Vitreous haemorrhage
14
Q
What causes diabetic maculopathy?
A
- Macular oedema - Macular ischaemia
15
Q
How do you manage diabetic maculopathy?
A
- Intra-vitral anti-VEGF (for oedema) - BGL, BP and cholestrol control (for ischaemia)
16
Q
What features are seen in dry age-related MD?
A
- Increasing age, smoker - Geographic atrophy, drusen
17
Q
What is the management of dry age-related MD?
A
- Smoking cessation - Low vision aids
18
Q
What feature is seen in wet age-related MD?
A
Choroidal neovascularisation
19
Q
What is the management of wet age-related MD?
A
- Anti-VEGF agents - Photodynamic therapy - Macular laser
20
Q
What is rhinitis medicamentosa?
A
Inflammation of the nasal mucosa secondary to prolonged alpha-agonist topical medications Associated with clear rhinorrhoea and marked nasal congestion
21
Q
What are the features of anterior epistaxis?
A
- Through the nares - Controlled by direct pressure
22
Q
What are the features of posterior epistaxis?
A
- Felt dripping down back of nose - May need nasal packing for control
23
Q
What raises your suspicion of a base of skull fracture?
A
- CSF rhinorrhoea/otorrhoea - Raccoon eyes - Battle’s sign (mastoid bruising) - Haemotympanum - Subconjunctival haemorrhage with no posterior margin
24
Q
Examination of the nares reveals the following, what is going on?
A
Septal haematoma
25
Patient has a 2 year history of clear rhinorrhoea, sneezing and bilateral nasal congestion. Worse in dusty environments
Allergic rhinitis
26
What is this nasal pathology?
Nasal polyp
27
A patient presents with 1 week of purulent rhinorrhoea, persistent nasal obstruction and a 2 day history of bilateral cheek and inter-orbital pain
Acute rhinosinusitis
28
57yo smoker presents with a 3 year history of post-nasal drip, facial pressure, nasal congestion and 3 weeks of purulent rhinorrhoea
Chronic rhinosinusitis
29
What's FESS?
Functional endoscopic sinus surgery?
30
What kind of hearing loss is shown?
Sensorineural hearing loss (air and bone conduction are similar)
31
What kind of hearing loss is shown?
Conductive hearing loss: top = bone conduction, bottom = air conduction
32
14yo presents with a painful, blocked left ear and an itchy right ear. She swims in a river every day
Otitis externa
33
What is the management of otitis externa?
- Analgesia
- Ear toilet/cleaning
- Topical Abx
34
18mo has thick, purulent discharge from his ear; he is happy and rubs at his ear. He has had a cold
Acute otitis media with perforation
35
What organisms cause otitis media?
- Strep. pneumoniae
- H. influenzae
- Morazella catarrhalis
36
Who should be treated with Abx in otitis media?
- Child
- TM perforation
- Indigenous
- Known immunodeficiency
- Cochlear implant
- Only hearing ear infected
- Has a complication, eg/ mastoiditis, facial paralysis, cerebral infection or venous thrombosis
37
What antibiotics are used to treat otitis media?
- Amoxycillin for 5 days
- Cerufoxime if allergy to penicillin
- Amoxycllin + clavulanate if recurrent or no improvement after 48hrs
38
A 23mo presents with his mother who is concerned because he is not speaking. He occasionally rubs at his ear
Chronic otitis media with effusion (glue ear)
39
Which children should have middle era ventilation tubes?
- OME for 4 months at least with hearing loss
- Recurrent or persistent OME in an "at risk" child, eg/ cleft palate, visual impairment, developmental delay, autism spectrum
- OME and TM structural damage
40
64yo presents with intermittent unilateral discharge with a foul odour. Poor hearing on this side and some imbalance
Chronic suppurative otitis media with cholesteatoma
41
What are the features of chronic suppurative otitis media?
- Recurrent or persistent bacterial infection of the ear
- Destruction of the TM ± ossicles
- Irreversible
- No pain, usually have itchiness and discharge
- Conductive hearing loss
42
What are the complications of cholesteatoma?
- Conductive hearing loss
- Sensorineural hearing loss
- Vertigo
- Facial paralysis
- Intracranial complications
43
If there is conductive hearing loss, where will the sound localise on Weber's?
In the worse hearing ear
44
If there is sensorineural hearing loss, in Weber's where will the sound localise?
In the better ear
45
What is a positive Rinne's?
Air conduction better than bone conduction
46
What is a Rinne's negative?
Bone conduction better than air conduction = **conductive hearing loss**
47
What are some causes of otorrhoea?
- Wax
- Otitis externa
- Foreign body in the ear canal
- Acute otitis media with perforation
- Chronic suppurative otitis media ± cholesteatoma
48
44yo presents with right ear pain for 2 days, he also has a facial nerve palsy and vesicles in his concha
Herpes zoster oticus (Ramsay Hunt syndrome)
49
What are the features of vestibular neuritis?
- Abrupt onset vertigo
- No hearing loss or tinnitus
50
What are the features of Meniere's disease?
At least 3 of:
- Vertigo: for at least half an hour, but less than a day
- Fullness in the ear
- Roaring tinnitus
- Initially low frequency SNHL that fluctuates but becomes worse and permanent
51
What is the management of Meniere's disease?
- Vestibular suppressants (prochlorperazine, diazepam)
- Lifestyle: reversible stresses
- Low salt diet
- Medications if persistent: thiazides, betahistine
52
What is the definition of sudden SNHL?
- Occurs within 3 days
- In at least 3 frequencies
- Is at least 30dB
