EENT part 1 Flashcards
Organisms of bacterial conjunctivitis
H. influenzae
H. aegyptius
S. pneumoniae
N. gonorrhoeae
S/sx of bacterial conjunctivitis
Mucopurulent unilateral or bilateral d/c Nl vision Photophobia Conjunctival injection and edema (chemosis) Gritty sensation
Tx of bacterial conjunctivitis
Topical abx- polymycin B-trimethoprim or sulfacetamide 5% or erythromycin for chlamydial
Parenteral ceftriaxone for gonococcus
Organisms of viral conjunctivitis
Adenovirus
Echovirus
Coxsackievirus
S/sx of viral conjunctivitis
Mucoid/serous d/c Nl vision Photophobia Conjunctival injection and edema Gritty sensation May be hemorrhagic Unilateral
Tx of viral conjunctivitis
Self-limited
Organisms of neonatal conjunctivitis
C. trachomatis
Gonococcus
Chemical
S. aureus
S/sx of neonatal conjunctivitis
Palpebral conjunctival or papillae
Same as for bacterial infection
Tx of neonatal conjunctivitis
Ceftriaxone for gonococcus
PO erythromycin for C. trachomatis
Causes of allergic conjunctivitis
Seasonal pollens or allergen exposure
S/sx of allergic conjunctivitis
Itching
Incidence of bilat chemosis (edema) greater than that of erythema, tarsal papillae
Tx of allergic conjunctivitis
Antihistamines
Steroids
Cromolyn
Organisms of postseptal orbital cellulitis: paranasal sinusitis
H. influenzae
S. aureus
S. pneumoniae
Other streptococci
Organisms of postseptal orbital cellulitis: trauma
S. aureus
Organisms of postseptal orbital cellulitis: fungi
Aspergillus
Mucor if immunodeficient
S/sx of postseptal orbital cellulitis
Rhinorrhea Chemosis Vision loss Painful EOM Proptosis Ophthalmoplegia Fever Lid edema Leukocytosis
Tx of postseptal orbital cellulitis
Systemic abx
Drainage of orbital abscesses
Organisms of preseptal orbital cellulitis: trauma
S. aureus
Other streptococci
Organisms of preseptal orbital cellulitis: bacteremia
Pneumococcus
Streptococci
H. influenzae
S/sx of preseptal orbital cellulitis
Cutaneous erythema Warmth Nl vision Minimal involvement of orbit Fever Leukocytosis Toxic appearance
Tx of preseptal orbital cellulitis
Systemic abx
What is most strabismus caused by?
Refractive error
Muscle imbalance
RFs for infantile strabismus
FHx Genetic d/os Prenatal drug exposure Prematurity or low birth weight Congenital eye defects Cerebral palsy
Causes of acquired strabismus
Refractive error Tumors Head trauma Neurologic conditions Palsy of CNs III, IV, or VI Viral infections Acquired eye defects
Esotropia characteristics
Commonly infantile
Accommodative esotropia occurs between 2 and 4 yoa
Characteristics of exotropia
Most often intermittent and idiopathic
Characteristics of hypertropia
Can be paralytic, caused by 4th cranial nerve palsy, or less commonly, as a result of 3rd cranial nerve palsy
Occurs congenitally or after head trauma
Characteristics of hypotropia
Can be restrictive
Dx of strabismus
Corneal light reflex test
Cover test
Alternate uncover test
Tx of strabismus
Patching or atropine drops to attendant amblyopia
Contact lenses or eyeglasses for refractive error
Eye exercises for convergence insufficiency only
Surgical alignment of the eyes
Pathophys of acute otitis media
Bacteria gain access to the middle ear when the nl patency of the eustachian tube is blocked by upper airway infection or hypertrophied adenoids
MC bacterial pathogens of acute otitis media
S. pneumoniae
H. influenzae
M. catarrhalis
Peak incidence of acute otitis media
Between 6 and 15 mos of life
January and February
Major RFs of acute otitis media
Young age
Lack of breastfeeding
Passive exposure to tobacco exposure
Increased exposure to infectious agents (day care)
Definition of recurrent OM
The presence of six or more acute OM episodes in the 1st 6 yrs of life
Sx of acute otitis media in infants
Fever
Irritability
Poor feeding
Sx of acute otitis media in older children and adolescents
Fever
Otalgia
Otorrhea
Signs of a common cold
PE of acute otitis media
Bulging TM
Air fluid level
Visualization of purulent material
Poor or absent mobility to negative and positive pressure
Light reflex is lost
Middle ear structures are obscured and difficult to distinguish
Tx of acute otitis media: otherwise healthy with mild sx, unilateral OM, age 6-24 mos
Acetaminophen
Ibuprofen
Tx of acute OM: otherwise healthy with mild sx, bilat/unilaterial, age 2+ yrs
Acetaminophen
Ibuprofen
What are considered mild sx in acute OM?
Low-grade fever
Not screaming in pain
Not much bulging in the TM
When are abx indicated in children 6 mos and older with acute OM?
Moderate otalgia
Otalgia for >48 hrs
Temp of 102.2 (39) or greater
Bilat OM if younger than 2 yrs
Tx of acute otitis media with abx: no daycare attendance and no abx within 30 days
High-dose amoxicillin
Greater than or equal to 2 yo: 7 days
>2 yrs: 10 days
Tx of acute otitis media with abx: daycare attendance and/or abx within 30 days
Augmentin
10 days
Tx of acute otitis media with abx: failure of amoxicillin
Augmentin
10 days
Tx of acute otitis media with abx: beta lactam allergy non-anaphylactic
Cefuroxime
Greater than or equal to 2 yo: 7 days
>2 yo: 10 days
Tx of acute otitis media with abx: beta lactam allergy anaphylactic or cephalosporin allergy
Clarithromycin
10 days
Tx of acute otitis media with abx: tympanostomy tubes
Ciprofloxacin 0.3%/dexamethasone 0.1% (Ciprodex)
Ofloxacin
