ENT

Question 1

Menniere’s disease features

Answer 1

recurrent episodes of vertigo,
tinnitus,
hearing loss (sensorineural)
aural fullness or pressure
nystagmous
romberg test
episodes: minutes to hours
symptoms are unilateral but bilateral may develop after years

Question 2

prognosis of symptoms in menieres disease

Answer 2

resolve after 5-10 years for majority of patients

Question 3

medication fo management of acute attacks of menieres disease

Answer 3

buccal or iM prochloperazine
admission may be required

Question 4

management of menieres disease

Answer 4

ENT assessment required to confirm diagnosis

Question 5

what is osteomyelitis

Answer 5

infection of the bone

Question 6

what are the two main classifications of osteomyelitis

Answer 6

haematogenous osteomyelitis

non haematogenous osteomyelitis

Question 7

which for of osteomyelitis is most common in adults and which in children

Answer 7

children: haematogenous
adults: non haematogenous

Question 8

what does haematogenous osteomyelitis result from and give some risk factors

Answer 8

bacteraemia

sickle cell anaemia, intravenous drug user, immunosuppression due to either medication or HIV, infective endocarditis

Question 9

which type of osteomyelitis tends to be monomicrobial vs which is polymicrobial

Answer 9

monomicrobial: haematogenous
polymicrobial: non haematogenous

Question 10

what does non haematogenous osteomyelitis result from and give some risk factors

Answer 10

results from the contiguous spread of infection from adjacent soft tissues to the bone or from direct injury/trauma to bone

risk factors include: diabetic foot ulcers/pressure sores, diabetes mellitus, peripheral arterial disease

Question 11

most common causative organism of osteomyelitis in general population

Answer 11

s aureus

Question 12

most common causative organisme in osteomyelitis patients with sickle cell anaemia

Answer 12

salmonella species

Question 13

investigations for soteomyelitis

Answer 13

MRI with 90-100% sensitivity

Question 14

management of osteomyelitis

Answer 14

flucloxacillin for 6 weeks
clindamycin if penicillin-allergic

Question 15

what is infective endocarditis

Answer 15

a microbial infection of the endocardial surface of the heart, most commonly affecting heart valves.

Question 16

infective endocarditis single strongest risk factor

Answer 16

previous episode of endocarditis

Question 17

what are the patient types that get infective endocarditis

Answer 17

with previously normal valves ( 50%) typically acute presentation

rheumatic valve disease 30%

prosthetic valves

congenital heart defects

IV drug users

( - recent piercings )

Question 18

most common valve affected in infective endocarditis

Answer 18

mitral

Question 19

most common valve affected in infective endocarditis in IV drug users

Answer 19

tricuspid valve

Question 20

most common causative organism of infective endocarditis in everyone

Answer 20

Staphylococcus aureus
particularly common in acute presentation and IVDUs

Question 21

most common causative org of infective endo in developing countries

Answer 21

strep viridans

Question 22

most common causative org of infective endo IN THE TWO MONTHS following prosthetic valve surgery, usually the result of perioperative contamination.

Answer 22

staph epidermis

Question 23

most common causative org of infective endo in colorectal cancer

Answer 23

Streptococcus bovis ( think bovis: bowel)

Question 24

some causes of NON infective endocarditis

Answer 24

SLE and malignancy

Question 25

culture negative causes of infective endocarditis

Answer 25

prior antibiotic therapy Coxiella burnetii Bartonella Brucella HACEK: Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella)

Question 26

what tool is used for the diagnosis of infective endocarditis

Answer 26

dukes criteria

Question 27

what combination of criteria need to be present for diagnosis of infective endo

Answer 27

pathological criteria positive, or 2 major criteria, or 1 major and 3 minor criteria, or 5 minor criteria

Question 28

what are pathological criteria in dukes criteria

Answer 28

Positive histology or microbiology of pathological material obtained at autopsy or cardiac surgery (valve tissue, vegetations, embolic fragments or intracardiac abscess content)

Question 29

major criteria dukes criteria

Answer 29

Positive blood cultures two positive blood cultures showing typical organisms consistent with infective endocarditis, such as Streptococcus viridans and the HACEK group, or persistent bacteraemia from two blood cultures taken > 12 hours apart or three or more positive blood cultures where the pathogen is less specific such as Staph aureus and Staph epidermidis, or positive serology for Coxiella burnetii, Bartonella species or Chlamydia psittaci, or positive molecular assays for specific gene targets Evidence of endocardial involvement positive echocardiogram (oscillating structures, abscess formation, new valvular regurgitation or dehiscence of prosthetic valves), or new valvular regurgitation

Question 30

minor criteria dukes criteria

Answer 30

Minor criteria predisposing heart condition or intravenous drug use microbiological evidence does not meet major criteria fever > 38ºC vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, Janeway lesions, petechiae or purpura immunological phenomena: glomerulonephritis, Osler's nodes, Roth spots

Question 31

poor prognostic factors for endocarditis

Answer 31

Staphylococcus aureus infection (see below) prosthetic valve (especially 'early', acquired during surgery) culture negative endocarditis low complement levels

Question 32

which bacterial class causing infective endocarditis have the highest mortality

Answer 32

staphylococci 30%

Question 33

Initial blind therapy infective endo in native valve and if pen allergic and mrsa or sepsis

Answer 33

Native valve amoxicillin, consider adding low-dose gentamicin If penicillin allergic, MRSA or severe sepsis vancomycin + low-dose gentamicin

Question 34

Initial blind therapy infective endo in prosthetic valve

Answer 34

vancomycin + rifampicin + low-dose gentamicin

Question 35

Native valve endocarditis caused by staphylococci treatment

Answer 35

Flucloxacillin If penicillin allergic or MRSA vancomycin + rifampicin

Question 36

antibiotic for Prosthetic valve endocarditis caused by staphylococci

Answer 36

Flucloxacillin + rifampicin + low-dose gentamicin If penicillin allergic or MRSA vancomycin + rifampicin + low-dose gentamicin

Question 37

Endocarditis caused by fully-sensitive streptococci (e.g. viridans) antibiotic

Answer 37

Benzylpenicillin If penicillin allergic vancomycin + low-dose gentamicin

Question 38

Endocarditis caused by less sensitive streptococci

Answer 38

Benzylpenicillin + low-dose gentamicin If penicillin allergic vancomycin + low-dose gentamicin

Question 39

indications for surgery in infective endo

Answer 39

severe valvular incompetence aortic abscess (often indicated by a lengthening PR interval) infections resistant to antibiotics/fungal infections cardiac failure refractory to standard medical treatment recurrent emboli after antibiotic therapy

Question 40

definition of rhinosinusitis

Answer 40

inflammation of the nose and paranasal sinuses. The diagnosis requires the presence of at least two symptoms, ONE of which must be either nasal blockage/obstruction/congestion or nasal discharge (anterior/posterior nasal drip).

Question 41

CAUSES OF rhinosinusitis

Answer 41

Viral, bacterial, or fungal infections, allergies, auto-immune reactions, and deviations or obstructions of the nasal septum can cause rhinosinusitis.

Question 42

presentation of rhinosinusitis

Answer 42

Nasal blockage/obstruction/congestion Nasal discharge Facial pain or heaviness Reduced olfaction Other symptoms may include headache, ear pain, sore throat, and cough.

Question 43

potential investigations in rhinosinusitis

Answer 43

Cultures: Can be useful when bacterial sinusitis is suspected and previous treatments have failed. Computed tomography (CT): Provides detailed images of the sinuses and can reveal evidence of sinus inflammation or obstruction. Nasal endoscopy: Allows for the visual examination of the internal nasal passages and the sinus openings.

Question 44

conservative management of rhinosinusitis

Answer 44

Conservative measures: These include nasal saline irrigation, analgesics for pain, and intranasal corticosteroids.

Question 45

second step rhinosinusitis management

Answer 45

High-dose nasal corticosteroids: If symptoms persist for more than 10 days, a 14-day course of high-dose nasal corticosteroids may be considered.

Question 46

management of severe rhinosinusitis

Answer 46

antibiotics reserved for severe or persistent cases guided by culture results