Special Senses Flashcards
(268 cards)
1
Q
Complications of tonsillitis?
A
Peritonsillar abscess (quinsy) - sore throat, dysphagia, peritonsillar bulge, uvular deviation, trismus and muffled voice.
1
Q
Causes of recurrent unilateral salivary gland symptoms?
A
Often from stones - 80% in submandibular. Pain/swelling worse on eating. Gland may be red, swollen and tender.
2
Q
1st line treatment for eczema?
A
Emollients (topical, soap substitute, bath additives) Topical steroids
3
Q
Infective causes of corneal ulcers?
A
Bacterial (pseudomonas), herpetic (simplex, zoster), funal (candida; aspergillus), protozoal or from vasculitis.
4
Q
4 topical steroids and their potencies?
A
Mild - hydrocortisone Moderate - eumovate Potent - betnovate Very potent - dermovate
4
Q
Definition of glue ear?
A
Otitis media with effusion
5
Q
How does a cataract present/
A
Blurred vision; unilateral cataracts cause loss of steropsis which affects distance judgement. Bilateral loss of vision +/- dazzle +/- monocular diplopia.
6
Q
What causes chicken pox?
A
Varicella zoster virus
6
Q
Signs of nasopharyngeal cancer?
A
Diplopia, conductive deafness (Eustachian tube affected), CN palsy (not I, VII, VIII), nasal obstruction or neck lumps
6
Q
Risk factors for oropharyngeal cancer?
A
Chewing or smoking tobacco, alcohol alone not a risk factor but is synergistic with smoking
7
Q
Define basal cell carcinoma?
A
Slow growing, locally invasive malignant tumour of the epidermal keratinocytes.
8
Q
What is episcleritis?
A
Infalammation below the conjunctiva - often seen with inflammatory nodule. Bilateral in 30%.
9
Q
Causes of acute unilateral salivary gland symptoms?
A
Likely to be due to mumps. Acute parotitis may occur by ascending oral infections. Occurs post op but now rare unless dehydrated or poor oral hygeine.
10
Q
Treatment of conjunctivitis?
A
Chloramphenicol drops
11
Q
Management of psoriasis?
A
General measures Topical - vit d analogues, topical corticosteroids, coal tar preparations, keratolytics, scalp preparations Phototherapy Oral therapies - methotrexate, ciclosporin, biologics…
11
Q
What causes impetigo?
A
Staph aureus/strep pyogenes
12
Q
What is acne rosacea and who does it affect?
A
Chronic inflammatory dermatosis Usually affects 30-50 year olds, common in women
13
Q
Treatment of choice for BCC?
A
surgical excision - allows histologcial examination of tumour and its margins
13
Q
Arise from jugular lymph sac and transilluminate brightly. Treated by surgery or hypertonic saline sclerosant.
A
Cystic hygromas - anterior triangle
14
Q
Treatment of candida?
A
Mouth treatment = nystatin, vagina treatment = imidazole cream.
15
Q
Symptoms of nasal polyps?
A
Watery anterior rhinorrhoea, purulent postnasal drip, nasal obstruction, change in voice, anosmia/taste disturbance, sinusitis, headaches, mouth-breathing, snoring, mucocele, pain
16
Q
Treatment of acne?
A
Retinoids - vit A derivatives Benzylperoxide - topical antimicrobial. Abx - erythromycin, tetracyclines, trimethorpim Hyfrecation - application of electrical energy to destroy small areas of soft tissue
16
Q
Presentation, cause and management of erysipelas?
A
Sharply defined superficial infection caused by Strep Pyogenes. Often affects face unilaterally with fever and ↑WCC. Systemic penicillin.
16
Q
If a lump is superoposterior in the anterior triangle…?
A
Parotid tumour - more likely in over 40s
16
What causes excess evaporation of tears?
Post exposure keratitis
17
Open angle glaucoma presentation?
Asymptomatic until fields badly impaired - central field intact so acuity maintained so presentation delayed.
18
Treatment for acute angle closure glaucoma?
Pilocarpine drops open the closed angle
19
Treatment for corneal ulcer?
Chloramphenicol ointment
19
Chief cause of registerable blindness?
Macular degeneration
20
How does molluscum contagiosum present?
Pink papules with an umbilicated (depressed) central punctum. Common in children. Resolve spontaneously, more common in atopic eczema.
21
Typical presentation of squamous cell laryngeal cancer?
Typical older patient = male smoker with progressive hoarseness, then stridor, difficulty or pain on swallowing +/- haemoptysis +/- ear pain (if pharynx involved)
22
What is cholesteatoma?
Active squamous otitis media
23
Presentation of malignant melanoma?
ABCDE symptoms rule: Asymmetrical shape Border irregularity Colour irregularity Diameter \>6mm Evolution of lesion (change in size and/or shape) Symptoms (bleeding, itching)
23
Wet ARMD?
Occurs when aberrant vessels grow from the choroid into the neuro-sensory retina and leak. Vision deteriorates rapidly and distortion is a key feature. (treatment available)
24
Symptoms of allergic rhinosinusitis?
Sneezing, pruritis, rhinorrhoea (bilateral and variable)
24
Causes of fixed salivary gland swellings?
Malignant, idiopathic or due to sarcoidosis
24
How does open angle glaucoma present on opthalmoscopy?
Raised IOP. Cupping, nerve damage, scotoma. Disc pales (atrophy) and cup widens and deepens so vessels emerging from disc appear to have breaks in them as they disappear into the cup and then seen in base again.
25
Precipitating factors in psoriasis?
Trauma (Koebner phenomenon), infection, drugs, stress and alcohol
26
How does Lichen Planus present?
Itchy, shiny, purple plaques. Flat-topped with Whickham's striae.
26
How is ambylopia caused?
Developmental failure of immature neuroretina during early childhood that occurs as a result of visual deprivation or abnormal binocular interaction.
27
What is a risk in orbital cellulitis?
Blindness from pressure on optic nerve or thrombosis of its vessels
29
Presentation of psoriasis?
Well demarcated erythematous scaly plaques. Lesions can be itchy, burning or painful. Common on extensor surfaces and over scalp. Auspitz sign (scratch and gentle removal of scales cause capillary bleeding) Associated nail changes (pitting, oncholysis) Associated psoratic arthropathy.
30
What is erythroderma/exfoliative dermatitis? Causes?
Widespread erythema and dermatitis. Sulfonamides, allopurinol, carbamezapine, gold
31
What is the corneal reflection test?
Reflection from bright light falls centrally and symmetrically on each cornea if no squint, asymmetrically if squint present.
32
Where is BCC most common?
Head and neck
32
Typical age/gender for nasal polyps?
Male \>40
32
Management of squamous cell laryngeal cancer?
Total laryngectomy - patient must have permanent tracheostomy so must learn oesophageal speech.
33
Name some ototoxic drugs?
Streptomycin, vancomycin, gentamicin, chloroquine and hydroxychloroquine, vinca alkaloids
34
Presentation of uveitis?
Acute pain, photophobia, reduced acuity, lacrimation, circumcorneal redness, small pupil. White precipitations on back of cornea.
35
What aggravates eczema?
Dryness, stress, infection and allergy
36
What can be a sinister complication of persistent otitis externa?
Malignant/necrotising otitis externa (in diabetics/immunocompromised/elderly)
37
Causes of tonsillitis?
Group A streps (pyogenes). Staphs, moraxella, mycolplasma, chlamydia, haemophilus
38
Definition of eczema?
Inflammatory skin condition with itching, redness and scaling.
39
Pathophysiology of glue ear?
Dysfunction of eustachian tubes
40
Management of cholesteatoma?
Mastoid surgery
41
What is tinea
Ringworm. Round, scaly, itchy lesion whose edge is more inflamed than its centre.
42
Infections causing facial palsy?
Otitis media, cholesteatoma, necrotising otitis externa
43
Presentation of acute otitis media?
Rapid onset of pain, fever +/- irritability, anorexia or vomiting, often after a viral URTI.
44
Should you try to remove a large foreign object from the eye?
NO. Support it with padding, transport supine. Pad unaffected eye to prevent damage from conjugate movement.
45
Two groups of skin cancer?
Non-melanoma and melanoma
47
Bulla definition?
Large fluid filled lesion
47
What are you thinking if many small lumps in posterior triangle?
Nodes - TB or viruses
47
What is congenital blocked nasolacrimal duct called?
Dacyrostenosis
48
Macule definition?
small flat lesion
48
Risk factors for SCC?
Excessive UV exposure, pre-malignant skin condition (actinic keratosis), chronic inflammation (leg ulcers, wound scars), immunosuppression and genetic predisposition
48
Compression of optic tracts causes what
Homonomous hemianopia
49
Treatment of acne rosacea?
Topical abx - metronidazole/azelaic acid Systemic abx - macrolides/tetracycline
50
Compression of optic nerve causes what?
Monocular blindness
51
Most common type of squint in children?
Convergent (esotropia). Exotropia tends to be in older kids
52
What type of epistaxis can be seen easily with rhinoscopy and is easier to treat?
Anterior
53
What is a cataract?
Any opacity in the lens
54
Patch definition?
Diffuse flat lesion
55
What is pityriasis rosea?
Rash preceded by a herald patch (ovoid red scaly patch with a scaly edge, similar to but larger than later lesions. Affects neck, trunk and proximal limbs. Affects young adults.
56
Causes of chronic bilateral salivary gland symptoms?
May be associated with dry eyes and mouth +/- Sjogren's or Mikulicz's syndromes
57
Atrophy definition?
Loss of tissue
57
Define sensorineural deafness?
Results from defects central to oval window in cochlea (sensory), cochlear nerve (nerual) or, rarely, more central pathways
57
Management of posterior epistaxis?
Examination under anaesthesia. Gold standard = endoscopic ligation of maxillary/sphenopalatine artery around the sphenopalatine foramen.
58
How does facial palsy in brainstem lesions present?
Produce only muscle weakness and may be accompanied by VI nerve palsies
59
What is myopia?
Short-sightendness - Eyeball is too long. Only close objects focus on the retina unless CONCAVE lenses used.
61
Name some retinoids?
Tretinoin gel, adapalene, isotrenitoin,
61
What is the cover test?
Movement of uncovered eye to take up fixation as the other eye is covered demonstrates manifest squint: latent squint revealed by movement of the covered eye as cover is removed
62
First line treatment for rhinosinusitis?
Topical corticosteroids and oral abx.
62
Where are most malignant salivary gland tumours?
Mandibular (50% of them are malignant.
63
Presentation of episcleritis?
Eye aches dully and is tender. Acuity usually okay. No cause in 70%.
63
Most prevalent inherited degeneration in the retina?
Retinitis Pigmentosa
65
Atopic eczema usually associated with what?
Hayfever and asthma
66
Aetiology of acne?
Abnormal cell turnover, inflammation and host immune reaction, excessive sebum production, P.acnes colonisation
66
Causes of sensorineural deafness?
Ototoxic drugs, postinfective, cochlear vascular disease, Méniére's disease, trauma, presbyacusis.
66
How does tonsillitis present?
Sore throat +/- lymphadenopathy
68
Risk factors for squamous cell laryngeal cancer?
Smoking, regular cannabis use, HPV +ve in young people
68
Risk from giant cell arteritis?
Anterior ischaemic optic neuropathy (AION) - optic nerve damaged if posterior ciliary arteries are blocked by inflammation or atheroma.
69
How do you test for and fix BPV?
Hallpike test, Epley manoeuvres
70
Associations of glue ear?
URTIs, oversized adenoids, narrow nasopharyngeal dimensions
71
What is Méniére's disease?
Vertigo with prostration, nausea/vomiting +/- feeling of fullness in the ear; unilateral or bilateral tinnitus +/- sensorineural deafness
71
How does facial palsy present in UMN and LMN lesions
UMN - upper portion of face spared LMN - can paralyse all of one side of face
71
Presentation of conjunctivitis?
Conjunctiva red and inflamed, hyperaemic vessels may be moved by gentle pressure on the globe. Eyes itch, burn and lacrimate. May be photophobia. Often bilateral with discharge sticking eyes together. Acuity, pupillary response and corneal lustre unaffected.
72
Symptoms of chronic otitis media?
Discharge, reduced hearing, but little pain
73
What happens if secretions from chronic otitis media cannot drain?
Differentiation into squamous epithelium occurs --\> retraction of pars tensa or flaccida
74
How does central retinal artery occlusion present?
Dramatic visual loss within seconds. Afferent pupil defect appears within seconds.
74
Risk factors for glaucoma
\>35, +ve FH, afro-caribbean, myopia, diabetic/thyroid eye disease
74
Compression of optic chiasm causes what?
Heteronomous hemianopia
75
Recovery from optic neuritis?
2-6 weeks
76
Where does anterior epistaxis usually come from?
Invariably septal - Little's area (Kiesselbach's plexus) is an anterior anastamotic aracade.
77
Causes of facial pain?
Tooth pathology, sinusitis, TMJ dysfunction, salivary pathology, migraine, trigeminal neuraglia, atypical facial pain, trauma, cluster headache, angina, fontal bone myelitis, ENT tumours
77
What can happen as a consequence of posterior vitreous detachment?
Retinal tears
78
What happens in IVth nerve palsy?
Eye looks upward in addution and cannot look down (SO paralysed). Diplopia and patient may hold head tilted (ocular torticollis)
79
Main cause of salivary gland inflammation?
Usually due to obstructing calculus (Calcium phosphates and carbonates)
80
Symptoms of giant cell arteritis?
Malaise, jaw claudication (chewing pain), tender scalp and temporal arteries (thickened, absent pulses), neck pain. ESR and CRP raised.
82
Pustule definition?
Raised and contains pus
83
Causes of central vertigo?
Acoustic neruoma, MS, head injury, inner ear syphilis, vertebrobasilar insufficiency
85
Key to treatment of otitis externa?
Aural toilet
86
Define conductive hearing loss?
Impaired sound transmission via external canal and middle ear ossicles to foot of the stapes
88
What is toxic epidermal necrolysis? Causes?
- The bad end of erythema multiforme/SJS spectrum - Widespread erythema then necrosis of large sheets of epidermis. Mucoase severely affected/ - Risk 1000 fold higher in HIV patients. - Causes – sulfonamides, anticonvulsants, penicillins, allopurinol, NSAIDs.
88
Management of Bell's palsy?
Protect eye, artifical tears, ?prednisolone
89
What is a squint?
Abnormality of co-ordinated movements of eyes.
90
Signs and causes of Stevens Johnson Syndrome?
- Signs – target lesions and polymorphic erythema, eg with blistering muscosae (conjunctivae, oral, labial, genital). - Mainly due to drugs (sulfonamides, anticonvulsants)
91
How do patients describe posterior vitreous detachment?
Monochromatic photopsia in peripheral temporal field. More obvious in dim light and with eye movements. Increase in floaters but vision remains unchanged and no field defects.
92
V.rare. Move from side to side but not up and down. Splay out to the carotid bifurcation. Firm and pulsatile but do not usually cause bruits. May be bilateral, familial and malignant. Treat by extirpation by vascular surgeons.
Carotid body paraganglioma
94
How is headlice spread?
common in children, spread only by head to head contact. Itch and popular rash on the nape. Neurotoxic agents work in 70%.
95
Differentials for midline neck lump?
If under 20, likely a dermoid cyst. If moves on tongue protrusion and below hyoid, thyroglossal cyst. If over 20, probably a thyroid mass - unless bony hard, may be a chondroma.
97
Risk factors for BCC?
UV exposure, history of severe or frequent sunburn in childhood, skin type I, increasing age, male sex, immunosuppression, previous history of skin cancer, genetic predisposition.
99
Where is eczema usually found?
Flexor surfaces
100
Dry ARMD?
Shows mainly drusen and degenerative changes at the macula. Progresses slowly.
101
What is candida?
common in immunocompromised. Affects mouth, vagina, glans, skin folds/toe web, nail areas. Often pink and moist +/- satellite lesions.
102
What is ambylopia?
Lazy eye.
103
When should you remove a salivary gland if swelling?
If swelling present for over 1 month
104
Where do nasal polyps most commonly arise?
Middle turbinates, middle meatus, ethmoids.
105
Management of epistaxis?
Resuscitate if needed. Vital signs often. Ask patient to apply pressure to lower part of nose. Fully decongest (ephedrine). Silver nitrate cautery - liodcaine and phenylephrine first (vasoconsriciton) Anterior nasal pack too (admit patients with packs and look for causes)
106
Orophargyngeal cancer - M:F ratio and what type?
M:F 5:1, 85% sqaumous
106
Association of optic neuritis?
45-80% go on to develop MS in next 10 years
108
Retinal detachment may happen following what?
Separation of the vitreous leading to retinal tear and then detachment
109
What makes up 90% of ocular carcinomas?
Basal cell carcinoma
110
Complications of BCC?
Local tissue invasion and destruction
110
What is allergic rhinosinusitis?
IgE mediated inflammation from allergen exposure to nasal mucosa causing inflammatory mediator release from mast cells - may be seasonal or perennial
111
Esotropia =?
Convergent squint (one eye turned in)
112
How does Bell's palsy present?
Onset abrupt, mouth sags, dribbling, watering (or dry eyes), impaired brow wrinkling, blowing, whistling, lid closure, cheek-pouting, taste and speech
114
What nasal polyp may be sinister?
Polyp causing unilateral nasal obstruction, esp if pain or bleeding
115
What happens in VIth nerve palsy?
Eye medially deviated and cannot move laterally from midline (LR paralysed). Diplopia in horizontal plane.
117
Management of malignant melanoma?
Surgical excision = definitive treatment Radiotherapy may sometimes be useful Chemotherapy for metastatic disease
119
What is vertigo?
Illusion of movement - may be accompanied by nausea, vomiting, hearing loss, tinnitus and nystagmus (usually horizontal)
120
2nd line treatment for eczema?
Antibiotics for secondary infection Phototherapy with UV Oral steroids Immunosuppressant
121
Causes of conductive hearing loss?
External canal obstruction, drum perforation, problems with ossicular chain, inadequate Eustachian tube ventilation of middle ear
122
Presentation of SCC?
Keratotic (scaly, crusty), ill-defined nodule which may ulcerate
123
Uveal injury risks what in the other eye?
Sympathetic opthalmia
124
Associations of nasopharyngeal cancer?
HLA A2 allele, HPV, EBV, tobacco, formaldehyde, wood dust exposure.
126
Management of SCC?
Surgical excision = treatment of choice
126
What do you need to think about when investigating a neck lump\>
How long has it been there? -
127
Extropia =?
Divergent squint (one eye turned out)
128
What is an acute angle closure glaucoma?
Blocked flow of aqueous from anterior chamber via canal of schlemm. Intraocular pressure rises.
130
What is pityriasis versicolor?
multi hypo- or hyperpigmented scaly macules on the upper trunk and back.
132
Other treatments of BCC?
Mohs micrographic surgery, radiotherapy, cryotherapy, curettage and cautery, topical treatment
133
Why do patients with sinus squamous cell cancer present late?
Because epistaxis, obstruction and headahce only occur with large tumours.
134
Chief organisms involved in otitis externa?
Pseudomonas and Staph aureus
135
Typical presentation of sinus squamous cell cancer?
Middle aged or elderly. Suspect when chronic sinusitis presents for first time in later life. Early signs = blood stained nasal discharge and nasal obstruction. Later = cheek swelling, swelling or ulcers of buccoalveolar plate or palate, epiphora due to blocked nasolacrimal duct, ptosis and diplopia as floor of orbit involved, and pain in maxillary division of trigeminal nerve.
136
Differentials for lump in submandibular triangle?
If
138
Treatment of tonsillitis?
Paracetamol +/- difflam - gargle if severe. Abx unlikely to help as most viral. If ill or centor criteria +ve --\> penicillin or erythromycin if penicllin allergic. NOT amoxicillin - rash in EBV.
139
Drugs that can cause vertigo?
Gentamicin, diuretics, co-trimoxazole, metronidazole
140
Erythema definition?
Red
141
Treatment for dry eyes?
Artificial tears give symptomatic relief
142
Rare causes of sensorineural deafness?
Acoustic neuroma, B12 deficiency, MS, secondary carcinoma in brain
143
Most common malignant skin tumour?
BCC
144
Peak age for cholesteatoma?
5-15 years
145
What is a corneal abrasion?
Epithelial breach. Causes pain, photophobia and decreased vision.
146
Prognosis of Bell's palsy?
1/3 full recovery 1/3 incomplete recovery of facial motor function Rest = permanent neurological and cosmetic abnormalities
148
What do polyps look/feel like?
Pale, mobile and insensitive to gentle palpation
150
Where does acne affect most?
Face, back, chest
151
Vesicle definition?
Small fluid filled lesions
152
Presentation of oropharyngeal cancer?
Often advanced at presentation. Typical older patient = smoker with sore throat, sensation of a lump, referred otalgia, local irritation by hot or cold foods, with risk factors.
153
Causes of otitis externa?
Moisture (swimming), trauma (fingernails), high humidity, absence of wax, narrow ear canal and hearing aids
154
Associations of paediatric cataracts?
Rubella, Down's
156
Cellulitis - cause, presentation and treatment?
acute infection of skin and soft tissues – deeper and less well-defined than erysipelas. Beta-haemolytic streps and staphs. Pain, swelling, erythema, warmth, systemic upset and lymphadenopathy. Benzylpenicllin + flucloxacillin or erythromycin if penicillin allergic.
157
Risk factors for ARMD?
Age, smoking, sun exposrue, poor diet, alcohol
159
Causes of external ear canal obstruction?
Wax, pus, debris, foreign body
160
Types of malignant melanoma?
Superficial spreading melanoma - common on lower limbs in young and middle aged adults; related to intermittent high intensity UV exposure Nodular melanoma - common on trunk, in young and middle aged adults, related to intermittent high-intensity UV exposure Lentio malinga melanoma - common on face in elderly, related to long term cumulative UV exposure Acral lentiginous melanoma - common on palms, sole and nail beds, in elderly population, no clear relationship with UV exposure
161
Plaque definition?
Diffuse raised lesion
163
What is contact dermatitis?
Inflammatory response to chemical penetration of epidermis
164
What is posterior vitreous detachment?
Degenerative changes in the vitreous lead to its eventual spearation from the retina (normal part of ageing)
166
Two key processes in acne rosacea?
Chronic inflammation, vasodilation/vascular instability
167
Causes of drum perforation?
Trauma, barotrauma, infection
168
What virus causes warts?
HPV
169
How does retinal detachment present?
4 Fs - floaters, flashes, field loss and fall in acuity. Painless and may be a curtain falling over the vision.
169
Test for dry eyes?
Schirmer's test - filter paper put overlapping lower lid; tears should soak.
170
Common organisms for otitis media
Pneumococcus, haemophilus, moraxella, other streps and staphs
172
Nodule definition?
Discrete raised lesion
172
Causes of facial palsy?
Intracranial - brainstem tumours, strokes, polio, MS, cerebellopontine angle lesions (acoustic neuroma, meningitis) Intratemporal - otitis media, Ramsay Hunt syndrome, cholesteatoma Infratemporal - parotid tumours, trauma Others - Lyme disease, sarcoid, Guillain-Baré, herpes, diabetes, Bell's palsy
173
Definition of rhinosinusitis?
Inflammation in the nose and paranasal sinuses with \>2 symptoms, one of which must be nasal congestion or nasal discharge
174
Treatment for allergic rhinosinusitis?
Loratidine = antihistamine. Systemic decongestants, nasal sprays, nasal steroids, oral steroids.
175
Generalised pustular psoriasis?
- May cause severe systemic upset (fever, high WCC, dehydration) – also triggered by withdrawal of systemic steroids.
176
What would you see on opthalmoscopy in cataracts?
No red reflex or visible fundus
178
What are plane warts?
flat skin coloured or brown lesions.
179
Pattern of visual loss in open angle glaucoma
Nasal and superior fields lost first, temporal last
180
Define squamous cell carcinoma?
Locally invasive malignant tumour of the epidermal keratinocytes or its appendiges, which has the potential to metastasise.
181
What is BPV?
Displacement of otoconia in semicircular canals. No persistent vertigo, no speech, visual, motor or sensory problems, no tinnitus, headache, ataxia, facial numbness or dysphagia, no vertical nystagmus.
183
Tests for vertigo?
Romberg's, provocation tests (hallpike test)
183
An uncommon cause of lump in anterior triangle - painless, more common in males and made worse by blowing?
Laryngocele
183
Causes of mucin deficiency in tears?
Avitaminosis A, Stevens-Johnson syndrome, pemphigoid, chemical burns
184
Treatment of optic neuritis?
High dose methylprednisolone
185
Signs of glue ear?
Retracted or bulging ear drum
186
Compression of optic radiation causes what/
Homonomous hemianopia
188
How does scabies present?
presents with little linear burrows, really itchy. Person to person spread. Very itchy papules, vesicles, pustules and nodules affecting finger webs, wrist flexures, axillae, abdomen, buttocks, groins. Permethrin is treatment.
189
What is horner's syndrome?
Disruption of sympathetic nerve fibres causing mitotic pupil, partial ptosis and unilateral anhydrosis.
191
In whom do you see BCC?
Older people
192
What do you see in ARMD on opthalmoscopy?
Pigment, drusen and sometimes bleeding at macula
194
Indications for tonsillectomy?
Sore throat definitely caused by tonsillitis. 5 or more episodes per year Symptoms for at least a year Respiratory obstruction, suspicion of malignancy
195
Presentation and mangement of impetigo?
Lesions usually start around nose and face with honey-coloured crusts on erythematous base. Topical abx, oral if more severe
196
Where are malignant melanomas more common in men and women?
More common on legs in women and trunk in men
198
Risk factors for malignant melanoma?
Excessive UV exposure, skin type I, history of multiple moles or atypical moles, and family or previous history of melanoma
199
Usually present in acne rosacea?
Flushing, non-transient erythema, papules and pustules, telangiectasia
200
How does retina appear in central retinal artery occlusion?
Appears white, with a cherry spot at the macula
200
Causes of orbital cellulitis?
Staphs, strep pneumoniae, strep pyogenes or milleri
201
What might a corneal abrasion result from?
Scratches from sharp objects, trauma, chemical injury or previous corneal disease.
202
Presentation of cholesteatoma?
Foul discharge +/- deafness; headache, pain, facial paralysis and vertigo indicate impending CNS conditions
204
How does nodular BCC present?
Small, skin coloured papule or nodule with surface talngiectasia, and a pearly rolled edge; may have a necrotic or ulcerated centre (rodent ulcer)
205
Presentation of acne?
Comedones, papules, pustules and nodules/cysts. If untreated can lead to scarring
206
Lichenification definition?
Thickening (if deeper = sclerosis)
207
Name another type of ocular malignancy?
Choroidal melanoma and eyelid skin melanoma
209
What is psoriasis?
Chronic inflammatory skin condition due to hyperproliferation of keratinocytes and inflammatory cell infiltration
211
If over 20, what are you thinking about lumps in posterior triangle?
Lymphoma or metastases
212
Management of giant cell arteritis?
Temporal artery biopsy within 1 week of starting prednisolone - other eye still at risk of AION until steroids given.
214
How does retinal detachment present on opthalmoscopy?
Grey opalescent retina, ballooning forward
215
What are nasal polyps?
Ciliated columnar epithelium with a thickened basement membrane and an avascular odematous stroma.
216
Where does lichen planus affect?
Wrists and ankles. Can affect scalp causing scarring alopecia or mucuous membranes causing white streaks and ulceration
217
How does optic neuritis present?
Unilateral loss of acuity over hours or days. Colour vision affected (dyschromatopsia): reds appear less red and eye movements hurt. Pupil shows an afferent defect.
218
How does eyelid BCC present?
Nodular lumps with pearly edges +/- telangiectasia
219
Main symptom of blocked nasolacrimal duct?
Excessive tearing.
221
Causes of conjunctivitis?
Adenoviruses (small lymphoid aggregates appear as follicles on conjunctiva), bacteria (purulent discharge - staphs) or allergic.
222
Treatment of glue ear?
Grommet insertion
223
Define malignant melanoma?
Invasive malignant tumour of the epidermal melanocytes which has the potential to metastasise.
224
What is Amaurosis fugax?
Painless transient monocular visual loss
225
Symptoms of squamous H&N cancers? (13)
Neck pain/lump, hoarse voice \>6 weeks, sore throat \>6 weeks, mouth bleeding, mouth numbness, sinus congestion, sore tongue, painless ulcers, patches in mouth, earache/effusion, lumps (lip, mouth, gum), speech change, dysphagia, epistaxis
226
Most common salivary gland tumour?
Pleomorphic adenoma (parotid).
227
What happens in IIIrd nerve palsy?
Ptosis, proptosis (as recti tone reduced), fixed pupil dilatation, eye looking down and out
228
Orbital cellulitis is typically spread via what?
A paranasal sinus infection (or eyelide, dental injury/infection or external ocular infection)
230
Lymph spread of nasopharyngeal cancer?
usually early to upper deep cervical nodes. Local spread may involve cranial nerves via jugular foramen.
232
Causes of red eye?
Conjunctivitis, corneal ulcers, acute angle closure glaucoma, uveitis, episcleritis/scleritis, loads more
233
Sequelae of otitis externa?
Hearing loss and canal stenosis (making hearing aids harder to wear)
235
Types of glaucoma surgery?
Laser - trebeculoplasty Surgery - trabeculectomy (establishes pressure valve at limbus so aqueous can flow into a conjunctival bleb)
236
Presentation of acute angle closure glaucoma?
Acute uniocular attacks occur with headache, nausea, and a painful red eye.
237
Papule definition?
Small raised lesion
238
Symptoms of ARMD?
Disturbed central vision - blurring, scotoma, distortion. Difficulty reading fine print. Difficulty recognising faces. Difficulty appreciating fine detail.
239
What are plantar warts?
Verucas
240
Emerges under anterior border of SCM where upper 1/3 meets middle 1/3; age
Brachial cyst - anterior triangle
241
What is hypermetropia?
Eye is too short. Distant objects focused behind retina. Can produce tiredness of gaze or a convergent squint in children. Corrected by CONVEX lenses.
242
What is Centor criteria?
History of fever, tonsillar exudates, tender anterior cervical adenopathy, absence of cough.
243
Causes of acute bilateral salivary gland symptoms?
Usually due to mumps (if young/unvaccinated)
244
Where are eyelid squamous and meibomian gland carcinomas common?
Commoner on upper lid, in females and increase with age
246
Primary sites of posterior triangle lymph mets in order of likelihood?
H&N, bronchus, gut, breast, gonad
247
What is scleritis?
Rarer than epi. When sclera itself is inflamed and pain is significant. Generalized inflammation with oedema of the conjunctiva and scleral thinning. Associated with CT disorders and infection. Acuity may be reduced.
248
Some infections that can give postinfective sesorineural deafness?
Meningitis, measles, mumps, flu, herpes, syphilis
249
Crust definition?
Tissue fluid + debris
250
Why retinoids only given in secondary care?
Teratogenic
251
Glaucoma medications?
1. Prostaglandins analogue - increase uveoscleral outflow. End in PROST - bimatoprost, travoprost etc 2. Beta-blockers - reduce aqueous production. Timolol. 3. Carbonic anhydrase inhibitors - reduces aqueous production (dorzolamide) 4. Selective alpha-2 receptor agonists - reduce aqueous production. (Brimonidine)
252
Symptoms of otitis externa?
Minimal discharge, itch, pain and tragal tenderness (due to inflammation of skin of meatus)
253
Causes/associations of epistaxis?
Trauma, local trauma or infection, hypertension, dyscrasia/haemophilia, high alcohol intake, septal perforation, neoplasm
255
Morphological types of BCC?
Nodular (most common), superficial (plaque like), cystic, morphoeic (sclerosing), keratoic and pigmented
256
Causes of peripheral vertigo
Méniére's disease, BPV, vestibular failure, labyrinthitis, cholestatoma
257
Typical causes of dry mouth?
Hypnotics and tricyclics, antipsychotics, beta blockers, diuretics, mouth breathing, ENT radiotherapy, Sjogren's syndrome, SLE/scleroderma, sarcoidosis, HIV/AIDS, parotid sialoliths.
258
Management of otitis media?
Analgesia - abx not usually needed If fails to resolve, amoxicillin +/- clavulanate for
259
Causes of dry eyes?
Decreased tear production in old age. Sjogren's syndrome, mumps, sarcoidosis, amyloidosis, lymphoma, lukaemia, haemochromatosis.
260
What may intrude in posterior triangle?
Cervical ribs mate
261
Cause of uveitis
Often none found, autoimmune
262
Telangiectasia definition?
Blood vessel dilatation
263
Keratin definition?
Scaly
264
Symptoms of rhinosinusitis?
Facial pain or pressure, reduced olfaction, endoscopic signs of nasal polyps or musucs +/- pus discharged primarily from sinuses
265
Herpes zoster aetiology and presentation?
varicella zoster becomes dormant in dorsal root ganglia. Recurrent infection affects one or more dermatomes. Polymorphic red papules, vesicles, pustules. Postherpetic neuralgia. Aciclovir or famciclovir.
266
Most common type of psoriasis?
Chronic plaque psoriasis
267
Sites of squamous cell laryngeal cancer? And which is best?
Supraglottic, glottic and subglottic. Glottic is best because it produces hoarseness earlier (and spreads to nodes late)
268
Typical patient with orbital cellulitis?
Child with inflammation in the orbit, fever, lid swelling and reduced eye mobility
