Passmedicine

Question 1

when are antibiotics indicated in a sore throat

Answer 1

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

Question 2

what is the centor criteria

Answer 2

presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever
absence of cough

3 or more = antibiotics

Question 3

antibiotics given for tonisllitis are

Answer 3

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

Question 4

name drugs that are ototoxic

Answer 4

gentamicin
furesomide
aspirin

Question 5

what is tachyphlaxis

Answer 5

After using topical decongestants for prolonged periods increasing doses are needed to provide the same effect, a phenomenon known as tachyphylaxis.

Question 6

management of allergic rhinitis

Answer 6

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

Question 7

what is malignant otitis externa

Answer 7

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

Question 8

infective organism in malignant otitis externais

Answer 8

pseudomonas

Question 9

treatment of malignant otitis externa is

Answer 9

ciprofloxacin

Question 10

symptoms of malignant otitis externa

Answer 10

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

Question 11

severe pain and protrusion of the ear forwards, with a tender, boggy and often reddened mass behind the ear

Answer 11

acute mastoiditis - admit!

Question 12

indications for tonsillectomy

Answer 12

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

Question 13

type of hearing loss in base of skull fracture

Answer 13

sensorineural

Question 14

type of hearnig loss in tympanic membrane perforation

Answer 14

conductivr

Question 15

midline lump moves with tongue protrusion

Answer 15

thyroglossal cyst

Question 16

features of ramsey hunt syndrome

Answer 16

auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear
other features include vertigo and tinnitus

Question 17

management of menieres

Answer 17

acute attacks = buccal or IM prochlorperazine

prophylaxis = betahistine or vestibular rehab

Question 18

most common gland affected by Sialolithiasis

Answer 18

submandibular - whartons duct is blocked

Question 19

most common causative organisom of Sialadenitis

Answer 19

staph aureus

Question 20

what is samters triad

Answer 20

asthma + aspirin sensitivity + nasal polyposis

Question 21

what is seen on otoscpoy in a cholestostoma

Answer 21

crusting in the attic

Question 22

management of a quinsy

Answer 22

surgical drainage and iv antibiotic

consider tonsillectomy in 6 weeks

Question 23

trismus

Answer 23

difficulty opening mouth

Question 24

most common cause of otitis media

Answer 24

haemophillus influenzae

Streptococcus pneumoniae and Moraxella catarrhalis

Question 25

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

Answer 25

Sjrogerns

Question 26

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.

Answer 26

sarcoidosis

Question 27

inications for antibiotics in acute otitis media

Answer 27

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

Question 28

what is ramsay hunt syndrome

Answer 28

shingles affecting the facial nerve

Question 29

management of ramsay hunt

Answer 29

oral aciclovir and oral steroids

Question 30

managment of perforated tympanic membrane

Answer 30

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

Question 31

medications that cause gingival hyperplasia

Answer 31

phenytoin ciclosporin calcium channel blockers (especially nifedipine)

Question 32

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.

Answer 32

post nasal drip

Question 33

what does rinne negative mean

Answer 33

bone is loader than air - either conductive loss

Question 34

rinne positive meants

Answer 34

air better than bone - sensorineural or normal

Question 35

medications that cause tinnitus

Answer 35

Aspirin Aminoglycosides Loop diuretics Quinine

Question 36

treatment of acute ulcerating gingivitis

Answer 36

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

Question 37

antibiotic treatment of tonislittis

Answer 37

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

Question 38

oral ulcer present for 6 weeks

Answer 38

refer to oral surgery if ulcer persists more than 3 weeks on a 2 week referral basis

Question 39

cancer referral to ENT criteria

Answer 39

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.

Question 40

investigation that always needs to be done prior to ENT referral for suspected cancer

Answer 40

chest xray

Question 41

what is as sistrunk procedure

Answer 41

thyroglossal cyst

Question 42

how should you manage a nasal fracture

Answer 42

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

Question 43

paroxysmal hemicrania

Answer 43

headache lasting a few minutes tirggered buy turning hed autonomic symptoms eg pstosis and eye watering rhinorrea

Question 44

epistaxis and sheep

Answer 44

orf

Question 45

chromium exposure and whistling

Answer 45

septal perf

Question 46

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.

Answer 46

A laryngocele - rare cause of neck lump in wind instruments players. High pressure in the larynx causes an out pouching of the laryngeal mucosa.

Question 47

indications for antibiotics in otitis media

Answer 47

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

Question 48

antibtioc given in otitis media is

Answer 48

amoxicillin | erythromicin if allergic