Otitis Media and Externa

Acute & Chronic Otitis Media

• Middle ear infection usually follows an upper respiratory tract infection (URTI)
• Common in young children
• Daycare attendance and smoking exposure are risk factors
• Cleft palate increases the chance of infection
• Otitis externa, mastoiditis, cholesteatoma, and eustachian tube dysfunction are differentials
• Can be viral, such as RSV, rhinovirus, or influenza
• Can be bacterial such as, Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis
• Presents with ear pain, fever, conductive hearing loss, and a bulging tympanic membrane
• Clinical diagnosis involves otoscopy showing a red, bulging tympanic membrane
• Supportive care and amoxicillin are treatments for bacterial infections
• Chronic cases require ENT referral for tympanostomy tubes

Otitis Externa

• Inflammation of the external ear canal, also known as swimmer's ear
• Common in swimmers
• Trauma from Q-tips or hearing aids can lead to infection
• Risk factors include diabetes and eczema
• Otitis media, mastoiditis, and fungal otitis externa should be considered as alternative possibilities
• Caused by bacteria, such as Pseudomonas aeruginosa, Staphylococcus aureus
• Can also be caused by fungi like Candida and Aspergillus, with black debris visible in the canal
• Ear pain, itching, discharge, and tenderness of the tragus are clinical signs
• Diagnosis involves a clinical examination and possibly a swab if severe
• Topical antibiotics like ciprofloxacin/hydrocortisone drops are used, and keeping the ear dry is important

Cerumen Impaction

• Earwax accumulation leading to conductive hearing loss
• Overuse of cotton buds is a risk factor
• Hearing aids and narrow ear canals can increase occurrences
• Otitis externa, foreign bodies, and otosclerosis must be ruled out
• Can occur due to excessive earwax production or issues with natural clearance
• Presents with hearing loss, ear fullness, and tinnitus
• Otoscopy shows a visible blockage of wax
• First-line is ear drops, such as olive oil or sodium bicarbonate
• Ear irrigation or microsuction are second-line treatments if needed

Labyrinthitis

• Inner ear infection causing vertigo, nausea, and hearing loss
• Recent viral infections and autoimmune diseases increase chances
• Vestibular neuronitis, BPPV, and Ménière's disease are differentials
• Viral infections are most common caused by post-URTI, HSV, or CMV
• Bacterial infections are rare and spread from Otitis media
• Symptoms include vertigo, hearing loss, tinnitus, nausea, and horizontal nystagmus
• Clinical diagnosis, with MRI if atypical
• Viral infections are managed via symptomatically with prochlorperazine and vestibular rehabilitation
• Bacterial infections are treated with IV antibiotics

Ménière's Disease

• Episodic inner ear disorder causing vertigo, hearing loss, and tinnitus
• Family history, autoimmune disorders, and migraines are risk factors
• BPPV, vestibular neuronitis, and acoustic neuroma are among differentials
• Increased endolymphatic fluid pressure (endolymphatic hydrops) is the cause
• Episodic vertigo, sensorineural hearing loss and tinnitus, and aural fullness characterizes presentation
• Audiometry detects sensorineural hearing loss
• MRI rules out acoustic neuroma
• Acute treatment includes prochlorperazine and vestibular sedatives
• Long-term management involves a low-salt diet, diuretics, and vestibular rehabilitation

Acute & Chronic Sinusitis

• Inflammation of the paranasal sinuses due to infection or allergy
• Risk factors include URTI, smoking, nasal polyps, and allergies
• Differentiated from allergic rhinitis, nasal polyps, and migraines
• Viral infections caused by rhinovirus, influenza, and coronavirus are most common
• Bacterial infections are caused by Streptococcus pneumoniae and Haemophilus influenzae
• Diagnosed after >10 days
• Facial pain, purulent nasal discharge, congestion, and headache are symptoms
• Clinical evaluation is done, with CT if recurrent or severe
• Symptomatic treatment for viral infections includes nasal saline and analgesics
• Bacterial infections treated with amoxicillin-clavulanate

Epistaxis

• Bleeding from the nasal mucosa, commonly from Kiesselbach's plexus
• Risk factors include trauma, dry air, anticoagulants, and hypertension
• Nasal polyps, bleeding disorders, and malignancy are of consideration
• Caused by trauma, mucosal dryness, and coagulopathy
• Presents with unilateral nasal bleeding and recurrent episodes
• Clinical examination is used for diagnosis
• International Normalized Ratio (INR) is tested if on anticoagulants
• Pinching the nose, leaning forward, and nasal packing are management techniques

Oral Thrush (Candidiasis)

• Fungal infection of the oral mucosa caused by Candida albicans
• Immunosuppression, diabetes, and antibiotic use can be contributing factors
• Leukoplakia and aphthous ulcers are differential diagnoses
• Overgrowth of normal oral flora due to impaired immunity
• White plaques that scrape off, are clinical characteristics
• Leaves erythema
• Clinical examination and oral swabs are diagnostic tools
• Nystatin oral suspension is prescribed, and fluconazole is used if severe

Glossitis & Gingivitis

• Glossitis is inflammation of the tongue
• Gingivitis is inflammation of the gums
• Poor oral hygiene is a risk factor
• Vitamin B12/iron deficiency and smoking also pose concerns
• Oral thrush, lichen planus, and herpes stomatitis are included on list of differential diagnoses
• Nutritional deficiencies, infections, and allergies lead to Glossitis
• Gingivitis is caused by plaque build-up and bacterial infection
• Glossitis presents with a red, swollen, smooth tongue
• Gingivitis includes bleeding gums, erythema, and swelling
• Clinical examination and checking vitamin B12 levels are needed
• Treatment involves improved oral hygiene, chlorhexidine mouthwash, and treating nutritional deficiencies

Bursitis

• Inflammation of the bursa, a fluid-filled sac reducing friction in joints
• Repetitive motion, trauma, infection, rheumatoid arthritis (RA) are contributing elements
• Tendinopathy, arthritis, gout, and septic bursitis are alternative diagnoses
• Traumatic: Overuse (kneeling = prepatellar bursitis)
• Infectious: Staphylococcus aureus
• Localized swelling, warmth, tenderness, and reduced movement are signs
• Clinical diagnosis is based on aspirating fluid for suspected septic bursitis, noting WBC and gram stain

Frozen Shoulder (Adhesive Capsulitis)

• Progressive loss of shoulder movement due to joint capsule fibrosis
• Diabetes and immobilization (stroke, post-surgery)
• Rotator cuff tear, osteoarthritis, and impingement syndrome are differential diagnoses
• Inflammatory response leads to capsular thickening and fibrosis
• Symptoms include painful stiffness and loss of active & passive movement
• Clinical examination and MRI are appropriate diagnostics to rule out other causes
• Physiotherapy, NSAIDs, steroid injections, and surgical release are appropriate treatments if severe

Rotator Cuff Injury

• Tear or inflammation of rotator cuff muscles, with supraspinatus most commonly affected
• Repetitive overhead activity, trauma, and aging are risk factors
• Frozen shoulder, bursitis, and shoulder impingement considerations
• Acute: Trauma (fall, heavy lifting)
• Chronic: Degeneration, repetitive strain
• A painful arc (60-120° abduction), weakness, and night pain characterize this injury
• MRI shoulder is the gold standard for diagnosis
• Physiotherapy, NSAIDs, steroid injections, and surgical repair may be used in complete tears

Carpal Tunnel Syndrome

• Median nerve compression at the wrist
• Pregnancy, diabetes, hypothyroidism, and repetitive wrist use are causes
• Differential diagnoses include ulnar neuropathy, cervical radiculopathy, and arthritis
• Swelling of flexor tendons compressing the median nerve is the cause
• Paresthesia in thumb, index, and middle fingers, weak grip, positive Tinel's & Phalen's tests are symptoms
• Diagnosed via nerve conduction studies and ultrasound
• Treated with wrist splinting, NSAIDs, steroid injections, and surgery if severe

Sciatica

• Radicular pain from lumbar nerve root compression (L4-S1)
• Disc herniation, spinal stenosis, and pregnancy are the cause
• Hip arthritis and sacroiliac joint dysfunction are differentials to consider
• Herniated disc, spinal stenosis, and spondylolisthesis are potential underlying processes
• Sharp, shooting leg pain and a positive straight leg raise (SLR) test are important key symptoms
• MRI of the lumbar spine serves as the gold standard for diagnosis
• Treatment includes NSAIDs, physiotherapy, epidural steroids, and surgery if severe

Osteoarthritis (OA)

• Degenerative joint disease due to cartilage breakdown
• Aging, obesity, and joint trauma are risk factors
• Rheumatoid arthritis, gout, and septic arthritis are factors to consider
• Wear & tear leads to cartilage erosion, osteophytes, and pain
• Symptoms worsens with activity, characterized with stiffness, crepitus, and bony swelling
• Diagnosed via X-ray to capture joint space narrowing and osteophytes
• Weight loss, NSAIDs, steroid injections, and joint replacement if severe are management options

Rheumatoid Arthritis (RA)

• Autoimmune inflammatory arthritis affecting small joints symmetrically
• Female sex, smoking, and HLA-DR4 gene predispositions
• Differentials to consider are OA, psoriatic arthritis, and lupus
• Chronic synovial inflammation leads to pannus formation and joint damage
• Characterized by morning stiffness lasting >1 hour
• Symmetrical features consist of polyarthritis (PIP, MCP joints)
• Ulnar deviation and swan-neck deformity can occur
• Tests should include RF, anti-CCP, and X-ray for joint erosions
• DMARDs like methotrexate and hydroxychloroquine are prescribed
• For flares use NSAIDs and steroids

Gout

• Inflammatory arthritis due to uric acid crystal deposition
• Male sex, alcohol, red meat consumption, and diuretics are risk factors
• Pseudogout, septic arthritis, and cellulitis are differentials when considering
• Hyperuricemia leads to monosodium urate crystal deposition
• Symptoms consist of severe joint pain (1st MTP joint - podagra), erythema, swelling
• Synovial fluid tests should include joint aspiration, which is negatively birefringent urate crystals
• Serum uric acid is also indicated
• Acute treatment consists of NSAIDs, colchicine, and steroids if severe
• Long-term management includes allopurinol and lifestyle changes

Septic Arthritis

• Infection of a joint, often bacterial
• Risk factors consist of prosthetic joints, diabetes, and immunosuppression
• Differentials should include gout, pseudogout, and reactive arthritis
• Most commonly caused by S. aureus, as well as Streptococcus and Neisseria gonorrhoeae
• The symptomatic profile is comprised of a hot, swollen, painful joint, systemic symptons, and a fever
• Diagnosis involves joint aspiration (WCC >50,000), blood cultures
• Managed with IV antibiotics and joint drainage

Fractures (Types & Management)

• Disruption in bone continuity due to trauma or disease
• Greenstick: Partial fracture, most common in children
  • Transverse: Straight across the bone
  • Spiral: Twisting force
  • Oblique: Diagonal fracture
  • Compression: Bone crushed, common in vertebrae
  • Comminuted: Bone breaks into multiple pieces
  • Open (compound): Bone pierces skin
• Risk factors include trauma, osteoporosis, and falls
• Clinical diagnoses involve pain, swelling, deformity, loss of function
• Investigations involve X-ray, CT/MRI if needed Non-surgical includes casting and splinting if stable Surgical can include ORIF for displaced fractures

Cranial Nerves

• The 12 paired cranial nerves (CN I-XII) control sensory and motor functions of the head, neck, and some thoracic organs
• Risk factors include trauma, stroke, MS, neurodegenerative diseases
• Brainstem stroke, multiple sclerosis, Guillain-Barré syndrome, myasthenia gravis are of mention
• The root cause can be congenital, traumatic, neoplastic, inflammatory, or vascular in nature
• CN I (Olfactory): Loss of smell (anosmia)
  • CN II (Optic): Visual field defects (hemianopia)
  • CN III, IV, VI (Oculomotor, Trochlear, Abducens): Diplopia, ptosis, pupil abnormalities
  • CN V (Trigeminal): Facial numbness, jaw weakness
  • CN VII (Facial): Facial paralysis (Bell's palsy)
  • CN VIII (Vestibulocochlear): Hearing loss, vertigo
  • CN IX, X (Glossopharyngeal, Vagus): Dysphagia, hoarseness
  • CN XI (Accessory): Weak shoulder shrug (trapezius)
  • CN XII (Hypoglossal): Tongue deviation
• Diagnosis includes clinical exam and MRI brain if pathology is suspected
• Management involves treating the underlying cause

Types of Seizures

• Uncontrolled electrical activity in the brain causing abnormal movements, sensations, or consciousness changes
• Risk factors include epilepsy, stroke, brain tumor, head injury, infection
• Syncope, migraine, psychogenic seizures, metabolic disturbances are differential diagnosis
• Focal seizures: Localized cortical disruption
• Generalized seizures: Widespread cortical involvement For seizures that are Focal, patients retain awareness Generalized seizures are those that cause a loss of consciousness, tonic-clonic movements
• Diagnosis involves EEG, MRI, and blood testing
• Acute: Benzodiazepines (lorazepam for status epilepticus)
• Chronic: Anti-epileptics

Stroke (Haemorrhagic & Ischaemic)

• Sudden loss of neurological function due to vascular occlusion or bleeding
• Risk factors include hypertension, atrial fibrillation, diabetes, smoking
• TIA, migraine, brain tumor, hypoglycemia are differentials
• Ischaemic strokes arise from Thrombotic causes
• Haemorraghic strokes have Hypertension and aneurysm rupture as the cause
• Key features are those of the FAST profile
• Investigations involve CT, MRI, carotid Doppler, and ECG
• Ischaemic strikes need Thrombolysis or aspirin

TIA (Transient Ischaemic Attack)

• Temporary stroke-like symptoms that resolve within 24 hours
• Risk Factors are those found in a stroke
• Differential diagnoses may include migraine, seizures, syncope
• Characterized as a temporary blockage of cerebral blood flow
• Presents in the FAST model
• Investigations include carotid Doppler, ECG, MRI, bloods
• Management focuses on changes to lifestyle in conjunction with Statins and Aspirin

Raised Intracranial Pressure (ICP)

• Increased pressure inside the skull, leading to brain dysfunction
• Risk factors include tumors, head trauma, hydrocephalus, stroke
• Differentiated from brain tumors, meningitis, cerebral edema
• Obstructive issues are Tumors, hydrocephalus
• Non-obstructive causes can be trauma, infections, cerebral edema
• Often presents as a headache
• Other features include vomiting and papilledema
• Testing consistes of CT/MRI brain, fundoscopy for papilledema, LP if safe
• During acute episodes, elevate the head, using mannitol
• Hyperventilation, and surgical decompression also viable

Parkinson's Disease

• Progressive neurodegenerative disorder due to dopamine depletion in substantia nigra
• The older population is affected at greater rates
• Differentials should include essential tremor and Lewy body dementia
• Loss of dopaminergic neurons in the substantia nigra causes the disease
• Characterized by Bradykinesia with resting tremor, rigidity, postural instability
• Diagnosis made through examination
• Management can be conducted by using medicine to deal with carbidopa to replenish dopamine
• Non-medical practices include therapy and speech

Guillain-Barré Syndrome (GBS)

• An immune-mediated demyelinating polyneuropathy affecting peripheral nerves
• Recent infections and vaccinations increase your potential
• Differentiated from Myasthenia Gravis or transverse myelitis stroke
• Autoimmune attack on schwann cells lead to demyelination of peripheral nevers
• Can trigger ascending weakness, areflexia, autonomic dysfunction for key clinical presentations
• Testing needs LP, nerve conduction studies
• Treatment involves immunoglobulin and supportive care