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CDM 3 Exam 1 > Lecture 3 - Otic Disorders > Flashcards

Lecture 3 - Otic Disorders Flashcards

1
Q

predisposing factors to impact earwax?

A

narrow/deformed ear canals
Overactive glands
using hearing aids or earplugs
excessive hair growth in eternal auditory canal
age = drier
Male> females

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2
Q

signs and symptoms of impacted earwax

A

feeling of fullness, pain or itching in ear canal
ringing in ears
loss of hearing ~80% obstruction

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3
Q

How to prevent impacted earwax

A

clean outer ear regularly
clear ear devices regularly
irrigation + prophylactic cerumenolytic agents

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4
Q

Self-care exclusions for Otic disorders

A

signs of infection
Pain w/ ear discharge
bleeding or trauma
ruptured tympanic membrane
ear surgery w/I 6wks
Tympanostomy tubes
< 12 yrs old

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5
Q

Treatment for impacted earwax

A

Cerumenolytics
irrigation
manual removal

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6
Q

water-based cerumenolytics

A

Acetic acid 2.5%
Docusate sodium 10mg/ml
Hydrogen peroxide 3%
Sodium bicarb 10%
Sterile water or saline

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7
Q

Carbide peroxide admin

A

5-10 drops, let sit for 15min, flush w/ water water and make sure all drained

repeat 2X day for 4 days

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8
Q

Carbide peroxide ADE

A

Popping sounds on admin

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9
Q

Carbide peroxide counseling points

A

careful to not break tympanic membrane

if dizziness occur, contact HCP

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10
Q

Ear drop admin adults

A

wash hands
lie on side so affected ear facing up
pull auricle up and toward back of head, instill drops

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11
Q

Ear drop admin kids < 3

A

wash hands
lie on side so affected ear facing up
gently pull earlobe down toward the back of the head, instill drops

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12
Q

earwax removal

A

irrigation or manual removal (by trained professional)

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13
Q

what to avoid for earwax removal

A

using cotton swabs or ear candling

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14
Q

predisposing factors to water-clogged ears

A

shape of ear canal
excessive earwax
swimming
excessive sweating
humid climates

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15
Q

signs and symptoms of water-clogged ears

A

feeling of wetness or fullness in ear
gradual hearing loss
not usually painful

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16
Q

non-pharm treatment for water-clogged ears

A

tilt head to side
lie down w/ affected ear facing down
chew/yawn

hair dryer on low setting

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17
Q

swim-EAR

A

isopropyl alcohol 95% in anhydrous Glycerin 5%

safe/effective

use after shower, swim, bath, washing hair

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18
Q

swim-EAR MOA

A

alcohol mixes w/ water and help dry canal, >70% can act as disinfectant

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19
Q

swim-EAR ADE

A

Generally well tolerated

can cause stinging if skin is broken

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20
Q

swim-EAR admin

A

instill 4-5drops into open ear canal
let sit for 30sec-1min
tilt head to side and let it drain out

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21
Q

Risk factors to swimmers ear

A

High humidity
warmer temp
maceration of skin
local trauma to external ear
exposure to water that is high in bacteria

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22
Q

signs and symptoms of swimmers ear

A

rapid onset
severe ear pain
itching
fullness

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23
Q

prevention of swimmers ear

A

using ear plugs
dry ear after swimming
tilt head to remove water

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24
Q

swimmers ear usually treated with….

A

topical antimicrobials, 7-10 day treatment

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25
Q

If ruptured tympanic membrane, you want to use…

A

Fluoroqinolones

26
Q

what should be avoided for ruptured tympanic membrane

A

Cipro-HC
avoid aminoglycosides

27
Q

topical antimicrobail fluoroquinolones

A

cipro 0.2/0.3%
cipro 0.3%/dex 0.1%
Cipro 0.2%/hydrocort 0.1% = no use rupture
Ofloxacin 0.3%

28
Q

swimmers ear non-pharm treatment

A

minimuze trauma to/manipulation f ear
avoid water submersion for 1 week

use ear plug when shower
dry canal after showering

29
Q

Analgesics preferred for swimmers ear?

A

Oral preferred, scheduled instead of PRN….48-72hrs worth

30
Q

are oral antibiotics used for swimmers ear?

A

not really, dont need to use

31
Q

who can recieve oral antibiotics for swimmers ear?

A

Altered immune function
prior radiation
Tympanostomy tubes or perforated TM

32
Q

acute otitis media is…

A

ear infection

33
Q

risk factor for ear infection

A

day care
siblings in home
lack of breast feeding
exposure to tobacco smoke
lower socioeconomic status
use of pacifier
anatomic abnormalities

34
Q

most common causes ear infection

A

viruses

Strep. pneum
H.influ
M.ctarrhalis

35
Q

diagnosis of ear infection

A

rapid onset of pain
presence of middle ear effusion (MEE)

36
Q

severe ear infection

A

Moderare or sever pain for > 48hrs
or temp >39 or 102

37
Q

non-severe ear infection

A

mild pin for < 48hrs
and temp < 39C or 102

38
Q

6-23 months, non-severe unilateral

A

observe or 10 days ABX

39
Q

2-5yrs, non-severe bilateral or unilateral

A

observe or 7 days ABX

40
Q

> 6yrs, non-severe bilateral or unilateral

A

Observe or 5-7days ABX

41
Q

1st line therapy for initial immediate or delayed therapy Ear infection

A

High dose Amox = 80-90mg/kg/day BID
or
Amox/clav = 90mg/kg/day amox + 6.4mg/kg/day clav BID

42
Q

alternative medications for ear infection if PCN allergy

A

Cefdinir
Cefuroxime
Cefpodoxime
Ceftriaxone

43
Q

1st line if antibiotic treatment failed for ear infection

A

Amox/clav = 90/6.4 mg/kd/day BID
or
Ceftriaxone 50mg/kg/day IM/IV 3 days

44
Q

alternative if failed 2nd ABX for ear infection

A

Clindamycin 30-40mg/kg/day PO TID w/ or w/o 3rd gen cephalosporin

45
Q

why use watchful waiting

A

normal clinical course of AOM= can resolve alone
ADEs associated w/ ABX
Proper use of analgesics
Followup plan if sx done improve

46
Q

prevention of AOM

A

immunizations - Prevnar, pneumovax, flu
breastfeeding = least 6 months
avoid tobacco smoke

47
Q

Most common cause acute bacterial rhino sinusitis (ABRS)

A

strep pneumo
H. influ
M.catrrhalis

48
Q

symptoms of sinusitis

A

Key = discolored discharge

sinus pressure/pain
post-nasal drip
sore throat
toothache
cough
headache
fatigue

49
Q

Diagnosis of ABRS

A

> 10 days symptoms
Fever >39 + discharge/pain

worsening = new onset of fever/HA, inc nasal drainage

50
Q

ABRS 1st line children

A

Amox/clav 45mg/kg/day BID 10-14 days

51
Q

ABRS 2nd line children

A

Amox/clav 90mg/kg/day BID 10-14days

52
Q

ABRS B-Lactam allergy Type 1 children

A

levo 10-20mg/kg/day q12-24hrs

53
Q

ABRS B-lactam alelrgy Non-type 1 children

A

Clindamyxin 30-40mg/kg/day TID + cefixime or cefpodoxime

54
Q

Severe infection req hospital ABRS children

A

IV Ceftriaxone or ampicillin/sulbactam

2nd = Cefotaxime or Levoflox IV

55
Q

ABRS 1st line adult

A

Amox/clav 500/125 TID or 875/125 BID 5-7days

56
Q

ABRS 1st line adult B-lactam allergy

A

Doxy 100mg PO BID 5-7days

57
Q

ABRS 1st line adult severe infection req hospital

A

Ceftriaxone 1-2g IV q12/24hrs
Ampicillin/sulbactam 1.5-3g IV q6h

58
Q

ABRS 2nd line adult

A

amoxicillin/clav 2000/125 PO BID
Doxy 100mg PO BID

59
Q

ABRS 2nd line adult B-lactam allergy

A

Levo 500mg PO QD
Moxiflox 400 PO QD

60
Q

ABRS 2nd line severe infection

A

Levo 500 PO or IV QD
Moxiflox 400 PO or IV QD

61
Q

Who gets High dose Amox/Clav for ABRS

A

high endemic rates >10% of pen non-sus S.pneum
Severe infection ( systemic toxicity, > 39C)
attend daycare
Age < 2 or > 65
Recent hospitalization w/I 5 days
ABX use in last month
immunocompromised or comorbid conditions

CDM 3 Exam 1 (10 decks)

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