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IBI Test 4 > B3.054 - Ear Infections Zuckert > Flashcards

B3.054 - Ear Infections Zuckert Flashcards

1
Q

what is otalgia

A

ear pain

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2
Q

what is diagnostic for primary otalgia

A

abnormal ear exam, discharge, tinnitus, hearing loss, vertigo

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3
Q

why does the inner ear structure not have pain and what are inner ear structures

A

cochlea, semicircular canals cranial enervation VIII has no pain fibers

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4
Q

secondary otalgia diagnostics

A

normal ear exam, reffered pain due to sensation fivers from V,VII, XI and X and cervical nerves C2, C3

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5
Q

common causes of otalgia in otitis media

A

recent URTI, red cloudy and immobile tympanic membrane

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6
Q

common causes of otalgia in otitis externa

A

swimmers ear ear phone use white discharge

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7
Q

what are causes of secondary otalgia

A

dental carries, periodontal abcesses, pharyngitis, tonsilitis

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8
Q

epidemiology and signs of malignant (necrotizing) otitis externa

A

diabetes, elderly immunocompromised painful granulation tissue

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9
Q

what are symptoms ramsay hunt syndrome

A

from herpes zoster oticus, vesicular rash, vertigo, hearing loss, tinnitus

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10
Q

whats the difference between viral myringitis and OME

A

similar but no tympanic bulging

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11
Q

what are risk factors for tumors causing otalgia

A

>50 tobacco alcohol use

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12
Q

what is ramsay hunt syndrome

A

reactivated VZV spreading to facial nerves paralysis and rash affecting mouth and ears tinnitus hearing loss

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13
Q

H. influenzae can cause

A

AOM

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14
Q

pseudomonas aeruginosa can cause

A

AOE

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15
Q

how does H. influenzae gram stain and where is it on the tree

A

gram - negative mcconkey oxygen positive

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16
Q

describe the physical characteristics of H. influenzae

A

small gram - rods/coccobacilli

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17
Q

what are the complex nutritional requirements of Haemophilus sp

A

X factor - hematin V factor - NAD

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18
Q

how many capsular antigenic serotypes does H. influenzae have

A

6 (a-f)

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19
Q

whats the most virulent type of H. inluenzae

A

Hib

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20
Q

what are non typable strains of Haemophilus inlfuenzae

A

non encapsulated rarely cause invasive disease

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21
Q

what does H. ducreyi cause

A

STD soft chancre/chancroid (panful)

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22
Q

what does H aegyptius cause

A

conjuctivitis

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23
Q

Hib colonizes what using what

A

oropharynx using adhesins like fimbriae, IgA protease

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24
Q

what causes local inflammation in Hib

A

LPS Impairment of ciliary function damage to respiratory epithelium

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25
Q

invasion of blood stream and bacteremia is cause by what in Hib

A

PRP (polyribitol capsule)

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26
Q

what type of antibody is protective for Hib

A

anti PRP

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27
Q

what aids Hib in hematogenous spread

A

PRP

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28
Q

what causes disseminated disease in Hib

A

LPS

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29
Q

what are the only hosts of Hib

A

humans

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30
Q

how is Hib transmitted

A

respiratory droplets, mainly pediatric disease

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31
Q

what does the Hib vaccine have in it

A

purified PRP conjugated to carrier proteins

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32
Q

what is the combination vaccine for Hib called and what is it a combination of

A

DTap-Hib and Hepatitis B-Hib DTap has Diphtheria toxoid, mutant diphtheria toxin, tetanus toxoid, meningococcal membrane protein

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33
Q

how does the vaccine help your immune system

A

Creates T cell dependent antigens, protective antibody response is created in >2mo

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34
Q

what is the immunization schedule of Hib

A

2, 4, 6 and 12-15 moths

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35
Q

who is the Hib vaccine not recommended for

A

>5 yo unless pt has sickle cell, asplenia, immunodeficiency, HIV

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36
Q

how does Hib gram stain and what specimen do you get

A

CSF or synovial fluid Gram -

37
Q

what test can you do for the capsule of Hib

A

latex agglutination

38
Q

what does a culture media for Hib require

A

Factor V and X

39
Q

what other organism do you plate with in a culture of Hib

A

Staph aureus because it has hemolysin RBCs releasing factor V and X allowing

40
Q

NTHi is not serum resistant, what does that mean

A

it lacks a capsule so its infection is localized and not able to spread to blood

41
Q

what are common issues caused by NTHi

A

otitis media sinusitits pneumonia

42
Q

how do you treat invasive H influenzae

A

3rd gen cephalosporins ceftriaxone

43
Q

how do you treat otitis media, sinusitis caused by H influenzae

A

ampicillin cephalosporin fluoroquinolone (ciprofloxacin)

44
Q

major sequelae of an Hib infection

A

meningitis

45
Q

describe the gram identification of psuedomonas and where if falls on tree

A

Gram - grows on mcconkey + Lactose - Glucose -

46
Q

is pseudomona motile

A

yes

47
Q

where do you find pseudomonas

A

ubiquitous in environment, soil, water, plants, animals, humans,

48
Q

how do people typically get infected with psudomonas

A

its a common nosocomial pathogen from hospital stays

49
Q

infections of psudomonas are found where on the body

A

skin pulmonary outer ear eye

50
Q

what is alginate

A

P. aeruginosa capsule

51
Q

what does the p. aeruginosa capsule do

A

prevents phagocytosis and contributes to antibiotic resistance adhesin

52
Q

describe the structure of the capsule

A

polymer of mannuronic and glucuronic acid

53
Q

how is p. aeruginosa production highly regulated

A

environmental and quorum sensing produced at high levels in lungs

54
Q

what does a culture of p aeruginosa look like

A

mucoid colonies, shiny, alginate +

55
Q

what does p aeroginosa look like in vitro

A

production ceases, smooth and pigmented, pycyanin, green colonies, flagella +, pilli +

56
Q

what is this and differentiate between left and right

A

left is acute and right is chronic (has capsule)

p. aeruginosa

57
Q

exotoxins of p aeruginosa

A

Exotoxin A, S, U

58
Q

what does exotoxin A do

A

A-B toxin: A subunit ADP ribosylates elongation factor EF-2 affecting protein synthesis

59
Q

what does exotoxin S do

A

major virulence factor

injected T3SS effector protein

disrupts signal transduction and blocks phagocytosis

60
Q

what does exotoxin U do

A

cytotoxic for macrophages

61
Q

what does p aeruginosa do to elastase and whats it regulated by

A

degrades elastin (protein in pulmonary and endothelial tissue)

Production regulated by quorum sensing

62
Q

what is quorum sensing

A

osmolarity/nitrogen sensing of external environment

63
Q

what type of infection do otherwise healthy individuals

A

folliculitis, hot tub rash

otitis externa (swimmers ear)

Eye infections associated with trauma

64
Q
A
65
Q

default treatment for P.a. otitis externa

A

eardrops

66
Q
A
67
Q

treatment for p.a. otitis externa mild

A

acetic acid + propylene glycol + hydrocortisone

68
Q

moderate to severe treatment for P.a. otitis externa

A

ciprofloxacin + hydrocortisone

69
Q

what do you not give for P.a. otitis externa if tympanic membrane is ruptured

A

neomycin

70
Q

what is used for prevention of p.a. otitis externa

A

alcohol ear drops

71
Q

P.a. diseases in immunocompromised

A

bacteremia

burn would infections

malignant otitis externa

pulmonary infections

72
Q

when after a burn wound would you see pseudomonas infections

A

>2 weeks

73
Q

whats the DOC for psudamonas caused malignat otitis externa

A

IV ciprofloxacin

74
Q

who do you see P.a. infections in

A

pts with COPD, CF, neutropenia

75
Q

by what age and how many CF pts have P.a. colonization

A

80-90%, by age 3

76
Q

P.a. biofilm formations are resistant to what

A

phagocytosis, complement, antibodies

77
Q

symptoms of pseudomonas pneumonia

A

fever, chills, sever dyspnea, cyanosis, productive cough

78
Q

risk factors of P.a. pneumonia

A

neutropenia, chronic lung disease, CHF, use of mechanical ventilators, lung burns

79
Q

what types of patients are more likely to get P.a. pneumonia

A

ICU pts and nursing home residents

80
Q

describe the ways to identify P.a. in lab

A

obligate aerobe

catalase +

oxidase +

green pigmented, often fluorescent colonies

81
Q

what causes green pigmented P.a.

A

pyocyanin - blue, antibiotic pigment

Fluorescein

82
Q

what does pyocyanin do

A

cytotoxic to eukaryotic cells, oxidative stress

83
Q

what are siderophores

A

pyoverdin and pyochelin

84
Q

what is distinct about the smell of p.a.

A

fruity (grapes, tortillas)

85
Q

where is PYO found

A

airway secretions

86
Q

what does PYO cause

A

low ATP (cilia, CFTR)

Low NADPH

neutrophils

87
Q

initial empiric combo treatment for P.a.

A

antipseudomonal beta lactam + beta lactamase inhibitor +aminoglycoside

88
Q

what is colistin and what does it do

A

polymixin E

last resort, solubilizes bacterial membranes

IBI Test 4 (12 decks)

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