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ID Review > Head and Neck Infections > Flashcards

Head and Neck Infections Flashcards

1
Q

What is ciliary flush

A

red ring around the iris

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2
Q

What is Hyphema

A

layering of red blood cells in the anterior chamber.

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3
Q

What is Iridocyclitis

A

inflammation of the anterior uveal tract including the ciliary body.

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4
Q

What is keratitis?

A

inflammation of the cornea, usually very painful

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5
Q

What is the uvea?

A

Includes the iris, ciliary body, and choroid. Very vascular.

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6
Q

What are the common viral causes of conjunctivitis? [6]

A 
Adenovirus
HSV
Rubella
Rubeola
Influenza
EBV
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7
Q

What is epidemic keratoconjunctivitis? What causes this?

A

More fulminant and involves the cornea. It is very contagious and due to adenovirus 8, 19, 37. Self limited

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8
Q

What are the common bacterial causes of conjunctivitis? [5]

A

Chlamydia, Neisseria, Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae.

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9
Q

Presentation of conjunctivitis?

A

Usually a watery, itchy, red eye. Typically is not painful, nor does it include significant vision loss. Gritty feeling or feeling of sand in eye

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10
Q

With conjunctivitis what does Preauricular lymphadenopathy indicate about the cause of the infection? [3]

A

Viral
Gonorrhea
Chlamydia

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11
Q

What is trachoma?

A

Starts as conjunctivitis and progresses to eyelid scarring resulting in the eyelid turning inward (entropion). The eyelashes turn inward (trichiasis) and ulceration of the cornea by abrasions can eventually lead to blindness.

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12
Q

What is Arlt’s line?

A

the horizontal line of conjunctival scarring found on the superior eyelid. In trachoma

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13
Q

Diagnosis of trachoma?

A

PCR

Clinical

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14
Q

Treatment of trachoma?

A

Surgery for trichiasis.
Antibiotics for active infection.
Facial cleanliness.
Environmental improvement.

Systemic erythromycin or tetracycline for 3–4 weeks and subsequent topical erythromycin or tetracycline for 6 months.

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15
Q

What is adult inclusion conjunctivitis?

A

Chronic follicular conjunctivitis.
Acquired sexually or via inoculation from contaminated secretions.
Due to D-K chlamydia serotypes

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16
Q

Presentation of adult inclusion conjunctivitis

A

red eye with purulent discharge, preauricular lymphadenopathy, and frequently has a urethritis/cervicitis present.

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17
Q

Treatment of adult inclusion conjunctivitis?

A

Treat underlying chlamydia infection

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18
Q

Presentation of gonorrhea conjunctivitis?

A

Marked purulent discharge, red eye, swollen eyelid, preauricular lymphadenopathy, and chemosis, rapidly progressive if untreated.

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19
Q

Treatment of gonorrhea conjunctivitis?

A

IM ceftriaxone if only conjunctivitis.

If cornea involved, longer treatment course of ceftriaxone.

Concomitant treatment for Chlamydia with azithro.

Requires frequent flushing of eye to remove inflammation and enzymes harmful to the eye.

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20
Q

Empiric treatment for bacterial conjunctivitis

A
  1. Topical trimethoprim/polymyxin B

2. bacitracin/polymyxin B.

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21
Q

Treatment of HSV conjunctivitis

A

Refer to ophthalmology.
If just conjunctivitis, usually no antiviral is necessary.
Need to rule out corneal involvement.

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22
Q

Risk factors for keratitis [cornea inflammation]

A
  1. Contact lens use (particularly overnight use or extended-wear lenses).
  2. Trauma: may be surgical or nonsurgical.
  3. Diabetes mellitus.
  4. Immunosuppression.
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23
Q

What organisms invade an intact cornea?

A

Neisseria, Listeria, and Corynebacterium

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24
Q

Presentation of keratitis?

A
  1. Exquisitely painful eye
  2. Decreased vision, tearing, and corneal edema.
  3. Foreign body sensation.
  4. +/- purulent discharge
  5. Bacterial keratitis frequently has a white infiltrate or “spot” on the cornea.
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25
Q

Work up of keratitis

A
  1. Fluorescein used to visualize ulcer or infiltrates.

2. Corneal scrapings and culture should be done with PCR as indicated for viral etiology.

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26
Q

Exam findings in HSV keratitis? [5]

A 
Dendritic lesions
Ciliary flush
Decreased sensation of the cornea.
May have vesicles on the eyelid.
Typically unilateral.
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27
Q

Diagnosis of HSV keratitis?

A

Clinical

PCR scrapings

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28
Q

Treatment of HSV keratitis [3]

A

Trifluridine, aciclovir, valaciclovir

–> Topical or PO

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29
Q

Presentation of VZV keratitis

A

Complete loss of sensation of cornea
Dendritic lesions as well
Hutchinson’s sign.

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30
Q

Mgmt of VZV keratitis

A

ophthalmic exam
Trifluridine, aciclovir, valaciclovir
–> Topical or PO

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31
Q

Bacteria a/w infection following LASIK? [2]

A
  1. Nocardia
  2. Mycobacterium
    - -> M. chelonae is most common of the atypical mycobacteria
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32
Q

Common causes of fungal keratitis? [3]

A

Fusarium [most common], Aspergillus, Candida.

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33
Q

Risk factors for fungal keratitis? [4]

A

Trauma
immunosuppression
contact lens use
topical steroid use in eye.

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34
Q

Treatment of fungal keratitis due to a mold? [3]

A

Combination of topical and systemic treatment.

Natamycin, voriconazole, or amphotericin for molds.

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35
Q

Treatment of fungal keratitis due to candida?

A

Azoles

Combination of topical and systemic treatment.

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36
Q

Risk factors for Acanthamoeba keratitis?

A

contact lens use (wearing for prolonged periods)
trauma
historically associated with the tablets used to make contact solution at home

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37
Q

Presentation of acanthamoeba keratitis?

A

Unilateral.
Red eye, pain, and photophobia.
Can have a dendritic lesion, so may be mistaken for HSV.
May have a ring lesion later in course

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38
Q

Diagnosis of Acanthamoeba keratitis?

A

Calcofluor white stains the trophozoite and the cyst.

plate the scraping on an E. coli lawn.

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39
Q

Treatment of Acanthamoeba keratitis?

A

Topical polyhexamethylene guanide or chlor-hexidine.
Plus topical propamidine isethionate or hexamidine.

May require keratoplasty

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40
Q

What is uveitis

A

Inflammation of the iris, ciliary body, choroid, or retina

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41
Q

What is anterior uveitis?

A

Inflammation of iris, ciliary body, or both called iritis, cyclitis, iridocyclitis respectively.

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42
Q

What is intermediate uveitis?

A

Inflammation of the viterous and retina

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43
Q

What is posterior uveitis?

A

Inflammation of the choroid, retina, or both.

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44
Q

Ocular findings in anterior uveitis?

A

WBCs in aqueous, keratic precipitates, iris nodules, synechiae

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45
Q

Ocular findings in intermediate uveitis?

A

WBCs or snowballs in the vitreous, pars plana snow bank

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46
Q

Ocular findings in posterior uveitis?

A

Lesions in choroid, retina, or both; vitritis in some

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47
Q

Ocular findings in panuveitis?

A

WBCs in aqueous and vitreous

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48
Q

Infectious etiology of anterior uveitis [5]

A 
Herpes simplex (10%)
Syphilis (<1%) 
TB (<1%)
Lyme disease (<1%)
Leprosy (<1%)
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49
Q

Infectious etiology of intermediate uveitis [1]

A

Lyme disease (<1%)

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50
Q

Infectious etiology of posterior uveitis [6]

A 
Toxoplasma (25%)
CMV (12%)
ARN (6%)
Toxocara (3%)
syphilis (2%)
Candida (<1%)
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51
Q

Infectious etiology of panuveitis [3]

A

Syphilis (6%)
TB (2%)
Candida(2%)

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52
Q

Presentation of anterior uveitis?

A

Presents as painful red eye with loss of vision.

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53
Q

Presentation of intermediate uveitis

A

Loss of vision with floaters
Typically painless
–> Usually NOT infectious

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54
Q

Presentation of posterior uveitis?

A

Usually painless loss of vision.

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55
Q

Presentation of HSV anterior uveitis?

A

usually a preceding keratitis
unilateral red, painful eye with impaired vision but absence of vesicles.
Decreased sensation of cornea

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56
Q

Treatment of HSV anterior uveitis?

A

Oral aciclovir, followed by oral suppression.

Topical steroids.

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57
Q

Presentation of VZV anterior uveitis?

A

Similar to HSV
No preceding keratitis
Cause of acute retinal necrosis and leading cause of progressive outer retinal necrosis

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58
Q

Diagnosis of HSV and VZV anterior uveitis?

A

PCR of aqueous humor

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59
Q

Treatment of VZV anterior uveitis?

A

Retinitis present: IV aciclovir followed by oral aciclovir or valaciclovir
Systemic steroids
May require vitrectomy or laser therapy.

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60
Q

Presentation of CMV on eye exam?

A

Retinitis with hemorrhages and flares of inflammation

61
Q

Diagnosis of CMV retinits?

A

clinical appearance but also with PCR of aqueous humor.

62
Q

Treatment of CMV retinitis? [3]

A

IV ganciclovir
Intravitreal antiviral.
Oral secondary suppression.

63
Q

What is acute retinal necrosis? [5]

A
  1. Well demarcated retinal necrosis on peripheral retina.
  2. Rapid progression of necrosis.
  3. Circumferential spread.
  4. Occlusive vasculopathy.
  5. Vitreal and aqueous inflammation.
64
Q

Etiology of acute retinal necrosis? [2]

65
Q

Presentation of acute retinal necrosis?

A

Occurs in immunocompetent patients.
Presents as anterior uveitis that progresses to necrosis.
Very high risk for retinal detachment and blindness.

66
Q

Treatment of acute retinal necrosis?

A

IV aciclovir followed by oral aciclovir or valaciclovir
Systemic steroids
May require vitrectomy or laser therapy.

67
Q

What is progressive outer retinal necrosis?

A
  1. Well demarcated retinal necrosis on outer retina.
  2. Rapid progression of necrosis.
  3. Circumferential spread.
  4. No Vitreal and aqueous inflammation.
68
Q

Who gets progressive outer retinal necrosis?

A

Exclusively in immunocompromised patients.

Typically persons with HIV and CD4 <100/μL.

69
Q

Etiology of progressive outer retinal necrosis?

70
Q

Treatment of progressive outer retinal necrosis? [4]

A
  1. IV antivirals (aciclovir or ganciclovir).
  2. Intravitreal antiviral
    Systemic steroids usually not needed (unless concerns for IRIS) given lack of inflammation.
  3. May require laser therapy and/or vitrectomy.
  4. Secondary oral suppression.
71
Q

Describe syphlitic uveitis?

A

Frequently presents as vision loss.
Occurs at any stage of syphilis.
Can involve any segment of the eye, but posterior disease and panuveitis predominate.

Case definition is ocular disease (uveitis, panuveitis, diminished visual acuity, blindness, optic neuropathy, interstitial keratitis, anterior uveitis, and retinal vasculitis) with syphilis of any stage.

72
Q

Work up of syphlitic uveitis? [2]

A

LP

HIV testing

73
Q

Treatment of syphlitic uveitis?

A

Same as neurosyphilis

IV Penicillin G

74
Q

What is Parinaud’s oculoglandular syndrome

A

Result of cat scratch near the eye or self-inoculation near eye. Lymphadenopathy of preauricular, submandibular, and cervical nodes along with involvement of lid or conjunctiva. Has red eye with watering.

75
Q

Treatment on parinaud’s oculoglandular syndrome

A

Supportive vs azithromycin

76
Q

Treatment of Bartonella henselae optic neuritis?

A

Prolonged doxycycline and rifampin.

77
Q

Most common effect of lyme in the eye?

A

Conjunctivitis in early lyme disease

78
Q

How does TB effect the eye?

A

Uncommon

If it does effect it is most commonly panuveitis

79
Q

Diagnosis of ocular TB?

A

difficult to establish as it is paucibacillary, so unlikely to have positive tissue cultures or acid-fast stains.

Relies on appropriate clinical setting and a positive PPD or interferon-gamma release assay.

80
Q

Treatment of ocular TB?

A

Rifampin, isoniazid, ethambutol, and pyrazinamide
May require systemic steroids.
–> Same as TB meningitis

81
Q

Presentation of toxoplasmosis in the eye?

A

Vision loss, unilateral or bilateral [unilateral is primary, bilateral is reactivation. +/- pain. Posterior uveitis or chorioretinitis.

82
Q

Dilated eye exam findings in toxoplasmosis?

A

White focal lesion with surrounding inflammation. Can have black pigmentation in areas that are healing. May have satellite lesions.

83
Q

Diagnosis of ocular toxoplasmosis?

A

Clinical
PCR of vitreous humor
Plasma serology.

84
Q

Treatment of ocular toxoplasmosis?

A

Pyrimethamine and sulfadiazine with leucovorin.

Systemic steroids.

85
Q

What is Endophthalmitis

A

Infection within the globe

86
Q

Risk factors for endopthalmitis? [4]

A

Instrumentation or trauma of eye.
Diabetes mellitus.
Injection drug use.
Risk factors associated with bacteremia or fungemia.

87
Q

Diagnosis of endopthalmitis [2]

A

Vitreal Gram stain and cultures.

Blood cultures.

88
Q

Common causes of endopthalmitis due to trauma? [4]

A

Bacillus, coagulase-negative staphylococci,

Pseudomonas, mold

89
Q

Causes of endopthalmitis s/p cataract surgery? [5]

A

Coagulase-negative staphylococci, Staphylococcus aureus, streptococci, gram-negatives

90
Q

Empiric treatment of endopthalmitis s/p cataract surgery?

A

Intravitreal vancomycin and ceftazidime

91
Q

Common causes of endopthalmitis with Pseudophakic(Chronic disease post-cataract surgery).

A

Cutibacterium acnes

92
Q

Treatment of Pseudophakic(Chronic disease post-cataract surgery) endopthalmitis? [2]

A

Intravitreal vancomycin

Vitrectomy, likely to require lens removal

93
Q

Most likely cause of Intravitreal injection related endopthalmitis [2]

A

Coagulase-negative staphylococci and streptococci

94
Q

Treatment of Intravitreal injection related endopthalmitis

A

Intravitreal vancomycin and ceftazidime

95
Q

Most likely cause of Bleb-related(Surgical treatment for glaucoma that creates scleral defect) endopthalmitis? [3]

A

Streptococci, Moraxella, H. influenzae

96
Q

Treatment of Bleb-related(Surgical treatment for glaucoma that creates scleral defect) endopthalmitis?

A

Intravitreal vancomycin, ceftazidime

97
Q

Most likely cause of endogenous endopthalmitis?

A 
Streptococci
coagulase-negative staphylococci
S. aureus
Bacillus
Candida
Aspergillus
98
Q

Treatment principles for endogenous endopthalmitis?

A

Both systemic and intravitreal antimicrobials.
Fulminant cases of bacterial will require vitrectomy
Most or all fungal will require vitrectomy.

99
Q

What antifungal should be avoided in fungal class endopthalmitis due to poor penetration?

A

echinocandins

100
Q

Treatment of resistant candida in the eye?

A

voriconazole

amphotericin

101
Q

Treatment of sensitive candida in the eye?

A

Fluconazole

102
Q

What is Malignant otitis externa

A

otitis externa that invades skull base.

103
Q

What is Chronic otitis media

A

otitis media lasting >3 months.

104
Q

Most common cause of otitis externa? [2]

A

Staphylococcus aureus, Pseudomonas

105
Q

Presentation of otitis externa?

A

Ear pain with drainage in canal

May be pruritic

106
Q

Treatment of otitis externa? [2]

A

Neomycin/polymyxin/hydrocortisone
or
Fluoroquinolone/hydrocortisone

107
Q

Presentation of malignant otitis externa?

A

Severe pain of ear and mastoid with purulent drainage in canal
May have cranial nerve palsy

108
Q

Treatment of malignant otitis externa?

A

Systemic antipseudomonal

Surgical debridement

109
Q

Treatment of otitis media? [4]

A
  1. Amoxicillin
  2. Amoxicillin/clavulanic acid if not improving
  3. Cephalosporin if PCN allergy [alt]
  4. Respiratory fluoroquinolone if severe PCN allergy
110
Q

Who gets parotitis?

A

Elderly
Diabetics
Those on anticholinergics due to decreased saliva production

111
Q

MCC of supporative vs nonsupportative parotitis?

A

Staph aureus

Mumps, sarcoid, sjogrens

112
Q

Presentation of suppurative parotitis?

A

unilateral.
Fever with severe pain and swelling of parotid gland.
May be able to “milk” purulence from Stenson’s duct.
May have obstructing stone.

113
Q

Presentation of nonsuppurative parotitis?

A

Typically bilateral.
Less fulminant presentation.
Prodrome was present prior to the parotitis

114
Q

Diagnosis of parotitis? [3]

A
  1. (CT vs. ultrasound) to see if drainable abscess.
  2. Presence of purulence from Stenson’s duct.
    Culture and Gram stain of any purulence.
  3. Serology for viral etiology as indicated.
115
Q

Treatment of suppurative parotitis? [4]

A
  1. Vancomycin (or antistaphylococcal beta-lactam if MRSA not suspected) AND clindamycin.
  2. May require removal of obstructing stone.
  3. Warm compresses.
  4. Sialagogues.
116
Q

What is a quinsy abscess?

A

Peritonsillar Abscess

117
Q

Etiology of peritonsillar abscess? [3]

A

Streptococci, staphylococci, and anaerobes

118
Q

Presentation of peritonsillar abscess?

A

Unilateral sore throat with edematous palatine tonsil that may be causing deviation of the uvula.
Fever.
Abrupt onset.
May have drooling or trismus.
Can also lead to a suppurative thrombophlebitis (Lemierre’s syndrome).

119
Q

Diagnosis of peritonsillar abscess? [3]

A

Clinical with a swollen tonsil and uvula that deviates
Aspiration for Gram stain and culture
May need imaging (ultrasound vs. contrast CT) if diagnosis is ambiguous.

120
Q

Treatment of peritonsillar abscess? [4]

A

I+D
Unasyn
Clinda as alt
+/- Tonsillectomy

121
Q

What is Ludwig’s Angina?

A

Bilateral sublingual and submylohyoid space infection.

122
Q

Etiology of ludwig’s angina?

A

Polymicrobial oral flora including anaerobes.
Streptococci including Group A Streptococcus.

–> Extension of tooth infection, particularly molar tooth

123
Q

Presentation of ludwig’s angina?

A

Rapidly progressing infection of floor of the mouth that is bilateral.
Fever present and may be toxic.
Tongue may be markedly swollen and patient may have difficulty swallowing leading to drooling

124
Q

Diagnosis of ludwig’s angina?

A

Clinical

CT

125
Q

Treatment of ludwig’s angina? [3]

A

Unasyn
Penicillin + Flagyl [alt]
Clinda [alt]

126
Q

What is Vincent’s Angina?

A

Acute necrotizing ulcerative gingivitis.

127
Q

Risk factors for Vincent angina? [4]

A

Gingivitis
Smoking
Poor oral care
Malnutrition

128
Q

Etiology of vincent angina? [2]

A

Polymicrobial oral flora

Anaerobes

129
Q

Presentation of vincent angina?

A

Pain with fetid breath.
Fevers.
Typically does have regional lymphadenopathy.
Pseudomembranes with ulcerative gingival lesions

130
Q

Diagnosis of vincent angina?

131
Q

Treatment of vincent angina?

A
  1. Penicillin
  2. Augmentin
  3. Flagyl
132
Q

Presentation of Septic Cavernous Sinus Thrombosis

A 
Headache with fever.
Cranial nerve III–VI palsy.
May have diplopia.
Proptosis.
Ptosis.
Periorbital edema.
Can lead to vision loss
133
Q

Diagnosis of Septic Cavernous Sinus Thrombosis?

A

MRI or MR venography.

CT if unable to do MRI.

134
Q

Treatment of septic cavernous sinus thrombosis?

A

Vancomycin + Cefepime +/- Flagyl

+/- Debridement

135
Q

What is the lateral pharyngeal space?

A

Base of skull to hyoid.

Medial border is the carotid sheath.

136
Q

What is the pretracheal space?

A

Esophagus and trachea.

Contiguous with mediastinum and carotid sheath

137
Q

What is the retropharyngeal space?

A

Posterior to hypopharynx and esophagus.

Extends to mediastinum inferiorly.

138
Q

What is the danger space?

A

Between alar fascia and prevertebral fascia

Communicates with posterior mediastinum.

139
Q

What is the prevertebral space?

A

Spinous process to prevertebral fascia.

140
Q

Etiology of deep neck space infection?

A

Polymicrobial
Staph
Strep
Oral anaerobes

141
Q

Presentation of a deep neck space infection

A

Fever and Toxic.
Can have dysphagia (particularly with pretracheal).
Dyspnea.
Concern is for possible extension into mediastinum.

142
Q

Diagnosis of a deep neck space infection?

A

CT imaging is paramount

143
Q

Mgmt of deep neck space infection?

A

Surgery
Unasyn
Add vanco if known colonization or recent trauma

144
Q

Risk factors for osteomyelitis of the jaw [5]

A 
DM
steroids
radiation
trauma (dental procedure)
necrosis from medication.
145
Q

Etiology of osteomyelitis of the jaw [3]

A

Streptococci, Actinomyces, S. aureus

146
Q

Presentation of osteomyelitis of the jaw

A

Jaw pain.

Exposed bone.

147
Q

Most likely area osteomyelitis of the jaw will occur?

A

Mandible much more common than maxilla given better vascular supply to maxilla.

148
Q

Treatment of osteomyelitis of the jaw?

A

Surgical debridement of necrotic tissue.
Unasyn +/- vancomycin
+/- hyperbaric oxygen

ID Review (25 decks)

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