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42 Cards in this Set

  • Front
  • Back
Most common causative agents of otitis externa
Pseudomonas and staph aureus
Management of otitis externa
Non infective? - Betamethasone

Infective? - Betamethasone + neomycin. Also consider oral flucloxacillin.
Most common cause of neck swelling
Reactive lymphadenopathy (i.e. illness)
Key feature of thyroid swelling
Moves upwards on swallowing
Features of thyroglossal cyst
Most common in patients <20, moves upwards on protrusion of the tongue
Features of cystic hygroma
Typically presents before age 2 (mostly present at birth). Swelling is classically on left side.
Common causative agents of otitis media
pneumococcus, haemophilus
Treatment of otitis media
Oral amoxicillin
Hearing tests in children
At birth - otoacoustic emissions and/or audiological brainstem responses

6-18 months - distraction testing

2-5 years - conditioned response audiometry and speech discrimination

5 years - pure tone audiogram
Tinnitus differentials
Ringing, hissing or buzzing = inner ear

Popping or clicking = external or middle ear

Pulsatile sounds = anxiety, inflammatory causes, vascular causes (including cardiac stenosis), carotid body tumours
Drug causes of tinnitus
Aspirin, loop diuretics, aminoglycosides, quinines, alcohol excess
Reasons for referral in nasal obstruction
Numbness, tooth loss, bleeding, unilateral mass, a tumour may be present.
Pathogenesis of sinusitis
Typically viral infection leading to mucosal oedema and decreased ciliary action, therefore stasis.

Or, outflow obstruction.
Symptoms of sinusitis
Pain, worse on leaning forward. Post nasal drip leading to foul taste in mouth. Nasal congestion. Anosmia.
Sinusitis imaging
Rigid endoscopy + CT
Common causative agents of sinusitis
Strep pneumoniae, haemophilus influenzae
Sinusitis management
Conservative. If no improvement after 5 days, nasal douching and topical steroids can be tried. Antibiotic therapy is typically via co-amoxiclav.
Typical patient with nasal polyps
Adult male (>40)
Most common sites of polyps
Middle turbinates, middle meatus, ethmoids
Nasal polyps S&S
Watery rhinorrhoea, postnasal drip, obstruction, changes in voice, sinusitis, anosmia, mouth breathing
Nasal polyps are associated with...
Rhinitis, asthma (esp adult onset), CF, aspirin hypersensitivity
Nasal polyps management
Betamethasone sodium phosphate drops. Maintenance with beclometasone spray. Prednisolone tablets may provide short term relief.
Management of anterior epistaxis
Tilt head downwards, pressure on cartilage for 15 mins.

Ribbon gauze soaked in vasoconstrictor +/- local anaesthetic e.g. xylometazaline (otrivine) with 2% lidocaine

Cauterize with silver nitrate sticks
Management of posterior epistaxis
Typically more complicated. Endoscopy and cautery. Packing for 48 hours.
Most common causative agent of sore throat
Group A strep
Antibiotic management of sore throat
Penicillin V (phenoxymethylpenicillin). Erythromycin if allergic
What is a quinsy?
A peritonsillar abscess, typically following tonsillitis. Look out for patient unable to swallow saliva who talks with a 'hot potato' voice
Sore throat + rash...
Think scarlet fever. Rash will typically be on chest, axillae, or behind ears. Normally 12-48 hrs after infection. Also look out for 'strawberry tongue'

Treat with penicillin
Severity grading of croup
1. Inspiratory stridor +/- barking cough
2. Grade 1 + expiratory stridor
3. Grade 2 + pulsus paradoxus
4. Grade 3 + cyanosis or decreased cognition
Main cause of stridor
Croup
Causative agent of croup
Parainfluenza virus
Cardinal signs of epiglottitis
Drooling, head forward, tongue out.

Sore throat, fever, dyspenoea, dysphagia, cellulitis, tenderness, hoarseness, pharyngitis, anterior neck nodes.
Managing epiglottitis
Take to ITU, give O2 by mask. Give nebulised adrenaline, IV dexamethasone. Cultures. Find cricothirotomy kit.

IV penicillin G (benzylpenicillin) + ceftriaxone
Antiobiotic therapy for laryngitis
Penicillin V (phenoxymethylpenicillin)
Common causes of layngeal nerve palsy
Cancers, iatrogenic.

Otherwise, CNS disease (polio, syringomyelia), aortic aneurysm. Neurotropic virus.
Symptoms of nasopharyngeal cancer
Epistaxis, diplopia, conductive deafness, referred pain, cranial nerve palsy, nasal obstruction, neck lumps.
Diagnosis of nasopharyngeal cancer
Endoscopy + Biopsy. Stage with MRI.
Management of nasopharyngeal cancer
Radiotherapy +/- chemo +/- surgery
Symptoms of acoustic neuroma (vestibular schwannoma)
Tinnitus +/- deafness, signs of raised ICP, dizziness.

Most commonly affected cranial nerves are V, VI and VII.
Malignant causes of dysphagia
Oesophageal cancer, pharyngeal cancer, gastric cancer, lung cancer.
Neuro causes of dysphagia
Bulbar palsy, myaesthenia gravis, syringomyelia
Non neuro or malignant causes of dysphagia
Strictures, pharyngeal pouch, achalasia, systemic sclerosis, oesophagitis, iron deficient anaemia