Oral Test summary for 2021 oral exam PDF

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Oral test summary for 2021 oral exam with the available topics...

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Ear Otitis Externa   

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It is usually acute but can be chronic (frequent) in children Caused by trauma (injury or something in the ear), dermatitis, prolonged exposure to moisture (regular swimming in unclean water) Symptoms o Itch in the external auditory meatus (ear canal) should be a differential point for otitis externa or dermatitis o Pain when pressing targus or moving pinna (how long, what type of pain), made worse by movements (chewing) o Feeling of pressure or fullness in the ear o Discharge is clear as ear canal has no mucous glands o Deafness (mild hearing loss) Treatments o Keep ear dry during and 2 weeks after treatment using cotton wool balls smeared in Vaseline while showering or bathing. Keep external ear canal dry using tissue spears and meticulous cleansing and drying 2-4 times daily. o Use ear plugs when swimming o Keep ear clean o If fever is present oral antibiotics are necessary so refer to doctor. Also refer if symptoms do not improve. Refer if pain is severe. Treatment Aqua Ear

Paracetamol

Ibuprofen (nurofen)

Action Restore acidic pH of external auditory canal, inhibit microbial growth Help reduce the pain

Indications Otitis externa Prevention of OE after water exposure

Precautions Perforated eardrums, tympanostomy tube Inflamed or broken skin

AE Stinging on instillation Irritation of skin

Dosage 4-6 drops into each ear after swimming or bathing

Mild-moderate pain Fever

Safe in pregnancy and breastfeeding

Safe to use

Help reduce the pain

Pain due to inflammation, fever

Asthma, heart failure, peptic ulcer disease, GI bleeding, hepatic impairment, safe to use for breastfeeding but not pregnancy

Nausea, GI bleeding, diarrhoea, headache, dizziness

Adult: 1-2 tablets every 4-6 hours. With max of 8 tablets per day Child: 15mg/kg every 4-6 hours. Single dose of 30mg/kg for night time dosing Adult: 1-2 tablets 3 or 4 times a day up to 12 tablets. CR: 2 tablets every 12 hours. Child: 5-10 mg/kg 3 or 4 times a day.

Otitis Media   

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Often starts from common cold, due to the build-up of fluid due to bacterial or viral infection. Symptoms include pain in mastoid area (back of the jawbone) when moving the jaw, mucous discharge, deafness, may cause fever Referral if need of antibiotic, depending on the age of the child, if there is fever and duration. Antibiotics are needed if there is no improvement. o Infants younger than 6 months o Children younger than 2 years with bilateral infection o Children who are systemically unwell (lethargic, irritable, pale) o Children with otorrhoea. Suppurative otitis media is characterised by chronically perforated eardrum and discharge over several weeks. Remove discharge 4 times a day by meticulous, cleaning and drying with tissue spears until ear is dry. Keep ear dry. Refer if response is slow >4-6 weeks. Mastoiditis signs include fever, irritability, lethargy, swelling behind the ears, redness and tenderness, discharge. Otitis media that hasn’t gone away. Refer for antibiotics. Glue ear mainly affects children. It is long term build up of sticky fluid in middle ear. Hearing impairment and can cause delay in speech. Refer to doctor to check the ear if persists >3months. Use ear plugs with swimming cap for grommets for glue ear. Ear drum perforation signs include hearing loss, pain in ear, clear, mucous or bloody discharge, tinnitus or vertigo, earache that suddenly goes away, air coming out of ears when blowing nose, fever if there is otitis media. Refer to doctor. Barotrauma signs include sensation of ear blockage, ear pain, tinnitus, vertigo and transient conductive hear loss. Last 2 to 3 days. Use analgesics and oral or topical decongestants. Adequate analgesia to help with pain.

Wax Impaction     

Symptoms include ear discomfort, blocked ear, gradual hearing loss Usually clear in 5 days. Treatments Avoid using cotton buds and ear candles. Gentle Syringing with warm water or sodium chloride 0.9% solution to loosen and remove wax, if wax is hard and impacted, use cerumenolytic drops 15 minutes before syringing. Treatment Waxsol

Action Aid wax removal by softening and dispersing wax

Indications Removal of excessive ear wax

Ear Clear Ear Wax Removal

Aid wax removal by softening and dispersing

Removal of excessive ear wax

Precautions AE Inflammation or Irritation perforation of eardrum or external auditory canal. Inflammation or Irritation perforation of eardrum

Dosage Fill ear canal with drops on 2 consecutive nights before syringing. 5-10 ear drops twice daily for up to 4

wax

or external auditory canal.

days.

Perichondritis         

Infection of tissue covering the external ear Caused by injuries, insect bites, burns, piercing, surgery or boil. Symptoms include redness, pain, swelling, fever, puss Treatments: Pain relievers, antibiotics and corticosteroids, warm compresses, removal of foreign objects Piercing causes mild redness, swelling and crusting. Takes up to 6-8 weeks to heal. Prevent infection by washing area twice daily. Treat infection locally and do not remove earing if possible. Infections of cartelage top of the pinna are more serious and should be referred Refer to GP immediately if moderate to severe presentation

Dermatitis in the ear area  

Ear dermatitis sits just down the crease area behind the ear, it can be quite red and can be a sort of yellow indicating there was a risk of secondary infection. Use moisturises such as Dermeze, avoid contact with the sun or any irritants such as perfumes, use dermatologically tested bodywash, avoid allergens. Treatment DermAid 0.5% cream

Action For allergic dermatitis

Indications For allergic dermatitis from piercing

Precautions Diabetes, immunocompromised, avoid extensive use. Safe for breastfeeding, use lowest potency for pregnancy

AE Transient burning, sting on application, inflammation of hair follicles, delayed wound healing

Elocon ointment 15g (Potent)

Relief inflammation and itch

Dermatitis

Diabetes, immunocompromised, avoid extensive use. Safe for breastfeeding, use lowest potency for pregnancy

Transient burning, sting on application, inflammation of hair follicles, delayed wound healing

Allergic Rhinits 

Presence of 2 or more nasal symptoms for more than 1hr per day. System Nose

Symptoms Sneezing, runny nose, blocked nose

Dosage One finger unit 1 or 2 times a day to cover affected areas. Until dermatitis has gone and skin is completely clear One finger unit once a day to cover affected areas. Until dermatitis has gone and skin is completely clear

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Eyes Tearful, burning. Itching Ears Ear popping and fullness Sinus Pressure over the cheeks and forehead Throat Itchy throat and post-nasal drip Lungs Cough and symptoms of asthma Could be seasonal; in a certain time of the year (most commonly pollen season) Duration is variable (months or shorter recurrent episodes) and symptoms are triggered by exposure to allergens. There is strong association with asthma, middle ear infections in children. Mild Moderate-severe Normal sleep Abnormal sleep No impairment of daily Impairment of daily activities activities Normal work and school Abnormal work and performance school performance No troublesome Troublesome symptoms symptoms

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Intermittent if 6 yrs: 2 spray to 4 max daily as needed

Allergic rhinitis

Sever nasal infections, bleeding disorders, recent nasal surgery or trauma

Nasal stinging, itching, nosebleed, dry mouth.

Adult, child >12 yrs: 2 sprays into each nostril once daily, then 1 spray into each nostril once daily when symptoms controlled. Child 2-12yrs: 1 spray into each nostril once daily.

and itchy eyes Eyes       

Broken blood vessel in conjunctiva is self-limiting and heals on its own. Lubricant eye drops are helpful In case of bacterial conjunctivitis, discharge tends to be purulent In case of allergic conjunctivitis, discharge tends to be mucoid In case of viral infections, discharge tends to be watery with gritty feeling, there might be light sensitivity, generalised redness with cough and cold symptoms. Refer to GP Pain is a signal that there is something more sever, especially if patient gets nausea which occurs in glaucoma Pain on eye movements is a factor that signals that the extra ocular muscles are involved  emergency case  refer. Photophobia is common if there is irritation on the surface of the cornea, approaching on the pupil.

Bacterial conjunctivitis   

Red sticky eyes generalised and can diffuse, foreign body sensation, gritty feeling (no pain) and no or mild photophobia. Significant purulent (mucous yellowy) discharge, some hyperaemia of the conjunctiva, and no corneal staining. Normally both eyes affected, occasionally unilateral. Use Systane lid wipes to keep area clean, do not reuse or share face towel. It is self-limiting but antibiotic can speed up recovery. Refer to doctor for antibiotic, if symptoms worsen and not improve by 3rd day of chlorsig. Refer to GP for 2yrs): 1 eye drop every 2 hours while awake for 1 day, then if there is improvement, 1 drop 4 times daily for other 4 days. Adult, child: massage ointment into lid margin once or twice daily for 1 week. Adult, child:1 eye drop 4 times a day until healed. Usually 3-5 days.

Allergic conjunctivitis  Could be bilateral with one eye worse than the other, itching, burning, tearing, redness with watery discharge that is not sticky and oedema in the conjunctiva, generalised redness, with other rhinitis symptoms. Should not be painful. Eyes can be puffy and red to differentiate with dry eyes.  Seasonal (spring) Allergic conjunctivitis tends to be more common and intense. Perennial Allergic conjunctivitis tends to be from animal dander, dust mite, but in majority of cases we tend to see seasonal variation.  Treatments o Avoid allergens (wear sunglasses), flushing tears, cold compresses, use Systane or little eyes cleansing wipes.

Treatment Zaditen

Action Fast relief of itchy, watery eyes in minutes up to 12 hours

Indications Allergic conjunctivitis

Precautions Safe to use

AE Allergy, blurred vision on instillation, dry eyes and mouth, sedation, stinging on instillation, mild eye irritation and headache

Dose Adult, child >3yrs: 1 eye drop into effected eye twice daily for 2-3 days. Remove lenses and wait for 15 minutes after using drops before reinserting lenses.

Dry eyes    

Symptoms include blurriness, excessive tearing, eye fatigue, irritation, foreign body sensation, sensitivity to light (photophobia), itchy eyes, soreness, stinging, gritty or sandy feeling. Evaporation of aqueous layer (Meibomian Gland deficiency) is the most common case of dry eyes. We can also see aqueous deficiency or both. If we use oil type drops for dry eyes, we need to replenish the aqueous layer before using the oil type drop. Refer to eye specialist if patient feels pain, has changes in vision, redness or irritation gets worse or persists, or experience persistent eye discomfort and children (use warm compresses to promote tear ducts to produce tears). Treatments o For meibomian gland disease we tend to give a lipid drop (tear lubricants) in conjunction with an aqueous supplement. Lid hygiene and warm compresses can help. o Environment: avoid dry and windy environments, sun and smoke, overheated or overcooled air, extended screen time. o Tea tree oil is a way to get rid of blepharitis.

Treatment Systane Complete eye drops

Action Relieve all types of dry eyes, burning and irritation, replenishes all layers of tear film for up to 8hrs

Indications Dry eyes

Precautions Safe to use

AE Ocular irritation

Belpharitis    

Usually related to Staph aureus Dandruff type material along the anterior lid margin Systane Lid wipes (eyelid cleanser) and compresses work nicely Refer to doctor for antibiotics.

Chalasia and Stye   

Chalasia is blockage of meibomian gland due to lipid thickening, tender at first and not sore. Stye is infection of hair follicle and associated glands Both treated using hot compresses and massage.

Dose Adult, children: 1 drop in effected eye every 1-12 hours as required. For up to 3 months. Remove lenses and wait for 15 minutes after using drops before reinserting lenses.

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Refer to doctor for stye antibiotics, Refer to doctor if don’t resolve in a few days and form a chronic lump for steroid injection or surgical Recurrence is common so ask if this has happened before Increased risk of blepharitis so we prescribe Systane lid wipes

Wet or Dry AMD  

Dry AMD is more common form of late AMD and develops slowly. Involves gradual or progressive death of retinal cells. Associated with Drusen (small yellowish deposits under retina), no vision loss. Eliminating modifiable risk factors, avoid fast food, increase consumption of dark leafy vegetables (silver beets spinach with olive oil or salad dressing), omega 3 fatty acids (fish and eggs) (inhibit development of plaque and blood clots, help retinal vessel health) and low Glycaemic Index foods (see dietician), exercise, oranges (reduce late AMD). Meals on wheels, My aged care services (for patients who cant cook) Treatment Bioglan Multivitamin + vision advanced

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Action Indications Dose Take 1 Support Eye macula health, AMD (Dry, Wet) tablet daily healthy eye function, with food. healthy immune system, antioxidants, maintain bone health, support energy levels. Wet AMD is associated with much rapid visual loss, it happens when there is abnormal blood vessel growth under the macula and cause hard tissue to develop on the retina AMD Risk factors are age, family history, diet, smoking, and lifestyle. Treatments: Refer to optometrist or eye specialist.

Eye dermatitis 

Treatments

Treatment Action DermAid 0.5% cream

Relieve the itchiness and inflammation

Indication s eczema

Precautions

AE

Dose

Contraindicated to ulcerative skin conditions, untreated skin infections, acne vulgaris. Avoid extensive use for diabetic and immunocompromised patients. Safe for breastfeeding, use lowest potency for pregnancy

Transient burning, stinging or pain on application, folliculitis, skin atrophy.

Adult, child: apply enough quarter ftu to cover affected areas 1 or 2 times a day up to 4 times daily until skin is clear.

Gingivitis   

Inflammation of the gums (generalised or localised) Treated with improved oral hygiene and dental cleaning so refer to dentist Advise patients to brush twice daily as well as CHX mouthwash (Savacol) for 2 weeks

Traumatic Ulcers  

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Patients present in pain for oral ulcerations. It is white crater and has a slightly raised boulder. Associated with o eating rough sharp, hot food, biting on cheek o Sharp broken teeth or dental restoration, braces o Toothbrushing o Chemical burns Treatment and prevention o Avoid eating rough, sharp, hoot foods. Use soft bristle brushes. Use saline mouthwash (dissolve half a teaspoon of salt in a glass of warm water) to soothe mild ulcers Non-alcoholic chlorhexidine mouthwash can be used short-term; it may hasten ulcer healing and prevent secondary infection (Colgate Savacol Mouthwash Fresh Mint; rinse 3 times daily; if red or bleeding gums persist for more than 2 weeks, stop use and seek advice from dentist). Should not last longer than 2 weeks  refer to dentist. OTC product Benzydamine 1% gel Difflam

Dosage Adult and children 6 years or older: 1cm topically to ulcer 2-3 hourly as necessary. Max 12 times a day. Don’t drink or eat 15 min after application

Benefits, precautions &SE Difflam Mouth Gel with a fresh peppermint flavour provides fast soothing pain relief for mouth ulcers and sore gums.

Treatment duration and referral Up to 2 weeks then refer to dentist

Infective Ulcers     

Secondary to a bacterial, viral or fungal infection Herpangina is viral illness in children causing painful ulcers in mouth, often in the back of the throat and roof of the mouth. Other symptoms include headache, fever, decreased appetite, and neck pain Treatment includes managing pyrexia using analgesics, symptomatic relief of ulcers (also mention a balanced diet- cold milk, icecream and avoid spicy foods). Refer to GP Hand, foot and mouth disease (HFMD). Similar presentation and considerations as herpangina, accompanied by small oval blisters on palms, and soles of feet (generally not itchy). Treatment: Provide symptomatic relief and reassurance. It is self-limiting and generally resolves within 2 weeks. Provide analgesics + anaesthetic containing mouthwash or gel (Cepacine, SM-33, Difflam mouth gel). Refer to GP

Cold sores  

Recurrent (patient usually has history) oral viral infection. Can occur at any age. Lesions usually occur on the lips but can also occur on the intraoral mucosa or other areas of the skin. Cold sores are more blistery, localised and red when it heals than impetigo. Lesions are preceded by the prodromal stage lasting for several hours to days which features pain, tingling or itching and fever. Recurrences are usually mild and infrequent.

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Treatment: o Start treatment as early as possible o If recurrent in the following groups refer to GP: patients with sever recurrences of herpes (systemic signs and symptoms, difficulty eating and swallowing), patients with generalised or chronic herpes infection (crusted lesions or ulcerations) Immunocompromised patients (HIV etc..) o Frequency can be minimised with sun protection. Patches to cover the sores.

Treatment Zovirax Cold Sore Cream

Action Minimise healing time and reduce cold sore symptoms

Indications Cold sores

Precautions Safe for pregnancy and breastfeeding.

AE Dry or flaking skin, transient stinging or burning, erythema, itch, hypersensitivity reaction.

Aciclovir 200 mg tablets

Minimise healing time and reduce cold sore symptoms

Cold sores

Safe for pregnancy and breastfeeding

Headache, vomiting, diarrhoea, confusion (do not drive or operate heavy machinery)

Dose Adult, child>3 months: At first sign of lesion or prodromal stage, apply 5 times a day every 4 hrs while awake for 4-5 days. Avoid contact with eyes and inside mouth. Adult: 2 tablets, 5 times daily for 5 days. 2 tablets 3 times daily for 510 days for HIV patients

Or a l t hr us h   

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Or a l c a n d i d i a s i si sa no p p o r t u n i s t i cf u n g a l i n f e c t i o no c c u r sd u et od e n t u r e s , s a l i v a r yg l a n dh y p o f u n c t i o n , c o r t i c o s t e r o i di n h a l e r s , p o o r o r a l h y g i e n ea n ds mo k i n g . Al s o o c c u r si ni mmu n o c o mp r o mi s e dp a t i e n t sa n dd u et od r u g s( s y s t e mi cc o r t i c os t e r o i d sa n da n t i b i o t i c s ) Ps e udome mbr a n ousc a ndi di a s i ss h o wsa sc r e a mywh i t ec u r d , p a p u l e sa n dp l a q u e st h a t a r eg e n e r a l l yr e mo v a b l e . Re d , r a wa n do f t e nb l e e d i n gb a s ea n di sg e n e r a l l y a s y mp t o ma t i c . An g ul a rCh e l i t i ss h o wsa sp a i n f u l e r y t h e maa n dwh i t ea n dc r ...