Module 4 Flashcards
What is the etiology of acute otitis media?
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
what are the common bacteria that can cause otitis media?
s. pneumoniae
h influenzae
st. pyogenes
what are the clinical findings of acute otitis media?
otalgia
discharge, pressure, decreased hearing, fever
erythema, effusion or redness of the TM
what is the treatment for acute otitis media?
amoxicillin 1st line
amoxi/clav 2nd life if resistant to first line
referral to ENT if recurrent
what is the etiology of chronic otitis media?
chronic otorrhea with no otalgia
TM perforation with hearing loss
recurrent otitis media
what are the most common bacteria that cause chronic otits media
p .aeringunosa
proteus
s. aureus
what is the treatment for chronic otitis media?
topical drops ie cipro or tobramycin
oral cipro
surgery if needed
what is the etiology of serous otitis media?
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
what is the treatment for serous otitis media?
ventilating tube (tymphanpanstomy) surgical repair
Differentiate between acute, subacute, and chronic cough
acute >3 weeks, subacute 3-8 weeks, chronic >8 weeks
Describe the management of someone with chronic cough
consider causes (COPD, pertussis, GERD, bronchitis) diagnostics- CXR, nasopharyngeal swab or sputum
chronic cough protocol
OTC therapy office spirometry if available or refer CXR CT sinuses PFT/methycholine testing
Describe the step wise approach to asthma treatment
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
Describe the step wise approach to COPD treatment
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
Etiology vs asthma and COPD
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
Clinical symptoms of asthma vs. COPD
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
Diagnostic evaluation of COPD and asthma
asthma: spirometry, reversible airway construction post dilator, increase in FEV after bronchodilator
COPD: spirometry, FEV <0.7 despite bronchodilator, reveals ongoing constriction despite treatment
Describe an asthma vs. COPD action plan
asthma: education surrounding triggers and disease management (including use of bronchodilators as rescue inhaler)
COPD: smoking cessation, use of inhalers, identify triggers, vaccination history
Red flags for red eye
increasing pain photophobia increased redness decreased visual acuity foreign body/ penetrating eye injury
Describe the clinical manifestations and treatment for viral conjunctivitis
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
Describe the clinical manifestations and treatment for bacterial conjucttivitis, what are the most common pathogens causing this condition
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
describe the clinical manifestations and treatment for allergic conjunctivitis
caused by allergens
itching, tearing, redness, stringy discharge, benign
treatment: antihistamines (drops or systemic)
What is the approach to epistaxis?
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
What are common pathogens that cause sinusitis and what are the common treatments?
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
contraindications to ear syringing
altered mental state or uncooperative previous surgeries or tympanoscope choleastema (non cancerous skin growth) anticoagulation otitis media/perforation
