question

2 pathogens mainly responsible for acute otitis externa

answer

1. pseudomonas 2. s. aureus

question

presentation: rapid onset of ear canal inflammation 1. otalgia 2. itching 3. canal edema 4. canal erythema 5. otorrhea

answer

acute otitis externa

question

classic finding of acute otitis externa

answer

tenderness of tragus or pinna

question

treatment of choice for uncomplicated acute otitis externa

answer

topical antimicrobials or abx such as acetic acid, aminoglycosides, polymyxin B and quinolones

question

adding what prep to treatment of choice can help in managing acute otitis externa?

answer

corticosteroids

question

what is the first-line therapy when TM intact?

answer

neomycin/polymyxin B/hydrocortisone

question

what should be given if otitis externa infxn spreads to ear canal or the pt is at risk of rapidly progressing infxn?

answer

oral abx

question

disease often occurs following swimming or minor trauma from inappropriate cleaning

answer

acute otitis externa

question

2 causes of CHRONIC otitis externa

answer

1. allergies 2. underlying inflammatory dermatologic conditions

question

how do you treat chronic otitis externa?

answer

address underlying causes

question

swimmer's ear

answer

otitis externa

question

disease involves diffuse inflammation of external ear canal that may extend distally to the pinna and proximally to the TM?

answer

otitis externa

question

therapy used to manage acute otitis externa depends on what 4 things name 2

answer

TM status adverse effect profiles compliance issues cost

question

on rare occasions, when otitis externa invades surrounding soft tissue and bone it is known as

answer

malignant or necrotizing otitis externa

question

2 high risk groups of developing necrotizing otitis externa

answer

1. elderly 2. diabetics

question

98% of causes of acute otitis externa is by

answer

bacteria

question

how many cases of otitis externa are polymicrobial

answer

1/3

question

2 fungal pathogens that can cause otitis externa

answer

aspergillus and candida--occur in more tropical or subtropical environments and in pts previously treated with abx

question

Anatomic abnormalities that are predisposing factors for otitis externa (3)

answer

1. canal stenosis 2. exostoses 3. hairy ear canals

question

3 canal obstructions that predispose people to otitis externa

answer

1.cerumen obstruction 2. foreign body 3. sebaceous cyst

question

4 cerumen/epithelial integrity predisposing factors for otitis externa

answer

1. hearing aids 2. cerumen removal 3. earplugs 4. instrumentation/itching

question

3 dermatologic conditions that predispose a person to otitis externa

answer

1. eczema 2. psoriasis 3. seborrhea

question

water in ear canal can predispose ppl to otitis externa. namme 3 examples

answer

1. humidity 2. sweating 3. swimming

question

4 misc predisposing factors to otitis externa

answer

1. purulent otorrhea from otitis media 2. soap 3. stress 4. type A blood

question

Predisposing factors to otitis externa generally work in either of what 4 ways

answer

1. loss of cerumen protective barrier 2. change pH of ear canal 3. inoculate with bacteria 4. disrupt epithelium

question

how can you prevent otitis externa?

answer

1. head tilt 2. low setting on hair dryer 3. use earplugs when swimming 4. avoid self cleaning ear canal 5. acetic acid 2% otic solutions 2 drops 2x a day or 2 to 5 drops after water exposure

question

how is acute otitis externa dx?

answer

clinically based on signs and sx

question

what symptom best correlates with severity of otitis externa disease?

answer

pain

question

if pt w/ otitis externa presents with temp greater than 101F, what can you assume?

answer

infxn extends beyond auditory canal

question

PE of otitis externa

answer

check auricle and surrounding lymph nodes skin exam otoscopy of ear canal check TM to see if intact

question

3 elements of dx of diffuse otitis externa

answer

1.rapid onset (last 48 hours) in the past 3 weeks AND 2. sx of ear canal inflamm that include: -otalgia, itching or fullness W/ OR WITHOUT hearing loss or jaw pain AND 3. signs of ear canal inflamm. that include: tenderness of tragus, pinna or both OR diffuse ear canal edema, erythema or both WITH or WITHOUT otorrhea, regional lymphadenitis, TM erythema or cellulitis of the pinna and adjacent skin

question

classically associated with itching, thick material in the ear canal, and failure to improve with use of topical antibacterials

answer

otomycosis

question

if pt is diabetic or immunocompromised with refractory purulent otorrhea and otalgia worse at night, what can you dx

answer

malignant otitis externa

question

clinical findings: -granulation tissue in external auditory canal esp. at bone-cartilage junction -extension of infxn beyond auditory canal can cause lymphadenopathy, trismus and facial nerve and other cranial nerve palsies

answer

malignant otitis externa

question

classic symptoms are itching and mild discomfort; may be lichenification on otoscopy; lasts 3 months

answer

chronic otitis externa

question

mainstay of treatment for uncomplicated acute otitis externa

answer

topical antimicrobials with or without corticosteroids

question

why are opthalmic preparations better tolerated than otic preps?

answer

differences in pH between preps can help with compliance and tx recommendations

question

T/F studies indicate that aminoglycosides are more effective than any other prep

answer

false; no studies show that one agent or prep is better than the other

question

adverse effect of otic preps

answer

contact dermatitis

question

adverse effect of aminoglycosides

answer

hypersensitivity to neomycin in up to 15% of people w/ 30% of them having chronic otitis externa

question

adding a corticosteroid to treat otitis externa helps in rapid improvement in sx such as

answer

pain, canal edema and erythema

question

indications for systemic abx--name 2

answer

1. spreads beyond ear canal 2. uncontrolled DM 3. immunocompromise 4. hx of local radiotherapy 5. inability to deliver topical abx

question

tx of otitis externa if TM is NOT intact or if pt is hypersensitive to neomycin or nonadherence to tx is an issue

answer

ofloxacin and ciprofloxacin dexamethasone are approved for middle ear use

question

first line analgesic for otitis externa

answer

non-steroidal anti-inflamm drugs and acetominophen

question

how much time post-therapy should lapse before reconsidering new treeatment plan to non-responsive therapy?

answer

48-72 hours; consider a culture for resistant strains or fungi

question

educate pt to properly admin ear drops

answer

lie on your side with the affected ear facing upward; run the prep to the side of the ear canal until is it full and gently move the pinna to relieve air pockets;stay in this position for 3-5 mins; do not occlude canal; let it dry--have someone else put drops in if you can also stay away from water spots for a week; avoid submersion

question

tx for pain from acute otitis externa

answer

oral analgesics

question

aural toilet recommendations

answer

gently lavage suctioning or dry mopping under otoscopic or microscopic visualization to remove obstructing material and to verify TM integrity

question

lavage should only be used if the TM is

answer

intact

question

lavage should not be perfored on patients with

answer

diabetes--can cause malignant

question

presentation: -acute onset -presence of middle ear EFFUSION -physical evidence of middle ear inflammation

answer

acute otitis media

question

sx include -pain -irritability -fever

answer

acute otitis media

question

complication of eustachian tube dysfxn that occurs during a viral upper resp. tract infection

answer

acute otitis media

question

3 most common organisms isolated from middle ear fluid

answer

1.S. pneumo 2. H. influenzae 3. Moraxella Catarrhalis

question

management of acute otitis media should begin with

answer

analgesia

question

mgmt of acute otitis media in kids 2 years or older w/ mild sx

answer

defer abx therapy

question

abx of choice for acute otitis media pts allergic to penicillin and for initial treatment in children

answer

high dose amoxicillin (80-90 mg per kg per day)

question

what should be done for kid with persistent sx despite 48-72 hours of abx therapy?

answer

should be reexmined and a 2nd line agent such as amoxicillin/clavulanate should be used

question

middle ear effusion in the absence of acute sx

answer

otitis media with effusion

question

3 therapies to avoid for treating clearance of middle ear fluid

answer

abx decongestants nasal steroids

question

what should be done for kid with anatomic damage, hearing loss or language delay?

answer

refer to otolaryngologist

question

most prevalent organism among children with severe or refractory AOM following introduction of pneumococcal conjugate vaccine

answer

H. influenzae

question

Name as many risk factors for acute otitis media

answer

age-younger allergies craniofacial abnormalities exposure to environmental smoke or other resp irritants exposure to group day care fmhx of recurrent acute otitis media GE reflux immunodeficiency no breastfeeding pacifier use upper resp tract inxn

question

criteria for AOM dx

answer

moderate to severe bulging of TM; new onset of otorrhea not by otitis externa or mild bulging of TM assoc with recent onset of ear pain less than 48 hours or erythema

question

what can you use to detect middle ear effusion

answer

otoscopy, pneumatic otoscopy, and tympanometry

question

preferred method for detecting presence of middle ear effusion and documenting bacterial etiology, rarely performed in pcp setting

answer

tympanocentesis

question

most common sx motivating parents to seek care in regards to AOM

answer

disrupted sleep

question

preferred analgesic for AOM

answer

ibuprofen

question

indication for routine abx (AOM)

answer

1. kids 6 MO and older with severe signs and sx -moderate or severe otalgia -otalgia for at least 48 hours -temp of 102.2 F 2. kids <2 years w/ bilateral AOM REGARDLESS of sx or signs

question

observation is recommended for treatment of AOM when

answer

kids have mild sx -unilateral AOM in kids 6 to 23 mo of age 2 out of 3 kids will recover w/out therapy

question

AAFP recommendation for AOM

answer

if kid is 2-12 yo with nonsevere sx, observe if sx persist longer than 48-72 hrs, schedule follow up visit or provide pts with a backup abx script to be filled if sx persist

question

advantages of ammoxicillin

answer

1.safe 2. low cost 3.acceptable taste 4. effective 5.narrow microbio spectrum

question

kids who took amoxicillin in past 30 days, have conjunctivitis and need converage for B lactamasee-pos orgd should be given

answer

amoxicillin clavulanate

question

what should kids be given if allergic to penicillin-AOM

answer

CEPHALOSPORIN

question

MEDICATION reserved for episodes of treatment failure or when serious comorbid bacterial infxn is suspected

answer

ceftriaxone

question

adverse effect of abx for AOM

answer

diarrhea

question

what can you give to pt to combat diarrhea from abx?

answer

probiotic or yogurt with active cultures

question

if kid has amoxicillin allergy and cephalosporin does not work, what can you try?

answer

IM ceftriaxone, clindamycin or tympanocentesis

question

option for kids with recurrent AOM infxn - of 3 or more episodes in 6 mo or 4 episodes within 12 mo w. at least one episode during preceding 6 mo with middle ear effusion

answer

tympanostomy tubes

question

adverse effect of tympanostomy tubes

answer

may increase risk of long-term tm abnormalities and reduced hearing compared with medical therapy

question

therapy suggested to reduce incideence of infections during first year of life

answer

probiotics

question

2 rare complications to OME

answer

1. transient hearing loss 2. chronic anatomic injury to TM requiring surgery

question

TF children should be screened for speech delay in all visits

answer

true

question

what should you do if kid has developmental delay or middle ear structures are abnormal?

answer

refer to otolaryngologist

question

appropriate therapy for kid 6 mo -12 years of age who had bilateral OME for 3 mo or longer w/ documented hearing probs or for kids w/ recurrent AOM who have evidence of middle ear effusion at time of assessment

answer

tympanostomy tubes

question

can tympanostomy tubes be used in kids with single episode of OME of less than 3 months?

answer

no

question

can you use tympanostomy tubes for kid with recurrent AOM but no middle ear effusion?

answer

no

question

when should observation end for chronic OME pt without tubes?

answer

every 3-6 months should be observed until effusion is gone, hearing loss detected or structural abnormalities of TM or middle ear suspected

question

therapy for kids with tympanostomy tubes with acute uncomplicated otorrhea

answer

topical abx not oral

question

T/F kids with tympanostomy tubes need to follow water precautions

answer

false

question

middle ear pathogens found in neonates younger than 2 weeks

answer

group B strep gram - enterics chlamydia trachomatis

question

febrile neonates with AOM should have

answer

full sepsis workup

question

therapy for neonate older than 2 weeks with URI and AOM who are otherwise healthy

answer

empiric amoxicillin

question

mgmt of adult with recurrent AOM or persistent OME

answer

refer to otorlarynologist

question

adults with new onset of unilateral, recurrent AOM greater than 2 episodes per year or persistent OME greater than 6 weeks should receive

answer

additional eval to rule out mechanical obstruction like carcinoma

question

adults with isolated AOM or transient OME may be caused by

answer

eustachian tube dysfxn from viral URI

question

dx and management of effusion that appears to be assoc with anatomic damage such as adhesive otitis media or retractio n pockets

answer

reeval in 4-6 weeks; if still abnormal=otorynologist

question

name at least 2 ways to prevent recurrent otitis media

answer

1. check for undiagnosed allergies leading to chronic rhinorrhea 2. eliminate bottle propping and pacifiers 3. routinely immunize with pneumoccal conjugate and flu vaccine 4. use xylitol gum in approp. kids=children 2 pieces 5x a day after meals and chewed for at least 5 mins

question

most cases of acute rhinosinusitis is preceded by

answer

URI

question

consists of 90% of the rhinosinusitis causes

answer

virus etiology

question

inflammation of the lining of the nasal mucosa and paranasal sinuses

answer

acute rhinosinusitis

question

what lines the sinuses?

answer

ciliated epithelium that contains mucus-producing goblet cells

question

how does a virus affect sinuses?

answer

causes inflammation of the epithelial cell lining, causing overproduction of mucus and impaired mucociliary clearance causing obstruction of sinuses making it ideal home for bacterial growth

question

typical process of viral infection of sinuses takes how long

answer

7-10 days

question

IDSA criteria for presentation of viral sinusitis include

answer

nasal discharge: clear at first and then becomes purulent after a few days congestion without a cough often a sore throat

question

distinguishing sign of uncomplicated viral URI

answer

return of nasal discharge to a clear wateryy consistency without the use of antimicrobial therapy

question

2 additional sx of viral URI

answer

myalgias and headaches may also develop fever

question

how long will uncomplicated URI sx last?

answer

5-10 days

question

persistant sx lasting mroe than 10 days with no evidence of improvement -onset with severe sx including fever of 102F, higher or purulent nasal discharge at onset -double-sockening patter: new onset of fever headache or increase in rhinorrhea that worsen or return after 5-6 day viral presentation initially improving

answer

bacterial rhinosinusitis

question

classic triad of acute bacterial rhinosinusitis presentation

answer

facial pain or pressure, fever and headache

question

conventional criteria to Dx bacterial rhinosinusitis involves presence of at least what 2 major sx? OR 1 major sx and what 2 minor sx?

answer

1. purulent discharge 2. facial pain minor 1. headache 2. dental pain

question

most accurate dx approach for acute rhinosinusitis

answer

quality history of disease pattern and progression approrpriate PE

question

primary objectives for acute viral rhinosinusitis

answer

relieve sx of nasal obstruction and rhinorrhea

question

nonpharmaco therapy for viral sinusitis

answer

-increased fluid intake, bedrest, good personal hygiene

question

common ancillary therapies for viral sinusitis

answer

saline nasal spray mucolytic agents antipyretics/analgesics decongestants antihistamines

question

IDSA guidelines for nasal sprays

answer

good ancillary therapy for adults with low to moderate sx of viral rhinosinusitis

question

most common mucolytic agent

answer

guaifenesin; thins out mucus but no evidence of effectiveness fo not recommended against acute rhinosinusitis

question

to relieve pain in pts with acute rhinosinusitis use

answer

NSAID like acetominophen which is also an antipyeretic

question

may induce inflammation or rebound congestion in pts with rhinosinusitis

answer

topical decongestants

question

can cause drowsiness or xerostomia in pts with rhinosinusitis

answer

oral antihistamines

question

oral antihistamines and topical decongestants are not to be given to kids

answer

younger than 2 years

question

recommended first line drug therapy once confirmation of bacterial rhinosinusitis is

answer

amoxicillin-clavulanate

question

alternate empiric therapy for patients w bacterial rhinosinusitis who cannot tolerate amoxicillin-clavulanate

answer

doxycyline

question

for pts with rhinosinusitis from bacterial and have a penicillin allergy can be given

answer

doxycycline or resp. fluoroquinolone like levofloxacin or monofloxacin

question

further workup for pt with bacterial rhinosinusitis who does ot respond to abx after 3-5 days or worsens

answer

endoscopic eval of sinuses with aspiration for culture

question

what two drugs cannot be used for empiric therapy of bacterial rhinosinusitis due to high rates of resistance?

answer

tmp-sulfa or 3rd gen cephalosporin

question

most acute pharyngitis is caused by

answer

respiratory viruses

question

most common bacterial species causing pharyngitis

answer

GAS

question

GAS pharyngitis occurs mostly in kids of the ages

answer

5-15

question

when does bacterial pharyngitis typically occur?

answer

winter and early spring

question

supparative complications of GAS

answer

peritonsillar abscess and mastoiditis

question

non-supparative complications of GAS

answer

rheumatic heart disease, acute rheumatic fever and post-strep glomerulonephritis

question

t/f/ NO single element of the history or physical exam accurately excludes or diagnoses GAS pharyngitis

answer

TRUE

question

SORE THROAT pain with swallowing fever

answer

GAS pharyngitis

question

children have: headache nausea vomiting abd pain

answer

GAS pharyngitis

question

PE shows: erythematous tonsillopharyngeal mucosa w or without exudates lymphadenitis with tender and enlarged cervical lymp nodes erythematous beefy uvula hard palate petechiae scarlatiniform rash excoriated nares, esp in infants

answer

GAS pharyngitis

question

absence of fever presence of conjunctivitis cough coryza stomatitis diarrhea hoarseness ulcerative oropharyngeal lesions

answer

viral pharyngitis

question

gold standard for dx GAS pharyngitis

answer

positive throat swab culture

question

disadvantage of throat culture

answer

takes 18-24 hours to incubate

question

what test can detect group-specific cell wall carbohydrate antigen of GAS and provide result in minutes?

answer

RADT

question

t/f NEITHER throat swab or RADT can distinguish between acute pharyngitis infxn with GAS and asymptoatic carrier of GAS with viral pharyngitis

answer

TRUE

question

what should you do with patient presenting with pharyngitis?

answer

throat swab with culture and/or do RADT

question

if pt has signs and sx of GAS pharyngitis and RADT is +

answer

you can dx the patient with it

question

if RADT is negative in a kid or teen

answer

swab and culture pts throat for backup

question

if RADT is negative for adult

answer

dnt do anything

question

Tx for GAS pharyngitis

answer

10 day course therapy

question

preferred med for pts without penicillin allergy

answer

penicillin or amoxicillin

question

drug of choice for treating GAS pharyngitis

answer

penicillin V bc of narrow spec of activity, safe, effective and cheap

question

kids with GAS pharyngitis often given

answer

amoxicillin

question

adolescents and adults dosing for gas pharyngitis

answer

penicillin V 250 mg 4x a day or 500 mg 2x daily

question

amoxicillin for GAS

answer

50 MG/kg/body weight once daily up to 1000 mg or 25 mg/kg/day up to 500 mg twice daily

question

if pt cannot comply with 10- day course

answer

one time dose of IM benzathing penicillin G at 600000 units if pt is less than 27 kg or 1.2 mill units if over 27 kg

question

pts who are penicillin allergic but not anaphylactic sensitive for GAS pharyngitis can be given

answer

10 days of first gen cephalosporin 20 mg/kg body weight 2x daily

question

pts with penicillin allergy and sensitive to anaphylaxis

answer

10 day course of clindamycin or clarithromycin

question

pts with moderate to severe sx and or fever with GAS pharyngitis

answer

give analgesic or antipyretic

question

kids under 12 with GAS pharyngitis should not be given what med?

answer

aspirin

question

adverse effects of kids who did not complete 10day course

answer

self-limiting effects diarrhea vomiting ab pain

acute otitis externa – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards