ENT Flashcards
What is otitis externa
Inflammatory reaction of meatus skin
What to do before treating otitis externa
Rule out underlying chronic otitis media
Treating otitis externa
Thorough cleansing via suction or dry mopping, to apply lotions may need ribbon gauze dressing or sponge wick soaked with astringent/corticosteroid ear drops
Treating otitis externa infection pharmacologically
Topical neomycin or clioquinol, chloramphenicol, aluminium acetate , if staph the fluclox/ciproflox
What is acute otitis media
Self-limiting condition characterised by inflammation in middle ear
Acute otitis media symptoms
Ear pain, rubbing of the ear, fever, irritability, crying, poor feeding, restlessness at night, cough, or rhinorrhoea
Other name for otitis media
Glue ear
How long does acute otitis media last
3-7 days without Antibiotics
Treating acute otitis media
Paracetamol, ibuprofen, Antibiotics if systemically unwell and refer severe infection to hospital
Otitis media with effusion treatment
Active observation over 6–12 weeks is appropriate for most children, as spontaneous resolution is common.
Otitis media with effusion is
Characterised by the collection of fluid within the middle ear without any signs of inflammation.
Removing ear wax
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.
Causes of otitis externa
P aeruginosa or staph a
Treating otitis externa infection
Fluclox or clarithromycin (if penicillin allergy) or ciprofloxacin if pseudomonas
Otitis media infection treatment
Amoxicillin second line co-amox, clari/erythromycin if penicillin allergy
How to use eye drops
Pull down lower eyelid keep eye closed for long as possible
What to do when two eye drops needed
5 minute interval
When to stop using eye drop
More than 4 weeks since opening at home or 1 week in hospital
Drugs with effect on contact lenses
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).
Purulent meaning
consisting of, containing, or discharging pus.
Treating purulent conjunctivitis
Chloramphenicol
Dry eye presentation
Chronic soreness, inflammation of ocular surface associated with reduced/abnormal tear secretion
Treating dry eye
Eye drops/ointment at night or gels
Treating mild dry eye
Hypromellose frequently if not then carbomers and polyvinyl alcohol
Why is hypromellose preferred to carbomer
Carbomer impacts vision
Preservative free or preservative
Preservative free better especially if chronic/frequent use
Ocular lubricants ingredients
Sodium hyaluronate, hydroxypropyl guar, carmellose soidum
When are ocular lubricants used
Moderate to severe dry eye, after 6-8 week trial of mild treatment
Treating anterior segment inflammation
Corticosteroids topically
Treating macular oedema
IV implant containing dexamethasone of fluocinolone
Topical treatment for eye inflammation and allergic conjunctivitis
Antihistamines, lodoxamide, sodium cromoglicate, diclofenac eye drops, ketotifen
Treating severe keratitis
Ciclosporin
Common cause of blepharitis
Staph
Bacterial conjunctivitis common cause
Strep pneumoniae, staph a, haem influenzae
Treating blepharitis
Chloramphenicol
Blepharitis symptoms
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
Keratitis cause
Bacterial, viral, fungal
What is age related macular degeneration
Progressive eye condition affecting the macula ( central area of retina)
What is the macula
Central area of retina
What AMD is worse dry or wet
Wet
Difference between dry and wet AMD
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.
Different wet AMD
Active=neovascular lesions benefit from treatment and inactive= irreversible structural change
Treatment of wet AMD
Smoking cessation , anti-VEGF (Afilbercept, bevacizumab)
Risk factors for glaucoma
Age, family history, ethnicity, corticosteroid, myopia, type 2 diabetes mellitus, CVD and hypertension, raised intra-ocular pressure
Common form of glaucoma
Chronic open-angle glaucoma it means drainage of aqueous humour through trabecular meshwork it is asymptomatic then loss of vision as progresses.
Less common form of glaucoma
Acute angle-closure is less common, aqueous outflow is completely obstructed
Treating ocular pressure
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]
Brinzolamide or dorzolamide class
carbonic anhydrase inhibitors
Topical sympathomimetic
apraclonidine
topical miotic example
Pilocarpine
Eye betablockers
Betaxolol, levobunolol hydrochloride, or timolol maleate
Topical prostglandin analogue treatment
Latanoprost, tafluprost, travoprost, or bimatoprost
Treating chronic open angle glaucoma
Topical prostaglandin analogues if not beta if not carbonic inhibitor or topical sympathomimetic
Effect of antimuscarinics on pupil
Dilate and paralyse the ciliary muscle
What is mydriatic
Eye dilates
What is miotic
Eye closes
Cycloplegia
Paralysis of ciliary muscle
When are myadriatic and cycloplegia used for
Anterior uveitis
Sinusitis
Inflammation of the mucosal lining of the paranasal sinuses.
Sinusitis symptoms
Nasal blockage or congestion, nasal discharge, dental or facial pain or pressure, and reduction or loss of the sense of smell.
Sinusitis cause
URTI e.g. Common cold
Normal length of sinusitis
2-3 weeks
How to treat patients with sinusitis that have had symptoms for 10 or less days
self-care of pain or fever with paracetamol or ibuprofen, and maybe nasal saline or decongestion but there is no evidence for it helping
How to treat patients with sinusitis that have had symptoms for 10 or more days
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
Rare sinusitis symptoms that need referring to hospital
Orbital, intracranial or skeletal complications (e.g. periorbital cellulitis, symptoms or signs of meningitis)
Rhinitis causes
Acute/chronic allergic or non allergic
Treating rhinitis
Nasal spray and drop
Treating nasal allergy
Sodium chloride, antihistamines, nasal corticosteroids
Nasal corticosteroid
Mometasone, fluticasone, betamethasone use short term
What nasal corticosteroids can be used in pregnant
Fluticasone has lowest systemic absorption but beclo, budesonide and fluticasone can technically be used
Pregnancy and decongestants
Not recommended but some antihistamines and sodium cromoglicate can be used
Topical nasal decongestants
NaCl
Issue with decongestant
Contain sympathomimetics which work via vasocontriction reducing oedema but in long term use = rebound congestion resulting in a cycle if patient uses decongestent again
How to eliminate nasal staph
Chlorhexidine with neomycin (naseptic) or mupirocin
When is muprocin used in hospitals
To get rid of MRSA
Treating superficial mouth infections
Warm mouthwashes
How to use mouthwashes effectively
Frequently and vigorously
How to make salt water
Half a teaspoonful of salt in glassful of warm water
Treating ulcerative gingivitis
Mouthwash with hydrogen peroxide
What is chlorhexidine
Antiseptic
Chlorhexidine effect
Inhibits plaque formation
Chlorhexidine indication
Denture stomatitis, oral candidiasis,
Chlorhexidine side effects
Reversible brown staining of teeth and tongue, may interact with some toothpaste
Cause of dry mouth
Reduced saliva secretion, antimuscarinics, antihistamines, TCA diuretics, dehydration, anxiety, infection
How to relieve dry mouth
Sucking pieces of ice, sugar-free fruit pastilles, chewing sugar-free gum, pilocarpine, oral lozenges/gel/spray/pastille
Gingivitis treatment
Metronidazole or amoxicilin
Treating oropharyngeal abscess
Amoxicillin or metronidazole
peridontitis treatment
Metronidazole
Corticosteroids and thrush
Increase risk of thrush
How to sort thrush associated with corticosteroids
Rinsing mouth
Treating denture stomatitis
Miconazole, cleanse dentures
Angular cheilitis is
Angular stomatitis
Angular chelitis characterisation
Soreness erythema and fissuring at angles of mouth
Angular cheilitis treatment
Miconazole fusidic acid if not working then hydrocortisone with miconazole
Drugs used to treat oropharyngeal candidasis
Nystatin, miconazole locally if not then fluconazole
What to do if oropharyngeal candidiasis last longer than 1-2 weeks
Send for investigation to try and identify eliminate underlying
How to prevent oral candidiasis
Antiseptic mouthwashes in immunocompromised and those with denture stomatitis
Common cause of sore throat
Viral
Primary hepatic gingivostomatitis treatment
Soft diet, fluid intake, analgesics and benzydamine, chlorhexidine
Treating severe hepatic stomatitis
Aciclovir
