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BNF Chapters > ENT > Flashcards

ENT Flashcards

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
Q

Why is hypromellose preferred to carbomer

A

Carbomer impacts vision

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26
Q

Preservative free or preservative

A

Preservative free better especially if chronic/frequent use

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27
Q

Ocular lubricants ingredients

A

Sodium hyaluronate, hydroxypropyl guar, carmellose soidum

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28
Q

When are ocular lubricants used

A

Moderate to severe dry eye, after 6-8 week trial of mild treatment

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29
Q

Treating anterior segment inflammation

A

Corticosteroids topically

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30
Q

Treating macular oedema

A

IV implant containing dexamethasone of fluocinolone

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31
Q

Topical treatment for eye inflammation and allergic conjunctivitis

A

Antihistamines, lodoxamide, sodium cromoglicate, diclofenac eye drops, ketotifen

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32
Q

Treating severe keratitis

A

Ciclosporin

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33
Q

Common cause of blepharitis

A

Staph

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34
Q

Bacterial conjunctivitis common cause

A

Strep pneumoniae, staph a, haem influenzae

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35
Q

Treating blepharitis

A

Chloramphenicol

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36
Q

Blepharitis symptoms

A

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

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37
Q

Keratitis cause

A

Bacterial, viral, fungal

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38
Q

What is age related macular degeneration

A

Progressive eye condition affecting the macula ( central area of retina)

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39
Q

What is the macula

A

Central area of retina

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40
Q

What AMD is worse dry or wet

A

Wet

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41
Q

Difference between dry and wet AMD

A

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
Q

Different wet AMD

A

Active=neovascular lesions benefit from treatment and inactive= irreversible structural change

43
Q

Treatment of wet AMD

A

Smoking cessation , anti-VEGF (Afilbercept, bevacizumab)

44
Q

Risk factors for glaucoma

A

Age, family history, ethnicity, corticosteroid, myopia, type 2 diabetes mellitus, CVD and hypertension, raised intra-ocular pressure

45
Q

Common form of glaucoma

A

Chronic open-angle glaucoma it means drainage of aqueous humour through trabecular meshwork it is asymptomatic then loss of vision as progresses.

46
Q

Less common form of glaucoma

A

Acute angle-closure is less common, aqueous outflow is completely obstructed

47
Q

Treating ocular pressure

A

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
Q

Brinzolamide or dorzolamide class

A

carbonic anhydrase inhibitors

49
Q

Topical sympathomimetic

A

apraclonidine

50
Q

topical miotic example

A

Pilocarpine

51
Q

Eye betablockers

A

Betaxolol, levobunolol hydrochloride, or timolol maleate

52
Q

Topical prostglandin analogue treatment

A

Latanoprost, tafluprost, travoprost, or bimatoprost

53
Q

Treating chronic open angle glaucoma

A

Topical prostaglandin analogues if not beta if not carbonic inhibitor or topical sympathomimetic

54
Q

Effect of antimuscarinics on pupil

A

Dilate and paralyse the ciliary muscle

55
Q

What is mydriatic

A

Eye dilates

56
Q

What is miotic

A

Eye closes

57
Q

Cycloplegia

A

Paralysis of ciliary muscle

58
Q

When are myadriatic and cycloplegia used for

A

Anterior uveitis

59
Q

Sinusitis

A

Inflammation of the mucosal lining of the paranasal sinuses.

60
Q

Sinusitis symptoms

A

Nasal blockage or congestion, nasal discharge, dental or facial pain or pressure, and reduction or loss of the sense of smell.

61
Q

Sinusitis cause

A

URTI e.g. Common cold

62
Q

Normal length of sinusitis

A

2-3 weeks

63
Q

How to treat patients with sinusitis that have had symptoms for 10 or less days

A

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
Q

How to treat patients with sinusitis that have had symptoms for 10 or more days

A

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
Q

Rare sinusitis symptoms that need referring to hospital

A

Orbital, intracranial or skeletal complications (e.g. periorbital cellulitis, symptoms or signs of meningitis)

66
Q

Rhinitis causes

A

Acute/chronic allergic or non allergic

67
Q

Treating rhinitis

A

Nasal spray and drop

68
Q

Treating nasal allergy

A

Sodium chloride, antihistamines, nasal corticosteroids

69
Q

Nasal corticosteroid

A

Mometasone, fluticasone, betamethasone use short term

70
Q

What nasal corticosteroids can be used in pregnant

A

Fluticasone has lowest systemic absorption but beclo, budesonide and fluticasone can technically be used

71
Q

Pregnancy and decongestants

A

Not recommended but some antihistamines and sodium cromoglicate can be used

72
Q

Topical nasal decongestants

A

NaCl

73
Q

Issue with decongestant

A

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
Q

How to eliminate nasal staph

A

Chlorhexidine with neomycin (naseptic) or mupirocin

75
Q

When is muprocin used in hospitals

A

To get rid of MRSA

76
Q

Treating superficial mouth infections

A

Warm mouthwashes

77
Q

How to use mouthwashes effectively

A

Frequently and vigorously

78
Q

How to make salt water

A

Half a teaspoonful of salt in glassful of warm water

79
Q

Treating ulcerative gingivitis

A

Mouthwash with hydrogen peroxide

80
Q

What is chlorhexidine

A

Antiseptic

81
Q

Chlorhexidine effect

A

Inhibits plaque formation

82
Q

Chlorhexidine indication

A

Denture stomatitis, oral candidiasis,

83
Q

Chlorhexidine side effects

A

Reversible brown staining of teeth and tongue, may interact with some toothpaste

84
Q

Cause of dry mouth

A

Reduced saliva secretion, antimuscarinics, antihistamines, TCA diuretics, dehydration, anxiety, infection

85
Q

How to relieve dry mouth

A

Sucking pieces of ice, sugar-free fruit pastilles, chewing sugar-free gum, pilocarpine, oral lozenges/gel/spray/pastille

86
Q

Gingivitis treatment

A

Metronidazole or amoxicilin

87
Q

Treating oropharyngeal abscess

A

Amoxicillin or metronidazole

88
Q

peridontitis treatment

A

Metronidazole

89
Q

Corticosteroids and thrush

A

Increase risk of thrush

90
Q

How to sort thrush associated with corticosteroids

A

Rinsing mouth

91
Q

Treating denture stomatitis

A

Miconazole, cleanse dentures

92
Q

Angular cheilitis is

A

Angular stomatitis

93
Q

Angular chelitis characterisation

A

Soreness erythema and fissuring at angles of mouth

94
Q

Angular cheilitis treatment

A

Miconazole fusidic acid if not working then hydrocortisone with miconazole

95
Q

Drugs used to treat oropharyngeal candidasis

A

Nystatin, miconazole locally if not then fluconazole

96
Q

What to do if oropharyngeal candidiasis last longer than 1-2 weeks

A

Send for investigation to try and identify eliminate underlying

97
Q

How to prevent oral candidiasis

A

Antiseptic mouthwashes in immunocompromised and those with denture stomatitis

98
Q

Common cause of sore throat

A

Viral

99
Q

Primary hepatic gingivostomatitis treatment

A

Soft diet, fluid intake, analgesics and benzydamine, chlorhexidine

100
Q

Treating severe hepatic stomatitis

A

Aciclovir

BNF Chapters (11 decks)

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