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

Block G -- Infection > Dr. Daniel -- Common Infections in Otolaryngology, Head and Neck Surgery > Flashcards

Flashcards in Dr. Daniel -- Common Infections in Otolaryngology, Head and Neck Surgery Deck (62)
1

Signs and symptoms of tonsililitis (6)

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

2

Etiology of tonsilitis (2)

Viral (EBV)
Bacterial (S. pyogenes)

3

2 methods of diagnosis for tonsillitis

Physical exam
Culture

4

5 complications of tonsillitis

Abscess formation
Loss of airway
Sepsis
Nephritis
Rheumatic fever

5

Natural progression of otitis externa

Usually self-limited

6

2 symptoms of otitis externa

Otalgia
Otorrhea

7

3 findings of otitis externa

Ear canal edema
Otorrhea
Tender to pinna traction

8

Pathogenesis of AOE (4 steps)

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

9

Lifetime incidence of otitis externa

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

10

4 most common pathogens associated with otitis externa

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

11

4 antibiotics options for otitis externa

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

12

2 steroids for otitis externa

1) Hydrocortisone
2) Dexamethasone

13

3 treatment options of otitis externa

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

14

3 pairs of AOE treatments that have equivalent clinical outcomes

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

15

2 Most common pathogens of fungal otitis

1) Aspergillus
2) Candida

16

Classic pathogenesis of fungal otitis

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

17

2 symptoms and findings of fungal otitis

1) Clogged, itchy or painful ears
2) Thick fungal debris in the external auditory canal

18

3 generally safe treatments for fungal otitis

1) Clotrimazole
2) Miconazole
3) Tolnaftate

19

Fungal otitis treatment that has potential for severe damage

Gentian violet

20

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

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

21

Define otitis media

Inflammatory disease of the mucosal lining of the middle ear

22

Common group of people affected by otitis media

Children

23

2 most common pathogens of otitis media

Streptococcus pneumoniae
Haemophilus influenzae in infants

24

7 symptoms of otitis media

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

25

3 reasons for the pathogenesis of otitis media

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

26

4 examples of eustachian tube dysfunction causing otitis media

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

27

3 examples of immunologic compromise causing otitis media

1) Developmental
2) Immunodeficiency
3) Infectious

28

3 examples of microbial challenge causing otitis media

1) Viral
2) Bacterial
3) Daycare!

29

3 methods of diagnosis of otitis media

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

30

3 treatment options of otitis media

1) Antibiotics
2) Drainage
3) Myringotomy

31

3 first line antibiotics for otitis media

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

32

4 antibiotics in cause of first line treatment failure

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

33

3 fluoroquinolones to treat otitis media

Grepafloxacin
Levofloxacin
Sparfloxacin

34

Treatment course of otitis media antibiotics

10 - 14 days

35

Complication of otitis media

acute mastoiditis

36

3 classes of sinus infections

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

37

Define acute bacterial sinusitis (2)

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

38

Define subacute bacterial sinusitis

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

39

Define recurrent acute bacterial sinusitis

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

40

3 things that result in healthy sinuses

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

41

3 most common acute sinusitis pathogens

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

42

2 rare pathogens of acute sinusitis

1) Staph aureus
2) Anaerobes

43

3 first line antibiotics for acute sinusitis

1) Amoxicillin
2) erythromycin
3) TMP/SMX

44

5 second-line antibiotics for acute sinusitis

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

45

Compare the treatment outcomes for acute sinusitis

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

46

Usual course of disease for viral otitis and sinusitis

8 - 10 days

47

Usual course of disease for otitis and sinusitis due to aerobes

10 days to less than 3 months

48

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

Over 3 months

49

Define chronic sinusitis

Symptoms of sinusitis persisting beyond 3 months without improvement

50

Most common pathogen associated with chronic sinusitis

H. influenzae

51

4 most common pathogens for refractory chronic sinusitis

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

52

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

Pseudomonas aeruginosa

53

2 local complications of sinusitis

1) Polyps
2) Mucoceles

54

6 orbital complications of sinusitis

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

55

3 intracranial complications of sinusitis

1) Meningitis
2) Peridural abscess
3) Brain abscess

56

3 lower respiratory tract complications of sinusitis

1) Cough
2) Pneumonitis
3) Asthma

57

5 classes of periorbital/orbital cellulitis/abscess

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

58

2 benign salivary gland diseases

1) Sialolithiasis
2) Parotitis

59

2 treatments for sialolithiasis

1) Stone removal
2) Sialogogues

60

Common pathogen of parotitis

S. aureus

61

2 treatments for parotitis

1) Sialogogues
2) Antibiotics

62

3 malignant salivary gland diseases

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