1
Q
What is PTA,
A
PTA - headphones deliver tone at different frequencies and strengths in a sound proofed room - pt indicate when sound appears and disappears
Mastoid vibrator used to test bone conduction
2
Q
Tympanometry?
A
Measures stiffness of ear drum
–> Evaluates middle ear function
Flat tympanogram: Mid ear fluid or perforation
Shifted tympanogram: +- mid ear pressure
(look up diagrams)
3
Q
Evoked response audiometry?
A
Auditory stimulus + measurement of elicited brain stem response by surfance electrode.
Used for neonatal screening (If otoacoustic emission testing negative)
4
Q
Otitis externa organisms + management?
A
- Mainly pseudomonas
- Staph aures
Mx: Aural toilet with drops - Betamethasone for non-infected eczematous OE - Betamethasone + neomycin drops - hydrocortisone + gentamicin drops
5
Q
Otitis externa: PC + causes?
A
PC:
watery discharge
Itch
Pain and tragal tenderness
Causes:
- Moisture (swimming)
- Trauma
- Absence of wax
- Hearing Aid
6
Q
Malignant otitis externa?
A
Life threatening infection which can lead to skull osteomyelitis
- 90% pts diabetic/immunocomp
PC
- Severe otalgia, worse at night
- Copious otorrhoea
- granulation tissue in canal
Mx:
- Surgical debridement
- Systemic Abx
7
Q
Bullous myringitis?
Organisms?
A
Painful haemorrhagic blisters (Bubbles filled with blood) form on the surface of the ear drum and burst, effusing blood.
- Most commonly caused by strep pneumoniae
- Commonly associated with mycoplasma pneumoniae & influenza infection
8
Q
TMJ dysfunction: Symptoms, signs and Mx
A
Sx:
- Ear ache (referred from auriculotemporal nerve)
- Facial pain
- Joint clicking/popping
- Teeth grinding (bruxism)
- Stress (c depression)
Signs: Joint tenderness exacerbated by lateral movements of an open jaw.
Ix: MRI
Mx: NSAIDs
Stabilising orthodontic occlusal prostheses
9
Q
Otitis media types?
A
Acute
Glue ear/ Otitis media with effusion
Chronic: Effusion > 3mo if bilateral or 6mo if unilateral
Chronic suppurative OM: Ear discharge with hearing loss and evidence of central drum perforation
10
Q
Otitis Media organisms?
A
Viral
Pneumococcus
Haemophilus
Moraxella
11
Q
Acute Otitis Media Pc + Mx
A
PC: Usually children post viral URTI Rapid onset ear pain + Tugging at ear Irritability, anorexia and vomiting Purulent discharge if drum perforates
O/E:
- Bulging red TM
- Fever
Mx: Antipyretic analgesia + observe - Oral amoxicillin > Augmention - If complicated: IV ABx myringotomy/drainage > MCS
12
Q
Acute Otitis Media: Complications
A
Intratemporal:
- OME
- Perforation of TM
- Mastoiditis
- Facial N.palsy
Intracranial:
- Meningitis/ encephalitis
- Brain abscess
- Sub/epidural abscess
Systemic:
- Bacteraemia
- Septic arthritis
- IE
13
Q
OME PC, IX + RX
A
P/C:
Inattention at school
Poor speech development
Hearing impairment
O/e
Retracted dull TM
Fluid level
Ix:
- Audiometry: Flat tympanogram
Rx:
Conservative
- Usually resolves spontaneously : Wat & wait. Seasonal, self limiting.
Medical: Otovent; Hearing Aid
Surgical:
- Consider grommets if persistent hearing loss (>30DB)
- -> SE: Infections/tympanosclerosis
14
Q
Chronic suppurative OM?
A
Painless discharge + hearing loss
O/E : TM perforation
Rx: Aural toilet
Abx/ steroid ear drops
Complication: Cholesteatoma
15
Q
Mastoiditis?
A
Middle ear inflammation –> Destruction of mastoid air cells and abscess formation
PC:
- Fever
- Mastoid tenderness
- Protruding auricle
Ix: CT
Rx:
- IV ABx
- Myringotomy +- mastoidectomy
16
Q
Cholesteatoma + Complications
A
Locally destructive expansion of the stratified squamous epithelium within the middle ear
Complications:
- Deafness (Ossicle destruction)
- Meningitis
- Cerebral abscess
17
Q
Cholesteatoma classification, PC + Mx
A
classification:
1) Congenital
2) Acquired 2ndry to perforation in chronic suppurative OM
P/c: Foul smelling white discharge Headache, pain CN involvement: --> Vertigo --> Deafness --> Facial paralysis
O/E:
- Appears pearly white with surrounding inflammation
Mx: Surgery
18
Q
Tinnitus define + Hx
A
Sensation of sound w/o external sound stimulation. Very common 1 in 10
Hx:
Character: Constant, Pulsatile?
Unilateral? - Acoustic neuroma
FH: Otosclerosis?
Alleviating/exacerbating factors, worse at night?
Cause? Head injury, noise, drugs, FH
Associations:
- Vertigo –> Meniere’s/Acoustic neuroma
- Deafness: Meniere’s, acoustic neuroma
19
Q
Tinnitis Causes
A
Specific:
- Meniere’s
- Acoustic neuroma
- Otosclerosis
- Noise induced
- Head injury
- Hearing loss (presbyacsus) –> Most common bilateral
General:
- Increased BP
- Decreased HB
Drugs:
- Aspirin
- Aminoglycosides
- Loop diuretics
- EtOH
20
Q
Vertigo Causes?
A
The illusion of movement
Peripheral/vestibular:
- Meniere’s (hours)
- BPV (minutes)
- Labyrinthitis (weeks)
Central:
- Acoustic neuroma
- MS
- Vertebrobasilar insufficiency/stroke
- Head injury
- Inner ear syphilis
Drugs:
- Gentamicin
- Loop diuretics
- Metronidazole
- Co-trimoxazole
21
Q
Meniere’s disease?
A
Endolymphatic oedema
PC: Progressive SNHL + vertigo + tinitius
- Aural fullness
- N/V
- Attacks occur in clusters and last up to 12h
Ix: Audiometry shoes low-freq SNHL which fluctuates
Mx:
Medical: Vertigo - Cyclizine
Surgical:
- Gentamicin instillation via grommets
- Saccus decompression
22
Q
Vestibular neuronitis/ viral labrynthitis PC + Rx
A
PC:
- Follows febrile illness (URTI)
- Sudden vomiting
- Severe vertigo exacerbated by head movement
Rx:
- Cyclizine
- Improvement in days
23
Q
BPV?
A
Displacement of otoliths in semicircular canals, common after head injury
PC:
- Sudden rotational vertigo Provoked by head turning
- Nystagmus
Dx: Hallpike manoeuvre + observe for rotational nystagmus (towards affected year)
Mx:
- Self limiting - good prognosis and usually resolves spontaneously after a few weeks to months.
Symptomatic relief by:
- Epley manoeuvre (successful in around 80%) of cases)
- Teaching pt exercises they can do themselves at home eg. Brandt-Daroff exercises
- Betahistine: Histamine analogue
24
Q
BPV causes?
A
1) Idiopathic
2) Head Injury
3) Otosclerosis
4) Post-viral
25
Conductive hearing loss causes?
Impaired conduction anywhere between auricle and round window
1) External canal obstruction:
- Wax
- Pus
- Foreign body
2) TM perforation:
- Trauma
- Infection
3) Ossicle defects
- Otosclerosis
- Infection
- Trauma
+ inadequate eustachian tube ventiliation of middle ear
26
Sensorineural hearing loss causes?
Defects of cochlea, cochlear N or brain
1) Drugs:
- Aminoglycosides
- Vancomycin
2) Post-infective
- Meningitis
- Measles
- Mumps
- Herpes
3) Misc:
- Meniere's
- Trauma
- MS
- CPA lesion (acoustic neuroma)
- Reduced b12
27
Acoustic neuroma
Mx?
AKA vestibular schwannoma
Benign, slow growing tumour of superior vestibular N
- Acts as SOL --> CPA syndrome (Accounts for 80% of CPA tumours)
- Associated with NF2
Mx:
- Gamma knife
- Surgery (risk of hearing loss)
28
Acoustic neuroma triad & differentials?
PC:
- Slow onset unilateral SNHL + Tinnitus + veritgo
- Headache (increased ICP)
- CN plasies: 5, 7, 8 (CPA)
- Cerebellar signs
Differentials:
- Meningioma
- cerebellar astrocytoma
- Mets
29
Otosclerosis?
Autosomal dominant
Characterised by fixation of stapes the at oval window
F>M 2:1
PC:
- Begins in early adult life
- Bilateral conductive deafness + tinnitus
- HL improved in noisy places: Willis paracousis
- Worsened by pregnancy
30
Presbyacussis?
Age-related hearing loss
```
Presentation:
>65
Bilateral
Slow onset
+- tinnitus
```
Ix: PTA
Rx: Hearing aid
31
Congenital conductive hearing loss in kids?
Conductive:
- Anomalies of pinna, external auditory canal, TM, or ossicles
- Congenital cholesteatoma
- Pierre-robin sequence
32
Congenital SNHL
SNHL:
AD: Waaredenburgs: SNHL, heterochromia + telecanthus
AR:
- Alports (SNHL + Haematuria)
- Jewell-Lange-Nielson: SNHL + Long QT
X-linked:
Alports
Infection: CMV, rubella, HSV, toxo, GBS
Ototoxic drugs
33
Perinatal causes of hearing loss ?
```
Anoxia
Cerebral palsy
Kernicterus
Infection: Meningitis
?--> Congenital rubella syndrome?
```
34
Acquired causes of childhood hearing loss?
OM/OME
Infection: meningitis/measles
Head injury
35
Cauliflower ears?
Blunt trauma -> subperichondrial haematoma (Pinna haematoma)
Can lead to ischaemic necrosis of cartilage and subsequent fibrosis leads to cauliflower ears
Mx: Aspiration + firm packing to auricle contour
36
Exostoses?
Smooth symmetrical bony narrowing of external canals
37
Causes of TM perforation?
OM
Foreign body
Barotrauma
Trauma
38
Allergic rhinosinusitis signs + symptoms + Ix
seasonal (hay-fever) vs perennial
Pathoologgy: T1 HS IgE mediated inflammation from allergen exposure lead to mediator release from mast cells
Sx: Sneezing, pruritis, rhinorrhoea
Signs: Swollen, pale, boggy turbinates
- Nasal polyps
Ix:
- Skin prick testing to find allergens
- RAST tests
39
Allergic rhinosinusitis Mx
Allergen avoidance:
- Regular washing bedding (inc toys) on high heat
- Avoid going outside when pollen content high
1st line:
- Anti-histamines: Cetirazine
OR beclometasone/chromoglycate nasal spray
2nd line:
Intranasal steroids + anti-histamines
3rd line: Zafirlukast
4th line: Immunotherapy:
- Aim to induce desensitisation to allergen
Adjuvants:
- Nasal decongestants eg. pseudoephrine
40
Sinusitis: Pathophys + Organisms
Causes?
Viruses --> Mucosal oedema and reduced mucosal ciliary action --> Mucus retention + secondary bacterial infection
Acute: Pneumococcus, haemophilus , Moraxella
Chronic: S.aureus, anaerobes
Causes:
- Majority are bacterial infection secondary to viral
- 5% secondary to dental root infection
- Diving/swimming in infected water
- Anatomical susceptibility; deviated septum, polyps
- Systemic disease:
- -> Kartagener's
- -> Immunodeficiency
41
Sinusitis Symptoms:
Pain (1-5(
- Maxillary (cheek/teeth)
- Ethmoidal (between eyes)
- Increased on bending/straining
Discharge from nose - post nasal drip with foul taste
Nasal obstruction/congestion
Anosmia/ cacosmia
Systemic symptoms: fever
NB. Most important symptoms are actually discharge and congestion
42
Sinusitis Ix + Mx
Ix: Nasendoscopy + CT
```
Mx:
Acute/single episode:
- Bed rest, decongestants, analgesia
- Nasal douching + topical steroids
- Abx (clarithro) of uncertain benefit
```
Chronic/recurrent:
- Usually a structural or drainage problem
- Stop smoking + Fluticasone nasal spray
- Functional endoscopic sinus surgery if failed medical therapy
43
Sinusitis complications?
Mucoceles --> Pyoceles (Mucus retention cysts)
Orbital cellulitis/abscess
Osteomyelitis eg. staph in frontal bone
Intracranial infection:
- Meningitis, encephalitis
- Abscess
- Cavernous sinus thrombosis
44
Nasal polyps: Sites + Symptoms
Pt: Males, >40
Sites:
- Middle turbinates
- Middle meatus
- Ethmoids
Sx:
- Watery, anterior rhinorrhoea
- Purulent post-nasal drip
- Nasal obstruction
- Sinusitis
- Headaches
- Snoring
Signs: Mobile, pale, insensitive
45
Nasal polyps associations
```
Associations:
- Allergic/non-allergic rhinitis
- CF
Aspirin hypersensitivity
- Asthma
```
46
Single unliateral polyp
May be a sign of rare but sinister pathology:
- Nasopharyngeal Ca
- Glioma
- Lymphoma
- Neuroblastoma
- Sarcoma
Do CT and get histology
47
Nasal polyps in children?
polyp Mx?
Rare Betamethasone drops for 2/7
- Short course of oral steroids
Endoscopic polypectomy
48
Fractured nose: Ix & Mx?
Upper 3rd of nose has bony support
Lower 2/3 and septum are cartilaginous
--> cartilaginous injury won't show and radiographs don't alter Mx
Mx:
- Exclude septal haematoma
- Re-examine after 1 wk (reduced swelling)
- Reduction under GA + post-op splinting best w/i 2 weeks
49
Septal haematoma?
Septal necrosis + Nasal collapse if untreated
--> Cartilage blood supply comes from mucosa
Boggy swelling and nasal obstructon
Needs evacuation under GA with packing +- suturing
50
Epistaxis causes?
80% idiopathic
Trauma: Nose picking, #s
Local infection: URTI
Pyogenic granuloma: overgrowth of tissue on
Little's area due to irritation or hormonal factors
Osler-weber-rendu/ HHT
Coagulopathy: Warfarin, NSAIDs, Haemophilia, reduced platelets, vWD, EToH
Neoplasm
51
Epistaxis: Initial Mx
nb in primary care: Naseptin nasal cream massaged onto area twice a day for 2 weeks is as effective as cautery
1) Wear PPE
2) Assess for shock and resuscitate appropriately
3) If not shocked:
- Sit up, head tilted down
- Compress nasal cartilage for 15 minutes
4) If bleeding not controlled - remove clots with suction or by blowing and try to visualise bleed by rhinoscopy
52
Anterior Epistaxis
Usually septal haemorrhage from Little's area (Kisselbach's plexus)
Insert gauze soaked in vasoconstrictor + LA
- Xylometazoline + 2% lignocaine for 5 min
Bleeds can be cauterised with silver nitrate sticks
Persistent bleed should be packed with merocel pack
- Refer to ENT if this fails or if you can't visualise the bleeding point
- They may insert a posterior pack or take pt to theatre for endoscopic control
53
Posterior / Major epistaxis
Posterior packing (+ anterior pack)
- -> Pass 18g Foley catheter through the nose into the nasopharnyx, inflate with 10ml water and pull forward until it lodges
- Admit pt and leave for 48 hrs
Gold standard: Endoscopic visualisation + direct control eg. by cautery or ligation
54
After epistaxis advice:
1) Don't pick nose
2) Sit upright, out of sun
3) Avoid bending, lifting or straining
4) Sneeze through mouth
5) NO hot food or drink
6) Avoid EtOH and tobacco
55
Osler-weber-Rendu/HHT?
Inheritance + features?
Autosomal DOMINANT
- 5 genetic subtypes
Telangiectasias in mucosa:
- Recurrent spontaneous epistaxis
- GI bleed (usually painless)
Internal telangiectasias and AVMs:
- Lungs
- Liver
- Brain
Rarer:
- Pulmonary HTN
- Colon polyps: may --> CRC
56
Tonsilitis Organisms + Signs
Viruses are most common (consider EBV)
GAS : Pyogenes
Staphs
Moraxella
Signs:
- Lymphadeopathy esp. Juguludigastric node
- Inflamed tonsils and oropharynx
- Exudates
57
Centor Criteria
Guideline for admin of Abx in acute sore throat/ tonsillitis/ pharnygitis
1 point for each of:
1) Fever
2) Tonsillar exudates
3) Tender anterior cervical adenopathy
4) No Cough
Mx: 0-1 no Abx (risk of strep or equal 3: Abx (Pen V 250mg QDS or erythromycin for 5/7)
58
Tonsilitis Mx:
Swabbing of superficial bacteria is irrelevant and can lead to overdiagnosis
Analgesia: ibuprofen/Paracetamol + Difflam gargle (Local anesthetic/NSAID)
Consider Abx only with CENTOR
- Pen V 250mg PO QDS (125mg TDS in children) or erythromycin for 5/7
NOT amoxicillin: MACPAP RASH IN EBV
59
Tonsillectomy indications?
Recurrent tonsilitis if all the below criteria are met:
- Caused by tonsilitis
- 5+ episodes/yr
- Symptoms for >1yr
- Episodes are disabling and prevent normal function
Airway obstruction eg. OSA IN children
Quinsy
Suspicious of Ca: Unilateral enlargement or ulceration
60
Tonsillectomy: Methods + complications?
Methods: - Cold steel
- Cautery
Complications:
- Reactive haemorrhage
- Tonsillar gag may dmg teeth, TMJ or posterior pharngeal wall
61
Kisselbach's plexus arteries?
Anterior ethmoidal artery
Spenopalatine Artery
Facial Artery
62
Strep throat complications
Peritonsillar abscess (quinsy)
Retropharyngeal abscess
Lemierre's syndrome
Scarlet Fever
Rheumatic Fever
Post-streptococcal Glomerulonephritis
63
Peritonsillar Abscess?
Typically occurs in adults
Symptoms:
- Trismus (jaw tetanus)
- Odonophagia
- Halitosis
Signs:
- Tonsillitis
- Unilateral tonsillar enlargement
- Contralateral uvula displacement
- Cervical lymphadenopathy
Rx:
Admit
IV ABC
I&D under LA or tonsillectomy under GA
64
Retropharyngeal abscess
Rare
PC:
Unwell child with stiff, extended neck who refuses to eat or drink
Fails to improve with IV ABx
Unilateral swelling of tonsil and neck
Ix:
Lat. neck x-rays shows soft tissue swelling
CT from skull-base to diaphragm
Rx:
IV Abx
I&D
65
Lemierre's syndrome
IJV thrombophlebitis with septic emboli, most commonly affecting the lungs
Organism: Fusobacterium necrophorum
Rx:
IV Abx: Pen G, Clinamycin, metro
66
Scarlet fever?
'Sandpaper' like rash on chest, axillae or behind ears, 12-48hrs after pharyngotonsillitis
Circumoral pallor
Strawberry tongue
Rx: Start Pen V/G and notify HPA
67
Rheumatic fever features
Carditis
Arthritis
Subcutaneous nodules
Erythema marginatum
Sydenham's chorea
68
PSGN
Malaise and smokey urine 1-2 weeks after pharyngitis
69
Laryngitis?
Usually viral and self-limiting
Secondary bacterial infection may develop
Symptoms: Pain, hoarseness and fever
O/E: Redness & Swelling of vocal cords
Rx: Supportive, Pen V if necessary
70
Laryngeal papilloma
Pedunculated vocal cord swellings caused by HPV
Presents with hoarseness
Usually occur in children
Rx: Laser removal
71
Recurrent laryngeal N.palsy
Supplies all intrinsic muscles of larynx except cricothyroideus (Ext. branch of sup laryngeal n)
- Responsible for ab and adduction of vocal cord
```
Sx:
- Hoarseness
- Breathy voice with bovine cough
- Repeated coughing from aspiration (reduced supraglottic sensation)
Exertional dyspnoea (narrow glottis)
```
Causes:
- 30% cancers: Larynx, thyroid, oesophagus, hypopharynx, bronchus
- 25% iatrogenic: para/thyroidectomy, carotid endartectomy
- Other: Aortic aneurysm, bulbar/pseudobulbar palsy
72
Laryngeal SCC
2000/yr UK, associated with smoking/EtOH
PC: Male smoker, with progressive hoarseness --> Stridor.
Dys/odonophagia
Wt loss
Ix: Laryngoscopy + biopsy
MRI staging
Mx: Based on stage Radiotherapy/ laryngectomy
After total laryngectomy:
- - Pts have permanent tracheostomy
- Speech valve
- Electrolarynx
- Oesophageal speech (Swallowed air)
73
Laryngomalacia
Immature and floppy aryeepiglottic folds and glottis lead to laryngeal collapse on inspiration
PC: Stridor, PC w/i first weeks of life
Noticeable @ certain times
- Lying on back
- Feeding
- Excited/upset
Problems can occur with concurrent laryngeal infections or with feeding
Mx: Usually no Mx required, but severe cases may warrant surgery
74
Epiglottitits
Sx:
Sudden onset continuous stridor
Drooling
Toxic
Pathogens: Haemophilus B (HIB), GAS
Rx:
Don't examine throat
Consult with anaesthetists and ENT surgeons
02 + Nebulised adrenaline
IV dexamethasone
Cefotaxime
Take to theatre to secure airway by intubation
75
Foreign body
Sudden onset stridor in a previously normal child
- BLS
- Needle cricothyrotomy in children
- Can only exclude foreign body in bronchus by bronchoscopy
76
Subglottic stenosis
Subglottis - narrowest part of resp tract in children
Symptoms: Stridor + FTT
Causes:
- Prolonged intubation
- Congenital abnormalities
77
Wax management?
GP:
Olive oil drops
Irrigation to syringe wax out
Secondary care:
- Microsuction
'educate pt about wax'
- not dirty
- Self cleaning
78
Most common causes of hearing loss?
Congenital:
Intrauterine infection: German measles, toxo, rubella
Acquired: Meningitis
79
ENT tuning fork?
512hz (smallest one)
80
Bells palsy Mx
Early prednisolone (lot's of RCT evidence)
Some people think it's viral so would consider aciclovir, however evidence for this is very weak
81
Adenoid facies
```
Overbite
underdeveloped thin nostrils
short upper lip
prominent upper teeth
crowded teeth
narrow upper alveolus
high-arched palate
hypoplastic maxilla
```
82
Samter's triad?
Association of asthma, aspirin sensitivity and nasal polyposis
83
Meniere's Mx?
ENT assessment is required to confirm the diagnosis
patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved
acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
prevention: betahistine may be of benefit
Acute Attacks: Buccal prochlorperazine
Prevention: Betahistadine
84
Thyroid malignancy - Commonest subtype?
Papillary carcinoma :
Commonest sub-type
Accurately diagnosed on fine needle aspiration cytology
Histologically they may demonstrate psammoma bodies (areas of calcification) and so called 'orphan Annie' nuclei
They typically metastasise via the lymphatics and thus laterally located apparently ectopic thyroid tissue is usually a metastasis from a well differentiated papillary carcinoma.
85
In which thyroid cancer is calcitonin raised?
These are tumours of the parafollicular cells ( C Cells) and are of neural crest origin.
The serum calcitonin may be elevated which is of use when monitoring for recurrence.
They may be familial and occur as part of the MEN -2A disease spectrum.
Spread may be either lymphatic or haematogenous and as these tumours are not derived primarily from thyroid cells they are not responsive to radioiodine.
86
Acute necrotizing ulcerative gingivitis Mx?
refer the patient to a dentist, meanwhile the following is recommended:
oral metronidazole* for 3 days
chlorhexidine (0.12% or 0.2%) or hydrogen peroxide 6% mouth wash
simple analgesia
87
Absent corneal reflex + dizziness & right sided hearing loss?
Loss of corneal reflex - Think acoustic neuroma
88
Otosclerosis?
Otosclerosis describes the replacement of normal bone by vascular spongy bone. It causes a progressive conductive deafness due to fixation of the stapes at the oval window. Otosclerosis is autosomal dominant and typically affects young adults
```
Onset is usually at 20-40 years - features include:
conductive deafness
tinnitus
normal tympanic membrane*
positive family history
```
Management
hearing aid
stapedectomy
*10% of patients may have a 'flamingo tinge', caused by hyperaemia
89
Pseudophedrine - CI with which med?
MAOi - could potentially cause a hypertensive crisis
90
Tonsillitis first line Tx?
7/10 day course of Phenoxymethylpenicillin
Erythromycin if pen allergic
IF 3 or more of Centor, 40-60% sore throat is caused by Group A Beta-haemolytic strep
91
Motion sickness mx?
Motion sickness describes the nausea and vomiting which occurs when an apparent discrepancy exists between visually perceived movement and the vestibular systems sense of movement
Management
the BNF recommends hyoscine (e.g. transdermal patch) as being the most effective treatment. Use is limited due to side-effects
non-sedating antihistamines such as cyclizine or cinnarizine are recommended in preference to sedating preparation such as promethazine
92
EBV associated malignancies?
Burkitt's
Hodgkin's
Nasopharyngeal carcinoma
93
Trigeminal neuralgia - first line Tx?
Carbemazepine
- Failure to respond to tx or atypical features (
94
Pharyngeal pouch?
More common in older men
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough
95
Cystic hygroma?
A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
Most are evident at birth, around 90% present before 2 years of age
96
Branchial cyst?
An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood
97
Rinne positive/negative
Rinne positive if Air>bone (Normal)
Rinne negative if Bone > Air (Abnormal) - CHL
98
```
How long do the following RTIs last?
Acute otitis media
Acute tonsillitis
Common cold
Acute rhinosinusitis
Acute cough/bronchitis
```
```
acute otitis media: 4 days
acute sore throat/acute pharyngitis/acute tonsillitis: 1 week
common cold: 1 1/2 weeks
acute rhinosinusitis: 2 1/2 weeks
acute cough/acute bronchitis: 3 weeks
```
99
Otitis externa Mx
Initially: topical antibiotic/ combined topical antibiotic + steroid
Secondline: Oral abx if infection spreading - oral fluclox
5th year
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