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.
