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ENT Flashcards

1
Q

Viral Tonsillitis and Pharyngitis Causes

A

Most common cause: viral

Adenovirus
Rhinovirus
H. Influenza
Coronavirus
RSV
Rarely: EBV, HSV, CMV
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2
Q

Bacterial Tonsillitis and Pharyngitis causes

A

2nd most common cause of tonsillitis and pharyngitis

Group A Beta-hemolytic Streptococcus

Less common:
S. Aureus (incl. MRSA)
S. Pneumonia
Mycoplasma pneumonia
Bordetella pertussis
Fusobacterium
C. Diphtheriae
T. Pallidum
N. Gonorrhoeae
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3
Q

Otitis Media (intact TM)

A

Cause: bacteria (most common)

  • Strep pneumoniae
  • H influenza
  • Moraxella catarrhalis
  • Group B strep
  • Staph aureus

Treat:

  • Penicillin
  • <5y old: amoxicillin
  • Moraxella: Co-amoxiclav (amoxicillin + clavulanic acid)
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4
Q

Otitis media with perforation

A

Cause: bacteria (most common)

  • Strep pneumoniae
  • H influenza
  • Moraxella catarrhalis
  • Group B strep
  • S aureus

Treat:
-Topical Ciprofloxacin (fluoroquinolones effective against staph and pseudomonas) + dexamethasone (corticosteroid)

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5
Q

Otitis Externa causes

A

Mainly due to bacteria

  • Pseudomonas aeruginosa
  • S aureus

Then fungal (called otomycosis)

  • Candida albicans
  • Aspergillus
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6
Q

Otitis Externa Treatment

A 
Otic drops: acetic acid, fluoroquinolones + steroids (eg. cilodex)
Alternatively aminoglycosides (avoid in grommets or perforation)
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7
Q

Bells palsy

A
  • most common cause of unilateral facial paralysis
  • due to oedema of VII in the fallopian (facial) canal (bony canal)
  • secondary to HSV type 1

Rx:
Oral corticosteroids (Prednisone for 10d)
Antivirals: acyclovir/valacyclovir within 72h
Eye drops: artificial tears / ocular ointment

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8
Q

Acute otitis media

A

H influenza, S pneumoniae, M catarrhalis

Mild: Amoxicillin
Moderate/severe: Augmentin
Macrolides in penicillin allergy

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9
Q

Chronic suppurative otitis media

A

Mixed, S aureus, P aerurginosa, anaerobes

Topical AB (fluoroquinolones, aminoglycoside with steroid drops (neomycin/ polymycinB)
\+ Aural Toilet
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10
Q

Acute otitis externa

A

P aeruginosa, S aureus, <2% fungal, viral or eczema

Topical acetic acid / alcohol + topical antimicrobials + removal of debris

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11
Q

Acute bacterial rhinosinusitis

A

H influenza, S pneumonia, M catarrhalis, S pyogenes, S aureus, P aeruginosa, anaerobes (odontogenic)

Spontaneous resolution OR
Amoxicillin (10-4d) / Augmentin
Penicillin allergy: doxycycline / bactrim

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12
Q

Chronic rhinosinusitis

A

Mixed: S aureus, P aeruginosa and anaerobes

Combined quinolones & steroids

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13
Q

Acute bacterial tonsillitis or pharyngitis

A

S pneumoniae, Group A beta-hemolytic strep

Penicillin

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14
Q

Local anaesthesia mechanism

A

Interferes with Na channel functioning
Decreased Na intracellularly
Prevents propagation of action potential

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15
Q

Cocaine

A

Amino-ester

Blocks re-uptake of Na & dobutamine at adrenergic nerve endings

Onset: slow, duration 30-60min

Side effects:
-vasoconstriction, tachycardia, HT, mydriasis, addiction

Admin route:
-topical

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16
Q

Lidocaine

A

Amno-amide

Interrupts vagal afferent pathways

Onset: rapid, duration 1-3h

Admin route: topical, IVI, submucosal, endotracheal

17
Q

Aphthous ulcer

A

Theory: T-cell mediated immune response to nutritional deficiencies, stress, trauma, hormonal and allergies

Treat: topical anaesthetic & anti-inflammatory agents

  • Viscous lidocaine 2%
  • Apthasol 5%
  • Temovate 0.05% (glucocorticoid: clobetasol)

AND antimicrobial mouthwash (reduces ulcer size, duration and pain) - chlorhexidine gluconate

18
Q

Allergy medication

A

Anti-histamines
Decongestants
Corticosteroids
Leukotriene receptor antagonist

19
Q

Antihistamines

A

H1 receptor antagonists
Target cells: eyes, nose, skin, lungs
-best for immediate, early phase allergic response

20
Q

1st Generation antihistamines

A
  • highly lipophilic (cross BBB - sedation & CNS suppression)
  • highly anticholinergic (dries mucosa, increased mucous tenacity, blurred vision, constipation & urinary retention)

Diphenhydramine
Chlorpheniramine
Triprolidine
Azatadine

21
Q

2nd Generation antihistamines

A

Lipophobic

  • doesn’t cross BBB, no likely sedation
  • little/no anticholinergic activity (safe in asthma, little/no tachyphylaxis)
Loratadine
Fexofenadine
Cetirizine
Desloratidine
Levocetirizine
22
Q

Decongestants mechanism

A

Alpha-agonists

-binds alpha-2 receptors - vasoconstriction (decreases engorgement)

23
Q

Systemic decongestants

A

Pseudoephedrine, phenylephrine

Significant alpha-adrenergic side effects
-increased BP, appetite, cardiac symptoms (tachycardia, arrhythmia)

24
Q

Topical decongestants

A

Oxymetazolin, Phenylephrine, Naphazoline, Tetrahydrozoline

Rapid rebound congestion can develop within 3 days of use
Rapid tachyphylaxis with increased use
Mucosal hypoxia & neurotransmitter depletion
Leads to RHINITIS MEDICANTOSA

25
Corticosteroids
Block generation & release of mediators and influx of inflammatory cells Wide range of effects: - cellular: mast cells, eosinophils, macrophages, lymphocytes & neutrophils - humoral mediators: histamines, eicosanoids, leukotrienes & cytokines Prolonged systemic usage -> suppression of hypothalamic pituitary axis (innate corticosteroid production) -> tapering doses NB
26
Systemic Corticosteroids
-short course in serious allergic inflammation (effects 12-24h) Commonly used preps: -prednisone, methylprednisone, dexamethasone Side effects: - reduced bone density - increased intraocular pressure - cataracts - increased glucose and potential difficulty controlling diabetes - increased peptic ulcer disease - capillary fragility - reduction in bone growth in children
27
Topical
-allergic rhinitis and nasal polyps ``` Beclomethasone diproprionate Fluticasone proprionate Mometasone furoate Fluticasone furoate Budesonide ``` Side effects: epistaxis, rarely septal perforation
28
Leukotriene receptor antagonsists
Blocks binding of leukotrienes to target cells Montelukast - also for asthma & exercise induced bronchospasm -use from >6mo old
29
Ototoxic medications
Cochlear & vestibular toxicities -reversible or permanent hearing loss - Aminoglycosides - loop diuretics - cytotoxic drugs (platinum based chemotherapy) - ARV's - Anti-malaria: quinine -salicylates (reversible)
30
Aminoglycosides
- bilateral permanent and high frequency sensorineural hearing loss - excreted by kidneys - renal dysfunction needs dose adjustment to decrease ototoxic effects Binds to outer hair cells in cochlea, chelates iron leading to free radical formation and cell destruction Tobramycin, Gentamycin and Streptomycin -> vestibulotoxic Neomycin, Kanamycin -> cochleotoxic Topical: only when TM is INTACT!!!
31
Loop diuretics
Transient cochlear toxicity (affects striavascularis) Furosemide (commonly used) - administer parenterally over several minutes
32
Chemotherapy (platinum based)
Cochleotoxic - stria vascularis and outer hair cells Tinnitus: presenting symptom Commonly used: Cisplatin & Carboplatin
33
Vertigo
Peripheral - benign paroxysmal positional vertigo - Meniere's disease - vestibular neuritis - vestibular migraine Central -stroke Other: -toxin exposure (carbon monoxide, aspirin, alcohol)
34
Vertigo Management
Meniere's disease - low salt diet, caffeine & alcohol avoidance - diuretics (HCTZ) - diazepam (vestibular suppressant) - intratympanic injections of gentamycin - antihistamines: betahistine, dimenhydrinate, meclizine may have antiemetic properties
35
Laryngopharyngeal reflux and Gastroesophageal reflux presentation
Chronic cough Throat clearing Hoarseness Globus sensation
36
Laryngopharyngeal/gastroesophageal reflux treatment
1st line: lifestyle modification -elevate head of bed, decrease fat intake, avoid certain foods (caffeine, alcohol, peppermint), smoking cessation Antacids: hydroxide aluminum and magnesium, sodium bicarbonate, calcium bicarbonate Alginic acid Combination preps (gaviscon) Acid suppression for persistent reflux: H2 receptor antagonists, proton pump inhibitors
37
H2 receptor antagonists
-prevent histaminergic stimulation of acid secreting parietal cells Ranitidine Famotidine Cimetidine (CYP450 inhibitor - monitor for interactions) -take 30 min before meals Side effects - headache - constipation - confusion - elevated liver enzymes - confusion
38
Proton pump inhibitors
Act on luminal surface of parietal cell - inhibit H+/K+ ATPase (site of acid entry into gastric lumen) Omeprazole Lansoprazole Esomeprazole Pantoprazole Take 30-60 min before meals Side effects: long term - B12 deficiency and fracture risk

Pharmacology (17 decks)

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