Case 2b

Question 1

What are some risk factors for ear infections?

Answer 1

Smoker in the home

Daycare

Question 2

What would you do for the family in this case?

• Father smokes
• Child with left TM bulging, some redness
• Unhappy, holding ear

Answer 2

• Child has bacterial infection

- Give parents amoxicillin on hold - get script in a few days if it doesn’t clear up on its own

Question 3

Is otitis media related to hearing problems? If not, what is?

Answer 3

No, Chronic middle ear effusion

Question 4

When do you give tubes?

Answer 4

If chronic serous infection (not if recurrent infections that resolve)

Question 5

What can viral cause in an ear infection?

Answer 5

Redness and fluid (usually)

Question 6

What can bacteria cause in an ear infection?

Answer 6

Bulging TM

Question 7

What do changes in mental status of activity indicate for a patient with an ear infection?

Answer 7

It could mean the infection spread to a dangerous area!

Question 8

What should you give to children under 24 months with a bacterial infection?

Answer 8

Amoxicillin! (sometimes give clavulanate if the infection doesn’t resolve)

Question 9

Where is the most likely place in catch an adenovirus in a group setting?

Answer 9

Swimming pool/pond

Question 10

What symptoms does Type D-K chlamydia cause?

Answer 10

• Yellow discharge
• Viewed on Giemsa stain
• Intracytoplasmic inclusion bodies

Question 11

What antibiotic should be used for chlamydia?

Answer 11

Azithromycin/Erythromycin

Question 12

What is the mechanism of Azithromycin?

Answer 12

Inhibits translation - binds 23s rRNA of 50s subunit

Question 13

If a baby has chlamydia eye infection, who else should you treat?

Answer 13

Mother + partners

Question 14

What side effects can doxycycline cause?

Answer 14

Tendon & defects in children

-Not good for kids >8 and pregnant people

Question 15

What is the mechanism of moxifloxacin?

Answer 15

Topoisomerase II (gyrase) and IV inhibitor
-Inhibits DNA replication --> bactericidal

Question 16

What organism is known to be the most resistant of all clinically relevant bacteria due to (1) expression of multi drug efflux pumps, (2) presence of mutant porin proteins,, (3) presence of a polysaccharide capsule?

Answer 16

Pseudomonas aeruginosa

Question 17

What drug is effective against pseudomonas aeruginosa?

Answer 17

Polymyxin B

Question 18

What is chorioretinitis?

Answer 18

Blurred vision and visual field defects

-It usually gets to the eyes through retinal arteries via blood borne route, often manifestation of systemic disease

Question 19

What are the most common causes of chorioretinitis?

Answer 19

Toxoplasma and CMV (ganciclovir implant)

Question 20

What does CMV retinitis look like on retina?

Answer 20

Begins in periphery and spreads like “brushfire”

Question 21

What is the mechanism of ganciclovir?

Answer 21

It inhibits viral DNA synthesis

Question 22

What should Trifluidine be used on?

Answer 22

Acyclovir resistant viruses

-HSV keratoconjunctivitis

Question 23

What are the TORCH infections? What can they do?

Answer 23

Toxoplasmosis - chorioretinitis, neurologic deterioration
Other viruses - HIV
Rubella - deafness, chorioretinitis
Cytomegalovirus (CMV) - infected cells become swollen, most infections are asymptomatic
Herpes Simples
They cross the placenta and cause congenital disease.

Question 24

What is toxoplasma?

Answer 24

• Most common parasitic disease
• Late term congenital infections are more likely to produce progressive blindness
• Causes a linear scar on eye

Question 25

How do you diagnose toxoplasma?

Answer 25

IgM serology

Question 26

How do you treat toxoplasmosa?

Answer 26

Folate synthesis inhibitors!

-Pyrimethamine and Sulfadiazine

Question 27

What is acanthamoeba?

Answer 27

• Single cell, eukaryote
• Keratitis or granulomatous amebic encephalitis
• Can be found in soil, water, sewage, etc.

Question 28

How do you treat acanthamoeba?

Answer 28

-Azoles