ENT SDL

Question 1

qs to ask px with earache after swimming?

Answer 1

• Duration and nature of pain and getting worse?
• Associated symptoms: hearing loss/ discharge or cold
• Had similar issues before? Esp after swimming / any other trigger/ event
• Taken any meds?

Question 2

what red flags would trigger referral for a child that is experiencing earache after swimming in the sea

Answer 2

dizziness
tinnitus
pain in middle ear
fever
malaise
foreign body
deafness
inflammation of pinna

Question 3

what are the benefits of topical over systemic abx for the management of otitis externa

Answer 3

systemic abx have little penetration into external auditory canal, topical treatment with steroids most effective

Question 4

name 2 common causative agents of otitis externa

Answer 4

staph aureus and pseudomonas

so topical tx better

Question 5

what treatment advice can you give someone with otitis externa

Answer 5

avoid water
good pain control
microsuction of debris
avoid cotton buds
keep ears clean and dry
use ear plugs and tight cap when swimming
keep shampoo soap and water out of ear when bathing

Question 6

it is important to ensure that topical treatments are being used correctly to treat otitis externa, if patients are not responding to drops what formulation can you switch to and vice versa

Answer 6

sprays

Question 7

true or false, if you suspect contact sensitivity to neomycin or another aminoglycoside you should switch patients to non aminoglycosides

Answer 7

true
avoid anything with gentamicin/ neomycin

Question 8

what abx should not be given to patients with perforated tympanic membranes and why

Answer 8

aminoglycosides due to ototoxicity

Question 9

under what circumstances would it be okay to give gentamicin or neomycin to treat otitis externa

Answer 9

active discharge

Question 10

what drug may be used with caution if tympanic membrane is perforated but pseudomonas is suspected

Answer 10

ciprofloxacin

Question 11

otitis media is usually self limiting and can be resolved itself within what time period

Answer 11

3 days to 1 week

Question 12

what analgesia can be used regularly for pain management in otitis media

Answer 12

paracetamol or ibuprofen

Question 13

true or false, there is no evidence to suggest the use of decongestants or antihistamines for the management of otitis media symptoms

Answer 13

true

Question 14

there is no restrictions to daily activities in otitis media, but what might you tell patients to avoid doing if there is evidence of tympanic membrane perforation

Answer 14

swim

Question 15

if otitis media progresses to systemic infection, broad spectrum abx are used, name some different options

Answer 15

amoxicillin, co amoxiclav, clarithromycin

Question 16

broad spectrum abx are useful to target what causative organism in otitis media complications

Answer 16

strep pneumoniae

Question 17

what is meant by conservative treatment

Answer 17

pain management

Question 18

if yellow discharge starts dripping from ear in the case of otitis media, is this serious

Answer 18

perforated tympanic membrane common in otitis media as pressure in ears eased

Question 19

discharge from ears in otitis media should ease within x weeks but beyond that requires referral to ent

Answer 19

6

Question 20

why should gentamicin drops be avoided in the case of perforated tympanic membranes

Answer 20

ototoxic

Question 21

what drug may be given for otitis externa and otitis media with tympanic membrane perforation

Answer 21

ciprofloxacin

Question 22

in addition to the usual symptoms of otitis media what would suggest a new diagnosis of acute mastoiditis

Answer 22

ear pushed forward
redness and swelling behind pinna
bulging red tympanic membrane

Question 23

what treatment considerations must be made for acute mastoiditis tests toconduct

Answer 23

ct scans
surgery arranged by ent
patient review
iv fluids
blood tests
abx
nil by mouth in case of surgery and refer ent

Question 24

list some different abx that can be recommended for use in the case of intracranial sepsis

Answer 24

cephalosporin
clindamycin
metronidazole
cephalexin

If concern about resistance;
o Vancomycin and cefotaxime
o Clindamycin
o Vancomycin … tazobactam..
o V strong antibiotics

Question 25

empirical treatment for intracranial sepsis should target what different organisms

Answer 25

staph aureus staph pyrogenes strep pneumoniae

Question 26

treatment for intracranial sepsis should cover sinus pathogens that exhibit beta lactamase resistance and be able to penetrate the

Answer 26

CSF

Question 27

if resistance was of particular concern what abx might be considered for intracranial sepsis

Answer 27

clindamycin vancomycin piperacillin tazobactam

Question 28

what symptoms of a sore throat would trigger a referral

Answer 28

signs of epiglottis breathing difficulty abscess over a week rash earache signs of systemic illness tonsillar exudate rheumatic fever parotid gland swelling

Question 29

list some medications known to cause blood disorders that may present with sore throat and require immediate medical attention

Answer 29

clozapine cytotoxics sulfasalazine sulfonamides penicillamine carbimazole Sulphonamide including co-trimoxazole and trimethoprim

Question 30

what otc remedies are available to manage sore throats that dont need to be referred

Answer 30

- Demulsants - Honey and glycerin syrups - Lozenges to soothe throat – stop dryness - Antiseptics like benzylcholine lozenge Local anaesthetics containing bezalkain - Volatiles like menthol - Antinflamm sprays - diflam

Question 31

give example of demulsant

Answer 31

honey and sugar

Question 32

viral or bacterial tonsilitis glands not enlarged low grade fever cough

Answer 32

viral

Question 33

viral or bacterial tonsillitis often children cough rare high grade fever exudate present swollen glands

Answer 33

bacterial

Question 34

what tools can be used to diagnose tonsilliitis

Answer 34

feverpain and centor

Question 35

what class of abx are most effective in treating acute bacterial tonsillitis

Answer 35

penicillins

Question 36

what drug can be used for acute bacterial tonsillitis in the case of penicillin allergy

Answer 36

clarithromycin

Question 37

why should amoxicillin be avoided in acute bacterial tonsillitis

Answer 37

can cause macular papillar rash if glandular fever present

Question 38

what symptoms would indicate the tonsillitis has progressed to quinsy

Answer 38

swelling above tonsils uvula pushed aside pyrexial pain pus abscess

Question 39

which abx are best to treat tonsillitis and peritonsillar abscesses

Answer 39

metronidazole added to penicillin

Question 40

why might metronidazole be added to penicillin the event of quinsy

Answer 40

cover raised possibility of anaerobic bacteria

Question 41

why might dexamethasone be added to the treatment regime of quinsy

Answer 41

help reduce swelling

Question 42

what are the management steps for quinsy

Answer 42

admission under ent aspiration and incision of pus improve breathing iv abx

Question 43

what are the common bacterial causes of acute sinusitis

Answer 43

streptococcus haemophylus influenzae moraxella catharrhalis staph aureus strep pyrogenes

Question 44

what are the common viral causative agents of acute sinusitis

Answer 44

o rhinoviruses o influenzas o para influenza viruses

Question 45

are most acute cases of sinusitis due to viral or bacterial causes

Answer 45

viral

Question 46

in complicated cases of sinusitis that do not resolve in 5 days or in children that are septic antibacterial therapy may be needed, what can be used first line and then second line after 48 hrs if no improvement

Answer 46

phenoxymethylpenicllin or amoxicillin first line and then co amoxiclav

Question 47

what are the common bacterial causative agents of acute sinusitis

Answer 47

o strep pneumoniae o H influenzae o Moraxella catarrhalis o Strep progenys

Question 48

what non pharmacological treatment can be used for acute sinusitis

Answer 48

nasal decongestants and saline douching

Question 49

first line tx if pen allergic?

Answer 49

clarithromycin

Question 50

operative management for sinusitis is reserved for what cases

Answer 50

oral complications or chronic sinusitis

Question 51

steam inhalation, oral corticosteroids and anthistamines may be used for acute sinusitis unless allergic rhinitis is present, What might mucolytics be used for

Answer 51

thin mucus making it easier to pass

Question 52

what physiochemical barriers affect nasal drug delivery

Answer 52

molecular size weight of drug lipophilicity diffusion co efficient

Question 53

what physiological barriers exist for nasal drug delivery

Answer 53

foreign material trapped in viscous mucus enzymatic activity epithelial bacterial mucocilliary clearance

Question 54

true or false dental abscess can cause sinusitis

Answer 54

true

Question 55

do lower resp tract infections usually cause sinusitis in patients that are immunocompromised, yes or no

Answer 55

no

Question 56

how might chronic sinusitis without nasal polyps be managed

Answer 56

topical steroid nasal saline irrigation oral abx in exacerbation

Question 57

for chronic sinusitis abx can be given over x week period provided that there are breaks in between

Answer 57

12