Passmedicine Flashcards
when are antibiotics indicated in a sore throat
features of marked systemic upset secondary to the acute sore throat
unilateral peritonsillitis
a history of rheumatic fever
an increased risk from acute infection (such as a child with diabetes mellitus or immunodeficiency)
patients with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more Centor criteria are present
what is the centor criteria
presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever
absence of cough
3 or more = antibiotics
antibiotics given for tonisllitis are
If antibiotics are indicated then either phenoxymethylpenicillin or erythromycin (if the patient is penicillin allergic) should be given. Either a 7 or 10 day course should be given
name drugs that are ototoxic
gentamicin
furesomide
aspirin
what is tachyphlaxis
After using topical decongestants for prolonged periods increasing doses are needed to provide the same effect, a phenomenon known as tachyphylaxis.
management of allergic rhinitis
allergen avoidance
oral or intranasal antihistamines are first line
intranasal corticosteroids
course of oral corticosteroids are occasionally needed
there may be a role for short courses of topical nasal decongestants (e.g. oxymetazoline). They should not be used for prolonged periods as increasing doses are required to achieve the same effect (tachyphylaxis) and rebound hypertrophy of the nasal mucosa may occur upon withdrawal
what is malignant otitis externa
Uncommon type of otitis externa that is found in immunocompromised individuals (90% cases found in diabetics)
Infection commences in the soft tissues of the external auditory meatus, then progresses to involve the soft tissues and into the bony ear canal
Progresses to temporal bone osteomyelitis
infective organism in malignant otitis externais
pseudomonas
treatment of malignant otitis externa is
ciprofloxacin
symptoms of malignant otitis externa
Diabetes (90%) or immunosuppression (illness or treatment related)
Severe, unrelenting, deep-seated otalgia
Temporal headaches
Purulent otorrhea
Possibly dysphagia, hoarseness, and/or facial nerve dysfunction
severe pain and protrusion of the ear forwards, with a tender, boggy and often reddened mass behind the ear
acute mastoiditis - admit!
indications for tonsillectomy
sore throats are due to tonsillitis (i.e. not recurrent upper respiratory tract infections)
the person has five or more episodes of sore throat per year
symptoms have been occurring for at least a year
the episodes of sore throat are disabling and prevent normal functioning
recurrent febrile convulsions secondary to episodes of tonsillitis
obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils
peritonsillar abscess (quinsy) if unresponsive to standard treatment
type of hearing loss in base of skull fracture
sensorineural
type of hearnig loss in tympanic membrane perforation
conductivr
midline lump moves with tongue protrusion
thyroglossal cyst
features of ramsey hunt syndrome
auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear
other features include vertigo and tinnitus
management of menieres
acute attacks = buccal or IM prochlorperazine
prophylaxis = betahistine or vestibular rehab
most common gland affected by Sialolithiasis
submandibular - whartons duct is blocked
most common causative organisom of Sialadenitis
staph aureus
what is samters triad
asthma + aspirin sensitivity + nasal polyposis
what is seen on otoscpoy in a cholestostoma
crusting in the attic
management of a quinsy
surgical drainage and iv antibiotic
consider tonsillectomy in 6 weeks
trismus
difficulty opening mouth
most common cause of otitis media
haemophillus influenzae
Streptococcus pneumoniae and Moraxella catarrhalis
A 50-year-old lady presents with symptoms of a dry mouth that has been present for the past few months. She also has a sensation of grittiness in her eyes. On examination she has a diffuse swelling of her parotid gland. There is no evidence of facial nerve palsy
Sjrogerns
A 50-year-old female presents with bilateral parotid gland swelling and symptoms of a dry mouth. On examination she has bilateral facial nerve palsies. This improved following steroid treatment.
sarcoidosis
inications for antibiotics in acute otitis media
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 perforation and/or discharge in the canal
what is ramsay hunt syndrome
shingles affecting the facial nerve
management of ramsay hunt
oral aciclovir and oral steroids
managment of perforated tympanic membrane
no treatment is needed in the majority of cases as the tympanic membrane will usually heal after 6-8 weeks. It is advisable to avoid getting water in the ear during this time
give antibiotics if occurig in the context of AOM (amox)
myringoplasty is surgical treatment
medications that cause gingival hyperplasia
phenytoin
ciclosporin
calcium channel blockers (especially nifedipine)
A 44-year-old man comes to see you describing a constant feeling of mucus in the back of the throat. He also describes that he has had a cough for 6 months and often has bad breath -especially in the mornings. He reports that he is otherwise well but admits to smoking 10 cigarettes a day.
On examination, the ears appear normal and the throat appears slightly erythematous with no tonsillar swelling.
post nasal drip
what does rinne negative mean
bone is loader than air - either conductive loss
rinne positive meants
air better than bone - sensorineural or normal
medications that cause tinnitus
Aspirin
Aminoglycosides
Loop diuretics
Quinine
treatment of acute ulcerating gingivitis
refer the patient to a dentist, meanwhile the following is recommended:
oral metronidazole* for 3 days
chlorhexidine (0.12% or 0.2%) or hydrogen peroxide 6% mouth wash
simple analgesia
antibiotic treatment of tonislittis
If antibiotics are indicated then either phenoxymethylpenicillin or erythromycin (if the patient is penicillin allergic) should be given. Either a 7 or 10 day course should be given
oral ulcer present for 6 weeks
refer to oral surgery if ulcer persists more than 3 weeks on a 2 week referral basis
cancer referral to ENT criteria
A suspected cancer pathway referral to an ENT specialist should be considered for people aged 45 and over with:
persistent unexplained hoarseness or
An unexplained lump in the neck.
investigation that always needs to be done prior to ENT referral for suspected cancer
chest xray
what is as sistrunk procedure
thyroglossal cyst
how should you manage a nasal fracture
either reset immediately before swelling develops
or reset 7-14 days after fracture when swelling has settled under local
after 14 days callouses develop and septal deviation is corrected under GA
if this fails then elective septorhinoplasty in 6 months
paroxysmal hemicrania
headache lasting a few minutes
tirggered buy turning hed
autonomic symptoms eg pstosis and eye watering rhinorrea
epistaxis and sheep
orf
chromium exposure and whistling
septal perf
trumpet player presents with an uncomfortable feeling in the front of his neck when he plays the trumpet. His friends have also notice a lump at the same location while he plays. On examination there is a smooth reducible mass in the anterior triangle. Coughing causes the mass to increase.
A laryngocele - rare cause of neck lump in wind instruments players. High pressure in the larynx causes an out pouching of the laryngeal mucosa.
indications for antibiotics in otitis media
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 perforation and/or discharge in the canal
antibtioc given in otitis media is
amoxicillin
erythromicin if allergic
