B3.054 - Ear Infections Zuckert

Question 1

what is otalgia

Answer 1

ear pain

Question 2

what is diagnostic for primary otalgia

Answer 2

abnormal ear exam, discharge, tinnitus, hearing loss, vertigo

Question 3

why does the inner ear structure not have pain and what are inner ear structures

Answer 3

cochlea, semicircular canals cranial enervation VIII has no pain fibers

Question 4

secondary otalgia diagnostics

Answer 4

normal ear exam, reffered pain due to sensation fivers from V,VII, XI and X and cervical nerves C2, C3

Question 5

common causes of otalgia in otitis media

Answer 5

recent URTI, red cloudy and immobile tympanic membrane

Question 6

common causes of otalgia in otitis externa

Answer 6

swimmers ear ear phone use white discharge

Question 7

what are causes of secondary otalgia

Answer 7

dental carries, periodontal abcesses, pharyngitis, tonsilitis

Question 8

epidemiology and signs of malignant (necrotizing) otitis externa

Answer 8

diabetes, elderly immunocompromised painful granulation tissue

Question 9

what are symptoms ramsay hunt syndrome

Answer 9

from herpes zoster oticus, vesicular rash, vertigo, hearing loss, tinnitus

Question 10

whats the difference between viral myringitis and OME

Answer 10

similar but no tympanic bulging

Question 11

what are risk factors for tumors causing otalgia

Answer 11

>50 tobacco alcohol use

Question 12

what is ramsay hunt syndrome

Answer 12

reactivated VZV spreading to facial nerves paralysis and rash affecting mouth and ears tinnitus hearing loss

Question 13

H. influenzae can cause

Answer 13

AOM

Question 14

pseudomonas aeruginosa can cause

Answer 14

AOE

Question 15

how does H. influenzae gram stain and where is it on the tree

Answer 15

gram - negative mcconkey oxygen positive

Question 16

describe the physical characteristics of H. influenzae

Answer 16

small gram - rods/coccobacilli

Question 17

what are the complex nutritional requirements of Haemophilus sp

Answer 17

X factor - hematin V factor - NAD

Question 18

how many capsular antigenic serotypes does H. influenzae have

Answer 18

6 (a-f)

Question 19

whats the most virulent type of H. inluenzae

Answer 19

Hib

Question 20

what are non typable strains of Haemophilus inlfuenzae

Answer 20

non encapsulated rarely cause invasive disease

Question 21

what does H. ducreyi cause

Answer 21

STD soft chancre/chancroid (panful)

Question 22

what does H aegyptius cause

Answer 22

conjuctivitis

Question 23

Hib colonizes what using what

Answer 23

oropharynx using adhesins like fimbriae, IgA protease

Question 24

what causes local inflammation in Hib

Answer 24

LPS Impairment of ciliary function damage to respiratory epithelium

Question 25

invasion of blood stream and bacteremia is cause by what in Hib

Answer 25

PRP (polyribitol capsule)

Question 26

what type of antibody is protective for Hib

Answer 26

anti PRP

Question 27

what aids Hib in hematogenous spread

Answer 27

PRP

Question 28

what causes disseminated disease in Hib

Answer 28

LPS

Question 29

what are the only hosts of Hib

Answer 29

humans

Question 30

how is Hib transmitted

Answer 30

respiratory droplets, mainly pediatric disease

Question 31

what does the Hib vaccine have in it

Answer 31

purified PRP conjugated to carrier proteins

Question 32

what is the combination vaccine for Hib called and what is it a combination of

Answer 32

DTap-Hib and Hepatitis B-Hib DTap has Diphtheria toxoid, mutant diphtheria toxin, tetanus toxoid, meningococcal membrane protein

Question 33

how does the vaccine help your immune system

Answer 33

Creates T cell dependent antigens, protective antibody response is created in \>2mo

Question 34

what is the immunization schedule of Hib

Answer 34

2, 4, 6 and 12-15 moths

Question 35

who is the Hib vaccine not recommended for

Answer 35

\>5 yo unless pt has sickle cell, asplenia, immunodeficiency, HIV

Question 36

how does Hib gram stain and what specimen do you get

Answer 36

CSF or synovial fluid Gram -

Question 37

what test can you do for the capsule of Hib

Answer 37

latex agglutination

Question 38

what does a culture media for Hib require

Answer 38

Factor V and X

Question 39

what other organism do you plate with in a culture of Hib

Answer 39

Staph aureus because it has hemolysin RBCs releasing factor V and X allowing

Question 40

NTHi is not serum resistant, what does that mean

Answer 40

it lacks a capsule so its infection is localized and not able to spread to blood

Question 41

what are common issues caused by NTHi

Answer 41

otitis media sinusitits pneumonia

Question 42

how do you treat invasive H influenzae

Answer 42

3rd gen cephalosporins ceftriaxone

Question 43

how do you treat otitis media, sinusitis caused by H influenzae

Answer 43

ampicillin cephalosporin fluoroquinolone (ciprofloxacin)

Question 44

major sequelae of an Hib infection

Answer 44

meningitis

Question 45

describe the gram identification of psuedomonas and where if falls on tree

Answer 45

Gram - grows on mcconkey + Lactose - Glucose -

Question 46

is pseudomona motile

Answer 46

yes

Question 47

where do you find pseudomonas

Answer 47

ubiquitous in environment, soil, water, plants, animals, humans,

Question 48

how do people typically get infected with psudomonas

Answer 48

its a common nosocomial pathogen from hospital stays

Question 49

infections of psudomonas are found where on the body

Answer 49

skin pulmonary outer ear eye

Question 50

what is alginate

Answer 50

P. aeruginosa capsule

Question 51

what does the p. aeruginosa capsule do

Answer 51

prevents phagocytosis and contributes to antibiotic resistance adhesin

Question 52

describe the structure of the capsule

Answer 52

polymer of mannuronic and glucuronic acid

Question 53

how is p. aeruginosa production highly regulated

Answer 53

environmental and quorum sensing produced at high levels in lungs

Question 54

what does a culture of p aeruginosa look like

Answer 54

mucoid colonies, shiny, alginate +

Question 55

what does p aeroginosa look like in vitro

Answer 55

production ceases, smooth and pigmented, pycyanin, green colonies, flagella +, pilli +

Question 56

what is this and differentiate between left and right

Answer 56

left is acute and right is chronic (has capsule) p. aeruginosa

Question 57

exotoxins of p aeruginosa

Answer 57

Exotoxin A, S, U

Question 58

what does exotoxin A do

Answer 58

A-B toxin: A subunit ADP ribosylates elongation factor EF-2 affecting protein synthesis

Question 59

what does exotoxin S do

Answer 59

major virulence factor injected T3SS effector protein disrupts signal transduction and blocks phagocytosis

Question 60

what does exotoxin U do

Answer 60

cytotoxic for macrophages

Question 61

what does p aeruginosa do to elastase and whats it regulated by

Answer 61

degrades elastin (protein in pulmonary and endothelial tissue) Production regulated by quorum sensing

Question 62

what is quorum sensing

Answer 62

osmolarity/nitrogen sensing of external environment

Question 63

what type of infection do otherwise healthy individuals

Answer 63

folliculitis, hot tub rash otitis externa (swimmers ear) Eye infections associated with trauma

Question 65

default treatment for P.a. otitis externa

Answer 65

eardrops

Question 67

treatment for p.a. otitis externa mild

Answer 67

acetic acid + propylene glycol + hydrocortisone

Question 68

moderate to severe treatment for P.a. otitis externa

Answer 68

ciprofloxacin + hydrocortisone

Question 69

what do you not give for P.a. otitis externa if tympanic membrane is ruptured

Answer 69

neomycin

Question 70

what is used for prevention of p.a. otitis externa

Answer 70

alcohol ear drops

Question 71

P.a. diseases in immunocompromised

Answer 71

bacteremia burn would infections malignant otitis externa pulmonary infections

Question 72

when after a burn wound would you see pseudomonas infections

Answer 72

\>2 weeks

Question 73

whats the DOC for psudamonas caused malignat otitis externa

Answer 73

IV ciprofloxacin

Question 74

who do you see P.a. infections in

Answer 74

pts with COPD, CF, neutropenia

Question 75

by what age and how many CF pts have P.a. colonization

Answer 75

80-90%, by age 3

Question 76

P.a. biofilm formations are resistant to what

Answer 76

phagocytosis, complement, antibodies

Question 77

symptoms of pseudomonas pneumonia

Answer 77

fever, chills, sever dyspnea, cyanosis, productive cough

Question 78

risk factors of P.a. pneumonia

Answer 78

neutropenia, chronic lung disease, CHF, use of mechanical ventilators, lung burns

Question 79

what types of patients are more likely to get P.a. pneumonia

Answer 79

ICU pts and nursing home residents

Question 80

describe the ways to identify P.a. in lab

Answer 80

obligate aerobe catalase + oxidase + green pigmented, often fluorescent colonies

Question 81

what causes green pigmented P.a.

Answer 81

pyocyanin - blue, antibiotic pigment Fluorescein

Question 82

what does pyocyanin do

Answer 82

cytotoxic to eukaryotic cells, oxidative stress

Question 83

what are siderophores

Answer 83

pyoverdin and pyochelin

Question 84

what is distinct about the smell of p.a.

Answer 84

fruity (grapes, tortillas)

Question 85

where is PYO found

Answer 85

airway secretions

Question 86

what does PYO cause

Answer 86

low ATP (cilia, CFTR) Low NADPH neutrophils

Question 87

initial empiric combo treatment for P.a.

Answer 87

antipseudomonal beta lactam + beta lactamase inhibitor +aminoglycoside

Question 88

what is colistin and what does it do

Answer 88

polymixin E last resort, solubilizes bacterial membranes