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Neuro Block 3 > Ear Infections > Flashcards

Ear Infections Flashcards

0
Q

What is the pathogenesis of AOM?

A

URI or allergy causes congestion of mucosa

Narrowing or obstruction of tubes prevents drainage

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1
Q

What is otitis media with effusion?

A

Build up of fluid in the Eustachian tube

No infection
Associated with URI
Cigarette smoke
Allergies
Resolve of it own
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2
Q

What can enlarged adenoids cause?

A

Acute otitis media

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3
Q

Why are ear infections more common in children!

A

Eustation tubes are more narrow and horizontal

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4
Q

What is the most common cause of AOM?

A

Strep pneumoniae

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5
Q

What are the main causes of AOM in order of most common?

A 
Strep pneumonia 
Haemophilus influenza (non typable)
Moraxela catarrhalis
Viral (RSV, rhinovirus)
Idiopathic (16-25%)
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6
Q

What is strep pneumonia like?

A

Gram positive
Diplococcus
Alcoholism, diabetes mellitus, chronic renal disease increase susceptibility

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7
Q

What are the strep pneumonia virulence factors?

A

Resistance to PBP
Capsule
Choline-binding - bind carbs on epithelium
Neuroaminidases - cleave mucins
Pneumolysin - pore forming toxin is released disrupts cilia
- iron acquisition and uptake proteins

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8
Q

What are some characteristics of Haemophilus influenza?

A

Gram neg
Coccobacillus
Biofilms
Facultative anaerobes

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9
Q

What bacteria has humans as the only host?

A

Haemophilus influenza

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10
Q

What blood factors are required for growth of Haemophilus influenza?

A

Hematin (X) and NAD (V)

Both present in chocolate agar

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11
Q

What type is most Haemophilus flu is most common in AOM?

A 
Nonencapsulated nontypeable (NTHi)
Colonize nasopharynx
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12
Q

What is the cause of resistance in NTHi?

A

Many express beta lactamases

Throw in a beta lactamase inhibitor

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13
Q

What can NTHi cause other than AOM?

A

Genital track

Conjunctivitis

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14
Q

What are some characteristics of Moraxella catarrhalis?

A 
Gram neg
Aerobic
Diplococci 
Oxidase positive
Non motile
Chocolate agar
Pili
Adhere to upper respiratory
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15
Q

What percent of M. Catarrhalis produce beta-lactamases?

A

95%

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16
Q

How do you test for the presence of Moraxella catarrhalis?

A

Hockey puck test - easily slide across agar (not as well attached to agar)
Chocolate agar

17
Q

How do you diagnosis AOM?

A

Pneumatic otoscope to access tympanic membrane

Tympanometry - detect fluid

If recurrent, culture, gram stain

18
Q

What are some prevention strategies for AOM?

A

Avoid cigarette smoke
Breast feeding and avoid bottles before bed
Wash hands
Flu vaccine and 13- valent pneumococcal vaccine

19
Q

What would you start 6-24 months empiric treatment for AOM?

A

Oral amoxicillin

Covers strep and Haemophilus

20
Q

What are some side effects of a broad spec amoxicillin?

A

Oppertunistic infection

Allergy

21
Q

If you do not improve AOM after 48 hours with amoxicillin what do you switch to?

A

Amoxicillin + clavulanate

22
Q

What is clavulanate?

A

A beta lactamase inhibitor

23
Q

How do you treat AOM when the Px has a penicillin allergy?

A

Azithromycin (macrolide)

24
Q

Why would clavulanate not help a resistant strep AOM?

A

Because the cause of resistance is a change in the target not expression of a beta lactamase

25
Q

What are some complications of otitis media?

A 
Erosion of ossicles 
Cholesteatoma - cyst of epithelium cells
Rupture of ear drum
Infection of the mastoid
Meningitis 
Speech delay
Hearing loss
26
Q

What is swimmers ear?

A

Otitis externa

27
Q

What are some risk factors for otitis externa?

A

Diabetes
Moisture
Foreign bodies
Trauma

28
Q

How does cerumen prevent otitis externa?

A

Lysozyme breaks cells

More acidic

29
Q

What species causes and acute localized otitis externa?

A

Staph

30
Q

What organism causes acute diffuse otitis externa?

A

Pseudomonas aeroginsoa

31
Q

What organisms cause malignant otitis externa the most?

A

Pseudomonas aeruginosa

32
Q

What two types of otitis externa does pseudomonas aeruginosa cause?

A

Acute diffuse

Malignant

33
Q

What are some characteristics of acute diffuse otitis externa?

A

Itches, red, pain

34
Q

What is malignant otitis externa?

A

Invasion of the adjacent bone and cartilage

Can progress to cranial nerve palsy and death

More In elderly, immunocompromized and diabetes

35
Q

What are some common causes of fungal otitis externa?

A

Aspergillus

Candida albicans

36
Q

How do you diagnosis otitis externa?

A

Hard because normal flora
KOH for fungal
Acetic acid cleansing

37
Q

How do you treat otitis externa?

A

Neomycin(staph)
Polymixin
Hydrocortisone

NSAIDs
Topical antibiotics

38
Q

What releases pneumolysin pore forming toxin?

A

Strep pneumonia

39
Q

What causes visual field deficit most common in HIV patients?

A

CMV

Neuro Block 3 (17 decks)

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