ENT/Ophthal

Question 1

Symptoms of secondary bacterial infection of the sinuses (and which sinus commonly)

Answer 1

Pain, swelling and tenderness over cheek

Maxillary sinus

Question 2

How is sinusitis treated?

Answer 2

Antibiotics, analgesia, topical decongestants +/- intranasal CS + antihistamines

Question 3

Types of squint

Answer 3

Concomitant, paralytic

Question 4

Cause of concomitant squint

Answer 4

Refractive error in one or both eyes, can treat via glasses/surgery. Most often inwards

Question 5

Tests for strabismus

Answer 5

Corneal light reflex test and cover test

Question 6

When to give antibiotics for pharyngitis in kids?

Answer 6

If Centor score 3 or more and if any of these RF present:

• systemically unwell
• suppurative complications
• scarlet fever
• patients aged 2-25 with sore throat in communities with a high incidence of rheumatic fever
• patients of any age with existing rheumatic fever/valvular heart disease

Question 7

What antibiotics to give for pharyngitis?

Answer 7

Phenoxymethylpenicillin for 5-10 days/erythromycin if allergic

Question 8

Only prescribe antibiotics for otitis media if

Answer 8

Kid < 6 m/o 
Severe pain 
Perforation
Fever > 48 hours 
Immediate if: infection in only remaining ear, cochlear implant, aboriginal/Torres

Question 9

What antibiotics and dosage for otitis media

Answer 9

Amoxicillin 30-45 mf/kg/d BD for 5 days

Question 10

Complications of otitis media

Answer 10

1. Glue ear/otitis media with effusion
   - clear blue/grey fluid located behind TM, bubbles, eardrum retraction, loss of drum mobility
   - most resolve spontaneously in 4 weeks
   - refer to ENT if > than 3 months
2. Chronic suppurative otitis media
   - perf > 6 weeks
   - can lead to mastoiditis and cholesteatoma
   - MX: dry aural toilet + cipro ear drops
3. Acute mastoiditis
   - tender, red, swollen, fluctuant, protruding auricle/external auditory canal and AOM
   - IV antibiotics: flucloxacillin + 3rd gen cephalosporin

Question 11

Orbital cellulitis management

Answer 11

• admit
• NBM till surgery clarified
• refer ENT and ophthal urgently
• consider urgent contrast enhanced CT of orbits, sinuses and perhaps brain
• FBC, blood culture
• antibiotics for 10-14 days: IV flucloxacillin + Ceftriaxone + vancomycin/augmentin
• treat underlying sinus disease