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Respiratory/Musculoskeletal > M- Otititis Media/Sinusitis > Flashcards

M- Otititis Media/Sinusitis Flashcards

1
Q

What is the definition of acute otitis media?

A
  1. history of acute onset of signs/symptoms
  2. presence of middle ear effusion (MEE)
  3. signs and symptoms of middle ear inflammation
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2
Q

What is otitis media with effusion?

A

It is the presence of fluid in the middle ear (MEE) without the signs/symptoms of acute otitis media (inflammation)

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3
Q

How is diagnosis of acute otitis media and otitis media with effusion made?

A

By looking at the tympanic membrane.
They will both have:
1. reduced mobility with pneumatic otoscopy
2. effusion

OME will be:

  1. opaque or translucent
  2. gray or pink
  3. neutral or retracted

AOM will be:

  1. opaque
  2. red, yellow, cloudy
  3. bulging or full position
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4
Q

In the setting of AOM, what are the 4 indications on physical exam that there is MEE?

A
  1. bulging of tympanic membrane (pain)
  2. absent mobility of tympanic membrane
  3. air-fluid level behind the tympanic membrane
  4. otorrhea - discharge from the ear due to rupture
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5
Q

In the setting of AOM, what are the 2 physical exam findings that demonstrate middle ear inflammation?

A
  1. erythema of the tympanic membrane

2. otalgia - discomfort in the ear that results in interference with normal activity or sleep

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6
Q

What is the usual first step to AOM?
How does the progression occur?
At which part of progression do antibiotics work?

A
  1. Viral URI which leads to
  2. Eustachian tube dysfunction
  3. OME (retracted tympanic)
  4. Bacterial infection and inflammation
  5. AOM ** antibiotics work here NOT when it is just OME
  6. OME
  7. resolution/normalization
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7
Q

What are the 3 most common etiologic bacteria of AOM and sinusitis?
What are their spontaneous resolution rates?

A
  1. S. pneumonia (alpha hemolytic strep) - 19%
  2. Haemophilus influenza - 48%
  3. Moraxella catarrhalis - 75%
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8
Q 
Describe the capsule of S. pneumoniae. 
What is it composed of?
What is the function?
How many serotypes are there?
How does the human immune system deal with it?
A

It is a polysaccharide capsule that protects the pneumococci from phagocytosis by interfering with complement C3b binding to the bacterial cell surface. IMPORTANT VIRULENCE FACTOR.

There are 90 serotypes based on antigenic differences in the polysaccharides composition.

Humans make serotype-specific anticapsular antibodies and then the pneumococci is cleared via the spleen

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9
Q

S. pneumonia can colonize asymptomatically. When does it cause symptoms?

A

When bacterial clearance mechanisms are disrupted by viral, environmental or smoking disturbances

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10
Q

What are the 3 general categories of Haemophilus influenza?

What does each cause?

A

They are all small gram neg coccobacilli- filamentous

  1. Non-encapsulated - AOM, sinusitis, exacerbation of chronic bronchitis
  2. Encapsulated type B - meningitis, epiglottitis, pneumonia, cellulitis
  3. Encapsulated A, C-F
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11
Q

When is observation of AOM without the use of an antibiotic an option?

A

When it is uncomplicated AOM and it depends on:

  1. diagnostic certainty
  2. age of the patient
  3. extent and severity of symptoms
  4. assurance of followup
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12
Q

What is the major benefit of observation over antibiotics for AOM?

A

It is usually mild and self-limiting in otherwise healthy children. Follow-up observation ensures that it doesn’t progress to meningitis or mastoiditis.
Avoidance of antibiotics until necessary ensures less antibiotic resistance

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13
Q

What are the 4 major factors that determine whether spontaneous resolution from AOM will occur?

A
  1. age of the patient (greater resolution in older)
  2. which bacteria (Moraxella> haemophilus> s. pneumo)
  3. immune response of the host
  4. drainage via Eustachian tubes
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14
Q

What are the 2 major preventative measures for AOM?

A
  1. flu vaccines - 30% efficacy in reducing AOM
  2. Pneumococcal Conjugate Vaccines (PCV) for infants show 6% reduction in AOM, 34% reduction in AOM, but slight increase in Haemonphilus (which is better because it has a higher rate of self resolution)
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15
Q

How do viral URI, acute severe sinusitis and acute persistent sinusitis differ in severity for fevers and respiratory symptoms?

A

Viral URI- rapid onset fever that drops by day 3. Respiratory symptoms rise to peak at day 4-5 and then steadily decline

Acute severe sinusitis- fever rapidly rises later (sigmoid shaped) and remains high and the respiratory symptoms slowly increase

Acute persistent sinusitis- fever is not very severe and remains unchanged. Respiratory symptoms increase in a sigmoid pattern

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16
Q

Which clinical presentations best identify patients with acute bacterial versus viral rhinosinusitis?

A
  1. persistent symptoms of acute rhinosinusitis lasting >10 days without evidence of improvement
  2. High fever and purulent nasal discharge/face pain lasting for 3-4 consecutive days at beginning of illness
  3. worsening symptoms, new onset of fever, headache and increased nasal discharge following a typical viral URI that lasted 5-6 days and was initially improving (double sickening)
17
Q

What is double sickening?

A

When a patient gets worsening symptoms (fever, headache, increased nasal discharge) following a viral URI that lasted 5-6 days and had shown signs of improvement.
It is associated with acute bacterial rhinosinusitis.

18
Q

What is initial empirical therapy for acute rhinosinusitis in children?
What if there is a risk for antibiotic resistance or failed therapy?

A
  1. amoxicillin-clavulanate 45mg OR amoxicillin 90mg

2. amoxicillin-clavulanate 90mg

19
Q

What is initial empirical therapy for acute bacterial rhinosinusitis in adults?
What if there is risk for antibiotic resistance or failed initial therapy?

A
  1. amoxicillin-clavulanate 500 mg

1. amoxicillin-clavulanate 2000mg

20
Q

What is clavulanate and why is it given with amoxicillin to treat acute bacterial rhinosinusitis?

A

It is a B-lactamase inhibitor so that resistant bacteria with b-lactamase activity (like haemophilus) do not degrade the amoxicillin

21
Q

What are the 5 major factors that put a person at an increased risk for antibiotic resistance?

A
  1. age 65
  2. prior antibiotics in the past month
  3. hospitalization in the past 5 days
  4. comorbidities
  5. immunocompromised
22
Q

What is epiglottitis?
What age group is it most common in?
What is the most common bacterial cause?
What has allowed for the decreased incidence of the disease?

A

supraglottitis- cellulitis of the epiglottis and adjacent structures that can abruptly and completely block the airway.
Most common in 2-6 year olds.
Haemophilus influenza type B is the most common cause and so HiB vaccine has been decreasing the incidence

23
Q

What are the symptoms of epiglottitis?

A
  1. drooling
  2. sore throat
  3. difficulty swallowing/breathing
  4. stridor
  5. hoarseness
  6. fever
24
Q

What are the most common bacterial causes of epiglottitis POST vaccine?

A
  1. GABHS (S. pyogenes)
  2. H. flu
  3. S. aureus
  4. S. pneumo

Respiratory/Musculoskeletal (36 decks)

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