Eyes Ears Mouth Flashcards
1
Q
What is conjunctivitis?
A
Inflammation of the conjunctiva, the thin membrane covering the white of the eye and inside surface of the eyelids.
2
Q
What are common symptoms of conjunctivitis?
A
Irritation, itching, grittiness in the eye, and watering or discharge.
3
Q
What are the typical causes of conjunctivitis?
A
Viral, bacterial, or allergic; with Staphylococcus and Haemophilus influenzae as common bacterial causative organisms.
4
Q
How can bacterial conjunctivitis be identified?
A
Yellow-white discharge, bilateral infection, and the absence of itching are suggestive; usually self-limiting.
5
Q
What characterizes allergic conjunctivitis?
A
Bilateral, itching eyes with oedema and clear watery discharge; often associated with allergic rhinitis, eczema, or asthma.
6
Q
What causes seasonal allergic conjunctivitis?
A
Mostly caused by pollen.
7
Q
What causes perennial allergic conjunctivitis?
A
Allergens such as house dust mite.
8
Q
What are danger symptoms in newborns with conjunctivitis?
A
Chronic conjunctivitis within 14 days after birth may indicate Chlamydia; profuse, purulent conjunctivitis within the first seven days may indicate gonorrhoea, requiring urgent medical treatment.
9
Q
What complications can bacterial conjunctivitis in infants lead to?
A
Secondary infections like otitis media, meningitis, or septicaemia, especially in premature infants.
10
Q
What should be considered in conjunctivitis differential diagnoses?
A
Any pain beyond discomfort, marked redness, or impaired vision requires further investigation for possible acute glaucoma, keratitis, or iritis.
11
Q
How does bacterial conjunctivitis in infants differ from adults?
A
It can lead to more severe complications like otitis media, meningitis, or septicaemia.
12
Q
What distinguishes allergic conjunctivitis from bacterial conjunctivitis in terms of discharge?
A
Bacterial conjunctivitis has a yellow-white discharge, while allergic conjunctivitis has a clear watery discharge.
13
Q
What urgent medical treatment may be needed in newborns with conjunctivitis symptoms?
A
Symptoms in a baby under 28 days old need urgent medical attention to distinguish from a simple sticky eye and identify potential serious infections like Chlamydia or gonorrhoea.
14
Q
What distinguishes bacterial conjunctivitis from viral conjunctivitis?
A
Bacterial conjunctivitis often has yellow-white discharge and may be self-limiting, while viral conjunctivitis is typically associated with clear watery discharge.
15
Q
What is the role of the conjunctiva in the eye?
A
The conjunctiva is a thin protective membrane that covers the white of the eye and the inside surface of the eyelids.
16
Q
How is allergic conjunctivitis linked to other allergic conditions?
A
Patients with allergic conjunctivitis often also suffer from allergic rhinitis, eczema, or asthma, indicating a systemic allergic response.
17
Q
What is the distinction between seasonal and perennial allergic conjunctivitis?
A
Seasonal allergic conjunctivitis is mostly caused by pollen, while perennial allergic conjunctivitis is triggered by allergens like house dust mite throughout the year.
18
Q
Why is conjunctivitis in newborns a cause for urgent medical attention?
A
Conjunctivitis symptoms in a baby under 28 days old may indicate serious infections like Chlamydia or gonorrhoea, requiring prompt medical treatment.
19
Q
What potential complications may arise from bacterial conjunctivitis in infants?
A
Premature infants, particularly, are at risk of secondary infections such as otitis media, meningitis, or septicaemia.
20
Q
When should further investigation be considered in conjunctivitis cases?
A
If there is more than discomfort, marked redness, or impaired vision, further investigation is needed to rule out serious conditions like acute glaucoma, keratitis, or iritis.
21
Q
How does conjunctivitis in newborns due to Chlamydia present?
A
Chlamydia presents with chronic conjunctivitis within 14 days after birth and requires urgent medical attention.
22
Q
What distinguishes gonorrhoea-related conjunctivitis in newborns?
A
Gonorrhoea may present with profuse, purulent conjunctivitis within the first seven days of life, necessitating urgent medical treatment.
23
Q
What precautions should be taken with NSAIDs in conjunctivitis treatment?
A
NSAIDs may be considered for pain relief, but caution is advised due to potential adverse effects, especially in certain populations.
24
Q
How can conjunctivitis symptoms be managed without medication?
A
Topical heat, such as warm compresses, can help alleviate symptoms, providing a non-pharmacological approach to relief.
25
What lifestyle factors can contribute to the severity of conjunctivitis symptoms?
Smoking and excess weight have been associated with more severe symptoms, emphasizing the importance of lifestyle modifications.
26
What should be considered in managing conjunctivitis in infants?
Conjunctivitis in infants, especially premature ones, should be closely monitored for potential complications like secondary infections.
27
What distinguishes the discharge in bacterial conjunctivitis from allergic conjunctivitis?
Bacterial conjunctivitis typically presents with a yellow-white discharge, while allergic conjunctivitis has a clear watery discharge.
28
What are the treatment options for infective conjunctivitis?
Chloramphenicol eye drops and eye ointment, available without prescription, are commonly used for their broad-spectrum activity against Gram-positive and Gram-negative bacteria.
29
What has clinical research shown about the efficacy of topical antibiotics in bacterial conjunctivitis?
Cure rates for suspected bacterial conjunctivitis are similar whether treated with a topical antibiotic or a placebo, but topical antibiotics can shorten the time taken to cure the infection.
30
When is the use of topical eye drops beneficial in bacterial conjunctivitis?
In culture-positive bacterial conjunctivitis, topical eye drops show a benefit in cure rate and duration, but this facility is not commonly available.
31
How should chloramphenicol eye drops be applied in the first two days of treatment for conjunctivitis?
Every two hours, and then every four hours thereafter, continuing treatment for a minimum of five days, even if symptoms improve.
32
What adverse effects are associated with chloramphenicol eye ointment?
Transient blurred vision, transient localized stinging, and burning sensations.
33
Are OTC chloramphenicol preparations suitable for pregnant or breastfeeding individuals and children under two?
No, they should not be used in these cases, and patients in these categories require routine referral to their GP.
34
What are other OTC preparations for conjunctivitis treatment?
Brolene® and Golden eye® brands containing propamidine isethionate for antibacterial, trypanocidal, and fungicidal activity against certain bacteria and fungi.
35
What is the antibacterial and antifungal property of dibromopropamidine isethionate found in ointment preparations?
It is active against pyogenic cocci, Staphylococcus aureus, certain Gram-negative bacteria, and fungi like Aspergillus niger and Candida albicans.
36
How often should Brolene® or Golden eye® drops be applied for conjunctivitis treatment?
Four times a day, although hourly use has been suggested for achieving the required antimicrobial levels.
37
How often should the ointment preparations containing dibromopropamidine isethionate be applied for conjunctivitis?
Once or twice daily, potentially used at night in combination with daytime drops.
38
What are rapid-acting and highly effective treatments for allergic conjunctivitis?
Topical antihistamines, such as Otrivine-antistin®, containing antazoline and xylometazoline to relieve redness.
39
Why is prolonged use of Otrivine-antistin® not advised?
Prolonged use is not recommended due to potential side effects; it's important to follow usage guidelines.
40
How do topical mast cell stabilizers, like sodium cromoglicate (Opticrom®), work in allergic conjunctivitis?
They prevent the release of histamine and other inflammatory mediators from mast cells, providing relief.
41
What is the recommended frequency of use for topical mast cell stabilizers?
Regular use up to four times a day for up to 14 days is recommended for optimal benefit.
42
What special considerations should contact lens wearers be aware of?
Potential bacterial conjunctivitis can lead to bacterial keratitis, posing a threat to vision. Acanthamoeba infection, though rare, should also be considered. Contact lenses should not be worn during infection treatment.
43
How does benzalkonium chloride, a preservative in eye drops, affect contact lens wearers?
It can interact with soft contact lenses, so they should not be worn during treatment or for 24 hours after treatment.
44
What precautions should contact lens wearers take during eye infection treatment?
Thorough cleaning of lenses is imperative to prevent future infection, and lenses should not be worn in the presence of infection.
45
Why are eye infections highly contagious, and what precautions should be taken?
Patients should wash hands thoroughly after touching the eyes and avoid sharing towels or pillows to prevent the spread of infection.
46
How can cold compresses help in conjunctivitis, and why are they recommended?
Cold compresses may soothe the eye in any form of conjunctivitis, providing relief from symptoms.
47
What practical tips can help manage allergic conjunctivitis triggered by pollen?
Avoidance of trigger factors, such as pollen, is key. Some people find that wearing sunglasses helps reduce symptoms.
48
What should be questioned during a patient history to determine the need for urgent referral?
Question the patient on a history of foreign body presence or eye injury, as it may indicate the need for urgent GP referral or a visit to an accident and emergency department.
49
What produces tears in the eyes?
Lacrimal glands, ocular surface epithelium, conjunctival goblet cells, and meibomian glands.
50
How are tears distributed and drained?
Tears are distributed by blinking and drain via the lacrimal ducts.
51
What is dry eye syndrome, and what can aggravate it?
Dry eye syndrome (keratoconjunctivitis sicca) is a tear deficiency causing eye discomfort, aggravated by factors such as dry air, dust, wind, and smoke.
52
What factors can cause decreased tear production?
Drugs, Sjögren’s syndrome, allergy, dehydration, trauma (e.g., surgery, radiation), abnormal ocular surface, disruption of trigeminal sensory nerves, and decreased lipid production by meibomian glands.
53
What is the relationship between blepharitis and dry eye syndrome?
Dry eye syndrome is associated with, a complication of, and may be exacerbated by chronic blepharitis. Low tear film phospholipids in blepharitis can lead to increased tear film evaporation and dry eyes.
54
What are common symptoms of dry eye?
Feeling of irritation or grittiness, transient blurring of vision, and excessive tearing (watery eyes). Patients may not complain of ‘dryness.’
55
How can dry eye symptoms be managed?
Removal of exacerbating factors (e.g., adverse drug reactions, environmental conditions) and treating underlying conditions such as blepharitis.
56
What complications can arise from dry eye?
Complications include filamentary keratitis (fine filaments of epithelium and mucus attached to the cornea) and epithelial damage leading to corneal ulceration.
57
How does a viral or bacterial infection in the eyes present?
Described as grittiness or foreign body sensation, with red and inflamed conjunctiva, discharge making eyelids stick together.
58
What are danger symptoms of dry eye?
Complications such as filamentary keratitis or epithelial damage leading to corneal ulceration.
59
What is the differential diagnosis for grittiness in the eyes?
Viral or bacterial infection, presenting with red and inflamed conjunctiva and discharge causing eyelids to stick together.
60
What is the first-line choice for treating dry eye syndrome?
Artificial tear preparations, with Hypromellose being the most widely available and cost-effective treatment.
61
Are there significant differences among artificial tear preparations?
There is no evidence to suggest superiority among artificial tear preparations, although carbomer-based ones may cling to the eye surface more readily, allowing reduced frequency of application.
62
How frequently should artificial tear preparations be used?
As frequently as necessary to relieve symptoms.
63
What are potential adverse effects of artificial tear preparations?
Ocular irritation, especially due to preservatives, may occur if used very frequently. Preservative-free drops could be considered to minimize this, although they are a more expensive option.
64
What should patients be reminded of regarding artificial tear drops?
Preserved drops should be discarded after 28 days, and single-application packs (Minims®) should be discarded immediately after use.
65
What are the components of lubricant eye ointments like Lacri-lube®?
They contain liquid paraffin, white soft paraffin, and wool alcohols, providing prolonged lubrication, and are suitable for bedtime use due to transient blurring of vision.
66
Can lubricant eye ointments be used during contact lens wear?
No, ointments should not be used during contact lens wear.
67
What is the astringent found in some eye preparations, and what is its value?
Witch hazel is found in products like Optrex® and Eye dew®, but its value is doubtful.
68
What is essential for managing blepharitis in terms of eye care?
Good eye care, including using boiled and cooled water to soak cotton wool for gentle cleaning of eyelids, and occasionally using antibiotic ointments if bacterial debris infiltrates the conjunctiva.
69
Which antibiotic ointment can be used for eye infection in blepharitis sufferers?
Chloramphenicol ointment can be used for signs of eye infection in individuals with blepharitis.
70
What is ear wax composed of?
Ear wax is a combination of cerumen, sebum, desquamated corneocytes, sweat, hair, and foreign matter like dust.
71
Why is ear wax considered normal and necessary?
Ear wax is needed to protect the ear canal, but it becomes a problem if it causes deafness, pain, or obstructs inspection by a healthcare professional.
72
What can contribute to the build-up of ear wax?
Factors such as wearing hearing aids or using cotton buds for cleaning can prevent normal extrusion of ear wax, leading to build-up.
73
What are the symptoms of otitis externa?
Itch, dullness of hearing, discharge, and pain characterize otitis externa, which can be caused by infection, allergy, or irritation.
74
What are common irritants for otitis externa?
Shampoo, soap, or water can act as irritants, particularly in swimmers. Tight-fitting caps and earplugs are recommended for prevention in swimmers.
75
What advice should be given to otitis externa sufferers?
Avoid irritants, keep the ear canal dry, and refrain from using cotton buds.
76
What characterizes otitis media (inflammation of the middle ear)?
Severe ear pain, often preceded by upper respiratory tract symptoms, commonly occurring in children under 10 years.
77
What are systemic symptoms associated with otitis media?
Fever, nausea, vomiting, inexplicable crying, irritability, and frequent tugging at the ear may be present.
78
What are possible long-term consequences of recurrent acute otitis media?
Atrophy and scarring of the eardrum, chronic perforation with otorrhoea, cholesteatoma (skin growth behind the middle ear), and chronic or permanent hearing loss.
79
When is referral warranted for otitis media symptoms?
Referral is warranted if symptoms are unresolved after three days or are severe, considering potential long-term consequences.
80
What could cause deafness and pain in the ear?
Presence of a foreign body in the ear, especially in children, may cause deafness and pain, requiring referral for examination.
81
When is referral necessary for otitis externa or otitis media?
Referral is necessary for severe or persisting ear pain for three or more days, suggesting otitis externa or otitis media due to infection.
82
What is glue ear, and when is referral necessary for this condition?
Glue ear (otitis media with effusion) is the accumulation of fluid resembling glue in the middle ear. Referral is necessary if there is continuing dulled hearing.
83
What are first-line choices for treating impacted ear wax?
Cerumenolytics, such as urea-hydrogen peroxide (Otex®, Exterol®), are the most appropriate first-line choices.
84
How do cerumenolytics work to treat impacted ear wax?
Cerumenolytics hydrate desquamated corneocytes, the major constituent of cerumen plugs, inducing keratolysis and disintegration of the wax.
85
What are recommended cerumenolytics according to PRODIGY?
Warm tap water, sodium chloride 0.9%, sodium bicarbonate ear drops, olive oil, and almond oil are recommended. Organic solvents in proprietary preparations may irritate the ear canal.
86
Why may proprietary preparations be advantageous?
They come with instructions for use and an appropriate dropper, which may be preferred by some patients.
87
What precautions should be taken for people with nut allergies?
People with nut allergies should avoid using almond oil.
88
What potential side effect may occur with sodium bicarbonate ear drops?
Dryness of the ear canal may occur, and the preparation should be applied generously, with the patient lying with the affected ear uppermost for five to ten minutes to allow penetration.
89
When is referral for irrigation necessary, and who should avoid ear irrigation?
Referral for irrigation is necessary if deafness or pain persists after using ear wax softeners. Patients with a previously perforated eardrum should avoid ear irrigation.
90
What is appropriate for relieving ear pain, and provide examples?
Simple analgesia, such as paracetamol or ibuprofen, is appropriate for relieving ear pain.
91
Why should cotton buds not be used to clean excess ear wax?
Cotton buds push ear wax back onto the ear drum, increasing the likelihood of impaction. The ear is a self-cleaning system.
92
What risk does using cotton buds pose to the external ear canal?
Cotton buds may scratch or irritate the external ear canal, leading to inflammation and worsening the condition.
93
What practical tips can help with otitis externa?
Avoid irritants by using earplugs or cotton wool coated in white soft paraffin during showering or bathing. However, cotton wool should not be left in the ear.
94
What risk factors for recurrent acute otitis media in children should be considered?
Risk factors include contact with a large number of other children (e.g., at nursery), use of formula milk instead of breast milk, use of a dummy, and feeding in a supine position.
95
What should be considered when glue ear (otitis media with effusion) is suspected?
Glue ear should be considered when a suspected middle ear infection is referred. Main symptoms of middle ear infection include earache, irritability, and fever. Glue ear can cause chronic hearing loss with no other symptoms.
96
What is the relationship between recurrent ear infections and glue ear?
There is often a relationship between recurrent ear infections and glue ear, with glue ear causing chronic hearing loss, often without other symptoms.
97
What are the characteristics of aphthous ulcers?
Aphthous ulcers are painful, shallow, rounded lesions with a shallow necrotic center covered by a yellow-greyish pseudomembrane, surrounded by raised margins. They may recur and are most common in young adults.
98
What are the causes of aphthous ulcers?
Causes include local trauma (physical or chemical), stress, hormone imbalance, and stopping smoking. Some individuals may be prone to oral ulceration, and there may be a familial link.
99
What is the prodromal phase of aphthous ulcers?
A prodromal phase usually occurs 24-48 hours before the ulcer appears, with burning or localized pain.
100
What are the three main clinical types of aphthous ulcers?
The three types are minor aphthous ulcers (5-8 mm, heal in 10-14 days without scarring), major aphthous ulcers (larger, irregular border, heal slowly over weeks, may lead to scarring), and herpetiform ulcers (rare, multiple pinpoint ulcers, merge to form larger ulcers lasting 10-14 days).
101
When should routine referral be considered for aphthous ulcers?
An ulcer lasting for more than three weeks requires routine referral to exclude oral cancer.
102
What childhood infections may present with spots in the mouth?
Hand, foot, and mouth disease may present with spots in the mouth. Chickenpox can also occur in the mouth, with spots on the body, especially the trunk and face. Koplik’s spots are diagnostic features of measles, often seen before other symptoms.
103
When should referral for oral malignancy be considered?
Referral for oral malignancy should be considered with a history of heavy smoking or alcohol consumption, or in males aged over 45 years, especially if ulceration has persisted for longer than three weeks or is very red, painful, and swollen.
104
What are some systemic conditions that may present with aphthous-like ulcers?
Systemic conditions include vitamin B12, folate, or iron deficiency, coeliac disease, Crohn’s disease, ulcerative colitis, or other malabsorption syndromes.
105
Can zinc deficiency be responsible for recurrent mouth ulcers, and what is the treatment outcome with zinc sulfate therapy?
While zinc deficiency was once thought to be responsible, treatment with zinc sulfate therapy was not clinically effective for recurrent mouth ulcers.
106
Name some drugs that may cause aphthous-like ulcers.
NSAIDs, nicorandil, sodium lauryl sulphate (in toothpastes), and oral nicotine replacement therapy have been reported to induce ulceration.
107
What factors influence the choice of treatment for aphthous ulcers?
Treatment choice depends on the severity of pain, accessibility of the ulcer site, number of ulcers, and patient preference.
108
How do topical corticosteroids help with aphthous ulcers, and when should they be applied?
Topical corticosteroids aid healing and provide pain relief. They are best applied as soon as the prodromal sensations are felt. Hydrocortisone muco-adhesive buccal tablets should be sucked and allowed to dissolve slowly in the mouth four times a day.
109
What is the purpose of local analgesics like benzydamine (Difflam®) mouthwash or spray for mouth ulcers?
Local analgesics help alleviate the pain and discomfort of mouth ulcers, especially those that are hard to reach. Benzydamine may cause stinging at full strength and can be diluted with water.
110
What precautions should be taken when using choline salicylate gel (Bonjela®) for mouth ulcers?
Choline salicylate gel should be applied every three hours, with a maximum of six applications daily to avoid salicylate poisoning. It should not be applied to dentures and is only for use in adults and young people over the age of 16 years.
111
How can antiseptic mouthwashes help with aphthous ulcers?
Antiseptic mouthwashes aid in oral hygiene and treat or prevent secondary bacterial infection, reducing discomfort and promoting healing. Chlorhexidine may stain teeth, and povidone iodine should not be used for more than 14 days to avoid significant iodine absorption.
112
How does Aloclair® mouthwash provide pain relief for aphthous ulcers?
Aloclair® mouthwash forms a protective mechanical barrier of polyvinylpyrrolidine (PVP) over oral lesions, offering pain relief.
113
What are some practical tips to manage aphthous ulcers?
#NAME?
114
What are some potential consequences of a dry mouth?
Sufferers may have difficulty eating or speaking, leading to poor oral hygiene, increased dental caries, halitosis, and oral infections like candidiasis.
115
What are some common drug classes that may cause dry mouth as a side effect?
Tricyclic antidepressants, antihistamines, antimuscarinics, and diuretics are common drug classes that may cause dry mouth as a side effect.
116
What are some other causes of dry mouth besides medications?
Other causes include radiotherapy to the head or neck, mouth breathing (due to a blocked nose or other causes), anxiety, dehydration, and Sjögren’s Syndrome.
117
How can dry mouth due to medications be managed?
Doses may be adjusted or therapy reviewed if the dry mouth side effect is unbearable. Artificial saliva, sugar-free chewing gum, and mucin-based products can provide relief.
118
What is a practical tip for managing dry mouth symptoms?
Taking frequent sips or sprays of cold water, sucking ice cubes, and using sugar-free chewing gum can help alleviate dry mouth symptoms.
119
What is a potential consequence of consuming caffeine and alcohol for individuals with dry mouth?
Caffeine and alcohol have a diuretic effect, leading to dehydration. Cutting down on tea, coffee, cola, and alcoholic drinks may help manage dry mouth.
120
How can petroleum jelly or lip salve be helpful for individuals with dry mouth?
Applying petroleum jelly or lip salve to the lips can help prevent drying and cracking.
121
What is the role of artificial saliva in managing dry mouth symptoms?
Artificial saliva may provide limited benefit, with sugar-free chewing gum often offering as much relief. Mucin-based products, such as AS Saliva Orthana®, are preferred over carmellose-based products.
122
What are the symptoms of acute pseudomembranous candidiasis (thrush)?
Symptoms range from asymptomatic infection to a sore and painful mouth with a burning tongue and altered taste. White discrete plaques on an erythematous background are usually seen on the buccal mucosa, throat, tongue, or gums.
123
What are predisposing factors for persistent oral thrush?
Oral thrush may persist for months in patients receiving inhaled corticosteroids, cytotoxics, or broad-spectrum antibacterials. Smoking is also a risk factor for all candidal infections.
124
What are danger symptoms associated with oral thrush?
Oral thrush can be a symptom of serious systemic diseases associated with reduced immunity, such as leukaemia, other malignancies, and HIV infection.
125
What is leukoplakia, and how does it differ from oral thrush?
Leukoplakia is a white patch or plaque on the mucosa that cannot be rubbed off. It may be caused by chronic exposure to irritants, particularly tobacco, or by chronic infections, particularly oral candidiasis. Unlike oral thrush, leukoplakia is commonly benign but may be pre-malignant.
126
What is the recommended OTC treatment for oral thrush?
Oral thrush responds well to treatment with miconazole 2% oral gel, which is available OTC. The gel should be used after food or drink, held in the mouth for as long as possible, and treatment should continue for two days after clearance.
127
Is miconazole gel suitable for neonates and babies up to four months old?
Miconazole gel is not licensed for treatment in neonates and babies up to four months old and only with care between four and six months old, due to the potential risk of ingestion and choking. Referral will be required for prescription-only treatment in this age group.
128
How should miconazole gel be applied for breastfeeding babies over six months old?
For breastfeeding babies over six months old, a small amount of miconazole gel should be gently applied to the surfaces of the mouth, avoiding touching the back of the throat with the gel or the finger to eradicate infection.
129
What is axial cheilitis?
Axial cheilitis, or angular stomatitis, is erythema and maceration of the skin around the mouth's angle, often occurring bilaterally.
130
What are the symptoms of axial cheilitis?
Cracked fissures, bleeding, and pain at the corners of the mouth, usually seen in the elderly or young children with lip-licking habits.
131
What are the predisposing factors for axial cheilitis?
Sagging facial muscles and ill-fitting dentures, leading to a fold in the mouth's angle, are common predisposing factors.
132
Who is more prone to a milder form of axial cheilitis?
Young children, who may develop chapped lips due to lip-licking, with common causes including dry skin, eczema, and lip licking.
133
What can cause secondary infection in axial cheilitis?
Crusting in axial cheilitis may lead to secondary infection with Staphylococcus aureus.
134
What are less common causes of angular stomatitis?
Allergy, atopic or seborrhoeic dermatitis, vitamin B deficiency, or iron deficiency can be less common causes of angular stomatitis.
135
What is often mistaken for axial cheilitis?
Cold sores are often mistaken for axial cheilitis, requiring careful questioning for a proper diagnosis.
136
What antifungal cream can be used for treatment?
Clotrimazole 1% antifungal cream is a suitable treatment for axial cheilitis.
137
When should a patient be referred to a GP?
If symptoms do not improve within one week with clotrimazole, referral to a GP is recommended, as the cause may be bacterial.
138
How can recurrence of axial cheilitis be prevented?
Advising the patient to avoid lip-licking, using paraffin-based lip balm, and improving dental hygiene with mouthwashes and xylitol-containing gums may help prevent recurrence.
139
What is an effective treatment for axial cheilitis?
Hydrocortisone with or without clotrimazole is often effective, but this might require a GP's prescription beyond OTC licenses.
140
What is the purpose of paraffin-based lip balm?
Paraffin-based lip balm helps protect the lips, particularly when poorly fitting dentures are suspected as a cause.
141
What advice can help prevent axial cheilitis?
Recommending improved dental hygiene, mouthwashes, and xylitol-containing gums after meals can contribute to preventing axial cheilitis.
142
Is axial cheilitis more common in the elderly?
Yes, axial cheilitis is often seen in the elderly due to sagging facial muscles and ill-fitting dentures.
143
What could be a less common cause of angular stomatitis?
Less common causes include allergy, atopic or seborrhoeic dermatitis, vitamin B deficiency, or iron deficiency.
144
Why should a GP be consulted if symptoms persist?
If symptoms persist after one week of antifungal treatment, it indicates a potential bacterial cause, necessitating GP consultation.
145
What is the role of clotrimazole in treating axial cheilitis?
Clotrimazole 1% antifungal cream can help alleviate axial cheilitis symptoms and treat Candida infection.
146
Can hydrocortisone be used without a prescription?
Hydrocortisone with or without clotrimazole for axial cheilitis treatment often requires a prescription, going beyond OTC licenses.
147
How can a dentist assist in treating axial cheilitis?
If poorly fitting dentures are a suspected cause, a visit to the dentist for re-fitting can be recommended.
148
What habits should patients avoid to prevent recurrence?
Patients should avoid lip-licking to prevent recurrence and promote healing in cases of axial cheilitis.
149
What are common symptoms accompanying a sore throat?
Common accompanying symptoms include sinusitis, cough, headache, and may be caused by viral or bacterial infections.
150
How long does a typical sore throat usually last?
Sore throats are self-limiting, typically resolving within one week.
151
What is the Cochrane systematic review's finding?
The Cochrane review found modest absolute benefits of antibiotics for sore throat, with the maximum benefit seen by day three.
152
Why is clinical examination ineffective in differentiating sore throat causes?
Clinical examination cannot reliably differentiate between bacterial and viral sore throats.
153
What are some symptomatic relief options for sore throats?
Many patients find relief with analgesics and demulcent throat preparations for soothing.
154
What is the danger symptom indicating urgent referral?
High temperature in a systemically unwell patient, possibly indicating glandular fever, epiglottitis, or quinsy.
155
When is urgent referral necessary for a sore throat?
Urgent referral is required if the patient has breathing difficulties or is unable to swallow.
156
What is infectious mononucleosis, and who does it commonly affect?
Infectious mononucleosis (glandular fever) can cause a viral sore throat, especially in adolescents or young adults.
157
What are the symptoms of infectious mononucleosis?
Symptoms include sore throat, loss of appetite, malaise, chills, headache, fever, lymphadenopathy, swelling around the eyes, nausea, and vomiting.
158
What is quinsy, and how does it present?
Quinsy is a tonsillar abscess, presenting with a significantly enlarged, tense tonsil, fever, and overall unwellness.
159
What blood dyscrasias can present as a sore throat?
Neutropenia and agranulocytosis due to bone marrow suppression, warned against in carbimazole use, may present as a sore throat.
160
What is the cause of infectious mononucleosis?
Epstein-Barr virus causes infectious mononucleosis, often resulting in prolonged malaise.
161
What is the risk associated with antibiotic use for sore throats?
Antibiotic use increases the risks of adverse effects and contributes to bacterial resistance in the community.
162
What are potential causes of sore throat other than infections?
GORD (gastroesophageal reflux disease) and physical or chemical irritation can also cause sore throat.
163
What oral analgesics are recommended for sore throat pain relief?
Paracetamol and NSAIDs (nonsteroidal anti-inflammatory drugs) are effective for relieving sore throat pain.
164
Which NSAID is available for topical use in sore throat treatment?
Flurbiprofen (Strefen®) is an NSAID available for topical use as a lozenge for sore throat, with a maximum use of three days.
165
What is the recommended first-line choice for sore throat pain?
Paracetamol is recommended as the first-line choice for sore throat pain relief, according to SIGN guidelines.
166
What local anesthetics are used for sore throat in aerosol sprays?
Benzocaine and lidocaine are local anesthetics used in aerosol sprays or throat lozenges for sore throat, not exceeding five days.
167
What side effects should be considered with local anesthetics?
Allergic reactions and local irritation are potential side effects of using local anesthetics for sore throat.
168
What is the theory behind using local antiseptics in throat lozenges?
Local antiseptics, like benzalkonium chloride and hexylresorcinol, aim to prevent secondary bacterial infection in sore throat.
169
What are glycerin, honey, and lemon preparations used for in sore throat?
These demulcents provide short-term relief for sore throat and are suitable for children, pregnant women, and breastfeeding mothers.
170
What is the role of gargles in sore throat treatment?
Gargling with salt water or aspirin may provide relief, but there is limited evidence. Benzydamine gargle showed significant pain relief in one small study.
171
When should patients with fever be referred for sore throat?
Patients with an accompanying fever should be referred to their GP to rule out more serious systemic causes of sore throat.
172
What is a subconjunctival haemorrhage
Blood vessel burst due to pressure or injury to eye, coughing or randomnly
173
Is there any treatment for subconjunctival haemorrhage
None.
174
When to refer with subconjunctival haemorrhage
If pain in eye, visual distrubances, if it hasn’t cleared up after 10-14 days.
175
What is keratitis
inflammation of cornea. Can be due to overuse of antibiotics leading to corneal ulcer.
176
Symptoms of keratitis
distinct red around iris. severe pain, very Photophobic, decline in visual accurity
177
Should you refer if pt has keratitis?
Yes urgent referral
178
RED FLAG REFERRALS OF EYE Symptoms
VAPOUR
• Vision affected
• Associated symptoms eg N,V,headache - shows raise in intraoccular pressure
• Photophobia/Pain
• OTC treatment failure/Other eye conditions
• Under 2 for chloramphenicol eye drops
• Recurrent problem
