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MI HARRISSONS > Chapter 44 > Flashcards

Chapter 44 Flashcards

1
Q

3 most clinically relevant spaces in the neck

A

submandibular (and sublingual) space

the lateral pharyngeal (or parapharyngeal) space,

the retropharyngeal space.

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2
Q

mortality rates of deep neck infection can be as high as

A

20–50%.

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3
Q

Infection of the submandibular and/or sublingual space typically originates from

A

an infected or recently extracted lower tooth

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4
Q

Life threatening infection of deep neck

serious, potentially life-threatening cellulitis or connective tissue infection, of the floor of the mouth, usually occurring in adults with concomitant dental infections and if left untreated, may obstruct the airways, necessitating tracheostomy.

A

Ludwig’s angina

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5
Q

Infection of the _____ is most often a complication of common infections of the oral cavity and upper respiratory tract, including tonsillitis, peritonsillar abscess, pharyngitis, mastoiditis, and periodontal infection.

A

lateral pharyngeal (or parapharyngeal) space

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6
Q

contains a number of sensitive structures, including the carotid artery, internal jugular vein, cervical sympathetic chain, and
portions of cranial nerves IX through XII

A

Lateral pharyngeal wall/space

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7
Q

Diagnosis of infection in the lateral pharyngeal space can be confirmed by

A

CT SCAN

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8
Q

Treatment consists of deep neck index consist of

A

airway management, operative drainage of fluid collections, and at least 10 days of IV therapy with an antibiotic active against streptococci and oral anaerobes (e.g., ampicillin/ sulbactam).

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9
Q

Infections in this space are more common among children <5 years old because of the presence of several small retropharyngeal lymph nodes that typically atrophy by age 4 years.

A

retropharyngeal space

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10
Q

are the most common pathogens of Retropharyngeal space infection

A

group A β-hemolytic streptococci and S. aureus

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11
Q

Patients with retropharyngeal abscess typically present with

A

sore throat, fever, dysphagia, and neck pain and are often drooling because of difficulty and pain with swallowing.

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12
Q

Upon PE of retropharyngeal abscess soft tissue mass is usually demonstrable by

A

lateral neck radiography or CT

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13
Q

Primary acute herpetic gingivostomatitis (HSV type 1; rarely type 2)

A

Heals spontaneously in 10–14 days; unless secondarily infected, lesions lasting >3 weeks are not due to primary HSV infection

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14
Q

occurs primarily in infants, children, and young adults

A

Primary acute herpetic gingivostomatitis (HSV type 1; rarely type 2)

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15
Q

The most common type of URTI

A

rhinovirus 30-40%

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16
Q

a well-established pathogen in pediatric populations, is also a recognized cause of significant disease in elderly and immu- nocompromised individuals.

A

Respiratory syncytial virus (RSV),

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17
Q

may suggest infection with adenovirus or enterovirus.

A

conjunctivitis

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18
Q

% of colds that are complicated by secondary bacterial infections

A

0.5% and 2%

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19
Q

rebound after initial clinical improvement

A

the “double-dip” sign

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20
Q

refers to an inflammatory condition involving the nasal sinuses.

A

Rhinosinusitis

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21
Q

is most commonly involved in rhinosinusitis

next, in order of frequency, are the ethmoid, frontal, and sphenoid sinuses.

A

maxillary sinus

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22
Q

Defined as sinusitis of <4 weeks’ duration

A

Acute rhinosinusitis

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23
Q

Among community- acquired cases of sinusitis, _______are the most common pathogens, accounting for 50–60% of cases.

A

s. pneumoniae and nontypable Haemophilus influenzae

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24
Q

patients with advanced frontal sinusitis with soft tissue swelling and pitting edema over the frontal bone from a communicating subperiosteal abscess.

A

Pott’s puffy tumor,

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25
Q

diagnosis for patients with “per- sistent” symptoms (i.e., symptoms lasting >10 days in adults or >10–14 days in children) accompanied by the three cardinal signs of purulent nasal discharge, nasal obstruction, and facial pain

A

Acute bacterial sinusitis

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26
Q

Acute sinusitis with Moderate symptoms (e.g., nasal purulence/ congestion or cough) for >10 d

A

Amoxicillin, 500 mg PO tid; or
Amoxicillin/clavulanate, 500/125 mg PO tid or 875/125 mg PO bidb

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27
Q

Acute sinusitis with Severe symptoms of any duration, including unilateral/focal facial swelling or tooth pain

A

Penicillin allergy:
Doxycycline, 100 mg PO bid; or Clindamycin, 300 mg PO tid
Exposure to antibiotics within 30 d or >30% prevalence of penicillin-resistant Streptococcus pneumoniae:
Amoxicillin/clavulanate (extended release), 2000/125 mg PO bid; or
An antipneumococcal fluoroquinolone (e.g., moxifloxacin, 400 mg PO daily)
Recent treatment failure:
Amoxicillin/clavulanate (extended release), 2000 mg PO bid; or
An antipneumococcal fluoroquinolone (e.g., moxifloxacin, 400 mg PO daily)

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28
Q

antibiotic therapy can be considered in acute rhinosinusitis

A

for adult patients whose condition does not improve after 10 days, and patients with more severe symptoms (regard- less of duration) should be treated with antibiotics

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29
Q

Chronic sinusitis is characterized by symptoms of sinus inflamma- tion lasting

A

> 12 weeks.

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30
Q

is seen in patients with a history of nasal polyposis and asthma, who often have had multiple sinus surgeries.

A

allergic fungal sinusitis

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31
Q

Is a disease of immunocompetent hosts and is usually noninvasive, although slowly progressive invasive disease is sometimes seen.

A

Chronic fungal sinusitis

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32
Q

is an infection of the skin overlying the external ear and typically follows minor local trauma.

A

Auricular cellulitis

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33
Q

an infection of the perichondrium of the auricular cartilage, typically follows local trauma (e.g., piercings, burns, or lacerations).

A

Perichondritis

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34
Q

Most common cause of perichondritis

A

P. Aeruginosa

And s. Aureus

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35
Q

refers to a collection of diseases involving primarily the auditory meatus.

A

otitis externa

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36
Q

usually results from a combination of heat and retained moisture, with desquamation and maceration of the epithelium of the outer ear canal.

A

Otitis externa

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37
Q

can develop in the outer third of the ear canal, where skin overlies cartilage and hair follicles are numerous.

A

Acute localized otitis externa (furunculosis)

38
Q

As in furunculosis elsewhere on the body, _____ is the usual pathogen, and treatment typically consists of an oral antistaphy- lococcal penicillin (e.g., dicloxacillin or cephalexin), with incision and drainage in cases of abscess formation.

A

S. Aureus

39
Q

is also known as swimmer’s ear,

A

Acute diffuse otitis externa

40
Q

Predominant pathogen in Acute diffuse otitis externa

A

Pseudomonas aeruginosa

41
Q

Acute diffuse Otitis externa

Treatment

A

consists of cleansing the canal to remove debris and enhance the activity of topical therapeutic agents—usually hypertonic saline or mixtures of alcohol and acetic acid.

42
Q

aluminum acetate in water

A

Burow’s solution

43
Q

is caused primarily by repeated local irrita- tion, most commonly arising from persistent drainage from a chronic middle-ear infection

A

Chronic otitis externa

44
Q

Rarely can cause otitis externa

A

chronic infections such as syphilis, tuberculosis, and leprosy.

45
Q

Predominant sx of Chronic otitis externa

A

PRURITUS

46
Q

also known as malignant or necrotizing otitis externa, is an aggressive and potentially life-threatening disease that occurs predominantly in elderly diabetic patients and other immuno- compromised persons

A

Invasive otitis externa,

47
Q

Begins in the EXTERNAL CANAL AND Severe, deep-seated otalgia, frequently out of proportion to findings on examination,

A

Invasive otitis externa

48
Q

Most common affected CN in Internal otitis externa

A

Facial nerve or CN7

49
Q

IV antibiotic therapy should be given for a prolonged course for internal otitis externa

A

6–8 weeks)

50
Q

necrotizing otitis externa, recurrence is documented up to

A

20%

51
Q

is an inflammatory condition of the middle ear that results from dysfunction of the eustachian tube in association with a number of illnesses, including URIs and chronic rhinosinusitis.

A

Otitis media

52
Q

diagnosis of acute otitis media requires the

A

demonstration of fluid in the middle ear

53
Q

Most common pathogens for otitis media

A

consistently found S. pneumoniae to be the most important bacterial cause, isolated in up to 35%

54
Q

In OM, Viruses have been recovered either alone or with bacteria in

A

17–40% of cases.

55
Q

Fluid in the middle ear is typically demonstrated or confirmed with

A

pneumatic otoscopy

56
Q

In OM, Treatment is typically indicated for

A

for patients <6 months old;
for children 6 months to 2 years old who have mid- dle-ear effusion and signs/symptoms of middle-ear inflammation;
for all patients >2 years old who have bilateral disease, TM perfora- tion, immunocompromise, or emesis;
and for any patient who has severe symptoms, including a fever ≥39°C or moderate to severe otalgia

57
Q

In OM, ____ is as successful as any other agent, and it remains the drug of first choice in recommendations from multiple sources

A

amoxicillin

58
Q

Recurrent acute otitis media

A

more than three episodes within 6 months or four episodes within 12 months

59
Q

In serous OM, Antibiotic therapy or myringotomy with insertion of tympanostomy tubes typically is reserved for patients in whom bilateral effusion

A

1) has persisted for at least 3 months and (2) is associated with significant bilateral hearing loss.

60
Q

acute effusions are self-limited; most resolve in

A

2–4 weeks.

61
Q

chronic effusions are often associated with significant hearing loss in the affected ear. The great majority of cases of otitis media with effusion resolve spontaneously within _____ without antibiotic therapy.

A

3 months

62
Q

is characterized by persistent or recurrent purulent otorrhea in the setting of TM perforation.

A

Chronic suppurative otitis media

63
Q

In chronic OM, squamous epithelium from the auditory canal may invade the middle ear through the perforation, forming a mass of keratinaceous debris called?

A

cholesteatoma

64
Q

Treatment of chronic active otitis media is surgical; mastoidectomy, myringoplasty, and tympanoplasty can be performed as outpatient surgical procedures, with an overall success rate of ~

A

80%

65
Q

Treatment of chronic active otitis media is surgical;

A

MTM

mastoidectomy, myringoplasty, and tympanoplasty

66
Q

purulent exudate collects in the mastoid air cells , producing pressure that may result in erosion of the surrounding bone and formation of abscess-like cavities that are seen at ct scan

A

acute mastoiditis

67
Q

Initial empirical therapy usually is directed against the typical organisms associated with acute otitis media, such as

A

S. pneumoniae, H. influenzae, and M. catarrhalis.

68
Q

In acute pharyngitis, The most important source of concern is infection with _____ that is associated with acute glomerulonephritis and acute rheumatic fever.

A

group A β-hemolytic Streptococcus (S. pyogenes)

5-15%

69
Q

respiratory viruses are the most common identifiable cause of acute pharyngitis,

A

with rhinoviruses and coronaviruses accounting
for large proportions of cases (~20% and at least 5%, respectively).

70
Q

In acute pharyngitis, ______ has been increasingly recognized as a cause of pharyngitis in adolescents and young adults and is isolated nearly as often as group A streptococci. This organism is important because of the rare but life-threatening Lemierre’s disease

A

Fusobacterium necrophorum

FB NP

71
Q

is distinguished by the presence of conjunctivitis in one-third to one- half of patients

A

adenoviral pharyngitis

72
Q

This HSV syndrome is distinct from pharyngitis caused by _________ which is associated with small vesicles that develop on the soft palate and uvula and then rupture to form shallow white ulcers

A

coxsackievirus (herpangina)

73
Q

Acute exudative pharyngitis coupled with fever, fatigue, generalized lymphadenopathy, and (on occasion) splenomegaly is characteristic of

A

infectious mononucleosis due to EBV or CMV

74
Q

diagnosis of acute EBV infection depends primarily on the detection of antibodies to the virus with a:

A

heterophile agglutination assay (monospot slide test) or

enzyme-linked immunosorbent assay.

75
Q

should be performed when acute primary HIV infection is suspected.

A

Testing for HIV RNA or antigen (p24)

76
Q

Antibiotic therapy for acute phar- yngitis is therefore recommended in cases in which S. pyogenes is confirmed as the etiologic agent by

A

rapid antigen-detection test
(RAD test)

or throat swab culture.

77
Q

Effective therapy for streptococcal pharyngitis consists of

A

either a single dose of IM benzathine penicillin

or a full 10-day course of oral penicillin

78
Q

Treatment of acute pharyngitis

A

•Penicillin G 1.2 million units IM × 1
• Penicillin VK 250 mg orally QID, or 500 mg orally BID, or
• Amoxicillin 500 mg
orally BID

79
Q

Treatment of acute pharyngitis with penicillin allergy

A

•Cephalexin 500 mg orally
BID or TID (only if non- anaphylactic penicillin allergy), or
• Azithromycin† 500 mg orally QD × 5 days, or
• Clindamycin 300 mg
orally TID

80
Q

Treatment of viral pharyngitis is entirely symptom based except in infection with

A

influenza virus or HSV

81
Q

______ and ____ are active against both influenza A and influenza B

A

oseltamivir and zanamivir

82
Q

is the best-known complication of acute streptococcal pharyngitis

A

rheumatic fever

83
Q

Aka Postanginal septicemia which is a rare anaerobic oropharyngeal infection caused predominantly by F. necrophorum.

A

Lemierre’s disease

84
Q

is a rapidly progressive, potentially fulminant form of cellulitis that involves the bilateral sublingual and sub- mandibular spaces and that typically originates from an infected or recently extracted tooth, most commonly the lower second and third molars.

A

Ludwig’s angina

85
Q

Fever, dysarthria, and drooling also may be noted, and patients may speak in a “hot potato” voice.

A

Ludwig’s angina

86
Q

is the most common cause of death in ludwigs angina

A

asphyxiation

87
Q

Recommended agents for ludwigs angina

A

include ampicillin/sulbactam, clindamycin, or high-dose penicillin plus metronidazole

88
Q

also known as acute necrotizing ulcerative gingivitis or trench mouth, is a unique and dramatic form of gingivitis characterized by painful, inflamed gingiva with ulcerations of the interdental papillae that bleed easily

A

Vincent’s angina

89
Q

Trench mouth Treatment consists of debridement and oral administration of

A

penicillin plus metronidazole, with clindamycin or doxycycline alone as an alternative.

90
Q

Oropharyngeal candidiasis (thrush) is caused by a variety of Candida species, most often

A

C. albicans.

MI HARRISSONS (62 decks)

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