Otolaryngology ENT

Question 1

What are the three required elements to diagnosed acute otitis media (AOM)

Answer 1

• acute onset of SYMPTOMS of otalgia
• presence of middle ear EFFUSION
• Acute signs of middle ear INFLAMMATION

Question 2

What are severe symptoms of Acute otitis media

Answer 2

• mod-severe pain
• Fever > 39 or 102.2
• Non-verbal child < 6 mo with irritability

Question 3

Signs of Otitis Media with Effusion (OME)

Answer 3

• retracted or neutral TM
• TM amber or blue
• air fluid levels or bubbles

Question 4

Acute otitis media, should they get antibiotics?

< 6 mo

Answer 4

All get antibiotics if AOM suspected

Question 5

Acute otitis media, should they get antibiotics?

6-23 mo

Answer 5

• Abx if diagnosis of AOM and symptoms are “severe”
• Abx if AOM is bilateral
• observation is option of not the above two cases

Question 6

Acute otitis media, should they get antibiotics?

> 24 months old

Answer 6

• abx if child has severe symptoms

Question 7

When is observation appropriate for management of Acute Otitis media

Answer 7

• only appropriate if follow up can be ensured and antibiotics can be started if symptoms worsen or persist
• f/u in 48-72 hours
• prescription that can be filled if child not improving

Question 8

What is the antibiotic treatment for Acute Otitis Media?

• Antibiotic and dosing
• when to use stronger abx

Answer 8

• Amoxicillin 80-90 mg/kg per day for 10 days

- Amox-Clv for those: treated with Abx in last 30 days, with concurrent conjunctivitis

Question 9

Follow up after acute otitis media

• when
• what are you looking for

Answer 9

• recommended at 8-12 weeks

- hearing/language/learning problems or recurrence

Question 10

After you prescribe amoxicillin for AOM, what do you do if no improvement after 48-72 hours?

Answer 10

Switch to second line Abx –> Amox/clav

Question 11

Treatment of otitis media with effusion

Answer 11

• watchful waiting 3 months
• at 3 months test for hearing loss
• may need tympanostomy tubes
• do NOT use antibiotics, antihistaines, decongestants, or steroids

Question 12

What are indicators that Rhinosinusitis might be bacterial?

Answer 12

• Duration of symptoms > 7 days
• worsening of symptoms
• mod-severe pain and fever > 101
• “second sickening”

Question 13

Treatment for bacterial rhinosinusitis

Answer 13

Amox-clav

Adding nasal steroids reduced inflammation and swelling

Question 14

What is high dose amox-clav and when should you use it for treatment of bacterial rhinosinusitis

Answer 14

High dose (2 g BID or 90 mg/kg/day)

• > 10% PCN resistant strain
• severe infection
• immunocompromised
• daycare attendance
• < 2 yo or > 65 yo

Question 15

What are second line choices for treatment of bacterial rhinosinusitis?

Answer 15

fluoroquinolones and doxycycline

Question 16

after treatment with amox, then amox-clav, what would come next in cases of AOM that don’t improve

Answer 16

ceftriaxone

Question 17

Definition of chronic rhinosinusitis

Answer 17

> 12 weeks of symptoms:

• nasal obstruction
• facial pain
• mucopurulent discharge
• decreased sense of smell

Is a complex inflammatory change rather than persistent bacterial infection

Question 18

What are 5 causes of peripheral vertigo?

Answer 18

• benign paroxysmal positional vertigo (BPPV)
• Vestibular neuronitis
• Herpes Zoster Oticus (ramsay hunt syndrome)
• Menier’s disease
• acoustic neuroma (tinnitus and hearing loss are main complaints)

Question 19

What are 3 causes of Central Vertigo?

Answer 19

• Migrainous Vertigo
• Wallenberg’s syndrome (infarction of lateral medulla)
• Cerebellar hemorrhage or infarction (sudden, intense, with vomiting, impaired gait falling to side of lesion)

Question 20

When should medication for vertigo be considered?

Answer 20

When vertigo lasts hours or days - not helpful for short lasting symptoms and has side effects