ENT SDL Flashcards
qs to ask px with earache after swimming?
- Duration and nature of pain and getting worse?
- Associated symptoms: hearing loss/ discharge or cold
- Had similar issues before? Esp after swimming / any other trigger/ event
- Taken any meds?
what red flags would trigger referral for a child that is experiencing earache after swimming in the sea
dizziness
tinnitus
pain in middle ear
fever
malaise
foreign body
deafness
inflammation of pinna
what are the benefits of topical over systemic abx for the management of otitis externa
systemic abx have little penetration into external auditory canal, topical treatment with steroids most effective
name 2 common causative agents of otitis externa
staph aureus and pseudomonas
so topical tx better
what treatment advice can you give someone with otitis externa
avoid water
good pain control
microsuction of debris
avoid cotton buds
keep ears clean and dry
use ear plugs and tight cap when swimming
keep shampoo soap and water out of ear when bathing
it is important to ensure that topical treatments are being used correctly to treat otitis externa, if patients are not responding to drops what formulation can you switch to and vice versa
sprays
true or false, if you suspect contact sensitivity to neomycin or another aminoglycoside you should switch patients to non aminoglycosides
true
avoid anything with gentamicin/ neomycin
what abx should not be given to patients with perforated tympanic membranes and why
aminoglycosides due to ototoxicity
under what circumstances would it be okay to give gentamicin or neomycin to treat otitis externa
active discharge
what drug may be used with caution if tympanic membrane is perforated but pseudomonas is suspected
ciprofloxacin
otitis media is usually self limiting and can be resolved itself within what time period
3 days to 1 week
what analgesia can be used regularly for pain management in otitis media
paracetamol or ibuprofen
true or false, there is no evidence to suggest the use of decongestants or antihistamines for the management of otitis media symptoms
true
there is no restrictions to daily activities in otitis media, but what might you tell patients to avoid doing if there is evidence of tympanic membrane perforation
swim
if otitis media progresses to systemic infection, broad spectrum abx are used, name some different options
amoxicillin, co amoxiclav, clarithromycin
broad spectrum abx are useful to target what causative organism in otitis media complications
strep pneumoniae
what is meant by conservative treatment
pain management
if yellow discharge starts dripping from ear in the case of otitis media, is this serious
perforated tympanic membrane common in otitis media as pressure in ears eased
discharge from ears in otitis media should ease within x weeks but beyond that requires referral to ent
6
why should gentamicin drops be avoided in the case of perforated tympanic membranes
ototoxic
what drug may be given for otitis externa and otitis media with tympanic membrane perforation
ciprofloxacin
in addition to the usual symptoms of otitis media what would suggest a new diagnosis of acute mastoiditis
ear pushed forward
redness and swelling behind pinna
bulging red tympanic membrane
what treatment considerations must be made for acute mastoiditis tests toconduct
ct scans
surgery arranged by ent
patient review
iv fluids
blood tests
abx
nil by mouth in case of surgery and refer ent
list some different abx that can be recommended for use in the case of intracranial sepsis
cephalosporin
clindamycin
metronidazole
cephalexin
If concern about resistance;
o Vancomycin and cefotaxime
o Clindamycin
o Vancomycin … tazobactam..
o V strong antibiotics
empirical treatment for intracranial sepsis should target what different organisms
staph aureus
staph pyrogenes
strep pneumoniae
treatment for intracranial sepsis should cover sinus pathogens that exhibit beta lactamase resistance and be able to penetrate the
CSF
if resistance was of particular concern what abx might be considered for intracranial sepsis
clindamycin
vancomycin
piperacillin tazobactam
what symptoms of a sore throat would trigger a referral
signs of epiglottis
breathing difficulty
abscess
over a week
rash
earache
signs of systemic illness
tonsillar exudate
rheumatic fever
parotid gland swelling
list some medications known to cause blood disorders that may present with sore throat and require immediate medical attention
clozapine
cytotoxics
sulfasalazine
sulfonamides
penicillamine
carbimazole
Sulphonamide including co-trimoxazole and trimethoprim
what otc remedies are available to manage sore throats that dont need to be referred
- Demulsants
- Honey and glycerin syrups
- Lozenges to soothe throat – stop dryness
- Antiseptics like benzylcholine lozenge
Local anaesthetics containing bezalkain - Volatiles like menthol
- Antinflamm sprays
- diflam
give example of demulsant
honey and sugar
viral or bacterial tonsilitis
glands not enlarged
low grade fever
cough
viral
viral or bacterial tonsillitis
often children
cough rare
high grade fever
exudate present
swollen glands
bacterial
what tools can be used to diagnose tonsilliitis
feverpain and centor
what class of abx are most effective in treating acute bacterial tonsillitis
penicillins
what drug can be used for acute bacterial tonsillitis in the case of penicillin allergy
clarithromycin
why should amoxicillin be avoided in acute bacterial tonsillitis
can cause macular papillar rash if glandular fever present
what symptoms would indicate the tonsillitis has progressed to quinsy
swelling above tonsils
uvula pushed aside
pyrexial
pain
pus
abscess
which abx are best to treat tonsillitis and peritonsillar abscesses
metronidazole added to penicillin
why might metronidazole be added to penicillin the event of quinsy
cover raised possibility of anaerobic bacteria
why might dexamethasone be added to the treatment regime of quinsy
help reduce swelling
what are the management steps for quinsy
admission under ent
aspiration and incision of pus
improve breathing
iv abx
what are the common bacterial causes of acute sinusitis
streptococcus
haemophylus influenzae
moraxella catharrhalis
staph aureus
strep pyrogenes
what are the common viral causative agents of acute sinusitis
o rhinoviruses
o influenzas
o para influenza viruses
are most acute cases of sinusitis due to viral or bacterial causes
viral
in complicated cases of sinusitis that do not resolve in 5 days or in children that are septic antibacterial therapy may be needed, what can be used first line and then second line after 48 hrs if no improvement
phenoxymethylpenicllin or amoxicillin first line and then co amoxiclav
what are the common bacterial causative agents of acute sinusitis
o strep pneumoniae
o H influenzae
o Moraxella catarrhalis
o Strep progenys
what non pharmacological treatment can be used for acute sinusitis
nasal decongestants and saline douching
first line tx if pen allergic?
clarithromycin
operative management for sinusitis is reserved for what cases
oral complications or chronic sinusitis
steam inhalation, oral corticosteroids and anthistamines may be used for acute sinusitis unless allergic rhinitis is present, What might mucolytics be used for
thin mucus making it easier to pass
what physiochemical barriers affect nasal drug delivery
molecular size
weight of drug
lipophilicity
diffusion co efficient
what physiological barriers exist for nasal drug delivery
foreign material trapped in viscous mucus
enzymatic activity
epithelial bacterial
mucocilliary clearance
true or false dental abscess can cause sinusitis
true
do lower resp tract infections usually cause sinusitis in patients that are immunocompromised, yes or no
no
how might chronic sinusitis without nasal polyps be managed
topical steroid
nasal saline irrigation
oral abx in exacerbation
for chronic sinusitis abx can be given over x week period provided that there are breaks in between
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