Osteo/HeadNeck/Skin Flashcards
Osteomyelitis: testing
best initial: Plain XR (periosteal elevation) second line: MRI most accurate: Bone biopsy & culture monitory therapy: ESR CCS: (+) blood cultures (+) ESR
Osteomyelitis: presentation
Warmth, Redness, Swelling, +/- draining purulent sinus tract
Osteomyelitis: cause
MCC: S. Aureus; S.S: Salmonella
Adults: Contiguous spread (nearby infection) from vascular insufficiency/diabetes
Kids: Hematogenous spread
Osteomyelitis: risk factors
Diabetes, Peripheral Vascular Disease with an ulcer, soft tissue infection
Osteomyelitis treatment: MSSA, MRSA
M.S.S.A: Oxacillin or Nafcillin IV x 4-6 weeks
M.R.S.A: Vancomycin, Linezolid, or Daptomycin IV 4-6 wks
Osteomyelitis treatment: Gram-negative bacilli
(salmonella or pseudomonas)
1) Confirm gram (-) with bone biopsy
2) Organism MUST be sensitive to antibiotics
3) Oral antibiotics
Otitis Externa (swimmer’s ear)
- Swimming washes out acidic environment/foreign objects
Diagnosis: itching, drainage, painful, swelling
Tx: topical ofloxacin or polymyxin/neomycin + acetic acid + water solution
Malignant Otitis Externa (osteomyelitis of the skull from Pseudomonas in diabetic patient): presentation
- Pain + purulent discharge
pathognomonic: granulation tissue @ floor of bone-cartilage junction
+/- h/o aural irrigation for cerumen removal
Malignant Otitis Externa: Dx/Tx
Best initial test: Skull XR or MRI
Most accurate: Biopsy
Tx: Surgical debridement and antibiotics against Pseudomonas (IV Ciprofloxacin)
Otitis Media: Key features
Redness, bulging, decreased/muffled hearing, Loss of light reflex, Immobility of tympanic membrane
Otitis Media: Causes
S. Pneumonia, Morexella Cattarhalis,
Nontypable Haemophilus Influenzae (+ purulent conjunctivitis)
Otitis Media: Treatment
Best initial: Amoxicillin x 7-10 days;
older (shorter) younger (longer)
Treatment failure: Amoxicillin + Clavulanate
Otitis Media: Complication - Acute Mastoiditis
Occurs exclusively as complication of AOM - mucosal response of mastoid air cells
-pain/swelling behind ear; erythematous tympanic memb.
TX: resolves quickly upon ABX treatment
Sinusitis: causes
MCC: viral
Bacterial: S. Pneumonia, H. Influenzae, Moraxella catarrhalis (same as otitis media)
Sinusitis: presentation
Nasal Discharge, Recent URI, HA, Facial pain/tenderness, tooth pain, bad taste in mouth, decreased transillumination of sinuses
Sinusitis: diagnosis
Best initial test: XR
Most accurate: Sinus aspirate for culture
CCS (office): treat, follow up in two weeks
Sinusitis: treatment
Amoxicillin + Inhaled steroids (Fluticasone) IF:
(1) Fever/Pain (2) Persistent sx despite 7 days of decongestants (3) Purulent nasal discharge
CCS: Pseudophedrine + Acetaminophen + Amoxicillin
(Pen allergic: TMP-SMX, Doxycycline, Macrolides)
Pharyngitis: (group A Strep; S. Pyogenes)
(1) Pain, sore throat (2) Exudate in Pharynx
(3) Adenopathy (4) No cough/hoarseness
Pharyngitis: Dx
initial: Rapid Strep test (sensitive enough for adults)
accurate: Culture
Pharyngitis: Tx
Penicillin or Amoxicillin
Penicillin allergy: Azithromycin or Clarithromycin
Influenza: presentation
Arthralgia, Myalgia, Cough, HA, Fever, Sore throat, Fatigue
Influenza: Dx
Viral antigen detection: nasopharyngeal swab/next step
Influenza: Tx
< 48 hrs: Oseltamivir or Zanamivir
> 48 hrs: Symptomatic; Acetaminophen, Rest, Hydration
Influenza Vaccine: Every year
- not 100%; (may contact flu especially in first 2 weeks)
- Strongest indications: COPD, CHF, Dialysis, Steroid users, Healthcare workers, >50yo
