amoxicillin vs augmentin vs cephalosporin 2 yo: 5-7 days

ENOT/ opth (Alice) (15%) Flashcards by Seth Northway

AOM is mc caused by

1. strep pneumo
2. h. flu
3. m. cat

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classification of AOM

acute: < 3 weeks
chronic: > 3 mos
recurrent: 3 episodes x 6 mos OR 4 w.o clearing in between
chronic: > 3 mos of serous fluid in middle ear w.o s/sxof infxn

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do you use abx for chronic AOM

no!

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2 key findings of AOM

bulging of TM
limited mobility of the TM

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1st line tx for AOM

amoxicillin
vs
augmentin
vs
cephalosporin

< 2 yo: 10 days
> 2 yo: 5-7 days

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tx for AOM if pcn allergy

macrolide

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2 complications of AOM

mastoiditis
bullous myringitis

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mcc of acute pharyngotonsillitis

adenovirus

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EBV triad

fever
sore throat
LAD

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recent sexual encounter + non resolving pharyngitis

gonorrhea pharyngitis

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consider _ pharyngitis in pt’s using ICS

fungal

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centor criteria

absence of cough
exudates
fever > 100.4
cervical LAD

2-3 = rapid strep
4 = empiric tx

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what 3 sx are NOT suggestive of strep pharyngitis

coryza
cough
hoarseness

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gs dx for strep pharyngitis

throat culture

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gs tx for strep pharyngitis

pcn

pcn allergy: azithromycin

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2 complications of strep pharyngitis

rheumatic fever
psgn

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for EBV, how long do pt’s need to avoid contact sports

3 weeks from symptom onset
strenuous sports: 4 weeks

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tx for gonorrhea pharyngitis

IM ceftriaxone
PLUS
azithromycin

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what is this showing

edematous, bluish nasal mucosa ->
allergic rihinitis

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what are these showing

transverse nasal crease
allergic shiners

allergic rhinitis

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allergic rhinitis is _ mediated mast cell _ release

IgE
histamine

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what is rhinitis medicamentosa

rebound congestion from using intranasal decongestants > 3-5 days

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mc cause of viral and bacterial conjunctivitis

viral: adenovirus
bacterial: s.aureus, strep pneumo

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what pathogens do you think of when you see copious, purulent conjunctival discharge not responsive to conventional tx

m cat
gonococcal

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-giemsa stain -inclusion body -scant mucopurulent conjunctival discharge

chlamydia (newborn) conjunctivitis

tx for bacterial conjunctivitis

in order: 1. gentamicin/tobramycin (tobrex) 2. erythromycin (e-mycin) 3. trimethoprim and polymixin b (polytrim) 4. cipro (clioxan)

pathogen and tx for conjunctivitis in contact lens wearer

pseudomonas fluoroquinolone drops (ciloxan)

tx for neisseria conjunctivitis

referral topical + systemic abx

tx for chlamydia conjunctivitis

-systemic tetracycline vs erythromycin x 3 weeks PLUS abx drops -asses for STI/child abuse

tx for viral conjunctivitis

eye lavage w. NS x 7-14 days antihistamine drops warm/cool compress

tx for allergic conjunctivitis

**systemic vs topical antihistamines or mast cell stabilizers:** **azelastine (optivar)** epinastine (elestat) emedastine difumarate (emadine) levocabastine (livostin)

stridor, restless, cough, dyspnea, fever, dysphagia, drooling, tripod/sniffing dog posture, neck extended

epiglottitis

3 d's of epiglottitis

dysphagia drooling distress - respiratory

mcc of epiglottitis

Hib

what is this showing

thumbprint sign -> **epiglottitis**

abx for epiglottitis

ceftriaxone

mc site for anterior nosebleed

kesselbach's plexus (little's area)

kesselbach's plexus includes (4)

anterior ethmoid a superior laial a sphenopalatine a greater palatine a

mc location for posterior nosebleeds

woodruff's plexus

woodruff's plexus includes _ artery

sphenopalatine a

most nosebleeds are anterior and respond to

**1. direct pressure x 10-15 min seated/leaning forward** 2. decongestants: afrin, phenylephrine, cocaine? 3. petroleum jelly or abx ointment inside the nostril bid x 4-5 days

all pt's who get nasal packing for epistaxis must be treated with _ to prevent _

cephalosporin toxic shock syndrome

t/f: pt w. anterior nasal packing for epistaxis must return to the clinic to have it removed

management of pt who needs posterior balloon packing for epistaxis

consult admit

you must rule out what 2 conditions in a pt w. recurrent epistaxis

htn hypercoagulable d.o

classifications of hearing loss

conductive sensorineural mixed

for the weber test, sound lateralizes to the affected ear in _ hearing loss and to the unaffected ear in _ hearing loss

affected: conductive unaffected: sensorineural

for the rinne test: BC > AC = AC > BC =

BC > AC: conductive AC > BC: sensorineural

mcc of conductive hearling loss

otitis media

trick to remember weber and rinne results

we**b**er: hear in **b**ad ear rinne: BC > AC (think rhino = bone)

mcc of sensorineural hearing loss

presbycusis

gradual, symmetric hearing loss associated w. aging

prebycusis

moi for presbycusis

degeneration of sensory cells and nerve fibers at the base of the cochlea

8 causes of sensorineural hearing loss

**presbycusis** noise infxn drugs congenital meniere CNS lesions

8 causes of conductive hearing loss

**cerumen impaction** **otitis media** otitis externa exotoses TM perforation otosclcerosis neoplasms

what are exotoses

bony outgrowths of external auditory canal caused by exposure to cold water - "surfers ear"

what is this showing

anterior/inferior displacement of the auricle -> **mastoiditis**

mastoiditis is a complication of

acute otitis media

5 pathogens associated w. mastoiditis

strep pneumo h.flu m.cat s. aureus s.pyogenes

dx for mastoiditis

CT w. contrast

tx for mastoiditis

ceftriaxone

10 month old boy w. friable white plaques on the tongue that bleed when scraped

oral thrush

what is this showing

oral thrush

oral thrush is caused by what fungus

candida albicans

white plaques that bleed when scraped

oral thrush

dx and tx for oral thrush

dx: KOH smear -> budding yeast and pseudohyphae tx: nystatin vs oral fluconazole

what is this showing

orbital cellulitis

proptosis, pain w. eye movements, inability to adduct or abduct the eye

orbital cellulitis

periorbital cellulitis is infxn of the _ orbital cellulitis is infxn of the _

periorbital: skin orbital: muscles and fat behind the eye

orbital cellulitis can be a complication of

sinusitis

_ is a rare symptom of orbital cellulitis

decreased vision

PE exam of suspected orbital cellulitis should focus on

assessment of extraocular movements

tx for orbital cellulitis

admit vancomycin

what is this showing

otitis externa - swimmers ear

what 2 actions increase pain w. otitis externa

movement of the tragus eating

what discharge is associataed w. otitis externa

cheesy white

rinne testing suggestive of otitis externa

BC > AC

pathogens associated w. otitis externa: simmer's ear vs digital trauma

swimmers: pseudomonas digital trauma: s.aureus

what pt pop does malignant otitis externa make you think of

diabetics

tx for otitis externa

abx drops: aminoglycosides vs fluoroquinolones +/- steroids

tx for otitis externa if perforated TM

cipro drops PLUS dexamethasone drops

tx for malignant otitis externa

admit IV abx

what pathogen is associated w. malignant otitis externa

aspergillus

pruritis, weeping pain, hearing loss, swollen, moist appearance

fungal otitis externa: aspergillus vs candida

tx for fungal otitis externa

2% acetic drops clotrimazole drops oral itraconazole

fever hot potato voice trismus

peritonsillar abscess

what is this showing

peritonsillar abscess

peritonsillar abscess is mc caused by

strep pyogenes

tx for peritonsillar abscess (3)

aspiration I&D IV abx +/- tonsillectomy

abx for peritonsillar abscess (3)

amoxicillin augmentin clindamycin

strabismus is defined as

any form of ocular misalignment

what is this showing

out-turning of eye -> **exotropia**

what is this showing

in-turning of eye -> **esotropia**

PT test for strabismus

cover/uncover

indications for referral for strabismus

constant intermittent > 6 mo

what exercise is used in strabismus management

patch exercises

complication of strabismus if treated after age 2

amblyopia

2 causes of TM perf

AOM barotrauma/direct impact/explosion

management of TM perf

usually self resolve keep dry surgery if persists > 2 mo +/- abx drops

only abx ear drop that is not ototoxic

floxin