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Symptoms Management, Winter 2020 > Midterm > Flashcards

Midterm Flashcards

1
Q

What is the physical exam you would see for acute otitis media (AOM)

A

Bulging of the tympanic membrane, impaired mobility, loss of bony landmarks, Erythematous, otorrhea, effusion
+ fever (39C) and Pain

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2
Q

What past medical history would a patient with AOM present?

A

Cleft lip/palate, immune status, hearing loss, Hx of acute or chronic otitis media, presence of myringotomy/ tympanostomy tubes

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3
Q

What past social history would a patient with AOM present?

A

Day care, bottle feeding, pacifier use, exposure to tobacco smoke

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4
Q

What are the common risk factors for AOM, COM, OM with Effusion?

A

Age (<3yrs), FH, Day care, exposure to tobacco smoke, lactation less than 6 months, snoring, URI, Hx: AOM/ recurring, Low SES, pacifier use, allergy/atopy

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5
Q

What bacterial pathogen is most cultured that is responsible for causing AOMs?

A

S. Peumoniae

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6
Q

What is one protective/ preventative factors for AOM/ COM/ OM with effusion?

A

Lactation beyond 6months

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7
Q

What are the symptoms for AOM?

A

Pain, pressure in one or both ears, Pain radiating to outer ear/jaw/head. Hearing loss, vertigo, ear drainage

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8
Q

What are the nonspecific associated patient complaints for AOM?

A

Fever, irritability, anorexia, N/V, diarrhea, eye drainage (conjunctivitis), upper respiratory symptoms, nasal congestion, sore throat.

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9
Q

When does the patient need ENT referral?

A

AOM has not cleared after 3 courses of abx
Recurrent AOM
Chronic serous otitis or chronic otitis media
Perforated TM with hearing loss and dizziness

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10
Q

What device would a clinician use to test for mobility of the tympanic membrane?

A

Pneumatic otoscopy (insufflation)

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11
Q

What warrants a diagnosis of AOM?

A

Eryhema of TM + Bulging (loss of bony landmarks) + Immobility (using Pneumatic otoscopy),

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12
Q

When would clinician know perforation of the TM has occurred?

A

subsequent otorrhea

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13
Q

What are the guidelines for treating AOM with antibiotics?

A

Starting at 6months to greater than 2 years, with severe otorrhea, bilateral or unilateral without severe s/sx

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14
Q

When is follow up necessary for patient with AOM?

A

When patient is prescribed antibiotics and symptoms persist or worsen post Tx

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15
Q

What is the antibiotics of choice for AOM Tx?

A

Amoxicilin

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16
Q

When is amoxicillin not appropriate?

A

If patient is allergic to it, antibiotics received in previous month, concurrent otitis- conjunctivitis syndrome, recurrent AOM or UTIs (prescribing it as prophylaxis), AOM unresolved with amoxicilin.

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17
Q

What is an alternative antibiotics choice for AOM if amoxicillin is not appropriate?

A

Amoxicillian- clavulanate

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18
Q

When is follow up necessary?

A

48-72 hours if symptoms not improved.

8-12 weeks (or at well child care appnt) for recheck of eats.

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19
Q

What considerations would you consider when prescribing antibiotics for AOM?

A

Patient’s age (6months -2+yrs),

severity of S/Sx, otorrhea, laterality.

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20
Q

What is otitis media with effusion (OME)?

A

presence of fluid in the middle ear without S/Sx of acute ear infection.

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21
Q

What are the S/Sx of OME?

A

May have mild URI symptoms.
S/Sx of acute ear infection not present.
Often asymptomatic

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22
Q

When does OME usually occur?

A

After AOM

Or due to chronic inflammation in response

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23
Q

What are the risk factors for OME?

A 
Same as AOM: 
Exposure to tobacco smoke
Low SES
Pacifier use
Bottle feeding
Allergy/atopy
Day care
24
Q

What is the clinical presentation of patients with OME?

A

Balance can be affected.
Conductive hearing loss.
No acute illness/ usually asymptomatic

25
Q

What Diagnostics is used to determine OME?

A 
Pneumatic otoscopy (primary method), Tympanometry
Myringotomy
26
Q

What does pneumatic otoscopy used for?

A

determine TM mobility

27
Q

When is tympanometry used?

A

when diagnosis is still uncertain.

28
Q

what does tympanometry show?

A

measures the flexibility of the TM

29
Q

Why is Myringotomy considered the gold standard when diagnosing OME?

A

Withdraws fluid from middle ear via making an incision in TM to confirm OME

30
Q

What are the treatment options for OME?

A

Watchful waiting, rechecking every 3 months

31
Q

Should clinicians recommend antibiotics, antihistamines, decongestants or steroids (for patient’s without allergies)?

A

NO

32
Q

If OME persists over 12 weeks/ 3 months, what should be recommended

A

Audiogram and speech/ language evaluation

33
Q

When and why should Audiogram and speech/ language evaluation be performed for patient with OME?

A

Patient with language delay, learning problems, hearing loss.

34
Q

when is surgical indicated for patient with OME?

A 
Complications of AOM (mastoiditis)
Persistent OME
Recurrent AOM 
Structural changes in TM
Individuals with craniofacial anomalies
Middle ear ventilation disorders >3months
35
Q

What does the surgery involve when indicated for OME?

A

Making an incision into the TM and placing a tube to drain the fluid

36
Q

What are the two chronic conditions that could occur as complications from OME?

A

chronic serous otitis media (lasting 3 moths)

chronic suppurative otitis media (not responding to abx)

37
Q

What are the few complications with OME?

A

Mastoiditis (inflammation of the mastoid bone)
persistent perforation (perforation of the TM)
Cholesteatoma (noncancerous skin/ sac/ cyst growth)

38
Q

When does recurrent AOM grant ENT referral?

A

When 3 or more cases within 6 months or more than 4 infections a year
Recurrent despite: Treated with abx (prophylactic), Decreased risk factors, PNA/Flu immunizations, myringotomy/ tympanostomy tubes

39
Q

What is otitis externa (OE)?

A

inflammation of external auditory canal

40
Q

Is OE usually more bacterial or viral in origin?

A

Bacterial. S. aureus & Psuedomonas as most common.

41
Q

What are the risk factors for OE?

A 
trauma to ear canal
lack of cerumen
moisture and warmth in ear canal
chronic eczema
infection of hair follicle
recent ear surgery or instrumentation
42
Q

What are the symptoms of OE?

A

ear pain, pruritis of ear canal or external ear, discharge from canal, conductive hearing loss, tinnitus, dizziness, chronic cough if impacted cerumen

43
Q

What are some of the physical exam findings of the external ear for patient with OE?

A

pain with manipulation of pinna or tragus. erythema, crusting, edema of the external ear

44
Q

What are some of the physical exam findings of the ear canal for patient with OE?

A

erythema, edema, occluded canal, yellow, brown, whitish/ grayish discharge, profuse/ prulent discharge

45
Q

What are some of the physical exam findings of the TM for patient with OE?

A

No middle ear fluid, mobile structures

46
Q

What are some of the physical exam findings of the lymph nodes for patient with OE?

A

preauricular/ cervical node tenderness with more severe infection

47
Q

What is the treatment for OE?

A

Topical abx, topical corticosteroids, acidifying agents, analgesics

48
Q

What should be included in the patient education?

A

Proper use of ear drops, avoiding water in ear until symptoms improve, preventing OE

49
Q

When is ENT referral necessary?

A

Canal obstruction, malignant OE

50
Q

When should symptoms of OE resolve?

A

within 36-48 hours

51
Q

What are the 3 most common viral etiology for adult pharyngitis?

A

adenovirus, parainfluenza, rhinovirus

52
Q

What are the most common bacterial etiology for adult pharyngitis?

A

Group A beta-hemolytic streptococcus
H.influenzae
Mycoplasma pneumoniae
Neisseia gonorrhoeae

53
Q

What are precipitating factors for pharyngitis?

A

exposure to infection, allergies, pollutants, trauma to oral cavity, excessive use of voice, unprotected oral sex

54
Q

What are the symptoms of pharyngitis?

A

URI symptoms, allergy symptoms, fever, headache, abdominal pain, lesions in mouth, drooling, hoarseness, malaise, myalgias.

55
Q

What complications may result for people with group A beta-hemolytic strep pharyngitis?

A

rheumatic fever, post strep glomerulonephritis

56
Q

what to look for on a PE?

A

fever, altered breathing, pallor, flushed skin,

Symptoms Management, Winter 2020 (2 decks)

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