Otitis Media/sinusitis/bronchitis/UTI

Question 1

acute otitis media is diagnosed based on

Answer 1

acute onset of pain and fever
a red, bulging tympanic membrane
middle ear effusion

Question 2

AOM is managed by

Answer 2

analgesia (paracetamol or non-steroidal anti-inflammatory drugs)

Question 3

when should antibiotics be used

Answer 3

minimally effective for most patients
most effective for children <2 years with bilateral otitis media and for children with discharging ears
national guidelines recommend antibiotic therapy for indigenous children

Question 4

otitis media with effusion (OME)

Answer 4

presence of middle ear effusion (type B tympanogram or immobile tympanic membrane on pneumatic otoscopy) without AOM criteria
usually asymptomatic but can cause balance issues

Question 5

management of OME

Answer 5

well children with OME with no speech and language delays can be observed for the first three months, perform audiological evaluation and refer to an ear, nose and throat specialist if they have bilateral hearing impairment >30dB or persistent effusion

Question 6

children with effusions persisting longer than 3 months

Answer 6

may benefit from a 2-4 week course of amoxycillan

Question 7

chronic suppurative otitis media

Answer 7

chronic discharge (at least 6 weeks) through a tympanic membrane perforation
managed with regular ear cleaning (dry mopping or betadine washouts) until discharge resolves, topical ear drops, audiological evaluation and ENT review

Question 8

rhinosinusitis define

Answer 8

nasal blockage
nasal discharge
facial pain or pressure
reduction or loss of sense of smell

Question 9

clinical features of acute rhinosinusitis that indicate spreading bacterial infection

Answer 9

clinical features of bacterial infection extending beyond the paranasal sinuses and nasal cavity into adjacent spaces (eg. meninges, ocular space, pariorbital space)
- acute onset confusion or impaired consciousness
- diplopia or impaired vision
- meningism (stiff neck, severe headache, photophobia)
- periorbital oedema or cellulitis
- proptosis
- signs of sepsis or septic shock

Question 10

management of complicated bacterial rhinosinusitis (spreading)

Answer 10

hospitalisation for IV antibiotics and urgent surgical referral

Question 11

how to tell the difference between bacterial and viral rhinsinusitis

Answer 11

Question 12

treatment flow for acute rhinosinusitis

Answer 12

Question 13

symptomatic therapy for acute rhinosinusitis

Answer 13

regular oral analgesia and salne nasal preperations (sprays, rinses or drops)
intranasal corticosteroids
intranasal and systemic decongestants are beneficial for short term (up to 5 days) if congestion is the prominent symptom
intranasal ipratropium bromide of rhinorrhea is the predominant symptom
ceasing smoking
return in 5 days if symptoms persist

Question 14

how long does sinusitis usually last

Answer 14

2-3 weeks

Question 15

when to offer an antibiotic in sinusitis

Answer 15

if the person is systemically unwell
has symptoms of a more serious illness or condition
has a high risk of complications
intraorbital or periorbital complications
intracranial complications

Question 16

evidence for sinusitis self care

Answer 16

paracetamol or ibuprofen for pain
little evidence for nasal saline or nasal decongestants
no evidence for oral decongestants, antihistamines, mucolytics, steam inhalation or warm face packs

Question 17

evidence for antibitoics for sinusitis

Answer 17

antibiotics make little difference to how long the symptoms last or the number of people who’s symptoms improve
possible adverse effects include diarrhoea and nausea

Question 18

potential harms of antibiotics

Answer 18

adverse affects include diarrhoea, rash, hypersensitivity reactions
disrupt the balance of bacteria in the body, which can cause thrush or clostridium deficile
can breed superbugs
of every 100 patients treated with antibiotics for acute rhinosinusitis, 12 will have an adverse reaction

Question 19

bacterial cause of sinusitis may be more likely if

Answer 19

symptoms last for more than 10 days
discoloured or purulent discharge
severe localised unilateral pain (particulalry pain over teeth and jaw)
fever
marked deterioration after an initial milder phase

Question 20

choice of antibiotic for sinusitis

Answer 20

amoxicillin
if allergic: cefuroxime or doxycycline

Question 21

antibiotic in pregnancy for sinusitis

Answer 21

erythromycin

Question 22

what is bronchitis

Answer 22

self-limiting lower respiratory tract infection
most common cause of cough in general practice setting

Question 23

symptoms of acute bronchitis

Answer 23

purulent or coloured sputum
dyspnoea
wheeze
chest discomfort or pain (due to frequent coughing)
nasal congestion
headache
fever

Question 24

differential diagnosis of acute bronchitis

Answer 24

pneumonia
influenza
pertussis
asthma
heart failure

Question 25

when to consider pneumonia instead of bronhcitis

Answer 25

consider in patients with tachypnoea at rest, tachycardia, persistent fever, rigors, hypoxaemia, or crepitations on auscultations that do not clear with coughing

Question 26

what is the evidence for antibiotics for acute bronchitis

Answer 26

limited evidence for clinical benefit to support the use of antibiotics in acute bronchitis
may have a modest beneficial effect in frail, elderly people with multimorbidity

Question 27

management of UTI

Answer 27

if not pregnant and mild symptoms, watch and wait and back up antibiotic
if pregnant immediate antibiotic

Question 28

signs of pylonephritis

Answer 28

kidney pain/tenderness if back under rribs
new/different myalgia, flu like illness
shaking chills (rigours) or temperature
nausea/vomiting

send urine for culture if suspected and immediately start antibiotic

Question 29

does vaginal discharge indicate UTI

Answer 29

75-80% with vaginal discharge do not have UTI

Question 30

otitis externa treatment

Answer 30

topical dexamethasone + framycetin + gramicidin ear drops (sofradex)
instill 3 drops into the affected ear 3 times per day
a cotton ball must be placed into the ear canal for 20 minutes after the instillation of ear drops
cleaning and drying of the ear canal is important and must be done six hourly and/or prior to the instillation of ear drops