HEENT infections

Question 1

Otitis Media presents with

Answer 1

Redness, immobility, bulging, and a decreased light reflex of the TM. Pain is common. Decreased hearing and fever also occur.

Question 2

What is the most sensitive physical finding for otitis media?

Answer 2

Immobility is so sensitive a physical finding that a fully mobile TM essentially excludes otitis media.

Question 3

What radiologic tests are useful for otitis media?

Answer 3

none

Question 4

What is the most accurate diagnostic test for otitis media and when is it the correct answer?

Answer 4

Tympanocentesis is the most accurate diagnostic test. It is used if there are multiple recurrences or if there is no response to multiple antibiotics.

Question 5

Best initial therapy for otitis media?

Answer 5

Amoxicillin

Question 6

Alternative treatment for otitis media if no responce to therapy

Answer 6

Amoxicillin/clavulanate
Azithromycin, clarithromycin
Cefuroxime, loracarbef
Levofloxacin, gemifloxacin, moxifloxacin

Question 7

A 34 y/o woman presents with facial pain, discolored nasal discharge, bad taste in her mouth, and fever. On PE she has facial tenderness. Which of the following is the most accurate diagnostic test?

a. Sinus biopsy or aspirate
b. CT scan
c. Xray
d. Culture of the discharge
e. Transillumination

Answer 7

A. in ID, radiologic test is never correct. Only a biopsy or aspirate will give a precise microbiological diagnosis. Culture of nasal discharge is alway incorrect for sinusitis.

Question 8

A sinus biopsy is only needed if

Answer 8

Infection frequently recurs or there is no responce to antibiotic therapy

Question 9

A 34y/o woman presents with facial pain, a discolored nasal discharge, bad taste in her mouth, and fever. On PE she has facial tenderness. What is the most appropriate next step/action/managment?

a. Linezolid
b. CT scan
c. Xray
d. Amoxicillin and a decongestant
e. erythromycin and a decongestant

Answer 9

D. When diagnosis is this clear radiologic testing is not necessary. Amoxicillin, doxycycline, and trimethoprim/sulfamethaxozole remain first line therapy for otitis and sinusitis. Decongestant is used in all cases to promote sinus drainage. Erythromycin is inadequate because of poor coverage of Strep pneumo, Linezolid would not cover Haemophilus.

Question 10

First line therapy for otitis and sinusitis

Answer 10

Amoxicillin, doxycycline, trimethoprim/sulfamethoxazole

Question 11

Pharyngitis presents with

Answer 11

Pain on swallowing, enlarged lymph node in the neck, exudate in the pharynx, fever, no cough and no hoarseness. With these present the likelyhood of streptococcal infection exceeds 90%

Question 12

Best initial test for pharyngitis

Answer 12

Rapid strep. Negative test is considered sufficiently sensitive to exclude disease, no abx necessary

Question 13

pharyngitis with small vesicles or ulcers

Answer 13

HSV or herpangina

Question 14

pharyngitis with membranous exudates

Answer 14

diphtheria, Vincent angina, or EBV

Question 15

Positive rapid strep treatment

Answer 15

Penicillin or amoxicillin is best initial therapy. If allergy tx with cephalexin if rx is rash. If anaphylaxis use clindamycin or macrolide

Question 16

Why treat Streptococcal pharyngitis?

Answer 16

Prevent rheumatic fever

Question 17

Influenza presents with

Answer 17

arthralgias/myalgias, cough, fever, headache, sore throat, N/V/D

Question 18

Most appropriate next step in management of flu

Answer 18

Depends on time course from presentation. If within 48hrs perform nasopharyngeal swab for influenza. Less than 48hrs, Oseltamivir, Zanamivir to shorten duration of symptoms. More than 48hrs- symptomatic tx, analgesics, rest, antipyretics, hydration

Question 19

Do Oseltamivir and Zanamivir successfully treat complications of influenza such as pneumonia?

Answer 19

no