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Fitzgerald Review > CH 4 EENT > Flashcards

CH 4 EENT Flashcards

1
Q

does acute bacterial rhinsinusitis (ABRS), aka URI that is secondary infection of the sinuses after a viral URI, need antibiotics?

A

NO! <3% of viral URI are complicated in ABRS and resolve without antimicrobial therapy

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2
Q

number 1 organism leading cause of acute bacterial rhinusitis

A

Strep pneumoniae

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3
Q

Diseases caused by Strep pneumoniae:

A

COMPS
Conjunctivitis
Otitis media
Meningitis
Pneumonia
Sinusitis

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4
Q

Diseases caused by H. influenzae:

A

COMPS
Conjunctivitis
Otitis media
Meningitis (Type B)
Pneumonia
Sinusitis

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5
Q

what is the 2nd most causative organism for ABRS

A

gram negative bacillus: H influenzae

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6
Q

what is the 3rd most causative organism for ABRS

A

M. catarrhalis (gram negative coccus)

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7
Q

acute bacterial rhinosinusitis/URI signs and sx’s:

A

fever & sx > 10 days
maxillary toothache
initial sx improvement then sudden worsening of sx
cacosmia (sense of bad odor in nose)
unilateral facial pain

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8
Q

bacterial URI need at least 1 of these to dx (compared to viral):

A

a) not improving 10 or more days
b) severe fever >102, purulent nasal discharge/facial pain for 3 + days
c) worsening or “double sickening” usu per 5-6 days of illness

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9
Q

if dx of ABRS, analyze for antibiotic resistance!
most common risk:

A

age < 2 or >65
day care attendance
use of antibiotics in past month

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10
Q

if there is NO/worsening improvement after 3-5 days with antimicrobial class, broaden or switch to different antimicrobial class, if worsening/no improvement after 3-5 days, get

A

CT or MRI to investigate non infectious causes
sinus or meteal cultures

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11
Q

if there is a risk for resistance present, use

A

2nd line therapy, should improve after 3-5 days

complete therapy in 7-10 days

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12
Q

antimicrobial therapy for acute bacterial rhinusitis days?

A

5-7 days

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13
Q

what antimicrobials are NOT recommended in ABRS treatment due to rising resistance rates and tx failure?

A

macrolides (azithromycin, clarithromyin, erythromycin) and bactrim/ TMP-SMX

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14
Q

first line antib for acute bacterial rhinosinusitis in adults?

A

amoxicillin 500 TID or 875 mg PO BID

OR

Amoxicillin clavulanate 1000mg/62.5 mg PO BID (take with food)

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15
Q

when someone is penicillin allergy, ask…

A

what happens when you take penicillin?
“idk”,
if no compromise in breathing, BP, no hives, no anaphlyaxis history

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16
Q

Antib for beta lactam allergy to ABRS, depends on anaphylaxis history. If no hx, then give:

If have anaphylaxis hx, give:

A

No hx:
- Cefdinir 600 mg/day q 12 hrs
OR
- Cefpodoxime 200 mg PO BID
OR
Cefuroxime 500 mg PO BID

if hx:
- levofloxacin 750 mg PO QD
OR
- moxifloxacin 400 mg PO QD
OR
- doxycycline 100 mg PO BID
**give doxy over -floxacin, but NO pregnant women*

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17
Q

if treatment failure after 3-5 days of therapy of ABRS:

A

mild/moderate symptoms:
amoxicillin-clavulanate 2000mg/125mg PO BID
OR
2nd or 3rd generation cephalosporin (Cefpodoxime, cefprozil, cefdinir)

severe symptoms:
levofloxacin 750mg PO QD
OR
Moxifloxacin

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18
Q

limit what antibiotic use in treating ABRS?

A

fluroquinolones (-floxacins)

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19
Q

substrate and example

A

a medication that is biotransformed by the isoenzyme, utilizing this enzme in order to be modified so it can reach drug site of action and/or be eliminated

CYP450 3A4 substrate: Sildenafil, atorvastatin, simvastatin, alprazolam

20
Q

inhibitor and examples

A

drug that blocks isoenzyme activity, limiting substrate excretion, allowing increased in substrate lvls, possible risk of toxicity

erythromycin

21
Q

if use any CYP450 drug is used with an inhibitor drug,

A

increases substrate levels

ex: clarithromycin + alprazolam = increased sedation, fall risk

22
Q

inducer

A

accelerates lvl of isoenzyme so substrate pushed out, and decreases substrate level

ex: St johns wort + 3A4 substrate (COC use) lead to spotting, potential contraceptive failure

23
Q

allergic rhinitis patho

A

inflammatory, IgE dz due to genetic and environmental interactions with nasal congestion, rhinorrhea, sneezing, intraocular and/or nasal itching

24
Q

huge difference with allergic rhinitis and covid/flu/cold is

A

itch! eyes, nose, throat

25
Q

first line for allergic disorder

A

avoid allergen

26
Q

What controller therapy to prevent sx by preventing formation of inflammatory mediators in allergic rhinitis?

A

First line: intranasal corticosteroids
- fluticasone proprionate (Flonase), Itramcinolone (Nasacort)
educate takes 1 week to work

Intranasal antihistamine
- Azelastine (Astelin); rapid sx relief

27
Q

What reliever therapy to relieve acute sx’s by blocking action of histamine?

A

2nd gen oral antihistamine:
- loratadine (Claritin), cetirizine (ZYrtec), levocetrizine (Xyzal)
[NO 1st gen antihistamine use [diphenhydramine/benadryl] bc sedation

ocular histamine for allergic conjunctivitis:
- olopatadine, azelastine, bepotastine

28
Q

which 2nd gen antihistamine most potent to give for allergic rhinitis?

A

levocetrizine (Xyzal)

29
Q

for allergic rhinitis, meds NOT routinely advised to give?

A

leukotriene modifier
- montelukast (Singulair) bc SE of agitation, depression, suicidal thoughts, sleep disturbances

systemic corticosteroids
- long acting or oral systemic causes risk of adrenal suppression, neg impact of bone density, and gastropathy
-takes days to work

30
Q

always get what when someone presents with eye complaint?

A

always get vision screen with anyone presenting with eye complaint

31
Q

painful

A

aphthous stomatitis
painful, self resolving

32
Q

painless oral lesion

A

squamous cell carcinoma
persistent PAINLESS oral lesion (poke with tongue blade and won’t hurt)
encourage HPV vaccine (gardasil)

33
Q

painless

A

syphilic chancre (but usu appears on genitals)

34
Q

95% of oral cancers are what type of cell?

A

squamous cell carcinoma (SCC)

35
Q

risk factors and risk factor reduction of oral cancer

A

longstanding HPV infectio (HPV16)
tobacco
alcohol misuse
>55 yrs

get HPV vaccine! avoid tob/alcohol

36
Q

oral cancer presentation

A

painLESS, ulcerating oral lesions x months

adjacent lymphadenopathy, immobile NONtender nodes usually >1cm

refer for bx

37
Q

when is a referral to an eye specialist?

A

sig change from baseline/new onset
red eye, painful, new onset vision change

38
Q

gradual PERIPHERAL vision loss

A

open-angle glaucoma

painless, gradual onset of increased intraocular pressure = optic atrophy which can loss peripheral vision if no intervention

> 80% of all glaucoma
tx: topical miotics, beta-blockers

39
Q

gradual onset blurring of near vision

A

presbyopia

40
Q

central vision loss

A

macular degeneration
- From age; thickening slcerotic changes in retinal basement membrane complex
-pain LESS vision changes, distorted central vision
check Amsler grid test (early sign if abnormal)

41
Q

presbycusis

A

-difficulty hearing conversation in a noisy environment
- accelerated by noisy environments, ototoxic meds (uncommon)

42
Q

Group A beta hemolytic strep (GABS)/strep diagnosis and when to treat?

A

CENTOR Score:
-COUGH absent 1+
-Exudates (patchy tonsilar exudates) 1+
-NODES swollen 1+
-feveR 1+
-15 or younger is 1+
45 or older is - 1

treat if 4 or more points

-SUDDEN sore throat (next day)
-frontal headache (NO body aches)

43
Q

Viral pharyngitis sx’s

A

-running nose THEN sore throat
-cough
-clear nasal discharge
-hoarseness
-scattered small vesicles on soft palate and tonsils
-generalized body aches

44
Q

GABHS treatment

A

oral penicillin or amoxicillin

45
Q

sudden increase in intraocular pressure

A

angle closure glaucoma
usu unilateral, acutely red, painful eye with vision change (halos around light)
refer!

46
Q

conjunctivitis (non-gonococcal, non chlamydia) treatment

A

optic cipro soln or polymyxin B with trimethoprim ophthalmic soln

OR

Azithromycin ophthalmic soln

Fitzgerald Review (22 decks)

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