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DAST 7 Exam 2 > Otitis Media & Externa - 5Qs > Flashcards

Otitis Media & Externa - 5Qs Flashcards

1
Q

Define Acute Otitis Media (AOM).

A

RAPID onset, symptomatic infection of middle ear with MEE

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2
Q

Define recurrent AOM.

A

6 episodes of AOM over 12 months

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3
Q

Define OME.

A

OME with duration of > 3 months

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4
Q

When does acute bacterial inf occur?

A

Acute bacterial infection usually follows viral upper respiratory tract infection.

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5
Q

List non-modifiable risk factors

A 
< 2 year
Family members with respiratory infection
Genetic predisposition 
Eustachian tube anatomy
Premature birth
Male gender
Immunodeficiency 
Family hx of recurrent otitis media
Siblings in the household
Low socioeconomic status
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6
Q

List modifiable risk factors

A 
Daycare attendance 
Breast feeding v.bottle feeding
Breast feeding < 3 months
Supine bottle feeding position
Pacifier use from 6months to 1year
Exposure to parental smoking or secondhand smoke
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7
Q

List the most common bacterial pathogens

A

Streptococcus Pnuemoniae
Haemophilus Influenzae
Moraxella catarrhallis

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8
Q

List the other bacterial pathogens that cuz OM

A

S. aureus

Gram-negative bacilli

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9
Q

List the viral pathogens that cuz OM

A 
RSVP
Parainfluenza viruses
Influenza viruses
Rhinovirus
Coronavirus
Adenovirus
Enterovirus
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10
Q

Name clinical presentation of AOM

A

Bulging, cloudy, immobile and/ or red Tympanic Membrane (TM)

Otalgia, ear pulling, and otorrhea

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11
Q

Name non-specific clinical presentation of AOM (mimics URT)

A 
Fever
Rhinitis
Irritability
Cough
Congestion
Poor appetite
Vomiting
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12
Q

List the 3 criteria used to diagnose AOM

A 
ACUTE onset of s/sx
MEE (at least 1 of the ff)
-bulging TM
-decreased/ absent motility of TM
-otorrhea
Middle ear inflammation (at least 1 of the ff)
-red TM 
-otalgia affecting normal activity and/or sleep
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13
Q

How’s AOM diagnosed?

A

Via Otoscopy and tympanometry

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14
Q

How do you treat ear pain?

A

Usually self-limiting

May consider analgesic regardless of AB use e.g. Oral acetaminophen, ibuprofen, topical analgesic ear drops

Avoid topical ear drops if perforated ear drum or otorrhea

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15
Q

What possible complications may result from AOM (usually why tx is done, to avoid these complications)

A

Mastoiditis
Meningitis
Intracranial abscess formation
Hearing, speech or language impairment

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16
Q

What’s the evidence based tx guideline for < 6months (certain v. uncertain diagnosis)

A

AB for both cases

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17
Q

What’s the evidence based tx guideline for 6months to 2 yrs (certain v. uncertain diagnosis).

A

Certain diagnosis - AB

Uncertain diagnosis - AB, if severe
Observation, if not severe

18
Q

What’s the evidence based tx guideline for >2yrs (certain v. uncertain diagnosis)

A

Certain diagnosis - AB, if severe
Observation, if not severe

Uncertain diagnosis - Observation option

19
Q

What’s the 1st line tx for AOM

A

Amoxicillin
0-2yrs x 10 days
> 2 yrs x 5-7 days

20
Q

What’s the option for resistant/recurrent b-lactamase producers?

A

Amoxicillin / Clavulanate acid (augmentin)

21
Q

When do you consider using the alternative therapy?

A
  • Sx worsens / doesn’t improve 48-72h after starting amoxicillin
  • Recurrence of AOM <2 yrs of age
  • Culture shows resistance pathogen
  • Penicillin allergy
22
Q

Name the AB of choice for penicillin-allergic (non-type1) inf

A

Cephalosporin

  • Cefdinir
  • Cefprozil
  • Cefuroxime
  • Cefpodoxime
23
Q

Which of the penicillin-allergic (non-type 1) alternatives is equivalent to Augmentin?

A

Cefprozil

24
Q

Which cephalosporin is used of nausea/vomiting or tx failure happens?

A

Ceftriaxone

25
Q

Name the options for penicillin- allergenic (type 1)

A

Azithromycin
Clarithromycin
Clindamycin

26
Q

Which ones can’t be used for children < 6 months?

A

Azithromycin

Clarithromycin

27
Q

Which AB is the option for PCN-resistant pneumococcal inf?

A

Clindamycin

28
Q

What tx is NOT recommended for AOM?

A 
Prolonged/prophylactic AB
Steroids
Antihistamine (becuz allergies don't cuz AOM)
Decongestants
CAM
29
Q

What inf is common and may take weeks to months to resolve?

A

MEE

30
Q

What’s the relationship btw vaccination and AOM.?

A

Vaccination may reduce the incidence of AOM

31
Q

What are the benefits of Tympanostomy tubes?

A
  • reduce recurrent AOM
  • reduce amt of time with effusions
  • maximize hearing potential for at risk children
  • prevent chronic changes to TM or middle ear space
  • prevent/treat acute complications of AOM
32
Q

Definite AOE

A

-Diffuse inflammation of external ear canal, possibly involving the pinna or TM

Also known as “Swimmer’s ear” or “Tropical ear”

33
Q

What’s the payhophysiology of AOE?

A

Normal protective layer of cerumen becomes altered

Exposure to bacteria is easier, and this occurs usually through water exposure

34
Q

Name risk factors for AOE

A 
Freq removal or alteration of cerumen
Chronic dermatological condition
Local trauma
Warmer, more humid climate
Increased water exposure
genetics
Allergy
Sweating
35
Q

Name clinical presentation of AOE

A 
Redness and inflammation of external ear
Variable edema and otalgia
Pruritis
Diff sleeping
Mild to mod hearing impairment
Exudative discharge
36
Q

Name the primary pathogens that are responsible for AOE

A

P. aeruginosa
S. aureus

T4 it’s a mainly bacterial inf

37
Q

Name atypical causes of AOE

A

Aspergillus sp
Candida sp
Immunocompromised pts - diabetes, HIV etc

38
Q

What’s the preferred tx for AOE.

A

Topical therapy

Ciprofloxacin + dexamethasone
Ciprofloxacin + hydrocortisone

39
Q

What is oral AB for AOE?

A

Fluoroquinolones are the only effective PO AB for AOE

40
Q

In what pt population is systemic tx considered, either alone or with topical therapy?

A
  • Diabetics
  • AIDS/HIV
  • AOE that has spread to the skin of the neck and face
  • Malignant externa otitis
  • AOE complicated by osteomyelitis, abscess formation or middle ear dx
  • Recurrent episode of AOE

DAST 7 Exam 2 (9 decks)

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