Vertigo Flashcards
Acute sinusitis
1) what is it
2) commonest infectious agents
3) predisposing factors?
1) inflammation of the mucous membranes of the paranasal sinuses
2) Strep pneumonaie, Haemophilis influenza and rhinoviruses
3) nasal obstruction (polyps, septal deviation), recurrent local infection (rhinitis, dental extraction), swimming, smoking
T/F: the sinuses are usually sterile
T
features of acute sinusitis?
nasal d/c (thick and purulent)
facial pain: frontal, worse on bending forwards
nasal obstruction
Rx of acute sinusitis?
analgesia
intranasal corticosteroids if symptoms >10 days
antibiotics only if severe
T/F: antibiotics are routinely used in acute sinusitis
false - only for severe presentations
when might intranasal corticosteroids be used in acute sinusitis
if symptoms persist >10 days
T/F: vast majority of cases of acute tonsillitis are viral
false - over 50% bacterial
commonest organism in acute tonsillitis?
Strep pyogenes
CENTOR criteria?
What merits antibiotics?
Fever (>38)
Tender anterior cervical lymphadenopathy
Tonsillar exudate
Absence of a cough
complications of tonsillitis?
Peritonsillar abscess (Quinsy)
Otitis media
Rheumatic fever and glomerulonephritis (rare)
indications for tonsillectomy?
Must meet ALL of the following: ≥5 episodes/ year Symptoms for at least 1 year Interfering with normal functioning Sore throat is due to tonsillitis
complications post-tonsillectomy?
management?
primary haemorrhage (<24h): usually inadequate haemostasis»_space; immediate return to theatre
secondary haemorrhage (1-10 days): usually due to infection»_space; admission and antibiotics (surgery if severe)
ALL cases require ENT referral (even if resolved by time of presentation).
peritonsillar abscess (quinsy)
1) features
2) treatment?
1) tonsillar deviation away from affected side, voice changes, severe unilateral throat pain
2) IV Abx and drainage
peritonsillar abscess (quinsy)
1) features
2) treatment?
1) uvular deviation away from affected side, severe throat pain lateralising to one side, trismus, reduced neck mobility
2) urgent ENT review, IV Abx + drainage (tonsillectomy considered after 6 weeks)
T/F: most cases of acute otitis media are viral in origin
false- although typically preceded by viral URTI, mainly caused by bacteria esp S. pneumoniae, H. influenza and Moraxella catarrhalis
(viral URTIs are thought to disturb the normal nasopharyngeal microbiome, allowing bacteria to infect the middle ear via the Eustachian tube)
acute otitis media
1) features
2) otoscopy findings
3) if using pneumatic otoscopy
1) otalgia (may pull at ear), fever in 50%, hear loss, recent viral URTI, ear d/c if perforates
2) bulging TM > loss of light reflex, opacification or erythema of TM, purulent otorrhoea (perforation)
3) reduced mobility
Treatment of acute otitis media?
Analgesia, most self resolve. Seek help if not resolved after 3 days.
Antibiotics if
- <2 and b/l
- perforated/ dc in canal
- systemically unwell
- immunocompromised/ high risk of complications
- > 4 days symptoms
1st line antibiotic in acute otitis media?
if pen allergic?
amoxicillin (5-7 days)
erythromycin/ clarithromycin if pen allergic
define chronic suppurative otitis media? (CSOM)
ear pain with otorrhoea for >12 weeks
define chronic suppurative otitis media? (CSOM)
ear pain with otorrhoea for >6 weeks
common sequelae of acute otitis media?
perforation > CSOM
learing loss
labyrinthitis
causes of otitis externa?
infection: bacteria (S aureus, Pseudomonas) or fungal
Seborrhoeic dermatitis
Contact dermatitis
features of otitis externa?
otoscopy findings?
particularly common in which athletes?
ear pain, itch, discharge
otoscopy: red, swollen, or eczematous canal
swimming - ‘swimmers ear’
1st line Rx of otitis externa?
topical antibiotic/ combined topical antibiotic + steroid
ear wick sometimes used if canal extensively swollen
what is malignant otitis externa? who gets it?
severe otitis externa
immunocomprised individiuals e.g. DM
what is malignant otitis externa? who gets it?
extension of infection into the bony ear canal and soft tissues deep to bony canal
immunocomprised e.g. elderly diabetics
commonest pathogen causing malignant otitis externa
pseudomonas aeruginosa
features of malignant otitis externa?
Severe, unrelenting, deep-seated otalgia
Temporal headaches
Purulent otorrhea
Possibly dysphagia, hoarseness, and/or facial nerve dysfunction
treatment of malignant otitis externa?
ENT referral
IV Abx to cover pseudomonas (e.g. ciprofloxacin)
treatment of malignant otitis externa?
urgent ENT referral
IV Abx to cover pseudomonas (e.g. ciprofloxacin)
what is chronic rhinosinusitis
inflammation of mucosa of paranasal sinuses lasting >12 weeks
what is chronic rhinosinusitis
inflammation of mucosa of paranasal sinuses and lining of nasal passages lasting >12 weeks
predisposing factors to chronic rhinosinusitis?
atopy: hay fever, asthma
nasal obstruction e.g. Septal deviation or nasal polyps
recent local infection e.g. Rhinitis or dental extraction
swimming/diving
smoking
features of chronic rhinosinusitis?
facial pain: frontal, worse on leaning forward
nasal d/c: usually clear if allergic or vasomotor. Purulent suggests secondary infection.
Nasal obstruction (mouth breathing)
postnasal drip (may cause chronic cause)
Rx of chronic rhinosinusitis?
allergic avoidance
intranasal corticosteroids
nasal irrigation with saline solution
red flag symptoms in chronic rhinosinusitis?
unilateral symptoms
symptoms persisting despite 3 months of treatment
epistaxis
features of allergic rhinitis?
sneezing bilateral nasal obstruction clear nasal discharge post-nasal drip nasal pruritus
Rx of allergic rhinitis
1) general
2) mild-mod
3) mod-severe
4) what is sometimes needed to cover important life events
1) allergen avoidance
2) oral/ intranasal antihistamines
3) intranasal corticosteroids
4) oral corticosteroids
what is rhinitis medicamentosa?
rebound hypertrophy of nasal mucosa following withdrawal from long term topical nasal decongestants e.g. oxymetazoline
T/F: topical nasal decongestants should not be used for prolonged periods in allergic rhinitis
true - can lead to tachyphylaxis and also rhinitis medicamentosa
presentation of mastoiditis?
otalgia: severe, behind ear Hx of recurrent otitis media fever pt very unwell swelling, erythema and tenderness over mastoid process external ear may protrude forwards ear d/c may if perforation
Black hairy tongue
1) what ees it
2) predisposing factors?
3) the tongue should be swabbed to exclude ____
4) treatment?
1) defective desquamation of filliform papillae
2) HIV, poor dental hygiene, recent antibiotics, immunocompromised
3) candida
4) tongue scraping,
Black hairy tongue
1) what ees it
2) predisposing factors?
3) the tongue should be swabbed to exclude ____
4) treatment?
1) defective desquamation of filiform papillae
2) HIV, poor dental hygiene, antibiotics, head and neck radiation, IVDU
3) candida
4) tongue scraping, topical antifungal if candida
features of Ramsay Hunt syndrome?
otalgia
vesicular rash in ear canal/ anterior 2/3 of tongue
features of Ramsay Hunt syndrome?
auricular pain often first
facial nerve palsy
vesicular rash around the ear (or anterior 2/3 of tongue)
vertigo and tinnitus
Rx of Ramsay Hunt syndrome?
oral aciclovir and corticosteroids
1st line antibiotic in acute sinusitis? (used for severe cases)
Phenoxymethylpenicillin
Co-amoxiclav if systemically very unwell/ high-risk of complications
