Adult - Ears, Nose, Throat, URI

Question 1

Common bacterial cause in otitis externa

Answer 1

staph aureus

Question 2

Possible causes of otitis externa

Answer 2

fungal

bacterial - acute or chronic

eczema

Question 3

Management of cholesteatoma?

Answer 3

refer for surgery

Question 4

What are three important differentials to rule out with vertigo?

Answer 4

brain tumor
medication toxicity
otitis media

Question 5

Treatment for vertigo (5)

Answer 5

valium

benadryl

meclizine

scopolamine

antiemetics if needed

Question 6

What drugs tend to be ototoxic? (5)

Answer 6

aminoglycosides (-mycin)

diuretics

salicylates

NSAIDs

antineoplastics

Question 7

Most common cause of acute otitis media in the adult?

Answer 7

viral

Question 8

Most common three bacterial pathogens in order in acute otitis media in the adult?

Answer 8

S pneumoniae
H influenzae
M catarrhalis

Question 9

There is a key pathogen in adults. What is the pathogen and what 4 conditions is it largely responsible for?

Answer 9

S pneumoniae

acute otitis media
meningitis
sinusitis
community acquired pneumonia

Question 10

In children, what are the the top two pathogens in community acquired pneumonia?

Answer 10

H. influenzae
S. pneumoniae

(#1 and #2 flip from the adult)

Question 11

What are three “weird” symptoms of acute otitis media in the adult?

Answer 11

nystagmus
anorexia
lethargy

Question 12

Is erythema alone diagnostic for acute otitis media in the adult?

Answer 12

no

there must be fluid behind the TM

Question 13

What is the management for acute otitis media in the adult?

Answer 13

most resolve spontaneously

if support needed=
hydration
oral decongestants
cool mist humidifiers (???)

Question 14

If bacterial cause is suspected in acute otitis media in the adult, what antibiotics are used?

Answer 14

amoxicillin

if allergic fo PCN – Erythromycin

Question 15

Type of chronic otitis media consisting of peeling layers of keratinized epithelium.

Answer 15

cholesteatoma

Question 16

What are the potential sequelae of cholesteatoma?

Answer 16

erosion of the middle ear leading to nerve damage and deafness

Question 17

What is one feature of cholesteatoma that is either unremitting or frequently recurrent?

Answer 17

painLESS otorrhea

Question 18

What is the most common form of vertigo?

Answer 18

benign paroxysmal positional vertigo (BPPV)

Question 19

What sign is associated with vertigo?

Answer 19

Dix-Hallpike

aka

Nylen-Barany

Question 20

What are the diagnostics for vertigo? (4)

Answer 20

CT to rule out brain tumor or bleed
serum medication levels
ear exam
VDRL/RPR to rule out syphilis

Question 21

What are the three hallmarks of Meniere’s disease?

Answer 21

Hearing loss
Tinnitus
Vertigo

Question 22

Management of hearing loss

Answer 22

conductive hearing loss -
treat underlying cause
clear canal

sensorineural - refer

Question 23

What two symptoms set the common cold apart from other illnesses and allergies?

Answer 23

watery rhinorrhea
and
erythematous nasal mucosa

Question 24

Is fever usually associated with the common cold?

Answer 24

No

Question 25

What three symptoms are associated with a bacterial cause of pharyngitis?

Answer 25

Fever ANTERIOR cervical adenopathy Macropapular rash

Question 26

What symptom is associated with a VIRAL cause of pharyngitis?

Answer 26

rhinorrhea

Question 27

Is strep a common cause of pharyngitis in adults?

Answer 27

no

Question 28

What criteria is used to determine whether a rapid strep test is indicated?

Answer 28

Centor criteria = FLEA Fever Lack of cough Exudate in the pharynx/tonsils Anterior cervical adenopathy

Question 29

Is the FLEA criteria sensitive or specific?

Answer 29

Sensitive | a negative result effective rules strep out SNOUT

Question 30

What medications may be used to treat influenza?

Answer 30

neuraminidase inhibitors - a type of antiviral zanamivir (Relenza) - inhaler oseltamivir (Tamiflu) - oral

Question 31

What are four hallmarks of mono?

Answer 31

severe pharyngitis extreme malaise POSTERIOR cervical adenopathy splenomegaly - usu during second week

Question 32

Diagnostics for mono

Answer 32

Monospot | increased WBC with relative lymphocytosis and neutropenia (shift to the R)

Question 33

When would a predisone taper be used in mono?

Answer 33

for severely enlarged tonsils

Question 34

When is a bacterial cause suspected in sinusitis?

Answer 34

fever | purulent nasal drainage

Question 35

What antibiotics are used in sinusitis?

Answer 35

augmentin - amoxicillin/clavulunate | biaxin - clarithromycin