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NUNP543 > EENT - MIDTERM content (plus a little extra) > Flashcards

EENT - MIDTERM content (plus a little extra) Flashcards

1
Q

Palsy of what cranial nerve would cause decreased lacrimation, leading to dry eye?

A

CN VII

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2
Q

What kind of medications cause dry eye?

A

Anticholinergics, antihistamines, diuretics, b-blockers

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3
Q

Risk factors for dry eye

A

History of severe conjunctivitis

Eyelid defects such as CN V or VII palsy, incomplete blinking, exophthalmos, scar hindering lid movement

Environmental: heat (wood, coal, gas), ac, winter air, tobacco smoke

Contacts

Increasing age

Lipid abnormalities

Prolonged computer use

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4
Q

S&S of dry eye

A

Dry eyes, red eyes, foreign body sensation, blurred vision, tearing, eye pain, ocular fatigue

On slit lamp exam: decreased tear meniscus, decreased tear breakup time (normal > 10s), punctate staining of cornea with fluorescein

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5
Q

When assessing dry eye, why might we palpate joints and check for butterfly rash?

A

Autoimmune issues
Butterfly rash is sign of SLE

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6
Q

Tx of dry eye

A

Preservative free artificial tears up to q1H and ointment at bedtime (preservative toxicity occurs if used more than 4-6x/day)

Reduce environmental dryness with humidifier

Possible short course of mild topical corticosteroid, omega-3 fatty acids (controversial)

Eyelid hygiene for blepharitis

Surgical/procedural if indicated – refer

Treat underlying cause

Refer to ophthalmology if symptoms unrelieved after 2 weeks

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7
Q

Ropey eye discharge is seen in what condition?

A

Allergic conjunctivitis

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8
Q

Purulent eye discharge is seen in what conditions (3)?

A

Bacterial conjunctivitis
Blepharitis
Hordeolum

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9
Q

What is blepharitis?

A

= common inflammation of the eye lid

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10
Q

Is blepharitis typically unilateral or bilateral?

A

Bilateral

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11
Q

S&S of belpharitis?

A

Red, swollen eyelids

transient blurred vision that improves with blinking

Itching

Tearing

Gritty, FB sensation

crusting of the eyelashes

conjunctival injection (common)

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12
Q

Causes of anterior vs posterior blepharitis

A

Anterior = Seborrheic or bacterial (S. Aureus)

Posterior = Meibomian Gland Dysfunction

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13
Q

Risk factors for blepharitis

A

Diabetes

Candida

Seborrheic Dermatitis

Rosacea

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14
Q

Patho of posterior blepharitis

A

inflammation of the inner eyelid at the level of the meibomian glands

hyperkeratinization of the meibomian gland duct leads to altered lipid composition of the gland secretion

favors bacterial growth, leading to an inflammatory response in the posterior eyelid

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15
Q

Patho of anterior blepharitis

A

inflammation at the bases of the eyelashes

can be due to S. aureus or coagulase-negative staphylococci

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16
Q

Tx of blepharitis

A

warm compresses, lid massages, and lid washing using commercially available eyelid scrub solution

topical or systemic antibiotics (doxycycline) as needed

if severe, ophthalmologist may prescribe a short course of topical corticosteroids, omega-3 fatty acids

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17
Q

What is a chalazion?

A

A chalazion is a chronic lipogranulomatous lesion affecting the upper or lower eyelid, caused by blockage of Meibomian gland duct(s) with retention and stagnation of secretion.

May occur spontaneously or follow an acute hordeolum (internal)

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18
Q

Does a chalazion come on suddently?

A

NO - Gradual – develops over days to weeks. Typically improve over months.

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19
Q

Is a chalazion painful or painless?

A

Painless

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20
Q

What does a chalazion look like?

A

Painless lid lump

Usually single; sometimes multiple

May rupture through the skin

Well-defined, 2-8mm diameter subcutaneous nodule in tarsal plate

Lid eversion may show external conjunctival granuloma

**May be associated with blepharitis

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21
Q

How is a hordeolum different than a chalazion?

A

chalazion: on inside of lid (not usually at lid margin). Nontender.

hordoleum (stye) = near lid margin (either inside or outside lid). swollen, tender, erythematous and/or purulent nodule

Hordeola = infectious etiology
Chalazion = granulomatous inflammation

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22
Q

Hordeolum presentation

A

Painful, red swelling of lid

Sudden onset purulent discharge

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23
Q

How do we diagnose a hordeolum?

A

Based on exam. Can culture discharge, but usually treated presumptively

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24
Q

Treatment of hordeolum

A

Prevent spread: good handwashing, lid hygiene, discard all eye makeup,

Warm compresses, gentle massage

Usually resolves within 2 weeks without treatment, but may require I&D

Topical antibiotics are typically ineffective. Refer to ophthalmologist if does not respond

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25
Q

In what population is a hordeolum most common?

A

children/adolescents

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26
Q

S&S of FB in eye?

A

-Sensation of FB
-Red, painful eye
-Tearing, photophobia
-Epithelial defect that stains with fluorescein

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27
Q

Diagnosing a FB in eye - what do we need to check? When might referral be necessary?

A

Clinical dx

-Fluorescein to assess for corneal abrasion due to foreign body

-If concerned about corneal abrasion or injury was high speed (i.e., grinding metal), refer to opto/ optho (requires dilated exam, slit lamp exam)

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28
Q

Tx of FB in eye

A
  • “if a corneal foreign body is detected, an attempt can be made to remove by irrigation after instillation of topical anesthetic; this is particularly helpful if multiple foreign bodies, i.e., sand” (up to date)

-Can then attempt to remove with sterile swab using direct visualization

-If unable to remove, refer to optometry/ ophthalmology for removal under magnification

-Treat corneal abrasion if present: topical antibiotic (drop or ointment, cover for pseudomonas if organic material or contact lens), +/- artificial tears; most abrasions clear spontaneously within 24 hours

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29
Q

Why don’t we give everyone with a sore eye after an FB typical anesthetics to take home?

A

-Note: topical analgesics only for facilitating eye exam, NEVER for tx (risk of corneal melt or infection)

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30
Q

S&S of a corneal abrasion

A

Pain, redness, tearing, photophobia, FB sensation

De-epithelialized area stains with fluorescein dye

Pain relieved with topical anesthetic

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31
Q

Complications of a corneal abrasion

A

infection, ulceration, recurrent erosion, secondary iritis

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32
Q

Treatment of corneal abrasion

A

Topical antibiotic (drops or ointment) to prevent superinfection, abrasion from organic material should be covered against Pseudomonas

Pain relief:

Consider topical NSAIDs (caution due to risk of corneal melt with prolonged use). Can also give oral NSAIDs for mild to moderate pain.

Cycloplegic (relieves pain and photophobia by paralyzing ciliary muscle) - only in case of large abrasions (>50% of cornea) according to UptoDate

Pressure patch not recommended for small abrasions or contact wearers d/t infection risk & delayed healing (may help decrease pain in large abrasions)

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33
Q

How quickly does a corneal abrasion usually heal

A

Small abrasions will heal overnigtht. Most abrasions clear spontaneously within 24-48 h – just need to not rub it!

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34
Q

What STI can cause bacterial conjunctivitis?

A

Gonorrhea, chlamydia

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35
Q

S&S of bacterial conjunctivitis

A

Conjunctiva erythematous (unilateral or bilateral - usually starts in 1 eye and can spread to other)

Burning, gritty sensation or foreign body sensation in eyes

Thick, purulent discharge with crusting

Chemosis (swelling of conjunctiva) if severe

Visual acuity normal

Pre-auricular nodes palpable in Neisseria gonorrhea, Chlamydia, and MRSA

  • Complicating bacterial infections, such as otitis media, may be evident. Assess if anyone around them has similar symptoms
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36
Q

Describe the typical onset of viral conjunctivitis. Unilat or bilat?

A

Acute onset of conjunctival injection commonly preceded by a viral upper respiratory tract infection

May begin unilateral, but often bilateral within 24-48 hours.

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37
Q

S&S of viral conjunctivitis

A

Mucoid or water discharge

Red eyes

Chemosis & eyelid edema if severe

Pre-auricular lymphadenopathy

Possibly painful, or mild itching

Systemic symptoms may be present (e.g., sneezing, runny nose, sore throat, preauricular lymphadenopathy)

Recent contact with others with similar symptoms

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38
Q

What virus needs to be ruled out as cause of viral conjunctivitis? What is seen on evaluation for this

A

Herpes (herpes simplex keratitis) - can cause blindness

Dendritic keratitis on fluorescein staining with herpes simplex virus

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39
Q

What history do you expect to collect from someone with allergic conjunctivitis?

A

Seasonal, known, or environmental allergies, allergic rhinitis

Eczema, asthma, urticaria

Bilateral watery, red, itchy eyes, without purulent drainage

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40
Q

S&S of allergic conjunctivitis

A

Ropey discharge
Very itchy eyes!
Bilateral
Chemosis and lid edema (see cobble-stoning)
Grittiness or stabbing pain

Often worse in AM

Rhinorrhea or other resp symptoms from allergies

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41
Q

would you expect visual acuity to change in conjunctivitis?

A

Generally no (although one of my sources says you might have blurry vision in viral conjunctivitis)

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42
Q

T/F you give antivirals for viral conjunctivitis? How to treat?

A

No! Except herpes keratitis.

  • Cold compresses
  • Artificial tears
  • decongestants
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43
Q

Patient education re: conjunctivitis

A
  1. Cool compresses to the affected eye should be applied
    several times a day.
  2. Clean eyes with warm, moist cloth from inner to outer
    canthus to prevent spreading infection.
  3. Encourage good handwashing technique with
    antibacterial soap
  4. Throw away makeup
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44
Q

How long are bacterial and viral conjunctivitis contagious?

A

Bacterial conjunctivitis is contagious until 24 hours
after beginning medication.

Viral conjunctivitis is contagious for 48 to 72 hours,
but it may last up to two weeks. This is typically self-limiting

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45
Q

What is periorbital cellulitis? What causes it?

A

Infection of the anterior portion of the eyelid, not involving the orbit or other ocular structures

Usually follows periorbital trauma or dermal infection

Suspect H. influenzae in children, s.aureus in adults

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46
Q

Risk factors for periorbital celluliti

A

Sinusitis

Local trauma, insect bites, foreign bodies

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47
Q

Presentation in periorbital cellulitis

A

Unilateral ocular pain, eyelid swelling, erythema

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48
Q

How do you diagnose periorbital cellulitis?

A

Clinical diagnosis made in patient with unilateral eyelid swelling once orbital cellulitis has been ruled out

Cultures are low yield, not usually indicated

CT indicated to rule out orbital cellulitis if unclear. Also indicated with marked eyelid swelling, fever, leukocytosis, or failure of infection to improve after 1-2 days appropriate abx

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49
Q

What is ORBITAL cellulitis?

A

an ocular and medical emergency - can result in loss of vision and even life

infection involving the contents of the orbit (fat and ocular muscles, not the globe)

50
Q

Tx of periorbital cellulitis

A

Systemic antibiotics

If severe or child < 1 year, treat as orbital cellulitis

Hospitalization recommended for children < 1, severely ill patients, findings suggesting orbit involvement

51
Q

Risk factors for uveitis

A

LA-B27 (Reactive arthritis, ankylosing spondylitis, psoriatic arthritis, IBD (Crohn’s or UC), infection (syphilis, Lyme, toxoplasmosis, TB, HSV, HZV), sarcoidosis, trauma, large abrasion, post ocular surgery, autoimmune, malignancy (i.e., malignant melanoma, lymphoma).

52
Q

Time course of uveitis

A

-recurrent attacks common

-hours to days

-can be insidious (i.e., in juvenile arthritis)

53
Q

Patho of uveitis

A

-inflammation of uvea (middle layer of eye between sclera/ retina; vascular and pigmented); can involve one or all parts (iris, ciliary body, chroroid). Technically classified as anterior uveitis, posterior uveitis, and panuveitis.

-Idiopathic, autoimmune, infectious, granulomatous, malignant cause

54
Q

What would you expect to see on a PERRLA exam for a patient with uveitis?

A

unequal pupils - pupil is smaller/ constricted than that of the other eye because of spasm of the circular muscle of the iris

55
Q

Is uveitis usually unilateral or bilateral?

A

usually unilateral (can be bilateral in systemic disease)
…in which case both pupils would be constricted

56
Q

Signs and symptoms of uveitis

A
  • pupil constriction

-dull ache/ pain

-photophobia (irritative spasm of pupillary sphincter)

-blurred vision with decreased visual acuity

-black spots, floaters

-eye redness, ciliary flush (erythema around border of cornea)/ limbal flush (limbus is junction between cornea and sclera

-halos in lights

-pus in anterior chamber (hypopyon)

57
Q

Tx of uveitis?

A

-treat underlying cause

-urgent referral to ophthalmology

-recurrent attacks common, and need immediate attention

58
Q

Complications of uveitis

A

Cataracts, glaucoma, blindness

59
Q

What are the 3 types of hearing loss?

A

Conductive
Sensorineural
Mixed

60
Q

Conductive Hearing Loss (CHL) =

A

conduction of sound to the cochlea (the inner ear) is impaired

Can be caused by external and middle ear disease

61
Q

Sensorineural Hearing Loss (SNHL)=

A

defect in the conversion of sound into neural signals or in the transmission of those signals to the cortex

Can be caused by disease of the inner ear (cochlea), acoustic nerve (CN VIII), brainstem, or cortex

62
Q

Mixed Hearing Loss (MHL) =

A

combination of CHL and SNHL

63
Q

What medications are known to cause hearing loss?

A

Aminoglycosides
Macrolides
Glycopeptides
Antineoplastic drugs
NSAIDS
Antimalarials
Loop diuretics

64
Q

During the weber test in a patient with sensorineural hearing loss, will the normal ear (unaffected ear) hear it louder or quieter?

A

Louder in the normal ear

65
Q

During the weber test in a patient with conductive hearing loss, will the normal ear (unaffected ear) hear it louder or quieter?

A

Quieter in the normal ear

Louder in the affected ear (because conducting well through the occlusion or whatever is there

66
Q

Cardinal signs of cerumen impaction (ceruminosis)

A

Tinnitus
Ear fullness
Hearing loss
Vertigo
Cough
Discharge
Odour
Hearing aid feedback or malfunction
Itching

67
Q

Management of ceruminosis with irrigation

A
  • soften with slightly warmed mineral oil or olive oil for several days before attempting irrigation (unless bothersome vertigo or pain)
  • administer warm water or saline for 10-15 minutes before syringing

Irrigation: inject lukewarm water upwards within ear canal with ear syringe until cerumen cleared.

  • examine TM to make sure you didn’t bust it!
68
Q

Potential complications of irrigating cerumen?

A
  • Vertigo
  • Otitis externa
  • TM perforation
  • nystamus and vertigo
69
Q

What can be used as prevention for recurrent cerumen impaction

A

70% isopropyl alcohol or hydrogen peroxide drops

70
Q

What is otitis externa? What is it caused by?

A

Inflammation of EAC or auricle

Bacterial (90%): pseudomonas aeruginosa, pseudomonas vulgaris, e.coli, Staph. aureus

Fungal: Candida albicans, aspergillus niger

More common in summer

71
Q

Risk factors for otitis externa

A

Anatomic abnormalities: canal stenosis, exostoses, hairy ear canal

Canal obstruction: cerumen, foreign body, cyst

Epithelial integrity: cerumen removal, earplugs, hearing aids, instrumentation/itching

Derm: eczema, psoriasis, seborrhea

Water in ear canal: swimming, other prolonged water exposures

72
Q

Presentation of otitis externa (acute vs chronic)

A

Acute: otalgia, itching, fullness, +/- HL, +/- ear canal pain with chewing, tenderness aggravated by traction of pinna or pressure over tragus, ear canal edema, erythema, +/-otorrhea, +/- regional lymphadenitis, +/- cellulitis of pinna

Chronic: pruritis of external ear +/- excoriations of ear canal, atophic and scaly epidermal lining +/- otorrhea, +/- HL, wide meatus but no pain with movement of auricle, TM appears normal

73
Q

Dx of otitis externa

A

If history indicates fungal infection, could examine ear canal scrapings under microscope for hyphae

Culture vesicular lesions for viruses (herpes zoster)

74
Q

Tx of otitis externa

A

Microdebridement - must clear occlusion (if present) to ensure can instill drops properly

Early, mild swimmer’s ear can sometimes be managed with 50% isopropyl alcohol and 50% vinegar as a drying agent

Mild infection can be treated with an acidifying agent such as aluminum acetate (otic solution)

Moderate infection: acidifying agent, topical antimicrobials, +/- topical steroids

Keep EAC dry (keep water out of ear for 4-6 weeks)

Oral antibiotics if infection has spread beyond ear canal

+/- analgesia

Chronic OE: treat the underlying cause (ex. Derm conditions)

75
Q

What antibiotics are used to treat otitis externa?

A

As per MUMS
OTC Polysporin (eye and ear drops)
Rx: Ciprodex otic suspension or Sofracort otic solution

76
Q

What age gets otitis media most often

A

Most common 6mo to 24mo
; declines after 5.
Less common in adults

77
Q

Risk factors for otitis media?

Is breastfeeding protective or a risk factor? How does bottle feeding contribute?

A

Dysfunction/obstruction of the eustacian tube: URTI, allergic rhinitis, chronic rhinosinusitis, adenoid hypertrophy,
barotrauma

decreased immunity, genetic, mucins, anatomic abnormalities of palate, ciliary dysfunction, cochlear implants, vit A deficiency, allergies,

  • Hx of otitis media in last month or recurrent episodes
  • Age <12 mo
  • Pacifier use
  • prolonged bottle feeding, bottle feeding laying down
  • lack of breastfeeding
  • passive smoke exposure & air pollution
  • daycare attendance
  • low SES
  • fam hx
78
Q

What are the usual culprits that cause otitis media? Usually bacterial or viral?

A

-Usually caused by bacterial pathogens (95%); 5% caused by viral

S. pneumoniae
H. infuenzae
M. catarrhalis

79
Q

What is acute OM?

A

Infection of the middle ear= ossicles (malleus, incus, stapes)

80
Q

Patho of AOM

A

Usually begins as inflammatory process following viral URTI involving nose/ nasopharynx/ eustachian tube and middle ear mucosa.

Edema caused by inflammatory process obstructs middle ear, leading to decrease in ventilation.

This leads to increased negative pressure from ear which acts as irritant, increasing exudate from middle ear, build of up mucosal secretions, allowing for bacterial/ viral colonization. They grow and can result in purulence

81
Q

What symptoms form the triad of AOM?

A

Olagia
Fever (especially in younger children…2/3 present with low grade fever)
Conductive hearing loss

82
Q

Other signs and symptoms of AOM?

A
  • Possible yellow green discharge (otorrhea) with TM perforation
    -Red bulging TM
    -Associated fever, sore through, cough, URTI
    -Peds: pulling or tugging on ears, irritability, HA, restless sleep, poor feeding, anorexia, vomiting, diarrhea. 2/3 present with low grade fever

Rare: tinnitus, vertigo, facial nerve paralysis

83
Q

When do we treat with abx in acute otitis media?

A

if <6 mo or moderate-severe illness
(fever >39, bilateral AOM, bulging TM, systemic features, vomiting, or severe local signs (perforation with purulent discharge)

signs of a perforated TM should always be treated with antimicrobial therapy (most commonly topical
Ciprodex) and examined for complications

84
Q

First line abx in AOm?

A

High dose Amoxicillin BID x 5 days (10d if <2 years, perforated TM, or recurrent AOM)

85
Q

Are most people with AOM treated with abx? What is the standard treatment approach?

A

Watchful waiting for 48- 72 hours (if previously healthy)

  • High spontaneous recovery rate (80-90%)
  • Does not affect incidence of severe complications (mastoiditis, meningitis)
  • Provide conditional prescription (start if symptoms do not improve after 2-3 days)
  • Need to be sure patient/ parent is reliable for follow up.
  • Can give acetaminophen/ ibuprofen to treat earache
  • Seek immediate reassessment if symptoms worse or new symptoms appear (rash, drowsy, vomiting, difficulty breathing)
86
Q

Prophylactic measures that can be taken to prevent AOM in kids?

A
  • Breast feed at least 6 months if possible
  • Avoid supine bottle feeds
  • Reduce and eliminate pacifier use in second 6 months
  • Eliminate second hand smoke
  • Vaccinations (pneumococcal & flu)
87
Q

What is sinusitis?

A
  • acute or chronic infammation of the sinuses, ofen also involving the nasal cavities
    (rhinosinusitis)
88
Q

Etiology of sinusitis
- is it usually bacterial or viral?

A
  • viral more common
  • viral: rhinovirus, infuenza, parainfuenza
  • bacterial: S. pneumoniae, H. infuenzae, M. catarrhalis

Other non infectious causes of rhinosinusitis:

  • allergy
  • Mechanical: septal deviation, turbinate hypertrophy, polyps, tumors, adenoid hypertrophy, foreign body, congenital (eg cleft palate)
  • Immune: GPA, lymphonma, leukemia, immunosuppressed (HIV, DM)
  • Systemic: CF, immotile cilia
  • Direct extension: dental infection, facial fractures
89
Q

Patho of rhinosinusitis

A

Ostial obstruction or dysfunctional cilia permit stagnant mucous and, consequently, infection

90
Q

Sinusitis lasting > _____days means a high likelihood of bacterial infection

A

7 days

For bacterial, will see persistent symptoms or worsening symptoms >5 d or presence of purulence for 3-4 d with high fever (>39°C)

91
Q

What are the criteria for diagnosing acute bacteria rhinosinusitis (ABRS)?
Think PODS!

(there’s a great flowsheet in Toronto notes that I’ve put into our shared notes)

A

For diagnosis of ABRS, patient must have
1. nasal obstruction or nasal purulence/discoloured postnasal
discharge and

  1. at least one other PODS symptom
    P Facial Pain/pressure/fullness
    O Nasal Obstruction
    D Nasal purulence/discoloured postnasal Discharge
    S Hyposmia/anosmia (Smell)

**In other words, need either O or D and at least 2 major symptoms overall (P, O, D, or S)

92
Q

If it has lasted less than 7 days, we assume the sinusitis is caused by what?

A

Virus (usually peaks by day 3 and resolves by day 5-7 days)

Then if symptoms worsen, persist, or change, consider bacterial cause (and follow acute bacterial algorithm)

93
Q

What sinuses are most often affected in sinusitis?

A

Maxillary

94
Q

Easy assessment technique we can do to detect sinusitis?

A

Have bend over - if increased pain/pressure, is sinusitis

95
Q

In acute rhinosinusitis, what will you see when you peek in someone’s nose?

A

erythematous mucosa, mucopurulent discharge, pus originating from the middle meatus

96
Q

Treatment of sinusitis?

A

for symptom relief: oral analgesics (acetaminophen, NSAIDs), nasal saline rinse, short-term use of
topical/ or oral decongestants

  • mild to moderate acute bacterial sinusitis: intranasal corticosteroids

severe acute bacterial sinusitis: antibiotics and intranasal corticosteroids

frst-line antibiotic is amoxicillin, and second line is amoxicillin-clavulanic acid or a
fuoroquinolone

97
Q

ENT referral necessary for sinusitis in what circumstances?

When is urgent referral needed?

A

anatomic defect (e.g. deviated septum, polyp, adenoid hypertrophy), failure of
second-line therapy, or ≥4 episodes/yr

Urgent referral for red flags: systemic toxicity, altered mental status, severe headache, swelling of the orbit or changes to visual acuity

98
Q

What are some non-infectious causes of pharyngitis?

A

Allergic rhinitis
Sinusitis with post nasal drip
Mouth breathing
Trauma
GERD

99
Q

Infectious causes of pharyngitis?

A

viral: adenovirus, rhinovirus, infuenza virus, RSV, EBV, coxsackie virus, herpes simplex virus, CMV,
HIV

  • bacterial: Group A β-Hemolytic Streptococcus, Neisseria gonorrhoeae, Chlamydia pneumoniae, Mycoplasma
    pneumoniae, Corynebacterium diphtheriae, Fusobacterium necrophorum
100
Q

What are some red flags for a patient with a sore throat?

A
  • Persistence of symptoms longer than 1
    wk without improvement
  • Respiratory difficulty (particularly
    stridor, croup, etc.)
  • Difficulty in handling secretions
    (peritonsillar abscess)
  • Difficulty in swallowing (Ludwig’s
    angina)
  • Severe pain in the absence of
    erythema (supraglottitis/epiglottitis)
  • Palpable mass (neoplasm)
  • Blood in the pharynx or ear (trauma)
101
Q

What is pharyngitis?

A

infammation of the oropharynx

102
Q

How common is viral vs bacterial causes of pharyngitis in adults vs kids

A

Adults - ~90% viral, 5-15% of cases caused by GABHS

Kids
- up to 50% GABHS
◆ most prevalent between 5-17 y/o

103
Q

In bacterial causes of sore throat, do you expect a cough?

A

No - absence of cough is evidence for bacterial cause (+1 on centor)

104
Q

What other signs and symptoms give a +1 score on the modified centor criteria (indicating more likely is bacterial)

A
  • absent cough
  • history fever >38
  • tonsillar exudate
  • swollen anterior lymph nodes
  • age 5-14 yrs
105
Q

You can a score of -1, 0, 1 on the centor criteria. What do you do?

A

No further testing or abx

106
Q

You can a centor score of 2 or 3. What do you do?

A

Perform culture of rapid test. Treat only if test is POS.

107
Q

Centor score 4 or more, what do you do?

A

Start abx if patient situation warrants (high fever or clinically unwell)

If culture or rapid strep test performed and negative, discontinue abx.

108
Q

How does indication for taking throat culture differ in children from adults?

A

For suspected Strep throat in children, if they have a negative Rapid Strep Test, guideline still recommends a throat culture to confirm as children are at a higher risk of developing rheumatic fever

A negative antigen test for strep A is enough in adults (test is much more specific and sensitive for adults than children)

109
Q

Treatment with abx may be indicated for treatement of pharyngitis regardless of centor score in what circumstances?

A
  • household contact with strep infection
  • community endemic
  • client hx of rheumatic fever, valvular heart disease, or immunosuppression
  • population in which rheumatic fever remains a problem

(I assume we still take culture for each of these situations and they would need to be presenting with symptoms)

110
Q

Primary purpose of treatment of strep infection is?

A

To prevent acute rhematic fever

111
Q

How long is abx treatment for strep infection?

A

10 days

112
Q

First line tx for strep A infection in adults?

A

Penecillin V or amoxicillin

113
Q

T/F Lots of people carry group A strep asymptomatically. Do you care about this?

A

Yes 20% of population.

Only need to be identified and treated if there is family hx of rhematic fever, outbreak of rheumatic fever, outbreak of pharyngitis in closed community, or repeat trasmission within families

114
Q

You patient presents with a sore throat. They are also having a very hard time swallowing, are drooling and speak with a “hot potato” voice. What are you thinking?

A

Consider epiglottitis, peritonsillar abscess, retropharyngeal abscess until proven otherwise
- may also present with stridor

115
Q

Topical decongestants should not be used for > ____ days to avoid _______

A

3-4 days
Rebound congestion

116
Q

If you prescribe amoxicillin to a person who has mono, what happens?

A

Develop rash

117
Q

Prolonged oral decongestant use can cause what?

A

Elevated BP

118
Q

T/F Mild erythema around the TM is always a sign of infection

A

No - Mild erythema around the tympanic membrane without ear pain, bulge & pus— can be caused by many reasons—crying, URI, fever, irritation etc.

If there is ear pain with a red, bulging TM and pus behind it, most likely it is an infection

119
Q

Your patient is confirmed to have strep throat but they are allergic to penicillins. What do you do?

A
  • need to assess severity of allergy
  • If not severe, can give any cephalosporins
  • If severe, avoid 1st gen cephalosporins (cefazolin, cephalexin, cefadroxil, and ceforozil) but can give 2nd or 3rd gen cephalosporins
120
Q

How long are bacterial/viral conjunctivitis contagious? How long to advise to restrict contact after treatment initiated?

A

High contagious for 48-72 hours

Restrict contact for 24-28 hours after treatment initiated

121
Q
A

NUNP543 (11 decks)

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