HEENT II

Question 1

Why should sinus infections be taken seriously

Answer 1

because of the anatomy–>easy to enter the bone which makes it hard to treat

Question 2

What is the gold standard for the diagnosis of otitis media

Answer 2

pneumatic otoscopy

Question 3

Middle ear effusion

Answer 3

fluid behind the tympanic ,membrane

Question 4

Diagnosis of acute otitis media

Answer 4

• moderate/severe bulging of the TM or otorrhea

- mild bulging TM and recent ear pain or intense redness

Question 5

Diagnosis of OME

Answer 5

-middle ear effusion without sings or symptoms of acute ear infection

Question 6

Can you have otitis media without a middle ear effusion

Answer 6

NO

Question 7

What causes acute otitis media

Answer 7

• strep pneumo
• H. flu
• M. cat
• viruses
• ostiomeatal complex dysfunction

Question 8

What casues chronic otitis media

Answer 8

• ET tube dysfunction
• sequelae of AOM
• viral
• idiotpathic
• biofilm

Question 9

Treatment for chronic otitis media

Answer 9

WATCH AND WAIT

• for children not at increased risk for speech, language or learning problems
• reexamine every 3-6 months

Question 10

Surgery options for chronic otitis media

Answer 10

• myringotomywith tube insertion
• typanocentesis
• adenoidectomy

Question 11

Medications for chronic otitis media

Answer 11

• prednisone (oral or topical)
• antihistamines/decongestants

not recommended but often given

Question 12

Criteria for recurrent AOM

Answer 12

three or more well documented and separate AOM episodes in the past 6 months
OR
4 AOM episodes in the past 12 months with one in the past 6 months

Question 13

Criteria for persistent AOM

Answer 13

persistence of signs and symptoms of AOM during ABX therapy
AND/OR
relapse of AOM within 1 month of completing antibiotic therapy

Question 14

First line for AOM treatment

Answer 14

amoxicillin
OR
quinolone drops if tubes present

Question 15

Second choice for AOM treatment

Answer 15

augmentin (dosed based on amox component)

Question 16

Other alternatives for AOM treatment

Answer 16

• bactrim
• 2nd or 3rd gen ceph
• ceftriaxone

Question 17

AOM treatment for patient with PCN allergy

Answer 17

• azithromycin

- clindamycin

Question 18

Management of AOM

Answer 18

PAIN RELIEF

• topical decongestants (not recommended)
• cold meds (mostly kids over 4)

Question 19

When to follow up with acute otitis media

Answer 19

• improvement expected in 24-48 hours

- re evaluate in 2 weeks

Question 20

Prophylaxis for AOM

Answer 20

• pneumococcal vaccine
• breast feeding
• smoke free environment
• no bottles in bed
• ABX prophylaxis not recommended

Question 21

What can cause a perforation of the TM

Answer 21

• infection
• trauma
• blows to the ever
• severe atmospheric overpressure
• exposure to excessive water pressure
• improper wax cleaning

Question 22

What should you avoid in TM perf

Answer 22

eardrops containing gentamicin, neomycin sulfate or tobramycin

Question 23

When do you give systeic abx for a TM perf

Answer 23

if otorrhea present

Question 24

Treatment of TM perf

Answer 24

• most heal spontaneously
• in office paper patch method, gelfoam plug, firbrin glue
• tympanoplasty

Question 25

When to refer a pt with a TM perf

Answer 25

• > 2 months
• significant hearing loss
• ossicular trauma

Question 26

What causes an auricular hematoma

Answer 26

result from direct trauma

-shearing forces cause separation of the anterior auricular perichondrium from the cartilage

Question 27

Treatment for auricular hemotoma

Answer 27

EARLY IDENTIFICATION

• drainage
• splints
• compression

Question 28

Mastoiditis treatment

Answer 28

• consult
• medical (as with AOM)
• surgical