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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
Q

What is a “cholinergic” med?

A

Meds that act via Ach, either by binding to its receptors or changing its concentration

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26
Q

Why are muscarinic agonists also called “parasympathomimetic” meds?

A

Muscarinic agonists mimic PNS stimulation

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27
Q

For what EENT conditions are muscarinic agonists used?

A

Acute angle-closure glaucoma
Maintenance med in primary open angle glaucoma
Dry mouth and dry eyes in Sjogrens

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28
Q

For what EENT conditions are muscarinic antagonists used?

A

Topically for pupil dilation during ophthalmic procedures
As cycloplegics for uveitis, iritis, UV keratitis

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29
Q

What patient population should avoid muscarinic antagonists?

A

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

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30
Q

What are “adrenergic” medications?

A

Act by binding to adrenergic receptors or changing the concentration of epi and norepi

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31
Q

what do andrenergic agonists mimic?

A

SNS stimulation

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32
Q

For what EENT conditions are alpha 1 agonists used?

A

Nasal congestion and red eyes

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33
Q

For what EENT conditions are alpha 2 agonists used/

A

Glaucoma

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34
Q

For what EENT conditions are beta blockers used?

A

Glaucoma

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35
Q

Which pt populations should avoid alpha 1 agonists

A

HTN/CVD
Angle closure glaucoma
Urinary retention
Bowel obstruction

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36
Q

Which pt populations should avoid beta blockers

A

Asthma
Obstructive airway disease

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37
Q

What is the effect of histamine in the allergic response?

A

Vasodilation
Inc vascular permeability (edema, redness, inc mucus)
Stimulation of afferent neurons (pruritis, pain)
Contraction of bronchial smooth muscle (bronchoconstriction)

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38
Q

What types of histamine receptors are involved in the allergic response?

A

H1 receptors for allergic response
(H2 = reg of acid in gastric mucosa)
NT in CNS - several types of receptors

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39
Q

What EENT conditions are treated with H1 antagonists?

A

Reduces itching sneezing, rhinorrha, congestion of allergic rhinitis
Itching, redness, and watery eyes of allergic onjunctivitis

40
Q

Which pt population should avoid antihistamines?

A

Children <2

41
Q

How does the mechanisms of antihistamines differ from that of mast cell stabilizers?

A

Antihistamines block histamine receptors, mast cell stabilizers prevent the release of histamine from mast cells

42
Q

What EENT conditions are treated with mast cell stabilizers?

A

IN for allergic rhinitis
Eye drops for allergic conjunctivitis
Topically for allergic conjunctivitis

43
Q

What are the 2 eicosanoid pathways? Which eicosanoids are made by each?

A

Cyclooxygenase (COX) > prostaglandins and thromboxane

Lipoxygenase (LOX) > leukotrienes

44
Q

How are NSAIDS and acetaminophen used in EENT conditions

A

Fever and pain

45
Q

How are prostaglandins used in EENT conditions

A

Glaucoma

46
Q

How are leukotrinee antagonists used in EENT conditions

A

Allergic rhinitis
Chronic rhinosinusitis

47
Q

What types of ddxs are there for a sore throat other than pharyngitis?

A

Systemic disease (arthritis, HIV, TSS, hepatitis)
Head/neck disorders (cervical pain, sinusitis, mumps, thyroiditis)
Lesions (herpes, candida, mono, canker sores)

48
Q

What is a red flag with sore throats?

A

Sudden severe throat pain, esp in older pts > aortic dissection, pneumothorax

49
Q

Signs/sx of mono

A

Teens with sore throats > 1 week
Post cervical tender nodes
Adenopathy in groin + axilla
Functional impairment w myalgia
Tonsil exudate
Petechiae on pharynx

50
Q

How do you confirm a mono infection with lab tests?

A

Peripheral smear (atypical lymphocytes)
Monospot (more sens 2 weeks after contraction)
Mildly elevated transaminase levels
Liver transaminases to assess for EBV hepatitis

51
Q

Centor criteria points

A

+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
Q

Centor criteria meanings

A

<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
Q

are strep carriers at risk for non-suppurativa complications of strep like RF?

A

No, they dont mount an antibody response

54
Q

Antibiotics effect on sequela of strep

A

Prevents:
RF

Probably don’t prevent:
Guttate psoriasis
Erythema nodosum

Don’t prevent:
Glomerulonephritis

55
Q

Botanicals for strep

A

HEMP - hydrastis, echinacea, myrrh, phytolacca

Synergism’s like belladonna, Bryonia, aconite, gelsemium

56
Q

Repertories for strep

A

Throat, inflammation, erysipelatous
Mouth, papillae, erect, red

57
Q

When should you do repeat cultures on a sore throat?

A

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
Q

What is trismus

A

Lockjaw; muscle spasm, unable to open mouth fully

59
Q

How is peritonsillar abscess diagnosed?

A

Needle aspiration

60
Q

What are the suppurativa complications of poorly treated/untreated pharyngitis?

A

Peritonsillar abscess (quinsy)
Retropharyngeal abscess

61
Q

What is Ludwig’s angina?

A

Infection to sub mental space, severe trismus, drooling, airway compromise

62
Q

Ddx of chronic sore thraot

A

Infectious
Irritative (reflux, post nasal drip, toxins, vocal bad hygiene/abuse)
Neoplastic

63
Q

Causes of globus

A

GERD
Abnormal UES function
Motor disorders
Thyroid disease
Hypertrophy of tongue base
Cervical osteophytes
Stress/psych

64
Q

How to work up hoarseness? When is referral needed?

A

HEENT, lymph node exam, laryngoscopy

Referral to voice therapy to reduce laryngeal trauma

65
Q

Naturopathic tx options rhinosinusitis

A

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
Q

When and why would you use N-acetyl cysteine in your tx of ENT conditions?

A

Tx of hay fever allergic rhinitis; potent antioxidant and mucolytic

Chronic rhinosinusitis - immune support and protection

67
Q

When should imaging be ordered in cases of rhinosinusitis?

A

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
Q

Are antibiotics indicated for the tx of acute sinusitis?

A

For bacterial yes; not effective or recommended for acute VIRAL rhinosinusitis

69
Q

How to assess epistaxis

A

Assess for hemodynamic stability
Look for bleeding site
Wear gloves + eye protection
Use topical neo-synephrine if needed

70
Q

Tx epistaxis

A

Cold application
Topical anesthetic and topical silver nitrate
Vit C
Bioflavinoids
Homeopathy
Pharm

71
Q

When is epistaxis potentially dangerous?

A

Post epistaxis

72
Q

RF rhinosinusitis

A

Polyps
Septal deviation
Viral URI (most imp RF for acute bacterial rhinosinusitis)
Dairy/food allergy

73
Q

Pathogenesis rhinosinusitis

A

Viral rhinitis > blocked Ostia > O2 absorbed > neg pressure (pain=vacuum sinusitis) > transudate > bacteria invade > ciliary dyskinesia > pos pressure > pain

74
Q

Indications for urgent referral with rhinosinusitis

A

Abnormal vision
Change in mental status
Periorbital edema
CN abnormalities (2, 3, 4, 6)

75
Q

How do children’s sinuses develop?

A

Maxillary and ethmoid present at birth

Sphenoid develops from ethmoid at 9 yrs

Frontal develops from ethmoid at 5-7 years

76
Q

How is rhinosinusitis diagnosed in children?

A

A presumptive dx is made if there is a persistent cough and nasal rhinorrhea > 10 days (cough usually due to postnasal drip)

77
Q

What classes are included in the B lactam antibiotics?

A

Penicillins
Cephalosporins

78
Q

Ex of penicillins

A

Penicillin G, V (natural penicillins)
Amino penicillins - Amoxicillin
Amplicillin

79
Q

Ex of cephalosporins

A

Cephalexin
Cefuroxime
Ceftriaxone
Cefdinir

80
Q

Drug type/Ex of tetracyclines

A

antibiotic
Tetracycline, doxycycline, minocycline

81
Q

Drug type/Ex of Macrolides

A

Antibiotics
Azithromycin, clarithromycin, erythromycin

82
Q

Drug type/Ex of Fluoroquinolones

A

Antibiotics
Ciprofloxacin, levofloxacin, oflocaxin

83
Q

Drug type/Ex of Lincosamides

A

Antibiotics
Clindamycin, lincomycin

84
Q

Drug type/Ex of Aminoglycosides

A

Antibiotics
Gentamicin, neomycin, tobramycin, streptomysin

85
Q

Antibiotic classes used for ENT conditions

A

B lactams
Tetracyclines
Macrolides
Fluoroquinolones
Lincosamides
Aminoglycosides
Mupirocin

86
Q

penicillin G vs V administration and use

A

G - IV / IM, syphilis
V - oral, first line for group A strep pharyngitis

87
Q

Amino penicillins are first line therapies for

A

AOM
Bacterial rhinosinusitis
first line alternative for GAS

88
Q

Cephalosporins uses

A

Alternatives for penicillins for AOM, bacterial rhinosinusiits, GAS

Ceftriaxone (IM) for gonococcal pharyngitis and conjunctivitis

89
Q

Tetracycline uses

A

Alternative for penicillin allergic patients in tx of bacterial sinusitis

90
Q

Macrolides uses

A

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
Q

Fluoroquinolones uses

A

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
Q

Lincosamides (clindamycin, lincomycin) uses

A

Alternative in b-lactam allergies for GAS and rhinosinusitis (preferred over fluoroquinolones in kids for this purpose)

93
Q

Aminoglycoside uses

A

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
Q

Mupirocin uses

A

MRSA
Nasal vestibular is, elimination of nasal MRSA colonization

95
Q

Nucleoside analogues uses

A

Orally at first sign of viral activation, also topical

Herpes zoster oticus/ophthalmicus

Herpes simplex pharyngitis / keratitis

EENT (6 decks)

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