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Finals > ENT SDL > Flashcards

ENT SDL Flashcards

1
Q

qs to ask px with earache after swimming?

A
  • 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?
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2
Q

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

A

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

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3
Q

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

A

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

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4
Q

name 2 common causative agents of otitis externa

A

staph aureus and pseudomonas

so topical tx better

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5
Q

what treatment advice can you give someone with otitis externa

A

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

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6
Q

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

A

sprays

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7
Q

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

A

true
avoid anything with gentamicin/ neomycin

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8
Q

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

A

aminoglycosides due to ototoxicity

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9
Q

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

A

active discharge

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10
Q

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

A

ciprofloxacin

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11
Q

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

A

3 days to 1 week

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12
Q

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

A

paracetamol or ibuprofen

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13
Q

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

A

true

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14
Q

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

A

swim

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15
Q

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

A

amoxicillin, co amoxiclav, clarithromycin

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16
Q

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

A

strep pneumoniae

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17
Q

what is meant by conservative treatment

A

pain management

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18
Q

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

A

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

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19
Q

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

A

6

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20
Q

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

A

ototoxic

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21
Q

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

A

ciprofloxacin

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22
Q

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

A

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

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23
Q

what treatment considerations must be made for acute mastoiditis tests toconduct

A

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

24
Q

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

A

cephalosporin
clindamycin
metronidazole
cephalexin

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

25
Q

empirical treatment for intracranial sepsis should target what different organisms

A

staph aureus
staph pyrogenes
strep pneumoniae

26
Q

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

A

CSF

27
Q

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

A

clindamycin
vancomycin
piperacillin tazobactam

28
Q

what symptoms of a sore throat would trigger a referral

A

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

29
Q

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

A

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

30
Q

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

A
  • 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
31
Q

give example of demulsant

A

honey and sugar

32
Q

viral or bacterial tonsilitis

glands not enlarged
low grade fever
cough

A

viral

33
Q

viral or bacterial tonsillitis

often children
cough rare
high grade fever
exudate present
swollen glands

A

bacterial

34
Q

what tools can be used to diagnose tonsilliitis

A

feverpain and centor

35
Q

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

A

penicillins

36
Q

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

A

clarithromycin

37
Q

why should amoxicillin be avoided in acute bacterial tonsillitis

A

can cause macular papillar rash if glandular fever present

38
Q

what symptoms would indicate the tonsillitis has progressed to quinsy

A

swelling above tonsils
uvula pushed aside
pyrexial
pain
pus
abscess

39
Q

which abx are best to treat tonsillitis and peritonsillar abscesses

A

metronidazole added to penicillin

40
Q

why might metronidazole be added to penicillin the event of quinsy

A

cover raised possibility of anaerobic bacteria

41
Q

why might dexamethasone be added to the treatment regime of quinsy

A

help reduce swelling

42
Q

what are the management steps for quinsy

A

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

43
Q

what are the common bacterial causes of acute sinusitis

A

streptococcus
haemophylus influenzae
moraxella catharrhalis
staph aureus
strep pyrogenes

44
Q

what are the common viral causative agents of acute sinusitis

A

o rhinoviruses
o influenzas
o para influenza viruses

45
Q

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

A

viral

46
Q

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

A

phenoxymethylpenicllin or amoxicillin first line and then co amoxiclav

47
Q

what are the common bacterial causative agents of acute sinusitis

A

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

48
Q

what non pharmacological treatment can be used for acute sinusitis

A

nasal decongestants and saline douching

49
Q

first line tx if pen allergic?

A

clarithromycin

50
Q

operative management for sinusitis is reserved for what cases

A

oral complications or chronic sinusitis

51
Q

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

A

thin mucus making it easier to pass

52
Q

what physiochemical barriers affect nasal drug delivery

A

molecular size
weight of drug
lipophilicity
diffusion co efficient

53
Q

what physiological barriers exist for nasal drug delivery

A

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

54
Q

true or false dental abscess can cause sinusitis

A

true

55
Q

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

A

no

56
Q

how might chronic sinusitis without nasal polyps be managed

A

topical steroid
nasal saline irrigation
oral abx in exacerbation

57
Q

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

A

12

Finals (30 decks)

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