ENOT/ophthalmology Flashcards
what does the clinical diagnoses of AOM require?
1) bulging of the tympanic membrane or 2) other signs of acute inflammation (eg, marked erythema of the tympanic membrane, fever, ear pain) and middle ear effusion
MCC or otitis media?
S. pneumoniae 25%,
H. influenzae 20%,
M. catarrhalis 10%
what is the difference btw chronic and acute otitis media?
chronic: >3 mo, recurrent: 3 episodes in 6 mo or 4 in 12 with clearing between
Acute: < 3 weeks
first line Tx for AOM?
amoxicillin
If the pt has taken an amoxicillin in the past 30 days what med do you use for AOM?
augmentin
if the Pt is allergic to PCN what meds should you use for AOM?
- Azithromycin
- erythromycin
- bactrim
How long do you treat AOM if Pt is < 2years old? older than 2 years?
<2 years old 10 day
>2 years old 5-7 days
what are the complications of AOM?
Mastoiditis and bullous myringitis
a 7-year-old boy is brought to his pediatrician for evaluation of a sore throat. The sore throat began 4 days ago and has progressively worsened. Associated symptoms include subjective fever, pain with swallowing, and fatigue. The patient denies cough or rhinorrhea. Vital signs are as follows: T 101.4 F, HR 88, BP 115/67, RR 14, and SpO2 99%. Physical examination is significant for purulent tonsillar exudate; no cervical lymphadenopathy is noted.
What is the most likely diagnoses?
Acute pharyngotonsillitis
What is the most common cause of Acute pharyngotonsillitis?
adenovirus
If someone uses an inhaled steroids what type of infection in throat should you think about?
fungal
What is the CENTOR criteria?
- Absence of a cough
- exudates
- fever (> 100.4 F)
- cervical lymphadenopathy
Tx for Group A strep?
Penicillin is first line. azithromycin if penicillin-allergic.
What are two complications from group a strep?
Rheumatic fever and post-strep glomerulonephritis
Tx for fungal infection in the throat?
clotrimazole, miconazole, or nystatin
a 13-year-old boy with clear fluid discharge from his nose for 2 days duration. This has also been associated with sneezing. On nasal exam, the mucosa and turbinates appear edematous and slightly bluish, he has swollen dark circles under his eyes, and a transverse nasal crease.
What is the most likely cause?
allergic rhinitis
A common description of the mucosa in allergic rhinitis is?
bluish and boggy
a 6-year-old boy complaining of itchy eyes. The mother states that she has noted that he has been tearing and that both of his eyes have been red for the past 4 days. The patient denies any pain but has had a runny nose for the past week. The mother states that he has not had any sick contacts, and he has been home from school for summer vacation. On exam, there is marked redness, tearing, and eyelid edema of both eyes.
What is the most likely diagnoses?
conjunctivitis
What are the three kinds of conjunctivitis ?
- viral
- bacterial
- allergic
what is the MCC of viral conjunctivitis?
andenovirus- transmission via direct contact/swimming pools
how will bacterial conjunctivitis present?
will present with purulent (yellow) discharge from both eyes (“glued shut”), crusting, usually worse in the morning; May be unilateral
S. pneumonia, S. aureus conjuctivitis will present as?
acute mucopurulent
M. catarrhalis, Gonococcal conjunctivitis will present as?
copious purulent discharge, in a patient who is not responding to conventional treatment
chlamydia conjunctivitis will be in?
a newborn
Giemsa stain will have- inclusion body and the Pt will have scant mucopurulent discharge
What is the first line Tx for bacterial conjunctivitis?
Gentamicin/tobramycin (Tobrex): aminoglycoside antibiotic used for gram-negative bacterial coverage. Most cases of bacterial conjunctivitis will respond to this agent
If it is a newborn presenting with chlamydia conjunctivitis what would you use?
erythromycin ointment
for ocular infections involving the cornea or conjunctiva what combination of abx should be used?
Trimethoprim and polymyxin B
how should the abx Tx for conjunctivitis be applied?
the dose is 0.5 inch (1.25 cm) of ointment (preferable in children) deposited inside the lower lid or 1 to 2 drops instilled four times daily for five to seven days.
Tx for viral conjunctivitis ?
eye lavage with normal saline bid 7-14 days; antihistamine drops, warm to cool compresses
Tx for allergic conjunctivitis?
azelastine (Optivar)
a 3-year-old boy who is brought to the ER with a sudden onset of fever (104.0 F), respiratory distress, and stridor. On examination, the boy appears acutely ill. He is sitting, leaning forward with his mouth open, he has a muffled voice and is drooling. When asked the parents report “we don’t believe in vaccinations.”
What is the most likely diagnoses?
epiglottitis
MCC of epiglottitis
H. FLu
What are the 3 D’s of epiglottitis?
Dysphagia
Drooling
Respiratory distress
a 14-year-old who is brought to your Emergency Department (ED) with an intractable nosebleed. Pinching of the nose has failed to stop the bleed. In the ED a topical vasoconstrictor is tried but also fails to stop the bleeding.
Most likely Dx?
Epistaxis
What must you rule out for recurrent nose bleeds?
hypertension of hypercoagulable state
a 2 month-old infant presents for a routine health maintenance visit. The mother has been concerned about the infant’s hearing since birth. Physical examination reveals no apparent response to a sudden loud sound.
most likely Dx?
hearing impairment lol
Weber hearing results in conductive? Rhinne?
weber is heard in the bad ear
Rhinne is bone conduction greater than air
Weber and rhinne results with sensorineural hearing loss?
weber is heard in good ear
Rhinne air is > bone
a 10-year-old boy with otalgia, worsening over the last 5-days and associated with nasal congestion. The patient is afebrile with a temperature of 98 ° F. Examination reveals edema of the external auditory canal producing an anterior and inferior displacement of the auricle with percussion tenderness posteriorly.
Most likely Dx?
Mastoiditis
organisms for mastoiitis?
S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus, S. pyogenes
presenting symptoms of mastoiditis?
Fever, otalgia, pain, erythema posterior to ear and forward displacement of the external ear
If mastoiditis was complicated or toxic appearing what imaging study would you do?
CT scan temporal bone w/contrast
Tx for mastoiditis?
oral antibiotics or IV ceftriaxone
a 10-month-old boy with friable white plaques on the tongue that bleed when scraped.
most likely Dx?
oral candidiasis
an infection in which the fungus (candida albicans accumulates in the mouth is called what?
oral thrush
how do you Dx oral thrush?
KOH smear reveals budding yeast and pseudohyphae
how do you Tx oral thrush?
with nystatin, oral fluconazole
a 2-year-old who arrives at the ED with a swollen and erythematous eyelid, proptosis, pain with movement of the eye, and an inability to adduct or abduct his eye.
What is the most likely Dx?
orbital cellulitis
pt with orbital cellulitis will present with?
Decreased extraocular movement, pain with movement of the eye and proptosis, signs of infection
what is orbital cellulitis associated with?
sinusitis
what kind of imaging would you do to Dx orbital cellulitis?
CT scan of orbits (confirmatory)
Tx for orbital cellulitis?
Hospitalization and IV broad-spectrum antibiotics (vancomycin)
What IV antibiotics are used for peritonsillar abscess?
amoxicillin, amoxicillin-sulbactam, and clindamycin
a 3-year-old girl brought to you by her mother who is worried about her daughter’s “lazy eye.” She reports that her daughter’s symptoms are exaggerated when she has a cold. Past medical history is negative for trauma or headaches. The patient has an asymmetric corneal light reflex and the cover/uncover test reveals a right-sided esotropia. You refer the patient to a pediatric ophthalmologist.
What is the most likely diagnoses?
Strabismus
Define Strabismus?
Strabismus is defined as any form of ocular misalignment
a 4-year-old girl who is brought to the clinic by her mother who states that the child has been complaining of progressively worsening ear pain and itchiness over the past week. Examination reveals left tragal tenderness and an edematous and closed canal. Weber lateralizes to the left.
most likely Dx?
otitis externa
what type of ear infection is commonly seen in adults?
Malignant otitis externa
What makes malignant otitis media different than regular?
this form is necrotizing and pt needs to be hospitalized w/IV Abx
What type of abx are first line in otitis externa?
aminoglycosides or fluoroquinolones
If the TM is perforated in otitis externa what abx should you use?
Ciprofloxacin 0.3% and dexamethasone 0.1% suspension: 4 drops BID × 7 days
Can also use ofloxacin: 0.3% solution 10 drops once a day × 7 days
What are the two bacteria that cause fungal otitis media?
Aspergillus and candida albicans
What is the Tx for fungal otitis externa
2% acetic acid 3–4 drops QID; clotrimazole 1% solution
