ENT

Question 1

Otitis externa

Answer 1

Inflammation of the external portion of the ear and or auditory canal
Pain, itchiness, hearing loss, discharge and swollen ear canal.
Non-infectious cause; atopic dermatitis, psoriasis, seborrhoea dermatitis, acne and eczema
Infectious causes;
Bacterial - most common cause; cause fever, lymphadenopathy, white mucus discharge
Fungal - asymptomatic but can have white,black,grey,yellow discharge

Question 2

Otitis externa treatment

Answer 2

Ear calm (acetic acid 2%)
Simple analgesia
Neomycin/cloquinol max of 7 days
Aluminium acetate
Consider oral antibiotics if systemically unwell or it is spreading past the ear; flucloxacillin or clarithromycin

Question 3

Acacute otitis media

Answer 3

Self limiting - clear up 3-7 days
Often children
Middle ear infection
Viral or bacterial
Advice, duration, self care and paracetamol should clear it up if systemic symptoms develop or longer lasting consider oral antibiotics
Often without effusion

Question 4

Red flags for acute otitis media

Answer 4

Severe systemic infection (NEWS score)
Signs of meningitis (rash, high temperature, confusion, mottled skin)
Mastoiditis (large lump behind ear)
Intracranial abscess
Sinus thrombosis
Facial nerve paralysis
Children younger than 3 months with a temperature of 38’ or more
Children between 2-6 months of age with a temperature of 39’

Question 5

Ear wax

Answer 5

Cerum, brown, orange red yellow or grey
Ear wax is normal bodily secretion, protective film
Remove if it begins to cause hearing loss or interferes with a proper view of the ear drum
Earache, hearing difficulty, itchiness, diziness

Question 6

Ear wax treatment

Answer 6

3 to 5 days; olive oil, almond oil, sodium bicarbonate (helps dryness), sodium chloride nasal drops
Otex can be sued but it contained peanuts - avoid if have allergy
Patient must lie to side to allow wax to soften
Failure treatment consider irrigation
Never give drops to patients with a suspected perforated tympanic membrane is suspected

Question 7

Rhinitis/ cattarh

Answer 7

Cattarh is build up of mucus in nose and sinuses and phlegm in the throat
Often self-limiting
Nasal congestion, runny nose, sneezing and itching
Caused by allergies mainly
Rhinitis affects 1/4 people - common

Question 8

Causes rhinitis/cattarh

Answer 8

Infections
Allergies
Change in temperature
Hormone imbalances
Nasal polyps

Question 9

Red flags for rhinitis/ cattarh

Answer 9

Significant respiratory involvement
Purulent nasal discharge Sinusitis?

Question 10

Treatment cattarh/rhinitis

Answer 10

Infection-associated; dependent on co-existing symptoms manage as a URTI (amox/clarity/erythromycin) or sinusitis (phen v or doxy)
Allergy associated; intranasal antihistamine (azelastine), oral histamine, cromoglicate nasal spray, intranasal steroids (mometatsone fluticasone, triamcinolone, belcomethasone)
OTC corticosteroids; 18+ and 2 puffs per dose max 3 months
Avoid or review trigegrs

Question 11

Nasal congestion

Answer 11

Infection, allergies, nasal polyps, sinusitis, deviated nasal septum

Question 12

Nasal congestion red flags

Answer 12

Significant respiratory involvement
Purulent nasal discharge sinusitis?
Periodical swelling
Altered speech
Double vision or reduced visual acuity
Unilateral polyps and other symptoms
Bloody nasal discharge

Question 13

Nasal congestion treatment

Answer 13

Polyps; intranasal steroids (high dose 6 weeks) then surgery; blocked nose and decreases smell
Sinusitis; analgesia, nasal saline, nasal decongestants (medicamentosa if used more than 7 days)
Decongestants; not under 6 and 6-12 years for max 5 day treat
Moist air / menthol and eucalyptus
Ephedrine is the safest - 7 days, sympathomimetic
Refer; nasal staphylococci infection (naseptin or mupirocin as well)

Question 14

Sterimar

Answer 14

Can be used from birth
Isotonic - same concentration
Hypertonic - different concentration to cell membrane (more saline) concentration is stronger

Question 15

Epistaxis

Answer 15

Nose bleeding
Caused by; trauma, infection, picking or blowing nose, dry skin, high BP, medication and nasal polyps

Question 16

Epistaxis red flags

Answer 16

Haemodynamic compromises (lightheadedness, syncope, pallor)
<2 years of age
Facial pain or numbness
Double vision
Hearing loss
Bleeding lasts longer than 10-15 mins
Clotting abnormalities

Question 17

Epistaxis management or treatment

Answer 17

Acute; sit with upper body tilted forward and mouth open, pinch the cartilaginous part of the nose firmly and hold it for 10-15 mins without releasing the pressure
Infection-associated (crusting) - naspetin QDS for 1 days, or mupirocin ointment BD/TDS for 5-7 days
High BP or medication - review as appropriate

Question 18

To treat dermatitis of ear

Answer 18

Dry skin build up and itchy aoroung outside ear
Steroid drops used to treat

Question 19

What can cause a dry mouth

Answer 19

Antimuscarinics
TCAs
Antipsychotics
Diuretics
Disease to salivary glands

Question 20

What can dry mouth lead to?

Answer 20

Increased risk dental caries
Periodontal disease
Intolerance of dentures
Oral infection (particularly candidiasis)

Question 21

How to treat dry mouth

Answer 21

Frequent sips of cool drinks
Artificial saliva - has neutral pH contains electrolytes
ACBS, biotrax, glandsane, saliva orphans and saliveze
Fluoride prevents dental caries

Question 22

Other preparations for orophanygeal use

Answer 22

Lozenges and sprays no evidence
Mouthwashes, gargles and dentifrices
Warm saline mouthwash for cleaning effects
Hydrogen peroxide useful for ulcerative gingivitis

Question 23

Chlorohexidine

Answer 23

Antiseptic
Stops plaque formation and prevents candidiasis
Can’t replace brushing, adjunct to other oral hygiene measures
Mouthwash, spray or gel
Secondary infection in mucosal ulceration and for controlling gingivitis
Main side effects; temperature, stain teeth; dilute water and decrease irritation and staining
Reversible brown staining of teeth and tongue with prolonged use

Question 24

Oral ulceration and inflammation

Answer 24

Refer if longer than 3 weeks
Simple mouthwashes - saline may relieve pain
Antiseptic mouthwashes
Secondary bacterial infection use Chlorohexidine

Question 25

Thrush

Answer 25

Often caused corticosteroid treatment with inhaler use
White inside of mouth
Miconazole; daktarin oral gel used - to for warfarin patients
Nystatin is alternative

Question 26

Other mouthwashes

Answer 26

Benzydamine hydrochloride; difflam
Dilute mouthwashes with equal water if causing stinging
Flurbiprofen lozengers - relief sore throat
Choline salicylate (bonemeal), dental gel too much = irritate mucosa causing ulceration
Other preparations doxycycline rinsed in mouth apotheosis ulceration

Question 27

Pericoronitis

Answer 27

Inflammation of gum tissue surrounding crown
Would give metronidazole or amoxicillin for 3 days

Question 28

Gingivitis

Answer 28

Inflammation of gum
Metronidazole or amoxicillin 3 days

Question 29

Abscess

Answer 29

Pocket of pus inside the gum
Amoxicillin or metronidazole 5 days

Question 30

Periodontitis

Answer 30

Inflammation of the gums and structures supporting the teeth
Give metronidazole or doxycycline if over 12

Question 31

Sore throat (pharyngitis)

Answer 31

Acute
Viral and often self-limiting
Symptoms can last a week
If bacterial then give phen v pr clarithromycin for 5 days
Report in blood dyscarsia causing drugs; e.g methotrexate

Question 32

Tonsillitis

Answer 32

Fever pain score
Red flag; issues with wheezing and breathing difficulties
Pus and inflammation of the Toni’s
Antibiotics often needed if serious

Question 33

Aperitonsilar absess

Answer 33

999 referral
Dehydration breathing difficult
Drainage and antibiotic