Passmed Cards Flashcards

1
Q

What are some causes of tinnitus?

A

Meniere’s disease- associated vertigo and s sense of fullness/pressure in one or both of the ears
Otosclerosis
Acoustic neurona
Hearing loss
Drugs Aspirin, aminoglycosides, loop diuretics, quinine
Vascular malformations

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2
Q

What drugs can cause tinnitus?

A

Aspirin
Quinine
Amino-glycosides
Loop diuretics

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3
Q

What are some drugs that cause gingival hyperplasia?

A

Phenytoin
Ciclosporin
Calcium channel blockers e.g. Nifedipine

Other causes if not on above medication include- acute myeloid leukaemia

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4
Q

What is tachyphylaxis?

A

Increased doses of a drug are needed to have the same affect

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5
Q

What is allergic rhinitis?

A

Inflammatory disorder of the nose where it becomes sensitised to allergens

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6
Q

What are symptoms of allergic rhinitis?

A
Sneezing
Runny nose
Bilateral nasal obstruction
Clear nasal discharge
Nasal pruritus/itching
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7
Q

What is the management for allergic rhinitis?

A

Avoid known allergens
1st- Oral/Nasal Anti-histamines
2nd- Intranasal Steroids
Oral corticosteroid course may be needed

Nasal decongestants e.g. Oxymetazoline.

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8
Q

What is a side effect to nasal decongestants? Give an example

A

Nasal decongestants such as oxymetazoline is used for a prolonged period of time may lead to tachyphylaxis (increased dose required for same effecT) or rebound hypertrophy of nasal mucosa when use is stopped

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9
Q

When should antibiotics be prescribed for otitis media?

A

Symptoms lasting more than 4 days without improvement
Systemically unwell
Immunocompromised
High risk of secondary complications such as co-existing lung, heart, kidney disease
Children younger than 2 with bilateral otitis media
Otitis media with perforation and/or discharge in the canal
Any signs of mastoiditis

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10
Q

What is the first line treatment for otitis media?

A

5 day course of amoxicillin

If penicillin allergic use erythromycin or clarithromycin

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11
Q

What process causes cholesteatomas to form?

A

Negative pressures in the middle ear (as with chronic otitis media, eustachian tube dysfunction) cause a retraction pocket. Squamous epithelium can collect to form cholesteatoma.

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12
Q

What are the symptoms of a cholesteatoma?

A
Foul smelling discharge
Tinnitus
Hearing loss
Headache
Pain
Facial paralysis (if involvement of facial nerve)
Vertigo
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13
Q

What some serious complications of cholesteatoma?

A

Meningitis
Facial nerve paralysis
Erosion of ossicles leading to hearing loss
Cerebral abscess

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14
Q

What is a serious complication of mastoiditis?

A

Intra-cranial expansion-

Causing cerebral abscess, infection, meningitis

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15
Q

What can mastoiditis be a complication of?

A

Otitis media

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16
Q

What is mastoiditis?

A

Inflammation of the mastoid air cells- leads to destruction of the mastoid bone and abscess formation.

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17
Q

What are some signs of mastoiditis?

A
Fever
Mastoid tenderness
Swelling
Redness behind the pinna
Anteriorly displaced/protruding auricle
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18
Q

What is the management for mastoiditis?

A

Refer to secondary care
Admit for IV ABx
Surgical- Mastoidectomy

19
Q

What are some ototoxic medications?

A

Gentamicin and other aminoglycosides
Furosemide
Aspirin
Some chemotherapy drugs

20
Q

What are the criteria for the CENTOR criteria?

A

Tonsillar exudate= 1 point
Temperature above 38 = 1 point
Absence of cough= 1 point
Tender cervical lymphadenopathy= 1 point

21
Q

For what score on the centor criteria should antibiotics be prescribed?

A

3 or 4

Offer an immediate antibiotic prescription.

22
Q

What should be done for scores of 0 1 or 2 on the Centor criteria?

A

No antibiotic prescription as this is unlikely to be due to a bacterial infection

Advise to seek further medical help if symptoms worsen at all.

23
Q

What antibiotic should be offered for an bacterial tonsillitis?

A

1st line- Phenoxymethylpenicillin or if penicillin allergic erythromycin or clarithromycin

24
Q

What should be advised for people with a centor score of 0,1 or 2?

A

Rest
Stay hydrated
Can use analgesic agents if required- e.g. paracetamol, ibuprofen

25
Regardless of centor criteria, when should antibiotics be prescribed for a sore throat?
Marked systemic upset Unilateral peritonsillitis (could develop into Quinsy) History of rheumatic fever Increased risk with infection- such as immunodeficient children
26
What are some causes of otitis externa?
Infection- staph, pseudomonas, fungal Seborrhoeic dermatitis Contact dermatitis
27
What are some features of otitis externa?
Pain Redness Tragal tenderness Itch
28
What might be seen on otoscopy for otitis externa?
Red Swollen Erythematous ear canal
29
What is the recommended first line treatment for otitis externa?
Topical ABx May be combined with steroid If tympanic membrane is perforated aminoglycosides e.g. gentamicin should not be used due to the theoretical risk of ototoxicity
30
What are some second line treatment options for the management of otitis externa?
Oral antibiotics e.g. flucloxacillin Take a swab from inside the ear canal and send for MC and S
31
What is a serious risk of otitis externa?
Malignant otitis external- there is extension into the temporal bone and base of the skull (osteomyelitis)- it is potentially life threatening
32
What is the most common cause of malignant otitis externa?
Pseudomonas and Klebsiella
33
What is the treatment for malignant otitis externa?
Surgical debridement IV ABx Immunoglobulins
34
What is Ramsay Hunt Syndrome?
Herpes zoster oticus- VZV affecting the facial nerve. Causes auricular pain, facial nerve palsy, vesicular rash around the ear, vertigo and tinnitus
35
What is the treatment for Ramsay Hunt Syndrome?
Oral acyclovir and corticosteroids
36
Who should be referred urgently to ENT for suspicion of laryngeal cancer?
Anyone aged 45 and over with persistent unexplained hoarseness or an unexplained lump in the neck
37
What might cause airway obstruction after thyroid surgery?
Damage to the laryngeal nerve Bleeding- causing a haematoma and leading to impaired venous return causing laryngeal oedema.
38
What should be done for all unilateral nasal polyps?
Refer to ENT as could be tumorous
39
What are some symptoms of nasal polyps?
Nasal obstruction Rhinorrhoea Sneezing Poor sense of taste and smell
40
What anti-biotic should be given for the management of otitis media
Amoxicillin 500mg TDS Erythromycin in penicillin allergic Note- Co-amoxiclav is 2nd line
41
How long should a perforated ear-drum usually take to heal?
6-8 weeks Patients should be advised that it is a skin like structure and therefore takes a similar amount of time as skin cuts to heal.
42
When should antibiotics be prescribed for perforated tympanic membrane?
If the perforation was due to otitis media
43
When should a mouth ulcer be considered for urgent referral?
Mouth ulcers persisting for more than 3 weeks. Unexplained oral ulceration or mass persisting for greater than 3 weeks Unexplained red, or red and white patches that are painful, swollen or bleeding Unexplained one-sided pain in the head and neck area for greater than 4 weeks, which is associated with ear ache, but does not result in any abnormal findings on otoscopy Unexplained recent neck lump, or a previously undiagnosed lump that has changed over a period of 3 to 6 weeks Unexplained persistent sore or painful throat Signs and symptoms in the oral cavity persisting for more than 6 weeks, that cannot be definitively diagnosed as a benign lesion