Passmedicine Flashcards
(41 cards)
A 36-year-old man presents with recurrent episodes of right-sided tinnitus, hearing loss and vertigo. These episodes typically last between 10-30 minutes. He also describes a ‘full’ sensation in his right ear. Otoscopy is unremarkable and the cranial nerve examination is normal.
Meniere’s disease
A 31-year-old man presents with bilateral hearing loss and tinnitus. There is a family history of similar problems. Examination of the tympanic membranes is unremarkable. Audiometry shows bilateral conductive hearing loss.
Otosclerosis
A 2-year-old boy is brought in by his mother due to concerns about his hearing and delayed speech. She has noticed problems for the past three months. You can see from the notes that he has had frequent courses of amoxicillin for otitis media in the past. There is no evidence of excessive ear wax on examination.
Glue ear
A 25 year-old lady with no significant past medical history presents with 2 days of right ear discomfort, discharge and reduced hearing. She is systemically well and has not had a recent cold. On examination the auditory canal appears inflamed and there is a small amount of debris, but you can still see the tympanic membrane. What is the best management from the options below?
Start a combination topical antibiotic and steroid
How is mild otitis externa defined?
Mild discomfort and/or pruritus
No deafness or discharge
How is mild otitis externa treated?
Topical acetic acid 2% spray.
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
(herpes zoster oticus - Reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve)
A 51-year-old female with a 3 week history of vertigo, right ear tinnitus and the sensation of fullness in her right ear
Meniere’s disease
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?
Ramsay Hunt syndrome
purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham’s striae over surface. Oral involvement common
Lichen planus
A 75-year-old man presents with dysphagia and halitosis. On the left side of the neck is a small, fluctuant swelling which gurgles when palpated.
Pharyngeal pouch
A newborn baby is noted to have a large swelling on the left-side of the neck. On examination a soft, fluctuant and highly transilluminable lump is noted just beneath the skin.
Cystic hygroma
You review a 23-year-old woman who presents with a three week history of bilateral nasal obstruction, cough at night and a clear nasal discharge. She had similar symptoms around this time last year and the only history of note is asthma. What is the most likely diagnosis?
Allergic rhinitis
A 3-year-old boy is brought to surgery. His mum reports that he has been complaining of a sore left ear for the past 2-3 weeks. This morning she noticed some ‘green gunge’ on his pillow. On examination his temperature is 37.8ºC. Otoscopy of the right ear is normal. On the left side the tympanic membrane cannot be visualised as the ear canal is full with a yellow-green discharge. What is the most appropriate action?
Amoxicillin and 2-week review
A 62-year-old man with a 3 month history of dizziness when he rolls over in bed. Episodes last for about 20 seconds
BPPV
A 51-year-old female with a 3 week history of vertigo, right ear tinnitus and the sensation of fullness in her right ear
Meniere’s disease
A 37-year-old man presents with nasal obstruction and loud snoring. He has noticed these symptoms get gradually worse for the past two months. His left nostril feels blocked whilst his right feels clear and normal. There is no history of epistaxis and he is systemically well. On examination a large nasal polyp can be seen in the left nostril. What is the most appropriate action?
Refer to ENT (since unilateral)
Which one of the following is least recognised in patients with Meniere’s disease:
- Aural fullness
- Symptoms triggered by sudden change in head position
- Sensorineural hearing loss
- Tinnitus
- Nystagmus
Symptoms triggered by sudden change in head position
A 20-year-old girl presents with a thyroid cancer, she is otherwise well with no significant family history. On examination she has a nodule in the left lobe of the thyroid with a small discrete mass separate from the gland itself. Which of the following is the most likely cause?
Papillary
A 21-year-old man presents with halitosis and mouth pain. Examination reveals very poor dental hygiene with bleeding gums and widespread gingival ulceration. He has a temperature of 38.0ºC. You advise him to see a dentist. What other treatment options should be offered?
Paracetamol + oral metronidazole + chlorhexidine mouthwash
A 45-year-old man presents with dizziness and right-sided hearing loss. Which one of the following tests would most likely indicate an acoustic neuroma?
- Jerky nystagmus
- Left homonymous hemianopia
- Tongue deviated to the left
- Fasciculation of the tongue
- Absent corneal reflex
Absent corneal reflex
What drugs can cause tinnitus?
Aspirin
Aminoglycosides (eg. Gentamicin)
Loop diuretics
Quinine
A 71-year-old man presents with two year history of intermittent problems with swallowing. His wife has also noticed he has halitosis and is coughing at night. He has a past medical history of type 2 diabetes mellitus but states he is otherwise well. Of note his weight is stable and he has a good appetite. Clinical examination is unremarkable. What is the most likely diagnosis?
Pharyngeal pouch
What drugs can cause deafness?
Aminoglycosides (e.g. Gentamicin)
Furosemide
Aspirin
Cytotoxic agents
