EENT Flashcards
Most common bacterial pathogen in bacterial sinusitis, acute otitis media, & community acquired pneumonia?
Streptococcus pneumoniae (gram + diplococci)
Common pathogen in bacterial rhino sinusitis, comm acquired pneumonia (particularly with tobacco use).
H. Influenza (gram - bacillus)
Less common pathogen in bacterial rhino sinusitis, uncommon cause of comm acquired pneumonia
M. Catarrhalis (gram - coccus)
Antibiotic resistance risk factors
Age 65 Daycare Prior abt in the past month Prior hospitalization w/in the past 5 days Comorbidities Immunocompromised
Symptomatic treatments for bacterial rhino sinusitis
Nasal saline irrigation
Intranasal corticosteroids (when accompanying allergic rhinitis)
Topical or systemic decongestant
Treatment of bacterial rhino sinusitis (adults)
Duration- 10-14 days
1st line- amox./clavulanate 500/125mg po TID or 875/125mg BID, TMP/SMX (Bactrim), doxycycline
2nd line- amox/clavulanate 2000/125mg BID (? Resistance) or doxycycline 100mg BID or 200mg QD
PCN/ceph. Allergy- doxycycline 100mg BID or 200mg QD, or Levaquin 500mg QD (? Resistance) or Moxifloxacin 400mg QD (? Resistance)
CYP450 3A4 substrate
Utilizes a specific enzymatic pathway.
Medication that is metabolized by the isoenzyme, utilizing this enzyme in order to be modified so it can reach drug site of action &/or be eliminated
CYP450 3A4 inhibitor
Blocks a specific enzymatic pathway, keeps substrate (medication) from exiting (leads to toxicity)
Blocks the activity of the isoenzyme limiting substrate excretion, allowing increase of substrate levels & possible risk of substrate induced toxicity.
CYP450 3A4 inducer
Pushes the substrate out the exit pathway.
Accelerates the activity of the isoenzyme so that substrate is pushed out the exit pathway, leading to reduction in substrate (medication) level.
Treatments of allergic rhinitis
- Avoidance measures
- Controller meds (1st line- Intranasal corticosteroids, ex. Flonase, nasocort), add on treatment- singulair.
- Reliever meds (2nd gen antihistamines- Claritin, Zyrtec), Intranasal antihistamine- asteline, astepro) ocular antihistamine- patanol, pataday.
- Immunotherapy- ex-Xolair
Characteristics of eye discharge with allergic conjunctivitis?
Bacterial conjunctivitis?
Viral conjunctivitis?
Allergic- ITCHING, stringy, rope like discharge, tearing, mild lid edema, bilateral conjunctival hyperemia.
Bacterial- UNILATERAL, mucopurulent discharge, crusty drainage in eyelids, conjunctival injection/hyperemia
Viral- watery discharge, acute onset, highly contagious, conjunctival hyperemia, edema.
Clinical findings in closed-angle glaucoma?
A deeply cupped optic disc
Usually unilateral, acutely red, & painful (due to sudden increase in intraocular pressure)
Vision changes including halos around lights.
Pt complaints with open-angle glaucoma?
Peripheral vision loss (due to gradual onset of increased intraocular pressure leading to optic atrophy)
Avoidable with appropriate, ongoing intervention
Pt complaints with macular degeneration?
Clinical findings?
Painless vision changes including distortion of central vision (due to thickening, sclerotic changes in retinal basement membrane complex)
Clinical- Drusen (soft yellow deposits in the macular region) often visible with funduscopic exam.
Ophthalmologic test for early detection of Macular degeneration?
Amsler grid test
Ophthalmologic test for measuring intraocular pressure (test for glaucoma)
Tonometry
Definition of Anosmia/hyposmia?
Diminished sense of smell, with resulting decline in fine taste discrimination (due to neural degeneration)
*accelerated by tobacco use
Definition of presbycusis?
Difficulty with conversation in noisy environment. Person can hear, but it’s hard to understand what is said (due to loss of 8th CN sensitivity)
Treatment of suppurative (purulent) conjunctivitis?
1st line- ophthalmic fluroquinolone (levofloxicin, Moxifloxacin)
Alternative- polymixin B with trimethoprim solution or azithromycin 1% ophthalmic solution. Tobramycin 0.3%, gentamicin 0.3% solution.
Treatment of otitis externa?
Mild- acetic acid with propylene glycol & hydrocortisone gtts.
Moderate to severe- ciprofloxacin with hydrocortisone gtts.
Treatment of Malignant otitis externa in pt with DM, HIV, or on chemotherapy? (Invasive form that can lead to osteomyelitis of cartilage/bone)
Oral ciprofloxacin for early disease, suitable for outpatient use.
Send to ER or ENT
Treatment of exudative pharyngitis?
1st line- PCN VK po x10 days, or benzathine Pcn IM x1dose
Alternative- erythromycin x10 days, 2nd generation cephalosporin x4-6 days, azithromycin x5 days
Treatment of otitis media?
Amoxicillin, azithromycin, augmentin, cefdinir (omnicef), clindamycin for persistent AOM
What are nasal polyps?
What conditions are they seen with?
Pale, sack-like growths of tissue, that may be inflamed.
May be present with chronic allergic rhinitis, chronic sinusitis, asthma, ASA sensitivity, & cystic fibrosis.
Diabetic retinopathy definition?
3 stages?
Damage to the retina caused by complications of Diabetes. Stages: 1. Background DM retinopathy 2. Pre-proliferative DM retinopathy 3. Proliferative DM retinopathy
Subjective & objective findings with DM retinopathy?
Sub- visual changes
Obj- microaneurysms, intra-retinal hemorrhage, macular edema, & lipid deposits.
Nerve layer infractions, COTTON WOOL SPOTS, venous dilation & retinal hemorrhage.
Only pharmacological agent found to slow progression of DM retinopathy?
ACE inhibitor- Lisinopril
Risk factors for Tinnitus?
Ménière’s disease, labyrinthitis, HTN, head trauma, thyroid dysfunction.
Meds with reversible effects-salicylate, quinine, indocin, alcohol.
Meds with irreversible effects- streptomycin, gentamicin, vancomycin (aminoglycosides)
Management of tinnitus?
Avoidance of offending med- (such as ASA, NSAIDS)
Antidepressants may be helpful.
Supplements- (vitamin A, C, B12, nicotinic acid, magnesium or copper).
Tinnitus-masking devices.
Learning to cope with tinnitus is necessary.
Temporomandibular Joint Disease TMJ definition & symptoms?
A cluster of disorders related to mastication.
Sx- (most common)-pain in the muscles of mastication, preauricular area, & tenporomandibular area.
Treatment of TMJ?
PT, behavioral therapy.
Meds- NSAIDS, muscle relaxants, antidepressants, topical analgesics.
