Exam Flashcards
What is the most common bacterial cause of sore throat?
Strep pyogenes
What are the potential acute and long-term complications of strep throat?
Acute: peritonsillar abscess (quinsy), sinusitis, otitis media, scarlet fever.
Late: rheumatic fever (3 weeks post infection), glomerulonephritis (1-3 weeks post op)
How does diphtheria present?
Severe sore throat, lymphadenopathy, grey/white membrane across the pharynx
How is diphtheria treated?
Antitoxin+ penicillin/erythromycin
Which bacteria are often implicated in acute otitis media?
H. influenzae
Strep pneumoniae
Strep pyogenes
How is acute otitis media treated?
Most resolve without antibiotics. If perforation/otorrheoa- amoxicillin 1st line 7 days, 2nd line doxycycline
When should antibiotics be used in sinusitis and what is first-line?
Deteriorating cases of 7-10 days duration
Penicillin
How is oral thrush treated?
Nystatin
What is the classic triad of symptoms in mono?
Pharyngitis, lymphadenopathy, fever
What other signs/symptoms may be seen in mono?
Palatal petechiae
Jaundice
Splenomegaly
Which lab tests can be used to confirm mono?
Blood film- atypical lymphocytes, lymphocytosis.
Heterophil antibody tests
EBV IgM
Which lab tests can be used to confirm mono?
Blood film- atypical lymphocytes, lymphocytosis.
Heterophil antibody tests
EBV IgM
How does primary gingivostomatitis present and what is the cause?
In childhood-systemic upset, lesions on buccal mucosa and lips
Herpes simplex virus (HSV-1)
Coxsackie enterovirus causes which ENT infections?
Hand foot and mouth
Herpangina
Coxsackie enterovirus causes which ENT infections?
Hand foot and mouth
Herpangina
What is a cholesteatoma?
Squamous epithelium trapped in the skull base
What signs/symptoms are often seen in acute otitis media?
Otalgia
Bulging tympanic membrane
Otorrheoa
Why is epiglottitis now less common in children?
Immunisation against H. influenzae B
Where is the narrowest part of a childs airway?
Sub-glottic space
What are the signs of increased work of breathing?
Accessory muscle use
Tracheal tug
Sternal indrawing
What other signs may indicate a compromised airway?
Stridor
Central cyanosis
Inability to complete sentences
Absent chest sounds
How should a compromised airway be managed?
A B C approach
Nebulised corticosteroids
Nebulised adrenaline
How should a compromised airway be managed?
A B C approach
Nebulised corticosteroids
Nebulised adrenaline
What causes most cases of tonsilitis?
Viruses- influenza virus, rhinovirus, EBV
What is the purpose of the Centor criteria and what are they?
Distinguish bacterial from viral strep throat (and guide whether to give antibiotics)
If three of:
fever, purulent tonsils, cervical lymphadenopathy, NO cough then antibiotics may be of benefit
What is the empirical treatment of bacterial tonsilitis?
10 days penicillin or erythromycin if true penicillin allergy
What are the SIGN guidelines for tonsillectomy?
Tonsillectomy should only be considered if:
a) 7 or more episodes in previous year
b) 5 or more episodes in each of two previous years
c) 3 or more episodes in each of three previous years
What is the classical history of quinsy?
History of preceding acute tonsillitis
Unilateral throat pain, dysphagia and trismus
How is quinsy treated?
Aspiration of abscess + antibiotics
Why should ampicillin and amoxicillin never be used in tonsilitis/glandular fever?
Causes a widespread severe rash in EBV-infected patients
How can otitis media with effusion be managed surgically?
Grommet insertion
Adenoidectomy if persistent
How can otitis media with effusion be managed surgically?
Grommet insertion
Adenoidectomy if persistent
What should be excluded in any patient with unilateral deafness, tinnitus and/or facial nerve palsy? How would this be achieved?
Acoustic neuroma (vestibular Schwannoma). MRI brain scan
How is Meniere’s disease managed?
Lifestyle: avoid salt, caffeine, alchohol.
Tinnitus therapy
Hearing aids
Betahistine may be trialled
What more invasive treatments can be tried for Meniere’s disease?
Grommet insertion
Intratympanic steroids/gentamicin
Which test is used to clinically confirm posterior BPPV?
Dix-Hallpike test. Patient sits on couch so that head will be off the end if they lie down, ask patient to turn head to 45 and warn not to close eyes if dizzy, lie the patient back as quickly as possible, hold in position and observe. Positive test is nystagmus after a delay of around 30 seconds
How does labrynthitis differ from vestibular neuronitis?
Vestibular neuronitis= prolonged vertigo
Labyrinthitis- may be associated hearing loss/tinnitus
What disease may BPPV be confused with? What other symptoms need to present for this diagnosis to be made?
Vertebrobasilar insufficiency
Need other central neurological symptoms + vertigo, e.g. visual disturbance, weakness, numbness
What disease may BPPV be confused with? What other symptoms need to present for this diagnosis to be made?
Vertebrobasilar insufficiency
Need other central neurological symptoms + vertigo, e.g. visual disturbance, weakness, numbness
What are the mainstays of treatment of allergic rhinitis?
Oral antihistamines
Topical nasal corticosteroids
What are the two main symptoms of nasal polyps?
Rhinorrhoea
Nasal obstruction
What is the mainstay of treatment of nasal polyps, and why should unilateral polyps always be referred?
Topical nasal corticosteroids
Investigation of possible underlying malignancy
What are the possible complications of sinusitis?
Orbital cellulitis Meningitis Cavernous sinus thrombosis chronic infection brain abscess osteomyelitis
Sudden onset off facial nerve palsy often after URTI
Bell’s palsy
Why does stroke spare the upper face?
Bilateral motor innervation of the upper face
Management of Bell’s palsy?
High dose oral steroids + eye protection (taping, ocular lubricants)
