Hunter: EENT Infections Flashcards
1
Q
External auditory canal infection (swimmer’s ear)
Occurs in 4 of every 1000 persons each year
Most common in swimmers and divers who frequently get water trapped in the external canal
A
otitis externa
2
Q
What are some predisposing factors for otitis externa?
A
high environmental temperatures
trauma from mechanical removal of cerumen or foreign objects
chronic dermatologic disease (ex: eczema)
3
Q
Most common cause of otitis externa?
A
gram-negative bacilli
4
Q
The major pathogen associated with otitis externa; the most common cause of swimmer’s ear and malignant otitis externa
A
Pseudomonas aeruginosa
5
Q
Less common cause of otitis externa
A
Staph aureus
6
Q
Symptoms of otitis externa?
A
ear pain, itching, and discharge
external canal red and swollen
tender pinna, can make chewing difficult
7
Q
What is used to treat otitis externa?
A
dicloxacillin
ciprofloxacin
**less severe cases, use ofloxacin eardrops
8
Q
Suspected when temperature is >38.3°C, pain is severe, and there is a purulent exudate in the ear;
Necrotizing infection can spread to the cartilage, blood vessels, bone (mastoid), and brain
Often seen in immunosuppressed adults with diabetes
A
malignant otitis externa
9
Q
How to treat malignant otitis externa?
A
imepenem
**think about ENT referral for surgical debridement
10
Q
Primarily a bacterial infection of the inner ear mucosa with exudate production seen in children
50% of children experience an episode before 1 year of age; 80% by the age 3
the most frequent diagnosis in febrile children; boys more often than girls
A
Otitis media
11
Q
Infants and children with purulent conjunctivitis or rhinosinusitis should be examined to determine if they have (blank) (otoscopy)
A
otitis media
12
Q
Persons with (blank) are more likely to have recurrent otitis media
A
immune deficiencies
13
Q
Most common causes of otitis media?
A
Strep pneumo
non-typeable H. influenzae
Moraxella catarrhalis
**can be caused by Staph aureus or Strep pyogenes
14
Q
In children younger than 6 weeks of age, (blank) commonly cause acute otitis media
A
gram negative bacilli
**E. coli, Klebsiella, Pseudomonas aeurginosa
15
Q
Acute otitis media is usually preceded by a (blank)
A
upper respiratory tract infection
16
Q
What causes the serous effusion in otitis media?
A
blocked eustachian tube –> prevents mucosal absorption of air –> negative pressure in middle ear –> serous effusion
17
Q
These symptoms are definitive for acute otitis media
A
pain
fever
middle ear effusion (tympanic membrane bulge)
18
Q
How to treat acute otitis media?
A
many cases resolve w/o antibiotics, prescribe an analgesic, like acetaminophen or amoxicillin if symptoms aren’t relieved in 3 days
19
Q
relatively common eye infection; appear as acute purulent papules that occur at the lid margin;
can occur as a complication of blepharitis (blockage and infection of the Zeiss or Moll sebaceous glands or meibomian glands in the tarsal plate)
A
hordeola (styes)
20
Q
What causes hordeola (styes) in 90-95% of cases?
A
staph aureus
21
Q
granulomatous lesions that are not painful
A
chalazia
22
Q
How to treat hordeola? External vs internal?
A
most drain spontaneously;
if external, lance it or epilate nearby lashes; if internal, apply warm compresses plus oral dicloxacillin
23
Q
How to prevent hordeola?
A
good hygiene of the eyelid margin
24
Q
Suspected in patients with recent sinusitis, facial trauma or surgery, or dental work
A
orbital cellulitis
25
Most common cause of orbital cellulitis?
Strep pneumo and other strep, staph aureus
| H. influenzae
26
Most cases of orbital cellulitis result from (blank)
ethmoid sinusitis
27
(blank)% of orbital cellulitis cases result in some vision loss
10
28
Serious complications of orbital cellulitis
brain abscess
meningitis
cavernous venous thrombosis
29
Inflammation of the palpebral and bulbar conjunctiva
Most organisms causing conjunctivitis also cause keratitis (keratoconjunctivitis)
Very common (30% of all eye complaints to family physicians); can occur at any age
A common name for this disease, pinkeye, caused by inflammatory blood vessel dilatation
conjunctivitis
30
Most common cause of viral conjunctivits?
adenoviruses
**HSV1 and HSV2 less common
31
These bugs can cause purulent conjunctivitis
Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis
32
can cause hyperpurulent conjunctivitis, which can cause significant corneal damage
Neisseria gonorrhoeae
33
causes follicular (inclusion) conjunctivitis in sexually active teenagers and young adults; also causes trachoma, the leading cause of infectious blindness in the world
Chylamydia trachomatis
34
can cause conjunctivitis in newborns (ophthalmia neonatorum), which can spread from the conjunctiva and rapidly infect the cornea
N. gonorrhoeae
| C. trachomatis
35
Infectious agents adhere to the conjunctiva and overwhelm normal defense mechanisms (e.g., tearing, lysozyme): clinical symptoms of redness, discharge, and irritation
usually is a self-limited process; however, in immunocompromised patients and in patients with certain infectious agents, conjunctivitis can cause serious infections of the cornea that threaten loss of sight
conjunctivitis
36
caused by N. gonorrhoeae acquired in the birth canal can be invasive and can lead to rapid corneal perforation
ophthalmia neonatorum
37
can lead to conjunctival scarring (particularly in trachoma)
chlamydial conjunctivitis
38
(blank) causes conjunctival blood vessels to dilate and the underlying white sclera to appear red (injection)
The patient may have a sensation of fullness, burning, or of grit or a foreign body in the eye
Excessive (blank) may also occur
A purulent discharge is more common in (blank) causes of conjunctivitis
Dried exudate can “glue” the eyelid shut
Usually (blank) is not impaired; cornea and pupil appear normal
Treatment of viral conjunctivitis is usually (blank) (artificial tears and cold compresses)
```
viral conjunctivitis;
tearing;
bacterial;
vision;
supportive
```
39
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Ophthalmia neonatorum (conjunctivitis occurring within the first month of life)
(blank) occurs within 2 or 3 days of delivery, compared to 4-10 days for the more common Chlamydia trachomatis
Untreated Neisseria kerato-conjunctivitis can progress to ulceration or perforation of the (blank) in 24 hr
In actively infected mothers, there is a 30-50% vertical transmission rate during vaginal delivery
(blank) is effective in treating neisserial infections in the newborn; erythromycin ointment use for prophylaxis
```
N. gonorrhoeae;
cornea;
ceftriaxone
40
A disease of poverty and unsanitary living conditions
Active form presents as a mucopurulent keratoconjunctivitis
The conjunctival surface of the upper eyelid shows a follicular response
Causes an intensely irritating foreign body sensation and corneal scarring
The cicatricial or corneal scarring phase can lead to blindness (C)
trachoma
41
Inflammation of the cornea
keratitis
42
Most cases of keratitis also involve the conjunctiva, leading to (blank)
keratoconjunctivitis
43
Microbial keratitis is a potentially vision-threatenind condition. What is the most common risk factor for microbial keratitis?
contact lenses!
44
Most common cause of viral keratitis?
Bacterial keratitis?
Most common cause in contact lens wearers?
Herpes simplex
Staph aureus
Acanthamoeba and Pseudomonas aeurginosa
45
the most common corneal infection in the U.S.
Leading cause of infectious blindness and need for corneal transplantation
Most cases (> 90%) are unilateral
Can be transferred to eye from oral or genital herpes lesions; can also spread from trigeminal ganglion
Infection may progress from epithelium to more damaging stromal involvement
HSV keratitis
46
How to treat HSV keratitis?
trifluridine drops for 3 weeks; if infections persists, try acyclovir
**corticosteroids can dampen inflammation caused by HSV cytotoxicity and the immune response
47
inflammation of the uvea, the pigmented, vascular middle layer of the eye between the cornea-sclera outer protective layer and the retina
uveitis
48
What can cause uveitis?
autoimmune conditions
infections (20%)
trauma
idiopathic (50%)
49
(blank) uveitis presents with eye pain, decreased vision, ciliary flush, and cells in the anterior chamber (hypopyon). The vitreous has few cells and the retina is normal.
(blank) uveitis presents with painless loss of vision, few cells in the anterior chamber, many cells in the vitreous, and lesions in the retina, choroid, or both
anterior; posterior
50
refers to bacterial or fungal infection of the vitreous or aqueous humor or both. Most cases are exogenous; organisms are introduced from an external source (e.g. cataract surgery)
endophthalmitis
51
What causes anterior uveitis?
Posterior uveitis?
Panuveitis?
Endopthalmitis?
Herpes simplex
Toxoplasma gondii, CMV, toxocara canis
Treponema pallidum
Staph aureus, strep, gram-negative bacilli
52
the most common form of posterior uveitis in otherwise healthy individuals (worldwide)
An active, unifocal area of acute chorioretinal inflammation adjacent to an old chorioretinal scar
Vision may be impaired when lesions form in critical locations (macula)
Toxoplasma chorioretinitis
53
Many cases of toxoplasma chorioretinitis originate as (blank) infections
(blank) transmission occurs in a third of women who acquire T. gondii infection during pregnancy
congenital; transplacental
54
Who gets the common cold?
Most common cause?
How is it spread?
world-wide, children less than 5yo get 5-7 a year, esp in winter months, adults get 1-2 per year;
caused by rhinovirus most commonly;
spread person to person by coughing and shaking hands
55
What causes the pathogenesis of the common cold? Start with the rhinovirus entering the nose...
Rhinovirus enters nasal passages (from contact with contaminated surfaces or inhalation of infectious droplets)
Virus infects ciliated columnar epithelial cells
Host cells killed causing inflammation
Clear, mucoid nasal secretions (rhinorrhea) initially produced; can become mucopurulent with secondary bacterial infection (normal flora)
If severe, blockage of the sinus ostia or the eustachian tubes occurs; paranasal sinusitis or otitis media results
Infection may extend to the lower respiratory tract and cause bronchitis
56
What can be used to treat the common cold? What can be done to prevent it?
supportive therapy;
| handwashing and disinfecting contaminated objects, avoid contact with others during the cold season
57
Inflammation or infection of nasal passage mucosa and at least one of the paranasal sinuses that lasts no longer than 4 weeks
Mostly caused by respiratory viruses
Infection may follow the common cold, dental extractions, or allergies
Occurs most often during winter months
acute rhinosinusitis
58
What causes acute rhinosinusitis?
resp viruses esp rhinovirus, parainfluenza virus, RSV and adenovirus
59
This occurs when acute viral rhinosinusitis is complicated by bacterial infection
acute bacterial rhinosinusitis
60
Most common causes of acute bacterial rhinosinusitis?
Strep pneumo
nontypeable H. influenzae
Moraxella catarrhalis
61
T/F: Rhinosinusitis can be caused by fungi, like mucor, rhizopus and aspergillus
True
**esp in immunocompromised patients
62
What are the symptoms of acute bacterial rhinosinusitis?
```
sneezing
rhinorrhea
nasal congestion
postnasal drip
aural fullness
facial pressure and headache
sore throat
cough
fever
muscle ache
```
**if caused by bacteria, high fever and purulent discharge
63
How to treat acute viral rhinosinusitis?
oral hydration: saline in nose and steam to promote drainage
antifever, antipain, anti-congestant
mucolytics (like guaifenesin) to break up mucous and reduce postnasal drip
64
How to treat acute bacterial rhinosinusitis?
antibiotic therapy with amoxicillin or cefdinir
have septal deviations, large nasal polyps, and foreign bodies surgically removed
proper dental management
65
Most common presentation includes facial pain, headache, lethargy, visual loss, proptosis, and/or palatal ulcer (eschar)
Diabetes is an important risk factor
Fine-needle aspiration can yield a diagnosis (silver stain shows nonseptate hyphae and right angle branching)
Can rapidly progress to CNS involvement (cavernous venous thrombosis) and death
acute rhinocerebral mucormycosis
66
How to treat acute rhinocerebral mucormycosis?
systemic antifungals immediately (amph B)
Surgical consult for extensive débridement of all infected and necrotic tissue, with drainage of all sinus and abscess fluid collections
67
Who gets pharyngitis?
Most common cause?
How is it acquired?
world-wide distribution, most common in winter and early spring;
most cases caused by viruses (strep pharyngitis usu in people age 5-15)
acquired by person-to-person contact
68
Most common cause of viral pharyngitis?
Bacterial pharyngitis?
Fungal pharyngitis with thrush?
rhinovirus, adenovirus
Strep pyogenes
Candida albicans
69
causes a serious pharyngitis with systemic complications
Cornybacterium diphtheriae
70
In viral pharyngitis, viruses gain access to (blank) lining the nasopharynx and replicate and damage them
In bacterial pharyngitis, S. pyogenes attaches to the mucosal epithelial cells using (blank)
Extracellular factors produced by S. pyogenes during the infection include protease and hyaluronidase; these extracellular factors assist the bacteria in invading the mucosa
Post-streptococcal rheumatic fever can occur after an episode of (blank)
(blank) is most often seen in immunocompromised patients
mucosal cells;
M protein;
pharyngitis;
thrush
71
How do patients with strep pharyngitis present?
```
fever
severe pain upon swallowing
headache
nausea, vomiting, abdominal pain
tonsillopharyngeal erythema
untreated pts can develop rheumatic fever
```
72
How to treat strep pharyngitis?
oral penicillin V for 10 days
73
How do you diagnose strep pyogenes pharyngitis?
throat swab, grow on blood agar
rapid strep antigen tests are available, but not as sensitive as cultures
74
If a rapid strep A test is positive, what should you do? If negative?
start antibiotics; wait for cultures to start Abx
75
White creamy colonies grown from mouth
Mostly painful
Can cause dysphagia (trouble swallowing)
oropharyngeal candidiasis (thrush)
76
How to treat thrush?
Treatment with topical nystatin or clortrimazole
| Manage the cause of immunosuppression
77
What causes diphtheria? What does this bacteria look like?
Where does it colonize?
How is it transmitted?
Corynebacterium diphtheriae; irregularly staining gram +, club shaped bacteria; colonizes oropharynx and skin; transmitted via respiratory droplets and skin contact
78
What causes damage to the pharynx in diphtheria?
Damage to the pharynx is caused by the diphtheria toxin, which kills the mucosal cells by ADP-ribosylation of elongation factor II and terminates protein synthesis
An inflammatory response to cell death and the dead cells form the pharyngeal pseudomembrane; toxin can also bind to and damage the heart and nerve cells
79
What is the major complication of diphtheria?
myocarditis
**high mortality rate
80
Which nerves are most sensitive to the Diphtheria toxin, resulting in difficulty swallowing and in nasal regurgitation of liquids?
cranial nerves
81
```
Presents with pharyngeal pain, pseudomembrane on the tonsils and back of the oropharynx
Regional lymphadenopathy (“bull neck”), edema of the surrounding tissues, fetid breath, low-grade fever, and cough are also common
Airway obstruction can occur, and findings of tachypnea, stridor, and cyanosis are seen
The toxin can damage the heart and the cranial nerves, causing myocarditis and neurologic abnormalities (e.g., palatine palsy, difficulty swallowing, nasal regurgitation of liquids)
```
Diphtheria
82
What can be done to diagnose diphtheria?
swab oropharynx, and culture sample - use Elek assay or PCR
83
How should you treat a diphtheria patient?
1. hospitalize them and place them in isolation
2. give antiserum immediately to neutralize the toxin
3. next urgent step is antimicrobial treatment with erythromycin or clindamycin
4. give diphtheria vaccine to ensure immunity to the disease - this will provide active immunity!
84
3 acute inflammatory diseases of the upper airway are croup, acute laryngitis, and epiglottitis. What is the most common and most serious risk for this group of diseases?
airway obstruction
**risk is particularly important in young children who have narrower airways than older children/adults
85
What is the most common cause of croup?
viruses, especially parainfluenza virus
86
What is the most common cause of laryngitis?
many microorganisms, including rhinovirus, adenovirus, coronavirus, metapneumovirus, etc
87
What is the most common cause of epiglottitis?
H. influenzae type b
88
Viral infection of the upper airways causes inflammation and edema of the larynx in acute (blank); Viral infection in the larynx, trachea, and bronchi causes viral (blank)
(blank) is produced by the host and causes partial obstruction of the airway in both acute laryngitis and viral croup
laryngitits; croup; mucous
89
How does acute laryngitis present?
swelling of the vocal cords --> dysphonia (hoarseness), odynophonia (pain when speaking), and dysphagia (difficulty swallowing)
90
What causes the audible inspiratory stridor in croup? What causes the barking cough in croup?
narrowing of the subglottic trachea in a child's airway; laryngotracheal inflammation
91
Epiglottitis is a cellulitis of the epiglottis and surrounding tissues. What are the symptoms?
inflammatory response --> erythema and edema
| sore throat --> difficulty breathing, stridor, obstruction of airway can lead to respiratory arrest
92
How do you diagnose croup? What would you see on xray?
clinical diagnosis based on fever, stridor, and barking cough
look for steeple sign on x-ray
93
(blank) is still the most common cause of epiglottitis; the (blank) vaccine has significantly reduced the incidence
H influenzae type b; Hib
**prevalence in adults now greater than in children due to Hib vaccination
94
What is the classical presentation of epiglottitis? What would you see on a neck radiograph?
```
fever
drooling
dysphagia
distress
thumbprint sign on imaging (swollen epiglottis)
```
95
How to treat epiglottitis?
ceftriazone for 7-10 days;
| corticosteroids to calm inflammation
96
What causes pertussis (whooping cough)? How is it transmitted? Who does it affect?
caused by Bordetella pertussis, a gram negative bacteria; transmitted person to person via respiratory droplets, and is highly infectious; most serious in children <12yo - can be transmitted to adults who get a chronic cough (carriers)
97
What causes the pathology in pertussis?
B pertussis is inhaled and attaches to the ciliated epithelium in the trachea; produces pertussis toxin, tracheal cytotoxin, and filamentous hemagglutinin which causes tracheal tissue damage; large amounts of mucus are produced causing the cough; neurologic effects associated with hypoxia and intracerebral hemorrhage
98
How does pertussis present?
paroxysmal phase: sudden episodic coughing for 2-4 weeks
cough begins with an inspiratory whoop
severe cases can result in hemoptysis, hernias, seizures, and death
99
How to diagnose pertussis?
culture aspirate on Bordet-Gengou medium or use serology, looking for elevated white count with lymphocytosis
100
How to treat pertussis?
erythromycin
