Chapter 5: Eye, Ear, Nose and Throat infection

Question 1

what is the most common cause of conjunctivits? and how does it look like

Answer 1

bacterial conjunctivitis causes thiccc purulent discharge

most common causative agents are:
S. aureus, S. pneumoniae, H. influenzae. Neisseria gonorrhoeae can cause a very severe conjunctivitis that can progress to keratitis.

VIRUSES ARE THE MOST COMMON CAUSE of conjunctivitis: bilateral involvement is the rule which results in serous exudate and follicle formation but its self limiting

allergic is bilateral and accompanied by itching

Question 2

what is the greatest risk factor for development of keratitis

Answer 2

break in the cornea

Question 3

which symptom is most helpful for differentiating conjunctivitis from keratitis

Answer 3

in keratitis (corneal infection), patients complain of foregin body sensation in their eye

onjunctivits: corneal edema impairs vision
.

Question 4

what’s dangerous about keratitis

Answer 4

treat quickly to prevent blindness

Question 5

organisms associated with keratitis

Answer 5

those organisms will cause keratitis without a preexisting break in the cornea corynebacteria diphtheriae, listeria and shigella

Question 6

which organisms causes keratitis with association with a contact lense

Answer 6

pseudomonas aeruginosa, causes severe pain

acanthamoeba causes keratitis in those who use water with their cleaning solutions

Question 7

what causes circumscribed ulcer with sharp margins keratitis

Answer 7

strep pneumoniae

Question 8

which lesions cause unilateral keratitis that take up fluorescein

Answer 8

herpes simplex

Question 9

which lesions cause unilateral keratitis that take up fluorescein

Answer 9

herpes simplex

Question 10

predisposing condition to endophthalmitis (causes and routes of infection). and treatment

Answer 10

-posttraumatic: will result in mixed infections bacillus cereus is very aggressive. fungal infection follow from injuries with organic material

• hematogenous: from more commonly involves the right eye. candida is the most common
• contagious: spreads from severe keratitis
• acute postoperative form cause by endogenous flora S. epidermidis, S aureus, Streptococcus species

treat with antibiotic, unless the patient has sensation of light only then do vitrectomy is recommended

Question 11

what is the most common disease that causes pharyngitis

Answer 11

viruses. if its severe and prolonged keep in mind HIV and Epstein barr virus

S. pyogenes is also common

Question 12

which disease is suggested by the presence of a gray pseudomembrane

Answer 12

Corynebacterium diphtheriae

Question 13

what complication should be considered when unilateral tonsillar swelling develops

Answer 13

peritonsillar abscess

Question 14

what is the most common disease that causes pharyngitis

Answer 14

viruses. if its severe and prolonged keep in mind HIV and Epstein barr virus

S. pyogenes is also common (treat with penicillin and detect with antigen test)

Question 15

which infection should be considered in the patient with inspiratory stridor and sore throat

Answer 15

epiglottitis

Question 16

symptoms and causes of epiglottitis

Answer 16

common in children

sore throat combined with stridor is suggestive

indirect laryngoscopy demonstrates a cherry red epiglottis

patients should be intubated due to the fear of obstruction of the airways

most common cause is H influenzae but strep and staph are increasing in frequency

Question 17

symptoms and causes and treatmentof epiglottitis

Answer 17

common in children

sore throat combined with stridor is suggestive

indirect laryngoscopy demonstrates a cherry red epiglottis

patients should be intubated due to the fear of obstruction of the airways

most common cause is H influenzae but strep and staph are increasing in frequency

treat with ceftriaxone (3rd gen)

Question 18

why do children develop otitis MEDIA more commonly than adults do

Answer 18

they have narrower eustachian tube, since otitis media develops as a consequence of eustachian tube obstruction, the narrower the higher the risk for obstruction.

Question 19

causes and treaament of otitis EXTERNA

Answer 19

caused with water trapping in the external ear
caused by G- bacilli, pseudomonas aeruginosa being the most common

malignant otitis extrema occurs in diabetic and immunocompromised patients which can infect the base of the skill and be fatal, this requires prolonged antipseudomonal antibiotic therapy

Question 20

what are the two most common pathogens that cause otitis MEDIA

Answer 20

strep pneumoniae, H. influenza, moraxella atarrahalis

Question 21

causes and treaament of otitis EXTERNA

Answer 21

caused with water trapping in the external ear
caused by G- bacilli, pseudomonas aeruginosa being the most common

malignant otitis extrema occurs in diabetic and immunocompromised patients which can infect the base of the skill and be fatal, this requires prolonged antipseudomonal antibiotic therapy

Question 22

otitis media presentation, diagnosis and causes

Answer 22

infants may present with irritability and diarrhea

diagnose by demonstrating fluids behind the tympanic membrane and inflammation of that membrane

causative organisms strep pneumoniae, H. influenza, moraxella atarrahalis

treat with amoxicillin then follow with cefuroxime if there was no response within 72

Question 23

causes and treatment of otitis EXTERNA

Answer 23

caused with water trapping in the external ear
caused by G- bacilli, pseudomonas aeruginosa being the most common

malignant otitis extrema occurs in diabetic and immunocompromised patients which can infect the base of the skill and be fatal, this requires prolonged antipseudomonal antibiotic therapy

Question 24

causes, dangers and presentation of mastoiditis

Answer 24

a rare complication of otitis media
readily diagnosed by mastoid radiographs
requires prolonged antibiotic therapy for 3-4 weeks
can lead to brain abscess or septic lateral sinus thrombosis

Question 25

what are the clinical manifestation of sinusitis, and its causes

Answer 25

bacterial sinusitis is more likely in case of one of the following three presentations:

• persistent symptoms or signs of acute sinusitis from the onset that last for 10 days without clinical improvements
• onset is accompanied by severe or high fever (39C, 102F) and purulent nasal discharge
• sudden worsening of a typical viral upper respiratory infection that had lasted 5-6 days and was beginning to improve (sometimes termed double-sickening). new symptoms and signs may include new onset of fever, headache, or increase in nasal discharge

symptoms of bacterial sinusitis as compared with viral disease

• more severe pain, often localized to a cranial nerve dermatome
• purulent discharge and or foul-smelling breath
• imaging cannot differentiate bacterial from viral in most cases

Question 26

how do you diagnose sinusitis

Answer 26

nasopharyngeal cultures are NOT helpful
imaging is not recommended unless a complication is suspected
a)a limited commuted tomography scan of sinuses is preferred over routine sinus radiographs or MIR
b) CT allows for assessment of bony erosions and extension of infection beyond the sinuses

Question 27

what are the complications of ethmoid sinusitis and how do u diagnose it

Answer 27

can easily spread medially though the lamina papyracea to cause periorbital cellulitis, orbital cellulitis, orbital abscess, or septic cavernous sinus thrombosis (rare)
infection can spread posteriorly and cause epidural , subdural, brain abscess or septic cavernous sinus thrombosis
orbital cellulitis is usually unilateral; cavernous sinus thrombosis is bilateral. papilledema deficits of the Vth cranial nerve, and pleocytosis of the cerebrospinal fluid are also found with septic cavernous sinus thrombosis

orbital computed tomography scan with contrast delineates the extent of infection
surgical drainage of the sinus is recommended if loss of visual acuity, proptosis, or ophthalmoplegia develop

surgical drainage of the sinus is recommended if loss of visual acuity, proptosis, or ophthalmoplegia develop

Question 28

complication of frontal sinusitis and how do u diagnose it

Answer 28

infection can spread anterior, causing Potts puffy tumor

infection can spread posteriorly and cause epidural, subdural, or brain abscess

posterior spread leads to severe headache, but frontal cerebral cortex lesions are usually neurologically silent

contrast enhanced computed tomography scan is recommended in cases of severe frontal sinusitis

Question 29

complication of sphenoid sinusitis

and how do u diagnose it

Answer 29

most dangerous form of sinusitis
most patients require hospitalization intravenous antibiotics
sphenoid is close to many vital neurologic structures
the major complication is septic cavernous sinus thrombosis
CT scan with contrast defines the sites of involvement, including cavernous sinus thrombosis
surgical drainage of the sinus is often required to prevent spread outside its walls

Question 30

how do you treat sinusitis and what are the most common causative agents

Answer 30

S. pneumoniae and H. influenzae are most common
S. aureus is the most frequent in sphenoid disease
G- pseudomonas aeruginosa are seen in AIDS patients
if presents with one of the three conditions begin antibiotics:
a)amoxicillin-clavulanate is the treatment of choice
b)fluoroquinolones
c)doxycycline
d)azithromycin and amoxicillin is no longer recommended

patients with frontal, ethmoid , or sphenoid sinus infection often require hospitalization and intravenous antibiotics (oxacillin plus 3rd gen cephalosporin)