Internal Medicine - Infectious Diseases - Head & Neck Infections Flashcards
What sign on physical exam effectively EXCLUDES otitis media?
Fully mobile tympanic membrane; immobility is the most sensitive sign for otitis media.
What is the best initial treatment for otitis media?
Amoxicillin + decongestant
A patient presents with recurrent otitis media (or a diagnosis of otitis media that is failing to respond to multiple antibiotics). What is the next best step in the management of this patient?
Tympanocentesis
A patient with a recent diagnosis of otitis media has no response to treatment with amoxicillin. Give two other medications that can be used next to treat this patient.
Amoxicillin/clavulanate
Macrolide: azithromycin or clarithromycin
A patient presents with facial pain/tenderness, discolored nasal discharge, a bad taste in their mouth, and a fever. What is the most likely diagnosis? What is the most accurate diagnostic test for this condition?
In real life, what test would you most likely get for diagnosing this patient?
Sinusitis
Sinus biopsy or aspirate
CT scan
A patient presents with recurrent sinusitis (or sinusitis that does not respond to different empiric therapies). What is the next best step in the management of this patient?
Biopsy
What are two key signs/symptoms of pharyngitis?
- Pain on swallowing
2. Pharyngeal exudates
What is the most likely causative agent for pharyngitis?
Streptococcus pyogenes
What is/are the best diagnostic step(s) for pharyngitis?
Rapid strep test + culture
A patient presents with pain on swallowing, enlarged lymph nodes in their neck, exudates in their pharynx, and fever. They deny any hoarseness or cough. Their rapid strep test comes back negative. What is the next best step in management for this patient?
Prescribe antibiotics; a negative rapid strep test does not exclude pharyngitis, especially if the patient is presenting with the classic symptoms of pharyngitis!
Give them antibiotics until the culture comes back one way or the other.
More for wards, less for exam: if these two symptoms are present, the patient is less likely to have true pharyngitis…
Hoarseness
Cough
A patient presents with symptoms of pharyngitis along with small vesicles or ulcers of the oral mucosa. What is the most likely causative agent?
HSV or herpangina
A patient presents with symptoms of pharyngitis along with membranous exudates at the back of their throat. What is the most likely causative agent (there are 3 choices).
Diphtheria, Vincent angina, or EBV
Note: Vincent angina = acute necrotizing infection of pharynx caused by a combination of Fusiformis fusiformis (a fusiform gram negative bacillus) and Borrelia vincentii (a spirochete). These same organisms can also cause a gingivostomatitis known as “trench mouth”.
What is the main reason for treating streptococcus pharyngitis with antibiotics instead of waiting for infection to resolve on its own?
Treatment prevents development of rheumatic fever
What is the best treatment for pharyngitis?
Penicillin or amoxicillin
