HEENT Infections - Hunter Flashcards
1
Q
what is swimmer’s ear?
A
otitis externa
2
Q
Swimmer’s ear happens when water gets trapped in what part of the ear?
A
external canal
3
Q
What are the predisposing factors to getting swimmer’s ear?
A
- hi environmental temps
- trauma from Q-tip abuse
- chronic dermatologic dz (eczema)
4
Q
what are the most common bugs causing otitis externa?
A
gram-neg bacilli
5
Q
What is the most common bug cuasing MALIGNANT otitis externa?
A
Pseudomonas aeruginosa
6
Q
What is the second most common cause of otitis externa?
A
Staph aureus
7
Q
The fever associated with swimmer’s ear is usually lower than….
A
38.3 C
8
Q
What are the common clinical presentations of swimmer’s ear?
A
ear pain
itching
discharge
red canal, swollen (otoscopy)
9
Q
What part of the ear can be painful in swimmer’s ear which makes chewing painful?
A
the pina
10
Q
What is the standard abx to use for swimmer’s ear?
A
dicloxacillin or ciprofloxacin
11
Q
less severe cases of swimmer’s ear can use abx eardrops of….
A
ofloxacin
12
Q
what is the temperature greater than in malignant otitis externa?
A
greater than 38.3 C
must have severe pain and purulent exudate
13
Q
Malignant otitis media begins as an infx of the external auditory meatus and the patient then develops….
A
otorrhea
14
Q
Necrotizing infx from malignant otitis externa can spread to what areas?
A
MASTOID BONE
blood vessels
cartilage
brain!
15
Q
In what types of patients do you see malignant otitis externa?
A
DIABETES; immunosuppresed
16
Q
What is the Abx for malignant otitis externa?
A
imepenem and refer to ENT
17
Q
T/F: malignant otitis externa is fatal if untreated
A
true
18
Q
what percent of kids younger than one year get otitis media?
A
50%
19
Q
what percent of kids younger than 3 get at least one bout of otitis media?
A
80%
20
Q
What is the most common Dx in febrile children?
A
otitis media
21
Q
if a kid presents with purulent conjunctivitis or rhinosinusitis, what should they be examined for?
A
otitis media
22
Q
Immune deficient people are more likely to have what type of otitis media?
A
recurrent
23
Q
What are the three most common causes of otitis media?
A
Strep pneumo
nontypeable H. flu
Moraxella catarrhalis
24
Q
What are the two uncommon causes of otitis media?
A
staph aureus
strep pyogenes
25
In children younger than (blank) weeks of age, gram-negative bacilli (e.g., Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeurginosa) commonly cause acute otitis media
6 weeks
26
Acute otitis media is usually preceded by an upper respiratory tract (blank) infection
viral
27
A blocked eustachian tube creates negative pressure and produces what type of effusion?
serous
28
What are the definitive criteria for Dx of otitis media?
1. pain
2. fever
4. effusion
29
A tympanic membrane (blank) is an indication of effusion
bulge
30
T/F: most cases of otitis media resolve without abx
true
31
If pts are still symptomatic by day 3 with otitis media, what abx should you start?
amoxicillin
32
da fuck is a hordeola?
stye
33
hordeolas appear as.....
acute purulent papules
34
WHERE do hordeolas occur?
lid margin
35
what is the cause of 90%+ of all hordeola?
staph aureus
36
Hordeola are a complication of what?
blepharitis
37
What is blepharitis?
blockage and infection of the Zeiss or Moll sebaceous glands or meibomian glands in the tarsal plate
38
What is a chalazia?
GRANULOMATOUS hordeola that is not painful
39
T/F: most hordeolas drain spontaneously
true
40
How do you drain an external hordeola?
lance it and pluck the nearby lashes
41
How do you treat an internal hordeola?
warm compress
| oral dicloxacillin
42
what prevents hordeola formation?
good hygeine
43
what are the symptoms of orbital cellulitis?
```
proptosis
ophthalmoplegia
edema
erythema
pain on eye movement
fever, headache, malaise
chemosis, hyperemia of conjunctivia
```
44
When should you suspect orbital cellulitis?
recent sinus infection
| facial trauma/surgery/dental work
45
What is the most common sinus to cause orbital cellulitis?
ethmoid
46
What are the common pathogens that cause orbital cellulitis?
Strep pneumo
staph aureus
H. flu
anaerobes
47
Which three antibiotics do you use to treat orbital cellulitis?
nafcillin
ceftriaxone
metronizadole
48
10% of orbital cellulitis results in...
vision loss
49
What type of orbital cellulitis is less serious?
preseptal/preorbital
50
What are the serious complications of orbital cellulitis?
1. CAVERNOUS VENOUS THROMBOSIS
2. brain abscess
3. meningitis
4. vision loss
51
Conjunctivitis is inflamm of....
palpebral and bulbar conjunctiva
52
bugs that cause conjunctivitis also cause...
keratitis, resulting in keratoconjunctivitis
53
what percent of all eye complaints are conjunctivitis?
30%
54
whats the common name for conjunctivitis?
pink eye
55
What are the three most common viral causes of pink eye
1. Adenovirus (most)
| 2. HSV1/2 (less likely)
56
which viral pink eye causes more serious keratitis?
HSV1/2
57
Which bugs can cause purulent conjunctivitis?
1. staph aureus
2. strep pneumo
3. h. flu
4. moraxella catarrhalis
58
What bug causes HYPERpurulent pink eye?
Neisseria gonorrhoeae; causes SIG CORNEAL DAMAGE
59
what bug causes follicular (inclusion) pink eye?
chlamydia trachomatis
60
What is the leading cause of blindness in the world? what causes it?
trachoma; chlamydia
61
N. gonorrhoeae and C. trachomatis can cause conjunctivitis in newborns (blank), which can spread from the conjunctiva and rapidly infect the cornea
ophthalmia neonatorum
62
what are the defense mechanisms of the eye?
tearing and lysozyme in tears
63
what are the symptoms of an overwhelmed eye defense?
redness
discharge
irritation
64
T/F: pink eye is self limited
true
65
ophthalmia neonatorum is acquired in the (blank) and can lead to rapid corneal perforation
birth canal
66
chlamydial pink eye can lead to (blank) causing vision loss
scarring -- especially in trachoma
67
follicle formation happens post what types of pink eye?
viral and chlamydia
68
what is injection in pink eye?
white sclera turning red from BV dilation
69
what are the symptoms of pink eye?
fullness
BURNING
sensation of "grit/dust" in the eye
lots of tearing
70
purulent discharge is seen in (viral/bacterial) pink eye
bacterial
71
is vision impaired in pink eye?
nope
72
What do you use to treat viral herpes conjunctivitis?
acyclovir
73
Neisseria ophthalmia neonatorum will present in what time frame after birth?
2-3 days
74
Chlamydia ophthalmia neonatorum will present in what time after birth?
4-10 days
75
In 24 hours, untreated Neisseria ophthalmia neonatorum keratoconjunctivitis can progress to....
ulceration or perforation of the cornea
76
what is the vertical transmission rate from mom to baby of ophthalmia neonatorum?
30-50%
77
what abx do you give for neisseria ophthalmia neonatorum?
ceftriaxone
78
what abx do you give for ophthalmia neonatorum prophylaxis?
erythromycin ointment
79
(blank) presents as mucopurulent keratoconjunctivitis
active trachoma
80
(blank) causes an intensely irritating foreign body sensation and corneal scarring
trichiasis
81
which phase of trichiasis leads to blindness?
cicatricial or corneal scarring phase
82
what actually is trichiasis?
in-turned eye lashes
83
What are the buzz words associated with trichiasis?
```
in-turned eye lashes
poverty/ poor hygeine
periauricular LAD
light sensitivity
follicular inflamm
eye exudate
```
84
Inflamm of the cornea is called..
keratitis
85
Most cases of keratitis also cause..
conjunctivitis
86
T/F: keratitis cna be vision threatening
true
87
What types of bugs can cause keratitis?
viruses, bacteria, fungi, or parasites
88
What are the most common risk factor for microbial keratitis in the US?
contact lenses
89
What are the most common causes of viral keratitis?
1. HSV
2. VSV
3. adenovirus
90
adults tend to get HSV (1/2) keratitis
HsV1
91
neonates tend to get HSV (1/2) viral keratitis
HSV 2
92
What is the MOST common type of bacterial keratitis?
Staph aureus
93
Besides staph aureus, what are the most common causes of bacterial keratitis?
strep pneumo
strep pyogenes
H. flu
94
What are the most common causes of fungal keratitis?
aspergillus
Fusarium
Candida
95
What is the MOST common protozoa that causes keratiis, EPSECIALLY WITH CONTACT LENSES
Acanthamoeba
96
what is the most common bacterial keratitis from contact lenses?
Pseudomonas aeurignosa
97
what is the most common corenal infection in the US?
HSV keratitis
98
Greater than 90% of HSV keratitis are (uni/bi)lateral
unilateral
99
HSV keratitis is spread from oral or genital herpes or from which CN?
trigeminal ganglion
100
HSV keratitis can progress from epithelilal to more serious (blank) involvement
stromal
101
What is the Tx for HSV keratitis?
trifluridine drops for 3 weeks; add acyclovir if it persists
102
What are the two reason why corticosteroids are sued to dampen the inflamm and scarring due to HSV keratitis?
pathology is cause by both HSV cytotoxicity AND the immune response
103
What are the buzzwords associated with HSV keratitis?
unilateral eye pain
photophobia
oral/genital herpes
dendritic epithelial defects
104
the (blank) is the pigmented, vascular middle layer of the eye between the cornea-sclera outer protective layer and the retina
uvea
105
what are the eye structures involved in anterior uveitis?
```
Eyelids
Cornea
Iris
Pupil
Anterior chamber
posterior chamber
Ciliary body
conjunctiva
```
106
What are the four general classes of uveitis?
autoimmune
infectious
traumatic
idiopathic
107
What percent of cases of uveitis are idiopathic?
50%
108
what percent of uveitis is caused by infx?
20%
109
what are the two most common infectious causes of uveitis?
Herpes
| toxoplasmosis
110
what are the symptoms of anterior uveitis?
```
eye pain
decreased vision
CILIARY FLUSH
cells in the anterior chamber (HYOPYON).
Vitreous has few cells; retina is normal!
```
111
What are the symptoms of posterior uveitis?
PAINLESS loss of vision
few cells in anterior chamber
MANY CELLS in vitreous
LESIONS IN THE RETINA, and/or choroid
112
what are the eye strucutres affected by posterior uveitis?
retina
choroid
vitreous body
113
what is endophthalmitis?
bacterial or fungal infection of the vitreous or aqueous humor or both
114
What is the cause of most cases of endophthalmitis?
exogenous; cataract surgery
115
what are the three types of anterior uveitis?
iritis
cyclitis
iridocyclitis
116
What are the three types of posterior uveitis?
choroditis
chorioretinitis
retinitis
117
What is the most common cause of panuveitis?
treponema pallidum
118
which strucures are involved in panuveitis?
ALL uveal structures
119
What are the three most common (bacterial) causes of endopthalmitis?
staph aureus
strep
gram negative bacilli
120
what is the most common form of posterior uveitis?
toxoplasma chorioentereitis
121
An active, unifocal area of acute chorioretinal inflammation adjacent to an old (blank) suggests toxoplasma chorioretinitis
chorioretinal scar
122
(blank) inflammation can be severe in toxoplasma chorioenteritis
vitreous
123
what is the mechanism of damage in toxoplasma choroenteritis?
T-cell mediated immunopathology
124
Dormant (blanks) cysts can reactivate in the eye
bradyzoites
125
In toxoplasma chorioenteritis, vision may be impaired if lesions form within the...
macula
126
Transplacental transfer of toxoplasma choroenteritis happens in a third of women infected with...
toxoplasma gondii
127
T/f: many cases of toxoplasma chorioenteritis are congenital infxs
true
128
What fundoscopic findings do you see with toxoplasma chorioenteritis?
whitish-yellow inflammatory lesion near an atrophic, pigmented retinochoroidal scar.
129
What is the Tx for ocular toxoplasmosis?
Trimethoprim/sulfamethoxazole, clindamycin, and prednisone
130
how many colds per year doe a kid younger than five get?
5-7
131
how many colds per year does an adult get?
1-2
132
90% of colds are caused by.....
```
viruses:
RHINOVIRUS
coronavirus
adenovirus
myxovirus
enterovirus
```
133
how are colds spread?
person to person
134
Rhinovirus enters nasal passages and infect-2s what type of cells?
ciliated columnar epithelial cells
135
what protein on nasal mucosa does rhinovirus bind to?
ICAM-2
136
Death of host cells leads to inflammation causing what two symptoms?
hyperemia and edema
137
What type of snot do you have when you have a viral infx?
clear, mucoid
138
When does your snot turn green in a viral infx?
mucopurulent with secondary bacterial infx from NORMAL FLORA
139
paranasal sinusitis or otitis media may occur if you block what two structures?
sinus ostia
| eustachian tubes
140
T/f: rhinoviral colds may turn into bronchitis
true
141
T/F: lab culture and serologic testing for viruses is common
FALSE
142
What is the Tx for a viral cold?
supportive therapy
143
What are the things that make up the dx of a viral infx?
symptoms
localization of dz process
time of year
144
What leads to lowering viral spread?
HANDWASHING and disinfecting surfaces
145
why do you develop nasal polyps?
chronic nasal inflammation
146
Which sinuses are involved and for how long in acute rhinosinusitis?
paranasal; no longer than 4 weeks
147
What is the most common cause of rhinosinusitis?
resp. viruses
148
T/F: most people recover form acute rhinosinutsitis without medical care
true
149
acute rhinosunitis follows what types of infections?
COMMON COLD
dental extractions
rhinitis due to allergies
150
what are the most common viral causes of acute rhinosinusitis?
rhinovirus
parainfluenza virus
RSV
adenovirus
151
What are the most common secondary bacterial causes of acute rhinosinusitis?
Strep pneumo
nontypeable H. flu
Moraxella catarrhalis
152
What are the fungal bugs that immunocompromised pts get that may cause acute rhinosinusitis?
Mucor
Rhizopus
Aspergillus
153
t/F: acute rhinosinusitis is dx'd with cultures
false; clinical signs
154
What are the symptoms of acute rhinosinusitis?
rhinorrhea
| facial pressure
155
What level of fever and what type of discharge are seen in acute rhinosinusitis?
>39 C
| purulent dischage
156
what are some of the buzzwords associated with acute rhinosinusitis?
```
maxillary sinus pressure
facial pain
sinus congestion on xray
nasal passage inflammation
purulent discharged
blocked nasal ostium
gram stain with strep pneumo
```
157
What are the symptomatic Tx for viral rhinosinusitis?
1. oral hydration
2. antipyretics, analgesics, decongestants
3. mucolytics
158
What are the abx you shoud use in bacterial rhinosinusitis?
axocillin or cefdinir
| TMP/SMA or z-pack in PCN allegies
159
what types of things need to be repaired surgically in bacterial rhinosinusitis?
septal deviations
large nasal polyps
foreign bodies
160
what are the important signs in rhinocerebral mucormycosis/
BLACK PALATAL ESCHAR
facial pain
headache, lethargy
vision loss, proptosis
161
what is a huge risk factor in rhinocerebral mucormycosis?
diabetes
162
What histo test gives you a Dx of what is a huge risk factor in rhinocerebral mucormycosis?
fine needle aspirate
163
what do you see on fine needle aspirate in what is a huge risk factor in rhinocerebral mucormycosis?
nonseptate hyphae and right angle branching
164
what type of major CNS complication may happen because of rhinocerebral mucormycosis?
cavernous venous thrombosis
165
What type of imaging study is useful in the Dx of rhinocerebral mucormycosis?
CT
166
Which systemic antifungal should you start immediately in rhinocerebral mucormycosis?
Amphotericin B
167
What type of surgery is needed in rhinocerebral mucormycosis?
debridement
168
what is the most common cause of pharyngitis?
viruses
169
what age group gets strep throat?
5-15
170
what bug causes strep throat?
strep pyogenes
171
Besides (blank), pharyngitis is self limiting
diphtheria
172
What is the most common viral cause of pharyngitis?
RHINOVIRUS
ADENOVIRUS
ebv, cmv, hsv, influenza, parainfluenza, corona, entero, hiv
173
What is the most common bacterial cause of pharyngitis?
GAS
174
what causes fungal oropharyngitis aka thrush?
candida albicans
175
in viral pharyngitis, viruses infect what type of cell?
mucosa of the nasopharynx
176
S. pyogenes causing pharyngitis attaches to the mucosal epithelial via...
M protein
177
What two factors produced by strep pyogenes aid in its invasion of the mucosa?
protease
| hyaluronidase
178
what is the most common sequelae after pharyngitis?
rheumatic fever
179
what is the clinical presentation of pharynngitis?
```
fever
cervical LAD
maybe vomiting
no cough, conjunctivits or runny nose
PAIN UPON SWALLOWING
```
180
What are the lab results that indicate a strep pyogenes pharyngitis?
b-hemolytic
| bacitracin sensitive
181
what types of symptoms of pharyngitis do kids get?
HA
N/V
abd. pain
182
Pharyngitis presents with (blank) erythema with or without exudate.
tonsillopharyngeal
183
What are the complications of pharyngitis?
rheumatic fever
peritonssilar abscess
cervical LAD
mastoiditis
184
What is the Tx for bacterial pharyngitis?
oral PCN V for ten days
185
what are the common methods of Dx for viral pharyngitis?
S. pyogenes rapid AG detection test
186
are the rapid Ag detectoin tests as sensitive as cutlures?
nope
187
What should you do if rapid strep A is positive?
begin Abx
188
what should you do if a rapid strep A test is negative?
wait for cultures before beginning Abx
189
What type of sample should you take to culture pharyngitis?
throat swab; place on blood agar
190
What are the complicatoins from pharyngitis that we are trying to avoid by using abx?
rheumatic fever and suppurative complications
191
T/F: most causes of candidiasis are painful
false; painless
192
what two drugs do you use to treat candidiasis?
nystatin or clortrimazole
193
How do you manage candidiasis?
manage the underlying cause of immunosuppresion
194
how will candidiasis appear in culture?
creamy white colonies on SABOURAUD dextrose agar with chlromamphenicol B
195
how will candidiasis look on gram stain?
positive, large, oval, budding organisms
196
what is the only known reservoir for diphtheria?
humans
197
How is diphtheria transmitted?
respiratory droplets and skin contact
198
what does diphtheria look like on gram stain?
irregularly staining
gram positive
club-shaped!
199
Only C. diphteriae (blank) for the beta bacteriophage carrying the toxin gene causes diphtheria
lysogenic
200
What causes damage to the oropharynx in diphtheria?
diphtheria toxin
201
What is the method of damage mediated by diphteria toxin?
ADP-ribosylation of eFII, terminating protein synth in mucosal cells
202
What process forms the pseudomembrane in diphtheria?
anit-inflamm response to cell death and the dead cells themselves
203
Besides the mouth, what two other areas can diptheria toxin bind to?
heart and nerve cells
204
What is a major complicatoin of diphtheria?
myocarditis
205
What types of nerves are most sensitive to diptheria toxin?
cranial nerves
206
what is the result of CN infx with diphtheria toxin?
difficulty in swallowing and nasal regurgitation of liquids; can't feel the roof of the mouth (palatine palsy)
207
What is the special type of LAD you get with diphtheria?
bull neck; regional LAD and edema of the surrounding tissues
208
Describe the respiratory symptoms of diphtheria?
```
airway obstruction
tachypnea
stridor
cyanosis
fetid breath
```
209
what are the two methods to assay for diphtheria toxin?
Elek immunodiffusion assay
| PCR
210
what samples do you use to test for diphtheria toxin?
oropharynx swabs (grey pseudomembrane)
211
Where in the hospital do you put someone with diphtheria?
isolation
212
what do you give to neutralize diphtheria toxin?
antiserum
213
What are the two abx you can use for diphtheria?
erythromycin
| clindamycin
214
T/F: pts presenting with diptheria should receive the vaccine
true; ensures immunity
215
Which diptheria vaccine do we give to kids? to adults?
kids: DTaP
adults: DT
216
why is it extra important to manage the airway of young kids?
narrower than older kids and adults and will close sooner
217
what is the most common cause of croup?
parainfluenza virus
218
What are the viruses that causes laryngitis?
```
rhinovirus
adenovirus
corona
metapneumo
influenza
```
219
what are the bacteria that cause laryngitis?
Mycoplasma pneumonia
| Chlamyophila pneumonia
220
What is the most important cause of epiglottitis?
H. flu B
221
infx of the upper airways resulting in edema of the larynx causes (blank) while edema of the larynx, trachea, and bronchi causes (blank)
laryngitis
| croup
222
what causes the partial airway obstructoin in croup and laryngitis?
mucus made by host
223
What effect does laryngitis have on speech?
dysphonia (hoarseness)
odynophonia (pain with speaking)
dysphagia
224
In viral croup, narrowing of the (blank) results in inspiratory stridor
subglottic trachea
225
(blank) causes the barking cough in viral croup
laryngotracheal inflamm
226
Epiglotitis is a (blank) of the epiglottis and surrounding tissue
cellulitis
227
describe the croup prodrome
mild URI
coryza, nasal congestion, sore throat cough
lasts 2-3 days
228
How do you Dx croup?
Clinically;
fever
stridor
barking cough
229
What is the steeple sign on xray?
subglottic narrowing in croup
230
What must you rule out before making a Dx of croup?
epiglotitis; it's life threatening
231
why is there now more cases of epiglotitis in adults rather than kids?
successful child vax programs!!!
232
T/F: morbidity and mortality of epiglotitis is low
false
233
What is the HIGEST PRIORITY when treating epiglotitis?
securing the airway
234
Where in the hospital do you put pts with epiglotitis?
ICU
235
how high do fevers get in epiglotitis?
>40C
236
What is the triad associated with epiglotitis?
drooling
dysphagia
distress
237
what is the thumbrpint sign on xray?
swollen epiglottis
238
Epiglotitis cultures are positive in what percent of cases?
50-75% in Hflu
239
What is the Tx for epiglotitis?
1. Abx: ceftriaxone
| 2. corticosteroids for inflamm
240
what causes whooping cough?
bordetella pertussis
241
what is the gram stain of pertussis like?
gram neg coccobacillus
242
what is the only natural host of pertussis?
humans
243
how is pertussis spread?
aerosolized droplets
244
In what age group is pertusis most serious?
less than 12 months
245
50% of kids with pertussis can be attributed to...
adult carriers with chronic cough
246
pertussis inhaled in resp. droplets attaches to the (blank) in the trachea
ciliated epithelium
247
What three virulence factors cause damage in pertussis?
Pertussis toxin
tracheal cytotoxin
filamentous hemagglutinin
248
Describe the MOA of pertussis toxin?
ADP-ribosylates guanine-nucleotide binding protein
249
what causes the cough in pertusis?
mucus production
250
What are the neruologic complications of pertussis?
hypoxia and intracerebral hemorrhage
251
what part of the pt history is most important when considering pertussis?
immunization history
252
The (blank) phase of pertussis looks the same as a URI
catarrhal phase
253
The (blank) phase of pertussis begins with sudden episodic coughing for 2-4 weeks
paroxysmal
254
What does the pertussis cough sound like on inspiration
whooping
255
What are the symptoms of severe pertussis?
```
hemoptysis
subconjunctival hemorrhage
hernias
seizures
death
```
256
What type of french sounding medium do you need for pertussis?
Bordet Gengou
257
what sample do you use for Dx of pertussis?
aspirates
258
Besides cultures, what else do you do to Dx pertussis?
serology; will also see sig. lymphocytosis
259
What drug is used to Tx pertussis?
erythromycin
260
T/F: erythromycin is most effective when started during the paroxysmal phase
false; no effect!
