Surgery

Question 1

Top 3 causes of hearing loss

Answer 1

1. ear Wax
2. otitis media
3. otitis externa

Question 2

Presbyacusis

Answer 2

Age related hearing loss.
Sensorineural
Audiometry: high frequency hearing loss

Question 3

Otosclerosis

Answer 3

AD (+ FH)
Conductive
Tinnitus

Question 4

Glue Ear/Otitis media with effusion

Answer 4

• Approx 2yrs old
• Hearing loss +/- seondary problems relating to loss of hearing eg. SALT
• Painful!
• Complications: ruptured membrane- once ruptured pain gone and gunk on pillow.
• Rx: Abx and r/v in 2/52 (Amoxicillin)

Question 5

Menieres disease

Answer 5

• Idiopathic
• mins:hours recurrent
• Sensorineural
• vertigo, tinnitus, aural fullness
• (nystagmus and + romberg)

Question 6

Noise damage

Answer 6

Bilateral

Audiometry: hearing worse at 3000-6000Hz

Question 7

Acoustic Neuroma

Answer 7

CN specific

• VIII: hearing loss, vertigo, tinnitus
• V: No corneal reflec
• VII: facial palsy

if bilateral: think NEUROFIBROMATOSIS TYPE II

Question 8

Trigeminal Neuralgia

Answer 8

Unilateral electric shocks in >=1 of V1-3
triggers: light touch, smoking, talking
Rx: Carbemazepine (stabilises VG Na channels)

Question 9

criteria for Tonsillectomy

Answer 9

• > 5 sore throats (tonsillitis/1year)

- significant imapact on daily life

Question 10

Centor Score

Answer 10

Likelihood of adults w/sore throat caused by group A B haemolytic Strep.

1. Fever
2. exudates
3. adenopathy
4. No cough

> =3: 40-60% chance

Rx: Penicillin V (erythromycin)

Question 11

NICE guidelines for ABx in tonsillitis

Answer 11

• systemic upset 2ary to sore throat
• unilateral peritonsillitis
• Hx of rheumatic fever
• increased risk of infection (child with DM, immunosuppression)
• acute sore throat + >=3 centor criteria

Question 12

Cholesteatoma

Answer 12

Squamous epithelium shed --> stuck in skull --> local destruction.
ATTIC CRUST
foul smelling DC
hearing loss
Rx: surgery- mastoidectomy

Question 13

Otitis Externa

Answer 13

Rx:
first line- steroid and Abx spray
second line - oral fluclox/cipro

Question 14

Bells Palsy

Answer 14

Acute idiopathic Facial Nerve Palsy

LMN

Question 15

Viral Labyrinthitis

Answer 15

Sudden onset
hearing loss
Nausea and vertigo
Preceeding coryza

Question 16

Otitis media

Answer 16

Bulging membrane

Rx: None unless <2years old or bilateral and otorrhoea.

Question 17

Vestibular Neuritis

Answer 17

recent viral infection
recurrent vertigo
No hearing loss

Question 18

BPPV

Answer 18

Gradual onset
Triggered by change in head position
Lasts 10-20 seconds

Question 19

Diagnosing BPPV

Answer 19

Modified Dix-Hallpike:

• determines posterior semicircular canal involvement.
• reproduced vertigo and nystagmus
• Patient sitting
• Swiftly move patient to side lying and head rotated 45 degrees away from side being tested.
• look for nystagmus

Roll test: horizonal semicircular canal:

• lie supine with head 20degrees flexion
• roll head 90 degrees to left
• look for vertgio and nystagmus

Question 20

Treating EPPV with the Epley Manouvre

Answer 20

tbc

Question 21

Vertebrobasilar Ischaemia

Answer 21

Elderly Patient

Dizziness on neck extension

Question 22

• Sudden onset backpain leaning forwards
• tenderness on lumbar spine
• Neuro exam NAD
• Straight leg raise NAD

Answer 22

Facet Joint Pain

- normal straight leg raise means this is unlikely to be disc prolapse.

Question 23

• Progressively severe lower back pain (no trigger)
• hypotensive 90/60
• HR 120

Answer 23

Leaking AAA

Question 24

Indications for an ankle XRAY: THE OTTOWA RULES

Answer 24

• Pain in the malleolar zone plus any one of…
  1. bony tenderness at he lateral malleolar zone (includes lower 6cm fibula)
  2. bony tenderness of the medialmalleolar zone (lower 6cm of tibia)
  3. inability to walk 4 weight bearing steps immediately after injusty and in ED