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Special Senses Flashcards

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1
Q

Causes of dry eyes

A

Causes:
• Excess tear loss - blepharitis, contact lens wear, drugs
• Insufficient production - sjogrens, allergic conjunctivitis
Abnormalities of eyelids and blinking - parkinsons

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2
Q

S&S of dry eyes

A

S&S:
• Gritty irritation and FB sensation
• Mild pain aggravated by reading, dry air, PC work
• Worse at end of day

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3
Q

Tx of dry eyes

A

Tx:
• Review meds
• Tear substitutes
• Avoid contact lenses where possible

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4
Q

Differentials of a red eye

A 
Differentials:
	• Conjunctivitis
	• Corneal ulcer
	• Iritis
Foreign body
	• Episcleritis
	• Scleritis
	• Acute angle closure glaucoma
	• Age related macular degeneration
	• Diabetic Retinopathy
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5
Q

S&S of conjunctivitis

A

S&S:
• Mucopurulent discharge on eyelashes
• Dilated red blood vessels on sclera
• Acute onset often bilateral red eyes

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6
Q

Tx of conjunctivitis

A

Tx:
• Topical chloramphenicol or topical fusidic acid
• Don’t wear contacts
• Don’t share towels

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7
Q

Allergic conjunctivitis S&S and tx

A 
Allergic conjunctivitis:
	• Bilateral sx
	• Prominent itch
	• History of atopy
	• Tx - Antihistamines or sodium cromoglicate
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8
Q

corneal ulcer S&S

A 
S&S:
	• Pain
	• Photophobia
	• Blurred vision
	• Sensation of foreign body
	• Signs - Red eye, corneal stain with fluorescein, hypopyon
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9
Q

Causes of corneal ulcer

A

Aetiology:
• Infections - herpes, streptococcus
• Contact lens wear
• Blepharitis

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10
Q

Tx of corneal ulcer

A

Tx:
• Herpes - aciclovir ointment
• Bacterial - topical abx
• Topical steroids

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11
Q

Tx of corneal FB

A

Tx:
• Topical NSAID
• Topical abx
• Tetanus ppx to prevent secondary infection if rust
• Refer if not healed in 72 hrs or worsening sx

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12
Q

Open angle glaucoma S&S

A

Open angle Glaucoma:
• Develops slowly over time, no pain
• Side vision begins to decrease followed by central
• Optic disc cupping (see pic)

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13
Q

Tx of closed angle glaucoma

A

Tx:
• Urgent admission
• Acetazolamide (reduces aqueous secretions) and topical pilocarpine (pupillary constriction)

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14
Q

S&S of acute angle closed glaucoma

A 
S&S:
	• Female over 50 usually
	• Unilateral eye pain
	• Eye watering
	• Headache
	• Progresses to N&V
	• May collapse
	• Reduced vision
	• Red eye
	• Fixed mid dilated pupil
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15
Q

Causes of homonymous Quadrantanopia

A

Homonymous quadrantanopia:
• Lesion of temporal lobe - superior
• Lesion of Parietal lobe - Inferior
PITS - Parietal Inferior Temporal Superior

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16
Q

Wet AMD tx

A

Anti-VEGF injection

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17
Q

S&S of cataracts

A 
S&S:
	• Slowly progressive visual loss or blurring
	• Glare
	• Reduced colour sensitivity
	• Reduced night vision
	• Double vision
	• No red reflex with opthalmoscope
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18
Q

Tx of cataracts

A

Tx:

• Lens extraction and intraocular lens implant surgery

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19
Q

Classification of diabetic retinopathy

A

Background - microaneurysms, blot hemorrhages <3, hard exudates

Pre-proliferative - cotton wool spots, >3 blot hem, cluster hemorrhages

Proliferative - Fibrous tissue anterior to retinal disc, retinal neovascularisation

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20
Q

Tx of diabetic retinopathy

A

Tx:
• Preproliferative - Laser photocoagulation
• Proliferative - Anti VEGF injection
• Glycemic control, lower BP, lower lipids

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21
Q

S&S of HTN retinopathy

A 
S&amp;S:
	• Headache
	• +/- visual disturbance
	• Underlying causes may be present eg pain
BP >200/130
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22
Q

Tx of HTN retinopathy

A

Management:
• Use oral therapy with short half life so you can monitor the drop in BP without taking ages
• Reduce BP by not more than 25% to avoid stroke risk

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23
Q

Optic neuritis S&S

A 
S&amp;S:
	• Unilateral decrease in visual acuity over hours or days
	• Red desaturation
	• Pain worse on eye movement
	• Central scotoma (blindness)
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24
Q

Causes of optic neuritis

A

Causes:
• MS
• Diabetes
• Syphilis

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25
Patho of stye and tx
Infection of glands of eyelids Tx: • Hot compress • Analgesia • Abx if associated conjunctivitis
26
Differentials of sudden painless loss of vision. S&S of each
Central retinal artery occlusion: • Sudden painless loss of vision • Cherry red spot on a pale retina Central retinal vein occlusion: • Causes - glaucoma, polycythemia, HTN • Severe retinal hemorrhages on fundoscopy Retinal detachment: • Flashes of light • Floaters • Curtain being drawn, tunnel vision to central vision.
27
Blepharitis patho and S&S and tx
Inflammation of eyelid margins ``` S&S: • Bilateral • Discomfort around eyelid margins • Eyes sticky in morning • Eyelid margins red • Secondary conjunctivitis may occur ``` Tx: • Hot compresses • Mechanical removal of debris from lid margins with cotton wool buds dipped in hot water
28
Tx of pinna haematoma
urgent drainage and pressure dressing
29
S&S of otitis externa
S&S: • Painful discharging ear • History of itchy ear • Hearing muffled by discharge
30
Tx of otitis externa
Tx: • Topical eardrops empirically - gentamicin • Swab discharge in resistant cases • Microsuction of pus to enable drops to get to source
31
Acute otitis media S&S
S&S: • Ear pain - due to Increased pressure • Discharge - if tymp membrane ruptures. Pain settles • Fever
32
Tx of acute otitis media
``` Tx: • Most managed with analgesia • Medical - abx prescribed if: ○ Sx >4days ○ Systemically unwell ○ Immunocompromised ○ <2 yrs old ○ Perforation in tymp membrane • Surgery - Recurrent requires grommet ```
33
Chronic otitis media classify
Divided into: • Mucosal: ○ Active - chronic discharge through tymp perforation ○ Inactive - tymp perforation but no discharge • Squamous - develops when keratinisied squamous cells introduced into middle ear via perforation: ○ Active - cholesteatoma ○ Inactive
34
S&S of active COM
Active COM - S&S: • Chronic ear discharge • Conductive hearing loss • Cx of temporal bone and intracranial infection
35
S&S of cholesteatoma. ix
``` Cholesteatoma S&S: • Hearing loss • Foul smelling discharge • Invasion leads to: ○ Vertigo ○ Facial nerve palsy • Ix - Otoscopy shows attic crust ```
36
Tx of COM
Tx: • Cholesteatoma - surgery to clear • Mucosal disease - topical abx and aural toilet
37
S&S of otitis media with effusion
S&S: • Middle ear effusion on otoscopy • Conductive hearing loss - associated with speech delay and problems at school • No pain
38
Ix of OME
Ix: • Tympanogram • Pure tone audiogram - conductive hearing loss
39
Tx of OME
`Tx: • Self limiting in most cases • Hearing aid • Surgery if prolonged hearing loss - grommets
40
S&S of otosclerosis. ix
S&S: • Progressive hearing loss • Tinnitus • FHx ix - pure tone audiogram - conductive hearing loss and carhart notch
41
Causes of vertigo
``` Central causes: • Stroke • Migraine • Neoplasms • Demyelination eg MS • Drugs ``` Peripheral causes: • BPPV • Menieres • Vestibular Neuronitis
42
Patho of BPPV
Patho - otoliths in semicircular canals causing abnormal stimulation of hair cells
43
S&S of BPPV
S&S: | • Benign and short lasting but can be very distressing
44
Ix and Tx of BPPV
Ix: • Dix-hallpike test Tx: • Epley manoeuvre
45
S&S of Menieres
S&S: • Tinnitus in affected ear • Episodic vertigo lasting minutes to hours with N&V • Fluctuating sensorineural hearing loss which becomes permanent • Aural fullness
46
Tx of Menieres
Tx: • Dietary - reduce salt, chocolate, alcohol, caffeine • Medical: ○ Thiazide diuretics, bendrofluazide ○ Betahistine ○ Vestibular sedative, prochlorperazine, for acute attacks • Surgical: ○ Grommet insertion ○ Dexamethasone middle ear injection ○ Endolymphatic sac decompression ○ Vestibular destruction using middle ear injection of gentamicin
47
S&S of vestibular neuronitis
S&S: • Severe vertigo lasting several days • N&V • Horizontal nystagmus
48
Tx of vestibular neuronitis
Tx: • Prochlorperazide during acute episode • Vestibular rehab exercises eg cawthorne-cooksey exercises
49
Explain Rinnes and webers
Rinne and Webers: • Normally air conduction louder than bone • Rinne - which sounds louder bone or air conduction: ○ Tests for conductive hearing loss • Weber - which ear sounds louder ○ Sensorineural loss localises to good ear ○ Conductive localises to bad ear
50
Causes of epistaxis
``` Causes: • Local ○ Idiopathic ○ Trauma ○ Iatrogenic ○ Foreign body ○ Inflammatory ○ Neoplastic • Systemic ○ HTN ○ Coagulopathy ○ Vasculopathy ```
51
Tx of Epistaxis
``` Tx: • ABCDE • First aid: ○ Pinch soft part of nose ○ Head forward ○ Spit out blood • Conservative: ○ Cautery - silver nitrate § If anterior - anterior rhinoscopy § If posterior - rigid endoscope ○ Nasal packing if cautery fails • Surgical: ○ Ligate or embolise vessels: § Sphenopalatine § External carotid last resort ```
52
S&S of rhinosinusitis. CT changes?
S&S: • Nasal congestion • Facial pain or pressure • Reduction in smell • + endoscopic signs of polyps, discharge or oedema In middle meatus and/or: ○ CT changes - mucosal changes in sinus or osteomeatal complex
53
Tx of acute rhinosinusitis
• Tx: ○ Analgesia ○ Nasal decongestants >5 days - consider nasal steroids and oral abx
54
Tx of chronic rhinosinusitis
``` • Tx: ○ Conservative: § Nasal douching § Avoid allergens ○ Medical: § Antihistamines § Topical nasal steroids § Oral steroids if severe § Oral abx ○ Surgery: § Nasal polypectomy Functional endoscopic sinus surgery to improve drainage ```
55
S&S of retropharyngeal abscess
``` S&S: • Common in young children post URTI • Neck held rigid and upright • Systemically unwell • Airway compromise • Dysphagia • Widening of retropharyngeal space on lateral xray ```
56
Tx of retropharyngeal abscess
Tx: • Secure airway • IV abx • Surgery - incision and drainage
57
Epiglottitis S&S and tx
``` S&S: • Rapidly progressive • Stridor • Drooling • Pyrexia ``` Tx: • Secure airway immediately - DO NOT EXAMINE • IV abx • Take child to theatre immediately for intubation
58
Causes of obstructive sleep anpoea
Causes: • Adult - obesity • Children - adenotonsillar hypertrophy
59
Ix of obstructive sleep apnoea
``` Ix: • BMI • TFT - ?hypothyroidism • CXR - ?Signs of obstructive lung disease • ECG - ?RV failure • Sleep study ```
60
Tx of obstructive sleep apnoea
Tx: • Advice - weight loss • CPAP • Surgery - adenotonsillectomy in children
61
Tonsillitis S&S
``` S&S: • Pyrexia • Dysphagia • Lymphadenopathy • Odynophagia - pain swallowing • Trismus - reduced jaw movement • Swollen tonsils • Otalgia (referred ear pain) ```
62
Tx of tonsillitis
``` Tx: • Analgesia • Abx - Avoid Amoxicillin • Drainage if abscess • Tonsillectomy if recurrent ```
63
S&S of H&N cancer
``` S&S: • Dysphonia - hoarseness • Dysphagia • Dryspnoea • Neck mass • Pain • Bleeding from nose or mouth • Nasal blockage ```
64
Goitre differentials
Non neoplastic: • Single nodule - colloid, cyst • Multinodular goitre: Neoplasm: • Benign: ○ Adenoma • Malignant: ○ Papillary adenocarcinoma - hx of irradiation ○ Follicular carcinoma - mets to bone and lungs Medullary carcinoma - seen in MEN syndrome
65
Cx of thyroid surgery
``` Complications of thyroid surgery: • Post op hemorrhage • Airway obstruction • Vocal cord palsy • Hypocalcemia ```
66
Sialolithiasis S&S
pain and swelling worse during meals
67
Tx of sialolithiasis
``` Tx: • Conservative: ○ Analgesia ○ Hydration ○ Sialogogues • Endoscopy • Radiological removal • Surgery: ○ Removal of gland ○ Removal of stones ```
68
Centor critera for URTI
Centor Criteria - LEAF: • presence of tonsillar exudate - E • tender anterior cervical lymphadenopathy or lymphadenitis - L • history of fever - F • absence of cough - A 3+ means sore throat likely due to bacteria.
69
S&S of Post nasal drip and tx
S&S: • Excess mucus accumulates in throat • Chronic cough • Bad breath Tx - decongestants and antihistamines
70
Neck lump differentials
Reactive lymphadenopathy - hx of local infection Lymphoma - rubbery + painless, night sweats Thyroid swelling - moves up on swallowing Thyroglossal cyst - midline. Moves upwards with protrusion of tongue Branchial cyst - mobile cyst between SCM and pharynx Cervical rib - adult females Carotid aneurysm - pulsatile mass, doesnt move on swallow

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