Passmed Cards Flashcards
What are some causes of tinnitus?
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
What drugs can cause tinnitus?
Aspirin
Quinine
Amino-glycosides
Loop diuretics
What are some drugs that cause gingival hyperplasia?
Phenytoin
Ciclosporin
Calcium channel blockers e.g. Nifedipine
Other causes if not on above medication include- acute myeloid leukaemia
What is tachyphylaxis?
Increased doses of a drug are needed to have the same affect
What is allergic rhinitis?
Inflammatory disorder of the nose where it becomes sensitised to allergens
What are symptoms of allergic rhinitis?
Sneezing Runny nose Bilateral nasal obstruction Clear nasal discharge Nasal pruritus/itching
What is the management for allergic rhinitis?
Avoid known allergens
1st- Oral/Nasal Anti-histamines
2nd- Intranasal Steroids
Oral corticosteroid course may be needed
Nasal decongestants e.g. Oxymetazoline.
What is a side effect to nasal decongestants? Give an example
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
When should antibiotics be prescribed for otitis media?
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
What is the first line treatment for otitis media?
5 day course of amoxicillin
If penicillin allergic use erythromycin or clarithromycin
What process causes cholesteatomas to form?
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.
What are the symptoms of a cholesteatoma?
Foul smelling discharge Tinnitus Hearing loss Headache Pain Facial paralysis (if involvement of facial nerve) Vertigo
What some serious complications of cholesteatoma?
Meningitis
Facial nerve paralysis
Erosion of ossicles leading to hearing loss
Cerebral abscess
What is a serious complication of mastoiditis?
Intra-cranial expansion-
Causing cerebral abscess, infection, meningitis
What can mastoiditis be a complication of?
Otitis media
What is mastoiditis?
Inflammation of the mastoid air cells- leads to destruction of the mastoid bone and abscess formation.
What are some signs of mastoiditis?
Fever Mastoid tenderness Swelling Redness behind the pinna Anteriorly displaced/protruding auricle
What is the management for mastoiditis?
Refer to secondary care
Admit for IV ABx
Surgical- Mastoidectomy
What are some ototoxic medications?
Gentamicin and other aminoglycosides
Furosemide
Aspirin
Some chemotherapy drugs
What are the criteria for the CENTOR criteria?
Tonsillar exudate= 1 point
Temperature above 38 = 1 point
Absence of cough= 1 point
Tender cervical lymphadenopathy= 1 point
For what score on the centor criteria should antibiotics be prescribed?
3 or 4
Offer an immediate antibiotic prescription.
What should be done for scores of 0 1 or 2 on the Centor criteria?
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.
What antibiotic should be offered for an bacterial tonsillitis?
1st line- Phenoxymethylpenicillin or if penicillin allergic erythromycin or clarithromycin
What should be advised for people with a centor score of 0,1 or 2?
Rest
Stay hydrated
Can use analgesic agents if required- e.g. paracetamol, ibuprofen
