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Year 3 core conditions > ENT > Flashcards

ENT Flashcards

1
Q

define tonsilitis

A

inflammation of the palantine tonsils, suaully bilateral and can be viral or bacterial

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2
Q

bacterial causes of tonsilitis

A

group A beta haemoltic strep
staphylococci
H. influenzae
pneumococci

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3
Q

presentation of tonsilitis

A

few days of sore throat
referred otalgia, fever, generally unwell and dehydrated
may have difficutly eating and drinking
enlarged tonsils, muffled voice

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4
Q

when to refer tonsuilitis to ENT

A

unable to eat and drink
difficulty swalllowing salviva
signs of resp distress or airway compromise

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5
Q

glandular fever AKA

A

infectious mononucleosis

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6
Q

cause of glandular fever

A

epstein barr virus (EBV) and some CMV

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7
Q

complications of galndular fever

A

bacterial tonsilitis

hepatitis and splenic rupture

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8
Q

testing of glandular fever

A

infectious mononucleosis screen acutely

EBV serology or IgG testing

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9
Q

presentation of glandular fever

A

tonsilitis
already treated with course of antibiotics with minimal effect
amox + EBV = widespread rash (not allergic)

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10
Q

advise for those with glandular fever

A

avoid contact sports, alcohol and attend A+E if sudden onset abdo pain - hepatitis and splenic rupture

avoid kissing and sharing cutlery/gasses

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11
Q

when to refer glandular fever to ENT

A
  • Unable to eat and drink
  • Difficulty swallowing saliva
  • Signs of respiratory distress or airway compromise (very rare!)
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12
Q

Quinsy AKA

A

peritonsillar abscess

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13
Q

what is qunisy

A

pus collects between tonsillar caosule and superior constrictor muscle as a complication of tonsilitis, usually unilateral

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14
Q

presentation of quinsy

A

few day history of bilateral sore throat which has significantly worsened unilaterally

severe odynophagia, fever, unwell, dehydrated, trismus, hot potato voice, spitting oiut saliva

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15
Q

when to refer quinsy to ENT

A

all suspected should be referred for needle aspiration or incision and drainage of pus

most drained and patient goes home same day with oral antibiotics

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16
Q

red flags of acute throat infections

A

severe sore throat:

  • without evidence of tonsilitis/pharyngitis
  • with hoarse/croaky voice, dysphagia and fever
  • with neck swelling or neck stiffness (reduced range of movement)

severe trismus
stridor

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17
Q

what is supraglottisis and epiglottis

A

inflammation of the supraglottis and/or epiglottis

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18
Q

cause of supraglottis and epiglottisis

A

Haemophilus influenza type B

but reduced due to vaccinations

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19
Q

presentation of supra/epiglotttis

A

worsening sore throat
uanble to eat and drink often drooling saliva

hoarse or croaky and possibly stridor

children = tripod for airflow

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20
Q

treatment of supra/epiglottisis

A

adrenaline nebulisers
IV steroids
broad spec antibiotics (IV ceftriaxone)

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21
Q

what are deep neck space infections

A

collection of pus within potential spaces of the neck formed by investing layer of cervical fascia

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22
Q

cause of deep neck space infectioms

A

mostly dental origin

can progress from tonsils/quinsies or infected epidermoid, branchial or thyroglossal cysts

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23
Q

presentation of deep neck space infections

A

toothache, sore throat or prev neck swelling (cyst) now progressed to neck pain

redyuced neck movements, localised or widespread nbeck swelling (fluctuant or firm) possibly with overlying cellulitis

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24
Q

management of deep neck space infecdtionns

A

FNE and liekly CT of the neck, broad spectrum antibiotics and possbily surgical drainage and debridement

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25
Q

who gets epistaxis

A

<10 yo

45-65 yo

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26
Q

why male predomination of epistaxis in < 49 yo

A

protective effect of oestrogen

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27
Q

seasonal factors affecting epsitaxis?

A

incidence of upper respiratory infections
allergic rhinitis
mucosal changes associated with fluctuations in temp and humidity

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28
Q

types of epistaxis

A

anterior = from kiesselbatches plexus or littles area –> slef limited, most common, managed in primary setting, mucosal truama or irritation

posterior - postlateral bracnhes of sphenpalantine artery but also arise from branches of the carotid, significant haemorrhage

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29
Q

risk factors of epistaxis

A 
trauma
inflammatory - sinusitis or rhinitis
drugs - apsirin, clopidogrel, anticoagulant and cocaine
neoplasm
systemic disease- granulomatosis with polyangitis, CPA, sarcoidosis
hereditary bleeding disorder 
low moisture contnet of air
intranasal drug use
hypertension
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30
Q

management of epsitaxis

A

ABCDE approach

local compression for 20min and ice packs
examine nose - rule out septal haematoma and reduce nasal fracture

nasal cautery
nasal pakcing

surgical option s- intervential radiologist angiogrpahic embolization

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31
Q

house-brackmann clasification

A

facial nerve weakness classficiation of facial nerve palsy

I for normal, VI for no movement

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32
Q

House-Brackmann Grading System I

A

normal facial function

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33
Q

House-Brackmann Grading System II

A
  • Slight weakness, normal symmetry and tone
  • Complete eye closure and forehead movement with effort
  • Mouth slightly weak
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34
Q

House-Brackmann Grading System III

A
  • Small difference between 2 sides at rest
  • Complete eye closure with effort, slight to moderate forehead movement
  • Mouth slightly weak
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35
Q

House-Brackmann Grading System IV

A
  • Obvious weakness and disfiguring asymmetry
  • No forehead movement
  • Incomplete eye closure
  • Mouth asymmetrical
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36
Q

House-Brackmann Grading System V

A
  • Only barely perceptible motion, asymmetrical at rest
  • No forehead movement
  • Incomplete eye closure
  • Mouth asymmetrical
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37
Q

House-Brackmann Grading System VI

A

• No movement / Total paralysis

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38
Q

forehead involved

forehead sparred (contralateral supply)

A

LMN lesions

UMN lesions

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39
Q

idiopathic - bells palsy (most)
trauma - temporal bone or facial wound
infection - ear infections, lymes disease, viral infection

tumour - parotid malignanc
iatrogenic - parotid or ear surgery
autoimmune - sarcoidosis
neurological conditions
congenital - CHARGE, mobius syndrome, melkersson-rosenthal syndrome, birth trauma/forceps
A

causes of FN palsy

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40
Q

neurological conditions causing FN palsy

A

MS
CVA (stroke)
Myasthenia gravis
Guillain Barre

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41
Q

investigations for FN palsy

A

full facial nerve examination and grade weakness

classify into UMN and LMN

assess hearing of ipsilateral ear and mastoid + tuning fork

cranial nerve examination

examination of neck and parotid to exclude parotid tumour

examination of oral cavity to assess palatal weakness etc

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42
Q

schrimers test for lacrimation - what does it suggest in FN lesion?

A

abnormal lesion suggests lesion affecting the geniculate ganglion

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43
Q

stapedial reflex - what does it suggest in FN lesion?

A

abnormal suggests lesion proximal nerve to stapedius

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44
Q

taste testing - what does it suggest in FN lesion?

A

clinically or electrogustometry and salivary flow testing

  • if abnoramla suggests lesion proximal to the root of chorda tympani
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45
Q

treatment of FN palsy

  • education
  • blood tests
  • bells palsy
  • ramsay hunt syndrome
A

education - eye protection since corneal drying can lead to ulceration and then blindness

manage obvious cause

blood tests - lymes disease if indicated in history

if bells palsy - 7-10day reducing dose of corticosteroids

ramsay hunt syndrome (VZV) - course of aciclovir and reducing corticosteroids

follow up in 3-4 weeks - lakc of recover, investigate for neoplasia via MRI

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46
Q

prognosis of bells palsy

A

full recovery in 3-4 months

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47
Q

advise for bells pasly

A

keep affected eye lubricated

tape eye closed at bedtime if needed

wear sunglasses outdoors to protect eye

swimming and dusty environments should be avoided

surgery for protection - tarsorraphy +/- gold weight implant to aid eyelid closure

eye irritation pain or vsion changes - seek immediate medical advice

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48
Q

if facial weakness or paralysis affects eating

A

suggest using straw for liquids and advice soft foods

exercise to rehab facial muscles

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49
Q

things to do in first 6 weeks of bells palsy

A

massage face with strokes towards ear

facial exercises to achieve symmetrical movements in front of mirror and use fingers to assist
perform slowly and gently

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50
Q

conductive deafness

A

failure of the conversion of sound waves into movements by the ear drum and ossicles of the middle ear

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51
Q

sensorineural deafness - congenital or acquired

A

problem of the inner ear or of the nerve that carries the signal from the inner ear to the hearing centres of the brain

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52
Q

weber test results

A

forehead

unilateral conudctive loss = lateralisation to the affected side

unilateral sensorineural loss = lateralisation to normal or better hearing side

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53
Q

rinnes test results

A

air conduction and bone conduction

normal = AC >BC - (pt can hear fork at ear)

conductive loss = BC>AC (pt will not hear fork at ear)

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54
Q

conductive hearing loss causes

A

wax/foreign body/polyps

otitis externa

otitis media

perforation

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55
Q

sensorineural hearing loss causes

A

age related/trauma
ototoxic drugs
infections of labyrinth
acoustic neuroma

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56
Q

congenital hearing loss causes

A

TORCH infections in pregnancy

low birth weight

asphyxia

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57
Q

red flag for ENT

A

sudden sensorineural hearing loss

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58
Q

infections causing sudden sensorineural hearing loss

A 
mumps
herpes zoster
syphilis
meningitis
encephalitis
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59
Q

vascular causing sudden sensorineural hearing loss

A 
haemorrhage
thrombosis
leukaemia
vasospasm
diabetes
HTN
sickle cell
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60
Q

trauma causing sudden sensorineural hearing loss

A

head injury
noise trauma
surgery

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61
Q

toxic causing sudden sensorineural hearing loss

A

ototoxic insecticides

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62
Q

ear causes of sudden sensorinueral hearing loss

A

meniere

large aqueduct

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63
Q

neoplastic causing sudden sensorineural hearing loss

A

acoustic neuroma

CP tumors

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64
Q

vertigo

A

hallucination of rotatory movement

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65
Q

light headedness

A

Non-specific term: temporary reduction of cerebral blood flow

66
Q

dizziness

A

Non-specific term: disorientation

67
Q

Unsteadiness

A

Indicates gait issue/central causes: cerebellum/MSK

68
Q

central causes of vertigo and dizziness

A 
stroke/TIA
postural hypotension
cervical spondylosis/age-related disequilibrium
migraine
MS
tumour
medication related
hypoglycaemia
sleep deprivation
69
Q

peripheral causes of vertigo and dizziness

A

labyrinthitis
BPPV
mineres disease
vestibular schwannomma

70
Q

vestibular neuronitis

A

reactivation of latent type 1 HSV in vestibular ganglion

71
Q

presentation of vestibula r neuronitis

A

prior URTI

sudden, spontaneous, severe vertigo which is constant and ongoing

common cause of vertigo often used interchangeably with labyrinthitis =WRONG

affects adults 4-50 y ears

72
Q

labyrinthitis

A

viral origin, URTI precedes the onset of symptoms

bacterial also possible

73
Q

presentation of labyrinthitis

A

affects adults in 30-60 yo, rarely in children F>M

vertigo associated with hearing loss +/- tinnitus

74
Q

menieres disease

A

change in fluid volume in the labyrinth

progressive distension of the membranous labyrinth

allergy, metabolic disturbance, vascular factors, viral infections

75
Q

presentation of menieres disease`

A

40-60 yo

attacks lasting minutes/hours
fluctuating and episodic patterns, tinnitus, hearing loss, aural fullness

76
Q

nystagmus

A

side, fast component, vertical, horizontal, rotatory

77
Q

rombergs posititve

A

suggestive of proprioception or vestibular function

78
Q

unterbergs test

A

labyrinth function, assessing whether rotation is induced when marching on the spot eyes closed

79
Q

tinnitus

A

perception of sounds in the ear/head with no external source

  • ringing/buzzing/hissing/whistling/humming
    unilateral or bilateral
80
Q

subjective tinnitus

A

common
noise-induced
impacted wax, infection (ear infection, meningitis, syphilis), drugs related, jaw disorders, no cause found

81
Q

drugs related to subjective tinnitus

A

NSAIDs, aminoglycosides, loop diuretics

82
Q

common and important neck lumps

A 
malignancy 
salivary glands
sebaceous cysts
lymph nodes 
thyroglossal cysts
thyroid goitre
83
Q

intradermal
non-tender
well circumscribed fluctuant lumps
relatively fixed and do not have overlying skin changes
central punctum blocks outflow of sebum which can lead to infection and abscesses

A

sebaceous cysts

84
Q

fluid filled sac occuring due to incomplete closure of the thyroglossal duct during embryological development

normally presents in children or young adults as a painlss midline fluctuant lump - mostly in hyoid bone

USS investigation and then surgical excision + antibiotics if acutely inflamed

A

thyroglossal cyst

85
Q

non tender lumps/swelling which are fixed
moves upwards with swallowing as the isthmus is attached to the trachea
investigate for thyroid function tests and antibodies, USS and referral to head and neck/endocrine surgeons

A

thyroid goitre

86
Q

diffuse thyroid goitre causes

A

may be phsyiologcal
graves disease
hashimotos thyroiditis
subacute thyroiditis

87
Q

nodular thyroid goitre causes

A

multinodular goitre
adenoma
carcinoma

88
Q
  1. sepsis with post-auricular swelling
  2. cranial nerve palsy
  3. symptoms of meningism
  4. altered conscious state
A

acute otitis media - RED FLAGS

risk of progression to extra and intracranial complications

89
Q

who gets acute otitis media?

A

usually children under 7 yo

adults sometimes - more likely primary acute otitis externa

90
Q

presentation of AOM

A

gradually increasing otalgia with no discharge

red bulging ear drum on otoscopy

91
Q

common pathogens causing AOM

A

influenza virus
haemophilus
streptococcus pneumoniae

92
Q

otoscopy findings of AOM

A

opaque and protruding ear drum with erythema and prominent blood vessels

93
Q

history of acute suppurative otitis media (ASOM)

A

history of gradually increasing otalgia followed by appearance of discharge with some reduction of otalgia
hear/feel a pop just before this appears

may also get hearing loss, tinnitus, and fever
small children= unwell, crying and be pulling the affected ear

94
Q

otoscopy of ASOM

A

mucopurulent watery discharge in the ear canal and perforation of the tympanic membrane

discharge and associated ear canal swelling may make the tympanic membrane no visible

95
Q

with AOM what examinations are needed?

A

facial nerve, neurological status and ear examination inc mastoid area

96
Q

treatment of ASOM

A

antibiotic and steroid combination drops/sprays - sofradex, otomise

97
Q

when to admit AOM

A

any sign of mastoiditis, petrositis or intracranial complications

98
Q

extracranial complications of AOM

A

facial palsy - AOM and faical palsy without sparing of frontalis - when infection spreads to nerve

mastoiditis - when ifection spreads to mastoid air spaces of temporal bone

petrositis - infection spread to apex of petrous temporal bone

99
Q

gradenigos syndrome

A

in petrositis

triad: pururlent ottorhoea, pain deep inside ear (V1) and ipsilateral lateral rectus palsy (VI)

100
Q

intracranial complications of AOM

A

meningitis
sigmoid sinus thrombosis
brain abscess

101
Q

investigations for complicated AOM

A

microbiological swabs and blood cultures
FBC, U+Es, CRP, G+S
CT head
LP if signs of meningitis

102
Q

management of facial palsy in AOM

A

myringotomoy +/- grommet insertion

103
Q

management of mastoiditis

A

cortical mastoidectomy, possible incision and drainage of spreading abscess

104
Q

bacterial labyrinthitis treatment

A

observe carefully for mastoiditis

105
Q

otitis media with effusion

A

glue ear, middel ear effusion, secretory otitis media

106
Q

types of otitis media

A

acute otitis media
acute suppurative otitis media
otitis media with effusion

107
Q

red fkags of otitis media with effusion

A

unilateral - urgent outpatient appointment is appropriate

108
Q

presentation of OME

A 
sensation of pressure inside ear (sometimes painful)
noises inside ear (popping)
conductive hearing loss
poor speech development
dysequilibrium
109
Q

pinna and ear canal normal
tympanic membrane dull or opque
fluid level or bubbles behind it

A

examination of OME

110
Q

risk factors for OME in children

A 
young
male
multiple runny noses/URTI
bottle fed
daycare
parents smoke
cranial facial abnormalities
mucociliary abnormalities - CF
111
Q

red flags of acute otitis externa

A

complete acute stenosis of the ear canal - sepculum cannot insert
cellulitis of the pinna or peri-auricular area
ipsilateral cranial nerve palsy
ipsilateral severe deep otalgia (causing insomnia)

112
Q

swimmers ear

A

primary bacterial AOE

  • occurs after a change in environment of the ear canal (increased humidity, pH change due to impacted wax etc)

pseudomonas spp
staphylococcus spp

113
Q

history of AOE

A

short history of increasing otalgia
with custard like ear discharge
hearing loss and tinnitus sometimes

114
Q

NOE

A

necrotising otitis externa

infection spreads through soft tissue resulting in osteomyelitis of the tmeporal bone and skull base

115
Q

who is at risk of NOE

A

DM
>65
recurrent AOE
chem/radio therpay or immune compromise

116
Q

secondary AOE cause

A

occurs in the presence of ASOM or foreign body

117
Q

fungal acute otitis externa - presentation and cuase

A

all hallmarks of bacterial AOE except discharge looks like white blobs of rice pudding (candida albicans) with or without black spots

cause = prolonged use of antibiotic drops

118
Q

what is furunculosis

A

infection of the hair follicle in the canal

119
Q

what is Ramasay hunt syndrome

A

zoster of the VII nerve causing palsy and vesicles in the canal

120
Q

treatment of otitis externa

A

topical drops - antibitoic and steroid, canesten in fungal AOE

microsuction of the ear - removal of exudates and debris

insertion of popewick in stenosed/oedematous canals

analgesia

avoid water near ears

121
Q

NOE presentation

A

non resolving AOE despite treatment,
severe pain - insomnia
purulent ottorhoea
granulation and necrotic tissue with ear canal
hearing loss and lower crnaila nerve neuropathies in severe

122
Q

pinna perichondritis or cellulitis red flags

A

pinna abscess or necrosis

any ear infection with central neurological signs such as low GCS

123
Q

what causes pinna cellulitis

A

complication of acute otitis externa, eczema, psoriasis or insect bite

124
Q

cause of pinna peichondritis

A

penetrating truama - inc ear peircing - can form abscess resulting innecrosis and cauliflower deformity

DM increases risk

125
Q

what can pinna perichondritis lead to?

A

systemic infection or serious soft tissue infection inc necrotising fasicitis

126
Q

presentation of pinna perichondritis

A

infection of cartilaginous pinna and sparing of the lobule (ear lobe) whereas cellulitis does not spare the lobule

look for:

  • painful erythema or loss of contour sof pinna
  • localised abscess frmation
  • necrosis of soft tissue
  • primary otitis externa (ototscopy)
  • clinical hearing deficit
  • spreading of cellulitis to face or scalp
  • trauma or wounds
127
Q

treatment of pinna perichondritis

A

swabs of pinna, any otitis externa and MRSA status
trial with systemic and topical antibiotics
good analgesia
control blood sugars
blood cultures if septic

128
Q

rhinosinusitis definition

A

inflammation of the nose and the paranasal sinuses characterised by 2 or more symptoms:

  • rhinorrhoea (nasal discharge), postenasal drip, nasal blockage or obstruction
  • w/wo facial pain/pressure
  • w/wo reduction (hyposmia) or loss of smell (anosmia) +/- cough
129
Q

endoscopic signs of rhinosinusistis

A

nasal polyps
mucopurulent dishcarge from middle meatus
oedema/mucosal obstruction in middle meatus

130
Q

CT signs of rhinosinusitis

A

mucosal changes within the ostemeatal unit and/or sinuses

131
Q

cause of rhinosinusitis

A

usually due to URTI followed by bacterial infection, dental sepsis

132
Q

broad classification of rhinosinusitits

A

acute (ARS) <4 weeks with complete resolution of symptoms

chronic (CRS) >12 weeks without complete resolution of symptoms. with or without polyp

133
Q

define these types of ARS:

  • common cold/acute viral rhinosinusitis

- acute post viral rhinosinusitis

A

coryzal symptoms + duration <10 days

increase in symptoms after 5 days or persistent symptoms after 10 days

suggested by presenc eof least 3 symptoms - discoloured discharge and purulent secretion in nasal cavity, severe local pain (unilat. predom), fever, elevated ESR/CRP, double sickening (deterioration)

134
Q

investigations for rhinosinusitis

A 
nasal swab for pus
nasoendoscopy 
dental examination
skin prick test or RAST to exclude an allergic element after 6-12 weeks 
CT scan
135
Q

treatment of rhinosinusitis

A 
analgesia
steroids nasal drops or systemic oral steroids (for facial pain)
nasal decongestants
nasal irrigation with saline
antihistamine 
antibiotics if bacterial
steam inhalation

functional endoscopic sinus surgery

136
Q

alarm symptoms of the eye, extension and malignancy in rhinosinusitits

A

Eyes:

1) Periorbital Oedema/Erythema
2) Reduced Visual Acuity
3) Ophthalmoplegia
4) Double Vision
5) Displaced Globe

Extension:

1) Frontal Swelling
2) Signs Of Sepsis
3) Signs Of Meningitis
4) Neurological Signs

Malignancy:

1) Unilateral Symptoms
2) Bleeding Crusting
3) Cacosmia

137
Q

3 major pairs of salivary glands

A

parotid
submandibular
sublingual

138
Q

viral parotitis causes

A

mumps (paramyxovirus)

HIV

139
Q

why mumps is a notifiable disease

A

risk of orchitis and therefore subsequent infertility in males
females may experience generalised abdo pain

140
Q

causes of bacterial parotitis/submandibular gland infection

A

most commonly due to obstruction from salivary stone

141
Q

presentation of bacterial parotitis/submandibular infection

A

intermittent swelling of gland followed by acute pain and swelling which is tender to palpation

overlying cellulitis/erythema

septic with fever and raised WCC

142
Q

who gets bacterial parotitis/submandibular infection

A

elderly
dehydrated
poor oral hygiene
sjogrens

143
Q

treatment of bacterial parotitis/submandibular infection

A

rehydration
antibiotics (IV if required)
oral hygiene advice

144
Q

investigations for bacterial parotitis/submandibular infection

A

bloods - sepsis etc
stensens duct in oral cavity for pus
whartons duct if submandibular gland inflammation
assess facial nerve
CT or USS if any suspician of abscess formation

145
Q

presentation of salivary stones

A

cuase intermittent unilateral swelling which is markedly worse on eating

gland is red and tender with swelling but not appear infected

stones seen on xrat, sialogram or USS can be removed via duct if sited distally

146
Q

viral parotitis
bacterial parotitis/submandibular infection
salivary gland stones

A

acute swelling of salivary glands

147
Q

tumours

  • pleomorphic adenomas - parotid
  • warthins tumour - parotid
  • carcinomas
A

chronic swelling of slivary glands

148
Q

presentation of salivary tumours

A

slow growing lumps in the gland, pain and/or nerve infiltration indicates malignancy

149
Q

pleomorhpic adenomas

A

most common salivary tumour

150
Q

warthins tumour

A

benign slow growing swelling in parotid

middle aged men

151
Q

carcinomas of salivary gland

A

fast growing, hard and fixed

may be painful or have nerve involvement

152
Q

which salivary tumour:

  1. facial nerve palsy
  2. lingual nerve parasthesia
A
  1. parotid tumour

2. submandibular gland tumour

153
Q

investigations of salivary tumours

A

MRI

FNE

154
Q

treatment of salivary tumours

A

mostly surgical - superifical parotidectomy for benign tumours and radical for malignant +/- neck dissection

155
Q

complications of salivary tumour radical ressection?

A

facial nerve damage and freys syndrome (facial flushing and sweating when patient salivates)

156
Q

risk factors for head and neck cancer

A

carcingens - smoking, alcohol, sun exposure, occupation exposure

infection - HPV16, hyerplastic candidiasis

immunodeficiency or immunosuppression

157
Q

most common head and neck cancer

A

squamous cell carcinomas

158
Q

what are head and neck cancers?

A

any cancer of the upper aerodigestive tract

159
Q

pesentation of head and neck cancer

A

present to GP, dentist or A+E then reffered to a 2 week ait

may have seen them many times with unsuccessful treatment

neck lump/swelling

160
Q

red flags for head and necl lumps

A

Persistent oral ulcers, often painful and bleed
o Oral swelling – be suspicious of unexplained loose teeth or an asymmetrically
enlarged tonsil
o Persistent sore throat (not responsive to antibiotics or nystatin)
o Dysphagia
o Unilateral otalgia in the absence of other otological symptoms
§ Unilateral recurrent otitis media or new glue ear
o Hoarse voice lasting >3 weeks (chest malignancy should be excluded)
o Persistent and unilateral epistaxis or serosanguinous nasal discharge

Year 3 core conditions (15 decks)

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