3. MTB Step 3 - Head & Neck

Question 1

OTITIS EXTERNA

What are (4) Signs/Symptoms of Otitis Externa?

Answer 1

1. Itching
2. Pain, especially on manipulation of the Tragus
3. Drainage from & Swelling in the External Auditory canal
4. Tympanic Membrane hard to visualize

Question 2

OTITIS EXTERNA

Which Infection is Otitis Externa a form of, specifically on the Skin of the External Auditory canal?

Answer 2

Cellulitis of the External Auditory canal

Question 3

OTITIS EXTERNA

What Activity is Otitis Externa associated with?

Answer 3

Swimming - washes out the acidic environment

Other causes of OE = foreign objects (e.g., cotton swabs, hearing aids, etc.)

**OE is a Clinical Diagnosis**

Question 4

OTITIS EXTERNA

What are (3) Topical Antibiotics used to treat suspected Otitis Externa?

Answer 4

1. Ciprofloxacin
2. Ofloxacin
3. Polymyxin/Neomycin

“Top COP”

Question 5

OTITIS EXTERNA

What Medication can be added to the treatment for Otitis Externa to Decrease the Swelling & Itching?

Answer 5

Hydrocortisone (topical)

Question 6

OTITIS EXTERNA

In the treatment of Otitis Externa, what can be added to reacidify the ear to help eliminate the infection?

Answer 6

Acid & Water solution

Question 7

MALIGNANT OTITIS EXTERNA

What Form of infection is Malignant Otitis Externa a form of, but specifically of the skull?

Answer 7

Osteomyelitis

Question 8

MALIGNANT OTITIS EXTERNA

What is the Causal Agent of Malignant Otitis Externa?

Answer 8

Pseudomonas in a patient with Diabetes

Question 9

MALIGNANT OTITIS EXTERNA

What can Malignant Otitis Externa lead to, and the reason why it is such an extremely serious disease?

Answer 9

Brain Abscess & Destruction of the Skull

Question 10

MALIGNANT OTITIS EXTERNA

What are the (2) Best Initial Tests and the Most Accurate Test for Diagnosing Malignant Otitis Externa?

Answer 10

Best Initial Tests:

• CT
• MRI

Most Accurate Test

• Bone Biopsy/Culture

Question 11

MALIGNANT OTITIS EXTERNA

What are the (2) Treatments for Malignant Otitis Externa?

Answer 11

1. Surgical Debridement
2. Antibiotics (active against Pseudomonas)
   
   • Aztreonam​​​
   • Carbapenem
   • Cefepime
   • Ciprofloxacin
   • Piperacillin

Question 12

OTITIS MEDIA

What are (5) Signs/Symptoms associated with Otitis Media?

Answer 12

1. Redness
2. Bulging
3. Decreased Hearing
4. Loss of Light Reflex
5. 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**

Question 13

OTITIS MEDIA

What is the Best Initial Treatment for Otitis Media?

Answer 13

Amoxicillin: 7 - 10 day (Shorter for Older patients; Longer for Younger patients.)

**Same as for Sinusitis**

Question 14

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?

Answer 14

Tympanocentesis & Aspirate of the TM for Culture

Question 15

OTITIS MEDIA

What should be tried as 2nd Line Therapy in a patient with Otitis Media that is not improving with 1st Line Therapy?

Answer 15

Switch from Amoxicillin (1st line therapy) to one of the following:

• Amoxicillin-Clavulanate
• Cefdinir
• Ceftibuten
• Cefuroxime
• Cefprozil
• Cefpodoxime

Question 16

SINUSITIS

What are (6) Clinical Manifestations of Sinusitis?

Answer 16

1. Nasal Discharge
2. Headache
3. Facial Tenderness
4. Tooth Pain
5. Bad Taste in the Mouth
6. Decreased Transillumination of the Sinuses

Question 17

SINUSITIS

Even though most cases of Sinusitis are Viral, which (3) Bacteria can cause Sinusitis?

Answer 17

The same Group that causes Otitis Media:

• Streptococcus pneumoniae
• Haemophilus influenzae
• Moraxella catarrhalis

Question 18

SINUSITIS

1. What is the Best Initial Test for Sinusitis?
2. What is the Most Accurate Test for Sinusitis?

Answer 18

1. ​​​Best Initial Test: X-Ray
2. Most Accurate Test: Sinus Aspirate for Culture

Question 19

SINUSITIS

What is the Best INITIAL Treatment for Sinusitis?

Answer 19

Amoxicillin: 7 - 10 days; Shorter for Older patients; Longer for Younger patients.

**Same as the Treatment for Otitis Media**

Question 20

SINUSITIS

Under which (3) Conditions would you use Amoxicillin/Clavulanate in the treatment of Sinusitis?

Answer 20

1. Fever & Pain
2. Persistent Symptoms despite 7 days of decongestants
3. Purulent Nasal Discharge

Question 21

PHARYNGITIS

What are (3) Clinical Manifestations of Streptococcal Pharyngitis that, if all present, make the diagnosis certain?

Answer 21

1. Adenopathy
2. Pain/Sore Throat
3. Exudate

**No cough//hoarseness**

“A.P.E. Throat”

Question 23

PHARYNGITIS

1. What is the Best INITIAL Test for diagnosing Strep Pharyngitis?
2. What is the Most ACCURATE Test for diagnosing Strep Pharyngitis?

Answer 23

1. Best INITIAL Test = Rapid Strep Test
   
   • If Positive Adult or Child = Treat
   • If Negative Adult = Don’t treat
   • If Negative Child = Throat Culture
2. Most ACCURATE Test = Throat Culture

Question 24

INFLUENZA

What are (7) Constitutional Symptoms (a.k.a. flu-“like”) in a patient with Influenza?

Answer 24

1. Arthralgia
2. Myalgia
3. Headache
4. Fever
5. Cough
6. Sore Throat
7. Feeling of Tiredness

Question 25

PHARYNGITIS

What are the (2) acceptable Treatments for Strep Pharyngitis?

Answer 25

Penicillin or Amoxicillin

Penicillin Allergy:

Rash = Cephalexin

Anaphylaxis = Azith or Clarith

Question 27

**INFLUENZA** What are (**2**) _PO_ _Medications_ given to patients with ***Influenza, but only*** if within the _first 48 hours_ of *symptom onset*?

Answer 27

**Oseltamivir** or **Zanamivir** - *neuraminidase inhibitors effective against Influenza A & B.*

Question 28

**INFLUENZA** What is (**1**) _IV_ _Medication_ given to patients with ***Influenza, but only*** if within the _first 48 hours_ of *symptom onset*?

Answer 28

**Peramivir**

Question 29

**INFLUENZA** What are the (**6**) _*Strongest* Indications_ for receiving the **Influenza Vaccine**?

Answer 29

1. **COPD** 2. **CHF** 3. **Dialysis patients** 4. **Steroid use** 5. **Health Care Workers** 6. **Age \> 50** ## Footnote ***\*\*However, Influenza Vaccine is acceptable in the general population at ANY age\*\****

Question 30

**INFLUENZA** 1. What _Type of Vaccine_ is the *INHALATION* version of the **Influenza Vaccination**, and who can use it? 2. What _Type of Vaccine_ is the *INTRAMUSCULAR* version of the **Influenza Vaccination**, and who can use it?

Answer 30

1. **Inhalation Flu Vaccine = Live Attenuated** * Age \< 50 and Healthy 2. **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