18/4/22 Flashcards
What is used to manage thyroid storm?
Beta blockers
Anti-thyroid drugs e.g. carbimazole and propylthiouracil
What is first line investigation in patient with potential spinal malignancy?
Xray - if negative MRI
What is the pathology behind Grave’s disease?
Antibodies against the TSH receptor which cause them to be constantly activated
Match the following types of sputum to cause:
- Red jelly
- Mucoid
- Rusty brown
Red jelly - klebsiella
Mucoid - chlamydophila psittaci
Rusty brown - strep pneumoniae
Management of otitis externa
Management of otitits interna
Externa
- topical AB +/- steroid (steroid if inflammed)
Interna
1. Supportive treatment - regular painkillers (vast majority are normally viral)
Amoxicillin/clarithomycin
What is the complication that can occur as a result of untreated otitis externa - how is it managed?
Malignant otitis (infection in the temporal bone) - ciprofloxacin
How can you tell difference between otitis media and externa from history?
Otitis media - pain before discharge (build up of pressure and causes eardrum to perforate -> discharge)
Otitis externa - discharge first
Name some complications of otitis media
Intratemporal
- facial nerve palsy (runs through the middle ear)
- mastoiditis
Extratemporal
- meningitis
- sigmoid sinus thrombosis
Match each of the following risk factors to the type of H+N cancer it causes? EBV Chewing tobacco HPV Smoking and alcohol
Chewing tobacco - oral cavity
EBV - nasopharyngeal
HPV - oropharyngeal
Smoking and alcohol - laryngopharyngeal
Go through a neck mass Hx
Potential causes = hypo/hyperthyroidism, malignancy, inflammatory, trauma, hyperparathyroidism
HPC
- Duration and growth rate of mass
= malignant mass grow faster
(7 days = inflam, 7 months = malignant, 7 years = congenital/benign)
- Painful
(pain often related to growth and expansion)
Location
(head and neck cancer follows lymph spread)
Progressive or constant
- change in size, shape, colour
Inflammatory Cause
- previous infection?
- fever?
- any URTI?
- Dental problem?
Malignant
- weight loss?
- fever?
- night sweats?
- previous head and neck malignancy?
- hoarseness?
- SOB?
- otalgia? (referred pain to ear)
- bleeding?
- haemoptysis?
- odynophagia? dysphagia?
- adenopathy (gland swelling)
- speech changes (vocal cord paralysis = thyroid carcinoma)
- unilateral blocked nose and epistatixis (nose)
- unilateral glue ear (blocking off eustachian tube)
Trauma
- head and neck trauma?
Hypo/hyperthyroid Qs
- any palpations?
- feeling hotter or colder than normal?
- any tremor?
- unexplained nervousness and sweating?
- fatigue?
- weight gain?
- constipation?
- thinning hair?
- weakness?
Hyperparathyroidism (high Ca+)
- bones = any bone pain?
- stones = any renal stones?
- groans = dehydration and constipation?
- psychic moans = thirstier and weeing more than normal?
- fatigue
PMH
- MEN?
- Diaebetes?
- HIV?
- Malignancy?
- Previous glandular fever?
- autoimmune conditions
DH + allergies
FH
- head and neck malignancy (medually thyroid cancer has genetic link)
Social Risk factors for malignancy - smoking - alcohol - work General other bits and bobs
ICE
What investigation would you do for a neck lump?
USS
Followed by FNA
What advice do you give to a patient regarding how to use ear drops?
Make sure room temp as can irritate if not
Tilt head on side
Pull pinna back for kids, up and back for adults
Insert drops
Repeatedly press the pinna
What is the common cause of sensironeural hearing loss in old people?
Presbycusis - age related hearing loss
Loss of hearing at higher pitches
What symbol is used for right and left ear air conduction on audiogram?
Circle = right (right is never wrong) Cross = left
Pattern for noise induced hearing loss
Drop at 4kHz
