Most common cause of conductive hearing loss in childhood is: GLUE EAR/ OTTITIS MEDIA WITH

EFFUSION. Bluish grey retracted or bulging tympanic membrane, ear pain is rare, parental
smoking is a R/F, audiogram show conductive hearing loss, reassure and review after 3 months,
surgery grommet insertion, hearing aids

ACUTE OTTITIS MEDIA: usually preceding viral URTI, red, erythematous or cloudy bulging
tympanic membrane, absence of cone reflex or light reflex not visible rapid onset of ear pain,
fever, bacterial [s.oneumonia] or viral [conservative treatment, PCM, analgesics] , Amoxicillin 5
days course. erythro or clarithromycin.

Malignant otitis externa: in diabetes or immunocompromised patients, severe ear pain,

headaches, conductive hearing loss, foul smelling discharge, cranial nerve involvement [7,1 CN],
IV antibiotics. Acute otitis externa: itch first then ear pain, discharge, bacterial, hearing
diminished, topical gentamycin + hydrocortisone, oral flucloxacillin if infection spreading.

Tonsillar CA: SCC [70%] Lymphomas, smoking, plummer vinson syndrome [R/F]

Laryngeal CA: last resort: chemoradiation + larynx preservation, cordectomy, initial advice s/b to
avoid smoking [major R/F], HPV 16

NASOPHARYNGEAL CA; EBV, smoking & Alcohol [R/F], SCC

Lipoma: soft, mobile, round and painless mass within dermal layer of the skin. Epidermoid cyst:
firm, round nodules of various sizes with a central punctum, cutaneous cyst results from
proliferation of epidermal cells within a circumscribed pace of dermis. Cystic hygroma:
transilluminates. Branchial cleft cyst: do not transilluminate

Conductive hearing loss Sensorineural hearing loss

Glue ear/OTTITIS MEDIA WITH EFFUSION Labyrinthitis viral

[childhood], chronic otitis media
Malignant otitis externa Presbycusis [age-related] progressive bilateral
high frequency hearing loss
Cholesteatoma [progressive deafness] Meniere’s d/s low frequency hearing loss
Otosclerosis [progressive] flamingo tinge TM Vestibular schwannoma high frequency
due to hyperemia hearing loss [acoustic neuroma] MRI
Noise induced hearing loss high frequency
hearing los

Stensens duct drains the parotid gland. Whartons duct drains the submandibular glands. Stones
are common in submandibular glands.
Parotid gland: most tumors; submandibular gland: most stones

Viral sinusitis: no fever and clear nasal discharge. Bacterial sinusitis: fever present and nasal
discharge can be colored

Allergic rhinitis: for mild to moderate cases oral or intra-nasal antihistamines can be used; for
moderate to severe cases intranasal corticosteroids can be used. Topical decongestants should
not be used for more than a week as they may cause rebound congestion [rhinitis
medicamentosa] on withdrawal, also tachyphylaxis.

Nasal polyps: if small and bilateral not causing severe nasal obstruction managed with saline
nasal douche and intranasal steroids. If unilateral, large polyps causing obstruction or bleeding
present refer to ENT or nasal endoscopy.

Abscess will usually present with fever and general malaise.

Pure tone audiometry or MRI: to investigate Sensorineural type of hearing loss

Otoscopy for examination of external auditory canal, tympanic membrane, and the middle ear.

CT scan FOR HEAD INJURIES AND CSF RHINORRHEA

Auditory brainstem response (ABR) is a test that can help to identify

neural or brainstem abnormalities in the auditory pathway, such as an
acoustic neuroma. However, it is not the first-line test for a simple
sensorineural hearing loss and would not typically be used unless
there was a concern for a central cause of the patient's hearing loss.

Pure-tone audiometry is the initial test of choice for assessing

sensorineural hearing loss. It is a subjective test that measures the
softest sound an individual can hear at various frequencies. This test
provides an audiogram, which is a graphical representation of the
auditory threshold as a function of frequency. The test can distinguish
between conductive and sensorineural hearing loss and can quantify
the degree of hearing loss. This test is preferred over other options
because it directly assesses the patient's perception of sound across
a range of frequencies and can differentiate between types of hearing
loss.

Tympanometry is typically used to assess the function of the middle

ear, looking for evidence of fluid, wax, or perforation of the tympanic
membrane that might be causing conductive hearing loss, which does
not fit with this patient's presentation.

Otoacoustic emissions (OAE) are sounds produced by the inner ear

that can be measured with a sensitive microphone placed in the ear
canal. This test can provide objective evidence of damage to the
cochlea, particularly to the outer hair cells, but does not directly
assess a patient's hearing.
DERMATOLOGY

Actinic keratoses: pre malignant skin lesion that develops as a result of chronic sun
exposure. Small, crusty or scaly lesions (different colored) on sun exposed areas like
temples of the head feet hands ear etc. fluorouraxcil cream/ topical diclofenac/ topical
imiquimod.

Impetigo: S.aureus or streptococcus pyogenes. Common in children. Golden crusted skin

lesions around the mouth mostly, face, limbs, flexures. Topical antibiotic (limited
disease) fusidic acid 2% or Mupirocin 2%. Hypdrogen peroxide 1% cream. Oral
antibiotics (extensive disease): fluoxacillin or clarithromycin or erythromycin. Non
bullous: golden crusted plaques. (2cm or less) bullous: have thin roof and tend to rupture
spontaneously.

Acanthosis nigricans: GI cancer, PCOD, DM, obesity, cushing’s disease, familial, prader
willi syndrome, acromegaly, OCP, nicotine acid.

Milia: small benign keratin filled cysts seen usually around the face, common in
newborns, white papules.

Keratoacanthoma: benign epithelial tumour, seen in advancing age, smooth dome shaped
papule at first then grows as a volcano/crater centrally filled with keratin. S/B surgically
excised as it is difficult to exclude SCC.

Pityriasis versicolor: malassezia furfur, superficial cutaneous fungal infection, affects the
trunk, patches are hypopigmented/ depigmented, pink/brown, scaly, itchy notes after
suntan. Topical antifungal: ketoconazole or oral itraconazole.

Herpes zoster/ shingles: reactivation of varicella zoster virus, acute painful blistering
rash, unilateral, oral acyclovir, NSALD’s for pain. To decrease incidence of post-herpetic
neuralgia.

Dermal melanosis: mongolian blue spot, seen at base of back and on buttocks.
Bullous pemphigoid: no mucosal involvement, autoimmune condition causing sub-
epidermal blistering of the skin. Elder patients, antibodies against hemidesmosomal
proteins BP180 & 230. Itchy, tense blisters, around flexures, no scaring, mouth spared
(involved in pemphigus), refer to dermatologist for skin biopsy immunofluroscence
shows IgG and C3 at derma-epidermal junction) and confirming diagnosis, Oral
corticosteroid, topical steroids, immunosuppressants, AB’s.

Athlete’s foot: tinea pedis, scaling, flaking, itching seen between the toes. Topical
imidazole, undecenoate, terbinafine, miconazole.

Erythema multiforme: hypersensitivity reaction and is most commonly triggered by

infections, minor and major forms (mucosal involvement), target lesions- seen on the
back of the hands and feet before spreading to the torso, upper limbs more common,
pruritus. HSV (m/c/c), idiopathic, mycoplasma, streptococcus, SLE, sarcoidosis,
malignancy, Drugs: allopurinol, penicillin, sulphonamides, carbamazepine, NSAID,
OCP, nevirapine.

Erythema herpeticum: severe primary skin infection by the herpes simplex virus 1 or 2,
common in children with stupid eczema, asthma, itchy painful blisters or rashes on the
face, torso, arms and legs, systemic upset: fever, flu-like symptoms, feeling extremely
unwell, life-threatening condition so admission and IV acyclovir.

Erythema ab igne: skin disorder caused by overexposure to infrared radiation (heaters/

open fire) reticulated, erythematous patches with hyperpigmentation, telangiectasia. Elder
people, etiology treated as it can develop to SCC.

Lanugo hair: fine, soft, unpigmented [malnutrition, newborns, anorexia nervosa]. Thick
dark hair seen on certain areas of the body like face [hirsutism]

Type 4 hypersensitivity reaction: allergic contact dermatitis, scabies [pruritis d/t delayed
Type 4 reaction

Basal cell papilloma: seborrhoeic keratosis

Lichen planus: P- pruritic, purple, papules, polygonal

Kobner phenomenon: trauma precipitating new lesions. Lichen planus, psoriasis [auspitz
sign], vitiligo

Toxic epidermal necrolysis is a life-threatening skin disorder

characterized by a blistering and peeling of the skin. This disorder can
be caused by a drug reaction—often antibiotics or anticonvulsives.
Sebaceous cyst complication is cocks peculiar tumour. Have a
punctum [centrally may be]

Molluscum contagiousum: central umbilication

Burns: curlings ulcers

Self-limiting conditons: Molluscum contagiousum [resolves in 18

months], erythema nodusum [6 weeks], pityriasis rosea [4-12 weeks/6
weeks], Guttate psoriasis [resolves in 2-3 months] [tear drop lesions]

Herald patch, fir tree appearance: pityriasis rosea

OBSTETRICS

Term: 37 week or more

Post-term pregnancy: extended to or beyond 42 weeks

Oligohydramnios: <500 ml at 32-36 weeks and AFI<5th percentile

Group b streococcus: benzylpenicillin

Chorioamnionitis: gentamycin + metronidazole

Puerperal pyrexia: endometritis clindamycin and gentamycin

Endometritis: co-amoxiclav

Mastits: S.aureus, flucloxacillin

Pre-eclampsia [BP>140/90 OR >30 SBP OR >15 DBP FROM NORMAL: labetalol 1st
line, nifedipine if patient is asthmatic, [nifedipine or methyldopa], MgSO4 eclampsia.
Severe pre-ecclampsia start treatment if BP>/= 160/110, target sbp<150 dbp 80-100

Uterine inversion: ABCDE approach, johnson maneuver, O sullivan’s

Rubella varicella : immunization after delivery. Varicella IG can be given if non immune.

Glibenclimide and metformin safe