ATI 37 - Otitis Media + Conjunctivitis + Cellulitis

Question 1

Otitis Media

Answer 1

infection of structures in middle ear

Question 2

Otitis Media w Effusion

Answer 2

collection of fluid in middle ear

-no infection

Question 3

otitis media is usually triggered by…

Answer 3

bacterial infection
strep.pneumoniaie, h.influenzae, moraxella

viral infectoin
RSV or influenza

allergies

enlarged adenoids

Question 4

lower incidence of otitis in…

Answer 4

infants that are breastfed

Question 5

acute otitis media signs

Answer 5

• tugging at ears
• red, bulging, nonmobile tympanic membrane
• fussy
• freq crying
• acute onset of changes in behavior

Question 6

otitis media w effusion signs

Answer 6

• orange discoloration of TM w decr mvmt
• fluid line or air bubbles
• difficulty hearing

Question 7

recurrent otitis media or with effusion for more than 3 months…

Answer 7

consider ENT referral or tympanostomy tube placement

Question 8

Tx for non-severe UNILATERAL

Answer 8

abx or 2-3day observation

Question 9

Tx for non-severe BILATERAL or severe w fever + pain

Answer 9

abx

Question 10

if observing for 2-3 days…

Answer 10

must have follow up after

Question 11

vaccination risk factor for otitis media

Answer 11

not being immunized to Haemophilus influenzae (2 mo) or streptococcus pneumonia (2 mos)

Question 12

risk factors for hearing impairment

Answer 12

down syndrome or extended NICU stay

Question 13

tx for ruptured tympanic membrane

Answer 13

systemic abx

-cover ear loosely w sterile cotton or gauze

Question 14

do not try to remove foreign body w…

Answer 14

tweezers

Question 15

types of Conjunctivitis [4]

Answer 15

1 Bacterial
2 Viral
3 Allergic
4 Chemical

Question 16

Chemical Conjunctivitis

Answer 16

mild lid edema

non purulent discharge

Question 17

Bacterial Conjunctivitis

symptoms

Answer 17

• usually starts UNILATERALLY
• mucoid or mucopurulent drainage w mattering
• incr tears
• redness + swelling
• itching/burning
• mild photophobia

Question 18

Viral Conjunctivitis

symptoms

Answer 18

• serous drainage
• usually starts BILATERALLY
• milder incr in tears, rednss, swellng, itchng, burng

Question 19

Viral Conjunctivitis caused by Herpesvirus

Treatment

Answer 19

aggressive IV acyclovir (>14dy)

+ topical meds [trifluderine, iodeoxyuride, vidarabine]

Question 20

Viral Conjunctivitis NOT caused by Herpesvirus

Treatment

Answer 20

comfort measures
clean eyes
prophylactic abx

Question 21

if pt has vesicular lesions anywhere positive fr herpes…

Answer 21

assume conjunctivitis is fr herpes

Question 22

Allergic Conjunctivitis

symptoms

Answer 22

• intense itch
• water drainage
• starts BILATERALLY
• cobblestone appearance of conjunctiva

Question 23

w bacterial conjunctivitis, mattering could be from ______, and _____ may present discharge

Answer 23

blocked lacrimal ducts;

gentle pressure to inner corner of eye

Question 24

Conjunctivitis

diagnosis

Answer 24

hx + assessment

culture or gram is suspicious of bacteria or herpes

Question 25

treat conjunctivitis empirically

Answer 25

broad spectrum abx while waiting for results

Question 26

how to prevent spread of conjunctivitis

Answer 26

• dont rub eyes
• mittens over hands
• distract toddlers
• wash hands
• DONT share towels
• NO SCHOOL FOR 24 HOURS AFTER STARTING ABX

Question 27

Periorbital [Preseptal] Cellulitis

Answer 27

bacterial infection of eyelid + surrounding tissue

Question 28

Periorbital [Preseptal] Cellulitis is usually caused by…

Answer 28

streptococcus or staphylococcus

Question 29

Periorbital [Preseptal] Cellulitis

symptoms

Answer 29

• swollen, tender, red eyelids
• restricted, painful mvmt of eye
• fever

Question 30

Periorbital [Preseptal] Cellulitis can lead to…

Answer 30

orbital cellulitis

bacterial meningitis