Module 4

Question 1

What is the etiology of acute otitis media?

Answer 1

bacterial infection of the middle ear- could be caused by structural deformities, previous upper resp infections, sinusitis
clogged eustachian tubes allows increased risk of bacterial infection

Question 2

what are the common bacteria that can cause otitis media?

Answer 2

s. pneumoniae
h influenzae
st. pyogenes

Question 3

what are the clinical findings of acute otitis media?

Answer 3

otalgia
discharge, pressure, decreased hearing, fever
erythema, effusion or redness of the TM

Question 4

what is the treatment for acute otitis media?

Answer 4

amoxicillin 1st line
amoxi/clav 2nd life if resistant to first line
referral to ENT if recurrent

Question 5

what is the etiology of chronic otitis media?

Answer 5

chronic otorrhea with no otalgia
TM perforation with hearing loss
recurrent otitis media

Question 6

what are the most common bacteria that cause chronic otits media

Answer 6

p .aeringunosa
proteus
s. aureus

Question 7

what is the treatment for chronic otitis media?

Answer 7

topical drops ie cipro or tobramycin
oral cipro
surgery if needed

Question 8

what is the etiology of serous otitis media?

Answer 8

eustachian tube contanly blocked
blocked tube causes transudation (passing of fluid through membranes)
usually occrs after resp URI, allergi rhinitis
CARCINOMA IF UNILATERAL
effusion, fullness

Question 9

what is the treatment for serous otitis media?

Answer 9

ventilating tube (tymphanpanstomy) 
surgical repair

Question 10

Differentiate between acute, subacute, and chronic cough

Answer 10

acute >3 weeks, subacute 3-8 weeks, chronic >8 weeks

Question 11

Describe the management of someone with chronic cough

Answer 11

consider causes (COPD, pertussis, GERD, bronchitis)
diagnostics- CXR, nasopharyngeal swab or sputum

Question 12

chronic cough protocol

Answer 12

OTC therapy
office spirometry if available or refer
CXR 
CT sinuses
PFT/methycholine testing

Question 13

Describe the step wise approach to asthma treatment

Answer 13

step down or step up depending on usage
1. rescue inhaler SABA (ventolin) ALWAYS NEED THIS
2. inhaled corticosteroid (flovent)
3. ICS + LABA (advair)
may need to refer if these are not sufficient for asthma relief

Question 14

Describe the step wise approach to COPD treatment

Answer 14

step down or step up depending on usage and symptoms
1. SAMA or SABA or combo of the two for mild symptoms and relief
2. LABA or LAMA or combo
3. LABA + LAMA + ICS (only if needed, increased risk of side effects with ICS)
may need to refer if these are insuffieicnt for COPD relief

Question 15

Etiology vs asthma and COPD

Answer 15

asthma: reactive airways, genetic predisposition caused by eisonophils and increased inflammatory process
COPD: reactive airways that are narrowing due to preventable causes, causes chronic bronchitis and emphysema

Question 16

Clinical symptoms of asthma vs. COPD

Answer 16

asthma: wheezing (hallmark sign), chest tightness, cough, infrequent and episodic, can be triggered by environment or activity
COPD: increased sputum production, cough, SOB, dypsnea, does not usually improve with bronchodilators

Question 17

Diagnostic evaluation of COPD and asthma

Answer 17

asthma: spirometry, reversible airway construction post dilator, increase in FEV after bronchodilator
COPD: spirometry, FEV <0.7 despite bronchodilator, reveals ongoing constriction despite treatment

Question 18

Describe an asthma vs. COPD action plan

Answer 18

asthma: education surrounding triggers and disease management (including use of bronchodilators as rescue inhaler)
COPD: smoking cessation, use of inhalers, identify triggers, vaccination history

Question 19

Red flags for red eye

Answer 19

increasing pain
photophobia
increased redness
decreased visual acuity
foreign body/ penetrating eye injury

Question 20

Describe the clinical manifestations and treatment for viral conjunctivitis

Answer 20

usually accompanied by a URTI
quick onset, red eye and clear discharge, often unilateral but spreads bilaterally
follicles to lower lids, pharyngo conjunctival fever, tender preauricular and anterior chain lymph nodes

treatment: self limiting, cool compresses, artification tears, contagious if still tearing

Question 21

Describe the clinical manifestations and treatment for bacterial conjucttivitis, what are the most common pathogens causing this condition

Answer 21

usually accompanied by a URTI
purulent discharge, may or may not have eye pain
could be caused by alternative pathogens such as Ct or GC, most commonly MRSA, staph, s. pneumoniae, h influenzae, m catarrahlis

treatment: self limited, try 10-14 days without treatment
no resolution can try topical macrolides ie) erythromycin, tobramycin

Question 22

describe the clinical manifestations and treatment for allergic conjunctivitis

Answer 22

caused by allergens
itching, tearing, redness, stringy discharge, benign

treatment: antihistamines (drops or systemic)

Question 23

What is the approach to epistaxis?

Answer 23

usually from the anterior nares due to trauma, humidity, cocaine or etoh use, anticoagulation
bleeding into pharynx is usually posterior bleeding
manage by applying pressure for 15 minutes
nasal decongestants sprays
cautery or silver nitrate or balloon

refer if bleeding is >15 minutes, or recurrent large volume epistaxis

bleeding stable? no sraing and vigourous activity for 14 hours, control diet (spicy foods can trigger epixtaxis)
maintain lubrication

Question 24

What are common pathogens that cause sinusitis and what are the common treatments?

Answer 24

commonly viral, bacterial, and fungal causes
baterial: s. pneumoniae, h influenzae, m catarrhalis
clinical manifestations: inflammation of paranasal sinuses, congestion, purulent discharge, headache, pressure, quick onset, facial pain, dental pain
maxially and ethmoid sinuses are the most common areas
sinuses become blocked, bacteria sits and inflammatory process occurs

treatment: NSAIDs for pain
decongestants (nasal sprays)
saline rinses
usually imrpves in 2 weeks iwth no systemic abx

consider abx -amoxi/clav if severe symptoms and >10 days or immunocompromised

Question 25

contraindications to ear syringing

Answer 25

altered mental state or uncooperative
previous surgeries or tympanoscope
choleastema (non cancerous skin growth) 
anticoagulation
otitis media/perforation