Ear, Nose & Oropharynx

Question 1

Define otitis externa:

Answer 1

Inflammation of the external ear canal which may involve oedema, primarily caused by bacterial infection

Question 2

How to clean ear with otitis externa:

Answer 2

Ribbon gauze dressing or sponge wick soaked with corticosteroid drops or with an astringent such as aluminium acetate solution

Question 3

If an infection is present what is given:

Answer 3

Clioquinol or neomycin but only for one week as may result in fungal infections

Question 4

What can be used in mild otitis externa:

Answer 4

Acetic acid 2% - ear calm spray (licensed for 12+) to public Acts as antifungal and antibacterial in external ear canal. Efficacy reduced if extends more than one week

Question 5

For severe pain, associated with otitis externa what is used:

Answer 5

Paracetamol or ibuprofen

Question 6

When is treatment with topical aminoglycosides contraindicated

Answer 6

With a perforated eardrum

Question 7

When would a systemic antibacterial be indicated in ottitis externa?

Answer 7

Infection spreading outside the ear canal, patient systemically unwell, high risk groups. Refer if excessive swelling outside ear canal

Question 8

When a resistant staph aureus infection (boil is present) what is given:

Answer 8

Flucloxacillin
Ciprofloxacin or an aminoglycoside is given if patient has diabetes or is immunocompromised

Question 9

What are the symptoms of acute otitis media?

Answer 9

Ear pain
Rubbing of ear
Fever
Crying, poor feeding, restlessness, cough
Symptoms usually resolves 3-7 days without antibacterial

Question 10

How to treat pain and fever in patients with acute otitis media:

Answer 10

Paracetamol or ibuprofen

Question 11

When would an immediate antibacterial be indicated for ottitis media?

Answer 11

If the child is systemically very unwell, has signs or symptoms of a serious illness or at high risk of complications. Discharge following perforation.

Question 12

State treatment of acute otitis media:

Answer 12

Amoxicillin 5-7 day course
Erythromycin or clarithromycin (erythromycin preferred in pregnant women)

Question 13

Which drugs are contraindicated in patients with patent grommet / perforated tympanic membrane:

Answer 13

Framceytin/gentamicin/neomycin

Question 14

For ciprofloxacin ear drops, how many days after should a patient discard any ampoules remaining after opening the pouch:

Answer 14

8 days

Question 15

State treatment of removing ear wax:

Answer 15

Almond oil ear drops or olive oil ear drops
Sodium bicarbonate ear drops but may cause dryness of ear canal. Can be used three to four times a day for several days. Lying down and wait for 5 minutes. can remove wad with irrigation by water.

Question 16

What is the mhra alert for aminoglycosides?

Answer 16

Associated with rare cases of ototoxicity

Question 17

What is the difference between topical and oral antihistamines?

Answer 17

Topical are faster acting therefore are useful for controlling breakthrough symptoms of allergic rhinitis.

Question 18

What should be monitored in children receiving tx with corticosteroids?

Answer 18

Growth

Question 19

What are not recommended in pregnancy?

Answer 19

Decongestants

Question 20

How long should decongestant nasal drops and sprays be used for?

Answer 20

Usually no more than 7 days

Question 21

What is associated with topical nasal decongestants?

Answer 21

Rebound congestion, which leads to a viscous cycle of their use.

Question 22

What is the maximum amount of ephedrine you can sell in a single sale:

Answer 22

180 mg. Up to 5 days tx in children aged 6-12 years. Do not use in under 12. Pseudoepehdrine cannot be sold at same time

Question 23

What is associated with use of decongestants in children under 6?

Answer 23

Psychosis, ataxia, hallucinations, death.

Question 24

State symptoms of sinusitis:

Answer 24

Nasal blockage, congestion, facial pain, dental pain, sinus headache, fever, loss of smell Triggered by upper viral tract infection such as common cold
Symptoms usually improve within 2-3 weeks without treatment

Question 25

State treatment of sinusitis if less than 10 days:

Answer 25

Paracetamol or ibuprofen

Question 26

State treatment of sinusitis if more than 10 days:

Answer 26

High dose mometasone or fluticasone nasal corticosteroid for 14 days

Question 27

When should a backup antibacterial be given in sinusitis?

Answer 27

If symptoms do not improve within 7 days or if they worsen rapidly

Question 28

State antibiotic treatment of sinusitis in adults:

Answer 28

1. Phenoxymethylpenicillin 2. High risk of complications – co-amoxiclav 3. Allergic or intolerant to penicillin – doxycycline

Question 29

Which drug is licensed for treatment of xerostomia (dry mouth) following irradiation for head and neck cancer and for dry mouth and dry eyes:

Answer 29

Pilocarpine. Can take up to 3 months to be effective, remove tx if ineffective after this time

Question 30

Which drugs can cause dry mouth?

Answer 30

Antimuscarinics, antihistamines, tricyclic antidepressants and diuretics.

Question 31

What is the tx for dry mouth?

Answer 31

Sips of cold unsweetened drinks, suck ice or sugar free sweets, chewing gum. Artificial saliva

Question 32

State treatment for a patient having an unexplained ulcer in mouth for more than 3 weeks:

Answer 32

Refer to specialist to exclude oral cancer

Question 33

State treatment of aphthous ulcer:

Answer 33

- advise patients to avoid known triggers - if mild and does not interfere with life, may not be required - 1. Hydrocortisone oromucosal tablets 2. Beclometasone inhaler (unlicensed) / betamethasone soluble (unlicensed) Note: for people with severe recurrent aphthous ulcer – prednisolone prescribed Vitamin B12 potentially may be added - topical anaesthetics or analgesics can be used

Question 34

What is the contraindication with salycylic acid?

Answer 34

In children under 16 years old can give rise to reyes syndrome

Question 35

State treatment of pericoronitis/gingivitis:

Answer 35

Metronidazole or amoxicillin. 3 days or until pain reduction allows for dental hygiene

Question 36

State treatment of dental abscess:

Answer 36

Amoxicillin or metronidazole

Question 37

State treatment of periodontitis:

Answer 37

Metronidazole or doxycycline

Question 38

State treatment of sore throat:

Answer 38

1. Phenoxymethylpenicillin 2. If penicillin allergic – erythromycin / clarithromycin 5 days severe symtpoms, signs or symptoms of a severe illness, risk of complications

Question 39

State treatment of chronic hyperplastic candidiasis / acute erythematous candidiasis:

Answer 39

Fluconazole Avoid use of tobacco

Question 40

What can cause oral thrush?

Answer 40

Patients receiving inhaled steroids, chemotherapy or broad spec abx.

Question 41

How would you treat oral thrush?

Answer 41

Miconazole oral gel or oral nystatin. oral fluconazole if severe infection

Question 42

What is the treatment for denture stomatitis?

Answer 42

Cleanse dentures, soak overnight in disinfectant and allow to air dry. Do not wear for more than 6 hours in 24 hours to promote healing.

Question 43

Define angular cheilitis:

Answer 43

Soreness, erythema and fissuring at angles of mouth

Question 44

Treatment of angular cheilitis:

Answer 44

Miconazole cream / daktacort / fusidic acid ointment

Question 45

State licensing of daktarin oral gel:

Answer 45

4 months+

Question 46

State treatment of severe herpetic stomatitis:

Answer 46

Acyclovir

Question 47

State treatment of oral lesions associated with herpes zoster:

Answer 47

Valaciclovir or famciclovir