DISORDERS OF ENT (NELSONS) Flashcards
What is otitis externa?
An infection of the external auditory canal, commonly related to water exposure, often occurring in warm, humid climates.
What age group has the highest annual rates of ambulatory care visits for acute otitis externa in the U.S.?
5-9 year-olds, followed by 10-14 year-olds.
What are the most common bacterial pathogens in otitis externa?
Pseudomonas (32%) and Staphylococcus aureus (21%).
What is the most common fungal pathogen in otitis externa?
Aspergillus (20%).
What are the clinical manifestations of localized otitis externa?
Pain on pinna manipulation, redness, swelling of the canal, with or without purulent discharge.
What is the first-line treatment for otitis externa?
Topical antibiotics, insertion of ear wicks with antibiotics or povidone iodine, and analgesics.
What did the Cochrane Systematic Review reveal about treating otitis externa?
Topical antimicrobials with steroids are more effective than placebo; acetic acid is effective only in the first week.
What is otitis media?
A spectrum of diseases including acute otitis media, recurrent otitis media, otitis media with effusion, and chronic otitis media.
What is the prevalence of otitis media in the Philippines?
12%, the highest among Asia-Pacific countries.
What percentage of children experience acute otitis media (AOM) by age 3?
20% experience at least one episode, with incidence peaking at 6-11 months.
What are the most common bacterial pathogens in acute otitis media (AOM)?
Streptococcus pneumoniae, non-typeable Haemophilus influenzae, and Moraxella catarrhalis.
What are the otoscopic findings in acute otitis media?
Erythema of the drum, bulging drum, air-fluid levels, or perforation with otorrhea.
What is the recommended first-line antibiotic for acute otitis media in the Philippines?
Amoxicillin.
What preventive measures can reduce the risk of acute otitis media?
Breastfeeding for 6 months, upright feeding position, and avoiding tobacco smoke exposure.
What is otitis media with effusion (OME)?
Presence of fluid behind an intact eardrum without acute signs of inflammation.
What are the otoscopic findings in otitis media with effusion?
Air-fluid levels and impaired mobility of the eardrum.
When is surgical intervention recommended for otitis media with effusion?
Persistent bilateral OME for 3 months with hearing loss of 25-30 dB or worse.
What is chronic otitis media (COM)?
A condition characterized by discharge through a perforated drum lasting longer than 2 weeks.
What are the most common bacterial pathogens in chronic otitis media in the Philippines?
Staphylococcus aureus and Pseudomonas.
What are the extracranial complications of chronic otitis media?
Facial paralysis, labyrinthitis, petrositis, and subperiosteal abscess.
What are the intracranial complications of chronic otitis media?
Meningitis, brain abscesses, lateral sinus thrombosis, and hydrocephalus.
What is the first-line treatment for chronic otitis media with discharge?
Topical quinolone antibiotics.
What surgical interventions are used for chronic otitis media?
Mastoidectomy combined with ossicle or tympanic membrane reconstruction.
Define acute rhinosinusitis in children according to EPOS.
The sudden onset of 2 or more symptoms: nasal blockage/obstruction/congestion, discolored nasal discharge, and daytime and nighttime cough of less than 12 weeks’ duration.
What is the most common etiology of acute rhinosinusitis?
Acute rhinosinusitis is usually infectious in etiology.
What are the most common pathogens in Filipino children with acute bacterial rhinosinusitis?
Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus.
What percentage of patients with acute bacterial rhinosinusitis have mixed isolates?
64% of patients.
What is the most common combination of pathogens in Filipino children with acute bacterial rhinosinusitis?
Streptococcus pneumoniae and Haemophilus influenzae.
What percentage of patients with a cold develop viral sinusitis?
90% of patients with a cold develop viral sinusitis.
What percentage of individuals with viral sinusitis develop acute bacterial sinusitis?
0.5%-2%.
What are the IDSA criteria for diagnosing bacterial rhinosinusitis?
Persistent signs/symptoms lasting 10+ days without improvement, severe symptoms (high fever, purulent nasal discharge, facial pain) lasting 3-4 days, or worsening symptoms (new fever, headache, increased nasal discharge) in an initially improving viral URI.
When is radiologic examination recommended for rhinosinusitis diagnosis in children?
In cases unresponsive to medical therapy or with worsening symptoms.
What is the IDSA-recommended first-line treatment for non-severe acute bacterial rhinosinusitis in children?
Amoxicillin-clavulanate.
What is the recommended empiric therapy for regions with high rates of invasive penicillin non-susceptible Streptococcus pneumoniae?
High-dose amoxicillin-clavulanate.
What antibiotics are not recommended for empiric therapy in rhinosinusitis due to resistance?
Macrolides and trimethoprim-sulfamethoxazole.
What evidence supports the use of saline nasal irrigation in rhinosinusitis?
It alleviates symptoms, improves endoscopic findings, and improves quality of life.
What is acute pharyngotonsillitis?
An inflammatory condition of the pharynx and tonsils with symptoms like sore throat, dysphagia, odynophagia, fever, and enlarged tender cervical lymph nodes.
What is the most common bacterial cause of pharyngotonsillitis?
Group A Streptococcus pyogenes (GABHS).
What complications can arise from GABHS pharyngotonsillitis?
Suppurative complications (e.g., cervical adenitis, abscesses) and non-suppurative complications (e.g., rheumatic fever, acute glomerulonephritis).
What are the IDSA-recommended antibiotics for GABHS tonsillopharyngitis?
Amoxicillin or phenoxymethylpenicillin for 10 days, or a single intramuscular injection of benzathine penicillin G.
What is peritonsillar abscess also known as?
Quinsy.
What are hallmark signs of peritonsillar abscess?
Fullness of the anterior tonsillar pillar, uvular deviation away from the abscess, ‘hot potato’ voice, and trismus.
What is the first-line antibiotic treatment for peritonsillar abscess?
Penicillin targeting Streptococcus species.
What surgical procedures are used to treat peritonsillar abscess?
Needle aspiration, incision and drainage, and immediate tonsillectomy.
What complications can arise from untreated peritonsillar abscess?
Spread of infection to the carotid sheath, deep spaces of the neck, and mediastinum.
What virus most commonly causes infectious mononucleosis (IM)?
Epstein-Barr virus (EBV).
What age group is most commonly affected by infectious mononucleosis in the U.S.?
Individuals between 15 and 19 years old.
How is Epstein-Barr virus (EBV) most commonly spread?
Through contact with saliva, such as kissing or sharing feeding utensils.
What is the incubation period for infectious mononucleosis?
30-50 days.
What are the hallmark symptoms of infectious mononucleosis?
Sore throat, fever, swollen glands, and pus on the tonsils.
What lab finding is most frequent in infectious mononucleosis?
Atypical lymphocytosis with atypical mononuclear cells in the peripheral blood.
Which antibody test is more reliable for diagnosing primary EBV infection than heterophile antibodies?
EBV nuclear antigen I (EBNA-I) IgG antibodies.
Is there a standard treatment for the acute pharyngitis of infectious mononucleosis?
No, but corticosteroids are sometimes used for faster symptom relief.
What is the typical clinical presentation of acute epiglottitis?
High fever, sore throat, dyspnea, and rapidly progressive respiratory obstruction.
What organism most commonly causes acute epiglottitis?
Haemophilus influenzae type B (HiB).
What classic position do children with acute epiglottitis often assume?
The tripod position (upright sitting, leaning forward, mouth open).
What is the thumb sign on a lateral neck X-ray indicative of?
A swollen epiglottis, suggestive of acute epiglottitis.
What is the treatment priority for suspected acute epiglottitis?
Immediate airway maintenance and culture-guided antimicrobial therapy.
What virus is the most common cause of laryngotracheobronchitis (croup)?
Parainfluenza virus types 1 and 3.
What are the hallmark symptoms of croup?
Barking cough, inspiratory stridor, and respiratory distress.
How does croup typically differ from acute epiglottitis?
Croup has a more insidious onset and is less likely to present with systemic toxicity.
What is the first-line treatment for mild croup?
Supportive care, such as fluids, upright positioning, and fever management.
What medication is commonly used to improve symptoms in moderate to severe croup?
Glucocorticoids (e.g., dexamethasone).
What hearing test is typically used for newborn screening?
Otoacoustic emission (OAE) test.
What is the Moro reflex used to assess in infants under 6 months?
Response to loud sounds (more than 80 dB) during a behavioral hearing test.
What is the auditory brainstem response (ABR) test used for?
To determine the integrity of the auditory pathway up to the brainstem.
