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EENT > Test five (weeks 8 + 9) > Flashcards

Test five (weeks 8 + 9) Flashcards

1
Q

First line therapy for group a strep pharyngitis

A

Penicillin V (B lactam antibiotic)

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2
Q

First line therapy for AOM, bacterial rhinosinusitis, GAS

A

Amoxicillin and amoxicillin / clavulanate

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3
Q

When might a cephalosporin be prescribed instead?

A

More resistant to b lactamases and have a broader spectrum of activity than penicillins, with more efficacy against gram neg species

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4
Q

Why might a non-lactam be prescribed instead?

A

Those with severe penicillin / b lactam allergies

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5
Q

What are some physiologic features of EENT that might affect drug absorption and distribution?

A

TM impermeable to most drugs, but if ruptured then drugs administered to cancel can damage middle/inner ear.

Drugs topically to eye will drain into nose where they’re systemically absorbed.

Blood-ocular barrier comparable to blood-brai barrier; drugs administered systemically don’t easily enter the eye

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6
Q

Adverse effects of antibiotic use

A

Hypersensitivity reactions
Organ toxicity
CYP450 induction or inhibition
Teratogenicity (penicillins are safest)
Disruption of microbiome

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7
Q

When is it appropriate to prescribe antibiotics for EENT conditions?

A

Infections threatening deeper structures
Cases not responding to treatment
Specific populations (Immunocompromised pts) or circumstances (pts w strep pharyngitis who have had RF)

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8
Q

What determines the choice of specific antibiotic for a given condition?

A

Microbes sensitivity to a drug
Current resistance to drug
Safety profile for individual pt
Cost/availability

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9
Q

Which classes of oral antibiotics are not recommended for children?

A

Tetracyclines
Fluoroquinolones

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10
Q

Which class of antibiotics should be used in the ear if there is TM rupture?

A

Topical fluoroquinolones

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11
Q

What class of antibiotics is so ototoxic its used for inner ear ablation in severe meniere disease?

A

Aminoglycosides (gentamicin)

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12
Q

What class of antivirals is helpful with the herpes virus conditions?

A

Nucleoside analogues such as acyclovir

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13
Q

What molecule is the target of most anti fungal medications?

A

Ergosterol, part of the fungal cell membrane

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14
Q

What are possible adverse effects of oral antifungals?

A

Oral: GI disturbance, hepatotoxicity, drug interactions
Topical: local hypersensitivity reactions

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15
Q

What ENT conditions are treated with antifungals?

A

Otitis externa
Oropharyngeal thrush
Rhinosinusitis

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16
Q

What routes of administration of glucocorticoids can cause HPA axis suppression?

A

Systemic absorption

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17
Q

Why might an atopic patient have particularly high plasma levels of glucocorticoids, even using topicals?

A

Combined effects of topical for atopic dermatitis, inhaled for asthma, intranasal for allergic rhinitis

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18
Q

What conditions might be treated with intranasal glucocorticoids?

A

All forms of rhinitis and rhinosinusitis

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19
Q

What conditions might be treated with otic glucocorticoids?

A

Ear conditions such as otitis externa and inflammatory conditions of the outer ear

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20
Q

What conditions might be treated with opthalmic glucocorticoids?

A

Inflammatory conditions of the eyes
Post op inflammation for ophthalmic surgery
To minimize damage of ocular injuries

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21
Q

Why are 2nd general IN glucocorticoids preferred?

A

Less systemic absorption

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22
Q

What are local adverse effects of IN glucocorticoids?

A

Local irritation, epistaxis, nasal ulceration

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23
Q

What are systemic effects of IN glucocorticoids?

A

Adrenal suppression, growth delays in children, increased intraocular pressure, increase risk of nasal and pharyngeal candida

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24
Q

Why is it reccomended that ophthalmic glucocorticoids be managed under the guidance of an ophthalmologist?

A

Inc risk cataracts and glaucoma
Infection
Delayed healing
Systemic absorption

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25
What is a “cholinergic” med?
Meds that act via Ach, either by binding to its receptors or changing its concentration
26
Why are muscarinic agonists also called “parasympathomimetic” meds?
Muscarinic agonists mimic PNS stimulation
27
For what EENT conditions are muscarinic agonists used?
Acute angle-closure glaucoma Maintenance med in primary open angle glaucoma Dry mouth and dry eyes in Sjogrens
28
For what EENT conditions are muscarinic antagonists used?
Topically for pupil dilation during ophthalmic procedures As cycloplegics for uveitis, iritis, UV keratitis
29
What patient population should avoid muscarinic antagonists?
Elderly due to risk of confusion, dry mouth and eyes, constipation, urinary retention Pts with glaucoma and those at risk of acute angle-closure glaucoma
30
What are “adrenergic” medications?
Act by binding to adrenergic receptors or changing the concentration of epi and norepi
31
what do andrenergic agonists mimic?
SNS stimulation
32
For what EENT conditions are alpha 1 agonists used?
Nasal congestion and red eyes
33
For what EENT conditions are alpha 2 agonists used/
Glaucoma
34
For what EENT conditions are beta blockers used?
Glaucoma
35
Which pt populations should avoid alpha 1 agonists
HTN/CVD Angle closure glaucoma Urinary retention Bowel obstruction
36
Which pt populations should avoid beta blockers
Asthma Obstructive airway disease
37
What is the effect of histamine in the allergic response?
Vasodilation Inc vascular permeability (edema, redness, inc mucus) Stimulation of afferent neurons (pruritis, pain) Contraction of bronchial smooth muscle (bronchoconstriction)
38
What types of histamine receptors are involved in the allergic response?
H1 receptors for allergic response (H2 = reg of acid in gastric mucosa) NT in CNS - several types of receptors
39
What EENT conditions are treated with H1 antagonists?
Reduces itching sneezing, rhinorrha, congestion of allergic rhinitis Itching, redness, and watery eyes of allergic onjunctivitis
40
Which pt population should avoid antihistamines?
Children <2
41
How does the mechanisms of antihistamines differ from that of mast cell stabilizers?
Antihistamines block histamine receptors, mast cell stabilizers prevent the release of histamine from mast cells
42
What EENT conditions are treated with mast cell stabilizers?
IN for allergic rhinitis Eye drops for allergic conjunctivitis Topically for allergic conjunctivitis
43
What are the 2 eicosanoid pathways? Which eicosanoids are made by each?
Cyclooxygenase (COX) > prostaglandins and thromboxane Lipoxygenase (LOX) > leukotrienes
44
How are NSAIDS and acetaminophen used in EENT conditions
Fever and pain
45
How are prostaglandins used in EENT conditions
Glaucoma
46
How are leukotrinee antagonists used in EENT conditions
Allergic rhinitis Chronic rhinosinusitis
47
What types of ddxs are there for a sore throat other than pharyngitis?
Systemic disease (arthritis, HIV, TSS, hepatitis) Head/neck disorders (cervical pain, sinusitis, mumps, thyroiditis) Lesions (herpes, candida, mono, canker sores)
48
What is a red flag with sore throats?
Sudden severe throat pain, esp in older pts > aortic dissection, pneumothorax
49
Signs/sx of mono
Teens with sore throats > 1 week Post cervical tender nodes Adenopathy in groin + axilla Functional impairment w myalgia Tonsil exudate Petechiae on pharynx
50
How do you confirm a mono infection with lab tests?
Peripheral smear (atypical lymphocytes) Monospot (more sens 2 weeks after contraction) Mildly elevated transaminase levels Liver transaminases to assess for EBV hepatitis
51
Centor criteria points
+1 Temp > 38/100.4 Absence of cough Swollen tender ant cervical nodes Tonsillar swelling or exudate 3-14 0 points: 15-44 -1 points: 45+
52
Centor criteria meanings
<1 risk of GABHS 1-2% No further testing/tx 1: 5-19%, no further testing/tx 2: 11-17%, culture/RADT, antibiotics if pos 3: 28-35%, same as 2 4+: 51-53%, can treat empirically with antibiotics
53
are strep carriers at risk for non-suppurativa complications of strep like RF?
No, they dont mount an antibody response
54
Antibiotics effect on sequela of strep
Prevents: RF Probably don’t prevent: Guttate psoriasis Erythema nodosum Don’t prevent: Glomerulonephritis
55
Botanicals for strep
HEMP - hydrastis, echinacea, myrrh, phytolacca Synergism’s like belladonna, Bryonia, aconite, gelsemium
56
Repertories for strep
Throat, inflammation, erysipelatous Mouth, papillae, erect, red
57
When should you do repeat cultures on a sore throat?
In most cases, NOT indicated Indicated in pts who: Have a hx of ARF Have pharyngitis during outbreaks of ARF or glomerulonephritis In families/daycares with ping pong spread
58
What is trismus
Lockjaw; muscle spasm, unable to open mouth fully
59
How is peritonsillar abscess diagnosed?
Needle aspiration
60
What are the suppurativa complications of poorly treated/untreated pharyngitis?
Peritonsillar abscess (quinsy) Retropharyngeal abscess
61
What is Ludwig’s angina?
Infection to sub mental space, severe trismus, drooling, airway compromise
62
Ddx of chronic sore thraot
Infectious Irritative (reflux, post nasal drip, toxins, vocal bad hygiene/abuse) Neoplastic
63
Causes of globus
GERD Abnormal UES function Motor disorders Thyroid disease Hypertrophy of tongue base Cervical osteophytes Stress/psych
64
How to work up hoarseness? When is referral needed?
HEENT, lymph node exam, laryngoscopy Referral to voice therapy to reduce laryngeal trauma
65
Naturopathic tx options rhinosinusitis
Prevention - treat URIs/hay fever sufficiently Maintain open drainage of sinus ostia Dec inflammation Improve tissue integrity Address known RFs Keep bowels using, alteratives
66
When and why would you use N-acetyl cysteine in your tx of ENT conditions?
Tx of hay fever allergic rhinitis; potent antioxidant and mucolytic Chronic rhinosinusitis - immune support and protection
67
When should imaging be ordered in cases of rhinosinusitis?
For pts who have persistent sx, CT may show an anatomical reason why there is recurrent or chronic sinusitis Order CT if your pt develops dec visual acuity, diploplia, peri orbital edema, severe headache, or altered mental status. LIMITED SINUS CT.
68
Are antibiotics indicated for the tx of acute sinusitis?
For bacterial yes; not effective or recommended for acute VIRAL rhinosinusitis
69
How to assess epistaxis
Assess for hemodynamic stability Look for bleeding site Wear gloves + eye protection Use topical neo-synephrine if needed
70
Tx epistaxis
Cold application Topical anesthetic and topical silver nitrate Vit C Bioflavinoids Homeopathy Pharm
71
When is epistaxis potentially dangerous?
Post epistaxis
72
RF rhinosinusitis
Polyps Septal deviation Viral URI (most imp RF for acute bacterial rhinosinusitis) Dairy/food allergy
73
Pathogenesis rhinosinusitis
Viral rhinitis > blocked Ostia > O2 absorbed > neg pressure (pain=vacuum sinusitis) > transudate > bacteria invade > ciliary dyskinesia > pos pressure > pain
74
Indications for urgent referral with rhinosinusitis
Abnormal vision Change in mental status Periorbital edema CN abnormalities (2, 3, 4, 6)
75
How do children’s sinuses develop?
Maxillary and ethmoid present at birth Sphenoid develops from ethmoid at 9 yrs Frontal develops from ethmoid at 5-7 years
76
How is rhinosinusitis diagnosed in children?
A presumptive dx is made if there is a persistent cough and nasal rhinorrhea > 10 days (cough usually due to postnasal drip)
77
What classes are included in the B lactam antibiotics?
Penicillins Cephalosporins
78
Ex of penicillins
Penicillin G, V (natural penicillins) Amino penicillins - Amoxicillin Amplicillin
79
Ex of cephalosporins
Cephalexin Cefuroxime Ceftriaxone Cefdinir
80
Drug type/Ex of tetracyclines
antibiotic Tetracycline, doxycycline, minocycline
81
Drug type/Ex of Macrolides
Antibiotics Azithromycin, clarithromycin, erythromycin
82
Drug type/Ex of Fluoroquinolones
Antibiotics Ciprofloxacin, levofloxacin, oflocaxin
83
Drug type/Ex of Lincosamides
Antibiotics Clindamycin, lincomycin
84
Drug type/Ex of Aminoglycosides
Antibiotics Gentamicin, neomycin, tobramycin, streptomysin
85
Antibiotic classes used for ENT conditions
B lactams Tetracyclines Macrolides Fluoroquinolones Lincosamides Aminoglycosides Mupirocin
86
penicillin G vs V administration and use
G - IV / IM, syphilis V - oral, first line for group A strep pharyngitis
87
Amino penicillins are first line therapies for
AOM Bacterial rhinosinusitis first line alternative for GAS
88
Cephalosporins uses
Alternatives for penicillins for AOM, bacterial rhinosinusiits, GAS Ceftriaxone (IM) for gonococcal pharyngitis and conjunctivitis
89
Tetracycline uses
Alternative for penicillin allergic patients in tx of bacterial sinusitis
90
Macrolides uses
Topical erythromycin ointment for bacterial conjunctivitis, and in newborns for prophylaxis against chlamydial and gonorrheal conjunctivitis Oral used as alternative for b lactam allergies in GAS and for bacterial conjunctivitis caused by gonorrhea and chlamydia and for gonococcal pharyngitis; long term low dose for chronic rhinosinusitis Not used as empiric for acute bacterial rhinosinusitis bc they are resistance to S pneumonia
91
Fluoroquinolones uses
topical for otitis externa with TM rupture, chronic suppurativa otitis media Oral for otitis externa in Immunocompromised patients or has extension of infection beyond the ear canal (pseudomonas)
92
Lincosamides (clindamycin, lincomycin) uses
Alternative in b-lactam allergies for GAS and rhinosinusitis (preferred over fluoroquinolones in kids for this purpose)
93
Aminoglycoside uses
Oral/IV Reserved for serious multi-drug resistant conditions or are used topically Topical for otitis externa with intact TM, bacterial keratitis Gentamicin for end stage intractable meniere disease to destroy inner ear/trans tympanic injection
94
Mupirocin uses
MRSA Nasal vestibular is, elimination of nasal MRSA colonization
95
Nucleoside analogues uses
Orally at first sign of viral activation, also topical Herpes zoster oticus/ophthalmicus Herpes simplex pharyngitis / keratitis

EENT (6 decks)

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