3. MTB Step 3 - Head & Neck Flashcards
Cards Complete: Day 1 - 5/1/2019 * Day 2 - 5/3/2019 * Day 3 - 5/11/2019 * Day 4 - 5/31/2019 Day 5 - 6/30/2019
OTITIS EXTERNA
What are (4) Signs/Symptoms of Otitis Externa?
- Itching
- Pain, especially on manipulation of the Tragus
- Drainage from & Swelling in the External Auditory canal
- Tympanic Membrane hard to visualize
OTITIS EXTERNA
Which Infection is Otitis Externa a form of, specifically on the Skin of the External Auditory canal?
Cellulitis of the External Auditory canal
OTITIS EXTERNA
What Activity is Otitis Externa associated with?
Swimming - washes out the acidic environment
Other causes of OE = foreign objects (e.g., cotton swabs, hearing aids, etc.)
**OE is a Clinical Diagnosis**
OTITIS EXTERNA
What are (3) Topical Antibiotics used to treat suspected Otitis Externa?
- Ciprofloxacin
- Ofloxacin
- Polymyxin/Neomycin
“Top COP”
OTITIS EXTERNA
What Medication can be added to the treatment for Otitis Externa to Decrease the Swelling & Itching?
Hydrocortisone (topical)
OTITIS EXTERNA
In the treatment of Otitis Externa, what can be added to reacidify the ear to help eliminate the infection?
Acid & Water solution
MALIGNANT OTITIS EXTERNA
What Form of infection is Malignant Otitis Externa a form of, but specifically of the skull?
Osteomyelitis
MALIGNANT OTITIS EXTERNA
What is the Causal Agent of Malignant Otitis Externa?
Pseudomonas in a patient with Diabetes
MALIGNANT OTITIS EXTERNA
What can Malignant Otitis Externa lead to, and the reason why it is such an extremely serious disease?
Brain Abscess & Destruction of the Skull
MALIGNANT OTITIS EXTERNA
What are the (2) Best Initial Tests and the Most Accurate Test for Diagnosing Malignant Otitis Externa?
Best Initial Tests:
- CT
- MRI
Most Accurate Test
- Bone Biopsy/Culture
MALIGNANT OTITIS EXTERNA
What are the (2) Treatments for Malignant Otitis Externa?
- Surgical Debridement
-
Antibiotics (active against Pseudomonas)
- Aztreonam
- Carbapenem
- Cefepime
- Ciprofloxacin
- Piperacillin
OTITIS MEDIA
What are (5) Signs/Symptoms associated with Otitis Media?
- Redness
- Bulging
- Decreased Hearing
- Loss of Light Reflex
-
Immobility of the Tympanic Membrane (MOST SENSITIVE)
- If there is TM mobility of insufflation then it’s NOT Otitis Media
**OM is a Clinical Diagnosis**
OTITIS MEDIA
What is the Best Initial Treatment for Otitis Media?
Amoxicillin: 7 - 10 day (Shorter for Older patients; Longer for Younger patients.)
**Same as for Sinusitis**
OTITIS MEDIA
What is the Next Step in management for a patient with Recurrent OM or Persistent OM that Fails 1st and 2nd Line Therapy?
Tympanocentesis & Aspirate of the TM for Culture
OTITIS MEDIA
What should be tried as 2nd Line Therapy in a patient with Otitis Media that is not improving with 1st Line Therapy?
Switch from Amoxicillin (1st line therapy) to one of the following:
- Amoxicillin-Clavulanate
- Cefdinir
- Ceftibuten
- Cefuroxime
- Cefprozil
- Cefpodoxime
SINUSITIS
What are (6) Clinical Manifestations of Sinusitis?
- Nasal Discharge
- Headache
- Facial Tenderness
- Tooth Pain
- Bad Taste in the Mouth
- Decreased Transillumination of the Sinuses
SINUSITIS
Even though most cases of Sinusitis are Viral, which (3) Bacteria can cause Sinusitis?
The same Group that causes Otitis Media:
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
SINUSITIS
- What is the Best Initial Test for Sinusitis?
- What is the Most Accurate Test for Sinusitis?
- Best Initial Test: X-Ray
- Most Accurate Test: Sinus Aspirate for Culture
SINUSITIS
What is the Best INITIAL Treatment for Sinusitis?
Amoxicillin: 7 - 10 days; Shorter for Older patients; Longer for Younger patients.
**Same as the Treatment for Otitis Media**
SINUSITIS
Under which (3) Conditions would you use Amoxicillin/Clavulanate in the treatment of Sinusitis?
- Fever & Pain
- Persistent Symptoms despite 7 days of decongestants
- Purulent Nasal Discharge
PHARYNGITIS
What are (3) Clinical Manifestations of Streptococcal Pharyngitis that, if all present, make the diagnosis certain?
- Adenopathy
- Pain/Sore Throat
- Exudate
**No cough//hoarseness**
“A.P.E. Throat”
PHARYNGITIS
- What is the Best INITIAL Test for diagnosing Strep Pharyngitis?
- What is the Most ACCURATE Test for diagnosing Strep Pharyngitis?
-
Best INITIAL Test = Rapid Strep Test
- If Positive Adult or Child = Treat
- If Negative Adult = Don’t treat
- If Negative Child = Throat Culture
- Most ACCURATE Test = Throat Culture
INFLUENZA
What are (7) Constitutional Symptoms (a.k.a. flu-“like”) in a patient with Influenza?
- Arthralgia
- Myalgia
- Headache
- Fever
- Cough
- Sore Throat
- Feeling of Tiredness
PHARYNGITIS
What are the (2) acceptable Treatments for Strep Pharyngitis?
Penicillin or Amoxicillin
Penicillin Allergy:
Rash = Cephalexin
Anaphylaxis = Azith or Clarith
INFLUENZA
What are (2) PO Medications given to patients with Influenza, but only if within the first 48 hours of symptom onset?
Oseltamivir or Zanamivir - neuraminidase inhibitors effective against Influenza A & B.
INFLUENZA
What is (1) IV Medication given to patients with Influenza, but only if within the first 48 hours of symptom onset?
Peramivir
INFLUENZA
What are the (6) Strongest Indications for receiving the Influenza Vaccine?
- COPD
- CHF
- Dialysis patients
- Steroid use
- Health Care Workers
- Age > 50
**However, Influenza Vaccine is acceptable in the general population at ANY age**
INFLUENZA
- What Type of Vaccine is the INHALATION version of the Influenza Vaccination, and who can use it?
- What Type of Vaccine is the INTRAMUSCULAR version of the Influenza Vaccination, and who can use it?
-
Inhalation Flu Vaccine = Live Attenuated
- Age < 50 and Healthy
-
Intramuscular Flu Vaccine = Inactivated
- Anyone can take it
- The only option for those with COPD, CHF, dialysis patients, steroid use, health care workers, Age > 50
