GP3 Flashcards
1
Q
Otitis externa
A
- Definition: an inflammatory condition affecting the skin of the external auditory meatus
- Cause: Pseudomonas aeruginosa and S.aureus, seborrhoeic dermatitis, contact dermatitis
- Symptoms: otalgia (ear pain), minimal discharge, itchiness, pain due to inflammation, conductive hearing loss
- Otoscopy: red, swollen or eczematous canal
- Inv: clinical with otoscopy but cultures can be used in refractory or severe cases
- Can be acute <3 weeks or chronic
2
Q
Otitis externa management
A
- Mild to moderate: topical drops which are combined antibiotics/steroids (gentamicin and hydrocortisone), acetic acid and other preparations. Keep ear dry for next 7-10 days
- Severe: strip of ribbon gauze known as ‘Pope’ wicks which can be used to apply topical antibiotics (i.e. gentamicin) for deeper application
- Indications for oral abx: immunocompromised, cellulitis beyond the external ear canal, canal occluded by swelling, diabetes, systemic infection
- Refer to ENT if ear canal is so swollen you cant see the infection
3
Q
Malignant otitis externa
A
- more common in elderly diabetics.
- There is extension of infection into the bony ear canal and the soft tissue deep to the bony canal.
- Can progress to osteomyelitis of the temporal bone.
- IV antibiotics may be required and admission to hospital.
- Will need CT or MRI head
- Complications: facial nerve damage, meningitis
4
Q
Otitis media: definition and causes
A
Otitis media: an infection induced inflammation of the middle ear. Commonly affects young children.
Bacterial causes: H.influenza, S.pneumonia
Viral causes: RSV, rhinovirus and adenovirus
5
Q
Otitis media: risk factors, symptoms, investigations
A
Risk factors: young age, male, cigarettes, viral illness, prematurity
Symptoms: deep seated ear pain (may pull on ear), fever, irritability, weight loss, vomiting, impaired hearing, systemic illness, aural fullness, viral URTI symptoms
Diagnosis: clinical, based on otoscopy
6
Q
Otitis media: otoscopy findings
A
- bulging tympanic membrane → loss of light reflex
- opacification or erythema of the tympanic membrane
- perforation with purulent otorrhoea
- decreased mobility if using a pneumatic otoscope
7
Q
Otitis media: management
A
- Admit any child <3 months with temperature >38 or patients with suspected complications such as meningitis, mastoiditis or facial nerve palsy
- Supportive: give paracetamol or ibuprofen. If no perforation give analgesia and anaesthetic ear drops to those <18
- Most dont require abx as symptoms usually clear within 7 days: can give delayed abx
- If abx are given is a 5-7 day course of amoxicillin. If penicillin allergic give erythromycin or clarithromycin.
8
Q
When to prescribe immediate abx in otitis media
A
- Symptoms lasting more than 4 days or not improving
- Systemically unwell but not requiring admission
- Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
- Younger than 2 years with bilateral otitis media
- Otitis media with perforationand/or discharge in the canal
9
Q
Complications of otitis media
A
- Extra-cranial: Facial nerve palsy, Mastoiditis, Petrositis, Labrynthitis
- Intra-cranial: Meningitis, Sigmoid sinus thrombosis, Brain abscess
- Glue ear, hearing losss
10
Q
Radiculopathies causes
A
- disorders affecting spinal nerves or nerve roots
- Can occur in any part of the spine: cervical, thoracic and lumbar
- Cervical: degenerative changes which narrow the space where nerve roots exit the spine
- Lumbar: herniated disc
- Thoracic: less common but can be due to a variety of conditions including herpes zoster
11
Q
Radiculopathies: clinical features
A
- Sharp, burning or stabbing pain that radiates along the path of the affected nerve
- Sensory: numbness, tingling or hypersensitivity in the same area
- Motor: weakness or paralysis of muscles innervated by the nerve root. Get muscle atrophy and fasciculations
12
Q
Radiculopathies: investigations
A
- MRI: first line
- CT when MRI is contraindicated
- Nerve conduction studies and Electromyography: assess nerve impulses
13
Q
Radiculopathies management
A
- Medication: NSAID (first line), Corticosteroids (if resistant to NSAID’s)
- Neuropathic pain: gabapentin, TCA’s or SSRI
- Physical: physiotherapy to improve strength and flexibility. Patient education can prevent further nerve root compression
- Lifestyle: weight loss (reduces stress on spine)
- Surgery: for severe or progressive neurological deficits or haven’t responded to treatment over 6 weeks. Depends on cause and location - discectomy, laminectomy and spinal fusion
14
Q
Rhinosinusitis
A
- inflammation of the nose and paranasal sinuses
- Caused by viral, bacterial or fungal infections, allergies, autoimmune
- Clinical diagnosis but can take cultures
15
Q
Rhinosinusitis: signs and symptoms
A
- Nasal blockage/obstruction/congestion
- Nasal discharge, postnasal drip, mouth breathing
- Facial pain or heaviness: worse leaning forwards
- Reduced olfaction
- Other symptoms may includeheadache, ear pain, sore throat, and cough.
16
Q
Rhinosinusitis management
A
- Conservative: nasal saline irrigation, analgesia, intranasal corticosteroids
- High-dose nasal corticosteroids: If symptoms persist for more than 10 days, a 14-day course of high-dose nasal corticosteroids may be considered.
- Antibiotics: if severe or persistent (>17days)
17
Q
Chronic rhinosinusitis
A
- Lasting >12 weeks
- Risk factors: atopy, nasal obstruction, recent local infection, swimming, smoking
- Management: avoid allergen, intranasal corticosteroid, nasal irrigation. If not responding Functional endoscopic sinus surgery (FESS)
- If investigations needed: Nasal endoscopy, CT scan
18
Q
Scabies
A
- Highly infectious caused by Sarcoptes scabiei
- Spread by direct contact
- Itch caused by delayed type 4 reaction 30 days after initial infection. Itch can persist for 4-6 weeks after treatment
19
Q
Scabies symptoms
A
- Intensely itchy rash that affects the inter-web spaces, flexures of the wrist, axillae, abdomen and groin.
- The itch is classically worse at night.
- The rash is usually papular or vesicular with superficial burrows
20
Q
Scabies management
A
- Topical permethrin 5% cream
- Permethrin: apply to cool dry skin (not after a bath) and to the whole body (including face and scalp). Allow lotion to dry before dressing and after 12hrs wash off and repeat after 7 days
- Crotamiton cream: relieve itch
- Malathion 0.5%: second line
- All contacts including members of the same household are treated on the same day
- Launder all bedding and clothes on the first day to kill mites
21
Q
Norwegian (or crusted) scabies
A
- Where an individual is affected by millions of mites causing a generalised scaly rash, often misdiagnosed as psoriasis
- Often seen in immunocompromised patients (HIV)
- Treat with Ivermectin and isolate
22
Q
Trigeminal neuralgia
A
- Chronic neurological disorder causing bouts of shooting or stabbing pain which follow the distribution of one or more branches of the trigeminal nerve
- Tends to affect women >50
- Can be primary or secondary to Malignancy, Arteriovenous malformation, MS, Sarcoidosis and Lyme disease
- Clinical diagnosis
23
Q
Trigeminal neuralgia signs and symptoms
A
- Unilateral facial pain that is sudden, severe, and brief.
- The pain is often described as shooting or stabbing,
- Triggered by lightly touching the affected side of the face, eating, or wind blowing on the face.
24
Q
Trigeminal neuralgia management
A
- Medical: Carbamazepine (first line), phenytoin
- Surgical: Microvascular decompression, alcohol or glycerol injection (damage trigeminal nerve and reduce pain signal)
- Treat underlying cause: i.e. remove tumour
- Failure to respond to treatment or atypical features (<50) refer to neurology
25
Q
Vasovagal syncope
A
- Transient loss of consciousness due to cerebral hypoperfusion. May be some twiching or shaking
- Often triggered by dehydration, missing a meal, emotional stress, pain or standing for too long
- Prodrome: feel hot or clammy, sweaty, heavy, dizzy or lightheaded, vision goes blurry
- Investigations: blood glucose, ECG, bloods
- Reassure and advice about avoiding dehydration, missing meals and standing for too long
26
Q
Syncope and driving
A
- Patients with unexplainedsyncopemust inform the DVLA and their licence will be revoked for 6 months (12 months if Group 2)
- Patients with a vasovagal whilst standing can drive and need not inform the DVLA if they are Group 1 drivers (Group 2 drivers must not drive and should inform the DVLA)
- Patients with cardiacsyncopemust not drive and inform the DVLA - group 1 drivers may be allowed to drive after 4 weeks if a cause is identified and treated
27
Q
Viral exanthem
A
- A widespread rash occurring alongside systemic symptoms of infection
- Variable appearance but is widespread and may be more noticeable on the trunk. Presents as spots or blotches. With or without pruritis. Is an eruptive widespread rash
- Occurs in childhood
- Causes: chickenpox, measles, rubella, roseola infantum, Parvovirus B19, scarlet fever
- Diagnosed clinically
28
Q
Tests for an undifferentiated exanthem
A
- Viral swab: culture, immunofluorescence & PCR
- Blood tests: serology, PCR, ANA, specific antibodies
- HIV testing
29
Q
Viral exanthem treatment
A
Supportive: paracetamol for fever, emollients for itch, patients stay hydrated
