Dr. Daniel -- Common Infections in Otolaryngology, Head and Neck Surgery

Question 1

Signs and symptoms of tonsililitis (6)

Answer 1

Severe sore throat
Difficult or painful swallowing
Headache
Fever/chills
Enlarged, tender neck nodes
Voice change

Question 2

Etiology of tonsilitis (2)

Answer 2

Viral (EBV)

Bacterial (S. pyogenes)

Question 3

2 methods of diagnosis for tonsillitis

Answer 3

Physical exam

Culture

Question 4

5 complications of tonsillitis

Answer 4

Abscess formation
Loss of airway
Sepsis
Nephritis
Rheumatic fever

Question 5

Natural progression of otitis externa

Answer 5

Usually self-limited

Question 6

2 symptoms of otitis externa

Answer 6

Otalgia

Otorrhea

Question 7

3 findings of otitis externa

Answer 7

Ear canal edema
Otorrhea
Tender to pinna traction

Question 8

Pathogenesis of AOE (4 steps)

Answer 8

1) Water exposure
2) Loss of protective barriers (removal of wax, irritation of EAC skin)
3) Accumulation of exfoliated skin debris
4) Obstruction

Question 9

Lifetime incidence of otitis externa

Answer 9

10% (accounts for 7.5 million annual ototopical prescription in US)

Question 10

4 most common pathogens associated with otitis externa

Answer 10

1) Pseudomonas aeruginosa (20 - 60%)
2) S. aureus (10 - 70%); often polymicrobial
3) Other gram - organisms
4) Fungal

Question 11

4 antibiotics options for otitis externa

Answer 11

1) Aminoglycoside
2) Polymyxin B
3) Quinolone
4) A combination of these agents

Question 12

2 steroids for otitis externa

Answer 12

1) Hydrocortisone

2) Dexamethasone

Question 13

3 treatment options of otitis externa

Answer 13

1) Antibiotics
2) Steroids
3) Low pH antiseptic (i.e. aluminum acetate solution or acetic acid)

Question 14

3 pairs of AOE treatments that have equivalent clinical outcomes

Answer 14

1) Antiseptic vs. antimicrobial
2) Quinilone vs. non-quinolone
3) Steroid-antimicrobial vs. antimicrobial alone

NOTE: Regardless of topical agent, about 65 - 90% have clinical resolution within 7 - 10 days

Question 15

2 Most common pathogens of fungal otitis

Answer 15

1) Aspergillus

2) Candida

Question 16

Classic pathogenesis of fungal otitis

Answer 16

Prolonged treatment of bacterial otitis externa that alters the flora of the ear canal

Question 17

2 symptoms and findings of fungal otitis

Answer 17

1) Clogged, itchy or painful ears

2) Thick fungal debris in the external auditory canal

Question 18

3 generally safe treatments for fungal otitis

Answer 18

1) Clotrimazole
2) Miconazole
3) Tolnaftate

Question 19

Fungal otitis treatment that has potential for severe damage

Answer 19

Gentian violet

Question 20

2 treatments for fungal otitis that can cause appreciable elevation of brainstem response thresholds

Answer 20

Drops containing:
1) Acetic acid
OR
2) Propylene glycol

Question 21

Define otitis media

Answer 21

Inflammatory disease of the mucosal lining of the middle ear

Question 22

Common group of people affected by otitis media

Answer 22

Children

Question 23

2 most common pathogens of otitis media

Answer 23

Streptococcus pneumoniae

Haemophilus influenzae in infants

Question 24

7 symptoms of otitis media

Answer 24

1) Abrupt onset
2) Ear pain
3) Fullness
4) Fever
5) Irritability
6) Vomiting
7) Loose stools

Question 25

3 reasons for the pathogenesis of otitis media

Answer 25

1) Eustachian tube dysfunction 2) Immunologic compromise 3) Microbial challenge

Question 26

4 examples of eustachian tube dysfunction causing otitis media

Answer 26

1) Developmental 2) Cleft palate 3) Infectious 4) Environmental (allergies, smoke)

Question 27

3 examples of immunologic compromise causing otitis media

Answer 27

1) Developmental 2) Immunodeficiency 3) Infectious

Question 28

3 examples of microbial challenge causing otitis media

Answer 28

1) Viral 2) Bacterial 3) Daycare!

Question 29

3 methods of diagnosis of otitis media

Answer 29

1) Red TM with bulging and loss of normal landmarks 2) Spontaneous perforation possible in first 24-48 h --> alleviation of pain 3) Pneumatic otoscopy to determine the presence of fluid in middle ear

Question 30

3 treatment options of otitis media

Answer 30

1) Antibiotics 2) Drainage 3) Myringotomy

Question 31

3 first line antibiotics for otitis media

Answer 31

1) Amoxicillin 2) Macrolides (10% pneum. resistance) 3) TMP/SMX (25% pneum. resistance)

Question 32

4 antibiotics in cause of first line treatment failure

Answer 32

1) Amoxicillin/clavulanate 2) 2nd gen cephalosporins (i.e. cefuroxime axetil, cefactor) 3) TMP/SMX and macrolildes 4) Fluoroquinolones

Question 33

3 fluoroquinolones to treat otitis media

Answer 33

Grepafloxacin Levofloxacin Sparfloxacin

Question 34

Treatment course of otitis media antibiotics

Answer 34

10 - 14 days

Question 35

Complication of otitis media

Answer 35

acute mastoiditis

Question 36

3 classes of sinus infections

Answer 36

1) Acute bacterial sinusitis 2) Subacute bacterial sinusitis 3) Recurrent acute bacterial sinusitis

Question 37

Define acute bacterial sinusitis (2)

Answer 37

Bacterial infection lasting less than 30 days in which symptoms resolve completely Persistent and worsening upper resp. symptoms for longer than expected 7 day course of a viral illness, but for less than 3 weeks

Question 38

Define subacute bacterial sinusitis

Answer 38

Bacterial infection lasting between 30 - 90 days in which symptoms resolve completely

Question 39

Define recurrent acute bacterial sinusitis

Answer 39

Episodes lasting less than 30 days and separated by intervals of at least 10 days during which the patient is asymptomatic

Question 40

3 things that result in healthy sinuses

Answer 40

1) Adequate ventilation through patent ostia 2) Adequate mucociliary clearance 3) Adequate local and systemic immune defense

Question 41

3 most common acute sinusitis pathogens

Answer 41

1) Strep pneumoniae 2) H. influenzae 3) M. catarrhalis occasionally

Question 42

2 rare pathogens of acute sinusitis

Answer 42

1) Staph aureus | 2) Anaerobes

Question 43

3 first line antibiotics for acute sinusitis

Answer 43

1) Amoxicillin 2) erythromycin 3) TMP/SMX

Question 44

5 second-line antibiotics for acute sinusitis

Answer 44

1) Clarithromycin, azithromycin 2) Amoxicillin/clavulanate 3) Cefuroxime axetil, cefprozil, cefactor 4) Ciprofloxacin, levofloxacin 5) Clindamycin

Question 45

Compare the treatment outcomes for acute sinusitis

Answer 45

For patients with uncomplicated acute sinusitis, less expensive first-line agents = as effective as costlier second-line agents

Question 46

Usual course of disease for viral otitis and sinusitis

Answer 46

8 - 10 days

Question 47

Usual course of disease for otitis and sinusitis due to aerobes

Answer 47

10 days to less than 3 months

Question 48

Usual course of disease for otitis media and sinusitis due to anaerobes

Answer 48

Over 3 months

Question 49

Define chronic sinusitis

Answer 49

Symptoms of sinusitis persisting beyond 3 months without improvement

Question 50

Most common pathogen associated with chronic sinusitis

Answer 50

H. influenzae

Question 51

4 most common pathogens for refractory chronic sinusitis

Answer 51

1) S. aureus 2) Anaerobic bacteria 3) Gram-negative organisms 4) Polymicrobial infection in general

Question 52

Pathogen commonly cultured from chronic sinusitis patients who have received multiple courses of antibiotics over a prolonged period

Answer 52

Pseudomonas aeruginosa

Question 53

2 local complications of sinusitis

Answer 53

1) Polyps | 2) Mucoceles

Question 54

6 orbital complications of sinusitis

Answer 54

1) Periorbital cellulitis 2) Periorbital cellulitis with chemosis 3) Orbital cellulitis 4) Subperiosteal abscess 5) Orbital abscess 6) Cavernous sinus thrombosis

Question 55

3 intracranial complications of sinusitis

Answer 55

1) Meningitis 2) Peridural abscess 3) Brain abscess

Question 56

3 lower respiratory tract complications of sinusitis

Answer 56

1) Cough 2) Pneumonitis 3) Asthma

Question 57

5 classes of periorbital/orbital cellulitis/abscess

Answer 57

``` I - inflammatory edema (pre-septal) II - Orbital cellulitis (post-septal) III - Subperiosteal abscess IV - Orbital abscess V - Cavernous sinus thrombosis ```

Question 58

2 benign salivary gland diseases

Answer 58

1) Sialolithiasis | 2) Parotitis

Question 59

2 treatments for sialolithiasis

Answer 59

1) Stone removal | 2) Sialogogues

Question 60

Common pathogen of parotitis

Answer 60

S. aureus

Question 61

2 treatments for parotitis

Answer 61

1) Sialogogues | 2) Antibiotics

Question 62

3 malignant salivary gland diseases

Answer 62

1) Pleomorphic adenoma (most common) 2) Adenoid cystic carcinoma (CNVII involvement) 3) Mucepidermoid carcinoma