EENT - MIDTERM content (plus a little extra) Flashcards
Palsy of what cranial nerve would cause decreased lacrimation, leading to dry eye?
CN VII
What kind of medications cause dry eye?
Anticholinergics, antihistamines, diuretics, b-blockers
Risk factors for dry eye
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
S&S of dry eye
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
When assessing dry eye, why might we palpate joints and check for butterfly rash?
Autoimmune issues
Butterfly rash is sign of SLE
Tx of dry eye
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
Ropey eye discharge is seen in what condition?
Allergic conjunctivitis
Purulent eye discharge is seen in what conditions (3)?
Bacterial conjunctivitis
Blepharitis
Hordeolum
What is blepharitis?
= common inflammation of the eye lid
Is blepharitis typically unilateral or bilateral?
Bilateral
S&S of belpharitis?
Red, swollen eyelids
transient blurred vision that improves with blinking
Itching
Tearing
Gritty, FB sensation
crusting of the eyelashes
conjunctival injection (common)
Causes of anterior vs posterior blepharitis
Anterior = Seborrheic or bacterial (S. Aureus)
Posterior = Meibomian Gland Dysfunction
Risk factors for blepharitis
Diabetes
Candida
Seborrheic Dermatitis
Rosacea
Patho of posterior blepharitis
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
Patho of anterior blepharitis
inflammation at the bases of the eyelashes
can be due to S. aureus or coagulase-negative staphylococci
Tx of blepharitis
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
What is a chalazion?
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)
Does a chalazion come on suddently?
NO - Gradual – develops over days to weeks. Typically improve over months.
Is a chalazion painful or painless?
Painless
What does a chalazion look like?
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
How is a hordeolum different than a chalazion?
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
Hordeolum presentation
Painful, red swelling of lid
Sudden onset purulent discharge
How do we diagnose a hordeolum?
Based on exam. Can culture discharge, but usually treated presumptively
Treatment of hordeolum
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
In what population is a hordeolum most common?
children/adolescents
S&S of FB in eye?
-Sensation of FB
-Red, painful eye
-Tearing, photophobia
-Epithelial defect that stains with fluorescein
Diagnosing a FB in eye - what do we need to check? When might referral be necessary?
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)
Tx of FB in eye
- “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
Why don’t we give everyone with a sore eye after an FB typical anesthetics to take home?
-Note: topical analgesics only for facilitating eye exam, NEVER for tx (risk of corneal melt or infection)
S&S of a corneal abrasion
Pain, redness, tearing, photophobia, FB sensation
De-epithelialized area stains with fluorescein dye
Pain relieved with topical anesthetic
Complications of a corneal abrasion
infection, ulceration, recurrent erosion, secondary iritis
Treatment of corneal abrasion
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)
How quickly does a corneal abrasion usually heal
Small abrasions will heal overnigtht. Most abrasions clear spontaneously within 24-48 h – just need to not rub it!
What STI can cause bacterial conjunctivitis?
Gonorrhea, chlamydia
S&S of bacterial conjunctivitis
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
Describe the typical onset of viral conjunctivitis. Unilat or bilat?
Acute onset of conjunctival injection commonly preceded by a viral upper respiratory tract infection
May begin unilateral, but often bilateral within 24-48 hours.
S&S of viral conjunctivitis
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
What virus needs to be ruled out as cause of viral conjunctivitis? What is seen on evaluation for this
Herpes (herpes simplex keratitis) - can cause blindness
Dendritic keratitis on fluorescein staining with herpes simplex virus
What history do you expect to collect from someone with allergic conjunctivitis?
Seasonal, known, or environmental allergies, allergic rhinitis
Eczema, asthma, urticaria
Bilateral watery, red, itchy eyes, without purulent drainage
S&S of allergic conjunctivitis
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
would you expect visual acuity to change in conjunctivitis?
Generally no (although one of my sources says you might have blurry vision in viral conjunctivitis)
T/F you give antivirals for viral conjunctivitis? How to treat?
No! Except herpes keratitis.
- Cold compresses
- Artificial tears
- decongestants
Patient education re: conjunctivitis
- Cool compresses to the affected eye should be applied
several times a day. - Clean eyes with warm, moist cloth from inner to outer
canthus to prevent spreading infection. - Encourage good handwashing technique with
antibacterial soap - Throw away makeup
How long are bacterial and viral conjunctivitis contagious?
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
What is periorbital cellulitis? What causes it?
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
Risk factors for periorbital celluliti
Sinusitis
Local trauma, insect bites, foreign bodies
Presentation in periorbital cellulitis
Unilateral ocular pain, eyelid swelling, erythema
How do you diagnose periorbital cellulitis?
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
What is ORBITAL cellulitis?
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)
Tx of periorbital cellulitis
Systemic antibiotics
If severe or child < 1 year, treat as orbital cellulitis
Hospitalization recommended for children < 1, severely ill patients, findings suggesting orbit involvement
Risk factors for uveitis
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).
Time course of uveitis
-recurrent attacks common
-hours to days
-can be insidious (i.e., in juvenile arthritis)
Patho of uveitis
-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
What would you expect to see on a PERRLA exam for a patient with uveitis?
unequal pupils - pupil is smaller/ constricted than that of the other eye because of spasm of the circular muscle of the iris
Is uveitis usually unilateral or bilateral?
usually unilateral (can be bilateral in systemic disease)
…in which case both pupils would be constricted
Signs and symptoms of uveitis
- 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)
Tx of uveitis?
-treat underlying cause
-urgent referral to ophthalmology
-recurrent attacks common, and need immediate attention
Complications of uveitis
Cataracts, glaucoma, blindness
What are the 3 types of hearing loss?
Conductive
Sensorineural
Mixed
Conductive Hearing Loss (CHL) =
conduction of sound to the cochlea (the inner ear) is impaired
Can be caused by external and middle ear disease
Sensorineural Hearing Loss (SNHL)=
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
Mixed Hearing Loss (MHL) =
combination of CHL and SNHL
What medications are known to cause hearing loss?
Aminoglycosides
Macrolides
Glycopeptides
Antineoplastic drugs
NSAIDS
Antimalarials
Loop diuretics
During the weber test in a patient with sensorineural hearing loss, will the normal ear (unaffected ear) hear it louder or quieter?
Louder in the normal ear
During the weber test in a patient with conductive hearing loss, will the normal ear (unaffected ear) hear it louder or quieter?
Quieter in the normal ear
Louder in the affected ear (because conducting well through the occlusion or whatever is there
Cardinal signs of cerumen impaction (ceruminosis)
Tinnitus
Ear fullness
Hearing loss
Vertigo
Cough
Discharge
Odour
Hearing aid feedback or malfunction
Itching
Management of ceruminosis with irrigation
- 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!
Potential complications of irrigating cerumen?
- Vertigo
- Otitis externa
- TM perforation
- nystamus and vertigo
What can be used as prevention for recurrent cerumen impaction
70% isopropyl alcohol or hydrogen peroxide drops
What is otitis externa? What is it caused by?
Inflammation of EAC or auricle
Bacterial (90%): pseudomonas aeruginosa, pseudomonas vulgaris, e.coli, Staph. aureus
Fungal: Candida albicans, aspergillus niger
More common in summer
Risk factors for otitis externa
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
Presentation of otitis externa (acute vs chronic)
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
Dx of otitis externa
If history indicates fungal infection, could examine ear canal scrapings under microscope for hyphae
Culture vesicular lesions for viruses (herpes zoster)
Tx of otitis externa
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)
What antibiotics are used to treat otitis externa?
As per MUMS
OTC Polysporin (eye and ear drops)
Rx: Ciprodex otic suspension or Sofracort otic solution
What age gets otitis media most often
Most common 6mo to 24mo
; declines after 5.
Less common in adults
Risk factors for otitis media?
Is breastfeeding protective or a risk factor? How does bottle feeding contribute?
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
What are the usual culprits that cause otitis media? Usually bacterial or viral?
-Usually caused by bacterial pathogens (95%); 5% caused by viral
S. pneumoniae
H. infuenzae
M. catarrhalis
What is acute OM?
Infection of the middle ear= ossicles (malleus, incus, stapes)
Patho of AOM
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
What symptoms form the triad of AOM?
Olagia
Fever (especially in younger children…2/3 present with low grade fever)
Conductive hearing loss
Other signs and symptoms of AOM?
- 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
When do we treat with abx in acute otitis media?
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
First line abx in AOm?
High dose Amoxicillin BID x 5 days (10d if <2 years, perforated TM, or recurrent AOM)
Are most people with AOM treated with abx? What is the standard treatment approach?
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)
Prophylactic measures that can be taken to prevent AOM in kids?
- 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)
What is sinusitis?
- acute or chronic infammation of the sinuses, ofen also involving the nasal cavities
(rhinosinusitis)
Etiology of sinusitis
- is it usually bacterial or viral?
- 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
Patho of rhinosinusitis
Ostial obstruction or dysfunctional cilia permit stagnant mucous and, consequently, infection
Sinusitis lasting > _____days means a high likelihood of bacterial infection
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)
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)
For diagnosis of ABRS, patient must have
1. nasal obstruction or nasal purulence/discoloured postnasal
discharge and
- 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)
If it has lasted less than 7 days, we assume the sinusitis is caused by what?
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)
What sinuses are most often affected in sinusitis?
Maxillary
Easy assessment technique we can do to detect sinusitis?
Have bend over - if increased pain/pressure, is sinusitis
In acute rhinosinusitis, what will you see when you peek in someone’s nose?
erythematous mucosa, mucopurulent discharge, pus originating from the middle meatus
Treatment of sinusitis?
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
ENT referral necessary for sinusitis in what circumstances?
When is urgent referral needed?
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
What are some non-infectious causes of pharyngitis?
Allergic rhinitis
Sinusitis with post nasal drip
Mouth breathing
Trauma
GERD
Infectious causes of pharyngitis?
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
What are some red flags for a patient with a sore throat?
- 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)
What is pharyngitis?
infammation of the oropharynx
How common is viral vs bacterial causes of pharyngitis in adults vs kids
Adults - ~90% viral, 5-15% of cases caused by GABHS
Kids
- up to 50% GABHS
◆ most prevalent between 5-17 y/o
In bacterial causes of sore throat, do you expect a cough?
No - absence of cough is evidence for bacterial cause (+1 on centor)
What other signs and symptoms give a +1 score on the modified centor criteria (indicating more likely is bacterial)
- absent cough
- history fever >38
- tonsillar exudate
- swollen anterior lymph nodes
- age 5-14 yrs
You can a score of -1, 0, 1 on the centor criteria. What do you do?
No further testing or abx
You can a centor score of 2 or 3. What do you do?
Perform culture of rapid test. Treat only if test is POS.
Centor score 4 or more, what do you do?
Start abx if patient situation warrants (high fever or clinically unwell)
If culture or rapid strep test performed and negative, discontinue abx.
How does indication for taking throat culture differ in children from adults?
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)
Treatment with abx may be indicated for treatement of pharyngitis regardless of centor score in what circumstances?
- 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)
Primary purpose of treatment of strep infection is?
To prevent acute rhematic fever
How long is abx treatment for strep infection?
10 days
First line tx for strep A infection in adults?
Penecillin V or amoxicillin
T/F Lots of people carry group A strep asymptomatically. Do you care about this?
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
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?
Consider epiglottitis, peritonsillar abscess, retropharyngeal abscess until proven otherwise
- may also present with stridor
Topical decongestants should not be used for > ____ days to avoid _______
3-4 days
Rebound congestion
If you prescribe amoxicillin to a person who has mono, what happens?
Develop rash
Prolonged oral decongestant use can cause what?
Elevated BP
T/F Mild erythema around the TM is always a sign of infection
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
Your patient is confirmed to have strep throat but they are allergic to penicillins. What do you do?
- 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
How long are bacterial/viral conjunctivitis contagious? How long to advise to restrict contact after treatment initiated?
High contagious for 48-72 hours
Restrict contact for 24-28 hours after treatment initiated
