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HEENT disorders Flashcards

1
Q

Acute rhinosinusitis defined

A

inflammation of the mucosal lining of nasal passages and paranasal sinuses lasting up to 4 weeks
can be cause by allergens, virus, bacteria and fungi

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2
Q

Acute bacterial rhinosinusisits defined

A

secondary bacterial infection of paranasal sinuses following a viral URI
“sinus infection”

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3
Q

What questions to ask prior to antimicrobial therapy

A

what are the most likely pathogens
what is the spectrum of the given antimicrobial
what is the likelihood of the resistant pathogen
what is the danger if there is tx failure

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4
Q

Pathogens that cause acute bacterial rhinosinusitis

A

S. pneumoniae (most common)
H. influenzae (common cause of recurrent infections and those who are tobacco users
M. cat (least common)

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5
Q

S. pneumoniae description

A

gram pos diplococci

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6
Q

H. influenza description

A

gram neg bacillus

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7
Q

M. cat description

A

gram neg coccus

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8
Q

drug resistance in s. pneumonia

A

> 25% drug resistance from altered protein binding and can limits its ability to bind to pathogen

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9
Q

drug resistance to h. influenza

A

> 30% PCN resistant from production of beta-lactamase

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10
Q

drug resistance to m. cat

A

> 90% PCN resistance from beta-lactamase

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11
Q

Risk factors for abx resistance

A 
age < 2 and >65
daycare
prior abx within past month
comorbidities
immunocompromised
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12
Q

Needing Abx therapy without risk for resistance

A

start first line antimicrobial and do 5-7 days

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13
Q

Needing abx therapy with risk of resistance

A

start 2nd line antimicorbial and do for 7-10 days

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14
Q

First line therapy for ABRS (bacterial sinusitis)

A

High dose Amox 3-4g/day
Amox-clavulanate (augmentin) 500/125 TID
Amox-clavulanate (augmentin) 875/125 BID

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15
Q

What does claculanate do with drug resistance?

A

it is a beta lactamase inhibitor and allows amox to have activity against beta lactamase producting organisms such as h.influenza and m. cat

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16
Q

Second line therapy for ABRS

A

Amox-clavulanate 2000/125 PO BID

Doxy 100 mg PO BID

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17
Q

Doxy cautions

A

Pregnancy category D
Can stain teeth
sit upright 30 minutes following taking

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18
Q

Tx choices for ABRS with beta-lactam allergy

A

Doxy
Levofloxacin 500 daily
moxifloxacin 400 daily
(these are active against drug resistant s. pneumo, gram neg and are stable in presence of beta lactamase

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19
Q

Tx choice for abx resistance or failed initial therapy

A

Amox-clavulanate 2000/125 BID
Levofloxacin 500 daily
moxifloxacin 400 daily

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20
Q

Trimethoprim-sulfamethoxazole for ABRS

A

bactrim

not a good option, does not always cover

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21
Q

3 questions to ask when choosing abx therapy

A

Is it gram pos or neg?
Is it safe?
Is it stable in beta lactamase

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22
Q

S/S of otitis externa

A

erythema of external ear

discomfort when tragus is pulled

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23
Q

Normal finding with unilateral AOM with ear fullness

A

weber test lateralization to the affected ear
shows conductive hearing loss
ear fullness is a normal finding

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24
Q

hearing loss associated with presbycuis presentation

A 
age r/t
slowly progressive
symmetic
high frequency
"sensoryneural"
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25
Controller medications for allergic rhinitis
intranasal corticosteroids leukotriene receptor antagonist/modifiers mast cell stabilizers both intranasal and ophthalmic
26
Intranasal corticosteroids used for allergic rhinitis
``` beclomethasone budesonide ciclesonide flunisolide fluticason triamcinolone "the ides and one's" ```
27
Leukotriene receptor antagonists/modifiers used for allergic rhinitis
montelukast (Singulair)
28
Intranasal mast cell stabilizers for AR
cromolyn | safe and less effective than corticosteroids
29
Opthalmic mast cell stabilizers for AR
cromolyn nedocromil improves when combined with antihistamines
30
Use of intranasal corticosteroids
can cause nasal irritation and bleeding some systemic bioavailability in elderly takes 1-2 weeks to reach optimal efficacy can be used in acute sinusitis
31
1st generation antihistamines for reliever meds for AR
``` diphenhydromine chlorpheniramine hydroxyzine block histamine 1 receptors have anticholinergic effects ```
32
2nd generation antihistamines for reliever meds for AR
``` loratadine desloratadine cetirizine (zyrtec) levocetirizine fexofendadine (Allegra) better than 1st generation little benefit with nasal congestion ```
33
nasal antihistamines for reliever meds for AR
azelastine olopatadine for non-allergic AR and nasal congestion systemic absorption so drowzy
34
opthalmic antihistamines for relieve meds for AR
olopatadine azelastine bepotastine for ocular allergy symptoms
35
Oral decongestants for relieve meds for AR
Sudafed "vasoconstric" alpha adrenergic agonist
36
Caution for oral degongestants
``` elderly young HTN bladder neck obstruction glaucoma hyperthyroid ```
37
Nasal decongestants for relieve meds for AR
oxymetazoline (Afrin) phenylephrine limit use to 5-7 days can cause rebound congestion
38
Intranasal antocholinergic use
ipratropium bromide (Atrovent) only reduces rhinorrhea use with corticosteroids
39
short-term oral cortocosteroid use
for severe nasal symptoms not for single use or recurrent use prednisone 20mg BID x 5-7 days
40
Anticholinergic side effects from 1st generation antihistamines
``` Dry as a bone Red as a beet (flushed) Mad as a hatter (confused) Hot as a hare (hyperthermia) Can't see (vision) Can't pee Can't spit Can't shit ```
41
adverse S/E from oral decongestants
increase in BP
42
s/s of allergic conjunctivitis
hyperemic bulbar and palebral conjunctiva | rope like pale yellow d/c
43
meds to avoid is someone with allergic rhinitis who is a machine operator
1st generation antihistamines- cause drowsiness
44
painless ulceration with indurated margins on the lateral tongue with a firm, non tender submandibular node could be
squamous cell carcinoma most oral cancers are squamous cell squamous cell = non tender
45
leukoplakia described
white plaque that is painless no ulcer can't scrape off
46
aphthous stomatitis described
ulcer on the lip
47
CN for puffing out cheeks
VII
48
CN for smelling
I
49
CN for following finger with eyes
III
50
CN for shrugging shoulders
XI
51
CN for sticking out tongue
XII
52
What cranial nerve does bell's palsey typically affect
VII
53
Tx bell's palsey
oral corticosteroids
54
How often to assess visual acuity in adult and child
annually
55
What vision complaints warrant a referral to eye specialist
change in baseline vision | eye pain and redness
56
normal eye exam for 55 year old woman
sharp disc margins
57
lid ectropion =
sagging eyes | happens in older adults
58
found on funduscopic exam with angle-closure glaucoma
deeply cupped optic disk
59
peripheral vision loss
untreated open-angle glaucoma
60
central vision loss
macular degeneration
61
screening tool for macular problems
amsler grid test
62
when is tonometry used for eye exam
increased occular pressure | glucoma screening test
63
slit-lamp exam
looks at anterior eye including the cornia, conjunctiva, sclera and iris
64
the purpose of snellen eye chart is to determine
visual acuity
65
presbyopia
problems with close vision due to hardening of lens happens to majority over 45
66
senile cataracts
progressive vision dimming, trouble with distance close up vision good caused by lens clouding
67
risk factors for senile cataracts
smoking poor nutrition sun exposure cortocosteroid therapy
68
angle closure glaucoma
``` unilateral acutely red painful vision change firm eye ball halos seen around lights REFER ```
69
open angle glaucoma
loss of peripheral vision if untreated painless gradual onset of pressure
70
evaluation and management of open angle glaucoma
periodic screening with tonometry visual fields assessment tx with topical miotics, beta blockers or surgery
71
age-r/t macular degeneration
central vision issues often seen yellow deposits in macular due to sclerotic changes in retinal basement membrane
72
risk factors for macular degeneration
aging tobacco sun fam hx
73
Anosmia
diminished sense of smell due to neural degeneration there is also decline in fine taste
74
Presbycusis
difficulty with conversation in noisy environment due to loss of 8th cranial nerve sensitivity accelerated by excessive noise exposure
75
cerumen impaction
causes conductive hearing loss
76
common pathogen of otitis externa
pseudomonas strep pneumo proteus strep pneumo s. aureus
77
tx for otitis externa
acetic acid with propylene drops for mild | ciprofloxacin for mod to severe
78
do not use if TM ruptured
neomycin products
79
malignant otitis externa in persons with DM, HIV
from pseudomonas strep pneumo oral cipro risk for osteomyelitis of skull or TMJ MRI or CT to rule out osteomyelitis
80
common pathogens of suppurative conjunctivitis
s. aureus s. pneumo h. influenza
81
tx for suppurative conjunctivitis
"floxacins" polymyxin B and trimethoprim azithromycin 1%
82
s. pneumo is resistant to
tobramycin | gentamicin
83
exudate pharyngitis common pathogens
Group A, C G strep viral M. pneumoniae
84
Tx for exudate pharyngitis
PCN V x 10 days Erythromycin x 10 days Azithromycin x 5 days Clarithromycin x 10 days
85
common cause of pharyngitis is children
group A strep
86
why test for group A strep
prevention of rheumatic fever and eradication of organism
87
tx for recurrent culture proven group S pyogenes
consider coinfection with beta lactame producting organism | consider amox-clavulanate or clinda

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