Other clinical pathology

Question 1

otitis externa:

main sx

main causative organism

rx

Answer 1

Itch (+ pain/ discharge)

Pseudomonas aerginosa

topical abx / steroid drops or acetic acid spray

Question 2

sx of necrotizing/ malignant OE aka skull base osteomyelitis

Answer 2

Disproportionate pain + night waking

Discharge - not resolving with abx
Unilateral
+/- facial n palsy
granulation tissue in ear

Question 3

Rx of malignant OE

Answer 3

CT temporal bones
6 weeks IV abx
refer ENTfor admission
regular washout
control cause

Question 4

acute otitis media

common organisms

main presentation

rx

Answer 4

1) Strep pneumo, H. influenza

2)post viral, hearing loss/pain (d/c if perf)

3)oral amox/ clari (consider 3 day delayed)

Question 5

OME

• appearance of TM
• rx

Answer 5

dull, retracted, grey, +/- fluid level

watch + wait (50%)
Myringotomy + grommet (+? adenoidectomy)

Question 6

types of chronic otitis media

Answer 6

Mucosal - TM perf
Squamous - cholesteatoma

Both can be active (infected) or inactive

Question 7

Define cholesteatoma

Answer 7

accumulation of benign keratinising squamous cells in middle ear - locally destructive + mass effect

Question 8

Presentation of cholesteatoma

+ management

Answer 8

Unilateral hearing loss + chronic d/c. No pain/ fever

Advanced - tinnitus/ vertigo/ facial n palsy

Rx: surgical removal + any surrounding destructed tissue

Question 9

Define acoustic neuroma

Answer 9

Benign slow growing tumour of schwann cells on vestibular nerve - local SOL

Question 10

Disease assoc with acoustic neuroma

Answer 10

neurofibromatosis 2 (if bilateral)

Question 11

acoustic neuroma presentation/

inv

rx

Answer 11

hearing loss/ tinnitus/ vertigo - gradual and progressive

CN 5-7 palsy, raised ICP

Inv: MRI + gadolinium contrast

Rx: surgery/ radiotherapy

Question 12

What is Ramsay Hunt syndrome

Answer 12

Herpes zoster

Question 13

Why does submandibular gland have higher rate of stones than parotid?

Answer 13

Secretions are more mucous with increased conc of calcium and phosphate

Also due to anatomy of duct > stasis

Question 14

How do parotid + submandibular stones differ

what % are radio-opaque

Answer 14

Parotid - multiple, within gland (60%)

Submandibular - multiple smaller, intraductal (80-90%)

Question 15

Main component of salivary gland stones

Answer 15

Calcium phosphate + hydroxyapetite

Saliva high in calcium+ slow flow - predisposed

Question 16

Causes of bilateral parotid swelling

Answer 16

Infections: Mumps, HIV,TB

Inflam: sarcoid, Sjogren’s

Local: stones, neoplasia

Drugs: OCP, thiouralcil

Other: Cushing’s, bulimia, diabetes, gout, ALD