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ENT Flashcards

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1
Q

What is otitis externa

A

Inflammatory reaction of meatus skin

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2
Q

What to do before treating otitis externa

A

Rule out underlying chronic otitis media

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3
Q

Treating otitis externa

A

Thorough cleansing via suction or dry mopping, to apply lotions may need ribbon gauze dressing or sponge wick soaked with astringent/corticosteroid ear drops

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4
Q

Treating otitis externa infection pharmacologically

A

Topical neomycin or clioquinol, chloramphenicol, aluminium acetate , if staph the fluclox/ciproflox

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5
Q

What is acute otitis media

A

Self-limiting condition characterised by inflammation in middle ear

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6
Q

Acute otitis media symptoms

A

Ear pain, rubbing of the ear, fever, irritability, crying, poor feeding, restlessness at night, cough, or rhinorrhoea

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7
Q

Other name for otitis media

A

Glue ear

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8
Q

How long does acute otitis media last

A

3-7 days without Antibiotics

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9
Q

Treating acute otitis media

A

Paracetamol, ibuprofen, Antibiotics if systemically unwell and refer severe infection to hospital

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10
Q

Otitis media with effusion treatment

A

Active observation over 6–12 weeks is appropriate for most children, as spontaneous resolution is common.

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11
Q

Otitis media with effusion is

A

Characterised by the collection of fluid within the middle ear without any signs of inflammation.

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12
Q

Removing ear wax

A

Olive/almond oil, sodium bicarbonate drops can be used three to four times daily for several days. Lying down with the affected ear uppermost, ear drops are instilled before waiting for 5 minutes.

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13
Q

Causes of otitis externa

A

P aeruginosa or staph a

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14
Q

Treating otitis externa infection

A

Fluclox or clarithromycin (if penicillin allergy) or ciprofloxacin if pseudomonas

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15
Q

Otitis media infection treatment

A

Amoxicillin second line co-amox, clari/erythromycin if penicillin allergy

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16
Q

How to use eye drops

A

Pull down lower eyelid keep eye closed for long as possible

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17
Q

What to do when two eye drops needed

A

5 minute interval

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18
Q

When to stop using eye drop

A

More than 4 weeks since opening at home or 1 week in hospital

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19
Q

Drugs with effect on contact lenses

A

Oral contraceptives (particularly those with a higher oestrogen content),
drugs which reduce blink rate (e.g. anxiolytics, hypnotics, antihistamines, and muscle relaxants),
drugs which reduce lacrimation (e.g. antihistamines, antimuscarinics, phenothiazines and related drugs, some beta-blockers, diuretics, and tricyclic antidepressants)
drugs which increase lacrimation (including ephedrine hydrochloride and hydralazine hydrochloride).
isotretinoin (can cause conjunctival inflammation), aspirin (salicylic acid appears in tears and can be absorbed by contact lenses—leading to irritation), and rifampicin and sulfasalazine (can discolour lenses).

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20
Q

Purulent meaning

A

consisting of, containing, or discharging pus.

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21
Q

Treating purulent conjunctivitis

A

Chloramphenicol

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22
Q

Dry eye presentation

A

Chronic soreness, inflammation of ocular surface associated with reduced/abnormal tear secretion

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23
Q

Treating dry eye

A

Eye drops/ointment at night or gels

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24
Q

Treating mild dry eye

A

Hypromellose frequently if not then carbomers and polyvinyl alcohol

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25
Why is hypromellose preferred to carbomer
Carbomer impacts vision
26
Preservative free or preservative
Preservative free better especially if chronic/frequent use
27
Ocular lubricants ingredients
Sodium hyaluronate, hydroxypropyl guar, carmellose soidum
28
When are ocular lubricants used
Moderate to severe dry eye, after 6-8 week trial of mild treatment
29
Treating anterior segment inflammation
Corticosteroids topically
30
Treating macular oedema
IV implant containing dexamethasone of fluocinolone
31
Topical treatment for eye inflammation and allergic conjunctivitis
Antihistamines, lodoxamide, sodium cromoglicate, diclofenac eye drops, ketotifen
32
Treating severe keratitis
Ciclosporin
33
Common cause of blepharitis
Staph
34
Bacterial conjunctivitis common cause
Strep pneumoniae, staph a, haem influenzae
35
Treating blepharitis
Chloramphenicol
36
Blepharitis symptoms
Sore eyelids itchy eyes a gritty feeling in the eyes flakes or crusts around the roots of the eyelashes red eyes or eyelids eyelids sticking together in the morning when you wake up can lead to conjunctivitis
37
Keratitis cause
Bacterial, viral, fungal
38
What is age related macular degeneration
Progressive eye condition affecting the macula ( central area of retina)
39
What is the macula
Central area of retina
40
What AMD is worse dry or wet
Wet
41
Difference between dry and wet AMD
Dry progresses slowly and is the wasting of macula cells but with wet new blood vessels develop beneath and within retina leading to rapid vision deterioration.
42
Different wet AMD
Active=neovascular lesions benefit from treatment and inactive= irreversible structural change
43
Treatment of wet AMD
Smoking cessation , anti-VEGF (Afilbercept, bevacizumab)
44
Risk factors for glaucoma
Age, family history, ethnicity, corticosteroid, myopia, type 2 diabetes mellitus, CVD and hypertension, raised intra-ocular pressure
45
Common form of glaucoma
Chronic open-angle glaucoma it means drainage of aqueous humour through trabecular meshwork it is asymptomatic then loss of vision as progresses.
46
Less common form of glaucoma
Acute angle-closure is less common, aqueous outflow is completely obstructed
47
Treating ocular pressure
Topical prostaglandin analogue, such as latanoprost, tafluprost, travoprost, or bimatoprost if not then switch to a topical beta-blocker such as betaxolol, levobunolol hydrochloride, or timolol maleate if still not working the carbonic anhydrase inhibitors such as brinzolamide or dorzolamide, a topical sympathomimetic such as apraclonidine [unlicensed use] or brimonidine tartrate, or a topical miotic such as pilocarpine [unlicensed use]
48
Brinzolamide or dorzolamide class
carbonic anhydrase inhibitors
49
Topical sympathomimetic
apraclonidine
50
topical miotic example
Pilocarpine
51
Eye betablockers
Betaxolol, levobunolol hydrochloride, or timolol maleate
52
Topical prostglandin analogue treatment
Latanoprost, tafluprost, travoprost, or bimatoprost
53
Treating chronic open angle glaucoma
Topical prostaglandin analogues if not beta if not carbonic inhibitor or topical sympathomimetic
54
Effect of antimuscarinics on pupil
Dilate and paralyse the ciliary muscle
55
What is mydriatic
Eye dilates
56
What is miotic
Eye closes
57
Cycloplegia
Paralysis of ciliary muscle
58
When are myadriatic and cycloplegia used for
Anterior uveitis
59
Sinusitis
Inflammation of the mucosal lining of the paranasal sinuses.
60
Sinusitis symptoms
Nasal blockage or congestion, nasal discharge, dental or facial pain or pressure, and reduction or loss of the sense of smell.
61
Sinusitis cause
URTI e.g. Common cold
62
Normal length of sinusitis
2-3 weeks
63
How to treat patients with sinusitis that have had symptoms for 10 or less days
self-care of pain or fever with paracetamol or ibuprofen, and maybe nasal saline or decongestion but there is no evidence for it helping
64
How to treat patients with sinusitis that have had symptoms for 10 or more days
high-dose nasal corticosteroid, such as mometasone furoate [unlicensed use] or fluticasone [unlicensed use] for 14 days. If systemically very unwell and looks serious treat with Abx
65
Rare sinusitis symptoms that need referring to hospital
Orbital, intracranial or skeletal complications (e.g. periorbital cellulitis, symptoms or signs of meningitis)
66
Rhinitis causes
Acute/chronic allergic or non allergic
67
Treating rhinitis
Nasal spray and drop
68
Treating nasal allergy
Sodium chloride, antihistamines, nasal corticosteroids
69
Nasal corticosteroid
Mometasone, fluticasone, betamethasone use short term
70
What nasal corticosteroids can be used in pregnant
Fluticasone has lowest systemic absorption but beclo, budesonide and fluticasone can technically be used
71
Pregnancy and decongestants
Not recommended but some antihistamines and sodium cromoglicate can be used
72
Topical nasal decongestants
NaCl
73
Issue with decongestant
Contain sympathomimetics which work via vasocontriction reducing oedema but in long term use = rebound congestion resulting in a cycle if patient uses decongestent again
74
How to eliminate nasal staph
Chlorhexidine with neomycin (naseptic) or mupirocin
75
When is muprocin used in hospitals
To get rid of MRSA
76
Treating superficial mouth infections
Warm mouthwashes
77
How to use mouthwashes effectively
Frequently and vigorously
78
How to make salt water
Half a teaspoonful of salt in glassful of warm water
79
Treating ulcerative gingivitis
Mouthwash with hydrogen peroxide
80
What is chlorhexidine
Antiseptic
81
Chlorhexidine effect
Inhibits plaque formation
82
Chlorhexidine indication
Denture stomatitis, oral candidiasis,
83
Chlorhexidine side effects
Reversible brown staining of teeth and tongue, may interact with some toothpaste
84
Cause of dry mouth
Reduced saliva secretion, antimuscarinics, antihistamines, TCA diuretics, dehydration, anxiety, infection
85
How to relieve dry mouth
Sucking pieces of ice, sugar-free fruit pastilles, chewing sugar-free gum, pilocarpine, oral lozenges/gel/spray/pastille
86
Gingivitis treatment
Metronidazole or amoxicilin
87
Treating oropharyngeal abscess
Amoxicillin or metronidazole
88
peridontitis treatment
Metronidazole
89
Corticosteroids and thrush
Increase risk of thrush
90
How to sort thrush associated with corticosteroids
Rinsing mouth
91
Treating denture stomatitis
Miconazole, cleanse dentures
92
Angular cheilitis is
Angular stomatitis
93
Angular chelitis characterisation
Soreness erythema and fissuring at angles of mouth
94
Angular cheilitis treatment
Miconazole fusidic acid if not working then hydrocortisone with miconazole
95
Drugs used to treat oropharyngeal candidasis
Nystatin, miconazole locally if not then fluconazole
96
What to do if oropharyngeal candidiasis last longer than 1-2 weeks
Send for investigation to try and identify eliminate underlying
97
How to prevent oral candidiasis
Antiseptic mouthwashes in immunocompromised and those with denture stomatitis
98
Common cause of sore throat
Viral
99
Primary hepatic gingivostomatitis treatment
Soft diet, fluid intake, analgesics and benzydamine, chlorhexidine
100
Treating severe hepatic stomatitis
Aciclovir

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