Ear and sinus infections Flashcards

1
Q

Otitis externa

Characterized by :
General ________ and ________, with associated _______, with or without ______

A

Oedema

Erythema

Itchy discomfort

Eat discharge

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2
Q

Otitis externa

Causative agents :

List 3

A

Pseudomonas species

Staphylococci

Streptococci/Gram negative rods

Fungi( Aspergillus/candida species)

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3
Q

Treatment for Otitis externa:

Most common pathogens are :_____,______,_______, and ———

Treatment :
_______
________
__________
___________

A

Pseudomonas , staph, E.coli, and proteus

Ear toilet
Antibiotics
Medicated wicks
Analgesics

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4
Q

Treatment for Otitis externa:

Avoid _______ or ________ or ________

A

Water entry

Cotton buds

Digital manipulation of ear canal

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5
Q

Fungal Otitis Externa
(Otomycosis)

• Aspergilus niger -I- ______ headed filamented growth

• Aspergilus fumigatus- _______

• Candida albicans- ______/______ deposits

• Secondary fungal infection may be seen in patients using ___________ for otitis externa/ middle ear suppuration

A

black ; brown

white/creamy

topical antibioties

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6
Q

Fungal Otitis Externa
(Otomycosis)

• _____________ -I- black headed filamented growth
• ________________- brown
• ________________- white/creamy deposits

A

Aspergilus niger -I-

Aspergilus fumigatus

Candida albicans

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7
Q

OTITIS MEDIA
Definition: Presence of a ___________

A

middle ear infection

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8
Q

OTITIS MEDIA

Acute Otitis Media: occurrence of ________ infection within the ___________

Otitis Media with Effusion: presence of __________ within the ___________

A

bacterial infection ; middle ear cavity.

nonpurulent fluid ; middle ear cavity

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9
Q

OTITIS MEDIA

OM is the _______ most common clinical problem in childhood after _____________________

A

second

upper respiratory infection.

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10
Q

RISK FACTORS for OM

_________________ Infections
_________
_________ abnormalities (_________) _________ Syndrome
_________ smoking
(Boys or Girls?) > (boys or girls?)
Daycare

A

Upper Respiratory

Allergies

Craniofacial ;cleft palate

Down’s ; Passive

Boys > girls

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11
Q

SIGNS & SYMPTOMS of otitis media

Neonates/Infants: change in _______,
irritability, ______ at ears, decreased _______, vomiting.

Children(2-4): ______, fever, _____ in ears,
cannot _____ properly, changes in _______

Children (>4): complain of _______, changes In _________-

A

behavior ; tugging ; appetite

otalgia ; noises ; hear ; personality

ear pain ; personality

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12
Q

EPIDEMIOLOGY of otitis media

Peak incidence in the _____ years of life (esp. _____months)

(Boys or Girls?) more affected than (boys or girls?)

50% of children under ___ yr of age will have at least 1 episode.

1/3 of children will have 3 or more infections by age _____

90% of children will have at least one infection by age ____.

50,000 deaths / year worldwide

A

first two ; 6-12 months

Boys ; girls

1 ; 3 ; 6

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13
Q

causative agents of otitis media

_____________ —————-
_____________ —————-(non-typeable)
_____________ —————-
Group ___ Streptococcus
_____________ —————-
_____________ —————-
____ associated with _____________

A

Streptococcus pneumoniae Haemophilus influenzae(non-typeable) Moraxella catarrhalis
Group A Streptococcus
Staph aureus
Pseudomonas aeruginosa
RSV assoc. with Acute Otitis Media

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14
Q

Most common cause of Acute otitis media is???

Most uncommon cause of AOM

A

Streptococcus pneumoniae

Pseudomonas aeruginosa

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15
Q

Treatment Considerations for otitis media

________________ (DRSP) incidence is increasing

Patients at high risk for DRSP
– Attending _______
– <___ years old
– Antibiotic therapy in _________

A

Drug resistant S. pneumoniae

day care

2; preceding 3 months

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16
Q

Number Need to Treat (NNT) NNT for antibiotic therapy in AOM

________ children with AOM would have to be treated with antibiotics to prevent one case of clinical failure by 1 week.

One review estimated the need to treat ________ in order for 1 child to have improved pain at 2 days.

In addition, ______ were associated with almost twice the rate of vomiting, diarrhea, and rashes.

A

7 to 8

17 children

antibiotics

17
Q

Definitions

Non-severe illness is :______ otalgia and fever ____°C in the past 24 hours

Severe illness is __________ otalgia OR fever _____°C

A

Mild; <39

Moderate to severe

> or equal to 39

18
Q

certain diagnosis of AOM meets all 3 criteria …

1)______ onset
2) Signs of _____
3) Signs and symptoms of ____________

A

Rapid

MEE

middle-ear inflammation.

19
Q

Otitis media

Observation is only appropriate when …

_______ can be ensured and ______ therapy initiated if symptoms persist or worsen

A

Follow-up

antibiotic

20
Q

Why Focus on Pneumococcus?

Most common _________ pathogen
Most common isolate after ______
Least likely bacterial pathogen to _______
Most likely to cause _____ otitis media
Most likely to cause _______ complications of otitis ( __________ )

A

initial bacterial

failed therapy

self resolve; severe

suppurative

mastoiditis

21
Q

In allergy to Amoxicilin

Alternative therapy in the penicillin-allergic patient who is being treated for infection that is known or presumed to be caused by penicillin-resistant S pneumoniae is _________ at 30 to 40 mg/kg per day in ___ divided doses.

In the patient who is vomiting or cannot otherwise tolerate oral medication, a _____ dose of _______ __________ (50 mg/kg) has been shown to be effective for the initial treatment of AOM.

A

clindamycin; 3

single; parenteral ceftriaxone

22
Q

Duration of therapy for otitis media

For children ≥ 6 years of age with mild to moderate disease _______ days is appropriate

For younger children and for children with severe disease, a standard ____-day course is recommended

23
Q

Treatment Failure
No improvement in ear pain, fever, or tympanic membrane otorrhea, bulging or redness after ______ of antibiotic therapy

2nd Line Therapy
–_______
– ___________ producing _________ and __________

A

3 days

DRSP

Beta-lactamase

H.influenza and M. cattarhalis

24
Q

Prevention of Otitis Media

_____________ pneumococcal conjugate vaccine (n=37,868)

Reduction of ______________

Reduction of _________ prescriptions

Influenza vaccine: Goal: decrease number of URI

______________

A

Heptavalent

otitis office visits; antibiotic

Breast feeding

25
Prevention Prophylaxis 3 episodes in _______ or 4 episodes in ______ <6 months with ____ episode Cause of resistance in the community
6 months ; 1 yr >1
26
AOM is common amongst _______ and the complications can be serious and sometimes life threatening. Guidelines advocates ____________ However with emerging resistance issues in the causative pathogens HD ____________ is advocated. The PK/PD results of this time dependent drug has achieved cure in > ___% in clinical trials
children ; amoxicillin amoxicillin clavuate 96%
27
Infection of the sinuses The sinuses are _____ paired cavities (spaces) in the head. They are connected by (narrow or wide?) channels The sinuses make (thin or thick?) mucus that drains out of the channels of the ________ , helps keep the nose _____ and free of _________
four ; narrow thin ;nose clean ; bacteria
28
The sinuses Normally filled with ______, the sinuses can get ______ and filled with _______ When that happens, _____________ and cause an infection (bacterial sinusitis)
air ; blocked fluid; bacteria can grow
29
(Viruses or Bacterias?) cause most sinus infections, but (virus or bacteria?) can cause some sinus infections
Viruses bacteria
30
Types of sinuses The paranasal sinuses are located in your _____ near your _____ and ______. They are named after the _______ that provide their structure.
head nose and eyes. bones
31
Types of sinuses . The ethmoidal sinuses are located _______ your eyes. The maxillary sinuses are located _______ your eyes. The sphenoidal sinuses are located _______ your eyes. The frontal sinuses are located _______ your eyes.
between Below Behind Above
32
Types of sinuses The biggest sinus cavity is the ______ cavity, and it is one of the cavities that most often becomes infected.
maxillary cavity
33
Sinusitis can be caused by a virus, bacteria, or fungus that ______ and ______
swells and blocks the sinuses
34
Sinusitis Specific causes include: The ____________ Nasal and seasonal _______ ________ A _______ septum A weak immune system from illness or medications.
common cold; allergies Polyps; deviated
35
Sinusitis Specific causes include: For infants and young children, spending time in ________, using _______ or drinking bottles while _________ could increase the chances of getting sinusitis. For adults, ———- increases the risks for sinus infections
day cares; pacifiers lying down smoking
36
Signs and symptoms of sinusitis Post ________ (mucus _________________). Nasal discharge ((thin or thick?) _______ or _______ discharge from nose) or ____ nose Facial _________ (particularly around the nose, eyes, and forehead), headache and or pain in your _______ or _______. Halitosis Cough Tiredness Fever
nasal drip; drips down the throat Thick; yellow or green stuffy; pressure teeth or ears
37
pathogenesis The early stage of sinusitis is often a _______ infection that generally lasts up to _______ and that ______________ in 99% of cases However, a small number of patients may develop a ______________ infection that is generally caused by _______ bacteria (e.g, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) Initially, the resulting acute sinusitis involves only _____ type of aerobic bacteria Persistence of the infection, _______ flora, _______ organisms, and, occasionally, _______ [contributes to the pathogenesis, with anaerobic bacteria of oral flora origin often eventually predominating
viral ;10 days completely resolves in secondary acute bacterial aerobic ; one mixed ; anaerobic ; fungus