ENOT/OPHTHALMOLOGY (Seth's Additional info) (15%) Flashcards
What is the MC reason children receive ABX in the US?
AOM
More than 90% of all antibiotic use in the first 2 years of life is due to OM
what is the pathophys of AOM
Inflammatory fluid and pathogenic respiratory bacteria that reflux into the middle ear space do not drain properly
This process effectively leads to the formation of an abscess in the middle ear
Exposure to this environmental hazard is a RF for AOM
Second hand smoke exposure
The _______ is shorter and more horizontal in infants and small children, which is a RF for AOM
Eustachian tube
This common action in young kiddos increases the likelihood of AOM
Pacifier use
Why can Pacifier use lead to AOM?
sucking on a pacifier increases the reflux of nasopharyngeal secretions into the middle ear, i.e. during a common cold pathogens can enter the middle ear more easily through this route.
the use of a pacifier may induce changes in dental structure and thereby dysfunction of the Eustachian tube
What age involves immediate treatment of AOM?
< 6 months
6-24 months can observe, but will need traetment
For AOM, if you are over the age of ___ you have the option of initially observing if mild s/s
24 months
1st line treatment of AOM and 2nd line if that does not work
Amoxicillin
Augmentin if refractory
Treatment for AOM if non IgE mediated reaction vs IgE mediated reaction
for allergies
Cefdinir (non-IgE)
Macrolide/clinda/bactrim (IgE)
If you do not have systemic symptoms and you have ______, you can use drops (cipro/ofloxacin) for AOM
tympanostomy tubes
Two complications of AOM
Tympanosclerosis (white plaque on TM from chronic inflammation)
Cholesteatoma (a greasy-looking or pearly white mass seen in a retraction pocket,
Occasionally with perforation, a temporary conductive hearing loss may be present)
for cholesteatoma
- Most perforations heal within 2 weeks
- When fail to heal within 3-6 months, surgical repair is indicated
If OM lasts > ___ it is chronic
3 months
treatment of recurrent OM and MOA
Tympanostomy tubes
Allows for drainage and decreases OM episodes; creates an airway that ventilates the middle ear and prevents the accumulation of fluid behind middle ear
MCC of strep pharyngitis is group ___ strep
Group A
pathophys of allergic rhinitis
Complex inflammatory disease of the upper airways, mediated by Immunoglobulin E (IgE)
type 1 hypersensitivity reaction
very strong RF for alergic rhinitis
Asthma
In patients with asthma, allergic rhinitis prevalence is > 80%
T/F, as you enter middle adulthood, allergic rhinitis worsens
FALSE
Peak in childhood and adolescence before the 4th decade
diminishes gradually with aging
MC gender for allergic rhinitis
Male
Accentuated lines of the eyes seen in allergic rhinitis are called:
Dennie-Morgan lines
The Nasal mucosa of allergic rhinitis is pale, with a ___ hue and ___ d/t venous engorgement
The Nasal mucosa of allergic rhinitis is pale, with a bluish hue and boggy d/t venous engorgement
also see Cobblestoning and nasal polyps (think obstructive symptoms)
What is a positive pick test for allergic rhinitis (basically allergies in general)
wheal 5 mm or greater
NO ANTIHISTAMINES PRIOR TO TESTING for at least 5 days
What is a mild, intermittent allergic rhinitits?
< __ days/week
< ___ weeks
abscence of ___
<4 days/week
<4 weeks
does not greatly affect QOL
if different timing, then persistent
if affects QOL, then mod/severe
Most effective treatment for allergic rhinitis (suffix?) and when to treat
intranasal glucocorticoids (-asone)
if persistent or mod/severe
Down regulates inflammatory response - decreases swelling of nasal mucosa
Although not as effective, this class of meds is first line for mild/intermittent symptoms (suffix)
H1 antihistamines (not as sedating)
-adine
MC organisms for bacterial conjunctitivitis
S pneomo
H flu
M Cat
MCC of viral conjunctivitis
Adenovirus
watery d/charge and HIGHLY contagious
starts in one eye and spreads to the other
t/f both allergic conjuntivitis and allergic rhinitis are type 1 hypersensitvity reactions
TRUE
treat allergic conjunctivitis with -tidine
most common in Spring