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Block G -- Infection > Dr. Daniel -- Common Infections in Otolaryngology, Head and Neck Surgery > Flashcards

Dr. Daniel -- Common Infections in Otolaryngology, Head and Neck Surgery Flashcards

1
Q

Signs and symptoms of tonsililitis (6)

A 
Severe sore throat
Difficult or painful swallowing
Headache
Fever/chills
Enlarged, tender neck nodes
Voice change
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2
Q

Etiology of tonsilitis (2)

A

Viral (EBV)

Bacterial (S. pyogenes)

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3
Q

2 methods of diagnosis for tonsillitis

A

Physical exam

Culture

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4
Q

5 complications of tonsillitis

A 
Abscess formation
Loss of airway
Sepsis
Nephritis
Rheumatic fever
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5
Q

Natural progression of otitis externa

A

Usually self-limited

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6
Q

2 symptoms of otitis externa

A

Otalgia

Otorrhea

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7
Q

3 findings of otitis externa

A

Ear canal edema
Otorrhea
Tender to pinna traction

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8
Q

Pathogenesis of AOE (4 steps)

A

1) Water exposure
2) Loss of protective barriers (removal of wax, irritation of EAC skin)
3) Accumulation of exfoliated skin debris
4) Obstruction

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9
Q

Lifetime incidence of otitis externa

A

10% (accounts for 7.5 million annual ototopical prescription in US)

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10
Q

4 most common pathogens associated with otitis externa

A

1) Pseudomonas aeruginosa (20 - 60%)
2) S. aureus (10 - 70%); often polymicrobial
3) Other gram - organisms
4) Fungal

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11
Q

4 antibiotics options for otitis externa

A

1) Aminoglycoside
2) Polymyxin B
3) Quinolone
4) A combination of these agents

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12
Q

2 steroids for otitis externa

A

1) Hydrocortisone

2) Dexamethasone

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13
Q

3 treatment options of otitis externa

A

1) Antibiotics
2) Steroids
3) Low pH antiseptic (i.e. aluminum acetate solution or acetic acid)

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14
Q

3 pairs of AOE treatments that have equivalent clinical outcomes

A

1) Antiseptic vs. antimicrobial
2) Quinilone vs. non-quinolone
3) Steroid-antimicrobial vs. antimicrobial alone

NOTE: Regardless of topical agent, about 65 - 90% have clinical resolution within 7 - 10 days

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15
Q

2 Most common pathogens of fungal otitis

A

1) Aspergillus

2) Candida

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16
Q

Classic pathogenesis of fungal otitis

A

Prolonged treatment of bacterial otitis externa that alters the flora of the ear canal

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17
Q

2 symptoms and findings of fungal otitis

A

1) Clogged, itchy or painful ears

2) Thick fungal debris in the external auditory canal

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18
Q

3 generally safe treatments for fungal otitis

A

1) Clotrimazole
2) Miconazole
3) Tolnaftate

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19
Q

Fungal otitis treatment that has potential for severe damage

A

Gentian violet

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20
Q

2 treatments for fungal otitis that can cause appreciable elevation of brainstem response thresholds

A

Drops containing:
1) Acetic acid
OR
2) Propylene glycol

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21
Q

Define otitis media

A

Inflammatory disease of the mucosal lining of the middle ear

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22
Q

Common group of people affected by otitis media

A

Children

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23
Q

2 most common pathogens of otitis media

A

Streptococcus pneumoniae

Haemophilus influenzae in infants

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24
Q

7 symptoms of otitis media

A

1) Abrupt onset
2) Ear pain
3) Fullness
4) Fever
5) Irritability
6) Vomiting
7) Loose stools

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25
Q

3 reasons for the pathogenesis of otitis media

A

1) Eustachian tube dysfunction
2) Immunologic compromise
3) Microbial challenge

26
Q

4 examples of eustachian tube dysfunction causing otitis media

A

1) Developmental
2) Cleft palate
3) Infectious
4) Environmental (allergies, smoke)

27
Q

3 examples of immunologic compromise causing otitis media

A

1) Developmental
2) Immunodeficiency
3) Infectious

28
Q

3 examples of microbial challenge causing otitis media

A

1) Viral
2) Bacterial
3) Daycare!

29
Q

3 methods of diagnosis of otitis media

A

1) Red TM with bulging and loss of normal landmarks
2) Spontaneous perforation possible in first 24-48 h –> alleviation of pain
3) Pneumatic otoscopy to determine the presence of fluid in middle ear

30
Q

3 treatment options of otitis media

A

1) Antibiotics
2) Drainage
3) Myringotomy

31
Q

3 first line antibiotics for otitis media

A

1) Amoxicillin
2) Macrolides (10% pneum. resistance)
3) TMP/SMX (25% pneum. resistance)

32
Q

4 antibiotics in cause of first line treatment failure

A

1) Amoxicillin/clavulanate
2) 2nd gen cephalosporins (i.e. cefuroxime axetil, cefactor)
3) TMP/SMX and macrolildes
4) Fluoroquinolones

33
Q

3 fluoroquinolones to treat otitis media

A

Grepafloxacin
Levofloxacin
Sparfloxacin

34
Q

Treatment course of otitis media antibiotics

A

10 - 14 days

35
Q

Complication of otitis media

A

acute mastoiditis

36
Q

3 classes of sinus infections

A

1) Acute bacterial sinusitis
2) Subacute bacterial sinusitis
3) Recurrent acute bacterial sinusitis

37
Q

Define acute bacterial sinusitis (2)

A

Bacterial infection lasting less than 30 days in which symptoms resolve completely

Persistent and worsening upper resp. symptoms for longer than expected 7 day course of a viral illness, but for less than 3 weeks

38
Q

Define subacute bacterial sinusitis

A

Bacterial infection lasting between 30 - 90 days in which symptoms resolve completely

39
Q

Define recurrent acute bacterial sinusitis

A

Episodes lasting less than 30 days and separated by intervals of at least 10 days during which the patient is asymptomatic

40
Q

3 things that result in healthy sinuses

A

1) Adequate ventilation through patent ostia
2) Adequate mucociliary clearance
3) Adequate local and systemic immune defense

41
Q

3 most common acute sinusitis pathogens

A

1) Strep pneumoniae
2) H. influenzae
3) M. catarrhalis occasionally

42
Q

2 rare pathogens of acute sinusitis

A

1) Staph aureus

2) Anaerobes

43
Q

3 first line antibiotics for acute sinusitis

A

1) Amoxicillin
2) erythromycin
3) TMP/SMX

44
Q

5 second-line antibiotics for acute sinusitis

A

1) Clarithromycin, azithromycin
2) Amoxicillin/clavulanate
3) Cefuroxime axetil, cefprozil, cefactor
4) Ciprofloxacin, levofloxacin
5) Clindamycin

45
Q

Compare the treatment outcomes for acute sinusitis

A

For patients with uncomplicated acute sinusitis, less expensive first-line agents = as effective as costlier second-line agents

46
Q

Usual course of disease for viral otitis and sinusitis

A

8 - 10 days

47
Q

Usual course of disease for otitis and sinusitis due to aerobes

A

10 days to less than 3 months

48
Q

Usual course of disease for otitis media and sinusitis due to anaerobes

A

Over 3 months

49
Q

Define chronic sinusitis

A

Symptoms of sinusitis persisting beyond 3 months without improvement

50
Q

Most common pathogen associated with chronic sinusitis

A

H. influenzae

51
Q

4 most common pathogens for refractory chronic sinusitis

A

1) S. aureus
2) Anaerobic bacteria
3) Gram-negative organisms
4) Polymicrobial infection in general

52
Q

Pathogen commonly cultured from chronic sinusitis patients who have received multiple courses of antibiotics over a prolonged period

A

Pseudomonas aeruginosa

53
Q

2 local complications of sinusitis

A

1) Polyps

2) Mucoceles

54
Q

6 orbital complications of sinusitis

A

1) Periorbital cellulitis
2) Periorbital cellulitis with chemosis
3) Orbital cellulitis
4) Subperiosteal abscess
5) Orbital abscess
6) Cavernous sinus thrombosis

55
Q

3 intracranial complications of sinusitis

A

1) Meningitis
2) Peridural abscess
3) Brain abscess

56
Q

3 lower respiratory tract complications of sinusitis

A

1) Cough
2) Pneumonitis
3) Asthma

57
Q

5 classes of periorbital/orbital cellulitis/abscess

A 
I - inflammatory edema (pre-septal)
II - Orbital cellulitis (post-septal)
III - Subperiosteal abscess
IV - Orbital abscess
V - Cavernous sinus thrombosis
58
Q

2 benign salivary gland diseases

A

1) Sialolithiasis

2) Parotitis

59
Q

2 treatments for sialolithiasis

A

1) Stone removal

2) Sialogogues

60
Q

Common pathogen of parotitis

A

S. aureus

61
Q

2 treatments for parotitis

A

1) Sialogogues

2) Antibiotics

62
Q

3 malignant salivary gland diseases

A

1) Pleomorphic adenoma (most common)
2) Adenoid cystic carcinoma (CNVII involvement)
3) Mucepidermoid carcinoma

Block G -- Infection (23 decks)

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