Passmedicine Flashcards
Most common infectious agents seen in sinusitis
Strep pneumoniae
Haemophilus influenzae
Rhinovirus
Treatment of Qunisy
IV antibiotics and surgical drainage
Consider tonsillectomy at 6 weeks
A 50-year-old female presents with bilateral parotid gland swelling and symptoms of a dry mouth. On examination she has bilateral facial nerve palsies. This improved following steroid treatment.
Sarcoidosis
An 18-year-old boy presents with pancreatitis. He has bilateral painful parotid enlargement.
Viral parotitis (mumps) In a young adult with parotid swelling and pancreatitis/orchitis/reduced hearing/meningoencephalitis, suspect mumps
Features of acoustic neuroma?
cranial nerve VIII: hearing loss, vertigo, tinnitus
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy
Drugs which are ototoxic
FAG+Q
Aspirin, furosemide, gentimicin, quinine
FAG+Q
Treatment of necrotising ulcerative gingivitis
Paracetamol + oral metronidazole + chlorhexidine mouthwash
Drugs (and one condition) which cause gingival hyperplasia
CCAP CCBs (especially nifedipine) Ciclosporin AML Phenytoin
Can you get nystagmus in menieres?
Ye
Abx for severe otitis media?
Amoxicillin
A 40-year-old man presents with a 4-day history of vertigo. This seems to have followed a viral upper respiratory tract infection in the past week. He is generally fit and well. His symptoms are associated with some nausea but there is no hearing loss or tinnitus. On examination fine horizontal nystagmus is noted. What is the most likely diagnosis?
Vestibular neuronitis
Risk factor for malignant otitis externa?
Diabetes
Medication which can be used in the acute phase of vestibular neuronitis
Prochlorperazine
James, 40, has presented to his GP with weakness of the right side of his face, which examination confirms. James also reveals that he has experienced pain in his ear and otoscopy reveals the presence of vesicles on his tympanic membrane. Which of the following is the likely diagnosis?
Ramsay hunt syndrome
First line antibiotic for tonsillitis in BNF
Phenoxymethylpenicillin for 10 days
How long should you put up with an ulcer for?
3 weeks and then send urgently to oral surgery as a 2 week wait referral
What does sicca mean
Dryness
What is sicca syndrome?
Dry eyes, dry mouth and another disease of connective tissue such as rheumatoid arthritis (most common), lupus, scleroderma or polymyositis
What is sistrunk’s procedure performed for?
Performed for excision of thyroglossal cyst
What is tachyphylaxis?
When you need increasing doses to provide the same effect
Main side effect of using topical decongestants for a long time?
Tachyphylaxis
you can also get rebound hypertrophy of the nasal mucosa upon withdrawal
What is oxymetazoline
Topical decongestant
You area reviewing a 24-year-old lady who has had episodes of wheeze and breathless. She is otherwise fit and well, and has no significant past medical history. Her wheeze improves with her brother’s ‘blue inhaler’. She also complains of having a blocked nose for years.
Samter’s triad (asthma, polyps and aspirin sensitivity)
What is Samter’s triad?
Asthma, aspirin sensitivity and nasal polyps
How do nasal tumours present?
Present with nosebleeds, persistent blocked nose, blood stained mucous draining from the nose and a decreased sense of smell
How does a nasal polyp present?
A nasal polyp results in nasal obstruction, sneezing, rhinorrhoea and a poor sense of taste and smell. Sinister features include unilateral symptoms or bleeding.
What is a post-nasal drip and how does it present?
Occurs as a result of excessive mucous production by the nasal mucosa.
This excess mucous accumulates in the back of the throat/back of the nose and results in a chronic cough and bad breath
What should you do if unilateral polyps
Refer to ENT
Severe pain and protrusion of the ear forwards, with a tender, boggy and often reddened mass behind the ear
Acute mastioditis
- need to treat urgently as can lead to meningitis
- the patient is typically very unwell
A 25-year-old lady presents with an swelling located at the anterior border of the sternocleidomastoid muscle. The swelling is intermittent and on examination it is soft and fluctuant.
Branchial cyst
- mobile cyst
- usually present in early adulthood
A 19-year-old presents to his general practitioner (GP) with an asymptomatic right sided neck lump that he noticed 4 weeks previously. On examination the lump is soft and mobile, is within the dermal layer of the skin and on transillumination the area is equal to the surrounding tissue. There is no central punctum. What is the most likely diagnosis?
Lipoma
Pars flaccida
Attic
(Pars flattica)
-Any crusting or ear wax obscuring the attic is a cholesteatoma until proven otherwise
Where are salivary stones most commonly found?
Usually form in the submandibular gland and may therefore occlude Wharton’s duct
A 61-year-old woman with a history of cardiac problems develops hearing loss after a prolonged admission in hospital. Drug toxicity is suspected.
Furosemide
A 78-year-old man complains of difficultly following conversations. His wife says he has the TV turned up too loud. Audiometry shows sensorineural hearing loss at the higher frequencies.
Presbyacusis
A 37-year-old cello player complains of a three month history of vertigo and hearing loss on the left side. On examination he has an absent corneal reflex on the left eye.
Acoustic neuroma
A 59-year-old man presents with a severe pain deep within his right ear. He feels dizzy and reports that the room ‘is spinning’. Clinical examination shows a partial facial nerve palsy on the right side and vesicular lesions on the anterior two-thirds of his tongue. What is the most likely diagnosis?
Ramsayhint syndrome
A 64-year-old woman with a one week history of pain above and lateral to her left eye. On examination she is tender over that area.
Temporal arteritis
Facial fullness and tenderness
Nasal discharge, pyrexia or post-nasal drip leading to cough
Sinusitis
Commonest form of tumour in the parotid gland
Pleomorphic adenoma
Acute otitis media with perforation in children, what should you do
Prescribe antibiotics
