HEENT Infections - Hunter Flashcards
what is swimmer’s ear?
otitis externa
Swimmer’s ear happens when water gets trapped in what part of the ear?
external canal
What are the predisposing factors to getting swimmer’s ear?
- hi environmental temps
- trauma from Q-tip abuse
- chronic dermatologic dz (eczema)
what are the most common bugs causing otitis externa?
gram-neg bacilli
What is the most common bug cuasing MALIGNANT otitis externa?
Pseudomonas aeruginosa
What is the second most common cause of otitis externa?
Staph aureus
The fever associated with swimmer’s ear is usually lower than….
38.3 C
What are the common clinical presentations of swimmer’s ear?
ear pain
itching
discharge
red canal, swollen (otoscopy)
What part of the ear can be painful in swimmer’s ear which makes chewing painful?
the pina
What is the standard abx to use for swimmer’s ear?
dicloxacillin or ciprofloxacin
less severe cases of swimmer’s ear can use abx eardrops of….
ofloxacin
what is the temperature greater than in malignant otitis externa?
greater than 38.3 C
must have severe pain and purulent exudate
Malignant otitis media begins as an infx of the external auditory meatus and the patient then develops….
otorrhea
Necrotizing infx from malignant otitis externa can spread to what areas?
MASTOID BONE
blood vessels
cartilage
brain!
In what types of patients do you see malignant otitis externa?
DIABETES; immunosuppresed
What is the Abx for malignant otitis externa?
imepenem and refer to ENT
T/F: malignant otitis externa is fatal if untreated
true
what percent of kids younger than one year get otitis media?
50%
what percent of kids younger than 3 get at least one bout of otitis media?
80%
What is the most common Dx in febrile children?
otitis media
if a kid presents with purulent conjunctivitis or rhinosinusitis, what should they be examined for?
otitis media
Immune deficient people are more likely to have what type of otitis media?
recurrent
What are the three most common causes of otitis media?
Strep pneumo
nontypeable H. flu
Moraxella catarrhalis
What are the two uncommon causes of otitis media?
staph aureus
strep pyogenes
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
Acute otitis media is usually preceded by an upper respiratory tract (blank) infection
viral
A blocked eustachian tube creates negative pressure and produces what type of effusion?
serous
What are the definitive criteria for Dx of otitis media?
- pain
- fever
- effusion
A tympanic membrane (blank) is an indication of effusion
bulge
T/F: most cases of otitis media resolve without abx
true
If pts are still symptomatic by day 3 with otitis media, what abx should you start?
amoxicillin
da fuck is a hordeola?
stye
hordeolas appear as…..
acute purulent papules
WHERE do hordeolas occur?
lid margin
what is the cause of 90%+ of all hordeola?
staph aureus
Hordeola are a complication of what?
blepharitis
What is blepharitis?
blockage and infection of the Zeiss or Moll sebaceous glands or meibomian glands in the tarsal plate
What is a chalazia?
GRANULOMATOUS hordeola that is not painful
T/F: most hordeolas drain spontaneously
true
How do you drain an external hordeola?
lance it and pluck the nearby lashes
How do you treat an internal hordeola?
warm compress
oral dicloxacillin
what prevents hordeola formation?
good hygeine
what are the symptoms of orbital cellulitis?
proptosis ophthalmoplegia edema erythema pain on eye movement fever, headache, malaise chemosis, hyperemia of conjunctivia
When should you suspect orbital cellulitis?
recent sinus infection
facial trauma/surgery/dental work
What is the most common sinus to cause orbital cellulitis?
ethmoid
What are the common pathogens that cause orbital cellulitis?
Strep pneumo
staph aureus
H. flu
anaerobes
Which three antibiotics do you use to treat orbital cellulitis?
nafcillin
ceftriaxone
metronizadole
10% of orbital cellulitis results in…
vision loss
What type of orbital cellulitis is less serious?
preseptal/preorbital
What are the serious complications of orbital cellulitis?
- CAVERNOUS VENOUS THROMBOSIS
- brain abscess
- meningitis
- vision loss
Conjunctivitis is inflamm of….
palpebral and bulbar conjunctiva
bugs that cause conjunctivitis also cause…
keratitis, resulting in keratoconjunctivitis
what percent of all eye complaints are conjunctivitis?
30%
whats the common name for conjunctivitis?
pink eye
What are the three most common viral causes of pink eye
- Adenovirus (most)
2. HSV1/2 (less likely)
which viral pink eye causes more serious keratitis?
HSV1/2
Which bugs can cause purulent conjunctivitis?
- staph aureus
- strep pneumo
- h. flu
- moraxella catarrhalis
What bug causes HYPERpurulent pink eye?
Neisseria gonorrhoeae; causes SIG CORNEAL DAMAGE
what bug causes follicular (inclusion) pink eye?
chlamydia trachomatis
What is the leading cause of blindness in the world? what causes it?
trachoma; chlamydia
N. gonorrhoeae and C. trachomatis can cause conjunctivitis in newborns (blank), which can spread from the conjunctiva and rapidly infect the cornea
ophthalmia neonatorum
what are the defense mechanisms of the eye?
tearing and lysozyme in tears
what are the symptoms of an overwhelmed eye defense?
redness
discharge
irritation
T/F: pink eye is self limited
true
ophthalmia neonatorum is acquired in the (blank) and can lead to rapid corneal perforation
birth canal
chlamydial pink eye can lead to (blank) causing vision loss
scarring – especially in trachoma
follicle formation happens post what types of pink eye?
viral and chlamydia
what is injection in pink eye?
white sclera turning red from BV dilation
what are the symptoms of pink eye?
fullness
BURNING
sensation of “grit/dust” in the eye
lots of tearing
purulent discharge is seen in (viral/bacterial) pink eye
bacterial
is vision impaired in pink eye?
nope
What do you use to treat viral herpes conjunctivitis?
acyclovir
Neisseria ophthalmia neonatorum will present in what time frame after birth?
2-3 days
Chlamydia ophthalmia neonatorum will present in what time after birth?
4-10 days
In 24 hours, untreated Neisseria ophthalmia neonatorum keratoconjunctivitis can progress to….
ulceration or perforation of the cornea
what is the vertical transmission rate from mom to baby of ophthalmia neonatorum?
30-50%
what abx do you give for neisseria ophthalmia neonatorum?
ceftriaxone
what abx do you give for ophthalmia neonatorum prophylaxis?
erythromycin ointment
(blank) presents as mucopurulent keratoconjunctivitis
active trachoma
(blank) causes an intensely irritating foreign body sensation and corneal scarring
trichiasis
which phase of trichiasis leads to blindness?
cicatricial or corneal scarring phase
what actually is trichiasis?
in-turned eye lashes
What are the buzz words associated with trichiasis?
in-turned eye lashes poverty/ poor hygeine periauricular LAD light sensitivity follicular inflamm eye exudate
Inflamm of the cornea is called..
keratitis
Most cases of keratitis also cause..
conjunctivitis
T/F: keratitis cna be vision threatening
true
What types of bugs can cause keratitis?
viruses, bacteria, fungi, or parasites
What are the most common risk factor for microbial keratitis in the US?
contact lenses
What are the most common causes of viral keratitis?
- HSV
- VSV
- adenovirus
adults tend to get HSV (1/2) keratitis
HsV1
neonates tend to get HSV (1/2) viral keratitis
HSV 2
What is the MOST common type of bacterial keratitis?
Staph aureus
Besides staph aureus, what are the most common causes of bacterial keratitis?
strep pneumo
strep pyogenes
H. flu
What are the most common causes of fungal keratitis?
aspergillus
Fusarium
Candida
What is the MOST common protozoa that causes keratiis, EPSECIALLY WITH CONTACT LENSES
Acanthamoeba
what is the most common bacterial keratitis from contact lenses?
Pseudomonas aeurignosa
what is the most common corenal infection in the US?
HSV keratitis
Greater than 90% of HSV keratitis are (uni/bi)lateral
unilateral
HSV keratitis is spread from oral or genital herpes or from which CN?
trigeminal ganglion
HSV keratitis can progress from epithelilal to more serious (blank) involvement
stromal
What is the Tx for HSV keratitis?
trifluridine drops for 3 weeks; add acyclovir if it persists
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
What are the buzzwords associated with HSV keratitis?
unilateral eye pain
photophobia
oral/genital herpes
dendritic epithelial defects
the (blank) is the pigmented, vascular middle layer of the eye between the cornea-sclera outer protective layer and the retina
uvea
what are the eye structures involved in anterior uveitis?
Eyelids Cornea Iris Pupil Anterior chamber posterior chamber Ciliary body conjunctiva
What are the four general classes of uveitis?
autoimmune
infectious
traumatic
idiopathic
What percent of cases of uveitis are idiopathic?
50%
what percent of uveitis is caused by infx?
20%
what are the two most common infectious causes of uveitis?
Herpes
toxoplasmosis
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!
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
what are the eye strucutres affected by posterior uveitis?
retina
choroid
vitreous body
what is endophthalmitis?
bacterial or fungal infection of the vitreous or aqueous humor or both
What is the cause of most cases of endophthalmitis?
exogenous; cataract surgery
what are the three types of anterior uveitis?
iritis
cyclitis
iridocyclitis
What are the three types of posterior uveitis?
choroditis
chorioretinitis
retinitis
What is the most common cause of panuveitis?
treponema pallidum
which strucures are involved in panuveitis?
ALL uveal structures
What are the three most common (bacterial) causes of endopthalmitis?
staph aureus
strep
gram negative bacilli
what is the most common form of posterior uveitis?
toxoplasma chorioentereitis
An active, unifocal area of acute chorioretinal inflammation adjacent to an old (blank) suggests toxoplasma chorioretinitis
chorioretinal scar
(blank) inflammation can be severe in toxoplasma chorioenteritis
vitreous
what is the mechanism of damage in toxoplasma choroenteritis?
T-cell mediated immunopathology
Dormant (blanks) cysts can reactivate in the eye
bradyzoites
In toxoplasma chorioenteritis, vision may be impaired if lesions form within the…
macula
Transplacental transfer of toxoplasma choroenteritis happens in a third of women infected with…
toxoplasma gondii
T/f: many cases of toxoplasma chorioenteritis are congenital infxs
true
What fundoscopic findings do you see with toxoplasma chorioenteritis?
whitish-yellow inflammatory lesion near an atrophic, pigmented retinochoroidal scar.
What is the Tx for ocular toxoplasmosis?
Trimethoprim/sulfamethoxazole, clindamycin, and prednisone
how many colds per year doe a kid younger than five get?
5-7
how many colds per year does an adult get?
1-2
90% of colds are caused by…..
viruses: RHINOVIRUS coronavirus adenovirus myxovirus enterovirus
how are colds spread?
person to person
Rhinovirus enters nasal passages and infect-2s what type of cells?
ciliated columnar epithelial cells
what protein on nasal mucosa does rhinovirus bind to?
ICAM-2
Death of host cells leads to inflammation causing what two symptoms?
hyperemia and edema
What type of snot do you have when you have a viral infx?
clear, mucoid
When does your snot turn green in a viral infx?
mucopurulent with secondary bacterial infx from NORMAL FLORA
paranasal sinusitis or otitis media may occur if you block what two structures?
sinus ostia
eustachian tubes
T/f: rhinoviral colds may turn into bronchitis
true
T/F: lab culture and serologic testing for viruses is common
FALSE
What is the Tx for a viral cold?
supportive therapy
What are the things that make up the dx of a viral infx?
symptoms
localization of dz process
time of year
What leads to lowering viral spread?
HANDWASHING and disinfecting surfaces
why do you develop nasal polyps?
chronic nasal inflammation
Which sinuses are involved and for how long in acute rhinosinusitis?
paranasal; no longer than 4 weeks
What is the most common cause of rhinosinusitis?
resp. viruses
T/F: most people recover form acute rhinosinutsitis without medical care
true
acute rhinosunitis follows what types of infections?
COMMON COLD
dental extractions
rhinitis due to allergies
what are the most common viral causes of acute rhinosinusitis?
rhinovirus
parainfluenza virus
RSV
adenovirus
What are the most common secondary bacterial causes of acute rhinosinusitis?
Strep pneumo
nontypeable H. flu
Moraxella catarrhalis
What are the fungal bugs that immunocompromised pts get that may cause acute rhinosinusitis?
Mucor
Rhizopus
Aspergillus
t/F: acute rhinosinusitis is dx’d with cultures
false; clinical signs
What are the symptoms of acute rhinosinusitis?
rhinorrhea
facial pressure
What level of fever and what type of discharge are seen in acute rhinosinusitis?
> 39 C
purulent dischage
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
What are the symptomatic Tx for viral rhinosinusitis?
- oral hydration
- antipyretics, analgesics, decongestants
- mucolytics
What are the abx you shoud use in bacterial rhinosinusitis?
axocillin or cefdinir
TMP/SMA or z-pack in PCN allegies
what types of things need to be repaired surgically in bacterial rhinosinusitis?
septal deviations
large nasal polyps
foreign bodies
what are the important signs in rhinocerebral mucormycosis/
BLACK PALATAL ESCHAR
facial pain
headache, lethargy
vision loss, proptosis
what is a huge risk factor in rhinocerebral mucormycosis?
diabetes
What histo test gives you a Dx of what is a huge risk factor in rhinocerebral mucormycosis?
fine needle aspirate
what do you see on fine needle aspirate in what is a huge risk factor in rhinocerebral mucormycosis?
nonseptate hyphae and right angle branching
what type of major CNS complication may happen because of rhinocerebral mucormycosis?
cavernous venous thrombosis
What type of imaging study is useful in the Dx of rhinocerebral mucormycosis?
CT
Which systemic antifungal should you start immediately in rhinocerebral mucormycosis?
Amphotericin B
What type of surgery is needed in rhinocerebral mucormycosis?
debridement
what is the most common cause of pharyngitis?
viruses
what age group gets strep throat?
5-15
what bug causes strep throat?
strep pyogenes
Besides (blank), pharyngitis is self limiting
diphtheria
What is the most common viral cause of pharyngitis?
RHINOVIRUS
ADENOVIRUS
ebv, cmv, hsv, influenza, parainfluenza, corona, entero, hiv
What is the most common bacterial cause of pharyngitis?
GAS
what causes fungal oropharyngitis aka thrush?
candida albicans
in viral pharyngitis, viruses infect what type of cell?
mucosa of the nasopharynx
S. pyogenes causing pharyngitis attaches to the mucosal epithelial via…
M protein
What two factors produced by strep pyogenes aid in its invasion of the mucosa?
protease
hyaluronidase
what is the most common sequelae after pharyngitis?
rheumatic fever
what is the clinical presentation of pharynngitis?
fever cervical LAD maybe vomiting no cough, conjunctivits or runny nose PAIN UPON SWALLOWING
What are the lab results that indicate a strep pyogenes pharyngitis?
b-hemolytic
bacitracin sensitive
what types of symptoms of pharyngitis do kids get?
HA
N/V
abd. pain
Pharyngitis presents with (blank) erythema with or without exudate.
tonsillopharyngeal
What are the complications of pharyngitis?
rheumatic fever
peritonssilar abscess
cervical LAD
mastoiditis
What is the Tx for bacterial pharyngitis?
oral PCN V for ten days
what are the common methods of Dx for viral pharyngitis?
S. pyogenes rapid AG detection test
are the rapid Ag detectoin tests as sensitive as cutlures?
nope
What should you do if rapid strep A is positive?
begin Abx
what should you do if a rapid strep A test is negative?
wait for cultures before beginning Abx
What type of sample should you take to culture pharyngitis?
throat swab; place on blood agar
What are the complicatoins from pharyngitis that we are trying to avoid by using abx?
rheumatic fever and suppurative complications
T/F: most causes of candidiasis are painful
false; painless
what two drugs do you use to treat candidiasis?
nystatin or clortrimazole
How do you manage candidiasis?
manage the underlying cause of immunosuppresion
how will candidiasis appear in culture?
creamy white colonies on SABOURAUD dextrose agar with chlromamphenicol B
how will candidiasis look on gram stain?
positive, large, oval, budding organisms
what is the only known reservoir for diphtheria?
humans
How is diphtheria transmitted?
respiratory droplets and skin contact
what does diphtheria look like on gram stain?
irregularly staining
gram positive
club-shaped!
Only C. diphteriae (blank) for the beta bacteriophage carrying the toxin gene causes diphtheria
lysogenic
What causes damage to the oropharynx in diphtheria?
diphtheria toxin
What is the method of damage mediated by diphteria toxin?
ADP-ribosylation of eFII, terminating protein synth in mucosal cells
What process forms the pseudomembrane in diphtheria?
anit-inflamm response to cell death and the dead cells themselves
Besides the mouth, what two other areas can diptheria toxin bind to?
heart and nerve cells
What is a major complicatoin of diphtheria?
myocarditis
What types of nerves are most sensitive to diptheria toxin?
cranial nerves
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)
What is the special type of LAD you get with diphtheria?
bull neck; regional LAD and edema of the surrounding tissues
Describe the respiratory symptoms of diphtheria?
airway obstruction tachypnea stridor cyanosis fetid breath
what are the two methods to assay for diphtheria toxin?
Elek immunodiffusion assay
PCR
what samples do you use to test for diphtheria toxin?
oropharynx swabs (grey pseudomembrane)
Where in the hospital do you put someone with diphtheria?
isolation
what do you give to neutralize diphtheria toxin?
antiserum
What are the two abx you can use for diphtheria?
erythromycin
clindamycin
T/F: pts presenting with diptheria should receive the vaccine
true; ensures immunity
Which diptheria vaccine do we give to kids? to adults?
kids: DTaP
adults: DT
why is it extra important to manage the airway of young kids?
narrower than older kids and adults and will close sooner
what is the most common cause of croup?
parainfluenza virus
What are the viruses that causes laryngitis?
rhinovirus adenovirus corona metapneumo influenza
what are the bacteria that cause laryngitis?
Mycoplasma pneumonia
Chlamyophila pneumonia
What is the most important cause of epiglottitis?
H. flu B
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
what causes the partial airway obstructoin in croup and laryngitis?
mucus made by host
What effect does laryngitis have on speech?
dysphonia (hoarseness)
odynophonia (pain with speaking)
dysphagia
In viral croup, narrowing of the (blank) results in inspiratory stridor
subglottic trachea
(blank) causes the barking cough in viral croup
laryngotracheal inflamm
Epiglotitis is a (blank) of the epiglottis and surrounding tissue
cellulitis
describe the croup prodrome
mild URI
coryza, nasal congestion, sore throat cough
lasts 2-3 days
How do you Dx croup?
Clinically;
fever
stridor
barking cough
What is the steeple sign on xray?
subglottic narrowing in croup
What must you rule out before making a Dx of croup?
epiglotitis; it’s life threatening
why is there now more cases of epiglotitis in adults rather than kids?
successful child vax programs!!!
T/F: morbidity and mortality of epiglotitis is low
false
What is the HIGEST PRIORITY when treating epiglotitis?
securing the airway
Where in the hospital do you put pts with epiglotitis?
ICU
how high do fevers get in epiglotitis?
> 40C
What is the triad associated with epiglotitis?
drooling
dysphagia
distress
what is the thumbrpint sign on xray?
swollen epiglottis
Epiglotitis cultures are positive in what percent of cases?
50-75% in Hflu
What is the Tx for epiglotitis?
- Abx: ceftriaxone
2. corticosteroids for inflamm
what causes whooping cough?
bordetella pertussis
what is the gram stain of pertussis like?
gram neg coccobacillus
what is the only natural host of pertussis?
humans
how is pertussis spread?
aerosolized droplets
In what age group is pertusis most serious?
less than 12 months
50% of kids with pertussis can be attributed to…
adult carriers with chronic cough
pertussis inhaled in resp. droplets attaches to the (blank) in the trachea
ciliated epithelium
What three virulence factors cause damage in pertussis?
Pertussis toxin
tracheal cytotoxin
filamentous hemagglutinin
Describe the MOA of pertussis toxin?
ADP-ribosylates guanine-nucleotide binding protein
what causes the cough in pertusis?
mucus production
What are the neruologic complications of pertussis?
hypoxia and intracerebral hemorrhage
what part of the pt history is most important when considering pertussis?
immunization history
The (blank) phase of pertussis looks the same as a URI
catarrhal phase
The (blank) phase of pertussis begins with sudden episodic coughing for 2-4 weeks
paroxysmal
What does the pertussis cough sound like on inspiration
whooping
What are the symptoms of severe pertussis?
hemoptysis subconjunctival hemorrhage hernias seizures death
What type of french sounding medium do you need for pertussis?
Bordet Gengou
what sample do you use for Dx of pertussis?
aspirates
Besides cultures, what else do you do to Dx pertussis?
serology; will also see sig. lymphocytosis
What drug is used to Tx pertussis?
erythromycin
T/F: erythromycin is most effective when started during the paroxysmal phase
false; no effect!
