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Flashcards in ENT Deck (244):
1

Criteria for antibiotics in otitis media

symptoms longer than 4 days, or not improving
systemically unwell
immunocompromised, or high risk of complications secondary to significant heart, lung, kidney, liver or neuromuscular disease
younger than 2 years old with bilateral otitis media
otitis media with perforation and/or discharge in the canal

2

symptoms longer than 4 days, or not improving
systemically unwell
immunocompromised, or high risk of complications secondary to significant heart, lung, kidney, liver or neuromuscular disease
younger than 2 years old with bilateral otitis media
otitis media with perforation and/or discharge in the canal are conditions for

giving antibiotics in otitis media

3

if antibiotics required to treat otitis media what is given?

amoxicillin, erythromycin/clarithromycin if penicillin allergic

4

amoxicillin, erythromycin/clarithromycin if penicillin allergic are given for

otitis media

5

common organisms causung otitis media

rhinovirus, staphylococcus, haemophilus, moroxella

6

rhinovirus, staphylococcus, haemophilus, moroxella are common organisms causing

otitis media

7

vertigo is defined as

the false sensation that the body or environemnt is moving

8

the false sensation that the body or environemnt is moving defines

vertigo

9

causes of vertigo

viral labyrinthitis, vestibular neuronitis, benign paroxysmal positional vertigo, Meniere's disease, vertebrobasilar ischaemia, acoustic neuroma, trauma, multiple sclerosis, ototoxicity e.g gentamicin

10

viral labyrinthitis, vestibular neuronitis, benign paroxysmal positional vertigo, Meniere's disease, vertebrobasilar ischaemia, acoustic neuroma, trauma, multiple sclerosis, ototoxicity e.g gentamicin are causes of

vertigo

11

viral labyrinthitis

vertigo, recent viral infecion, sudden onset, nausea, vomiting, hearing may be affected

12

vertigo, recent viral infecion, sudden onset, nausea, vomiting, hearing may be affected in

viral labyrinthitis

13

vestibular neuronitis

recent viral infection, recurrent vertigo attacks lasting hours/days, no hearing loss

14

recent viral infection, recurrent vertigo attacks lasting hours/days, no hearing loss in

vestibular neuronitis

15

benign paroxysmal positional vertigo

gradual onset vertigo, triggered by change in head position, each episode lasts 10-20 seconds

16

gradual onset vertigo, triggered by change in head position, each episode lasts 10-20 seconds in

benign paroxysmal positional vertigo

17

Meniere's disease

middle ages adults, recurent episodes of vertigo associated with hearing loss (sensorineural), tinnitus, sensation of fullness/pressure in one or both ears, nystagmus, positive Romberg's test, episodes last minutes to hours, typically unilateral

18

middle ages adults, recurent episodes of vertigo associated with hearing loss (sensorineural), tinnitus, sensation of fullness/pressure in one or both ears, nystagmus, positive Romberg's test, episodes last minutes to hours, typically unilateral in

Meniere's disease

19

vertebrobasilar ischaemia

elderly patient, vertigo, dizziness on neck extension

20

elderly patient, vertigo, dizziness on neck extension in

vertebrobasilar ischaemia

21

acoustic neuroma

cranial nerve VIII: hearing loss, vertigo, tinnitus
cranial nerve V: absent corneal reflex (important sign)
cranial nerve VII: facial palsy
bilateral associated with neurofibromatosis type 2

22

hearing loss, vertigo, tinnitus, absent corneal reflex, facial palsy, associated with neurofibromatosis type 2 is

acoustic neuroma

23

three most common causes of hearing loss

ear wax, otitis media, otitis externa

24

ear wax, otitis media, otitis externa are the three most common causes of

deafness

25

presbycusis

age related sensorineural hearing loss, difficulty following conversations, audiometry shows bilateral high frequency hearing loss

26

age related sensorineural hearing loss, difficulty following conversations, audiometry shows bilateral high frequency hearing loss describes

presbycusis

27

otosclerosis

autosomal dominant, replacement of bone by vascular spongy bone, onset at 20-40 years, conductive deafness, tinnitus, 'flamingo tinge' to tympanic membrane, positive family history

28

autosomal dominant, replacement of bone by vascular spongy bone, onset at 20-40 years, conductive deafness, tinnitus, 'flamingo tinge' to tympanic membrane, positive family history describes

otosclerosis

29

glue ear/otitis media with effusion

peaks at 2 years old, conductive hearing loss, secondary problems e.g. speech, language, behavioural, balance problems

30

peaks at 2 years old, conductive hearing loss, secondary problems e.g. speech, language, behavioural, balance problems describes

glue ear/otitis media with effusion

31

drugs causing ototoxicity

aminoglycosides (gentamicin), furosemide, aspirin, cytotoxic agents

32

aminoglycosides (gentamicin), furosemide, aspirin, cytotoxic agents are drugs which cause

ototoxicity

33

noise damage

workers in heavy industries, bilateral, 4000Hz notch on audiogram, sensorineural hearing loss

34

workers in heavy industries, notch on audiogram at 4000Hz, sensorineural hearing loss

noise damage

35

acoustic neuroma is more correctly called

vestibular schwannoma

36

vestibular schwannoma

is the correct name for acoustic neuroma

37

reactive lymphadenopathy

most common cause of neck swelling, history of local infection, generalised viral illness

38

most common cause of neck swelling, history of local infection, generalised viral illness describes

reactive lymphadenopathy

39

lymphoma

rubbery, painless, lymphadenopathy, night sweats, splenomegaly

40

rubbery, painless, lymphadenopathy, night sweats, splenomegaly describes

lymphoma

41

thyroid swelling

moves upwards on swallowing, symptoms of hyper/eu/hypothyroidism

42

moves upwards on swallowing, symptoms of hyper/eu/hypothyroidism

thyroid swelling

43

thyroglossal cyst

more common in patients <20 years old, midline, between isthmus of the thyroid and the hyoid bone, moves upwards with tongue protrusion, painful if infected

44

more common in patients <20 years old, midline, between isthmus of the thyroid and the hyoid bone, moves upwards with tongue protrusion, painful if infected describes

thyroglossal cyst

45

isthmus of the thyroid

the bit of the thyroid gland that crosses the midline of the throat, about at the level of the shoulders

46

hyoid bone

top bone under the chin, above the Adam's apple

47

the bit of the thyroid gland that crosses the midline of the throat, about at the level of the shoulders

isthmus

48

top bone under the chin, above the Adam's apple

hyoid bone

49

pharyngeal pouch

more common in older men, posteriomedial herniation between thyropharyngeus and cricopharyngeus muscles, usually not seen, if large midline lump, gurgles on palpation, dysphagia, regurgitation, aspiration, chronic cough

50

more common in older men, posteriomedial herniation between thyropharyngeus and cricopharyngeus muscles, usually not seen, if large midline lump, gurgles on palpation, dysphagia, regurgitation, aspiration, chronic cough describe

pharyngeal pouch

51

cystic hernia/lymphangioma

congenital lymphatic lesion, left side, present before 2 years

52

congenital lymphatic lesion, left side, present before 2 years describes

cystic hernia/lymphangioma

53

branchial cyst

oval, mobile, cystic mass, between sternocleidomastoid muscle and pharynx, due to failure of obliteration of the second branchial cleft in embryonic development, early adulthood

54

oval, mobile, cystic mass, between sternocleidomastoid muscle and pharynx, due to failure of obliteration of the second branchial cleft in embryonic development, early adulthood describes

branchial cyst

55

cervical rib

adult females, can lead to thoracic outlet syndrome

56

adult females, can lead to thoracic outlet syndrome

cervical rib

57

thoracic outlet syndrome

when the blood vessels between clavicle and first rib get compressed

58

when the blood vessels between clavicle and first rib get compressed describes

thoracic outlet syndrome

59

carotid aneurysm

pulsatile, lateral, doesn't move on swallowing

60

pulsatile, lateral, doesn't move on swallowing describes

carotid aneurysm

61

mnemonic to remember how to describe a lump

5 Students and 3 Teachers went to build a CAMPFIRE

62

5 Students and 3 Teachers went to build a CAMPFIRE to remember

how to describe a lump

63

5 students to comment on when you find a lump

site - from a specific landmark
size
shape
skin
scar

64

3 teachers to comment on when you find a lump

tenderness - pain on touching
temperature - feel with back of hand
transillumination - especially for testicular masses

65

campfire to comment on when you find a lump

consistency - soft, spongy, firm
attachment - identify between which layers it is by moving the skin, then muscle etc over it
mobility - try to move lump horizontally and vertically
pulsatile - assess with two fingers, transmitted vs expansile
fluctuance - tap lump with fingers either side, fluctuant will displace fingers
irr/
reducible
enlarged lymph nodes

66

cause of Meniere's disease

unknown

67

site of Meniere's disease

inner ear

68

inner ear is the site of what disease

Meniere's

69

Meniere's disease is characterised by

the progressive dilation of the endolymphatic system

70

the progressive dilation of the endolymphatic system characterises

Meniere's disease

71

the natural history of Meniere's disease

symptoms resolve after 5-10 years, degree of residual hearing loss (sensorineural), psychological distress

72

symptoms resolve after 5-10 years, degree of residual hearing loss, psychological distress describes the natural history of

Meniere's disease

73

management of Meniere's disease

ENT assessment, inform DVLA, cease driving until satisfactory control of symptoms, buccal/intramuscular prochlorperazine for acute attacks, betahistine and vestibular rehabilitation exercises may be of benifit in prevention

74

ENT assessment, inform DVLA, cease driving until satisfactory control of symptoms, buccal/intramuscular prochlorperazine for acute attacks, betahistine and vestibular rehabilitation exercises may be of benifit in prevention describes the management of

Meniere's disease

75

prochlorperazine

dopamine receptor antagonist, antipsychotic class, buccal or intramuscular for acute Meniere's disease attacks, extrapyramidal side effects

76

dopamine receptor antagonist, antipsychotic class, buccal or intramuscular for acute Meniere's disease attacks, extrapyramidal side effects

prochlorperazine

77

betahistine

used in the prevention of the symptoms of Meniere's disease

78

used in the prevention of the symptoms of Meniere's disease

betahistine

79

the effusion in glue ear is a transudate or an exudate?

transudate (systemic, low protein)

80

glue ear is caused by a

dysfunction eustatian tube

81

a dysfunctional eustation tube in children causes

glue ear/otitis media with effusion

82

otitis externa orgnaisms

staphylococcus, streptococcus, pseudomonas

83

staphylococcus, streptococcus, pseudomonas are common causative orgnaisms of

otitis externa

84

middle ear bones in order

malleus, incus, stapes

85

adult with glue ear think

nasopharyngeal cancer

86

think of nasopharyngeal cancer in

adults with glue ear/otitis media with effusion

87

sodium bicarbonate ear drops

softens ear wax

88

ear drops used to softens ear wax

sodium bicarbonate

89

obstructive sleep apnoea in young children may be caused by enlarged

tonsils and adenoids

90

enlarged tonsils and adenoids in young children may cause

obstructive sleep apnoea

91

cholesteatoma

squamous cells in the middle ear causing local destruction

92

squamous cells in the middle ear causing local destruction describes

cholesteatoma

93

features of cholesteatoma

foul smelling discharge, hearing loss, vertigo, facial nerve palsy, cerebellopontine angle syndrome, otoscopy = 'attick crust' seen in uppermost part of eardrum

94

foul smelling discharge, hearing loss, vertigo, facial nerve palsy, cerebellopontine angle syndrome, otoscopy = 'attick crust' seen in uppermost part of eardrumare features of

cholesteatoma

95

management of cholesteatoma

ENT referral for surgical removal

96

ENT referral for surgical removal is the management for

cholesteatoma

97

cerebellopontine angle syndrome

caused by a space occupying lesion at junction fo cerebellar and pons: ipsilateral deafness, nystagmus, reduced corneal reflex, V and VII nerve palsys, ipsilateral cerebellar signs

98

caused by a space occupying lesion at junction fo cerebellar and pons: ipsilateral deafness, nystagmus, reduced corneal reflex, V and VII nerve palsys, ipsilateral cerebellar signs

cerebellopontine angle syndrome

99

normal on an audiogram

above 20dB

100

above 20dB on an audiogram

normal

101

audiogram of sensorineural hearing loss

both bone (arrowheads) and air (circles or crosses) are >20dB

102

both bone (arrowheads) and air (circles or crosses) are >20dB on audiogram indicates

sensorineural hearing loss

103

audiogram of conductive hearing loss

only air (circles or crosses) are >20dB

104

only circles or crosses are >20dB

conductive hearing loss

105

audiogram of mixed hearing loss

both bone (arrowheads) and air (circles or crosses) are >20dB, with air significantly worse than bone

106

both bone (arrowheads) and air (circles or crosses) are >20dB, with air significantly worse than bone

mixed hearing loss

107

chronology of symptoms in otitis media acute

pain, pop, discharge

108

pain, pop, discharge is the chronology of

otitis media acute

109

what route to give antibiotics for otitis media acute

orally/systemically

110

what route to give antibiotice for otitis externa

topical/drops

111

chronology of events for otitis externa

pus, pain

112

pus, pain is the chronology of events for

otitis externa

113

stapes connects with

oval window

114

the cochlea is filled with

perilymph

115

perilymph lines the

cochlea

116

metaplasia

when one fully differentiated cell type changes into a different fully differentiated cell type in respose to a stimuli (occurs in otitis media with effusion)

117

when one fully differentiated cell type changes into a different fully differentiated cell type in respose to a stimuli describes

metaplasia

118

window of opportunity to develop speech

<6 years old

119

<6 years old is the window of opportunity

to develop speech, after that a cochlear implant will only enable the perception of sounds as Wernike's + Broca's areas haven't developed

120

transient evoked otoacoustic emissions

used in newborn screening hearing test

121

used in newborn screening hearing test

transient evoked otoacoustic emissions

122

automated brainstem responce

secondary testing if neonates scores low on the transient evoked otoacoustic emission, hearing version of an EEG

123

secondary testing if neonates scores low on the transient evoked otoacoustic emission

automated brainstem response

124

management of glue ear/otitis media with effusion

grommets or hearing aids

125

grommets or hearing aids id the management of

glue ear/otitis media with effusion

126

caution with grommets

don't get water in the ear - no swimming, wear plugs when showering, will fall out in 7-9/12
"water precautions"

127

water precautions must be adhered to when

domeone has grommets in their ears, or when a perforation is healing

128

mild hearing loss

20-40dB

129

20-40dB

mild hearing loss

130

moderate hearing loss

40-70dB

131

40-70dB

moderate hearing loss

132

severe hearing loss

70-90dB

133

70-90dB

severe hearing loss

134

profound hearing loss

>90dB

135

>90dB

profound hearing loss, required cochlear implant

136

range of frequencies of human ear

20-20000Hz

137

20-20000Hz

range of frequencies of the human ear

138

range of frequencies of speech

250-8000Hz

139

250-8000Hz

range of frequencies of speech

140

5-10dB differnce between ears/air and bone conduction

insignificant, can say symetrical

141

insignificant, can say symetrical audiometry difference

5-10dB

142

carhart notch

at 2000Hz, indicated otosclerosis

143

at 2000Hz, indicated otosclerosis

cahart notch

144

management of otosclerosis

stapedectomy and prosthesis

145

stapedectomy and prosthesis is the management for

otosclerosis

146

Meniere's hearing loss is worse at which frequencies

lower

147

hearing loss worse at lower frequencies indicates

Meniere's disease

148

tympanometry

test of middle ear relative pressure

149

test of middle ear relative pressure

tympanometry

150

microtia

congenital malformation of pinna

151

congenital malformation of pinna

microtia

152

types of hearing aids

post auricular, bone conduction, cochlear implant, bone anchored hearing aid

153

post auricular, bone conduction, cochlear implant, bone anchored are

types of hearing aid

154

tachyphylaxis definition

increasing dose required to achieve same effect

155

increasing dose required to achieve same effect

tachyphylaxis

156

prolonged periods of using topical nasal decongestants can lead to

tachyphylexis

157

tachyphylexis can develop when

using topical nasal decongestants e.g. oxymetazoline

158

types of allergic rhinitis

seasonal e.g. hayfever, perennial (all year round) e.g. house mites, occupational

159

seasonal, perennial, occupational are types of

allergic rhinitis

160

first line management of allergic rhinitis

oral/intranasal antihistamines

161

oral/intranasal antihistamines are first line management for

allergic rhinitis

162

otalgia

ear pain

163

ear pain

otalgia

164

small bilateral nasal polyps

can be treated in primary care with saline nasal douche and intranasal steroids

165

can be treated in primary care with saline nasal douche and intranasal steroids

small bilateral nasal polyps

166

polyps due to rhinosinusitis are usually unilateral or bilateral?

bilateral

167

complications of tonsillitis

otitis media, quinsy, rheumatic fever, glomerulonephritis

168

otitis media, quinsy, rheumatic fever, glomerulonephritis are complications of

tonsillitis

169

quinsy

peritonsillar abscess

170

peritonsillar abscess is called

quinsy

171

indications for tonsillectomy - NICE recommends meeting all of these

disabling sore throats due to tonsillitis, 5+ episodes of tonsillitis per year, symptoms for at least 1 year

172

disabling sore throats due to tonsillitis, 5+ episodes of tonsillitis per year, symptoms for at least 1 year are

what NICE recommends need to be met (all) in order to justify a tonsillectomy

173

other established indications for tonsillectomy

recurrent febrile convulsions secondary to tonsillitis, obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils, quinsy if unresponsive to standard treatment

174

recurrent febrile convulsions secondary to tonsillitis, obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils, quinsy if unresponsive to standard treatment are

other established indications for a tonsillectomy

175

tonsillectomy complications

primary (within 24h) = haemorrhage, secondary = haemorrhage, pain, infection

176

Ramsey Hunt syndrome also known as

herpes zoster oticus

177

herpes zoster oticus also known as

Ramsey Hunt syndrome

178

features of Ramsey Hunt syndrome/herpes zoster oticus

auricular pain, facial nerve palsy, vesicular rash around ear, vertigo, tinnitus

179

auricular pain, facial nerve palsy, vesicular rash around ear, vertigo, tinnitus are features of

Ramsey Hunt syndrome/herpes zoster oticus

180

management of Ramsey Hunt syndrome/herpes zoster oticus

oral aciclovir + corticosteroids

181

oral aciclovir + corticosteroids given in

Ramsey Hunt syndrome/herpes zoster oticus

182

sialadenitis

inflammation of the salivary gland

183

inflammation of the salivary gland

sialadenitis

184

sialadenitis is often secondary to a

stone impacted in the duct

185

a stone impacted in the salivary duct can lead to

sialadenitis

186

three main salivary glands

parotid, submandibular, sublingual

187

parotid, submandibular, sublingual describe

the three main salivary glands

188

otoscopy L vs R ear

half with cone of light + maleolus process (i.e. L/R) is same half as the ear (i.e. L/R ear)

189

ear wax impaction

excessive build up of ear wax in canal, conductive hearing loss, sometimes pain

190

excessive build up of ear wax in canal, conductive hearing loss, sometimes pain

ear wax impaction

191

myringosclerosis

thickening + calcification of the tympanic membrane 2' to inflammation, usually asymptomatic

192

thickening + calcification of the tympanic membrane 2' to inflammation, usually asymptomatic

myringosclerosis

193

nosebleed management

1. local compression over Little's area
2. nasal cautery (chemical or electrical)
3. nasal packing - uncomfortable for PT, risks of P necrosis, post migration into the airway + aspiration of blood clots
4. ligation of sphenopalatine a (life threatening haemorrhage)

194

salivary duct calculus

Ca, submandibular gland > affected due to longer duct, antigravity drainage + > vicous secretions, pain + swelling when eating

195

salivary duck calculus management

siologram > XR, conservative = increasing saliva produciton (sucking sweets), drinking H2O, massaging the area, silandoscopy, lithotripsy

196

siologram > XR, conservative = increasing saliva produciton (sucking sweets), drinking H2O, massaging the area, silandoscopy, lithotripsy describes the managementof

salivary duck calculus

197

tuning fork for hearing test

512Hz

198

parts of the eardrum

pars tensa (lower part), pars flaccida (upper part)

199

inspection of the ear

examine face for palsy/m weakness, , scars inflammation, trauma, pits/sinuses around pinna

200

palpation of the ear

mastoid tip, mastoid bone, pinna, parotid, temperomandibular joint area

201

otoscopy

inspect the meatus, tympanic menbrane

202

doccument fondings from otoscopy

draw a picture of the tympanic menbrane

203

Rinne's test

512Hz tunig fork - air vs bone conduction, 1. can you hear both 2. which is louder

204

+ve Rinne's test

air > bone conduction, indicated N hearing or SNHL

205

-ve Rinne's test

bone > air, conductive HL

206

false -ve Rinne's test

v severe unilateral SNHL so much so that when tuning fork is placed on the mastoid it conducts round + is detected by the other cochlear

207

Weber's test

512Hz tuning fork - placed in centre of forehead, equal or localises to one ear

208

equal hearing in Weber's indicates

N hearing or equal SNHL/CHL

209

Weber's localises to

good ear in SNHL, bad ear in CHL

210

512Hz tunig fork - air vs bone conduction, 1. can you hear both 2. which is louder

Rinne's

211

air conduction > bone condutcion

+ve Rinne's test

212

bone conduciton > air conduciton

-ve Rinne's test

213

512Hz tuning fork - placed in centre of forehead, equal or localises to one ear

Webber's

214

inspecting the nose

inspect from all angles, size of nostrils, size of septum

215

test of airway patency (nose)

cold Lack's depressor under nostrils + ask PT to exhale through nose

216

otoscopy

comment on nasal septum, nose floor, lateral turbinate

217

mouth inspection

lip border, (head torch/good light source) stick out tongue, Lack's tongue depressors, inspect contents, hard, soft palate, tonsils, upper teeth, lateral mouth, tongue, floor of mouth, lower teeth, lower lateral buccal area

218

number of adult teeth

32

219

mouth palpation

bimanual, submanibuilar gland, mucosa, check for thickening, abnormalities, stones, cysts, ulcers

220

neck inspection

fully exposed, swellings, skin lesions, skin discolouration, scars, lumps: size, site, shape, overlying skin (scar/colour), surface,margin, pulsatile, cross fluctiation

221

neck palpation

from behind, start with abnormality (single/multiple, discrete/diffuse, surface, edge, T'c, consistency, fluctuation, compressibility, reducibility, pulsatility, fixation), stick out tongue

222

nasendoscopy is used to examine the

nose, pharynx, larynx

223

epistaxis

nosebleed

224

types of epistaxis

1' (majority of epistaxis, no obvious causal factor), 2' (due to an identifiable cause), childhood, adult, acute, recurrent

225

2' causes of epistaxis

EtOH, aspirin, NSAIDs, antiplatelets (clopidogrel), anticoagulants (warfarin), herbal remidies (St John's wort, fish oil), blood dyscrasias (thrombocytopaenia), coagulopathy (haemophillia, vWD), trauma (nasal #), tumour, Sx, septal perforation

226

childhood epistaxis

common, tends to be 1', ant inf bleeding of nasal septum (Little's area)

227

susceptibility to childhood epistaxis

nose picking, infection

228

management of childhood epistaxis

pinch Little's area (Hippocratic manoeuvre), examine nose (good light) once bleeding stopped, spray bleeds with LA + vasoconstrictor (lignocaine + phenylephrine), chemical cautery, diathermy

229

prescribed to prevent recurrence of childhood epistaxis

course of chlorhexidine-neomycin cream

230

adult 1' epistaxis

> posteriorly than in children, > bleeding

231

management of adult 1' epistaxis

Hippocratic manoeuvre, IV access, contact ENT, examination, cautery of bleed, diathermy

232

failure to control bleeding in 1' adult epistaxis within

24h warrents referral to specialist rhinologist (endoscopy under GA, diathermy, ligation)

233

2' epistaxis management

identificaion/treatment of cause, Hippocratic manoeuvre

234

pharmacological causes of 2' epistaxis

NSAIDs, clopidogrel, aspirin, warfarin, herbal remidies, EtOH - loss of control, OD

235

2' epistaxis by trauma

craniofacial trauma required ENT referral, risk = ethmoidal #

236

ethmoidal # presentation

black eyes, nasal #, dislocation with broadened nasal dorsum, episodes of epistaxis

237

ethmoidal # management

ENT referral, assessment, Sx ligation, angiography

238

ux, bloodstained discharge indication for

urgent ENT referral, ?malignancy

239

ux nasal obstruction + epistaxis in pubertal/adolescent male think

juvenile nasopharyngeal angiofibroma (rare)

240

hereditary haemorrhagic telangectasia

rare, AD, variable penetrance, severe recurent epistaxis, telangectasias on mucosal surface/oral cavity/lips, anaemia, spider naevi, AVM

241

course of chlorhexidine-neomycin cream is used to

prevent recurrence of childhood epistaxis

242

black eyes, nasal #, dislocation with broadened nasal dorsum, episodes of epistaxis

ethmoidal #

243

juvenile nasopharyngeal angiofibroma (rare) presentation

ux nasal obstruction + epistaxis in pubertal/adolescent male

244

rare, AD, variable penetrance, severe recurent epistaxis, telangectasias on mucosal surface/oral cavity/lips, anaemia, spider naevi, AVM

hereditary haemorrhagic telangectasia